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Kristoffersson, EmelieORCID iD iconorcid.org/0000-0002-8404-9623
Publications (7 of 7) Show all publications
Bitar, A., Amnelius, L., Kristoffersson, E. & Boman, J. (2023). Emotional intelligence among medical students in Sweden: a questionnaire study. BMC Medical Education, 23(1), Article ID 603.
Open this publication in new window or tab >>Emotional intelligence among medical students in Sweden: a questionnaire study
2023 (English)In: BMC Medical Education, E-ISSN 1472-6920, Vol. 23, no 1, article id 603Article in journal (Refereed) Published
Abstract [en]

Background. Emotional intelligence (EI), the ability to understand and regulate one’s and other’s emotions, has been linked to academic and clinical performance and stress management, making it an essential skill to develop during medical school. Nevertheless, uncertainty remains about the impact of medical education on EI, its association with sociodemographic factors, and the potential moderating role of gender. Therefore, this study aimed to explore levels of global EI among Swedish medical students based on their completed semesters while analyzing the potential moderator role of gender and identifying potential EI differences associated with age, gender, prior education, work experience, and previous experience working in a leadership position.

Methods: The participants were medical students in semesters 1, 3, 5, 7, 9, and 11 at a Swedish University. Participants answered the self-report Trait Emotional Intelligence Questionnaire - Short Form (TEIQue-SF) and demographic questions. For each participant, the mean global trait EI was calculated (range 1–7), and differences were compared based on semesters and sociodemographic factors. In addition, we investigated the relationship between semester and EI scores with gender as a moderator.

Results: Of the 663 invited medical students, 429 (65%) responded, including 269 women (62.7%), 157 men (36.6%), and 3 identifying as others (0.7%). The participants had a mean global trait EI score of 5.33. Final-year students demonstrated significantly higher global trait EI scores than first-year students, and gender did not have a moderating effect across semesters. Furthermore, students in the age group 25–29 years showed higher EI scores compared to those in the age group 21–24 years, while there were no significant differences in EI scores for older students (≥ 30 years) compared to other age groups. Higher EI scores were also positively associated with previous work-and leadership experiences. Gender and previous education did not significantly impact EI scores.

Conclusions. Our findings suggest that higher EI scores are associated with semesters of medical education, age, and previous work and leadership experience. Future longitudinal studies are needed to identify factors that could improve EI among medical students to design curricular activities aimed at supporting the EI of the next generation of physicians.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Emotional intelligence (EI), Swedish medical students, Questionnaire
National Category
Pedagogy Learning
Identifiers
urn:nbn:se:umu:diva-214002 (URN)10.1186/s12909-023-04570-0 (DOI)37620811 (PubMedID)2-s2.0-85168663184 (Scopus ID)
Available from: 2023-09-01 Created: 2023-09-01 Last updated: 2023-09-04Bibliographically approved
Kristoffersson, E. & Hamberg, K. (2022). "I have to do twice as well" – managing everyday racism in a Swedish medical school. BMC Medical Education, 22(1), Article ID 235.
Open this publication in new window or tab >>"I have to do twice as well" – managing everyday racism in a Swedish medical school
2022 (English)In: BMC Medical Education, E-ISSN 1472-6920, Vol. 22, no 1, article id 235Article in journal (Refereed) Published
Abstract [en]

Background: Mounting evidence suggests that medical students from cultural/ethnic minority backgrounds face recurring and more or less subtle racist oppression, i.e., everyday racism. Insights into how they handle these inequalities, though, are scarce – especially in a Swedish context. In this interview study we therefore explored and analyzed the strategies used by racialized minority medical students to manage episodes of everyday racism – and their underlying motives and considerations.

Methods: Individual interviews were carried out with 15 medical students (8 women, 7 men) who self-identified as having ethnic- or cultural minority backgrounds. Inspired by constructivist grounded theory, data were collected and analyzed simultaneously.

