Perspectives of female medical students and physicians on professional development in Japan

Hinako Sudo ¹, Seri Kojima ¹, Kiko Hayashi ¹, Sakura Hosoki ¹, Arisu Tanaka ¹ and Rintaro Imafuku ²

Date submitted: 1-July-2024

Email: Rintaro Imafuku (imafuku.rintaro.f9@f.gifu-u.ac.jp)

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Citation: Sudo H, Kojima S, Hayashi K, Hosoki S, Tanaka A, and Imafuku R. Perspectives of female medical students and physicians on professional development in Japan. Educ Health 2024;37:389-395

Online access: www.educationforhealthjournal.org
DOI: 10.62694/efh.2024.120

Published by The Network: Towards Unity for Health

Introduction

Women tend to take on caregiving roles such as child-rearing and care of the elderly as gendered responsibilities. Given this situation, previous studies have internationally reported that female physicians inevitably interrupt their careers.^1–3 In addition to medicine, this issue is a worldwide common concern across various professions, such as dentistry,⁴ pharmacy,⁵ academia,⁶ and management in the hospitality industry.⁷ For example, in the UK, more female dental undergraduates than males intend to work part-time five years after qualifying due to childcare commitments. Similarly, in Japan, childbirth and child-rearing are considered major reasons for temporary leave or resignation among female physicians.⁸ The employment rate of female physicians is characterized by an M-shaped curve, decreasing until 12 years after medical registration and, subsequently, gradually recovering.⁹ However, the proportion of female physicians in leadership positions remains low.¹⁰ Although there is recognition of the necessity for support systems that consider the working arrangements of female physicians with families,¹⁰, ¹¹ their own experiences and perceptions of career development have not been fully explored from an insider perspective, which delves into the personal experiences and beliefs of a specific culture or society (i.e., an emic approach).

In this context, previous studies have reported that female medical students also experience anxiety about balancing family and work when considering future career paths.¹², ¹³ However, the detailed investigation of how female medical students perceive their ideal career as a physician, and the issues related to potential future life events and work has not been conducted adequately. Their voices expressing anxiety and their visions for future career are fundamental to developing a career support approach in medical education. Therefore, this case study developed the following research questions:

The findings regarding the actual experiences of career development among Japanese female physicians would be fundamental for the educational development aimed at helping female medical students clarify their vision of future careers.

Methods

This qualitative study adopted a case study methodology with an emphasis on gaining a deeper understanding of people’s perceptions, beliefs, and values within a specific context.¹⁴ These aspects are difficult to reveal solely through statistical analysis in quantitative research.

Data collection was conducted in January and February, 2023. Using convenience sampling, this study selected eight fourth-year Japanese female medical students who participated in clinical clerkships. Additionally, this study purposively selected nine Japanese female physicians with over nine years of clinical experience, as well as experience in marriage and childbirth. Their clinical experiences range from nine to 23 years, and specialty areas included anesthesiology, cardiovascular surgery, emergency medicine, gastroenterology, obstetrics and gynecology, neurology, ophthalmology, otolaryngology, and pediatrics.

Written consent has been obtained from all participants. HS, SK, AT, SH, and KH conducted semi-structured interviews with the medical students and physicians in person or online, which lasted 30–50 min each. The interviewers were second-year medical students at the time of data collection who received training in qualitative research and interviewing as part of their undergraduate research course in medical education. The main interview questions for medical students are about: the ideal image of a physician; future plans regarding marriage and childbirth; and concerns about their future career. For female physicians, the questions focused on work-life balance, support systems and difficulties encountered upon returning to work.

The interviews were audio-recorded and produced verbatim as transcripts. The excerpts of Japanese transcripts were translated into English by the first and last authors. During this process, private identifiers were replaced with anonymized data, such as S1 for students and P1 for physicians.

Reflexive thematic analysis in an inductive way was employed for qualitative data analysis.¹⁵ All the researchers (HS, SK, AT, SH, KH and RI) systematically reviewed the transcribed data. Then, HS, SK, AT, SH and KH individually performed initial coding to the data that were broken into small analytical units. All the researchers compared the results of individual initial coding and identified themes representing abstract concepts. After that, the researchers iteratively reviewed the themes to ensure that the interpretation was congruent with the data.

This study was approved by Gifu University Institutional Review Board (No.28-468). Confidentiality was assured for the content of their interviews regarding their career.

