Sex and Gender Representation in Cardiothoracic Surgical Textbooks

Abstract

Objective Gender differences among disease patterns have been well-established across many diseases and procedures. However, female patients have consistently experienced poorer healthcare outcomes. This is particularly prominent among heart and lung diseases, which represent two leading causes of mortality internationally. To address this, female healthcare outcomes need to be investigated, and solutions placed at the forefront of healthcare advancement, beginning with medical education. The aim of this study was to evaluate sex and gender representation in cardiothoracic surgical textbooks used by medical schools within the Republic and Northern Ireland. Design and setting Public online databases of medical libraries within the Republic and Northern Ireland were searched using the term ‘cardiothoracic’ and resulting texts were screened for relevancy. Sex and gender representation was evaluated in each chosen text using a modified version of the validated protocol outlined by Alexanderson. 20 This involved evaluation of epidemiological data, risk factors, disease presentation, treatment guidelines and post-operative outcomes, as well as illustrations and radiographic images. Results Two full textbooks and two textbook chapters were evaluated. Epidemiological data was segregated by gender in 8% of diseases/procedures and was more commonly segregated among thoracic cases than cardiac cases. Disease symptoms were not gender-specific, lacking mention of potential differences between genders, and treatment guidelines reported gender-specific information only when addressing pregnant patients. Illustrations also lacked female representation, with 74% representing a male body and the remaining 26% gender-neutral, while radiological images showed a more equal distribution. Conclusions Cardiothoracic surgical textbooks currently used by medical trainees in Ireland lack discussion of gender differences and rely heavily on male representation to inform disease patterns. This may create an unconscious bias among trainees that these diseases only occur in men, leading to poorer outcomes for female patients. This study highlights the need for purposeful discussion of gender among cardiothoracic diseases, which could translate into meaningful changes clinically.