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

The impact of gendered experiences on the career choice of swiss medical students: A qualitative study protocol

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.

Medical students' experiences in learning to perform pelvic examinations: a mixed-methods study

OBJECTIVES

We aimed to explore learning experiences among medical students learning to perform pelvic examinations and to identify factors that facilitate their training.

METHODS

A mixed-methods study including a web-based survey and focus group discussions (FGDs) was conducted among medical students who had completed their obstetrics and gynaecology (ObGyn) clerkship. The FGDs were recorded, transcribed and analysed using qualitative content analysis with systematic text condensation. Survey factors were compared using the χ² test or Fisher's exact test.

RESULTS

160 students (97 female, 61 male, two other) at six universities in Sweden responded to the survey. Two mixed FGDs were conducted. The majority (87%) of the students experienced confidence in performing pelvic examinations, stating that sufficient, repeated training opportunities and support from a clinical tutor were crucial components of the learning experience. Prior to the ObGyn clerkship, negative expectations were more common among male students. The male participants experienced having a disadvantage because of their gender, while female students considered their gender an advantage (p<0.001, N=121, Fisher's Exact Test). The clinical tutor and the use of professional patients (PPs) had a fundamental role in providing learning opportunities by including the student in patient care activities.

CONCLUSIONS

The importance of the clinical tutor, as well as the use of PPs, are important factors when planning education in pelvic examinations, and this knowledge could be used when educating other intimate examinations during medical school. In addition, similar investigations on students' experience in training other intimate examinations could be considered.

Gendered Differences in Teaching Performance Evaluations of Obstetrics and Gynecology Residents

OBJECTIVE

Teaching performance evaluations are commonly used for career development and advancement. Due to possible gendered expectations, implicit or explicit bias may emerge in evaluations completed by learners. This study investigated how third-year medical students evaluated teaching performance of obstetrics and gynecology resident physicians based on resident gender.

SETTING

This study was conducted at the Medical College of Wisconsin in Milwaukee, Wisconsin.

DESIGN

This retrospective mixed methods study examined teaching performance evaluations of obstetrics and gynecology resident physicians from 2010 to 2018, completed by third-year medical students. A two-sample, two-sided t-test was used to compare numerical scores. Deductive content analysis of written comments focused on specific categories: positive or negative agentic or communal demeanors and characteristics, teaching skills, character and professionalism, leadership abilities, clinical skills and knowledge, and frequency of words and phrases used to describe residents.

SETTING

This study was conducted at the Medical College of Wisconsin in Milwaukee, Wisconsin.

RESULTS

Of 83 residents (71 females, 12 males), there was no statistical significance in the teaching performance evaluation scores between male and female residents (n = 10,753 total completed evaluations). Female residents had lower scores than male residents; males tended not to score below 4 (5-point response scale; 5 = outstanding). Of 3,813 written comments, male residents had more positive comments, with statistical significance in communal characteristics (71.4% male, 53.9% female, p = 0.01). Female residents received more negative comments, with statistical significance in communal characteristics (7.5% female, 2.8% male, p = 0.01). Frequency of words presented that male residents had more "standout" traits ("outstanding," "excellent," "exemplary"), "ability" terms ("intelligent," "bright," "talented," "smart"), and were often considered "fun," "funny," and "humorous." Female residents were described by "compassion" terms ("kind," "compassionate").

CONCLUSION

Student-completed teaching performance evaluations are a valuable assessment of teaching skills and influence department recognition, award distribution, fellowship and employment opportunities. This study found that medical students did evaluate female residents differently than male residents. Understanding gendered expectations may assist in findings ways to address discrepancies between male and female physician evaluations.

Gender differences in specialty preference among medical Students at Aleppo University: a cross-sectional study

BACKGROUND

This study aims to identify gender differences in specialty preference and career choice among Syrian medical students.

METHOD

A cross-sectional study comprising currently enrolled second, fourth and sixth year medical students at Aleppo University was conducted. Demographics, specialty preferences and factors influencing this decision were collected and analyzed.

RESULTS

A total of 561 students (44% males, 56% females) responded to our survey (87% response rate). Surgical specialties (40%) and internal medicine (16%) comprised the two most common specialties chosen by males. In contrast, the majority of females preferred other specialties (17%), internal medicine (16%) and surgical specialties (15%). The most common factor affecting the choice of a specialty by both genders (74% females and 71% males) was 'A specialty that I like and find interesting'. Work/life balance and anticipated income were the second most common influencing factors by females (62%), males (67%), respectively. The majority of both genders supported the idea that medical students should be able to pursue any medical specialty they want, regardless of their gender. However, females more often believed that they had decreased opportunities for professional advancement based on their gender compared to males (33% vs. 4% respectively, p < 0.001).

