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Arnoux S, Hirshfield LE, Abbiati M, Nendaz MR, Savoldelli GL, Bajwa NM. The impact of gendered experiences on the career choice of swiss medical students: A qualitative study protocol. PLoS One 2024; 19:e0302538. [PMID: 38768187 PMCID: PMC11104654 DOI: 10.1371/journal.pone.0302538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/05/2024] [Indexed: 05/22/2024] Open
Abstract
The problem of gender discrimination and sexual harassment in medicine is long-standing and widespread. This project aims to document and understand how gendered experiences encountered by final-year medical students in Switzerland are experienced by these individuals and how they influence their career choice. It also aims to identify representations and stereotypes linked to the different specialties. The project will take place at all Swiss universities offering a master's degree in human medicine, for a total of 9 programs. Around 36 participants will be recruited. Semi-structured qualitative individual interviews will be conducted. Analysis will be based on Grounded Theory principles.
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Affiliation(s)
- Sylvie Arnoux
- Faculty of Medicine, Unit of Development and Research in Medical Education, University of Geneva, Geneva, Switzerland
| | - Laura E. Hirshfield
- Department of Medical Education, University of Illinois College of Medicine, Chicago, Illinois, United States of America
| | - Milena Abbiati
- Faculty of Medicine, Unit of Development and Research in Medical Education, University of Geneva, Geneva, Switzerland
| | - Mathieu R. Nendaz
- Faculty of Medicine, Unit of Development and Research in Medical Education, University of Geneva, Geneva, Switzerland
| | - Georges L. Savoldelli
- Faculty of Medicine, Unit of Development and Research in Medical Education, University of Geneva, Geneva, Switzerland
- Department of Anaesthesiology, Division of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nadia M. Bajwa
- Faculty of Medicine, Unit of Development and Research in Medical Education, University of Geneva, Geneva, Switzerland
- Department of Pediatrics, Division of General Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
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Konopasky A, Wyatt TR, Blalock AE. Past resources, future envisioning, and present positioning: how women who are medical students at one institution draw upon temporal agency for resistance. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:425-441. [PMID: 37428344 DOI: 10.1007/s10459-023-10263-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 06/18/2023] [Indexed: 07/11/2023]
Abstract
While women entering medical school are faced with a patriarchal system, they also enter into a community with other women and the potential for resistance. The purpose of this study is to use the theory of temporal agency to explore how first-year medical students who identify as women draw upon past, future, and present agency to resist the patriarchal system of medicine.The data for this study were drawn from the first year (October 2020-April 2021) of a longitudinal project using narrative inquiry to understand the socialization of women students in undergraduate medical education. Fifteen participants performed two interviews and a series of written reflection prompts about their childhood and medical school experiences, each lasting approximately 45 min.Participants' resistance drew on past resources, recognizing themselves as Other, which contributed to categorically locating themselves as part of a broader resisting community, even outside their institution. They also hypothesized future possibilities as part of resistance, either an ideal future where they would exercise power, or an unchanged one and the hypothetical resolutions they would use to manage it. Finally, they contextualized past and future in the present, identifying problems to make strategic decisions and execute actions.Our creative interweaving of the constructs of temporal agency, communal agency, and resistance allows us to paint a nuanced picture of how these women conceive of themselves as part of a larger group of women amidst the hierarchical, patriarchal structures of medical school while, at times, internalizing these hierarchies.
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Affiliation(s)
- Abigail Konopasky
- Department of Medical Education, Dartmouth College Geisel School of Medicine, Hanover, NH, USA.
| | - Tasha R Wyatt
- Center for Health Professions Education, Uniformed Services University, Bethesda, MD, USA
| | - A Emiko Blalock
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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Gupta S, Howden S, Moffat M, Pope L, Kennedy C. Girls in scrubs: An ethnographic exploration of the clinical learning environment. MEDICAL EDUCATION 2024. [PMID: 38581403 DOI: 10.1111/medu.15379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/18/2024] [Accepted: 02/23/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Gender bias is an enduring issue in the medical profession despite women being more represented within medical schools and the health care workforce in numerous countries across the world. There have been frequent calls for further exploration of gender-based discriminations within medical education, owing to its lasting impact on student's professional development and career trajectories. This paper presents an ethnographic exploration of the experiences of female medical students and doctors in the clinical learning environment (CLE), aiming to disrupt the cycle of gender inequity in the clinical workplace. METHODS Our research field involved two teaching wards in a Scottish urban hospital, where 120 h of non-participant observations were conducted over 10 months. Combining purposive and convenience sampling, we conducted 36 individual interviews with key informants, which included medical students, foundation doctors, postgraduate trainees, consultant supervisors, and other health care professionals such as nurses and pharmacists. Data was thematically analysed using Bourdieu's theory of social power reproduction. The research team brought diverse professional backgrounds and perspectives to the exploration of data on gendered encounters. RESULTS Combining the observational and interview data, five themes were generated, which suggested gender-related differentials in social and cultural capital that the participants acquired in the CLE. Experiences of discriminatory behaviour and stereotypical thought processes impacted the female students' engagement and drive towards learning, implying an adverse influence on habitus. In contrast, the valuable influence of gendered role-models in building confidence and self-efficacy signified a positive transformation of habitus. The research participants displayed considerable internalisation of the gendered processes in the CLE that appeared to be linked to the transient nature of clinical placements. CONCLUSIONS This research reveals that despite constituting the majority demographic of medical school, female students struggle to gain social and cultural capital. Gendered hierarchies that structure clinical workplaces disadvantage female students and doctors, and the differential experiences transform their habitus. Based on our theoretically informed investigation, we advocate for role-models given their positive impact on students' and doctors' habitus. Additionally, medical educators may consider extended clinical placements that provide opportunities for female students and early-career doctors to secure social and cultural capital through integrating better in health care teams and building meaningful interprofessional relationships.
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Affiliation(s)
| | - Stella Howden
- Learning and Teaching Academy, Herriot-Watt University, Edinburgh, UK
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Rozario SY, Farlie MK, Sarkar M, Lazarus MD. The die-hards, negotiators and migrants: Portraits of doctors' career pathways through specialisation. MEDICAL EDUCATION 2024. [PMID: 38468409 DOI: 10.1111/medu.15368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Global workforce shortages in medical specialties strain healthcare systems, jeopardising patient outcomes. Enhancing recruitment strategies by supporting professional identity (PI) development may be one way to address this workforce gap-yet little research has explored this topic. The goal of the current study was to explore specialty-specific recruitment through considering PI. As proposed causes of workforce shortages in anatomical pathology (AP) bear similarities to many other specialties, this study uses the field of AP as a model for specialist PI development and asks: (1) why, how and when do doctors choose to pursue AP training and (2) what can be learned from this for recruitment to AP and other specialties? METHODS A qualitative research approach was undertaken using narrative inquiry. Interviews with junior doctors interested in AP, AP registrars and AP consultants from Australia and New Zealand were interpreted as stories via 're-storying'. Narrative synthesis of participants' collective stories identified chronological key events (i.e. 'turning points') in choosing AP. RESULTS Narrative synthesis resulted in identification of three portraits entering medical specialist training: (1) die-hards, deciding upon initial exposure; (2) negotiators, choosing after comparing specialties; and (3) migrants, seeking to move away from non-pathology specialties. The negotiators and migrants cemented their decision to pursue AP as a postgraduate doctor, whereas the die-hards made this decision during medical school. CONCLUSIONS Given the similarities in portrait traits between AP and other specialties across the literature, our results suggest ways to support specialty recruitment using PI development. We propose a medical specialist recruitment framework to support the PI development of doctors with die-hard, negotiator and migrant traits. Use of this framework could enhance current specialty-specific recruitment approaches, particularly in fields challenged by workforce shortages.
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Affiliation(s)
- Shemona Y Rozario
- Centre of Human Anatomy Education (CHAE), Department of Anatomy and Developmental Biology, Biomedical Discovery Institute, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Melanie K Farlie
- Department of Physiotherapy, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Mahbub Sarkar
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Monash Education Academy, Monash University, Melbourne, Victoria, Australia
| | - Michelle D Lazarus
- Centre of Human Anatomy Education (CHAE), Department of Anatomy and Developmental Biology, Biomedical Discovery Institute, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Zimerman A, Rotenstein LS, Jena AB. Trends in Scientific Collaboration Between Men and Women Following the #MeToo Movement. J Gen Intern Med 2024; 39:201-206. [PMID: 37783977 PMCID: PMC10853124 DOI: 10.1007/s11606-023-08441-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND The #MeToo movement raised global awareness about harassment in the workplace. Concerns were raised, however, that the movement may have unintendedly harmed women in academia by decreasing collaboration invitations from men in senior positions, who might be more reluctant to collaborate. OBJECTIVE To analyze whether collaborations between first author women and last author men decreased after the #MeToo movement. DESIGN Retrospective observational study. PARTICIPANTS Names of first and last authors of 122,450 US review articles from the PubMed database published between 2014 and 2020. MAIN MEASURES Change in the proportion of review articles with a first author woman and a last author man following the peak of the #MeToo movement in October 2017. Additionally, among review articles with a last author man, trends of women first authorship in the USA and Europe (control group) were compared. KEY RESULTS We analyzed 122,450 review articles with first and last authors from US institutions. Of 85,015 articles by a man last author, 37.5% (31,902) had a woman first author. In contrast, when the last author was a woman, the first author was also a woman in 53.6% of articles (20,078) (p<0.001 for difference). Among review articles with a last author man, there was no change in the proportion of articles with a woman first author before versus after the peak of the #MeToo movement (e.g., p=0.13 for difference between the 12 months following October 2017 compared to the pre-#Me-too period). Among European institutions, of 72,036 articles by a man last author, 43.4% (31,294) had a woman first author, higher than the proportion observed in the USA. Trends in collaboration between first author women and last author men were similar in the USA and Europe after the peak of the #MeToo movement (p=0.65). CONCLUSIONS The #MeToo movement was not associated with a reduction in the rate of scientific review article authorship collaborations between first author women and last author men in the life sciences. These findings, if generalizable, suggest it is possible to promote accountability for harassment in the workplace without limiting decreases in collaboration.
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Affiliation(s)
- André Zimerman
- TIMI Study Group, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lisa S Rotenstein
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA.
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
- National Bureau of Economic Research, Cambridge, MA, USA.
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Tarzia L, Henderson-Brooks K, Baloch S, Hegarty K. Women Higher Education Students' Experiences of Sexual Violence: A Scoping Review and Thematic Synthesis of Qualitative Studies. TRAUMA, VIOLENCE & ABUSE 2024; 25:704-720. [PMID: 37036144 PMCID: PMC10666468 DOI: 10.1177/15248380231162976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Sexual violence (SV) against women is common in higher education settings, causing serious harm to the health, well-being, and academic outcomes of victim/survivors. There have been numerous systematic reviews of the quantitative evidence on this topic, highlighting the prevalence, health impacts, and barriers and facilitators to help-seeking after SV. To date, however, qualitative research exploring the lived experience of women higher education students has not been synthesized. This scoping review and thematic synthesis of qualitative studies aims to map the global evidence on women higher education students' experiences of SV and explore how they understand and make sense of their experiences. We searched five databases (CinAHL, Academic Search Complete, Medline, PsychInfo, and SocIndex) in January 2023 for relevant articles. Eligible articles needed to be published in English and describe qualitative or mixed-methods primary research on the lived experiences of women higher education students who were victim/survivors of SV. In all, 34 articles describing 32 studies met these inclusion criteria. Thematic analysis of data extracted from the included studies suggests that, for women higher education students, the experience of SV is characterized by profound shame, with often-irreversible impacts on hopes and plans for the future. Yet, at the same time, SV is normalized and expected as a part of the "student experience." Furthermore, an imagined "specter" of "real violence" is held up as a constant comparison that serves to minimize and trivialize their experiences. These findings have important implications for higher education providers seeking to improve programs to address SV.
