Challenges Remain for Female Medical Students

It might actually come as a surprise to many would-be medical students that gender is an issue that still affects those who are training for a career as a doctor. After all, there are more women in medicine than ever before–and certain areas of practice have become largely female-dominated. Despite this, however, gender attitudes can color nearly every aspect of medical education.

Women in Medicine: Close to Parity – at Least In Numbers
Statistically, if you just look at the numbers, the participation of women in medicine has indeed come a long way. According to the AAMC, as of 2013, of the 20,055 students who were accepted into medical schools across the country, the split between men and women was almost evenly divided: 53% male and 47% female. It is important to look at these stats in terms of their historical context in order to truly appreciate them.


Women in Medicine, Historically
Medicine, historically, was a field mostly closed to women through most of American history. America did not even see its first female doctor until the 1840’s, when Elizabeth Blackwell earned her MD and later opened the Women’s Medical College, the first in the country to offer medical training to women. The American Medical Association accepted its first female member in the 1870’s and by the 1930’s, there were enough women in medicine to form the Medical Women’s National Association.Still, numbers remained relatively low. This current, nearly even split is especially striking when compared with the more recent past, where the percentage of women in medicine was far lower:

● 1970: 7.6% female
● 1980: 11.6% female
● 1990: 16.9% female
● 2000: 24% female

As women’s presence in medicine grew, they began to win awards such as the Nobel Prize in Medicine (1940’s) and to take positions of authority as such Commissioner of the Food and Drug Administration and US Surgeon General (both in the 1990’s).

However, despite the growing presence and the number of glass ceilings women have broken, the medical school experience can be very different for female students and affect many aspects of their educational and personal lives while they are studying to become doctors. The next sections looks at these specific experiences in greater detail.

The Effects of Gender on Specific Medical School Experiences
Despite the advancements women have made in the field of medicine and the increasing numbers of them joining the ranks of American physicians, it appears that gender can color nearly every aspect of a female medical student’s experience during her training. We will look at these aspects in more detail below.

Reversion to Stereotypical Behavior and Perceptions
One recurring theme in studies done on the experiences of female physicians-in-training is a reversion to stereotypical behavior during their interactions with patients, supervisors and fellow medical trainees. In one study, female medical students reported that they often found themselves reverting to traditional “feminine” behavior while on the wards, including assisting the nursing and support staff, apologizing for errors that were made whether or not they themselves were at fault, and nurturing/comforting their patients. The students believed that this more traditional behavior colored the way they were viewed by their attendings as well as their fellow students.

In another study, interviews with female third-year students just finishing their first clerkship found similar common themes running through the perceptions and behaviors of their interviewees. On the whole, researchers found that these women:

● Struggled with the role they needed to play as medical students and often reverted to stereotypical behavior,
● Perceived that their role in the workplace was different than their male counterparts,
● Had perceptions of male and female physicians that were influenced by stereotypical thinking,
● Felt more able to deal with socially difficult situations with patients than they did with their colleagues and
● Felt the presence of a “gender learning curve” that made their experiences different and influenced the way they saw themselves professionally.

This reversion to stereotyped thinking and behavior is not just a problem in American medical schools: in a British study of medical students training in the UK, interviewers found this same kind of thinking in both the male and female medical students they interviewed, with gender-based perceptions such as female doctors being more empathetic and sensitive to their patients and male doctors better at the competitive, physically taxing world of surgery.

In short, certain actions and personality traits traditionally perceived as being “feminine” or “masculine” still abound in medicine (as they do in other professions) and can color the experience that female medical students have as they train to become physicians.

Sexual Harassment
No discussion of women’s experience in medical school would be complete without a discussion of the issue of sexual harassment.

