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Lambert TW, Smith F, Goldacre MJ. Career choices for obstetrics and gynaecology: recent updates from 40 years of national surveys of UK medical graduates. JRSM Open 2019. [PMID: 31620304 PMCID: PMC6775562 DOI: 10.1177/2054270419861611;] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE To report doctors' early career choices for obstetrics and gynaecology, their eventual career destinations and factors influencing their career pathways. DESIGN Multi-cohort multi-purpose national questionnaire surveys of medical graduates in selected graduation years between 1974 and 2015. SETTING UK. PARTICIPANTS UK-trained medical graduates. MAIN OUTCOME MEASURES Career specialty choices; certainty about specialty choice; factors which influenced doctors' career choices; career specialty destinations 10 years after graduation. RESULTS Obstetrics and Gynaecology was the first choice of career for 5.7% of post-2002 graduates in year 1, 4.3% in year 3 and 3.8% in year 5. A much higher percentage of women than men specified Obstetrics and Gynaecology as their first choice: in year 1, 7.7% of women and 2.3% of men did so. The gender gap has widened since the 1970s and 1980s. In recent years, of those who specified Obstetrics and Gynaecology as their first choice in year 1 after graduation, 48% were working in Obstetrics and Gynaecology in year 10 (63% of men, 45% of women). Looking backwards from career destinations, 85% of doctors working in Obstetrics and Gynaecology in year 10 had specified Obstetrics and Gynaecology as a first, second or third choice of preferred career in year 1. CONCLUSIONS Interest in Obstetrics and Gynaecology among UK graduates appears to be exceeding the demand for new specialists. Policy needs to address risks of over-production of trainees and ensure that some graduates interested in Obstetrics and Gynaecology consider alternative careers. The large gender imbalance should encourage consideration of the reasons for men choosing Obstetrics and Gynaecology in falling numbers.
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Lambert TW, Smith F, Goldacre MJ. Career choices for obstetrics and gynaecology: recent updates from 40 years of national surveys of UK medical graduates. JRSM Open 2019; 10:2054270419861611. [PMID: 31620304 PMCID: PMC6775562 DOI: 10.1177/2054270419861611] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective To report doctors' early career choices for obstetrics and gynaecology, their eventual career destinations and factors influencing their career pathways. Design Multi-cohort multi-purpose national questionnaire surveys of medical graduates in selected graduation years between 1974 and 2015. Setting UK. Participants UK-trained medical graduates. Main outcome measures Career specialty choices; certainty about specialty choice; factors which influenced doctors' career choices; career specialty destinations 10 years after graduation. Results Obstetrics and Gynaecology was the first choice of career for 5.7% of post-2002 graduates in year 1, 4.3% in year 3 and 3.8% in year 5. A much higher percentage of women than men specified Obstetrics and Gynaecology as their first choice: in year 1, 7.7% of women and 2.3% of men did so. The gender gap has widened since the 1970s and 1980s. In recent years, of those who specified Obstetrics and Gynaecology as their first choice in year 1 after graduation, 48% were working in Obstetrics and Gynaecology in year 10 (63% of men, 45% of women). Looking backwards from career destinations, 85% of doctors working in Obstetrics and Gynaecology in year 10 had specified Obstetrics and Gynaecology as a first, second or third choice of preferred career in year 1. Conclusions Interest in Obstetrics and Gynaecology among UK graduates appears to be exceeding the demand for new specialists. Policy needs to address risks of over-production of trainees and ensure that some graduates interested in Obstetrics and Gynaecology consider alternative careers. The large gender imbalance should encourage consideration of the reasons for men choosing Obstetrics and Gynaecology in falling numbers.
