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.KEY WORDS: cardiovascular disease; clinical skills assessment; disparities; women's health; medical student and residency education.

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