Altruism vs. pragmatism
Students' choice of medicine as a career was influenced by a number of factors, the most common of which were an interest in both people (28/36) and science (19/36). Female students were more likely to mention 'being with people' as an 'internal' (private) motivating aspect (19/21 compared with 9/15 males) and were dissimilar to some male students (7/15) who reported 'external' (public) reasons why they decided to study medicine.
'I really love communicating with people and I really get on well and I like talking to people and that is when I decided to do medicine rather than veterinary [medicine like my father], yeah that was really the main factor' (Year 2 'white' female student).
'It [medicine] has a lot of social importance and that it was a very big position to be in....you are making a change to somebody's life that perhaps no other ordinary person would be able to do...'(Year 5 'non-white' male student).
External career incentives were not mentioned by any of the women. Only female students (7/21) expressed a fascination with the human body (anatomy) and its functions.
'I have always been interested in the anatomy side of things, I mean to me there is nothing more amazing than how the human body works and how the sperm and an egg meet and make a unit. To me that is amazing....' (Year 2 'non-white' female student).
Half of the students (18/36) reported how older male 'informants' (such as medical relatives) had influenced their decision to study medicine, whereas few (4/36) mentioned such female 'informants'.
'I wasn't sure if I wanted to do medicine, and my mum's friend offered to give me some work experience in hospital. I went down, and I thought it was really good. Like he was a really good doctor and I was really impressed, so I thought I'd apply for it. And that was really what happened.' (Year 3 'white' male student).
'And I guess the other person is probably my mother, mostly. Just because of getting into medicine when she did, and doing as well as she did. Yeah, so... so like, you know, she was so...very, very dedicated.' (Year 1 'white' female student).
Ethnic and gender stereotypes
A number of perceived differences and disadvantages were reported by 'non-white' students. The issue of independence from family was mentioned by 8 of the 14 'non-white' students. They reported conflicting loyalties between the culture of their families and the demands of both academic work and social life at the medical school. Such concerns were not stated by any 'white' students.
'I think the major thing is compromising my family life... which is in my religion it's.....you know, families are very important....clearly it is less in the Western culture but....much so in my culture...compared to everyone else in my family like my brothers they're able to go to things ... a lot of the time I can't go home at the weekends although my parents are expecting me to. When I am at [clinical] work coming home is much harder.' (Year 3 'non-white' female student).
Two female black (African) students identified a contrast between their image outside the medical school and their identity as future doctors.
'People sort of say, "Oh my daughter tried to get into medical school and she didn't," and it's kind of...you know, I do feel that I do have to sort of justify my intelligence all the time. Umm, I don't know. I suppose...I don't know, I suppose because, okay, I'm black, I'm female – and also, I suppose, I don't particularly look kind of studious or whatever. People don't think...people just don't think I fit the image. And I do find myself trying to conform, and be a different person sort of in hospital, so I look like a medical student.' (Year 4 'non-white' female student).
Such perceptions of needing to conform to the expected template of a 'real' medical student were not brought up by any 'white' or Asian students. In this context the lack of 'non-white' role models may be significant. It is telling that this issue of not fitting in was raised by a black female student, who in a sense was furthest away from the traditional stereotype of a white, male doctor . Some 'non-white' students (5/14) were concerned about the potential for their ethnicity to adversely affect their career prospects in medicine.
'There is something about doctors and position of power,...it's just so obvious ...consultants are all Caucasian. And registrars are mostly all, umm, Asian – it's an amazing clear-cut line, you can actually see it!' (Year 4 'non-white' female student).
'People get to places [in medicine] because of who they know, and I don't appreciate that. Part of the reason I probably don't appreciate that is because I'll never be part of the old boys' network fully, and I think that's because of my ethnic origin.'(Year1 'non-white' male student).
Among female Muslim students, 5 out of 6 mentioned the importance in the Islamic religion of separating men and women in clinical practice, a matter which they said did not always receive enough attention during the training.
'I know this girl [medical student] who was placed with a male GP and she said to him that she couldn't talk to his male patients while she was there with the doors closed and...this would be ladened [sic] by her religious beliefs. Religion... has a big role to play in medicine, because I am a Muslim.' (Year 1 'non-white' female student).
Five of the whole sample of students said that shy and quiet female Asian students were more likely to be humiliated or ignored by consultants during the ward rounds.
