CHAPTER -1

INTRODUCTION

1.1 Situating the Study

1.2 Historical Background of Medical Education in India
Women’s Entry into Medical Education in India
1.3 Present Situation
1.4 Theoretical Background of the Study
1.5 Conceptual Framework of the Study
1.6 Rationale of the Study
1.7 Operational Definitions
1.8 Research Questions
1.9 Objectives
1.10 Overview of the Chapters
 Introduction

“A boy is considered to be better until he proves himself to be worse.

A girl is considered inferior or bad until she proves herself to be better”.
(Female Post-graduate Respondent -Surgery)

1.1 Situating the Study

Since time immemorial the concept of gender with binary categories has been in
operation across all the civilizations. However, its usage in the core academic research is
a modern and more appropriately a post-modern phenomenon. It is only through such an
intervention (research) that the term gender got a distinct inference as a social category
from the term sex used for biological distinction between men and women. Also very
recently the fact of sex as a natural/biological category is being questioned apart from
exposing flaw of binary usage of the term. The development is revolutionary in the sense
that in the academic research attempts are being made to comprehend the social realities
of the subordinate roles assigned to women. And through such an interrogation, facts
behind ever existing opinion in natural sciences especially medical sciences about
different learning capacities for men and women (Bradley, 2000; Thomas, 1990) are
being explored. The above said opinion was understood as a legitimate fact whereby
women were considered unfit for scientific knowledge. As a result, academic world
witnessed an extreme disparity favoring men in Science, Technology, Engineering and
Management –STEM (Kumar, 2012; Subrahmanyan, 1998).

Interestingly, medical science appears to be liberated of such a taboo as we find relatively

better presence of women in comparison to other science disciplines. The reason for this
is medical science is supposed to be a relatively “soft discipline” (Bradley, 2000). India
presents a no different story except the fact that medical education was supposed to be
most suitable feminine choice among educational elites. And through a glance over
educational statistics, better enrolment of women leads to assume that gender does not

2
matter in medical education. However, such an assumption fails the litmus test of
empirical reality with missing female (practicing) doctors in general and extremely scarce
in certain specializations (Rao et al, 2011; Sood & Chadda, 2010). The present study is an
attempt to comprehend element of „gender‟ in medical education scenario.

Subjugation of one and dominance of other (gender) is a conspicuous feature of many

social systems as can be seen across the world. Throughout the historical period,
prevalent notion was that men are by default more powerful than women where the latter
were understood as inefficient and therefore a synonym of „weaker sex‟ (Geetha, 2002).
In keeping with the ascribed subordinate status, women were kept reserved for all the
(peripheral) actions or it became of low prestige with their presence. It is interesting to
note down that elements of arbitrariness in such a hypothesis were so subtle that till
recently women were surmised to be non-rivalrous to men in the (defined) core areas of
developmental processes (Ryle, 2015; Henslin, 1999). Such notions gradually waned
away with the onset of modern period which emphasized though theoretically equal role
for both the categories of „sex‟. However, normative notion of „gender‟ which identifies
specialized roles for men and women did not alter much to match the theoretical
development.

Historically education has always been understood as a source of liberation from

ignorance paving way for realization and enhancement of one‟s capabilities. However the
prevalent normative framework of roles for socially constructed categories of „gender‟
add dichotomy to the above proposition for education. This dichotomous and gendered
notion of education was allowed to continue where unequal roles of men and women
were construed.

Indian social and cultural milieu also considered „right to be educated‟ as a matter of
privilege limiting it largely to men. Though there are glimmerings of instances in ancient
period where venerated (albeit unequal) status for women could be noticed, canonical
literature of later period warranted denial of education to women (Das, 2009). Further
analysing it is revealed that there is a symbiotic relationship between reverence for
women in societal setup and right to education of women, i.e. enhancement in one leads
to acknowledgement of the other.

3
Till the onset of modern period which coincides with colonial era, there was a long period
of denial or limited access for women to education. The modern western culture had great
impact on socio-religious reform movements in 19th century India (Grover & Mehta,
2015). The effect of these were not magnanimous enough to undo the social myth which
has hovered around the image of women keeping them tied to household chores (Pandya,
1999). However there is no denial to the fact that they had the potential elements to
unleash a better than hitherto image for women.

Indian education system (as revealed from educational statistics) corroborates such a
normative practice, and women are seen enrolling more for medical education which is
thought to be soft and suitable for them. Implicit reality from perusal of statistics may
erode the notion of well representation and participation of women vis-à-vis men in
medical education. There is concentration of women in certain courses of medical
discipline (based on surmised opinion) which are understood as “soft” e.g. paediatrics,
gynaecology, etc, while predominant participation of men is witnessed in certain tough
and core courses pertaining to neurology, cardiology, surgery, etc (Lefevre et al, 2010;
Sood & Chadda, 2010; Dante et al, 2009; Buddeberg- Fischer et al, 2006; Khanijow,
2002; Miles, 1991; Bhargava, 1983). Generally, the areas chosen by men forms the core
while women enrollment is found in peripheral courses thus adding prestige to male
doctors. Further at the administration level, key positions are held by men thereby
shaping the process of women‟s participation in medical education to facilitate male
supremacy in hierarchical setup.

