Gender and Diversity Gender and Diversity TrainingTraining

Graduate Certificate inGraduate Certificate in

Health Professional EducationHealth Professional Education 20042004

Ann-Maree Nobelius & Sheila Ann-Maree Nobelius & Sheila Vance Vance

CMHSE & Language and Learning CMHSE & Language and Learning Services Services

Monash University AustraliaMonash University Australia

First order of business…First order of business…

Please tell me what these two Please tell me what these two concepts mean to you:concepts mean to you:

1.1. ‘‘gender’gender’

2.2. ‘‘a gender perspective in medicine’a gender perspective in medicine’

Today’s ProgrammeToday’s ProgrammeTime Topic Presenter

9.30 Gender ConceptsGender Concepts Ann-Maree Nobelius

9.50 Social Analysis FrameworkSocial Analysis Framework Ann-Maree Nobelius

10.00 Framework with cultural focusFramework with cultural focus Sheila Vance

10.20 Small Groups WorkSmall Groups Work Ann-Maree & Sheila

10.30 Morning teaMorning tea

10.50 Group discussionGroup discussion Ann-Maree & Sheila

11. 50 SummationSummation Ann-Maree & Sheila

Conceptual Session Conceptual Session ObjectivesObjectives

To develop skills in identifying needs and To develop skills in identifying needs and issues related to gender and cultural issues related to gender and cultural diversity for the teacher and the student in diversity for the teacher and the student in the clinical teaching contextthe clinical teaching context

To develop strategies to help students to To develop strategies to help students to engage appropriately in the clinical engage appropriately in the clinical teaching environment which are mindful of teaching environment which are mindful of gender and cultural differencesgender and cultural differences

Meeting the session Meeting the session objectives objectives

To understand the difference between To understand the difference between sex and gendersex and gender

To understand the concept of a gender To understand the concept of a gender perspective in clinical teachingperspective in clinical teaching

To acquire social analysis skillsTo acquire social analysis skills To have greater insight into and more To have greater insight into and more

empathy for the value of differenceempathy for the value of difference

DefinitionsDefinitions

What is the difference between What is the difference between sex and gender?sex and gender?

Sex = male and femaleSex = male and female Gender = masculine and feminineGender = masculine and feminine

SEXSEX

refers to biological differences; refers to biological differences; chromosomes, hormonal profiles, chromosomes, hormonal profiles, internal and external sex organs.internal and external sex organs.

GENDERGENDER

describes the qualities that a describes the qualities that a society or culture delineates as society or culture delineates as masculine or feminine. masculine or feminine.

It’s culturally definedIt’s culturally defined

‘‘man’ = male + masculine social roleman’ = male + masculine social rolea real ‘man’, ‘masculine’ or ‘manly’a real ‘man’, ‘masculine’ or ‘manly’

‘‘woman’ = female + feminine social woman’ = female + feminine social rolerole

a real ‘woman’, ‘feminine’ or ‘womanly’a real ‘woman’, ‘feminine’ or ‘womanly’

Misunderstandings…Misunderstandings… ‘‘gender’ does not mean sex, female or feminismgender’ does not mean sex, female or feminism

‘‘a gender perspective in medicine’ is not a a gender perspective in medicine’ is not a euphemism for women’s health, feminism or for men euphemism for women’s health, feminism or for men needing to ‘get in touch with their feminine side’needing to ‘get in touch with their feminine side’

at times impossible to differentiate the biological from at times impossible to differentiate the biological from the social determinants of health; convention dictates the social determinants of health; convention dictates the use of ‘gender’ rather than ‘sex’ in those casesthe use of ‘gender’ rather than ‘sex’ in those cases

misuse of terms is widespread (we use WHO and UN misuse of terms is widespread (we use WHO and UN definitions)definitions)

MEN HAVE GENDER TOOMEN HAVE GENDER TOO

A gender perspective in medicine is A gender perspective in medicine is multidimensional…multidimensional…

…because all players in the healthcare and …because all players in the healthcare and educational process have a gendereducational process have a gender

So from the patient’s perspective…So from the patient’s perspective… … … a gender perspective in medicine a gender perspective in medicine

acknowledges the role that masculinity and acknowledges the role that masculinity and femininity plays in men’s and women’s healthfemininity plays in men’s and women’s health

From the providers perspective…From the providers perspective… … … a gender perspective acknowledges the ways a gender perspective acknowledges the ways

in which the gender of the provider impacts on in which the gender of the provider impacts on the health care eventthe health care event

From an educational perspective…From an educational perspective… … … identifies the gendered nature of medical identifies the gendered nature of medical

education/texts/teaching styleseducation/texts/teaching styles

From an evidence based perspective… From an evidence based perspective… … … acknowledges the clinical consequences of acknowledges the clinical consequences of

gender blind medical research and the resulting gender blind medical research and the resulting medical evidencemedical evidence

Why should we teach about Why should we teach about difference?difference?

