'Man up': Medical students' perceptions of gender and learning in clinical practice: A qualitative study

Girls in scrubs: An ethnographic exploration of the clinical learning environment

BACKGROUND

Gender bias is an enduring issue in the medical profession despite women being more represented within medical schools and the health care workforce in numerous countries across the world. There have been frequent calls for further exploration of gender-based discriminations within medical education, owing to its lasting impact on student's professional development and career trajectories. This paper presents an ethnographic exploration of the experiences of female medical students and doctors in the clinical learning environment (CLE), aiming to disrupt the cycle of gender inequity in the clinical workplace.

METHODS

Our research field involved two teaching wards in a Scottish urban hospital, where 120 h of non-participant observations were conducted over 10 months. Combining purposive and convenience sampling, we conducted 36 individual interviews with key informants, which included medical students, foundation doctors, postgraduate trainees, consultant supervisors, and other health care professionals such as nurses and pharmacists. Data was thematically analysed using Bourdieu's theory of social power reproduction. The research team brought diverse professional backgrounds and perspectives to the exploration of data on gendered encounters.

RESULTS

Combining the observational and interview data, five themes were generated, which suggested gender-related differentials in social and cultural capital that the participants acquired in the CLE. Experiences of discriminatory behaviour and stereotypical thought processes impacted the female students' engagement and drive towards learning, implying an adverse influence on habitus. In contrast, the valuable influence of gendered role-models in building confidence and self-efficacy signified a positive transformation of habitus. The research participants displayed considerable internalisation of the gendered processes in the CLE that appeared to be linked to the transient nature of clinical placements.

CONCLUSIONS

This research reveals that despite constituting the majority demographic of medical school, female students struggle to gain social and cultural capital. Gendered hierarchies that structure clinical workplaces disadvantage female students and doctors, and the differential experiences transform their habitus. Based on our theoretically informed investigation, we advocate for role-models given their positive impact on students' and doctors' habitus. Additionally, medical educators may consider extended clinical placements that provide opportunities for female students and early-career doctors to secure social and cultural capital through integrating better in health care teams and building meaningful interprofessional relationships.

Self-perception of the acquisition of transferable competencies by the participants in a research congress for undergraduate students: A cross-sectional study

Context

Several curricular initiatives have been developed to improve the acquisition of research competencies by Health Science students.

Objectives

To know how students self-perceived of whether their participation in the XIV National Research Congress for Undergraduate Students of Health Sciences had helped them in the acquisition of 36 research-related transferable competencies (TCs) common to Health Science degrees.

Methods

A survey design (Cronbach's alpha = 0.924), using a self-administered questionnaire, was conducted among undergraduate students who voluntarily participated in the Congress. Data analysis was performed using SPSS 25 and Statgraphics 19. Statistical significance was considered for P < 0.05.

Results

Eighty-one students from 12 Health Science degree programs responded. Key findings are presented in a structured manner, using a Likert-5 scale. Twenty-five of the competencies surveyed obtained an average ≥ 4 highlighting: "Critically evaluate and know how to use sources of clinical and biomedical information to obtain, organize, interpret, and communicate scientific and health information"; "To be able to formulate hypotheses, collect and critically evaluate information for problem solving, following the scientific method", "Critical analysis and research" and "Communicate effectively and clearly, orally and in writing with other professionals". Significance was found in 15 competencies. The development of the competencies "Teamwork", "Critical reasoning" and "Analysis and synthesis abilities" was considered to be of greater "personal utility" by the respondents.

Conclusion

Participation in this event contributed to the development of research-related TCs, critical analysis and information management and communication, especially in relation to learning the sources of clinical and biomedical information, to know, following the scientific method, how to formulate hypotheses that allow students to solve problems in their professional activity. The experience was significantly influenced by the respondents' year, the type of participation in the event and the gender of the students. Limitations and suggestions regarding future research are discussed to encourage further exploration of the topic.

Influence of a sexism and sexual harassment prevention course on medical students' perceptions of and responses to problematic situations

BACKGROUND

Issues of sexism and sexual harassment within the medical field are widespread. The aim of his study was to describe the influence of a training course on the prevention of sexism and sexual harassment on medical students' perceptions and responses to problematic situations in the workplace.