Results

This study identified four main themes regarding the anxieties about the careers of female medical students (Table 1) and the career development experiences of female physicians (Table 2): work environment, marriage and childbirth, continuation of work, and career development approach. In the following sections, this study illustrates each theme on the perceptions of the students and physicians regarding their careers.

Work environment

Female students expressed concerns that in environments with few female physicians, they might not receive colleagues’ understanding regarding taking maternity or childcare leave. Consequently, they were concerned about the establishment of sufficient support systems in terms of their careers and institutional support. On the other hand, female physicians, even in environments with many women and well-established support systems, tended to worry about imposing a heavy burden on those providing support. Some attempted to resolve issues independently, without relying on others. Additionally, others had experienced gender bias in the past, leading to restricted future choices. Medical students, however, did not make any comments on gender bias. This might be because they have not experienced or learned much about unconscious gender bias during their medical education.

Marriage and childbirth

Female students considered having children by the age of 30 to avoid advanced maternal age. However, they were also anxious about whether they could marry and have children during busy periods as physicians. Similarly, female physicians harbored concerns about advanced maternal age and faced various issues regarding their careers. For example, some mentioned that continuing to work part-time due to child-rearing made it difficult to acquire the expertise necessary for future career advancement, posing a barrier to career development.

Continuation of work

Female students expressed a desire to return to and maintain work after their leave. However, as they worried that the employment gaps such as childcare leave would pose barriers to career development, they also hoped for some support in their careers. Female physicians shared the opinion that the longer the breaks, such as childcare leave, the greater the anxiety and hesitation about returning to work. Some mentioned struggling to regain procedural skills and update knowledge after being away from work. With the support of people around them, they were able to balance work and childcare.

Career development approach

Female students tended to consider gender roles and life events such as childbirth and childcare when selecting a medical specialty. However, some expressed concerns about prioritizing family too much, leading to potential risks for their career as physicians. On the other hand, female physicians stressed the importance of selecting medical specialties based on their interests, because it would be difficult to continue in a field they did not enjoy. Regarding female physicians’ career development, both female medical students and female physicians expressed concerns about the absence of role models.

Discussion and Conclusion

This case study explored the future perspectives of female medical students and the actual experiences of female physicians’ career development in Japan. The students harbored some anxieties about the future, such as balancing childbirth, childcare, and their work. Since they were fourth-year students who had recently started clinical training, they had limited opportunities to observe the actual working environment of female physicians. In other words, they were in the process of forming clear future images. Aoki et al.’s study targeting fifth and sixth-year students found that they were starting to consider more specific career plans.¹² Therefore, as suggested by Okamoto et al.,¹⁶ it is crucial to integrate learning opportunities of the career experiences of female physicians and the practical career support into early stages of their education. For example, given the fact that there was no comment on gender bias from medical students, gender bias and its impact on career development are essential issues to be discussed among students in medical education.

Female physicians experienced barriers regarding work-life balance after becoming physicians. Echoing Yamazaki et al.’s study,¹⁷ their own feelings of guilt, gender discrimination from male physicians, and a lack of understanding of pregnancy and childcare, were main challenges in work environment in this study. As shown in Table 2 (e.g., excerpts from P5 regarding “marriage and childbirth” and “career development approach”), this study revealed that female physicians who successfully balanced marriage, childbirth, childcare, and work believed they could attain a sense of fulfillment that male physicians may not achieve.

To alleviate the vague anxieties of the students and further enhance the fulfillment of the physicians, it is important to establish communities of practice for career development.¹ For students, this provides an opportunity to know various experiences and perspectives from female physicians, while it allows female physicians to share their fulfillment and struggles and also gain inspiration from students. Furthermore, it can serve as a platform to discuss issues of gender equality and a support system for both recipients and providers of support, involving male and female medical students and physicians.

This study is significant in that it discussed the perspectives of both female students and physicians on career development. This study has some limitations. Firstly, it should be noted that the sample size is too small to reflect differences among specialties. In particular, the perspectives of female generalists could not be explored. Secondly, the results were not generalizable due to the small number of participants in a specific context. Thus, for future research, based on the findings of this study, quantitative investigations can be designed to generalize the results. Furthermore, it is worthwhile to investigate the career of female physicians who decided to leave their jobs, as this would provide valuable insights for developing a community of practice aimed at supporting female physicians’ career development.

Acknowledgements

The authors would like to express their gratitude to the female medical students and physicians who shared their perspectives and experiences in career development.

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Student Contribution