Parting ways: Sex-based differences in premedical attrition.

Despite women's greater propensity to enter college aspiring to careers in medicine, they are less likely than men to persist in these ambitions. Past research suggests that students' experiences in coursework strongly influence their decision to continue along or depart from the premedical track, yet it remains unclear whether women and men have differential experiences in coursework that contribute to sex-based disparities in premedical attrition. To gain insight into whether and how premeds' experiences in coursework contribute to gendered patterns of attrition, this study employs a mixed methods design that combines longitudinal survey data collected from premedical students at a large state university with in-depth interview data collected from a subset of respondents. Survey results (n = 268) demonstrate that while women report more stress from premedical coursework than men, these differences do not help to explain the female-male gap in attrition. Rather, it is women's lower levels of affinity for premedical coursework-specifically, their less positive evaluations of premed coursework, and greater enjoyment of non-premed courses-that contribute most notably to the gender gap in attrition. Qualitative results (n = 39) suggest that women's affinity for premed coursework is diminished by more frequent, negative interactions with faculty, and a tendency to interpret low grades in premedical coursework as a sign that this career track is a 'poor fit' for their strengths and aptitudes. These findings broadly align with scholarship on the role of self-expressive decision-making in curricular sex segregation. Interview data also point to a critical factor for sustaining women's medical career aspirations: clinical experiences. Ranging from shadowing, to volunteer experiences, to jobs in local hospitals, these experiences allow women to 'try on' the role of doctor and inspire resilience in the face of academic adversity. The implications of findings for future research on premedical education are discussed.