Addressing All Facets of Patients

Those at HMS entrusted with providing a world-class education to the next generation of doctors and biomedical researchers know that they must continually scrutinize and evolve the School's medical curriculum. That includes ensuring that graduates have the knowledge and training to provide expert care to people who belong to groups often underserved by the profession.

A new elective achieves this goal twice over, taking the unusual step of integrating women’s health with LGBTQ health to offer students a four-week intensive on sex- and gender-informed medicine. The course covers how the range of human sexes, genders, and sexual orientations affect health, health care, and health policy as well as how to conduct and critique biomedical research related to sex and gender.

“Sex- and gender-informed medicine," or SGIM, “is a vast, exploding, and exciting field that our students need to be rigorously trained in,” says Alex Keuroghlian, an expert in sex and gender minority health who designed and directs the course with JoAnn Manson, an authority on women’s health, and Deborah Bartz, a medical education specialist focusing on reproductive health.

HMS has fostered efforts for curriculum reform to better reflect the sex and gender diversity of patients and providers. Student demand, along with efforts such as the Sexual and Gender Minorities Health Equity Initiative, has furthered this commitment to change. The new course, which debuted in April 2021, is one welcome result of this effort.

One of only two classes at HMS centered on SGIM—the other is an existing senior clerkship that Keuroghlian directs—the elective represents the School’s thirteenth advanced integrated science course. Each student in the Pathways MD curriculum must take at least two of these electives over the span of their third and fourth years.

Given that sex and gender factors are tremendously important in health, in patient care, and in research, it’s surprising how little attention they receive.

Including, and ranging beyond, health-related differences between heterosexual, cisgender women and men, the sex-and gender-informed medicine elective goes where no other medical school, to the course directors’ knowledge, has gone before.

“It’s rare that curricula cover SGIM in any way,” says Manson, the Michael and Lee Bell Professor of Women’s Health and professor of medicine at HMS and chief of the Division of Preventive Medicine at Brigham and Women’s Hospital. “Even women’s health rarely goes beyond the ‘bikini medicine’ of breast cancer and reproductive health. This course integrates women’s health, sex and gender factors in health, and sex and gender diversity, a range that appears unprecedented.”

“Given that sex and gender factors are tremendously important in health, in patient care, and in research, it’s surprising how little attention they receive,” she says.

Those who teach and take the elective are in a position to change that. Across twenty sessions, students gain the latest understanding about variations in disease risk, presentation, treatment responses, and outcomes among sex and gender groups—and identify vast gaps in knowledge. They delve into the potential biological and social roots of these differences and discuss the effects of chronic stress on people in sex and gender minority groups.

The inaugural participants were restricted to a virtual classroom because of the pandemic, but still took advantage of remote learning to hear from SGIM experts across the country.

The course attracted students with little background in SGIM alongside those passionate about the subject, such as Jacob Arellano-Anderson, MD ’21. Although he knew he wanted to specialize in SGIM, the elective deepened his appreciation of how patients’ “sex and gender are always important, whether or not it’s in a marginalized way.” The course strengthened his confidence among peers as he began his residency in family medicine this summer.

“I feel more prepared to contribute, and my program directors are happy for me to bring my expertise,” he says.

Jacob Arellano-Anderson, a student in the inaugural course on sex- and gender-informed medicine, describes what it means to him that HMS offers the elective.

Shaping the course proved “a profound and transformative experience” for teachers and students, says Keuroghlian, an HMS associate professor of psychiatry, part-time, and director of the Psychiatry Gender Identity Program at Massachusetts General Hospital. “It’s been a highlight of my career.”

The team plans to make course materials available for other medical schools to adapt.

“It’s good for HMS to be setting an example,” says Bartz, an HMS associate professor of obstetrics, gynecology, and reproductive biology at Brigham and Women’s. “Hopefully being ahead of the curve will lead to others catching up and offering courses of this nature.”

Stephanie Dutchen is the manager of feature content and multimedia in the HMS Office of Communications and External Relations

Image: Erik Eastman/Unsplash

Video: Stephanie Dutchen