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McCormack P. From embodiment to evidence: The harmful intersection of poor regulation of medical implants and obstructed narratives in embodied experiences of failed metal-on-metal hips. Health (London) 2024; 28:578-595. [PMID: 37272683 PMCID: PMC11149390 DOI: 10.1177/13634593231179026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This research presents the results of a study about people with failed metal-on-metal hip implants, and draws on the STS concept of the technological imperative alongside research on the value of patient knowledge in clinical settings and the legitimacy of embodied stories. Popularly understood as positive and life changing, hip replacement surgery was hailed as 'the operation of the century', until a series of widespread failures of hundreds of thousands of hip implants, known collectively as metal-on-metal (MoM) hips, drew attention to the poor regulation of medical implants. This paper argues that poor regulation intersects with narratives of patients' pain, which are obstructed by surgeons and the UK regulatory body, with the effect of denying both patients' embodied experiences of implant failure, and their restitution to good health. Patient narratives about problems with their hip implant are the wellspring from which scientific evidence emerges which can indicate widespread implant failure. By obstructing these narratives the regulatory system undermines the very evidence it needs to operate effectively.
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Merone L, Tsey K, Russell D, Nagle C. Representation of Women and Women's Health in Australian Medical School Course Outlines, Curriculum Requirements, and Selected Core Clinical Textbooks. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:276-285. [PMID: 38596478 PMCID: PMC11002328 DOI: 10.1089/whr.2023.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 04/11/2024]
Abstract
Background Historically, medical research has, outside of reproductive health, neglected the health needs of women. Medical studies have previously excluded female participants, meaning research data have been collected from males and generalized to females. Knowledge gained from research is translated to clinical education and patient care, and female exclusion may result in gaps in the medical school curricula and textbooks. Materials and Methods This study involved a desktop review of the Australian Medical Council Standards for assessment and accreditation of primary medical programs, the online publicly available Australian medical school course outlines, and finally, an analysis of the recommended textbooks. Results There is no fixed or explicit requirement to include women's health in Australian medical school curricula. Medical school course outlines do not adequately include women's health; similarly, clinical medicine textbooks do not account for sex and gender differences. Conclusion Important sex and gender differences in medicine are not reflected adequately in the medical school course outlines, curricula, or clinical textbooks. This may have significant consequences on women's health.
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Affiliation(s)
- Lea Merone
- James Cook University, College of Healthcare Sciences, Townsville, Queensland, Australia
- Cairns Voluntary Assisted Dying Service, Cairns and Hinterland Hospital and Health Service, Cairns North, Queensland, Australia
| | - Komla Tsey
- James Cook University, College of Healthcare Sciences, Townsville, Queensland, Australia
| | - Darren Russell
- James Cook University, College of Healthcare Sciences, Townsville, Queensland, Australia
- Cairns Sexual Health Service, Cairns North, Queensland, Australia
| | - Cate Nagle
- James Cook University, College of Healthcare Sciences, Townsville, Queensland, Australia
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3
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Longhurst GJ, Bazira PJ, Finn GM. Student's perspectives of inclusive practices in anatomy education. ANATOMICAL SCIENCES EDUCATION 2024; 17:571-590. [PMID: 38372435 DOI: 10.1002/ase.2388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/20/2024]
Abstract
There is a drive to implement inclusive practices in anatomy by adapting curricula and utilizing inclusive language and resources that negate biases. However, to date there is no data regarding student's perception of inclusivity. Therefore, the study aims to investigate anatomy student's opinions on inclusive practices in anatomy education based on the protected characteristics of age, disability, ethnicity, gender affirmation and sex. One hundred and forty-five students completed a questionnaire with 21 Likert-scale and two open-ended questions. Kruskal-Wallis tests compared responses by groups defined by the protected characteristics of the Equality Act (2010). Most students (71.2%; n = 84) agreed or strongly agreed that "improving inclusivity in anatomy education should be educator's priority". In terms of representation, there was a statistically different response rate from students from different ethnic backgrounds to the statements "there are anatomy educators" (p < 0.001), "images in textbooks" (p < 0.001) and "models in the dissection room" (p < 0.001) "that look like me". Most students agreed or strongly agreed to statements relating to the protected characteristics of age (70.4%; n = 68), disability (78.6%; n = 77), ethnicity (59.8%; n = 64), gender affirmation (46.3%; n = 46) and sex (51.5%; n = 62). Themes identified relating to improving inclusivity included "reflecting reality", "teaching the truth", "the invisibility of women" and the "learning environment". Students have confirmed that anatomists, as gatekeepers of the knowledge of the human body, should foster inclusive teaching practices that will benefit all students and potentially future patient care.
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Affiliation(s)
| | - Peter J Bazira
- Centre for Anatomical and Human Sciences, Hull York Medical School, University of Hull, Kingston upon Hull, UK
| | - Gabrielle Maria Finn
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Dhengre S, Nam H, Helm M, Rothrock L. Investigating effect of standardized total body skin examination using sequence-networks. APPLIED ERGONOMICS 2024; 116:104219. [PMID: 38181457 DOI: 10.1016/j.apergo.2023.104219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 12/16/2023] [Accepted: 12/22/2023] [Indexed: 01/07/2024]
Abstract
This study employs sequence-network analysis to investigate the influence of instructing a standardized procedure on total-body skin examination (TBSE) performance. A between-subjects study was conducted with thirty-one participants comprising medical students and attending physicians. Among these participants, fifteen were randomly assigned to the uninstructed group and sixteen to the instructed group. The participants' gaze and field of view were recorded using eye tracking glasses while performing TBSE on a male and a female standardized patient. The recordings were then transcribed to depict the examination process. The instructed group missed significantly fewer body parts (p = 0.045) and had higher time efficiency (p = 0.007) while examining the female patient, but no significant difference was observed for the male patient examination. Furthermore, the examination sequences of the instructed group contained lesser variability than the uninstructed group. Hence, implementing a standard optimal procedure to perform TBSE could minimize the likelihood of missing body parts, increase examination efficiency, and improve performance consistency. This study demonstrated the potential of sequence-network analysis to study human performance in sequential tasks.
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Affiliation(s)
- Snehal Dhengre
- The Pennsylvania State University, University Park, State College, PA, USA
| | - Hannah Nam
- Penn State Health Hershey Medical Center, Hershey, PA, USA
| | - Matthew Helm
- Penn State Health Hershey Medical Center, Hershey, PA, USA
| | - Ling Rothrock
- The Pennsylvania State University, University Park, State College, PA, USA.
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Seidler ZE, Benakovic R, Wilson MJ, Davis JM, Sheldrake M, McGee MA. "I'd have no idea how to go about this…" - a survey of Australian medical students' perspectives on their men's health education. BMC MEDICAL EDUCATION 2024; 24:260. [PMID: 38459497 PMCID: PMC10924408 DOI: 10.1186/s12909-024-05045-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/09/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND While there have been calls over the last 15 years for the inclusion of training in sex and gender-based medicine in medical school curricula and to sustain such improvements through a more gender responsive health system, little progress has been made. A related objective of the Australian National Men's Health Strategy (2020-30) is to improve practitioner core learning competencies in men's health as a critical step to reducing the burden of disease in men and disparities between men in health care access and outcomes. The aim of this study was therefore to obtain Australian medical student perspectives on the extent to which men's health and sex and gender-based medicine education is delivered in their curricula, their preparedness for engaging with men in clinical practice, and the men's health content they would have found useful during their training. METHODS Eighty-three students (48% male) from 17 accredited medical schools, and in at least their fourth year of training, completed an online survey. The survey was co-designed by a multidisciplinary team of men's health researchers and clinicians, alongside a student representative. A mix of quantitative and qualitative survey items inquired about students' preparedness for men's health clinical practice, and coverage of men's health and sex- and gender-based medicine in their curricula. RESULTS Most students reported minimal to no men's health coverage in their medical school education (65%). While few were offered optional men's health units (10.5%), the majority would have liked more formal training on the topic (78%). Accompanying qualitative findings substantiated a lack of preparedness among medical students to engage male patients, likely stemming from minimal coverage of men's health in their medical education. CONCLUSIONS Australian medical students may feel underprepared for contemporary men's health clinical practice, as well as, albeit to a lesser extent, women's health clinical practice. There is a clear need and desire amongst medical students to enhance curricula with sex and gender-based medicine training.
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Affiliation(s)
- Zac E Seidler
- Movember, Level 4/21-31 Goodwood St, 3121, Richmond, VIC, Australia.
- Orygen, Parkville, VIC, Australia.
- Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia.
| | - Ruben Benakovic
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia
| | - Michael J Wilson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia
| | - Jasmine M Davis
- Australian Medical Students' Association, Australian Capital Territory, Barton, Australia
- University of Melbourne, Victoria, Australia
| | | | - Margaret A McGee
- Movember, Level 4/21-31 Goodwood St, 3121, Richmond, VIC, Australia
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Hillcoat A, Prakash J, Martin L, Zhang Y, Rosa G, Tiemeier H, Torres N, Mustieles V, Adams CD, Messerlian C. Trauma and female reproductive health across the lifecourse: motivating a research agenda for the future of women's health. Hum Reprod 2023; 38:1429-1444. [PMID: 37172265 PMCID: PMC10391316 DOI: 10.1093/humrep/dead087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 04/10/2023] [Indexed: 05/14/2023] Open
Abstract
The aetiology behind many female reproductive disorders is poorly studied and incompletely understood despite the prevalence of such conditions and substantial burden they impose on women's lives. In light of evidence demonstrating a higher incidence of trauma exposure in women with many such disorders, we present a set of interlinked working hypotheses proposing relationships between traumatic events and reproductive and mental health that can define a research agenda to better understand reproductive outcomes from a trauma-informed perspective across the lifecourse. Additionally, we note the potential for racism to act as a traumatic experience, highlight the importance of considering the interaction between mental and reproductive health concerns, and propose several neuroendocrinological mechanisms by which traumatic experiences might increase the risk of adverse health outcomes in these domains. Finally, we emphasize the need for future primary research investigating the proposed pathways between traumatic experiences and adverse female reproductive outcomes.
