eGender-from e-Learning to e-Research: a web-based interactive knowledge-sharing platform for sex- and gender-specific medical education

Key Learnings and Perspectives of a Newly Implemented Sex-and Gender-Based Medicine Modular Course Integrated into the First-Year Medical School Curriculum: A Mixed-Method Survey

Purpose

Sex and Gender-Based Medicine (SGBM) addresses the influence of sex and gender on health and healthcare, emphasizing personalized care. Integrating SGBM into medical education is challenging. This study examines the implementation of an SGBM course in an Israeli university during the first year of the medical school.

Methods

The course integrated lectures, group work, online gender studies resources, workshops, teacher training, and essential literature. The curriculum spanned pre-clinical and clinical aspects, featuring seven 90-minute sessions. Surveys assessed course structure, content, and lecturers using a 5-point Likert scale and qualitative feedback. Quantitative analysis involved descriptive statistics, and thematic analysis was used for qualitative data.

Results

Of the 84 students surveyed, 35 (41.7%) responded to the first part, and 30 (35.7%) to the second. The SGBM course received high satisfaction with an average score of 3.63, surpassing other first-year courses (average 3.21). Students appreciated the supportive academic atmosphere (mean score 4.20) and diverse teaching methods (mean score 4.03), while the development of feminist thinking was less appreciated (average score 3.49). Lecturers received high ratings (average score 4.33). Qualitative feedback highlighted the value of group work, the significance of the subject matter, and the helpfulness of supplementary videos. Students requested more content on contemporary issues like gender transition and patient perspectives. The feminist medicine aspect was contentious, with students seeking better gender balance and scientific evidence.

Conclusion

Introducing SGBM into the first-year curriculum yielded positive results with high student satisfaction for content and lecturers. An expanded course module is planned, to be assessed at the end of the next academic year.

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.

Are stereotypes in decline? The portrayal of female anatomy in e-learning

Sex and gender bias in anatomy learning materials are considered a "hidden obstacle" to gender equity in medical curricula. The purpose of this study was to investigate whether quantitative sex and gender biases do exist in popular anatomy e-learning platforms and compare the results with those found in contemporary textbooks and atlases. A systematic content-analysis was performed on N = 3767 images published from 2008 to 2021 in which sex/gender could be identified by considering technical aspects of illustration and various intersectional categories. E-learning platforms took into account an appropriate representation of the female body and presented even more females (n = 932/1412; 66%), more frequently from a ventral/anterior (χ²  = 26, P < 0.001) and whole-body perspective (χ²  = 27, P < 0.001). This was in contrast to German anatomy books, where the results pointed to a significant sex and gender bias. For example, all books assessed underrepresented females (n = 707/2355; 30%) and placed them in stereotypical sex-specific context (χ²  = 348, P < 0.001), showing them more often from a caudal/inferior (χ²  = 99, P < 0.001) and internal (χ²  = 132, P < 0.001) perspective. Altogether, the visual representation of sex and gender in anatomical curricula is still biased and the stereotypical perceptions of human anatomy seem to be a global issue. However, the increasing use of electronic learning platforms, which gradually replace traditional books is changing the way the male and female body is depicted, which might offer new opportunities for reducing stereotypes in anatomy 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.

Current approaches to the integration of sex- and gender-specific medicine in teaching: a qualitative expert survey

Aim: Although criteria and recommendations for the successful integration of sex- and gender-sensitive aspects in medical teaching have already been published, only a few medical faculties in Germany have conducted the systematic integration of sex- and gender-sensitive medicine. The aim of this expert survey, therefore, was to describe the current approaches to the integration of sex- and gender-sensitive medicine in teaching in the sense of Good Practice. Method: Between April and June 2018, guided interviews were conducted with nine experts in the field of sex- and gender-sensitive medicine. Each of the experts had had experience of implementing sex- and gender-sensitive medicine at their universities. The expert interviews were then evaluated by means of quality content analysis, and frequency analyses were carried out. Results: Aspects of sex- and gender-sensitive medicine were integrated both longitudinally and selectively into the compulsory curriculum or elective fields of various medical, health and nursing science courses. In the opinion of the experts, medical studies should promote the students' gender sensitivity and in particular impart knowledge about the psychosocial and biological aspects of sex- and gender-related differences and sex- and gender-sensitive communication. For the methodological implementation of the integrated contents, didactic resources were partly adapted or developed. The players in the implementation process were confronted with various challenges, e.g. the involvement of the lecturers, the perception of sex- and gender-sensitive medicine as a women's theme as well as ensuring the sustainable integration of sex- and gender-sensitive medicine, which is also structurally anchored in the faculty. Aspects of the curricular integration (e.g. evidence-basing, relevance in examinations) and the structural anchoring (e.g. central organization, staff availability) were mentioned i.a. as being crucial for success. A combination of top-down and bottom-up processes, e.g. by involving the faculty management but also by supporting student initiatives, was described as conducive to success. Conclusion: The depicted approaches to the integration of sex- and gender-sensitive teaching contents give insight as to how sex- and gender-sensitive medicine can be integrated into the curricula. The interviews with the experts point to current themes related to sex- and gender-sensitive medicine and didactic resources. Moreover, it becomes clear which challenges are to be expected for the integration of sex- and gender-sensitive medicine in teaching and how these can be addressed. Particularly the involvement of the faculty's lecturers but also the sustainable integration and continual quality assurance of sex- and gender-sensitive contents present challenges of a crucial nature.

Does diversity go beyond sex and gender? Gender as social category of diversity training in health profession education - a scoping review

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.

