**4. What is the ideal obstetrics/gynecologist physician and mentor?**

6 From Preconception to Postpartum

Racz et al. (2008) examined the acceptability of involving Ontario-based medical students in OB/GYN care in two different patient groups: ages 17-85 and secondary school students with an average age of sixteen. Twenty-two percent of the older patients preferred a female student, increasing to 55% in the younger patients. Overall, the greater number of intimate examinations a patient had experienced, the less of a preference she had for OB/GYN gender. When the patients were asked about the presence of medical students in the examination room, there were significant differences expressed by the two age groups. The older patients were more accepting of having medical students of either sex participate in their care (73%) than the younger patients (32%). Over 36% of the younger patients said it would be "very embarrassing" or "unbearable" for a male medical student to perform an intimate examination. Because male medical students were rejected by younger patients to a much higher degree than by the older patients, it is advisable for clerkship directors to forewarn male medical students that younger patients may not want them in the

In conclusion, although many women may prefer a female physician, it has been demonstrated that physician gender is often not the most important attribute under consideration when patients select an OB/GYN. Clearly, good bedside manner and communication skills are essential in establishing an effective doctor/patient rapport. This is often followed by technical expertise and a good medical reputation. Before the 1970s, most patients had little say in the gender of their OB/GYN, but with the rapidly increasing number of practicing female OB/GYNs, patients now have a greater freedom to make gender a selection preference. Therefore, to maintain an adequate patient population, it will become even more important for male OB/GYNs to practice good bedside manners and empathic communication skills, as well as having technical

A unique study by Kincheloe (2004) clearly found a physician gender bias when he examined six popular women's magazines over an 18 month period; *Cosmopolitan, Fitness, Glamour, Good Housekeeping, Ladies Home Journal* and *Redbook*. Kincheloe found that female physicians were 20 times more likely to have an identifying photograph as compared to males. Women OB/GYNs were interviewed 47-80% of the time, and female physicians from all other specialties accounted for 31-57% of the articles. When pronouns were used to describe an OB/GYN, a negative connotation was used 92% of the time for male OB/GYNs

In five of the six magazines reviewed, physicians had their quoted gender changed from neutral to reflect female-specific pronouns. The exception was if the physician was portrayed negatively, and then the physician was significantly more likely to be identified as male (Kincheleo, 2004). Since attitudes are shaped by what we see, hear and read, women who buy these magazines seem to be influenced, whether purposefully or subliminally, to acquire a negative bias toward male physicians, in general, and male OB/GYNs specifically. Patients, and the physicians who refer patients, must be reminded to tell their patients that OB/GYN choice should be based on professionalism and clinical skills vs. using gender as a

examination room.

expertise.

vs. 17% for females.

main deciding factor.

**3.2 The influence of media on gender bias** 

Carmel and Glick did a study in 1996 where physicians were asked to rank six attributes of a "good" doctor. The physicians placed the following descriptions in rank order from highest to lowest; humane to patients, has good medical knowledge and skills, is devoted to helping their patients, has a good working relationship with the staff, can research and publish, and are good at management and administration. Carmel & Glick (1996) concluded that the rank order of these attributes was in contrast to the duties needed to get promoted in academia, i.e., research, publications, administrative duties and spending less time with each patient. Therefore, the current academic "system" does not reward being a "good" doctor. Medical students, after starting their clinical rotations, have slightly different priorities as compared to practicing physicians. Students felt that knowledge and skills were the most important factors, followed by being humane, intellectually competent, honest, and reliable (Notzer et al., 1988). It is understandable for students to place knowledge and skills as the most important qualities since they were in the initial stage of their career.

In light of the above, and despite the pressured academic environment in which physicians work, the ability to teach and mentor is viewed as extremely important by medical students. Therefore, faculty and residents must maintain a high degree of professionalism/humanism while still being technically competent. The same is true for residents being taught by faculty. Although patient care must take first priority, 62% of OB/GYN residents say finding time to look for "teachable moments" on the collection and interpretation of critical information in emergent situations is vital to the education of students and residents. Over 90% say you must find time to teach procedures (Gil et al., 2009). Faculty agree to a greater degree than residents that they need to be an appropriate role model, to be enthusiastic about patient care, and teach evidence-based medicine. Although residents still feel these are important skills, they are more pressured for time than faculty and are less likely to express these traits because of time constraints (Johnson & Chen, 2006).

Regardless of time constraints under which faculty and residents are placed, students appreciate constructive criticism given in a timely manner. Students have some ability to self-assess their progress, but specific, descriptive, written feedback is best for increasing student learning (Stalmeijer et al., 2010). In this regard, medical students say the ideal attending physician should spend more than 25% of their time teaching, with at least 25 hours of teaching per week occurring during rounds. Residents and faculty need to stress the importance of the doctor/patient relationship and emphasize the social aspects of medicine so that the patient is seen as an individual rather than an illness. Finally, students feel the faculty need to have served as chief resident in order to be a successful teacher (Wright et al., 1998).
