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To select or be selected - gendered experiences in clinical training affect medical students' specialty preferences
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).ORCID iD: 0000-0002-8404-9623
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.ORCID iD: 0000-0001-6897-5515
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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. Vol. 18, article id 268
Keywords [en]
Medical students, Specialty preference, Professional identity formation, Sexism, Mixed methods
National Category
Gender Studies
Identifiers
URN: urn:nbn:se:umu:diva-154055DOI: 10.1186/s12909-018-1361-5ISI: 000451080300003PubMedID: 30453953Scopus ID: 2-s2.0-85056700280OAI: oai:DiVA.org:umu-154055DiVA, id: diva2:1272519
Funder
Swedish Research CouncilVästerbotten County CouncilAvailable from: 2018-12-19 Created: 2018-12-19 Last updated: 2023-03-24Bibliographically approved
In thesis
1. Är det bara jag? Om sexism och rasism i läkarutbildningens vardag: erfarenheter, förklaringar och strategier bland läkarstudenter
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

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Kristoffersson, EmelieDiderichsen, SaimaHamberg, KatarinaAndersson, Jenny

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