METHODS

We performed a secondary analysis of the transcripts of 16 medical students' interviews. The data were initially gathered as part of an external evaluation of the course. We decided to further explore these with a focus on potential changes about sexism and sexual harassment awareness induced by the course. Data were analyzed using qualitative thematic analysis.

RESULTS

Most medical students were aware of the existence of sexism and sexual harassment in the medical environment before the course but were not always able to delineate what could be considered as such or not. The course allowed them to broaden their ability to identify problematic situations, that were somewhat "trivialized" before, and to set a lower cut-off when judging what constitutes sexism or sexual harassment. It also provided them with tools on how to react when confronted to these situations, as well as resources to seek help. However, students stressed the importance of such courses also being offered to medical staff higher up in the hierarchy, as they are the ones in a position of power.

CONCLUSIONS

The course helped students to better identify and react to sexism and sexual harassment. However, given students' lack of power within the hierarchy, efforts to prevent sexism and sexual harassment must be undertaken at an institutional level to allow for change in the system as a whole.

A gender biased hidden curriculum of clinical vignettes in undergraduate medical training

OBJECTIVES

Medical education relies extensively on clinical vignettes, yet little attention has been given to what hidden curriculum they might convey. Our research aimed to identify whether the clinical vignettes used in pre-graduate medical education transmit gender stereotypes or gender biases.

METHODS

We conducted a mixed quantitative and qualitative analysis of gender-related characteristics currently existing in clinical vignettes used for pre-graduate teaching and evaluation at the Geneva Faculty of Medicine.

RESULTS

2359 vignettes were identified, of which 955 met inclusion criteria. Patients' professions and family caregiver roles showed a strongly gendered distribution, as did the healthcare professions where male physicians and female nurses were the norm. Qualitative results identified widespread stereotyped gender roles and gender expression.

CONCLUSION

Our study reveals that the clinical vignettes used in education and evaluation materials in pre-graduate medical education in Geneva convey a gender-biased hidden curriculum, which could negatively impact patient care and undermine equal opportunity for men and women.

PRACTICE IMPLICATIONS

Active revision of the content and the form of clinical vignettes used in undergraduate medical education is needed using a gender lens. Based on rare gender neutral or gender transformative examples from our study, we propose guidelines for writing non-gender-biased vignettes.

Female Medical Students’ Experiences of Sexism during Clinical Placements: A Qualitative Study

In the UK, more women are studying medicine than men, most of whom have experienced sexism, yet these experiences are under-researched. This qualitative study explores female medical students’ experiences of sexism on placement, impacts sustained, barriers and facilitators encountered upon reporting. A total of 17 semi-structured interviews were conducted, employing purposive sampling, snowball sampling and an inductive thematic analysis. A qualitative methodology was underpinned by the feminist social constructionist theory. Four themes were identified: 1—experiences of sexism, comprising physical and verbal harassment and microaggressions; 2—negative impacts of sexist encounters ranged from psychosocial to repercussions on learning and development; 3—systemic and attitudinal barriers to reporting; 4—recommendations to tackle sexism shaped by the views and experiences of female medical student participants. Female medical students experienced wide-ranging sexism which negatively impacted their wellbeing with negative repercussions for their training and development. The barriers to reporting need to be urgently addressed, and systems, policies and processes need to be over-hauled to sensitively, effectively and equitably manage and provide justice to students who experience and report sexism. Students need to be empowered to respond, report and be offered psychological safety in doing so. Attitudes and practices which are complicit in sustaining sexism need to be challenged and changed.

Redressing injustices: how women students enact agency in undergraduate medical education

This study presents descriptions of epistemic injustice in the experiences of women medical students and provides accounts about how these students worked to redress these injustices. Epistemic injustice is both the immediate discrediting of an individual's knowledge based on their social identity and the act of persistently ignoring possibilities for other ways of knowing. Using critical narrative interviews and personal reflections over an eight-month period, 22 women students during their first year of medical school described instances when their knowledge and experience was discredited and ignored, then the ways they enacted agency to redress these injustices. Participants described three distinct ways they worked to redress injustices: reclaiming why they belong in medicine, speaking up and calling out the curriculum, and uplifting one another. This study has implications for recognizing medical students as whole individuals with lived histories and experiences and advocates for recognizing medical students' perspectives as valuable sources of knowledge.

