Gender equity in undergraduate medical education: a status report

Gender Inequality in Leadership Positions in Neurology and Neurosurgery Journals and Societies

OBJECTIVE

Gender inequalities persist in several areas of medicine, despite the growing number of female doctors and medical students. In this study, we aimed to reveal the gender inequality in the top journals' editorial boards and national societies' leadership positions in the field of neurology and neurosurgery.

METHOD

This is a cross-sectional study that uses public information accessed through the internet via journals' and academic societies' public websites. The medical journals are selected and included according to their h5-index in the field of neurology and neurosurgery. We evaluated the gender composition of the editorial boards and academic societies' leadership positions.

RESULTS

The female editorial board member ratio was 44.0% in the top 10 neurology journals. However, this ratio was significantly decreased to 29.7% in the other journals(P < 0.001). The top 10 neurosurgery journals had a female editorial board member ratio of 13.7%. This ratio was significantly decreased to 5.3% in the other 10 journals with lower h5-index(P < 0.001). A significantly lower number of female individuals are present in the editorial boards of the neurosurgery journals than in neurology(P < 0.001). The female president or delegate ratio was 19.3% in the World Federation of Neurology-affiliated countries, and it was 4% in the World Federation of Neurosurgical Societies-affiliated countries.

CONCLUSIONS

In conclusion, there is a significant gender inequality among editorial board members. The position of neurosurgical societies and journals is far different than the field of neurology. Furthermore, these findings should be evaluated as a continuum of the gender inequality in the professional societies' executive boards and delegates representing the national academical community.

Women in Radiology: A perspective from Spain

INTRODUCTION

There are gender inequalities in all fields, including radiology. Although the situation is improving, the presence of radiologists in leadership positions continues to be a minority. The objective of this article is to analyse the situation of women in the spanish radiology, comparing it with Europe and the United States.

MATERIALS AND METHODS

We selected the years 2000-2022 as reference period to make a comparison with feminization data throughout history. In addition, relevant specific data from the just begun 2023 were also included. The variables in which we investigated feminization were the following: medical students, medical graduates, radiology residents and specialists, section chiefs, department chairs, radiology residency programme directors, radiology university professors, presidents of the main radiological entities and societies in Spain, Europe and the United States, recipients of the main awards given by these radiological societies and chief editors of their journals. In order to perform this analysis we conducted an in-depth bibliographic research, we contacted the radiological societies of Spain, Europe and the USA and we carried out a survey in the main Spanish radiology departments.

RESULTS

The female presence in radiology decreases as we rise to leadership positions, a situation that is patent in Spain, Europe and the US, comparison that will be analysed in depth throughout the article. In Spanish hospitals in 2021 there were 58.1% female radiology residents, 55% female radiologists, 42.9% female section chiefs and 24.4% female department chairs. In SERAM's history there have been 10% female presidents, 22% female gold medallists and 5% female editors-in-chief. If we analyse data from 2000 to 2023, female presidents reach 32% and female gold medallists 31%.

CONCLUSIONS

Although gender inequality is declining, in radiology women continue to be underrepresented in leadership positions. Work must be done in order to build a diverse and inclusive profession that reflects demographic reality.

Latina Women in the U.S. Physician Workforce: Opportunities in the Pursuit of Health Equity

PURPOSE

Some progress has been made in gender diversity in undergraduate medical education and the physician workforce, but much remains to be done to improve workforce disparities for women, particularly women from underrepresented populations, such as Latinas. This study examines the current level of representation and demographic characteristics of Latina physicians, including age, language use, nativity, and citizenship status.

METHOD

The authors used data from the 2014-2018 U.S. Census Bureau's American Community Survey (ACS) 5-year estimates for their analyses. During the time period covered by this analysis, ACS response rates ranged from 92.0% to 96.7%. The authors included in this study individuals who self-reported their occupation as physician and who self-identified their race/ethnicity as either non-Hispanic White (NHW) or Hispanic/Latino, regardless of race. The authors used person-level sampling weights provided by the ACS to convert the original 1% sample to a 100% enumeration of the population.

RESULTS

According to the ACS 2014-2018 5-year estimates, NHW physicians make up 65.8% (660,031/1,002,527) of physicians in the United States. Women comprise 36.1% (361,442) of the total U.S. physician population; however, Hispanic/Latina women comprise only 2.4% (24,411). The female physician population is younger than the male physician population, and Hispanic female physicians are the youngest. Latina physicians are far more likely to speak Spanish at home than NHW physicians. Immigrants make up 40.1% (9,782/24,411) of the Hispanic female physician population, and 12.3% (3,012/24,411) of Hispanic female physicians are not U.S. citizens.

CONCLUSIONS

This study suggests that Latina physicians in the United States are younger, more likely to be bilingual and speak Spanish at home, and very underrepresented, compared with NHW female and male physicians. Increasing their share of the U.S. physician workforce would benefit the pursuit of health equity for an ever more diverse population.

Training and Retaining Physician‒Scientists in Dermatology in Taiwan

Currently, only 14.7% of practicing dermatologists in Taiwan who work at medical centers are dedicated to innovative research. Dermatology departments appear to face steeper challenges with the recruitment and retention of physician‒scientists than other medical specialties. The need to increase the number of physician‒scientists is clear and can be achieved through the provision of good training programs, financial support, early mentorship, and sustained funding.

Diversity begets diversity: Factors contributing to emergency medicine residency gender diversity

BACKGROUND

Although the number of women entering medical school and emergency medicine (EM) residencies has increased, female physicians are still proportionally underrepresented in EM. The goal of this study was to determine if there was a relationship between resident gender and program leadership gender.

METHODS

A survey of residency leadership and residents was completed, and multivariate factor analysis was performed.

RESULTS

It was found that 31% of program directors (PDs) were women, along with 42% of associate PDs, 48% of assistant PDs, 36% of residents, and 48% of chief residents. The strongest correlation between female residents and program leadership was between female residents and female assistant PDs (0.25). Female residents were also strongly correlated with female chief residents (0.40).

CONCLUSIONS

Although we cannot determine the direction of causation, moving forward, programs looking to increase their female resident cohort should consider focusing efforts around increasing representation at the program leadership and chief resident level.

Systematic review of interventions to improve gender equity in graduate medicine

Women are substantially underrepresented in senior and leadership positions in medicine and experience gendered challenges in their work settings. This systematic review aimed to synthesise research that has evaluated interventions for improving gender equity in medicine. English language electronic searches were conducted across MEDLINE, CINAHL, Academic Search Complete, PsycINFO and Web of Science. Reference list screening was also undertaken. Peer-reviewed studies published between 2000 and March 2020 that evaluated interventions to improve gender equity, or the experiences of women, in academic or clinical medicine were reviewed. Dual reviewer data extraction on setting, participants, type of intervention, measurement and outcomes was completed. Methodological rigour and strength of findings were evaluated. In total, 34 studies were included. Interventions were typically focused on equipping the woman (82.4%), that is, delivering professional development activities for women. Fewer focused on changing cultures (20.6%), ensuring equal opportunities (23.5%) or increasing the visibility or valuing of women (23.5%). Outcomes were largely positive (87.3%) but measurement typically relied on subjective, self-report data (69.1%). Few interventions were implemented in clinical settings (17.6%). Weak methodological rigour and a low strength of findings was observed. There has been a focus to-date on interventions which Equip the Woman Interventions addressing systems and culture change require further research consideration. However, institutions cannot wait on high quality research evidence to emerge to take action on gender equity. Data collated suggest a number of recommendations pertaining to research on, and the implementation of, interventions to improve gender equity in academic and clinical settings.

