Improving Medical Education Using a Sex- and Gender-Based Medicine Lens

[Validation of a gender awareness scale in health sciences students]

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.

Sex and Gender Health Educational Tenets: A Report from the 2020 Sex and Gender Health Education Summit

Background: Sex as a biological variable and gender as a sociocultural variable influence many health conditions and outcomes. However, they have not been incorporated systematically into education across health professions. Methods: Areas of knowledge and abilities that apply to sex and gender education across health professions were summarized from the 2015 and 2018 Sex and Gender Health Education Summits. Results: Using this summary, draft tenets were developed by facilitated interprofessional discussion groups at the 2020 Summit, and then reviewed, edited, and refined by a writing group who recommended four tenets that health care professionals should be able to do: (1) demonstrate knowledge of sex and gender specific health (SGSH), (2) evaluate literature and the conduct of research for incorporation of sex and gender, (3) incorporate sex and gender considerations into clinical decision making, and (4) demonstrate patient advocacy with respect to sex and gender. Conclusion: These tenets provide the framework for collaborative interprofessional education about SGSH. Individual professions can also use the tenets to develop practice-specific competencies, competency statements, and/or assessment benchmarks within the structures of their respective accrediting bodies to advance the health of women, men, and sex and gender minority persons. Interprofessional collaborations are key for sharing best practices in development, curricular integration, and dissemination.

Men's health disparities: Causes and interventions

According to the existing, extensive scientific evidence in the literature, men on average are living sicker and dying younger at a higher rate compared to women. The causes of men's infirmities are complex and multifaceted, contributing to increased morbidity and mortality rates and decreased life expectancy. Despite the statistics of the doomed health status among men, interests to eliminate their health disparities remain inconsistent and ill-defined. Therefore, efforts to eradicate men's health disparities should be positioned in interdisciplinary health education, research, and policy using sex and gender-based health frameworks. The purpose of this paper is to explore men's health generally by discussing common health disparities, the causes of the gender gap in men's health outcomes, proposing some strategies for advancing men's health, and finally providing nursing implications for education, practice, research, and health/public policy. Notably, interdisciplinary, gender-based health education potentially has significant impacts on men's health. The promotion of such initiatives can consequently address the intricacies of men's health, which will provide future healthcare professionals with the knowledge, attitude, and skills necessary to improve men's health.

The importance of providing gender-affirming care in pharmacy practice

Transgender and gender diverse (TGD) individuals face bias and discrimination across many health care settings including pharmacy. While there is evidence of successful interventions to increase provider awareness of the needs of TGD individuals in medicine, nursing, and social work, little work has been done by the pharmacy profession to recognize and meet the needs of this population. This commentary examines the gaps in pharmacy practice and pharmacy research with regards to the needs of TGD individuals and looks at allied health fields for potential solutions that can be adapted by the pharmacy profession. We first examine the social pressures that TGD individuals face in multiple social contexts and describe how bias and discrimination spill over into their interactions with providers and health care systems. Solutions for improving pharmacy practice research's ability to identify TGD individuals and their needs follows as a measure that will lead to solutions for improving pharmacy practice. A discussion of TGD individuals' responses to actual and perceived discrimination by pharmacists is discussed next, and why their avoidance of pharmacy care can be problematic to their health. The remainder of the paper focuses on how pharmacy education can train future pharmacists to provide inclusive care to TGD individuals, and how interprofessional education and continuing education can enhance future and practicing pharmacists' ability to provide high quality care to TGD individuals.

Solving gender gaps in health, what else is missing?

In recent years, a great deal of attention has been paid to gender inequities in health. However, while we have a good body of evidence on the impact of gender on the health and vulnerability of women and men, we have not yet been able to generate sufficient evidence on effective interventions that can transform this situation or can influence public health policy making. Only a limited number of educational interventions on gender-sensitivity, gender bias in clinical practice and policies to tackle gender inequalities in health have been formulated, implemented and evaluated. Even in the current pandemic situation caused by SARS-CoV2, we have seen the lack of gender mainstreaming reflected in the global response. This happens even when we have tools that facilitate the formulation and implementation of actions to reduce gender inequities in health. We consider that the current initiatives organized to carry out advocacy activities on gender inequity in health to be very positive. In the same line of these initiatives, we propose that while academic and institutional research on gender and health remains essential, we need to shift the focus towards action. In order to move forward, we need public health researchers questioning what public health practice need to do to address gender inequities and shake structural and social power inequities in order to increase the gender equity in health.

