Empowering Medical Education Through Gender Integration: A Personal Journey

In my designation as an Assistant Professor in the Department of Community Health at St. John's Medical College, Bangalore, I attended the Gender in Medical Education (GME) training conducted by the Centre for Enquiry into Health and Allied Themes (CEHAT). I am sharing my journey and experiences after the training in this narrative.

This training has not only expanded my understanding of social determinants of health, gender-based violence, and the health issues faced by sexual and gender minorities but has also empowered many faculty in our institution to integrate gender concerns into teaching activities and community outreach activities as well. 

Embarking on the GME training

When I participated in the GME training at Bangalore along with faculty from across the country, I found it a transformative experience. Before the training, gender-related topics were given minimal emphasis in our lectures, often limited to women's empowerment and gender discrimination. However, the training equipped me to understand the profound impact of gender on health and also provided the necessary tools to incorporate gender content into teaching.

Revolutionising teaching approaches

Armed with newfound knowledge and inspiration, I took the initiative to introduce various gender issues into teaching activities with the help of gender-integrated modules. The gender-integrated modules designed by CEHAT served as a valuable resource for the development of the learning materials which I used in my lectures.

The modules provided diverse methodologies, such as case studies, discussions, debates, and films, which I could use to make my lectures more engaging and interactive for students. One notable example is the gender roles and norms game I learned to incorporate into my classes. 

This game starts with a display of everyday items individuals use daily, such as ladles, car keys, credit cards, lipstick, diapers, sanitary napkins, nail polish, and Barbie dolls. After the display, we request students to volunteer and participate in the game by choosing one of the displayed items, ascribing it to a particular gender and explaining why they did so.

By presenting scenarios that addressed gender biases and challenges, such as a preference for a male child and the issues surrounding various country-specific gender discrimination practices, the game became an engaging platform for students to analyse and discuss these issues critically.

A thought-provoking segment showed cases of intimate partner violence from the community, highlighting the struggles faced by abused women seeking refuge with their families and how their families reject them. The Medical, Allied Health Sciences and Health Administration stream students responded positively to this content, reaffirming the effectiveness of integrating gender content into teaching.

Collaborative efforts

After participating in GME training, we developed a cohesive network within our educational institution, with faculty from my Department and those from general medicine, psychiatry, forensic medicine, obstetrics, and gynaecology. Our Department recognised the potential for a more significant impact when working alongside educators on a joint mission. As a result, we introduced the privilege walk activity—an educational concept frequently employed in universities in Developed Countries. We concentrated on addressing diverse intersectionalities with a focus on gender-related aspects.

In the Privilege walk, a few students volunteer among large groups of students. We give them a role with different intersectionalities to play, such as a migrant man, an educated man, a man in a political position, a housewife, an adolescent girl, a working woman, a domestic maid, a person with a disability, a scheduled caste person, etc.

Then, we give this group scenarios such as access to health care, clean water, a discrimination-free workplace, and chances of violence. We will then instruct the students to walk forward or backwards based on their role's power to get access to a privilege. At the end of the game, students could see the power difference across individuals with different intersectionalities, and they share their experiences and perspectives. 

This collaboration and integrating gender content into our teaching represented a significant step forward. We organised a guest lecture by Professor Dr Kathleen O'Reilly on "Creating safe sanitation for women and girls in India" for undergraduate students to emphasise the importance of gender equality and access to Water, Sanitation and Hygiene. We have also included gender content in postgraduate education through seminars, journal article discussions and clinical-social case presentations. We have also conducted workshops on workplace sexual harassment, research on sensitive topics among women and conduct of gendered research. 

Training health workers and community members

Tapping on the potential of community health workers is crucial in implementing any community health practice. Everyone understands that community health workers can have a transformative impact on a wide range of activities in their field. So, we conducted dedicated sessions with ASHA (Accredited Social Health Activist) and Anganwadi workers on Psychological First Aid, focusing on gender issues at home.

Psychological first aid is supportive care a fellow human being provides to another suffering person through non-intrusive care and support. It allows people to check for needs, provide basic needs and provide listening support. It also links people to essential services and social support.

We taught health workers to provide simple psychological first aid to community members. We focussed on nutrition, breastfeeding and the involvement of both parents in child rearing for the Anganwadi workers and taught them in one-day workshops. During these sessions, I highlighted the importance of actively involving fathers in counselling sessions, adopting an empathetic approach when dealing with mothers, and addressing critical issues such as parenting challenges, mental health promotion and breastfeeding.

It is worth noting that these training sessions raised awareness among the workers regarding gender issues and empowered them to reflect upon their own lives. Consequently, considering their unique vulnerabilities, this enhanced their capacity to provide compassionate care and support to women.

