Comparing the participation of men and women in academic medicine in medical colleges in Sudan: A cross-sectional survey
Anas Ibn Auf1, Heitham Awadalla2, Magda Elhadi Ahmed3, Mohamed H Ahmed4
1 Consultant Psychiatrist, Mental Health Hospital, Taif, Saudi Arabia; Assistant Professor, Department of Psychiatry, Faculty of Medicine, Sudan International University, Khartoum, Sudan
2 Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
3 Director of the Primary Health Care and Health Education Center, Faculty of Medicine, University of Gezira, Wad Madani, Sudan
4 Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Buckinghamshire, UK
|Date of Submission||19-Jul-2018|
|Date of Acceptance||23-Sep-2018|
|Date of Web Publication||15-Feb-2019|
Dr. Mohamed H Ahmed
Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire
Source of Support: None, Conflict of Interest: None
INTRODUCTION: In different countries around the world, the involvement of women in academic medicine was less in comparison with men. This study aimed to assess whether there were significant gender differences in research perception, practice, and publication in Sudan.
METHODS: This was an analytical cross-sectional study was carried out using questionnaire among 153 teaching staff of five Sudanese medical faculties from both genders, including teaching assistants, lecturers, assistant professors, associate professors, and full professors.
RESULTS: There were no significant differences among participants' gender regarding their universities, qualifications, research training received after graduation, and participation in research currently or in the past or current position, but female participants seem to be younger as their mean of age was 38.8 (±9.2) compared with 42.6 (±10.1) for males. Importantly, the males' researcher has not only published significantly more than females but also appeared to have significantly more years of research experience. The mean score of research perception was higher among male participants who indicated that they had a more favorable perception of research.
CONCLUSION: The study showed that in Sudanese medical colleges significantly higher percentage of men published scientific papers more than women. In addition, the male also had a significantly higher mean score of research perception which indicated that they had a more favorable perception of research.
Keywords: Academic medicine, female, male, Sudan
|How to cite this article:|
Ibn Auf A, Awadalla H, Ahmed ME, Ahmed MH. Comparing the participation of men and women in academic medicine in medical colleges in Sudan: A cross-sectional survey. J Edu Health Promot 2019;8:31
|How to cite this URL:|
Ibn Auf A, Awadalla H, Ahmed ME, Ahmed MH. Comparing the participation of men and women in academic medicine in medical colleges in Sudan: A cross-sectional survey. J Edu Health Promot [serial online] 2019 [cited 2020 Jul 2];8:31. Available from: http://www.jehp.net/text.asp?2019/8/1/31/252330
| Introduction|| |
Besides the fact that research is regarded as a tool of scientific progress for any nation, it also plays a major role in the field of medicine and development of both medical practice and academic work. Therefore, research is part of the activities of medical staff in most of the Sudanese medical school. Several studies showed less perception and involvement of women in comparison with men in the practice of research among faculty members in medical colleges.,, One of the factors that found to be significantly affecting research perception and practice among faculty members is gender.,
For instance, Alghanim and Alhamali in Saudi Arabia found that 42.2% of males faculty members had published their research comparing with only 28.4% of females (P = 0.020). In Pakistan significantly, a higher proportion of men were involved in research compared to women (men: 50.0% and women: 30.8%; P = 0.01). This observation of less female involvement in academic medicine was also reported in the USA and Nigeria., Importantly, many studies showed the presence of high negative perception of academic medicine among female in comparison with men., For instance, it was shown that women in the Arab countries were often confined to lower-ranking faculty positions having more to do with teaching than with research. Different factors can influence the contribution of women in academic medicine. For example, in Lebanon, socioeconomic factors; demographic factors; family networks and interpersonal connections; government, legal frameworks, and legislation; religious were shown to influence women contribution in Academic medicine. Other factors that decrease women contribution in academic medicine in the Middle East and North Africa (MENA) regions were attributed to the patriarchic atmosphere of educational institutions, the gender climate, lack of mentoring and training in research and in leadership and the difficulties to achieve work and family life balance. In Sudan and MENA regions, the number of women joining the faculty of medicine is almost similar or exceeded the number of men. In certain specialties such as pediatric and obstetrics and gynecology, the number of women exceeded the number of men.,,
In the presence of adequate support, the number of women who joined academic medicine was shown to be almost similar or exceeded the number of men. For example, in Saudi Arabia, women contribution in academic medicine was assessed for 21 years in one university. Women joined academic medicine were found to be 4.4% in comparison with 4% of males of the total graduates. Importantly, women specialized in various fields and progressed equitably with the men in their postgraduate studies. It worth mentioning that women in this study progressed slowly in academic medicine rank and this delay was attributed to family, and social responsibilities and lack of clear policies about the adequate support the medical school can provide. This study showed that women in MENA are capable in the presence of adequate support to progress well with their academic career. Little information is known about the gender differences in Sudanese medical colleges concerning perception and practice of research. Therefore, this study aimed to assess whether there were significant gender differences in research perception, practice, and publication in Sudan.
