Abstract
The proportion of women in medical school intake has continued to increase since the 1960s and is now 55% female.1,2 A report published by the Royal College of Physicians suggests that women will make up the majority of the medical workforce by 2017. 1 This report also addresses the fact that more females are entering less technical specialties, with 62% currently working in general practice and over 70% in pediatrics and public health at Junior dr level. 1 While some specialties have doubled the number of women entering them, in comparison, only 9% of surgeons are women. 4 However, the feminization of the medical workforce has been raised. 3
Although women in medicine now make up 41% of the medical workforce, only a small proportion of females occupy senior positions, with 29% at the consultant level.4,5 Likewise, in 2006, only 2 of the 34 medical schools were led by women, and in 2007, 88% of university-contracted clinical professors were men. 1 On average, women in academic medicine have fewer research outputs and successful grant applications. 6 Reasons put forward to explain these discrepancies include child-rearing commitments, poor mentoring, and an environment that is less supportive to women.5,6 There have been several pieces of work carried out recently that examine the problems that women face in medicine. The Royal College of Physicians found that an increasing number of women (and men) were looking for more flexible working conditions and a balance between working and family lives. 7 A recent report commissioned by the Department of Health, “Women Doctors: Making a Difference”, recognizes that few women reach senior leadership positions even though there has been an increasing number entering the profession over the last 20 years. 7 This report identifies barriers to women’s progression and makes a number of recommendations to improve the current situation, one of which is to “encourage women in leadership”. 8 Chief Medical Officer Sir Liam Donaldson commissioned a national working group for women to investigate these issues, 5 and this report identifies barriers to women’s progressions and suggests several outcomes to improve the current situation.
There is limited work on undergraduates and their perceptions of leadership9,10; this is important and may influence aspirations to future leadership. The aim of the current research therefore was to explore perceptions of leadership and gender in medical undergraduates in a pilot study. The hypothesis under consideration was to determine gender-based leadership perceptions.
Methods
This is a pilot study that will inform a larger scale UK-wide investigation. The research design was a survey using a structured questionnaire. Ethical approval was granted by the University Ethics Committee. All medical students in one medical school (N = 1567) were invited to participate in the study via an email, which included study details and a link to the study online questionnaire. A guidance sheet was attached to the email, providing full study details and explaining its voluntary nature. Students were informed that completion of the questionnaire was anonymous and completion taken as consent to participate in the study.
A 17-item online confidential survey was used. Questions included a 4-point Likert scale, which assessed understanding of good leadership and opinion on women’s ability to perform leadership attributes. For example, question one listed 12 attributes for leadership (Figure 1), and the participants were asked whether they strongly agreed, agreed, disagreed, or strongly disagreed if the attributes were important for leadership. Closed questions assessed how they perceive themselves as leaders at present and in the future and their views on leadership and gender. There were also qualitative open questions for free-text responses, which assessed views on leadership and gender that are not part of this article. Attributes for effective leadership were developed from a previous study by Sheffield University and from the Medical Leadership Competency Framework, which outlines domains and attributes required for leadership.8,9 The survey was subject to expert validation and piloted on a small sample of the target population before modification. Quantitative data analysis was by SPSS 14 (Chicago, Illinois). The results were analyzed using the Mann-Whitney U test for ranked level agreement.
Results
An invitation to participate was emailed to all 1567 undergraduates at a single UK medical school, of which 469 (30%) responded (males, n = 120; females, n = 331; not given, n = 18).
Perceptions of Female Leaders
As illustrated in Figure 1, male undergraduates rated females significantly (P < .01) lower at being able to display 10 of 12 attributes for leadership as well as their male counterparts. Interestingly, women felt they did not display arrogance to the same degree as their male counterparts.
Level of disagreement by gender on women displaying leadership attributes
Undergraduates were asked whom they thought made a better leader, with the option of male, female, or gender irrelevant. The majority of respondents (77%) stated that gender was irrelevant, yet almost a quarter (22%) of participants stated that males made better leaders. The group who stated males made better leaders comprised 14% (44/315) of the females and 45% (49/109) of the male participants.
Self-Confidence
Males rated self-confidence as a more important attribute for leadership than females (P < .05). Further, more males than females agreed with the statement that they have the necessary attributes for leadership (P < .05) and that they currently see themselves as a leader (P < .01). Students were also asked to consider reasons why all but one of their previous Medical School Student Society presidents had been male. Almost a third (31%) of the total sample agreed that lack of confidence was the reason for females not putting themselves forward.
Barriers
Both male and female participants agreed that there were barriers in achieving leadership positions within the medical school society. Important cited barriers included “tradition” (76%) and a perceived lack of acceptance of a female leader in the society (65%).
Curriculum
Just over a half of participants (51%) either agreed or strongly agreed with the statement “medical school prepares you well for leadership”. Importantly, 68% (288/424) stated that they would like more leadership development in the curriculum.
The Future
Proportionally double the amount of males (42.2%) compared to females (21.7%) strongly agreed that they could see themselves in a position of leadership in the future.
Discussion
The exploratory pilot survey suggests that male undergraduates show some negative perceptions towards female leaders. It also suggests that females are perceived to lack self-confidence and that males are more ambitious towards achieving a leadership role in the future. Females will continue to find progression to leadership difficult unless negative perceptions are removed and self-confidence is improved. Self-confidence needs to be developed from an early stage through greater feedback and mentorship. Undergraduate perceptions need to be improved through female role models and greater exposure to successful male and female leaders.
Furthermore, undergraduates of both genders identified barriers to women taking up leadership roles in the medical student society. It suggests more work is required to ensure all undergraduates have an opportunity to aspire to an early leadership position.
It is of particular concern that double the amount of male undergraduates saw themselves in a position of leadership in the future. Overt leadership development needs to be built into the curriculum at the undergraduate and postgraduate levels to ensure that medical professionals are prepared for a leadership role. There is hope that the Medical Leadership Competency Framework (MCLF) will progress leadership and possibly even increase individual awareness on their leading capabilities.
While the response rate to the pilot study was low, it is possible that greater numbers would yield different results, and this should be considered in relation to the findings. However, results have provided directions for further research with a larger sample and interesting items for consideration by those who train our future leaders.
Conclusions
Barriers to progression require further investigation and removal, especially as females are expected to comprise the majority of the medical workforce by 2017. 1 Discrepancies remain among the number of females compared to males occupying positions of leadership. 3 For our future leaders, it is crucial to ensure that leadership development skills are embedded into the curriculum and aspiration is developed and encouraged, irrespective of gender.
Footnotes
Acknowledgements
The authors wish to acknowledge Ray Fewtrell, Research Fellow, Institute of Teaching and Learning, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK for providing statistical advice.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The author(s) received no financial support for the research, authorship, and/or publication of this article.