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Swedish medical students' expectations of their future life
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.ORCID iD: 0000-0001-6897-5515
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.
VU University Medical Center, Department of Medical Humanities, EMGO Institute for Health and Care Research, Amsterdam, the Netherlands.
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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.

Place, publisher, year, edition, pages
2011. Vol. 2, 140-146 p.
Keyword [en]
medical students, future expectations
National Category
Family Medicine
Identifiers
URN: urn:nbn:se:umu:diva-61478DOI: 10.5116/ijme.4ec5.92b8OAI: oai:DiVA.org:umu-61478DiVA: diva2:568018
Available from: 2012-11-15 Created: 2012-11-15 Last updated: 2017-12-07Bibliographically 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. 94 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1525
Keyword
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
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: 2013-04-11Bibliographically approved
2. It's just a job: a new generation of physicians dealing with career and work ideals
Open this publication in new window or tab >>It's just a job: a new generation of physicians dealing with career and work ideals
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Today, women constitute about half of medical students. However, women are still underrepresented in prestigious specialties such as surgery. Some suggest that this could be explained by women being more oriented towards work-life balance.

Aim: The overall aim of this dissertation was to explore aspects of gender in work-life priorities, career plans, clinical experiences and negotiations of professional ideals among medical students and newly graduated doctors, all in a Swedish setting.

Method: We based the analysis on data from two different sources: an extensive questionnaire exploring gender and career plans among medical students (paper I-III) and interviews with newly graduated doctors (study IV).

In paper I, four classes of first- and final-year medical (N=507, response rate 85%) answered an open-ended question about their future life, 60% were women. We conducted a mixed methods design where we analyzed the answers qualitatively to create categories that could be analyzed quantitatively in the second stage.

In paper II, five classes of final-year medical students  were included (N = 372, response rate 89%), and 58% were women. We studied their specialty preference and how they rated the impact that the motivational factors had for their choice. In order to evaluate the independent impact of each motivational factor for specialty preference, we used logistic regression.

In paper III, final-year medical students answered two open-ended questions: “Can you recall an event that made you interested of working with a certain specialty?” and “Can you recall an event that made you uninterested of working with a certain specialty?”. The response rate was 62% (N = 250),  and 58% were women. The analysis was similar to paper I, but here we focused on the qualitative results.

In paper IV, thematic interviews were conducted in 2014 and 2015. We made a purposeful sampling of 15 junior doctors, including nine women and six men from eight different hospitals. Data collection and analysis was inspired by constructivist grounded theory methodology.

Results: When looking at the work-life priorities of medical students and junior doctors it is clear that both men and women want more to life than work in their ideal future. The junior doctors renounced fully devoted and loyal ideal and presented a self-narrative where family and leisure was important to cope and stay empathic throughout their professional lives.

The specialty preferences and the highly rated motives for choosing them were relatively gender neutral. However, the gender neutrality came to an end when the final-year medical students described clinical experiences that affected their specialty preference. Women were more often deterred by workplace cultures, whereas men were more often deterred by knowledge area, suggesting that it is a male privilege to choose a specialty according to interest.

Among the newly graduated doctors, another male privilege seemed to be that men were able to pass more swiftly as real doctors, whereas the women experienced more dissonance between their self-understanding and being perceived as more junior and self-doubting.

Conclusions: The career plans and work-life priorities of doctors-to-be were relatively gender neutral. Both female and male doctors, intended to balance work not only with a family but also with leisure. This challenges the health care system to establish more adaptive and flexible work conditions.

Gender segregation in specialty choice is not the result of gender-dichotomized specialty preferences starting in medical school. This calls for a re-evaluation of the understanding where gender is seen as a mere background characteristic, priming women and men for different specialties. 

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2017. 65 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1919
Keyword
Medical students, junior doctors, gender perspective, medical education, graduate medical education, professional identity, career choice, gender discrimination, mixed methods
National Category
Family Medicine Other Health Sciences
Research subject
Family Medicine
Identifiers
urn:nbn:se:umu:diva-139976 (URN)978-91-7601-764-7 (ISBN)
Public defence
2017-10-20, Sal 135, By 9A, Enheten för allmänmedicin, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-09-29 Created: 2017-09-27 Last updated: 2017-10-16Bibliographically approved

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Andersson, JennyJohansson, Eva EHamberg, Katarina

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