Gender bias in the medical education of obstetrician-gynaecologists in the United States: A systematic review

Abstract

Background: The number of men entering obstetrics and gynaecology (Ob/Gyn) residencies and general Ob/Gyn practice is decreasing. Gender biases against their participation may affect career decisions. Objective: This systematic review examines: (i) female patients’ gender preferences and perceptions of men as Ob/Gyns and/or medical students; and (ii) the influence of gender on students’ education and career decisions. Search strategy: We identified relevant research via PubMed using variations of three concepts in combination: Ob/Gyn care, gender bias/preference, and medical education or career. We conducted the initial review in 2018 and repeated the search in March 2021, adding additional references via citation review of included research. Selection criteria: We restricted the review to original research from the United States between 2000–2021. Data collection: Fifteen studies met inclusion criteria, categorised into three groups: (i) patient’s gender preference for Ob/Gyns; (ii) patient’s gender preference for medical students during the Ob/Gyn clerkship; and (iii) influence of gender bias on Ob/Gyn career decisions. Main results: Patients prioritised their physician’s care attributes (eg technical skill, compassion, experience) over gender when choosing Ob/Gyns; however, provider gender was prioritised for medical students. Male medical students more commonly reported exclusion from clinical opportunities, although objective clinical exposure was like that of female counterparts. Despite perceived gender bias, male medical students reported increased Ob/Gyn interest post-clerkship; interest did not translate into residency applications. These findings are limited by study quality and heterogeneity. Conclusions: Real and perceived gender bias among female patients and male medical students in Ob/Gyn may underlie declining numbers of men entering the field.