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Gender & Medical Education Part 2

Editor Note: This is the second in a three part series. To read part one, click here.

How do these gender roles play a part in medicine? First, our specialties in medicine can be characterized as more “agentic” vs “communal”. For example, communal specialties are ones that involve care of families and children and are not considered highly technical. These fields are considered lower status, often lower salary, and have a higher percentage of female physicians. Other more agentic fields, such as orthopedics, neurosurgery and neurology, are perceived as higher status, more technical, and more male-dominated. Medical students likely experience a significant number of subtle messages related to gender bias that influence their career direction to align with gender stereotypes. Below is a table from Carnes et al. (3) depicting the effects of gender roles on specialty.

How else does our sex affect us as women in medicine? Remember that “likeability penalty” we talked about. Well, wait until you see your evaluations! In medical school, my evaluations were great. I aced my classes while trying not to be a “gunner” along the way. But as I stepped into the role of a resident, the role of a physician CARING for the patient, the role of needing to get things done to save a life, my evaluations changed. In fact, they screamed, “You have a vagina!" And not in a good way. Peers labeled me called bossy, bitchy, and arrogant. I thought they were my personality flaws, something intrinsically wrong with me and how I was practicing as a physician. I called my senior, one of the most amazing doctors I know, crying about how mean my evaluations were, how everyone hated me. She promptly pulled up her evaluations and read them aloud to me over the phone. I stopped crying and started laughing. They were EXACTLY the same as mine but even meaner. My faculty evals also showed significant dichotomy. I was either overly-confident and arrogant, or not confident enough and needed to make swifter decisions with more self-assurance. I could never sort out how to improve because of mixed messages. In emergency medicine (EM), a couple of studies were recently done looking at the effects of gender on evaluations. The first study looked at quantitative feedback using the EM milestones, and found that during their intern year, men and women were considered equally competent, but by graduation, the males attained higher milestones than the females across all subcompetencies, concerning for a gender gap in evaluations (5). The second study looked at the qualitative feedback that the residents received and found that women received less consistent feedback then the males and that feedback often referred to personality traits (6). Males typically received consistent feedback on what they needed to do to improve, while females would get mixed messages, especially regarding autonomy and assertiveness (6). Despite the strides we have made in integrating women into the workplace and the field of medicine, the gender specific traits that allow women to succeed are considered “MALE” and unappealing or "bitchy" when women possess them, as shown in previous gender studies.

Editor Note:

This is part two in a three part series. Click here to read part 1. Click here to read part 3.

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1. Eagly, Alice H., and Steven J. Karau. “Role Congruity Theory of Prejudice toward Female Leaders.” Psychological Review 109, no. 3 (2002): 573–98.

2. Heilman, Madeline E., Aaron S. Wallen, Daniella Fuchs, and Melinda M. Tamkins. “Penalties for Success: Reactions to Women Who Succeed at Male Gender-Typed Tasks.” Journal of Applied Psychology 89, no. 3 (2004): 416–27.

3. Carnes, Molly; Christie Bartels; Carol Isaac; Anna Kaatz; and Christine Kolehmainen. 2015. “Why is John More Likely to Become Department Chair than Jennifer?” American Clinical and Climatological Society. 126: 197–214.

4. Sandberg, S. (2013). Lean in: Women, work, and the will to lead (First edition.). New York: Alfred A. Knopf.

5. Dayal, Arjun, Daniel M. O’Connor, Usama Qadri, and Vineet M. Arora. “Comparison of Male vs Female Resident Milestone Evaluations by Faculty During Emergency Medicine Residency Training.” JAMA Internal Medicine 177, no. 5 (May 1, 2017): 651.

6. Mueller, Anna S., Tania M. Jenkins, Melissa Osborne, Arjun Dayal, Daniel M. O’Connor, and Vineet M. Arora. “Gender Differences in Attending Physicians’ Feedback to Residents: A Qualitative Analysis.” Journal of Graduate Medical Education 9, no. 5 (October 2017): 577–85.

7. Kolehmainen, Christine, Meghan Brennan, Amarette Filut, Carol Isaac, and Molly Carnes. “Afraid of Being ‘Witchy With a “B”’: A Qualitative Study of How Gender Influences Residents’ Experiences Leading Cardiopulmonary Resuscitation.” Academic Medicine 89, no. 9 (September 2014): 1276–81.

8. Choo, Esther K. “Damned If You Do, Damned If You Don’t: Bias in Evaluations of Female Resident Physicians.” Journal of Graduate Medical Education 9, no. 5 (October 2017): 586–87.

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