gender in medicine
‘Important… but of low status’: male education
leaders’ views on gender in medicine
Gunilla Risberg, Eva E Johansson & Katarina Hamberg
OBJECTIVES The implementation of and
communication about matters associated with
gender in medical education have been
predominantly perceived as women’s issues.
This study aimed to explore attitudes towards
and experiences of gender-related issues among
key male members of faculties of medicine.
METHODS We conducted semi-structured
interviews with 20 male education leaders from
the six medical schools in Sweden. The
interviews were analysed qualitatively using a
modified grounded theory approach.
RESULTS The core category – ‘important… but
of low status’ – reflects ambivalent attitudes
towards gender-related issues in medicine
among male education leaders. All informants
were able to articulate why gender matters. As
doctors, they saw gender as a determinant of
health and, as bystanders, they had witnessed
inequalities and the wasting of women’s
competence. However, they had doubts about
gender-related issues and found them to be
overemphasised. Gender education was seen as
a threat to medical school curricula as a
Medical Education 2011; 45: 613–624
doi:10.1111/j.1365-2923.2010.03920.x
Department of Public Health and Clinical Medicine, Family
Medicine, Umeå University, Umeå, Sweden
ª Blackwell Publishing Ltd 2011. MEDICAL EDUCATION 2011; 45: 613–624
consequence of the time and space it requires.
Gender-related issues were considered to be
unscientifically presented, to mostly concern
women’s issues and to tend to involve ‘male
bashing’ (i.e. gender issues were often labelled
as ideological and political). Interviewees
asked for facts and knowledge, but questioned
specific lessons and gender theory. Experiences
of structural constraints, such as prejudice,
hierarchies and homosociality, were presented,
making gender education difficult and
downgrading it.
CONCLUSIONS The results indicate that male
faculty leaders embrace the importance of
gender-related issues, but do not necessarily
recognise or defend their impact on an area of
significant knowledge and competence in
medicine. To change this and to engage more
men in gender education, faculty measures are
needed to counteract prejudice and to upgrade
the time allocation, merits and status of gender
implementation work. Based on our findings,
we present and discuss possible ways to interest
more men and to improve gender education in
medicine.
Correspondence: Gunilla Risberg, Department of Public Health and
Clinical Medicine, Family Medicine, Umeå University, Umeå SE
90185, Sweden. Tel: 00 46 907853557; Fax: 00 46 90776883;
E-mail: guarig97@student.umu.se
613
G Risberg et al

gender among students,25 doctors,26,27 researchers28,29

INTRODUCTION
and faculty members.30,31 Literature published in the
last few years shows that harassment and discrimina-
Gender has been recognised as a key determinant of
tion hurt not only the victims themselves and their
social outcomes, including health and access to
organisations, but also directly affect the well-being of
health care. Gender also strongly influences career
male and female colleagues within the organisation.32
opportunities. Consequently, knowledge and aware-
Gender bias, such as manifested in the neglect of
ness of gender-related issues are important among
women’s health issues and gender stereotyping, has
medical professionals.1–4
also been shown in educational material and medical
textbooks33,34 and in medical curricula.35,36
In medicine, the term ‘gender’ is often mistakenly
used as if it were synonymous with biological sex.2,5–7
These insights have given rise to a discussion on how to
Yet gender is a wider concept than sex and refers to
prevent and avoid gender bias in medicine. One way
more than biological differences between women and
would be to introduce and implement a gender-based
men.2,4,8,9 Gender refers to the constant, ongoing
perspective and gender-associated issues in medical
social construction of what is considered to be
education.37,38 Here, teachers are key persons. Reports
‘feminine’ and ‘masculine’ (‘doing gender’), a con-
from such implementation efforts describe the hard
struction based on the asymmetrical distribution of
work required to inform and interest teachers.3,39–42
power between and socio-cultural norms about
One obstacle is that gender issues seem to be consid-
women and men.8–11 Socio-cultural norms build on a
ered to represent women’s issues. Studies carried out
dichotomous thinking about women and men, which
in the USA43 and Canada44 showed that female
suggests the existence of innate and stable differ-
medical faculty staff were more gender-sensitive and
ences.12 The concept of gender, however, implies the
found gender discrimination to be more of a problem
possibility of change and negotiation. We all ‘do
than men did. A questionnaire study of medical
gender’ in all kinds of social interactions.8–10 In
teachers in Sweden showed that women regarded
professional everyday life, doctors, too, ‘do gender’.
