BMJ  2004;328:142-143 (17 January), doi:10.1136/bmj.328.7432.142

Paper

Gender gap in undergraduate experience and performance in obstetrics and gynaecology: analysis of clinical experience logs

¹ Academic Department of Obstetrics and Gynaecology, Faculty of Medicine, Imperial College, London W2 1NY, ² Chelsea and Westminster Hospital Campus, Faculty of Medicine, Imperial College

Introduction

The percentage of UK graduates considering a career in obstetrics and gynaecology is falling.¹ In 1974, for example, 3.9% of men (55) and 4.3% of women (23) specified the specialty as their first preference for a career²; by 2000, this was only 0.9% (12) and 3.2% (54).¹ An increasing proportion of women in the workforce exacerbates the shortage, as overall women contribute fewer working hours than men to the specialty.³ Experiences during undergraduate training are likely to influence graduates' perceptions of identifying with and thriving within a given specialty. Differences in experience and performance in examinations may explain, at least in part, the current reluctance of male students to consider a career in obstetrics and gynaecology.

Participants, methods, and results

All undergraduates have completed a detailed log of clinical experience since 1997. By sex, we analysed recorded experience and performance in examinations (two case presentations, a multiple true or false paper, and an objective structured clinical examination) for 1036 consecutive students (529 men and 507 women). Men and women had done similar numbers of clerkings.

Men had significantly less clinical experience in obstetrics and in gynaecology, except in relation to scrubbing for caesarean sections (table). Women did significantly better in all aspects of assessment. Nine men failed compared with three women, although this was not significant (Fisher's exact test P = 0.145). Eight men were awarded distinctions, compared with 26 women, which was highly significant (Fisher's exact test P = 0.0014).

View this table: [in this window] [in a new window]   Clinical experience and performance in examinations for obstetrics and gynaecology among medical students, analysed by sex*

 

Comment

Male students have significantly less clinical experience than female students in key areas of obstetrics and gynaecology, such as passing a speculum and taking a cervical smear. Men also perform less well in examinations. These significant differences between the sexes are perhaps not unexpected, but we were surprised by the magnitude of some of them.

We now use mannekins for testing competency at passing a speculum and taking cervical smears in our final examination, to ensure basic competency. Anecdotally, our male students report increasing numbers of women declining to have male students involved in their care, often reflecting cultural issues. In addition, male students report that some midwives are less helpful than they are to female students.

Differences in clinical experience according to sex have been reported in the United States, with women students receiving more experience in seven of 12 skills specific to women and men receiving more experience in two of three skills specific to men. Greatest experience was gained where teacher, student, and patients were of the same sex.

Traditionally women are discriminated against in medical training; however, men are increasingly excluded from certain opportunities. Students of both sexes have voiced discomfort about what has been perceived as an anti-male environment in obstetrics and gynaecology.⁴ This unwelcoming attitude towards men is also a reason for men to reject careers in obstetrics and gynaecology.⁵ We must always respect patient autonomy, but we try to balance this by asking teachers to ensure men feel welcome and wanted.

Continuing to fail to recruit men to obstetrics and gynaecology will halve the pool of potential recruits while, allowing for career breaks, it will increase the number required. Additionally, negative undergraduate experiences may discourage men from involvement in contraception, well woman screening, and gynaecological problems in family practice. Excluding men from important aspects of reproduction is fundamentally unwise; the lack of adequate male role models is already widely cited as a problem afflicting society as a whole.

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Contributors: Both authors conceived and designed the study, collected and analysed the data, and wrote the paper. Both authors are guarators.

Funding: None.

Competing interests: None declared.

Ethical approval: Not needed.

References

1. Lambert TW, Goldacre MJ, Turner G. Career choices of United Kingdom medical graduates of 1999 and 2000: questionnaire surveys. BMJ 2003;326: 194-5.[Free Full Text]
2. Lambert TW, Goldacre MJ, Edwards C, Parkhouse J. Career preferences of doctors who qualified in the United Kingdom in 1993 compared with those of doctors qualifying in 1974, 1977, 1980, and 1983. BMJ 1996;313: 19-24.[Abstract/Free Full Text]
3. Pearse WH, Haffner WH, Primack A. Effect of gender on the obstetric-gynecologic work force. Obstet Gynecol 2001;97: 794-7.[CrossRef][Web of Science][Medline]
4. Nora LM, McLaughlin MA, Fosson SE, Stratton TD, Murphy-Spencer A, Fincher RM, et al. Gender discrimination and sexual harassment in medical education: perspectives gained by a 14-school study. Acad Med 2002;77: 1226-34.[Web of Science][Medline]
5. Lambert TW, Davidson JM, Evans J, Goldacre MJ. Doctor's reasons for rejecting initial choices of specialties as long-term careers. Med Edu 2003;37: 312-8.

(Accepted 5 August 2003)

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Rapid Responses:

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Patients must be encouraged to see beyond gender

Oliver J Warren
bmj.com, 16 Jan 2004 [Full text]

Good topic, wrong research method?

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obstetrics and gynaecology - Gender Gap

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Re: obstetrics and gynaecology - Gender Gap- What about Geriatrics and Psychiatry?

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Males are appreciated

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