5 Feminist Theory
Lauren Evans; Dolly Yadav; Sreeja Natesan; and Teresa M. Chan
Authors: Lauren Evans, MD; Dolly Yadav, MD
Editor: Sreeja Natesan, MD; Teresa Chan, MD, MHPE
A Case
As she pre-rounding for Trauma Surgery rounds, medical student Jane Adams felt she was as prepared as she could be. She had arrived early to interview their patient, Frank, and had been through all the labs twice. She again ruffled through her notes as the other student on the service, Jagdeep Sahotra.
“You’re late again,” she sighed.
“I know, I know…” replied Jagdeep as he quickly jotted down the latest vital signs. He had missed his chance to examine Frank that morning. Dr. Fox, the Attending Surgeon, had already arrived so they quickly rushed off after him. As they arrived at Frank’s room, Jane started with the presentation and John added in the additional vital signs and stated that Frank appeared in a better mood this morning.
As they walked into the room, Dr. Fox again introduced the students.
“Good morning, you remember student doctor Jane and student doctor Sahotra.”
“Yes,” Frank stated, “I remember them! It’s good to see you again Dr. Sahortra and Jane.”
Jane watched Dr. Fox, and hoped he would correct Frank but instead he just nodded along. John quickly responded to the patient with, “It’s good to see you again. I’m happy to see you doing so well.”
As they walked out of the room, Frank called out to ask for juice. Dr. Fox turned to Jane and asked her to go down the hall and grab the juice for him. She rushed off so that she could meet the needs of her patient, but when she arrived back on rounds, Dr. Fox had just finished discussing the plan for Frank that day. Dr. Fox commented on the excellent rapport Jagdeep had with Frank and announced that John would be the student to join him in the operating room that afternoon. Jane wondered what she could do about this disparaging situation.
Overview
Feminism has been defined by feminist scholar and author, bell hooks, as “a movement to end sexism, sexist exploitation and oppression.” While there exists no singular feminist theory, Sharma describes “a family of critical theories and approaches that enable us to understand complexity.” Sharma also wrote a scoping review examining feminist theory as it relates to medical education and medical education research and found four overarching topics that exist in the Feminist theory literature:
- Assessment of what is taught in medical curricula: Addressing the need for more education in women’s health and gender sensitivity.
- Female experiences in medical training: Perspectives of female trainees, including challenges faced.
- Pedagogical approaches to medical education: Scrutinizing hidden curriculum and assumptions.
- Methodologies and inquiries in medical education research: What questions are asked and is there action based on these questions.
Main Originators of the Theory
Sandra Lee Bartky, Annette Claire Baier, Simone de Beauvoir, Ferdinand Bebel, Grace Lee Boggs, Judith Butler, Hélène Cixous, Voltaire Cleyre, Juana Inés de la Cruz, Patricial Hill Collins, Mary Daly, Angela Davis, Emma Goldman, Sally Haslanger, bell hooks, Catharine MacKinnon, Amina Mama, Louise Michel, John Stuart Mill, Kate Millett, Martha Craven Nussbaum, Estelle Pankhurst, Carole Pateman, Val Plumwood, Gayle Rubin, Nawal El Saadawi, Gayatri Chakravorty Spivak, Suzanne Voilquin, Mary Wollstonecraft, Iris Young, Clara Zetkin.
Background
In 1848, a group gathered in Seneca Falls, New York seeking equal rights for women, including suffrage, education, and property rights, but later focused mainly on the right to vote. This first-wave feminism ultimately led to the 19th amendment being passed in the United States in 1920. The movement continued in other countries, and Saudi Arabia became the last country to allow women to vote in national elections (2015). After women’s suffrage was passed, there was a decline in the movement in the United States. In the 1960’s, a second-wave feminism was born and since that time feminism has been a constant, evolving theory. Second-wave feminism focused primarily on workplace rights and reproductive rights. They sought equal pay, equal job opportunities, and improved childcare options. Third-wave feminism challenged gender identity and the rights of underrepresented females, and fourth-wave feminism has focused on sexual harassment.