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Affiliation(s)
- Trevor W Lambert
- UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
| | - Fay Smith
- UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
| | - Michael J Goldacre
- UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
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Bossé J, Woolcott C, Coolen J. Barriers Preventing Medical Students From Performing Pelvic Examinations During Obstetrics and Gynaecology Clinical Clerkship Rotations. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1093-1098. [PMID: 30803877 DOI: 10.1016/j.jogc.2018.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/13/2018] [Accepted: 12/18/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study sought to identify barriers that prevent medical students from performing pelvic examinations in their obstetrics and gynaecology (Ob/Gyn) clinical clerkship rotations and to compare the perspectives of faculty, residents, nurses, and students regarding perceived barriers. METHODS An electronic survey was distributed to third-year Dalhousie University (Halifax, NS) medical students on completion of their Ob/Gyn clerkship rotations in the 2015-2016 academic year and to Ob/Gyn nursing staff, faculty, and residents (Canadian Task Force Classification III). RESULTS There were 82 responses, giving an overall response rate of 28%. Students reported performing an average of 9.2 speculum examinations, 3.8 cervical checks, and 2.8 bimanual examinations during their 6-week rotations. They reported being declined the opportunity to perform an examination an average of 7.1 times. Students perceived themselves to be more competent performing these examinations compared with staff perception of student competency. Students perceived resident interest in teaching, resident and staff time constraints, and patient willingness to have a medical student involved in their examination as frequent barriers. Faculty, residents, and nurses perceived student gender, patient willingness, difficulty of examination, and resident time constraints to be significant barriers. CONCLUSION This study is the first to examine multidisciplinary perspectives on perceived barriers to medical students performing pelvic examinations. Staff and students have different perceptions of a student's competence performing these examinations. Existing barriers are likely multifactorial.
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Affiliation(s)
- Jessica Bossé
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS
| | - Christy Woolcott
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS; Department of Pediatrics, Dalhousie University, Halifax, NS
| | - Jillian Coolen
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS.
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Santhirakumaran S, Kalkat HS, Sonagara VJ. Pelvic floor examination performed by medical students: a model to obtain consent. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2018; 10:7-10. [PMID: 30643478 PMCID: PMC6314380 DOI: 10.2147/amep.s180310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Student-led clinical examinations, including pelvic floor examinations, are an integral part of clinical training and can be beneficial to both students and patients alike. However, our experience and previous literature catalog numerous obstacles in obtaining consent for student-led pelvic floor examinations. Although some of these factors may not be modifiable, it is evident that efforts can be made to overcome those that are. An examination of these obstacles can help to provide a clear and succinct template to overcoming them: we propose a "5-Rs" framework that may bridge the apparent gap between the students' need to practice and obtain valid consent.
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Affiliation(s)
- Swina Santhirakumaran
- Department of Undergraduate Medicine, Faculty of Medicine, Imperial College London, London, UK,
| | - Harkaran Singh Kalkat
- Department of Undergraduate Medicine, Faculty of Medicine, Imperial College London, London, UK,
| | - Vinay Jamnadas Sonagara
- Department of Undergraduate Medicine, Faculty of Medicine, Imperial College London, London, UK,
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Ismail SIMF, Kevelighan EH. A questionnaire survey of second year graduate-entry medical students' perception of obstetrics and gynaecology as a future career speciality. J OBSTET GYNAECOL 2018; 38:556-561. [PMID: 29431009 DOI: 10.1080/01443615.2017.1380612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this study was to explore the impressions of second year graduate-entry medical students of Obstetrics and Gynaecology, before their attachment in the speciality in the subsequent year, so as to improve its appeal to them and increase their recruitment into it. A total of 74 questionnaires were distributed at the end of the Learning Opportunities in Clinical Setting (LOCS) week in the speciality and 66 (89.19%) completed questionnaires were returned. Over 4% of the respondents were considering the speciality as their career choice and less than half would consider it as a second option. Whilst more than a third perceived some of the demerits of the speciality, more than a third endorsed its merits. This showed the need to explore and address their concerns about training and working in the speciality. Having a health-related primary degree, prior employment and being female were significantly associated with choosing the speciality as a career (p < .001). Barriers for male respondents were flagged, which need to be addressed, and a bias towards Obstetrics was noted, which reflects the narrow focus on the Labour Ward and necessitates a broader exposure to the speciality. Impact statement What is already known on this subject? The perception of third year graduate-entry medical students of Obstetrics and Gynaecology is biased towards Obstetrics, and they have apprehensions about the challenges of training and working in the speciality. What do the results of this study add? The views of second year graduate-entry medical students are consistent with the views of third year graduate-entry medical students, which shows that these views may be formed early. What are the implications of these findings for clinical practice and/or further research? More research is needed to establish and understand the perception of the speciality earlier than second year and explore the value of practical steps that may improve this perception and increase the interest in it and recruitment into its training programmes.
