Change search
ReferencesLink to record
Permanent link

Direct link
Comparing gender awareness in Dutch and Swedish first-year medical students: results from a questionaire
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
Show others and affiliations
2012 (English)In: BMC Medical Education, 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. Vol. 12, 3- p.
Keyword [en]
Medical curricula, medical students, gender implementation, gender, attitudes, stereotypical thinking
National Category
Educational Sciences Medical and Health Sciences
URN: urn:nbn:se:umu:diva-52857DOI: 10.1186/1472-6920-12-3ISI: 000300156300001OAI: diva2:508042
Available from: 2012-03-07 Created: 2012-03-05 Last updated: 2012-11-16Bibliographically 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.


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.
Umeå University medical dissertations, ISSN 0346-6612 ; 1525
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
Family Medicine
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)
Swedish Research Council
Available from: 2013-04-11 Created: 2012-11-15 Last updated: 2013-04-11Bibliographically approved

Open Access in DiVA

fulltext(261 kB)113 downloads
File information
File name FULLTEXT02.pdfFile size 261 kBChecksum SHA-512
Type fulltextMimetype application/pdf

Other links

Publisher's full text

Search in DiVA

By author/editor
Andersson, JennyJohansson, Eva EHamberg, Katarina
By organisation
Family Medicine
In the same journal
BMC Medical Education
Educational SciencesMedical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 113 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 169 hits
ReferencesLink to record
Permanent link

Direct link