A Curricular Audit Method: Addressing the Erasure of Intersex, Trans and Two-Spirit People and the Imprecise Use of Gender and Sex Concepts in Undergraduate Medical Education

Phenomenon: Intersex, trans, and Two-Spirit people report overwhelmingly negative experiences with health care providers, including having to educate their providers, delaying, foregoing, and discontinuing care due to discrimination and being denied care. Medical education is a critical site of intervention for improving the health and health care experiences of these patients. Medical research studies, clinical guidelines, textbooks, and medical education generally, assumes that patients will be white, endosex, and cisgender; gender and sex concepts are also frequently misused. Approach: We developed and piloted an audit framework and associated tools to assess the quantity and quality of medical education related to gender and sex concepts, as well as physician training and preparedness to meet the needs of intersex, trans, and Two-Spirit patients. We piloted our framework and tools at a single Canadian medical school, the University of British Columbia, focused on their undergraduate MD program. We were interested in assessing the extent to which endosexnormativity, cisnormativity, transnormativity, and the coloniality of gender were informing the curriculum. In this paper, we detail our audit development process, including the role of advisory committees, student focus groups, and expert consultation interviews. We also detail the 3-pronged audit method, and include full-length versions of the student survey, faculty survey, and purpose-built audit question list. Findings: We reflect on the strengths, limits, and challenges of our audit, to inform the uptake and adaptation of this approach by other institutions. We detail our strategy for managing the volume of curricular content, discuss the role of expertise, identify a section of the student survey that needs to be reworked, and look ahead to the vital task of curricular reform and recommendations implementation. Insights: Our findings suggest that curricular audits focused on these populations are lacking but imperative for improving the health of all patients. We detail how enhancing curriculum in these areas, including by adding content about intersex, trans, and Two-Spirit people, and by using gender and sex concepts more accurately, precisely and inclusively, is in line with the CanMEDS competencies, the Medical Council of Canada's Objectives for the Qualifying Examinations, many institutions' stated values of equity, inclusion and diversity, and physicians' ethical, legal and professional obligations.

Planetary health and sustainability teaching in UK medical education: A review of medical school curricula

BACKGROUND

The doctors of the future need to be empowered to deliver healthcare sustainably while protecting their patients' health in the context of a degrading environment. This study aimed to objectively review the extent and nature of the teaching of planetary health and sustainability topics in UK medical education.

METHODS

A multi-centre national review of the timetabled teaching sessions in medical courses in the UK during the academic year 2020/2021 against the General Medical Council's adopted 'Educating for Sustainable Healthcare - Priority Learning Outcomes'. Medical students were recruited and reviewed the entirety of their own institution's online teaching materials associated with core teaching sessions using a standardised data collection tool. Learning outcome coverage and estimated teaching time were calculated and used to rank participating medical schools.

RESULTS

45% of eligible UK medical schools were included in the study. The extent of teaching varied considerably amongst courses. Mean coverage of the 13 learning outcomes was 9.9 (SD:2.5) with a mean estimated teaching time of 140 min (SD:139). Courses with dedicated planetary health and sustainability sessions ranked best.

CONCLUSION

There is large disparity in the education that medical students receive on these topics. Teaching may not adequately prioritise sustainability or reflect advances in planetary health knowledge.[Box: see text].

