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Background & Objective: Small-group learning is a popular fundamental teaching strategy in undergraduate medical education (UME). Evidence of women acting as “social vaccines” for their women peers in small groups has been described in engineering, but not in UME. We seek to better understand the impact of smallgroup gender composition on medical student learning.

Methods: Preclinical medical students were surveyed throughout their clinical skills (CS) course. Likert-scale questions measured students’ perception of their simulation encounters as challenging or threatening, and data were used to calculate a challenge-to-threat ratio (CTR). Scores >1 indicated a situation more challenging than threatening, whilesurvey.

Results: Survey response rates ranged from 62.6-78.8%. Average CTRs of firstyear students were higher for men (1.52-1.64, n=62) than women (1.23-1.46, n=71). All CTRs decreased at the start of the second year (0.80-1.40, n=108), but rebounded as student training progressed (1.29-2.36, n=118). Early second-year CS group gender composition did not impact men (similar CTRs ranging 0.83-1.09). However, women reported a disparate CTR across groups with one, two, and three women (0.80, 1.40, and 1.38 , respectively). Late second-year students reported the highest CTRs in groups with gender parity and lowest CTRs in groups with only one female student. Sentiment analysis of open comments shows a gender effect, with more negative sentiments from women.

Conclusions: Women were less confident than their male peers in the early CS small-group learning environment. Less confidence for all students was reported as CS cases progressed in the second-year to an internal medicine focus; however, confidence recovered in the late second year. A significant threat was perceived by the sole woman in a small group, but the presence of 1-2 other women appeared to be protective against this effect on confidence.

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women, medical education, stereotype threat

Decreasing the threat to learning: the impact of gender ratio in clinical skills small groups