Gender awareness among medical students in a Swiss University

Bridging the Gap: A Mixed-Method Study on Gender and Sexuality Awareness in Medical Education and Practice

BACKGROUND

The integration of gender and sexuality awareness in healthcare is increasingly recognized as vital for patient outcomes. Despite this, there is a notable lack of comprehensive data on the current state of physicians' training and perceptions in these areas, leading to a gap in targeted educational interventions and optimal healthcare delivery.

OBJECTIVE

The study's aim was to explore the experiences and perceptions of attending and resident physicians regarding the inclusion of gender and sexuality content in medical school curricula and professional practice in Israel.

METHODS

This cross-sectional survey targeted a diverse group of physicians across various specializations and experience levels. Distributed through Israeli medical associations and professional networks, it included sections on experiences with gender and sexuality content, perceptions of knowledge, the impact of medical school curricula on professional capabilities, and views on integrating gender medicine in medical education. Descriptive and correlational analyses, along with gender-based and medical status-based comparisons, were employed, complemented and enhanced by qualitative analysis of participants' replies.

RESULTS

The survey, encompassing 189 respondents, revealed low-to-moderate exposure to gender and sexuality content in medical school curricula, with a similar perception of preparedness. A need for more comprehensive training was widely recognized. The majority valued training in these areas for enhancing professional capabilities, identifying ten essential gender-related knowledge areas. The preference for integrating gender medicine throughout medical education was significant. Gender-based analysis indicated variations in exposure and perceptions.

CONCLUSIONS

The study highlights a crucial need for the inclusion of gender and sexuality awareness in medical education and practice. It suggests the necessity for curriculum development, targeted training programs, policy advocacy, mentorship initiatives, and research to evaluate the effectiveness of these interventions. The findings serve as a foundation for future directions in medical education, aiming for a more inclusive, aware, and prepared medical workforce.

CLINICALTRIAL

Gender awareness among general practitioners in France: a cross sectional study using the Nijmegen Gender Awareness in Medicine Scale (N-GAMS)

Gender is a key determinant of health and healthcare use. The question of whether physicians are aware of gender issues is important to avoid gender bias in medical practice. This study aimed to validate the Nijmegen Gender Awareness in Medicine Scale (N-GAMS) in a representative population of French general practitioners (GPs) and to analyze their gender sensitivity and the presence of gender stereotypes among them. The N-GAMS, already validated in medical students, measures gender awareness through 3 subscores: gender sensitivity (GS) and gender-role ideology towards patients (GRIP) and doctors (GRID) (gender stereotypes). After translation into French, it was distributed to 900 GPs. The scale was validated through exploratory factor analysis (EFA). Psychometric properties were tested. Multivariate linear regressions were conducted to explore the associations between GPs' characteristics and N-GAMS subscores. EFA identified 3 meaningful factors consistent with prior theory. Subscores exhibited good internal consistency. The main findings were that GRIP was significantly higher in older physicians, in male physicians, among those who less involved their patients in decisions, and those who were not training supervisors. For GRID, results were quite similar to those of GRIP. GS was significantly higher for physicians working in health centres or medical homes and for those with gynecological practices but lower when they less involved patients in medical decisions. This study suggests that it is necessary to teach gender issues not only in medical schools but also as part of continuing medical education.

Gender medicine attitudes among medical students: An Italian cross-sectional study

We aimed to explore attitudes and training experiences of medical students toward gender medicine (GM). A cross-sectional study with convenience sampling was conducted (sample size = 430). To assess predictors of high GM consideration in patient management, a multivariable logistic regression was performed. A total of 82% considered sex and gender important; 61% stated that they would use GM skills in their careers. A total of 76% had never discussed GM with their tutors, with differences between male and female students (p = .002). Predictors of high GM consideration were: age (adjOR = 1.4, 95%CI = 1.1-1.8) and the impression that tutors considered patients' sex and gender during practice (adjOR = 3.9, 95%CI = 2.0-7.6). Thus, participants considered GM important, but some students were unsure whether it could be useful in practice. The strongest predictor of high GM consideration was the tutors' good example during training. It would be advisable to implement the teaching of this topic during both courses and traineeships.

Gender-based differential management of acute low back pain in the emergency department: A survey based on a clinical vignette

BACKGROUND

Women may receive suboptimal pain management compared with men, and this disparity might be related to gender stereotypes.