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Affiliation(s)
- Sharif I M F Ismail
- a Department of Obstetrics and Gynaecology , Royal Sussex County Hospital, Sussex Universities NHS Trust , Brighton , UK
| | - Euan H Kevelighan
- b Department of Obstetrics and Gynaecology , Singleton Hospital , Swansea , UK
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Wilson S, Eagles JM. The feminisation of psychiatry: changing gender balance in the psychiatric workforce. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.30.9.321] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Male and Female Emirati Medical Clerks’ Perceptions of the Impact of Gender and Mobility on Their Professional Careers. SOCIAL SCIENCES 2017. [DOI: 10.3390/socsci6030109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Buck K, Littleton H. Impact of educational messages on patient acceptance of male medical students in OB-GYN encounters. J Psychosom Obstet Gynaecol 2016; 37:84-90. [PMID: 27094338 DOI: 10.3109/0167482x.2016.1167181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Although training in obstetrics and gynecology is a key part of medical education, male students receive less extensive experience, due in part to patient refusals. However, there is limited work seeking to reduce patient refusal rates of male students. The current study examined the efficacy of two messages at increasing male medical student acceptance into a well-woman visit. METHODS A total of 656 college women participated in a simulation study where they viewed a video of a nurse asking for permission to have a male medical student participate in their well-woman visit. The 30.5% of women who refused student participation (n = 181) were randomly assigned to view a video of the nurse either describing students' medical knowledge and technical skills training (e.g. training in performing pelvic exams) or empathic skills training (e.g. training in communication about sensitive issues). They were again asked if they would be willing to have the student participate. RESULTS Both messages similarly increased student acceptance with 44.8% of those receiving the empathic skills training message and 48.9% of those who received the medical/technical skills training message accepting student participation, χ(2) (1, N = 181) = 0.3, p = 0.58. DISCUSSION Educational messages about medical student training delivered in an engaging fashion by a credible source are a potentially effective tool to increase male student acceptance into sensitive patient encounters. Future work should test these messages in real-world settings as part of a focus on patient education to increase comfort with student participation.
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Affiliation(s)
- Katherine Buck
- a Department of Family Medicine , John Peter Smith Hospital , Forth Worth , TX , USA
| | - Heather Littleton
- b Department of Psychology , East Carolina University , Greenville , NC , USA
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Manley K, Edwards S, Mears J, Siassakos D. Hybrid simulation compared to manikin alone in teaching pelvic examinations: a randomised control trial. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2016; 2:6-10. [DOI: 10.1136/bmjstel-2015-000078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 11/04/2022]
Abstract
IntroductionPerforming a pelvic examination is a core skill for all medical undergraduates. The use of hybrid simulation, manikin with patient actress, to attain technical and communication skills competencies and to improve the quality of care we offer women, has not been compared to other teaching methods before. Outcome measures were technical skills, communication skills and confidence in completing a pelvic examination.MethodsA cluster randomised control trial was conducted over an academic year. Forty-eight medical students who completed an 8-week obstetrics and gynaecology attachment were recruited. Clusters were randomly assigned for initial training on hybrid or manikin only models and attended an end of attachment Objective Structured Clinical Assessment.ResultsOutcome data were received for 43/48 students (89.5%). Following the objectively structured clinical examination, the hybrid trained cohort had higher technical scores (mean 23 (95% CI 20.1 to 25.8) vs 16.7 (CI 14.7 to 18.6); mean difference 6.3, CI 3.0 to 9.6) and communication skills scores (mean 22.6 (CI 21.2 to 23.8) vs 15.9 (CI 14.4 to 17.3); mean difference 6.7, CI 4.8 to 8.5) compared to the manikin only trained participants. Confidence in undertaking future pelvic examinations were similar in the control and intervention groups; (p=0.10, r=0.18).ConclusionsThis study demonstrates the value of hybrid simulation compared to manikins alone in improving the short-term acquisition of competence in simulated pelvic examinations at an undergraduate level. Future research should focus on whether hybrid models lead to long-term acquisition of skill and comparison of these models with other innovative methods such as clinical teaching associates.
