Gender bias in medical school: A level start?
By George Hunt
As a late 90s baby, the initial most turbulent change in my life was the turn of a new century – I am told this is when the London New Year’s fireworks first occurred, though in my memory this is taken for granted as a year on year annual celebration.
Second place, I’d like to rank the tide of gender change. Times have changed from the Pankhurstian efforts to win small, but important, concessions. However, changing cultural and societal expectations is no small feat. There is still change to be made, and healthcare is no exception.
During my last summer holidays (I am now a third year medical student) I took up a project exploring the current state of gender bias in medical education – I interviewed a wide range of staff and students looking to find out what was really going on now.
Through analysing the themes that came up in the interviews, by the words and phrases used, I found out that the trend in my medical school was very similar to the global successes and areas for continued change.
Positive steps have been made. Initiatives such as ATHENA Swan (an award recognising STEM and other institutions for female excellence) and Women in Surgery are tangible markers of change. Students at my medical school have noticed that there was a balanced approach to teaching and assessment. Indeed, by removing gender cuing from exam questions it is understood to be a more accurate test of students’ medical knowledge. Many students reported never to have experienced gender influencing the experiences and education that they had so far received.
Areas for change
Nonetheless, these initiatives are a double edged sword. While their aim is to promote change for the better, care must be taken that they do not become “PC gone too far”. This was illustrated by the perception of female-only diversity committees, lacking the stakeholder involvement in change that men, and others, may have.
Furthermore, medical education (as any teaching) is impacted by a phenomenon known as the ‘hidden curriculum’. This phenomenon was first noticed by anatomists as they found increased professionalism in students that was a bizarre and unpredicted result of performing human cadaveric dissection. This has been understood to extend to all realms of education.
Take a teaching session where medical students are being taught how to perform the cardiovascular examination. Anecdotally this ‘hidden curriculum’ could manifest itself through:
Clinical teachers being assumed to be more likely to choose a male student as the model
Questions being mainly directed at male students
Male students being perceived as more eager to learn, and treated as such (e.g. the preferential development of professional relationships)
This atmosphere may have the hidden effect of conveying to male students a sense of priority and confidence, while instilling in the non-male students an attitude of by-standing, undermining the belief in the ability and contribution that they may have.
This impact of the subtle shaping of future clinicians in respect to gender was an issue that came up in the project I was completing. It was mentioned to be reinforced by clinical encounters with some patients. The most illustrative occurrence of this is the assumption that female medical students are nurses, while the male medical students are ‘real’ doctors. One can wonder – does this assumption stem from patients’ own core beliefs, or the hidden curriculum shaping students according to their gender which in turn leads patients to make those judgments?
A word about the impact of this on LGBTQ+ issues, though I’ve mainly addressed Male/Female gender bias. My hope is that this false male / female divide will be levelled to such an extent that binary and non-binary attributes are equally absent in professional life.
Things have changed regarding gender – hopefully that isn’t news to you! What is still being developed is the attitudes and opportunities that medical and healthcare students, as future professionals, have. These will shape the way that gender is interpreted in the medical field, hopefully to a point where initiatives such as ‘Women in Surgery’ (though currently having a very valuable role) are superfluous, due to the level playing field of opportunity.
I dream that as I expect those New Year fireworks to occur every year, as they seemingly have done forever, that medical schools will be shaping the future cohorts of students to be expectant of a healthcare system uninfluenced by gender.