CONCLUSIONS

We illustrated significant gender differences in specialty preferences and factors influencing this decision. While the majority of participants agreed that medical students should be able to pursue any medical specialty they desire regardless of gender, more women believed they had decreased opportunities for professional advancement based on gender. Policy makers should advocate for a culture of gender equity and develop educational programs to insure gender balance of physicians into different specialties.

Female victims and female perpetrators: medical students' narratives of gender dynamics and professionalism dilemmas

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.

Gender of Provider-Barrier to Immigrant Women's Obstetrical Care: A Narrative Review

OBJECTIVE

To explore the preference for female obstetrician/gynaecologists among immigrant women, and providers' understandings of these preferences, to identify challenges and potential solutions.

METHODS

Five databases (Medline, Embase, CINAHL, Global Health, and Scopus) were searched using combinations of search terms related to immigrant, refugee, or Muslim women and obstetrics or gynaecological provider gender preference.

STUDY SELECTION

Peer reviewed, English-language articles were included if they discussed either patient or provider perspectives of women's preference for female obstetrics or gynaecological care provider among immigrant women in Western and non-western settings. After screening, 54 met inclusion criteria and were reviewed.

DATA EXTRACTION

Studies were divided first into those specifically focusing on gender of provider, and those in which it was one variable addressed. Each category was then divided into those describing immigrant women, and those conducted in a non-Western settings. The research question, study population, methods, results, and reasons given for preferences in each article were then examined and recorded.

CONCLUSION

Preference for female obstetricians/gynaecologists was demonstrated. Although many will accept a male provider, psychological stress, delays, or avoidance in seeking care may result. Providers' views were captured in only eight articles, with conflicting perspectives on responding to preferences and the health system impact.

To the point: gender differences in the obstetrics and gynecology clerkship

Gender differences in performance on the obstetrics and gynecology clerkship have been reported, with female students outperforming male students. Male students report that their gender negatively affects their experience during the clerkship. Additionally, there are fewer male students applying for obstetric/gynecology residency. This "To The Point" article by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee will describe the gender differences that have been found, examine factors that could be contributing to these issues, and propose measures to correct these disparities.

Perspectives of Immigrant Women on the Gender of Provider During Childbirth

OBJECTIVE

This study sought to gain an understanding of the importance and effect of provider gender for immigrant women accessing obstetrical care.

METHODS

A focused ethnography was conducted using purposive sampling of 38 immigrant women from one hospital in Edmonton, Alberta. Data collection consisted of semistructured interviews conducted antenatally (n = 38); an attempt was made to conduct interviews postpartum (n = 21), and intrapartum observations were made (n = 17). Interviews were audio-recorded and transcribed verbatim. Data were managed using qualitative data analysis software and analyzed through thematic analysis.

RESULTS

Study participants came from varied educational and ethnic backgrounds (predominately North/East African, Middle Eastern, and South Asian), but most were Muslim (n = 30) and married (n = 36), with a mean age of 27.7. All of the women stated that they preferred a female provider, which they explained in terms of the high value they placed on modesty, often as part of the Muslim faith. The women deemed provider competency and having safe childbirth more important, however, and said that they would accept intrapartum care from a male provider. A small minority of the women reported experiencing psychological stress as a consequence of having received care from a male provider.

CONCLUSION

As a whole, our study population accepted care from male providers, yet for some women this compromise came at a price, and a small minority of women perceived it as profoundly detrimental. There is a need to identify those women for whom gender of provider is a substantial barrier, so that optimal support can be provided.

Accommodating Immigrant Women's Preferences for Female Health Care Providers

OBJECTIVE

To investigate obstetricians' perspectives of the importance, effect, and challenges of providing intrapartum care to immigrant women who request a female obstetrician.

METHODS

A focused ethnography was conducted at a large teaching hospital, which serves a high proportion of immigrant clientele (predominantly North or East African, Middle Eastern, and South Asian) in Edmonton, Alberta, Canada. Data collection comprised single, semistructured interviews with a purposive sample of 20 obstetric health care providers (10 resident and 10 staff obstetricians). Interviews were audio-recorded and transcribed verbatim. Data were managed with Quirkos and analyzed using thematic analysis.

