Academic achievement in obstetrics and gynecology clerkships amongst medical students: Gender difference and importance of simulation in women’s health

Academic achievement in obstetrics and gynecology clerkships amongst medical students: Gender difference and importance of simulation in women’s health | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Academic achievement in obstetrics and gynecology clerkships amongst medical students: Gender difference and importance of simulation in women’s health Shahid Akhtar Akhund This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5642595/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background This study examines Pakistan’s high maternal death rate, attributing it to cultural sensitivities such as gender segregation, which impacts patient care and medical education. Obstetrics and gynecology are specialties for female physicians, resulting in male trainees’ restricted exposure and underperformance in clinical skills. This study investigates the influence of these barriers on clerkship evaluation outcomes for male and female students and proposes employing simulations to promote learning. Methods This retrospective cohort study was conducted at the University of Wollongong in 2021. It used obstetrics and gynecology and internal medicine end-of-year clerkships assessment scores of students from Pakistan. Data of 795 male and 777 female students were compared. Results In the obstetrics and gynecology assessment, the mean percentage scores of male students ( M = 70.46, SD = 6.32) was higher for written components than that of female students ( M = 68.69, SD = 7.28; p < 0.001). However, in the practical component, female students scored higher ( M = 69.05, SD = 10.39) than male students ( M = 65.98, SD = 10.47; p < 0.001). Both groups had almost the same total scores. No significant difference was observed in internal medicine clerkship scores. Conclusion Incorporating high-fidelity simulation during obstetrics and gynecology clerkship training may improve male trainees’ performance and motivate them to pursue the specialization. Simulation Medical Students Gender-Bias Obstetrics and Gynecology Educational Shortcomings Women’s Health Assessment Figures Figure 1 Figure 2 Introduction Exploring the influence of gender norms on maternal mortality is critical considering the high maternal mortality rate in Pakistan. The cultural structure of Pakistan is highly patriarchal, with a feudal sociopolitical system supported by a strong Islamic ideology that further solidifies gender roles. The lack of male healthcare physicians in the obstetrics and gynecology (O&G) specialty can be attributed to gender discrimination leading to insufficient clinical experience. Various mechanisms, including gender stereotypes and cultural settings, affect the quality of male medical students’ learning experience and clinical skills compared with their female counterparts during the clerkships. The use of new technologies, such as simulations and active learning, may counteract gender bias and improve students’ learning experiences. Pakistan has the highest maternal mortality ratio in South Asia ( 1 ), attributable to cultural practices. Cultural sensitivities are important in patient care ( 2 ), and healthcare utilization is related to a normative culture. Patients in Pakistan have preferences for physicians’ gender, with female patients preferring female physicians and male patients preferring male physicians ( 3 , 4 ). Most ethnic and religious groups in Pakistan share similar cultures and beliefs ( 5 ). The cultural structure in Pakistan is characterized by gender segregation through the observance of purdah (veil) by women ( 6 ). The roles of men and women in society are demarcated by purdah, which is considered a measure of men’s honor and is often strictly enforced ( 7 – 9 ). These cultural practices contribute to the conservative normative culture in Pakistan, which affects healthcare delivery and patient preferences for healthcare providers. This cultural structure presents some disadvantages for male O&G students, especially in the communication and intimate examinations of female patients, prompting the lack of interest in the specialty, consequently leading to a shortage of OB/GYNs and the potential risk of delivery for women in Pakistan ( 10 ). The Pakistan Medical & Dental Council is an accreditation body that monitors standards of medical education in Pakistan. This encompasses the learning objectives and standard of training for O&G clerkships, which include identification and treatment of diseases, minor surgical procedures, effective communication, and understanding of medical ethics, public health issues, and medical research. These objectives are assessed through a written and oral/practical examination, with a passing score of 50%. The lack of proper training and resources to achieve these objectives presents risks to childbirth in Pakistan ( 11 ). Compared with their female counterparts, male students are reported to have less confidence and clinical experiences during clerkships owing to cultural gender segregation and societal norms. This has resulted in a significant decline in male obstetricians and gynecologists potentially leading to limited maternal healthcare. Understanding these discrepancies is crucial to ensure gender equity in medical education, especially in O&G ( 12 ). Lee et al. ( 13 ) discussed the challenges of providing gender-neutral education in nursing schools during O&G clerkships ( 14 ). Gender bias may lead to lower interest in the specialty, potentially exacerbating the shortage of male healthcare providers in O&G. Addressing these biases through gender-neutral education, the use of technology, and active learning methods may help provide equal opportunities for both male and female medical students to learn and practice in this specialty ( 15 ). Mendes et al. ( 16 ) emphasized the importance of addressing systemic issues in the healthcare system to improve the quality of clinical training and ultimately reduce maternal mortality rates in Angola. Students felt that the lack of appropriate infrastructure in the healthcare system, such as poorly equipped health centers, was a significant barrier to effective clinical training. They also highlighted the need for better collaboration between healthcare professionals