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Affiliation(s)
- Laura Tarzia
- The University of Melbourne, VIC, Australia
- Centre for Family Violence Prevention, The Royal Women’s Hospital, Australia
| | | | | | - Kelsey Hegarty
- The University of Melbourne, VIC, Australia
- Centre for Family Violence Prevention, The Royal Women’s Hospital, Australia
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Evéquoz Y, Pichonnaz L, Dubois J. Influence of a sexism and sexual harassment prevention course on medical students' perceptions of and responses to problematic situations. BMC MEDICAL EDUCATION 2023; 23:939. [PMID: 38066505 PMCID: PMC10709927 DOI: 10.1186/s12909-023-04902-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Issues of sexism and sexual harassment within the medical field are widespread. The aim of his study was to describe the influence of a training course on the prevention of sexism and sexual harassment on medical students' perceptions and responses to problematic situations in the workplace. METHODS We performed a secondary analysis of the transcripts of 16 medical students' interviews. The data were initially gathered as part of an external evaluation of the course. We decided to further explore these with a focus on potential changes about sexism and sexual harassment awareness induced by the course. Data were analyzed using qualitative thematic analysis. RESULTS Most medical students were aware of the existence of sexism and sexual harassment in the medical environment before the course but were not always able to delineate what could be considered as such or not. The course allowed them to broaden their ability to identify problematic situations, that were somewhat "trivialized" before, and to set a lower cut-off when judging what constitutes sexism or sexual harassment. It also provided them with tools on how to react when confronted to these situations, as well as resources to seek help. However, students stressed the importance of such courses also being offered to medical staff higher up in the hierarchy, as they are the ones in a position of power. CONCLUSIONS The course helped students to better identify and react to sexism and sexual harassment. However, given students' lack of power within the hierarchy, efforts to prevent sexism and sexual harassment must be undertaken at an institutional level to allow for change in the system as a whole.
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Affiliation(s)
- Yves Evéquoz
- Institute of Family Medicine, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Lauriane Pichonnaz
- Gender and Health Unit, Department of ambulatory care, University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Julie Dubois
- Institute of Family Medicine, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland.
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Monteiro S, Chan TM, Kahlke R. His opportunity, her burden: A narrative critical review of why women decline academic opportunities. MEDICAL EDUCATION 2023; 57:958-970. [PMID: 37312630 DOI: 10.1111/medu.15141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This paper stems from a desire to deepen our own understanding of why women might 'say no' when allies and sponsors offer or create opportunities for advancement, leadership or recognition. The resulting disparity between representation by men and women in leadership positions, invited keynote speakers and publication counts in academic medicine is a stubborn and wicked problem that requires a synthesis of knowledge across multidisciplinary literature. Acknowledging the complexity of this topic, we selected a narrative critical review methodology to explore reasons why one man's opportunity might be a woman's burden in academic medicine. METHODS We engaged with an iterative process of identifying, reviewing and interpreting literature from Psychology (cognitive, industrial and educational), Sociology, Health Professions Education and Business, placing no restrictions on context or year of publication. Knowledge synthesis and interpretation were guided by our combined expertise, lived experience, consultations with experts outside the author team and these guiding questions: (1) Why might women have less time for career advancement opportunities? (2) Why do women have less time for research and leadership? (3) How are these disparities maintained? RESULTS Turning down an opportunity may be a symptom of a much larger issue. The power of social expectations, culture and gender stereotypes remains a resistant force against calls for action. Consequently, women disproportionately take on other tasks that are not as well recognised. This disparity is maintained through social consequences for breaking with firmly entrenched stereotypes. CONCLUSIONS Popular strategies like 'lean into opportunities', 'fake it till you make it' and 'overcome your imposter syndrome' suggest that women are standing in their own way. Critically, these axioms ignore powerful systemic barriers that shape these choices and opportunities. We offer strategies that allies, sponsors and peers can implement to offset the power of stereotypes.
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Vanstone M, Cavanagh A, Molinaro M, Connelly CE, Bell A, Mountjoy M, Whyte R, Grierson L. How medical learners and educators decide what counts as mistreatment: A qualitative study. MEDICAL EDUCATION 2023; 57:910-920. [PMID: 36815430 DOI: 10.1111/medu.15065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/18/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The mistreatment or abuse (maltreatment) of medical learners by their peers and supervisors has been documented globally for decades, and there is significant research about the prevalence, sequelae and strategies for intervention. However, there is evidence that learners experience maltreatment as being less clear cut than do researchers, educators and administrators. This definitional ambiguity creates problems for understanding and addressing this issue. The objective of this study was to understand how medical learners and educators make sense of less-than-ideal interactions in the clinical learning environment, and to describe which factors influenced their perception that the encounter constituted maltreatment. METHODS Using constructivist grounded theory, we interviewed 16 medical students, 15 residents or fellows, and 18 educators associated with a single medical school (n = 49). Data collection began with the most junior learners, iterating with analysis as we progressed through the project. Constant comparative analysis was used to gather and compare stories of 'definitely', 'maybe' and 'definitely not' maltreatment across a variety of axes including experience level, clinical setting and type of interaction. RESULTS Our data show that learners and educators have difficulty classifying their experiences of negative interpersonal interaction, except in the most severe and concrete cases. While there was tremendous variation in the way they categorised similar experiences, there was consistency in the elements drawn upon to make sense of those experiences. Participants interpreted negative interpersonal interactions on an individual basis by considering factors related to the interaction, initiator and recipient. CONCLUSIONS Only the most negative behaviour is consistently understood as maltreatment; a complex process of individual sense-making is required to determine the acceptability of each interaction. The differences between how individuals judge these interactions highlight an opportunity for administrative, research and faculty development intervention.
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Affiliation(s)
- Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alice Cavanagh
- McMaster Program for Education Research, Innovation and Theory, Hamilton, Ontario, Canada
- MD/PhD Program, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Monica Molinaro
- McMaster Program for Education Research, Innovation and Theory, Hamilton, Ontario, Canada
| | - Catherine E Connelly
- Michael G. DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada
| | - Amanda Bell
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster Program for Education Research, Innovation and Theory, Hamilton, Ontario, Canada
- Undergraduate MD Program, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Margo Mountjoy
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Undergraduate MD Program, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Robert Whyte
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Grierson
- McMaster Program for Education Research, Innovation and Theory, Hamilton, Ontario, Canada
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Díaz-Fernández M, Llorente-Marrón M, Cocina-Díaz V, Asensi V. COVID-19 and Access to Medical Professional Careers: Does Gender Matter? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6477. [PMID: 37569018 PMCID: PMC10418388 DOI: 10.3390/ijerph20156477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE To know to what extent home confinement resulting from the COVID-19 pandemic has affected the results of the Medical Intern Resident Program (MIR) exam and whether or not a gender gap has occurred as a consequence. METHOD Econometric modeling of the final result obtained in the MIR exam and identification of the explanatory factors that determine it and its relevance, effect and meaning. RESULTS From the results obtained in the MIR test of the 2019, 2020 and 2021 calls, it can be seen that examinations and academic records together with demographic and calendar factors are determinants to explain the observed behavior of the final result. In relation to the gender factor, the existence of a differential fixed effect in favor of women is shown, although the interaction with the exam shows the opposite result. The nationality variable allows us to visualize a scenario of academic homogeneity. The effect of the calendar directly linked to the COVID-19 pandemic makes it possible to quantify the negative impact exerted on the final result. CONCLUSIONS (1) The work reflects the impact of factors such as sex, nationality or the COVID-19 pandemic on access to specialized health training in Spain. (2) In contrast to previous studies, we found a significant difference in behavior between men and women, favorably linked to the female sex. However, the so-called sprint effect associated with the male sex was detected. (3) The negative effects of the COVID-19 pandemic on the final score are visualized. The existing differential with respect to the control category is quantified and the dominance of the hierarchical position of the temporal component within the set of explanatory factors is visualized.
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Affiliation(s)
| | - Mar Llorente-Marrón
- Department of Quantitative Economics, University of Oviedo, 33006 Oviedo, Spain;
| | | | - Victor Asensi
- Department of Medicine, University of Oviedo, 33006 Oviedo, Spain;
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Barbier JM, Carrard V, Schwarz J, Berney S, Clair C, Berney A. Exposure of medical students to sexism and sexual harassment and their association with mental health: a cross-sectional study at a Swiss medical school. BMJ Open 2023; 13:e069001. [PMID: 37105707 PMCID: PMC10151891 DOI: 10.1136/bmjopen-2022-069001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVES To assess the self-reported prevalence of sexism and sexual harassment at a Swiss medical school, and to investigate their association with mental health. Research hypotheses were an association between sexism/sexual harassment and poor mental health and a higher prevalence of sexism/sexual harassment in clinical rotations. DESIGN Cross-sectional study as a part of ETMED-L project, an ongoing cohort study of interpersonal competences and mental health of medical students. SETTING Single-centre Swiss study using an online survey submitted to medical students. PARTICIPANTS From 2096 registered students, 1059 were respondents (50.52%). We excluded 26 participants (25 due to wrong answers to attention questions, and 1 who did not answer the sexism exposure question). The final sample (N=1033) included 720 women, 300 men and 13 non-binary people. MEASURES Prevalence of self-reported exposure to sexism/sexual harassment. Multivariate regression analyses of association between being targeted by sexism or sexual harassment and mental health (depression, suicidal ideation, anxiety, stress, burnout, substance use and recent mental health consultation). Regression models adjusted for gender, academic year, native language, parental education level, partnership and an extracurricular paid job. RESULTS Being targeted by sexism or sexual harassment was reported by 16% of participants with a majority of women (96%). The prevalence increased with clinical work. After adjusting for covariates, we found association between being targeted by sexism/harassment and risk of depression (OR 2.29, 95% CI 1.54 to 3.41, p<0.001), suicidal ideation (B coefficient (B) 0.37, p<0.001) and anxiety (B 3.69, p<0.001), as well as cynicism (B 1.46, p=0.001) and emotional exhaustion (B 0.94, p=0.044) components of burnout, substance use (B 6.51, p<0.001) and a recent mental health consultation (OR 1.78, 95% CI 1.10 to 2.66, p=0.005). CONCLUSIONS Sexism and sexual harassment, although less common than usually reported, are behaviours of concern in this medical school and are significantly associated with mental health.