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Affiliation(s)
- Alexandra Hillcoat
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jaya Prakash
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Leah Martin
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yu Zhang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Gabriela Rosa
- Office of Educational Programs, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Henning Tiemeier
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nicole Torres
- Department of Obstetrics and Gynecology, Vincent Center for Reproductive Biology, Massachusetts General Hospital Fertility Center, Boston, MA, USA
| | - Vicente Mustieles
- Department of Radiology and Physical Medicine, School of Medicine, Center for Biomedical Research (CIBM), University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs GRANADA, Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Charleen D Adams
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Carmen Messerlian
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Obstetrics and Gynecology, Vincent Center for Reproductive Biology, Massachusetts General Hospital Fertility Center, Boston, MA, USA
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Wortmann L, Haarmann L, Yeboah A, Kalbe E. Gender medicine teaching increases medical students' gender awareness: results of a quantitative survey. GMS JOURNAL FOR MEDICAL EDUCATION 2023; 40:Doc45. [PMID: 37560043 PMCID: PMC10407584 DOI: 10.3205/zma001627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 03/31/2023] [Accepted: 04/20/2023] [Indexed: 08/11/2023]
Abstract
Background Knowledge about gender implications of health is insufficiently integrated into university teaching in Germany. Gender awareness represents a key competence to integrate this knowledge into the medical practice. This study is the first survey of the gender awareness of medical students in a cross-sectional design in Germany. Methods From April to July 2021, a quantitative cross-sectional survey in an online format using the "Nijmegen Gender Awareness in Medicine Scale" (2008) was conducted at four German universities (Charité Berlin, Friedrich-Schiller-University Jena, Ludwig-Maximilians-University Munich, and the University of Cologne) with a varied implementation of teaching gender medicine. Students indicated their agreement or disagreement with assumptions and knowledge about the influence of gender in everyday medical practice (gender sensitivity), as well as gender role stereotypes towards patients and physicians (gender role ideology). Results The 750 included participants showed relatively high gender sensitivity and low gender role stereotyping towards patients and physicians. The curricular implementation of gender medicine in the universities showed a significant influence on the students' gender sensitivity, as well as on their gender role stereotyping towards patients. Students who reported having taken classes in gender medicine or stated a definite interest in doing so showed significantly higher levels of gender sensitivity. Cis-males showed significantly lower gender sensitivity and significantly higher gender role stereotyping. Conclusion Implementation of gender medicine in the medical curriculum, attending courses on gender education as well as one's gender and interest have a significant impact on medical students' gender competencies. These results support the need for structural integration of gender medicine in medical education and gender trainings at medical schools in Germany.
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Affiliation(s)
- Laura Wortmann
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Medizinische Psychologie, Neuropsychologie und Gender Studies, Cologne, Germany
| | - Lena Haarmann
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Medizinische Psychologie, Neuropsychologie und Gender Studies, Cologne, Germany
| | | | - Elke Kalbe
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Medizinische Psychologie, Neuropsychologie und Gender Studies, Cologne, Germany
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Leir SA, Sun L, Fraser A. Representation of patient diversity in anesthesia curricular materials. Can J Anaesth 2023; 70:1097-1099. [PMID: 35437685 DOI: 10.1007/s12630-022-02251-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/01/2022] [Accepted: 02/18/2022] [Indexed: 10/18/2022] Open
Affiliation(s)
- Sarah Anne Leir
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Louise Sun
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Amy Fraser
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada
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Thomas YT, Chary AN, Suh MI, Samaei M, Dobiesz V, Kalantari A, Buehler G, Das D, Wolfe J. The development of an educational workshop to reframe and manage professional conflict via a sex and gender lens. AEM EDUCATION AND TRAINING 2023; 7:e10872. [PMID: 37261219 PMCID: PMC10227172 DOI: 10.1002/aet2.10872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/13/2022] [Accepted: 12/28/2022] [Indexed: 06/02/2023]
Abstract
Background Conflict is inevitable in the emergency department, and conflict resolution is an essential skill for emergency providers to master. Effective conflict management can optimize patient care and enhance professional satisfaction. To communicate effectively in high-stress, high-impact situations, sex- and gender-based differences need to be considered. Methods Nine resident, fellow, junior, and senior faculty members of the Academy for Women in Academic Emergency Medicine collaborated to design a 4-h workshop. The focus was on professional communication and conflict resolution in emergency medicine (EM), with special attention on how sex and gender can influence these processes. Results The final educational workshop utilized a variety of formats focused on communication and effective conflict resolution including: traditional didactics, facilitated small groups with case-based learning, expert panel discussion, and an experiential learning session. The consideration of how sex- and gender-associated factors might contribute additional complexity or challenges to conflictual interactions were interwoven into each session to highlight alternative vantage points. Conclusions Effective conflict resolution is an important skill for success in EM. We developed a workshop that went beyond typical communication-based programming to consider how sex- and gender-related factors influence communication and conflict resolution.
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Affiliation(s)
- Ynhi T. Thomas
- Henry J.N. Taub Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
| | - Anita N. Chary
- Henry J.N. Taub Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
| | - Michelle I. Suh
- Henry J.N. Taub Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
| | - Mehrnoosh Samaei
- Emory Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Valerie Dobiesz
- Department of Emergency MedicineSTRATUS Center for Medical Simulation, Brigham and Women's Hospital, Harvard Medical School, Harvard Humanitarian InitiativeBostonMassachusettsUSA
| | - Annahieta Kalantari
- Department of Emergency MedicinePenn State Health Milton S. Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Greg Buehler
- Henry J.N. Taub Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
| | - Devjani Das
- Department of Emergency MedicineColumbia University Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Jeannette Wolfe
- Department of Emergency MedicineUniversity of Massachusetts Chan Medical School–BaystateSpringfieldMassachusettsUSA
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Bartual-Figueras MT, Donoso-Vázquez T, Sierra-Martínez FJ, Turmo Garuz J. [Validation of a gender awareness scale in health sciences students]. GACETA SANITARIA 2023; 37:102304. [PMID: 37163928 DOI: 10.1016/j.gaceta.2023.102304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Given the need to promote gender equity in healthcare, this research aimed to adapt and validate a short version of the Nijmegen Gender Awareness Scale (N-GAMN), that assesses attitudes and gender stereotyping of health sciences students. METHOD A cross-sectional study was carried out using a questionnaire among health sciences students from the universities of Barcelona, Cantabria, Cartagena de Indias and the National Autonomous University of Nicaragua. Nine hundred fifty-six students filled out the questionary. A confirmatory factor analysis was performed to establish the relationship between the observed variables and the latent dimensions. RESULTS The factorial analysis evaluated the validity of the scale and confirmed the existence of a three-dimensional structure composed of: (F1) gender stereotypes towards patients, (F2) gender stereotypes towards professionals and (F3) gender sensitivity in the healthcare (fit data: CFI=0.917, TFI=0.899, RMSEA=0.08 and SRMEA=0.06). Descriptive statistics showed relatively high levels of gender awareness among the participants. Fewer stereotypes were observed towards professionals than towards patients. Women and students from Spanish universities showed a higher level of awareness. However, the significance values of the Mann-Whitney U test allow us to infer the existence of differences based on geographical area, but not based on gender. CONCLUSIONS The results suggest the potential application of the scale to assess the attitudes of students and professionals towards gender stereotypes and biases associated with clinical practice, as well as to assess the impact of gender awareness actions.
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Affiliation(s)
| | - Trinidad Donoso-Vázquez
- Departamento de Métodos de Investigación y Diagnóstico en Educación, Universidad de Barcelona, Barcelona, España
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Le Boudec J, Félix S, Gachoud D, Monti M, Barazzoni MS, Clair C. The influence of patient gender on medical students' care: Evaluation during an objective structured clinical examination. PATIENT EDUCATION AND COUNSELING 2023; 110:107655. [PMID: 36805929 DOI: 10.1016/j.pec.2023.107655] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 12/15/2022] [Accepted: 02/05/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To assess whether men and women are evaluated and treated differently by medical students. METHODS We evaluated patient care provided by 110 fifth-year medical students during an objective structured clinical examination (OSCE), using two clinical cases with standardized patients (SPs): generalized anxiety disorder (GAD) and ascending aortic dissection (AAD). Half of the students encountered male and half female SPs. Except for gender, the cases were identical. We compared diagnosis and treatment of male vs female SPs. RESULTS Students diagnosed GAD more often in female SPs than in male SPs (diagnosis completed, partially completed, and not completed in 47%, 16% and 36% respectively vs. 22%, 20%, and 58% for male SPs, p = 0.02). The nature of symptoms was better described for male SPs. For AAD, the emergency was more frequently identified and the examination of femoral pulses better performed in female SPs. CONCLUSION Medical students have a gender bias when evaluating patients with GAD and AAD. PRACTICE IMPLICATION The observed gender bias in the evaluation of patients, likely leads to differences in treatment between male and female patients (i.e. under-recognition of anxiety in men). Medical schools should implement gender-sensitive medical education initiatives to improve inclusive patient care.
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Affiliation(s)
- Joana Le Boudec
- Centre for Primary Care and Public Health, Department of Training, Research and Innovation, Lausanne, Switzerland.
| | - Sylvie Félix
- Faculty of Biology and Medicine, University of Lausanne, Clinical Skills Unit, Medical School, Lausanne, Switzerland.
| | - David Gachoud
- Faculty of Biology and Medicine, University of Lausanne, Medical Education Unit, Lausanne, Switzerland; Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
| | - Matteo Monti
- Faculty of Biology and Medicine, University of Lausanne, Medical Education Unit, Lausanne, Switzerland; Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
| | | | - Carole Clair
- Centre for Primary Care and Public Health, Department of Training, Research and Innovation, Lausanne, Switzerland.
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Bakkum MJ, Verdonk P, Thomas EG, van Rosse F, Okorie M, Papaioannidou P, Likic R, Sanz EJ, Christiaens T, Costa JN, Dima L, de Ponti F, van Smeden J, van Agtmael MA, Richir MC, Tichelaar J. A Clinical Pharmacology and Therapeutics Teacher's Guide to Race-Based Medicine, Inclusivity, and Diversity. Clin Pharmacol Ther 2023; 113:600-606. [PMID: 36325997 DOI: 10.1002/cpt.2786] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
The relationship between race and biology is complex. In contemporary medical science, race is a social construct that is measured via self-identification of study participants. But even though race has no biological essence, it is often used as variable in medical guidelines (e.g., treatment recommendations specific for Black people with hypertension). Such recommendations are based on clinical trials in which there was a significant correlation between self-identified race and actual, but often unmeasured, health-related factors such as (pharmaco)genetics, diet, sun exposure, etc. Many teachers are insufficiently aware of this complexity. In their classes, they (unintentionally) portray self-reported race as having a biological essence. This may cause students to see people of shared race as biologically or genetically homogeneous, and believe that race-based recommendations are true for all individuals (rather than reflecting the average of a heterogeneous group). This medicalizes race and reinforces already existing healthcare disparities. Moreover, students may fail to learn that the relation between race and health is easily biased by factors such as socioeconomic status, racism, ancestry, and environment and that this limits the generalizability of race-based recommendations. We observed that the clinical case vignettes that we use in our teaching contain many stereotypes and biases, and do not generally reflect the diversity of actual patients. This guide, written by clinical pharmacology and therapeutics teachers, aims to help our colleagues and teachers in other health professions to reflect on and improve our teaching on race-based medical guidelines and to make our clinical case vignettes more inclusive and diverse.