Women in thoracic surgery: lesson learned from medical industry partners

Medical technology has led to important achievements in surgery as minimally invasive techniques have expanded over the past several years. These innovations have changed the dynamic between industry and surgeons towards a more collaboration relationship forming partnerships important to surgical advancement and technical training opportunities. On this backdrop of transformation is growing awareness of the gender disparity that exists within the thoracic surgery workforce where we have experienced strikingly little change. At the same time, medicine is not unique with its gender disparity. As we have benefited from important partnerships to create excellence in technical innovation, so too may we benefit from drawing upon some of the successes within the medical industry towards achieving gender equity. This paper highlights examples of female leaders in the medical industry surrounding thoracic surgery, who have demonstrated excellence in the advancement and promotion of female thoracic surgeons through fellowships, mentorships or networking.

Factors influencing medical students' choice of specialization: A gender based systematic review

BACKGROUND

Students' choice of medical specialties has evolved throughout year, with a growing interest in quality of life and in technological specialties. We investigated the repartition of such choices in the world and its influencing factors with a focus on the gender's influence, for helping policy-makers to deal with medical shortage and territorial to specialty disconnect.

METHODS

A systematic search was conducted on MEDLINE and Scopus from January 2010 to January 2020. Data extraction and analysis followed JBI and PRISMA recommendations. The selected articles had to focus on medical students, detail their choice of specialty, and look for factors influencing their choice. Articles were excluded if they only assessed the attractiveness of a specialty, or evaluated a public policy. This review was registered on PROSPERO, CRD 42020169227.

FINDINGS

751 studies were screened, and fifty-four were included. Surgery and internal medicine were the most wanted specialties, both in occidental and non-occidental countries. The main factors influencing the choice of specialty were lifestyle, work-life balance and discipline interest, with variation across different countries. Gender clearly affected this choice with 63.7% of men willing radiology and 14.7% of men in obstetrics and gynecology.

INTERPRETATION

Influential factors vary with specialty and are affected by the country of residence. Gender has a great impact in students' willingness to work in specific specialties. Policymakers should adapt their appealing strategies according to the country and the medical discipline concerned.

FUNDING

The authors have no support or funding to report.

The Women in Medicine Summit (WiMS): Engaging students to identify and address gender-associated challenges in medicine

The Women in Medicine Summit (WiMS) is a novel, student-led conference initiated at the University of Toronto to engage the medical community in a discussion about unique gender-distinctive challenges in medicine. We identified topics inadequately addressed in undergraduate curriculums, including techniques to address microaggressions and balance work-life commitments. Students from five Canadian medical schools attended WiMS in 2018. Attendees perceived significant improvement in readiness in identifying and resolving gender-associated issues following the conference. Our findings may be used to motivate curriculum development and adoption of similar initiatives to improve education on diversity.

Emergency Medicine Gender in Resident Leadership Study (EM GIRLS): The Gender Distribution Among Chief Residents

OBJECTIVES

The goal of this research was to determine the gender distribution of chief residents in emergency medicine (EM) residencies in the United States to explore whether the gender leadership gap is present at the resident level in EM.

METHODS

The investigators compiled a list of EM residency programs accredited by the Accreditation Council for Graduate Medical Education. Investigators reached out to the programs using established best practices in survey distribution collecting the following: program name, program location, program length, total number of residents, total number of female residents, total number of chief residents, and the total number of female chief residents.

RESULTS

Of the 223 programs contacted 194 programs responded and 182 programs were included in the study (a response rate of 82%). As of the 2019 to 2020 academic year, female EM residents account for 37.0% (2,459/6,718) of all EM residents and female EM chief residents account for 42.2% (250/593) of EM chief residents. The proportion of female EM chief residents was significantly higher than the proportion of both female EM residents (42.2% vs. 37%, p = 0.007) and female EM attending physicians (42.2% vs. 27.5%, p < 0.001). When comparing proportions of female residents based on duration of program, female physicians comprised 35.0% (1,652/4,720) of residents at 3-year programs and 40.4% (807/1998) of residents at 4-year programs (p < 0.01).

CONCLUSIONS

While the proportion of female EM residents remains significantly lower than the proportion of male residents, females and males are similarly represented at the chief resident role.

Investigating Stress and Sources of Stress Among Female Health Profession Students in a Saudi University

Background

Health profession students experience tremendous levels of stress throughout their education. A high level of stress may have a negative effect on the cognitive functioning and learning of students.

Objective

The study sought to determine the levels and main sources of stress and its possible correlation with academic performance in the preclinical female health profession.

Methods

The cross-sectional design involved the use of self-administered questionnaires. Data were collected from 260 students in health profession programmes in Saudi Arabia. The Medical Student Stressor Questionnaire (MSSQ) was used to collect the data from all second-, third-, and fourth-year undergraduate students.

Results

A high level of stress was observed in 42.7% of the students, and a moderate stress level was observed in 41.5% of the students. The major source of stress experienced by students was related to the academic domain (mean= 2.7±0.73), followed by the group activity domain (mean= 2.1±0.91; p< 0.05). Second-year and third-year students were significantly less likely to show high stress levels compared with fourth-year students (AOR= 0.3; 95% CI: 0.1–0.8; p≤ 0.030 and AOR= 0.4; 95% CI: 0.1–0.5; p≤ 0.001, respectively). High stress levels were not found to be associated with students’ age and academic performance.

Conclusion

Half of the students experienced high and severe levels of stress. Academic and group activity domains were perceived as the major stressors. The year of study was the only significant factor associated with stress levels. Stress among female health profession students should be acknowledged, and efforts should be made to alleviate it. Students should be guided to reduce their stress levels, as this can enhance their quality of life and study experience.

A growing trend of females and dermatologists among top medical graduates in 30 years

BACKGROUND

Career outcomes of top medical graduates (TMG) are seldom studied. The Tsungming Tu Foundation (TTF) has awarded the number one graduate from each medical school in Taiwan since 1981. We aimed to study whether TMG differ from all medical graduates (AMG) in gender, specialty, and geographic regions in the last 30 years.

METHODS

Overall, 322 TMG and 40,075 AMG were identified from 1981 to 2017 from TTF and Taiwan healthcare public data, respectively. Subjects were further grouped by their graduation year: 1981-1994, 1995-2001, 2002-2011, and after 2012. Ranges were based on implementation dates of new health care policies.