OBJECTIVES

To assess the influence of patient gender on the management of acute low back pain.

DESIGN

We assessed pain management by 231 physicians using an online clinical vignette describing a consultation for acute low back pain in a female or male patient. The vignette was followed by a questionnaire that assessed physicians' management decisions and their gender stereotypes.

METHODS

We created an online clinical vignette presenting a patient with acute low back pain and assessed the influence of a patient's gender on pain management. We investigated gender-related stereotyping regarding pain care by emergency physicians using the Gender Role Expectation of Pain questionnaire.

RESULTS

Both male and female physicians tended to consider that a typical man was more sensitive to pain, had less pain endurance, and was more willing to report pain than a typical woman. These stereotypes did not translate into significant differences in pain management between men and women. However, women tended to be referred less often for imaging examinations than men and were also prescribed lower doses of ibuprofen and opioids. The physician's gender had a modest influence on management decisions, female physicians being more likely to prescribe ancillary examinations.

CONCLUSION

We observed gender stereotypes among physicians. Our findings support the hypothesis that social characteristics attributed to men and women influence pain management. Prospective clinical studies are needed to provide a deeper understanding of gender stereotypes and their impact on clinical management.

Gender medicine teaching increases medical students' gender awareness: results of a quantitative survey

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.

[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.

The influence of patient gender on medical students' care: Evaluation during an objective structured clinical examination

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.

Gender-Based Discrimination Among Medical Students: A Cross-Sectional Study in Brazil

INTRODUCTION

Gender-based discrimination (GBD) creates a hostile environment during medical school, affecting students' personal life and academic performance. Little is known about how GBD affects the over 204,000 medical students in Brazil. This study aims to explore the patterns of GBD experienced by medical students in Brazil.

METHODS

This is a cross-sectional study using an anonymous, Portuguese survey disseminated in June 2021 among Brazilian medical students. The survey was composed of 24 questions to collect data on GBD during medical school, formal methods for reporting GBD, and possible solutions for GBD.

RESULTS

Of 953 responses, 748 (78%) were cisgender women, 194 (20%) were cisgender men, and 11 (1%) were from gender minorities. 65% (616/942) of respondents reported experiencing GBD during medical school. Women students experienced GBD more than men (77% versus 22%; P < 0.001). On comparing GBD perpetrator roles, both women (82%, 470/574) and men (64%, 27/42) reported the highest rate of GBD by faculty members. The occurrence of GBD by location differed between women and men. Only 12% (115/953) of respondents reported knowing their institution had a reporting mechanism for GBD.

CONCLUSIONS

Most respondents experienced GBD during medical school. Cisgender women experienced GBD more than cisgender men. Perpetrators and location of GBD differed for men and women. Finally, an alarming majority of students did not know how to formally report GBD in their schools. It is imperative to adopt broad policy changes to diminish the rate of GBD and its a consequential burden on medical students.

Gender Awareness in Healthcare: Contextualization of an Arabic Version of the Nijmegen Gender Awareness in Medicine Scale (N-GAMS)

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.

Reflexivity as a tool for medical students to identify and address gender bias in clinical practice: A qualitative study

OBJECTIVES

Gender bias interferes with medical care for both men and women, leading to health inequalities. Reflexivity is used in medical education to improve health provision. This study aims to understand if a reflective approach integrated in medical practice enables raising awareness of gender bias during medical school teaching.

METHODS

We conducted this study in general ambulatory medicine in Lausanne Hospital, Switzerland with 160 Master's students. Through group discussions and reflection questionnaires, students were asked to discuss clinical cases they encountered focusing on potential gender bias. We analyzed the data using a thematic analysis approach.

RESULTS

The reflection on the clinical reasoning steps from a real case identified gender bias at each stage of the clinical case management. The analysis revealed two factors that facilitated gender reflexivity: guidance from a gender expert and peer-to-peer exchange.

CONCLUSIONS

Our study shows that a reflective approach integrated in medical practice enables raising awareness of gender bias during medical teaching. It provides students with a systematic method they can apply in their future clinical work, thus improving care processes and experiences towards more equitable care.

PRACTICE IMPLICATIONS

All gender and medicine curricula should include teaching such as this linking theory and practice through reflexivity.

Gender awareness is also nurses' business: Measuring sensitivity and role ideology towards patients

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.

