20 Horsfall, S., ‘Doctors who commit suicide while under GMC fitness to practice investigation. Internal review,’ GMC online (2014) available online at: https://www.gmc-uk.org/Internal_review_into_suicide_in_FTP_processes.pdf_59088696.pdf.
Role Reversal
1 The extreme difficulty of being both a doctor and a patient in: Klitzman, R., When Doctors Become Patients (New York: Oxford University Press, 2008).
2 The author Michael Crichton and his comments on the role of human dissection in: Crichton, M., Travels (New York: Vintage Books, 2004).
3 Two researchers concluded that dissection ‘has the effect of setting the medical student apart from others’ in: Madill, A., and Latchford, G., ‘Identity change and the human dissection experience over the first year of medical training,’ Soc Sci Med 60 (2005), pp. 1637–1647.
4 Psychiatrist and psychoanalyst Norman Straker’s experience as a medical student as described in: Straker, N., ed., Facing Cancer and the Fear of Death: A Psychoanalytic Perspective on Treatment. (Lanham Maryland: Jason Aronson, 2012).
5 Sabine Hildebrandt’s strategies for the anatomy curriculum: Hildebrandt, S., ‘Thoughts on practical core elements of an ethical anatomical education,’ Clin Anat 29 (2016), pp.37–45.
6 Some medical schools have abandoned the use of human dissection as a way of teaching anatomy: Patel, B. S., et al., ‘Is dissection the only way to learn anatomy? Thoughts from students at a non-dissecting medical school,’ Perspect Med Educ 4 (2015), pp. 259–260.
7 In medical schools that use human dissection, the cadaver is still routinely referred to as the ‘first patient’: Bohl, M., et al., ‘Medical students’ perceptions of the body donor as a ‘first patient’ or ‘teacher’: a pilot study,’ Anat Sci Educ 4:4 (2011), pp. 208–13.
8 Julie Madorsky, a physical medicine and rehabilitation specialist, wrote of her teaching experiences in: Corbet, B., and Madorsky, J., ‘Physicians with disabilities,’ West J Med 154 (1991), pp. 514–521.
9 Thoughtlessness, with regards to disabled access, has been detailed in studies such as: Steinberg, G. A., et al., ‘Reasonable accommodations for medical faculty with disabilities,’ JAMA 288: 24 (2002), pp. 3147–54.
10 A doctor who walked with crutches described his experience of attending an interview for an academic position in: Steinberg, G. A., et al., ‘Reasonable accommodations for medical faculty with disabilities,’ JAMA 288: 24 (2002), pp. 3147–54.
11 A doctor who relied on crutches described her first hospital post as ‘an environment of isolation’: Corbet, B., and Madorsky, J., ‘Physicians with disabilities,’ West J Med 154 (1991), pp.514–521.
12 Jenny Morris writing on disability in: Watermeyer, B., ‘Disability and Psychoanalysis,’ in Watermeyer, B., Swartz, L., Lorenzo, T., et al., eds. Disability and Social Change: A South African Agenda (Cape Town: HSRC Press, 2006).
13 The report by the BMA Equal Opportunities Committee in 2007 is available online at: http://www.hscbusiness.hscni.net/pdf/BMA_Disability_equality_in_the_medical_profession_July_2007_pdf.
14 A 2009 study, in a Scottish medical school, found that there was a great deal of under-reporting of impairment by doctors: Miller, S., et al., ‘Medical students’ attitudes towards disability and support for disability in medicine,’ Med Teach 31 (2009), pp. 556–561.
15 Some medical schools have introduced a ‘card’ scheme to empower students with disabilities or health conditions: Cook, V., et al., ‘Supporting students with disability and health issues: lowering the social barriers,’ Med Educ 46 (2012), pp. 564–574.
16 The UK Equality Act 2010, available online at: https://www.equalityhumanrights.com/en/equality-act/equality-act-2010.
17 The Americans with Disabilities Act of 1990, available online at: https://www.ada.gov/ada_intro.htm.
18 The GMC major review of health and disability in medical education and training is available online at: https://www.gmc-uk.org/H_26D_review_statement___May_13.pdf_56450036.pdf.
19 A GMC publication entitled ‘Achieving Good Medical Practice: A Guide for Medical Students’ available online at: https://www.gmc-uk.org/Achieving_good_medical_practice_0816.pdf_66086678.pdf.pdf.
20 Jemma Saville’s article ‘Guidance for disabled students,’ (April 2008) is available online at: http://careers.bmj.com/careers/advice/view-article.html?id=2897.