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Affiliation(s)
- Jeanne Marie Barbier
- Health and Gender Unit, Department of ambulatory care, University Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland, Lausanne, Switzerland
| | - Valerie Carrard
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Joelle Schwarz
- Health and Gender Unit, Department of ambulatory care, University Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland, Lausanne, Switzerland
| | - Sylvie Berney
- General Psychiatry Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Carole Clair
- Health and Gender Unit, Department of ambulatory care, University Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland, Lausanne, Switzerland
| | - Alexandre Berney
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Abate LE, Greenberg L. Incivility in medical education: a scoping review. BMC MEDICAL EDUCATION 2023; 23:24. [PMID: 36635675 PMCID: PMC9838055 DOI: 10.1186/s12909-022-03988-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/24/2022] [Indexed: 06/17/2023]
Abstract
Incivility in the workplace, school and political system in the United States has permeated mass and social media in recent years and has also been recognized as a detrimental factor in medical education. In this scoping review, we use the term incivility to encompass a spectrum of behaviors that occur across the continuum of medical education, and which include verbal abuse including rude or dismissive conduct, sexual and racial harassment and discrimination, and sexual and physical assault. We identified research on incivility involving medical students, residents and fellows, and faculty in North America to describe multiple aspects of incivility in medical education settings published since 2000. Our results reinforce that incivility is likely under-reported across the continuum of medical education and also confirmed incidences of incivility involving nursing personnel and patients, not emphasized in previous reviews. The authors suggest a zero-tolerance national policy if this problem is to be resolved.
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Affiliation(s)
- Laura E. Abate
- School of Medicine & Health Sciences, The George Washington University, 2300 Eye St NW, Washington, DC 20037 USA
| | - Larrie Greenberg
- School of Medicine & Health Sciences, The George Washington University, 2300 Eye St NW, Washington, DC 20037 USA
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Summers OS, Medcalf R, Hubbard KA, McCarroll CS. A cross-sectional study examining perceptions of discriminatory behaviors experienced and witnessed by veterinary students undertaking clinical extra-mural studies. Front Vet Sci 2023; 10:940836. [PMID: 37187930 PMCID: PMC10175701 DOI: 10.3389/fvets.2023.940836] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 03/24/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction Recent research showed that 29% of respondents in a survey of veterinary professionals reported experiencing self-described discrimination in their workplaces. Senior colleagues and clients were responsible for discriminatory behaviors. As part of their training, veterinary students are expected to undertake extra-mural study (EMS) within these same workplaces and are likely to be vulnerable to discrimination from senior colleagues and clients. This study's objectives were to identify and characterize the pattern of perceived discriminatory behaviors (i.e., belief of being treated unfairly) that veterinary students encounter while seeing practice and explore students' attitudes toward discrimination. Methods Students at British and Irish veterinary schools who undertook some clinical EMS completed a survey of closed and open questions as part of a cross-sectional study. Demographic data and experiences of discrimination with details of incidents and reporting were collected, alongside respondent attitudes. Quantitative data were analyzed using Pearson's chi-squared analysis to analyse respondents' characteristics and their experiences of discriminatory behaviors and subsequent reporting. Qualitative content analysis was used for open-question data. Results Of the 403 respondents, 36.0% had perceived behavior they believed was discriminatory. The most frequent form of discrimination was based on gender (38.0%), followed by ethnicity (15.7%). There were significant associations between respondents' experience of discriminatory behaviors and the following characteristics: age (p = 0.0096), disability (p < 0.00001), race/ethnicity (p < 0.0001), gender/sex (p = 0.018), and LGBTQ+ status (p = 0.001). Supervising veterinarians were the most commonly reported perpetrators of discriminatory behaviors (39.3%) compared with clients (36.4%). Only 13.9% of respondents who experienced discrimination reported the event(s). Respondents with a disability were the least likely to agree with the statement that professional bodies are doing enough to tackle discrimination (p < 0.0001). Most respondents agreed that sexism is still an issue (74.4%), but men were more likely to disagree (p = 0.004). Most respondents felt that ethnic diversity needed to be increased (96.3%). Discussion Discriminatory behavior is a problem for students seeing practice, especially those with one or more protected characteristics (as defined by the UK Equality Act 2010). Improved education would need to include perspectives from minority groups to help remove discriminatory behavior from veterinary practice.
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Affiliation(s)
- Olivia S. Summers
- Department of Comparative Biomedical Sciences, Faculty of Health and Medical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
| | - Rebecca Medcalf
- Department of Comparative Biomedical Sciences, Faculty of Health and Medical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
| | - Katherine A. Hubbard
- Department of Sociology, Faculty of Arts and Social Sciences, University of Surrey, Guildford, United Kingdom
| | - Charlotte S. McCarroll
- Department of Comparative Biomedical Sciences, Faculty of Health and Medical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
- *Correspondence: Charlotte S. McCarroll
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14
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Khan S. The impact of gendered experiences on female medical students' specialty choice: A systematic review. Am J Surg 2023; 225:33-39. [PMID: 36435655 DOI: 10.1016/j.amjsurg.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 10/04/2022] [Accepted: 10/12/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Women make up 50% of American medical school graduates, yet are not equally represented in the vast spectrum of medical specialties. Many fields within medicine remain male dominated. This systematic review will explore social factors that affect female medical students' specialty choice. HYPOTHESIS Gendered experiences influence the specialty choice of female medical students, resulting in their concentration in a specific cohort of specialties. METHODS Studies were gathered by searching MEDLINE/Pubmed and EBSCOhost for sociological factors that impact female medical students' specialty choice. RESULTS 34 articles were selected for this systematic review. Factors that contribute to gender segregation within medical specialties include gender discrimination, socialization, lifestyle considerations, negative perceptions of male-dominated medical specialties and lack of female role models. CONCLUSION This systematic review supported the hypothesis that gendered experiences impact women's medical specialty choice, and thus result in their concentration in specialties such as family medicine, pediatrics and obstetrics and gynecology.
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Affiliation(s)
- Sana Khan
- Detroit Medical Center/Wayne State University School of Medicine, United States.
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15
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Leep Hunderfund AN, Kumbamu A, O'Brien BC, Starr SR, Dekhtyar M, Gonzalo JD, Rennke S, Ridinger H, Chang A. "Finding My Piece in That Puzzle": A Qualitative Study Exploring How Medical Students at Four U.S. Schools Envision Their Future Professional Identity in Relation to Health Systems. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1804-1815. [PMID: 35797546 DOI: 10.1097/acm.0000000000004799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Health systems science (HSS) curricula equip future physicians to improve patient, population, and health systems outcomes (i.e., to become "systems citizens"), but the degree to which medical students internalize this conception of the physician role remains unclear. This study aimed to explore how students envision their future professional identity in relation to the system and identify experiences relevant to this aspect of identity formation. METHOD Between December 2018 and September 2019, authors interviewed 48 students at 4 U.S. medical schools with HSS curricula. Semistructured interviews were audiorecorded, transcribed, and analyzed iteratively using inductive thematic analysis. Interview questions explored how students understood the health system, systems-related activities they envisioned as future physicians, and experiences and considerations shaping their perspectives. RESULTS Most students anticipated enacting one or more systems-related roles as a future physician, categorized as "bottom-up" efforts enacted at a patient or community level (humanist, connector, steward) or "top-down" efforts enacted at a system or policy level (system improver, system scholar, policy advocate). Corresponding activities included attending to social determinants of health or serving medically underserved populations, connecting patients with team members to address systems-related barriers, stewarding health care resources, conducting quality improvement projects, researching/teaching systems topics, and advocating for policy change. Students attributed systems-related aspirations to experiences beyond HSS curricula (e.g., low-income background; work or volunteer experience; undergraduate studies; exposure to systems challenges affecting patients; supportive classmates, faculty, and institutional culture). Students also described future-oriented considerations promoting or undermining identification with systems-related roles (responsibility, affinity, ability, efficacy, priority, reality, consequences). CONCLUSIONS This study illuminates systems-related roles medical students at 4 schools with HSS curricula envisioned as part of their future physician identity and highlights past/present experiences and future-oriented considerations shaping identification with such roles. These findings inform practical strategies to support professional identity formation inclusive of systems engagement.
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Affiliation(s)
- Andrea N Leep Hunderfund
- A.N. Leep Hunderfund is associate professor of neurology and director, Learning Environment and Educational Culture, Mayo Clinic Alix School of Medicine, Rochester, Minnesota
| | - Ashok Kumbamu
- A. Kumbamu is assistant professor of biomedical ethics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Bridget C O'Brien
- B.C. O'Brien is professor of medicine and education scientist, Center for Faculty Educators, University of California, San Francisco, San Francisco, California
| | - Stephanie R Starr
- S.R. Starr is associate professor of pediatrics, Mayo Clinic College of Medicine and Science, and director, Science of Health Care Delivery Education, Mayo Clinic Alix School of Medicine, Rochester, Minnesota
| | - Michael Dekhtyar
- M. Dekhtyar is research associate, Department of Medical Education, University of Illinois College of Medicine at Chicago; ORCID: https://orcid.org/0000-0002-8548-3624
| | - Jed D Gonzalo
- J.D. Gonzalo is professor of medicine and public health sciences and associate dean for health systems education, Penn State College of Medicine, Hershey, Pennsylvania; ORCID: https://orcid.org/0000-0003-1253-2963
| | - Stephanie Rennke
- S. Rennke is professor of medicine, Division of Hospital Medicine, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Heather Ridinger
- H. Ridinger is assistant professor of medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anna Chang
- A. Chang is professor of medicine, Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
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16
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Blalock AE, Leal DR. Redressing injustices: how women students enact agency in undergraduate medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022:1-18. [PMID: 36394683 PMCID: PMC9672615 DOI: 10.1007/s10459-022-10183-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
This study presents descriptions of epistemic injustice in the experiences of women medical students and provides accounts about how these students worked to redress these injustices. Epistemic injustice is both the immediate discrediting of an individual's knowledge based on their social identity and the act of persistently ignoring possibilities for other ways of knowing. Using critical narrative interviews and personal reflections over an eight-month period, 22 women students during their first year of medical school described instances when their knowledge and experience was discredited and ignored, then the ways they enacted agency to redress these injustices. Participants described three distinct ways they worked to redress injustices: reclaiming why they belong in medicine, speaking up and calling out the curriculum, and uplifting one another. This study has implications for recognizing medical students as whole individuals with lived histories and experiences and advocates for recognizing medical students' perspectives as valuable sources of knowledge.
