Centre for Gender and Sexual Health Equity, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Teach Learn Med. 2024 Jun-Jul;36(3):280-292. doi: 10.1080/10401334.2023.2226651. Epub 2023 Jun 22.
: Intersex, trans, and Two-Spirit people report overwhelmingly negative experiences with health care providers, including having to educate their providers, delaying, foregoing, and discontinuing care due to discrimination and being denied care. Medical education is a critical site of intervention for improving the health and health care experiences of these patients. Medical research studies, clinical guidelines, textbooks, and medical education generally, assumes that patients will be white, endosex, and cisgender; gender and sex concepts are also frequently misused. : We developed and piloted an audit framework and associated tools to assess the quantity and quality of medical education related to gender and sex concepts, as well as physician training and preparedness to meet the needs of intersex, trans, and Two-Spirit patients. We piloted our framework and tools at a single Canadian medical school, the University of British Columbia, focused on their undergraduate MD program. We were interested in assessing the extent to which endosexnormativity, cisnormativity, transnormativity, and the coloniality of gender were informing the curriculum. In this paper, we detail our audit development process, including the role of advisory committees, student focus groups, and expert consultation interviews. We also detail the 3-pronged audit method, and include full-length versions of the student survey, faculty survey, and purpose-built audit question list. : We reflect on the strengths, limits, and challenges of our audit, to inform the uptake and adaptation of this approach by other institutions. We detail our strategy for managing the volume of curricular content, discuss the role of expertise, identify a section of the student survey that needs to be reworked, and look ahead to the vital task of curricular reform and recommendations implementation. : Our findings suggest that curricular audits focused on these populations are lacking but imperative for improving the health of all patients. We detail how enhancing curriculum in these areas, including by adding content about intersex, trans, and Two-Spirit people, and by using gender and sex concepts more accurately, precisely and inclusively, is in line with the CanMEDS competencies, the Medical Council of Canada's many institutions' stated values of equity, inclusion and diversity, and physicians' ethical, legal and professional obligations.
双性人、跨性别者和 Two-Spirit 人群报告称，他们在医疗保健提供者方面的经历绝大多数是负面的，包括不得不教育他们的提供者、因歧视而延迟、放弃和停止护理以及被拒绝护理。医学教育是改善这些患者健康和医疗体验的一个重要干预场所。医学研究、临床指南、教科书和医学教育通常假设患者是白人、内生殖器和顺性别者；性别概念也经常被误用。
我们开发并试行一个审计框架及相关工具，以评估与性别和性概念相关的医学教育数量和质量，以及医生培训和准备情况，以满足双性人、跨性别者和 Two-Spirit 患者的需求。我们在加拿大的一所医学院，不列颠哥伦比亚大学，试行我们的框架和工具，重点是他们的本科医学课程。我们感兴趣的是评估内生殖器正常性、顺性别正常性、跨性别正常性和性别殖民化在多大程度上影响课程。在本文中，我们详细介绍了我们的审计开发过程，包括顾问委员会、学生焦点小组和专家咨询访谈的作用。我们还详细介绍了三管齐下的审计方法，并包括学生调查、教师调查和专门设计的审计问题清单的全文。
我们反思了审计的优势、限制和挑战，以告知其他机构采用这种方法。我们详细介绍了我们管理课程内容量的策略，讨论了专业知识的作用，确定了学生调查中需要重新设计的部分，并展望了课程改革和建议实施的重要任务。
我们的研究结果表明，针对这些人群的课程审计是缺乏的，但对于改善所有患者的健康是必要的。我们详细介绍了如何通过增加关于双性人、跨性别者和 Two-Spirit 人的内容，以及更准确、精确和包容地使用性别和性概念，来加强这些领域的课程，这符合加拿大医师学会的能力要求、加拿大医学协会许多机构所宣称的公平、包容和多样性价值观，以及医生的道德、法律和专业义务。
