The hidden curriculum: examining gender disparities in career trajectories of female medical graduates from Nepal

Abstract

Background: Achieving gender equality in education is crucial for promoting social equity, driving economic growth, and improving overall population health. In Nepal, deeply rooted socio-cultural norms, economic disparities, and patriarchal values greatly impact women's access to educational opportunities, particularly in the field of medicine. Although there has been an increase in female enrollment in medical programs, pervasive biases, gendered expectations, and informal cultural scripts-often referred to as the "hidden curriculum"-continue to influence their aspirations, specialty choices, and professional journeys. Understanding these dynamics is vital for ensuring women's full engagement in the medical workforce.

Methods: This qualitative study employed semi-structured interviews with fifteen final-year female undergraduate medical students at a private medical college in Bharatpur, Nepal. Thematic analysis was employed to identify and interpret the key themes.

Results: Five key themes emerged: (1) The Marriage Mandate: Negotiating Family, Tradition, and Professional Aspirations; (2) The Gendered Clinic: Unveiling Bias in Medical Education and Practice; (3) Investing in Daughters, Expecting Returns: The Gendered Economics of Medical Education; (4) Transnational Aspirations: Negotiating Mobility, Marriage, and Medical Careers and (5) Claiming Space: Agency, Resistance, and Redefining Success in the Medical Profession.

Discussion: The pervasive "hidden curriculum" of gendered barriers persists despite policy efforts, constitutional safeguards, and increasing female representation in medical schools. These challenges, if unaddressed, risk perpetuating a cycle of underutilizing women's talents, limiting the diversity of the healthcare workforce, and hindering progress toward achieving equitable health outcomes. The findings underscore the urgent need for gender-transformative approaches that acknowledge and actively dismantle these deeply rooted biases at institutional, community, and policy levels. These approaches should focus on creating supportive structures that empower women to fully contribute to the medical profession.

Conclusion: Female medical graduates encounter significant obstacles, including entrenched patriarchal norms, systemic inequalities, and a pervasive "hidden curriculum" of biases. However, they demonstrate remarkable resilience and determination in challenging stereotypes, redefining success, and reimaging their professional identities. Their experiences align with global efforts toward gender parity in education and employment. Equitable representation of women in the medical workforce is not only a moral imperative but also a strategic necessity for advancing public health, strengthening healthcare systems, and promoting social justice.

Clinical trial number: Not applicable.

Keywords: Career trajectories; Female medical students; Gender equality; Hidden curriculum; Medical education; Nepal; Public health.

Fig. 1

Key themes shaping the experiences of female medical students in Nepal