RESULTS

The percentages of female AMG increased from 10.9% before 1994 to 32.6% after 2012 (linear trend, P < 0.001). Similarly, the percentages of female TMG increased from 23.1% before 1994 to 42.4% after 2012 (linear trend, P = 0.003). In contrast to 2% of AMG, the percentages of TMG who became dermatologists increased from 11% to 20.5% (linear trend, P = 0.024). TMG favored dermatology, ophthalmology, and neurology, and avoided general surgery (P < 0.001). While still higher than AMG, the percentages of TMG working in medical centers dropped significantly from 58% during 1981-1994 to 33.3% during 1995-2001 (P = 0.035). This coincided with the launch of National Health Insurance in 1995. Finally, though more than half of TMG previously worked in Northern Taiwan, they have recently moved to Central Taiwan.

CONCLUSIONS

The percentages of female AMG and TMG reached 32.6% and 42.4%, respectively, after 2012. TMG prefer to choose dermatology, ophthalmology, and neurology, but avoid general surgery. Changes in health policy, reimbursement policy, and medical education may be associated with AMG and TMG career choices.

Ausencia de perspectiva de género en la educación médica. Implicaciones en pacientes mujeres y LGBT+, estudiantes y profesores

La Salud corresponde a un estado de bienestar completo, donde interactúan factores biológicos, socioculturales y psicosociales. El género es uno de ellos. Actualmente está demostrado que las diferencias entre sexos y géneros tienen efectos en múltiples enfermedades, diferencias que tienden a omitirse en la educación médica. Entre las principales consecuencias a dicha omisión se encuentra la atención inadecuada a pacientes y la existencia de distintas discriminaciones dentro de la enseñanza médica.La siguiente revisión bibliográfica abordará cómo la ausencia de perspectiva de género en la educación en la salud afecta a los pacientes y estudiantes de medicina, sean femeninas o LGBT+. Se concluye que han existido mejoras tanto en la atención como en la enseñanza, pero debe continuarse el trabajo, en particular, en la formación inicial de los profesionales de la medicina.

What Emergency Medicine Rewards: Is There Implicit Gender Bias in National Awards?

STUDY OBJECTIVE

Multiple studies have demonstrated a gender gap in the percentage of women recognized in national awards, but to our knowledge this gap has not been studied within emergency medicine. This study is designed to evaluate the presence of a gender gap in female representation in awards from national emergency medicine organizations in the United States and Canada.

METHODS

The awards from 5 national organizations during the past 5 years were reviewed. We developed a data extraction tool to identify and categorize the awards and recipients. Data were grouped according to gender distribution and assessed with respect to emergency medicine organization, year of award, category of award, and career phase specified by award.

RESULTS

The overall percentage of female awardees across all 5 organizations from 2014 to 2018 was 28%. Only 16% of all named awards were named after women, and female awardees were more likely to be recognized early in their career for advocacy and work pertaining to the advancement of women, whereas men were favored for awards recognizing mentorship and organizational contributions.

CONCLUSION

Emergency medicine is unique among other specialties in that the percentage of women represented in national awards (28%) closely mirrors the overall representation of women in emergency medicine (27.6% in the United States, 31% in Canada). This is in contrast to the documented leadership gap in academic medicine and emergency medicine, which may reflect a lag time between receiving national awards and earning academic and professional promotion. Although some organizations had significantly lower representation of female awardees, the overall trends indicate that women have closed the gender gap in award representation. This may signal a forthcoming change in other domains with established gaps in emergency medicine; specifically, in leadership and pay.

To select or be selected - gendered experiences in clinical training affect medical students' specialty preferences

BACKGROUND

The literature investigating female and male medical students' differing career intentions is extensive. However, medical school experiences and their implications for professional identity formation and specialty choice have attracted less attention. In this study we explore the impact of medical school experiences on students' specialty preferences, investigate gender similarities and differences, and discuss how both might be related to gender segregation in specialty preference.

METHODS

In a questionnaire, 250 Swedish final-year medical students described experiences that made them interested and uninterested in a specialty. Utilizing a sequential mixed methods design, their responses were analyzed qualitatively to create categories that were compared quantitatively.

RESULTS

Similar proportions of women and men became interested in a specialty based on its knowledge area, patient characteristics, and potential for work-life balance. These aspects, however, often became secondary to whether they felt included or excluded in clinical settings. More women than men had been deterred by specialties with excluding, hostile, or sexist workplace climates (W = 44%, M = 16%). In contrast, more men had been discouraged by specialties' knowledge areas (W = 27%, M = 47%).

CONCLUSIONS

Male and female undergraduates have similar incentives and concerns regarding their career. However, the prevalence of hostility and sexism in the learning environment discourages especially women from some specialties. To reduce gender segregation in specialty choice, energy should be directed towards counteracting hostile workplace climates that explain apparent stereotypical assumptions about career preferences of men and women.

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.

Gender differences in job quality and job satisfaction among doctors in rural western China

Background

Few studies about gender differences in job quality and job satisfaction among medical professionals have been carried out in China. So the objectives of this study were to examine whether and to what extent gender differences existed in job quality and job satisfaction of doctors in rural western China.

Methods

From 2009 to 2011, a total of 1472 doctors from 103 selected county-level health care facilities in rural western China were recruited into the study. Information about the doctors’ demographic characteristics, job quality, and job satisfaction was collected through a designed questionnaire. Besides examining gender differences in single dimensions of job quality and job satisfaction, principal component analysis was used to construct a composite job quality index to measure the differences in the comprehensive job quality, and exploratory factor analysis was applied to evaluate the differences in the overall job satisfaction. Chi-square test was used to calculate differences between proportions, and t-test was used to compare differences between means.

Results

Among the doctors, there were 705 males and 767 females (ratio 1:1.09). Male doctors had significantly higher monthly salaries, longer working hours, more times of night shifts per month, longer continuous working hours, and longer years of service at current facilities, and marginally significantly higher hourly wage and longer years of service in current professions. However, female doctors showed greater overall job qualities. Significant and marginally significant gender differences were only found in satisfaction with remuneration compared to workload, the chance of promotion and working environment. But female showed greater satisfaction in the overall job satisfaction and the factor including sub-aspects of working environment, remuneration compared to workload, the chance of promotion, utilization of subjective initiative, and sense of achievement.

Conclusions

Gender differences in job quality and job satisfaction did exist among doctors in rural western China. The participating female doctors were shown to have better job quality and greater job satisfaction.

Electronic supplementary material

The online version of this article (doi: 10.1186/s12913-017-2786-y) contains supplementary material, which is available to authorized users.

An index to characterize female career promotion in academic medicine

BACKGROUND

Imbalances in female career promotion are a key factor of gender disparities at the workplace. They may lead to stress and stress-related diseases including burnout, depression or cardiovascular diseases. Since this problem cannot be generalized and varies between different fields, new approaches are needed to assess and describe the magnitude of the problem in single fields of work.