21 Jemma Saville’s story was included in a BMA publication entitled ‘A Celebration of Disabled Doctors,’ (December 2009) and is available online at: http://www.hscbusiness.hscni.net/pdf/BMA-_Disabled_doctors_December_2009_pdf.pdf.
22 Jemma Saville’s petition page: ‘Petition for partially sighted doctor to be allowed to practise,’ available at: http://www.thepetitionsite.com/1/help-VI-doctor/.
23 Tim Cordes’ description of how he managed to complete his medical degree: Cordes, T., ‘A practicing blind physician,’ Braille Monitor 53:10 (2010).
24 Dr Dean Krahn described Tim Cordes’ treatment of veterans with addiction problems in the article ‘Blind doc at VA sees patients differently,’ (June 2013). The article is available online at: https://www.va.gov/health/NewsFeatures/2013/June/Blind-Doc-at-VA-Sees-Patients-Differently.asp.
25 Clinical psychologist Brian Watermeyer wrote ‘disabled people remain unknown’ in Watermeyer, B., Towards a Contextual Psychology of Disablism (London: Routledge, 2013).
26 Canadian doctor, Jessica Dunkley is one of the first deaf doctors in the country: Moulton, D., ‘Physicians with disabilities often undervalued,’ CMAJ 189:18 (2017), e678-e679.
Leaky Pipes
1 Isobel Allen’s study of women doctors: Allen, I., Doctors and their careers, 1st ed., (London: Policy Studies Institute, 1988).
2 The National Working Group on Women in Medicine report, ‘Women doctors: making a difference’ is available online at: https://hee.nhs.uk/sites/default/files/documents/WIMreport.pdf.
3 A study published in the BMJ in 2016 reported negative attitudes towards pregnancy and maternity/paternity leave: Rich, A., et al., ‘You can’t be a person and a doctor: the work–life balance of doctors in training—a qualitative study,’ BMJ Open, 6:12 (2016), 10.1136/bmjopen-2016–013897.
4 Social anthropologist Joan Cassell’s study in: Cassell, J., The woman in the surgeon’s body (Cambridge, Mass: Harvard University Press, 1998).
5 A study published in the American Journal of Surgery in 2016 found that half of the women in the study felt discriminated against based on their gender: Seemann, N., et al., ‘Women in academic surgery: why is the playing field still not level?’ Am J Surg 211: 2 (2016), pp. 343–349.
6 A 2016 study published in the British Medical Journal reported responses from trainee female surgeons: Rich, A., et al., ‘You can’t be a person and a doctor: the work–life balance of doctors in training—a qualitative study,’ BMJ Open 6:12 (2016), 10.1136/bmjopen-2016–013897.
7 According to Jyoti Shah, a consultant urological surgeon in the UK, female surgeons still encounter comments on menstruation in the operating theatre: Harley, N., ‘Sexism in surgery: Females being put off becoming surgeons by men,’ Telegraph available online at: http://www.telegraph.co.uk/news/health/11903476/Sexism-in-surgery-Females-being-put-off-becoming-surgeons-by-men.html.
8 In 1863 Elizabeth Garrett Anderson wrote to the Aberdeen Medical School, requesting permission to attend classes: Anderson, L., Elizabeth Garrett Anderson 1836–1917 (Cambridge: Cambridge University Press, [reprint] 2016).
9 Canadian physician William Osler in: Moldow, G., Women doctors in gilded-age Washington 1st ed., (Urbana and Chicago: University of Illinois Press, 1987).
10 By the end of the Second World War, 25% of medical students were female, although after the war, ex-servicemen returned to claim university places: Pringle, R., Sex and Medicine. Gender, power and authority in the medical profession (Cambridge: Cambridge University Press, 1998).
11 In 1962, just over 20% of UK medical students were women. Twenty years later the proportion rose to 45.3%. Figures available online at:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/507651/CfWI_future_consultant_workforce.pdf.
12 Latest figures for the UK show that 55% of medical students are women. Figures available online at: http://www.gmc-uk.org/SOMEP_2013_web.pdf_53703867.pdf.
13 Between 1970 and 1980, the proportion of female medical students more than doubled: Walsh, M. R., ‘The rediscovery of the need for a feminist medical education,’ Harv Educ Rev 49:4 (1979), pp. 447–466.
14 The latest US figures, for 2016 entry, indicate that, for the first time, parity has almost been achieved: News.aamc.org., ‘Number of Female Medical School Enrollees Reaches 10-Year High,’ available online at: https://news.aamc.org/press-releases/article/applicant-enrollment-2016/.
15 Female GPs tend to have a significantly higher proportion of lengthy consultations than their male counterparts: Hedden, L., et al., ‘The implications of the feminization of the primary care physician workforce on service supply: a systematic review,’ Hum Resour Health 12:32 (2014), 10.1186/1478–4491-12–32.