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Affiliation(s)
- A Emiko Blalock
- Office of Medical Education Research and Development, Michigan State University College of Human Medicine, 964 Wilson Road, Fee Hall A214, East Lansing, MI, 48824, USA.
| | - Dianey R Leal
- Michigan State University College of Education, East Lansing, USA
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17
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Surviving in scrubs: sexism, sexual harassment, and assault in the primary care workforce. Br J Gen Pract 2022. [DOI: 10.3399/bjgp22x720749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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18
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Teshome BG, Desai MM, Gross CP, Hill KA, Li F, Samuels EA, Wong AH, Xu Y, Boatright DH. Marginalized identities, mistreatment, discrimination, and burnout among US medical students: cross sectional survey and retrospective cohort study. BMJ 2022; 376:e065984. [PMID: 35318190 PMCID: PMC8938931 DOI: 10.1136/bmj-2021-065984] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To describe the association between mistreatment, burnout, and having multiple marginalized identities during undergraduate medical education. DESIGN Cross sectional survey and retrospective cohort study. SETTING 140 US medical schools accredited by the Association of American Medical Colleges. PARTICIPANTS 30 651 graduating medical students in 2016 and 2017. MAIN OUTCOME MEASURES Self-reported sex, race or ethnicity, and sexual orientation groups were considered, based on the unique combinations of historically marginalized identities held by students. Multivariable linear regression was used to determine the association between unique identity groups and burnout along two dimensions (exhaustion and disengagement) as measured by the Oldenburg Burnout Inventory for Medical Students while accounting for mistreatment and discrimination. RESULTS Students with three marginalized identities (female; non-white; lesbian, gay, or bisexual (LGB)) had the largest proportion reporting recurrent experiences of multiple types of mistreatment (88/299, P<0.001) and discrimination (92/299, P<0.001). Students with a higher number of marginalized identities also had higher average scores for exhaustion. Female, non-white, and LGB students had the largest difference in average exhaustion score compared with male, white, and heterosexual students (adjusted mean difference 1.96, 95% confidence interval 1.47 to 2.44). Mistreatment and discrimination mediated exhaustion scores for all identity groups but did not fully explain the association between unique identity group and burnout. Non-white and LGB students had higher average disengagement scores than their white and heterosexual counterparts (0.28, 0.19 to 0.37; and 0.73, 0.52 to 0.94; respectively). Female students, in contrast, had lower average disengagement scores irrespective of the other identities they held. After adjusting for mistreatment and discrimination among female students, the effect among female students became larger, indicating a negative confounding association. CONCLUSION In this study population of US medical students, those with multiple marginalized identities reported more mistreatment and discrimination during medical school, which appeared to be associated with burnout.
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Affiliation(s)
- Bethelehem G Teshome
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA
| | - Mayur M Desai
- Department of Chronic Disease Epidemiology, Associate Dean for Diversity, Equity, and Inclusion, Yale School of Public Health, New Haven, CT, USA
| | - Cary P Gross
- Department of Internal Medicine, National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA
| | | | - Fangyong Li
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Elizabeth A Samuels
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Ambrose H Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Yunshan Xu
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Dowin H Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
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19
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Murphy M, Callander JK, Dohan D, Grandis JR. Networking practices and gender inequities in academic medicine: Women's and men's perspectives. EClinicalMedicine 2022; 45:101338. [PMID: 35299655 PMCID: PMC8921538 DOI: 10.1016/j.eclinm.2022.101338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/28/2022] [Accepted: 02/17/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Studies of gender inequities in academic medicine suggest the negative impact of men's networking practices, but little is known about how they shape faculty experiences. METHODS In this qualitative study, in-depth, semi-structured interviews were conducted with 52 women and 52 men academic medicine faculty members at 16 institutions across the US in 2019. Interviews explored participants' experiences and perceptions of gender inequities in academic medicine, including perceptions of men's networking practices. Interviews were recorded and transcribed verbatim, and transcripts were analyzed using a mixture of deductively and inductively generated codes. FINDINGS Qualitative analysis of interview transcripts identified different dominant themes: (1) Women were often excluded from networking activities dominated by men, (2) Both women and men referred to men's networking practices in academic medicine, and believed they conferred benefits to members and excluded non-members from such benefits, (3) Participation in such networking activities yielded professional advantages, (4) Women made efforts to counteract their exclusion yet identified limits of those efforts. INTERPRETATION The data suggests that gender inequities in academic medicine might be associated with professional interactions that occur outside of the scope of professional work practices and in formal work sites. Additional research is needed to better understand practices such as informal networking activities and their impact in order to promote gender equity.
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Affiliation(s)
- Marie Murphy
- Department of Otolaryngology-Head and Neck Surgery, University of California, 1450 Third Street, Room 268, Box 3111, San Francisco, CA 94143, United States
| | - Jacquelyn K. Callander
- Department of Otolaryngology-Head and Neck Surgery, University of California, 1450 Third Street, Room 268, Box 3111, San Francisco, CA 94143, United States
| | - Daniel Dohan
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, United States
| | - Jennifer R. Grandis
- Department of Otolaryngology-Head and Neck Surgery, University of California, 1450 Third Street, Room 268, Box 3111, San Francisco, CA 94143, United States
- Corresponding author.
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20
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Balmer DF, Richards BF. Conducting qualitative research through time: how might theory be useful in longitudinal qualitative research? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:277-288. [PMID: 34460054 DOI: 10.1007/s10459-021-10068-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/22/2021] [Indexed: 06/13/2023]
Abstract
This paper explores the use of theory in longitudinal qualitative research, an approach to research which explores lived experiences as they unfold. The authors illustrate how the complexity of conducting qualitative research through time drives an understanding and use of theory that differs from other research approaches. Longitudinal qualitative research considers time as fluid, subjective, and unbounded-in contrast to the more common taken-for-granted understanding of time as fixed, objective, and linear. Furthermore, longitudinal qualitative research is predicated on a premise of trust in the context of enduring research relationships. Therefore, while subject-matter theories used to investigate topics of interest to health professions educators may be useful frameworks for other types of research, longitudinal qualitative research needs theories that accommodate the myriad of changes in lived experiences through time. The authors share their decade-long, longitudinal qualitative research story, highlighting their decision points and insights. In doing so, they foreground issues such as time as fluid as an important contribution to health professions education literature.
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Affiliation(s)
- Dorene F Balmer
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, 9NW 72, Philadelphia, PA, 19104, USA.
| | - Boyd F Richards
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
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21
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Siad FM, Rabi DM. Harassment in the Field of Medicine: Cultural Barriers to Psychological Safety. CJC Open 2022; 3:S174-S179. [PMID: 34993446 PMCID: PMC8712706 DOI: 10.1016/j.cjco.2021.08.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022] Open
Abstract
Psychologically safe organizational cultures are inherently inclusive and promote healthy sharing of power and knowledge. These conditions allow innovation to thrive and optimize member performance. Unfortunately, despite its evidence-based nature, the field of medicine continues to struggle with providing safe environments for its members. Several cultural barriers to psychological safety permit endemic harassment. These include having large power gradients, a weak ethical climate, and a number of enabling structural factors that maintain a toxic culture. Moving toward psychological safety will be challenging work, as it requires a difficult and complex analysis of the shared value system that enables the status quo. Programs and policies that promote equity, diversity, and inclusion are an important start, but they are likely insufficient on their own to achieve psychological safety. Leadership that models difficult reflection and supports inclusive transformation is the key to a safe culture shift.
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Affiliation(s)
- Fartoon M Siad
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Doreen M Rabi
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Cardiac Science Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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22
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Pitot MA, White MA, Edney E, Mogensen MA, Solberg A, Kattapuram T, Sinha C, Kadom N. You Too? Female Radiologists' Narratives on Discrimination and Harassment. J Am Coll Radiol 2021; 19:288-303. [PMID: 34822789 DOI: 10.1016/j.jacr.2021.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/23/2021] [Accepted: 09/25/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is a paucity of examples for gender discrimination and sexual harassment in radiology. This lack of knowledge can limit radiologists' ability to relate to this topic, acknowledge its importance and impact, and take actions toward improvement. MATERIALS AND METHODS We conducted a qualitative analysis using the model of thematic analysis developed by Braun and Clarke of narrative responses to a survey on the topic of #MeToo, which was distributed to a social media group of female radiologists. RESULTS In all, 575 anonymous survey responses from 3,265 social media group members were analyzed. Among these responses, the study team identified important themes with examples, including Victims and Perpetrators, Acts of Gender Discrimination, Inequalities, Sexual Harassment and Assault, and Microaggressions. CONCLUSION The narratives provide relatable examples of gender discrimination and sexual harassment in radiology. These may spark discussions that raise awareness among radiologists and result in interventions geared toward improvement.
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Affiliation(s)
- Marika A Pitot
- Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota
| | - Marney A White
- Director, Online Education Social and Behavioral Sciences Track; and Director, Essential Topics in Public Health, Yale School of Public Health, New Haven, Connecticut
| | | | - Monique A Mogensen
- Neuroradiology Fellowship Program Director and Co-Chair, Radiation Safety Subcommittee, Quality and Safety Committee, University of Washington and University of Washington Medical Center, Seattle, Washington
| | | | - Taj Kattapuram
- RadKatt, La Crosse, Wisconsin; ACR, Council Steering Committee; and Wisconsin Rad Society, Board Director-at-Large
| | - Cynthia Sinha
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Atlanta, Georgia; Department of Pediatric Hematology-Oncology-BMT, Emory University, Children's Healthcare of Atlanta, Atlanta, Georgia; and Editorial Board Member, Journal of Marriage and Family
| | - Nadja Kadom
- Director for Quality, Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Director for Quality Education, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia; and Associate Professor, Emory University Hospital, Atlanta, Georgia.
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23
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Ahmad SR, Ahmad TR, Balasubramanian V, Facente S, Kin C, Girod S. Are You Really the Doctor? Physician Experiences with Gendered Microaggressions from Patients. J Womens Health (Larchmt) 2021; 31:521-532. [PMID: 34747651 DOI: 10.1089/jwh.2021.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: In contrast to physician implicit bias toward patients, bias and microaggressions from patients toward physicians have received comparatively less attention. Materials and Methods: We captured physician experiences of gendered microaggressions from patients by conducting a mixed-methods survey-based study of physicians at a single academic health care institution in May 2019. A quantitative portion assessed the frequency of gendered microaggressions (microaggression experiences [ME] score) and the association with measures of perceived impacts (job satisfaction, burnout, perceived career impacts, behavioral modifications). A one-tailed Wilcoxon rank sum test compared distributional frequencies of microaggressions by gender, and by gender and race. Chi-square tests measured the associations between gendered microaggressions and perceived impacts. Welch two-sample t-tests assessed differences in ME scores by rank and specialty. Linear regression assessed the association of ME scores and job satisfaction/burnout. A qualitative portion solicited anecdotal experiences, analyzed by inductive thematic analysis. Results: There were 297 completed surveys (response rate 27%). Female physicians experienced a significantly higher frequency of gendered microaggressions (p < 0.001) compared with male physicians. Microaggressions were significantly associated with job satisfaction (chi-square 6.83, p = 0.009), burnout (chi-square 8.76, p = 0.003), perceived career impacts (chi-square 18.67, p < 0.001), and behavioral modifications (chi-square 19.96, p < 0.001). Trainees experienced more microaggressions (p = 0.009) and burnout (p = 0.009) than faculty. Higher ME scores predicted statistically significant increases in burnout (p < 0.0001) and reduced job satisfaction (p = 0.02). Twelve microaggressions themes emerged from the qualitative responses, including role questioning and assumption of inexperience. The frequency of microaggressions did not vary significantly by race; however, qualitative responses described race as a factor. Conclusions: Physicians experience gendered microaggressions from patients, which may influence job satisfaction, burnout, career perceptions, and behavior. Future research may explore the multidirectionality of microaggressions and tools for responding at the individual and institutional level.