RESULTS

A total of 13 female and seven male physicians were interviewed. Physicians recognized the validity of immigrant women's preference and requests for female health care providers and expressed sympathy for them. However, they were also resistant and expressed several concerns about accommodating these requests, including fear of perpetuating and exacerbating gender inequalities in medicine, the extent to which patient decision-making was coercion-free, the ability of the health system to meet the demands, and implications for training and quality of care.

CONCLUSION

Although physicians were sympathetic to immigrant women's requests for female obstetricians, they placed greater value on maintaining gender equity both within the medical profession and in wider society and resisted accommodating gender-of-health-care-provider requests. Our qualitative study suggests a need for greater research to inform policy that meets the professional and personal values of both physicians and patients.

Impact of educational messages on patient acceptance of male medical students in OB-GYN encounters

INTRODUCTION

Although training in obstetrics and gynecology is a key part of medical education, male students receive less extensive experience, due in part to patient refusals. However, there is limited work seeking to reduce patient refusal rates of male students. The current study examined the efficacy of two messages at increasing male medical student acceptance into a well-woman visit.

METHODS

A total of 656 college women participated in a simulation study where they viewed a video of a nurse asking for permission to have a male medical student participate in their well-woman visit. The 30.5% of women who refused student participation (n = 181) were randomly assigned to view a video of the nurse either describing students' medical knowledge and technical skills training (e.g. training in performing pelvic exams) or empathic skills training (e.g. training in communication about sensitive issues). They were again asked if they would be willing to have the student participate.

RESULTS

Both messages similarly increased student acceptance with 44.8% of those receiving the empathic skills training message and 48.9% of those who received the medical/technical skills training message accepting student participation, χ(2) (1, N = 181) = 0.3, p = 0.58.

DISCUSSION

Educational messages about medical student training delivered in an engaging fashion by a credible source are a potentially effective tool to increase male student acceptance into sensitive patient encounters. Future work should test these messages in real-world settings as part of a focus on patient education to increase comfort with student participation.

The effect of an evidence-based medicine curriculum on breast cancer knowledge and satisfaction of surgical residents

OBJECTIVE

The current study was performed to determine if evidence-based medicine (EBM) curriculum would affect education of surgical residents.

DESIGN

A 5-year prospective study was designed to determine if EBM curriculum could improve residents' satisfaction and understanding of breast cancer management during a breast surgical oncology rotation. During the first 2 years, 45 journal articles were used. During the subsequent 3 years, journal articles were not used. The proportion of patients seen in clinic was collected as an objective measure of the "effort" made by the resident. The final assessment was a 120-question examination.

SETTING

Maricopa Medical Center, Phoenix, AZ. Safety net institution with General Surgery residency program.

PARTICIPANTS

Postgraduate year 2 general surgery residents.

RESULTS

Over 5 years, 30 postgraduate year 2 residents were involved. Univariate analysis showed that female sex (p = 0.04), residents with peer-reviewed publications (p = 0.03), younger age (p = 0.04), American Board of Surgery in-service training examination score (p = 0.01), and clinical effort (p < 0.01) were associated with higher scores. Although residents taught using the journal articles scored 7 points higher on the final examination, this was not significant (p = 0.10). Multivariate analysis showed that American Board of Surgery in-service training examination score and clinic efficiency remained statistically significant. Residents who were taught using the EBM curriculum had significantly higher satisfaction (4.4 vs 3.5, p = 0.001) compared with those who did not go through the EBM curriculum.

CONCLUSIONS

The current study demonstrates that an EBM curriculum significantly improved resident satisfaction with the rotation. The EBM curriculum may improve residents' breast cancer knowledge. The most important predictor of resident performance was the effort of resident.

Gender bias in training of medical students in obstetrics and gynaecology: a myth or reality?

OBJECTIVE

To investigate the experience of medical students during a clinical attachment in obstetrics and gynaecology (O&G).

STUDY DESIGN

A questionnaire was distributed to medical students who completed their O&G posting between August 2012 and August 2013. The first part included basic demographic details (age, gender, and ethnicity) and frequency of actual clinical experience; the second part explored students' perception of their training and their relationship with other staff, in particular feeling of discrimination by specified groups of medical personnel. The responses were recorded using a Likert scale and were recategorised during analysis.