Sharma2 identifies 11 different feminist theories that are present in the medical literature, including examples and critiques. These broad theories show the diversity of the topic and the avenues for future research. We have adapted the table by Sharma below for your reference.
| Principles | Examples in Health Professions Education | Problems or Critiques with this approach | |
| Liberal Feminism | All genders are fundamentally equal; social conditions create and dictate differences and inequities; political and structural changes are required to close the gap. | Implementing quotas and other recruitment policies that increase the number of women in leadership positions. | Has been critiqued for the lack of intersectional awareness of other oppressive factors (e.g. race, class, language, sexual orientation, etc..). |
| Cultural Feminism | Women and men are fundamentally different and that there are certain attributes within women (e.g. being more relational or empathetic) that come more naturally to them. | Examining the caring nature of more “feminine” specialties within medicine. | Rather reductionistic at times. Notion of male vs. female attributes, values, and set points are problematic for many. Denies a spectrum of genders. |
| Queer Feminism | Core to this movement are the concept that sex and gender are socially constructed. | Work that examines gendered experiences between men and women physicians with other staff within the operating room setting. | Focuses on discourse and therefore may preclude examination of social structures that are at play (e.g. race, class, sexual orientation, etc..) |
| Radical Feminism | Identifies the patriarchy as the main source of oppression and gender as a tool of these individuals to oppress women. Suggests that radical (and not incremental) change is required. | Enacting legal changes to legislation around women’s reproductive rights. | Many critics feel that radical change is unlikely to occur in most jurisdictions and may be a fantasy. |
| Anti-racist Feminism |
Race is an oppressive construct. | Creating a curriculum that examines the intersectionality of gender AND race in the clinical learning environment. | Leans heavily towards seeing intersectionality as a probably solution. May not examine other sources of structural or cultural oppression. |
| Socialist Feminism |
Emphasizes economic oppression. Women’s oppression is part of a large structural inequity that is driven by class and economics. | Creating new policies for encouraging all genders to engage in parental leave. | Often misses out on other sources of oppression (e.g. race, language, sexual orientation, etc..) |
| Postmodern Femininism |
Language and social discourse create our understanding of women and their identity. | Examining medical literature or policy documents for evidence of gender bias. | Focuses largely on language and does not often create new structures and enable change. |
| Indigenous Feminism |
Focuses on how decolonisation and indigenous sovereignty may intersect with feminism. | Indigenous cultural safety training for clinicians and trainees. | Often very North American-centric, although Australia and New Zealand are often thought of as leaders in this space as well. |
| Marxist Feminism | Sees capitalism as primary source of oppression, leading to a devaluing or undervaluing of women’s labour. | Determining differences in women and men’s clinical revenues and academic contributions to see if women are penalized for increased caregiving and household labour responsibilities. | Does not usually account for other intersectional sources of oppression (e.e. race, language, sexual orientation). |
| Postcolonial Feminism |
Asks us to examine via a postcolonial lens whether white women’s experiences and values are being generalised inappropriately. | Examination of a medical school application system to examine how non-White women experience this process. | Colonialist and imperialist practices are still pervasive in the world, so perhaps the “post” in postcolonialism is inappropriate. |
Modern takes on this Theory
Organizations, such as FemInEM (feminism.org), have created online communities of practice directed at gender equity and empowering all physicians. They aim to “address gender disparities in a positive way.” This community has open access to resources for gender studies in medicine directed at both personal and group development. They also have in-person events available for further networking and education. FemInEM also supports research into gender equity in medicine. SheMD is another example of an organization that uses the online social media platform of Twitter to educate on topics of gender equity, workplace disparities, and more. National organizations such as ACEP, SAEM, and others have created Women In Medicine committees to also help advocate for policy changes, increase education on gender equity issues, and allow networking and creation of a community for women in medicine.