Results: Participants strove to retain their sense of self as active students and professional future physicians – as opposed to passive and problematic ‘Others’. Based on this endeavor, they tried to manage the threat of constraining stereotypes and exclusion. Due to the power relations in medical education and clinical placement settings as well as racialized students’ experience of lacking both credibility and support from bystanders, few dared to speak up or report negative treatment. Instead, they sought to avoid racism by withdrawing socially and seeking safe spaces. Or, they attempted to adopt a professional persona that was resistant to racial slights. Lastly, they tried to demonstrate their capability or conform to the majority culture, in attempts to refute stereotypes.

Conclusions: Racism is not caused by the exposed individuals’ own ways of being or acting. Therefore, behavioral changes on the part of minority students will not relieve them from discrimination. Rather, strategies such as adaptation and avoidance run the risk of re-inscribing the white majority as the norm for a medical student. However, as long as racialized minority students stand alone it is difficult for them to act in any other way. To dismantle racism in medical education, this study indicates that anti-racist policies and routines for handling discrimination are insufficient. School management should also acknowledge racially minoritized students’ experiences and insights about racist practices, provide students and supervisors with a structural account of racism, as well as organize training in possible ways to act as a bystander to support victims of racism, and create a safer working environment for all.

Place, publisher, year, edition, pages
BioMed Central, 2022
Keywords
Everyday racism, Grounded theory, Interviews, Medical education, Racial microaggressions
National Category
Pedagogy International Migration and Ethnic Relations
Identifiers
urn:nbn:se:umu:diva-193798 (URN)10.1186/s12909-022-03262-5 (DOI)000777233400010 ()35365131 (PubMedID)2-s2.0-85127530216 (Scopus ID)
Available from: 2022-05-06 Created: 2022-05-06 Last updated: 2022-05-06Bibliographically approved
Kristoffersson, E., Rönnqvist, H., Andersson, J., Bengs, C. & Hamberg, K. (2021). "It was as if I wasn't there": experiences of everyday racism in a Swedish medical school. Social Science and Medicine, 270, Article ID 113678.
Open this publication in new window or tab >>"It was as if I wasn't there": experiences of everyday racism in a Swedish medical school
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2021 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 270, article id 113678Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to explore and analyze how cultural/ethnic minority students at a Swedish medical school perceive and make sense of educational experiences they viewed as related to their minority position. We interviewed 18 medical students (10 women, and 8 men), who self-identified as coming from minority backgrounds. Data were collected and analyzed simultaneously, inspired by constructivist grounded theory methodology. The concepts 'everyday racism' and 'racial microaggressions' served as a theoretical framework for understanding how inequities were experienced and understood. Participants described regularly encountering subtle adverse treatment from supervisors, peers, staff, and patients. Lack of support from bystanders was a common dimension of their stories. These experiences marked interviewees' status as 'Other' and made them feel less worthy as medical students. Interviewees struggled to make sense of being downgraded, excluded, and discerned as different, but seldom used terms like being a victim of discrimination or racism. Instead, they found other explanations by individualizing, renaming, and relativizing their experiences. Our results indicate that racialized minority medical students encounter repeated practices that, either intentionally or inadvertently, convey disregard and sometimes contempt based on ideas about racial and/or cultural 'Otherness'. However, most hesitated to name the behaviors and comments experienced as "discriminatory" or "racist", likely because of prevailing ideas about Sweden and, in particular, medical school as exempt from racism, and beliefs that racial discrimination can only be intentional. To counteract this educational climate of exclusion medical school leadership should provide supervisors, students, and staff with theoretical concepts for understanding discrimination and racism, encourage them to engage in critical self-reflection on their roles in racist power relations, and offer training for bystanders to become allies to victims of racism.