and the community and the importance of educating and empowering women to take charge of their own health. While there may be gender disparities in O&G clerkships, these disparities may not always be gender-based. Other factors, such as limited clinical exposure, inadequate teaching, and insufficient resources, can also affect medical students’ learning and confidence in their specialty ( 17 ). Addressing these issues and providing equal opportunities for all medical students, regardless of gender, is essential to ensure adequate healthcare delivery for women. There is a trend toward a lower proportion of men in O&G residency programs ( 18 ), which could be due to the difficulties faced by male medical students during their undergraduate education, as discussed earlier. The lack of male representation in the field may also contribute to the perpetuation of gender stereotypes and biases. It is important to address these issues to ensure equal opportunities for both male and female medical students and to encourage diversity in the field (19) . It is critical to investigate how a lack of clinical exposure affects the academic performance of male medical students in O&G. This study will not only provide a better understanding of the impact of gender biases on medical education but also help devise strategies to provide equal opportunities for all medical students in Pakistan. Furthermore, addressing gender biases and ensuring equal opportunities for all medical students will improve the quality of healthcare deliveries for women. This study will help elucidate the impact of gender biases on male medical students’ academic performance in O&G clerkships and provide insights into how to improve curriculum delivery. Methods This retrospective cohort study was conducted at the University of Wollongong, NSW, Australia. The data were analyzed in 2021, and the manuscript was prepared subsequently. Data focusing on medical students who underwent O&G clerkship examinations were gathered from Pakistan after obtaining ethics approval. This study collected data from a public medical university in Pakistan and used official records to obtain student assessment scores during undergraduate medical education. The study site was Liaquat University of Medical and Allied Health Sciences (LUMAHS), and the population comprised medical students who had completed the O&G clerkship examination. The data were de-identified before analysis using the IBM Statistical Program for Social Sciences version 29. The mean ( M ) and standard deviation ( SD ) of the scores were calculated for both male and female students for further analysis. The statistical analysis included a detailed descriptive analysis and parametric statistical techniques, such as the Student’s t-test, to analyze the differences and similarities between male and female medical student groups. This study highlights the traditional method of medical curriculum delivery followed by the LUMAHS, including teaching, learning, and assessment processes governed by the rules and regulations of the Pakistan Medical Council. Results The normal distribution of the data was checked, and descriptive and inferential statistical tests were performed. The data did not violate the assumptions of normal distribution (Skewness = -0.46). The data satisfies the assumptions of the parametric statistic tests. Jaccard and Becker (1) noted the debate between using parametric and nonparametric techniques among researchers. Descriptive data in Table 1 show the gender distribution and achievement scores of the sample (795 male and 777 female students). These students graduated over four batches of MBBS courses and undertook O&G clerkships during their clinical years (2013–2016). Their mean percentage written scores, clinical skills scores, and total scores on end-of-year clerkship examinations were analyzed. Figure 1 shows the scores on the written and practical tests and the overall scores of the students. Male students scored higher on average on the written tests, whereas female students scored higher on the practical tests, and both attained almost the same total scores. As presented in Table 1 , in the written tests, the mean score obtained by male students was 70.46 ± 6.32%, and female students obtained 67.34 ± 7.7%. In the practical tests, male students scored 65.98 ± 10.47% and female students scored 69.05 ± 10.39%. The total score obtained by male students was 68.15 ± 7.12% and by female students was 68.19 ± 7.30%. The hypothesis of male students underperforming compared with their female counterparts was explored using a parametric Student t test. The performance of male students ( M = 70.46, SD = 6.32%) on the written test was higher than that of female students ( M = 68.69, SD = 7.28%), and the difference between the two groups was statistically significant ( t (1570) = 5.15, p < 0.001, 95% CL 1.10–2.45; Table 2, Figure 2 ). The difference in both groups’ performance on practical tests was also statistically significant, with female students ( M = 68.08, SD = 10.76%) performing better than male students ( M = 65.98, SD = 10.47 %) ( t (1570) = -3.93, p <0.001, 95% CL = -3.16–-1.05). The comparison of the overall performance of male and female students was not statistically significant ( t (1570) = -0.47, p = 0.64, 95% CI -0.87–0.54). To understand whether the gender difference in clinical skills is only observed in O&G clerkships or other clinical clerkships, clinical skills achievement in medicine clerkships was also analyzed. As shown in Figure 2 and Table 3, no significant differences were observed in the achievement scores of male and female students. Discussion This study explored the differences between male and female medical students’ performances in O&G clerkships. The differences in the achievement scores of male and female students in the different components of the assessment were not consistent. The findings of this study suggest that the cognitive learning scores of male students in the written components were higher than those of female students; however, their oral/practical scores reflecting clinical skills were lower. The hypothesis that female medical students outperform male medical students was not supported by the results. Female medical students performed better than male medical students on practical examinations only when an intimate clinical