Other Examples of Where this Theory Might Apply
In the classroom, Feminist theory has recognized the “one-sex body” present in the pre-clinical curriculum. Studies have found that anatomy textbooks have more anatomic illustrations of male figures than females as the “norm.” The concerns that arise are that medical students are less likely to fully recognize the normal female anatomy or the differences between the sexes. In Emergency Medicine, we can see an example of this with the teaching of thoracostomy tubes. One of the most commonly used books for procedures, Roberts and Hedges’, uses a male figure to show anatomy and states “the fifth intercostal space is approximately at the level of the nipple,” but “the position of the female breast mass leads to variance” with no further information provided. The concern is that students who use these resources will be less prepared to properly care for a female patient compared to their male counterpart.
Feminist theory has also looked broadly at the experience of females in the clinical setting. There has been literature that focuses on the different experiences of female and male medical students, residents, and faculty. This research has identified significant challenges including sexual harassment and hostile work environment. There has also been significant research into the reduction of female career advancement and the lower numbers of female editors in medical journals.
Limitations of this Theory
Sharma2 notes that there appears to be a deficit in the number of publications referencing feminist theory in medical education. She notes that this is possibly related to a publication bias. There has been literature that identifies a male dominance in the editorial boards of prominent medical journals,9 with up to only 21% of editorial board members found to be female. There has also been research into the underrepresentation of female authorships in both medical, and general sciences, literature.
Returning to the case…
Jane focused on the morning’s events wondering what she could have done differently. She knew that she had been better prepared for the day than John, but felt frustrated that she had still missed out on the afternoon surgeries. She discussed the problem with her roommate and he suggested that she speak to Jagdeep about it tomorrow.
“Maybe he didn’t realize what was happening?” he asked.
The next morning when Jagdeep arrived, Jane brought up the topic. Initially, Jagdeep felt frustrated because he knew he deserved to see the surgeries. She reminded him that he had been late that day and hadn’t even examined Frank.
She then asked him “Did you notice how Frank called you Dr. Smith and then referred to me as Jane and Dr. Fox just ignored it?”
She reminded him that Dr. Fox had sent her to go get juice instead of hearing about the plan for her patient. The more examples of the sexism that had occurred, the more Jagdeep realized the struggles that Jane was facing.
“I didn’t realize what was happening or I would have said something!” Jagdeep said.
Jane believed him, but wondered what could be done to prevent it from happening again. She had heard about some medical schools that were incorporating gender awareness into their curriculum and thought maybe her school could do the same. Jagdeep agreed that it was needed and asked to be a part of this new project. They set off that afternoon to find a mentor for their new curriculum and to figure out ways to disseminate this to the faculty and staff as well.
References
- hooks, bell, 1952-. Feminism Is for Everybody : Passionate Politics. Cambridge, MA: South End Press, 2000.
- Sharma M. Applying feminist theory to medical education. Lancet. 2019;393(10171):570-578. doi:10.1016/S0140-6736(18)32595-9
- Burkett E, Brunell L. feminism | Definition, History, & Examples. Encyclopedia Britannica. https://www.britannica.com/topic/feminism. Published 2020.
- FemInEM. FemInEM. https://feminem.org/about/. Published 2020.
- Mendelsohn KD, Nieman LZ, Isaacs K, Lee S, Levison SP. Sex and gender bias in anatomy and physical diagnosis text illustrations. JAMA. 1994;272(16):1267-1270. doi:10.1001/jama.1994.03520160051042
- Thomsen, and Jerris R. Hedges. Roberts and Hedges’ Clinical Procedures in Emergency Medicine., 7th ed. Elsevier; 2014.
