Introduction

The impact of sex and gender represents a major domain in the field of diversity and is analysed in the novel discipline of sex and gender medicine. Sex and gender medicine takes into account both biological sex and gender as a sociocultural process and their effects on women’s and men’s health to improve health and health care for both women and men. Because sex and gender cannot be properly separated in the medical field, biological sex is seen to influence health by modifying one’s behaviour and lifestyle and gender-behaviour can modify biological factors and thereby health, thus the term ‘‘sex and gender medicine’’ was introduced. (pp. 996-997)

In 2010, a large European medical faculty, the Charité-Universitätsmedizin Berlin, started to enrol all new medical students into a new medical curriculum.1This undergraduate program is of modular structure, fully integrated, competence based, outcome oriented, and involves patient contact from the beginning. The new curriculum has been sequentially (i.e., module and term wise) planned and implemented following a standardized, systematic, and faculty-wide approach. (p. 997)

Objectives

The key institutional goal is to systematically integrate sex and gender medicine and gender perspectives into the curriculum in order to foster adequate gender-related knowledge and skills for future doctors concerning the etiology, pathogenesis, clinical presentation, diagnosis, treatment, and research of diseases. (p.996)

The final aim is to foster the students’ ability to apply the gender perspective as an important tool to improve their diagnostic, clinical and treatment skills as well as communication abilities with the patient. The consideration and knowledge of sex and gender differences in the development, diagnosis, and treatment of diseases results in a more personalized, cost-effective, and better quality of medical care for men and women. (p.997)

Details

The new undergraduate medical training program is 6 years long and follows the European Union standard requirement of 5500 teaching hours per student. There are two intakes per year, comprising 300 students each. Years 1–5 consist of 10 semesters and comprise 40 modules. Year 6 consists of 3 clinical rotations, each 4 months long. The planning of the modules of the new curriculum started in 2010 and was finalized in 2014. During each curricular development cycle, four modules of one semester were planned. The planning cycle began nine months before the corresponding semester started. Module planning and design involved a standardized eight-step approach, with eight sessions, where one session was 2 hours per week. (p.997)

In terms of methodology, a change agent was integrated directly into the curriculum development team to facilitate interactions with all key players of the curricular development process. The gender change agent established a supporting organizational framework of all stakeholders, and developed a 10-step approach including identification, selection, placing relevant sex and gender medicine–related issues in the curricular planning sessions, counseling of faculty members, and monitoring of the integration achieved. (p.996)

FIG.1. Systematic, 10-step approach to incorporate sex and gender medicine issues along the regular module-planning cycles of the new medical curriculum. (p.999)

There was one change agent employed for a full position as research officer being recruited through a common vacancy announcement. The position was co-financed by a grant of the Berlin state government (Berliner Chancengleichheitsprogramm). The change agent did not receive any special training, but was supported mainly content-wise—by the Institute of Gender in Medicine at Charité. That person was then given the opportunity and also expected to deepen his/ her knowledge while being in this position (‘‘learning on the job’’). In addition to the characteristics similar to those of a curriculum developer, the key features of the change agent were a medical background (medicine, public health) and a qualification involving social sciences/gender studies. Also, a thorough knowledge of sex and gender medicine aspects as well as gender mainstreaming into organizations, like those of higher education institutions, were compulsory. (p.997)

The change agent developed and followed a systematic, 10-step approach (Fig. 1 above). For the planned curriculum, this approach involved three phases and was adjusted to the general standardized curriculum planning process. (p. 998)

With this approach, quantitatively sex and gender medicine–related content was widely integrated throughout all teaching and learning formats and from early basic science to later clinical modules (94 lectures, 33 seminars, and 16 practical courses). Gender perspectives involve 5% of the learning objectives and represent an integral part of the assessment program. Qualitatively, the relevance of gender (sociocultural) differences was combined with sex (biological) differences in disease manifestation throughout the curriculum. (p. 996)

One of the main success factors identified after the implementation of this program has been the appointment of a change agent that facilitates the development of systematic approaches that can be a key and serve as practice models to successfully integrate new overarching curricular perspectives and dimensions—in this case sex and gender medicine—into a new medical curriculum. (p. 996)

For more information:

* This information is extracted from the paper: Ludwig Sabine, Oertelt-Prigione Sabine, Kurmeyer Christine, Gross Manfred, Grüters-Kieslich Annette, Regitz-Zagrosek Vera, and Peters Harm. A Successful Strategy to Integrate Sex and Gender Medicine into a Newly Developed Medical Curriculum. Journal of Women’s Health. December 2015, 24(12): 996-1005. doi:10.1089/jwh.2015.5249.
  • 1. Supplementary Data are available online at www.liebertpub.com/jwh