Medical Students Learn How Medicine Shaped Sex, Gender, and Sexuality

Medical schools around the world have spent the past decade working to improve care for sexually and gender diverse patients, adding lectures on LGBTQ+ health, gender-affirming care, and the social determinants of health to curricula that once ignored these topics entirely. Yet a new pilot study from Harvard Medical School argues that something fundamental is still missing: history. Without teaching students how the categories of sex, gender, and sexuality were socially constructed—and how the medical profession itself helped produce, pathologize, and regulate them—educators may inadvertently reinforce the very power structures their curricula aim to dismantle. The study, published in BMC Medical Education, describes the design and evaluation of a voluntary three-session lecture series that brought professional historians and social scientists into the first-year medical classroom, and it offers early evidence that this historically grounded approach is both feasible and welcomed by learners.

The intervention was conceived and organized by a team of Harvard Medical School students working in collaboration with the school’s LGBTQ+ and Allies organization, known as LAHMS, and with senior author Alex S. Keuroghlian, a psychiatrist affiliated with MaineHealth who has long worked at the intersection of transgender health and medical education. Development of the series was supported by a grant from the Massachusetts Medical Society, although the funder played no role in the study’s design, data analysis, or reporting. The format was deliberately co-curricular, meaning it sat alongside the required curriculum rather than inside it, allowing the organizers to test the concept without waiting for formal curricular reform. Each of the three sessions was delivered by an expert historian or social scientist rather than by a clinician, a choice that reflected the series’ central premise: that understanding the historical production of medical knowledge requires disciplinary perspectives that clinical faculty rarely possess.

The three lectures followed a logical conceptual arc. The first addressed sexuality, the second addressed sex, and the third addressed gender, with each session tracing how that particular category has been defined, measured, classified, and contested over time. Rather than presenting history as a gallery of past errors that modern medicine has corrected, the series invited students to see medicine as an active participant in constructing the categories it claims merely to describe. This framing draws on decades of scholarship in the history of science and science and technology studies, which has documented how diagnostic manuals, surgical practices, and public health policies have shaped what societies understand sexual identity, biological sex, and gender to be. For medical students trained to think in terms of evidence-based protocols, the message is potentially transformative: the tools of their profession are themselves historical artifacts with consequences for patients.

To evaluate whether the series actually changed how students thought, the researchers used a pre-post mixed-methods design combining quantitative surveys with qualitative focus groups. Twenty-eight first-year students enrolled, with a mean age of 23.8 years and a standard deviation of 1.28. The quantitative instruments comprised three subscales measured on five-point Likert scales: a 22-item attitude scale with excellent internal consistency, a nine-item learning objectives scale, and a ten-item post-lecture assessment. Paired-samples t tests were used to assess change from before to after each lecture, while semi-structured focus groups were analyzed using inductive thematic analysis, a technique that allows themes to emerge from the data rather than being imposed in advance. Formal ethics review was waived by the Harvard Longwood Campus Institutional Review Board, and all participants provided verbal informed consent.

The quantitative results revealed a pattern familiar to anyone who studies attitude change in highly motivated populations. Baseline attitude scores were already high, averaging 3.98 on the five-point scale, indicating that students who chose to enroll arrived with strongly favorable dispositions toward sexually and gender diverse health. Notably, one attitude item stood apart: comfort discussing gender-affirming care averaged only 3.26, suggesting that even among sympathetic students, clinical confidence lags behind attitudinal support. Despite the high baseline, the first two lectures produced statistically significant improvements in both attitudes and learning objectives. After the first lecture, attitude scores rose by a mean difference of 0.24 and learning objective scores by 0.38, both highly significant. The second lecture produced comparable gains, with attitude scores rising by 0.27 and learning objective scores by 0.44. The post-lecture assessment scores were uniformly high, averaging 4.41.

The third lecture, covering gender, did not produce statistically significant changes, but the researchers caution that this finding should not be overinterpreted. The analytic sample for that session shrank to only five or six students, leaving the comparison severely underpowered and making it impossible to distinguish a true absence of effect from a simple lack of statistical capacity to detect one. The authors also flag a likely ceiling effect: when baseline scores hover near the top of a five-point scale, there is simply little room left for measurable improvement, however powerful the instruction. This methodological honesty is one of the study’s strengths, and it frames the results appropriately as evidence of feasibility and acceptability rather than as proof of large-scale educational impact.

The focus groups added texture that the numbers alone could not provide, and the inductive analysis surfaced four distinct themes. First, students described a strong motivation to improve care for sexually and gender diverse patients, connecting the historical material to their future clinical responsibilities. Second, they reported having had almost no prior exposure to the history of sex, gender, and sexuality, confirming that the series was filling a genuine gap rather than repeating familiar content. Third, students expressed appreciation for the clinical relevance of historical analysis, an outcome the organizers might reasonably have worried about, since humanities content in medical curricula is sometimes dismissed as tangential to boards and wards. Fourth, and perhaps most actionable, students recommended that the instruction be made mandatory and more interactive, signaling that voluntary, lecture-based delivery may undersell the format’s potential.

Those recommendations point toward the study’s broader implications for curriculum design. The authors explicitly position the series as a replicable model, a framework that other institutions can adapt to embed historically grounded instruction into education on sexually and gender diverse health. The co-curricular structure has clear advantages as a testing ground: it requires no curricular committee approval, carries no risk of displacing required content, and attracts students who can provide detailed feedback. But the students’ own call for mandatory, interactive instruction suggests that the ultimate goal should be integration into the required curriculum, where all students—not only the self-selected enthusiasts—encounter the material. Transformative learning theory, which the authors cite in their abbreviations, offers a theoretical scaffold for this ambition: the idea that education works best when it forces learners to interrogate the assumptions underlying their professional worldview.

The study’s limitations are acknowledged candidly by its authors and deserve equal emphasis here. Participation was voluntary and therefore self-selected, meaning the sample likely overrepresented students already committed to equity-oriented work. The sample size was small, the implementation took place at a single institution with unusual resources, and the outcome measures relied on self-report, which is vulnerable to social desirability bias. Whether historically grounded instruction translates into measurably better clinical communication with sexually and gender diverse patients—particularly around gender-affirming care, where baseline comfort was lowest—remains an open question that future studies with larger, more diverse samples and behavioral outcomes will need to answer.

Even with those caveats, the pilot makes a contribution that extends beyond LGBTQ+ health education. It demonstrates that medical students will voluntarily spend their limited time engaging with critical historical scholarship, that such engagement produces measurable short-term gains in attitudes and self-assessed learning, and that students themselves recognize the clinical stakes of understanding how their profession’s categories came to be. At a moment when medical education is being asked to prepare clinicians for a diverse patient population with a history of well-documented mistreatment by medicine, the Harvard pilot suggests that looking backward may be one of the most forward-looking things a curriculum can do.

Subject of Research: Integrating the history of sex, gender, and sexuality into undergraduate medical education through a mixed-methods pilot lecture series

Article Title: Integrating the history of sex, gender, and sexuality into undergraduate medical education: a mixed-methods pilot study

Article References: Hanshaw, B. D., Liu, J., Esmail, K. P., Sander, M. T., & Keuroghlian, A. S. (2026). Integrating the history of sex, gender, and sexuality into undergraduate medical education: a mixed-methods pilot study. BMC Medical Education. https://doi.org/10.1186/s12909-026-10382-9

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10382-9

Keywords: medical education, LGBTQ+ health, history of medicine, gender-affirming care, curriculum development, health equity, sexually and gender diverse, Harvard Medical School, mixed methods, medical humanities, pilot study, Integrating