|Year : 2021 | Volume
| Issue : 1 | Page : 6-11
Is there a gender disparity in the residency training programme? Perspectives of trainees from a tertiary hospital in Nigeria
Omumuawuike Chinenyenwa Ebi1, Akpabio Akanimo Akpabio1, Edesiri Ejovwoke Ighorodje1, Mkpang Esio Emenyi1, Enobong Cyril Mkpang2, Christie Divine Akwaowo3
1 Department of Internal Medicine, University of Uyo Teaching Hospital, Uyo, Nigeria
2 Department of Obstetrics and Gynaecology, University of Uyo Teaching Hospital, Uyo, Nigeria
3 Department of Community Health, Faculty of Clinical Sciences, University of Uyo, Uyo, Nigeria
|Date of Submission||08-Feb-2021|
|Date of Decision||13-Mar-2021|
|Date of Acceptance||15-Apr-2021|
|Date of Web Publication||30-Jun-2021|
Akpabio Akanimo Akpabio
Department of Internal Medicine, University of Uyo Teaching Hospital, Uyo
Source of Support: None, Conflict of Interest: None
INTRODUCTION: Universal health coverage in Africa is constantly threatened by inadequate workforce relative to the health needs of the population. These inadequacies may be worsened by gender disparities with female doctors worse affected. This study aims to highlight the gender distribution of residents across specialties, compare the residency programme experiences of male and female trainees and assess their perspectives towards gender disparities in training.
METHODOLOGY: This was a pretested cross-sectional online survey using Google Forms© involving all 208 University of Uyo Teaching Hospital (UUTH) residents with additional information from the hospital database. Data was analyzed using Stata version 16 with statistical significance P < 0.05. Ethical approval was obtained for the study.
RESULTS: Of 208 trainees, 128 (61.5%) were male while 80 (38.5%) were female. Departments had from 2 (ENT) to 29 residents (internal medicine). A response rate of 58.6% was obtained from 122 respondents (62.3% males). General surgery had a 100% male predominance while paediatrics had a 68% female predominance. Most respondents (72.9%) felt that the programme was quite stressful and 36.9% had considered leaving. Half of the trainees (50.8%) got maximum support from their families in the form of emotional and psychological care. While 73.8% acknowledged gender disparities, only 24.6% experienced discrimination.
CONCLUSION: The UUTH residency training programme is male dominated, especially in general surgery with training challenges experienced by male and female trainees. Gender disparities exist though only a quarter experienced discrimination. Existing disparities should be urgently addressed and gender mainstreaming promoted by training institutions.
Keywords: Gender disparity, Nigeria, perspectives, residency, trainees
|How to cite this article:|
Ebi OC, Akpabio AA, Ighorodje EE, Emenyi ME, Mkpang EC, Akwaowo CD. Is there a gender disparity in the residency training programme? Perspectives of trainees from a tertiary hospital in Nigeria. J Med Womens Assoc Niger 2021;6:6-11
|How to cite this URL:|
Ebi OC, Akpabio AA, Ighorodje EE, Emenyi ME, Mkpang EC, Akwaowo CD. Is there a gender disparity in the residency training programme? Perspectives of trainees from a tertiary hospital in Nigeria. J Med Womens Assoc Niger [serial online] 2021 [cited 2021 Sep 27];6:6-11. Available from: http://www.jmwan.org/text.asp?2021/6/1/6/319616
| Introduction|| |
The World Health Organization policy of universal health coverage in Africa is constantly threatened by inadequate workforce relative to the health needs of the population., Personnel availability alone is insufficient; equitable distribution and access by the population are essential to translate theoretical coverage to effective service. Medical specialist training is essential to ensuring high-quality care and a popular career pathway amongst many young doctors. Despite similar numbers of medical graduates, females are under-represented in residency programmes, especially in surgery and related specialties. Apart from the challenges of excelling in male-dominated specialties, the training of some female residents tends to be prolonged due to childbearing and other family commitments.
