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Genusgörande och läkarblivande: attityder, föreställningar och förväntningar bland läkarstudenter i Sverige
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
2012 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Doing gender, becoming doctors : attitudes, preconceptions and expectations among medical students in Sweden (English)
Abstract [en]

The inclusion of a gender perspective in medicine has shown that gender is an essential factor in health and disease, in medical encounters and also in medical students’ educational environment. The aim of this study was to explore attitudes, preconceptions and norms regarding gender within medical education and processes of gender bias. First, we explored medical students gendered beliefs about patients. Second, we examined the medical students ideas about their future careers. Third, we compared awareness on gender issues among medical students in Sweden and the Netherlands.

Method and material

The analyses were based on data from two different sources: one experimental study based on authentic patient narratives about being diagnosed with cancer and one extensive questionaire exploring different aspects of gender issues in medical education. Both studies had a design which enabled both qualitative and quantitative research and mixed methods was used.

Study I (Paper I and II): Eighty-one anonymous letters from patients were read by 130 students of medicine and psychology. For each letter the students were asked to state the patient’s sex and explain their choice. In paper I the students’ success rates were analysed statistically and the explanations to four letters were used to illustrate the students’ reasoning. Paper II examined the 87 medical students’ explanations closer to examine gender beliefs about patients.

Study II (Paper III and IV): The questionaire started with an open question where medical students were asked to describe their ideal future, it also included a validated scale designed to estimate gender awareness. Paper III examined 507 swedish medical students descriptions about their ideal future and compared answers from male and female students in the beginning and at the end of medical school. Paper IV compared gender awareness among 1096 Swedish and Dutch medical students in first term.

Findings with reflections

Paper I showed that the patient’s sex was correctly identified in 62% of the cases. There were no difference between the results of male and female students. However, large differences between letters were observed, i.e. there were some letters were almost all students correctly identified the patient´s sex, others were almost all students were incorrect and most letters were found somewhere in the middle. Another significant finding was that the same expressions were interpreted differently depending on which initial guess the medical student had made regarding the sex of the patient.

Paper II identified 21 categories of justifications within the students’ explanations, twelve of which were significantly associated with an assumption of either a male or female patient. Only three categories led to more correct identifications of the patients’ sex and two were more often associated with incorrect assignments. The results illustrate how beliefs about gender difference, even though they might be recognizable on a group level, are not applicable on individuals. Furthermore, the results show that medical students enter the education with beliefs about male and female patients, which could have consequenses and cause bias in their future work as doctors.

Paper III found that almost all students, both male and female, were work-oriented. However, the female students even more so than their male counterparts. This result is particularly interesting in regards to the debate about the “feminization of medicine” in which the increasing number of female students has been adressed as a problem. When reflecting on their own lifes and their future its obvious that medical students nowadays, male and female, expect more to life than work, especially those who are on the doorstep to their professional life.

Paper IV found that the national and cultural setting was the most crucial impact factor in relation to the medical students preconceptions and awareness about gender. The Swedish students expressed less stereotypic thinking about patients and doctors, while the Dutch students were more sensitive to gender difference. In both countries, the students’ sex mattered for gender stereotyping, with male students agreeing more to stereotypes.

Conclusions

A gender perspective is important in medical education. Our studies show that such initiatives needs to take cultural aspects, gender attitudes and students’ gender into account. Moreover, reflections on assumptions about men and women, patients as well as doctors, need to be included in medical curricula and the impact of implicit gender beliefs needs to be included in discussions on gender bias in health care. Also, the next generation of doctors want more to life than work. Future Swedish doctors, both female and male, intend to balance work not only with a family but also with leisure. This attitudinal change towards their future work as doctors will provide the health care system with a challenge to establish more adaptive and flexible work conditions.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2012. , 94 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1525
Keyword [en]
gender bias, gender perspective, medical education, medical students, gender awareness, gender beliefs, gender norms, mixed methods, feminization of medicine, medical curricula, gender sensitivity
Keyword [sv]
genus bias, genusperspektiv, läkarutbildning, läkarstudenter, genusmedvetenhet, föreställningar om kön, mixed method, feminisering, dold läroplan
National Category
Family Medicine
Identifiers
URN: urn:nbn:se:umu:diva-61469ISBN: 978-91-7459-488-1 (print)OAI: oai:DiVA.org:umu-61469DiVA: diva2:569938
Public defence
2012-12-07, Tandläkarhögskolan, sal B, 9 tr, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Funder
Swedish Research Council
Available from: 2013-04-11 Created: 2012-11-15 Last updated: 2013-04-11Bibliographically approved
List of papers
1. Is it possible to identify patient´s sex when reading blinded illness narratives? An experimental study about gender bias.
Open this publication in new window or tab >>Is it possible to identify patient´s sex when reading blinded illness narratives? An experimental study about gender bias.
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2008 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 7, no 21, 1-9 p.Article in journal (Refereed) Published
National Category
Family Medicine
Identifiers
urn:nbn:se:umu:diva-10488 (URN)10.1186/1475-9276-7-21 (DOI)
Available from: 2008-10-23 Created: 2008-10-23 Last updated: 2016-01-01
2. Using patients' narratives to reveal gender stereotypes among medical students
Open this publication in new window or tab >>Using patients' narratives to reveal gender stereotypes among medical students
2013 (English)In: Academic Medicine, ISSN 1040-2446, E-ISSN 1938-808X, Vol. 88, no 7, 1015-1021 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: Gender bias exists in patient treatment, and, like most people, health care providers harbor gender stereotypes. In this study, the authors examined the gender stereotypes that medical students hold about patients. Method: In 2005, in Umeå, Sweden, the authors collected 81 narratives written by patients who had undergone cancer treatment; all information that might reveal the patients’ gender was removed from the texts. Eighty-seven medical students read 40 or 41 narratives each, guessed the patient’s gender, and explained their guess. The authors analyzed the students’ explanations qualitatively and quantitatively to reveal the students’ gender stereotypes and to determine whether those stereotypes had any predictive value for correctly guessing a patient’s gender. Results: The students’ explanations contained 21 categories of justifications, 12 of which were significantly associated with the students guessing one gender or the other. Only three categories successfully predicted a correct identification of gender; two categories were more often associated with incorrect guesses. Conclusions: Medical students enter their training program with culturally shared stereotypes about male and female patients that could cause bias during their future careers as physicians. To prevent this, medical curricula must address gender stereotypes and their possible consequences. The impact of implicit stereotypes must be included in discussions about gender bias in health care.