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Affiliation(s)
- Sarah R Ahmad
- Division of Headache Medicine, Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Tessnim R Ahmad
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
| | - Vidhya Balasubramanian
- Quantitative Sciences Unit, Biomedical Informatics Research Division in the Department of Medicine, Stanford Medicine, Stanford, California, USA
| | | | - Cindy Kin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford Medicine, Stanford, California, USA
| | - Sabine Girod
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford Medicine, Stanford, California, USA
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24
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Balmer DF, Varpio L, Bennett D, Teunissen PW. Longitudinal qualitative research in medical education: Time to conceptualise time. MEDICAL EDUCATION 2021; 55:1253-1260. [PMID: 33847408 PMCID: PMC8596518 DOI: 10.1111/medu.14542] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/26/2021] [Accepted: 04/09/2021] [Indexed: 05/14/2023]
Abstract
CONTEXT Longitudinal qualitative research is an approach to research that entails generating qualitative data with the same participants over extended periods of time to understand their lived experiences as those experiences unfold. Knowing about dynamic lived experiences in medical education, that is, learning journeys with stops and starts, detours, transitions and reversals, enriches understanding of events and accomplishments along the way. The purpose of this paper is to create access points to longitudinal qualitative research in support of increasing its use in medical education. METHODS The authors explore and argue for different conceptualisations of time: analysing lived experiences through time versus analysing lived experiences cross-sectional or via 2-point follow-up studies and considering time as subjective and fluid as well as objective and fixed. They introduce applications of longitudinal qualitative research from several academic domains: investigating development and formal education; building longitudinal research relationship; and exploring interconnections between individual journeys and social structures. They provide an illustrative overview of longitudinal qualitative research in medical education, and end with practical advice, or pearls, for medical education investigators interested in using this research approach: collecting data recursively; analysing longitudinal data in three strands; addressing mutual reflexivity; using theory to illuminate time; and making a long-term commitment to longitudinal qualitative research. CONCLUSIONS Longitudinal qualitative research stretches investigators to think differently about time and undertake more complex analyses to understand dynamic lived experiences. Research in medical education will likely be impoverished if the focus remains on time as fixed. Seeing things qualitatively through time, where time is fluid and the past, present and future interpenetrate, produces a rich understanding that can move the field forward.
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Affiliation(s)
- Dorene F. Balmer
- Department of PediatricsPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Lara Varpio
- Department of MedicineCenter for Health Professions EducationUniformed Services University of the Health SciencesBethesdaMDUSA
| | - Deirdre Bennett
- Medical Education UnitSchool of MedicineUniversity College CorkCorkIreland
| | - Pim W. Teunissen
- Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
- Department of Obstetrics and GynecologyMaastricht University Medical CenterMaastrichtThe Netherlands
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25
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Innes S, Maurice L, Lastella M, O'Mullan C. Understanding Australian female chiropractors' experiences of inappropriate patient sexual behaviour: a study using Interpretive Phenomenological Analysis. Chiropr Man Therap 2021; 29:36. [PMID: 34526040 PMCID: PMC8442263 DOI: 10.1186/s12998-021-00394-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/07/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Female practitioners are often subjected to inappropriate patient sexual behaviour (IPSB). Adverse consequences of such sexual harassment include for the practitioner psychological stress effects and negative work-related consequences that contributes to career dissatisfaction and burnout. Confronting the issue within the healthcare context has been shown to be problematic because practitioners feel an obligation to protect the therapeutic relationship above their own personal discomfort. There is an absence of research on this topic with respect to female chiropractors and we proposed a qualitative study aimed to explore female chiropractors lived experiences of managing incidents of IPSB. Method An Interpretive Phenomenological Analysis methodology was chosen for this study. In June and July of 2018 female chiropractors in Western Australian were recruited via Facebook sites and invited to participate in face-to-face interviews for an Honours degree study exploring the lived experience of IPSB. Results Participants were seven female chiropractors currently practicing in Western Australia, who had experienced an incident of IPSB. Four super-ordinate themes emerged from the analysis; (1) familiar but inarticulable, (2) the cost of conflict, (3) I’m used to it, and (4) the element of surprise. Overall, the participants recognised the incidents as inappropriate but chose to ignore the situation as a means to avoid conflict in the treatment room. Recommendations are made to better manage IPSB including greater patient awareness of appropriate behaviour, specific curriculum content and assertiveness training in undergraduate programs and continuing professional education, as well as the creation of ethical guidelines for patient behaviour by regulatory bodies. Conclusion This is the first study to give a forum for female chiropractors to discuss their experiences of IPSB. The domain of private practice is not immune to incidents IPSB and although similar to day-to-day non-clinical life is nonetheless surprising and impactful.
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Affiliation(s)
- Stanley Innes
- College of Science, Health, Engineering and Education (SHEE) , Murdoch University, Murdoch, Australia.
| | - Laura Maurice
- School of Health, Medical and Applied Sciences, CQUniversity Australia, Bundaberg Campus, Norman Gardens, Australia
| | - Michele Lastella
- School of Health, Medical and Applied Sciences, CQUniversity Australia, Bundaberg Campus, Norman Gardens, Australia
| | - Catherine O'Mullan
- School of Health, Medical and Applied Sciences, CQUniversity Australia, Bundaberg Campus, Norman Gardens, Australia
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Lisan Q, Pigneur B, Pernot S, Flahault C, Lenne F, Friedlander G, Badoual C, Ranque B, Lemogne C. Is sexual harassment and psychological abuse among medical students a fatality? A 2-year study in the Paris Descartes School of Medicine. MEDICAL TEACHER 2021; 43:1054-1062. [PMID: 33882785 DOI: 10.1080/0142159x.2021.1910225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION An observatory of sexual harassment and psychological abuse was set up at one of France's largest schools of medicine to both quantify and reduce sexual harassment or psychological abuse of medical students. METHODS Over a 2-year period, we described the evolution of sexual harassment and psychological abuse and explored for associated factors. Moreover, a qualitative analysis using an inductive approach was performed from students' verbatim. RESULTS 2795 responses were collected. Sexual harassment was reported in 7% and psychological abuse in 15%, at baseline, and decreased after the observatory was set up. Women had higher odds of being a victim of sexual harassment. Older students reported less often psychological abuse and being a witness of sexual harassment. Surgery departments were associated with up to 5.7-fold increased odds of sexual harassment. Surgery and pediatrics departments were associated with a 2-fold increased odds of psychological abuse. Qualitative analysis revealed four categories: humiliation, the feeling of inferiority, sexual harassment, and manifestations of violence. CONCLUSION During clerkships, factors associated with higher odds of sexual harassment and psychological abuse were female gender, younger age, and departments of surgery. Setting up such an observatory may contribute to reduce this burden and provide a useful tool to raise awareness.
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Affiliation(s)
- Quentin Lisan
- Faculty of Health, School of Medicine, Université de Paris, Paris, France
- Department of Head and Neck Surgery, Hôpital Européen Georges-Pompidou, AP-HP.Centre-Université de Paris, Paris, France
- Department of Epidemiology, INSERM UMR 970, PARCC, Paris, France
| | - Bénédicte Pigneur
- Faculty of Health, School of Medicine, Université de Paris, Paris, France
- Department of Pediatric Gastroenterology, Hôpital Necker, AP-HP.Centre-Université de Paris, Paris, France
- Faculty of Pharmacy, INSERM UMR S 1139, Paris, France
| | - Simon Pernot
- Medical Oncology, Institut Bergonié Unicancer, University of Bordeaux, Bordeaux, France
| | - Cécile Flahault
- Faculty of Health, School of Medicine, Université de Paris, Paris, France
- Service de psychiatrie et d'addictologie de l'adulte et du sujet âgé, Hôpital Européen Georges-Pompidou, AP-HP.Centre-Université de Paris, Paris, France
- Laboratoire de Psychopathologie et Processus de Santé, Institut de Psychologie, Université de Paris, Paris, France
| | - Frédéric Lenne
- Faculty of Health, School of Medicine, Université de Paris, Paris, France
| | - Gérard Friedlander
- Faculty of Health, School of Medicine, Université de Paris, Paris, France
- School of Medicine, Paris Descartes University, Paris, France
| | - Cécile Badoual
- Faculty of Health, School of Medicine, Université de Paris, Paris, France
- Department of pathology, Hôpital Européen Georges-Pompidou, AP-HP.Centre-Université de Paris, Paris, France
| | - Brigitte Ranque
- Faculty of Health, School of Medicine, Université de Paris, Paris, France
- Department of Epidemiology, INSERM UMR 970, PARCC, Paris, France
- Department of Internal Medicine, Hôpital Européen Georges-Pompidou, AP-HP.Centre-Université de Paris, Paris, France
| | - Cédric Lemogne
- Faculty of Health, School of Medicine, Université de Paris, Paris, France
- Université de Paris, AP-HP, Hôpital Hôtel-Dieu, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l'adulte, INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Paris, France
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The Role of Gender in Careers in Medicine: a Systematic Review and Thematic Synthesis of Qualitative Literature. J Gen Intern Med 2021; 36:2392-2399. [PMID: 33948802 PMCID: PMC8342686 DOI: 10.1007/s11606-021-06836-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Gender disparities exist in the careers of women in medicine. This review explores the qualitative literature to understand how gender influences professional trajectories, and identify opportunities for intervention. METHODS A systematic review and thematic synthesis included articles obtained from PubMed, Cochrane Central Register of Controlled Trials (Ovid), EMBASE (Ovid), APA PsycInfo (Ovid), and GenderWatch (ProQuest) on June 26 2020, updated on September 10, 2020. Included studies explored specialty choice, leadership roles, practice setting, burnout, promotion, stigma, mentoring, and organizational culture. Studies taking place outside of the USA, using only quantitative data, conducted prior to 2000, or focused on other health professions were excluded. Data were extracted using a standardized extraction tool and assessed for rigor and quality using a 9-item appraisal tool. A three-step process for thematic synthesis was used to generate analytic themes and construct a conceptual model. The study is registered with PROSPERO (CRD42020199999). FINDINGS Among 1524 studies identified, 64 were eligible for analysis. Five themes contributed to a conceptual model for the influence of gender on women's careers in medicine that resembles a developmental socio-ecological model. Gender influences career development externally through culture which valorizes masculine stereotypes and internally shapes women's integration of personal and professional values. CONCLUSION Medical culture and structures are implicitly biased against women. Equitable environments in education, mentoring, hiring, promotion, compensation, and support for work-life integration are needed to address gender disparities in medicine. Explicit efforts to create inclusive institutional cultures and policies are essential to support a diverse workforce.
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Abstract
Men and women receive unequal pay for equal work, a gap of approximately 20% to 30% in income across most professions, including medicine and surgery. Inequality also exists in academic advancement, with far fewer women holding positions as full professors, program directors, or department heads. Women may be discouraged from pursuing surgery as a career, and they face unique challenges related to gender expectations in their role as surgeons. Steps to identifying gender bias and correcting the pay gap are important to ensure the growth and vitality of the specialty.
