7/29/2019 Pushing Things Too Far? The untimely demise of the male medical student. Ed Fitzgerald, Oxford University Medical School Gazette

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Oxford Medical School Gazette EditorialVolume 53 (2)

Pushing Things Too Far?The untimely demise of the male medical student

Ipicture myself 50 years from now. As my good healthslowly slips away and the hospital beckons my ageing

ailments, I imagine how the medical staff will havechanged. My female GP will have referred me. The

female A&E medics will assess me. I will enjoy chatting with

the female medical students as they practice examining me,then talk seriously about my health with the female house

officer as she clerks me. The female consultant will discussdays gone by and explain the newfangled treatments my pre-historic training could never have foreseen. The female regis-

trar will then oversee my transfer and ongoing care on theward.

Fact or fiction? Almost certainly fiction. Yet the meteoric risein the number of female medical students is starting to raiseeyebrows in the profession. Are male medical students at risk

of becoming an endangered species? As recently as 1995females were often under-represented in medical schools,

accounting for just over 45% of those receiving offers fromOxford. Seven years later that figure jumps to just under 60%.

While Oxford exactly matches the national average figures on

this, there are several more extreme examples with somemedical schools exceeding 75% female intake.

Do the girls beat the boys?

So what has happened in the past decade to cause such a turn-around? Are male students discriminated against or simplydisadvantaged in todays admission process? Certainly it

would be hard to make a case for the former, but given girlson-going success in GCSE and A Levels, it is easy to imagine

how girls out-qualify boys in the race for places. Other reasonsinclude the better developed communication skills and matu-rity that 17 year old girls convey at interview, compared to

boys who havent quite left their teenage awkwardnessbehind. Several commentators have pointed out that girlsoften look better in person, as well as on paper, and suggest

this aesthetic quality could swing the often male-dominatedselection panels. If only it were all that simple.

Articles on this controversial topic are rare, presumably dueto potential authors not wishing to appear sexist in their con-

clusions. The occasional report suggests indirect discrimina-tion, in that boys may be less likely than girls to meet the ini-tial academic or non-academic criteria for consideration.

However, this is not the general experience at Oxford.Fortunately the medical school (perhaps through necessity,

following recent press coverage) has invested heavily in adetailed statistical analysis of applications, offers and admis-

sions based on gender, social class, school type and homeregion. Their findings paint a very different, if equally con-

cerning picture explaining the disparity.

Statistical Truths

One notable article researching this area was McManus retro-spective study investigating factors affecting likelihood of

admission to UK medical schools in 1996/97. His statisticalanalysis clearly showed that male applicants were disadvan-taged. In the fever of correspondence following publication in

the BMJ, many highlighted that his study was flawed, as it didnot take into account previous exam results or predicted ALevels on which the crucial admissions decisions are made.

The Oxford analysis does. The findings are clear. For GCSEresults there is no significant difference between male and

female applicants. Compared to national figures, there is nosignificant bias in the number of offers made in relation togender. For A level results, there is no significant difference

between males and females obtaining the grades. However,one major difference stands out like a beacon. Boys just arentapplying in the numbers they used to. In 2002 60% of appli-

cants were female, significantly higher than expected com-pared to national figures for University applications. The

number of female students taking up places simply reflectsthe greater numbers applying in the first place.

Sir Lancelot Spratt

It comes as a surprise to hear that the number of boys apply-ing is declining. This finding is set against a well reporteddecline in the number of medical student applications overall.

Are these related? Despite an unexpected rise last year, overthe past 7 years the total numbers applying have dropped byover 12%. Is medicine declining in its popularity as a career?

On the surface it appears there could be a link. But part of theproblem is we have no idea of what lies under the surface.

