New approaches and established models for scaling up sex- and gender-sensitive medicine teaching – Nature

Report on the Integration of Sex- and Gender-Sensitive Medicine (SGSM) in Medical Education with Emphasis on Sustainable Development Goals (SDGs)

Abstract

Teaching sex- and gender-sensitive medicine (SGSM) enhances the quality of healthcare for all genders. Despite its importance, literature on SGSM implementation in medical education is limited, and theoretical models are scarce. This report reviews existing approaches and introduces a new theoretical model to systematically evaluate SGSM integration. Implementation steps at the content level and learner competencies are outlined, with recommendations to advance comprehensive SGSM teaching. This aligns with SDG 3 (Good Health and Well-being) and SDG 4 (Quality Education) by promoting inclusive and equitable healthcare education.

Introduction

Medical professionals must incorporate sex and gender considerations into daily practice to ensure high-quality healthcare for all patients, supporting SDG 3. Ignoring these factors leads to misdiagnosis, delayed diagnosis, and suboptimal treatment. SGSM addresses the influence of sex and gender on health, disease, and care, aiming to remove gender-based barriers and improve diagnosis and treatment for all genders.

Despite its critical role, SGSM is not yet systematically taught worldwide. Knowledge of sex and gender impacts on chronic diseases such as diabetes, cardiovascular diseases, pulmonary diseases, cancers, neurodegenerative diseases, strokes, infectious and autoimmune diseases, kidney and liver diseases, and psychiatric disorders is essential for medical students. Integrating SGSM into medical education promotes gender awareness, supporting SDG 5 (Gender Equality) and SDG 10 (Reduced Inequalities).

Methods

A comprehensive literature review was conducted using PubMed/Medline, Cochrane, and Embase databases, supplemented by snowballing. Search terms included “sex and gender,” “gender-sensitive medicine,” “medical education,” and “curriculum,” among others. Intersectionality and diversity were core components, incorporating terms like “diversity,” “equity,” “inclusion,” “social discrimination,” and “intersectionality.” Publications in English, German, or French were included without year restrictions, focusing on SGSM teaching design and integration.

Results

Barriers to SGSM Integration

• Perception of SGSM as politically ideological, conflicting with the notion of medicine as objective and neutral.
• Lack of best-practice examples.
• Limited resources including funding, personnel, expertise, and time.

Models of Curricular Integration

Four main models for integrating SGSM into medical curricula were identified:

1. Separate-Course Model: Offering dedicated SGSM courses or lecture series alongside existing curricula. This model is simple to implement but may isolate SGSM content.
2. Area-of-Concentration Model: Elective in-depth education for interested students, fostering skill acquisition and research engagement, but reaching fewer students.
3. Interdisciplinary Model: Collaboration across faculties, combining perspectives from gender studies, social sciences, and medicine, optimizing resource use and enriching content.
4. Integration Model: Longitudinal, cross-cutting incorporation of SGSM throughout the curriculum, considered the most effective but also the most challenging to implement.

Role of University Staff and Leadership

• Educators’ competencies in sex, gender, and diversity influence SGSM teaching quality.
• Training programs for faculty improve awareness and teaching practices.
• Institutional leadership and policies are critical for successful implementation, including appointing change agents and leveraging accreditation processes.

New Model for SGSM Integration: Edu-GRAS

A novel model, Edu-GRAS (Gender Responsive Assessment Scale adapted to medical education), was introduced to evaluate the depth of SGSM implementation. It defines five stages:

1. Gender-Discriminatory: Curriculum perpetuates biases and stereotypes, using a narrow standard (e.g., white, cis male).
2. Gender-Blind: Curriculum lacks explicit SGSM content but does not intentionally discriminate; however, biases persist implicitly.
3. Gender-Sensitive: Addresses sex/gender-specific needs without contextualization; promotes gender awareness.
4. Gender-Responsive: Provides contextualized SGSM content, inclusive language, and fosters cognitive, affective, and practical competencies for gender-responsive care.
5. Gender-Transformative: Aims to transform structural health inequities by addressing social determinants and power structures; empowers learners with structural competencies.