METHODS

To construct a new index, operating figures of female and male medical students were collected for Germany in a period over 15 years and their progression throughout their studies towards specialization and academic chair positions. By the use of different female to male ratios (f:m), we constructed an index that describes the extend by which women can ascent in their academic career by using the field of academic medicine as an example.

RESULTS

A medical student f:m ratio of 1.54 (52,366 female vs. 34,010 male) was found for Germany in 2013. In 1998, this f:m ratio was 0.999. In the same year (2013), the OB/GYN hospital specialists' f:m ratio was 1.566 (3347 female vs. 2137 male physicians) and 0.577 (516 female vs 894 male physicians) for ENT hospital specialists, respectively. The f:m ratios concerning chairs of OB/GYN and ENT were 0.105 and 0.1, respectively. Then an index was generated that incorporated these operating figures with the student f:m ratio as denominator and the chair f:m ratio as numerator while the hospital specialist f:m ratio served as a corrector in the numerator in order to adjust to the attraction of a given field to female physicians. As a result, the index was 0.044 for OB/GYN and 0.113 for ENT instead of ideally ~1 in a completely gender harmonized situation.

CONCLUSION

In summary, a new index to describe female career advancement was established for academic medicine. By the use of this index, different academic and medical fields can now be compared to each other and future benchmarks could be proposed. Also, country differences may be examined using the proposed index and the success of specific funding programs.

Unto the third generation: evidence for strong familial aggregation of physicians, psychologists, and psychotherapists among first-year medical and psychology students in a nationwide Austrian cohort census

BACKGROUND

Medical students present higher numbers of physician relatives than expectable from the total population prevalence of physicians. Evidence for such a familial aggregation effect of physicians has emerged in investigations from the Anglo-American, Scandinavian, and German-speaking areas. In particular, past data from Austria suggest a familial aggregation of the medical, as well as of the psychological and psychotherapeutic, professions among medical and psychology undergraduates alike. Here, we extend prior related studies by examining (1) the extent to which familial aggregation effects apply to the whole nation-wide student census of all relevant (eight) public universities in Austria; (2) whether effects are comparable for medical and psychology students; (3) and whether these effects generalize to relatives of three interrelated health professions (medicine, psychology, and psychotherapy).

METHODS

We investigated the familial aggregation of physicians, psychologists, and psychotherapists, based on an entire cohort census of first-year medical and psychology students (n = 881 and 920) in Austria with generalized linear mixed models.

RESULTS

For both disciplines, we found strong familial aggregation of physicians, psychologists, and psychotherapists. As compared with previous results, directionally opposite time trends within disciplines emerged: familial aggregation of physicians among medical students has decreased, whilst familial aggregation of psychologists among psychology students has increased. Further, there were sex-of-relative effects (i.e., more male than female physician relatives), but no substantial sex-of-student effects (i.e., male and female students overall reported similar numbers of relatives for all three professions of interest). In addition, there were age-benefit effects, i.e., students with a relative in the medical or the psychotherapeutic profession were younger than students without, thus suggesting earlier career decisions.

CONCLUSIONS

The familial aggregation of physicians, psychologists, and psychotherapists is high among medical and psychology undergraduates in Austria. Discussed are implications of these findings (e.g., gender equity, feminization of the medical field, ideas for curricular implementation and student counselling), study limitations, and avenues for future research.

Pipeline program recruits and retains women and underrepresented minorities in procedure based specialties: A brief report

As the US population continues to grow in racial and ethnic diversity, we also continue to see healthcare disparities across racial lines. Considerable attention has been given to creating a physician workforce that better reflects the population served by healthcare professionals. To address the low numbers of women and underrepresented minorities in procedural based specialties, Nth Dimensions has sought to address and eliminate healthcare disparities through strategic pipeline initiatives. This is a retrospective observational cohort study of 118 medical students from 29 accredited US medical schools, who were awarded a position in the Nth Dimensions Summer Internship program between 2005 and 2012. Overall, 84 NDSI scholars applied and 81 matched into procedure-based specialties; therefore the overall retention rate was 75% and the overall match rate across the eight cohorts was 72.3%. Through intervention-based change, the authors hypothesize that greater numbers in the residency training cohorts can lead to a greater number of physicians with diverse backgrounds and perspectives. Ultimately, this will enhance quality of care for all patients and improve decision making process that influence healthcare systems.

SUMMARY

Strategic pipeline programs increase successful recruit women and underrepresented minorities to apply and matriculate into procedure based residency programs. This is a retrospective observational cohort study of 118 medical students who completed the Nth Dimensions Summer Internship program between 2005 and 2012. Overall, 84 NDSI scholars applied and 81 matched into procedure-based specialties; therefore the overall retention rate was 75% and the overall match rate across the eight cohorts was 72.3%.

Experiences of the gender climate in clinical training - a focus group study among Swedish medical students

BACKGROUND

Research shows that medical education is characterized by unequal conditions for women and men, but there is a lack of qualitative studies investigating the social processes that enable and maintain gender inequalities that include both male and female students. In this focus group study, we therefore explored male as well as female medical students' experiences of the gender climate - i.e., how beliefs, values, and norms about gender were communicated - during clinical training and how the students dealt with these experiences.

METHODS

Focus group interviews were conducted with 24 medical students (nine men) at Umeå University, Sweden. The interviews were structured around personal experiences in clinical training where the participants perceived that gender had mattered. Data were analysed using qualitative content analysis.

RESULTS

The students described gender-stereotyped expectations, discriminatory treatment, compliments, comments, and demeaning jargon. Female students gave more personal and varied examples than the men. The students' ways of handling their experiences were marked by efforts to fit in, for example, by adapting their appearance and partaking in the prevailing jargon. They felt dependent on supervisors and staff, and due to fear of repercussions they kept silent and avoided unpleasant situations and people rather than challenging humiliating jargon or supervisors who were behaving badly.

CONCLUSIONS

Everyday communication of gender beliefs combined with students' adaptation to stereotyped expectations and discrimination came across as fundamental features through which unequal conditions for male and female students are reproduced and maintained in the clinic. Because they are in a dependent position, it is often difficult for students to challenge problematic gender attitudes. The main responsibility for improvements, therefore, lies with medical school leadership who need to provide students and supervisors with knowledge about gendered processes, discrimination, and sexism and to organize reflection groups about the gender climate in order to improve students' opportunities to discuss their experiences, and hopefully find ways to protest and actively demand change.

[Surgery as specialization for female physicians: Results from course evaluations and alumni studies at MHH]

BACKGROUND

There is a lack of young surgeons in Germany. In order to provide a successful learning environment in medical education and to attract more physicians, training concepts need to be regularly controlled.

MATERIAL AND METHODS

Evaluation results compiled over several years from the Hanover Medical School (MHH) were analyzed for gender-related differences. In addition to overall satisfaction with practical training items were included that consider aspects of interaction between students and instructors. Furthermore, alumni studies provided data on the postgraduate specialty choice made by MHH students.

