Medical student gender and issues of confidence
Why confidence matters in medical training
Confidence shapes how you present findings on rounds, ask for help, volunteer for procedures, and speak up for patient safety. It influences feedback you receive, how faculty remember you, and the opportunities you’re offered. Confidence is not the same as competence, yet supervisors and peers often read it as a signal of readiness.
For learners, an accurate sense of “I can do this safely” supports better performance; misplaced overconfidence risks error; underconfidence leads to hesitation and missed learning chances. In medicine—where decisions carry weight—calibrating confidence to skill matters for patients, teams, and your growth.
Across countries, women now make up about half—or more—of medical students and doctors, a major demographic shift. In the UK, women reached 50.04% of licensed doctors in March 2025; France crossed a similar threshold later in 2025. This changes who enters training, yet not every learning environment has adapted its culture, assessments, or support systems.
Table of Content
- Medical student gender and issues of confidence
- Representation is rising; confidence gaps can still appear
- Confidence vs. competence: what the research shows
- Pressures that shape confidence
- Intersectionality and specialty choice
- What actually helps: evidence-based moves
- What you can do today
- Key takeaways
- Conclusion
- FAQs
Representation is rising; confidence gaps can still appear
Women are the majority of applicants and graduates at U.S. medical schools, and women’s share of academic faculty continues to grow. Progress on leadership and pay equity, however, remains uneven, which affects day-to-day climate and mentoring.
Confidence isn’t a simple personality trait. Training culture, evaluation practices, access to practice opportunities, and bias all shape it. A classic study found independent observers rated women medical students as less confident than men during standardized patient exams, despite equivalent performance. Later work echoed the pattern in surgical and clinical settings where women reported lower procedural confidence or were perceived as less confident, again without performance gaps to match.
Confidence vs. competence: what the research shows
Observed differences in perceived confidence
Blanch and colleagues (2008) reported that third-year women students appeared less confident in OSCE encounters to neutral raters, even with comparable scores. The finding matters because supervisors often equate visible confidence with readiness for autonomy.
A narrative and empirical literature has since described similar tensions in training: women trainees self-assess lower, and observers sometimes mark them down on “confidence” even when objective measures are similar.
Self-assessment patterns and OSCE findings
Recent data give nuance. A 2024 study of French students found no gender difference in self-assessment accuracy during online OSCEs; both groups slightly overestimated performance, suggesting context matters and some gaps may be narrowing. Newer first-year and low-stakes settings often show smaller gender differences than high-stakes, hands-on exams.
Other studies still show men overpredicting test performance and women rating themselves more conservatively, especially in later stages of training.
Pressures that shape confidence
Stereotype threat
Focus groups and survey research in internal medicine residency show a high prevalence of gender-based stereotype threat for women: concern about confirming a stereotype drains working memory and dampens visible confidence during tasks that require decisive action. This pattern detracts from well-being and can blunt leadership behaviors.
Hidden curriculum, feedback, and evaluation bias
Students learn not only from lectures but from how teams talk, who gets credit, and what feedback looks like. Reviews of clinical feedback describe infrequent, vague comments, with narrative language that can differ by gender. Programmatic assessment—many low-stakes observations with coaching—reduces the weight of any single judgment and builds a richer picture of competence, which supports healthier confidence.
Access to procedural opportunities
Surgical education studies report that women often have fewer chances to practice technical skills and report lower confidence in the OR, even when objective performance is similar. Autonomy and repetition build confidence; limited access stalls it. Critical care and procedure-heavy rotations show similar themes.
Harassment, pay gaps, and safety
Surveys in surgery and other specialties document sexual harassment and discrimination that erode psychological safety, blunt participation, and chip away at confidence. Pay gaps and stalled advancement amplify the message that contributions are undervalued, which affects motivation and self-belief during training.
Intersectionality and specialty choice
Confidence is shaped by more than gender alone. Race, ethnicity, migration status, and socioeconomic background interact with gender to influence who speaks, who gets tapped for opportunities, and who feels “backed.” Reviews highlight persistent leadership gaps and uneven sponsorship for women, with compounded barriers for women from underrepresented groups. Learners who face several headwinds at once often carry the heaviest confidence tax.
What actually helps: evidence-based moves
Early procedural exposure and skills “primers”
Short, structured skills primers before clerkships raise procedural confidence and narrow gaps in perceived readiness. Bootcamps and targeted workshops build muscle memory and language for asking for a turn in the OR or clinic. Effects vary by design, but several studies report significant gains in confidence with focused practice and coaching.
Programmatic assessment and a coaching culture
Multiple low-stakes observations with timely, behavior-specific feedback create a steady drip of believable data about your skills. This approach reduces the “one bad day” effect, gives you more chances to improve, and helps calibrate self-confidence to actual performance. International consensus statements and recent evaluations recommend this approach for competency-based curricula.
