Differences in clinical experiences based on gender of third-year medical students in a required family medicine preceptorship

Exploring the Impact of the Surgical Exploration and Discovery (SEAD) Program on Medical Students' Perceptions of Gender Biases in Surgery: A Mixed-Method Evaluation

OBJECTIVE

Female representation in surgery is increasing; however, many surgical specialties continue to observe disproportionately fewer females entering their residencies. This study assesses how medical students' gender-based perceptions of surgical careers are impacted by attending the Surgical Exploration and Discovery (SEAD) program, a 2-week, immersive procedural program that offers observerships, mentorship, and workshops across 8 surgical specialties.

DESIGN

In this mixed-method prospective cohort study, medical students' awareness, beliefs, and experiences of gender bias in surgery were assessed using a 10-item Gender Bias in Medical Students Assessment-Surgery (GBMSA-S) psychometric survey instrument inspired by the validated Gender Bias in Medical Education Scale (Parker et al., 2016).

SETTING

Undergraduate Medical Education, Faculty of Medicine, at the University of Ottawa in Ottawa, Ontario, Canada.

PARTICIPANTS

Eighteen first-year medical students in the experimental group (8 male, 10 female) and 18 in the control group (7 male, 11 female).

RESULTS

Compared to the control group, SEAD participants had significant changes in agreement with the statements: "surgery is male-dominated," "medical studies are mainly done in males," "gender discrimination is more pronounced in surgery than other medical professions," "consideration of my gender is an important factor in whether or not to pursue surgery as a career," and "I have encountered gender-biased attitudes and/or behaviors among non-physician health care staff" (p < 0.05). Perceptions of gender bias were reduced post-SEAD. Subgroup analysis by gender suggested that the significance of these changing perspectives was due to female participants' responses. SEAD also produced an increase in the level of interest in surgery (p = 0.04). Receptive and authentic dialogue was identified as a critical step toward social inclusivity (n = 11).

CONCLUSIONS

Early surgical exposure through SEAD produces a statistically significant increase in surgical interest and reduces certain perceptions of gender bias in surgery, particularly among female medical students.

Steering the patient mix of GP trainees: results of a randomized controlled intervention

BACKGROUND

In studies exploring the patient mixes of general practitioner (GP) trainees, gaps were repeatedly found, as there were disparities between the patient mixes of GP trainers and trainees. This reduces the opportunities of trainees to acquire enough competence.

AIMS

To investigate whether steering the patient mix can be effectuated by instructing medical receptionist, trainer and trainee, and to study the effects of this intervention on trainee's self-efficacy (SE) and knowledge.

METHOD

Randomized Controlled Trial (RCT). After a six-month basic registration period, 73 trainees were randomized. Patients with skin conditions and psychosocial conditions were actively assigned to trainees in the intervention group (n=35) during two successive periods of three months. The patient mix was measured by extracting data from electronic patient records. Learning outcomes were measured by SE questionnaires and by a knowledge test.

RESULTS

No increase was found in patient volume and diversity of the steered conditions in the intervention group as compared to the control group. However, the percentual increase of exposure to skin conditions was greater in the intervention group. No difference in skin SE and psychiatric knowledge was found. The increase of psychosocial SE was greater in the intervention group. In a regression analysis, patient volume was a significant predictor of both skin and psychosocial SE.

CONCLUSIONS

Despite the difficulty in implementing steering in daily practice, tailoring the patient mix to the individual learning needs of trainees could be considered.

Comparing performance among male and female candidates in sex-specific clinical knowledge in the MRCGP

BACKGROUND

Patients often seek doctors of the same sex, particularly for sex-specific complaints and also because of a perception that doctors have greater knowledge of complaints relating to their own sex. Few studies have investigated differences in knowledge by sex of candidate on sex-specific questions in medical examinations.

AIM

The aim was to compare the performance of males and females in sex-specific questions in a 200-item computer-based applied knowledge test for licensing UK GPs.

DESIGN AND SETTING

A cross-sectional design using routinely collected performance and demographic data from the first three versions of the Applied Knowledge Test, MRCGP, UK.

METHOD

Questions were classified as female specific, male specific, or sex neutral. The performance of males and females was analysed using multiple analysis of covariance after adjusting for sex-neutral score and demographic confounders.

RESULTS

Data were included from 3627 candidates. After adjusting for sex-neutral score, age, time since qualification, year of speciality training, ethnicity, and country of primary medical qualification, there were differences in performance in sex-specific questions. Males performed worse than females on female-specific questions (-4.2%, 95% confidence interval [CI] = -5.7 to -2.6) but did not perform significantly better than females on male-specific questions (0.3%, 95% CI = -2.6 to 3.2%.

