BMJ Open: first published as 10.1136/bmjopen-2019-030390 on 21 August 2019. Downloaded from BMJ Open is committed to open peer review. As part of this commitment we make the peer review history of every article we publish publicly available. When an article is published we post the peer reviewers’ comments and the authors’ responses online. We also post the versions of the paper that were used during peer review. These are the versions that the peer review comments apply to. The versions of the paper that follow are the versions that were submitted during the peer review process. They are not the versions of record or the final published versions. They should not be cited or distributed as the published version of this manuscript. BMJ Open is an open access journal and the full, final, typeset and author-corrected version of record of the manuscript is available on our site with no access controls, subscription charges or pay-per-view fees (http://bmjopen.bmj.com). 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Downloaded from A Qualitative Study Exploring the Impact of Gender in Career Development as a Traditional Korean Medicine Doctor ForJournal: peerBMJ Open review only Manuscript ID bmjopen-2019-030390 Article Type: Research Date Submitted by the 12-Mar-2019 Author: Complete List of Authors: Chun, Se Eun; Dongshin University, Lee, JuHyun; Dongguk University, Lee, Ju Eun; Kyung Hee University, Lee, Seung Min; Pusan National University, Korean Medicine Science Research Center Leem, Jungtae; Chung-Yeon Central Institute; Dongshin Korean Medicine Hospital Kim, Hyunho; Dongshin Korean Medicine Hospital, ; Chung-Yeon Central Institute QUALITATIVE RESEARCH, Human resource management < HEALTH Keywords: SERVICES ADMINISTRATION & MANAGEMENT, MEDICAL EDUCATION & TRAINING http://bmjopen.bmj.com/ on September 28, 2021 by guest. Protected copyright. For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 21 BMJ Open 1 2 3 BMJ Open: first published as 10.1136/bmjopen-2019-030390 on 21 August 2019. Downloaded from 4 A Qualitative Study Exploring the Impact of Gender in Career Development as a 5 6 Traditional Korean Medicine Doctor 7 8 9 Se Eun Chun,1 Ju Hyun Lee,2 Ju Eun Lee,3 Seung Min Kathy Lee, KMD, PhD,4 Jungtae Leem, 10 5,6 5,6 11 KMD, PhD, Hyunho Kim, KMD, PhD 12 13 14 Author affiliations 15 16 1. College of Korean Medicine, Dongshin University, Naju, Republic of Korea, [email protected], 17 18 82-10-8976-7924 For peer review only 19 20 2. College of Korean Medicine, Dongguk University, Seoul, Republic of Korea, 21 [email protected] 22 23 3. College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korean, 24 25 [email protected] 26 27 4. Korean Medicine Science Research Center, Pusan National University, Pusan, Republic of 28 Korea, [email protected] 29 30 5. Dongshin Korean Medicine Hospital, Seoul, Republic of Korea, [email protected], 31 32 [email protected] 33 34 6. Chung-Yeon Central Institute, Gwangju, Republic of Korea 35 36 37 http://bmjopen.bmj.com/ 38 Correspondence to 39 40 Hyunho Kim; [email protected] 41 42 Address: 35, Omok-ro, Yangcheon-gu, Seoul, 07999, Korea 43 44 45 TEL: +82 - 2 -2640 -2800 on September 28, 2021 by guest. Protected copyright. 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 21 1 2 3 BMJ Open: first published as 10.1136/bmjopen-2019-030390 on 21 August 2019. Downloaded from 4 Abstract 5 6 Objective: This study aims to look into the impact that gender and expected gender roles may 7 8 have on the career development of young female traditional Korean Medicine (KM) doctors. 9 Design: We conducted semi-structured interview and the interview was designed to explore 10 11 the experiences of early career choices, employment, job performance and career move, future 12 career aspirations of the subjects related to their gender. The transcription was analyzed using 13 Strauss & Corbin constant comparative analysis method. 14 15 Setting: The interview conducted at a quiet and comfortable place chosen by the participants 16 in South Korea. 17 18 Participants: Ten femaleFor KM peer doctors in theirreview thirties. only 19 20 Results: This study shows that female KM doctors were initially unaware of their gender 21 affecting career decisions. However after graduation and during employment, females 22 23 experienced direct discrimination or gender segregation in choosing areas of treatment and 24 specialty, as they were preferred in pediatrics and dermatology than in departments treating 25 musculoskeletal health problems. After entering the workforce, female KM doctors had 26 experiences related to gender affecting patient-doctor relationship and life events such as 27 28 pregnancy and childbirth causing temporary career breaks. Female KM doctors also 29 experienced stereotypical gender roles in the workforce and at home, having to become the 30 main nurturer of the child. 