'The consultants do go for more insecure...I mean some students are less able clinically than others, but they tend to pick on those who are obviously less able.... particularly some of the quieter Asian girls, I mean they don't look fragile, but are mentally fragile, you know, they are not very kind of aggressive, a lot of them I think, you know wouldn't take that [humiliation], couldn't take it, they wouldn't know how to deal with it.' (Year 4 'white' female student).
At the same time both 'non-white' (4) and 'white' students (6) acknowledged that through the study of medicine they had benefited from being in contact with a wider range of ethnically diverse students (and patients).
'Coming to the medical school was a real eye opener to me.....especially this year, I'm with a lot of Muslims and people from a different religion. And it's amazing where I come from, it's 22,000 [the population] but I'd never spoken to an Asian person or a black person before I came here, so that's a big change for me. And learning about what they think, and their...how they, er, learn about medicine; their views and what they're going through.' (Year2 'white' female student).
Gender and future careers
The majority of students (22/36) commented on the fact that female medical students are now as common, or are more common, than males. Twenty one noted that there are more male than female clinical consultants and tutors.
'The top lecturers, I mean you can never see the dean of the medical school ever being a lady. And when you see this busts and paintings, they are always male.....We do have Prof. XX she is a lady, but generally it does tend to be still I think pretty male dominated on the top. I would say it is about....75% men.' (Year 2 'non-white' male student).
Nevertheless, in response to direct questioning (see Appendix 1) 29/36 denied any gender differences in the training experiences of themselves or their fellow students. Elsewhere in the interviews, though, some discrepancies were reported. For example, 10/21 female students and 1/15 males remarked that the people they regarded as positive role models treated them with respect.
'She treated students not like idiots, good manner and communication with patients which I could learn from.' (Year 3 female student).
In relation to medical specialties, 7/36 students (4 female, 3 male) commented that they had observed or experienced direct difficulties related to gender during the obstetric and gynaecology rotation, where male students had limited opportunities to obtain practical skills since female patients were reluctant to be examined by male students.
'I did feel at a disadvantage doing obstetrics in that a lot of women are not prepared in this day and age to allow you to attend their delivery or actually do their delivery. Er, that was pretty frustrating at the time; and in gynaecology as well.' (Year 5 'white' male student).
A majority 22/36 (14 females, 8 males) stated that surgery was dominated by men, reporting their perception that the specialty required physical strength (4 females/2 males), competitiveness (4 females/1 male), unusually hard work and long working hours (1 female/4 males) in order to succeed. Nevertheless four female students (of 21) were considering surgery as a career option, and four male students (of 15).
'Yes, top jobs, still tend to go to men, big surgeons, yeah. All anatomy demonstrators want to be surgeons, and 90% of them are male. It is all an assumption really. But I think it got some truth to it.' (Year 2 'non-white' male student).
'I think women who want to be surgeons, I think good luck to them... I think some jobs are more suited...like orthopaedics is not really a woman's job to do... it is quite difficult, because you need to be strong to move bones and the operations are quite...plumbing... carpentry...'(Year 3 'white' female student).
Most students (23/36) identified certain specialties as being 'suitable' for women, these being (in descending order of frequency) obstetrics and gynaecology, general practice, paediatrics and palliative care. Many (20/36) also described qualities which they believed women bring (positively) into medicine, such as talkativeness, empathy, caring, ability to listen, and emotional expressiveness.
'From a man's point of view, men can do cardiac thoracic, so we can be leading a cardiac thoracic surgery, possibly I think if the ladies thinking of having a family, personally I think they should choose something that, would fit their sort of setting, their life for example, obs and gynae.' (Year 4 'non-white' male student).
'Women are better at caring and communicating, they are thoughtful.' (Year 3 'white' female student).
Eleven students (7 females, 4 males) used the word 'sacrifice' in relation to women and their medical career, for example in having to limit either their career or their family aspirations, but none used this remark to describe the careers of male doctors.
'I think if you have a special interest in something...it depends how much of your personal life you are willing to sacrifice. If you want to do surgery then I don't think you can really have a very good family life, in the sense that the hours are very long. If you want to get to a consultant level you are going to have to sacrifice lots of things to get there.' (Year 4 'non-white' female student).