Sex and Gender Influences on Health and Disease: A Six-Step Framework for Intra- and Inter- Professional Education and Practice

Learning objectives
1. Define sex, gender, and intersectionality of race and social variables.
2. Describe examples of sex and gender ( S/G) differences in patient-practitioner communication, and disease manifestations, diagnosis and/or treatment.
3. Use the Six Step model for interprofessional S/G based education and collaborative practice.

Differences in biological sex and gender (S/G) influence patient-practitioner communication; attitudes towards health care; diagnosis, disease management, and health outcomes. Education on this topic is deficient. To achieve the quadruple aim, it is essential that providers across professions understand the impact of S/G on health and disease.

At the 2021 interprofessional summit on S/G health education, discussion of the “Six Steps” model (1) among professionals in Medicine, Nursing, Dentistry, Pharmacy, Nutrition, including students, found common examples.

Step Common Examples
1- Communication: Identify sex & gender of patient, with open-ended questions
2-History: Use psychosocial perspective, keeping in mind intersectionality
3-Examination: Apply lens of intersectionality, show respect for diverse cultures
4-Diagnostic tests: Consider S/G, race, ethnicity in interpretation of laboratory/ imaging tests
Address psychosocial aspects of testing, eg mammography for men
5- Treatment: Choose medications, considering S/G differences in efficacy and/or safety
6- Outcomes: Recognize effects of S/G & social situations on disease outcomes

This Seminar will 1) define sex, gender and intersectionality, 2) introduce the Six Steps model, (originally developed for physicians), for interprofessional S/G based education and collaborative practice, 3) stimulate inter-professional discussion about S/G based care of a patient with diabetes.
The Summit theme of interprofessional learning for practice and education will be addressed by a brief interactive lecture, and if sufficient participants, formation of interprofessional groups to discuss S/G based care of an adult patient with diabetes, using the Six Steps model as a framework. Each group will report back to all attendees.

Immediately actionable skills and/or practice knowledge to be gained by participants
• Using open ended questions, and a psychosocial perspective in history taking
• Preparing patients for a physical examination
• Problem solving
• Definitions: sex, gender, intersectionality
• Interprofessional collaboration to address S/G differences in disease and its management
• Prescribing medications with data in males and females

Active learning strategies include interactive lecture interspersed with questions for learners
group problem solving, brainstorming, collaborative learning

This seminar meets these priority criteria:
• Student workshop participant (now a nurse) on author team
• Measurable learning outcomes,
• Identification and addressing factors beyond clinical care that affect health of individuals,
• Design to impact quadruple aim because understanding S/G differences in health and disease is anticipated to:

1) Improve population health by reducing treatment delays; increased prescribing of medications with efficacy and safety data in both sexes.
2) Enhance patient experience by unbiased approach to patient-practitioner communication, and open-ended questions to identify S/G of patients.
3) Improve value by eliminating inappropriate tests; recognition of intersectionality of sex, gender, race and other factors that influence disease.
4) Improve work-life of clinicians and staff by increased efficiency.

1. Marjorie Jenkins, Connie Newman, editors. How Sex and Gender Influence Clinical Practice, Elsevier, 2021