Gender and Diversity Training Graduate Certificate in Health Professional Education 2004 Ann-Maree Nobelius & Sheila Vance Ann-Maree Nobelius & Sheila Vance CMHSE & Language and Learning Services Monash University Australia

First order of business… Please tell me what these two concepts mean to you: 1. ‘gender’ 2. ‘a gender perspective in medicine’

Today’s Programme TimeTopicPresenter 9.30 Gender Concepts Ann-Maree Nobelius 9.50 Social Analysis Framework Ann-Maree Nobelius Framework with cultural focus Sheila Vance Small Groups Work Ann-Maree & Sheila Morning tea Group discussion Ann-Maree & Sheila Summation Ann-Maree & Sheila

Conceptual Session Objectives To develop skills in identifying needs and issues related to gender and cultural diversity for the teacher and the student in the clinical teaching context To develop skills in identifying needs and issues related to gender and cultural diversity for the teacher and the student in the clinical teaching context To develop strategies to help students to engage appropriately in the clinical teaching environment which are mindful of gender and cultural differences To develop strategies to help students to engage appropriately in the clinical teaching environment which are mindful of gender and cultural differences

Meeting the session objectives To understand the difference between sex and gender To understand the difference between sex and gender To understand the concept of a gender perspective in clinical teaching To understand the concept of a gender perspective in clinical teaching To acquire social analysis skills To acquire social analysis skills To have greater insight into and more empathy for the value of difference To have greater insight into and more empathy for the value of difference

Definitions What is the difference between sex and gender? Sex = male and female Sex = male and female Gender = masculine and feminine Gender = masculine and feminine

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

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

It’s culturally defined ‘man’ = male + masculine social role a real ‘man’, ‘masculine’ or ‘manly’ ‘woman’ = female + feminine social role a real ‘woman’, ‘feminine’ or ‘womanly’

Misunderstandings… ‘gender’ does not mean sex, female or feminism ‘gender’ does not mean sex, female or feminism ‘a gender perspective in medicine’ is not a euphemism for women’s health, feminism or for men needing to ‘get in touch with their feminine side’ ‘a gender perspective in medicine’ is not a euphemism for women’s health, feminism or for men needing to ‘get in touch with their feminine side’ at times impossible to differentiate the biological from the social determinants of health; convention dictates the use of ‘gender’ rather than ‘sex’ in those cases at times impossible to differentiate the biological from the social determinants of health; convention dictates the use of ‘gender’ rather than ‘sex’ in those cases misuse of terms is widespread (we use WHO and UN definitions) misuse of terms is widespread (we use WHO and UN definitions) MEN HAVE GENDER TOO MEN HAVE GENDER TOO

A gender perspective in medicine is multidimensional… …because all players in the healthcare and educational process have a gender So from the patient’s perspective… … a gender perspective in medicine acknowledges the role that masculinity and femininity plays in men’s and women’s health … a gender perspective in medicine acknowledges the role that masculinity and femininity plays in men’s and women’s health From the providers perspective… … a gender perspective acknowledges the ways in which the gender of the provider impacts on the health care event … a gender perspective acknowledges the ways in which the gender of the provider impacts on the health care event

From an educational perspective… … identifies the gendered nature of medical education/texts/teaching styles … identifies the gendered nature of medical education/texts/teaching styles From an evidence based perspective… … acknowledges the clinical consequences of gender blind medical research and the resulting medical evidence … acknowledges the clinical consequences of gender blind medical research and the resulting medical evidence

Why should we teach about difference? More or less you are either one or the other on the basis of biological difference More or less you are either one or the other on the basis of biological difference Difference has profound consequences for clinical practice Difference has profound consequences for clinical practice Evidence?…a good and accessible example is AMI Evidence?…a good and accessible example is AMI

Symptoms of AMI crushing chest pain crushing chest pain pain radiating into the left arm pain radiating into the left arm feeling of acute indigestion feeling of acute indigestion