Keyword
sex categorization, gender stereotype, gender beliefs, gender bias, written illness narratives, gender preconceptions
National Category
Family Medicine
Research subject
medicinsk beteendevetenskap
Identifiers
urn:nbn:se:umu:diva-61490 (URN)10.1097/ACM.0b013e318295b3fe (DOI)000323038400035 ()23702533 (PubMedID)
External cooperation:
Available from: 2012-11-15 Created: 2012-11-15 Last updated: 2017-12-07Bibliographically approved
3. Swedish medical students' expectations of their future life
Open this publication in new window or tab >>Swedish medical students' expectations of their future life
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2011 (English)In: International Journal of Medical Education, ISSN 2042-6372, E-ISSN 2042-6372, Vol. 2, 140-146 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To investigate future life expectations among male and female medical students in their first and final year.

Methods: The study was cross-sectional and conducted at a Swedish medical school. Out of 600 invited students, 507 (85%) answered an open-ended question about their future life, 298 (59%) first-year students and 209 (41%) last-year students. Women constituted 60% of the respondents. A mixed model design was applied; qualitative content analysis was utilized to create statistically comparable themes and categories.

Results: Students' written answers were coded, categorized and clustered into four themes: "Work", "Family", "Leisure" and "Quality of personal life". Almost all students included aspects of work in their answers. Female students were more detailed than male ones in their family concerns. Almost a third of all students reflected on a future work-life balance, but considerations regarding quality of personal life and leisure were more common among last-year students.

Conclusions: Today's medical students expect more of life than work, especially those standing on the doorstep of working life. They intend to balance work not only with a family but also with leisure activities. Our results reflect work attitudes that challenge the health care system for more adaptive working conditions. We suggest that discussions about work-life balance should be included in medical curricula.

Keyword
medical students, future expectations
National Category
Family Medicine
Identifiers
urn:nbn:se:umu:diva-61478 (URN)10.5116/ijme.4ec5.92b8 (DOI)
Available from: 2012-11-15 Created: 2012-11-15 Last updated: 2017-12-07Bibliographically approved
4. Comparing gender awareness in Dutch and Swedish first-year medical students: results from a questionaire
Open this publication in new window or tab >>Comparing gender awareness in Dutch and Swedish first-year medical students: results from a questionaire
Show others...
2012 (English)In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 12, 3- p.Article in journal (Refereed) Published
Abstract [en]

Background: To ascertain good and appropriate healthcare for both women and men implementation of gender perspectives in medical education is needed. For a successful implementation, knowledge about students' attitudes and beliefs about men, women, and gender is crucial. The aim of this study was to compare attitudes to gender and gender stereotyping among Dutch and Swedish male and female medical students.

Methods: In this cross-sectional study, we measured the attitudes and assumptions about gender among 1096 first year medical students (616 Dutch and 480 Swedish) with the validated Nijmegen Gender Awareness in Medicine Scale (N-GAMS). The response rate was 94% in the Netherlands and 93% in Sweden. Univariate analysis of variance (ANOVA) was used to compare the scores between Dutch and Swedish male and female students. Linear regressions were used to analyze the importance of the background variables.

Results: There were significant differences in attitudes to gender between Dutch and Swedish students. The Swedish students expressed less stereotypical thinking about patients and doctors and the Dutch were more sensitive to gender differences. The students' sex mattered for gender stereotyping, with male students in both countries agreeing more with stereotypical statements. Students' age, father's birth country and mother's education level had some impact on the outcome.

Conclusions: There are differences between cultures as well as between men and women in gender awareness that need to be considered when implementing gender in medical education. This study suggests that to arouse the students' interest in gender issues and make them aware of the significance of gender in medical work, the examples used in discussions need to be relevant and challenging in the context of the specific country. Due to different levels of knowledge and different attitudes within the student population it is important to create a climate for dialogue where students feel permitted to disclose their ideas and attitudes in order to become aware of what these are as well as their possible consequences on interaction and decision-making in medical work.

Place, publisher, year, edition, pages
London: BioMed Central, 2012
Keyword
Medical curricula, medical students, gender implementation, gender, attitudes, stereotypical thinking
National Category
Educational Sciences Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-52857 (URN)10.1186/1472-6920-12-3 (DOI)000300156300001 ()
Available from: 2012-03-07 Created: 2012-03-05 Last updated: 2017-12-07Bibliographically approved

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