RESULTS

A total of 370 questionnaires were distributed, and 262 completed questionnaires were returned, giving a response rate of 71%. Female students had a significantly higher median (IqR) number of vaginal examinations performed 0.25(0.69) (p=0.002) compared to male students. Male students experienced a higher proportion of patient rejections during medical consultation, 87% vs. 32% of female students (p<0.001), a higher rate of refusal for clerking (71.4% vs. 57.5% of females, p=0.035) and a higher rate of patients declining consent for internal examination (93.3% vs. 67.6% of females, p<0.001). The majority of male students felt that their gender negatively affected their learning experience (87% vs. 27.4% of the female students, p<0.001). Male students reported a significantly higher proportion of discrimination against their gender by medical officers (p=0.018) and specialists/consultants (p<0.001) compared to females but there was no discrimination between genders by staff nurses or house officers. A majority (58%) of female students stated an interest in pursuing O&G as a future career compared to 31.2% of male students.

CONCLUSIONS

Our study confirmed that gender bias exists in our clinical setting as male students gain significantly less experience than female students in pelvic examination skills. We also demonstrated that compared to female students, male students experience higher levels of discrimination against their gender by trainers who are medical officers and specialists/consultants. Trainers must improve their attitudes towards male students, to encourage them and make them feel welcome in the clinical area. We must minimize gender discrimination and educational inequities experienced by male students, in order to improve their learning experience.

Stereotyped beliefs about male and female OB-GYNS: relationship to provider choice and patient satisfaction

BACKGROUND

Up to 60% of women prefer a female obstetrician-gynecologist (OB-GYN), perhaps in part due to holding negative stereotypes of male providers. However, provider gender stereotypes have not been directly examined. The purpose of the current studies was to evaluate women's stereotypes of male and female OB-GYN providers and the impact of these stereotypes on provider evaluations.

METHODS

First, stereotypes of male and female OB-GYNs were elicited from 96 undergraduate women who described the attributes and behaviors of a typical male or female OB-GYN. Next, 126 undergraduate women were randomized to review recordings depicting male or female OB-GYNs engaging in male or female-stereotype congruent behaviors during a well-woman visit.

RESULTS

Participants overall had positive stereotypes of female OB-GYNs (e.g. knowledgeable, easy to talk to) but some negative stereotypes of males (e.g. unable to fully understand women's health issues). However, male and female OB-GYNs who engaged in female stereotype-congruent behaviors were similarly preferred over providers who engaged in male-stereotype congruent behavior.

CONCLUSION

Women generally regard female OB-GYNs as highly competent, whereas some believe that being male is a disadvantage in providing OB-GYN care. However, providers who engage in behaviors associated with high quality care are evaluated positively, regardless of the provider's gender.

Medical students' perceptions of the physician's role in not allowing them to perform gynecological examinations

PURPOSE

To determine how often medical students are not allowed to perform gynecological examinations during their obstetrics-gynecology clerkship, identify the barriers to participation related to physicians and patients, explore the role of the supervisory physician in not allowing medical student involvement, and explore differences between male and female students' experiences.

METHOD

All medical students entering their obstetrics-gynecology clerkship at a medical school in the Netherlands between May and October 2011 were invited to participate in this study's questionnaire, which asked them to report the number of gynecological examinations they were allowed and not allowed to perform during their clerkship. Eighteen questionnaire respondents participated in three focus groups.

RESULTS

Of the 139 medical students invited, 76 (55%) completed the questionnaire. Students reported a total of 2,196 instances in which they were not allowed to participate in the examination; 89% (n = 1,956) were related to the supervisory physician. Qualitative data from the focus group interviews showed that female supervisory physicians prioritized patients' autonomy above students' learning needs. Furthermore, female students were less assertive than male students in asking the supervisory physician for permission to participate.

CONCLUSIONS

The physician's role in not allowing student involvement is substantial and results in fewer opportunities for students to perform gynecological examinations. For students to develop the necessary gynecological exam skills during their clerkship, medical educators need to improve the learning environment.

Obstetrics and gynecology clerkship for males and females: similar curriculum, different outcomes?

OBJECTIVE

To determine if performance differences exist between male and female students on a 6-week obstetrics and gynecology (Ob/Gyn) clerkship and to evaluate potential variables that might underlie any observed variations.

STUDY DESIGN

Final clerkship grades and component scores (clinical evaluations, objective structured clinical examination [OSCE], oral examination, and National Board of Medical Examiners [NBME] subject examination) from July 2007 to June 2010 were matched by student and analyzed by gender. Basic science grade point average (GPA) and initial United States Medical Licensing Exam (USMLE) Step 1 scores were used to establish students' baseline medical knowledge. On a post-clerkship questionnaire, a subset of students reported the numbers of procedures they performed during the clerkship; students also completed online pre- and post-clerkship questionnaires reflecting their self-assessed confidence in women's health clinical skills.