31 32 Conclusion: Gender and stereotyped gender roles affected overall career planning, career 33 moves, and even patient-doctor relationships. Females were also more likely to experience 34 specific gender roles in not only the workplace but also at home, with childbirth and also child 35 36 rearing. 37 http://bmjopen.bmj.com/ 38 39 Article Summary 40 41 Strengths and limitations of this study 42 43 - This is the first study on the effect of gender on the career of female KM doctors. 44 45 - The qualitative method allowed us to capture the real-world phenomena involved by gender on September 28, 2021 by guest. Protected copyright. 46 factor in various sectors such as employment, medical practice and career courses of female 47 48 KM doctors. 49 50 - The results of this study increase the understanding of female KM doctors’ career 51 development process and gives insight into the education and policy development for medical 52 workforce. 53 54 - The study results are not necessarily generalized because selection bias like non-response bias 55 exist. 56 57 58 59 Keywords: Qualitative Rerearch, Human resource management, Medical Education & 60 Training For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 21 BMJ Open 1 2 3 BMJ Open: first published as 10.1136/bmjopen-2019-030390 on 21 August 2019. Downloaded from 4 Introduction 5 6 7 8 The number of female workers in the medical field is increasing worldwide. This is also 9 true in the field of traditional Korean Medicine (KM). In 2017, the ratio of female traditional 10 11 KM doctors and female allopathic medicine doctors to the total number of KM and allopathic 12 doctors in Korea turned out to be 21% and 25.4%1). Although this figure is still lower than the 13 world average (46%2)), it is a significant increase compared to the ratio decades ago. Just in the 14 field of KM, the total number of female KM doctors has risen from 2.4% in 1980, to 11.1% in 15 1) 16 2000, and to 21% in 2017 . The number of female students getting admitted into KM 17 universities has also increased to 37% in 20173), and reports show that these numbers are 18 expected to rise. For peer review only 19 20 Yet, according to the Global Gender Gap Report 2017, South Korea ranked 118 among 21 144 nations in the gender gap index4), and ranked the lowest in glass ceiling index among the 22 5) 23 29 Organisation for Economic Co-operation and Development (OECD) countries . Previous 24 studies further support this data, as research indicates that the number of Korean females being 25 hired in the labor market lag far behind those of Korean men.6). The number of females entering 26 the professional work force is increasing, but females with advanced degrees are still under- 27 employed compared to those of their male counterparts, with a higher number working as part- 28 7) 29 time . Also, only in South Korea and Japan, the employment to population ratio show a 30 characteristic ‘M-shaped curve’ 8), with females in their thirties being hired less during their 31 pregnancy and after giving birth. Even after being hired, female workers report experiencing 32 discrimination, exclusion, and tokenism as minorities in the industry. In the professional field, 33 34 women physicians are positioned in lower ranking roles and have limited options in selecting 35 their specialties, choosing their forms of employment, and exhibiting leadership9). In the field 36 of KM we see a similar phenomenon. A total of 77.98% of practitioners work in local clinics, http://bmjopen.bmj.com/ 37 but only 15.9% female doctors are hired and only 31.1% and 28.9% are hired in KM hospitals 38 10) 39 and hospitals . Therefore, although the number of female KM doctors is increasing, they are 40 still subject to exclusion in the form of employment and career development, as well as being 41 prone to experiencing continued discrimination. 42 43 Despite these problems, research related to gender discrimination in the KM field is 44 insufficient. A previous study reported that females with advanced degrees have high 45 on September 28, 2021 by guest. Protected copyright. 46 expectations during their first few years of employment, but soon experience limits as female 11) 47 professionals and change career paths as they go through labor and childrearing .