Quantitative and Qualitative Analysis on Sex and Gender in Preparatory Material for National Medical Examination in Germany and the United States

BACKGROUND

Sex- and gender-based medicine (SGBM) should be a mandatory part of medical education. We compared the quantity and quality of sex- and gender-related content of e-learning materials commonly used by German and American medical students while preparing for national medical examinations.

METHODS

Quantitative, line-by-line analysis of the preparatory materials AMBOSS 2017 and USMLE Step 1 Lecture Notes (2017) by KAPLAN MEDICAL was performed between April and October 2017. Subjects were allocated to one of the three main fields: clinical subjects, behavioral and social science, and pharmacology. Qualitative analysis comprised binary categorization into sex- and gender-based aspects and qualification with respect to the presence of a pathophysiological explanation for the sex or gender difference.

RESULTS

In relation to the total content of AMBOSS and KAPLAN, the sex- and gender-based share of the clinical subjects content was 26.8% (±8.2) in AMBOSS and 21.1% (±10.2) in KAPLAN. The number of sex- and gender-based aspects in the behavioral and social science learning material differed significantly for AMBOSS and KAPLAN (4.4% ± 3.1% vs 10.7% ± 7.5%; P = .044). Most of the sex- and gender-related content covered sex differences. Most learning cards and texts did not include a detailed pathophysiological explanation for sex- or gender-based aspects. The knowledge provided in the preparatory documents represents only a small part of facts that are already known about sex and gender differences.

CONCLUSIONS

The preparatory materials focused almost exclusively on biological sex differences and the sociocultural dimension in particular is underrepresented. A lot more evidence-based facts are known and should be integrated into the materials to reflect the importance of SGBM as an integral component of patient-centered medicine.

[Gender and cardiovascular diseases : Why we need gender medicine]

Gender medicine is concerned with the question of why diseases are expressed differently in the genders. It takes differences between men and women into account, which are often neglected by traditional medicine. Sex differences can also be found in cardiovascular diseases; therefore, risk factors for cardiovascular diseases have a different significance depending on the sex. Diabetic diseases tend to promote the occurrence of coronary heart disease (CHD) more strongly in women than in men. Myocardial infarctions affect women 10 years later than men and young women are often treated too late, possibly because myocardial infarction is consider to be a "male disease". The number of cases of coronary syndrome is significantly increasing, particularly in young women. Some of the diseases which predominantly occur in women are takotsubo cardiomyopathy, microcirculation disorders and spontaneous coronary artery dissection. Pharmacological treatment of CHD is principally the same in men and women but attention must be paid to differences in the pharmacokinetics of important drugs. Coronary dilatation has comparable effects in both men and women but more complications occur in women. Cardiac failure with impaired left ventricular systolic function affects more men than women in the Western world but the opposite is true for cardiac failure with preserved left ventricular ejection fraction. Hypertrophic and dilatative cardiomyopathies are more frequent in men. Many of the drugs used to treat cardiac failure have different actions in men and women. Too little attention is paid to the pharmacokinetics and pharmacodynamics in women when testing active agents; however, awareness of the differences that need to be considered is growing.

Unsettled Issues and Future Directions for Research on Cardiovascular Diseases in Women

Biological sex (being female or male) significantly influences the course of disease. This simple fact must be considered in all cardiovascular diagnosis and therapy. However, major gaps in knowledge about and awareness of cardiovascular disease in women still impede the implementation of sex-specific strategies. Among the gaps are a lack of understanding of the pathophysiology of women-biased coronary artery disease syndromes (spasms, dissections, Takotsubo syndrome), sex differences in cardiomyopathies and heart failure, a higher prevalence of cardiomyopathies with sarcomeric mutations in men, a higher prevalence of heart failure with preserved ejection fraction in women, and sex-specific disease mechanisms, as well as sex differences in sudden cardiac arrest and long QT syndrome. Basic research strategies must do more to include female-specific aspects of disease such as the genetic imbalance of 2 versus one X chromosome and the effects of sex hormones. Drug therapy in women also needs more attention. Furthermore, pregnancy-associated cardiovascular disease must be considered a potential risk factor in women, including pregnancy-related coronary artery dissection, preeclampsia, and peripartum cardiomyopathy. Finally, the sociocultural dimension of gender should be included in research efforts. The organization of gender medicine must be established as a cross-sectional discipline but also as a centered structure with its own research resources, methods, and questions.

En route to precision medicine through the integration of biological sex into pharmacogenomics

Frequently, pharmacomechanisms are not fully elucidated. Therefore, drug use is linked to an elevated interindividual diversity of effects, whether therapeutic or adverse, and the role of biological sex has as yet unrecognized and underestimated consequences. A pharmacogenomic approach could contribute towards the development of an adapted therapy for each male and female patient, considering also other fundamental features, such as age and ethnicity. This would represent a crucial step towards precision medicine and could be translated into clinical routine. In the present review, we consider recent results from pharmacogenomics and the role of sex in studies that are relevant to cardiovascular therapy. We focus on genome-wide analyses, because they have obvious advantages compared with targeted single-candidate gene studies. For instance, genome-wide approaches do not necessarily depend on prior knowledge of precise molecular mechanisms of drug action. Such studies can lead to findings that can be classified into three categories: first, effects occurring in the pharmacokinetic properties of the drug, e.g. through metabolic and transporter differences; second, a pharmacodynamic or drug target-related effect; and last diverse adverse effects. We conclude that the interaction of sex with genetic determinants of drug response has barely been tested in large, unbiased, pharmacogenomic studies. We put forward the theory that, to contribute towards the realization of precision medicine, it will be necessary to incorporate sex into pharmacogenomics.