Expert consensus on gender criteria for assessment in medical communication education

"I'd have no idea how to go about this…" - a survey of Australian medical students' perspectives on their men's health education

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.

Approaches to Engaging Men During Primary Healthcare Encounters: A scoping review

Gender-responsive healthcare is critical to advancing men's health given that masculinities intersect with other social determinants to impact help-seeking, engagement with primary healthcare, and patient outcomes. A scoping review was undertaken with the aim to synthesize gender-responsive approaches used by healthcare providers (HCPs) to engage men with primary healthcare. MEDLINE, PubMed, CINAHL, and PsycINFO databases were searched for articles published between 2000 and February 2024. Titles and abstracts for 15,659 citations were reviewed, and 97 articles met the inclusion criteria. Data were extracted and analyzed thematically. Thirty-three approaches were synthesized from across counseling/psychology, general practice, social work, nursing, psychiatry, pharmacy, and unspecified primary healthcare settings. These were organized into three interrelated themes: (a) tailoring communication to reach men; (b) purposefully structuring treatment to meet men's health needs, and (c) centering the therapeutic alliance to retain men in care. Strength-based and asset-building approaches focused on reading and responding to a diversity of masculinities was reinforced across the three findings. While these approaches are recommended for the judicious integration into health practitioner education and practice, this review highlighted that the evidence remains underdeveloped, particularly for men who experience health inequities. Critical priorities for further research include intersectional considerations and operationalizing gender-responsive healthcare approaches for men and its outcomes, particularly at first point-of-contact encounters.

Virologists' Sex- and Gender-Based Medical Knowledge of COVID-19 Affects Quality of Students' Education

Background

A sex- and gender-based approach to medical education is important to develop new knowledge and to improve quality of and equality within health care. Results of a systematic survey showed a lack of sex- and gender-based medical education at German medical faculties. The global severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic is affecting people from diverse backgrounds differently, and the reciprocal interactions between biological sex and sociocultural gender aspects with regard to coronavirus disease 2019 (COVID-19) necessitate an intersectional research approach and transfer to medical education.

Methods

This descriptive-phenomenological qualitative online survey focused on the sex and gender knowledge of faculty staff and the status of implementation in medical education and research at departments of virology and immunology at German university hospitals. It comprised 16 questions generated by an expert consortium based on published research data. In the fall of 2021, 36 leading virologists were invited to participate anonymously in this survey.

Results

The response rate was 44%. Most experts deemed sex and gender knowledge as not that important or not important. Almost half the lecturers supported a sex- and gender-based research design and sex-disaggregated analysis of animal study data. Biological sex differences and gender aspects regarding SARS-CoV-2 were at least occasionally addressed upon a student's request.

Conclusion

Virologists attributed only minor importance to sex and gender knowledge, despite scientific evidence of sex and gender differences in the field of virology, immunology, and COVID-19 in particular. This knowledge is not systematically implemented in the curriculum, but rather only occasionally passed on to medical students.

Defining the observable processes of patient care related to social determinants of health

INTRODUCTION

An understanding of social determinants of health (SDH) and patients' social circumstances is recommended to deliver contextualised care. However, the processes of patient care related to SDH in clinical settings have not been described in detail. Observable practice activities (OPAs) are a collection of learning objectives and activities that must be observed in daily practice and can be used to describe the precise processes for professionals to follow in specific situations (process OPA.) METHODS: We used a modified Delphi technique to generate expert consensus about the process OPA for patient care related to SDH in primary care settings. To reflect the opinions of various stakeholders, the expert panel comprised clinical professionals (physicians, nurses, public health nurses, social workers, pharmacists and medical clerks), residents, medical students, researchers (medical education, health care, sociology of marginalised people), support members for marginalised people and patients. The Delphi rounds were conducted online. In Round 1, a list of potentially important steps in the processes of care was distributed to panellists. The list was modified, and one new step was added. In Round 2, all steps were acknowledged with few modifications.

RESULTS

Of 63 experts recruited, 61 participated, and all participants completed the Delphi rounds. A total of 14 observable steps were identified, which were divided into four components: communication, practice, maintenance and advocacy. The importance of ongoing patient-physician relationships and collaboration with professionals and stakeholders was emphasised for the whole process of care.

DISCUSSION

This study presents the consensus of a variety of experts on the process OPA for patient care related to SDHs. Further research is warranted to investigate how this Communication-Practice-Maintenance-Advocacy framework could affect medical education, quality of patient care, and patient outcomes.