16 A 2015 study of over 15,000 doctors: Lambert, T. W., et al., ‘Trends in attractiveness of general practice as a career: surveys of views of UK-trained doctors,’ Br J Gen Pract 67:657 (2017), 10.3399/bjgp17X689893.
17 The proportion of female consultants in obstetrics/gynaecology in the UK in: ‘State of Medical Education and Practice,’ GMC (2016) available online at: https://www.gmc-uk.org/SoMEP_2016_Overview.pdf_68137053.pdf.
18 A 2016 survey of over 10,000 doctors in the UK found that 42% of women worked part time: Lachish, S., et al., ‘Factors associated with less-than-full-time working in medical practice: results of surveys of five cohorts of UK doctors, 10 years after graduation,’ Hum Resour Health, 14:1 (2016), 10.1186/s12960-016–0162-3.
19 Perhaps most shocking of all, women doctors are paid less than their male counterparts: Connolly, S., and Holdcroft, A., ‘The Pay Gap for Women in Medicine and Academic Medicine,’ BMA (2009) available online at: http://www.medicalwomensfederation.org.uk/images/Daonload_Pay_Gap_Report.pdf.
20 Salary discrepancies have also been reported in the States: Willett, L., et al., ‘Gender Differences in Salary of Internal Medicine Residency Directors: A National Survey,’ Am J Med, 128:6 (2016), pp. 659–665.
21 Sir Liam Donaldson in the ‘Report of the Chair of the National Working Group on Women in Medicine,’ (2009) available online at: https://hee.nhs.uk/sites/default/files/documents/WIMreport.pdf.
22 Responses from the BMA 2009 report available online at: http://www.medicalwomensfederation.org.uk/images/Daonload_Pay_Gap_Report.pdf.
23 Studies from the US are replete with horror stories that women faced when they attempted to continue training with a young family: Boulis, A., and Jacobs, J., The Changing Face of Medicine: Women Doctors and the Evolution of Health Care in America (Ithaca and London: Cornell University Press, 2008).
24 ‘Ladies would make bad doctors, at best’: Anderson, L., Elizabeth Garrett Anderson 1836–1917 (Cambridge: Cambridge University Press, [reprint] 2016).
25 A 2017 study published in the Journal of the American Medical Association found that sick older patients did better if the doctor who admitted them was a woman: Tsugawa, Y., et al., ‘Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians,’ JAMA Intern Med, 177:2 (2017), pp. 206–213.
26 Professor Jane Dacre concluded that medicine is ‘richer’ for diversity in its workforce in: Dacre, J., ‘We need female doctors at all levels and in all specialties,’ BMJ 344 (2012), 10.1136/bmj.e2325.
27 A group of researchers from Oxford University concluded medicine needs to establish career paths that enable both sexes to train and work part-time: Lachish, S., et al., ‘Factors associated with less-than-full-time working in medical practice: results of surveys of five cohorts of UK doctors, 10 years after graduation,’ Hum Resour Health 14:1 (2016), 10.1186/s12960-016–0162-3.
28 Professor Fiona Karet Frankl in: Karet Frankl,E. F., ‘To be or not to be …’ Postgrad Med J 92 (2016), p. 569–570.
Risky Business
1 Psychologist Kath Woolf’s description of negative stereotypes in: Woolf, K., et al., ‘Ethnic stereotypes and the underachievement of UK medical students from ethnic minorities: qualitative study,’ BMJ 337 (2008), 10.1136/bmj.a1220.
2 Following the incident at Cardiff University, Dinesh Bhugra led an Independent Review Panel (2017). The report is available online at: https://www.cardiff.ac.uk/__data/assets/pdf_file/0011/551837/Prof-Dinesh-Bhugra-report-Final.pdf
3 John Dovidio’s: Dovidio, J., ‘The subtlety of racism,’ Train Dev J, 47: 4 (1993), pp.50–57.
4 The 2017 BBC interview with Professor Robert Kelly, available online at: http://www.bbc.co.uk/news/world-asia-39244325.
5 Physicians discounted based on their skin colour, gender or both: Cooke, M., ‘Implicit Bias in Academic Medicine,’ JAMA Intern Med, 177:5 (2017), p.657.
6 Psychiatrist Damon Tweedy’s account of being mistaken for a maintenance worker in: Tweedy, D., Black Man in a White Coat (New York: Picador, 2015).
7 Doctors’ unconscious biases can impact the actual treatment decisions that they make: FitzGerald, C., and Hurst, S., ‘Implicit bias in healthcare professionals: a systematic review,’ BMC Med Ethics, 18:1 (2017), p.19.
