Virginia M. Miller, PhD,1 Morrisa Rice, MHA,2 Londa Schiebinger, PhD,3
Marjorie R. Jenkins, MD,4 Janice Werbinski, MD,5 Ana Nu´n˜ez, MD,6
Susan Wood, PhD,7 Thomas R. Viggiano, MD,8 and Lynne T. Shuster, MD9
Sex, a biological variable, and gender, a cultural variable, define the individual and affect all aspects of disease
prevention, development, diagnosis, progression, and treatment. Sex and gender are essential elements of individualized
medicine. However, medical education rarely considers such topics beyond the physiology of
reproduction. To reduce health care disparities and to provide optimal, cost-effective medical care for individuals,
concepts of sex and gender health need to become embedded into education and training of health
professionals. In September 2012, Mayo Clinic hosted a 2-day workshop bringing together leading experts from
13 U.S. schools of medicine and schools of public health, Health Resources and Services Administration Office of
Women’s Health (HRSA OWH), the National Institutes of Health (NIH) Office of Research on Women’s Health
(ORWH), and the Canadian Institute of Health and Gender. The purpose of this workshop was to articulate the
need to integrate sex- and gender-based content into medical education and training, to identify gaps in current
medical curricula, to consider strategies to embed concepts of sex and gender health into health professional
curricula, and to identify existing resources to facilitate and implement change. This report summarizes these
proceedings, recommendations, and action items from the workshop.
In the United States, scientific attention to the array of sex and gender differences impacting medicine resulted,
in part, from the feminist movement of the 1960s and 1970s. Women were demanding an integrated approach to their
health care and information upon which they could make decisions about treatment options. In 1985, the National Institutes
of Health (NIH) Public Task Force on Women’s Health concluded that, apart from reproductive issues, little was known about the unique needs of the female patient.1 As a result of this report, the NIH Office of Research on Women’s
Health (ORWH) was created in 1990 to promote and support research on women’s health. In that same year, the General
Accounting Office (GAO) released a review of 50 NIH proposals and found that 50% included only men, 30% included
both sexes and 20% did not designate gender.2 Soon after, Congress permanently established ORWH with the 1993 NIH
Revitalization Act, which mandated that, if relevant, women and minorities be included in clinical research trials; that investigators
design clinical trials to ensure that valid scientific analysis could be performed to determine whether differences existed between women and minorities in relation to other study subjects; and that Phase III clinical trials include both sexes in adequate numbers to ensure data could be analyzed for an effect of gender.
These events led to a repository of medical evidence identifying sex- and gender-specific differences in disease incidence,
symptomatology, morbidity, and mortality. However, it was not until 2001 when the Institute of Medicine (IOM) asked the question ‘‘Does Sex Matter?’’ that sex and gender were considered as two variables forming the basis of individualized medicine. That report stated ‘‘Sex, that is being male or female, is an important basic human variable that should be considered when designing and analyzing studies in all areas and at all levels of biomedical and health related research’’ which includes investigations of single cells to organisms
and from conception to death, ‘‘womb to tomb’’.3 Researchers, educators, and health care providers struggle
with how to best incorporate information generated from the growing discipline of sex- and gender-based medicine into
educational and training programs that will ultimately impact patient care. Curricular models and instructional strategies
vary (Table 1). Perhaps most typical, coverage of sex and gender differences, is presented in specific courses such as physiology and pharmacology without application into clinical rotations.4 Based on the growing emphasis on individualized
medicine, the body of information regarding sex and gender differences in disease, and apparent barriers to incorporating
such topics into health professional education, Mayo Clinic hosted a workshop in September 2012 to bring
together leaders from health professional training programs. Representatives from 13 U.S. schools of medicine and schools
of public health, the NIH ORWH, Health Resources and Services Administration Office of Women’s Health (HRSA
OWH), and the Canadian Institute of Health and Gender (Appendix 1) came together to address the need to integrate
sex and gender concepts into medical education and training,to identify gaps in current medical curricula, to propose core
competencies, and to share practical strategies for success.
1Departments of Surgery and Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota.
2Office of Women’s Health, Health Resources and Service Administration, Rockville, Maryland.
3EU/US Gendered Innovations in Science, Health & Medicine, and Engineering Project, Stanford University, Stanford, California.
4Laura W. Bush Institute for Women’s Health, Texas Tech University Health Sciences Center, Amarillo, Texas.
5Michigan State University College of Human Medicine, Portage, Michigan.
6Women’s Health Education Program, National Center of Excellence of Women’s Health, Drexel University College of Medicine,
7Jacobs Institute of Women’s Health, The George Washington University School of Public Health and Health Services, Washington, DC.
8Mayo Medical School, Mayo Clinic, Rochester, Minnesota.
9Office of Women’s Health, Women’s Health Clinic Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.