The Effect of Gender on the Clinical Clerkship Experiences of Female Medical Students: Results From a Qualitative Study

Yale University School of Medicine, New Haven, Connecticut 06520-8088, USA.
Academic medicine: journal of the Association of American Medical Colleges (Impact Factor: 2.93). 08/2009; 84(7):859-66. DOI: 10.1097/ACM.0b013e3181a8130c
Source: PubMed


To characterize how female medical students perceive the role of gender within their medical education during the transition to the clinical curriculum.
In 2006-2007, the authors conducted a qualitative study consisting of in-depth interviews with 12 third-year female medical students completing their first clinical clerkship. Participants were purposefully selected from a single New England medical school to represent a range of ages, ethnicities, and prior life experiences.
Participants (1) struggled to define their role on the wards and often defaulted to stereotypical gender roles, (2) perceived differences in the nature of their workplace relationships compared with the nature of male medical students' workplace relationships, (3) had gendered expectations of male and female physicians that shaped their interactions with clinical supervisors, (4) felt able to negotiate uncomfortable situations with patients but felt unable to negotiate uncomfortable situations with supervisors and attendings, and (5) encountered a "gender learning curve" on the wards that began to shape their self-view as future female physicians.
Despite increased numbers of women in medicine, issues of gender continue to have a substantial impact on the medical education of female students. Institutions can design interventions about gender issues in medicine that expand beyond a focus on sexual harassment to address the complex ways in which students are affected by issues of gender.

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    • "Interns feel pressure to present themselves as ‘professional and self-confident’, even when they feel insecure, and this adds to their fear of not being suitable for the profession. Patient encounters seem rather a source of pride and satisfaction, as reported earlier [4,10,65]. The role of the medical faculty in fostering caring competence has also been called into question [66], although an earlier study has shown that 6th-year Dutch students are more patient-centered than their 1st-year counterparts [67]. "
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    ABSTRACT: Background Medical students report high stress levels and in particular, the clinical phase is a demanding one. The field of medicine is still described as having a patriarchal culture which favors aspects like a physicians’ perceived certainty and rationalism. Also, the Effort-Recovery Model explains stress as coming from a discrepancy between job demands, job control, and perceived work potential. Gendered differences in stress are reported, but not much is known about medical interns’ perceptions of how gender plays in relation to stress. The aim of this study is to explore how medical interns experience and cope with stress, as well as how they reflect on the gendered aspects of stress. Methods In order to do this, we have performed a qualitative study. In 2010–2011, semi-structured qualitative interviews were conducted with seventeen medical interns across all three years of the Masters programme (6 male, 11 female) at a Dutch medical school. The interview guide is based on gender theory, the Effort-Recovery Model, and empirical literature. Transcribed interviews have been analyzed thematically. Results First, stress mainly evolves from having to prove one’s self and show off competencies and motivation (“Show What You Know…”). Second, interns seek own solutions for handling stress because it is not open for discussion (… “And Deal With Stress Yourself”). Patient encounters are a source of pride and satisfaction rather than a source of stress. But interns report having to present themselves as ‘professional and self-confident’, remaining silent about experiencing stress. Female students are perceived to have more stress and to study harder in order to live up to expectations. Conclusions The implicit message interns hear is to remain silent about insecurities and stress, and, in particular, female students might face disadvantages. Students who feel less able to manifest the ‘masculine protest’ may benefit from a culture that embraces more collaborative styles, such as having open conversation about stress.
    BMC Medical Education 05/2014; 14(1):96. DOI:10.1186/1472-6920-14-96 · 1.22 Impact Factor
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    • "Furthermore, females experienced more workload and perceived a lower level of skills than males. The results of previous studies also showed that the transition may be more difficult for female than for male students (Hayes et al. 2004; Babaria et al. 2009). However, since no gender differences occurred in the baseline measurement (van Hell et al. 2008), it is possible that males benefit more from the dual learning year than females. "
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    ABSTRACT: The transition from preclinical to clinical training is perceived as stressful with a high workload being the main difficulty. To ease this transition, we implemented a dual learning year, where just-in-time skills training and clerkships alternated. To examine the effect of the dual learning year on students' stress and perceptions of workload and skills level, and to compare these data with a baseline measurement from a curriculum in which skills training was provided in advance of clerkships. During the first Master year, students completed four rotations in which 5 weeks of skills training and 5-week clerkships alternated. In the second clerkship week of each rotation, students (n = 476) completed questionnaires measuring their experienced workload, perceived skills level and stress. Analysis of variance was used for trend analysis and to determine differences with the baseline measurement (n = 83). During the dual learning year, 'experienced workload' decreased (F(1,471) = 9.408, p < 0.01), 'perceived skills level' increased (F(1,471) = 94.202, p < 0.001) and stress decreased (F(1,471) = 3.309, p < 0.10). 'Experienced workload' was lower (F(5,553) = 7.599, p < 0.001) and 'perceived skills level' was comparable to the baseline measurement. Compared to the baseline measurement and the results of earlier studies on transition difficulties, alternating just-in-time skills training and clerkships seem to ease the transition from preclinical to clinical training.
    Medical Teacher 12/2011; 33(12):e689-96. DOI:10.3109/0142159X.2011.611837 · 1.68 Impact Factor
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    • "The interpretation of concrete experiences may be influenced by students' prior experiences and expectations. This was suggested to differ greatly for male and female students during their transition into the clinical curriculum (Babaria et al. 2009). For younger students, this transition might be more stressful than for their more mature colleagues (Shacklady et al. 2009). "
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    ABSTRACT: Entering medicine for the first time is highly impressive for students, but we know little about the actual emotional learning processes taking place. We aimed to get more insight into expectations, experiences and emotions of students during their first clinical experiences in a hospital compared to a nursing home. We carried out a qualitative and a quantitative survey by administering questionnaires about expectations, impressive experiences and learning activities within two cohorts of first-year medical students before and after a 4-week nursing attachment. Despite different expectations, students reported similar experiences and learning activities for the nursing home and the hospital. Most impressive events were related to patient care, being a trainee, or professional identities being challenged. Students in nursing homes most often referred to their own relationships with patients. Students expressed different emotions, and frequently experienced positive and negative emotions at the same time. Rewarding experiences (not only difficult or stressful events) do matter for medical professional development. Students need to learn how to deal with and feel strengthened by the emotions evoked during clinical experiences, which should be supported by educators. The nursing home and the hospital seem to be equally suited as learning environments.
    Medical Teacher 11/2011; 33(11):e593-601. DOI:10.3109/0142159X.2011.610837 · 1.68 Impact Factor
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