gender as more important in professional relations
For example, when they ask female patients more
than did men45 and that men had more dismissive
than they ask male patients about their family,13
attitudes towards gender-related issues.46 When
doctors are demonstrating that they are influenced
gender was integrated into medical curricula at all
by, and contribute to maintaining, the gendered
Dutch medical schools in a national project in
view that family matters are women’s issues. An
2002–2005, female teachers were more accepting of
alternative way of doing gender would be to challenge
these changes than their male counterparts.41 How-
this view by asking male patients about their family
ever, to establish gender as an important field of
situation as often as female patients.
knowledge among medical students, knowledgeable
and interested teachers of both sexes are needed.47
Thus, a gender-aware perspective in medicine implies
How do we encourage more male teachers to become
consideration of life conditions, positions in society
involved? To the best of our knowledge no study has
and societal expectations about ‘femininity’ and
investigated male teachers’ attitudes towards and ideas
‘masculinity’, along with biology in professional
about gender-related issues in medicine.
relationships, when theorising about women and
men.4,10,14 Unawareness of gender-related issues in
Consequently, the aim of this interview study was to
medical professionals can lead to gender bias in
focus on influential male teachers’ attitudes towards
medicine. Medical research has identified an abun-
and experiences of gender-related issues in medicine
dance of such bias in recent decades.15–17
as a possible way of better understanding how to
interest more men in the subject and thereby
In clinical medicine, studies have shown that differ-
improve gender education in medicine.
ences that are not evidence-based occur in the
investigation and treatment of male and female
patients. Most research on this subject has been about
METHODS
coronary heart disease,18 but there are also studies
about many other conditions, including kidney
Recruitment
disease,19 depression,20 colorectal cancer,21
Parkinson’s disease,22 psoriasis,23 knee osteoarthritis24
We wanted to include male teachers who held key
and neck pain.13 In academic medicine, there are
positions in medical education and had experiences
reports about discrimination and harassment based on

614 ª Blackwell Publishing Ltd 2011. MEDICAL EDUCATION 2011; 45: 613–624

of gender-related issues in specific courses or in
medical school curricula. Key positions were defined
as those of dean, member of a medical school
steering committee or committee for curriculum
development, head of a course, and other posi-
tions implying leadership and influence on the
medical education at the respective university. To
identify eligible men, we turned to Equal Opportu-
nities Committee officials and gender researchers at
all six medical schools in Sweden. They recom-
mended 29 men whom we contacted by e-mail and
invited to participate in our interview study. A letter
of introduction described the background and aim of
the study and presented the researchers. Two
reminders were sent to those who did not
answer. Those who accepted the invitation were
contacted for interview; some of them recommended
new men (n = 8), who were contacted in the same
way.
By this process we contacted a purposeful sample of
37 male medical educators suiting our inclusion
criteria. Five of them did not answer. Seven declined;
out of these, four referred to lack of time, one to the
fact that he knew the researchers and two did not
state why they abstained.
The 25 who agreed to participate were contacted by
telephone by the first author to schedule a time for
the interview. Some interviews were rescheduled
and postponed several times and in five cases it was
not possible to find a suitable time. A total of 20
men were interviewed, representing two to five
interviewees from each school. As researchers, we had
no independent relationships with any of the
interviewees and did not know most of them, even
by name, before the study started.
Interviews
All interviews were conducted by telephone by the
first author in the autumn of 2005. Telephone
interviews were chosen to save time and travel
expenses because distances between universities in
Sweden are long. Each participant chose a time when
he could talk without being disturbed. The
interviewer encouraged him to talk freely by posing
open-ended questions around the research topics
(Table 1). In the interactive dialogue, the inter-
viewer endeavoured not to probe, but to obtain
broader and deeper information by asking: ‘Can you
explain what you mean by […]?’ or ‘Can you give
an example of that?’ The interviews lasted 30–60
minutes, were tape-recorded, transcribed verbatim
and made anonymous.
ª Blackwell Publishing Ltd 2011. MEDICAL EDUCATION 2011; 45: 613–624
Male education leaders’ views on gender
Table 1 Topics discussed in the interviews
What associations do gender and gender issues arouse in you?
