Box 1
Principles and content of gender medicine education
|
Modular cohort |
Mainstream cohort |
Control cohort | |
|---|---|---|---|
|
Principles for teaching |
Biopsychosocial perspective |
Biomedical perspective |
– |
|
Knowledge, attitude and skills |
Knowledge |
– | |
|
Multiple educational activities |
Multiple educational activities |
– | |
|
GP supervisor with content expertise |
GP supervisor |
GP supervisor with content expertise | |
|
Extended over time |
Extended over time |
– | |
|
Encourage reflection |
– |
– | |
|
Content of training |
Gender socializationa |
Gender socializationa |
Domestic violenceb |
|
Gender and doctor-patient communicationa |
Gender in sexually transmitted diseasea |
Sexual abuseb | |
|
Gender and mental disordersb |
Gender in doctor-patient communicationa |
Acute topics in women’s healthb | |
|
Gender and cardiovascular diseasec |
Gender and depressionb | ||
|
Gender and intimate partner abusec |
Gender and domestic violenceb | ||
|
Gender and cardiovascular diseasec | |||
|
Gender in medically unexplained symptomsc |
a Year 1; b year 2; c year 3
Table 1
The main factors of the modular gender medicine curriculum in GP training in Nijmegen
|
Tutorial theme |
Main objectives |
Teaching methods |
|---|---|---|
|
1. Gender and socialization |
1. Be able to understand the concept of gender |
A discourse on the subject (lecture) |
|
2. Be able to initiate a gender perspective in medical encounters |
Group analysis of a video consultation | |
|
3. Awareness of the existence of gender socialization and its implications for health issues |
Group reflection on subject with regard to content and process | |
|
2. Gender and communication |
1. Understanding of the influence of gender in doctor-patient communication |
A discourse on the subject (lecture) |
|
2. Understanding of how gender influences the process of medical decision-making |
Role play with simulation patients | |
|
3. Demonstrating gender-sensitive doctor-patient communication |
Group reflection on subject with regard to content and process | |
|
3. Gender and psychiatric disorders |
1. Be able to describe gender differences in depression, anxiety disorders, and substance abuse |
A discourse on the subject (a lecture) |
|
2. Be able to identify gender differences in social expectations with regard to substance abuse |
Group reflection on subject with regard to content and process | |
|
3. Be able to recognize male and female presentation and coping in depression and alcohol abuse |
Analysis of case reports | |
|
4. Gender and cardiovascular diseases/urinary incontinence |
1. Be able to understand the gender bias in the care of patients with cardiovascular disease |
Pretest to assess gender knowledge |
|
2. A willingness and ability to minimize the effect of gender bias in cardiovascular disease management |
A lecture on gender differences | |
|
3. Be able to describe and recognize the gender differences in presentation and management of urinary incontinence |
Group analysis of a ideo consultation | |
|
5. Gender and sexual abuse |
1. Be able to describe the patterns and common presentations of sexual violence |
A discourse on the subject (lecture) |
|
2. To increase awareness of sexual violence, potential gender prejudices, and consultation skills |
Role play with simulation patients | |
|
3. Be able to demonstrate gender-sensitive consultation skills to promote case-finding of sexual abused patients |
Group reflection on subject with regard to content and process |
Table 2