RESULTS

Scores were analyzed for 136 women and 220 men. Final clerkship grades were significantly higher for females than for males (89.05 vs. 87.34, p=0.0004, η(2)=0.08). Specifically, females outscored males on the OSCE, oral, and NBME subject examination portions of the clerkship but not clinical evaluations. Males reported completing fewer breast examinations (p=0.001, η(2)=0.14). Pre-clerkship, males were significantly less confident than females in women's health clinical skills (p<0.01) but reached similar levels upon completion of the clerkship. No gender differences were detected for basic science GPA and USMLE Step 1 scores.

CONCLUSION

Student gender is associated with final grades on an Ob/Gyn clerkship. Further research regarding these differences should be explored.

Multicenter Urogynecology Study on Education: Medical Student Educational Experiences and Knowledge Outcomes During the OBGYN Clerkship

OBJECTIVE

: The objective of this study was to describe self-assessed student knowledge of female pelvic medicine (FPM) during the OBGYN clerkship.

METHODS

: Students at 6 sites scored their knowledge of 12 FPM topics and 4 procedures both before and after their clerkship. Analysis included Wilcoxon tests, Spearman correlation, and univariate and multivariate models.

RESULTS

: A total of 323 students completed paired surveys. Mean knowledge scores (KSs) across FPM topics (1.40 ± 0.12; 95% confidence interval) and procedures (0.77 ± 0.08) increased significantly, with larger increases for topics (P < 0.001). Topic and procedure KSs were correlated (rs = 0.32, P < 0.0001). Mean KSs were significantly related to number and number of types of learning experiences (r = 0.13 and 0.08, both P < 0.001). Learning through text and inpatient encounters had independent effects on KS change in multivariate analysis (P = 0.01 and 0.007).

CONCLUSIONS

: Students reported increased knowledge although less for procedures than for topics. Text and inpatient learning independently increased students' self-assessed change in knowledge.

Predicting success in graduate entry medical students undertaking a graduate entry medical program

BACKGROUND

Success in undergraduate medical courses in the UK can be predicted by school exit examination (A level) grades. There are no documented predictors of success in UK graduate entry medicine (GEM) courses. This study looks at the examination performance of GEM students to identify factors which may predict success; of particular interest was A level score.

METHODS

Data was collected for students graduating in 2004, 2005 and 2006, including demographic details (age and gender), details of previous academic achievement (A level total score and prior degree) and examination results at several points during the degree course.

RESULTS

Study group comprised 285 students. Statistical analyses identified no significant variables when looking at clinical examinations. Analysis of pass/fail data for written examinations showed no relationship with A level score. However, both percentage data for the final written examination and the analysis of the award of honours showed A level scores of AAB or higher were associated with better performance (p<0.001).

DISCUSSION

A prime objective of introducing GEM programs was to diversify admissions to medical school. In trying to achieve this, medical schools have changed selection criteria. The findings in this study justify this by proving that A level score was not associated with success in either clinical examinations or passing written examinations. Despite this, very high achievements at A level do predict high achievement during medical school.

CONCLUSIONS

This study shows that selecting graduate medical students with the basic requirement of an upper-second class honours degree is justifiable and does not disadvantage students who may not have achieved high scores in school leaver examinations.

The interns' learning assessment in obstetrics and gynecology department of Zahedan University of Medical Sciences

OBJECTIVE

One of the aims of management priorities in medical universities is the evaluation of learning in educational departments in order to prevent educational retardation and to improve the quality of education. The aim of this study was to evaluate the interns' learning in the obstetrics and gynecology (O&G) department at Zahedan University of Medical Sciences (ZUMS).

MATERIALS AND METHODS

The study was performed in ZUMS, Iran, in 2002-2003 on all interns at the O&G department, including 30 men and 40 women. For data collection, a questionnaire was used and included some questions regarding the common emergencies and diseases in O&G, together with different learning indicators such as reading, observation, hearing, management, and the capability of management. The data were analyzed using descriptive statistics, tables, t test, and chi-square test using the SPSS software.

RESULTS

The mean percentages of learning indicators of observation, bedside teaching, supervised management, and personal management in the common emergencies and diseases of O&G in male interns were significantly lower than those in female interns. Also, the mean percentages of managing capabilities were 12% and 70.5% in common emergencies and 14.2% and 59.3% in common diseases for male and female interns, respectively. The chi-square test showed a significant difference between the mean percentages of the managing capabilities in male and female interns for the majority of the common emergencies and diseases. Also, the chi-square test revealed a significant relationship between the learning indicators and the interns' managing capabilities for common emergencies and diseases.