There appears to be an enigma where despite having relatively more number of female
enrolments medical education continues to be dominated by their male counterparts. The
basic explanation for such enigmatic situation lies at socio-cultural level where social
mores and stereotypes are designed to facilitate women‟s participation which is restricted
to few of the lowly understood courses. Otherwise they may inhibit women (at functional
level of the institution) to aspire for the areas accruing prestige to men. It is generally
seen that habitus of medical college is designed in a fashion that there could be no
challenge to the status quo of men.

4
This is in continuation of the historic advantage to men in medical education which is
alike the other disciplines of learning. It is easily evident and recently recognized that
knowledge which has emerged on the horizon of modernity were not remarkably
different from its predecessor periods when the social division of power between men
and women is in prime focus. However there could be no denial to rudimentary
glimmerings of emancipator elements through modern rational thought. The result in this
direction was the rise of „feminism‟ as a strand of „postmodernism‟ intellectual
movement. The objective of this strand is to comprehend the subjectivity involved in the
social processes that may lead to the discourse as a product and power relations between
men and women as an objective outcome (Branaman, 2010).

Normatively, any disciplinary learning needs to take place uniformly among the two
categories of gender provided the choice of learning exercised by the learner is free from
any social construction of roles. Having said this about the input part, there is also
requirement to comprehend the „process‟ through which learning takes place. The need is
therefore to investigate the independence of the act of learning (medical education) from
the Indian sociological opinion about gender of the learners.

While conducting research in medical science a subset of natural science, it is generally

assumed that realist ontology may reveal everything about it. The realist ontology holds
the view that the real world is existing independent of us, and therefore a perfect cause
and effect relationship exists between an act and actor. But as this pertains to a social
inquiry into medical education, the present research ought to rely on „relativist‟ ontology
which unlike the assumption of purely quantitative research tends to reject direct,
objective and (largely) universal relationships between the social actors. However, a
more composite comprehension is offered through critical realism a perspective which
also takes note of existing structure(s) having influence on people‟s actions, in our case
various (identified) dimensions of „participation‟ in medical education. In this approach it
is assumed that structures or mechanisms do not directly determine people‟s actions
instead structures can create inequalities that have the potential to influence our existence
(King & Horrocks, 2010).

5
From the above discussion it can be deduced that exploration of gender in Indian medical
education holds vitality in terms of academic input apart from social relevance. In the
present study such an exploratory exercise is being attempted through the understanding
of participation of medical students. The participation is primarily intended to gather
information about involvement of the enrolled students as an influence of their own
gender. Further, the study also aims to know how it (gender) is impacting their
professional aspirations which in turn act as a loop to involvement by becoming a direct
correlate to it.

1.2 Historical Background of (Modern) Medical Education in India

Pre-Independence or British Period

After the fall of Mughal Empire, the Britishers brought with them their own system of
medicine-allopathy, which was adopted as an official system of medicine in India. The
main objective of introducing the western system of medicine was to serve the British
military personnel and select groups of civilian population. However the allopathic
system of medicine influenced every other aspect of medical education such as
institutions, the syllabi, and the value system, and the social outlook of physicians.
Medical education was available to few selected elite students (Briscoe, 1978). The
French and British government spent huge amounts for patronizing allopathy, and
discouraged the development of other indigenous system of medicine with the result that
ayurveda and unani -tibb suffered heavily.

The first medical school for teaching allopathic system of medicine was opened at Goa
by Portuguese in 1687. However after the mid-eighteenth century only some Indians got
opportunity to be trained in that medical college. These trainees were called native
doctors and commenced their career as compounders and had to submit to examination
before they were entitled to higher rank and pay. Another medical college was opened at
Calcutta (now Kolkata) in 1835. Calcutta medical school a private institution was the first
institution which was run entirely by Indians. Lady Harding Medical College for Women
was started by Britishers in 1916 (Bhadra, 2011).

6
Post-Independence Period

Allopathic system of medicine progressed in the country to a larger extent establishing an

intimate relationship between the teaching and practice of medicine in India and Britain
where the model provided by the later prevailed in both the fields. However the progress
accompanied with many adequacies as far as needs of the people for professional care
was concerned (Madan, 1990). The Bhore committee in 1943 revealed acute scarcity of
health personnel. Most of the doctors were located in urban areas. The gravity of situation
made the Indian government include outlays on health care and medical education in the
First Five Year plan.

Since the First Five Year Plan to the present period many policies and programmes have
been undertaken by the government on healthcare and medical education. However the
Indian medical system is still facing certain crucial problems. Equitable availability of
medical facilities is still an issue. The doctors prefer more to work in urban areas than in
rural areas. Integrating and promoting the traditional and modern medical system is not
being taken seriously though the government has started certain programmes in this
direction (e.g. AYUSH). The medical education is composed of students from higher
socio-economic background. Absence of women students at the higher level of medical
education is persistent.