Socio-demographic characteristics of the cohorts at entry
|
Modular |
Mainstream |
Control |
P a | |
|---|---|---|---|---|
|
N = 72 |
N = 72 |
N = 60 | ||
|
Female (%) |
47 (65.3) |
55 (76.4) |
37 (61.7) |
0.160 |
|
Age (mean, SD) |
29.8 (4.2) |
29.5 (3.7) |
29.6 (4.3) |
0.936 |
|
Self-reported ethnicity (%) | ||||
|
Western |
64 (88.9) |
66 (91.7) |
53 (88.3) |
0.527 |
|
Non-Western |
5 (6.9) |
2 (2.8) |
3 (5.0) | |
|
Unknown |
3 (4.2) |
4 (5.6) |
4 (6.7) | |
|
Hospital working experience (%) |
36 (50.0) |
40 (55.6) |
29 (48.3) |
0.824 |
|
Out of hospital working experience (%) |
9 (12.5) |
10 (13.9) |
12 (20.0) | |
|
Both |
16 (22.2) |
10 (13.9) |
8 (13.3) | |
|
Other working experience |
11 (15.3) |
12 (16.7) |
11 (18.3) | |
|
Working experience, years (%) |
0.851 | |||
|
<1 year |
24 (33.4) |
20 (27.7) |
24 (40.0) | |
|
1–3 years |
29 (40.3) |
42 (58.3) |
26 (43.3) | |
|
>3 years |
18 (25.0) |
10 (14.0) |
9 (15.0) | |
|
Unknown |
1 (1.3) |
0 |
1 (1.7) | |
|
Former gender education (%) |
44 (61.1) |
20 (27.8) |
26 (43.3) |
0.000b |
|
No former gender education (%) |
28 (38.9) |
51 (70.8) |
33 (55.0) | |
|
Unknown |
0 |
1 (1.4) |
1 (1.7) | |
aOne-way ANOVA (means) or Chi square (percentages)
b p < 0.05; comparison statistical significant
Table 3
Socio-demographic characteristics and N-GAMS subscales scores of three study cohorts
|
Modular cohort |
N = 48 |
Mainstream cohort |
N = 45 |
Control cohort |
N = 45 |
p* |
Eta squared | |
|---|---|---|---|---|---|---|---|---|
|
2007 |
2011 |
2007 |
2011 |
2007 |
2011 | |||
|
Age, mean years (SD) |
29.6 (4.2) |
31.7 (4.5) |
29.5 (3.7) |
32.4 (3.7) |
29.1 (4.3) |
32.0 (4.1) |
0.840 | |
|
Gender, female (%) |
32 (66.7) |
34 (75.6) |
33 (70.2) |
0.639 | ||||
|
Western ethnicity, number (%) |
44 (91.6) |
42 (97.6) |
41 (95.5) |
0.435 | ||||
|
Working experience, mean years |
2.50 |
2.49 |
2.38 |
0.963 | ||||
|
Previous gender education (%) |
62.5 |
100 |
27.3 |
77.8 |
45.7 |
68.1 |
0.003b | |
|
Gender sensitivity, mean (SD) |
3.78 (0.38) |
3.98 (0.35) |
3.70 (0.36) |
3.83 (0.52) |
3.65 (0.37) |
3.80 (0.32) |
0.679 |
0.006 |
|
Mean change in scorea |
0.20b |
0.13 |
0.15b | |||||
|
GRI patients, mean (SD) |
2.42 (0.59) |
2.42 (0.48) |
2.04 (0.56) |
2.21 (0.63) |
2.20 (0.59) |
2.45 (0.60) |
0.138 |
0.029 |
|
Mean change in scorea |
0.00 |
0.17 |
0.25b | |||||
|
GRI doctors, mean (SD) |
2.41 (0.42) |
2.50 (0.45) |
2.19 (0.47) |
2.50 (0.73) |
2.30 (0.47) |
2.50 (0.56) |
0.288 |
0.018 |
|
Mean change in scorea |
0.09 |
0.21b |
0.20b | |||||
|
Gender knowledge, mean (SD) |
10.25 (1.59) |
11.64 (1.60) |
10.47 (1.84) |
10.80 (1.64) |
9.82 (1.40) |
11.08 (1.69) |
0.049b |
0.043 |
|
Mean change in scorea |
1.39b |
0.33 |
1.26b |
One-way ANOVA (means) or Chi square (percentages); to test whether means between cohorts differ
GRI gender role ideology (gender stereotyping)
aDependent Student’s t test; to test of whether means within cohort differ
b p < 0.05; comparisons significant, otherwise all comparisons non-significant
Table 4
Gender differences on N-GAMS and gender knowledge scores
|
Gender sensitivity |
GRI patients |
GRI doctors |
Gender knowledge | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
F |
M |
P a |
F |
M |
P a |
F |
M |
P a |
F |
M |
P a | |
|
Entry |
3.8 |
3.6 |
0.003b |
2.2 |
2.4 |
0.018b |
2.3 |
2.3 |
0.70 |
10.3 |
9.9 |
0.16 |
|
End |
3.9 |
3.7 |
0.002b |
2.3 |
2.6 |
0.001b |
2.5 |
2.6 |
0.17 |
11.1 |
11.4 |
0.25 |
aIndependent Student’s t-test; to test whether means between females and males differ
b p < 0.05; comparison statistically significant