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Gill HK, Niederer RL, Danesh-Meyer HV. Gender differences in surgical case volume among ophthalmology trainees. Clin Exp Ophthalmol 2021; 49:664-671. [PMID: 34218497 DOI: 10.1111/ceo.13969] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/27/2021] [Accepted: 07/01/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The number of females in ophthalmology has steadily increased over recent decades. The aim of this study was to evaluate whether there is a difference in procedural volume and cataract surgery between male and female trainees in the Royal Australian and New Zealand College of Ophthalmologists (RANZCO). METHODS A longitudinal retrospective review of de-identified surgical RANZCO trainee logbook data from 2008 to 2020 was undertaken. Data from 241 trainee logbooks were analysed for: location of training, gender, date of commencement of training, maternity/paternity leave status, number of surgeries observed, assisted, supervised and unsupervised. Surgical cases were grouped as: (1) all surgical cases; (2) complete cataract cases and (3) partial cataract cases. RESULTS Among 241 trainees (40.7% females), 197 263 procedures were performed. Total surgical volume was 21.1% lower at 4 years for females (median 665.5 vs. 843.5; p = 0.036). Completed cataract surgery was 21.5% lower at 18 months (median 87.5 vs. 111.5; p = 0.022) and 41.7% lower at 4 years (median 216 vs. 369; p < 0.001). Interrupted training was significantly more common in females (30.6% vs. 0.7%; p < 0.001). However, linear regression analysis did not identify parental leave or duration as a significant predictor for number of completed cataracts (p = 0.206). Complication rate was not different between males and females (p = 0.35). CONCLUSIONS Female trainees completed 41.7% fewer cataract operations at the end of their training compared to male counterparts with the gap widening between years 1 and 4 of training. The current data demonstrates that female and male RANZCO trainees are not receiving equivalent operating experiences.
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Affiliation(s)
- Hannah K Gill
- Department of Ophthalmology, The University of Auckland, Auckland, New Zealand
| | - Rachael L Niederer
- Department of Ophthalmology, The University of Auckland, Auckland, New Zealand
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Short C, Basuino M, Segalini N, Rialon KL, Brandt ML. Working Through the Pain: Surgical Culture and Musculoskeletal Injury. CURRENT SURGERY REPORTS 2021. [DOI: 10.1007/s40137-021-00295-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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A Report of Gender Bias and Sexual Harassment in Current Plastic Surgery Training: A National Survey. Plast Reconstr Surg 2021; 147:1454-1468. [PMID: 34019520 DOI: 10.1097/prs.0000000000007994] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gender bias and sexual misconduct continue to pervade medicine. The authors hypothesize that gender bias and sexual misconduct disproportionately and negatively affect female plastic surgery trainees. METHODS A national survey of plastic surgery trainees (2018 to 2019) was conducted using previously validated sexual harassment surveys adapted for relevance to plastic surgery. Respondents were queried about experiences with workplace gender bias and harassment; personal and professional impact; and reporting practices. Analyses included chi-square, logistic regression, and analysis of variance. Significance was accepted for values of p < 0.05. RESULTS There were 236 responses (115 female respondents; 20.1 percent response rate). Most respondents were Caucasian (Asian/Pacific Islander, n = 34) residents (n = 123). The feeling of hindrance to career advancement was greater for women, by 10-fold (p < 0.001), and increased with age (p = 0.046). Women felt uncomfortable challenging attitudes regarding gender inequality (p < 0.001), regardless of training levels (p = 0.670) or race (p = 0.300). Gender bias diminished female trainees' career goals/ambition (p < 0.001). Women were more likely to experience sexual harassment, in the form of jokes (p = 0.003) and comments about their body or sexuality (p = 0.014). Respondents reported the majority of perpetrators of harassment to be attending physicians (30 percent) and other trainees (37 percent). Most common reasons to not report incidents included "futility" (29 percent) and "fear" (20 percent). Women experienced at least three symptoms of depression/anxiety, significantly higher than men (p = 0.001). CONCLUSIONS Gender bias and sexual misconduct negatively affect female trainees' attitudes toward their career. Two-thirds of cases of sexual harassment originate from other physicians. Minority trainees are less prepared to address transgressions and more likely to experience sexual coercion. Trainees perceive a culture nonconducive to reporting. These findings can guide changes and discussions surrounding workplace culture in plastic surgery training.
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Bynum WE, Sukhera J. Perfectionism, Power, and Process: What We Must Address to Dismantle Mental Health Stigma in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:621-623. [PMID: 33885411 DOI: 10.1097/acm.0000000000004008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In this commentary, the authors draw on 2 personal accounts of mental illness published by Kirk J. Brower, MD, and Darrell G. Kirch, MD, in this issue to consider how and why mental health stigma is maintained in medical education. In particular, they explore how perfectionism, power differentials, and structural forces drive mental illness stigma in medical education. They argue that mental health stigma in medical education, while deeply embedded in the physician archetype and medical culture, is not inevitable and that dismantling it will require individual courage, interpersonal acceptance, and institutional action.
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Affiliation(s)
- William E Bynum
- W.E. Bynum IV is associate professor, Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina
| | - Javeed Sukhera
- J. Sukhera is associate professor, Departments of Psychiatry and Paediatrics and scientist, Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Lim WH, Wong C, Jain SR, Ng CH, Tai CH, Devi MK, Samarasekera DD, Iyer SG, Chong CS. The unspoken reality of gender bias in surgery: A qualitative systematic review. PLoS One 2021; 16:e0246420. [PMID: 33529257 PMCID: PMC7853521 DOI: 10.1371/journal.pone.0246420] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/19/2021] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE This study was conducted to better understand the pervasive gender barriers obstructing the progression of women in surgery by synthesising the perspectives of both female surgical trainees and surgeons. METHODS Five electronic databases, including Medline, Embase, PsycINFO, CINAHL and Web of Science Core Collection, were searched for relevant articles. Following a full-text review by three authors, qualitative data was synthesized thematically according to the Thomas and Harden methodology and quality assessment was conducted by two authors reaching a consensus. RESULTS Fourteen articles were included, with unfavorable work environments, male-dominated culture and societal pressures being major themes. Females in surgery lacked support, faced harassment, and had unequal opportunities, which were often exacerbated by sex-blindness by their male counterparts. Mothers were especially affected, struggling to achieve a work-life balance while facing strong criticism. However, with increasing recognition of the unique professional traits of female surgeons, there is progress towards gender quality which requires continued and sustained efforts. CONCLUSION This systematic review sheds light on the numerous gender barriers that continue to stand in the way of female surgeons despite progress towards gender equality over the years. As the global agenda towards equality progresses, this review serves as a call-to-action to increase collective effort towards gender inclusivity which will significantly improve future health outcomes.
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Affiliation(s)
- Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chloe Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sneha Rajiv Jain
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chia Hui Tai
- Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - M. Kamala Devi
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dujeepa D. Samarasekera
- Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shridhar Ganpathi Iyer
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
- Liver Transplantation, National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore
| | - Choon Seng Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
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Little D. Locker (operating) room talk: gender equity and the medical student's perspective. CANADIAN MEDICAL EDUCATION JOURNAL 2021; 12:e105-e106. [PMID: 33680242 PMCID: PMC7931474 DOI: 10.36834/cmej.68632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Ruzycki SM, Brown A, Bharwani A, Freeman G. Gender-based disparities in medicine: a theoretical framework for understanding opposition to equity and equality. BMJ LEADER 2021. [DOI: 10.1136/leader-2020-000231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Brown A, Bonneville G, Glaze S. Nevertheless, They Persisted: How Women Experience Gender-Based Discrimination During Postgraduate Surgical Training. JOURNAL OF SURGICAL EDUCATION 2021; 78:17-34. [PMID: 32654996 DOI: 10.1016/j.jsurg.2020.06.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE More women than ever are pursuing surgical specialties despite historical dominance by men. The objective of this study was to examine how surgical residents experience gender-based discrimination during their residency training, including the common sources, settings, and implications of these experiences. DESIGN A sequential explanatory mixed methods design was used to combine results from an initial quantitative survey of surgical residents of all genders at the University of Calgary with qualitative data derived from interviews with surgical residents who identified as women. PARTICIPANTS Thirty-seven surgical residents of all genders completed a survey. Fourteen women completed a one-to-one, semistructured interview. RESULTS Women reported significantly more frequent experiences of gender-based discrimination than men, particularly regarding lack of respect from others, inappropriate jokes or comments, and hostile or humiliating behaviors. Nursing staff and patients were reported as prominent sources of discrimination, and the emergency and operating rooms were the most common settings. The qualitative findings highlighted the additional challenges for women during surgical residency, including navigating the relationships with nursing, having to work "twice as hard" to receive respect from patients and nurses, reports of persistent harassment and bullying, becoming desensitized to mistreatment and discrimination, and the influence of their gender on the quality of their education as well as their well-being. CONCLUSIONS Despite the increasing number of women entering surgical specialties, women surgical residents report frequent and severe experiences of gender-based discrimination during their training, even at an academic institution where over half of residents are women.
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Affiliation(s)
- Allison Brown
- University of Calgary, Cumming School of Medicine, Department of Medicine, Calgary, Alberta, Canada; University of Calgary, Department of Community Health Sciences, Calgary, Alberta, Canada.
| | - Gabrielle Bonneville
- University of Calgary, Department of Obstetrics & Gynecology, Calgary, Alberta, Canada
| | - Sarah Glaze
- University of Calgary, Department of Obstetrics & Gynecology, Calgary, Alberta, Canada; Foothills Medical Centre, Department of Obstetrics of Gynecology, Division of Gynecologic Oncology, Calgary, Alberta, Canada
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Plews-Ogan ML, Bell TD, Townsend G, Canterbury RJ, Wilkes DS. Acting Wisely: Eliminating Negative Bias in Medical Education-Part 1: The Fundamentals. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:S11-S15. [PMID: 32889935 DOI: 10.1097/acm.0000000000003699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Bias is a ubiquitous problem in human functioning. It has plagued medical decision making, making physicians prone to errors of perception and judgment. Racial, gender, ethnic, and religious negative biases infest physicians' perception and cognition, causing errors of judgment and behavior that are damaging. In Part 1 of this series of 2 papers, the authors address the problem of harmful bias, the science of cognition, and what is known about how bias functions in human perception and information processing. They lay the groundwork for an approach to reducing negative bias through awareness, reflection, and bias mitigation, an approach in which negative biases can be transformed-by education, experience, practice, and relationships-into positive biases toward one another. The authors propose wisdom as a conceptual framework for imagining a different way of educating medical students. They discuss fundamental cognitive, affective, and reflective components of wisdom-based education. They also review the skills of awareness, using debiasing strategies, compassion, fostering positive emotion, and reflection that are inherent to a wisdom-based approach to eliminating the negative effects of bias in medical education. In Part 2, the authors answer a key question: How can medical educators do better? They describe the interpersonal, structural, and cultural elements supportive of a wisdom-based learning environment, a culture of respect and inclusion in medical education.