Dr. Susan Hinze’s 2004 piece, “’Am I Being Oversensitive?’” notes that, although sexual harassment has been prohibited since 1980, it is still present in the American workplace–and the medical field is no exception to this rule. In fact, she notes that the fact that medicine has traditionally been so male-dominated puts women at greater risk for sexual harassment as they struggle to find their role in it–and that laws and policies do not always go far enough in influencing behavior and the atmosphere of the hospital and other medical institutions.

Hinze notes that, according to past studies, while sexual harassment does happen once a woman has completed her medical training, it is more common during that training. Her study noted that, in past research, somewhere between 37% and 47% of female medical students had experienced some form of sexual harassment and in studying this phenomenon, she notes several common themes in her interviews (which included both male and female medical students):

● The hierarchical, male-dominated structure of medicine and the poor treatment of physicians-in-training (of both sexes) created an atmosphere where women felt they had to “put up” with the harassment as part of their rite of passage to becoming a doctor
● When talking about instances of sexual harassment, both male and female medical students emphasized a woman’s “sensitivity” to a certain behavior rather than the behavior itself and women frequently blamed themselves for being “oversensitive”.

Despite this kind of research, the problem persists to this day. Dr. Friedman, in her article, “Are We There Yet?” which was written in 2010, points out that despite the increase in the number of women in medicine, incidents of sexual harassment remain a part of the experience of many medical trainees.

Depression, Role Confusion and their Emotional Impacts
The experiences of female medical students as they are training to become doctors can also be colored by depression and role confusion and these issues can have a significant emotional impact on these students.

In should be said that, taken as a group, medical students (regardless of gender) have a rate of depression that is approximately 15-30% higher than the general population. Medical training is an inherently stressful undertaking and the poor diet, long working hours, academic pressure and lack of sleep can combine to have an emotional impact on male and female medical students alike. However, it does appear that female medical students suffer from higher rates of depression than their male counterparts–and that this can spill over into other aspects of their lives.

For instance, in a 2012 paper published in the journal Psychology, interviews with female medical students showed the students reported feeling of depression, self-criticism, insecurity over their roles and a decreased sexual satisfaction in their personal relationships; another study of over 1,200 female medical students published in 2011 found that 46% reported symptoms of depression and that this was positively correlated to sexual dysfunction and generally low levels of life satisfaction.

Sexual Division by Specialty
The issues above–role confusion, an increased rate for depression, even sexual harassment–can be hard to quantify in studies because of their sometimes intangible or emotional nature. One of the more concrete ways in which gender-colored perceptions can manifest themselves in the world of medical trainees is the specialties which those trainees choose as their career in medicine moves ahead.

In a 2015 study from the American Association of Medical Colleges, analyzing the graduating classes of the 2013-2014 school year from medical schools across the country, found several areas of medicine that are still sharply defined by one sex or the other.

To compare, female doctors dominated in the following areas:
● Family medicine (59%)
● Psychiatry (75%)
● Pediatrics (75%)
● Obstetrics-gynecology (85%)

At the same time, male doctors were prominent in:
● Surgery (59%)
● Emergency medicine (62%)
● Radiology (73%)
● Internal medicine (54%)

This is not the first study to note the continued sexual disparities in certain areas of medicine: a 2013 paper published in the Journal of the American College of Surgery found that women were still under-represented in a few key areas of medical practice, including neurosurgery, orthopedics, urology, general surgery and radiology.

It is interesting to note the recurring theme in many of these studies of surgery as being a “boys only” club. In the Hinze study on sexual harassment, it was found that, when broken down by area, the highest level of sexual harassment was found to be in the area of surgery. The uncomfortable atmosphere created by these behavior could well serve as a detractor for many women from entering into this particular branch of medicine.

In conclusion, the experience of female medical students during the course of their training is mixed. On one hand, women are more represented in medicine than ever and in some areas of medicine, actually represent a majority of new practitioners. However, old ways of thinking about gender roles abound even in medicine and these can color the experiences of female medical students in detrimental ways. Further workplace education to provide a deeper understanding of these roles may be needed to improve the experiences of these students.