Patrick Dielissen

Gendered specialities during medical education: a literature review

The careers of male and female physicians indicate gender differences, whereas in medical education a feminization is occurring. Our review aims to specify gender-related speciality preferences during medical education. A literature search on gender differences in medical students’ speciality preferences was conducted in PubMed, Eric, Embase and Social Abstracts, and reference lists from January 2000 to June 2013. Study quality was assessed by critical appraisal. Our search yielded 741 hits and included 14, mostly cross-sectional, studies originating from various countries. No cohort studies were found. Throughout medical education, surgery is predominantly preferred by men and gynaecology, paediatrics and general practice by women. Internal medicine was pursued by both genders. The extent of gender-specific speciality preferences seemed related to the male-to-female ratio in the study population. When a population contained more male students gynaecology seemed even more preferred by women, while in a more feminine population, men more highly preferred surgery. Internationally, throughout medical education, gender-related speciality preferences are apparent. The extent might be influenced by the male-to-female ratio of a study population. Further research of the role of gender in career considerations of medical students on the future workforce is necessary.

Attention to gender in communication skills assessment instruments in medical education: a review.

Medical Education 2011: 45: 239–248

How do trained raters take context factors into account when assessing GP trainee communication performance? An exploratory, qualitative study

Communication assessment in real-life consultations is a complex task. Generic assessment instruments help but may also have disadvantages. The generic nature of the skills being assessed does not provide indications for context-specific behaviour required in practice situations; context influences are mostly taken into account implicitly. Our research questions are: 1. What factors do trained raters observe when rating workplace communication? 2. How do they take context factors into account when rating communication performance with a generic rating instrument? Nineteen general practitioners (GPs), trained in communication assessment with a generic rating instrument (the MAAS-Global), participated in a think-aloud protocol reflecting concurrent thought processes while assessing videotaped real-life consultations. They were subsequently interviewed to answer questions explicitly asking them to comment on the influence of predefined contextual factors on the assessment process. Results from both data sources were analysed. We used a grounded theory approach to untangle the influence of context factors on GP communication and on communication assessment. Both from the think-aloud procedure and from the interviews we identified various context factors influencing communication, which were categorised into doctor-related (17), patient-related (13), consultation-related (18), and education-related factors (18). Participants had different views and practices on how to incorporate context factors into the GP(-trainee) communication assessment. Raters acknowledge that context factors may affect communication in GP consultations, but struggle with how to take contextual influences into account when assessing communication performance in an educational context. To assess practice situations, raters need extra guidance on how to handle specific contextual factors.

Geen uitstrijkje? In gesprek over seks

SamenvattingGiesen A, Lagro-Janssen ALM, Dielissen PW. Niet gekomen voor het uitstrijkje? In gesprek over seks. Huisarts Wet 2014;57(9):490-3. Eenderde tot de helft van de vrouwen met baarmoederhalskanker laat zich niet of onregelmatig screenen. Vaak is het een combinatie van lichamelijke, psychische, sociaal-culturele en cognitieve factoren die ervoor zorgt dat vrouwen niet meedoen aan het bevolkingsonderzoek baarmoederhalskanker. Vrouwen met een voorgeschiedenis van seksueel geweld of die besneden zijn, nemen minder vaak deel aan het onderzoek. Dat geldt ook voor vrouwen die seks hebben met vrouwen, want zij denken dat ze minder risico lopen. Angst en afkeer van het gynaecologisch onderzoek zijn eveneens belangrijke redenen om weg te blijven.Actief vragen naar de motieven om niet mee te doen kan niet alleen de opkomst verbeteren maar ook verborgen seksuele problemen of trauma’s aan het licht brengen. Hier kan de huisarts proactief en in een open gesprek met de vrouw nagaan of er sprake is van een seksueel probleem, zoals pijn bij het vrijen, vaginisme of (een verleden van) seksueel geweld. Bovendien is er een hrHPV-thuistest die mogelijke bezwaren bij deze vrouwen kan wegnemen.SummaryGiesen A, Lagro-Janssen ALM, Dielissen PW. Failure to attend for cervical screening: talking about sex. Huisarts Wet 2014;57(9):490-3. Up to half of the women with invasive carcinoma of the cervix have not or irregularly undergone cervical screening. This failure to take part in population screening programmes is often due to a combination of physical, psychological, socio-cultural, and cognitive factors. Women with a history of sexual abuse or who have undergone female genital mutilation have lower rates of attendance in cervical screening programmes. This is also true for women who have sex with women, because they think that they are at lower risk. Fear and aversion to a gynaecological investigation are also reasons not to come for screening. Actively asking women why they do not come for screening may not only improve attendance in the future but also uncover sexual problems or trauma. With sensitivity and respect, the general practitioner can ask women whether there are sexual problems, such as pain during intercourse, vaginismus, or past experience of sexual violence. Nowadays, there is a home testing kit for human papillomavirus, which might remove some of the barriers to cervical screening.

Should we assess clinical performance in single patient encounters or consistent behaviors of clinical performance over a series of encounters? A qualitative exploration of narrative trainee profiles

Abstract Background: A variety of tools have been developed to assess performance which typically use a single clinical encounter as a source for making competency inferences. This strategy may miss consistent behaviors. We therefore explored experienced clinical supervisors’ perceptions of behavioral patterns that potentially exist in postgraduate general practice trainees expressed as narrative profiles to aid the grading of clinical performance. Methods: We conducted semistructured interviews with clinical supervisors who had frequently observed clinical performance in trainees. Supervisors were asked to describe which behavioral patterns they had discerned in excellent and underperforming trainees, during different stages of training, in their careers as clinical supervisor. We analyzed the interviews using a grounded theory approach. Results: The analysis resulted in a conceptual framework that distinguishes between desirable and undesirable narrative profiles. The framework consists of two dimensions: doctor–patient interaction and medical expertise. Personal values appear to be a moderating factor. Conclusions: According to experienced clinical supervisors, consistent behaviors do exist in GP trainees when observing clinical performance over time. The conceptual framework has to be validated by further observational studies to assess its potential for making robust and fair assessments of clinical performance and monitor the development of consultation performance over time.

De diagnostiek van Chlamydia trachomatis: het verschil tussen mannen en vrouwen.

SamenvattingDielissen PW, Boeke AJP, Lagro-Janssen ALM. De diagnostiek van Chlamydia trachomatis: het verschil tussen mannen en vrouwen Huisarts Wet 2008;51(8):400-2.In de presentatie, de diagnostiek en de gevolgen van een Chlamydia trachomatis-infectie (CT) bestaan sekseverschillen. In deze klinische les wordt aan de hand van een illustratieve ziektegeschiedenis ingegaan op de verschillen tussen mannen en vrouwen in de diagnostiek. Een niet-soa-diagnose, zoals een bacteriële vaginose, beïnvloedt bij vrouwen wel en bij mannen niet de kans op een CT-infectie. Ook de keuze van de testlocatie en het type specimen bepalen bij vrouwen wel en bij mannen niet de sensitiviteit van de test. De casus onderstreept het belang om urethra/urine én cervix te testen, of een zelf afgenomen vaginale swab te gebruiken als er anamnestisch een risico is op een CT-infectie. Dat geldt óók als er een niet-soa-diagnose is die de klachten kan verklaren.