examination was performed on female patients. However, the overall performance of male and female medical students in core clerkships did not differ. Previous literature indicates similar gender biases among male students enrolled in O&G clerkships ( 2 – 4 ). The most obvious factor that can be assumed to have created this academic achievement difference is cultural sensitivity, which plays a role in medical education and healthcare delivery. A similar outcome was highlighted by Mendes et al. ( 5 ), who analyzed strategies to reduce MMR in Angola. Pakistan has the worst MMR in the region and cannot afford to have a major portion of the healthcare force with limited clinical skills to treat women’s health issues. This study’s findings are rooted in gender stereotyping ( 6 ). Female patients, who are the main source of learning regarding O&G health issues found in the community, are not easily accessible to male medical students owing to cultural sensitivities ( 7 ). Cultural sensitivity not only plays a major role in effective patient care ( 8 ), but also affects male medical students’ clinical learning. As Kerssens et al. ( 9 ) suggested, female patients prefer female doctors, particularly in clinical situations where intimate clinical examinations are required. This study highlighted similar findings. When there was a less intimate clinical examination, such as clinical skills assessment in internal medicine, no difference was observed in the performance of male and female medical students. In addition to the many challenges highlighted by Pradhan et al. ( 6 ), the interaction of beliefs, principles, and cultural demands ( 10 ) appears to have a greater effect on the clinical skills, learning, and performance of male students in O&G clerkships. In highly conservative societies such as Pakistan ( 11 – 13 ), it is difficult to address such sensitive issues by changing the mindset of cultural groups. To address this teaching and learning issue in medical education, the incorporation of simulations into O&G teaching and assessment may be a way forward. This suggestion was also identified in the literature as providing students with valuable real-time feedback ( 14 ). Levine et al. ( 15 ) and McGaghie et al. ( 16 ) explained the benefits of incorporating simulation-based learning exercises to standardize medical education globally. Simulation-based learning has shown positive effects on baseline knowledge. ( 17 ). Everett et al.( 18 ) identified the practicality of implementing simulation-based learning in undergraduate medical schools, and the findings support its use owing to the increased quality of education across larger student bodies. This enhances the students’ confidence levels and technical skills ( 18 ). Although this study obtained objective results regarding the differences in the performance of O&G examinations, it was limited by many factors. First, the results were obtained only from one institution. Second, the students’ perceptions, which may provide meaningful results, were not considered. Based on the findings of our study and previous literature, future research should draw comparisons with other gender-stereotyped specialties. This may include male-dominated specialties such as surgery. Conclusions While male medical students performed better in the written component of O&G clerkship examinations, they performed poorly in the practical components compared with their female counterparts. However, the overall performance of male and female students did not differ. A similar difference in the level of clinical skills was not observed in the internal medicine clerkship assessments. Identifying the causes of gender differences in core clerkship assessments is often complex. This difference in academic achievement could be rooted more in the cultural practices that affect medical education than in the performance of male students. Male medical students should be provided equal opportunities to improve their knowledge and skills. This issue can be addressed by incorporating simulations into medical education at public universities. Declarations Conflict of Interest The author reports no conflicts of interest in this work. Author Contribution There is no another author in this paper. I have completed and conducted research. Acknowledgments The author thanks and acknowledges the help and support of the university administration that provided the unidentified data. References Jaccard J, Becker MA. Statistics for the behavioral sciences. Belmont (CA): Wadsworth Publishing Company; 2002. Alam K, Safdar CA, Munir TA, Ghani Z. Teaching obstetrics and gynaecology to male undergraduate medical students: student’s perception. J Ayub Med Coll Abbottabad. 2014;26:539–42. Craig LB, Smith C, Crow SM, Driver W, Wallace M, Thompson BM. Obstetrics and gynecology clerkship for males and females: similar curriculum, different outcomes? Med Educ Online. 2013;18:21506. Lee YF, Yang YO, Tu CL. Perceiving gender or profession: the practical experience of male nursing students in the obstetrics and gynecology ward. Hu Li Za Zhi. 2013;60:64–72. Mendes M, Barbosa J, Loureiro E, Ferreira MA. How medical education can contribute towards the reduction of maternal mortality in Angola: the teaching/learning process of gynecology and obstetrics. Afr Health Sci. 2014;14:228–36. Pradhan A, Page-Ramsey S, Buery-Joyner SD, Craig LB, Dalrymple JL, Forstein DA, et al. Undergraduate obstetrics and gynecology medical education: why are we underrated and underappreciated? Am J Obstet Gynecol. 2016;214:345–7. Flores G. Culture and the patient-physician relationship: achieving cultural competency in health care. J Pediatr. 2000;136:14–23. Bussey-Jones J, Genao I. Impact of culture on health care. J Natl Med Assoc. 2003;95:732–5. Kerssens JJ, Bensing JM, Andela MG. Patient preference for genders of health professionals. Soc Sci Med. 1997;44:1531–40. Brake T. The impact of culture on simulation based medical education. Australas Anaesth 2013: 215–8. Amin S. The poverty-purdah trap in rural Bangladesh: implications for women's roles in the family. Dev Change. 1997;28:213–33. Mumtaz Z, Salway S, Waseem M, Umer N. Gender-based barriers to primary health care provision in Pakistan: the experience of female providers. Health Policy Plan. 2003;18:261–9. Patel R. Socio-economic political status and women and law in Pakistan. Karachi: Faiza; 1991. Smith ML, Foley MR. Transforming clinical education in obstetrics and gynecology: gone Is the day of the sage on the stage. Obstet Gynecol. 