Development and Validation of a Performance Assessment Checklist Scale for Vaccine Administration

Objective Vaccination technique is a crucial skill for medical trainees to learn, especially in the current coronavirus disease 2019 pandemic. To this end, validated assessment tools are essential in teaching appropriate techniques. However, valid instruments for assessing vaccine administration skills have not yet been developed. We therefore explored the development and validation of an assessment tool for vaccination techniques based on expert consensus. Methods We implemented a modified Delphi process to develop a vaccination technique assessment tool. We then conducted a validation study to establish the reliability and validity of the tool. Results Two rounds of the modified Delphi process were performed to generate a 19-item, vaccination performance assessment checklist. In the validation study, the linear weighted kappa value for inter-rater reliability of the overall checklist score was 0.725. Spearman's correlation coefficient between the mean checklist score and the global rating was 0.98 (p<0.01). Conclusions This is a pioneering study examining the development and validation of an assessment tool for vaccine administration techniques. The tool will be widely used in vaccination-related education.

How to Integrate Sex and Gender Medicine into Medical and Allied Health Profession Undergraduate, Graduate, and Post-Graduate Education: Insights from a Rapid Systematic Literature Review and a Thematic Meta-Synthesis

Sex and gender are concepts that are often misunderstood and misused, being utilized in a biased, preconceived, interchangeable way. Sex and gender medicine is generally overlooked, despite the profound impact of sex and gender on health outcomes. The aims of the present rapid systematic literature review were (i) to assess the extent to which sex- and gender-sensitive topics are covered in medical courses; (ii) to assess the need for and willingness toward integrating/incorporating sex and gender medicine into health-related education; (iii) to identify barriers and facilitators of the process of implementation of sex and gender medicine in medical teaching, mentoring, and training; and (iv) to evaluate the effectiveness of interventional projects targeting curriculum building and improvement for future gender-sensitive physicians. Seven themes were identified by means of a thematic analysis, namely, (i) how much sex- and gender-based medicine is covered by medical courses and integrated into current medical curricula, (ii) the knowledge of sex and gender medicine among medical and allied health profession students, (iii) the need for and willingness toward acquiring sex- and gender-sensitive skills, (iv) how to integrate sex- and gender-based medicine into medical curricula in terms of barriers and facilitators, (v) existing platforms and tools to share knowledge related to sex and gender medicine, (vi) sex- and gender-based medicine aspects in the post-medical education, and (vii) the impact of sex- and gender-sensitive topics integrated into medical curricula. Based on the identified gaps in knowledge, further high-quality, randomized trials with larger samples are urgently warranted to fill these gaps in the field of implementation of gender medicine in educating and training future gender-sensitive physicians.

Development of a list of competencies and entrustable professional activities for resident physicians during death pronouncement: a modified Delphi study

BACKGROUND

The appropriate delivery of death pronouncements potentially affects bereaved families' wellbeing positively. Although younger physicians need to learn the competencies and entrustable professional activities (EPAs) to conduct death pronouncement independently, both of which have not been clarified. Therefore, this study aimed to develop a list of competencies and EPAs necessary for death pronouncement practice, which resident physicians need to acquire by the end of their residency training (postgraduate year 2).

METHODS

An anonymous modified Delphi study was conducted with a panel of 31 experts. The experts were invited online from general wards in hospitals with resident physicians across Japan to participate in the study using the purposive and snowball sampling method. A non-anonymous web conference was held with three additional external evaluators to finalize the item list. The consensus criterion was defined as a mean response of at least 4 points on a 5-point Likert scale for each competency and EPA item and a rating of 4 or 5 points by at least 80% of the participants.

RESULTS

Consensus was achieved, with consistently high levels of agreement across panel members, on 11 competencies and 9 EPA items. Additionally, a correspondence matrix table between competencies and EPAs was developed.

CONCLUSIONS

This study clarified the standardized educational outcomes as competencies in death pronouncement practice and the unit of professional practice of physicians who can perform this independently (EPAs), serving as a blueprint to aid the development of an educational model and evaluation method for clinical educational institutions and developers of medical school curriculums.

Development of entrustable professional activities for residents rotating nephrology department in a Japanese university hospital: a Delphi study

OBJECTIVES

Training strategies regarding entrustable professional activities (EPAs) vary from country to country; one such strategy is for residents. However, there are no reports of EPAs developed for residents who rotate to the nephrology departments. We aimed to construct such EPAs, which could be generalised to other institutions.