Gender dynamics in higher education is a modern phenomenon, and so is the debate

about hierarchical stratification of knowledge. One aspect of „gender‟ i.e. „female‟ had
uniformly remained absent (across all the cultures) from the process of enlightenment via
education. Only at the turn of the 18th century (modern period) women were deemed fit
for education (Srivastava, 2000) with a design that may not alter their everlasting
stereotypical image. In 19th century it was argued that too much of intellectual work
would actually shrivel up a woman‟s ovary and render her both unfeminine and irrelevant
(Geetha, 2002). So in the shadow of reproductive functions women were barred from
intellectual arena. It is ironical that the first scientific discipline where women ventured
into i.e. medical science (Kumar, 2009) has always shown a biased approach and time to
time tried to justify that gender difference is natural (Geetha, 2002). The attraction of

7
women towards the medical profession was perhaps motivated by the fact that women‟s
health was at stake due to the lack of women medical professionals. (Abidi, 1988).

In the post-industrial society (ies), this position was however challenged, thanks to the
role played by feminism and other conscientious movements. This has furthered women‟s
participation to several domains of knowledge. But the cultural transformation has not yet
taken place to match other simultaneous developments. Familial and other social
obligations are tied to women in a manner that they can‟t be with best payoff. They could
be educated, however this must not contradict their (caring and subjugated) role being a
woman in a family or at societal level.

Women’s Entry into Medical Education in India

Women in India never lacked in grandma‟s medicine chest but lately emerged as
professional medical women. Women‟s emergence in the modernized medical profession
as trained one is a part of the long movement of professionalization of medicine. The
mindset of the society and stereotypes kept women at a subordinated position in the
modern medical profession. Presence of few male doctors in nineteenth and early part of
twentieth century explained the meager presence of women in the profession. However
efforts by missionaries towards the suffering of women in India were instrumental in
opening avenues for women in medical education (Forbes, 2009).

Maternal mortality rate, infant and child mortality rate and increasing diseases
necessitated educating women in medicine. This is because women at that time practiced
„purdah‟ and hesitated to consult male doctors. So the missionaries opened up hospitals
and schools for training women. The American Missionary Societies and The Indian
Female Normal School Society worked hard in this direction. The early missionaries did
a thorough and sensitive study of the condition of women. They mobilized themselves
accordingly so that propagation of Christianity might be continued, western medicine
might be introduced, and the untrained and trained women of the West might find a job
here.

Initially the policy of the British government favored foreign women only. But later due
to their inadequacy in serving to all sections of people of Indian society they made some

8
amendments. This happened also due to the reporting of Scharlieb to the Queen of
England about the suffering of Indian women (Balfour, 1929). Hence “The National
Association for Supplying Female Medical Aid to the Women of India” came into
existence. The primary aim of the association was to provide medical relief to women by
women and train women in India accordingly (Hogan, 1988). This was a crucial step
taken in the direction of women‟s medical education. This association launched a
movement for an all-round development for a female of India in western or modern
medicine. The association which was operationalized in 1885 was commonly called as
the Countess of Dufferin‟s Fund (Forbes, 2009). This scheme was funded not only by
foreigners but also by Indians. This period marked more and more women participating
in medical education as they got scholarship either by the Fund or the government. The
two main objectives of the Fund were medical tuition and medical relief. The efforts
made with regard to providing medical tuition increased the participation of women in
medicine resulting in responsible women doctors. The second objective medical relief
aided in treatment of large number of patients. Women who observed „purdah‟ also came
to the hospitals for treatment (Lal, 2009).

The Fund not only provided employment to British women professionals, it also resolved
gender conflicts at home that came in the wake of women‟s entry into the medical
profession (Lal, 2009). The British women doctors faced professional isolation and were
not offered employment in the British hospitals where they could practice medicine. Male
medical professionals opposed their entry into the medical profession and their demand
for employment opportunities. Then they were forced to grab the opportunity to practice
in India with the establishment of Dufferin fund. Thus women doctors redundant in their
own country found a sense of worth and achievement in India (Dhingra, 2001).

The life histories of women doctors in 19th century reveal that their career path was not
very smooth and they struggled a lot to overcome the patriarchal set up to establish
themselves. They were not only confined to the hospitals but also practiced obstetrics and
gynecology like their British counterparts. They came from the middle and upper class
background. The women doctors, who were appointed in female wards of the general
hospitals, had to work under the supervision of civil surgeon. In some cases the civil

9
surgeon junior in age and experience were to supervise the work of senior women doctors
(Dhingra, 2001).
Access of women to medical education in 19th century was minimal. However Madras
University was ahead of London School of Medicine and allowed admission of women in
1874 as the later did so in 1878 (Roy, 1990). This was the reason of Scharlieb taking
admission in Madras Medical College. But the fact remained that Indian medical degree
underwent strict scrutiny of western countries. Some private efforts were also made to
educate women in medicine in 1870-1880.

Due to the conservative nature of the society in general and North India in particular
efforts were made to arrange for separate institutions for women or arrange classes in a
manner that they can study without mixing up with the opposite sex. A class for women
students was opened at Agra Medical School in 1883. Lady Lyall Hospital was
established and a medical school for women was started with all the departments. In 1883
Medical College of Bombay gave admission to women. Punjab University took such a
step in 1884. So after a lots of struggle by 1990 women marked their presence in the
arena of medical education in Madras, Calcutta, Bombay, Lahore, Agra, Indore and
Hyderabad. The entry of women in medicine increased in successive years which gave
way to opening medical colleges for women. However women availing education aside
men were still a taboo in twentieth century. This gave impetus in opening of Lady
Hardinge Medical College for Women in Delhi in 1916.

