title: Gender and achievement in clinical medical students: a path analysis.
abstract: OBJECTIVE
  Men and women interact differently with the learning environment. Women's standards and goals are responsive to social and environmental influences. Men seem relatively indifferent but check their performance against strongly internalized standards. The purpose of this study was to discover how these interactions determined achievement.
  
  
  METHODS
  A longitudinal study examined students on their first clinical firms. Students' view of the learning environment was measured as their attribution style. Perceived self-efficacy, anxiety and fear of negative evaluation were also measured at the start of the course and again 3 months later. Path analysis was used to connect these measures to achievement assessed in tests of knowledge and skills after a further 3 months.
  
  
  RESULTS
  Men and women showed significant differences. In both, a perception that bad events in the learning environment were persistent and pervasive appeared to be causal of high achievement in tests of knowledge. In men this was dominantly mediated through fear of negative evaluation and anxiety. In women the path appeared to be direct and associated with a sense of reduced self-efficacy. Men also showed two additional and opposing paths to achievement when good events were pervasive and persistent. For some, achievement was improved. Others experienced a reduction in anxiety and performed poorly.
  
  
  CONCLUSIONS
  Achievement in men demands arousal. This is greatest in environments that provide frequent opportunities for comparison of their performance with their internal standards. Achievement in women seemed consequential on a re-evaluation of their sense of efficacy in adverse environments. Persisting with attempts to manage learning in a socially unresponsive environment can cause unproductive anxiety and poor performance.
authors.affiliation: Clinical Skills Centre, Department of Medical and Dental Education, St Bartholomew's and the Royal London Hospital School of Medicine Hospital, London, UK.
authors.forename: D M
authors.initials: DM
authors.lastname: de Saintonge
authors.forename: D M
authors.initials: DM
authors.lastname: Dunn
mesh_terms: D000124:Achievement; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D004501:Education, Medical; D005260:Female; D006801:Humans; D007858:Learning; D008131:London; D008137:Longitudinal Studies; D008297:Male; D012044:Regression Analysis; D020377:Self Efficacy; D012737:Sex Factors; D013337:Students, Medical / Q000523:psychology