| Methods|| |
This was a quantitative analytical cross-sectional study, conducted in the period from July 2016 to July 2017. The study recruited teaching staff of Sudanese medical faculties from both genders, including teaching assistants, lecturers, assistant professors, associate professors, and full professors. Five medical faculties were included in this study; three of them were governmental (Bahri, Gadarif, and Kordofan Universities) and the other two are private (The National Ribat University and Sudan International University). Two out of these chosen five medical faculties are established outside the Capital, Khartoum. Regarding sampling, we have obtained lists of teaching staff from the authorities to make the sample frame. Then, sample size was calculated by the following equation:
n: is the sample size
N: is the population size
d: is the degree of accuracy desired (0.05).
The total number of teaching staff in the five medical schools previously mentioned is about 390.
Then because the population size is small, the adjusted sample was used according to the following equation:
According to the equation, the sample size for this study is 132. It is increased to 180 to compensate for non respondents and inadequately filled questionnaires.
Data collection and analysis
The self-administered questionnaires were distributed across staff in these five medical colleges. The questionnaire consisted of four parts as follows: (i) sociodemographic data (besides age, gender, and marital status, we also added qualification, university, years of experience, current position at university, medical specialty, and years since graduation). (ii) research practice (questions about whether received research training, whether participated in research apart from necessary research for MBBS, MSc, MD, or Ph. D, Other questions about types of research, number of publications, oral and poster presentations, and whether published as the first or co-authors). (iii) research difficulties and barriers, and (iv) perception of research: this was assessed using Likert response scale from 1 to 5 (1 = strongly disagree; 2 = disagree; 3 = neutral; 4 = agree; and 5 = strongly agree). The perception section included 14 statements representing many aspects concerning medical research. This part was a predesigned validated structured questionnaire used to assess research perception in previous studies., We have previously published details about sampling and data collection, and in this occasion, we have done further analysis to assess the participation of men and women in academic medicine in medical colleges in Sudan. The collected data were analyzed using version 24 of the IBM statistical package for social science (SPSS) program (Chicago, IL, USA). A Chi-square test was carried out on the relationships between demographics and other variables. ANOVA was used to compare means of perception scores among different subgroups. A value of P < 0.05 was considered statistically significant.
The research ethics committee ethically approved the research at The National Ribat University, Khartoum, Sudan. Permission and approval were obtained from the authorities of the medical faculties. Informed consent was attached with the questionnaire, including the purpose of the study, voluntary participation, and confidentiality.
| Results|| |
Distribution of the study sample according to universities, qualifications, and demographic features
A total of 153 respondents, submitted adequately filled questionnaires, were included in the study. The response rate was 85%. Sixty-five percent of respondents were male (n = 100), and the mean age of them all was 41.25 (standard deviation ± 9.92) years. 90 (59%) were from public universities, and 63 (41%) were from private ones. The majority have the MD (36.8%), and MSc (30.9%) as qualification and almost half of them are assistant professors (49%) [Table 1]. There were no significant differences among participants' gender regarding their universities, qualifications, or current position, but female participants seem to be younger as their mean of age was 38.8 (±9.2) compared with 42.6 (±10.1) for males. Furthermore, there is a significant difference in years of experience [Table 1].
|Table 1: Distribution of the study sample according to universities, qualifications, current position and marital status, with mean and standard deviation of participants' age, years since graduation and years of experience (compared among gender)|
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Comparison of gender regarding research experience and output
There were no significant differences between male and female participants regarding research training received after graduation, and participation in research currently or in the past. However, the percentage of those who published their research was more among male participants. The mean score of research perception was higher among male participants who indicated that they had a more favorable perception of research. More male participants have published their work, but the difference is statistically significant in the case of publication as co-authors [Table 2]. The detailed questions on research perception with responses compared among gender are shown in [Table 3]. A significant difference in perception of the male was noted in research during medical school, recruitment and for promotion and also understanding for research methodology [Table 3].