- Wear D, Aultman JM, Borges NJ. Retheorizing sexual harassment in medical education: women students’ perceptions at five U.S. medical schools. Teach Learn Med. 2007;19(1):20-29. doi:10.1080/10401330709336619
- Raj A, Kumra T, Darmstadt GL, Freund KM. Achieving Gender and Social Equality: More Than Gender Parity Is Needed. Acad Med. 2019;94(11):1658-1664. doi:10.1097/ACM.0000000000002877
- Jagsi R, Tarbell NJ, Henault LE, Chang Y, Hylek EM. The representation of women on the editorial boards of major medical journals: a 35-year perspective. Arch Intern Med. 2008;168(5):544-548. doi:10.1001/archinte.168.5.544
- 10.Babaria P, Bernheim S, Nunez-Smith M. Gender and the pre-clinical experiences of female medical students: a taxonomy. Med Educ. 2011;45(3):249-260. doi:10.1111/j.1365-2923.2010.03856.x
- 11.Cheng LF, Yang HC. Learning about gender on campus: an analysis of the hidden curriculum for medical students. Med Educ. 2015;49(3):321-331. doi:10.1111/medu.12628
- 12.MacLeod A, Frank B. Feminist pedagogy and medical education: why not now? Med Educ. 2013;47(1):11-14. doi:10.1111/medu.12095
- 13.Silver JK, Poorman JA, Reilly JM, Spector ND, Goldstein R, Zafonte RD. Assessment of Women Physicians Among Authors of Perspective-Type Articles Published in High-Impact Pediatric Journals. JAMA Netw Open. 2018;1(3):e180802. Published 2018 Jul 6. doi:10.1001/jamanetworkopen.2018.0802
- 14.Hsiehchen D, Hsieh A, Espinoza M. Prevalence of Female Authors in Case Reports Published in the Medical Literature. JAMA Netw Open. 2019;2(5):e195000. Published 2019 May 3. doi:10.1001/jamanetworkopen.2019.5000
- 15.Gender imbalance in science journals is still pervasive. Nature. 2017;541(7638):435-436. doi:10.1038/541435b
- 16.Bendels MHK, Müller R, Brueggmann D, Groneberg DA. Gender disparities in high-quality research revealed by Nature Index journals. PLoS One. 2018;13(1):e0189136. Published 2018 Jan 2. doi:10.1371/journal.pone.0189136
Annotated Bibliography
1. Sharma M. Applying feminist theory to medical education. Lancet. 2019;393(10171):570-578. doi:10.1016/S0140-6736(18)32595-9
Provides an excellent overview of Feminist theory and how it can be applied within medical education.
2. Babaria P, Bernheim S, Nunez-Smith M. Gender and the pre-clinical experiences of female medical students: a taxonomy. Med Educ. 2011;45(3):249‐260. doi:10.1111/j.1365-2923.2010.03856.x
A qualitative study looking at female’s pre-clinical experiences relating to gender. The students reported multiple negative experiences that left them isolated and questioning of a future in the medical field.
3. Cheng LF, Yang HC. Learning about gender on campus: an analysis of the hidden curriculum for medical students. Med Educ. 2015;49(3):321‐331. doi:10.1111/medu.12628
This paper examines posts by medical students from multiple schools posted on an online communication board. Authors found biased treatment of women and overt sexual harassment present from both students and faculty. Among the strategies suggested to promote gender sensitivity is recounting examples of the lived experiences of those who have been discriminated against in medical curricula.
4. MacLeod A, Frank B. Feminist pedagogy and medical education: why not now? Med Educ. 2013;47(1):11‐14. doi:10.1111/medu.12095
This paper examines the need for social sciences such as gender and race studies in medical curriculum.
5. Mendelsohn KD, Nieman LZ, Isaacs K, Lee S, Levison SP. Sex and gender bias in anatomy and physical diagnosis text illustrations. JAMA. 1994;272(16):1267‐1270.4
This paper looks at the disproportionate number of male illustrations in anatomy textbooks used during pre-clinical years. Thus further perpetuating the male body as the medical standard and limiting medical student’s understanding of female anatomy. Also, female images were disproportionately higher in the reproductive chapters versus male’s.