CONCLUSION

Some learning indicators in the male interns were very low. This needs urgent improvement of the learning quality in the O&G department, especially for the male interns, particularly those who are supposed to work in the deprived areas of the country after graduation in the public service.

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' attitudes to gender issues in the role and career of physicians: a qualitative study conducted in Sweden

There is an increasing awareness of the importance to address gender issues during medical studies. This qualitative study is aimed at exploring students' attitudes to gender issues in the career of physicians, and identifying questions important to consider in medical education about gender. At Umeå University in Sweden, third-term medical students write an essay about 'being a doctor' and they also reflect on gender issues their future career. In 2002, the essays of 41 men and 63 women (75%) were analysed using open coding and repeated comparisons to elaborate categories. Four main attitudes towards gender were identified. Important and interesting (men 22%, women 63%), meaning gender was regarded as a crucial consideration in a physician's working life. Interested women expressed personal worries about their future, while interested men's reflections were more intellectually focused. Relevant with doubts (54%, 27%) represented a positive stand while simultaneously reducing the significance of gender. In Irrelevant and irritating (20%, 8%), gender was seen as over-talked and politics. Irritated students challenged the teachers and questioned gender as a field of scientific knowledge. Neglecting denoted avoidance of gender (5%, 3%). To avoid reinforcing stereotypical ideas about men and women, teachers and physicians need more knowledge about gender.

Gender differences among medical students in attitudes to learning about complementary and alternative medicine

OBJECTIVES

To explore gender differences in attitudes to CAM among Year 1, 2 and 3 medical students.

DESIGN

Survey; seven-item self-administered questionnaire.

SETTING

Plenary lectures at the start of semester 2 of the academic year at the University of Birmingham Medical School.

RESULTS

35.6% of 662 students were male and 64.4% female. Females were more likely than males to feel CAM has an important role in healthcare (p < 0.001). This difference increased through the medical course (p < 0.05). Females gave a more positive rating than males to the use of five therapies in healthcare (p < 001). Females were more positive than males about learning the theory (p < 0.001) and practice (p < 0.001) of CAM and a greater amount of CAM curriculum time (p < 0.001).

CONCLUSIONS

If CAM teaching is optional females may be more likely to choose it. An unexpected consequence of more women than men entering medical school may be a positive impact on the development of integrated medicine.

The influence of physician gender on practice satisfaction among obstetrician gynecologists

OBJECTIVE

A survey was conducted to investigate the hypothesis that female gender would positively affect job satisfaction among obstetrician gynecologists.

STUDY DESIGN

A survey was sent to 500 randomized, age matched American College of Obstetrics and Gynecology members, 50% each men and women: 49.8% responded. Data were analyzed with the chi2 contingency test, Cochran's test for linear trends, Student t tests, and multiple regression.

RESULTS

Women considered their gender an asset in deciding on a career in obstetrics and gynecology, in obtaining jobs, and in maintaining their practices. Men considered that their gender limited their practice options and were more likely to report that they would not choose a career in obstetrics and gynecology if they could choose again. The only significant difference between men and women in measures of obtaining and maintaining a practice was that men were more likely to practice in small urban or rural settings. Men reported higher incomes. Both genders were equally satisfied with their jobs.

CONCLUSION

Although both genders considered female gender to be an asset in obstetrics and gynecology, this survey showed no difference in their ratings of overall career satisfaction.

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.

Factors detracting students from applying for an obstetrics and gynecology residency

OBJECTIVE

This study compares perception about the characteristics of obstetrics-gynecology (OG) of medical students who choose to pursue a residency in OG and those students who choose to enter another specialty.

STUDY DESIGN

Fourth-year medical students were asked to complete a survey addressing their perceptions about OG. Responses were compared of (1) those entering OG to those entering other specialties, (2) those entering OG to those who seriously considered entering OG but chose another discipline, and (3) males to females. Chi-square tests were used for the comparisons.

RESULTS

Of the 267 eligible students, 137 (51.1%) completed the survey. Clerkship satisfaction was rated as high by 88.9% of students choosing OG vs 10.2% (P<.0005) of those who chose another discipline. The emerging predominance of female providers detracted 38.5% of males vs 10.2% of females (P<.0005).

CONCLUSION

Student perception of an OG clerkship may detract them from pursuing OG as a career.