'I wouldn't know what to do with the breasts': the impact of patient gender on medical student confidence and comfort in clinical skills

BACKGROUND

Previous research has found a relationship between students' gender and attitudes surrounding peer physical examination, but relationship between patient gender and confidence/comfort is less clear. We explored whether patient gender affects medical students' levels of confidence and comfort in clinical examination skills.

METHODS

An electronic survey and focus groups were conducted with medical students from one UK institution. Students reported levels of confidence/comfort when carrying out clinical examinations on men/women. An inductive thematic analysis was performed.

RESULTS

Of a total of 1500 students provided with the opportunity to participate, ninety (6%) responded. For cardiovascular and respiratory examinations, confidence/comfort were higher when examining male-presenting patients. The opposite was true for mental state examinations. Barriers to confidence/comfort included perceiving males as a norm, difficulty navigating breasts, tutors' internalised gendered attitudes and a wider sociocultural issue. Facilitators of confidence/comfort included students relating to patients, embodying a professional role, gender blindness, and authentic clinical environments. Fewer than 20% (n = 18) of students felt they had enough opportunity to practice clinical skills on women, versus 90% (n = 82) on men.

CONCLUSION

Our study identified an area where students' confidence and comfort in clinical examinations could be enhanced within medical education. Changes were implemented in the institution under study's vocational skills teaching, which is rooted in general practice. Information on gender and clinical skills was provided within course handbooks, time was scheduled to discuss gender and clinical skills in small group settings, and equitable gender representation was ensured in clinical assessment.

Prevalence and Impact of Academic Violence in Medical Education

Situations of mistreatment in the academic environment are prevalent worldwide, but research in this area is scarce in middle-low-income countries. This study aimed to estimate the prevalence of mistreatment inflicted against Brazilian medical students. In addition, characterize these situations and analyze their consequences. Cross-sectional study conducted with 831 medical students from public and private institutions. Absolute and relative frequencies of the analyzed variables and possible associations were determined through univariate and multivariate logistic regression. Chi-square test of association with second-order Rao-Scott adjustment was also used. The response rate was 56%. Public institution pointed to a higher prevalence of mistreatment when compared to private (59% versus 43%). Female students were the most affected. Verbal and psychological aggression was more prevalent. The aggressor usually was a faculty member. Mistreatment incidence increased over the years of training, with higher rates in the internship. About 94% of the students felt affected in anyway, with 77% feeling diminished and depressed. More than 50% reported impaired academic performance. Almost 30% sought help from experts. The reporting rate was extremely low. Adequate identification of the situations by the victims, safe reporting mechanisms and, an educational system capable of maintaining an appropriate learning environment are essential to break this destructive cycle.

Ova-looking feminist theory: a call for consideration within health professions education and research

The role of feminist theory in health professions education is often 'ova-looked'. Gender is one cause of healthcare inequalities within contemporary medicine. Shockingly, according to the World Health Organisation, no European member state has achieved full gender equity in regard to health outcomes. Further, contemporary curricula have not evolved to reflect the realities of a diverse society that remains riddled with inequity. This paper outlines the history of feminist theory, and applies it to health professions education research and teaching, in order to advocate for its continued relevance within contemporary healthcare.

Gender bias in the evaluation of interns in different medical specialties: An archival study

INTRODUCTION

The field of medicine is characterized by within-field gender segregation: Gender ratios vary systematically by subdisciplines. This segregation might be, in part, due to gender bias in the assessment of women and men medical doctors.

METHODS

We examined whether the assessments, i.e. overall score, department scores and skills scores, interns receive by their superiors during their internship year, vary as a function of their gender and the representation of women in the field. We analyzed an archival data set from a large hospital in Israel which included 3326 assessments that were given to all interns who completed their internship year between 2015 and 2019.

RESULTS

Women received lower department scores and skills scores in fields with a low (versus high) representation of women. Men received higher scores in fields with a high (versus low) representation of men, yet there was no difference in their skills scores.

