Gender Differences in Medical Student Performance of Simulated Vaginal Deliveries and Cervical Exams Nitsche J, Shumard K, Fino N, Denney J, Quinn K, Bailey J, Jijon R, Huang C, Kesty K, Whitecar P, Grandis A, Brost B Department of Obstetrics and Gynecology, Wake Forest School of Medicine Objective To determine if gender differences exist in vaginal delivery or cervical exam skill and determine if simulation can negate this difference. Background As OB/GYN is becoming an increasingly female dominated specialty, it will be important to make certain the male medical students continue to have appropriate exposure to the field both to make sure they receive a well rounded medical education and to avoid discouraging men with interest in the field from entering OB/GYN. Unfortunately, medical schools may be falling short of these goals as studies have demonstrated that many male medical students feel that their gender negatively influences their OB/GYN clerkship experience 1. In addition, it has been shown that female students perform better on many aspects of the OG/GYN clerkship 2,3, possibly due to women not wanting male trainees to participate in their care. Simulation may circumvent this problem as both male and female students can participate equally. In the simulated setting male students would potentially be able to make up for some of the lost exposure that occurs when women decline to have male trainees involved in their care. In addition, the experienced and confidence gained from the simulation could possibly increase a woman’s comfort level having male trainees participate in their care. To determine if simulation can help male students overcome the obstacles they face during the OB/GYN clerkship we assessed the effects of gender and simulation training on student performance during an objective structured clinical examination (OSCE) involving simulated cervical exams and a vaginal delivery to determine if a gender difference exists and if present determine if simulation training negates this difference. Methods During the 3 rd year OB/GYN clerkship students were assigned 1:1 to receive vaginal delivery or cervical exam training with each group serving as the simulation naïve control group for the other skill. Their performance of both skills was assessed during an end of clerkship OSCE including 10 simulated cervical exam suing a high fidelity task trainer and a simulated vaginal delivery using the Noelle birthing simulator. The accuracy of cervical exam accuracy for dilation and effacement was analyzed separately and together. Vaginal delivery performance was graded using a procedural checklist with possible scores of A satisfactory score was defined as a score of 16 or higher. The number of real-life vaginal deliveries and cervical exams performed were also recorded. The effects of student gender on cervical exam accuracy and vaginal delivery performance and its interactions with training were assessed using a 2 way ANOVA. Results Thirty male and 28 female students received cervical exam training. Thirty five male and 19 female students received vaginal delivery training. The data is provided in Tables 1-3. There was a significant impact of training on both cervical exam and vaginal delivery performance as we have previously demonstrated 4,5. There was a small (approximately 0.5 exams) but significant effect of training on the number of real-life cervical exams but not vaginal deliveries performed. There was no significant effect of gender or an interaction with gender and trainingsave for the number of real-life vaginal deliveries performed. Female vaginal delivery students performed significantly more real-life deliveries than male vaginal delivery students. Results (cont.) Discussion Our study did not find a main effect of gender for any of the clinical skills or number of real-life procedures performed. There was an interaction between gender and training, but this is unlikely to be a meaningful difference dictating a changes in the way we train student to perform vaginal deliveries. Although prior retrospective studies have shown female students to perform better on several aspects of the OB/GYN clerkship, our prospective study of OSCE performance did not show any gender differences in student performance. Likely there are several reasons for this discrepancy. The first is changing societal attitudes regarding gender. With the gains women have made in the workplace and the willingness of men to assume traditionally female roles, it is likely that women have become more welcoming of male obstetrics providers. Second, the majority of the patients under our department’s care receive care from the residents (approximately 50% of whom are male) throughout their pregnancy. Thus, our patients may have more accustomed to seeing male providers than the other medical centers where the prior studies were performed. Conclusions Student performance on the end of clerkship OSCE was not different based on gender As there was no effect of gender we could not assess the influence of simulation of gender differences in student performance References 1. Chang JC, Odrobina MR, McIntyre-Seltmean K. Journal of Women’s Health. 2010; 19(1): Craig LB, Smith C, Crow SM, Driver W, Wallace M and Thompson BM. Med Educ Online 2013;18: Bienstock JL, Martin S, Tzou W and Fox HE. Teach Learn Med 2002;14: Nitsche J, Shumard K, Fino N, Denney J, Quinn K, Bailey J, Jijon R, Huang C, Kesty K, Whitecar P, Grandis A, Brost B, et al. Obstet Gynecol 2015;126 Suppl 4:13S-20S. 5. Shumard K, Fino N, Denney J, Quinn K, Bailey J, Jijon R, Huang C, Kesty K, Whitecar P, Grandis A, Brost B, Nitsche J, in preparation. ©Creative Communications Wake Forest Baptist Medical Center Permission is granted for use when printed by Creative Communications. All other uses strictly prohibited. ©Creative Communications Wake Forest Baptist Medical Center Permission is granted for use when printed by Creative Communications. All other uses strictly prohibited. Table 1. Student Cervical Exam Accuracy DilationMaleFemale Simulation76 ± 39%69 ± 48% No Simulation43 ± 41%48 ± 48% EffacementMaleFemale Simulation82 ± 33%82 ± 31% No Simulation71 ± 44%66 ± 44% Table 2. Student Vaginal Delivery Performance Checklist ScoreMaleFemale Simulation28 ± ± 3.1 No Simulation22 ± ± 2.8 % Satisfactory ScoreMaleFemale Simulation88%83% No Simulation17%12% Table 3. Number of Procedures Performed Cervical ExamsMaleFemale Simulation No Simulation Vaginal DeliveriesMaleFemale Simulation No Simulation2.42.9