2016;127:763–7. Levine AI, Schwartz AD, Bryson EO, Demaria S. Jr. Role of simulation in US physician licensure and certification. Mt Sinai J Med. 2012;79:140–53. McGaghie WC, Issenberg SB, Barsuk JH, Wayne DB. A critical review of simulation-based mastery learning with translational outcomes. Med Educ. 2014;48:375–85. Shore EM, Davidson A, Arnason M, Kara H, Shah A, Shah R. Bridging the gap: incorporating simulation into obstetrics and gynaecology undergraduate medical education. J Obstet Gynaecol Can. 2019;41:191–e1962. Everett EN, Forstein DA, Bliss S, Buery-Joyner SD, Craig LB, Graziano SC, et al. To the Point: the expanding role of simulation in obstetrics and gynecology medical student education. Am J Obstet Gynecol. 2019;220:129–41. Tables Table 1 Obstetrics and gynecology examination scores of written and practical components and total scores Assessment Components Gender N Mean% Standard Deviation% Written Male 795 70.46 6.32 Female 777 68.69 7.28 Practical Male 795 65.98 10.47 Female 777 68.08 10.76 Total Male 795 68.23 6.79 Female 777 68.40 7.47 Table 2 Independent-sample t-test for obstetrics and gynecology assessment scores of male and female medical students Assessment Components t-test for Equality of Means t df Significance (2-tailed) Mean Difference Std. Error Difference 95% Confidence Interval of the Difference Lower Upper Written Equal variances assumed 5.15 1570.00 0.00* 1.77 0.34 1.10 2.45 Practical Equal variances assumed -3.93 1570.00 0.00* -2.10 0.54 -3.16 -1.05 Total Equal variances assumed -0.47 1570.00 0.64 -0.17 0.36 -0.87 0.54 p value significant at <0.05 Table 3 Independent-sample t-test for internal medicine practical assessment scores of male and female medical students Assessment Components t-test for Equality of Means t df Sig. (2-tailed) Mean Difference Std. Error Difference 95% Confidence Interval of the Difference Lower Upper Internal Medicine Practical assessment Equal variances assumed -1.69 1577.00 0.09 -0.74 0.44 -1.60 0.12 Additional Declarations No competing interests reported. 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The cultural structure of Pakistan is highly patriarchal, with a feudal sociopolitical system supported by a strong Islamic ideology that further solidifies gender roles. The lack of male healthcare physicians in the obstetrics and gynecology (O\u0026amp;G) specialty can be attributed to gender discrimination leading to insufficient clinical experience. Various mechanisms, including gender stereotypes and cultural settings, affect the quality of male medical students\u0026rsquo; learning experience and clinical skills compared with their female counterparts during the clerkships. The use of new technologies, such as simulations and active learning, may counteract gender bias and improve students\u0026rsquo; learning experiences.\u003c/p\u003e \u003cp\u003ePakistan has the highest maternal mortality ratio in South Asia (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), attributable to cultural practices. Cultural sensitivities are important in patient care (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), and healthcare utilization is related to a normative culture. Patients in Pakistan have preferences for physicians\u0026rsquo; gender, with female patients preferring female physicians and male patients preferring male physicians (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Most ethnic and religious groups in Pakistan share similar cultures and beliefs (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The cultural structure in Pakistan is characterized by gender segregation through the observance of purdah (veil) by women (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The roles of men and women in society are demarcated by purdah, which is considered a measure of men\u0026rsquo;s honor and is often strictly enforced (\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). These cultural practices contribute to the conservative normative culture in Pakistan, which affects healthcare delivery and patient preferences for healthcare providers. This cultural structure presents some disadvantages for male O\u0026amp;G students, especially in the communication and intimate examinations of female patients, prompting the lack of interest in the specialty, consequently leading to a shortage of OB/GYNs and the potential risk of delivery for women in Pakistan (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Pakistan Medical \u0026amp; Dental Council is an accreditation body that monitors standards of medical education in Pakistan. This encompasses the learning objectives and standard of training for O\u0026amp;G clerkships, which include identification and treatment of diseases, minor surgical procedures, effective communication, and understanding of medical ethics, public health issues, and medical research. These objectives are assessed through a written and oral/practical examination, with a passing score of 50%. The lack of proper training and resources to achieve these objectives presents risks to childbirth in Pakistan (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCompared with their female counterparts, male students are reported to have less confidence and clinical experiences during clerkships owing to cultural gender segregation and societal norms. This has resulted in a significant decline in male obstetricians and gynecologists potentially leading to limited maternal healthcare. Understanding these discrepancies is crucial to ensure gender equity in medical education, especially in O\u0026amp;G (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLee et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) discussed the challenges of providing gender-neutral education in nursing schools during O\u0026amp;G clerkships (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Gender bias may lead to lower interest in the specialty, potentially exacerbating the shortage of male healthcare providers in O\u0026amp;G. Addressing these biases through gender-neutral education, the use of technology, and active learning methods may help provide equal opportunities for both male and female medical students to learn and practice in this specialty (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMendes et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) emphasized the importance of addressing systemic issues in the healthcare system to improve the quality of clinical training and ultimately reduce maternal mortality rates in Angola. Students felt that the lack of appropriate infrastructure in the healthcare system, such as poorly equipped health centers, was a significant barrier to effective clinical training. They also highlighted the need for better collaboration between healthcare professionals and the community and the importance of educating and empowering women to take charge of their own health.