8 A 2012 study reported that paediatricians with greater pro-white bias were more likely to agree with prescribing a narcotic medication for a white patient than an African-American patient: Sabin, J., and Greenwald, A., (2012). ‘The Influence of Implicit Bias on Treatment Recommendations for 4 Common Pediatric Conditions: Pain, Urinary Tract Infection, Attention Deficit Hyperactivity Disorder, and Asthma,’ Am J Public Health, 102:5 (2012), pp. 988–995.
9 Authors Steele and Aronson reported ‘stereotype threat’ in: Steele, C. M., and Aronson, J., ‘Stereotype threat and the intellectual test performance of African-Americans,’ J Pers Soc Psychol 69 (1995), pp. 797–811.
10 Damon Tweedy described his fears of his colleagues’ views in: Tweedy, D., Black Man in a White Coat (New York: Picador, 2015).
11 BME doctors may be expected to be more involved in family crises than their white peers: Dickins, K., et al., ‘The Minority Student Voice at One Medical School,’ Acad Med 88:1 (2013), pp.73–79; Phoenix, A., and Husain, F., ‘Parenting and ethnicity,’ Joseph Rowntree Foundation (2007) available online at: https://www.jrf.org.uk/sites/default/files/jrf/migrated/files/parenting-ethnicity.pdf.
12 Studies have shown that UK BME medical students feel less well prepared for the transition to work: Goldacre, M., et al., (2010). ‘Views of junior doctors about whether their medical school prepared them well for work: questionnaire surveys,’ BMC Med Educ 10:78 (2010). 10.1186/1472–6920-10–78.
13 A follow-up study on specialist psychotherapy services for doctors: Davies, R. S., et al., ‘A sea change for sick doctors – how do doctors fare after presenting to a specialist psychotherapy service?’ JMH 25:3 (2016), pp. 238–244.
14 Figures from (UK) HESA available online at: https://www.hesa.ac.uk/data-and-analysis/students.
15 Figures from the (US) National Center for Education Statistics available online at: https://nces.ed.gov/fastfacts/display.asp?id=98.
16 Specific medical school statistics from the US available online at: http://www.aamcdiversityfactsandfigures2016.org/.
17 Afro-Caribbean students are poorly represented in UK medical training: McManus, I., ‘Medical school applicants from ethnic minority groups: identifying if and when they are disadvantaged,’ BMJ 310:6978 (1995), pp. 496–500.
18 Kath Woolf’s comprehensive study on ethnic differentials: Woolf, K., et al., ‘Ethnicity and academic performance in UK trained doctors and medical students: systematic review and meta-analysis,’ BMJ 342 (2011), 10.1136/bmj.d901.
19 An accompanying editorial by Professor Aneez Esmail: Esmail, A., ‘Ethnicity and academic performance in the UK,’ BMJ 342 (2011), 10.1136/bmj.d709.
20 Sir Ric
hard Doll’s research: Doll, R., and Hill, A., ‘The Mortality of Doctors in Relation to Their Smoking Habits,’ BMJ 1 (1954), pp.1451–1455.
21 A 2016 study from the GMC found that being an international medical graduate significantly increases the risk of failure. The study is available online at: http://www.gmc-uk.org/How_do_doctors_progress_through_key_milestones_in_training.pdf_67018769.pdf.
22 Open access data from the AAMC on MCAT scores by race/ethnicity is available online at: https://www.aamc.org/download/321498/data/factstablea18.pdf.
23 Socio-economic data from the AAMC by race/ethnicity is available online at: http://www.aamcdiversityfactsandfigures2016.org/report-section/section-3/.
24 Performance data from USMLE is available online at: http://www.usmle.org/performance-data/default.aspx#2016_overview.
25 A 2012 study of students found that black and African-American students were significantly more likely to fail STEP1 than their white peers: Andriole, D., and Jeffe, D., ‘A National Cohort Study of U.S. Medical School Students Who Initially Failed Step 1 of the United States Medical Licensing Examination,’ Acad Med 87:4 (2012), pp. 529–536.
26 MCAT scores are related to STEP1 scores: Brenner, J. M., et al., ‘Formative Assessment in an Integrated Curriculum: Identifying At-Risk students for poor performance on USMLE Step 1 Using NBME Custom Exam Questions,’ AAMC, Proceedings of the 56th Annual Research in Medical Education Sessions (2017), S21-25.
27 Charles Prober’s explanation on the use of STEP1 scores: Prober, C., et al., ‘A Plea to Reassess the Role of United States Medical Licensing Examination Step 1 Scores in Residency Selection,’ Acad Med 9:1 (2016), pp.12–15.
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