How did you learn about gender and become acquainted with
gender issues?
What are your experiences of working with gender issues in
education?
Do you have any ideas about how to interest other men in
gender work?
Do you have any ideas about how to implement gender in
medical education?
Participants
The participants were aged 45–64 years. Seven
represented pre-clinical specialties and 13 clinical
specialties, such as surgery, psychiatry and internal
medicine. Fifteen interviewees were professors and
five were senior lecturers. All of them held key
positions as defined above. Six had participated in
gender implementation work and four had experi-
ence of teaching gender-related material.
Analysis
Using a modified grounded theory approach48 with
an inductive qualitative research design,49 we con-
ducted preliminary analyses of the transcriptions
parallel to the interview process in order to let the
data and emerging theories refine the research
questions. By the time the data collection stopped,
the interviews were no longer adding new informa-
tion, but, rather, were confirming our findings.
All three researchers first read each interview inde-
pendently and made an open coding of the infor-
mants’ statements, ideas and reflections. Keywords,
expressions and contradictory passages were noted.
The codes were then compared, scrutinised and
discussed; connections and relationships between
the codes were noted and codes were sorted into
preliminary categories. The researchers continuously
wrote memos and made concept maps of the
ongoing analysis. New interviews were successively
added in a constant comparative analysis focusing
on emerging sub-categories, categories and a core
category. Three categories emerged. The respon-
dents’ ambivalence was summarised in the core
category: ‘Important… but of low status.’ Table 2
shows an example of coding from quotation to
category.
615
G Risberg et al
Table 2 Illustration of the coding procedure from quotation to category
Quotation
‘I get so upset when there are unjustified differences in
income and things like that. It is just stupid. And that
women simply disappear as you go up the hierarchy
ladder. I mean there is no difference in competence and
intelligence between women and men’
The study was approved by the ethics committee of
the faculty of medicine at our university. To secure
anonymity, participants are not identified and no
connections between quotations and any specific
person or university are indicated.
RESULTS
Table 3 summarises our analytical findings. The core
category – ‘important… but of low status’ – expresses
ambivalence towards gender and gender-related
issues in medicine. It contains three categories that
embrace the participants’ motives for considering
gender important (gender is important), their doubts
about the subject of gender (…but not that important)
and the obstacles they had confronted when
working with gender issues (…and not an easy task).
We present these categories and sub-categories. We
use quotations from the interviews to illustrate
the findings.
Gender is important
All informants said that they thought issues of gender
were important in medicine. They declared a variety
of incentives and sources for their interest in gender
issues. One overall motive was that gender is an
important determinant of ill health:
‘We need to take gender into consideration to
succeed better with prevention as well as with cure.’
More specific causes of motivation ranged from
private experiences to seeing the implementation of
gender-associated policies as a faculty duty. Quite
often, informants ascribed their interest in gender-
related issues to the women in their own families and two
interviewees specifically mentioned ideas passed on
to them from feminist daughters. One informant
616 ª Blackwell Publishing Ltd 2011. MEDICAL EDUCATION 2011; 45: 613–624
Codes Sub-categories Category
Upset Bystander Gender is
Injustice stress – witnessing important
Stupid of inequalities
Women disappear Waste of women’s
No differences in competence
competence or
intelligence
mentioned a woman colleague as a source of inspira-
tion. Two informants said that they had participated
in short courses on the subject of gender, which had
made them more motivated.
Being bystanders witnessing gender inequity in working
conditions for doctors, such as in salaries and career
opportunities, was a common reason for becoming
engaged. Interviewees saw such inequity as a waste of
women’s competence:
‘I get so upset when there are unjustified differences
in income and things like that. It is just stupid. And
that women simply disappear as you go up the
hierarchy ladder! I mean, there is no difference in
competence and intelligence between women and
men.’
Another reason was that students treat male and
female teachers differently:
‘I lecture about gender together with a female
colleague. We discuss the same issues, but the
students question her accounts and her credibility
much more than mine.’
Students’ demands and actions were described as
important driving forces:
‘A group of our students has published a bunch of
examples of gender-offensive remarks they have
heard in class from their teachers. That list has been
a real eye-opener – it is a remarkable language
we use.’