|Table 2: Comparison of gender regarding research training, participation in research, current involvement in research, publication, and research perception|
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Research barriers among female and male academic staff
Less female participants have chosen “lack of financial incentives” as one of the most important research barriers (45.3%) compared to male participants (77.8%) with P = 0.000. The same significant differences appeared in the other two barriers; “work-related stress” and “lack of motivation” which were indicated more by male participants [Table 4].
|Table 4: Comparison between male and female participants regarding research barriers|
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| Discussion|| |
In this cross-sectional study, the male proportion is almost double compared to the female gender in selected universities. This higher representation of males in academia and holding of academic and research positions is not uncommon. Even though male: female is almost 2:1, the findings reflect that there is no difference between male and female in practicing research training or being involved in research projects. Importantly, this study showed that male have higher publication output than female. This can be attributed in part to the fact that women are also having their own challenges of looking after families and children. Another reason, this study showed that the perception toward research and its importance and role in the medical field is generally higher among male doctors. Khan et al., mentioned that good perception is usually associated with the better production of research.,,
It is reasonable to suggest that men and women have the same enthusiasm for research as both agreed that teaching research methodology should be part of the curriculum and it is important to be conducted in medical schools., Despite this positive approach, women scored significantly less in these two areas; “research record should be an important criterion for recruitment and promotion of teaching staff.” In addition, female doctors think that their understanding of research methodology is not good. This lack of understanding of research methodology may affect the attitude and practice of research. A similar finding was reported by the study of Alghanim and Alhamali in Saudi Arabia, participants who did not publish research articles, reported lack of knowledge in research methodology. This finding requires attention not only because it will decrease research productivity by female faculty members but also it may affect their students' perception and practice of research indirectly. Although lack of research funding is a common problem across the world even in rich countries, large proportions in both male and female doctors believe that “lack of funding” is the main barriers (83% among males and 74% among females) and this was not statistically significant (P = 0.18)., Therefore, it is plausible to suggest this may decrease motivation in particular among women in a low resource setting country like Sudan.
Despite the fact that the following factors were not found to be statistically significant (lack of statistical support, supervisors, allocated research time an research skills), we believe that more investment and research capacity building are needed. Other areas for improvement are, but less effect on this study outcome was: “restricted literature access,” “perception that research is difficult,” “restricted internet accesses”, “restricted computer access,” and “difficulty in getting papers accepted in journals.” It is possible to suggest that large studies are needed to elicit factors that may decrease research practice in Sudan. Unfortunately, factors such as “lack of financial incentives,” work-related stresses, and lack of motivation are main barriers for practicing research with statistically significant difference (P = 0.00, 0.01, and 0.04, respectively). However, work-related stress as a research barrier was reported in many studies. Furthermore, male doctors usually have a dual practice of teaching and being clinicians at the public and private sectors at the same time. Appropriate rewards/incentives and time allocation are considered essential in promoting research cultures.,
In spite of these findings which showed that male doctors mentioned more barriers than female doctors, but still, their productivity in terms of publications as first and co-authors are higher than female doctors. This may be attributed to positive male perception about research as mentioned above. Laurel Edmund et al., reported that women are generally interested in teaching more than research and they lose commitment to research as their academic education progress. Furthermore, less production in academic and research areas is also among women was also reported in other similar studies.
This study is not without limitations. The cross-sectional design may not allow for generalization of the results to the whole universities in Sudan. A similar study that includes the majority of the medical schools in Sudan will lead to better understanding. Despite these limitations, this study is novel, essential, and pioneer in drawing the attention of health authorities to improve research practice in Sudanese medical schools.
| Conclusion|| |
In Sudanese medical colleges significantly, a higher percentage of men published scientific papers more than women. In addition, the male also had a significantly higher mean score of research perception which indicated that they had a more favorable perception of research.
The authors are grateful for the staff in five universities for their contribution in this study. The authors would like to dedicate this work for their mothers. Authors acknowledge the support of all staff contributed in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Vujaklija A, Hren D, Sambunjak D, Vodopivec I, Ivanis A, Marusić A, et al.
Can teaching research methodology influence students' attitude toward science? Cohort study and nonrandomized trial in a single medical school. J Investig Med 2010;58:282-6.
Mezrich R, Nagy PG. The academic RVU: A system for measuring academic productivity. J Am Coll Radiol 2007;4:471-8.
Alghanim SA, Alhamali RM. Research productivity among faculty members at medical and health schools in Saudi Arabia. Prevalence, obstacles, and associated factors. Saudi Med J 2011;32:1297-303.