CONCLUSIONS

Women are evaluated more negatively in fields with a low representation of women doctors. Similarly, men are evaluated more negatively in fields with a low representation of men, yet this cannot be explained by their skills. This pattern of results might point to a gender bias in assessments. A better understanding of these differences is important as assessments affect interns' career choices and options.

Relationship between research self-efficacy and evidence-based practice in the medical students

BACKGROUND

Due to the rapid advancement of medical knowledge, promotion in research is necessary to have the best clinical practice. Research Self-efficacy (RSE) is the researcher's confidence in their ability to conduct a specific study. The Evidence-Based Practice (EBP) represents how to improve the quality of care and treatment of patients. RSE and EBP are the cornerstones of successful research and then efficacious medical practice. This study aims to evaluate RSE and acceptance of EBP and their correlation among medical students.

MATERIALS AND MEHODS

This is a cross-sectional study designed on 600 clinical students at the medical school of Shiraz, using a census method in 2020. Students were invited to fill out the standardized Phillips and Russell's questionnaires about RSE (4 domains, 33 questions) and Rubin and Parrish's questionnaire of EBP (10 questions). The gathered data were analyzed through the SPSS at α = 0.05 using descriptive statistics, t-test, Chi-square, and multiple linear regressions.

RESULTS

There was a positive correlation between EBP and RSE score (P < 0.05). The results of linear regression test showed that all variables had a significant effect on our response variables and their effect were significant (P < 0.05). The highest mean score in RSE was shown in the subscale of writing skills (52.54). The lowest score was observed in the subscale of quantitative (student's subjective assessment of their ability to work with statistically related data and formulas) as well as computer skills (35.61).

CONCLUSIONS

Students who participated in a research project, workshop, or Master of Public Health program got a higher RSE and EBP. Due to the positive correlation between RSE and EBP, we conclude that trained physicians who can research independently and use research evidence can find the best treatment approach for patients. These finding support the importance of integrating research education in medical curriculum to increase RSE and finally improvement of EBP among medical students.

Assessing the gender gap in musculoskeletal radiology authorship across three continents: are really the "ladies first"?

AIM

To assess gender-specific authorship trends in musculoskeletal (MSK) radiology in three major radiology journals, Skeletal Radiology (SR), Clinical Radiology (CR) and Indian Journal of Radiology and Imaging (IJRI).

MATERIALS AND METHODS

Retrospective analysis of articles pertaining to MSK radiology was done for the years 2000, 2010, and 2020 for SR and CR and for the years 2010 and 2020 for IJRI. The number and positions of female authors was noted.

RESULTS

Three hundred and twenty-five articles were reviewed after excluding the articles where the gender of one or more authors could not be conclusively determined. In SR, the percentage of female authors increased significantly from 4% in 2000 to 17% in 2010 (p<0.0001) and to 21.9% in 2020 (p<0.0001) with an increase in the percentage of first female authors from 0.8% in 2000 to 4.9% in 2010 and further to 5.4% in 2020. In CR, the percentage of female authors reduced from 13.8% in 2000 to 13.6% in 2010 (p=0.9798 and further reduced to 7% in 2020 (p=0.1592). In IJRI, the percentage of articles with no female authors went down from 36.4% (2010) to 26.7% (2020).

CONCLUSION

There is an upward trend in female authorship in MSK radiology related articles in SR and IJRI with continued under-representation in CR. The first and middle order female authors have shown a significant increase, although the number of last female authors remains very low. Analysis of such trends in academic journals from other subspecialities in medicine needs to be undertaken to confirm or refute the findings of this study.

"I might not fit that doctor image": Ideal worker norms and women medical students

Despite the increasing numbers of women students in medical schools, focused attention on their perceptions about medical school and the medical profession remain underexamined. These perceptions are important to understand, particularly since women students are likely burdened with a host of gender norms related to work, family, and their future roles as physicians. Early experiences in medical school offer important insights into the larger student experience and are tied to academic outcomes and feelings of belonging. To examine early experiences of women medical students, this qualitative study used sensemaking theory to describe the current context and "story" of ideal worker norms. Critical qualitative interviews of 38 women students were performed during their first 2 months of medical school and explored both how the students perceived and experienced ideal worker norms, and how they made sense of the "story" of ideal worker norms. The participants described ways they encountered gendering and ideal worker norms through displays of nurturing behaviour, expectations to balance a future family, and whether they looked or acted the part of a doctor. This article highlights the challenges women medical students are already aware they will face, the opportunities they look forward to, and the strengths they anticipate leaning on to navigate their profession. Results from this study have implications for women medical students' learning experiences and transitions into medical school and for faculty, staff, and scholars concerned with challenging gendering norms that shape medical education.

