The Need for Sex and Gender Education Reform

Abstract

A dvances in our understanding of the very specific and unique medical needs of women have sparked a paradigm shift in the education of healthcare professionalsa shift in perspective that has been clarified around health care providers' acceptance that patient's sex and gender have an unavoidable influence on the prevention, diagnosis and treatment of disease. In 1991, the Office of Women's Health in the United States Department of Health and Human Services was established to improve the health of American women.1 One of the first initiatives of that office was the launching of specialized elective postgraduate level training as a resource for medical students to build their understanding and experience in women's health from the earliest days of their education. In 2005, the Directory of Residency and Fellowship Programs in Women's Health listed 10 residency programs and 16 fellowships in the United States with women's health tracks.2 Sadly, this number has not changed significantly in the last decade; only eight residency programs and 26 fellowships offered women's health tracks in 2015. 3The Office of Women's Health has relied on individual institutions to initiate and sustain postgraduate educational tracks focusing on women's health; this approach has faced many challenges and has not been particularly successful in increasing health care providers understanding and knowledge about the unique needs of female patients. While several fellowship programs in women's health have been established since 1990 and descriptions of the programs have been circulated in a directory, there is limited general knowledge about their existence. 4 Residents enrolled in these programs represent a small fraction of the total number of graduates per year and are drawn from a limited number of medical specialties. The medical specialties that have successfully endorsed women's health tracks are all primary care or primary care oriented, and include internal medicine, family medicine, emergency medicine, psychiatry, and obstetrics and gynecology. Surgery, radiology, neurology, allergy and immune, pediatrics, and many others have never endorsed a focus on education directed specifically at women's health. Women's health, once huddled under the umbrella of reproductive health, now is defined by conditions specific to women and conditions in which the risk, presentation, and/or response to treatment for women differs from that of men. Furthermore, the larger perspective in this field now encompasses sex-and gender-based medicine, acknowledging that both biological and sociocultural aspects of women's and men's health need to be incorporated into management of health and disease.A great deal of the postgraduate training designed to advance the care of women has worked to establish an interdisciplinary model; however, the traditional women's health frame centering on obstetrics and gynecologic issues still lingers in many centers. In 2015, a focus on gender differences was included as a significant goal for 25% of reporting residency p...