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Affiliation(s)
- Michiel J Bakkum
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education, Amsterdam, The Netherlands
| | - Petra Verdonk
- Department of Ethics, Law and Humanities, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Elias G Thomas
- Department of Internal Medicine, Geriatrics Section, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Floor van Rosse
- Erasmus Medical Centre, University Medical Center Rotterdam, Hospital Pharmacy, Rotterdam, The Netherlands
| | - Michael Okorie
- Clinical Pharmacology and Medical Education, Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Paraskevi Papaioannidou
- European Association for Clinical Pharmacology and Therapeutics Education Working Group, Athens, Greece.,Department of Pharmacology, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Robert Likic
- European Association for Clinical Pharmacology and Therapeutics Education Working Group, Athens, Greece.,Unit of Clinical Pharmacology, University of Zagreb School of Medicine and Clinical Hospital Centre Zagreb, Zagreb, Croatia
| | - Emilio J Sanz
- European Association for Clinical Pharmacology and Therapeutics Education Working Group, Athens, Greece.,Universidad de La Laguna, School of Health Sciences, Tenerife, Spain and Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | - Thierry Christiaens
- European Association for Clinical Pharmacology and Therapeutics Education Working Group, Athens, Greece.,Section Clinical Pharmacology, Heymans Institute of Pharmacology Ghent University, Ghent, Belgium
| | - João N Costa
- European Association for Clinical Pharmacology and Therapeutics Education Working Group, Athens, Greece.,Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Lorena Dima
- European Association for Clinical Pharmacology and Therapeutics Education Working Group, Athens, Greece.,Department of Fundamental Disciplines and Clinical Prevention, Faculty of Medicine, Transilvania University of Brașov, Brașov, Romania
| | - Fabrizio de Ponti
- Department of Medical and Surgical Sciences, Pharmacology Unit, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Jeroen van Smeden
- Division of Education, Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education, Amsterdam, The Netherlands.,European Association for Clinical Pharmacology and Therapeutics Education Working Group, Athens, Greece
| | - Milan C Richir
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,European Association for Clinical Pharmacology and Therapeutics Education Working Group, Athens, Greece
| | - Jelle Tichelaar
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education, Amsterdam, The Netherlands.,European Association for Clinical Pharmacology and Therapeutics Education Working Group, Athens, Greece
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13
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Gender Awareness in Healthcare: Contextualization of an Arabic Version of the Nijmegen Gender Awareness in Medicine Scale (N-GAMS). Healthcare (Basel) 2023; 11:healthcare11040629. [PMID: 36833163 PMCID: PMC9957215 DOI: 10.3390/healthcare11040629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Gender is one of the important social determinants of health known to be highly associated with health status. Despite the importance of gender awareness, it has not been addressed and researched in the Arab region, including Palestine. This study aimed to contextualize an Arabic version of the Nijmegen Gender Awareness in Medicine Scale (N-GAMS) and to assess the level of gender awareness and its associated factors among primary health care providers. The N-GAMS tool was translated and adapted through a gender expert consultation and a focus group discussion. Then, it was administered online to a sample of primary health care general physicians and nurses of all health care providing actors in Ramallah and al-Bireh Governorate. The reliability of the N-GAMS subscales using Cronbach's alpha (α) was 0.681 for the gender sensitivity (GS) scale (9 items), 0.658 for the gender role ideology towards co-workers (GRIC) scale (6 items), and α = 0.848 for the gender role ideology towards patients (GRIP) scale (11 items). The results showed that participants had scored near the midpoint of the gender sensitivity subscale (M = 2.84, SD = 0.486). They also expressed moderate gender stereotypes towards patients (M = 3.11, SD = 0.624), where females held lower stereotypical thinking. Participants also expressed low to moderate stereotypes towards co-workers (M = 2.72, SD = 0.660) and females expressed less stereotypical thinking compared to males. Furthermore, the participant's age had some effect on the outcome, specifically on the GRIP subscale, while gender was associated with both GRIP and GRID subscales. The rest of the social and other variables showed no association with the gender awareness subscales. This study adds to our understanding of gender awareness. Further tests are required to confirm the psychometric qualities of the instrument.
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14
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Aliri J, Prego-Jimenez S, Goñi-Balentziaga O, Pereda-Pereda E, Perez-Tejada J, Labaka Etxeberria A. Gender awareness is also nurses' business: Measuring sensitivity and role ideology towards patients. J Nurs Manag 2022; 30:4409-4418. [PMID: 36217683 PMCID: PMC10092084 DOI: 10.1111/jonm.13866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 09/02/2022] [Accepted: 09/28/2022] [Indexed: 12/30/2022]
Abstract
AIM This study aims to validate the Nijmegen Gender Awareness in Medicine Scale, which assesses gender sensitivity and gender-role ideology towards patients in the Spanish language for use among physicians and nurses. BACKGROUND Women are more likely to suffer pain, delays and health consequences related to low therapeutic effort. Health professionals' gender awareness may minimize such bias; however, the only instrument to assess such awareness is limited to physicians and lacks a Spanish version. METHODS After using the back-translation method, a sample of 167 Spanish nurses and nursing students completed the instrument. In order to obtain additional validity evidence, 98 health professionals filled in gender sensitivity and gender-role ideology towards patients' subscales and the short versions of the Ambivalent Sexism Inventory. RESULTS Gender-role ideology towards patients correlated strongly with sexist attitudes, demonstrating convergent validity, and Cronbach's alpha coefficients showed an adequate internal consistency. CONCLUSIONS Nijmegen Gender Awareness in Medicine Scale perfectly applies to nurse population, and this adaptation also broadens its use for Spanish professionals. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers and educators can use this applicable tool to treat low gender awareness levels as a modifiable risk factor and promote a gender-sensitive caring culture.
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Affiliation(s)
- Jone Aliri
- Clinical and Health Psychology and Research Methodology Department, University of the Basque Country (UPV/EHU), San Sebastian, Basque Country, Spain
| | - Sara Prego-Jimenez
- Clinical and Health Psychology and Research Methodology Department, University of the Basque Country (UPV/EHU), San Sebastian, Basque Country, Spain.,University Hospital Donostia, San Sebastian, Spain
| | - Olatz Goñi-Balentziaga
- Clinical and Health Psychology and Research Methodology Department, University of the Basque Country (UPV/EHU), San Sebastian, Basque Country, Spain
| | - Eva Pereda-Pereda
- Osakidetza-Basque National Health Service, Vitoria-Gasteiz, Basque Country, Spain.,Group of Mental Health and Psychiatric Care, Biodonostia Health Research Institute, San Sebastian, Basque Country, Spain
| | | | - Ainitze Labaka Etxeberria
- Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), San Sebastian, Basque Country, Spain
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15
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Politis M, El Brown M, Huser CA, Crawford L, Pope L. 'I wouldn't know what to do with the breasts': the impact of patient gender on medical student confidence and comfort in clinical skills. EDUCATION FOR PRIMARY CARE 2022; 33:316-326. [PMID: 36443928 DOI: 10.1080/14739879.2022.2129460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous research has found a relationship between students' gender and attitudes surrounding peer physical examination, but relationship between patient gender and confidence/comfort is less clear. We explored whether patient gender affects medical students' levels of confidence and comfort in clinical examination skills. METHODS An electronic survey and focus groups were conducted with medical students from one UK institution. Students reported levels of confidence/comfort when carrying out clinical examinations on men/women. An inductive thematic analysis was performed. RESULTS Of a total of 1500 students provided with the opportunity to participate, ninety (6%) responded. For cardiovascular and respiratory examinations, confidence/comfort were higher when examining male-presenting patients. The opposite was true for mental state examinations. Barriers to confidence/comfort included perceiving males as a norm, difficulty navigating breasts, tutors' internalised gendered attitudes and a wider sociocultural issue. Facilitators of confidence/comfort included students relating to patients, embodying a professional role, gender blindness, and authentic clinical environments. Fewer than 20% (n = 18) of students felt they had enough opportunity to practice clinical skills on women, versus 90% (n = 82) on men. CONCLUSION Our study identified an area where students' confidence and comfort in clinical examinations could be enhanced within medical education. Changes were implemented in the institution under study's vocational skills teaching, which is rooted in general practice. Information on gender and clinical skills was provided within course handbooks, time was scheduled to discuss gender and clinical skills in small group settings, and equitable gender representation was ensured in clinical assessment.
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Affiliation(s)
- Marina Politis
- Undergraduate Medical School, University of Glasgow, Glasgow, UK
| | - Megan El Brown
- Buckingham Medical School, Buckingham Medical School, University of Buckingham, Buckingham, UK.,Medical Education Innovation and Education Centre (MEdIC), Imperial College London, London, UK
| | - Camille Am Huser
- Undergraduate Medical School, University of Glasgow, Glasgow, UK
| | - Lynsay Crawford
- Undergraduate Medical School, University of Glasgow, Glasgow, UK
| | - Lindsey Pope
- Undergraduate Medical School, University of Glasgow, Glasgow, UK
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16
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Finn GM, Brown MEL. Ova-looking feminist theory: a call for consideration within health professions education and research. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:893-913. [PMID: 35389154 PMCID: PMC8988912 DOI: 10.1007/s10459-022-10108-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 03/06/2022] [Indexed: 06/14/2023]
Abstract
The role of feminist theory in health professions education is often 'ova-looked'. Gender is one cause of healthcare inequalities within contemporary medicine. Shockingly, according to the World Health Organisation, no European member state has achieved full gender equity in regard to health outcomes. Further, contemporary curricula have not evolved to reflect the realities of a diverse society that remains riddled with inequity. This paper outlines the history of feminist theory, and applies it to health professions education research and teaching, in order to advocate for its continued relevance within contemporary healthcare.
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Affiliation(s)
- G M Finn
- School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - M E L Brown
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
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17
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Rashid S, ElSalhy M. A cross-sectional study of dental students perception of dental faculty gender differences. PLoS One 2022; 17:e0271570. [PMID: 35905091 PMCID: PMC9337690 DOI: 10.1371/journal.pone.0271570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 07/04/2022] [Indexed: 11/19/2022] Open
Abstract
Objective
The objective of this study was to evaluate students’ perceptions of differences in learning from faculty of different gender.