Gender inequality can be defined as the “legal, social and cultural situation in which sex and/or gender determine different rights and dignity for women and men, which are reflected in their unequal access to or enjoyment of rights, as well as the assumption of stereotyped social and cultural roles.” Even in developed countries, gender disparities exist in secondary and tertiary educational levels in fields such as science, technology, engineering and medicine. It has been reported that gender inequality is a function of systemic factors unrelated to ability, such as bias, organisational constraints, culture and differential effects of work and family demands. In sub-Saharan Africa, only 30% of the research output across the continent is done by women, thus highlighting significant disparities.
It is worrisome that male trainees perceive disparities much less than female trainees and this may likely perpetuate the negative trend. In Nigeria, while the proportion of female dental lecturers rose from 36.2% in 2003 to 42.5% in 2013, the figures for female dental residents fell from 45.8% to 40.8% over the same period. A survey evaluating the residency programme in Nigeria's top tertiary hospital showed a marked male predominance of 73.4% compared to 26.6% for female residents.
Thus, there is a need to identify and address any existing gender disparities within the Nigerian residency training programme. Findings from this study will also serve as a basis for promoting gender balance and mainstreaming in residency training in Nigeria. This study aims to highlight the gender distribution of residents across different specialties, compare residency programme experiences of male and female trainees and also assess the perspectives of residents towards gender disparities in training.
| Methodology|| |
We created an online survey using Google Forms© to assess and compare training experiences of the male and female residents, as well as their perception towards gender discrimination in the residency training programme. Information on the gender distribution of residents across various departments in the hospital was acquired from the hospital's Human Resource Department. The survey consisted of 32 questions covering sociodemographics and the different study objectives. It was pretested by five resident doctors across different departments and adjusted based on feedback received.
The survey was disseminated electronically on all the social media platforms used exclusively by the hospital's 208 trainees. To ensure participation by as many residents as possible, trainees from departments that showed poor participation in the online survey were subsequently approached to complete a self-administered paper version. Recommendations from the CHEERIES checklist for standardized reporting of internet surveys were used during the study. Data was extracted to Microsoft Excel version 2016 and cleaned for errors. Information on each resident was strictly safeguarded and kept anonymous. Data was summarised as simple proportions with comparisons done using t-test for quantitative variables and Chi-square for categorical variables. Statistical analysis was done using Stata version 16 (StatCorp, Texas, USA) with P < 0.05 considered statistically significant. Institutional ethical approval was obtained before the study.
| Results|| |
The University of Uyo Teaching Hospital (UUTH) currently has a total of 208 trainees, of which 128 (61.5%) are male while 80 (38.5%) are female. The gender distribution across different departments is shown in [Figure 1] with internal medicine and ENT departments having the highest and lowest number of residents, respectively. One hundred and twenty-two residents completed the study questionnaire giving a response rate of 58.6%. There were 76 males (62.3%) and 46 females (37.7%) with a mean age of 35.9 ± 4.8 years.
|Figure 1: Gender distribution of University of Uyo Teaching Hospital residents by department|
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Most respondents graduated in the years 2009, 2010 and 2012 with most beginning residency in 2012, 2017 and 2019. Registrars accounted for 42.5% of participants while senior registrars made up the slight majority. Of the married trainees (73.8%), majority (61.5%) had non-doctor spouses while 38.5% had a doctor spouse. Trainees had a median of two children (range: 0–4) with an average of three dependants (range: 0–10).
Although males began residency training earlier than females (4.7 vs. 5.3 years), this was not statistically significant (P = 0.14). Overall, only seven respondents (four females and three males) had completed their training over an average of 7.1 years. Nearly 70% (69.6%) of trainees were from Akwa Ibom state with surrounding states accounting for the remainder. Most trainees (45.8%) were registered for both postgraduate colleges although 83.6% of all trainees had no additional qualifications before or during residency.
Roughly two-thirds of residents (61.3%) had done outside postings with a median of 10 months and a range of 1–36 months. Most respondents (72.9%) felt that the programme was quite stressful and 36.9% had considered leaving. [Table 1] compares the residency training experiences of male and female trainees. Half of the trainees (50.8%) got maximum support (scores of 5) from their families, mainly in the form of emotional and psychological care. Moderate levels of support (scores of 3) were obtained from friends (31.1%), colleagues (40.2%) and mentors (31.2%) while the lowest support (scores of 2) was received from the training institution (40.2%).