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Zahid AZM, Ismail Z, Abdullah B, Daud S. Gender bias in training of medical students in obstetrics and gynaecology: a myth or reality? Eur J Obstet Gynecol Reprod Biol 2014; 186:17-21. [PMID: 25614093 DOI: 10.1016/j.ejogrb.2014.12.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 12/04/2014] [Accepted: 12/18/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the experience of medical students during a clinical attachment in obstetrics and gynaecology (O&G). STUDY DESIGN A questionnaire was distributed to medical students who completed their O&G posting between August 2012 and August 2013. The first part included basic demographic details (age, gender, and ethnicity) and frequency of actual clinical experience; the second part explored students' perception of their training and their relationship with other staff, in particular feeling of discrimination by specified groups of medical personnel. The responses were recorded using a Likert scale and were recategorised during analysis. RESULTS A total of 370 questionnaires were distributed, and 262 completed questionnaires were returned, giving a response rate of 71%. Female students had a significantly higher median (IqR) number of vaginal examinations performed 0.25(0.69) (p=0.002) compared to male students. Male students experienced a higher proportion of patient rejections during medical consultation, 87% vs. 32% of female students (p<0.001), a higher rate of refusal for clerking (71.4% vs. 57.5% of females, p=0.035) and a higher rate of patients declining consent for internal examination (93.3% vs. 67.6% of females, p<0.001). The majority of male students felt that their gender negatively affected their learning experience (87% vs. 27.4% of the female students, p<0.001). Male students reported a significantly higher proportion of discrimination against their gender by medical officers (p=0.018) and specialists/consultants (p<0.001) compared to females but there was no discrimination between genders by staff nurses or house officers. A majority (58%) of female students stated an interest in pursuing O&G as a future career compared to 31.2% of male students. CONCLUSIONS Our study confirmed that gender bias exists in our clinical setting as male students gain significantly less experience than female students in pelvic examination skills. We also demonstrated that compared to female students, male students experience higher levels of discrimination against their gender by trainers who are medical officers and specialists/consultants. Trainers must improve their attitudes towards male students, to encourage them and make them feel welcome in the clinical area. We must minimize gender discrimination and educational inequities experienced by male students, in order to improve their learning experience.
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Affiliation(s)
- Akmal Z Mohd Zahid
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Malaysia.
