Abstract
BackgroundThere is much discussion about the sex differences that exist in medical education. Research from the United Kingdom (UK) and United States has found female doctors earn less, and are less likely to be senior authors on academic papers, but female doctors are also less likely to be sanctioned, and have been found to perform better academically and clinically. It is also known that international medical graduates tend to perform more poorly academically compared to home-trained graduates in the UK, US, and Canada. It is uncertain whether the magnitude and direction of sex differences in doctors’ performance is variable by country. We explored the association between doctors’ sex and their performance at a large international high-stakes clinical examination: the Membership of the Royal Colleges of Physicians (UK) Practical Assessment of Clinical Examination Skills (PACES). We examined how sex differences varied by the country in which the doctor received their primary medical qualification, the country in which they took the PACES examination, and by the country in which they are registered to practise.MethodsSeven thousand six hundred seventy-one doctors attempted PACES between October 2010 and May 2013. We analysed sex differences in first time pass rates, controlling for ethnicity, in three groups: (i) UK medical graduates (N = 3574); (ii) non-UK medical graduates registered with the UK medical regulator, the General Medical Council (GMC), and thus likely to be working in the UK (N = 1067); and (iii) non-UK medical graduates without GMC registration and so legally unable to work or train in the UK (N = 2179).ResultsFemale doctors were statistically significantly more likely to pass at their first attempt in all three groups, with the greatest sex effect seen in non-UK medical graduates without GMC registration (OR = 1.99; 95% CI = 1.65-2.39; P < 0.0001) and the smallest in the UK graduates (OR = 1.18; 95% CI = 1.03-1.35; P = 0.02).ConclusionsAs found in a previous format of this examination and in other clinical examinations, female doctors outperformed male doctors. Further work is required to explore why sex differences were greater in non-UK graduates, especially those without GMC registration, and to consider how examination performance may relate to performance in practice.
Highlights
There is much discussion about the sex differences that exist in medical education
We aimed to establish whether sex differences in performance were present in the new format Practical Assessment of Clinical Examination Skills (PACES), and whether any sex differences varied by candidates’ country of primary medical qualification (PMQ), whether or not they were registered with the United Kingdom (UK) General Medical Council (GMC) and likely to be working in the UK, and whether or not they sat the examination in the UK
Male candidates were statistically significantly more likely to be from a black and minority ethnic (BME) background, more likely to be a non-UK medical graduate, less likely to be registered with the GMC, and more likely to sit PACES at a non-UK centre
Summary
There is much discussion about the sex differences that exist in medical education. Research from the United Kingdom (UK) and United States has found female doctors earn less, and are less likely to be senior authors on academic papers, but female doctors are less likely to be sanctioned, and have been found to perform better academically and clinically. It is known that international medical graduates tend to perform more poorly academically compared to home-trained graduates in the UK, US, and Canada. It is uncertain whether the magnitude and direction of sex differences in doctors’ performance is variable by country. On the one hand female doctors have poorer career outcomes compared to male doctors, for example earning less [1,2,3] and being less likely to be senior authors on academic papers [4, 5]. A recent (currently unpublished) meta-analysis showed that female doctors tend to outperform men, with the largest effect in practical clinical examinations rather than in written examinations, which showed more gender parity
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