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Is it possible to identify patient´s sex when reading blinded illness narratives? An experimental study about gender bias
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
Umeå University, Faculty of Social Sciences, Department of Psychology.
Umeå University, Faculty of Social Sciences, Department of Psychology.
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2008 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 7, no 21, p. 1-9Article in journal (Refereed) Published
Abstract [en]

Background: In many diseases men and women, for no apparent medical reason, are not offered the same investigations and treatment in health care. This may be due to staff's stereotypical preconceptions about men and women, i.e., gender bias. In the clinical situation it is difficult to know whether gender differences in management reflect physicians' gender bias or male and female patients' different needs or different ways of expressing their needs. To shed some light on these possibilities this study investigated to what extent it was possible to identify patients' sex when reading their blinded illness narratives, i.e., do male and female patients express themselves differently enough to be recognised as men and women without being categorised on beforehand?

Methods: Eighty-one authentic letters about being diseased by cancer were blinded regarding sex and read by 130 students of medicine and psychology. For each letter the participants were asked to give the author's sex and to explain their choice. The success rates were analysed statistically. To illuminate the participants' reasoning the explanations of four letters were analysed qualitatively.

Results: The patient's sex was correctly identified in 62% of the cases, with significantly higher rates in male narratives. There were no differences between male and female participants. In the qualitative analysis the choice of a male writer was explained by: a short letter; formal language; a focus on facts and a lack of emotions. In contrast the reasons for the choice of a woman were: a long letter; vivid language; mention of emotions and interpersonal relationships. Furthermore, the same expressions were interpreted differently depending on whether the participant believed the writer to be male or female.

Conclusion: It was possible to detect gender differences in the blinded illness narratives. The students' explanations for their choice of sex agreed with common gender stereotypes implying that such stereotypes correspond, at least on a group level, to differences in male and female patients' illness descriptions. However, it was also obvious that preconceptions about gender obstructed and biased the interpretations, a finding with implications for the understanding of gender bias in clinical practice.

Place, publisher, year, edition, pages
BioMed Central, 2008. Vol. 7, no 21, p. 1-9
Keywords [en]
Gender Difference, Gender Bias, Correct Decision, Illness Narrative, Female Author
National Category
General Practice
Identifiers
URN: urn:nbn:se:umu:diva-10488DOI: 10.1186/1475-9276-7-21ISI: 000207448500021PubMedID: 18710522OAI: oai:DiVA.org:umu-10488DiVA, id: diva2:150159
Available from: 2008-10-23 Created: 2008-10-23 Last updated: 2019-03-15Bibliographically approved
In thesis
1. Genusgörande och läkarblivande: attityder, föreställningar och förväntningar bland läkarstudenter i Sverige
Open this publication in new window or tab >>Genusgörande och läkarblivande: attityder, föreställningar och förväntningar bland läkarstudenter i Sverige
2012 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[en]
Doing gender, becoming doctors : attitudes, preconceptions and expectations among medical students in Sweden
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. p. 94
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1525
Keywords
gender bias, gender perspective, medical education, medical students, gender awareness, gender beliefs, gender norms, mixed methods, feminization of medicine, medical curricula, gender sensitivity, genus bias, genusperspektiv, läkarutbildning, läkarstudenter, genusmedvetenhet, föreställningar om kön, mixed method, feminisering, dold läroplan
National Category
General Practice
Identifiers
urn:nbn:se:umu:diva-61469 (URN)978-91-7459-488-1 (ISBN)
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: 2018-06-08Bibliographically approved

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Andersson, JennySalander, PärHamberg, Katarina

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