Impact of Mentoring on Academic Career Success for Women in Medicine: A Systematic Review

PURPOSE

Research has shown that barriers to career success in academic medicine disproportionately affect women. These barriers include inadequate mentoring, which may perpetuate the underrepresentation of women in senior leadership positions. The purpose of this review was to summarize the qualitative and quantitative evidence of the impact of mentoring on women's career outcomes and to inform future interventions to support the promotion and retention of women in academic medicine.

METHOD

The authors conducted a systematic review of original research published in English-language, peer-reviewed journals through March 20, 2020. Search terms related to mentorship, women, and academic medicine. The authors searched MEDLINE, Embase, Scopus, Current Contents Connect via Web of Science, Cochrane Library, and PsycINFO. They excluded studies not specifically addressing women and those without gender-stratified outcomes. They extracted and analyzed the following data: study design, population, sample size, response rate, participant age, percentage of women, mentoring prevalence, and outcomes.

RESULTS

Of 2,439 citations identified, 91 studies met the inclusion criteria, including 65 quantitative and 26 qualitative studies. Mentoring was associated with objective and subjective measures of career success. Women perceived mentorship to be more valuable to their career development yet were more likely to report having no mentor. Additionally, women were more likely to report lower levels of research productivity, less career satisfaction, and greater barriers to promotion. Qualitative results indicated that women had less access to informal mentoring and family responsibilities had a greater effect on their career outcomes. Professional networking, female mentors, and relational aspects of mentoring were common themes.

CONCLUSIONS

This review examined gender disparities in mentoring and the impact on research productivity, promotion success, and career satisfaction for women in academic medicine. Institution-supported mentoring programs are needed to facilitate identification of appropriate mentors and promotion of a more equitable academic career environment for women.

Medical Students' Demographic Characteristics and Their Perceptions of Faculty Role Modeling of Respect for Diversity

IMPORTANCE

Faculty role modeling is critical to medical students' professional development to provide culturally adept, patient-centered care. However, little is known about students' perceptions of faculty role modeling of respect for diversity.

OBJECTIVE

To examine whether variation exists in medical students' perceptions of faculty role modeling of respect for diversity by student demographic characteristics.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study analyzed data from the Association of American Medical Colleges' 2016 and 2017 Medical School Graduation Questionnaire, which was administered to graduating students at 140 accredited allopathic US medical schools. Data were analyzed from January 1 to November 1, 2020.

MAIN OUTCOMES AND MEASURES

Students' perceptions of faculty role modeling of respect for diversity by the independent variables sex, race/ethnicity, sexual orientation, and age. Multivariable logistic regression was used to examine the extent to which student-reported perceptions of faculty respect for diversity varied by demographic characteristics, and logistic regression models were sequentially adjusted first for demographic characteristics and then for marital status and financial variables.

RESULTS

Of 30 651 students who completed the survey, the final study sample consisted of 28 778 respondents, representing 75.4% of the 38 160 total US medical school graduates in 2016 and 2017. Of the respondents, 14 804 (51.4%) were male participants and 1506 (5.2%) identified as lesbian, gay, or bisexual (LGB); a total of 11 926 respondents (41.4%) were 26 years or younger. A total of 17 159 respondents (59.6%) identified as White, 5958 (20.7%) as Asian, 1469 (5.1%) as Black/African American, 2431 (8.4%) as Hispanic/Latinx, and 87 (0.3%) as American Indian/Alaska Native/Native Hawaiian/Pacific Islander individuals. Overall, 5101 students (17.7%) reported perceiving that faculty showed a lack of respect for diversity. Of those who identified as Black/African American students, 540 (36.8%) reported perceiving a lack of faculty respect for diversity compared with 2468 White students (14.4%), with an OR of perceived lack of respect of 3.24 (95% CI, 2.86-3.66) after adjusting for other demographic characteristics and covariates. American Indian/Alaska Native/Native Hawaiian/Pacific Islander (OR, 1.73; 95% CI, 1.03-2.92), Asian (OR, 1.62; 95% CI, 1.49-1.75), or Hispanic/Latinx (OR, 1.43; 95% CI, 1.26-1.75) students also had greater odds of perceiving a lack of faculty respect for diversity compared with White students. Female students had greater odds compared with male students (OR, 1.17; 95% CI, 1.10-1.25), and students who identified as LGB (OR, 1.96; 95% CI, 1.74-2.22) or unknown sexual orientation (OR, 1.79; 95% CI, 1.29-2.47) had greater odds compared with heterosexual students. Students aged 33 years or older had greater odds of reporting a perceived lack of respect compared with students aged 26 years or younger (OR, 1.81; 95% CI, 1.58-2.08).