AnandiBai Joshi was first to get a medical degree in India (Bhadra, 2011). She had joined
medicine in 1882 because of a personal loss she suffered i.e. death of her son after birth
due to the absence of a women doctor. However she could not be the first doctor who
served people due to her early demise. The Indian women who took medical education
were Anandibai Joshi, RukmaBai, A.W. Jagardhan, KashiBaiNowrange, Ceclia D‟
Monte and jhirad (Dhingra, 2001). MotiBai was the first native women doctor to be
trained on parallel lines to native men doctors.

British women doctors in India dominated the professional field in the 19th century. There
were very few women doctors and their contribution in the establishment of the services
became evident only in the early 20th century. Women had to struggle against the

10
missionary enterprise, along with deep –rooted patriarchy within society, to become a
lady doctor for India (Burton, 2009). Women intending to enter the medical profession
were discouraged and severely criticized by society for their rebellious attitude. Not only
medical men but society at large was also opposed to women‟s entry into the medical
field. One of the popular beliefs was that “knowledge of human body and its functions
destroyed the fine gloss of innocence that added to women‟s charm” (Dhingra, 2001)

1.3 Present Situation

The broad gamut of medical science course in India comprises of Allopathy,

Homeopathy, Ayurvedic, Dental, and Nursing sciences at Undergraduate as well as Post
graduate level. In order to have a glimpse of recent enrolment scenario at Medical
education following table has been formulated giving a gender wise participation in it for
recent years from 2011 to 2013-14. As seen from the tables 1.1 given below at UG level,
the enrolment of female students vis-à-vis male students is almost in a proportion of 2:1
for all the social categories, i.e. enrolment of the females are twice than that of male
students when seen in an aggregate manner for all the (identified) courses for medical
education. However, when we attempt to disaggregate these enrolment figures by
excluding two dissimilar courses, i.e. Bachelor of Dentistry Sciences (BDS), and B.Sc.
Nursing which are of four years duration, enrolment is found to be almost in parity with
only a marginal leverage of females than their male counterparts. Further, if we detach
and keep our exclusive focus (in tune with the present study) on Allopathy (MBBS)
participation of women in terms of enrolment was found to be still less than that of men.

In a similar way at the PG level, we can see that the enrolment scenario is best although
they are still behind their male counterparts when all the courses of medical education are
clubbed together. This is consistent for all the years from 2011-12 to 2013-14 and for all
the identified social categories. From this when we take away the enrolment numbers for
Nursing and Dental Sciences, the parity level between males and females is found to be
further reduced. It can also be noted down here that the difference of enrolment level for
females and males have increased over the period of analysis favouring male students‟
enrolment.

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 Table 1.1: Enrolment in Medical Sciences in India at UG and PG level from 2011-12 to 2013-14

Bsc. MSc.
Year MBBS BDS BHMS BAMS BUMS DM MD MS MDS MAMS MHMS
Nursing Nursing
M 51872 17469 9487 6096 2195 17516 209 12184 3400 3640 70 26 2385
ALL
F 48189 36583 14121 8048 1239 99901 29 7727 1444 3500 13 25 7120
M 4420 1213 989 491 5 1841 1 830 191 129 0 2 83
2011- SC
F 3765 2294 1230 511 5 11290 1 649 101 127 0 1 399
12
M 1567 382 565 216 3 606 0 319 123 32 1 0 14
ST
F 1391 552 716 286 1 3726 0 283 58 47 0 0 106
2012- ALL M 68725 19525 11513 7800 2687 21867 415 15174 4069 3999 64 35 2240
F 62293 43283 17120 10123 1752 121157 63 9681 1733 3896 27 40 7764
M 5499 1374 1090 554 16 2469 6 1027 254 132 0 1 115
SC
13 F 4873 2684 1422 747 4 14003 1 792 152 121 0 1 408
M 1869 436 614 253 2 890 1 490 142 33 0 0 21
ST
F 1635 670 786 352 1 5199 0 400 84 38 0 0 134
M 76658 22528 13180 8980 2956 26500 619 18596 4587 4712 94 51 1996
ALL
F 71709 50650 21549 11820 1898 138199 170 11866 2088 5138 38 94 8298
2013- M 6839 1720 1217 716 19 3291 23 1291 282 181 0 2 121
SC
14 F 5881 3001 1765 922 4 17099 17 962 141 157 0 0 571
M 2308 576 656 311 2 1068 4 574 174 45 0 0 21
ST
F 1992 798 996 401 11 5542 0 384 87 35 1 0 170
Source: All India Survey in Higher Education, MHRD, GOI

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In absolute terms, the difference was of around six thousand in 2011-12 which
continuously increased and in 2013-14 to create a difference of more than nine thousand
between male and female students. Further in case of restricting our analysis to PG
courses of Allopathy (DM, MD, and MS), it is seen that the situation gets further dismal
in absolute numbers when female enrolments are far less in comparison to male
enrolments there.