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Affiliation(s)
- Margaret L Plews-Ogan
- M.L. Plews-Ogan is Brodie Professor of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Taison D Bell
- T.D. Bell is assistant professor of medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Gregory Townsend
- G. Townsend is associate professor of medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Randolph J Canterbury
- R.J. Canterbury is senior associate dean, Education, and professor of psychiatry and neurobehavioral sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - David S Wilkes
- D.S. Wilkes is dean, University of Virginia School of Medicine, Charlottesville, Virginia
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Mateo CM, Williams DR. Addressing Bias and Reducing Discrimination: The Professional Responsibility of Health Care Providers. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:S5-S10. [PMID: 32889919 DOI: 10.1097/acm.0000000000003683] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The prevalence of harmful bias and discrimination within the health professions is staggering. Moreover, literature consistently demonstrates their persistence and their negative impact on patient care. Several professional codes of conduct for health professionals highlight the importance of addressing these forces in practice. However, despite this, these forces are often discussed as tangential within health professions curricula. This paper examines the prevalence of bias and discrimination, its effects on patient care and health professions trainees, and reviews the historical context of societal bias and discrimination within the health professions institution. The authors argue that addressing harmful bias and discrimination is the professional responsibility of every provider and essential to effective and equitable care.
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Affiliation(s)
- Camila M Mateo
- C.M. Mateo is associate director, anti-racism curriculum and faculty development and instructor of pediatrics, Harvard Medical School, and attending physician, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - David R Williams
- D.R. Williams is the Florence Sprague Norman and Laura Stuart Norman professor of Public Health and chair, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, and professor of African and African American studies, Harvard University, Cambridge, Massachusetts
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Pendleton AA, McKinley SK, Pendleton VE, Ott QC, Petrusa ER, Srivastava SD, Lillemoe KD, Ferrone CR. A multi-institutional study of patient-derived gender-based discrimination experienced by resident physicians. Am J Surg 2020; 221:309-314. [PMID: 33081931 DOI: 10.1016/j.amjsurg.2020.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/16/2020] [Accepted: 10/11/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study characterizes prevalence, frequency, and forms of patient-derived gender-based discrimination (GBD) experienced by resident physicians, as well as their experiences witnessing and reporting patient-derived GBD. METHODS A web-based survey was sent to residents from 12 programs at three academic institutions. RESULTS Response rate was 47.9% (309/645) with 55.0% of respondents identifying as women. Women were more likely than men to experience patient-derived GBD during residency (100% vs 68.8%, p < 0.001), including inappropriate physical contact, receiving less trust from patients, and being mistaken for a nurse (p < 0.001). While 85.9% of residents personally experienced and 95.0% of residents witnessed patient-derived GBD, only 3.4% of residents formally reported patient-derived GBD. Women were more likely to report negative personal and professional consequences of patient-derived GBD. CONCLUSIONS Patient-derived GBD is pervasive and disproportionately affects women residents. Current reporting mechanisms are not adequately capturing nor addressing patient-derived GBD.
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Affiliation(s)
- Anna Alaska Pendleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA.
| | - Sophia K McKinley
- Department of General Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - Qi C Ott
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Emil R Petrusa
- Department of General Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Sunita D Srivastava
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Keith D Lillemoe
- Department of General Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Cristina R Ferrone
- Department of General Surgery, Massachusetts General Hospital, Boston, MA, USA
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Vogel C, Rohr-Kirchgraber T. Gender Harassment Persists in Medical Training. WOMEN'S HEALTH REPORTS 2020; 1:459-462. [PMID: 33786511 PMCID: PMC7784817 DOI: 10.1089/whr.2020.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 08/05/2020] [Indexed: 11/13/2022]
Abstract
Medical students start their career with enthusiasm for a profession that emphasizes caring for others so as to promote health, treat injury, and prevent disease. The profession of medicine selects those who have demonstrated compassion, knowledge, and leadership. As students enter the profession, many possess a certain naiveté with the expectation for equity. After a few encounters of her own, one of our authors wondered whether the statistic that female medical students are ∼220% greater to experience harassment in medical education from faculty, staff, and patients was true and sought to determine whether her experience was unique. Unfortunately, with just a quick Instagram post, she received numerous messages from peers indicating that gender harassment is all too common.
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Affiliation(s)
- Carolina Vogel
- Marian University College of Osteopathic Medicine, Indianapolis, Indiana, USA
| | - Theresa Rohr-Kirchgraber
- Marian University College of Osteopathic Medicine, Indianapolis, Indiana, USA.,Clinical Medicine and Pediatrics, IU School of Medicine, Indianapolis, Indiana, USA
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Allard D, Lieu A, Oliphant T. Reading between the Lines: An Environmental Scan of Writing about Third-Party Sexual Harassment in the LIS Literature and Beyond. LIBRARY QUARTERLY 2020. [DOI: 10.1086/710256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Brown MEL, Hunt GEG, Hughes F, Finn GM. 'Too male, too pale, too stale': a qualitative exploration of student experiences of gender bias within medical education. BMJ Open 2020; 10:e039092. [PMID: 32792453 PMCID: PMC7430333 DOI: 10.1136/bmjopen-2020-039092] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To explore medical student perceptions and experiences of gender bias within medical education. SETTING Gender bias-'prejudiced actions or thoughts based on the perception that women are not equal to men'-is a widespread issue. Within medicine, the pay gap, under-representation of women in senior roles and sexual harassment are among the most concerning issues demonstrating its presence and impact. While research investigating experiences of clinicians is gaining traction, investigation of medical students' experiences is lacking. This qualitative study analyses medical students' experiences of gender bias within their education to discern any patterns to this bias. Illuminating the current state of medical education gender bias will hopefully highlight areas in which student experience could be improved. Constructivist thematic analysis was used to analyse data, informed by William's patterns of gender bias, intersectional feminism and communities of practice theory. PARTICIPANTS Thirty-two medical students from multiple UK medical schools participated in individual interviews. Nine faculty members were also interviewed to triangulate data. RESULTS Gender bias has an overt presence during medical student education, manifesting in line with William's patterns of bias, impacting career aspirations. Physical environments serve to manifest organisational values, sending implicit messages regarding who is most welcome-currently, this imagery remains 'too male, too pale…too stale'. Existing gender initiatives require careful scrutiny, as this work identifies the superficial application of positive action, and a failure to affect meaningful change. CONCLUSIONS Despite progress having been made regarding overt gender discrimination, implicit bias persists, with existing positive action inadequate in promoting the advancement of women. Institutions should mandate participation in implicit bias education programmes for all staff and must strive to revise the imagery within physical environments to better represent society. Gender initiatives, like Athena Scientific Women's Academic Network, also require large-scale evaluation regarding their impact, which this work found to be lacking.
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Affiliation(s)
- Megan E L Brown
- Health Professions Education Unit, Hull York Medical School, York, UK
| | - George E G Hunt
- Health Professions Education Unit, Hull York Medical School, York, UK
| | - Ffion Hughes
- Health Professions Education Unit, Hull York Medical School, York, UK
| | - Gabrielle M Finn
- Health Professions Education Unit, Hull York Medical School, York, UK
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Janjua MB, Inam H, Martins RS, Zahid N, Sattar AK, Khan SM, Khan S, Darbar A, Faruqui N, Akram S, Enam SA, Haider AH, Malik MA. Gender discrimination against female surgeons: A cross-sectional study in a lower-middle-income country. Ann Med Surg (Lond) 2020; 57:157-162. [PMID: 32774847 PMCID: PMC7394833 DOI: 10.1016/j.amsu.2020.07.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 07/10/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction Although gender discrimination and bias (GD/bias) experienced by female surgeons in the developed world has received much attention, GD/bias in lower-middle-income countries like Pakistan remains unexplored. Thus, our study explores how GD/bias is perceived and reported by surgeons in Pakistan. Method A single-center cross-sectional anonymous online survey was sent to all surgeons practicing/training at a tertiary care hospital in Pakistan. The survey explored the frequency, source and impact of GD/bias among surgeons. Results 98/194 surgeons (52.4%) responded to the survey, of which 68.4% were males and 66.3% were trainees. Only 19.4% of women surgeons reported 'significant' frequency of GD/bias during residency. A higher percentage of women reported 'insignificant' frequency of GD/bias during residency, as compared to males (61.3% vs. 32.8%; p = 0.004). However, more women surgeons reported facing GD/bias in various aspects of their career/training, including differences in mentorship (80.6% vs. 26.9%; p < 0.005) and differences in operating room opportunities (77.4% vs. 32.8%; p < 0.005). The source was most frequently reported to be co-residents of the opposite gender. Additionally, a high percentage of female surgeons reported that their experience of GD/bias had had a significant negative impact on their career/training progression, respect/value in the surgical team, job satisfaction and selection of specialty. Conclusion Although GD/bias has widespread impacts on the training/career of female surgeons in Pakistan, most females fail to recognize this GD/bias as "significant". Our results highlight a worrying lack of recognition of GD/bias by female surgeons, representing a major barrier to gender equity in surgery in Pakistan and emphasizing the need for future research.
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Krishna L, Tay KT, Yap HW, Koh ZYK, Ng YX, Ong YT, Shivananda S, Compton S, Mason S, Kanesvaran R, Toh YP. Combined novice, near-peer, e-mentoring palliative medicine program: A mixed method study in Singapore. PLoS One 2020; 15:e0234322. [PMID: 32502180 PMCID: PMC7274408 DOI: 10.1371/journal.pone.0234322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 05/24/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION An acute shortage of senior mentors saw the Palliative Medicine Initiative (PMI) combine its novice mentoring program with electronic and peer mentoring to overcome insufficient mentoring support of medical students and junior doctors by senior clinicians. A three-phased evaluation was carried out to evaluate mentees' experiences within the new CNEP mentoring program. METHODS Phase 1 saw use of a Delphi process to create a content-valid questionnaire from data drawn from 9 systematic reviews of key aspects of novice mentoring. In Phase 2 Cognitive Interviews were used to evaluate the tool. The tool was then piloted amongst mentees in the CNEP program. Phase 3 compared mentee's experiences in the CNEP program with those from the PMI's novice mentoring program. RESULTS Thematic analysis of open-ended responses revealed three themes-the CNEP mentoring process, its benefits and challenges that expound on the descriptive statistical analysis of specific close-ended and Likert scale responses of the survey. The results show mentee experiences in the PMI's novice mentoring program and the CNEP program to be similar and that the addition of near peer and e-mentoring processes enhance communications and support of mentees. CONCLUSION CNEP mentoring is an evolved form of novice mentoring built on a consistent mentoring approach supported by an effective host organization. The host organization marshals assessment, support and oversight of the program and allows flexibility within the approach to meet the particular needs of mentees, mentors and senior mentors. Whilst near-peer mentors and e-mentoring can make up for the lack of senior mentor availability, their effectiveness hinges upon a common mentoring approach. To better support the CNEP program deeper understanding of the mentoring dynamics, policing and mentor and mentee training processes are required. The CNEP mentoring tool too needs to be validated.