InciSioN CollaborativeBandyopadhyaySohamSoham.bandyopadhyay@yahoo.co.ukKanmounyeUlrick S.MadaniKatayoun S.BeltranoJoanaIsaMashkur A.OoiReuben Y. K.SwaroopMamtaShahSayed S. N. H.KawkaMichalNteranyaDaniel S.KhalilHalimahBadwiNerminAnyomihTheophilus T. K.TwizeyimanaEricKimuraHitomiMatovuDissanRahmanSajiburSanaHamaiyalReidKevouyAlamSyeda FatemaShahPriyanshNdayiragijeRaoulShabaniMoshi M.RuzibukyaVictorPatelNaeem Abdul YusufFisshaAemon B.PatilPoorvaprabhaUdeme-AbasiNelsonNgYuki J.BrakeAaron DanielArshadAbdul RehmanAdekanleAdeolaElmelegyAhmed AymanWilkinsonAimeeTurabAl HasnatKilanyAmany Mostafa TahaHadzićAmarNaemeAminaPranjićAnamariaSnyderAndrewShahrinAnikaAdefolajuAnthoniaJayaramAnushaMuhumuzaArsenNyalundjaArsène DanielHayashiAsumiOdaAyakaKurokiAyukaMbogoBancy WaitheraWarisoBathshebaHauserBlake M.WilleyBreaMlulaChipegwaJordanChloePhiriChristabelSelvakumaranChunyingDamboCollins IghabaPeckConnor J.Chukwudi-OjeCynthiaEvansDaisyOtoboDaniel DavidGarbaDeenKasongiDoreenMulwandaEdwin M.OlarinreErinfolami HabibaAnnangEstherSolimanFady K.MuchemiFaith WambuiAdemovićFatihMsikwaFidelisYiFoo ChuanGoodluckGregoryKarelasGregoryLevyHannah A.SprowHollyHuzaifaIbrahim BinLeeJamesFerdousJannatulHenryKaweesiSukoJasminaBarayyaKhair UlMohamedKhairoon AbdulkadirDasKieranIftikharKomalKurosawaKotaNunezKristin CardielLangstonKyleAmlaniLahinStewartLatoya A.ChunLeong KahSolimanMahmoud AymanAkterMaisha Samiha BinteBjeletićMarijade Andres CrespoMartaSaadMarwaMenardMaylanderFaisalMd. FahimKakwaniMehakRiazMehr Muhammad AdeelMusyokiMercellina NdukuMaleševićMilicaPueschelMiriamAdwiMohamedJallohMohamed BellaGhanemMohamed E.BashirMohammed TalhaRajaMomna SajjadFaulknerMonalisa M. J.FatimaMoomtahinaChitaluMubangaAl MubinMuktasidArmandMushila NguzaBizwellMwaba KabweChoiMyoung HyunKhanNavid MahmudAdeyemoOlaoluwaHassanOyindayoChanaPavanraj SinghStephenPraise OluwajuwonMenonPriyankaMiuraRiekoTerashimaRikaFenderRobert ZacharyElsayedRokaya SalahRaynerRosieTakahashiRyoIlyasSaadHasanSakibDawoSalluTebhaSameer SaleemKafleSamipyaHusseinSara M.HonjoSarahShahSayed Shah Nur HusseinOoiSetthasorn Zhi YangAliyuShamsudeenRehmanShahyan UrUsamiShinjuKachiShionShafiShirazAl MajidSulaymaanAhnafSyed RamizMuhammadSyed ZakiMizuguchiTakakoMaselandTashiTehWei XiangShahVirajChenWentinMauyaWilliamYoonWon YoungIssiouYacineYekXinyeTsumuraYoshikiNishikawaYurikaKhanZara. International Survey of Medical Students Exposure to Relevant Global Surgery (ISOMERS): A Cross-Sectional Study

BACKGROUND

The principles of global surgery should be taught as a part of the core curriculum in medical schools. The need for medical students to be familiar with the topic is increasing in acceptance. There is, however, a paucity of data on how medical students are exposed to global surgery. This study aims to evaluate exposure of medical students to global surgery, awareness of the key messages of the Lancet Commission on Global Surgery, global surgery career aspirations and barriers to said aspirations.

METHODS

ISOMERS was a multi-centre, online, cross-sectional survey of final year medical students globally. The questionnaire utilised a combination of Likert-scale, multiple-choice, and free text questions.

RESULTS

In this study, 1593 final year medical students from 144 medical schools in 20 countries participated. The majority (n = 869/1496, 58.1%) believed global surgery to be relevant, despite 17.7% (n = 271/1535) having any exposure to global surgery. Most participants (n = 1187/1476, 80.4%) wanted additional resources on global surgery. Difficulty in providing appropriate care for patients living abroad (n = 854/1242, 68.8%) was the most common perceived barrier to a career in global surgery.

CONCLUSIONS

Participants believed global surgery was a relevant topic for medical students and wanted additional resources that they could access on global surgery. It is critical for medical students to become aware that global surgery is a field that aims to address inequity in surgical care not just internationally, but nationally and locally as well.

Cross-sectional Survey of Medical student Attitudes to Research and Training pathways (SMART) in the UK: study protocol

BACKGROUND

An understanding and appreciation of scientific research is a key quality of the modern clinician. Yet the Medical Schools Council has previously reported a reduction in the number of clinicians performing research. To explore the reasons for this difficulty, this multicentre, cross-sectional study aims to determine the medical student involvement and perceptions of research and research-orientated careers. It will additionally identify perceived barriers and incentives to participating in research as a student.