In a simpler way it could easily be deduced that the concentration of female enrolments is
found in nursing and dentistry both at UG and PG level. Also the scenario seems to
become that with relatively more male presence when the analysis is completely reduced
to Allopathy especially at PG level where the difference is more emphatic and
continuously rising giving a broad view of the academic integration 1 of women in the
medical education keeping micro analysis at the bay. Inflated enrolment of women in
medical science due to nursery and dentistry again reiterates the fact that in the hierarchy
of courses women tend to be present in more number at the so called less prestigious
ones. Or else we can say the course is perceived to have low prestige due association of
more number of women with it.

Parity level of female students in medical education at the undergraduate level for 15
years starting from 1990-91 to 2005-06 has been shown in Figure 1.1. The table shows
continuous increase since 1991 from 0.52 to 0.90 except year 2004 which shows great
decline to 0.53 from 0.73 in 2003 in case of all the students. According to the figures for
SC student‟s parity level is 0.86 in 2005 which has declined from 0.95 and 0.94 in 2003
and 2004 respectively. ST girls have reached nearer to the parity level of 0.81 in 2002, in
comparison to 0.39 in 1991, however since then their enrolment has declined to reach
0.76.

1
The term academic integration has been used in various researches pertaining to learning/attainment at
tertiary education level notably by Vincent Tinto (Tinto, 1975:89-125). The concept of academic
integration there is used to imply integration of students in academic learning of the discipline they are
enrolled. This is seen in terms of their continuation in the same/similar discipline after their graduation
from one level to the other higher level. In this way the term is used here to notice relatively higher
concentration of female students at undergraduate level of medical education which is discontinued and
replaced by more number of male students at post graduate level.

13
However it is evident that overall women are nearer to parity level in medical education
at the undergraduate level. But this statistical representation of women in medical
education (Figure 1.1) in 21st century owes to their early beginning in the 19th century.
Along with that the statistics provided by government for undergraduate level includes
nursing and other paramedical courses which increase the percentage of women.
However the figures do not make it explicit if women are equally represented in all the
specializations of medical education or are restricted to few of them. Further, there lies
merit in noting down that mere entry or enrolment does not represent the progress of any
student in a discipline, there is a need for active participation, and completion of the
course.

Figure 1.1 Gender Parity Level for Different Social Categories in India in Medical
Education

1
0.9
0.8
0.7
0.6
0.5 All Students
0.4
0.3 Scheduled Caste
0.2 Scheduled Tribe
0.1
0

Source: Selected Educational Statistics, MHRD, GOI

Statistics given in tables 1.1A, 2.1A & 3.1A (see appendix 1) draw our attention towards
two important issues. The first is that enrolment of women in medical education in
comparison to men is decreasing as the level is increasing. The higher is the level lower
is the share of women. Visibility of women is more only at the entry level. There is also
unequal distribution of male and female students in different specializations. Women are
restricted to some of the gender stereotyped areas in medical education. Since the
beginning male doctors were accorded higher prestige and considered as the formal
healers. This is also reflected in the gendered division of specializations where some

14
specializations are more prestigious than others and also specialists enjoy a very high
status than general practitioners (Sagar, 2009).

The participation of women shows a steeper pyramidal distribution, as they face

numerous obstacles for a variety of reasons being „women‟ during their trajectory
through the educational system. This is also found in case of medical education which is
considered as a feminine area of discipline. Women are concentrated at the entry level
and in restricted disciplines. Though women are now seen breaking the ice and entering
in the so called male bastions but the share is meager. And also how much they are
progressing in their career path is also a question needs to be engaged. Higher number of
women in medical education also necessitates in enquiring about reconciliation of women
within the profession to the position she occupies in the wider society where she is
subject to a number of social disabilities (Ahluwalia, 1967).

Having gleaned through the secondary data and literature an idea for the study emerged
and it was felt that there is a need to find answers to certain questions like what happens
after women enter in large numbers; what are the nuances of those process variables that
lead to such a scenario and how they cope with the same? Further what are their
aspirations and whether these are impacted by process variables?

1.4 Theoretical Background of the Study

The present study is about medical education whereby participation of male and female
students was studied to comprehend the social aspect of gender-division there. In order to
make clarification, let‟s deliberate here on the term „gender‟ and how it is different from
sex. In normal parlance there is no confusion about these two terms which are supposed
to be synonymous and therefore used interchangeably. However sociological
interpretation has delineated the boundaries of two terms providing them taxonomical
difference. Sex is a biological term used to distinguish anatomical difference between
male and female of a species where human being is not an exception to it. The difference
in anatomy here is the natural manifestation enabling procreation. Interestingly, the term
„gender‟ does not have any biological or natural roots. This has been utilized as a concept
by sociologist to distinguish between male and female. And such distinction symbolizes

15
psychological, social and cultural traits assigned for the recognition of male and female.
Therefore, it could be said that gender is external assignment of different characteristics
which are generally opposite over the biological distinction of sex. Further as identified
by various sociological thinkers such distinguishing trait(s) was not merely a guise to
mark distinction between two categories of gender rather these traits help in assigning un-
equal and hierarchical status among the categories of gender. Also, since the emergence
of civilization on the horizon of history such a distinguishing process (of assigning status
to male and female category of gender) is more or less uniform, continuous and dynamic.
And very recently since the dawn of modern period, any attempt to analyze the unequal
ascription (of status) and related empirical situation is made via social research. It may be
important to mention that broadly there are two facets of understanding gender through
social research, first which is primarily descriptive revealing the status of male and
female as an area of investigation and the second seemingly most important in
determining the first, is about the process and its reproduction.

