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      Few gender differences in specialty preferences and motivational factors: a cross-sectional Swedish study on last-year medical students

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          Abstract

          Background

          Today, women constitute about half of medical students in several Western societies, yet women physicians are still underrepresented in surgical specialties and clustered in other branches of medicine. Gender segregation in specialty preference has been found already in medical school. It is important to study the career preferences of our future physicians, as they will influence the maintenance of an adequate supply of physicians in all specialties and the future provision of health care. American and British studies dominate the area of gender and medical careers whereas Swedish studies on medical students’ reasons for specialty preference are scarce. The aim of this study is to investigate and compare Swedish male and female medical students’ specialty preferences and the motives behind them.

          Methods

          Between 2006 and 2009, all last-year medical students at Umea University, Sweden (N = 421), were invited to answer a questionnaire about their future career and family plans. They were asked about their specialty preference and how they rated the impact that the motivational factors had for their choice. The response rate was 89% (N = 372); 58% were women (N = 215) and 42% were men (N = 157). Logistic regression was used to evaluate the independent impact of each motivational factor for specialty preference.

          Results

          On the whole, male and female last-year students opted for similar specialties. Men and women had an almost identical ranking order of the motivational factors. When analyzed separately, male and female students showed both similarities and differences in the motivational factors that were associated with their specialty preference. A majority of the women and a good third of the men intended to work part-time. The motivational factor combining work with family correlated with number of working hours for women, but not for men.

          Conclusions

          The gender similarities in the medical students’ specialty preferences are striking and contrast with research from other Western countries where male and female students show more differences in career aspirations. These similarities should be seized by the health care system in order to counteract the horizontal gender segregation in the physician workforce of today.

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          Most cited references22

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          Explaining women's employment patterns: 'orientations to work' revisited.

          Explanations of the persisting differences in the structure of men's and women's employment have long been debated in the social sciences. Sociological explanations have tended to stress the continuing significance of structural constraints on women's employment opportunities, which persist despite the removal of formal barriers. Neo-classical economists, in contrast, have emphasized the significance of individual choice, an argument which has been recently endorsed by Hakim who suggests that patterns of occupational segregation reflect the outcome of the choices made by different 'types' of women. In this paper, a previous debate relating to the explanatory utility of men's 'orientations to work' is used to argue that employment structures are the outcome of both choice and constraint, and that this is the case for women, as well as men. The argument is illustrated with evidence from cross-nationally comparative biographical interviews carried out in five countries.
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            Career choices of medical students: a national survey of 1780 students.

            OBJECTIVES Many factors influence the career specialty decisions made by medical students. The aim of this study was to broaden consideration of the determinants of specialty choice in a large population of medical students in their sixth year of study. METHODS A total of 2588 students distributed across all of the 39 medical schools in France participated in a National Practice Examination in December 2008, after which an electronic questionnaire was administered. Study criteria were: population characteristics; demographics, and motivation for and drawbacks to medical specialty choice. RESULTS A total of 1780 students (1111 women, 62%) responded to the questionnaire (69% response rate). The mean age of respondents was 23.8 years (22-35 years). Of these, 1555 students (87%) stated their preferred medical specialty. Surgical and medical specialties were the two specialties selected most frequently by students (n = 729, 47%). General practice was chosen by 20%. Gender influenced the choice of specialty: 88% of future paediatricians, 82% of gynaecologists and 77% of general practitioners (GPs) were women (p < 0.05). Main motivating factors included interesting diseases, opportunities for private practice and patient contact. Main drawbacks limiting the choice of other specialties were poor quality of life, an exclusively hospital-based career and loss of patient contact. Gender was the criterion most associated with significant differences in factors of motivation for or discouragement from a career. Patient contact and opportunities for private practice were significantly highlighted by future GPs compared with students opting for the medical or surgical specialties (p < 0.0001). CONCLUSIONS Students' career choices regarding specialties or general practice result from the interplay among several factors. Career interest in general practice is particularly low. Initiatives to address the factors affecting student career choices regarding less favoured specialties and to deal with the growing feminisation of the profession, which will lead to irreversible changes in clinical practice, are required.
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              Women in medicine--is there a problem? A literature review of the changing gender composition, structures and occupational cultures in medicine.

              Internationally, there are increasing numbers of women entering medicine. Although all countries have different health care systems and social contexts, all still show horizontal (women concentrated in certain areas of work) and vertical (women under represented at higher levels of the professions) segregation. There is much discussion and competing explanations about the implications of the increasing numbers of women in the medical profession. The purpose of this review was to explore the evidence, issues and explanations to understand the effects of the changing composition of the medical profession. This review identified evidence that delineates some of the effects of gender on the culture, practice and organisation of medicine. There are problems with some of the research methodologies and we identify areas for further research. To understand the effects of the changing gender composition of medicine it will be necessary to use more sophisticated research designs to explore the structural, economic, historical and social contexts that interact to produce medical culture. This will provide a basis for exploring the impact and implications of these changes and has immediate relevance for workforce planning and understanding both the changing nature of health professions' education and health care delivery.
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                Author and article information

                Contributors
                Journal
                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central
                1472-6920
                2013
                8 March 2013
                : 13
                : 39
                Affiliations
                [1 ]Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, 901 85, Sweden
                [2 ]Department of Medical Humanities, VU Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
                [3 ]Department of General Practice and Community Care, Institute for Gender Studies, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
                Article
                1472-6920-13-39
                10.1186/1472-6920-13-39
                3599519
                23497262
                2c1c0951-6c75-4ea7-82c4-c8f72ccca7fb
                Copyright ©2013 Diderichsen et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 3 October 2012
                : 5 March 2013
                Categories
                Research Article

                Education
                Education

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