Competence over confidence: uncovering lower self-efficacy for women residents during central venous catheterization training

Background: While women make up over 50% of students enrolled in medical school, disparities in self-efficacy of medical skills between men and women have been observed throughout medical education. This difference is significant because low self-efficacy can impact learning, achievement, and performance, and thus create gender-confidence gaps. Simulation-based training (SBT) employs assessments of self-efficacy, however, the Dunning-Kruger effect in self-assessment posits that trainees often struggle to recognize their skill level. Additionally, the impact of gender on self-efficacy during SBT has not been as widely studied. The objective of this study was to identify if the gender-confidence gap and the Dunning-Kruger effect exist in SBT for central venous catheterization (CVC) on the dynamic haptic robotic trainer (DHRT) utilizing comparisons of self-efficacy and performance. Methods: 173 surgical residents (N_women=61, N_men=112) underwent training on the DHRT system over two years. Before and after using the DHRT, residents completed a 14-item Central Line Self-Efficacy survey (CLSE). During training on the DHRT, CVC performance metrics of the number of insertion attempts, backwall puncture, and successful venipuncture were also collected. The pre- and post-CLSE, DHRT performance and their relationship were compared between men and women. Results: General estimating equation results indicated that women residents were significantly more likely to report lower self-efficacy for 9 of the 14 CLSE items (p <.0035). Mann-Whitney U and Fisher’s exact tests showed there were no performance differences between men and women for successfully accessing the vein on the DHRT. Regression models relating performance and self-efficacy found no correlation for either gender. Conclusions: These results indicate that despite receiving the same SBT and performing at the same level, the gender-confidence gap exists in CVC SBT, and the Dunning-Kruger effect may also be evident.