gms | German Medical Science

Medically relevant sex and gender differences are insufficiently considered during medical training and continuing medical education at all levels. An increasing number of scientific studies have consistently reported gender-dependent differences in prevalence and incidence for many diseases. The presentation of symptoms, comorbidities, courses of diseases and outcomes do also differ between sexes. Accordingly, prevention, diagnosis and therapy could be highly improved by a gender-specific medicine. The 115^th German Medical Assembly recommends incorporating phase-of-life and gender-related differences in diagnosis and therapy (DEUTSCHES ÄRZTEBLATT, JG. 109, HEFT 22-23, C 1013, 4. JUNI 2012).

However, there seems to be an insufficient gender-related knowledge in many places (results of the online-survey: “Gender-specific teaching modules in medicine”; http://campus.uni-muenster.de/index.php?id=2147&L=1). Hence, it is pivotal to integrate gender aspects into medical curricula as well as into the training of all health-related professions to reach the goal of an ideal, tailored patient care. We consider the resulting improved training of future physicians as an important quality feature in medicine.

An interdisciplinary, international workshop took place in Muenster (Germany) in May 2012 on the topic how to integrate gender aspects into medical curricula in the future aiming at a better health care for both sexes in long term. This position paper summarizes the conclusions that will be presented in the following:

A consistent terminology is needed to form a uniform basis for discussion and to avoid potential misunderstandings. Currently the terms “sex“ and “gender“ cannot be distinguished in the German language, there is only one word „Geschlecht“ (gender) which is often applied in an arbitrary way. Using “gender” as generic term for the biological and social sex (e.g. in gender medicine) can cause some confusion. Since gender medicine is a nationwide and internationally widely accepted term - it is not sensible to change this term and to substitute “gender“ by another word. However, it is of high importance to define exactly what is meant by using a specific term in literature and especially in education. Therefore we suggest the following definitions for the German language: “Gender“ refers to the “social sex“, i.e. all aspects related to a person‘s role in society. Sex, on the other hand, depicts the biological sex, but is used less frequently due to its connotations. The German term “Geschlecht“ is the generic term for both - sex and gender. Whenever possible, it is recommended to use the terms „men and women“.

Moreover, it is also of high importance to be aware of possible stereotypes. They should be avoided in the field of curriculum development as well as in teaching materials.

As of the first semester, students should be sensitized for sex and gender differences. It is important to define significant terms and to elaborate on general biological principles at an early stage to create a basis for the comprehension of more complex issues in the different specifics - being covered later in the curriculum.

Subject-specific knowledge on sex and gender differences needs to become an essential part of the whole medical curricula - especially of preclinical subjects. Content of teaching should be integrated longitudinally into the course of study. The advantage is obvious: gender medicine is continuously present. Sex and gender differences become “natural” in each subject or module.

Despite the availability of declared experts in gender medicine, there is consensus on the fact that gender contents, specific for each subject, should be selected by the respective representatives themselves. The contents of teaching should be practically relevant and evidence-based. Experts in gender medicine should support lecturers/full professors in elaborating gender-specific contents - both with regard to content and organization.

At present, the student‘s workload clearly exceeds the didactically reasonable limit. Reasons among others are the consistently increasing knowledge in medicine and legal requirements resulting for example in a rising number of 41 graded certifications in the course of the medical curricula. Against this background it is vital not to increase the students’ workload due to the integration of gender-specific contents. In fact, a time- and content-balanced implementation is the key to success.

To put emphasis on gender-specific contents, they should be considered within students´ university and state exams. If they were excluded from exams, they would neither be taken seriously nor learned by students. Therefore, considering gender aspects in exams is a further step towards acceptance when integrating sex and gender aspects into medical education.

It is essential to add gender-specific learning objectives to the national competence-based learning catalogue for medical education (NKLM) to yield further support for the implementation from a political perspective.

• A maximum commitment of medical faculties is obligatory and related activities should be rewarded in an appropriate way.
• Every faculty needs a medical leader with scientific expertise in the field of gender medicine - for example one of the full professors. She/he could coordinate the implementation of gender-specific aspects. To avoid misunderstandings, this person should not belong to the department of gender equality or work in the area of gender mainstreaming. Addressing sex and gender aspects in medicine is not a women‘s topic, but an issue of both sexes. The leader‘s main task is to coordinate the learning objectives of lectures and seminars in the different medical subjects (see 4).
• To foster the topic at universities, it is important to ask faculty representatives to put emphasis on the gender-specific contents that are already part of their teaching. In doing so, the impression to force professors to integrate gender aspects can hopefully be avoided.
• To avoid increasing the student‘s workload, only a limited number of meaningful examples of gender aspects should be taught (e.g. two to three highlights regularly per subject/module). Furthermore, by shifting and adjusting the foci of learning contents, redundant repetitions will be avoided. A stringent coordination of the learning content within and among the particular subjects and modules creates free space for gender-specific aspects in the curriculum.
• The following innovations are beneficial to approach an effective and comparable realization of the project:
  • train the teacher-programs
  • online material pool (potentially nationwide)
  • institutional support (e.g. a coordinating position)
  • profitable networks of all participants (e.g. a coordinating position, which is responsible for mentoring medical theses and/or dissertations, fundraising for gender projects etc.)
  • regular conferences of faculty representatives on the topic gender medicine

The implementation of gender aspects in diagnosis, therapy, prevention and rehabilitation is of high importance and a starting point of diversity medicine. Addressing this topic is an indispensable basis for an optimized medical treatment which focuses on ideal medical care for everyone.

We like to thank the following workshop participants for critical review of the position paper as well as the inspiring discussion:

• Dr. Anja Böckers (University of Ulm, Department of Medicine, Institute of Anatomy and Cellbiology, Ulm, Germany)
• Prof. Dr. Margarethe Hochleitner (Medical University of Innsbruck, Innsbruck, Austria)
• Sabine Ludwig (Charité University Medicine Berlin, Project Controlling „Modellstudiengang Medizin“, Berlin, Deutschland)
• Dr. Anja Vervoorts (Heinrich-Heine University Duesseldorf, Department of Medicine, Duesseldorf, Germany)

The authors declare that they have no competing interests.