In Sweden, the government has decreed that a
gender-related perspective should be implemented in
medical schools.50 The government has also initiated
appraisals about gender in medical schools carried
out by the National Agency for Higher Education and
 Male education leaders’ views on gender

…but not that important

Table 3 Summary of analysis, sub-categories, categories and
core category Although our interviewees said that they found
gender important, they also described doubts about
Sub-categories Categories Core category
gender-related issues. Contradictions emerged
between the different interviews, as well as within
Determinant of health Gender is Important… specific interviews. In one part of the interview, an
Inspiration from close important but of low
informant would emphasise the importance of gen-
der-related issues, but in another part he would
women status
question them in different ways. Some of the quota-
Bystander
tions below illustrate how attitudes of doubt often
stress – witnessing of
appeared as negative examples when ideas of how to
inequalities interest men and how to implement gender in
Women’s competence medical education were discussed.
wasted
Students’ demands Many stated that they seldom took time to prioritise
A duty and decree gender-related work as a result of lack of time:
Lack of time ...but not
‘I don’t have the time, the research and the teaching
A threat to curricula that and… in my position there are so many assign-
Self-evident important ments. There is no time for reflection. I don’t have
Exaggerates differences a second left.’
Concerns women
only – men have Several interviewees expressed notions that gender is
nothing to gain overemphasised (‘It can’t be the primary subject
Question the definition matter’) and concerns that gender-related issues
of concepts would take too much time from ‘basic medical knowl-
Unscientific approaches
edge’ and thus represented a threat to the curricula:
Negative associations
‘Gender implementation might take time from basic
with feminism: ‘male
subjects, implying that students will end up knowing
bashing’
less about glomerular filtration or about muscle
Lack of knowledge …and not groups around the shoulder and I think that would
Prejudiced attitudes an easy be a real problem.’
Conservative and task
A common belief referred to the notion that
hierarchical discipline
awareness of gender and equality is self-evident
Little space for
today because faculty staff include qualified
reflection
women and more than 50% of medical students are
Homosocial behaviour female.
Hinders heterosexual
excitement As a result, gender-related issues were considered to
Not meritorious emerge ‘naturally’ in clinical situations and therefore
several interviewees saw no need for the implemen-
tation of theory or special teaching efforts, at least not
the National Board of Health and Welfare.51,52 This in their own departments or clinics:
has had effects on local university policies. Several
informants mentioned this as an explanation for ‘There has been an easy and natural atmosphere at
their interest: places where I have worked, so gender has been no
big deal… and students should have good tutors who
‘It is my duty as one of the faculty leaders to convey this perspective in a natural way, not like
implement gender issues and then I have to be lecturing or instructing.’
knowledgeable… So I have bought some books and I
try to read a little about it but I have not gotten very Some interviewees seemed to think that communi-
far yet, I am trying to learn.’ cating about gender is only about exaggerating

ª Blackwell Publishing Ltd 2011. MEDICAL EDUCATION 2011; 45: 613–624 617
G Risberg et al
differences between women and men, rather than
about the problematising of diversity, and were
critical of this:
‘Sometimes gender is overemphasised, because there is
a large variation between individuals within the group
of men and within the group of women. It’s probably
larger than the variation between the two groups.’
Several interviewees talked about gender mainly as
belonging to women’s territory, criticised the focus on
women’s problems and opined that today men have
nothing to gain from gender-related discussions:
‘You could easily get the impression that the inter-
pretations in gender research focus on negative
effects for women only. It would be wise to broaden
the analysis, to make it more generally applicable,
and show that there are negative effects for men as
well. That might be a way to get more men
interested.’
Other informants considered it self-evident that
women are more engaged than men because women
belong to the subordinate group in the gender
hierarchy. One interviewee saw class and gender as
parallel cases in this respect:
‘After all, it was the employees who started labour
unions, not the employers.’
Several informants conveyed that equality endeavours
too could be exaggerated and distrusted and ques-
tioned the definition of concepts like inequity and
discrimination:
‘You know, some women students are very militant.
They notice if a supervisor says something clumsy and
put it on the noticeboard. I mean [for example], if a
supervisor says, ‘‘The blondes follow that doctor and
the brunettes come with me.’’ That is not inequity or
harassment; that is clumsiness.’