Method
This cross-sectional study involved pre-doctoral dental students (years 2 to 4) who had a simulation and/or clinical experience working with dental faculty for at least one year. Students completed a self-administered questionnaire with three sections: demographic, difference between faculty related to their knowledge, skill, critical thinking, acceptance of cultural differences, and students’ preferences in working with faculty in specialty clinics.
Results
A total of 136 students completed the survey (75.4% response rate). Participants were 52.6% women, 62.2% self-identified as Caucasian/White. Students reported that female faculty are more understanding (p = 0.001) and accepting of cultural differences (p<0.001) compared to male faculty (p<0.05). Students reported perceiving female faculty more as being a role model than male faculty (p = 0.034). When comparing male and female students, male student’s perception of male faculty as a role model was significantly higher than female students (p<0.05). There was no significant difference in student’s perceptions between male and female faculty in their knowledge, skills, compassion, critical thinking, providing feedback, communication skills, and grading (p>0.05). Caucasian/White students perceived female faculty as more encouraging for discussions and male faculty as more rigid/inflexible (p<0.05).
Conclusions
Students perceived female faculty as more understanding and culturally competent compared to male faculty. There were no significant differences in student’s perceptions of male and female faculty in their knowledge, skills, compassion, critical thinking, feedback, communication skills, and grading. Students perceived female faculty as role models more than male faculty.
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Affiliation(s)
- Shaista Rashid
- A.T. Still University - Missouri School of Dentistry & Oral Health, St Louis, Missouri, United States of America
- * E-mail:
| | - Mohamed ElSalhy
- College of Dental Medicine, University of New England, Portland, Maine, United States of America
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18
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Chellappa AS, Sahoo M, Sahoo S. Gender inequality infiltrates the in silico modeling world. NATURE COMPUTATIONAL SCIENCE 2022; 2:346-347. [PMID: 38177579 DOI: 10.1038/s43588-022-00268-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Affiliation(s)
- Anirudh S Chellappa
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Madhulika Sahoo
- Department of Anthropology, Kalahandi University, Odisha, India
| | - Swagatika Sahoo
- Office of Global Engagement, Indian Institute of Technology Madras, Chennai, India.
- Centre for Integrative Biology and Systems medicine, Indian Institute of Technology Madras, Chennai, India.
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19
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Demsas F, Joiner MM, Telma K, Flores AM, Teklu S, Ross EG. Disparities in peripheral artery disease care: A review and call for action. Semin Vasc Surg 2022; 35:141-154. [PMID: 35672104 PMCID: PMC9254894 DOI: 10.1053/j.semvascsurg.2022.05.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022]
Abstract
Peripheral artery disease (PAD), the pathophysiologic narrowing of arterial blood vessels of the lower leg due to atherosclerosis, is a highly prevalent disease that affects more than 6 million individuals 40 years and older in the United States, with sharp increases in prevalence with age. Morbidity and mortality rates in patients with PAD range from 30% to 70% during the 5- to 15-year period after diagnosis and PAD is associated with poor health outcomes and reduced functionality and quality of life. Despite advances in medical, endovascular, and open surgical techniques, there is striking variation in care among population subgroups defined by sex, race and ethnicity, and socioeconomic status, with concomitant differences in preoperative medication optimization, amputation risk, and overall health outcomes. We reviewed studies from 1995 to 2021 to provide a comprehensive analysis of the current impact of disparities on the treatment and management of PAD and offer action items that require strategic partnership with primary care providers, researchers, patients, and their communities. With new technologies and collaborative approaches, optimal management across all population subgroups is possible.
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Affiliation(s)
- Falen Demsas
- Geisel School of Medicine at Dartmouth, Hanover, NH
| | | | - Kate Telma
- Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Alyssa M Flores
- Department of Surgery, Division of Vascular Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Elsie Gyang Ross
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA; Center for Biomedical Informatics Research, Stanford University, Stanford, CA; Stanford Cardiovascular Institute, 780 Welch Road, CJ350, Palo Alto, CA 94304.
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20
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Pourfarzi F, Moghadam TZ, Zandian H. Decomposition socio-economic inequality in cardiovascular disease prevalence in adult population: A cohort based cross-sectional study in north-west of Iran. J Prev Med Public Health 2022; 55:297-306. [PMID: 35678004 PMCID: PMC9201090 DOI: 10.3961/jpmph.22.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/29/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Farhad Pourfarzi
- Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil,
Iran
| | - Telma Zahirian Moghadam
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil,
Iran
| | - Hamed Zandian
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil,
Iran
- Department of Community Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil,
Iran
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21
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Prego-Jimenez S, Pereda-Pereda E, Perez-Tejada J, Aliri J, Goñi-Balentziaga O, Labaka A. The Impact of Sexism and Gender Stereotypes on the Legitimization of Women's Low Back Pain. Pain Manag Nurs 2022; 23:591-595. [DOI: 10.1016/j.pmn.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 11/28/2022]
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22
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Abstract
Seeking to support qualitative researchers in the artful development of feminist care scholarship, our goal here is to ‘look back’ on how we have conceptualized the problems of care and developed research that illuminates the social organization of care in distinct ways. As part of a ‘feminist care scholar retrospective’, we present five condensed ‘reverse research proposals’, which are retrospective accounts of past research or scholarly activity. From there, we discuss how each project begins with a particular problematic for investigation and a particular conception of care (e.g., as practices, as work, as a concept) to illuminate facets of the social organization of care shaping paid and unpaid care work and its interpretations. These approaches reveal multiple and overlapping ways that care is embodied, understood and organized, as well as ways care can be transformed.
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23
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Morais R, Bernardes S, Verdonk P. What is gender awareness in health? A scoping review of the concept, its operationalization, and its relation to health outcomes. Women Health 2022; 62:181-204. [PMID: 35220903 DOI: 10.1080/03630242.2022.2041150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Gender awareness emerged in the 1990s and aimed to provide awareness and sympathy toward the needs of women, measuring health-care providers' attitudes toward them and understand if providers possessed the knowledge for appropriate care. According to Miller et al.'s seminal model, gender awareness incorporates three sub-dimensions: gender sensitivity, gender ideology, and knowledge. Gender awareness has the potential to minimize gender bias in health care, improving the ecological validity of research. This scoping review provides an analysis of how gender awareness has been conceptualized, operationalized, and investigated in its relationship with health-related outcomes. A search was conducted on PubMed, PsycINFO, and ERIC. The relevance of 2.589 articles was assessed and 14 empirical studies were selected and included. Difficulties conceptualizing gender awareness were found and gender awareness and gender sensitivity were often presented as interchangeable. Most papers aimed to measure and compare levels of gender awareness among health professionals and the relationship between gender awareness and relevant health-related outcomes was not studied. Drawing upon a critical analysis of our findings, a proposal for a revised gender awareness conceptualization and operationalization is put forth as to inform novel research on its association with gender bias in health and health care.
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Affiliation(s)
- Rita Morais
- Instituto Universitário de Lisboa (ISCTE-IUL), Lisbon, Portugal.,Centro de Investigação e Intervenção Social (CIS-IUL), Lisbon, Portugal
| | - Sónia Bernardes
- Instituto Universitário de Lisboa (ISCTE-IUL), Lisbon, Portugal.,Centro de Investigação e Intervenção Social (CIS-IUL), Lisbon, Portugal
| | - Petra Verdonk
- Department Ethics, Law & Humanities, APH Research Institute, Amsterdam UMC-VUmc, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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24
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George R, Utunen H, Ndiaye N, Tokar A, Mattar L, Piroux C, Gamhewage G. Ensuring equity in access to online courses: Perspectives from the WHO health emergency learning response. WORLD MEDICAL & HEALTH POLICY 2022. [DOI: 10.1002/wmh3.492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Richelle George
- Learning and Capacity Development Unit, WHO Health Emergencies Programme World Health Organization Genève Switzerland
| | - Heini Utunen
- Learning and Capacity Development Unit, WHO Health Emergencies Programme World Health Organization Genève Switzerland
| | - Ngouille Ndiaye
- Learning and Capacity Development Unit, WHO Health Emergencies Programme World Health Organization Genève Switzerland
| | - Anna Tokar
- Learning and Capacity Development Unit, WHO Health Emergencies Programme World Health Organization Genève Switzerland
| | - Lama Mattar
- Learning and Capacity Development Unit, WHO Health Emergencies Programme World Health Organization Genève Switzerland
| | - Corentin Piroux
- Learning and Capacity Development Unit, WHO Health Emergencies Programme World Health Organization Genève Switzerland
| | - Gaya Gamhewage
- Learning and Capacity Development Unit, WHO Health Emergencies Programme World Health Organization Genève Switzerland
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25
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Bert F, Boietti E, Rousset S, Pompili E, Franzini Tibaldeo E, Gea M, Scaioli G, Siliquini R. Gender sensitivity and stereotypes in medical university students: An Italian cross-sectional study. PLoS One 2022; 17:e0262324. [PMID: 34990471 PMCID: PMC8735594 DOI: 10.1371/journal.pone.0262324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/22/2021] [Indexed: 11/19/2022] Open
Abstract
Gender medicine is crucial to reduce health inequalities. Knowledge about students’ attitudes and beliefs regarding men, women and gender is important to improve gender medicine courses. The aim of this study is to evaluate gender stereotypes and its predictors in Italian medical students. We performed an online cross-sectional study among students from the University of Turin. We used the validated Nijmegen Gender Awareness Scale in Medicine scale to explore gender sensitivity and stereotypes. Multivariable logistic regression model was performed to explore potential predictors of gender awareness. We enrolled 430 students. Female sex, a better knowledge on gender medicine and having had a tutor aware of gender issues are associated with higher gender sensitivity. Older age, a better knowledge on gender medicine and having had a tutor sensitive to gender issues were predictors of more stereotyped opinions towards patients. Having had a tutor aware of gender medicine, male sex and older age were associated with more stereotypes towards doctors. Italian students have high gender sensitivity and low gender stereotypes. Age, higher knowledge of gender medicine and having had a tutor that considered gender were associated with higher gender stereotypes. Focusing on gender awareness in medical schools can contribute to a better care.