Sex and gender specific health topics in medical student learners: pulse check eight years later

BACKGROUND

An essential component of patient-centered, individualized medicine is considering how sex and gender affect mechanisms of health and disease.

OBJECTIVES

To assess medical students' current knowledge of sex and gender specific health (SGSH) concepts compared to results from the same survey in 2012 to better inform development of curricular materials for medical education.

METHODS

A previously designed survey tool, which assessed current knowledge of sex and gender-based medicine of medical students, was emailed to all Mayo Clinic Alix School of Medicine (MCASOM) students on Minnesota, Arizona, and Florida campuses in 2020. Descriptive and qualitative thematic results were compared to the same survey administered in 2012 to students enrolled in MCASOM. Changes in the inclusion of SGSH topics were assessed over the eight years.

RESULTS

One hundred and one of 365 (27.7% response rate) surveys were returned with 2:1 female to male respondents with representation from all 4 years. The definitions of the terms "sex" and "gender" were correctly identified by most respondents (93.1%). However, only 36% (12/33) of questions related to other medical knowledge on SGSH topics had more than a 50% correct response rate. More than half of the students reported that SGSH topics were included in Gynecology, Cardiology, Pediatrics, and Immunology. SGSH topics were reported as not being routinely covered in Neurology and Nephrology, although more students said they were in 2020 then 2012. Sixty-two percent of students favored increasing SGSH in the current curriculum.

CONCLUSIONS

Medical students appear to understand the definition of and importance of SGSH in education. While some improvements in coverage by subject matter and topic area appear to have occurred as reported by medical students, opportunity remains to more fully integrate SGSH concepts in medical school curricula.

Sex and gender considerations in implementation interventions to promote shared decision making: A secondary analysis of a Cochrane systematic review

Background

Shared decision making (SDM) in healthcare is an approach in which health professionals support patients in making decisions based on best evidence and their values and preferences. Considering sex and gender in SDM research is necessary to produce precisely-targeted interventions, improve evidence quality and redress health inequities. A first step is correct use of terms. We therefore assessed sex and gender terminology in SDM intervention studies.

Materials and methods

We performed a secondary analysis of a Cochrane review of SDM interventions. We extracted study characteristics and their use of sex, gender or related terms (mention; number of categories). We assessed correct use of sex and gender terms using three criteria: “non-binary use”, “use of appropriate categories” and “non-interchangeable use of sex and gender”. We computed the proportion of studies that met all, any or no criteria, and explored associations between criteria met and study characteristics.

Results

Of 87 included studies, 58 (66.7%) mentioned sex and/or gender. The most mentioned related terms were “female” (60.9%) and “male” (59.8%). Of the 58 studies, authors used sex and gender as binary variables respectively in 36 (62%) and in 34 (58.6%) studies. No study met the criterion “non-binary use”. Authors used appropriate categories to describe sex and gender respectively in 28 (48.3%) and in 8 (13.8%) studies. Of the 83 (95.4%) studies in which sex and/or gender, and/or related terms were mentioned, authors used sex and gender non-interchangeably in 16 (19.3%). No study met all three criteria. Criteria met did not vary according to study characteristics (p>.05).

Conclusions

In SDM implementation studies, sex and gender terms and concepts are in a state of confusion. Our results suggest the urgency of adopting a standardized use of sex and gender terms and concepts before these considerations can be properly integrated into implementation research.

Educating the Scientific Workforce on Sex and Gender Considerations in Research: A National Scan of the Literature and Building Interdisciplinary Research Careers in Women's Health Programs