Interviewees said they had perceived overtones,
categorical solutions and emotions instead of facts
and thus were worried about unscientific teaching
approaches:
‘Positivistic research; that is what convinces us. We
can understand other things too, but it never has the
same deep impact. We must keep the scientific
banner flying.’
Most informants acknowledged that gender-
associated issues include some related to the distri-
618 ª Blackwell Publishing Ltd 2011. MEDICAL EDUCATION 2011; 45: 613–624
bution of power and that gender equity might imply
that men lose power and position:
‘If you see it like this, there is one dominant and one
subordinate group and of course the dominant group
is seldom interested in surrendering power and
privileges.’
However, when power-related aspects of gender were
touched upon, gender was often associated with
feminism, which some informants described as intim-
idating and male bashing:
‘Feminism is a movement that has gone too far, and
has become threatening and hostile to many men.’
They described female colleagues working with gen-
der and gender researchers in a negative light, as
disappointed feminists, directed by ideology and
bitterness rather than by scientific curiosity:
‘Several feminists and gender researchers seem to
belong to a special category of people who are
dissatisfied with their situation and blame everything
on their gender. They give many men an excuse to
hold on to their prejudices and to continue their
chauvinist attitudes.’
One participant, commenting on male bashing and on
how men can feel abused in discussions about gender,
proposed a constructive approach and concluded:
‘Don’t blame the men; blame the idea of gender roles
that both men and women embrace.’
…and not an easy task
Most participants described not only their own doubts,
but also how they had encountered scepticism or
indifference to the subject of gender from other
colleagues. They also described structural constraints.
These were factors that had obstructed their work with
gender-related issues. They considered insufficient
knowledge about gender to be a major problem, both
among colleagues and in medicine as a whole. For
example, they noted a lack of awareness of subtle
inequities, such as how men and women are differently
treated in conference rooms and in examinations.
Prejudiced attitudes were also described as a major
obstacle:
‘It’s about attitudes, you know, and that is difficult.
There are too many prejudices from all parties,
including myself.’
 Male education leaders’ views on gender

Interviewees perceived a ‘huge need for

DISCUSSION
information and discussion’ at local meetings
for teachers, at national gatherings, at
This interview study found that key male members
congresses and when discussing curricula and
of medical faculties in Sweden held ambivalent views
schedules:
on gender in medicine and considered the subject to
be important, but of low status. To a certain degree,
‘It is very important to work with conscious and
they all found gender important. As doctors, they had
unconscious attitudes among teachers in order to
seen the impact of gender on health and, as
teach and communicate gender.’
bystanders, they had witnessed inequalities and the
wasting of women’s competence. They were inspired
Some participants described medicine as a
by students’ demands and they regarded themselves
conservative and hierarchical discipline involving an
as duty-bound by official decrees to include gender-
‘enormous cramming of biological facts’, leaving
based material into the curriculum. However, they
very little space for reflection. As a consequence,
maintained many doubts. They asked for facts and
they had met a reluctance to change and to
knowledge, but at the same time they downgraded
consider new perspectives such as those related to
gender-related issues as self-evident and questioned
gender:
specific lessons and gender theory. Gender-based
perspectives were considered to be unscientific, to
‘There are defence mechanisms and aggressiveness
exaggerate differences and to be male bashing,
from groupings that claim that there are no problems
especially when power-related aspects of gender were
concerning gender in medical education. These
discussed. Experiences of obstacles, such as preju-
groupings focus only on biological differences and
dices, hierarchies and homosocial behaviour, and of
deny that there are social and socio-cultural gender
gender-based perspectives as hindering heterosexual
aspects.’
excitement, had made education about gender
difficult.
They also commented on the tendency of men to
choose other men to fulfil certain roles, thus dem-
We will comment on our method before we discuss
onstrating homosocial behaviour and a false belief in
our findings.
gender neutrality:
On method
‘Men in leading positions say they consider compe-
tence only, but in reality they vote for or choose
Twelve of the 37 men who were contacted declined to
friends whom they know and have collaborated with,
participate. They all held similar positions and fell into
most often other men.’