CONCLUSION

There was evidence of better performance by females in female-specific questions but this was small relative to the size of the test. Differential performance of males and females in sex-specific questions in a licensing examination may have implications for vocational and post-qualification general practice training.

Opening the black box: the patient mix of GP trainees

BACKGROUND

The variety of health problems (patient mix) that medical trainees encounter is presumed to be sufficient to master the required competencies.

AIM

To describe the patient mix of GP trainees, to study differences in patient mix between first-year and third-year GP trainees, and to investigate differences in exposure to sex-specific diseases between male and female trainees.

DESIGN AND SETTING

Prospective cohort study in Dutch primary care.

METHOD

During a 6-month period, aggregated data about International Classification of Primary Care diagnosis codes, and data on the sex and age of all contacts were collected from the electronic patient record (EPR) system.

RESULTS

Seventy-three trainees participated in this study. The mean coding percentage was 86% and the mean number of face-to-face consultations per trimester was 450.0 in the first year and 485.4 in the third year, indicating greater variance in the number of patient contacts among third-year trainees. Diseases seen most frequently were: musculoskeletal (mean per trimester = 89.2 in the first year/91.0 in the third year), respiratory (98.2/92.7) and skin diseases (89.5/96.0). Least often seen were diseases of the blood and blood-forming organs (5.3/7.2), male genital disorders (6.1/7.1), and social problems (4.3/4.2). The mean number of chronic diseases seen per trimester was 48.0 for first-year trainees and 62.4 for third-year trainees. Female trainees saw an average of 39.8 female conditions per trimester--twice as many as male trainees (mean = 21.3).

CONCLUSION

Considerable variation exists trainees in the number of patient contacts. Differences in patient mix between first- and third-year trainees seem at least partly related to year-specific learning objectives. The use of an EPR-derived educational instrument provides insight into the trainees' patient mix at both the group and the individual level. This offers opportunities for GP trainers, trainees, and curriculum designers to optimise learning when exposure may be low.

Exploring differences in patient mix in a cohort of GP trainees and their trainers

Background During specialty training for general practice, trainees acquire the required competencies through work-based learning. Previous small-scale and older studies suggest that the patient mix of general practitioner (GP) trainees differs from that of their trainers: trainees are exposed to more minor illnesses, and fewer chronic diseases and severe conditions, which may influence the development of their competency. Research question What are the differences in the patient mix between trainees and trainers? Methods 49 first- and 24 third-year trainees and their trainers (n=114) were included in the study. International Classification of Primary Care (ICPC) contact and diagnosis codes were extracted from electronic patient records over 6 months. Results Trainers had double the number of face-to-face consultations, and treble the number of telephone consultations compared with trainees. The trainees' patient mix consisted of significantly more patients with eye diseases, ear diseases, respiratory diseases, skin diseases and minor illnesses compared with their trainers. Trainers encountered significantly more patients with circulatory diseases, psychiatric diseases, metabolic diseases, male genital conditions, social problems, and chronic and oncological diseases. Female trainers and trainees encountered almost twice the number of female conditions compared with their male counterparts, while for male conditions, the opposite was found. Discussion Considerable differences between the patient mix of trainers and trainees were found. Specialty trainers and teachers must be aware of areas of low exposure. Trainers should ensure trainees handle more chronic, complex, psychosocial and circulatory conditions.

Medical interns' view of their undergraduate medical education in Uppsala: an alumnus study with clear attitude differences between women and men

BACKGROUND

An alumni study of graduates from the medical school in Uppsala, was performed to give input into an ongoing reform process.

AIMS

This study aimed to investigate how medical interns view their undergraduate medical education and the extent to which they felt that the curriculum prepared them for their current positions.

METHODS

A web-based questionnaire was sent out via mail in 2005 to all past graduates who had qualified in Uppsala in 2003.

RESULTS

Replies were obtained from 69 of 102 students (68%). The most apparent suggested change of the education was increased integration of preclinical and clinical teaching. Correlations were found between student satisfaction with the medical school and perceived teacher attitude, encouragement to reflect, and the graduates' perception of having sufficient practical abilities. Significant gender differences were found regarding perceived clinical ability and concerning feedback and encouragement from the teachers.

CONCLUSIONS

Our results suggest more direct feedback from the teachers and more integration between basic sciences and clinical education. Female and male students may have different needs. A key question is therefore to encourage teachers to learn about gender since female and male students should equally experience respectful encounters with teachers and doctors acting as role models.

