The Effect of Gender on Clerkship during Medical Education

In the last 10 years 60% of medical students are women nevertheless medical specialists are mainly men in The Netherlands. In the US close to 50% of all medical schools are women. Women in academic medicine are underrepresented and are less well payed.

Only 1 in 10 medical clinical professors are women in the United Kingdom (UK). No female professor was employed in 6 medical schools. The newer medical schools had a better gender balance than some of the more established schools.
For the lower ranks in medical academia these numbers are somewhat higher but still much lower than for men.

Moreover, In the international literature reports of sexual harassment of female med students fluctuate between 18-60%. The incidence of sexual harassment is relatively low in The Netherlands: 25%. Qualitative studies have previously described the potentially negative impact of gender on the professional relationships of female physicians. There is some research on the experiences of female physicians but little is known about the experiences of female medical students especially in those transitioning from a preclinical level to a clinical clerkship. Information would be of use for the next generation of female physicians.

How is transitioning from a preclinical to a clinical medical education (clerkship) influenced by gender?

A recent study was published from the US. A qualitative study consisting of in-depth interviews with only 12 third year female medical students after their first month of their first clerkship in one of seven different clinical specialty clerkships across a variety of clinical settings. They concluded that gender issues continue to have a considerable impact on the education of our female physicians to be.

• Most found the transition difficult resulting in “feminine behavior” which was appreciated by the supporting staff (e.g. nurses) and patients but not by the residents and attendings:
  

  She would ask, “I’m sorry, did I do that right? Did I do this right? Is this how you want this done?” As she explained, “I didn’t take as much initiative as I thought I would, and to me, to me it was very clear that I was doing that because I felt like . . . I didn’t fit in”

• The female medical students from both camps, msn vs dnp formed relationships with the predominantly female nursing and support staff while the male classmates were forming relationships with attendings who were most often males. Some of them felt this as a disadvantage, the males were more often asked questions and being included in procedures.
  

  When the female student assisted the nurse in moving a patient, the nurse “flipped in a heartbeat,” confiding in the student about her daughter’s struggle with an eating disorder.

• Many female students had anxiety towards working with male teams and supervisors. But their experiences surpassed their low expectations. Their encounters with female attendings and residents were disappointing.
  

  “males push you harder, they act more confidently, they ask you more questions, and they expect you to know more.”

• Most female students met with a range of uncomfortable situations with patients. Patients calling them nurse or patients flirting with the female students. The female students also were uncomfortable with encounters with male supervisors especially in a male dominated culture, one described a supervisor who only looked at their breasts instead of eye contact, he did so with all female students
• The female students experienced a “gender learning curve”: higher workplace expectations for female physicians, women had to be more serious had to prove them selfs. Women have to earn respect while men get it more automatically.

To my opinion it is not strange that they need some time to adjust to the new situation of clerkship. I think that goes for both men and women medical students. Nevertheless, the gender issues reported in this study do exist, women tend to have more trouble finding their role and their experiences are affected by gender. For female medical students there is a gender learning curve to become adjusted to the “culture of guyness” on most wards. Sexual harassment is an important but recognized issue in medical education but there is more that needs our attention. We can’t wait until most wards are run by female physicians.

it is necessary to expand the framework of gender discrimination beyond sexual harassment to include the myriad ways in
which gender affects the lives of female medical students.

The authors do not suggest programs to address the more subtle forms of gender stereotyping, does anyone have suggestions or know any programs? Please let me know in the comments.

Related post on this blog: Gender and Medical Education

Palav Babaria, Sakena Abedin, Marcella Nunez-Smith (2009). The Effect of Gender on the Clinical Clerkship Experiences of Female Medical Students: Results From a Qualitative Study Academic Medicine, 84 (7), 859-866 DOI: 19550176