the same age range as those who consented to be
interviewed. We assume that those who agreed to
Another idea that several informants said they had
participate may represent those most interested in
observed in male colleagues was that applying a
gender-related issues. This may imply that the declin-
gender-based perspective might ‘take away the fun’ or
ers were even more ambivalent about the subject or
hinder heterosexual excitement, thus diminishing ‘the
found gender to be less important, and thus we are
special relation and excitement that exists when there
unable to report all aspects of resistance and perceived
are women around’:
obstacles. Four of those who abstained referred to lack
of time, and another five were not interviewed because
‘You know, men are concerned nowadays about how
of problems in finding a time for the interview. Citing
to keep up the normal [degree of] excitement
‘lack of time’ as a reason for non-participation may
between the sexes.’
indicate that the respondent did not prioritise gender-
related issues, but it may also be indicative of the work
All these obstacles meant that applying a gender-
overload of education leaders.
based perspective is not prioritised at medical facul-
ties, is not considered meritorious and is therefore met
Telephone interviews were chosen as convenient
with scepticism:
because interviewees were spread all over the country.
However, the lack of face-to-face contact between
‘It gives [you] no credits and qualifications in your
interviewer and interviewee may have made the
CV, it gives no money… it is hard to attract people to
dialogues more impersonal. However, the impression
gender work.’

ª Blackwell Publishing Ltd 2011. MEDICAL EDUCATION 2011; 45: 613–624 619
G Risberg et al
of the interviewer was that most of the men talked
willingly and fluently, and that the data were enriched
by the many personal experiences described.
One man abstained from participation because he
knew the researchers. Others may have recognised
the researchers by name as gender researchers, which
may have led them to try to express themselves in
politically correct ways. This we do not know.
However, arguments both for and against the imple-
mentation of a gender-related perspective appeared
in the full data.
Findings in qualitative research do not represent
proof, but, rather, consist of descriptions and
interpretations. Our method for selecting
participants and holding interviews with 20 teachers
in key positions at Swedish medical schools has
limitations. We cannot lay claim to representativity
and generalisability, but, rather, we aim to make our
results recognisable and transferable to other
contexts.53 That all three researchers worked to-
gether on the analysis represents a strength of this
study. Analyses were discussed jointly and
disagreements were subjected to scrutiny in order to
obtain trustworthiness.54
On findings
Our key faculty leaders were able to justify why
gender matters and to describe sources of inspiration
for the implementation of material on gender-based
perspectives. This is important information on which
to build. For instance, developing men’s interest in
knowledge of gender as a determinant of ill health
might expand the relevance of gender for both
women and men. Research of this kind, such as on
how men may be under-diagnosed and women
over-diagnosed with depression, has recently been
presented.20
The bystander stress experienced by men as they
watch the wasting of women’s competence or as they
witness the downgrading or harassment of women
is also recognised as a gender-related issue for men
and may serve as a basis from which to build alliances
between women and men.40,41,43
Our finding that students’ actions and demands were
greatly influential in putting gender onto the agendas
of faculty leaders is important. Students may think
that their engagement has little impact on the way
curricula are planned. In this study, students’ actions
stood out as representing important eye-openers to
faculty staff.
620 ª Blackwell Publishing Ltd 2011. MEDICAL EDUCATION 2011; 45: 613–624
However, the male teachers also described why
gender was not that important. A recurring theme was
their lack of time as teachers, but they also cited lack
of time and space for gender-related lessons in
curricula. Few informants had themselves prioritised
attendance at courses or lectures on gender-related
issues. One reason for considering specific lessons as
unnecessary was the belief that gender-related issues
were self-evident and would emerge naturally. This
is in line with reports from an Australian medical
school at which the clinical teaching faculty staff
believed that gender-related issues did not require
specific teaching time because they considered that
appropriate attitudes would be learned by students in
the process of observing teachers’ interactions at
the bedside.40 Such a belief disregards gender as an
area of competence and knowledge and may con-
tribute to its low status. We would never claim that
students will absorb cardiology simply by being near
and observing cardiologists.
Another hindrance was that gender-related issues
were seen as being overemphasised by, for instance, a
perceived failure to take diversity into account.
Modern gender theory, however, does indeed
emphasise diversity within groups of men and
women55 and stresses the fact that other hierarchical
systems intersect with gender in relation to the
opportunities and positions available to individuals.56
Spokespersons for a gender-based perspective in
medicine should remember that focusing almost
exclusively on biological and behavioural differences
when communicating about gender implies an overly
narrow focus that might restrain male as well as
female doctors from engaging in gender issues.
