The use of clinical simulation for the detection and revelation of gender and sex biases in health

Abstract Background Health systems’ role in perpetuating sex-and-gender inequalities in health remains understudied. Biases among healthcare professionals may contribute to disparities through misdiagnoses, inadequate treatment, and poor continuity of care, negatively affecting health outcomes. This study uses rich data from clinical simulations conducted at several universities to identify sex-and-gender biases in medical students and intern residents and quantify their effects on the provision of care. It also examines whether these biases are already present at the early stage of their careers and if they evolve throughout experience and training acquisition. Methods Clinical simulations serve as the main research tool for the collection of data, allowing analysis of participants’ performance across key tasks in clinical patient management. The random allocation of study participants to simulated patient scenarios allows to causally determine the impact of patient sex on physicians’ performance in symptoms assessment, monitoring, medical tests, diagnosis, treatment administration, and communication with the patient. Results The findings reveal significant disparities in the early phase of clinical management, with lower quality-of-care scores for female patients in symptom assessment (-0.045; p < 0.1), initial diagnosis (-0.114; p < 0.01), diagnostic testing (-0.195; p < 0.01) and the communication with the patient (-0.088; p < 0.01). These differences remain robust when controlling for the participants’ level of experience or training. Conclusions These results demonstrate the presence of substantial sex-and-gender biases among healthcare providers at the early stages of their careers, and how they disproportionately affect the care female patients receive. The study also highlights the need to implement specific training programmes to reduce - and ultimately eliminate - sex-and-gender biases among healthcare providers. Key messages • Sex-and-gender biases among healthcare providers negatively affect the care female patients receive, especially when it involves tasks such as symptom assessment, diagnosis, testing and communication. • Clinical simulations provide valuable insights for health and education policies aimed at detecting and addressing sex-and-gender biases.