Discovering gender differences while teaching family genograms

Abstract

Context and setting Our family medicine clerkship (FMC) is a 4-week required rotation to which small groups of students are assigned at any time during Year 3. Students, then, gain variable clinical experience depending on when they begin their rotation. All students have the option of taking the course at the urban main campus or in a rural or underserved area. Why the idea was necessary In most of the underserved sites, the family medicine preceptors have been in practice at the same location for 20−30 years, treating multiple generations of the same families. Thus, these doctors have an exceptional depth of knowledge about family context, which is impossible for students to acquire in a 4-week rotation. To address this issue, FMC students are required to complete a family genogram during one of their clinical encounters. The genogram is a history-taking tool in which the clinician and patient diagram the patient's medical and family history, including their current living situations. What was done The genogram was introduced to FMC students during a mandatory orientation workshop held on the main campus. The workshop included a review of the principles of the family genogram and a discussion of clinical situations that might benefit from the information gained in a family genogram. A role-play exercise allowed students to use the genogram skills prior to applying them. Students were required to use the genogram in a clinical setting at least once and to present this genogram to their colleagues during a required 2-hour telemedicine conference. Family medicine clerkship telemedicine conferences are held weekly throughout the clerkship and are facilitated by the clerkship director. Both campus- and community-based teaching staff were aware of the genogram requirement; however, students were expected to obtain the family genogram independently. Evaluation of results and impact Over the course of a year, 79 students completed the FMC. Among participants, 48% were female and the median student age was 26 years. Using individually linked pre- and post-clerkship surveys, we assessed changes in students' understanding of the genogram and appreciation of the importance of the family in delivering health care. Students' knowledge and attitudes about the genogram tool and the family improved significantly during the clerkship; post-clerkship, the majority of students gave higher ratings on 6 of 7 survey items. Student gender was a statistically significant factor for 5 of the 7 survey items. Female students were more likely to give higher ratings on items addressing attitudes towards the genogram and the family. This corresponds with society's generally accepted view that women are more attentive to relationships and value family involvement. Of considerable interest to educators is the multivariate analysis predicting ratings for the statement: ‘The family is the unit of care.’ We found a statistically significant interaction between student gender and pre- versus post-results for this item. Female students began the clerkship already valuing family relationships to a high degree, and improved little. Male students, however, benefited more from the educational intervention, which was geared towards improving students' understanding and appreciation of family relationships. Understanding this gender difference may help target future educational programming.