OBJECTIVES

Surgical training is integrated into medical education as block training periods of various durations. Against the background of an increased percentage of women in medicine this article analyzed whether surgery is evaluated differently between female and male medical students with respect to their experiences in clinical teaching.

RESULTS

Evaluations of clinical training in surgery demonstrated that female and male medical students do not differ substantially with respect to the teaching quality; however, young female physicians choose surgery as a professional option less frequently than men.

CONCLUSION

A systematic review of clinical training evaluations is crucial to identify weaknesses of current curricula. More empirical data from other faculties can induce discussions about the attractiveness of surgery as a profession.

Incorporating Spirituality into Health Sciences Education

Researchers are beginning to collect empiric data about coping mechanisms of health science students. Yet, there is an important aspect of coping with stress that is only partially addressed in health sciences curricula: students' spiritual well-being. In this essay, we describe a course in spirituality and health care that we offered to fourth-year medical students, as well as a small empirical study we conducted to assess students' spiritual needs and practices. We then offer reflections on the broad applicability of this work to students in the health sciences more generally, including suggestions for curriculum interventions that may ensure students' success.

Gender Bias in Diagnostic Radiology Resident Selection, Does it Exist?

RATIONALE AND OBJECTIVES

To investigate whether there is a bias in the residency selection process that influences the proportion of females entering diagnostic radiology residencies.

MATERIALS AND METHODS

A total of 4117 applications to one diagnostic radiology residency program from 2008 to 2014 were analyzed. Invitations to interview were evaluated by each year, specifically looking at gender. Ranking of applicants, especially those placed in top 25% of the rank, was also assessed. Additional data analyzed included United States Medical Licensing Examination Step 1 board examination score (a proxy for academic performance), interview scores, and final position on rank list.

RESULTS

Female applicants averaged 24% of the total applicant pool during the years studied, yet made up a disproportionately high percentage of applicants invited to interview (30%) and those ranked in top 25% (38%). It was found that female applicants had slightly higher mean interview scores and lower Step 1 scores than male applicants.

CONCLUSIONS

Our findings suggest that program directors in one program want to increase gender diversity by making strides to keep the female candidate pool and the proportion of female residents in the program at least stable. The pipeline of female medical students pursuing a career in radiology appears to be a limiting factor rather than a bias against women in the resident selection process. Identifying such trends is important as it provides a better understanding of the etiology for an overall lack of gender diversity within the field. Furthermore, it may lead to closing the gender gap in radiology.

A national study of paramedic and nursing students' readiness for interprofessional learning (IPL): Results from nine universities

BACKGROUND

The development of successful and functional interprofessional practice is best achieved through interprofessional learning (IPL). Given that many paramedic programmes still take an isolative uni-professional educational approach to their undergraduate courses, it is unclear on their preparedness for students' IPL. Therefore, the objective of this study was to assess the attitudes of undergraduate paramedic and nursing/paramedic students from nine Australian universities towards IPL over a two year period.

METHODS

Using a convenience sample of paramedic and nursing/paramedic students-attitudes towards IPL was measured using the Readiness for Interprofessional Learning Scale (RIPLS) 5-point Likert-scale (1=strongly disagree and 5=strongly agree).

RESULTS

A total of 1264 students participated (n=303 in 2011 and n=961 in 2012) in this study, consistent with a 43% response rate. Surveyed students were predominantly first year n=506 (40.03%), female n=748 (59.2%) and undertaking single paramedic degrees n=948 (75.0%). Nursing/paramedic students demonstrated significantly lower Negative Professional Identity (M=6.26, p=0.004) and Roles and Responsibilities means (M=6.87, p<0.0001) and higher Positive Professional Identity means (M=15.68, p=0.011) compared with paramedic students.

CONCLUSIONS

The impact of nursing/paramedic education was shown to significantly enhance student attitudes towards interprofessionalism and the individual universities involved in this study generated students at varying stages of IPL preparedness. Students' year level appeared to influence IPL readiness, yet there are compelling paradoxical arguments for both earlier and later inclusion of IPL within curricula.

Gendered career considerations consolidate from the start of medical education

OBJECTIVE

To explore changes in specialty preferences and work-related topics during the theoretical phase of Dutch medical education and the role of gender.

METHODS

A cohort of medical students at Radboudumc, the Netherlands, was surveyed at start (N=612, 69.1% female) and after three years (N=519, 69.2% female), on specialty preferences, full-time or part-time work, motivational factors, and work-life issues. Chi square tests were performed to analyze gender-differences, and logistic regression to explore the influence of gender on considerations.

RESULTS

A total of 214 female and 78 male students completed both surveys. After three years, the male students remained highly interested in surgery, but the female students increasingly preferred gynecology. These initial preferences were predictive. Four out of five male students versus three out of five female students continued to show a full-time preference. Women increasingly preferred part-time work. After three years, the combination of work, care, and patient contact motivated female students more, whereas salary remained more important to male students. Female students indicated that their future careers would influence their family life; male students assumed having a family would only affect their partners' careers.

CONCLUSIONS

Against an international background of the feminization of medicine, our study shows that career considerations are reinforced early in medical studies. Women prefer to work fewer hours and anticipate care tasks more often. Students' preferences reflect Dutch cultural norms about working men and women. Therefore, guidance in choice-making much earlier in medical education can create opportunities.

Gender differences in the learning and teaching of surgery: a literature review

OBJECTIVE

To explore evidence concerning gender differences in teaching and learning in surgery to guide future initiatives.

METHODS

This systematic review was conducted searching in the following electronic databases: MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, Scopus and PubMed. All studies related to gender differences in surgical education, teaching or learning of surgery at an undergraduate level were included. Data was extracted and critically appraised. Gender differences in learning, teaching, skills acquisition, perceptions and attitudes, interest on surgery, personality and factors influencing interest in surgical careers were differentiated.

RESULTS

There is an underrepresentation of women in surgical academia, due to lack of role models and gender awareness. It is not clear whether or not gender itself is a factor that affects the learning of surgical tasks. Female students pursuing a surgical career had experienced sexual harassment and gender discrimination that can have an effect on the professional identity formation and specialty choice. There are differences in personality among female and male students interested in surgery. Gender is a determining factor to choose surgery, with a consistent lower proportion of women compared interested in pursuing a surgical career. Mentoring and personality fit are important in medical student's specialty selection. Female students are more likely to be discouraged from pursuing a surgical career by a lack of female role models.

CONCLUSIONS

Bias against women in surgery still exists. There is a lack of studies that investigate the role of women in the teaching of surgery.