Place, publisher, year, edition, pages
Elsevier, 2021
Keywords
Everyday racism, Interviews, Medical education, Minority students, Racial microaggressions, Sweden
National Category
Gender Studies General Practice
Research subject
family medicine
Identifiers
urn:nbn:se:umu:diva-179399 (URN)10.1016/j.socscimed.2021.113678 (DOI)000621367100002 ()33434719 (PubMedID)2-s2.0-85099220516 (Scopus ID)
Available from: 2021-02-01 Created: 2021-02-01 Last updated: 2023-09-05Bibliographically approved
Kristoffersson, E. (2021). Är det bara jag? Om sexism och rasism i läkarutbildningens vardag: erfarenheter, förklaringar och strategier bland läkarstudenter. (Doctoral dissertation). Umeå: Umeå universitet
Open this publication in new window or tab >>Är det bara jag? Om sexism och rasism i läkarutbildningens vardag: erfarenheter, förklaringar och strategier bland läkarstudenter
2021 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[en]
Is it just me? Everyday sexism- and racism in medical school : experiences, explanations, and strategies among medical students
Abstract [en]

Background: Medical education is characterized by unequal conditions for women/men and white/racialized students. Even subtle interactional processes of inclusion and exclusion convey messages about who rightfully belongs in medical school. Insights into these processes, though, are scarce – especially in the Swedish context. In this thesis, the concepts ’everyday sexism/racism’ and ’gendered/racial microaggressions’ serve as a theoretical framework for understanding these processes.

Aim: The main objective of this thesis is to explore and analyze how medical students experience, understand, and handle the norms, perceptions, and expectations about gender and culture/ethnicity that are expressed and (re)created in the specific contexts of medical education and clinical practice. In the analysis, a particular focus is placed on power inequalities. The role that the image of Sweden, which is characterized by equality, and the notion of medical education as characterized by objectivity and neutrality play in the participants' understanding and actions is discussed.

Method: The four articles that make up this thesis are based upon three empirical studies conducted among medical students at Umeå University. 

In the first study, focus groups were performed with 24 students (15 women, 9 men) to explore their experiences of situations during clinical training where they perceived that gender mattered. The material was explored using qualitative content analysis. 

In the second study, 250 students’ written answers to two short essay questions were analyzed to explore the impact of medical school experiences on specialty preferences. Utilizing a sequential mixed methods design, their responses were analyzed qualitatively to create categories that thereafter were compared quantitatively between men and women. 

In the third study, generating two articles, individual interviews were conducted with 18 students (10 women, 8 men) who self-identified as coming from cultural or ethnic minority backgrounds, exploring their experiences of interactions related to their minority position. Inspired by constructivist grounded theory, data collection and analysis were iterative.

Findings and reflections: In individual interviews and focus groups, many participants initially described the medical school climate as equal and inclusive. Still, in their narratives about concrete experiences they gave another picture. In interactions with supervisors, staff, and patients almost everyone had regularly encountered stereotypes, discriminatory treatment, and demeaning jargon. Simultaneously, a subtle favoring of male and white majority students was noted. Thus, values, norms, and hierarchies concerning gender and culture/ethnicity were crucial dimensions in their narratives.

These experiences made female students feel like they were rendered invisible and not taken seriously, and marked racialized minority students’ status as ’Others’ – making both female- and minority students feel less worthy as medical students. However, most were unsure whether they could call their experiences “sexist”, ”racist”, or ”discriminatory”. Instead, they found other explanations for people's actions such as curiosity, fear, or ignorance. 

Participants strove to manage the threat of constraining stereotypes and exclusion while maintaining an image of themselves as professional physicians-to-be. They opposed being seen – and seeing themselves as – problematic and passive victims. The clinical power hierarchy, fear of repercussions, and lack of support from bystanders affected what modes of action seemed accessible. Consequently, participants tended to stay silent, creating emotional distance, and adapting to avoid stereotypes rather than resisting, confronting, and reporting unfair treatment. 