Who gets "kicked out" of the exam room? Factors associated with patients declining medical student participation

BACKGROUND

Research on patients' decision to have medical students participate in clinical care has been examined predominantly from the patients' perspective rather than the students' perspective.

PURPOSE

This study investigated 3rd-year medical students' experiences with and perceptions of patients declining medical student participation in clinical care and identified factors associated with this decision.

METHODS

Third-year medical students (n = 103) completed a survey assessing demographic background, experiences with patients declining medical student participation in clinical care, preceptors' approach to obtaining patient consent for student participation, and ratings of preceptors' clinical education skills.

RESULTS

Fifty-nine percent, 22%, and 25% of students encountered patients declining student involvement in care (3 times or more) based on student's training status, student's gender, and in the context of a gynecological/urological exam, respectively. Patient consent obtained by clinic staff (r =.661, p < .001) was a significant predictor for patients declining based on training status. Gender (d = 40, p < .003) and patient consent obtained by clinic staff (r = .349, p < .001) were predictors of patients declining in the context of a gynecological/urological exam.

CONCLUSIONS

A majority of medical students have encountered multiple experiences with patients declining student participation in outpatient clinical care. The approach preceptors use to obtain patient consent may be important in increasing training opportunities for students.

Changes in self-perceived abilities among male and female medical students after the first year of clinical training

BACKGROUND

It is known that male and female medical students have different experiences in their clinical training.

AIMS

To assess whether male and female medical students change in their self-rated work habits and interpersonal habits during the first year of clinical training.

METHOD

Longitudinal study of self- and peer-assessment among 224 medical students in 3 consecutive classes at a private US medical school. Students rated themselves on global work habits (WH) and interpersonal attributes (IA). Students also rated and were rated by 6-12 peers on the same scale.

RESULTS

In the second year of medical school, there were no differences between men and women in quartiles of self-assessed WH or IA. At the end of the third year, however, women were more likely to be in the lower quartiles of self-assessed WH (X(2) = 6.77; p = 0.03), as well as the highest quartiles of self-assessed IA (X(2) = 11.36; p = 0.003). In both years, women rated their own WH skills significantly lower than they rated their peers, while men rated themselves similarly to peers. There were no sex differences in self-assessed IA.

CONCLUSIONS

Although second-year male and female medical students appear similar to one another in terms of self-assessed WH and IA, by the end of the third year women rate themselves relatively lower in WH, while men rate themselves relatively lower in IA.

Women in medicine--is there a problem? A literature review of the changing gender composition, structures and occupational cultures in medicine

BACKGROUND

Internationally, there are increasing numbers of women entering medicine. Although all countries have different health care systems and social contexts, all still show horizontal (women concentrated in certain areas of work) and vertical (women under represented at higher levels of the professions) segregation. There is much discussion and competing explanations about the implications of the increasing numbers of women in the medical profession.

AIMS

The purpose of this review was to explore the evidence, issues and explanations to understand the effects of the changing composition of the medical profession.

CONCLUSIONS

This review identified evidence that delineates some of the effects of gender on the culture, practice and organisation of medicine. There are problems with some of the research methodologies and we identify areas for further research. To understand the effects of the changing gender composition of medicine it will be necessary to use more sophisticated research designs to explore the structural, economic, historical and social contexts that interact to produce medical culture. This will provide a basis for exploring the impact and implications of these changes and has immediate relevance for workforce planning and understanding both the changing nature of health professions' education and health care delivery.

Medical students' self-reported experiences performing pelvic, breast, and male genital examinations and the influence of student gender and physician supervision

PURPOSE

To survey third- and fourth-year medical students about their experiences performing gender-specific examinations.

METHOD

In 2001, 402 third- and fourth-year medical students at the University of Washington School of Medicine were mailed a questionnaire that asked them to approximate the number of pelvic, breast, and male genital examinations they had performed and to estimate the percentage of these examinations that were observed and the percentage that were repeated by a supervising physician. They were also asked to rate their confidence performing these examinations. Chi-square analysis and stepwise multiple regression analysis were performed.

RESULTS

A total of 194 (48%) students completed the questionnaire. Fourth-year female students performed significantly more pelvic (p < .01) and breast examinations (p < .01) than did fourth-year male students. The percentage of examinations that were repeated by a supervising physician was low. Only 86 (45%) of third- and fourth-year students had greater than 75% of their breast examinations repeated by a supervising physician. Male students were less confident in performing the pelvic exam (p < .01) and female students were less confident performing the male genital exam (p < .01). The only predictor of confidence in performing each of these examinations was the number of examinations performed (p < .001). Confidence did not correlate with the percentage of exams observed, percentage of examinations repeated by a supervising physician, or student gender.

