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Does Patient Gender Impact Resident Physicians’ Approach to the Cardiac Exam?

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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.

Design

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.

Participants

One hundred forty-nine incoming residents.

Main Measures

Residents’ performance for each skill was classified as correct, incorrect, or unknown.

Key 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.

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Acknowledgments

This study was funded through an Educational Innovations Grant from Emory Healthcare, Atlanta, GA.

The preliminary results of this project were presented as a poster presentation at the ACGME/ABMS 2007 Joint Conference “Physician Competence: From Deconstruction to Reconstruction” in September 2007 and as an oral presentation at the Southern Society of General Internal Medicine Annual Meeting where Dr. Chakkalakal was awarded the Best Resident Abstract Award in March 2008 as well as at the Society of General Internal Medicine 31st Annual Meeting in April 2008 where Dr. Chakkalakal was a Lipkin Award Finalist.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Rosette J. Chakkalakal MD, MHS.

Additional information

Dr. Chakkalakal was affiliated with the Department of Internal Medicine, Emory University School of Medicine at the time this project was completed.

Appendix 1. Comparison of Scores from Reviewer 1 and 2 by Cardiac Exam Maneuver

Appendix 1. Comparison of Scores from Reviewer 1 and 2 by Cardiac Exam Maneuver

Table 3 Aortic Auscultation
Table 4 Pulmonic Auscultation
Table 5 Tricuspid Auscultation
Table 6 Mitral Auscultation
Table 7 Palpation of Apical Impulse

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Chakkalakal, R.J., Higgins, S.M., Bernstein, L.B. et al. Does Patient Gender Impact Resident Physicians’ Approach to the Cardiac Exam?. J GEN INTERN MED 28, 561–566 (2013). https://doi.org/10.1007/s11606-012-2256-5

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  • DOI: https://doi.org/10.1007/s11606-012-2256-5

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