Accurate self-assessment of performance is an essential component of professional development, yet significant gender differences in this regard have been observed (1–6). Research indicates that women tend to have a more accurate understanding of their own abilities, whereas men often overestimate their performance (5). This discrepancy, especially in high-stakes fields such as medicine, could have critical implications for both training and outcomes (2, 5, 7–11). Despite these findings, women remain underrepresented in surgical and interventional specialties (5, 12, 13), including interventional radiology (IR), raising the question of whether women’s more accurate self-assessment could contribute to their lower participation (1, 5, 6, 14, 15). This may be linked to factors such as perceived barriers or a lack of confidence, despite evidence of high competence. This disparity is attributed to several factors, including potential misconceptions about the field among medical students and female physicians, likely due to issues related to pregnancy, sex-specific dynamics in teamwork, and insufficient mentoring (15). Particularly, the concept of empowerment is multifaceted and influenced by numerous factors (16).

The manuscript “Gender differences in self-assessed performance and stress level during training of basic interventional radiology maneuvers” by Reder et al. (5), primarily focused on the female perspective, explored the impact of self-assessment and stress on performance during simulated interventional radiology tasks. However, the male perspective was not fully addressed, leaving a significant gap in understanding. Unresolved questions emerged regarding why men seemed to struggle with accurately assessing their performance, why higher reported stress levels correlated with poorer performance in men, and why stress appeared to have no such correlation in women. These findings prompted further investigation into these gender-specific disparities.

For this purpose, the previously published dataset and methodology of Reder et al. (5) was revisited using refined methodology (5), wherein individual cumulative fine motor skills acquired over the course of life were attempted to be objectively quantified and correlated with self-perception regarding objectively performed tasks. A positive effect of cumulative fine motor skills (or hand focus) over the individuals’ lifespan on the objective performance parameters of the experiments was hypothesized.

The baseline population and methodology for data acquisition (including training scenarios, experimental setting, objective and subjective data acquisition) have been described and published already in a previous study by Reder et al. (5). Data known from this study are unequivocally indicated and reported as Supplementary material.

Data were collected from 64 participants (26 female; right-handed > 95% each with p = 0.65), with one female participant withdrawing due to perceived stress levels (n = 63) (5). No significant differences were observed among the three main profession categories (medical, crafts, administrative; p = 0.584), or sex-specific age categories (p = 0.129; Supplementary Table 1) (5). There was no sex-specific differences in the hours of manual work per day during professional activities (p = 0.526), in the weekly hours dedicated to playing music (p = 0.463), participating in sports (p = 0.119), or pursuing other hobbies (p = 0.611; Supplementary Table 1). However, there were significant differences in the self-reported weekly working hours, with n = 24 men and n = 6 women reporting a working time >40 h (p = 0.025).

This study aimed to examine the influence of leisure activities, fine motor skills, and psychological factors on objective performance during early interventional radiology (IR) training, with a particular focus on sex-specific differences. A total of 63 participants (26 females) were included to explore how manual focus in both professional and non-professional activities impacted performance in a catheterization task. In men, non-professional activities were negatively correlated with self-reported stress levels, suggesting that diverse leisure activities might offer benefits. No significant sex-specific differences were observed in manual focus or perceived stress levels. For women, objective performance appeared to be primarily influenced by self-assessed performance, whereas in men, stress levels negatively impacted performance. Additionally, non-professional activities were positively correlated with performance in men, while professional activities showed no significant effect. Multiple regression analyses further supported the hypothesis that non-professional activities enhance male performance, while women’s performance seemed more influenced by self-assessment. Overall, the findings largely confirmed the proposed hypotheses regarding sex-specific differences in performance drivers.

In male participants’, fine motor skills - particularly those developed through leisure activities - positively influenced their objective performance. This highlights the potential benefits of a balanced lifestyle for men, where non-professional activities like playing musical instruments may foster manual dexterity and coordination in ways that professional training might not. These findings aligned with prior research, emphasizing the role of experiential learning in developing personal competencies (25–27), potentially offering a more significant impact than professional training alone (28–33). Conversely, female participants’ fine motor skills, irrespective of their source, did not correlate significantly with objective performance. Instead, their self-assessed performance played a critical role in determining their outcomes (34, 35). This suggested that psychological factors, particularly self-esteem and confidence, are more influential in women’s performance than in men’s (34–36). Women may benefit from psychosocial support to enhance their performance and avoid unjustified criticism (16, 34–36). It can be hypothesized that men’s performance could be influenced by their confidence in their abilities (37, 38), while women’s performance seemed more deeply tied to their internal processes of self-assessment (2, 5).