Though existing since time immemorial, „gender‟ roles have been noticed and made
conspicuous through various recent researches centered on issues pertaining to
„development‟. There are four different approaches to understand gender equality in
education. They are „Women in Development (WID)‟ from 1970s to the present, „Gender
and Development (GAD)‟ from 1980s to the present, „Post-structuralism‟ from 1990s to
the present and „Human Development‟ approach from 1990s to the present. This shift in
discourse on „gender‟ especially in developing societies is the result of feminist
movement which existed simultaneously. The framework WID is centered on issues of
inclusion of women in all the developmental projects. The major aspect here is to achieve
efficiency which is not possible without including women in different projects. In
between WID and GAD, there exists „Women and Development‟ (WAD) approach
influenced from Marxist Feminism where it was revealed that how the rigid internal
social structure directing the roles of women and men inside and outside the household
(patriarchy) has kept women away from owning wealth and resources. And thus the
development turned out to be disadvantageous to women. While WID approach equates
gender with girls, gender is understood as constructed relations and power in case of
GAD. According to GAD, social roles ascribed to men and women incur inequalities in

16
development. This approach focused on differential social roles of men and women
leading to gender inequalities and hierarchies. There are gender role in the society which
were shaped by the cultural practices over the period of time. The poststructuralist
approach emphasizes on the fluidity of the concept gender. The final approach i.e. human
development is based on human capability approach and understands gender in terms of
denial of capabilities. However the last three categories have mutual boundaries around
their core and vitally coexist along with the approach of WID. (Unterhalter, 2005: 15-17,
Rathgeber, 1989:489-502).

Having highlighted the importance of gendered social identity which has relational aspect
for two categories of gender at its core, the theoretical background for the present study
to understand „GENDER‟ is based on literature existing in the area of „Sociology of
Gender‟. Here employment of Interactionist and Institutional perspective is done to
analyse the gendered aspect in participation of medical students. These perspectives have
been considered for the reason of highlighting the structure and practices of organizations
and institutions. Coming to interactionist and institutional perspectives, the main
emphasis here is on social forces which are vitally operating from outside i.e. external to
the person. Therefore these perspectives may be an aid to comprehend the gender
dynamics in a social setting through interaction taking place.

Two features of interactionist perspective has been undertaken to unravel and

comprehend operationalization of social relation aspect. The first one is about „status
characteristics‟ which is a theory emphasizing the ways in which sex categories become
the basis for people‟s expectations about other‟s competence. In a very rudimentary yet
clear understanding, this is about who (two categories of gender) does what? In case of
medical education, there will be an attempt to understand status characteristics by
knowing the different task of medical education as ascribed on male and female students
there. Also, the study will try to analyse the ascription of status characteristics as a
process which is so continuous for a long period of time that it has taken a shape of
normalcy among the medical students. As the patients are important and inevitable part of
medical education, social relational aspect is also understood through interaction of

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medical students with them. One example of such interaction could be the competence of
male/female doctors socially perceived by the patients.

The other feature of interactionist perspective employed for the present study on gender
based analysis of medical education is „homophily‟. This emphasizes the consequences of
people classifying others (here the other gender) as similar or different from themselves.
In our study this could be seen notably in group composition, hierarchy involved there,
interaction with teachers, interaction with patients in terms of their diagnosis, etc.

Also analysis for the organization/institution becomes crucial as these have tendency to
reinforce the already existing social inequality rather than ameliorating them. Before
moving further lets deliberate on the usage of terms organization and institution and how
these are utilized for the present study. An organization is a social unit established to
pursue a particular goal. Organizations have boundaries, rules, procedures and means of
communication (Hall, (2002) as cited in Wharton, 2005). Here associated social
practices shall lead to gender inequality. Similarly sociological definition for institution is
taken into consideration which defines it as “an organized, established pattern‟‟
(Jepperson, 1991 cited in Wharton, 2005). Therefore, institutions are those features of
social life that seem so regular, so ongoing and so permanent that they are often accepted
as just the way they are (Wharton, 2005). Apparently, the rules at both organization and
institution appear to be gender neutral and normative, however on close analysis subtle
realities may get exposed.

In the present study medical education is considered as an institution with different

organizations as student groups, teachers, administrative staff and hospital. The study
aims to unravel these subtle realities pertaining to gendered ascriptions at different
organizational level (discussed above) resulting in the disguised picture of gender
difference. Clearly, it means rule of relational gender composition among teacher groups,
their expectations, administrative behavior in medical practices and attitude among
student groups etc. and obviously the study makes no attempt to detach role of society on
the institution of medical education. Therefore there is a strong and lasting impact of real
and mostly virtual (or symbolic) interaction of society with medical education. In this
way our notion of social interaction process creating and reproducing gender

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differentiated world is reiterated. Generally it is seen that medical education has not been
alienated from the society such that gendered expectation of the latter did not mark its
imprint on the former. Further, the institutional perspective used in the study shall help in
the identifying the rules which seem to be organized and established. The entire process
of „participation‟ of male and female students in two levels of medical education is seen
through a gender based analysis.

