Physicians’ training on gender-specific medicine in Italy
A thorough upgrading of the structures of physicians’ training on the differences, in all pathologies, between men and women, cannot be delayed any further, especially given the recent Italian law on gender medicine. This round table intends to gather information on how training agencies are getting organised: Universities, Primary Care Physicians (SIMG), Italian National Federation of the Orders of Doctors and Dentists (FNOMCeO), and to also hear about the experiences gained by the first Chair of Gender Medicine in Italy, at the University of Padua.
Ms Paola Boldrini, member of the Italian Parliament, talks about the difficulties encountered in enacting the law on gender medicine which was included, in a concise version (compared with the draft laws proposed in the past) into the Lorenzin draft law, although still comprehensive and important, and approved by the Chamber of Deputies (Editor’s note: approved by the Senate on 22 December 2017 and enacted after being signed by the President of the Republic on 15 February 2018).
We continue with a presentation on how the different sectors are organising themselves.
Prof Stefania Bellini (Chair of the Medicine and Surgery School of Ferrara and Member of the Conference of Presidents of the Degree Courses in Medicine and Surgery) speaks on behalf of Prof Andrea Lenzi.
The Permanent Conference of the Presidents of Degree Courses in Medicine and Surgery, headed by Prof Andrea Lenzi, has approved two innovations.
1. A Core curriculum, common to all the Medicine and Surgery Degree Programmes, consisting of different Elementary Educational Units (Unità Didattiche Elementari – UDE), including some related to a sex/gender approach.
2. A Motion, passed with a unanimous vote, that recommended to all 59 Medicine and Surgery Degree Programmes to integrate and implement, in each School, educational activities related to gender medicine.
On 12 December 2016, the sex/gender approach was proposed as an integral part of the students’ training process (already 40 Universities have accepted), consisting of 2 actions:
a. integration of this approach into the description of the specific Training Objectives of the Study Course, targeting the core of our University Degree Programmes, and especially highlighting it in the Single Annual Form of the Study Course (Scheda Unica Annuale del Corso di Studi – SUA CdS);
b. activation of a number of educational units adopting the Training Objectives of the Study Course, to be linked to the more detailed objectives of integrated study courses, with their inclusion in the Teaching Form: there should be at least one class a year highlighting, in its Teaching Form, the gender approach.
Therefore, gender medicine should not be a specific teaching subject, but a cross-study content applied to many teaching areas.
To achieve this, updating activities for teacher must be set up through Seminars and Distance Learning classes.
If included in the Degree Course, it will consequently appear in the Diploma Supplement. In addition, by specifying in a Degree Course that attention is being paid to sex/gender, this topic will not only be included, but it will also be monitored, with a subsequent improvement in the quality of the Degree Course.
Fifty-nine Italian Degree Study Courses in Medicine and Surgery have approved this motion and about 40 Universities have already added, in different ways, into their training modules, an emphasis on sex/gender differences.
Gender medicine will therefore become a normal methodological approach in medicine.
Raffaella Michieli (National Secretary of SIMG – Italian Society of General Medicine and Primary Care), and general practitioner (MMG: Medico di Medicina Generale) of Venice: SIMG comprises 7,000 primary care physicians and focuses mostly on training. The organisation has been officially authorised, by the National Institute of Health (ISS), to draw up the guidelines. SIMG has developed and has been using, for some time, a computerised medical record, with its data entered into a large database which allows it to conduct widespread research and subsequent training. A limitation is that the MMG providers must adopt the guidelines issued by the Regions, based on which they are evaluated, although the Regions are not or are minimally involved in gender medicine. Moreover, the general medicine schools are regional and they do not have a high level of sensitivity to the issue of gender differences in medicine. In fact, the current MMG providers are older people and the schools will not produce a high enough number of graduates to fill this gap; therefore it is hard to say if the culture of gender medicine will be taken up by the new generation.