\u003c/p\u003e \u003cp\u003eWhile there may be gender disparities in O\u0026amp;G clerkships, these disparities may not always be gender-based. Other factors, such as limited clinical exposure, inadequate teaching, and insufficient resources, can also affect medical students\u0026rsquo; learning and confidence in their specialty (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Addressing these issues and providing equal opportunities for all medical students, regardless of gender, is essential to ensure adequate healthcare delivery for women. There is a trend toward a lower proportion of men in O\u0026amp;G residency programs (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), which could be due to the difficulties faced by male medical students during their undergraduate education, as discussed earlier. The lack of male representation in the field may also contribute to the perpetuation of gender stereotypes and biases. It is important to address these issues to ensure equal opportunities for both male and female medical students and to encourage diversity in the field \u003cb\u003e(19)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eIt is critical to investigate how a lack of clinical exposure affects the academic performance of male medical students in O\u0026amp;G. This study will not only provide a better understanding of the impact of gender biases on medical education but also help devise strategies to provide equal opportunities for all medical students in Pakistan. Furthermore, addressing gender biases and ensuring equal opportunities for all medical students will improve the quality of healthcare deliveries for women. This study will help elucidate the impact of gender biases on male medical students\u0026rsquo; academic performance in O\u0026amp;G clerkships and provide insights into how to improve curriculum delivery.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis retrospective cohort study was conducted at the University of Wollongong, NSW, Australia. The data were analyzed in 2021, and the manuscript was prepared subsequently. Data focusing on medical students who underwent O\u0026amp;G clerkship examinations were gathered from Pakistan after obtaining ethics approval. This study collected data from a public medical university in Pakistan and used official records to obtain student assessment scores during undergraduate medical education. The study site was Liaquat University of Medical and Allied Health Sciences (LUMAHS), and the population comprised medical students who had completed the O\u0026amp;G clerkship examination. The data were de-identified before analysis using the IBM Statistical Program for Social Sciences version 29. The mean (\u003cem\u003eM\u003c/em\u003e) and standard deviation (\u003cem\u003eSD\u003c/em\u003e) of the scores were calculated for both male and female students for further analysis. The statistical analysis included a detailed descriptive analysis and parametric statistical techniques, such as the Student\u0026rsquo;s t-test, to analyze the differences and similarities between male and female medical student groups. This study highlights the traditional method of medical curriculum delivery followed by the LUMAHS, including teaching, learning, and assessment processes governed by the rules and regulations of the Pakistan Medical Council.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe normal distribution of the data was checked, and descriptive and inferential statistical tests were performed. The data did not violate the assumptions of normal distribution (Skewness = -0.46). The data satisfies the assumptions of the parametric statistic tests. Jaccard and Becker \u003cstrong\u003e(1)\u003c/strong\u003e noted the debate between using parametric and nonparametric techniques among researchers. Descriptive data in \u003cem\u003eTable 1\u003c/em\u003e show the gender distribution and achievement scores of the sample (795 male and 777 female students). These students graduated over four batches of MBBS courses and undertook O\u0026amp;G clerkships during their clinical years (2013\u0026ndash;2016). Their mean percentage written scores, clinical skills scores, and total scores on end-of-year clerkship examinations were analyzed. \u003cem\u003eFigure 1\u003c/em\u003e shows the scores on the written and practical tests and the overall scores of the students. Male students scored higher on average on the written tests, whereas female students scored higher on the practical tests, and both attained almost the same total scores.\u003c/p\u003e\n\u003cp\u003eAs presented in \u003cem\u003eTable 1\u003c/em\u003e, in the written tests, the mean score obtained by male students was 70.46 \u0026plusmn; 6.32%, and female students obtained 67.34 \u0026plusmn; 7.7%. In the practical tests, male students scored 65.98 \u0026plusmn; 10.47% and female students scored 69.05 \u0026plusmn; 10.39%. The total score obtained by male students was 68.15 \u0026plusmn; 7.12% and by female students was 68.19 \u0026plusmn; 7.30%.