This model supports SDG 3, SDG 4, SDG 5, and SDG 10 by promoting equitable, inclusive, and high-quality medical education and healthcare delivery.

Discussion

SGSM integration remains insufficient globally, with most medical schools offering elective or isolated courses rather than comprehensive, longitudinal curricula. Edu-GRAS provides a framework for stepwise implementation, encouraging progression from gender-sensitive to gender-transformative education.

Recommendations include:

• Systematic inclusion of SGSM content with balanced language and visuals.
• Embedding SGSM in learning objectives and assessments.
• Utilizing innovative teaching methods such as case studies, simulations, reflective writing, and community involvement.
• Strengthening faculty competencies through training and bias-awareness tools.
• Engaging university leadership to support and sustain curricular changes.
• Publishing best practices and standardizing evaluation to enhance global SGSM education.

These actions align with SDG 4 (Quality Education), SDG 5 (Gender Equality), SDG 10 (Reduced Inequalities), and SDG 3 (Good Health and Well-being), contributing to equitable healthcare systems and improved health outcomes.

Conclusion

The adaptation of the Gender Responsive Assessment Scale (Edu-GRAS) for medical education offers a nuanced tool to evaluate and guide SGSM implementation. Systematic approaches to document best practices are essential to develop evidence-based strategies for comprehensive SGSM integration. This supports the achievement of multiple Sustainable Development Goals by fostering inclusive, equitable, and high-quality medical education and healthcare.

1. Sustainable Development Goals (SDGs) Addressed or Connected

• SDG 3: Good Health and Well-being – The article focuses on improving medical education to enhance healthcare quality for all genders, addressing health disparities and promoting individualized care.
• SDG 4: Quality Education – It emphasizes the integration of sex- and gender-sensitive medicine (SGSM) into medical curricula and professional training, aiming for inclusive and comprehensive education.
• SDG 5: Gender Equality – The article addresses gender-based access barriers to healthcare and promotes gender-responsive and transformative approaches in medical education to reduce inequalities.
• SDG 10: Reduced Inequalities – By incorporating intersectionality and diversity into medical education, the article supports reducing inequalities in health outcomes related to sex, gender, race, and other social determinants.

2. Specific Targets Under the Identified SDGs

1. SDG 3: Good Health and Well-being
   • Target 3.8: Achieve universal health coverage, including access to quality essential healthcare services.
   • Target 3.c: Substantially increase health financing and recruitment, development, training, and retention of the health workforce.
2. SDG 4: Quality Education
   • Target 4.3: Ensure equal access for all women and men to affordable and quality technical, vocational, and tertiary education.
   • Target 4.7: Ensure that all learners acquire knowledge and skills needed to promote sustainable development, including gender equality and human rights.
3. SDG 5: Gender Equality
   • Target 5.1: End all forms of discrimination against all women and girls everywhere.
   • Target 5.5: Ensure women’s full and effective participation and equal opportunities for leadership at all levels.
4. SDG 10: Reduced Inequalities
   • Target 10.2: Empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, or economic or other status.

3. Indicators Mentioned or Implied to Measure Progress

• Indicators related to SDG 3:
  • Health workforce training and competency in sex- and gender-sensitive medicine (implied through evaluation of medical curricula integration).
  • Quality of healthcare services measured by reduction in misdiagnosis, delayed diagnosis, and suboptimal treatment related to sex and gender factors.
• Indicators related to SDG 4:
  • Proportion of medical schools integrating SGSM into their curricula (implied by the discussion of integrational models and longitudinal integration).
  • Students’ gender awareness and competencies acquired through SGSM teaching (measured by surveys and assessments cited in the article).
• Indicators related to SDG 5:
  • Reduction in gender-based access barriers to healthcare (implied through curriculum impact on clinical practice).
  • Inclusion of gender-responsive and gender-transformative content in medical education curricula.
• Indicators related to SDG 10:
  • Inclusion of intersectionality and diversity aspects in medical education content and teaching methods.
  • Reduction of discriminatory attitudes among medical students and faculty (measured by surveys and bias checklists).

4. Table of SDGs, Targets, and Indicators

Source: nature.com