Doing research on medical education in theory and practice to unravel the gendered
notion lying beneath could take assistance from several frameworks. The concern of
present study is to delineate the peculiarities involved in medical education that shapes
the identity formation process among male and female doctors. The researcher wishes to
understand the nature of social practice by probing into the phenomena such as
concentration of students displaying gendered division in different disciplines and super-
specialty of medical education. Therefore inevitably there is a need to employ an
analytical research framework that is concerned with identity formation as a result of
particular learning environment. The boundaries of such a research get converged with
analytical framework of „communities of practice‟ as a result of situated learning. This
framework is provided by J. Lave and E. Wenger (1991). It holds premises like
knowledge construction and transformation is a complex process. Learning is contextual
and involves role of environment while the „process of becoming‟ is finalized. In the
framework of „communities of practice‟, important concept is „legitimate peripheral
participation‟. The concept is crucial as it involves initialization to a particular set of
established meaning(s) in an environment, medical training in our case. In this process
student gets involved into community of practice. Meanwhile, various meanings are
constructed within communities of practice through dual process of participation and
reification (Wenger, 1998). Wenger describes that through participation we mutually
construct our identities and through reification we identify and accord meanings to
abstract concepts so that we can own them and manipulate them. Similarly in medical
education communities of practice is constructed and made permanent through practice.
The framework helps to analyze the power structure in organizations or groups. And
uncovering the legitimate peripheral participation may provide a lead to understand
communities of practice.

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1.5 Conceptual Framework of the Study

The field of medicine is socially considered as feminine and that‟s how we see women‟s
enrolment in medical education (Ghosh, 2012). This makes a strong proposition
according to which women ought to have marked their presence substantially or equally
in medical education and its different specializations. However empirical reality gives
indications which are incongruence to the above said proposition. There are missing
numbers of women in certain fields within medical education which are considered as
masculine. These missing numbers pose a question. There seems to be a gap between
what ought to be and what actually is. And the gap is supposedly attached to the existing
gendered ascriptions which enable or disable one or the other category from making any
professional ascriptions. The present research is an attempt to unravel the existing social
realities contributing to the gap.

Therefore this attempt to know the existing social reality involves the process through
which an entrant to the medical profession is transformed to fit in the societal mores. This
process in the present study is understood via „participation‟. Therefore it starts with the
level of entry i.e. enrolment in medical education. And it is basically judged through two
important levels of involvement which have bearing on the professional aspirations of
„becoming‟ someone. If the referred „someone‟ is conforming to gendered identity or not
is the basic question which needs to be explored. It is important to mention here is that
such a process is not linear and static. There may be several intervening variables
involved making it truly dynamic and complex. However based on a careful review of the
available literature the canvas of the present study has been conceptualised.

Broadly two levels have been identified through which participation of the enrolled
student is examined. These are academic and non-academic involvement which works in
conjunction to build an impact in the form of outcome. However there are several factors
that do impact these during the process of learning. Among these some may be
characterized as objectively institutional and others as extraneous to the institution or
personal factors. And both the former and latter may have several other factors in their
specific rubric. It is crucial to note that apart from these, there are some elements or traits

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that are inherent in. These have crucial impact for the entire process and outcome. These
may be categorized as entry level or background variables.

An attempt has been made to present the conceptual framework through the figure 1.2
given below depicting the pattern of interaction amongst conceptualized factors
influencing participation.

Figure 1.2: Conceptual framework for the present study

ENROLMENT

PARTICIPATION
BACKGROUND VARIABLE

Institutional
Factors

NON-ACADEMIC
ACADEMIC
Personal
INVOLVEMENT
INVOLVEMENT Factors

PROFESSIONAL
ASPIRATIONS

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 Background Variables
• Social Background
• Family Income
• Educational Background
• Familial Background
Academic Involvement Non-Academic Involvement
• Attendance • Extracurricular -
• No. of Hours Devoted to Study activities
• Choice of Course/Specialization • Sports/Games
• Pre-internship/Coursework • Dramatic
• Internship • Literary Activities
• Interest in the Course • Student Bodies
• Academic Performance • Seminar/Workshop
• Interaction with Teacher
• Interaction with Peer Group
Institutional and Personal Factors Professional Aspiration
• Location • Career Aspirations
• Student Support Service • Confidence in Ability
• College Environment • Reflections Towards Medical
• Infrastructure Education
• Harassment/Discrimination
• Financial Issues
• Support from the Parents
• Issue of Work Family Balance

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1.6 Rationale of the Study

The field of medical education has gained importance on several counts. If we restrict
ourselves to visualise its vitality as a measure to enhance human resource, it becomes
obvious that such light of education needs to be imparted to both categories of sex i.e.
men and women. It means that entire medical education in its totality and not in parts or
sub-parts (in terms of specializations or super-specialties) ought to be constructed such
that equity is established in the said area. And in this manner there is a need to establish
an order or strive towards equity. However if it does not happen despite the structural
construct (established constitutionally) there must be some issues at the process level
designed via social or other constructs enabling or inhibiting the functionality of the
structure. It is significant here to note down that historical analysis of social development
has contributed in terms of shedding light on construction and establishment of „gender‟
in the society. Indian society remaining no exception to such construction has attributed
differing roles for men and women on the basis of their gender. Following other strand of
gender specific roles in the society, medical education is structured to provide a
continuum to men‟s prestige in terms of their enrolment in the courses which may seek
more socio-economic prestige and diplomacy in the field.