Sumi E, Murayama T, Yokode M. A survey of attitudes toward clinical research among physicians at Kyoto University hospital. BMC Med Educ 2009;9:75.
Sabzwari S, Kauser S, Khuwaja AK. Experiences, attitudes and barriers towards research amongst junior faculty of Pakistani medical universities. BMC Med Educ 2009;9:68.
Barnett RC, Carr P, Boisnier AD, Ash A, Friedman RH, Moskowitz MA, et al.
Relationships of gender and career motivation to medical faculty members' production of academic publications. Acad Med 1998;73:180-6.
Tesch BJ, Wood HM, Helwig AL, Nattinger AB. Promotion of women physicians in academic medicine. Glass ceiling or sticky floor? JAMA 1995;273:1022-5.
Bakken LL, Sheridan J, Carnes M. Gender differences among physician-scientists in self-assessed abilities to perform clinical research. Acad Med 2003;78:1281-6.
Oloruntoba A, Ajayi MT. Gender and research attainment in Nigerian Agricultural Universities. J Higher Educ Afr 2006;4:83-98.
Carr PL, Friedman RH, Moskowitz MA, Kazis LE. Comparing the status of women and men in academic medicine. Ann Intern Med 1993;119:908-13.
Vydareny KH, Waldrop SM, Jackson VP, Manaster BJ, Nazarian GK, Reich CA, et al.
Career advancement of men and women in academic radiology: Is the playing field level? Acad Radiol 2000;7:493-501.
Mazawi A. Gender and higher education in the Arab states. International Higher Education 1999. Retrievered from https://ejournals.bc.edu/ojs/index.php/ihe/article/viewFile/6505/5728
Karam CM, Afiouni F. Localizing women's experiences in academia: Multilevel factors at play in the Arab Middle East and North Africa. Int J Hum Resour Manage 2014;25:500-38.
Ahmed AM, Mohamed EY. Women doctors and health services in Sudan. Sudan J Public Health 2006;1: 139-141
Farahat FM. Challenges facing female physicians in Egypt. Arch Environ Occup Health 2009;64:121-8.
Hannawi S, Al Salmi I. Time to address gender inequalities against female physicians. Int J Health Plann Manage 2018;33:532-41.
Al-Tamimi DM. Saudi women in academic medicine. Are they succeeding? Saudi Med J 2004;25:1564-7.
Noorelahi MM, Soubhanneyaz AA, Kasim KA. Perceptions, barriers, and practices of medical research among students at Taibah College of Medicine, Madinah, Saudi Arabia. Adv Med Educ Pract 2015;6:479-85.
Ibn Auf A, Awadalla H, Ahmed ME, Ahmed MH. Perception, barriers, and practice of research among teaching staff at five Sudanese medical faculties. J Public Health Emerg 2018, volume 2. Available from: http://jphe.amegroups.com/article/view/4671
. [Last accessed on 2018 Aug 25].
Thibault GE. Women in academic medicine. Acad Med 2016;91:1045-6.
Westring AF, Speck RM, Dupuis Sammel M, Scott P, Conant EF, Tuton LW, et al.
Culture matters: The pivotal role of culture for women's careers in academic medicine. Acad Med 2014;89:658-63.
Khan H, Khawaja MR, Waheed A, Rauf MA, Fatmi Z. Knowledge and attitudes about health research amongst a group of Pakistani medical students. BMC Med Educ 2006;6:54.
Aslam F, Shakir M, Qayyum MA. Why medical students are crucial to the future of research in South Asia. PLoS Med 2005;2:e322.
Lloyd T, Phillips BR, Aber RC. Factors that influence doctors' participation in clinical research. Med Educ 2004;38:848-51.
Brocato JJ, Mavis B. The research productivity of faculty in family medicine departments at U.S. medical schools: A national study. Acad Med 2005;80:244-52.
Bland CJ, Ruffin MT 4th
. Characteristics of a productive research environment: Literature review. Acad Med 1992;67:385-97.
Edmunds LD, Ovseiko PV, Shepperd S, Greenhalgh T, Frith P, Roberts NW, et al.
Why do women choose or reject careers in academic medicine? A narrative review of empirical evidence. Lancet 2016;388:2948-58.
Funston G, Piper RJ, Connell C, Foden P, Young AM, O'Neill P, et al.
Medical student perceptions of research and research-orientated careers: An international questionnaire study. Med Teach 2016;38:1041-8.
[Table 1], [Table 2], [Table 3], [Table 4]