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Female victims and female perpetrators: medical students’ narratives of gender dynamics and professionalism dilemmas

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Abstract

Medicine is a gendered discipline, in which women, both as patients and practitioners, have often held subordinate positions. The reproduction of dominant gender biases in the medical setting can negatively impact the professional development of medical students and the wellbeing of patients. In this analysis of medical students’ narratives of professionalism dilemmas, we explore students’ experiences of gender bias in hospital settings. Seventy-one students participated in 12 group interviews, where they discussed witnessing or participating in various activities that they thought were professionalism lapses. Within the dataset, 21 narratives had a distinctly gendered component broadly pertaining to patient dignity and safety dilemmas, informed consent issues, and female student abuse. Interestingly, perpetrators of such acts were commonly female healthcare professionals and educators. Although students recognized such acts as professionalism lapses and often expressed concern for patient wellbeing, students did not intervene or report such acts due to hierarchical cultural contexts, and at times even reproduced the discriminatory behavior they were criticizing. This raises concerns about medical students’ professionalism development and the extent to which gender bias is ingrained within particular medical systems. The normalization of disrespectful and abusive treatment of female patients poses immediate and future consequences to the wellbeing and safety of women. Furthermore, the same socio-cultural values that sustain these acts may account for perpetrators often being women themselves as they strive to overcome their subordinate position within medicine.

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Acknowledgements

We are grateful to all our participants who shared their stories with us. We would also like to thank Jesse Norris for helping us develop the original coding framework, and Katherine Gosselin and Yuting Chui for coding the data. This research was supported by a grant from the Association for Medical Education in Europe and a grant from the Ministry of Science and Technology, Taiwan.

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Authors and Affiliations

  1. Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan

    Malissa K. Shaw

  2. Department of Medical Education, University of Kelaniya, Kelaniya, Sri Lanka

    Madawa Chandratilake

  3. Department of Family Medicine and Center for Innovation and Leadership in Education, Georgetown University School of Medicine, Washington, DC, USA

    Ming-Jung Ho

  4. Monash Centre for Scholarship in Health Education (MCSHE), Monash University, Melbourne, Australia

    Charlotte E. Rees

  5. Faculty of Health Sciences, Work Integrated Learning, The University of Sydney, Room J213, Level 2, J Block, 75 East Street, Lidcombe, NSW, 2140, Australia

    Lynn V. Monrouxe

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Contributions

MC, M-JH, CER, and LVM developed the study, contributed to data collection, and participated in the initial analysis and interpretation of the data. MKS conducted the in-depth gendered analysis and in discussions with LVM and CER drafted the first version of the manuscript. LVM and CER edited the paper and MC and M-JH commented on manuscript revisions. All authors approve the final version.

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Correspondence to Lynn V. Monrouxe.

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Appendix: Higher order codes from new coding framework

Appendix: Higher order codes from new coding framework

  • Identity dilemmas: aspects of the student’s identity that placed them in a dilemma situation.

  • Consent dilemmas: situations in which informed consent for the student’s presence or actions may not have been obtained, including situations in which students were asked/told to perform examinations/procedures by others, situations instigated by the students, and situations in which patients might not have been able to give fully informed consent for either personal or situational reasons.

  • Humiliation and mistreatment dilemmas: students’ experiences of verbal, physical and emotional mistreatment towards them and others.

  • Patient care dilemmas around students’ action: patient care dilemmas that specifically focused on students’ direct involvement with patients.

  • Patient care dilemmas around healthcare professionals’ actions: patient care dilemmas that specifically focused on the actions of clinicians, nurses and other healthcare workers as reported by the medical students who were passive observer.

  • Dilemmas around healthcare professionals’ talk regarding own or other healthcare professionals: narratives of dilemmas around healthcare professionals’ talk, such as disrespectful talk about own and other healthcare professionals that the student witnessed.

  • Dilemmas encountered whilst overseas: dilemmas that medical students experienced whilst on their elective study overseas.

  • Dilemmas encountered when learning facts and procedures: dilemmas that medical students experienced during learning/teaching encounters with medical professionals that focused on situations encountered in university and medical settings.

  • Dilemmas encountered before University: ethical/professional issues students encountered before they came to University.

  • Dilemmas about challenging others over behaviors and whistleblowing: situations students narrated when they thought that they saw something or knew something that others in authority should be party to.

  • Dilemmas experienced around patient health and illness behavior: situations students narrated concerning the ways in which patients deal with their own health and illness issues, including situations that students encountered during which patients refused treatment or continued to engage in behavior that was detrimental to their own health.

  • Dilemmas around patients using CAM (complimentary and alternative medicine) and/or in place of Western medicine: situations in which students became aware of patients use of CAM without disclosing this information to other healthcare professionals or cases where students thought CAM may be interfering with the patients Western medicine treatment.

  • Dissection dilemmas: situations that happened in the dissecting room, such as the behavior of other students that caused participants discomfort.

  • Students’ narrations of unacceptable behavior of patients towards clinical educators and other healthcare professionals: situations in which students narrate unacceptable behavior of patients towards clinical educators and other healthcare workers, such as racist or sexist behavior.

  • Dilemmas around other experiences of student life: situations students’ narrated about their experiences at medical school such as lectures being cancelled or support services being accessed.

  • Dilemmas around intimate examinations or procedures: situations that involved students conducting or observing intimate examinations or procedures.

  • Students’ dilemmas about peers’ behaviors: situations students found themselves in when they felt that a fellow student had behaved inappropriately in some way.

  • Fitness to practice dilemmas: situations involving fitness to practice issues, either in the medical student themselves or in colleagues (e.g. peers, qualified clinicians, etc.), such as mental health problems.

  • Dilemmas around ethical issues of clinical educators in general: ethical dilemmas that students discussed for clinical educators. These were not dilemmas that the students themselves were in, but ethical dilemmas they encountered that clinical educators had to deal with.

  • Impact of family on patient care dilemmas: incidents where the patient’s family intervened or influenced the diagnosis or treatment processes by interacting with the doctor, medical students or other healthcare staff.

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Shaw, M.K., Chandratilake, M., Ho, MJ. et al. Female victims and female perpetrators: medical students’ narratives of gender dynamics and professionalism dilemmas. Adv in Health Sci Educ 25, 299–319 (2020). https://doi.org/10.1007/s10459-019-09919-z

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