Mentorship, sponsorship, and social capital
Mentors help you set goals and reflect; sponsors open doors and name you for stretch roles. Large studies link mentorship to higher satisfaction and lower burnout; scoping reviews call for stronger, equity-minded sponsorship so women are put forward for visible tasks and leadership tracks. Even brief mentorship seminars can shift interest toward surgical careers for women students.
Speaking up and psychological safety
Training that models respectful challenge and active listening helps everyone contribute. A 2024 trainee study found men reported speaking up more often, and women reported more internal barriers tied to self-confidence. Simulation with debriefing and clear phrase sets (“I’m concerned… I recommend…”) improves voice behaviors and reduces hesitation.
Assessment design that reduces noise
Small design choices shift confidence. A ten-minute OSCE orientation improved scores, likely by reducing anxiety from unfamiliar formats. Simulation tools and manikin diversity matter too—equipment that mirrors a range of bodies helps learners practice realistically and speak with confidence in real care.
Transparent opportunity mapping
Rotations that publish who did procedures, who presented, and who scrubbed signal fairness and help faculty spot uneven access. This kind of tracking pairs well with programmatic assessment dashboards to guide corrective action, not blame. (Emerging CBME evaluations describe how teams are implementing these systems.)
What you can do today
For students and learners
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Track experiences. Keep a simple log of procedures, presentations, and feedback. Patterns show up fast when you look.
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Ask for one clear skill target per week. “This week I’ll insert two IVs under supervision and get feedback after each.”
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Use precise language in self-assessment. Replace “I’m bad at this” with “I need two more supervised attempts to reach consistent speed and accuracy.”
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Practice voice lines. Short scripts lower the threshold to speak up: “I have a safety concern,” “May I try the next one under supervision?”
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Build your circle. Seek two mentors (one near-peer, one faculty) and at least one sponsor who will name you for opportunities.
For educators and supervisors
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Normalize calibrated confidence. Praise accurate self-assessment and constructive help-seeking, not bravado.
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Give behavior-based feedback. “You identified peritoneal signs and called for help early” is more useful than “be more confident.”
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Spread chances fairly. Rotate first attempts, keep a simple tally, and use pre-briefs so learners know when their turn is coming.
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Host micro-primers. Ten-to-twenty-minute refreshers before clinics and cases increase participation and confidence.
For programs and institutions
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Adopt programmatic assessment. More low-stakes observations with coaching; fewer one-shot judgments.
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Back mentorship with sponsorship. Fund mentor training, track sponsorship activity, and publish opportunity data by learner group.
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Strengthen reporting and safety. Clear anti-harassment pathways and visible consequences build trust and support learner confidence.
Key takeaways
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Representation has surged; confidence gaps persist in some settings, often without performance gaps to match.
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Context matters. Familiar formats, frequent practice, and fair access to hands-on tasks improve confidence for everyone.
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Stereotype threat, harassment, and pay inequities erode psychological safety and self-belief; strong policies and reporting systems help.
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Programmatic assessment with specific feedback supports accurate self-appraisal and healthy confidence growth.
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Mentorship plus sponsorship changes trajectories; brief mentorship interventions already show promising shifts in interest and confidence.
Conclusion
Confidence grows with practice, coaching, and fair chances to contribute. Visible parity in headcounts will not automatically fix day-to-day experience. When teams share opportunities, track access, give specific feedback, and call out bias, learners form a truer sense of their skill. That benefits your growth and, more importantly, the patients you care for.
FAQs
1) If I feel underconfident, should I still volunteer for procedures?
Yes—flag your level and ask for graded supervision: “I’d like to try the first pass with coaching.” Supervisors can right-size the task and give immediate feedback that builds skill and confidence. Programmatic assessment models support this approach.
2) How do I tell if my confidence is too low or too high?
Use three anchors: objective data (checklists, case numbers), external feedback, and outcomes. When those align with your self-view, confidence is well-calibrated. If they don’t match, ask for a direct observation and a short coaching plan.
3) Does stereotype threat only affect exams?
No. It can shape leadership behaviors on rounds and in emergencies. Teams can reduce it with explicit norms that invite questions, share uncertainty, and value early help-seeking.
4) Do bootcamps really help?
Short skills orientations before clerkships raise procedural confidence in several studies; effects are strongest when practice is hands-on, feedback is specific, and opportunities continue during rotations.
5) Is there any sign that gaps are closing?
Some. A 2024 OSCE study found no gender difference in self-assessment accuracy, hinting at progress in certain contexts. Broader culture change and fair access to practice still matter.
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