Abstract
BACKGROUND: There is growing focus on sex- and gender-sensitive medicine (SGSM) in the field of medical education, yet only few medical schools worldwide have successfully integrated SGSM content into their curricula. The topic is highly relevant, but it can be challenging due to its identity-related nature that can trigger questions about safe learning spaces. In this study we aimed at investigating the multilayered impact of safety on SGSM teaching. METHODS: We employed a multimethod qualitative approach to investigate perceptions and experiences of safety in studying SGSM and the implications for curriculum design. In the setting of a week-long summer school on SGSM we performed participant observation, a creative assignment, a focus group, and semi-structured interviews with participants to achieve a multi-dimensional framing of the concept of safety. RESULTS: The study highlights the interrelation of psychological, social, and cultural safety and a hierarchy in their exploration by the learners in the context of SGSM. If social safety is not guaranteed, learners do not proceed to explore psychological and eventually cultural safety. Learners often conflated safety with comfort and avoidance of conflict. Placing an explicit focus on safety can, thus, have a paradoxical effect, with learners avoiding learning about sensitive topics because of a heightened attention to safety. CONCLUSIONS: Conflation of safety with conflict avoidance can hinder learning in the field of SGSM as it might hinder deep engagement with the topic. Lecturers are responsible for the generation of safe learning spaces focused on social, psychological and cultural safety, yet need to encourage exploration and discussion within this framework. Hence, lecturers need appropriate training to support safety, in-depth engagement and critical reflection in class, in order to promote personal growth while acquiring professional skills in SGSM.