The most common symptoms reported by female patients 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)

Women < 50 years old have 24% higher mortality rate from myocardial infarct than men of the same age (Vaccarino V et al. Sex-Based Differences in Early Mortality after Myocardial Infarction. N Engl J Med 1999; 341(4): )

Gender-blindness in medical research women have only made up 7% of all cardiac research subjects women have only made up 7% of all cardiac research subjects 2/3 of all pharmaceuticals used to treat both men and women have only been tested in men 2/3 of all pharmaceuticals used to treat both men and women have only been tested in men 2/3 of all diseases that affect men and women have only been researched in men 2/3 of all diseases that affect men and women have only been researched in men

Journal of Gender Specific Medicine Coronary heart disease Coronary heart disease Cardiovascular disease and arrhythmia Cardiovascular disease and arrhythmia Brain differences including number of neurons and plasticity Brain differences including number of neurons and plasticity Differential addiction times Differential addiction times Responses to pain medication Responses to pain medication Eating and digestion Eating and digestion Differential drug metabolism Differential drug metabolism Differential treatment of dyslipidaemia Differential treatment of dyslipidaemia Differential carcinogenic and toxic effects of tobacco smoke Differential carcinogenic and toxic effects of tobacco smoke

…and more Differential risk of lung cancer Differential risk of lung cancer Differential HIV viral loads and treatment options Differential HIV viral loads and treatment options Depression from a genetic level Depression from a genetic level Sex hormones and cognitive function Sex hormones and cognitive function Differential dietary treatment for obesity Differential dietary treatment for obesity Gender differences in pre-pubertal children Gender differences in pre-pubertal children Differential lifetime medical costs Differential lifetime medical costs Cataract Surgery Cataract Surgery Stress responses and the sympathetic nervous system Stress responses and the sympathetic nervous system

Why is it ‘gender blind’? more developed medical research systems in countries with white populations of European genetic origins more developed medical research systems in countries with white populations of European genetic origins greater levels of funding in these countries with white populations of European genetic origins greater levels of funding in these countries with white populations of European genetic origins Medical evidence developed from research conducted in less than 10% of world population Medical evidence developed from research conducted in less than 10% of world population the teratogenic risk associated with involving women in clinical trails while in their reproductive years and potential longer-tem outcomes for offspring the teratogenic risk associated with involving women in clinical trails while in their reproductive years and potential longer-tem outcomes for offspring

Be aware that the whole story may not be told… Encourage you and your students to look 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 difference (p Tutor Guide) A lack of evidence is not a lack of difference (p Tutor Guide)

GCHPE …a gender perspective acknowledges the role that gender plays in clinical education But how can we analyse this role in a way that is useful and suggestive of ways to change?

Social Analysis This is the sociological bit…

Society Groups of people acting in organised ways Groups of people acting in organised ways Medicine is an institutionalised form of social behaviour with deep historical roots Medicine is an institutionalised form of social behaviour with deep historical roots Social institutions are reproduced and changed over time Social institutions are reproduced and changed over time Opportunity exists to change social behaviour Opportunity exists to change social behaviour

Purpose To deconstruct issues in a way that suggests multilevel strategies for dealing with them To deconstruct issues in a way that suggests multilevel strategies for dealing with them To identify and negotiate change for the most pertinent need To identify and negotiate change for the most pertinent need

Levels of social analysis 1. Individual 2. Environmental –sociocultural –communities –economics 3. Structural –institutional –legislative 4. Superstructural –international laws, policy and institutions

Gender Collisions Overt/covert curriculum Overt/covert curriculum Insight into what we have taught our students Insight into what we have taught our students

Remember Everyone will have a different perspective Everyone will have a different perspective Because everyone’s experience is different Because everyone’s experience is different Value and respect each others opinion Value and respect each others opinion Acknowledge how these opinions are socially situated Acknowledge how these opinions are socially situated A different perspective can afford invaluable insights A different perspective can afford invaluable insights