Gender bias in sports medicine: an international assessment of sports medicine physicians' perceptions of their interactions with athletes, coaches, athletic trainers and other physicians

OBJECTIVES

To evaluate the difference between female and male sports medicine physicians regarding disrespectful attitudes and sexual harassment perceived from athletes, coaches, physicians, athletic trainers (ATs) and organisations/administrations.

METHODS AND STUDY DESIGN

anonymous survey was distributed to sports medicine physicians practicing in 51 countries. χ² analysis was used to detect differences between female and male sports medicine physicians and logistic regression analysis was used to determine the independent variables that affect disrespectful attitudes and sexual harassment from sports participants.

RESULTS

1193 sports medicine physicians (31.9% female) participated from 51 countries. The survey revealed that female physicians, compared with male physicians, perceive significantly more disrespect or have their judgement questioned more by the following categories: male and female athletes, male and female coaches, female physicians with more years of experience, male physicians (regardless of years of experience), male and female ATs and organisation/administrations (all p<0.05). The only category where the frequency of disrespect was perceived equally by male and female physicians was during their interactions with female physicians who have the same or lesser years of experience. Female sports medicine physicians noted more sexual harassment than male physicians during interactions with male athletes, coaches, ATs and physicians (all p<0.001). In the logistic regression, gender was a related factor for perceiving disrespect, especially from male coaches (OR=2.01) and physicians with more years of experience (OR=2.18).

CONCLUSIONS

Female sports medicine physicians around the world experience disrespectful attitudes, questioning of their judgement and are sexually harassed significantly more often than male counterparts.

An integrative review of the literature on screening for gender-based violence during pregnancy: barriers, facilitators, and tools

An integrative review of the literature has been developed to explore barriers and facilitators in screening for gender‐based violence in pregnant women and identify available tools for this screening. Studies were identified via a systematic search on the PubMed, CINAHL Plus (Cumulative Index of Nursing and Allied Health Literature Complete), Scopus, and LILACS (Latin American and Caribbean Health Sciences Literature) databases and a manual reverse reference search to obtain literature published between 2015 and 2020. The methodology followed the recommendations made by Whittemore & Knafl. The quality of studies was evaluated using the Critical Skills Appraisal Program tool. Twenty‐three of the 4202 articles fulfilled the inclusion criteria. The principal barriers identified were lack of training for professionals (mainly nurses and midwives), lack of support policies, and lack of human and material resources. The main facilitators were to increase professional training programs on case detection, availability of effective instruments, and greater investment in resources to guarantee safety and referral of cases. With regard to the available tools, the Abuse Assessment Screen (AAS) continues to be the most widely used, although others such as the Humiliation, Afraid, Rape, and Kick questionnaire (HARK) could be suitable for antenatal care settings.

Gender sensitivity and stereotypes in medical university students: An Italian cross-sectional study

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.

Cultural competency and sensitivity in the curriculum for palliative care professionals: a survey in Switzerland

BACKGROUND

Cultural and linguistic diversity in patients and their relatives represents a challenge for clinical practice in palliative care around the world. Cross-cultural training for palliative care professionals is still scarce, and research can help determine and support the implementation of appropriate training. In Switzerland, health policies address diversity and equity issues, and there is a need for educational research on cross-cultural training in palliative care. The aim of this study was to investigate the clinical challenges faced by Swiss palliative care professionals when working with migrant patients and their relatives. We also documented professionals' interests in cross-cultural training.

METHODS

A web survey of professionals working in specialized palliative care in the French- and Italian-speaking areas of Switzerland investigated clinical challenges with migrant populations and interests in various training opportunities.

RESULTS

A total of 204 individuals responded to the survey, 48.5 % of whom were nurses. The major difficulties they reported were communication impediments associated with patients' linguistic and/or cultural backgrounds. In relation to educational needs, they expressed a particular interest in communication techniques that would allow them to deal with these issues autonomously. The professionals expressed less interest in training on collaborating with other professionals and examining one's own stereotypes.

CONCLUSIONS

Palliative care professionals' post-graduate and continuing education must address communication techniques for sensitive palliative and end-of-life topics in cross-cultural contexts. Beginning with their pre-graduate studies, health professionals should assimilate the importance of collaborating with other professionals in complex cross-cultural situations and learn to reflect on their stereotypes and pre-conceptions in clinical practice.