DESIGN

Purposive design and a modified Delphi method to build consensus.

SETTING

The department of nephrology in a university hospital in Aichi Prefecture, Japan.

PARTICIPANTS

Based on the attainment goals used in our department, an initial list was developed within the research group. The expert panel included 25 nephrologists from our affiliate hospital. Responses were based on a 5-point method and agreement was reached if both (A) and (B) were met: (A) mean≥4 with a SD <1; (B) more than 75% of respondents rated the item 4 or more. With agreement, the item was left for the next round. This round was repeated.

RESULTS

An initial list of 11 items was developed; after three Delphi rounds and revisions, eight items remained that were then established as the final EPAs. These items can serve as a list of goals to be reached by residents who rotate to the department of nephrology. The results indicated that most of the experts believed residents should be able to perform tasks deemed necessary or urgent for all physicians, such as those that deal with hyperkalaemia and heart failure.

CONCLUSIONS

The concept of EPAs enabled us to develop goals and evaluation criteria for residents' training in nephrology. This study can serve as a springboard for future discussions and contribute to the development of resident education in nephrology.

Lists of potential diagnoses that final-year medical students need to consider: a modified Delphi study

BACKGROUND

Contrastive learning is known to be effective in teaching medical students how to generate diagnostic hypotheses in clinical reasoning. However, there is no international consensus on lists of diagnostic considerations across different medical disciplines regarding the common signs and symptoms that should be learned as part of the undergraduate medical curriculum. In Japan, the national model core curriculum for undergraduate medical education was revised in 2016, and lists of potential diagnoses for 37 common signs, symptoms, and pathophysiology were introduced into the curriculum. This study aimed to validate the list of items based on expert consensus.

METHODS

The authors used a modified Delphi method to develop consensus among a panel of 23 expert physician-teachers in clinical reasoning from across Japan. The panel evaluated the items on a 5-point Likert scale, based on whether a disease should be hypothesized by final-year medical students considering given signs, symptoms, or pathophysiology. They also added other diseases that should be hypothesized. A positive consensus was defined as both a 75% rate of panel agreement and a mean of 4 or higher with a standard deviation of less than 1 on the 5-point scale. The study was conducted between September 2017 and March 2018.

RESULTS

This modified Delphi study identified 275 basic and 67 essential other than basic items corresponding to the potential diagnoses for 37 common signs, symptoms, and pathophysiology that Japanese medical students should master before graduation.

CONCLUSIONS

The lists developed in the study can be useful for teaching and learning how to generate initial hypotheses by encouraging students' contrastive learning. Although they were focused on the Japanese educational context, the lists and process of validation are generalizable to other countries for building national consensus on the content of medical education curricula.

Communicative and social competence in the medical curriculum of the Medical University of Innsbruck: learning objectives, content, and teaching methods

Aim: The Austrian Competence Level Catalogue for Medical Skills clearly states the importance of teaching communicative and social competence in the different subject areas of undergraduate medical and dental education. This paper aims to present an overview of the academic courses at the Medical University of Innsbruck that explicitly address the promotion of communication and social skills in medical students. Method: This paper focuses on educators' descriptions of how communicating with patients is taught. The Medical University's longitudinal curriculum on medical interviewing is presented in detail. The courses on ethical principles in the dissection course, palliative medicine, and gender medicine are also outlined as examples. In addition, lecturers (n=536) participated in an online survey to determine the teaching and testing content regarding patient communication and to measure the value attached to the associated teaching and learning methods. Results: The examples given by educators to illustrate learning objectives, educational content, and the teaching methods used to impart communicative and social competence provide an overview of the courses which focus on this topic or intentionally address it during the course. The results of the online survey offer a broad overview of the awareness of the topic at the university. Different testing formats are used to assess the skills being taught. Conclusion: Familiarity with the various teaching methods used in the different courses is important for developing communicative and social competence in medical education. Active networking is necessary to anchor communicative and social competency as a major thread throughout an entire medical curriculum.

Educating on Sexuality to Promote Health: Applied Experiences Mainstreaming the Gender and Human Rights Approach

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.

