There is a common complaint among medical educators: the medical school curriculum is “too crowded.” New themes appear, but where to put them? As ethics and quality improvement and “shared decision-making” permeate the program more widely than ever before, how can it be jammed without a complete redesign of medical training? There is real concern about trading hours that focus on the “science” of medicine to those that highlight the “art.”
i get it My first day of medical school was a crash course in drinking from the fire of knowledge. Even about 30 years ago, the sheer volume of studying involved memorizing tricks and creative drinking games (pass the skull! name the foreman!) from one test to the next. As a medical educator who has spent the last decade teaching doctors how to teach doctors, “cognitive overload” is a term I use regularly. For many, we have reached a point where medical school has become a giant game of Jenga, with each addition and subtraction threatening to collapse the entire structure.
And yet, when faced with both the carrot and the stick by HHS, more than 50 medical schools (about a quarter in the United States) have signed up to the federal framework for nutrition education. Schools that choose not to support the new framework cite an already inadequate curriculum and/or fear of federal interference in those decisions. But the concept of more nutrition education is rooted in a strong argument: diet-related diseases drive a large portion of the disease. Of course we need to educate doctors about the role nutrition plays in the prevention, treatment and management of conditions such as type 2 diabetes and heart disease.
The HHS framework undermines many of the areas proposed for nutrition competency development. But then it starts to ski out of bounds. “Field learning on farms including soil sampling, composting, crop rotation” is what caught my eye. Is it really necessary for the doctors of tomorrow?
I am not here to argue for or against the inclusion of evidence-based nutrition in the curriculum. What I am here to bring up is a little different. If political pressure for nutrition education means that schools change what they teach, then the curriculum is not the laws of nature. They change when institutions decide something. Even if the “issue” is funding.
Which begs the question: If medical schools can make room for nutrition, why can’t they make room for women’s health?
Women make up half of the population, yet medical schools remain surprisingly slow to represent their health equally in medical education. We all know that women have been excluded from clinical trials for years for a number of reasons, and the mistake of leaving has had serious consequences. When 51% of the population experiences symptoms of myocardial infarction compared to the other 49%, why in the world their A presentation labeled “atypical?” Isn’t the symptom profile affecting 49% an unusual one? The legacy of this exclusion still lingers in how medicine is taught and practiced.
This has given us a system in which biological sex differences in disease prevalence, presentation, and management have not been sufficiently emphasized. And this in turn gives us a system where conditions that uniquely, differently, or disproportionately affect women are misunderstood, misdiagnosed, or outright dismissed. These gaps are not simply academic. They make up what doctors know, what they miss, and what patients experience in exam rooms across the country.
And then, there’s that old chest: menopause. A global biological transition that half the world will experience if they live long enough. One whose shepherd lived with heart disease, bone loss, and years of frailty. And yet, it is hardly taught. As HHS pushes for changes to warning labels on hormone therapy for menopausal women, many report struggling to find a clinician who knows how to administer it.
Now that we’ve poked a few holes in the “curriculum is too full” argument, it’s time to make room for women’s health. The nutrition debate proves that “complete” is a rather flexible concept.
Medical education is frequently adapted as priorities change. Over the past few decades, schools have successfully integrated genetics, health equity, quality improvement, digital health, and artificial intelligence into already extensive programs. Somehow the system survived.
The fact that the curriculum expands and evolves when institutions decide on a subject is worth considering. The feeding proposal shows how quickly priorities can change when funding is attached. Whether that economic incentive comes from the government, from students who choose to spend their valuable tuition dollars, or from patients who have doctors properly trained in how to care for them. At times, the economics of failing to adequately train health care professionals about gender differences in medicine come back to haunt our academic institutions.
Yes, medical students should learn the basics of nutrition. However, “soil samples” may be traded for “sex-based pharmaceuticals.” “Personalized Metabolic Optimization” can be replaced with “Sex-Based Cardiovascular Assessment”. “How to prevent and manage osteoporosis” instead of “regenerative agriculture?” Preventing bone loss in women may be easier than trying to reproduce everything.
It is time to stop treating women’s health as a specialty or a topic relegated to a single lecture during an endocrinology unit. This is basic medical knowledge. It does not require a revolution in medical education or a radically different curriculum. It’s as simple as deciding that half the population’s health is worth its share of lecture time.
The current push for nutrition education has inadvertently revealed a useful truth: When funding is on the table, medical schools can find a place on the curriculum. If so, then perhaps the real question is not whether there is a place for women’s health.
That’s why we pretend it doesn’t exist.
Laura Zeibners, MD, MMEd, MBA, is co-founder and CEO of Calla Lily Clinical Care, a British women’s health company transforming medicine delivery for women. She is a board-certified pediatric emergency medicine specialist, national instructor for ATLS-UK at the Royal College of Surgeons-UK, and adjunct faculty at The Ohio State University School of Medicine teaching advanced competency in entrepreneurship in women’s health.
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