Ann-Maree Nobelius Faculty of Medicine, Nursing and Health Sciences Monash University Australia

1. Gender Competency Training for Medical Educators28th of April 2003SKILLS, GENDER COLLISIONS AND RESISTANCE Ann-Maree Nobelius Faculty of Medicine, Nursing and Health Sciences Monash University Australia

2. SKILLS, GENDER COLLISIONS AND RESISTANCE Gender Analysis • What difference does gender make to this scenario?

3. Levels of Analysis • Individual • Environmental • social • cultural • communities • economic • Structural • institutional • legislative • Superstructural • international laws, policy and institutions

4. 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

5. 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?

6. 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

7. Superstructural Level • International laws and institutions- do they acknowledge and support the need to encourage more women into rural practice?

8. So how does all of this relate to you as tutors facilitating discussion with medical students about potential gender issues in their cases?

9. 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?

10. 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?

11. …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?

12. Everybody’s experience is different • Gender analysis allows us to investigate difference

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. Q & A Participants • Ms Jo Wainer • Dr Kaye Birks • Dr Sudesh Arora

20. Conclusions and feedback