Remarkably little is known about the factors that drive todaysstudents to choose medicine, whilst many factors can be iden-

tified that might put them off. Compared to careers in the pri-vate sector, salaries have been eroded while our workloadrises. Negative press publicity is tarnishing the status doctors

once enjoyed. The cherished job independence is increasinglycontrolled by managers. And throughout this the long train-

7/29/2019 Pushing Things Too Far? The untimely demise of the male medical student. Ed Fitzgerald, Oxford University Medical School Gazette

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ing is becoming prohibitively expensive, with no grants andloans stretched to breaking point. Do these factors dispropor-

tionately affect boys and girls? I think they do. Perhaps theboys that were once drawn to James Robertson Justices fieryportrayal of Sir Lancelot Spratt are now drawn to equally

machismo business environments. Those boys dont want toplay communication skills and clinical governance. They are

financially driven in their career choice and for the sameworkload can claim greater rewards elsewhere. Or perhaps in

recent politically correct times medical schools have concen-trated too much on portraying the human, caring side of med-icine, which while tremendously important to our profession,

may turn-off some potential male applicants? Or perhaps thecontinued negative publicity in the press has dissuaded girlsfrom applying less than it has boys, for whom ego-boosting

professional status may count for much more?

Does it really matter?

There are some who argue that the male and female balance

of students simply isnt an issue. After all, who was kicking upa fuss 40 years ago when female students were few and far

between? Others argue that there is a natural justice in factorssuch as sex not becoming predictors of application success.Others argue that medicine is a special case, where patientsshould be able to see doctors of the gender they choose.

The most frequent objection to increasing numbers of female

medical students is the effect it will have on future doctornumbers and the balance of hospital versus community doc-tors. On the basis of this a BMA representative, Dr Peter

Holden, last year called for positive discrimination in favourof male applicants. His argument was that you do not get 35-40 years service from the females. Many females, burdened

with family commitments, leave the profession entirely or atleast work part-time. Given the current doctor shortage in the

country, Dr Holden predicts that the increase in female doc-tors will make this shortage even worse. But this takes a verynarrow view. What of male students who go on to academia,

BMA politics, etc? Should they too be weeded out and dis-criminated against?

Certainly a better way to counter this would be provision ofimproved support facilities, from part-time training to job-

share schemes and crches. But would this change the num-ber of female doctors staying on as hospital physicians or con-sultants?

Norway is well ahead of the UK in terms of sexual equality, yet

a recent study there showed that despite the availability of allof these facilities and more, females still chose not to enter

hospital careers in the numbers that would be expected. Thisultimately stems from basic psychological differences

between men and women that will take much longer to under-stand. The study concluded that women appear to choosetheir personal life over their professional career. Even if

women do choose to aim for the top, a glass ceiling still exists,both from fellow workers set against this change in social

structure and from society itself. In a commentary on thisBMJ article, Elaine Showalter highlighted the continued cul-

tural bias in society, pointing to the popular American TVseries ER, which features several female doctors in positionsof authority but without husbands, children or family life.

Faith in the profession

Hopefully as more female students graduate the system willchange itself. In the meantime more needs to done to under-stand what female professionals want from their work and

what we can all do to address this, before girls also decide toreject medicine as a career.

Perhaps the most important reason for considering this issue

is not for the benefit of patients, politicians or UCAS statisti-cians, but for our own peace of mind. For too long medicinehas relied on the surfeit of applicants from which a fortunatefew are picked. With sharp rises in medical school places and

a continued fall in applications the future may not be so easy.Unless we understand why our fellow male and female stu-dents are choosing to study or reject medicine as a career how

can we encourage applications? Unless we understand howand why our peers are choosing those students how can we

project a meritocratic selection process to applicants? Unlesswe ourselves have confidence in this being a fair and transpar-ent process how can we believe in the intrinsic tenets of benef-

icence and benevolence to each other, let alone to ourpatients?

The very same questions must be asked when consideringapplicants from different cultural, geographical and socioeco-

nomic backgrounds. We owe it to ourselves and the profes-sion. In the words of William Osler: If you do not believe in

yourself how can you expect other people to do so? If you have

not an abiding faith in the profession you cannot be happy init.

Edward Fitzgerald

McManus, IC.BMJ1998;317:11117

Griffiths, E.BMJ2003;326:S4Kvrner, KJ.BMJ1999;318:9194