| | - Zaliha Ismail
- Department of Population Health and Preventive Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Malaysia
| | - Bahiyah Abdullah
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Malaysia
| | - Suzanna Daud
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Malaysia
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Kumar A, Gilmour C, Nestel D, Aldridge R, MCLelland G, Wallace E. Can we teach core clinical obstetrics and gynaecology skills using low fidelity simulation in an interprofessional setting? Aust N Z J Obstet Gynaecol 2014; 54:589-92. [DOI: 10.1111/ajo.12252] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/23/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Arunaz Kumar
- Department of Obstetrics and Gynaecology; Monash University; Melbourne Victoria Australia
| | - Carole Gilmour
- School of Nursing and Midwifery; Monash University; Melbourne Victoria Australia
| | - Debra Nestel
- School of Rural Health, PEER; Monash University; Melbourne Victoria Australia
| | - Robyn Aldridge
- Department of Obstetrics and Gynaecology; Monash University; Melbourne Victoria Australia
| | - Gayle MCLelland
- School of Nursing and Midwifery; Monash University; Melbourne Victoria Australia
| | - Euan Wallace
- Department of Obstetrics and Gynaecology; Monash University; Melbourne Victoria Australia
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Scior K, Bradley CE, Potts HWW, Woolf K, de C Williams AC. What predicts performance during clinical psychology training? BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2014; 53:194-212. [PMID: 24206117 PMCID: PMC4153958 DOI: 10.1111/bjc.12035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 09/17/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES While the question of who is likely to be selected for clinical psychology training has been studied, evidence on performance during training is scant. This study explored data from seven consecutive intakes of the UK's largest clinical psychology training course, aiming to identify what factors predict better or poorer outcomes. DESIGN Longitudinal cross-sectional study using prospective and retrospective data. METHOD Characteristics at application were analysed in relation to a range of in-course assessments for 274 trainee clinical psychologists who had completed or were in the final stage of their training. RESULTS Trainees were diverse in age, pre-training experience, and academic performance at A-level (advanced level certificate required for university admission), but not in gender or ethnicity. Failure rates across the three performance domains (academic, clinical, research) were very low, suggesting that selection was successful in screening out less suitable candidates. Key predictors of good performance on the course were better A-levels and better degree class. Non-white students performed less well on two outcomes. Type and extent of pre-training clinical experience on outcomes had varied effects on outcome. Research supervisor ratings emerged as global indicators and predicted nearly all outcomes, but may have been biased as they were retrospective. Referee ratings predicted only one of the seven outcomes examined, and interview ratings predicted none of the outcomes. CONCLUSIONS Predicting who will do well or poorly in clinical psychology training is complex. Interview and referee ratings may well be successful in screening out unsuitable candidates, but appear to be a poor guide to performance on the course.
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Affiliation(s)
- Katrina Scior
- Research Department of Clinical, Educational and Health Psychology, University College LondonUK
| | - Caroline E Bradley
- Research Department of Clinical, Educational and Health Psychology, University College LondonUK
| | - Henry W W Potts
- CHIME (Centre for Health Informatics & Multiprofessional Education), Institute of Epidemiology & Health Care, University College LondonUK
| | | | - Amanda C de C Williams
- Research Department of Clinical, Educational and Health Psychology, University College LondonUK
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van den Einden LCG, te Kolste MGJ, Lagro-Janssen ALM, Dukel L. Medical students' perceptions of the physician's role in not allowing them to perform gynecological examinations. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:77-83. [PMID: 24280852 DOI: 10.1097/acm.0000000000000055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE To determine how often medical students are not allowed to perform gynecological examinations during their obstetrics-gynecology clerkship, identify the barriers to participation related to physicians and patients, explore the role of the supervisory physician in not allowing medical student involvement, and explore differences between male and female students' experiences. METHOD All medical students entering their obstetrics-gynecology clerkship at a medical school in the Netherlands between May and October 2011 were invited to participate in this study's questionnaire, which asked them to report the number of gynecological examinations they were allowed and not allowed to perform during their clerkship. Eighteen questionnaire respondents participated in three focus groups. RESULTS Of the 139 medical students invited, 76 (55%) completed the questionnaire. Students reported a total of 2,196 instances in which they were not allowed to participate in the examination; 89% (n = 1,956) were related to the supervisory physician. Qualitative data from the focus group interviews showed that female supervisory physicians prioritized patients' autonomy above students' learning needs. Furthermore, female students were less assertive than male students in asking the supervisory physician for permission to participate. CONCLUSIONS The physician's role in not allowing student involvement is substantial and results in fewer opportunities for students to perform gynecological examinations. For students to develop the necessary gynecological exam skills during their clerkship, medical educators need to improve the learning environment.