Gender awareness in medicine: adaptation and validation of the Nijmegen Gender Awareness in Medicine Scale to the Portuguese population (N-GAMS)

Health care professionals' gender awareness has been presented as a mechanism to minimize gender biases in health. The present paper aimed to adapt and validate the Nijmegen Gender Awareness in Medicine Scale (N-GAMS, Verdonk et al. in Sex Roles 58:222-234, 2008. https://doi.org/10.1007/s11199-007-9326-x) to the Portuguese population, also addressing some limitations of its original study, namely by: (1) testing the scale's three-fold underlying structure and (2) extending the study of its criteria-related validity, by analyzing sex-related differences in medical students' gender awareness and the associations between gender awareness and empathy and sexism. One thousand and forty-eight medical students (M_age = 22.90; 67.1% women) filled out the Portuguese version of the N-GAMS (N-GAMS.pt) along with measures of Physician Empathy and Sexism. A Parallel Analysis and an Exploratory Factor Analysis suggested the presence of three factors. A Confirmatory Factor Analysis showed a good fit of the hypothesized three-factor structure: (1) gender sensitivity (n = 6 items; α = .713), (2) gender-role ideologies towards patients (n = 7 items; α = .858) and (3) gender-role ideologies towards doctors (n = 5 items; α = .837), with a positive association between the latter two (r = .570; p < .001). The N-GAMS.pt also showed good criteria-related validity. Namely, as hypothesized: (1) more empathic students reported more gender sensitivity and lower endorsement of gender-role ideologies; (2) higher hostile and benevolent sexism were associated to higher endorsement of gender-role ideologies; and (3) higher hostile sexism was associated to lower gender sensitivity. Implications of the N-GAMS for research and interventional purposes are discussed.

"Sense of Control": Patients' Experiences of Multimodal Pain Rehabilitation and its Impact in their Everyday Lives

Objective

Long-lasting pain is a challenge for pa-tients’ everyday lives. The aim of this study was to examine how women and men who have participa-ted in multimodal pain rehabilitation experience its impact in their everyday lives.

Patients and methods

Individual semi-structured interviews with 5 women and 3 men who had parti-cipated in multimodal pain rehabilitation at a clinic in Sweden, analysed using qualitative content ana-lysis.

Results

Participants perceived that their “sense of control” increased, which had a positive impact in their everyday life. Sense of control consisted of 3 categories: importance of the patient-provider re-lationship, knowledge gained (especially on body functions and medication), and pain in a social con-text. Three results were discussed in particular: (i) a trustful patient-provider relationship based on confidence in the provider’s expertise was a pre-requisite for pain acceptance; (ii) patients were aware of gender norms in healthcare; (iii) social support was not stressed as important to cope with pain.

Conclusion

The importance of patients’ confidence in the provider’s expertise and patients’ awareness about gender norms need consideration in terms of the patient-provider encounter. The value of social support for pain rehabilitation was found to be less important compared with previous research; this should be explored further.

Significance of gender in the attitude towards doctor-patient communication in medical students and physicians

BACKGROUND

Gender-specific differences in the attitudes towards doctor-patient communication among medical students and physicians were assessed.

METHODS

A total of 150 medical students and 51 physicians from different departments took part in the study. The association, attitude and experiences regarding doctor-patient communication were assessed with a series of tools and questionnaires.

RESULTS

Female doctors and students tended to describe the doctor-patient communication with positive attributes, such as "helpful", "sentimental", "voluble", "sociable", "gentle", "yielding" and "peaceful". Male students and physicians, on the other hand, described doctor-patient communication as "overbearing", "robust" and "inhibited". The most frequent associations females had with the term doctor-patient communication were "empathy", "confidence", "openess", while the most frequent association of the male colleagues was "medical history". Female doctors reported speaking about the psychosocial situation of the patient significantly more often and believed in higher patient satisfaction by sharing more information. Furthermore, they reported having longer conversations with a more equal partnership than their male colleagues. Compared to male students, female students were willing to take part in training their communication skills more often and had more interest in research about doctor-patient communication. Male medical students reported self-doubt during conversations with female patients, while one third of the male physicians talked about "the power over the patient".

CONCLUSIONS

This study indicates a gender-dependent communication style influenced by stereotypes. At the establishment of communication training these differences should be taken into account, especially to strengthen male communication skills and improve their attitudes.

[Gender (role) aspects in doctor-patient communication]

Aspects of gender and gender roles are important factors influencing the interactions between physicians and their patients. On the one hand, gender roles have an impact on the behavior of the patients, such as in health care utilization or use of preventive examinations. On the other hand, gender issues influence doctors' actions with respect to communication, diagnosis, and treatment. Here, a gender bias may lead to misdiagnosis and inadequate treatment. In this paper certain pertinent aspects of gender roles in the doctor-patient relationship are discussed and illustrated by empirical findings.