Background: This study was a national scan of education resources on integrating sex and gender considerations into research. The purpose was to assess capacity for educating researchers and to identify gaps, with implications for implementation of guidelines or mandates to consider sex and gender differences in research. Information sources were U.S. training programs in women's health and sex/gender difference research, Building Interdisciplinary Research Careers in Women's Health (BIRCWH), and published peer-reviewed biomedical literature. Materials and Methods: This descriptive study used multiple methods: a national survey and a comprehensive literature review. BIRCWH leaders responded to a survey regarding education on sex/gender difference research for BIRCWH scholars (response rate 100%, 20 of 20). A comprehensive literature review was conducted for 1993-2018. Results: Nearly half (45%) of BIRCWH institutions offered education on integrating sex or gender differences in clinical translational research; of those, roughly half (54%) offered in-person training and one-third (31%) offered content within existing for-credit courses. Respondents preferred online training (84%) to in-person offerings or reference materials (47% and 42% respectively). Published indexed literature on sex or gender differences has quadrupled since 1993, although growth in these publications remained flat in the most recent six years. Conclusions: Published resources to educate researchers on integrating sex and gender differences into medical research have increased, and BIRCWH programs connect scholars to national resources. Educational gaps remain due to limited access to curricula on applied research approaches, design, and methods for sex/gender difference research. BIRCWH programs desire curricula that are easily accessible online and asynchronously; sanctioned and supported by national thought leaders; linked to required training such as rigor and reproducibility; foster collaboration; and offer practical applications. Evidence-based, high-quality educational curricula and a dissemination plan are needed to enhance the adoption and integration of sex and gender into scientific endeavors.

Integrating Sex and Gender into an Interprofessional Curriculum: Workshop Proceedings from the 2018 Sex and Gender Health Education Summit

Background: In the last 3 years, the National Institutes of Health (NIH) declared advancement of understanding the role sex as a biological variable has in research a priority. The burden now falls on educators and clinicians to translate into clinical practice the ensuing body of evidence for sex as a biological variable that clearly shows the effect of sex/gender on disease diagnosis and management. The 2018 Sex and Gender Health Education Summit (SGHE) organized an interdisciplinary and interprofessional workshop to (1) analyze common clinical scenarios highlighting the nuances of sex- and gender-based medicine (SGBM) in presentation, diagnosis, or management of illness; (2) utilize valid educational and assessment tools for a multiprofessional audience; and (3) brainstorm standardized learning objectives that integrate both. Materials and Methods: We describe the iterative process used to create these scenarios, as well as an interprofessional forum to develop standardized SGBM case-based objectives. Results: A total of 170 health education professionals representing 137 schools of Medicine, Dentistry, Pharmacy, Public Health, Nursing, Physical, and Occupational Therapy participated in this workshop. After attending the workshop, participants reported a significant increase in comfort level with using diverse educational modalities in the instruction of health profession learners. Recurrent themes included case-based learning, use of sex-neutral cases, simulation, and standardized patient scenarios for educational modalities; and self-assessment, peer assessment, and review of clinical documentation as used assessment tools. Materials created for the workshop included teaching SGBM case scenarios, methods of assessment, and sample standardized objectives. Conclusion: The SGHE Summit provided an interdisciplinary forum to create educational tools and materials for SABV instruction that may be applied to a diverse audience.

Faculty insights regarding incorporation of gender- and sex-related differences in the PharmD curriculum: Phase 2

BACKGROUND

While pharmacists should be aware of gender and sex-related differences in treatment related decisions, this is not a required doctor of pharmacy curricular component. A regional pilot study demonstrated that approximately half of pharmacy practice faculty discussed these differences in their content area. The aim of this study was to evaluate the extent of inclusion of gender and sex-related differences on a national level in doctor of pharmacy curricula and to determine if faculty are comfortable teaching the topic.

METHODS

An electronic message with a link to an online survey was distributed to 7250 faculty members at 139 colleges of pharmacy. The survey remained open for three weeks and potential participants received weekly email reminders. The survey was voluntary, and responses were de-identified.

RESULTS

Overall, 641 faculty participated in the survey (8.8% response rate). Most respondents indicated that they do not teach about gender or sex-related differences (54.9%). Of those faculty reporting teaching gender and/or sex-related differences, 28% indicated that it was addressed in one clinical topic, while some (7.7%) indicated that the content was included in up to five topics. Half of faculty (53.6%) indicated that they believe this topic is somewhat important.

CONCLUSIONS

Results of this study suggest that gender and sex-related differences are not adequately addressed in current pharmacy curricula.

Approaches to considering sex and gender in continuous professional development for health and social care professionals: An emerging paradigm

Consideration of sex and gender in research and clinical practice is necessary to redress health inequities and reduce knowledge gaps. As all health professionals must maintain and update their skills throughout their career, developing innovative continuing professional education programs that integrate sex and gender issues holds great promise for reducing these gaps. This article proposes new approaches to partnership, team development, pedagogical theory, content development, evaluation and data management that will advance the integration of sex and gender in continuing professional development (CPD). Our perspectives build on an intersectoral and interprofessional research team that includes several perspectives, including those of CPD, health systems, knowledge translation and sex and gender.