A visual analysis of gender bias in contemporary anatomy textbooks.

Empirical research has linked gender bias in medical education with negative attitudes and behaviors in healthcare providers. Yet it has been more than 20 years since research has considered the degree to which women and men are equally represented in anatomy textbooks. Furthermore, previous research has not explored beyond quantity of representation to also examine visual gender stereotypes and, in light of theoretical advancements in the area of intersectional research, the relationship between representations of gender and representations of ethnicity, body type, health, and age. This study aimed to determine the existence and representation of gender bias in the major anatomy textbooks used at Australian Medical Schools. A systematic visual content analysis was conducted on 6044 images in which sex/gender could be identified, sourced from 17 major anatomy textbooks published from 2008 to 2013. Further content analysis was performed on the 521 narrative images, which represent an unfolding story, found within the same textbooks. Results indicate that the representation of gender in images from anatomy textbooks remain predominantly male except within sex-specific sections. Further, other forms of bias were found to exist in: the visualization of stereotypical gendered emotions, roles and settings; the lack of ethnic, age, and body type diversity; and in the almost complete adherence to a sex/gender binary. Despite increased attention to gender issues in medicine, the visual representation of gender in medical curricula continues to be biased. The biased construction of gender in anatomy textbooks designed for medical education provides future healthcare providers with inadequate and unrealistic information about patients.

A psychometric evaluation of the Gender Bias in Medical Education Scale.

BACKGROUND: Gender bias within medical education is gaining increasing attention. However, valid and reliable measures are needed to adequately address and monitor this issue. This research conducts a psychometric evaluation of a short multidimensional scale that assesses medical students' awareness of gender bias, beliefs that gender bias should be addressed, and experience of gender bias during medical education. METHODS: Using students from the University of Wollongong, one pilot study and two empirical studies were conducted. The pilot study was used to scope the domain space (n = 28). This initial measure was extended to develop the Gender Bias in Medical Education Scale (GBMES). For Study 1 (n = 172), confirmatory factor analysis assessed the construct validity of the three-factor structure (awareness, beliefs, experience) and enabled deletion of redundant items. Study 2 (n = 457) tested the generalizability of the refined scale to a new sample. Combining Study 1 and 2, invariance testing for program of study and gender was explored. The relationship of the GBMES to demographic and gender politics variables was tested. The results were analyzed in R using confirmatory factor analysis and Multiple-Indicator-Multiple-Indicator-Cause models. RESULTS: After analysis of the responses from the original 16-item GBMES (Study 1), a shortened measure of ten items fitted the data well (RMSEA = .063; CFI = .965; TLI = .951; Mean R-square of items = 58.6 %; reliability: .720-.910) and was found to generalize to a new sample in Study 2 (RMSEA = .068; CFI = .952; TLI = .933; Mean R-square of items = 55.9 %; reliability: .711-.892). The GBMES was found to be invariant across studies, gender, and program of study. Female students and those who supported gender equality had greater agreement for each of the factors. Likewise, postgraduate students reported higher scores on experience of gender bias than undergraduate students. CONCLUSION: The GBMES provides a validated short multidimensional measure for use in research and policy. Given its good reliability across different target populations and its concise length, the GBMES has much potential for application in research and education to assess students' attitudes towards gender bias.