Gendered specialities during medical education: a literature review

The careers of male and female physicians indicate gender differences, whereas in medical education a feminization is occurring. Our review aims to specify gender-related speciality preferences during medical education. A literature search on gender differences in medical students' speciality preferences was conducted in PubMed, Eric, Embase and Social Abstracts, and reference lists from January 2000 to June 2013. Study quality was assessed by critical appraisal. Our search yielded 741 hits and included 14, mostly cross-sectional, studies originating from various countries. No cohort studies were found. Throughout medical education, surgery is predominantly preferred by men and gynaecology, paediatrics and general practice by women. Internal medicine was pursued by both genders. The extent of gender-specific speciality preferences seemed related to the male-to-female ratio in the study population. When a population contained more male students gynaecology seemed even more preferred by women, while in a more feminine population, men more highly preferred surgery. Internationally, throughout medical education, gender-related speciality preferences are apparent. The extent might be influenced by the male-to-female ratio of a study population. Further research of the role of gender in career considerations of medical students on the future workforce is necessary.

Show what you know and deal with stress yourself: a qualitative interview study of medical interns' perceptions of stress and gender

BACKGROUND

Medical students report high stress levels and in particular, the clinical phase is a demanding one. The field of medicine is still described as having a patriarchal culture which favors aspects like a physicians' perceived certainty and rationalism. Also, the Effort-Recovery Model explains stress as coming from a discrepancy between job demands, job control, and perceived work potential. Gendered differences in stress are reported, but not much is known about medical interns' perceptions of how gender plays in relation to stress. The aim of this study is to explore how medical interns experience and cope with stress, as well as how they reflect on the gendered aspects of stress.

METHODS

In order to do this, we have performed a qualitative study. In 2010-2011, semi-structured qualitative interviews were conducted with seventeen medical interns across all three years of the Masters programme (6 male, 11 female) at a Dutch medical school. The interview guide is based on gender theory, the Effort-Recovery Model, and empirical literature. Transcribed interviews have been analyzed thematically.

RESULTS

First, stress mainly evolves from having to prove one's self and show off competencies and motivation ("Show What You Know…"). Second, interns seek own solutions for handling stress because it is not open for discussion (… "And Deal With Stress Yourself"). Patient encounters are a source of pride and satisfaction rather than a source of stress. But interns report having to present themselves as 'professional and self-confident', remaining silent about experiencing stress. Female students are perceived to have more stress and to study harder in order to live up to expectations.

CONCLUSIONS

The implicit message interns hear is to remain silent about insecurities and stress, and, in particular, female students might face disadvantages. Students who feel less able to manifest the 'masculine protest' may benefit from a culture that embraces more collaborative styles, such as having open conversation about stress.

Few gender differences in specialty preferences and motivational factors: a cross-sectional Swedish study on last-year medical students

BACKGROUND

Today, women constitute about half of medical students in several Western societies, yet women physicians are still underrepresented in surgical specialties and clustered in other branches of medicine. Gender segregation in specialty preference has been found already in medical school. It is important to study the career preferences of our future physicians, as they will influence the maintenance of an adequate supply of physicians in all specialties and the future provision of health care. American and British studies dominate the area of gender and medical careers whereas Swedish studies on medical students' reasons for specialty preference are scarce. The aim of this study is to investigate and compare Swedish male and female medical students' specialty preferences and the motives behind them.

METHODS

Between 2006 and 2009, all last-year medical students at Umea University, Sweden (N = 421), were invited to answer a questionnaire about their future career and family plans. They were asked about their specialty preference and how they rated the impact that the motivational factors had for their choice. The response rate was 89% (N = 372); 58% were women (N = 215) and 42% were men (N = 157). Logistic regression was used to evaluate the independent impact of each motivational factor for specialty preference.

RESULTS

On the whole, male and female last-year students opted for similar specialties. Men and women had an almost identical ranking order of the motivational factors. When analyzed separately, male and female students showed both similarities and differences in the motivational factors that were associated with their specialty preference. A majority of the women and a good third of the men intended to work part-time. The motivational factor combining work with family correlated with number of working hours for women, but not for men.

CONCLUSIONS

The gender similarities in the medical students' specialty preferences are striking and contrast with research from other Western countries where male and female students show more differences in career aspirations. These similarities should be seized by the health care system in order to counteract the horizontal gender segregation in the physician workforce of today.

Pressures to "measure up" in surgery: managing your image and managing your patient

OBJECTIVE

To identify pressures created by surgical culture and social setting and explore mechanisms for how they might impact operative decision-making.

BACKGROUND

Surgeons apply judgments within a powerful social context and are constantly socialized and influenced by communicative exchanges. In this study, the authors characterized the nature of the surgical social context, focusing on the interactions between external social influences and the cognitive ability of the surgeon to respond to uncertain, unexpected, or critical moments in operations.

METHODS

The authors reviewed the sociological and psychosocial literatures to examine concepts in identity construction, socialization process, and image management literatures and synthesized a conceptual framework allowing for the examination of how social factors and image management might impact surgical performance.

RESULTS

The surgeon's professional identity is constructed and negotiated on the basis of the context of surgical culture. Trainees are socialized to display confidence and certainty as part of the "hidden curriculum" and several sociocultural mechanisms regulating "appropriate" surgical behavior exist in this system. In the image management literature, individuals put on a "front" or social performance that is socially acceptable. Several mechanisms for how image management might impact surgical judgment and decision-making were identified through an exploration of the cognitive psychology literature.

CONCLUSIONS

Sociopsychological literatures can be linked with decision-making and cognitive capacity theory. When cognitive resources reach their limit during critical and uncertain moments of an operation, the consumption of resources by the pressures of reputation and ego might interfere with the thought processes needed to execute the task at hand. Recognizing the effects of external social pressures may help the surgeon better self-regulate, respond mindfully to these pressures, and prevent surgical error.

Possible impact of increase in female medical student admissions in Nepal: Findings from a qualitative study among medical undergraduates

BACKGROUND

In Nepal, a developing country in South Asia, the number of female medical students has increased significantly.

AIMS

The present study was carried out to explore perceived perceptions for this increase, study the perceived impact on teaching-learning activities, medical school infrastructure and possible perceived changes in the doctor-patient relationship.

METHOD

First, second and third year students were invited to participate in focus group discussions (FGDs). Fifty-four students were willing to participate. Twenty-five were from the first year, 20 from the second and 9 from the third year. The FGDs conducted over a 90 minute period were voice and video recorded. The groups consisted of both males and females from a particular intake. The findings were transcribed verbatim.

RESULTS

Participants felt more female students were taking up medicine in the country because of more colleges opening in the cities and towns making it easier for female students to enrol in the course. Also parents consider medicine as a safe, noble and dignified profession for their daughters. Participants suggested women are more empathetic doctors and the doctor-patient relationship might become more patient-focused. Women doctors can serve as a source of inspiration and the overall impact on Nepal would be positive.

CONCLUSION

Participating students perceived the increasing number of female medical students may be due to changes in Nepalese society. This study was carried out only among three batches of students in a single medical school. Further studies among different batches of students and among interns in other medical schools are required. Studies among postgraduate students and doctors are also needed.

The Influence of Gender on ProfessionalismFemale in Trainees

PURPOSE

This study aimed to analyze the experience of female trainees who were trained in hospitals after graduating from medical school, focusing on methods of representing their gender in training courses.