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Affiliation(s)
- Fabrizio Bert
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - Edoardo Boietti
- Department of Public Health Sciences, University of Turin, Turin, Italy
- * E-mail:
| | - Stefano Rousset
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - Erika Pompili
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | | | - Marta Gea
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - Giacomo Scaioli
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - Roberta Siliquini
- Department of Public Health Sciences, University of Turin, Turin, Italy
- AOU City of Health and Science, University of Turin, Turin, Italy
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26
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Stark D, Ritter K. AIM and Gender Aspects. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Stenberg G, Fjellman-Wiklund A, Strömbäck M, Eskilsson T, From C, Enberg B, Wiklund M. Gender matters in physiotherapy. Physiother Theory Pract 2021; 38:2316-2329. [PMID: 34470538 DOI: 10.1080/09593985.2021.1970867] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The World Health Organization states that gender has implications for health across the course of a person's life in terms of norms, roles and relations. It also has implications in rehabilitation. In this article, we argue the need of gender perspectives in the field of physiotherapy; gender matters and makes a difference in health and rehabilitation. We highlight a number of central areas where gender may be significant and give concrete examples of social gender aspects in physiotherapy practice and in diverse patient groups. We also discuss why it can be important to consider gender from an organizational perspective and how sociocultural norms and ideals relating to body, exercise and health are gendered. Further we present useful gender theories and conceptual frameworks. Finally, we outline future directions in terms of gender-sensitive intervention, physiotherapy education and a gendered application of the ICF model. We want to challenge physiotherapists and physiotherapy students to broaden knowledge and awareness of how gender may impact on physiotherapy, and how gender theory can serve as an analytical lens for a useful perspective on the development of clinical practice, education and research within physiotherapy.
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Affiliation(s)
- Gunilla Stenberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | | | - Maria Strömbäck
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.,Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden
| | - Therese Eskilsson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Carin From
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Birgit Enberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Maria Wiklund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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28
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Rodríguez-Soza C, Ruiz-Cantero MT. [Gender blindness in medical textbooks: the case of leukemias]. GACETA SANITARIA 2021; 36:333-344. [PMID: 34274164 DOI: 10.1016/j.gaceta.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To analyse the existence of sex-differences in the content on leukemias in the Haematology and Internal Medicine textbooks recommended in the Medical Degrees, 2019-2020, by comparison with the sex-differences recognized in the scientific literature. METHOD Manifest content analysis of the content of chapters on leukemias in the books on hematology and internal medicine, clinical haematology and haematology undergraduate. Analysis categories: epidemiology, etiopathogenesis, diagnosis, treatment and prognosis of leukemias. RESULTS Epidemiological information from the revised books has a greater consideration of sex differences in incidence and prognosis but does not contain data on mortality and survival. Etiopathogenesis is described in all books as the same physiological process for both sexes and no differences in the presentation of symptoms are described in any book. Three books describe a unique treatment that is assumed equal for both sexes; two books mention the treatment of acute myeloid leukemia in pregnant women and one in chronic myeloid leukemia. No book mentions sex-differences in pharmacokinetics, efficacy, or treatment toxicity, although there is greater evidence on unequal behavior between the sexes. CONCLUSIONS The contents of sex and gender differences in the leukemia chapters analyzed are insufficient compared to the evidence in the scientific literature today. Hematology textbooks might increase their scientific quality in future editions, including knowledge of sex-gender interaction in the sections of epidemiology, etiology, pathogenesis, diagnosis, treatment, prognosis, and consequences of leukemias, which will contribute to better professional practices, more efficient and equitable.
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Affiliation(s)
| | - María Teresa Ruiz-Cantero
- Grupo de Investigación de Salud Pública, Universidad de Alicante, Alicante, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España.
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The effect of a situation model nursing education action program on gender-bias awareness and gender-friendliness barriers in novice nursing students. Nurse Educ Pract 2021; 54:103129. [PMID: 34214887 DOI: 10.1016/j.nepr.2021.103129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/14/2021] [Accepted: 06/22/2021] [Indexed: 11/21/2022]
Abstract
AIM This study presents a workshop on the Situation Model Nursing Education Action program, examines how to promote gender awareness and decrease barriers related to differences in gender friendliness through the implementation of this program and tracks the trends of the relevant variables. DESIGN Pre- and post-observations and a cohort study were conducted. METHODS A total of 58 nursing students (42 females and 16 males) were included. Nursing students were offered a gender-care intervention as two 90-minute workshops and surveys that measure gender awareness and gender friendliness were administered. RESULTS The results concerned gender-bias awareness and gender-friendliness barriers scores across the four weeks of the program intervention, with the generalized estimated difference score compared with the Week 1 baseline. Mean student scores showed that gender-bias awareness was significantly decreased at Week 2 (p < .001) and Week 4 (p < .001) and that mean gender-friendliness barrier scores significantly declined at Week 4 (p < .001). CONCLUSIONS The findings indicate that a faculty professional learning community workshop that facilitates intentional behavioral change can help faculty to become aware of gender bias, which can improve students' gender awareness through clinical case discussion and lead to a decline in barriers to students' gender friendliness.
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Wellesley Wesley E, Patel I, Kadra-Scalzo G, Pritchard M, Shetty H, Broadbent M, Segev A, Patel R, Downs J, MacCabe JH, Hayes RD, de Freitas DF. Gender disparities in clozapine prescription in a cohort of treatment-resistant schizophrenia in the South London and Maudsley case register. Schizophr Res 2021; 232:68-76. [PMID: 34022618 DOI: 10.1016/j.schres.2021.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/29/2021] [Accepted: 05/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gender disparities in treatment are apparent across many areas of healthcare. There has been little research into whether clozapine prescription, the first-line treatment for treatment-resistant schizophrenia (TRS), is affected by patient gender. METHODS This retrospective cohort study identified 2244 patients with TRS within the South London and Maudsley NHS Trust, by using a bespoke method validated against a gold-standard, manually coded, dataset of TRS cases. The outcome and exposures were identified from the free-text using natural language processing applications (including machine learning and rules-based approaches) and from information entered in structured fields. Multivariable logistic regression was carried out to calculate the odds ratios for clozapine prescription according to patients' gender, and adjusting for numerous potential confounders including sociodemographic, clinical (e.g., psychiatric comorbidities and substance use), neutropenia, functional factors (e.g., problems with occupation), and clinical monitoring. RESULTS Clozapine was prescribed to 77% of the women and 85% of the men with TRS. Women had reduced odds of being prescribed clozapine as compared to men after adjusting for all factors included in the present study (adjusted OR: 0.66; 95% CI 0.44-0.97; p = 0.037). CONCLUSION Women with TRS are less likely to be prescribed clozapine than men with TRS, even when considering the effects of multiple clinical and functional factors. This finding suggests there could be gender bias in clozapine prescription, which carries ramifications for the relatively poorer care of women with TRS regarding many outcomes such as increased hospitalisation, mortality, and poorer quality of life.
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Affiliation(s)
- Emma Wellesley Wesley
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - India Patel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Megan Pritchard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Hitesh Shetty
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Aviv Segev
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Rashmi Patel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Johnny Downs
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - James H MacCabe
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Richard D Hayes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Lu PY, Tsai JC, Green A, Hsu ASC. Assessing Asian Medical Students' Readiness for Diversity: Localizing Measures of Cross-Cultural Care Competence. TEACHING AND LEARNING IN MEDICINE 2021; 33:220-234. [PMID: 33181028 DOI: 10.1080/10401334.2020.1830097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Phenomenon: There is now broad acceptance that the development of cross-cultural competence (CCC) supports the delivery of appropriate care to diverse groups and is an essential component in medical education worldwide. CCC training in East Asian contexts has been constrained by the fact that "cultural diversity" training globally has focused primarily on the needs of racial and ethnic communities, to the relative neglect of other groups. The present study explores Taiwanese students' perceptions of CCC provision to identify gaps in local medical education and thus facilitate a more systematic delivery of CCC. Approach: Using an adapted and translated version of the Cross-Cultural Care Survey developed by Harvard Medical School, we collected 1567 student responses from four geographically-distributed Taiwanese medical schools between 2015 and 2017. In addition to student responses, we also collected 122 clinical teacher responses from two of the four medical schools that were surveyed to cross-examine the students' self-perceived competence. The data were analyzed with SPSS and ANOVA was employed with student data to compare the differences among different stages. The analysis focuses on CCC in 4 stages of training: general education, basic pre-clinical and integrated clinical sciences, clerkship, and internship. Findings: The findings show that students felt unprepared to deal with health disparities and the needs of diverse groups and there was no evidence of an increased sense of preparedness in the development of relevant skills in the analyses of the pre-clinical to clinical stages of the curriculum. Similarly, teachers also perceived students across the different stages of training to be unprepared in dealing with the health disparities and needs of diverse groups. However, although findings from teachers' responses parallel those from students, teachers tend to perceive students to be even more unprepared than they perceive themselves to be. The training for CCC appeared inadequate from both set of data and students perceive CCC training to be less explicitly evident in the medical program as it advances from the foundation stage to the pre-clinical stage. Insights: The study raises some crucial issues in terms of diversity and CCC training in medical education programs. The fact that increased awareness of health disparities and the needs of diverse groups fails to be aligned with a sense of preparedness and skillfulness confirms that CCC has not been explicitly and sufficiently addressed in the medical curriculum, particularly in the pre-clinical stage when the focus is on acquiring scientific and technical knowledge. This study shows how a questionnaire designed by and for an American medical institution situated in a highly diverse society can be adapted so that its findings serve as a baseline for medical education programs in Taiwan, and perhaps in other countries that are beginning to acknowledge hitherto "hidden" diversity. This study also has implications which indicate that CCC is crucial in the delivery of appropriate care by members of the medical profession to diverse patients.
