Medical students, gender and patient-centredness

Introduction: Changes are occurring in medical education, including increasing numbers of female students and a drive to include patient-centred medicine as an important principle of health care. Methodology: This project comprises two studies investigating these aspects of medical education. The first was a qualitative study exploring medical students’ experience of gender in medicine (individual semi-structured interviews with sixteen medical students and three graduates of varying experience and backgrounds, using an iterative process of concurrent data collection and analysis). The second was a quantitative study of medical students’ attitudes to patient-centredness (using an online survey of the student population based on an existing measure, the Patient-Physician Orientation Scale). Results: Differences in experience of gender in medicine were found between male and female students, though this was generally overtly denied. Female students experience more difficulties fitting into the medical culture, and have more concerns about future careers. There were two competing gendered discourses of medical practice revealed during data analysis, “real” medicine (congruent with doctor-centred medicine) and “nice” medicine (congruent with patient-centred medicine). “Nice” medicine (patient-centredness) is seen as inherently feminine, “real” medicine as masculine, and this was part of the conflict between the discourses. This conflict was also partly maintained by differences between university teaching and hospital-based medical culture. The conflict between discourses was a cause of stress for students. Significant associations with patient-centredness were found for gender and cultural background. Female students were more patient-centred, as were domestic (compared to international) students and students of rural (compared to urban) origin. Patient-centredness was associated with preferring a community practice setting and expecting to enjoy a medical career. Discussion: Gender impacts the experience of medical education, and the level of medical student patient-centredness. A new discourse combining the strengths of the masculine “real” and the feminine “nice” medicines is needed.