Prevalence and curriculum of sexual and gender minority education in Japanese medical school and future direction

Figures & data

Table 1. Explanation of Model Core Curriculum and background of introduction of sexual and gender minority education

Model Core Curriculum

‘The Model Core Curriculum for Medical Education is an abstraction of the “core”, within the respective “curriculum” formulated by each university, which should be taught in common by all universities in Japan; it is systematically organized as a “model” of what that core contains’

Background of introduction of sexual and gender minority education.

Model Core Curriculum was revised in 2016 with the goal of cultivating physicians who can serve diverse needs. The revision considered many changes occurring in international public health and healthcare systems, and is meant to cultivate physicians with practical clinical capability, who can serve the needs of the public in areas such as ethics, medical safety, team-based healthcare, the community-based integrated care system, and a healthy long-living society. This curriculum added ‘Human behaviour and psychology’ in General issues in medicine, which includes an item referring to ‘Individual differences'. Moreover, one of the objectives of ‘individual difference’ is ‘Explain gender formation, sexual orientation, and ways of consideration for gender identification'.

Medical Education Model Core Curriculum Coordination Committee and Medical Education Model Core Curriculum Expert Research Committee, 2017.

Table 2. Prevalence of sexual and gender minority education – including all 80 of Japan’s medical schools into denominator

Sexual and gender minority education(class or workshop)	N	%
Yes	22	27.5
No	14	70.9
Unknown	1	1.6

Table 3. Summary of sexual and gender minority educational coursework (N = 22)

Type of class or workshop	N	%
Required	19	86.3
Elective	2	9.1
No Answer	1	4.5
Target academic year level (multiple answers)	N	%
First	9	30.0
Second	5	16.7
Third	9	30.0
Fourth	5	16.7
Fifth	1	3.3
Sixth	1	3.3
Median time of lecture or workshop	130 (min)
Offered subjects (multiple answers)	N	%
Obstetrics and Gynecology	4	11.4
Neuropsychiatry	4	11.4
Introduction to Medicine	4	11.4
Ethics	3	8.6
Urology	2	5.7
Pediatrics	2	5.7
Introduction to Diagnosis	1	2.9
Professionalism	1	2.9
Human Rights Education	1	2.9
Healthcare and Society	1	2.9
Physician–Patient Relationships	1	2.9
Medical Education Workshop	1	2.9
Genetic Inheritance and Genes	1	2.9
English	1	2.9
Behavioral Science	1	2.9
Behavioral Therapy	1	2.9
Integrated Lecture	1	2.9
Freshman Seminar	1	2.9
Psychology	1	2.9
Male Organs and Retroperitoneal Diseases	1	2.9
Sociology	1	2.9
Others	1	2.9

Table 4. Extraction of sexual and gender minority course contents from 22 medical schools

Target Academic Year	Offered subjects	Course Outline
2	Professionalism	Introduction to sexual and gender minority
4	Professionalism	Treatments for Gender Identity Disorder
1	Freshman Seminar (Educational subject in first year)	As a group work, freshmen at medical college discussed the news which one women university was considering the enrollment of a transgender student (male to female)
4	Pediatrics and Obstetrics and Gynecology	Difference of Sex Development (DSD)
1	Ethics	Discussion about the case which lesbian women have a baby with artificial semination
5	Introduction to Medicine	Sexuality and Gender Diversity, A lecture conducted by those who identify with these groups, Contemplation about LGBTQ related issues
2	Medical Ethics	Concept about LGBTQ
4	Healthcare and Society	History, social problems, and discrimination about LGBTQ
3	Physician-Patient Relationships	Sexual and gender minority
3	Obstetrics and Gynecology	Indeterminate sex, Turner syndrome, Klinefelter’s syndrome, Prader disease, Swyer syndrome, androgen insensitivity syndrome, congenital adrenocortical hyperplasia, (Mayer–Rokitansky–Küster–Hauser) MRKH syndrome, congenital anomaly of uterus
3	Medical Education Workshop	‘To understand biological characteristics, sexual identity, sexual orientation, and sexual expression through the experiences of those who identify with these groups,’ and ‘To discuss the roles of healthcare professionals’
1	Psychiatry	anxiety and difficulties that persons with gender Identity Disorder (GID) and gender dysphoria are likely to experience
3	Introduction to Medicine (Psychiatry)	Medical interventions for transgender patients: hormone therapy and gender-affirming surgeries (what does determine sex?)

Table 5. Reasons for schools not offering sexual and gender minority educational coursework (N = 15:14 schools not offering lectures and 1 school with unknown status)

Reasons for not offering sexual and gender minority education (multiple answers)	N	%
No suitable instructors	8	27.5
No policy in medical schools	6	20.7
Not having concrete ideas about what to do	4	13.8
Curriculum is too tight to offer a class	3	10.3
Unable to find standard teaching materials	3	10.3
Currently no need has been identified	2	6.9
Others	3	10.3
Future plans	N	%
Yes	1	6.7
No	6	40.0
Unknown	6	40.0
No Answer	2	13.3

Table 6. Identified reforms in designing sexual and gender minority curricular competencies in Japan

Role of Competencies	Reforms
Ability to explain gender formation, sexual orientation, and ways of consideration for gender identification Patient Care: Sensitively and effectively eliciting relevant information about sex anatomy, sex development, sexual behaviour, sexual history, sexual orientation, sexual identity, and gender identity from all patients in a developmentally appropriate manner. Describing the special health care needs and available options for quality care for transgender patients and for patients born with DSD Recognizing the unique health risks and challenges often encountered by the individuals described above. Knowledge for Practice Defining and describing the differences among: sex and gender; gender expression and gender identity; gender discordance, gender nonconformity, and gender dysphoria; and sexual orientation, sexual identity, and sexual behaviour Understanding typical (male and female) sex development and knowing the main etiologies of atypical sex development Understanding and describing historical, political, institutional, and sociocultural factors that may underlie healthcare disparities experienced by the populations described above. Professionalism Accepting shared responsibility for eliminating disparities, over bias Developing policies and procedures that respect all patients’ rights to self-determination	i) List open-ended questions that can be used with any patient to elicit a sensitive and accurate history ii) Simulation exercise with peers or simulated patients demonstrating how to obtain a patient history of sexual behavior, sexual history, sexual orientation, and gender identity iii) Clinical practices such as how to ask patients’ their sexual orientation and gender identity in clinical settings i) Simulation with peers or simulated patients to elicit tailored health messages of sexual and gender minorities i) Problem Based Learning regarding sexual minority patients
Implementation Student Assessment Practices Instructional methods Tailored Learning Experiences	Multiple-choice exams Open-ended questions Multiple assessment tools i) Providing evaluation of the educational process with student responses to surveys. ii) Providing a student with feedback as a result of programmatic assessment. Small group discussion Small group discussion
Overall goals	To ensure that physicians can treat sexual and gender minority patients as effectively as heterosexual and cisgender patients.

Figure 1. Monitoring framework for developing competency-based sexual and gender minority education in Japanese Medical Schools

Table

	Academic Level	Course title that includes the class (or workshop) in its syllabus	Time allocation	Contents (summary)
e.g.	4^th year	Urology	Part of a 90-min class	About androgen insensitivity syndrome
e.g.	5^th year	During clinical training in Psychiatry	Unsure	About LGBTQ Issues