Objective <p>The authors aimed to determine if medical students’ self-assessment of abilities and performance differed by gender during the psychiatry clerkship and if these differences were reflected objectively in test scores or clinical evaluations from educators.</p> Methods <p>Data from mid-clerkship self-assessments completed during the psychiatry core clerkship were reviewed from two classes of medical students. Students rated their performance on 14 items across five domains: knowledge/clinical reasoning, differential diagnosis, data presentation, studying skills, and teamwork as “below,” “at,” or “above expected level.” Ratings were coded numerically, and statistical analysis was performed using Student’s <i>T</i>-test. National Board of Medical Examiners (NBME) Subject Exam scores and clinical evaluations served as measures of actual performance.</p> Results <p>Female students (<i>n</i> = 123) rated their performance significantly below male peers (<i>n</i> = 114) in medical knowledge (female − 0.05 vs male 0.13), clinical reasoning (− 0.02 vs 0.06), differential diagnosis (− 0.09 vs 0.00), balancing work and studying (− 0.02 vs 0.11), keeping up with clerkship assignments (0.03 vs 0.13), understanding role on the team (0.11 vs 0.23), interacting with other team members (0.15 vs 0.31), and functioning as part of the team (0.13 vs 0.25). Clinical evaluation scores and NBME Subject Exam scores showed no significant difference (evaluation scores 138.1 vs 136.0; NBME scores 163.8 vs 162.2) in performance between students.</p> Conclusions <p>Female medical students tend to underrate their performance compared to male peers in clinical knowledge, studying skills, and teamwork, despite equivalent academic and clinical performance. This study highlights gender disparities in self-assessment during medical training.</p>