Beyond bikini medicine: An analysis of  Sex- and Gender-Informed Medicine in a preclinical undergraduate medical education

TL;DR

This study finds that medical education lacks teaching on how sex and gender differences affect health, with only a small percentage of cases addressing these issues.

Contribution

The paper provides a detailed audit of sex and gender representation in medical case studies and highlights the need for curriculum reform.

Findings

Only 6.6% of cases included deliberate teaching on sex and gender differences in health and disease.

Most discussions on sex and gender were limited to reproductive or autoimmune diseases.

The majority of cases did not intentionally choose patient sex or gender during design.

Abstract

Despite the expanding literature demonstrating widespread sex and gender differences across all organ systems, the inclusion of Sex- and Gender-Informed Medicine (SGIM) in medical education is lacking, leaving medical students without an appreciation for physiologic and sociocultural differences that affect health, disease, and healthcare delivery.

We performed an audit of the five courses of the Harvard Medical School pre-clinical curriculum that teach physiology and pathophysiology using case-based collaborative learning (CBCL). Using a standard codebook, reviewers recorded: time per case, diagnosis/focus of case, age, sex, gender, pronouns, pregnancy status, and sexual orientation. Coders were asked to determine if the CBCL patient’s sex/gender chosen was “intentional” and if there was further discussion around sex- and gender-specific influences on disease. Each case was coded by two auditors, with discrepancies adjudicated by a third.

Across five courses, 591 patient cases taught over 380 hours were analyzed. 298 (50.4%) of CBCL patients were women, 235 (39.8%) men, five (0.8%) non-binary, and 53 (9.0%) gender undefined. Relationships were predominantly between discordant gendered partners (37 cases, 82.2% of cases with relationships). Only 60 cases (10.2%) were coded as having a patient sex or gender that was intentionally chosen during case design, predominantly to reflect population-level disease epidemiology or prevalence by gender (45%). Only 39 cases (6.6%) included deliberate learning dedicated to sex or gender differences in health and disease, with most discussions within cases of reproduction or inflammatory/autoimmune diseases.

Our review demonstrated a deficiency of SGIM content in our institution’s preclinical curriculum with only 6.6% of CBCL cases providing deliberate teaching on sex and gender differences in health and disease, largely confined to reproductive topics. We propose the creation of dedicated, daily course material in collaboration with experts to increase exposure to SGIM so students can confidently treat any patient.

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