These observations underscore the significant role of psychological factors in influencing women’s performance, a conclusion supported by Reder et al. (5), presuming that women were more accurate in assessing their objective performance than men (Figure 1). Given these findings, women may benefit from psychosocial support aimed at boosting self-esteem and counteracting self-doubt, possibly improving both their performance and satisfaction with training.

For men, an externally guided learning approach—particularly one that builds on their intrinsic motivation—may yield greater success, as suggested by previous research (2). This external guidance could complement their inclination to perform tasks independently and avoid seeking help, which was observed in this study and reported previously (5). In contrast, women seemed to benefit from a learning style that combines external motivation with intrinsic direction and task execution, evidenced by their tendency to seek help more often and spend more time comprehending instructions (5, 7–10). Interestingly, while women generally made fewer mistakes than men (5), this may be due to their more careful approach and desire to understand the material thoroughly (39).

In both sexes, feedback appears to be a key component for performance improvement, supporting the idea that constructive feedback is essential for developing both mental and physical skills (40–42). However, the gendered differences in response to feedback, self-assessment, and stress levels suggested that future research should consider how these factors interact with learning outcomes and task performance. Additionally, future studies should explore how other demographic factors, such as gender identity and socioeconomic status, may influence task performance and learning strategies. Overall, these findings highlight the importance of considering sex-specific differences when designing educational and occupational strategies. Tailoring approaches to the individual needs and learning preferences of both men and women could enhance fine motor performance, reduce stress, and improve satisfaction in educational settings and the workforce. Further studies are needed to explore the impact of other gender identities, including non-binary and intersex individuals, on learning behaviors, which could offer a more comprehensive understanding of these issues.

Several limitations must be acknowledged. One of the primary limitations was the relatively small sample size of 63 participants (26 female), constraining the generalizability of the results. A larger sample size would have increased statistical power and allowed for more reliable conclusions. Additionally, although standardized teaching methods were employed, a male medical student was involved in the recruitment, training, and execution of the experiments. This could have introduced gender-related bias, as the personality and gender of the experimenter might have influenced the behavior of the participants. Male participants might have felt more confident in demonstrating their skills or seeking help, while female participants might have been less likely to openly acknowledge difficulties due to social or cultural factors. Another limitation arose from the selection of participants with limited experience in catheterization. The study primarily targeted the early stages of learning, while the results might have been different for well-trained, experienced interventional specialists. However, defining “well-trained” individuals presented a challenge, as training levels varied greatly among individuals and institutions. By choosing inexperienced participants, potential confounding factors related to varying training levels were minimized, allowing the study to focus on the learning process during the early stages of training. It was also important to note that this study only investigated learning within a 90-min timeframe. This short duration of training likely did not capture the long-term effects of continuous training or the gradual development of fine motor skills that might have occurred with prolonged engagement in the task. Therefore, the results likely reflected short-term learning outcomes rather than the long-term effects of sustained practice. Future studies could extend the training duration to explore the impact of prolonged learning over weeks or months, providing deeper insights into the long-term learning process. Despite these limitations, the use of data from the previous study from Reder et al. (5) significantly strengthened the validity of the current investigation. Since the previously published findings formed the basis of the current results, and the new data merely augmented the previous findings, there was no concern regarding the introduction of bias or variability from a new cohort. This approach eliminated the need to account for the potential confounding effects of a new participant group, thereby enhancing the validity and relevance of the current study. Rather than introducing a new cohort, the findings of the prior study were extended by the current data, reinforcing the consistency and robustness of the results.

In conclusion, this study highlighted the importance of considering sex-specific differences in learning strategies and fine motor skill development. Men appeared to benefit from a varied, experience-based approach to learning that incorporated leisure activities, which could have enhanced their motor skills. In contrast, women’s performance seemed to be more influenced by self-assessment and psychological factors such as self-esteem. Tailoring training methods to account for these differences could have improved performance and satisfaction for both men and women in educational and professional settings. Further studies should have examined the influence of additional variables, such as personality, motivation, and gender identity, on learning behavior and performance outcomes. These findings may have contributed to the development of more effective and inclusive educational strategies that lead to better learning outcomes across diverse groups.