Transcript Conclusions and feedback

Gender Competency
Training for Medical
Educators
28th of April 2003
SKILLS, GENDER COLLISIONS AND
RESISTANCE
Ann-Maree Nobelius
Faculty of Medicine, Nursing and Health Sciences
Monash University Australia
SKILLS, GENDER COLLISIONS
AND RESISTANCE
Gender Analysis
 What difference does gender make to
this scenario?
Levels of Analysis
1. Individual
2. Environmental
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social
cultural
communities
economic
3. Structural
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institutional
legislative
4. Superstructural

international laws, policy and institutions
Individual Level
 must convince the medical student or
newly graduated doctor that rural practice
is challenging and rewarding so perhaps
 we must give the candidate role models
who have done it, hence the recruitment
of our rural GP tutors, both male and
female
Environmental Level
 social- moral support and a social network to provide social
support…this leads into..
 cultural- deconstruct the traditional rural doctor work model. The
standard that has been set is the ‘die with your boots on while the
wife takes care of the family’ model, but as Jo has frequently
pointed out what rural GP’s, both female and male need is a life
not a wife.
 communities in need of GPs must collectively acknowledge their
part in making this new and valued resource welcome and provide
support to accommodate the needs of the GP eg if the GP is a
single mum…how can she be on call for overnight
emergencies…these practicalities must be acknowledged and
planned for
 economic- is there an economic disadvantage to the GP for
choosing rural over urban practice and how can we need.
According to Medicare data female doctors on average make less
money than there male counterparts for a variety of reasons, is
this trend going to be exacerbated in rural practice?
Structural Level
 institutional- are the institutions involved, such
as the regional health authority or bush nursing
hospital support a woman in their environment,
and in the case you will teach in week 9, based
on a true story, this was a source of conflict
 legislative-Medicare rules, do they discriminate
against rural style of female style practice and
again is that going to be made worse by rural
practice
Superstructural Level
 International laws and institutions- do
they acknowledge and support the need
to encourage more women into rural
practice?
So how does all of this relate to you
as tutors facilitating discussion with
medical students about potential
gender issues in their cases?
Reflective Questioning
 what are the gender issues for the doctor as an individual?
 what are the gender issues for the patient as an individual?
 and so on with any other players presented in the case
and then move on to the environmental variables
 what role does gender play in social issues in this scenario?
 what role does gender play in cultural issues in this
scenario?
 what role does gender play in economic issues in this
scenario?
 What difference does gender make to
individual/social/cultural /environmental
economic….issues in this scenario
or
 How would this scenario be different if the
patient were a woman/man?
 How would this scenario be different if the
doctor were a woman/man?
…or in the more complex case of Mary’
patients:
 How would this scenario be different if
the patient/doctor were a
woman/man/gay/lesbian/transgender/
male self-identified woman?
 Everybody’s experience is different
 Gender analysis allows us to investigate
difference
Gender Collisions
 Process designed by Prof Elizabeth
Hultcrantz
 Reworked by Monash 6th year students
to reflect their experience
 Assist in acknowledging alternate
perspectives to our own
Case 1
Kon scrubbing in and Aletha observing
Female Solutions
 Introduce yourself to the surgeon, make sure he knows who you
are
 Express your enthusiasm, try not to be intimidated
 Discuss career options with a woman
 Talk to the surgeon if approachable
 Wear nice clothes
 Not to be disheartened by experience
 Wear a name tag, make sure he knows your not a nurse
 Ask Kon if he will take turns
Male Solutions
 Dismissing surgery over one incident is over reaction
 Comment that supervisor will focus on one student whether
because of gender, approachability, enthusiasm
 She needs to be more assertive with this surgeon if that fails go to
another one
 Negotiate with Kon and ask him to let Aletha do the scrubbing and
he can watch the anaesthetist
Case 2
Minh, Mario and the midwives
Female Solutions
 Generalised sucking up: find common ground, male midwives or
older midwives
 Do nights
 Be physically at the unit more often
 Mario could call Minh
 Speak to supervisor
Male Solutions
 Issues not gender, its assertiveness
 Perspective: males have trouble too
 Racial aspect: redneck
 Clear view of where medical students stand vs. midwifery students
 Talk with supervisors
 Don’t inflame situation
 Normal for her, he’s a ‘smoothe’ Italian Stallion
Case 3
Tim sitting in the waiting room
Female Solutions
 Talk to GP, maybe question could be worded better
 Nurses to warn patients as they arrive, may be happier if they are
not surprised
 Word the question as he is a final year student Doctor
 GP to explain to patient the importance of experience for the
student and the value of the patients contribution
 Find a female GP discuss the problem and get advice
Male Solutions
 Don’t over generalise
 Talk to GP re explanations to patients about student experience
 Talk to supervisor
 Lie to patients about qualification of students
 Is there something the student is doing to put the patient off
 Involve the student in the history taking to develop rapport
Case 4
Mick being grilled by the consultant, Nancy being ignored
Female Solutions
 Ask lots of questions
 Keep turning up
 Smile and be enthusiastic
 Speak to the patients
 Pre-reading/ask intelligent questions
 Decide to diffuse the answering the questions
 Mick to involve Nancy
 Look consultants in the eye
 Speak to clinical supervisor- get tutes from someone else
Male Solutions
 Assess if it will be an on-going issue - this may be a once-off problem
 Try to allow Nancy to answer questions
 Get Nancy to state her case to the surgeon assert her enthusiasm
 Perhaps allow both students to answer questions together
 Speak to faculty or other students if the it seems to be an ongoing issue
 Speak to registrar
RESISTENCE
 you mustn’t over generalise,
everybody is an individual
 its about power not gender
 that’s changing, that’s the problem of
the older generation
Q&A
Participants
 Ms Jo Wainer
 Dr Kaye Birks
 Dr Sudesh Arora
Conclusions and
feedback