METHODS

We interviewed 8 trainees who had been trained in a hospital in Seoul and 4 faculties from June 2010 to October 2010. We analyzed their similarities and differences and developed a vocational identity formation process to represent gender.

RESULTS

Gender was represented contradictorily in their training course, affecting their choice of specialties and interactions with patients. But, female trainees did not want to their being distinguished from their male counterparts with regard to being a good doctor to be influenced by meritocracy. It was difficult for them to bear children and balance work and family life due to aspects of the training system, including long work hours and the lack of replacement workers. Consequently, they asked their parents to help with child care, because hospitals are not interested in the maternity system. Female trainees did not consider being a doctor to be a male profession. Likely, they believed that their femininity influenced their professionalism positively.

CONCLUSION

The methods of representing gender are influenced by the training system, based a male-dominated apprenticeship. Thus, we will research the mechanisms that influence gender-discriminated choices in specialties, hospitals, and medical schools and prepare a maternity care system for female trainees. Strategies that maximize recruitment and retention of women in medicine should include a consideration of alternative work schedules and optimization of maternity leave and child care opportunities.

Medical Student Mentorship in a University Setting as a Strategy for a Career in Surgery

Gender balance in surgery is a respectable and necessary goal. At the University of Louisville (UL) School of Medicine, we have compared percentages of UL medical student applicants to general surgery or surgical subspecialty residency programs, surgical residents, and surgical faculty with the rest of the nation. Although UL has at times paralleled or exceeded the nation in many of these categories, there is room for improvement and the comparison data allow for strategic planning initiatives. To promote gender balance among future generations of surgeons at UL, we recently implemented a mentoring program that pairs medical students with residents and faculty in surgery. We plan to track the success over time and correct any shortcomings of this program. Virginia Commonwealth University's commitment to gender balance in surgery is exemplary. As part of a more comprehensive vision to create a mentorship program for female medical students at the UL School of Medicine, we have recently recruited female surgical residents and faculty, whom we hope will provide the type of inspiration and guidance that will increase the number of women from UL who decide to train in general surgery and the surgical specialties. To understand why women across the nation are not generally at numerical parity in these fields, it is important to consider the length and intensity of the surgical residency programs in the context of the other goals and objectives that a woman might have for her future. This article does not address this broad topic but provides a perspective of how a medical school can evaluate and perhaps intervene to mentor medical students more effectively about the satisfaction derived from a career in surgery. As part of this project, we have evaluated each step of the path through medical school and a surgical residency by comparing data for our students, residency programs, and faculty with national data.

Six ways problem-based learning cases can sabotage patient-centered medical education

PURPOSE

Problem-based learning (PBL) cases tell a story of a medical encounter; however, the version of the story is typically very biomedical in focus. The patient and her or his experience of the situation are rarely the focus of the case despite a prevalent discourse of patient-centeredness in contemporary medical education. This report describes a qualitative study that explored the question, "How does PBL teach medical students about what matters in medicine?"

METHOD

The qualitative study, culminating in 2008, involved three data collection strategies: (1) a discourse analysis of a set of PBL cases from 2005 to 2006, (2) observation of a PBL tutorial group, and (3) semistructured, in-depth, open-ended interviews with medical educators and medical students.

RESULTS

In this report, using data gathered from 67 PBL cases, 26 hours of observation, and 14 interviews, the author describes six specific ways in which PBL cases-if not thoughtfully conceptualized and authored-can serve to overlook social considerations, thereby undermining a patient-centered approach. These comprise the detective case, the shape-shifting patient, the voiceless PBL person, the joke name, the disembodied PBL person, and the stereotypical PBL person.

CONCLUSIONS

PBL cases constitute an important component of undergraduate medical education. Thoughtful authoring of PBL cases has the potential to reinforce, rather than undermine, principles of patient-centeredness.

'Important… but of low status': male education leaders' views on gender in medicine

OBJECTIVES

The implementation of and communication about matters associated with gender in medical education have been predominantly perceived as women's issues. This study aimed to explore attitudes towards and experiences of gender-related issues among key male members of faculties of medicine.

METHODS

We conducted semi-structured interviews with 20 male education leaders from the six medical schools in Sweden. The interviews were analysed qualitatively using a modified grounded theory approach.

RESULTS

The core category--'important… but of low status'--reflects ambivalent attitudes towards gender-related issues in medicine among male education leaders. All informants were able to articulate why gender matters. As doctors, they saw gender as a determinant of health and, as bystanders, they had witnessed inequalities and the wasting of women's competence. However, they had doubts about gender-related issues and found them to be overemphasised. Gender education was seen as a threat to medical school curricula as a consequence of the time and space it requires. Gender-related issues were considered to be unscientifically presented, to mostly concern women's issues and to tend to involve 'male bashing' (i.e. gender issues were often labelled as ideological and political). Interviewees asked for facts and knowledge, but questioned specific lessons and gender theory. Experiences of structural constraints, such as prejudice, hierarchies and homosociality, were presented, making gender education difficult and downgrading it.

CONCLUSIONS

The results indicate that male faculty leaders embrace the importance of gender-related issues, but do not necessarily recognise or defend their impact on an area of significant knowledge and competence in medicine. To change this and to engage more men in gender education, faculty measures are needed to counteract prejudice and to upgrade the time allocation, merits and status of gender implementation work. Based on our findings, we present and discuss possible ways to interest more men and to improve gender education in medicine.

Gender and the pre-clinical experiences of female medical students: a taxonomy

CONTEXT

The number of women entering medical school has increased substantially in recent years. However, practising female doctors still report gender-associated professional challenges. We focused on female medical students to characterise how gender shapes the range of their professional experiences during the pre-clinical years of medical school.

METHODS

We conducted a qualitative study from 2006 to 2007 using in-depth interviews with 12 Year 3 female medical students at a private New England medical school who had completed their pre-clinical years of training. All transcripts were analysed using a grounded theory approach; the code structure was developed through a process of inductive reasoning. Coding team members coded all transcripts line by line, using a constant comparative method of analysis.

RESULTS

The resulting taxonomy identifies three domains that capture the recurrent gender-associated experiences of our participants: (i) observations of the effect of gender on pre-clinical educational experiences through instructor, student and institutional behaviour; (ii) responses to observations of gender-based occurrences in terms of emotional reactions and strategic responses, and (iii) gender-associated expectations for the clinical years and beyond brought about by a heightened awareness of gender. Participants reported subtle as well as overt gender-based experiences and emotional consequences of both.

CONCLUSIONS

Female medical students continue to report numerous gender-based experiences during their pre-clinical training. Such experiences have both emotional and educational consequences and institutions should develop multifaceted approaches to address the full spectrum of gender-based experiences that affect medical students.