Further it is seen through educational statistics that women are majorly represented in
medical education. However the figures do not show clearly whether women are equally
represented in all the specializations of medical education or are restricted to few of
them. Further, it must be noted that mere entry or enrolment may represent the progress
of any student in a discipline but there is a further requirement to have active
participation and completion on the part of student.

This poses a question on the functional aspect of the institution(s) and also on the policy
aspect which fails to undo the present structure to enhance more egalitarian participation
in different aspects of Medical education. However, it may also be the result of prevalent
social mores putting women at a disadvantage. Such a scenario prompts us to delve
deeper into the study of medical students in order to establish a more clear picture of
„what‟ and „how‟ of participation of students.

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Though studies have been conducted on medical education in the past but most of them
do not address gender issues in medicine. There is a dearth of literature on women in
medicine in India while this aspect has been well studied in the west (Sood & Chadda,
2010). This scenario provides rationale to probe into the participation aspect of medical
students in the University of Delhi. The present study was undertaken to find out whether
the experiences of students (both men and women) differ on the basis of their gender
while pursuing medical education in the University of Delhi. Further the study has
analyzed the enrolment data to understand the extent of disparity in specializations of the
medical courses offered in University of Delhi. Attempt was also made to find out their
participation at the super specialty level. At the same time micro level investigation of
various factors was also done to have a better understanding of the ground realities.

1.7 Operational Definitions

Participation
The term participation for the present study includes enrolment, academic involvement
and non-academic involvement of the students in medical education.

Enrolment- for the present study implies admission of the students in medical education
at undergraduate as well as post graduate level in University of Delhi
Academic Involvement- Academic involvement in the study is about the involvement of
the students that may bring academic yields. Various indicators have been identified to
capture academic involvement of the students such as attendance, number of hours
devoted to study, choice of course/specialization, pre-internship/coursework, internship,
interest in the course, academic performance, interaction with teacher, and interaction
with peer group.
Non-academic Involvement- For the study, the non-academic involvement is captured
through involvement in extra-curricular activities with indicators such as- sports/games,
dramatics, literary activities, student bodies, and seminar/workshop.

Medical Education
Medical education for the present study includes courses in Allopathic medicine such as-

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  Bachelor of Medicine and Bachelor of Surgey (M.B.B.S.)
 M.D. / M.S.
 Super Specialty Courses

Gender
The term gender is often misunderstood and misused by referring to women only. But it
includes both men and women. Though the term sex and gender are used interchangeably
but they are not same. The distinction between sex and gender is essential to know, since
many differences between male and female are not biological in origin. The term sex is
used to refer to the biological differences that define male and female bodies. Gender by
contrast, concerns the psychological, social and cultural differences between male and
female. Gender is linked to socially constructed notions not necessarily a direct product
of an individual‟s biological sex (Giddens, 2002). This definition clearly shows that
gender is different from biological category of „sex‟. Cultures construct meaning(s)
which ultimately demarcates one category of gender from the other. These social
constructions attach themselves to behaviors, expectations, roles, representations, and
sometimes to values and beliefs that are specific to either men or women.

The present study includes both male and female students to fulfill the purpose of
analysing participation in medical education on the basis of gender.

1.8 Research Questions

o What is the gender pattern in enrolment of students in medical education?

o What is the pattern in the choice of specialization for men and women?
o Are the students of different social categories equally represented in medical
education?
o Is there a gender difference in background variables of students in medical
education? Does this difference have any effect on their participation?
o Is the performance different for male and female medical students?
o What are the reasons of their choice of specialization?
o On what grounds experiences of both men and women students differ in their
academic and non-academic involvement in medical education?
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 o How do the institutional and personal factors affect participation of male and
female students?
o What are the overt and unwritten (and indeed unspoken) demands and
expectations of becoming a doctor? Are these differentiated for men and women?
o What are the professional aspirations of male and female medical students?

1.9 Objectives

 To analyze the gender pattern in enrolment and in the specializations chosen by

medical students across different social groups
 To study the difference in background variables of male and female medical
students
 To find out the gender difference in academic and non-academic involvement of
male and female medical students
 To examine the institutional and personal factors affecting participation of male
and female medical students
 To understand the professional aspirations of male and female medical students
1.10 Overview of the Chapters

The thesis is divided into five chapters. In addition to the present chapter which is
introduction chapter (first) of the study, the thesis consists of following four chapters –

 Second Chapter deals with review of literature related to the present study. An
attempt has been made to explore various issues related to gender and medical
education in this chapter.
 Third Chapter provides description of the research methodology utilized to
conduct the present study. Research design, sample, tools, procedure of collection
of data and scheme of analysis of data have been discussed in the present chapter.
 Fourth Chapter presents results and duscussion of both secondary and primary
data collected from selected medical colleges.
 Fifth Chapter deals with conclusion, policy implications and limitations of the
present study.

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