|Table 1: Comparision of training experiences of male and female trainees|
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Job satisfaction, financial rewards and influence of mentors were the topmost factors residents considered when choosing a speciality while poor remuneration, unconducive environment and excessive were the most challenging issues faced. [Table 2] shows the speciality choices, challenges and levels of support received. Regarding gender disparities, most (73.8%) agreed that it existed, although about a quarter (24.6%) had experienced any form of gender discrimination, as shown in [Figure 2]. Although 47 participants (38.5%) felt that females were more favoured in the programme, an equal number also felt that no gender was favoured. Most trainees reported that males were the majority in their departments (50.1%) but were open to employ both genders (71%) during future recruitment exercises.
|Table 2: Trainees' choice of speciality, residency challenges and levels of support|
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| Discussion|| |
The age and gender distribution of our trainees is similar to a previous report from the largest Nigerian tertiary hospital. From our study, there was a predominance of male trainees overall (63%) similar to other studies from different parts of Nigeria.,, This may reflect a bias in employment though it is also possible that fewer females actually apply for the residency programme.
Specialties such as internal medicine, obstetrics and gynaecology, paediatrics and surgery are quite popular amongst our trainees as in other institutions, though there is a growing interest in family medicine also seen in our study. There were no female residents in general surgery and very few in obstetrics and gynaecology (11.5%) with this trend widely reported., Reasons identified for this negative trend include reduced family time, heavy workload, requirement of physical effort and lack of female role models/mentors. Trainees in this study identified job satisfaction, financial rewards and influence of mentors as the most important factors influencing their choice of speciality. Female predominance in paediatrics as shown in this study has been previously reported though the reasons for this are unclear.
The response rate of 57.8%, although regrettably low, is reflective of poor participation in research by trainees as highlighted by Eze et al. amongst trainees in Southeast Nigeria. Majority of residents were married (73.8%) mostly to non-doctors (61.5% vs. 38.5%) though how this may affect training is unclear. Female trainees started and finished training later than their male counterparts, and although this was non-significant, it is likely the result of childbearing and family commitments expected of them. Female trainees tended to have an extra child (2 vs. 1, P < 0.01) compared to male trainees, though there were no significant differences in number of dependants (P = 0.2). It is possible that in our environment, female residents get married and raise families earlier than their male counterparts.
Stress levels are quite high amongst both groups of UUTH residents as has been noted amongst trainees from other parts of the country,, with a significant proportion considering quitting the programme similar to the report by Ogunsemi et al. Residency stress is multifactorial and is worsened by outside posting requirements (training at a more equipped or accredited hospital usually outside the trainee's state of residence), most of which last for at least 12 months. Family support is essential, especially with regard to emotional and psychological care, with a need for improvement in various aspects of institutional support as recommended by Ogunnubi et al. Residents identified poor remuneration, unconducive environment and excessive workload as their top challenges during training. Addressing intrinsic and extrinsic factors (such as listed) in future residency training policies will enhance training quality and reduce underlying stress.
It is worthy of note that while most residents believe that a gender disparity exists in the training programme, only about a quarter experienced any form of discrimination with females significantly more affected. Our study suggests that there is a perceived existence of gender discrimination, but the actual experience of discrimination is low. Under-representation of females in general surgery and other specialties in the residency programme has been severally highlighted,, with such doctors experiencing greater discrimination., There seemed to be no agreement regarding which gender the programme favours though bias is possible as most respondents in our study were male. Despite a male preponderance in the residency programme, majority of respondents (71%) would prefer the employment of trainees of both genders in future interviews. While this is commendable, the proportion of females employed into residency may need to be increased in order to address the current disparity.,
This study had some limitations including its low response rate, cross-sectional design and inability to obtain past employment information. Moving forward, a multicentre study with better participation and qualitative components will better explore the deeper issues underlying any observed gender disparities. Greater participation in academic research by female trainees as afforded by this study is commendable and should be encouraged.,
| Conclusion|| |
The residency training programme in UUTH is male dominated, especially in general surgery and obstetrics with largely similar experiences of stress and other challenges by male and female trainees. Gender disparities exist though only a quarter of residents experience any form of discrimination with females more affected. There is a need to address existing disparities and promote gender mainstreaming in the Nigerian residency training programme.
The authors would like to thank all participating UUTH residents and staff of the HR unit.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]