title: Internal medicine residents' perceived ability to direct patient care: impact of gender and experience.
abstract: BACKGROUND
  Physicians are expected to effect patient care by giving orders to members of a healthcare team. Because women are socialized to be less directive than men, the assertive behavior required of new physicians may be experienced differently by male and female residents. We sought to explore the effects of gender and year of training on residents' experiences and perceived ability to direct patient care.
  
  
  METHODS
  This was a mixed-methods, cross-sectional, descriptive study employing a quantitative written survey and qualitative interviews among internal medicine residents at an academic health center. Measurements included questionnaires and interviews about stress, assertiveness, and personal factors that influence their effectiveness in directing patient care. Analyses examined differences by gender and year of training.
  
  
  RESULTS
  One hundred residents were invited to participate; 65 returned questionnaires, and 16 of these residents were interviewed. Compared with male residents, female residents selected less assertive behaviors for clinical scenarios (p = 0.047) and were more likely to perceive gender as inhibiting their ability to influence patient care (p < 0.01). Stress associated with being assertive varied more with experience than gender. Interviews corroborated these findings and supported the complexity of gender norms for behavior for female residents in a directive leadership position.
  
  
  CONCLUSIONS
  When compared with male peers, female residents reported more gender issues in residency and chose less assertive behaviors in clinical scenarios. Experience mitigated some gender differences. Our findings suggest that discussion of the existing research on prescriptive gender norms for behavior and leadership may be warranted in resident orientation.
authors.affiliation: Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Christie
authors.initials: C
authors.lastname: Bartels
authors.forename: Sarah
authors.initials: S
authors.lastname: Goetz
authors.forename: Earlise
authors.initials: E
authors.lastname: Ward
authors.forename: Molly
authors.initials: M
authors.lastname: Carnes
mesh_terms: D000328:Adult; D001242:Assertiveness; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D011369:Professional-Patient Relations; D012737:Sex Factors; D011795:Surveys and Questionnaires