The school climate also had consequences for specialty preferences. Both women and men expressed that working tasks and potential for work-life balance were motifs for their specialty preference. These aspects, however, were often secondary to feeling included or excluded during clinical practice. More women than men had been discouraged by workplaces with perceived hostile or sexist climates. In contrast, more men had been deterred by specialty knowledge areas and what they thought were boring work tasks. 

Conclusions: Medical students experience everyday sexism- and racism or microaggressions, i.e., practices that, intentionally or inadvertently, convey disregard or contempt. However, the contemporary discourse, which confines sexism and racism into conscious acts perpetrated by immoral or ignorant people, and the pretense that these phenomena no longer pose a problem in Sweden or in medical school, obscure their structural and systemic nature. In fact, this limited view of sexism and racism leaves inequities normalized and disempowers those targeted by discrimination. 

Constraining stereotypes and exclusion are not caused by the actions of their recipients, that is, female or racialized/minority students. Consequently, their behavioral changes like avoidance and adaptation will not eliminate discrimination but, instead, tend to re-establish the white male medical student as the norm. As long as students who do not fit the norm, rather than the norm itself are regarded as the problem, the sexist and racist practices described in this study will remain part of the hidden curriculum and part of the process of becoming and being a physician. Simultaneously, formal commitments to equality are at risk of being only symbolic while inequities persist. 

To counteract these inequities, the medical community needs to acknowledge female and racialized medical students’ knowledge about sexist and racist practices within our institutions. Further, medical school leadership should provide students, supervisors, and teachers with an account of structural and everyday sexism and racism, encourage them to engage in critical self-reflection on their roles in sexist and racist power relations, and with strategies and training on how to intervene as bystanders and allies. 

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2021. p. 114
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2116
Keywords
medical education, medical students, clinical training, specialty preference, qualitative methods, mixed methods, everyday sexism, everyday racism, gendered microaggressions, racial microaggressions
National Category
General Practice
Research subject
family medicine
Identifiers
urn:nbn:se:umu:diva-179402 (URN)978-91-7855-460-7 (ISBN)978-91-7855-461-4 (ISBN)
Public defence
2021-02-26, Hörsal B, nio trappor, Norrlands universitetssjukhus, Daniel Naezéns väg, 907 37, Umeå, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2021-02-05 Created: 2021-02-01 Last updated: 2021-12-09Bibliographically approved
Kristoffersson, E., Diderichsen, S., Verdonk, P., Lagro-Janssen, T., Hamberg, K. & Andersson, J. (2018). To select or be selected - gendered experiences in clinical training affect medical students' specialty preferences. BMC Medical Education, 18, Article ID 268.
Open this publication in new window or tab >>To select or be selected - gendered experiences in clinical training affect medical students' specialty preferences
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2018 (English)In: BMC Medical Education, E-ISSN 1472-6920, Vol. 18, article id 268Article in journal (Refereed) Published
Abstract [en]

Background: The literature investigating female and male medical students' differing career intentions is extensive. However, medical school experiences and their implications for professional identity formation and specialty choice have attracted less attention. In this study we explore the impact of medical school experiences on students' specialty preferences, investigate gender similarities and differences, and discuss how both might be related to gender segregation in specialty preference.

Methods: In a questionnaire, 250 Swedish final-year medical students described experiences that made them interested and uninterested in a specialty. Utilizing a sequential mixed methods design, their responses were analyzed qualitatively to create categories that were compared quantitatively.

Results: Similar proportions of women and men became interested in a specialty based on its knowledge area, patient characteristics, and potential for work-life balance. These aspects, however, often became secondary to whether they felt included or excluded in clinical settings. More women than men had been deterred by specialties with excluding, hostile, or sexist workplace climates (W = 44%, M = 16%). In contrast, more men had been discouraged by specialties' knowledge areas (W = 27%, M = 47%).

