Introduction of a new curriculum in women's health in medical education: a framework for change

From gender bias to gender awareness in medical education

Gender is an essential determinant of health and illness. Gender awareness in doctors contributes to equity and equality in health and aims towards better health for men and women. Nevertheless, gender has largely been ignored in medicine. First, it is stated that medicine was 'gender blind' by not considering gender whenever relevant. Secondly, medicine is said to be 'male biased' because the largest body of knowledge on health and illness is about men and their health. Thirdly, gender role ideology negatively influences treatment and health outcomes. Finally, gender inequality has been overlooked as a determinant of health and illness. The uptake of gender issues in medical education brings about specific challenges for several reasons. For instance, the political-ideological connotations of gender issues create resistance especially in traditionalists in medical schools. Secondly, it is necessary to clarify which gender issues must be integrated in which domains. Also, some are interdisciplinary issues and as such more difficult to integrate. Finally, schools need assistance with implementation. The integration of psychosocial issues along with biomedical ones in clinical cases, the dissemination of literature and education material, staff education, and efforts towards structural embedding of gender in curricula are determining factors for successful implementation. Gender equity is not a spontaneous process. Medical education provides specific opportunities that may contribute to transformation for medical schools educate future doctors for future patients in future settings. Consequently, future benefits legitimize the integration of gender as a qualitative investment in medical education.

Making a gender difference: case studies of gender mainstreaming in medical education

BACKGROUND

Curricula are accommodated to the interests of new groups after pressure from social movements outside institutions. A Dutch national project to integrate gender-gender mainstreaming (GM)-in all medical curricula started in 2002 and finished in 2005. GM is a long-term strategy which aims at eliminating gender bias in existing routines for which involvement of regular actors within the organization is required.

AIMS

In this paper, the challenges of GM in medical education are discussed. Three case studies of medical schools are presented to identify key issues in the change process.

METHOD

Steps taken in the national project included the evaluation of a local project, establishing a digital knowledge centre with education material, involving stakeholders and building political support within the schools and national bodies, screening education material and negotiating recommendations with course organizers, and evaluating the project with education directors and change agents. Data are gathered from interviews and document analysis.

RESULTS

Factors playing a role are distinguished at three levels: (1) policy level, such as political support and widespread communication of this support; (2) organizational level such as a problem-based curricula and procedures for curriculum development and evaluation; and (3) faculty's openness towards change in general and towards feminist influences in particular, and change agents' position as well as personal and communicative skills.

CONCLUSIONS

Successful GM in medical education is both a matter of strategy as well as how such strategy is received in medical schools. A time-consuming strategy could overcome resistance as well as dilemmas inherent in GM. More female teachers than male teachers were openly accepting. However, women were situated in less visible and less powerful positions. Hence, GM is accelerated by alliances between women aiming for change and senior (male) faculty leadership.

Integrating gender into a basic medical curriculum

INTRODUCTION

In 1998, gaps were found to exist in the basic medical curriculum of the Radboud University Nijmegen Medical Centre regarding health-related gender differences in terms of biological, psychological and social factors. After screening the curriculum for language, content and context, adjustments aimed at incorporating gender issues were proposed. The aim of this study was to evaluate those adjustments, as well as to investigate whether gender had been successfully incorporated into the basic medical curriculum, and to identify the factors that played a role in this.

METHODS

The education material of 9 curricular blocks was re-evaluated and interviews were held with block co-ordinators.

RESULTS

Since the beginning of the project, gender has increasingly been brought to the attention of the students. Various factors have played a role: concrete and directly executable content-oriented proposals for adjustment; adequate translation of gender differences into actual patient care; motivated block co-ordinators; the presence of a 'trigger person' in the faculty; incorporation into the existing education programme; the involvement of block co-ordinators in decision making, and the provision of practical support.

DISCUSSION

Integrating gender into the basic medical curriculum has been largely successful. Block co-ordinators' personal recognition of the importance of gender in patient care greatly facilitated implementation. The evaluation stimulated the forming of new ideas. It is recommended that these factors and those mentioned above should be taken into consideration when integrating gender into other faculties.

Increasing Recruitment of Quality Students to Obstetrics and Gynecology: Impact of a Structured Clerkship

OBJECTIVE

To evaluate the satisfaction of the third-year medical students with their basic third-year obstetrics and gynecology rotation before and after a concerted effort was made to improve the rotation with prompt feedback and problem-based case learning.

METHODS

At the end of each rotation, third-year medical students were asked to anonymously fill out an "in-house" course evaluation. A 1-5 rating scale to evaluate quality of teaching, instructor's commitment and enthusiasm, and enhancement of professional development was used. Scores were compared over 4 years, and a Wilcoxon rank sum analysis was performed to determine significance. Evaluations were compared for 1999 and 2000, which were the 2 years before the initiation of the structured rotation, with 2001 and 2002, the first 2 years of the new approach's implementation.

RESULTS

Sixty third-year students were evaluated. The students noted that the quality of teaching improved (P <.002), the instructors' commitment and enthusiasm increased (P <.001), instructors enhanced the student's professional development (P <.001), and students perceived faculty as positive role models (P <.001). It is noteworthy that between the years 1999 and 2000, the number of students interested in obstetrics and gynecology was 3 and 4, respectively, whereas in 2001 and 2002, the first 2 years after implementation of the new process, 6 and 7 students, respectively, were interested in this field.

CONCLUSION

Students' satisfaction with their third-year clerkship improved with a structured program and increased faculty involvement.

LEVEL OF EVIDENCE

II-2

Gender in medical curricula: course organizer views of a gender-issues perspective in medicine in Sweden

While there is growing awareness of the importance of gender issues in medicine, with new knowledge and new perspectives intensely debated, reports on the implementation of gender issues into medical curricula are scarce. In 1996, the Medical Faculty of Göteborg University, Sweden, determined that a gender-issues perspective be included in medical education. In 1999, course organizers from preclinical and clinical departments of the faculty were interviewed to determine whether they felt that a gender-issues perspective had contributed to their scientific field and, if so, how they implemented it in their teaching. The interviews revealed varied opinions on the relevance of this perspective in medicine. These variations followed gender division rather than that of preclinicians/clinicians. Thus, female gender was overwhelming for inspiring and introducing a gender-issues perspective both scientifically and practically. Positivism is firmly established in medicine and this must be taken into consideration when introducing a more culturally- and socially-based understanding of sex/gender issues. Female gender is important in this process, but successful implementation requires thorough faculty support and participation of male colleagues and students.