Criticisms also concerned the communication styles
used by female colleagues in gender research and
education. Descriptions of these women as disap-
pointed feminists who use overtones and emotions
rather than facts very definitely place them outside
the scientific medical field. Given the enormity of the
work carried out by many women pioneers during
the last few decades to introduce gender-associated
issues in medicine into curricula at Swedish medical
schools, such harsh comments came as a surprise to
us. Obviously, the way gender-related issues are
discussed can cause irritation. The project leaders
of a Dutch programme designed to mainstream
gender-related issues were urged to communicate
carefully to avoid resistance.42 However, focusing on
form more substantially than on content is a way of
disregarding and downgrading an issue. There is also
a risk that unconscious techniques of suppressing
indiviudals,57 such as by blaming individual women or

groups of women for the chauvinistic attitudes of
men, as exemplified in this study, will come into play.
Most informants gave examples in which issues
related to gender included hierarchies of power in
which women belonged to a subordinate group.
However, when education about power relations was
mentioned, interviewees often expressed perceived
associations with feminism and with ‘fighting on the
barricades’. This finding adds to the existing body of
knowledge in a meaningful way: important gender
inequalities in medicine were relabelled as belonging
within the remit of ideology and politics, and as
falling outwith the objective medical world. Similar
findings were described in a Dutch study with
education directors and agents of change. Power-
associated differences between men and women
and gender inequalities in health were framed as
feminist political issues and not as medical issues.42
Moreover, an Australian study reported that medical
staff were reluctant to engage in uncomfortable
discussions that might challenge the notion that all
people are treated equally and identically.40
A notable intricacy described by our participants
concerned the idea that men have nothing to gain
from assuming a gender-based perspective as it will
take away ‘fun’ (i.e. heterosexual excitement). Such a
fear may help to explain resistance to engagement
with gender-associated issues. It may also bring to the
fore reflections on how heterosexual relations are
organised. Are inequity and gender stereotyping
prerequisites for heterosexual excitement? Amusing
flirtation in the medical professional arena was
described in an earlier interview study with doctors, in
which such interaction was discussed as being con-
structed by the eroticising of super- and subordinate
relationships.58
Implications for medical education
The considerations of key male faculty leaders are
informative in developing our understanding of
difficulties in the implementation of gender-associated
work. We will now discuss possible improvements in
gender education in medicine and ideas of how to
interest more teachers, both men and women, in the
subject. Our suggestions are summarised in Table 4.
The low status of gender has been described in
earlier research.4,40,41,59 A contributing factor as
shown in this study is that gender is not always
acknowledged as an area of competence and scien-
tific knowledge. To establish gender as a field of
knowledge, medical education boards and course
ª Blackwell Publishing Ltd 2011. MEDICAL EDUCATION 2011; 45: 613–624
Male education leaders’ views on gender
Table 4 Suggestions for how to improve gender education
in medicine and how to interest more faculty members,
including men
Establish gender as an area of scientific knowledge
Define learning goals, time allocated and examinations of
gender in the curriculum
Encourage discussions among faculty members about the
nature of scientific knowledge
Show in practice that gender involves both men and women
Include literature and examples of aspects of gender and
gender bias in men’s as well as women’s lives
Involve both men and women in education about gender
Broaden gender education
Focus not only on biological and behavioural differences,
but also on similarities between women and men, and
diversity within the groups
Tackle teachers’ own doubts
Call attention to the perception of ‘male bashing’ and
discuss ways to avoid it
Focus on the structural rather than individual aspects of power
Allow teachers space to reflect on their own experiences of
and attitudes to gender and education about gender
leaders need to be clear about definitions of learning
goals throughout the curriculum and to allocate
time in the respective courses. Regular examination
of students on gender-associated issues also repre-
sents a way of improving the status of gender-related
work and making it more meritorious.60 In addition,
clear decisions on the part of deans and heads of
departments would help teachers who cite lack of
time to prioritise the matter.