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Affiliation(s)
- Loes C G van den Einden
- Dr. van den Einden is a PhD student, Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands. Ms. te Kolste is a sixth-year medical student, Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands. Dr. Lagro-Janssen is professor, Department of Primary Care and Community Care, Unit Gender and Women's Health, Radboud University Medical Centre, Nijmegen, The Netherlands. Dr. Dukel is a gynaecologist, Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Carson-Stevens A, Davies MM, Jones R, Chik ADP, Robbé IJ, Fiander AN. Framing patient consent for student involvement in pelvic examination: a dual model of autonomy. JOURNAL OF MEDICAL ETHICS 2013; 39:676-680. [PMID: 23322682 DOI: 10.1136/medethics-2012-100809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Patient consent has been formulated in terms of radical individualism rather than shared benefits. Medical education relies on the provision of patient consent to provide medical students with the training and experience to become competent doctors. Pelvic examination represents an extreme case in which patients may legitimately seek to avoid contact with inexperienced medical students particularly where these are male. However, using this extreme case, this paper will examine practices of framing and obtaining consent as perceived by medical students. This paper reports findings of an exploratory qualitative study of medical students and junior doctors. Participants described a number of barriers to obtaining informed consent. These related to misunderstandings concerning student roles and experiences and insufficient information on the nature of the examination. Participants reported perceptions of the negative framing of decisions on consent by nursing staff where the student was male. Potentially coercive practices of framing of the decision by senior doctors were also reported. Participants outlined strategies they adopted to circumvent patients' reasons for refusal. Practices of framing the information used by students, nurses and senior doctors to enable patients to decide about consent are discussed in the context of good ethical practice. In the absence of a clear ethical model, coercion appears likely. We argue for an expanded model of autonomy in which the potential tension between respecting patients' autonomy and ensuring the societal benefit of well-trained doctors is recognised. Practical recommendations are made concerning information provision and clear delineations of student and patient roles and expectations.
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Bonnett TJ, Roberts AL, Farrell TA. Translating obstetrics and gynaecology undergraduate experience into career aspiration: an audit of Royal College of Obstetricians and Gynaecologists (RCOG) medical student placement standards. J OBSTET GYNAECOL 2013; 32:733-5. [PMID: 23075343 DOI: 10.3109/01443615.2012.717124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In 2006, the Royal College of Obstetricians and Gynaecologists (RCOG) published a list of undergraduate placement standards in an effort to improve the obstetrics and gynaecology (O&G) undergraduate experience and reverse declining interest in the specialty among UK graduates. We surveyed 3rd-year medical students undertaking O&G placements to investigate how appropriate they felt the RCOG placement standards were. We present the first evaluation of these standards and discuss their potential role in improving the undergraduate O&G experience. We also sought to examine the influence of undergraduate O&G exposure on interest in entering the specialty and the effect of gender on perceived learning experience. Students rated the RCOG standards as highly appropriate, and significant differences in clinical exposure and career intentions were seen between genders. Overall, students demonstrated greater interest in pursuing O&G than has previously been documented, which may represent a wider upturn in interest in the speciality.
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Affiliation(s)
- T J Bonnett
- Jessop Wing, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
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Lumsden M, Symonds I. New undergraduate curricula in the UK and Australia. Best Pract Res Clin Obstet Gynaecol 2010; 24:795-806. [DOI: 10.1016/j.bpobgyn.2010.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 05/26/2010] [Indexed: 10/19/2022]
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McLean M, Al Ahbabi S, Al Ameri M, Al Mansoori M, Al Yahyaei F, Bernsen R. Muslim women and medical students in the clinical encounter. MEDICAL EDUCATION 2010; 44:306-15. [PMID: 20444062 DOI: 10.1111/j.1365-2923.2009.03599.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
CONTEXT Increasingly, male medical students report being refused by female patients, particularly in obstetrics and gynaecology, which is impacting on recruitment into the discipline. However, little has been documented in terms of Muslim patients and medical students in the clinical consultation. METHODS Female Emirati nationals (n = 218) attending out-patient clinics at a public hospital in Al Ain, United Arab Emirates (UAE), were interviewed by medical students. Participants were provided with four hypothetical clinical scenarios (three personal, one concerning a pre-pubertal child) and asked whether they would allow male and female students to be present at a consultation, take a history or perform an examination. They were also canvassed about their past experiences with medical students and their social responsibility to contribute towards the training of Emirati doctors. RESULTS Significant differences were recorded in terms of female versus male student involvement for all activities (P < 0.05-0.0005). For gynaecological and abdominal problems, patients would generally refuse male students. More than 50% of interviewees would not allow a male student to examine their face. Students of either gender could, however, examine their 8-year-old child. Although 47% of the women had had previous clinical encounters with students, in only 58% of consultations had the attending doctor asked their permission. Despite this, the women had generally felt comfortable, although satisfaction decreased with increasing age (P = 0.088). Almost 90% of the women believed that Emiratis had a social responsibility to contribute towards the training of Emirati doctors, but this decreased with increasing income (P = 0.004). CONCLUSIONS As many medical students will encounter Muslim patients during their training, they need to be sensitive to religious and cultural issues, particularly for personal examinations. In contexts where most patients are Muslim, alternative options (e.g. manikins, international rotations) may be required for male students. In the UAE, patient education may improve history-taking opportunities but will probably not transcend religious and cultural beliefs without intervention from religious leaders.
