[Reflexivity during medical internships†: how to think about gender in clinical practice]. / Pratique réflexive dans les cours-blocs de médecine ambulatoire ou comment penser le genre en clinique.

Gender bias in medicine negatively interfere with the medical care of both men and women, which can lead to risks for patients as well as health inequalities. Unisanté has launched a pilot project to integrate reflexivity by students at the Medical School of the University of Lausanne on the influence of gender in clinical practice, using an electronic portfolio. The clinical vignettes presented and discussed in this article illustrate this reflective work and the main biases and stereotypes encountered: pain management, assessment of the psychosocial context, management of domestic violence, screening for chlamydia infection and discussion of a contraceptive method.

Les biais de genre en médecine interfèrent négativement avec la prise en charge médicale tant des hommes que des femmes, ce qui peut entraîner des risques pour les patient·e·s et des inégalités de santé. Unisantéaa lancé un projet pilote visant à intégrer l'approche réflexive par les étudiant·e·s de l'École de médecine de l'Université de Lausanne (UNIL) sur l'influence du genre dans la pratique clinique, en utilisant un portfolio électronique. Les vignettes cliniques présentées et discutées dans cet article illustrent ce travail réflexif et les principaux biais et stéréotypes rencontrés : la prise en charge de la douleur, l'évaluation du contexte psychosocial, la prise en charge des violences au sein du couple, le dépistage d'une infection à Chlamydia ainsi que la discussion d'une méthode de contraception.

Reflexivity as a tool for medical students to identify and address gender bias in clinical practice: A qualitative study.

OBJECTIVES: Gender bias interferes with medical care for both men and women, leading to health inequalities. Reflexivity is used in medical education to improve health provision. This study aims to understand if a reflective approach integrated in medical practice enables raising awareness of gender bias during medical school teaching. METHODS: We conducted this study in general ambulatory medicine in Lausanne Hospital, Switzerland with 160 Master's students. Through group discussions and reflection questionnaires, students were asked to discuss clinical cases they encountered focusing on potential gender bias. We analyzed the data using a thematic analysis approach. RESULTS: The reflection on the clinical reasoning steps from a real case identified gender bias at each stage of the clinical case management. The analysis revealed two factors that facilitated gender reflexivity: guidance from a gender expert and peer-to-peer exchange. CONCLUSIONS: Our study shows that a reflective approach integrated in medical practice enables raising awareness of gender bias during medical teaching. It provides students with a systematic method they can apply in their future clinical work, thus improving care processes and experiences towards more equitable care. PRACTICE IMPLICATIONS: All gender and medicine curricula should include teaching such as this linking theory and practice through reflexivity.