Teresita Mazzei , Professor of Pharmacology at the University of Florence, elected President of the Order of Doctors and Dentists of Florence, takes the floor in her capacity as a coordinator of the Gender Medicine Commission of FNOMCeO (Italian National Federation of the Orders of Doctors and Dentists): FNOMCeO (106 provincial medical associations) has been offering training classes to many Associations and to many Regions, including Tuscany. In 2014, the first nucleus of the FNOMCeO Commission on gender medicine was established with Teresita Mazzei (coordinator), Giovannella Baggio, Raffaella Michieli, Annamaria Moretti, Cecilia Politi and Walter Malorni, later supported by Chairmen or Deputy Chairmen of Medical Associations such as Maria Assunta Ceccagnoli, Fiorella De Angelis, Carolina De Vincenzo, Rita Le Donne, in addition to Annamaria Celesti for the Tuscany Region and Giulia Arduino for the Ministry of Health. The objectives of the Commission were: specific training of Doctors and Dentists (courses held in 106 association facilities), information for the public, active participation in the National Network of Gender Medicine, cooperation with health and political Institutions, and a strong promotion of research activities. The main courses implemented to date have been in the association facilities of Naples, Florence, Campobasso, Pescara, San Donà di Piave (Venice), Pistoia, Padua, Milan, Treviso, and a Symposium on “Gender medicine as a paradigm of customised medicine” was held during the 3rd National Conference of FNOMCeO in Rimini. Following is a presentation of two Second Level Master Programmes, one set up for the Academic year 2015-16 at the University of Basilicata, Coordinator Prof Luigi Milella (with the support of Prof Flavia Franconi, Professor of Pharmacology in Sassari, currently Counsellor for Health and also Deputy President of the Basilicata Region), and the other for the Academic year 2016-17 at the University of Florence, Prof. Teresita Mazzei as coordinator. To be mentioned also are the publications promoted by FNOMCeO in its quarterly journal La Professione and a FAD course being prepared for a very widespread dissemination.
University of Padua
Prof Giovannella Baggio (Full Professor without tenure at the University of Padua) reports on the experience acquired from holding the Chair of Gender Medicine until 30 September 2017, currently being held by Prof Luca Fabris. In 2012, the Molecular Medicine Department of the University of Padua decided to establish a chair of gender medicine thus recognising the didactic necessity for this field of medicine, and asserting that the absence of this field of medicine is an actual didactic or cognitive scandal. However, gender medicine is not only a speciality but a cross-cutting dimension. How to then organise this course? After addressing many perplexities and difficulties, the proposal of an optional course in Gender Medicine was accepted.
But gender medicine cannot be the culture of only a single person. Experts in thousands of fields do not exist!
Therefore, a Course consisting of seminar-type classes (3 consecutive hours a week) was organised and the Chair Professors, or their Associates, teaching in various areas, were called upon to deliver the lessons. The following topics were covered: heart failure, ischaemic heart disease, cardiac arrhythmias, diabetes and risk factors for cardiovascular diseases, chronic obstructive pulmonary disease, osteoporosis, arthrosis, dementia, lung cancer, colon cancer, otorhinolaryngology pathologies, alcoholism, human papilloma virus. Epidemiology data were presented at the beginning by Prof Baggio and the speakers were the Chairs of various fields. Some very important meetings were organised and received much attention and participation also from students undergoing specialised training, from different schools, as well as from doctors of various disciplines.
Gender medicine has become in Padua a platform on which professors did not only lecture but have also learned that the way of teaching their classes had to change. They have often confessed that the implementation of a gender perspective in their lectures has made them change the way they are teaching.
Prof Baggio adds that at the International Conference held in Berlin in 2015, she was widely criticised for having stated in the plenary session:
■ that gender medicine does not exist: only gender-specific medicine exists;
■ that Gender Medicine Departments, conferences on gender medicine and Gender Medicine Chairs today should not exist, we must only talk about gender-specific medicine.
Given these important considerations, what is the result of this experience?
A very positive one because the Gender Medicine Chair is perceived in Padua as a start-up: a platform where professors get involved and learn the necessity to adopt a different teaching approach. Prof Baggio has always said from the beginning that the Gender Medicine Chair is a starter engine that after a certain number of years must disappear once all the specialities have adjusted their knowledge to the differences in gender.
However, today it can be stated that the Gender Medicine Chair is still a resource, a platform from where the professors are encouraged to sensitize and prepare themselves to address the differences in gender, in the spirit of the conclusions reached by the Conference of Presidents of Medicine and Surgery Degree Courses.
Gender Medicine Chair? Yes, we are still not mature enough to eliminate it. Gender Medicine Chair? A launch platform, a necessary start up! This is in order to begin a virtuous cycle around which the various disciplines converge and organise themselves into a new educational area that has been effectively structured by the Conference of Presidents of Medicine and Surgery Degree Courses (although this will be a very demanding journey!).