The Male Medical Student Problem

Abstract

Amajor part of an undergraduate’s training in obstetrics and gynaecology is learning to conduct pelvic examinations under supervision. Most Canadian curricula provide initial training with the use of plastic or inert pelvic models, and the luckier undergraduates also receive instruction from professional teaching associates who allow the students to examine them and provide subjective feedback. 1 The students then graduate to performing pelvic examinations in clinical settings under supervision. Clinicians negotiate consent with patients to permit medical students to carry out pelvic examinations with “hands on” supervision. 2 Given that pelvic examinations performed by students are of necessity more time-consuming than those performed by the clinician alone, the problem for organizers of undergraduate education used to be persuading clinicians to accept medical students into their offices. Now it’s not so much trying to place medical students, but to place male medical students. Clinicians have consciously or unconsciously come to recognize that less negotiation for consent to involve a student will be needed if the student is female. The lone male medical student standing uncomfortably outside the examining room while his gynaecology mentor attends to the patient within is one of the saddest sights in medical education. In this issue, Jennifer Racz and colleagues report their findings from a survey of the attitudes of clinic patients and high-school students to having medical students of either gender involved in conducting breast or pelvic examinations. The observation that young women with minimal experience of undergoing these examinations were less accepting of having male students involved than were older women with more experience is perhaps what we might expect, but it is discouraging for educators and male students nonetheless. What is not known is whether the reluctance of younger women to have male students involved in their examinations can be modified at all. As Dr Racz and colleagues point out, the potential consequences for male students of this reluctance are that they gain less experience in performing intimate examinations and develop an aversion to pursuing careers that involve performing these examinations, particularly obstetrics and gynaecology. Carried to extremes, the potential consequences include the perceptions inside and outside the profession that these examinations should be performed only by female clinicians and that obstetrics and gynaecology is a specialty for female practitioners only. The pool of candidates for residency training in obstetrics and gynaecology is shallow enough already; shrinking it to female candidates only would make it a puddle rather than a pool.