title: Does patient gender impact resident physicians' approach to the cardiac exam?
abstract: BACKGROUND
  Physical examination remains an important part of the initial evaluation of patients presenting with chest pain but little is known about the effect of patient gender on physician performance of the cardiovascular exam.
  
  
  OBJECTIVE
  To determine if resident physicians are less likely to perform five key components of the cardiovascular exam on female versus male standardized patients (SPs) presenting with acute chest pain.
  
  
  METHODS
  Videotape review of SP encounters during Objective Structured Clinical Examinations (OSCEs) administered by the Emory University Internal Medicine Residency Program in 2006 and 2007. Encounters were reviewed to assess residents' performance of five cardiac exam skills: auscultation of the aortic, pulmonic, tricuspid, and mitral valve areas and palpation for the apical impulse.
  
  
  METHODS
  One hundred forty-nine incoming residents.
  
  
  METHODS
  Residents' performance for each skill was classified as correct, incorrect, or unknown.
  
  
  RESULTS
  One hundred ten of 149 (74 %) of encounters were available for review. Residents were less likely to correctly perform each of the five skills on female versus male SPs. This difference was statistically significant for auscultation of the tricuspid (p = 0.004, RR = 0.62, 95 % CI 0.46-0.83) and mitral (p = 0.007, RR = 0.58, 95 % CI = 0.41-0.83) valve regions and palpation for the apical impulse (p < 0.001, RR = 0.27, 95 % CI = 0.16-0.47). Male residents were less likely than female residents to correctly perform each maneuver on female versus male SPs. The interaction of SP gender and resident gender was statistically significant for auscultation of the mitral valve region (p = 0.006) and palpation for the apical impulse (p = 0.01).
  
  
  CONCLUSIONS
  We observed significant differences in the performance of key elements of the cardiac exam for female versus male SPs presenting with chest pain. This observation represents a previously unidentified but potentially important source of gender bias in the evaluation of patients presenting with cardiovascular complaints.
authors.affiliation: Division of General Internal Medicine and Public Health, Department of Internal Medicine, Vanderbilt University School of Medicine, 1215 21st Ave South, 6000 Medical Center East, NT, Nashville, TN 37232-8300, USA. rosette.j.chakkalakal@vanderbilt.edu
authors.forename: Rosette J
authors.initials: RJ
authors.lastname: Chakkalakal
authors.forename: Stacy M
authors.initials: SM
authors.lastname: Higgins
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Bernstein
authors.forename: Kristina L
authors.initials: KL
authors.lastname: Lundberg
authors.forename: Victor
authors.initials: V
authors.lastname: Wu
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Green
authors.forename: Qi
authors.initials: Q
authors.lastname: Long
authors.forename: Joyce P
authors.initials: JP
authors.lastname: Doyle
mesh_terms: D000208:Acute Disease; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis*; D002637:Chest Pain / Q000209:etiology; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003935:Diagnostic Techniques, Cardiovascular / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D005845:Georgia; D006326:Heart Auscultation / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D008875:Middle Aged; D010173:Palpation / Q000592:standards / Q000706:statistics & numerical data; D010808:Physical Examination / Q000379:methods / Q000592:standards*; D010817:Physician-Patient Relations; D012737:Sex Factors; D014743:Videotape Recording