CONCLUSIONS

Student gender was a marker for suboptimal exposure for performing opposite-sex, gender-specific examinations. The only predictor of confidence in performing these examinations was the number of exams performed. Special efforts should be made to eliminate gender disparity in opportunities to perform gender-specific exams.

Does students' exposure to gender discrimination and sexual harassment in medical school affect specialty choice and residency program selection?

PURPOSE

To examine the role of gender discrimination and sexual harassment in medical students' choice of specialty and residency program.

METHOD

Anonymous, self-administered questionnaires were distributed in 1997 to fourth-year students enrolled in 14 public and private U.S. medical schools. In addition to reporting the frequency of gender discrimination and sexual harassment encountered during preclinical coursework, core clerkships, elective clerkships, and residency selection, students assessed the impact of these exposures (none, a little, some, quite a bit, the deciding factor) on their specialty choices and rankings of residency programs.

RESULTS

A total of 1,314 (69%) useable questionnaires were returned. Large percentages of men (83.2%) and women (92.8%) experienced, observed, or heard about at least one incident of gender discrimination and sexual harassment during medical school, although more women reported such behavior across all training contexts. Compared with men, significantly (p </= .01) more women who reported exposure indicated that gender discrimination and sexual harassment influenced their specialty choices (45.3% versus 16.4%) and residency rankings (25.3% versus 10.9%). Across all specialties, more women than men experienced gender discrimination and sexual harassment during residency selection, with one exception: a larger percentage of men choosing obstetrics and gynecology experienced such behavior. Among women, those choosing general surgery were most likely to experience gender discrimination and sexual harassment during residency selection. Interestingly, correlations between exposure to gender discrimination and sexual harassment and self-assessed impact on career decisions tended to be larger for men, suggesting that although fewer men are generally affected, they may weigh such experiences more heavily in their choice of specialty and residency program.

CONCLUSION

This study suggests that exposure to gender discrimination and sexual harassment during undergraduate education may influence some medical students' choice of specialty and, to a lesser degree, ranking of residency programs.

Trends in medical education research

The medical education community is reflecting increasingly on the role and nature of research in the field. Useful sources of data to include in these reflections are a description of the topics in which we are investing our energies, an analysis of the extent to which there is a sense of progress on these topics, and an examination of the mechanisms by which any progress has been achieved. This article presents the results of a thematic review of the medical education research literature in four key journals since the turn of the 21st century. It describes four examples of areas in which the community appears to be investing its energies: curriculum and teaching issues, skills and attitudes relevant to the structure of the profession, individual characteristics of medical students, and the evaluation of students and residents. A discussion of the recent publications in these domains highlights a distinction between thematic categories of research, in which many members of the community are working on the same topic, and programmatic lines of research, in which members of the community are working together toward the shared goal of consensual understanding. The author suggests that community-level, programmatic lines of research are necessary to build knowledge and understanding of a domain and that, in the absence of such communal effort, the value of research is limited to the uncoordinated accrual of information.

The impact of perceived gender bias on obstetrics and gynecology skills acquisition by third-year medical students

PURPOSE

To investigate the perceptions of third-year medical students about how their acquisition of skills during their obstetrics and gynecology clerkship may be affected by their gender.

METHOD

From January 1999 to December 2001, all third-year students at one school completing their obstetrics and gynecology rotation were given an anonymous questionnaire addressing whether gender had a positive, negative, or neutral effect on their learning experience. Students were also asked to enumerate procedures they had performed (e.g., deliveries and speculum examinations) and to rate their ability to counsel women on several clinical problems. To further investigate the perceptions of gender discrimination, a focus group of 12 fourth-year students was held.

RESULTS

A total of 263 questionnaires (95%) were returned. Of the respondents, 78% of the men felt their gender adversely affected their experience, and 67% of women felt gender had a positive affect. All but five of the remaining students were in the neutral group. Those students who reported a positive gender effect performed significantly more speculum examinations (15.5 versus 12.3), labor coaching (8.7 versus 6.2), and independent deliveries (3.4 versus 2.7) than did the negative gender-effect group. The positive gender-effect group felt more confident of counseling skills. The neutral group did not differ from the negative group. The overall numerical differences among groups were small, and all groups, on average, performed adequate numbers of skills to meet clerkship objectives.

CONCLUSIONS

There is a strong perception among medical students that gender influences experience on their obstetrics and gynecology clerkship, but the differences are actually small. Possible reasons for such strong feelings are addressed and related to the history of sexism in reproductive health care and to the ethics of patients' preferences.