Critics say gender bias survey does not go far enough

More details are needed to truly understand the extent of a bias against women who took entrance exams for Japan’s medical schools, critics said, after the government this month released some of the results of its survey of medical education institutions carried out after a recent sexism scandal in a medical university entrance examination.

The ministry of education surveyed all of the country’s 81 universities with medical facilities. The results, released on 4 September, showed that 77% of the country’s medical faculties – 63 institutions – had higher acceptance rates for men over the past six years.

The average pass rate in medical school entrance exams for male candidates was 1.2 times higher than for female counterparts. Overall, medical schools accepted 9.6% of women applicants and 11.3% of men.

The greatest gap was seen in three private institutions: Juntendo University, where the figure stood at 1.67 times, which means men were 67% more likely to be accepted, followed by 1.54 times at Tohoku Medical and Pharmaceutical University, and a similar figure for Showa University, Tokyo. Around 19 universities reported higher acceptance rates for men every year for the six years, from 2013-2018, covered by the government survey.

Nihon University in Tokyo and Osaka City University reported acceptance rates at least twice as high for men as for women in at least one year over the six-year period.

Tokyo Medical University, the institution whose discrimination against women candidates came to light in August after an internal investigation, reported acceptance ratios ranging from 0.93, slightly favouring women, up to 3.11 or admitting more than three times as many men, over that time.

Not the full results

The ministry released only partial results, hoping to quickly stem public outrage, and has said it will carry out follow-up investigations into institutions with particularly large gender gaps or those which had a smaller gap but over many years. A final report will be released next month.

But the partial information release was criticised by some experts who said it was not carried out with the aim of reforming the sexist bias.

Akira Takebayashi, head of Promedicus preparatory school for medical school applicants, describes the government survey as lacking detail and “a cover-up for the current closed system” that affects women candidates.

“The preparatory school has many female applicants and they do remarkably well,” Takebayashi told University World News. “Higher medical education should encourage women by changing the system.”

More details are needed from the ministry to understand the problem – such as breakdown between the genders based on age, as some students take the exams after being rejected many times, and this category also faces discrimination in Japanese universities, he said.

The survey found that admission rates for all applicants, male and female, tended to decline starting at age 20.

Universities such as Juntendo, with the worst male-female ratios, were among university hospitals that badly needed staff, “hence the preference for male students”, Takebayashi noted.

“For reform we need the education ministry with the health and welfare ministry to promote transparency and fair competition,” he said. “For example, it is important to make exam results and scoring systems public to ensure that they are fair.”

Dark side of medical education

A 6 September editorial in Mainichi Shimbun said the survey had drawn criticism for not answering the public’s biggest question of whether deliberate sexism played a role in the selection process.

The government questionnaire basically asked universities to confirm whether exam results were padded for men or if they practised discrimination. Understandably, the newspaper writes, all schools responded with a “no”, except Tokyo Medical University.

The daily also noted medical schools are allowed to determine whom they admit and the education ministry has no legal authority to verify the validity of the entrance exams.

Professor Masahiro Kami, head of the Medical Governance Research Institute, said the survey confirmed “the darker side” of Japan’s medical higher studies.

“In Japan, medical education is closely linked to employment rather than student’s academic performance. The entrenched system is for graduates to be employed in the hospital affiliated with their university,” he explained, adding that “management is keen to hire doctors who are willing to work long hours and accept low pay. Naturally the preference is for men.”

He said reform is difficult with more hospitals now facing financial difficulties as the government cuts subsidies to reduce the national debt.

More women in regional areas

Nonetheless, the survey revealed some hospitals’ success in having a higher ratio of female doctors, especially in regional areas, such as the universities of Hirosaki, Gifu, Tokushima, Mie and Ehime.

Dr Chizuko Yaguchi, head of the support department for female doctors at Hamamatsu University Hospital based in Shizuoka prefecture, explained that the prefecture faced a dire shortage of doctors with, on average, less than two doctors for every 1,000 people.

“For hospitals such as ours in local areas, female doctors are crucial, so we have a set-up where we counsel them to keep working by giving them options to work less at night and also flexible hours,” she said.