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe hypothesis of male students underperforming compared with their female counterparts was explored using a parametric Student \u003cem\u003et\u0026nbsp;\u003c/em\u003etest. The performance of male students (\u003cem\u003eM\u0026nbsp;\u003c/em\u003e= 70.46, \u003cem\u003eSD\u003c/em\u003e = 6.32%) on the written test was higher than that of female students (\u003cem\u003eM\u003c/em\u003e = 68.69, \u003cem\u003eSD\u003c/em\u003e = 7.28%), and the difference between the two groups was statistically significant (\u003cem\u003et\u003c/em\u003e(1570) = 5.15, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001, 95% CL 1.10\u0026ndash;2.45; \u003cem\u003eTable 2,\u003c/em\u003e \u003cem\u003eFigure 2\u003c/em\u003e). The difference in both groups\u0026rsquo; performance on practical tests was also statistically significant, with female students (\u003cem\u003eM\u003c/em\u003e = 68.08, \u003cem\u003eSD\u003c/em\u003e = 10.76%) performing better than male students (\u003cem\u003eM\u0026nbsp;\u003c/em\u003e= 65.98, \u003cem\u003eSD\u0026nbsp;\u003c/em\u003e= 10.47 %) (\u003cem\u003et\u003c/em\u003e(1570) = -3.93, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001, 95% CL = -3.16\u0026ndash;-1.05). The comparison of the overall performance of male and female students was not statistically significant (\u003cem\u003et\u003c/em\u003e(1570) = -0.47, \u003cem\u003ep\u003c/em\u003e = 0.64, 95% CI -0.87\u0026ndash;0.54).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo understand whether the gender difference in clinical skills is only observed in O\u0026amp;G clerkships or other clinical clerkships, clinical skills achievement in medicine clerkships was also analyzed. As shown in \u003cem\u003eFigure 2 and Table 3,\u0026nbsp;\u003c/em\u003eno significant differences were observed in the achievement scores of male and female students.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored the differences between male and female medical students\u0026rsquo; performances in O\u0026amp;G clerkships. The differences in the achievement scores of male and female students in the different components of the assessment were not consistent. The findings of this study suggest that the cognitive learning scores of male students in the written components were higher than those of female students; however, their oral/practical scores reflecting clinical skills were lower. The hypothesis that female medical students outperform male medical students was not supported by the results. Female medical students performed better than male medical students on practical examinations only when an intimate clinical examination was performed on female patients. However, the overall performance of male and female medical students in core clerkships did not differ. Previous literature indicates similar gender biases among male students enrolled in O\u0026amp;G clerkships (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe most obvious factor that can be assumed to have created this academic achievement difference is cultural sensitivity, which plays a role in medical education and healthcare delivery. A similar outcome was highlighted by Mendes et al. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), who analyzed strategies to reduce MMR in Angola. Pakistan has the worst MMR in the region and cannot afford to have a major portion of the healthcare force with limited clinical skills to treat women\u0026rsquo;s health issues. This study\u0026rsquo;s findings are rooted in gender stereotyping (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Female patients, who are the main source of learning regarding O\u0026amp;G health issues found in the community, are not easily accessible to male medical students owing to cultural sensitivities (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Cultural sensitivity not only plays a major role in effective patient care (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), but also affects male medical students\u0026rsquo; clinical learning. As Kerssens et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) suggested, female patients prefer female doctors, particularly in clinical situations where intimate clinical examinations are required. This study highlighted similar findings. When there was a less intimate clinical examination, such as clinical skills assessment in internal medicine, no difference was observed in the performance of male and female medical students. In addition to the many challenges highlighted by Pradhan et al. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), the interaction of beliefs, principles, and cultural demands (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) appears to have a greater effect on the clinical skills, learning, and performance of male students in O\u0026amp;G clerkships.\u003c/p\u003e \u003cp\u003eIn highly conservative societies such as Pakistan (\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), it is difficult to address such sensitive issues by changing the mindset of cultural groups. To address this teaching and learning issue in medical education, the incorporation of simulations into O\u0026amp;G teaching and assessment may be a way forward. This suggestion was also identified in the literature as providing students with valuable real-time feedback (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Levine et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) and McGaghie et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) explained the benefits of incorporating simulation-based learning exercises to standardize medical education globally.\u003c/p\u003e \u003cp\u003eSimulation-based learning has shown positive effects on baseline knowledge. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Everett et al.(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) identified the practicality of implementing simulation-based learning in undergraduate medical schools, and the findings support its use owing to the increased quality of education across larger student bodies. This enhances the students\u0026rsquo; confidence levels and technical skills (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough this study obtained objective results regarding the differences in the performance of O\u0026amp;G examinations, it was limited by many factors. First, the results were obtained only from one institution. Second, the students\u0026rsquo; perceptions, which may provide meaningful results, were not considered. Based on the findings of our study and previous literature, future research should draw comparisons with other gender-stereotyped specialties. This may include male-dominated specialties such as surgery.