Conclusions: Male and female undergraduates have similar incentives and concerns regarding their career. However, the prevalence of hostility and sexism in the learning environment discourages especially women from some specialties. To reduce gender segregation in specialty choice, energy should be directed towards counteracting hostile workplace climates that explain apparent stereotypical assumptions about career preferences of men and women.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Medical students, Specialty preference, Professional identity formation, Sexism, Mixed methods
National Category
Gender Studies
Identifiers
urn:nbn:se:umu:diva-154055 (URN)10.1186/s12909-018-1361-5 (DOI)000451080300003 ()30453953 (PubMedID)2-s2.0-85056700280 (Scopus ID)
Funder
Swedish Research CouncilVästerbotten County Council
Available from: 2018-12-19 Created: 2018-12-19 Last updated: 2023-03-24Bibliographically approved
Kristoffersson, E., Andersson, J., Bengs, C. & Hamberg, K. (2016). Experiences of the gender climate in clinical training: a focus group study among Swedish medical students. BMC Medical Education, 16, Article ID 283.
Open this publication in new window or tab >>Experiences of the gender climate in clinical training: a focus group study among Swedish medical students
2016 (English)In: BMC Medical Education, E-ISSN 1472-6920, Vol. 16, article id 283Article in journal (Refereed) Published
Abstract [en]

Background: Research shows that medical education is characterized by unequal conditions for women and men, but there is a lack of qualitative studies investigating the social processes that enable and maintain gender inequalities that include both male and female students. In this focus group study, we therefore explored male aswell as female medical students’ experiences of the gender climate – i.e., how beliefs, values, and norms about gender were communicated – during clinical training and how the students dealt with these experiences.

Methods: Focus group interviews were conducted with 24 medical students (nine men) at Umeå University, Sweden. The interviews were structured around personal experiences in clinical training where the participants perceived that gender had mattered. Data were analysed using qualitative content analysis.

Results: The students described gender-stereotyped expectations, discriminatory treatment, compliments, comments, and demeaning jargon. Female students gave more personal and varied examples than the men.The students’ ways of handling their experiences were marked by efforts to fit in, for example, by adapting their appearance and partaking in the prevailing jargon. They felt dependent on supervisors and staff, and due to fear of repercussions they kept silent and avoided unpleasant situations and people rather than challenging humiliating jargon or supervisors who were behaving badly.

Conclusions: Everyday communication of gender beliefs combined with students’ adaptation to stereotyped expectations and discrimination came across as fundamental features through which unequal conditions for male and female students are reproduced and maintained in the clinic. Because they are in a dependent position, it is often difficult for students to challenge problematic gender attitudes. The main responsibility for improvements, therefore, lies with medical school leadership who need to provide students and supervisors with knowledge about gendered processes, discrimination, and sexism and to organize reflection groups about the gender climate in order to improve students’ opportunities to discuss their experiences, and hopefully find ways to protest and actively demand change.

Place, publisher, year, edition, pages
London: BioMed Central, 2016
Keywords
Medical education, Clinical training, Gender equality, Attitudes, Sexism, Focus groups
National Category
Public Health, Global Health, Social Medicine and Epidemiology Sociology
Identifiers
urn:nbn:se:umu:diva-128667 (URN)10.1186/s12909-016-0803-1 (DOI)000386329100002 ()27784300 (PubMedID)2-s2.0-84995480646 (Scopus ID)
Available from: 2016-12-12 Created: 2016-12-12 Last updated: 2023-03-24Bibliographically approved
Kristoffersson, E. & Hamberg, K.“I have to do twice as well, so that no one will think: ‘It´s that immigrant’”: Managing everyday racism in a Swedish medical school.
Open this publication in new window or tab >>“I have to do twice as well, so that no one will think: ‘It´s that immigrant’”: Managing everyday racism in a Swedish medical school
(English)Manuscript (preprint) (Other academic)
National Category
General Practice
Identifiers
urn:nbn:se:umu:diva-179400 (URN)
Available from: 2021-02-01 Created: 2021-02-01 Last updated: 2021-12-09
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-8404-9623

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