Effects of age, gender and educational background on strength of motivation for medical school

The aim of this study was to determine the effects of selection, educational background, age and gender on strength of motivation to attend and pursue medical school. Graduate entry (GE) medical students (having Bachelor's degree in Life Sciences or related field) and Non-Graduate Entry (NGE) medical students (having only completed high school), were asked to fill out the Strength of Motivation for Medical School (SMMS) questionnaire at the start of medical school. The questionnaire measures the willingness of the medical students to pursue medical education even in the face of difficulty and sacrifice. GE students (59.64 ± 7.30) had higher strength of motivation as compared to NGE students (55.26 ± 8.33), so did females (57.05 ± 8.28) as compared to males (54.30 ± 8.08). 7.9% of the variance in the SMMS scores could be explained with the help of a linear regression model with age, gender and educational background/selection as predictor variables. Age was the single largest predictor. Maturity, taking developmental differences between sexes into account, was used as a predictor to correct for differences in the maturation of males and females. Still, the gender differences prevailed, though they were reduced. Pre-entrance educational background and selection also predicted the strength of motivation, but the effect of the two was confounded. Strength of motivation appears to be a dynamic entity, changing primarily with age and maturity and to a small extent with gender and experience.

Assessment of gender-specific preventive cardiovascular knowledge among house staff: Potential impact on cardiovascular management

BACKGROUND

Gender differences in cardiovascular prevention and treatment may be related to physicians' level of postgraduate training and gender.

OBJECTIVES

This study was designed to assess resident physician knowledge concerning general and gender-specific preventive cardiology topics and to determine whether there were differences in that knowledge based on the physicians' level of postgraduate training or gender.

METHODS

A 29-item true/false questionnaire was administered to residents in a large, university-based internal medicine residency program. All questions were drawn from evidence-based practice guidelines, and a subset of questions pertained to gender-specific issues in cardiovascular disease prevention. Scores on the overall test and gender-specific subset were computed as a percentage of correct answers. Differences were compared by postgraduate year (PGY) of training and physician gender.

RESULTS

Of the 190 eligible residents, 159 (88 men, 67 women, 4 not specified) completed the questionnaire. Overall test scores differed significantly by PGY (PGY-1, 83.4% correct answers; PGY-2, 52.9%; PGY-3, 65.3%; P < 0.001 for each paired comparison), but did not differ significantly by physician gender (males, 73.5%; females, 70.0%). Performance on gender-specific items also differed by PGY (PGY-1, 72.2% vs PGY-2, 20.0%; P < 0.001; and PGY-1, 72.2% vs PGY-3, 45.1%; P < 0.001). Knowledge of gender-specific preventive cardiology did not differ significantly by physician gender (males, 56.4%; females, 49.0%).

CONCLUSIONS

Residents in PGY-1 had better knowledge of preventive cardiology as assessed using this questionnaire than did residents in PGY-2 or PGY-3. Knowledge of general and gender-specific cardiology topics was not related to physician gender.

A theoretical model for analysing gender bias in medicine

During the last decades research has reported unmotivated differences in the treatment of women and men in various areas of clinical and academic medicine. There is an ongoing discussion on how to avoid such gender bias. We developed a three-step-theoretical model to understand how gender bias in medicine can occur and be understood. In this paper we present the model and discuss its usefulness in the efforts to avoid gender bias. In the model gender bias is analysed in relation to assumptions concerning difference/sameness and equity/inequity between women and men. Our model illustrates that gender bias in medicine can arise from assuming sameness and/or equity between women and men when there are genuine differences to consider in biology and disease, as well as in life conditions and experiences. However, gender bias can also arise from assuming differences when there are none, when and if dichotomous stereotypes about women and men are understood as valid. This conceptual thinking can be useful for discussing and avoiding gender bias in clinical work, medical education, career opportunities and documents such as research programs and health care policies. Too meet the various forms of gender bias, different facts and measures are needed. Knowledge about biological differences between women and men will not reduce bias caused by gendered stereotypes or by unawareness of health problems and discrimination associated with gender inequity. Such bias reflects unawareness of gendered attitudes and will not change by facts only. We suggest consciousness-rising activities and continuous reflections on gender attitudes among students, teachers, researchers and decision-makers.

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.

From gender bias to gender awareness in medical education

Gender is an essential determinant of health and illness. Gender awareness in doctors contributes to equity and equality in health and aims towards better health for men and women. Nevertheless, gender has largely been ignored in medicine. First, it is stated that medicine was 'gender blind' by not considering gender whenever relevant. Secondly, medicine is said to be 'male biased' because the largest body of knowledge on health and illness is about men and their health. Thirdly, gender role ideology negatively influences treatment and health outcomes. Finally, gender inequality has been overlooked as a determinant of health and illness. The uptake of gender issues in medical education brings about specific challenges for several reasons. For instance, the political-ideological connotations of gender issues create resistance especially in traditionalists in medical schools. Secondly, it is necessary to clarify which gender issues must be integrated in which domains. Also, some are interdisciplinary issues and as such more difficult to integrate. Finally, schools need assistance with implementation. The integration of psychosocial issues along with biomedical ones in clinical cases, the dissemination of literature and education material, staff education, and efforts towards structural embedding of gender in curricula are determining factors for successful implementation. Gender equity is not a spontaneous process. Medical education provides specific opportunities that may contribute to transformation for medical schools educate future doctors for future patients in future settings. Consequently, future benefits legitimize the integration of gender as a qualitative investment in medical education.

Attitudes toward and experiences of gender issues among physician teachers: a survey study conducted at a university teaching hospital in Sweden

BACKGROUND

Gender issues are important to address during medical education, however research about the implementation of gender in medical curricula reports that there are obstacles. The aim of this study was to explore physician teachers' attitudes to gender issues.

METHODS

As part of a questionnaire, physician teachers at Umeå University in Sweden were given open-ended questions about explanations for and asked to write examples why they found gender important or not. The 1 469 comments from the 243 respondents (78 women, 165 men) were analyzed by way of content analysis. The proportion of comments made by men and women in each category was compared.

RESULTS

We found three themes in our analysis: Understandings of gender, problems connected with gender and approaches to gender. Gender was associated with differences between women and men regarding behaviour and disease, as well as with inequality of life conditions. Problems connected with gender included: delicate situations involving investigations of intimate body parts or sexual attraction, different expectations on male and female physicians and students, and difficulty fully understanding the experience of people of the opposite sex. The three approaches to gender that appeared in the comments were: 1) avoidance, implying that the importance of gender in professional relationships was recognized but minimized by comparing gender with aspects, such as personality and neutrality; 2) simplification, implying that gender related problems were easy to address, or already solved; and 3) awareness, implying that the respondent was interested in gender issues or had some insights in research about gender. Only a few individuals described gender as an area of competence and knowledge. There were comments from men and women in all categories, but there were differences in the relative weight for some categories. For example, recognizing gender inequities was more pronounced in the comments from women and avoidance more common in comments from men.

CONCLUSION

The surveyed physician teachers gave many examples of gender-related problems in medical work and education, but comments describing gender as an area of competence and knowledge were few. Approaches to gender characterized by avoidance and simplification suggest that faculty development programs on gender need to address and reflect on attitudes as well as knowledge.