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Affiliation(s)
- Peih-Ying Lu
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- College of Humanities and Social Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Medical Education and Humanizing Health Professional Education, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jer-Chia Tsai
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Medical Education and Humanizing Health Professional Education, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Alexander Green
- Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anna S C Hsu
- Center for Medical Education and Humanizing Health Professional Education, Kaohsiung Medical University, Kaohsiung, Taiwan
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Weiss J, Balasuriya L, Cramer LD, Nunez-Smith M, Genao I, Gonzalez-Colaso R, Wong AH, Samuels EA, Latimore D, Boatright D, Sharifi M. Medical Students' Demographic Characteristics and Their Perceptions of Faculty Role Modeling of Respect for Diversity. JAMA Netw Open 2021; 4:e2112795. [PMID: 34086032 PMCID: PMC8178710 DOI: 10.1001/jamanetworkopen.2021.12795] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Faculty role modeling is critical to medical students' professional development to provide culturally adept, patient-centered care. However, little is known about students' perceptions of faculty role modeling of respect for diversity. OBJECTIVE To examine whether variation exists in medical students' perceptions of faculty role modeling of respect for diversity by student demographic characteristics. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed data from the Association of American Medical Colleges' 2016 and 2017 Medical School Graduation Questionnaire, which was administered to graduating students at 140 accredited allopathic US medical schools. Data were analyzed from January 1 to November 1, 2020. MAIN OUTCOMES AND MEASURES Students' perceptions of faculty role modeling of respect for diversity by the independent variables sex, race/ethnicity, sexual orientation, and age. Multivariable logistic regression was used to examine the extent to which student-reported perceptions of faculty respect for diversity varied by demographic characteristics, and logistic regression models were sequentially adjusted first for demographic characteristics and then for marital status and financial variables. RESULTS Of 30 651 students who completed the survey, the final study sample consisted of 28 778 respondents, representing 75.4% of the 38 160 total US medical school graduates in 2016 and 2017. Of the respondents, 14 804 (51.4%) were male participants and 1506 (5.2%) identified as lesbian, gay, or bisexual (LGB); a total of 11 926 respondents (41.4%) were 26 years or younger. A total of 17 159 respondents (59.6%) identified as White, 5958 (20.7%) as Asian, 1469 (5.1%) as Black/African American, 2431 (8.4%) as Hispanic/Latinx, and 87 (0.3%) as American Indian/Alaska Native/Native Hawaiian/Pacific Islander individuals. Overall, 5101 students (17.7%) reported perceiving that faculty showed a lack of respect for diversity. Of those who identified as Black/African American students, 540 (36.8%) reported perceiving a lack of faculty respect for diversity compared with 2468 White students (14.4%), with an OR of perceived lack of respect of 3.24 (95% CI, 2.86-3.66) after adjusting for other demographic characteristics and covariates. American Indian/Alaska Native/Native Hawaiian/Pacific Islander (OR, 1.73; 95% CI, 1.03-2.92), Asian (OR, 1.62; 95% CI, 1.49-1.75), or Hispanic/Latinx (OR, 1.43; 95% CI, 1.26-1.75) students also had greater odds of perceiving a lack of faculty respect for diversity compared with White students. Female students had greater odds compared with male students (OR, 1.17; 95% CI, 1.10-1.25), and students who identified as LGB (OR, 1.96; 95% CI, 1.74-2.22) or unknown sexual orientation (OR, 1.79; 95% CI, 1.29-2.47) had greater odds compared with heterosexual students. Students aged 33 years or older had greater odds of reporting a perceived lack of respect compared with students aged 26 years or younger (OR, 1.81; 95% CI, 1.58-2.08). CONCLUSIONS AND RELEVANCE In this cross-sectional study, female students, students belonging to racial/ethnic minority groups, and LGB students disproportionately reported perceiving a lack of respect for diversity among faculty, which has important implications for patient care, the learning environment, and the well-being of medical trainees.
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Affiliation(s)
- Jasmine Weiss
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Lilanthi Balasuriya
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Laura D. Cramer
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Marcella Nunez-Smith
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Inginia Genao
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Ambrose H. Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Elizabeth A. Samuels
- Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Darin Latimore
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mona Sharifi
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
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Prandelli M, Testoni I. Inside the doctor's office. Talking about intersex with Italian health professionals. CULTURE, HEALTH & SEXUALITY 2021; 23:484-499. [PMID: 32935650 DOI: 10.1080/13691058.2020.1805641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 08/01/2020] [Indexed: 06/11/2023]
Abstract
This article explores how health professionals in Italy understand variations of sex characteristics (VSC), also referred to as intersex and/or disorders of sex development (DSD). With estimates of VSC frequency ranging from 0.018% to 1.7%, only a handful of highly specialised medical doctors are considered DSD experts. When addressing the daily health management of children and families who do not live near specialist DSD centres, these experts may refer individuals to the nearest health professional that Italian health services provides, opening up questions regarding how these professionals might act and react when faced with VSC. In this analysis of interview data from 65 Italian general practitioners, paediatricians and psychologists, we address two themes. The first theme discusses participants' previous experiences and case management, with a focus on social, medical and gender biases. The second theme examines health professionals' opinions and perspectives on ongoing conflicts concerning current best care practices. Our results highlight health professionals' cultural and gendered biases, confirming the need to develop specific professional training, guidelines and policies to improve the healthcare of people with VSC.
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Affiliation(s)
- Marta Prandelli
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova, Padova, Italy
| | - Ines Testoni
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova, Padova, Italy
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Simbar M, Rahmanian F, Nazarpour S, Ramezankhani A, Zayeri F. Needs for a gender-based perimarital couples' counselling services in Iran. Nurs Open 2021; 8:850-857. [PMID: 33570272 PMCID: PMC7877227 DOI: 10.1002/nop2.692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 09/28/2020] [Accepted: 10/29/2020] [Indexed: 02/05/2023] Open
Abstract
AIM To assess needs for a gender-sensitive perimarital counselling services in Iran. DESIGN A descriptive cross-sectional study. METHODS This was a study on all 236 premarital counselling providers in 37 health centres in Shiraz-Iran. The tools for data collection included the following: (a) a demographic information questionnaire and; (b) a valid and reliable Needs Assessment questionnaire for Gender-Sensitive Perimarital Counseling Services (GSPCS) in 3 sections of needs for process, structure and policy making of the perimarital counselling services. Data were analysed using SPSS 21. RESULTS All health providers with average working experience of 8.63 (SD 5.35) years participated in the study. Results demonstrated highest scores for needs related to facilities as the structure of the services (90.09 SD 13.70 per cent) and community empowerment (89.50 SD 16.67 per cent) as the necessary policy for the gender-sensitive services. We concluded that providing gender-sensitive perimarital counselling healthcare services needs to reform the process, structure and policies of the services.
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Affiliation(s)
- Masoumeh Simbar
- Midwifery and Reproductive Health Research CenterSchool of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
| | - Fatemeh Rahmanian
- Department of MidwiferySchool of Nursing and MidwiferyShiraz University of Medical SciencesShirazIran
| | - Soheila Nazarpour
- Department of MidwiferyChalous BranchIslamic Azad UniversityChalousIran
| | - Ali Ramezankhani
- Department of Public HealthFaculty of HealthShahid Beheshti University of Medical SciencesTehranIran
| | - Farid Zayeri
- Department of BiostatisticsFaculty of ParamedicineShahid Beheshti University of Medical SciencesTehranIran
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Educating on Sexuality to Promote Health: Applied Experiences Mainstreaming the Gender and Human Rights Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052249. [PMID: 33668688 PMCID: PMC7956297 DOI: 10.3390/ijerph18052249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 11/18/2022]
Abstract
In the articulation between research and health intervention, we see the need to situate comprehensive sexuality education in the triangle formed by the salutogenic approach, the mainstreaming of gender and human rights, and the development of competencies in health promotion. For this purpose, we present a set of investigations carried out in Ecuador and Spain through a qualitative methodology with the respective health interventions that seek to obtain significant results of the teaching–learning process on sexuality. The field work contemplates situations of violence as a health problem, orienting the intervention in health empowerment toward pleasure. The health education experiences implemented allow us to conclude that comprehensive sexuality education reinforces the competencies of health personnel to attend to diversity. These findings, and the results expected in ongoing research, allow us to form a competency framework aimed at specifically improving medical education so that medical professionals can generate health processes with a cross-cutting approach to gender and human rights.
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Agboola IK, Coupet E, Wong AH. "The Coats That We Can Take Off and the Ones We Can't": The Role of Trauma-Informed Care on Race and Bias During Agitation in the Emergency Department. Ann Emerg Med 2021; 77:493-498. [PMID: 33579587 DOI: 10.1016/j.annemergmed.2020.11.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Isaac K Agboola
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
| | - Edouard Coupet
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Ambrose H Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
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AIM and Gender Aspects. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-58080-3_244-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Klein V, Brunner F, Grabowski M, Turner D. Stigma Surrounding Sexually Transmitted Infections among Medical Students in Germany. JOURNAL OF SEX RESEARCH 2021; 58:129-136. [PMID: 32500718 DOI: 10.1080/00224499.2020.1763238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Stigmatization by health care professionals leads to decreased help-seeking behaviors in those being stigmatized. Prejudicial attitudes are especially pronounced concerning sexually transmitted infections (STIs), which is crucial in light of rising prevalence rates of STIs in recent years. We aimed to examine stigmatization against patients with sexually versus non-sexually transmitted infections among medical students in Germany. We also assessed how a person's sexual orientation or gender might contribute to stigma. Medical students (N = 332) read about a fictious patient with symptoms of pharyngitis after having had a casual sex encounter. Gender (female/male) and sexual orientation (hetero-/bi-/homosexual) of the patient as well as the pathogen causing the infection (gonococcus/H1N1-virus) were randomly varied. Afterwards, stigma against the patient was assessed. Patients with a gonococcal pharyngitis were perceived as more prone to engage in risky behavior, dumber, and less responsible than patients with a H1N1-virus pharyngitis. Bisexual patients were perceived as more prone to engage in risky behavior than hetero- and homosexual individuals. The predictability of the consequences of the patient's actions was rated higher in bisexual patients. Stigmatizing attitudes toward patients with a STI were frequent, especially against bisexual patients. More education should be dedicated to sexual/LGB health during medical school to reduce existing stigma.
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Affiliation(s)
- Verena Klein
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf
| | - Franziska Brunner
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf
| | - Max Grabowski
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz
| | - Daniel Turner
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz
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Kisiel MA, Kühner S, Stolare K, Lampa E, Wohlin M, Johnston N, Rask-Andersen A. Medical students' self-reported gender discrimination and sexual harassment over time. BMC MEDICAL EDUCATION 2020; 20:503. [PMID: 33302936 PMCID: PMC7731624 DOI: 10.1186/s12909-020-02422-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/03/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND Gender discrimination (GD) and sexual harassment (SH) occur at all academic institutions worldwide. Medical students report high prevalence of GD and SH, which may negatively affect their education and health. There are indications that policies and reforms on reducing GD/SH are insufficient. Swedish medical students' experiences of GD/SH are monitored by course-evaluations and bi-annual student union evaluations; however, the response rate is usually low. The aim of this study was to compare the exposure to and context of self-reported GD/SH over an 11-year period amongst medical students at a Swedish university. METHODS In 2002, a questionnaire (n = 622) was mailed to medical students' home addresses. It was repeated in 2013 and then distributed during mandatory lectures (n = 856). The questions used a behavioristic approach and asked about specific GH/SH experiences. Participation was voluntary and anonymous. The changes in prevalence over time were calculated by sampling weights in order to obtain comparable estimates, representative of both cohorts. RESULTS The response frequency was 55% (62% women) in 2002 and 81% (59% women) in 2013. The prevalence of GD tended to decrease for male and clinical students in comparison to female and pre-clinical peers. However, the prevalence of SH increased for female compared to male students. The ratio of SH for female pre-clinical students doubled in many instances; most often, the mistreatment occurred in the clinic. Medical doctors were indicated as perpetrators up to five times more often by all students in 2013. CONCLUSION Our results show a disproportional change in exposure to GD/SH between female and male medical students, resulting in a widening of the gender gap regarding prevalence of GD and SH between 2002 and 2013. In particular, personal experiences of SH increased for both sexes. It is proof that institutional efforts to fight mistreatment might be ineffective.