Through research projects, I am developing interventions to prevent gender-based violence in the workplace through the creation of "Maitris", who can provide Listening, Empathy, Validation, Ensuring Safety and Psychosocial support to women undergoing Domestic violence and workplace sexual harassment along with creating Gender Champions at the workplace who can create respectful work environments for all genders 

We conducted a cervical cancer screening camp specifically targeted towards factory workers, allowing for early detection and intervention to mitigate the risks associated with cervical cancer development. While conducting awareness sessions for working women, we were able to discuss and address issues such as sexual violence within marriage and dyspareunia was discussed along with postcoital bleeding as a gynaecological symptom. 

Integration of gender in rural and urban orientation programs and family adoption programmes

Building on the foundation of the GME training, we were successful in integrating gender concerns into existing frameworks of rural and urban orientation programs for undergraduate students, which our Department implements. We organised roleplays, enabling students to immerse themselves in traditional gender roles within rural families. Through these experiences, they gained firsthand insights into individuals' challenges and expectations based on gender.

Family visits in rural settings and urban underprivileged areas played a crucial role in exploring gender dynamics, allowing students to engage in open conversations about women's empowerment, gender-based inequalities, and the impact of gender on health outcomes.

GME training gave me the necessary guidance to facilitate these discussions in a safe and inclusive environment. National Medical Council mandates every Medical College to conduct the Family Adoption Programme, in which each student is allotted to families in rural and urban underprivileged areas to act as the first doctor of contact and as a conduit between the community and health centre. In the Family Adoption Programme, through experiential learning, colleges trained students to interact with families and observe the social determinants of health and gender roles within families. 

Organising an exhibition to foster discussion on gender

With the Division of Humanities, we organised an exhibition with creators from the Indian Institute of Human Settlements on " Mental Health at the Margins". This exhibition was a powerful and thought-provoking way to challenge the conventional perceptions and misconceptions surrounding sex work. Through visual, aural, and audio-video presentations, students understood the humanising perspective of sex work and gender-based violence around sex work. They developed empathy through the points of view of human rights and the dignity of labour.

Minute changes=greater impact

One of the essential components of GME training was gender-sensitive healthcare, which inspired me to change my clinical practice. In general practice, it is we commonly observe women who come with complaints of musculoskeletal issues, menstrual issues, and problems due to non-communicable diseases have co-existing issues such as body image concerns and marital conflicts and face consequences of gender discriminatory practices at home, workplaces and educational institutes. 

Through observations and personal experiences, speaking empathetically to women could be manageable. It was a matter of shifting our perspective and priorities. Instead of wasting valuable time criticising our patients, we could use that time to engage in meaningful conversations with women, which can significantly improve patient-reported outcomes. This perspective shift should become a guiding principle in clinical care, leading to more compassionate and effective patient interactions.

It was a compelling point to counter fellow doctors' argument that their heavy patient load left them with limited time to communicate with each individual. By highlighting that doctors can have empathetic conversations with women without compromising efficiency, I challenge the notion that time constraints are an insurmountable barrier.

Personal impact and hope for the future

Attending the GME training and incorporating gender concerns within theory classes and community outreach activities has been transformative. It has broadened my understanding of the social determinants of health and gender-based violence and empowered me to create a more inclusive and equitable learning environment for my students. Due to time constraints, integrating gender in medical education in a rigid academic environment can be challenging. However, I have witnessed the positive impact of integrating gender content into my teaching activities.

Through the gender discrimination game, privilege walk activity, and training of community health workers, I have seen firsthand the transformative power of incorporating gender concerns into medical education. While there are still gaps in exposure to diverse communities, we have made progress in bridging these gaps. Including gender content in rural and urban orientation programs has allowed students to critically analyse and critically question existing gender norms prevalent in society.

As this journey continues, I remain committed to advocating for integrating gender concerns into medical education. By empowering future healthcare professionals with a deep understanding of the impact of gender on health outcomes, we can strive towards a more equitable and inclusive healthcare system.

In conclusion, attending the GME training has not only equipped me with the knowledge and tools to integrate gender concerns into my teaching. Still, it has also sparked a passion for creating a healthcare system that addresses gender disparities and promotes social justice. The road ahead may present challenges, but the determination to continue making a positive impact in medical education, one step at a time, is encouraging.

I acknowledge the contribution of Dr. Ajinkya Deshmukh and Ms. Amruta Bavadekar of CEHAT for their technical support and expertise in developing the manuscript and implementing Gender in Medical Education. 

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Edited by Christianez Ratna Kiruba

Image by Janvi Bokoliya