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, female students, students belonging to racial/ethnic minority groups, and LGB students disproportionately reported perceiving a lack of respect for diversity among faculty, which has important implications for patient care, the learning environment, and the well-being of medical trainees.

Nevertheless, They Persisted: How Women Experience Gender-Based Discrimination During Postgraduate Surgical Training

OBJECTIVE

More women than ever are pursuing surgical specialties despite historical dominance by men. The objective of this study was to examine how surgical residents experience gender-based discrimination during their residency training, including the common sources, settings, and implications of these experiences.

DESIGN

A sequential explanatory mixed methods design was used to combine results from an initial quantitative survey of surgical residents of all genders at the University of Calgary with qualitative data derived from interviews with surgical residents who identified as women.

PARTICIPANTS

Thirty-seven surgical residents of all genders completed a survey. Fourteen women completed a one-to-one, semistructured interview.

RESULTS

Women reported significantly more frequent experiences of gender-based discrimination than men, particularly regarding lack of respect from others, inappropriate jokes or comments, and hostile or humiliating behaviors. Nursing staff and patients were reported as prominent sources of discrimination, and the emergency and operating rooms were the most common settings. The qualitative findings highlighted the additional challenges for women during surgical residency, including navigating the relationships with nursing, having to work "twice as hard" to receive respect from patients and nurses, reports of persistent harassment and bullying, becoming desensitized to mistreatment and discrimination, and the influence of their gender on the quality of their education as well as their well-being.

CONCLUSIONS

Despite the increasing number of women entering surgical specialties, women surgical residents report frequent and severe experiences of gender-based discrimination during their training, even at an academic institution where over half of residents are women.

'Too male, too pale, too stale': a qualitative exploration of student experiences of gender bias within medical education

OBJECTIVE

To explore medical student perceptions and experiences of gender bias within medical education.

SETTING

Gender bias-'prejudiced actions or thoughts based on the perception that women are not equal to men'-is a widespread issue. Within medicine, the pay gap, under-representation of women in senior roles and sexual harassment are among the most concerning issues demonstrating its presence and impact. While research investigating experiences of clinicians is gaining traction, investigation of medical students' experiences is lacking. This qualitative study analyses medical students' experiences of gender bias within their education to discern any patterns to this bias. Illuminating the current state of medical education gender bias will hopefully highlight areas in which student experience could be improved. Constructivist thematic analysis was used to analyse data, informed by William's patterns of gender bias, intersectional feminism and communities of practice theory.

PARTICIPANTS

Thirty-two medical students from multiple UK medical schools participated in individual interviews. Nine faculty members were also interviewed to triangulate data.

RESULTS

Gender bias has an overt presence during medical student education, manifesting in line with William's patterns of bias, impacting career aspirations. Physical environments serve to manifest organisational values, sending implicit messages regarding who is most welcome-currently, this imagery remains 'too male, too pale…too stale'. Existing gender initiatives require careful scrutiny, as this work identifies the superficial application of positive action, and a failure to affect meaningful change.

CONCLUSIONS

Despite progress having been made regarding overt gender discrimination, implicit bias persists, with existing positive action inadequate in promoting the advancement of women. Institutions should mandate participation in implicit bias education programmes for all staff and must strive to revise the imagery within physical environments to better represent society. Gender initiatives, like Athena Scientific Women's Academic Network, also require large-scale evaluation regarding their impact, which this work found to be lacking.