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eWhile male medical students performed better in the written component of O\u0026amp;G clerkship examinations, they performed poorly in the practical components compared with their female counterparts. However, the overall performance of male and female students did not differ. A similar difference in the level of clinical skills was not observed in the internal medicine clerkship assessments. Identifying the causes of gender differences in core clerkship assessments is often complex. This difference in academic achievement could be rooted more in the cultural practices that affect medical education than in the performance of male students. Male medical students should be provided equal opportunities to improve their knowledge and skills. This issue can be addressed by incorporating simulations into medical education at public universities.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflict of Interest\u003c/h2\u003e \u003cp\u003eThe author reports no conflicts of interest in this work.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eThere is no another author in this paper. I have completed and conducted research.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e \u003cp\u003eThe author thanks and acknowledges the help and support of the university administration that provided the unidentified data.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJaccard J, Becker MA. Statistics for the behavioral sciences. Belmont (CA): Wadsworth Publishing Company; 2002.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlam K, Safdar CA, Munir TA, Ghani Z. Teaching obstetrics and gynaecology to male undergraduate medical students: student\u0026rsquo;s perception. J Ayub Med Coll Abbottabad. 2014;26:539\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCraig LB, Smith C, Crow SM, Driver W, Wallace M, Thompson BM. Obstetrics and gynecology clerkship for males and females: similar curriculum, different outcomes? Med Educ Online. 2013;18:21506.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee YF, Yang YO, Tu CL. Perceiving gender or profession: the practical experience of male nursing students in the obstetrics and gynecology ward. Hu Li Za Zhi. 2013;60:64\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMendes M, Barbosa J, Loureiro E, Ferreira MA. How medical education can contribute towards the reduction of maternal mortality in Angola: the teaching/learning process of gynecology and obstetrics. Afr Health Sci. 2014;14:228\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePradhan A, Page-Ramsey S, Buery-Joyner SD, Craig LB, Dalrymple JL, Forstein DA, et al. Undergraduate obstetrics and gynecology medical education: why are we underrated and underappreciated? Am J Obstet Gynecol. 2016;214:345\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlores G. Culture and the patient-physician relationship: achieving cultural competency in health care. J Pediatr. 2000;136:14\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBussey-Jones J, Genao I. Impact of culture on health care. J Natl Med Assoc. 2003;95:732\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKerssens JJ, Bensing JM, Andela MG. Patient preference for genders of health professionals. Soc Sci Med. 1997;44:1531\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrake T. The impact of culture on simulation based medical education. Australas Anaesth 2013: 215\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmin S. The poverty-purdah trap in rural Bangladesh: implications for women's roles in the family. Dev Change. 1997;28:213\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMumtaz Z, Salway S, Waseem M, Umer N. Gender-based barriers to primary health care provision in Pakistan: the experience of female providers. Health Policy Plan. 2003;18:261\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatel R. Socio-economic political status and women and law in Pakistan. Karachi: Faiza; 1991.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith ML, Foley MR. Transforming clinical education in obstetrics and gynecology: gone Is the day of the sage on the stage. Obstet Gynecol. 2016;127:763\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLevine AI, Schwartz AD, Bryson EO, Demaria S. Jr. Role of simulation in US physician licensure and certification. Mt Sinai J Med. 2012;79:140\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcGaghie WC, Issenberg SB, Barsuk JH, Wayne DB. A critical review of simulation-based mastery learning with translational outcomes. Med Educ. 2014;48:375\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShore EM, Davidson A, Arnason M, Kara H, Shah A, Shah R. Bridging the gap: incorporating simulation into obstetrics and gynaecology undergraduate medical education. J Obstet Gynaecol Can. 2019;41:191\u0026ndash;e1962.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEverett EN, Forstein DA, Bliss S, Buery-Joyner SD, Craig LB, Graziano SC, et al. To the Point: the expanding role of simulation in obstetrics and gynecology medical student education. Am J Obstet Gynecol. 2019;220:129\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e Obstetrics and gynecology examination scores of written and practical components and total scores\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"521\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eAssessment Components\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eMean%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eStandard Deviation%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eWritten\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e795\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 100px;\"\u003e\n \u003cp\u003e70.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e6.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e777\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 100px;\"\u003e\n \u003cp\u003e68.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e7.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003ePractical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e795\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 100px;\"\u003e\n \u003cp\u003e65.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e10.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e777\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 100px;\"\u003e\n \u003cp\u003e68.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e10.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e795\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 100px;\"\u003e\n \u003cp\u003e68.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e6.