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Affiliation(s)
- Marta A Kisiel
- Department of Medical Sciences, Environmental and Occupational Medicine, Uppsala University, Dag Hammarskjölds Väg, 60 751 85, Uppsala, Sweden.
| | - Sofia Kühner
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Karin Stolare
- Department of Psychiatry, Uppsala University, Uppsala, Sweden
| | - Erik Lampa
- UCR-Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Martin Wohlin
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Nina Johnston
- UCR-Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Anna Rask-Andersen
- Department of Medical Sciences, Environmental and Occupational Medicine, Uppsala University, Dag Hammarskjölds Väg, 60 751 85, Uppsala, Sweden
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Dash NR, Guraya SY, Al Bataineh MT, Abdalla ME, Yusoff MSB, Al-Qahtani MF, van Mook WNKA, Shafi MS, Almaramhy HH, Mukhtar WNO. Preferred teaching styles of medical faculty: an international multi-center study. BMC MEDICAL EDUCATION 2020; 20:480. [PMID: 33256705 PMCID: PMC7708200 DOI: 10.1186/s12909-020-02358-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 11/04/2020] [Indexed: 05/16/2023]
Abstract
BACKGROUND In the current wave of educational reforms, understanding teaching styles of medical faculty can help modify instructional strategies for effective teaching. Few studies have probed distinctive teaching styles of medical faculty. We compared preferred teaching styles of faculty from seven medical schools in United Arab Emirates, the Netherlands, Saudi Arabia, Malaysia, Pakistan, and Sudan. METHODS The validated Grasha-Riechmann teaching style inventory was administered online for data collection and used SPSS version 20.0 for statistical analysis. RESULTS Of the 460 invitees, 248 responded (response rate; 54%). Delegator teaching style was most common with a highest median and mean of 2.38 and 2.45, respectively. There was a significant correlation between expert and authority teaching styles, correlation coefficient 0.62. Similarly, we found a significant correlation between authority teaching style and nature of curriculum, correlation coefficient 0.30. Multiple regression analysis showed that only authority teaching style and male gender had significant correlation. Interestingly, 117 (47%) teachers disagreed with the teaching philosophy of delivering course contents by strictly following learning outcomes. Female teachers (114/248) were more willing to negotiate with their students regarding how and what to teach in their course, while male teachers tended to allow more autonomy by allowing students to set their learning agenda. CONCLUSIONS This study showed that the medical teachers preferred delegator teacher style that promotes students' collaboration and peer-to-peer learning. Most teachers are conscious of their teaching styles to motivate students for scientific curiosity. These findings can help medical educators to modify their teaching styles for effective learning.
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Affiliation(s)
- Nihar Ranjan Dash
- Clinical Sciences Department, College of Medicine, University of Sharjah, Post Box –, 27272 Sharjah, United Arab Emirates
| | - Salman Yousuf Guraya
- Clinical Sciences Department, College of Medicine, University of Sharjah, Post Box –, 27272 Sharjah, United Arab Emirates
| | - Mohammad Tahseen Al Bataineh
- Clinical Sciences Department, College of Medicine, University of Sharjah, Post Box –, 27272 Sharjah, United Arab Emirates
| | - Mohamed Elhassan Abdalla
- Clinical Sciences Department, College of Medicine, University of Sharjah, Post Box –, 27272 Sharjah, United Arab Emirates
| | | | - Mona Faisal Al-Qahtani
- College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Walther N. K. A. van Mook
- School of Health Professions Education, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Muhammad Saeed Shafi
- Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
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Berbegal-Bolsas M, Gasch-Gallén Á, Oliván-Blázquez B, Sánchez Calavera MA, García-Arcega P, Magallón-Botaya R. Variables associated with a higher awareness of gender-based violence by students of the health sciences and social work. GACETA SANITARIA 2020; 36:146-151. [DOI: 10.1016/j.gaceta.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 11/25/2022]
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Miles A, Hayden S, Carnell S, Halan S, Lok B. What do speech pathology students gain from virtual patient interviewing? A WHO International Classification of Functioning Disability and Health (ICF) analysis. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:239-245. [DOI: 10.1136/bmjstel-2020-000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 11/03/2022]
Abstract
BackgroundVirtual patients have an established place in medical education but do virtual patient interviews train holistic clinicians or just diagnosticians? This study explored speech pathology students’ virtual patient interviews using WHO International Classification of Functioning Disability and Health (ICF).MethodsEighteen speech pathology students in their final year of training participated. Students interviewed virtual patients with dysphagia (swallowing difficulties) as part of their curriculum. Student questions and patient responses were coded using established ICF coding. Codes were tallied and compared under categories of body structures, body functions, activities/participation and environmental factors. Flesch Reading Ease was calculated as a measure of health literacy.ResultsConversational turns primarily focused on the ICF component—activity and participation in both student questions and virtual patient responses: 0.03% body structures, 30% body functions—swallowing, 7% body functions—associated, 43% activities/participation and 19% environmental factors. Personal factors such as gender, ethnicity, age or socio-economic situation were not mentioned by student or patient. Patients commented on social impact on self and/or family, sometimes in the absence of targeted student questions. Student and virtual patient Flesch Reading Ease scores were congruent.ConclusionSpeech pathology students naturally matched their virtual patient’s health-literacy level and asked a range of medical and daily living questions. Virtual patients readily offered social impact information to student questions. Computer science: healthcare teams should consider creating virtual patients who challenge students to practise asking sensitive questions and in doing so develop holistic thinkers with competent communication skills.
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Ehlke SJ, Braitman AL, Dawson CA, Heron KE, Lewis RJ. Sexual Minority Stress and Social Support Explain the Association between Sexual Identity with Physical and Mental Health Problems among Young Lesbian and Bisexual Women. SEX ROLES 2020; 83:370-381. [PMID: 34149149 PMCID: PMC8211095 DOI: 10.1007/s11199-019-01117-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Bisexual women report more physical and psychological health problems than lesbian women do, which may be attributed to greater sexual minority stress and less social support. However, many studies combine lesbian and bisexual women into a single group. The current study examined if sexual minority stress and social support mediated the association between women's sexual identity (lesbian or bisexual) and health-related outcomes. A total of 650 U.S. young adult lesbian (n = 227) and bisexual (n = 423) women completed an online survey about sexual minority stress, social support, and physical and mental health problems. Bisexual women reported more physical and mental health problems. A sequential mediation model showed that bisexual women reported greater sexual minority stress than lesbian women, which in turn was associated with less social support, which was associated with more physical and mental health problems. Greater sexual minority stress and lower social support may help explain why bisexual women report more health-related problems than lesbian women. The results of the present study support the importance of examining risk and protective factors for health problems separately for lesbian and bisexual women. Health-related intervention programs that target sexual minority women may need to be tailored differently for lesbian and bisexual women.
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Affiliation(s)
- Sarah J Ehlke
- Department of Psychology, Old Dominion University, Norfolk, VA
| | - Abby L Braitman
- Department of Psychology, Old Dominion University, Virginia Consortium Program in Clinical Psychology, Norfolk, VA
| | - Charlotte A Dawson
- Department of Psychology, Old Dominion University, Virginia Consortium Program in Clinical Psychology, Norfolk, VA
| | - Kristin E Heron
- Department of Psychology, Old Dominion University, Virginia Consortium Program in Clinical Psychology, Norfolk, VA
| | - Robin J Lewis
- Department of Psychology, Old Dominion University, Virginia Consortium Program in Clinical Psychology, Norfolk, VA
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Rrustemi I, Locatelli I, Schwarz J, Lagro-Janssen T, Fauvel A, Clair C. Gender awareness among medical students in a Swiss University. BMC MEDICAL EDUCATION 2020; 20:156. [PMID: 32487129 PMCID: PMC7268694 DOI: 10.1186/s12909-020-02037-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 04/07/2020] [Indexed: 05/10/2023]
Abstract
BACKGROUND Gender is an important social determinant, that influences healthcare. The lack of awareness on how gender influences health might lead to gender bias and can contribute to substandard patient care. Our objectives were to assess gender sensitivity and the presence of gender stereotypes among swiss medical students. METHODS A validated scale (N-GAMS - Nijmegen Gender Awareness in Medicine Scale), with 3 subscores assessing gender sensitivity (GS) and gender stereotypes toward patients (GRIP) and doctors (GRID) (ranging from 1 to 5), was translated into French and was distributed to all medical students registered at the University of Lausanne, Switzerland in April-May 2017. Reliability of the three subscales was assessed calculating the alpha Cronbach coefficient. Mean subscales were calculated for male and female students and compared using two sample t-tests. A linear model was built with each subscale as a dependent variable and students' sex and age as covariables. RESULTS In total, 396 students answered the N-GAMS questionnaire, their mean age was 22 years old, 62.6% of them were women. GS and GRID sub-scores were not significantly different between female and male students (GS 3.62 for women, 3.70 for men, p = 0.27, GRID 2.10 for women, 2.13 for men, p = 0.76). A statistically significant difference was found in the GRIP subscale, with a mean score of 1.83 for women and 2.07 for men (p < 0.001), which suggests a more gender stereotyped opinion toward patients among male students. A trend was observed with age, gender sensibility increased (p < 0.001) and stereotypes decreased (GRIP p = 0.04, GRID p = 0.02) with students getting older. CONCLUSION Medical students' gender sensitivity seems to improve throughout the medical curriculum, and women students have less stereotypes towards patients than men do. The implementation of a gender-sensitive teaching in the medical curriculum could improve students' knowledge, limit gender bias and improve patients' care.