More or less you are either one or the More or less you are either one or the other on the basis of biological other on the basis of biological differencedifference

Difference has profound consequences Difference has profound consequences for clinical practicefor clinical practice

Evidence?…a good and accessible Evidence?…a good and accessible example is example is AMIAMI

Symptoms of AMISymptoms of AMI

crushing chest paincrushing chest pain pain radiating into the left armpain radiating into the left arm feeling of acute indigestionfeeling of acute indigestion

The most common symptoms The most common symptoms reported by female patients reported by female patients suffering AMI are:suffering AMI are:

shortness of breath – 58%shortness of breath – 58% weakness – 55%weakness – 55% unusual fatigue - 43%unusual fatigue - 43% cold sweat – 39%cold sweat – 39% dizziness – 39%dizziness – 39%

(NIH NEWS, J American College of Surgeons, 2004; 198: 177)(NIH NEWS, J American College of Surgeons, 2004; 198: 177)

Women < 50 years old Women < 50 years old

have 24% higher mortality ratehave 24% higher mortality rate

from myocardial infarctfrom myocardial infarct

than men of the same agethan men of the same age

(Vaccarino V et al. Sex-Based Differences in Early Mortality after (Vaccarino V et al. Sex-Based Differences in Early Mortality after Myocardial Infarction. N Engl J Med 1999; 341(4):217-25.)Myocardial Infarction. N Engl J Med 1999; 341(4):217-25.)

Gender-blindness inGender-blindness inmedical researchmedical research

women have only made up 7% of all women have only made up 7% of all cardiac research subjects cardiac research subjects

2/3 of all pharmaceuticals used to treat 2/3 of all pharmaceuticals used to treat both men and women have only been both men and women have only been tested in mentested in men

2/3 of all diseases that affect men and 2/3 of all diseases that affect men and women have only been researched in menwomen have only been researched in men

Journal of Gender Specific Journal of Gender Specific MedicineMedicine

Coronary heart diseaseCoronary heart disease Cardiovascular disease and arrhythmiaCardiovascular disease and arrhythmia Brain differences including number of neurons Brain differences including number of neurons

and plasticityand plasticity Differential addiction timesDifferential addiction times Responses to pain medicationResponses to pain medication Eating and digestionEating and digestion Differential drug metabolismDifferential drug metabolism Differential treatment of dyslipidaemiaDifferential treatment of dyslipidaemia Differential carcinogenic and toxic effects of Differential carcinogenic and toxic effects of

tobacco smoketobacco smoke

……and moreand more

Differential risk of lung cancerDifferential risk of lung cancer Differential HIV viral loads and treatment optionsDifferential HIV viral loads and treatment options Depression from a genetic levelDepression from a genetic level Sex hormones and cognitive functionSex hormones and cognitive function Differential dietary treatment for obesityDifferential dietary treatment for obesity Gender differences in pre-pubertal childrenGender differences in pre-pubertal children Differential lifetime medical costsDifferential lifetime medical costs Cataract SurgeryCataract Surgery Stress responses and the sympathetic nervous systemStress responses and the sympathetic nervous system

www.mmhc.com/jgsmwww.mmhc.com/jgsm

www.med.monash.edu.au/gendermedwww.med.monash.edu.au/gendermed

Why is it ‘gender blind’?Why is it ‘gender blind’?

more developed medical research systems in more developed medical research systems in countries with white populations of European genetic countries with white populations of European genetic originsorigins

greater levels of funding in these countries with greater levels of funding in these countries with white populations of European genetic originswhite populations of European genetic origins

Medical evidence developed from research Medical evidence developed from research conducted in less than 10% of world populationconducted in less than 10% of world population

the teratogenic risk associated with involving women the teratogenic risk associated with involving women in clinical trails while in their reproductive years and in clinical trails while in their reproductive years and potential longer-tem outcomes for offspring potential longer-tem outcomes for offspring

Be aware that the whole story Be aware that the whole story may not be told…may not be told…

Encourage you and your students to Encourage you and your students to look at the literature criticallylook at the literature critically

How has the data been produced?How has the data been produced? Does it consider gender or diversity?Does it consider gender or diversity? If not why not?If not why not? A lack of evidence is not a lack of A lack of evidence is not a lack of

difference difference (p 13-14 Tutor Guide)(p 13-14 Tutor Guide)

GCHPEGCHPE

……a gender perspective acknowledges a gender perspective acknowledges the role that gender plays in clinical the role that gender plays in clinical educationeducation

But how can we analyse this role in a But how can we analyse this role in a way that is useful and suggestive of way that is useful and suggestive of ways to change?ways to change?

Social AnalysisSocial Analysis

This is the sociological bit…This is the sociological bit…

SocietySociety

Groups of people acting in organised waysGroups of people acting in organised ways Medicine is an institutionalised form of Medicine is an institutionalised form of

social behaviour with deep historical rootssocial behaviour with deep historical roots Social institutions are reproduced and Social institutions are reproduced and

changed over timechanged over time Opportunity exists to change social Opportunity exists to change social

behaviourbehaviour

PurposePurpose

To deconstruct issues in a way that To deconstruct issues in a way that suggests multilevel strategies for suggests multilevel strategies for dealing with themdealing with them

To identify and negotiate change for To identify and negotiate change for the most pertinent need the most pertinent need

Levels of social analysisLevels of social analysis1.1. IndividualIndividual

2.2. EnvironmentalEnvironmental– socioculturalsociocultural– communities communities – economicseconomics

3.3. StructuralStructural– institutionalinstitutional– legislativelegislative

4.4. SuperstructuralSuperstructural– international laws, policy and institutionsinternational laws, policy and institutions

Gender CollisionsGender Collisions

Overt/covert curriculumOvert/covert curriculum

Insight into what we have taught our Insight into what we have taught our studentsstudents

RememberRemember

Everyone will have a different Everyone will have a different perspectiveperspective

Because everyone’s experience is Because everyone’s experience is differentdifferent

Value and respect each others opinionValue and respect each others opinion Acknowledge how these opinions are Acknowledge how these opinions are

socially situatedsocially situated A different perspective can afford A different perspective can afford

invaluable insightsinvaluable insights