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Affiliation(s)
- Michelle McLean
- Department of Medical Education, United Arab Emirates University, Al Ain, UAE.
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Makam A, Mallappa Saroja CS, Edwards G. Do women seeking care from obstetrician–gynaecologists prefer to see a female or a male doctor? Arch Gynecol Obstet 2009; 281:443-7. [DOI: 10.1007/s00404-009-1199-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 07/26/2009] [Indexed: 11/30/2022]
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Broadmore J, Hutton JD, Langdana F. Medical students’ experience of vaginal examinations of anaesthetised women. BJOG 2009; 116:731-3. [DOI: 10.1111/j.1471-0528.2008.02069.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Woolf K, Haq I, McManus IC, Higham J, Dacre J. Exploring the underperformance of male and minority ethnic medical students in first year clinical examinations. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2008; 13:607-16. [PMID: 17487565 DOI: 10.1007/s10459-007-9067-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Accepted: 04/18/2007] [Indexed: 05/13/2023]
Abstract
Evidence shows that medical students from Minority Ethnic (ME) backgrounds and male medical students underperform in undergraduate examinations. Our study confirmed these findings in first year clinical (year 3) medical students, and further explored this disparity in performance. We conducted a series of meta-analyses to measure the effects of sex and ethnic group on the written examination and Objective Structured Clinical Examination (OSCE) scores of three groups of year 3 medical students at two London UK medical schools (n = 1,051; 46.0% male; 48.7% White). Male and ME students scored lower on written and OSCE assessments. Both assessments were statistically significantly correlated (mean r = 0.45) and therefore the effects of sex and ethnic group were measured on each exam after being adjusted for the effect of the other. Although sex and ethnic differences remained on the OSCE when adjusted for written performance, these differences disappeared on the written when it was adjusted for OSCE performance. These findings may reflect a relative deficit in practical clinical knowledge in male and ME year 3 students. Results were unlikely to be due to examiner bias, as the machine-marked unadjusted written exam results showed significant sex and ethnic differences.
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Affiliation(s)
- Katherine Woolf
- Academic Centre for Medical Education, Division of Medical Education, Royal Free and University College Medical School, UCL Archway Campus, 4th Floor, Holborn Union Building, Highgate Hill, London, N19 5LW, UK.
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Akkad A, Bonas S, Stark P. Gender differences in final year medical students’ experience of teaching of intimate examinations: a questionnaire study. BJOG 2008; 115:625-32. [DOI: 10.1111/j.1471-0528.2008.01671.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Higham J, Nestel D, Lupton M, Kneebone R. Teaching and learning gynaecology examination with hybrid simulation. CLINICAL TEACHER 2007. [DOI: 10.1111/j.1743-498x.2007.00179_1.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Higham J. Current themes in the teaching of obstetrics and gynaecology in the United Kingdom. MEDICAL TEACHER 2006; 28:495-6. [PMID: 17074698 DOI: 10.1080/01421590600768468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Higham J. Commentary: How can we make our medical students enthusiastic about a future in obstetrics and gynaecology? BJOG 2006; 113:499-501. [PMID: 16637893 DOI: 10.1111/j.1471-0528.2006.00926.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Falling recruitment to obstetrics and gynaecology (O&G) among UK-trained undergraduates is a pressing concern. The reasons for this are multifactorial and include the previous restriction on the number of postgraduate training places. Undergraduate placements are a key time to encourage potential recruits into the specialty. A recent survey demonstrated various changes within medical school attachments over the past 15 years that are having a mixed influence on the undergraduate O&G experience. These are explored in relation to their potential impact on recruitment.