Another way to tackle the low status of gender is to
encourage discussions about the nature of scientific
knowledge among faculty staff. Criticism of gender-
associated issues as unscientific because they have
social and political connotations raises questions
about what is considered good and valid research in
medical society. A hierarchy prevails among different
fields of research in medicine, among which there is
competition. Traditional biomedicine, with its al-
leged objectivity and neutrality, often claims the right
to define the field. Other research traditions, such as
gender-associated research, end up in a low-status
group, sometimes defined as something other than
science,4 as in the critique in this study. We argue that
it is important that teachers are stimulated to reflect
on how they think about scientific knowledge and
learning processes and are given time to do so. The
621
G Risberg et al
biologist Fausto-Sterling has argued that the way
someone teaches science depends on how that
person thinks about the nature of scientific knowl-
edge. She emphasises that, in today’s world, teachers
must place the scientific matter in a social context in
order to make use of their knowledge. This means
that a teacher does not lose the scientific essentials of
the course content if some traditional details are left
out to make space for expanded coverage because
the value of what students learn does not lie in a
specific set of facts, but in a way of thinking.61
Accordingly, we argue that educators should not
worry that teaching about gender-associated issues
will take time away from teaching about ‘basic
medicine’; what matters is that we teach about how to
interpret and understand different aspects of health
and disease.
To improve gender education, both men and
women must be involved. A few informants in our
study had noticed that male teachers were taken
more seriously than female teachers when teaching
about gender. Accordingly, bringing more male
teachers into gender education in medicine might
improve the status of the gender-based perspective.
Earlier research has shown that mainstreaming and
implementing a gender-based perspective in
medicine is facilitated by alliances between
persons (women) aiming for change and senior
male faculty leadership.39,40,42 There is, however,
an inherent dilemma in this strategy: improving
the status of gender education by involving more
men in it may endorse the asymmetry of the
respective status of men and women. The solution
replicates the problem. Nevertheless, involving more
men in gender education is also a way of showing in
practice that gender concerns both men and
women.
Several of the male faculty leaders perceived gen-
der-related issues as mainly women’s issues. This
indicates that gender education ought to be
broadened. Gender-associated issues and gender-
influenced relationships have impact on men as
well as on women and it is important to discuss this
in medical education. The norms of masculinity,
like those of femininity, imply restrictions and
entail specific consequences, challenges and
difficulties. For example, there has been some
discussion as to how gendered expectations of men
can lead to exposures to risk, resulting in higher
mortality and poorer quality of life compared with
women.62 Moreover, gender bias affects not only
women but also men. There are reports that men
with depression20 and men with migraine63
622 ª Blackwell Publishing Ltd 2011. MEDICAL EDUCATION 2011; 45: 613–624
tend not to be diagnosed properly. Citing such
examples may demonstrate that men do have
something to gain from supporting a gender-based
perspective.
Resistance to the power-associated aspects of gender
can seem hard to tackle. We find that the comment
made by one interviewee – ‘Don’t blame the men;
blame the idea of gender roles that both men and
women embrace’ – is illuminating and summarises
most of our discussion. It illustrates the thin line
negotiated by communicators on gender and
described by Verdonk et al. as the line between being
considered confident and determined, which is
rewarded, and being judged as assertive (‘too pushy’),
which causes resistance.42 Even if gender educators
try to focus on the gender-based system – with its
gendered roles and asymmetry of power – as a system
upheld and reproduced by both women and men,
individual men may, and do, feel blamed and
perceive the power-related aspects of gender as
belonging to the realm of politics and ideology. To
channel this frustration into dialogue and reflection,
it is important to arrange faculty education pro-
grammes on gender and also to discuss the risk of
male bashing in order to find ways of avoiding it. One
approach in such a programme would be to intro-
duce theoretical knowledge and facts about structural
gender patterns. Changing the focus from an indi-
vidual to a structural level may make the power-
related aspects of the subject of gender seem less
intimidating. Another approach would involve
making space for reflection on one’s own doubts
and motivation.
Contributors: all three authors conceived and designed the
research and undertook the analysis and interpretation of
data. GR carried out the interviews and drafted the article.
EJ and KH conducted the critical revision of the article. All
three authors read and approved the final manuscript.
Acknowledgements: none.
Funding: none.
Conflicts of interest: none.
Ethical approval: the Ethics Committee of the Faculty of
Medicine, Umeå University approved the study (ref. 05-
037 Ö).
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Received 22 June 2010; editorial comments to authors 9 August
2010, 8 November 2010; accepted for publication 19 November
2010