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Affiliation(s)
- Ilire Rrustemi
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Center for Primary Care and Public Health (Unisanté), Lausanne, Rue du Bugnon 44, CH-1011 Lausanne, Switzerland
| | - Isabella Locatelli
- Center for Primary Care and Public Health (Unisanté), Lausanne, Rue du Bugnon 44, CH-1011 Lausanne, Switzerland
| | - Joëlle Schwarz
- Center for Primary Care and Public Health (Unisanté), Lausanne, Rue du Bugnon 44, CH-1011 Lausanne, Switzerland
| | - Toine Lagro-Janssen
- Dept. of Primary and Community Care, Radboud University Medical Center, Geert Grooteplein 21, 6525 EZ Nijmegen, Netherlands
| | - Aude Fauvel
- Institute of Humanities in Medicine, Lausanne University Hospital (CHUV), Lausanne, Avenue de Provence 82, 1007 Lausanne, Switzerland
| | - Carole Clair
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Center for Primary Care and Public Health (Unisanté), Lausanne, Rue du Bugnon 44, CH-1011 Lausanne, Switzerland
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Shaw MK, Chandratilake M, Ho MJ, Rees CE, Monrouxe LV. Female victims and female perpetrators: medical students' narratives of gender dynamics and professionalism dilemmas. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:299-319. [PMID: 31541318 DOI: 10.1007/s10459-019-09919-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 09/13/2019] [Indexed: 06/10/2023]
Abstract
Medicine is a gendered discipline, in which women, both as patients and practitioners, have often held subordinate positions. The reproduction of dominant gender biases in the medical setting can negatively impact the professional development of medical students and the wellbeing of patients. In this analysis of medical students' narratives of professionalism dilemmas, we explore students' experiences of gender bias in hospital settings. Seventy-one students participated in 12 group interviews, where they discussed witnessing or participating in various activities that they thought were professionalism lapses. Within the dataset, 21 narratives had a distinctly gendered component broadly pertaining to patient dignity and safety dilemmas, informed consent issues, and female student abuse. Interestingly, perpetrators of such acts were commonly female healthcare professionals and educators. Although students recognized such acts as professionalism lapses and often expressed concern for patient wellbeing, students did not intervene or report such acts due to hierarchical cultural contexts, and at times even reproduced the discriminatory behavior they were criticizing. This raises concerns about medical students' professionalism development and the extent to which gender bias is ingrained within particular medical systems. The normalization of disrespectful and abusive treatment of female patients poses immediate and future consequences to the wellbeing and safety of women. Furthermore, the same socio-cultural values that sustain these acts may account for perpetrators often being women themselves as they strive to overcome their subordinate position within medicine.
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Affiliation(s)
- Malissa K Shaw
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan
| | | | - Ming-Jung Ho
- Department of Family Medicine and Center for Innovation and Leadership in Education, Georgetown University School of Medicine, Washington, DC, USA
| | - Charlotte E Rees
- Monash Centre for Scholarship in Health Education (MCSHE), Monash University, Melbourne, Australia
| | - Lynn V Monrouxe
- Faculty of Health Sciences, Work Integrated Learning, The University of Sydney, Room J213, Level 2, J Block, 75 East Street, Lidcombe, NSW, 2140, Australia.
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Arda B. Is There Any Room for Women in Medical Research? Bioethical Concerns. Balkan Med J 2020; 37:58-59. [PMID: 31877617 PMCID: PMC7094180 DOI: 10.4274/balkanmedj.galenos.2020.2020.2.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Berna Arda
- Department of History of Medicine and Ethics, Ankara University Faculty of Medicine, Ankara, Turkey
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Scholte JK, van der Meulen FWM, Teunissen TAM, Albers M, Laan RFJM, Fluit CRMG, Lagro-Janssen ALM. Exploring the views of successful applicants for medical school about gender medicine using a gender-sensitive video assignment. BMC MEDICAL EDUCATION 2020; 20:25. [PMID: 31992281 PMCID: PMC6988225 DOI: 10.1186/s12909-020-1936-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 01/15/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Sex and gender influence health and disease outcomes, therefore, doctors should be able to deliver gender-sensitive care. To train gender-sensitive doctors, relevant sex and gender differences have to be included in medical education. In order to develop appealing, relevant, and effective education for undergraduate medical students, education should be tailored to students' level and anticipated on their ideas and assumptions. Therefore, we wanted to answer the following research questions: 1. What do aspiring medical students want to learn about gender medicine?; 2. How would they like to learn about gender medicine?; and 3. What are their ideas and assumptions about sex and gender differences in health and disease? METHODS We performed an explorative thematic document analysis of educational assignments made by successful applicants (n = 50) during the selection procedure of their entry into medical school. To test aspirants' capacity for self-directed learning, students were asked to formulate their own study plan after they watched a video that resembled a future practical experience (a consultation with a patient). As the content of this video was gender-sensitive, the assignments of the successful applicants gave us the unique opportunity to examine aspiring medical students' views about gender medicine. RESULTS Aspiring medical students were eager to start their training to become gender-sensitive doctors. They believed in better care for all patients and thought doctors should obtain gender competences during their medical training. Students preferred to start with acquiring basic biomedical knowledge about differences between men and women and continue their training by developing gender-sensitive communication skills in (simulated) practical settings. Students differed in their interpretation of the gender-sensitive video, some generalized potential differences to all men and all women. Teachers were considered as important role models in learning about gender medicine. CONCLUSIONS We advise medical schools to teach gender medicine from the beginning of medical school, by focusing on sex differences first and adding gender related themes later on in the curriculum. As students may interpret gender-sensitive information differently, structurally embedding reflection on gender medicine with gender competent teachers is necessary.
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Affiliation(s)
- Joni K. Scholte
- Department of Primary and Community Care, Gender & Women’s Health, Radboud University Medical Center, Post box 9101, 6500 HB Nijmegen, The Netherlands
| | - Francisca W. M. van der Meulen
- Department of Primary and Community Care, Gender & Women’s Health, Radboud University Medical Center, Post box 9101, 6500 HB Nijmegen, The Netherlands
| | - Theodora A. M. Teunissen
- Department of Primary and Community Care, Gender & Women’s Health, Radboud University Medical Center, Post box 9101, 6500 HB Nijmegen, The Netherlands
| | - Mieke Albers
- Department of Primary and Community Care, Gender & Women’s Health, Radboud University Medical Center, Post box 9101, 6500 HB Nijmegen, The Netherlands
| | - Roland F. J. M. Laan
- Radboudumc Health Academy, Research in Learning and Education, Radboud University Medical Center, Post box 9101, 6500 HB Nijmegen, The Netherlands
| | - Cornelia R. M. G. Fluit
- Radboudumc Health Academy, Research in Learning and Education, Radboud University Medical Center, Post box 9101, 6500 HB Nijmegen, The Netherlands
| | - Antoine L. M. Lagro-Janssen
- Department of Primary and Community Care, Gender & Women’s Health, Radboud University Medical Center, Post box 9101, 6500 HB Nijmegen, The Netherlands
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Siller H, Tauber G, Hochleitner M. Does diversity go beyond sex and gender? Gender as social category of diversity training in health profession education - a scoping review. GMS JOURNAL FOR MEDICAL EDUCATION 2020; 37:Doc25. [PMID: 32328527 PMCID: PMC7171361 DOI: 10.3205/zma001318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/09/2019] [Accepted: 05/28/2019] [Indexed: 05/03/2023]
Abstract
Background: Sex and gender are social categories of diversity. Diversity can be perceived with an intersectional framework as it demonstrates the intersecting categories that might contribute to oppression, inequality, power and privilege. This article focused on what aspects were considered in diversity training programmes for health professions and the role of sex/gender in this context. Method: This scoping review focuses on the social categories mentioned in diversity education of health professionals. Articles on diversity training for health professionals were searched for in the Web of Science database using the keywords gender, diversity, training, education and health professions. Twelve articles were finally included in this review. Thematic analysis was employed to summarise information deduced from articles. Findings: Gaps in the aspects included in diversity training were identified. Findings show that culture was mostly discussed, whereas sex/gender and lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) were focused on only to a minor extent. Cultural diversity training includes self-reflection on one's own culture, whereas a comparable tool for sex/gender and LGBTQI is missing. Additionally, other social categories of diversity, such as disability or age, are largely absent. Conclusion: Diversity should be incorporated in its full breadth in health profession education and not fragmented. Additionally, other social categories such as gender might benefit from including self-reflection on these categories in addition to reflecting on the role of power and privilege in order to increase self-awareness for diversity. In this way, othering of the population might be prevented and healthcare can be improved for all.
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Affiliation(s)
- Heidi Siller
- Medical University of Innsbruck, Gender Medicine Unit, Innsbruck, Austria
- *To whom correspondence should be addressed: Heidi Siller, Medical University of Innsbruck, Gender Medicine Unit, Innrain 66, A-6020 Innsbruck, Austria, phone: +43 (0)512 504 25714, Fax: +43 (0)512 504 25719, E-mail:
| | - Gloria Tauber
- Medical University of Innsbruck, Gender Medicine Unit, Innsbruck, Austria
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Lohr C, Schmidt T, Medina-Porqueres I, Braumann KM, Reer R, Porthun J. Diagnostic accuracy, validity, and reliability of Tensiomyography to assess muscle function and exercise-induced fatigue in healthy participants. A systematic review with meta-analysis. J Electromyogr Kinesiol 2019; 47:65-87. [DOI: 10.1016/j.jelekin.2019.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/16/2019] [Accepted: 05/03/2019] [Indexed: 02/04/2023] Open
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50
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Shahvisi A, Finnerty F. Why it is unethical to charge migrant women for pregnancy care in the National Health Service. JOURNAL OF MEDICAL ETHICS 2019; 45:489-496. [PMID: 31023767 DOI: 10.1136/medethics-2018-105224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/05/2019] [Accepted: 03/11/2019] [Indexed: 06/09/2023]
Abstract
Pregnancy care is chargeable for migrants who do not have indefinite leave to remain in the UK. Women who are not 'ordinarily resident', including prospective asylum applicants, some refused asylum-seekers, unidentified victims of trafficking and undocumented people are required to pay substantial charges in order to access antenatal, intrapartum and postnatal services as well as abortion care within the National Health Service. In this paper, we consider the ethical issues generated by the exclusion of pregnancy care from the raft of services which are free to all. We argue that charging for pregnancy care amounts to sex discrimination, since without pregnancy care, sex may pose a barrier to good health. We also argue that charging for pregnancy care violates bodily autonomy, entrenches the sex asymmetry of sexual responsibility, centres the male body and produces health risks for women and neonates. We explore some of the ideological motivations for making maternity care chargeable, and suggest that its exclusion responds to xenophobic populism. We recommend that pregnancy care always be free regardless of citizenship or residence status, and briefly explore how these arguments bear on the broader moral case against chargeable healthcare for migrants.
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