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Affiliation(s)
- J Higham
- Academic Obstetrics & Gynaecology, Imperial College, St Mary's Hospital, London, UK.
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Shann S, Wilson JD. Patients' attitudes to the presence of medical students in a genitourinary medicine clinic: a cross sectional survey. Sex Transm Infect 2006; 82:52-4. [PMID: 16461604 PMCID: PMC2563820 DOI: 10.1136/sti.2005.016758] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES It is recommended that medical students learn how to take a sexual history and gain experience in genital examination, but patients' reluctance may make this difficult to achieve, especially for male students. METHODS We performed a survey of 250 male and 250 female patients attending a genitourinary medicine (GUM) clinic to determine their attitudes towards the involvement of medical students during their visit. Data were collected on the patients' age, ethnic origin, parity, number of visits to the clinic, and the sex of the student. RESULTS 92.8% of women and 79.2% of men participated. Younger women and men, those visiting the clinic for the first time, and women with no children were less likely to accept a student of either sex to take their history or observe their examination. Women were less likely than men to accept students of either sex to take their sexual history or be present during their examination, but were more likely than men to accept only same sex students. CONCLUSIONS There was a high level of acceptability for the involvement of medical students; only 12.5% of women and 15% of men declined any medical student participation. Older women with children, and older men, were more likely to accept a student of either sex for all parts of the consultation. This information can be used to enhance the experience of male and female students and to minimise distress for those patients who are less likely to accept the presence of a medical student.
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Affiliation(s)
- S Shann
- Department of Genitourinary Medicine, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK
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Turner G, Lambert TW, Goldacre MJ, Barlow D. Career choices for obstetrics and gynaecology: national surveys of graduates of 1974-2002 from UK medical schools. BJOG 2006; 113:350-6. [PMID: 16487211 DOI: 10.1111/j.1471-0528.2006.00848.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report the trends in career choices for obstetrics and gynaecology among UK medical graduates. DESIGN Postal questionnaire surveys of qualifiers from all UK medical schools in nine qualification years since 1974. SETTING United Kingdom. POPULATION All graduates from UK medical schools in 1974, 1977, 1980, 1983, 1993, 1996, 1999, 2000 and 2002. METHODS Postal questionnaire surveys. MAIN OUTCOME MEASURES Career choices for obstetrics and gynaecology and factors influencing career choices for obstetrics and gynaecology. RESULTS Seventy-four percent (24,623/33,417) and 73% (20,709/28,468) of doctors responded at 1 and 3 years after qualification. Choices for obstetrics and gynaecology fell sharply during the 1990s from 4.2% of 1996 qualifiers to 2.2% of 1999 qualifiers, and rose slightly to 2.8% of 2002 qualifiers. Only 0.8% of male graduates of 2002 chose obstetrics and gynaecology compared with 4.1% of women. Forty-six percent of those who chose obstetrics and gynaecology 1 year after qualification were working in it 10 years after qualifying. Experience of the subject as a student, and the influence of a particular teacher or department, affected long-term career choices more for obstetrics and gynaecology than for other careers. CONCLUSIONS The unwillingness of young doctors to enter obstetrics and gynaecology may be attributable to concerns about workforce planning and career progression problems, rather than any lack of enthusiasm for the specialty. The number of men choosing obstetrics and gynaecology is now very small; the reasons and the future role of men in the specialty need to be debated.
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Affiliation(s)
- G Turner
- UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Oxford, UK
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Ali E. A midwife teaching medical students: can it work? CLINICAL TEACHER 2005. [DOI: 10.1111/j.1743-498x.2005.00049.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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