Investigating gender bias in pharmacy practice: a study nested in a pharmacy training exercise

Background Evidence on gender bias in the healthcare system is growing, and pharmacists have an important role in Swiss primary care. Yet, research on gender bias among pharmacists remains extremely sparse and highly relevant. Methods This study investigates gender bias in assessment, treatment and recommendations by pharmacy students within training consultations of a mild depression case and an acute lower back pain case, comparing those facing a male vs female simulated patient. The study was conducted at Swiss Master’s in Pharmacy programs, during 2023 and 2024. Results The study included 190 students in the mild depression case and 219 in the acute lower back pain case. Assessment and management were similar for female and male simulated patients, with only minor exceptions. In the mild depression case, women were more likely to be referred to a medical doctor (observed for direct referrals but not for referrals conditional to red flags or not improvement), and recommended to exercise and reduce stress; while men were more frequently recommended sleep-hygiene measures. In the acute lower back pain case, men were more frequently erroneously assessed as having a herniated disc (5.1% vs 0%); and women were more frequently recommended alternative medicine practices. Conclusions The study shows general absence of gender bias among pharmacy students handing these cases, besides overestimation of pain in men and variability in life-style recommendations. While the evaluation-like setting may hinder intuitive and bias behaviours and encourage intentional analytical thinking, results may also suggest that using structured guidance for consultation may aid equity in treatment and reduce gender bias. This is supported by the observed general consistency in assessment and pharmacological treatment, for which there is structured guidance within the educational curriculum; conversely to the higher variability in non-pharmacological recommendations, which are less strictly covered. Further research in experienced pharmacists remains of interest.