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e777\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 100px;\"\u003e\n \u003cp\u003e68.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e7.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003eIndependent-sample t-test for obstetrics and gynecology assessment scores of male and female medical students\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"649\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eAssessment Components\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 470px;\"\u003e\n \u003cp\u003et-test for Equality of Means\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eSignificance (2-tailed)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eMean Difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eStd. Error Difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e95% Confidence Interval of the Difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eWritten\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eEqual variances assumed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e5.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1570.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e1.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e2.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003ePractical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eEqual variances assumed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e-3.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1570.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e-2.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e-3.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e-1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eEqual variances assumed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e-0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1570.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e-0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e-0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003ep\u003c/em\u003e value significant at \u0026lt;0.05\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u0026nbsp;\u003c/strong\u003eIndependent-sample t-test for internal medicine practical assessment scores of male and female medical students\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"658\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eAssessment Components\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 475px;\"\u003e\n \u003cp\u003et-test for Equality of Means\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eSig. (2-tailed)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003eMean Difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003eStd. Error Difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e95% Confidence Interval of the Difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eInternal Medicine Practical assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eEqual variances assumed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e-1.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1577.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e-1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 100px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Simulation, Medical Students, Gender-Bias, Obstetrics and Gynecology, Educational Shortcomings, Women’s Health, Assessment","lastPublishedDoi":"10.21203/rs.3.rs-5642595/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5642595/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThis study examines Pakistan\u0026rsquo;s high maternal death rate, attributing it to cultural sensitivities such as gender segregation, which impacts patient care and medical education. Obstetrics and gynecology are specialties for female physicians, resulting in male trainees\u0026rsquo; restricted exposure and underperformance in clinical skills. This study investigates the influence of these barriers on clerkship evaluation outcomes for male and female students and proposes employing simulations to promote learning.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective cohort study was conducted at the University of Wollongong in 2021. It used obstetrics and gynecology and internal medicine end-of-year clerkships assessment scores of students from Pakistan. Data of 795 male and 777 female students were compared.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn the obstetrics and gynecology assessment, the mean percentage scores of male students (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;70.46, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6.32) was higher for written components than that of female students (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;68.69, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.28; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, in the practical component, female students scored higher (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;69.05, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10.39) than male students (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;65.98, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10.47; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Both groups had almost the same total scores. No significant difference was observed in internal medicine clerkship scores.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIncorporating high-fidelity simulation during obstetrics and gynecology clerkship training may improve male trainees\u0026rsquo; performance and motivate them to pursue the specialization.\u003c/p\u003e","manuscriptTitle":"Academic achievement in obstetrics and gynecology clerkships amongst medical students: Gender difference and importance of simulation in women’s health","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-24 17:26:40","doi":"10.21203/rs.3.rs-5642595/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"39ee53d5-b3f1-4d96-8e8f-cbb767e48419","owner":[],"postedDate":"December 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-09T09:09:40+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-24 17:26:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5642595","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5642595","identity":"rs-5642595","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}