METHODS AND ANALYSIS

This cross-sectional study of medical students at UK medical schools recognised by the General Medical Council will be administered using an online questionnaire. This will be disseminated nationally over a 2-month period through collaborative university medical school and student networks. The primary outcome is to determine the extent to which medical students are currently involved in research. Secondary outcomes include identifying the personal and demographic factors involved in incentivising and deterring medical students from becoming involved in research during medical school. This will be achieved using a selection of Likert scale, multiple-choice and free text questions. Ordinal logistic regression analysis will be performed to understand the association between specific factors and student involvement in research. This study will also characterise the proportion of medical students who are currently interested in conducting research in the future.

ETHICS AND DISSEMINATION

Ethics approval has been obtained from the Medical Sciences Interdivisional Research Ethics Committee, Oxford, England. The results will be disseminated via publication in a peer-reviewed medical journal and may be presented at local, regional, national and international conferences by medical student collaborators.

Impact of the COVID-19 pandemic on paediatric patients with cancer in low-income, middle-income and high-income countries: protocol for a multicentre, international, observational cohort study

INTRODUCTION

Childhood cancers are a leading cause of non-communicable disease deaths for children around the world. The COVID-19 pandemic may have impacted on global children's cancer services, which can have consequences for childhood cancer outcomes. The Global Health Research Group on Children's Non-Communicable Diseases is currently undertaking the first international cohort study to determine the variation in paediatric cancer management during the COVID-19 pandemic, and the short-term to medium-term impacts on childhood cancer outcomes.

METHODS AND ANALYSIS

This is a multicentre, international cohort study that will use routinely collected hospital data in a deidentified and anonymised form. Patients will be recruited consecutively into the study, with a 12-month follow-up period. Patients will be included if they are below the age of 18 years and undergoing anticancer treatment for the following cancers: acute lymphoblastic leukaemia, Burkitt lymphoma, Hodgkin lymphoma, Wilms tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas and neuroblastomas. Patients must be newly presented or must be undergoing active anticancer treatment from 12 March 2020 to 12 December 2020. The primary objective of the study was to determine all-cause mortality rates of 30 days, 90 days and 12 months. This study will examine the factors that influenced these outcomes. χ2 analysis will be used to compare mortality between low-income and middle-income countries and high-income countries. Multilevel, multivariable logistic regression analysis will be undertaken to identify patient-level and hospital-level factors affecting outcomes with adjustment for confounding factors.

ETHICS AND DISSEMINATION

At the host centre, this study was deemed to be exempt from ethical committee approval due to the use of anonymised registry data. At other centres, participating collaborators have gained local approvals in accordance with their institutional ethical regulations. Collaborators will be encouraged to present the results locally, nationally and internationally. The results will be submitted for publication in a peer-reviewed journal.

Implementing a Practical Global Health Curriculum: The Benefits and Challenges of Patient-Based Learning in the Community

Background: A growing number of medical schools across the world have incorporated global health (GH) into their curricula. While several schools focus GH education on lecture-based courses, our premise is that global health education should embody a holistic approach to patient care and medical education in local communities. Medical students may learn global health by focusing on real patients, their families and communities as part of a practical curriculum.

Aims and Objectives: A unique GH curriculum was devised to compare student learning outcomes on a practical vs. lecture-based course. The premise was that learning from patients would result in a greater breadth of coverage of the global health syllabus as compared to that from a lecture-based course.

Methods: A teaching and learning program was developed over 3 years to provide medical students interaction with real patients in the community on a first-preclinical-year Introduction to Global Health and Medical Anthropology course. Learning outcomes on the practical vs. lecture-based course were compared using thematic analysis of the written assignments of both courses: global health case reports and literature reviews, respectively. All members of three cohorts of students undertaking the course in successive academic years were compared (Group A: literature review; Groups B and C: case reports; n = 87).

Results: Case reports provided evidence of a greater breadth of learning outcomes when compared to the literature review (p < 0.001). The writing of the case report was enhanced by completion of a field journal and family health needs assessment tool (p < 0.001). Students demonstrated a closeness to their patients that added depth, understanding and motivation to assist patients in health activities and advocate for their needs.

Discussion: Placements with patients in the community provided students with a rich learning environment and facilitated the formation of relationships with patients to better understand the social determinants of health and advocate for improvements in their living and working conditions and access to healthcare.

Conclusions: Global health may be better learned experientially by following patients rather than from frontal lectures. Patient-based learning inspires a commitment to the individual and facilitates medical schools in meeting their obligations to the communities they serve.