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Affiliation(s)
- Lalit Krishna
- Academic Palliative & End of Life Care Centre, Palliative Care Institute Liverpool, University of Liverpool, Liverpool, United Kingdom
- Cancer Research Centre, University of Liverpool, Liverpool, United Kingdom
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Centre of Biomedical Ethics, National University of Singapore, Singapore, Singapore
- * E-mail:
| | - Kuang Teck Tay
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hong Wei Yap
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Zachary Yong Keat Koh
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yong Xiang Ng
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yun Ting Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sushma Shivananda
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Stephen Mason
- Academic Palliative & End of Life Care Centre, Palliative Care Institute Liverpool, University of Liverpool, Liverpool, United Kingdom
- Cancer Research Centre, University of Liverpool, Liverpool, United Kingdom
| | - Ravindran Kanesvaran
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Ying Pin Toh
- Department of Family Medicine, National University Health System, Singapore, Singapore
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Shaw MK, Chandratilake M, Ho MJ, Rees CE, Monrouxe LV. Female victims and female perpetrators: medical students' narratives of gender dynamics and professionalism dilemmas. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:299-319. [PMID: 31541318 DOI: 10.1007/s10459-019-09919-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 09/13/2019] [Indexed: 06/10/2023]
Abstract
Medicine is a gendered discipline, in which women, both as patients and practitioners, have often held subordinate positions. The reproduction of dominant gender biases in the medical setting can negatively impact the professional development of medical students and the wellbeing of patients. In this analysis of medical students' narratives of professionalism dilemmas, we explore students' experiences of gender bias in hospital settings. Seventy-one students participated in 12 group interviews, where they discussed witnessing or participating in various activities that they thought were professionalism lapses. Within the dataset, 21 narratives had a distinctly gendered component broadly pertaining to patient dignity and safety dilemmas, informed consent issues, and female student abuse. Interestingly, perpetrators of such acts were commonly female healthcare professionals and educators. Although students recognized such acts as professionalism lapses and often expressed concern for patient wellbeing, students did not intervene or report such acts due to hierarchical cultural contexts, and at times even reproduced the discriminatory behavior they were criticizing. This raises concerns about medical students' professionalism development and the extent to which gender bias is ingrained within particular medical systems. The normalization of disrespectful and abusive treatment of female patients poses immediate and future consequences to the wellbeing and safety of women. Furthermore, the same socio-cultural values that sustain these acts may account for perpetrators often being women themselves as they strive to overcome their subordinate position within medicine.
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Affiliation(s)
- Malissa K Shaw
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan
| | | | - Ming-Jung Ho
- Department of Family Medicine and Center for Innovation and Leadership in Education, Georgetown University School of Medicine, Washington, DC, USA
| | - Charlotte E Rees
- Monash Centre for Scholarship in Health Education (MCSHE), Monash University, Melbourne, Australia
| | - Lynn V Monrouxe
- Faculty of Health Sciences, Work Integrated Learning, The University of Sydney, Room J213, Level 2, J Block, 75 East Street, Lidcombe, NSW, 2140, Australia.
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Heffron AS, Braun KM, Allen-Savietta C, Filut A, Hanewall C, Huttenlocher A, Handelsman J, Carnes M. Gender Can Influence Student Experiences in MD-PhD Training. J Womens Health (Larchmt) 2020; 30:90-102. [PMID: 32349608 DOI: 10.1089/jwh.2019.8094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Female physician-scientists have led major advances in medicine broadly and particularly in women's health. Women remain underrepresented in dual MD-PhD degree programs that train many physician-scientists despite gender parity among medical and biomedical research students. Materials and Methods: To explore how the training environment might be experienced differently for male and female students in one MD-PhD program, the authors analyzed gender differences in annual symposium speakers with exact binomial tests, student participation as question-askers at a weekly seminar with logistic regression, and number of publications with quasi-Poisson generalized linear models. They compared male and female students' perceptions of gender-based discrimination using a survey, including qualitative analysis of free text responses. The program consisted of 71 total students in the 2017-2018 and 2018-2019 academic years. Female students comprised 42.0% (81/191) of program matriculants from 1997 to 2019. Results: Male and female students were equally likely to present at the annual program symposium, but faculty (p = 0.001) and keynote (p = 0.012) presenters were more likely to be male. Compared with male counterparts, female students asked fewer seminar questions (p < 0.005) and female speakers received more questions (p = 0.03). Female students perceived less support and differed from men in reasons for asking or not asking seminar questions. Free text responses described repeated small acts of discrimination toward women with cumulative impact. Positive program changes followed presentation of findings to program leaders and students. Conclusions: The authors identified several aspects of one MD-PhD program that could discourage career or training persistence of female students. Increasing awareness of these issues was temporally related to positive programmatic changes.
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Affiliation(s)
- Anna S Heffron
- Medical Scientist Training Program, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Katarina M Braun
- Medical Scientist Training Program, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Pathobiological Sciences, and University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Cora Allen-Savietta
- Department of Statistics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Amarette Filut
- Center for Women's Health Research, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Chelsea Hanewall
- Medical Scientist Training Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Anna Huttenlocher
- Medical Scientist Training Program, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Medical Microbiology & Immunology and Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jo Handelsman
- Department of Plant Pathology, Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Molly Carnes
- Center for Women's Health Research, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Psychiatry, and University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Industrial & Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Steiner-Hofbauer V, Capan Melser M, Holzinger A. Focus gender - medical students' gender-specific perception and attitudes towards the burdens of everyday student life. GMS JOURNAL FOR MEDICAL EDUCATION 2020; 37:Doc15. [PMID: 32328517 PMCID: PMC7171364 DOI: 10.3205/zma001308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/23/2019] [Accepted: 08/13/2019] [Indexed: 06/11/2023]
Abstract
Introduction: The aim of this study was to investigate if female and male medical students perceive burdens differently and if students of both sexes assess their capability to stand performance pressure differently. Material and Methods: In 2017, 2nd (n=424, 53% female) and 6th (n=161, 46.6% female) year students at the medical university of Vienna were surveyed using a fully structured questionnaire. Results: In 2nd year, female students felt significantly more often that they could not measure up to study requirements than male students (87,5% vs. 94,4%). Performance pressure was perceived as major problem by male (45,5%) and female (50,9%) students while in 6th year the number was only half as high than in 2nd (24%, 18,4%). In 6th year significantly more female than male students were complaining about competition between students (33,3% vs. 8%). Half of the students shared the view that there is no difference between men and women in the capability to deal with performance pressure. Most of the other half state that men are superior to women in handling performance pressure. In both groups significantly more male than female students were convinced that they are superior to the other sex in handling performance pressure. Conclusion: Perception of problems is similar in male and female students. While in objective assessments female students perform equally to male students they consider themselves less competent and are more inclined to doubt their capability.
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Affiliation(s)
| | - Mesküre Capan Melser
- Medical University Vienna, Research Unit für Curriculumentwicklung, Vienna, Austria
| | - Anita Holzinger
- Medical University Vienna, Research Unit für Curriculumentwicklung, Vienna, Austria
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Ng L, Lin C, Henning MA. A Narrative Review of Discrimination Experienced by Medical Students. MEDICAL SCIENCE EDUCATOR 2020; 30:577-584. [PMID: 34457705 PMCID: PMC8368317 DOI: 10.1007/s40670-019-00878-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION The aim of this review was to clarify the nature of discrimination experienced by medical students and identify institutional responses and directions for future research. METHOD A narrative literature review of first-hand experiences of discrimination reported by medical students across a 10-year time period. RESULTS Twenty-five reports with different methodologies were included. Discrimination was defined by a wide range of terms. Students had a range of responses to discriminatory treatment and many did not report their experiences. CONCLUSION Discrimination is a significant issue for medical students in clinical settings. Further research is needed to formulate institutional responses to understanding and addressing discrimination.
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Affiliation(s)
- Lillian Ng
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Charlie Lin
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Marcus A. Henning
- Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Lu DW, Lall MD, Mitzman J, Heron S, Pierce A, Hartman ND, McCarthy DM, Jauregui J, Strout TD. #MeToo in EM: A Multicenter Survey of Academic Emergency Medicine Faculty on Their Experiences with Gender Discrimination and Sexual Harassment. West J Emerg Med 2020; 21:252-260. [PMID: 32191183 PMCID: PMC7081862 DOI: 10.5811/westjem.2019.11.44592] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/04/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction Gender-based discrimination and sexual harassment of female physicians are well documented. The #MeToo movement has brought renewed attention to these problems. This study examined academic emergency physicians’ experiences with workplace gender discrimination and sexual harassment. Methods We conducted a cross-sectional survey of a convenience sample of emergency medicine (EM) faculty across six programs. Survey items included the following: the Overt Gender Discrimination at Work (OGDW) Scale; the frequency and source of experienced and observed discrimination; and whether subjects had encountered unwanted sexual behaviors by a work superior or colleague in their careers. For the latter question, we asked subjects to characterize the behaviors and whether those experiences had a negative effect on their self-confidence and career advancement. We made group comparisons using t-tests or chi-square analyses, and evaluated relationships between gender and physicians’ experiences using correlation analyses. Results A total of 141 out of 352 (40.1%) subjects completed at least a portion of the survey. Women reported higher mean OGDW scores than men (15.4 vs 10.2; 95% confidence interval [CI], 3.6–6.8). Female faculty were also more likely to report having experienced gender-based discriminatory treatment than male faculty (62.7% vs 12.5%; 95% CI, 35.1%–65.4%), although male and female faculty were equally likely to report having observed gender-based discriminatory treatment of another physician (64.7% vs 56.3%; 95% CI, 8.6%–25.5%). The three most frequent sources of experienced or observed gender-based discriminatory treatment were patients, consulting or admitting physicians, and nursing staff. The majority of women reported having encountered unwanted sexual behaviors in their careers, with a significantly greater proportion of women reporting them compared to men (52.9% vs 26.2%, 95% CI, 9.9%–43.4%). The majority of unwanted behaviors were sexist remarks and sexual advances. Of those respondents who encountered these unwanted behaviors, 22.9% and 12.5% reported at least somewhat negative effects on their self-confidence and career advancement. Conclusion Female EM faculty perceived more gender-based discrimination in their workplaces than their male counterparts. The majority of female and approximately a quarter of male EM faculty encountered unwanted sexual behaviors in their careers.
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Affiliation(s)
- Dave W Lu
- Tufts University School of Medicine - Maine Medical Center, Department of Emergency Medicine, Portland, Maine.,University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
| | - Michelle D Lall
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
| | - Jennifer Mitzman
- The Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio
| | - Sheryl Heron
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
| | - Ava Pierce
- University of Texas Southwestern Medical School, Department of Emergency Medicine, Dallas, Texas
| | - Nicholas D Hartman
- Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina
| | - Danielle M McCarthy
- Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Joshua Jauregui
- University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
| | - Tania D Strout
- Tufts University School of Medicine - Maine Medical Center, Department of Emergency Medicine, Portland, Maine
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50
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Stone L, Phillips C, Douglas KA. With the best will in the world: How benevolent sexism shapes medical careers. MEDICAL EDUCATION 2020; 54:94-97. [PMID: 31965643 DOI: 10.1111/medu.14038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Louise Stone
- Academic Unit of General Practice, ANU Medical School, Australian National University, Canberra, ACT, Australia
| | - Christine Phillips
- Social Foundations of Medicine, ANU Medical School, Australian National University, Canberra, ACT, Australia
| | - Kirsty A Douglas
- Academic Unit of General Practice, ANU Medical School, Australian National University, Canberra, ACT, Australia
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