Still far to go – An investigation of gender perspective in written cases used at a Swedish medical school

Figures & data

Table

Practice points

This study investigated the implementation of gender perspective in written cases used during the second-half of medical school (terms 5–11). Only 4% of the 257 cases touched on gender aspects and this lack of gender was related to a neglect of psychosocial issues and their impact on health and disease. In no more than 20% of the cases there were written instructions for tutors, although such instructions are important when new perspectives are introduced in the curriculum. Our way of scrutinizing the cases might be useful in gaining an overview of gender in cases in other medical schools. Investigations involving several countries are suggested to make it possible to compare, learn from each other, and expedite the implementation of gender in case education.

Table 1.  Proportion of cases containing information about the case-patients’ family situation, paid work, lifestyle, and leisure activities

	Total (N = 247)	Female patients (n = 112)	Male patients (n = 120)	Patients sex not defined (n = 15)
Family situation	112 (45)	57 (51)	50 (42)	5 (33)
Paid work	80 (32)	35 (31)	39 (33)	6 (40)
Lifestyle	69 (28)	32 (29)	34 (28)	3 (20)
Leisure activities	53 (21)	21 (19)	26 (22)	6 (40)

Note: Number and column per cent (%).

Box 1 Cases mentioning biological differences (or similarities) between men and women

Seven cases touched upon sex differences related to fertility and childbirth: investigation of infertility, disease post partum, pregnancy and breast-feeding as contradiction to trombolysis, prophylaxis against malaria during pregnancy, hepatitis during pregnancy, abuse of drugs in a pregnant woman, low stomach pain in women.

Ten cases brought up biological sex differences in the following: heart disease, iron deficiency, glaucoma, side-effects of medical drugs, increased levels of androgens, prevalence of diabetes, length of life, dangerous consumption of alcohol, urinary tract infections, and growth disturbances in children.

Box 2 Cases with a clear gender perspective

Case 1. This case concerned long-term pain and was written so that the patient's sex was not revealed. The teacher manual calls for a discussion about whether the management would differ in male and female patients and also in relation to the sex of the physician. The word gender was mentioned in the teacher manual.

Case 2. One-third of the students were instructed to collect knowledge about ‘‘gender aspects in depression’’ and later present the results to their fellow students. The other students worked with other aspects of depression.

Case 3. The main discussion in this case was why women live longer than men in many countries.

Case 4. A middle-aged woman complained about tiredness. The description pointed at her responsibility for family and relatives, risk factors for heart disease in women, and the higher frequency of pharmaceutical side-effects in women.

Box 3 Cases with gender as a partial or minor aspect

Case 5. This case posed many questions about anxiety, among them one about the fact that anxiety is regarded more common among women than men.

Case 6. This case focussed on a disease of the eye but gender aspects of the reception of a male patient was also considered. The word gender occurred twice in the teacher manual.

Case 7. A young woman encountered due to uro-genital symptoms. In the teacher manual it was underlined that one should reflect on whether the patient might have suffered sexual abuse.

Case 8. This case concerned fertility/infertility and as a part of this topic the question was raised about who in the relationship took the responsibility for contraception.

Case 9. A young woman sought help for acute abdominal pain and the students were instructed to reflect on whether rape or battering might have occurred.

Case 10. The case concerned statistical methods for determining prevalence and proposing preventive measures. The health problem used as an example in the case was violence towards women.

Box 4 Cases with a possibility for gender discussions

Cases 11 and 12. Both cases had male patients described as stoic, calm and autonomous. One was portrayed as a ‘'real Northlander’’ who for a long time abstained from seeking care and the other didn’t want to go to the doctor but agreed to go because his wife wanted him to. Here it would be possible to discuss knowledge and prejudice in our beliefs about men's and women's healthcare-seeking behaviour.

Case 13. Abuse of alcohol is presented as one reason for the patient's health problem and some biological differences between men and women involved in alcohol abuse were discussed. Here it is possible to also discuss social, psychological, and cultural aspects of alcohol abuse in men and women.

Case 14. The focus here was on uro-genital symptoms in a middle-aged woman. The students were asked to reflect on the psychological and social significance of menopause.