Zahid Akmal Z Mohd, Ismail Zaliha, Abdullah Bahiyah, Daud Suzanna
Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Malaysia.
Department of Population Health and Preventive Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Malaysia.
Eur J Obstet Gynecol Reprod Biol. 2015 Mar;186:17-21. doi: 10.1016/j.ejogrb.2014.12.018. Epub 2014 Dec 29.
To investigate the experience of medical students during a clinical attachment in obstetrics and gynaecology (O&G).
A questionnaire was distributed to medical students who completed their O&G posting between August 2012 and August 2013. The first part included basic demographic details (age, gender, and ethnicity) and frequency of actual clinical experience; the second part explored students' perception of their training and their relationship with other staff, in particular feeling of discrimination by specified groups of medical personnel. The responses were recorded using a Likert scale and were recategorised during analysis.
A total of 370 questionnaires were distributed, and 262 completed questionnaires were returned, giving a response rate of 71%. Female students had a significantly higher median (IqR) number of vaginal examinations performed 0.25(0.69) (p=0.002) compared to male students. Male students experienced a higher proportion of patient rejections during medical consultation, 87% vs. 32% of female students (p<0.001), a higher rate of refusal for clerking (71.4% vs. 57.5% of females, p=0.035) and a higher rate of patients declining consent for internal examination (93.3% vs. 67.6% of females, p<0.001). The majority of male students felt that their gender negatively affected their learning experience (87% vs. 27.4% of the female students, p<0.001). Male students reported a significantly higher proportion of discrimination against their gender by medical officers (p=0.018) and specialists/consultants (p<0.001) compared to females but there was no discrimination between genders by staff nurses or house officers. A majority (58%) of female students stated an interest in pursuing O&G as a future career compared to 31.2% of male students.
Our study confirmed that gender bias exists in our clinical setting as male students gain significantly less experience than female students in pelvic examination skills. We also demonstrated that compared to female students, male students experience higher levels of discrimination against their gender by trainers who are medical officers and specialists/consultants. Trainers must improve their attitudes towards male students, to encourage them and make them feel welcome in the clinical area. We must minimize gender discrimination and educational inequities experienced by male students, in order to improve their learning experience.
调查医学生在妇产科临床实习期间的经历。
向在2012年8月至2013年8月期间完成妇产科实习的医学生发放问卷。第一部分包括基本人口统计学细节（年龄、性别和种族）以及实际临床经验的频率；第二部分探讨学生对其培训的看法以及他们与其他工作人员的关系，特别是特定医疗人员群体的歧视感。使用李克特量表记录回答，并在分析过程中重新分类。
共发放370份问卷，回收262份完整问卷，回复率为71%。与男学生相比，女学生进行阴道检查的中位数（IqR）显著更高，为0.25（0.69）（p=0.002）。男学生在医疗咨询期间被患者拒绝的比例更高，分别为87%和女学生的32%（p<0.001），拒绝问诊的比例更高（71.4%对女学生的57.5%，p=0.035），患者拒绝内诊的比例更高（93.3%对女学生的67.6%，p<0.001）。大多数男学生认为他们的性别对其学习经历有负面影响（87%对女学生的27.4%，p<0.001）。与女学生相比，男学生报告称医疗主任（p=0.018）和专家/顾问（p<0.001）对其性别的歧视比例显著更高，但护士和住院医生不存在性别歧视。与31.2%的男学生相比，大多数（58%）女学生表示有兴趣将妇产科作为未来职业。
我们的研究证实，在我们的临床环境中存在性别偏见，因为男学生在盆腔检查技能方面获得的经验明显少于女学生。我们还表明，与女学生相比，男学生受到医疗主任和专家/顾问等培训人员对其性别的歧视程度更高。培训人员必须改善对男学生的态度，鼓励他们并使他们在临床领域感到受欢迎。我们必须尽量减少男学生所经历的性别歧视和教育不平等，以改善他们的学习体验。
