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

Medical education increasingly addresses sexually and gender diverse (SGD) health, yet curricula often lack historical analysis of how sex, gender, and sexuality were socially constructed—and how medicine helped produce, pathologize, and regulate them. Without this grounding, curricula may reinforce the power structures they seek to dismantle. We developed and evaluated a co-curricular lecture series at Harvard Medical School (HMS) integrating historical scholarship on sex, gender, and sexuality into undergraduate medical education. We implemented a voluntary three-session co-curricular lecture series for first-year HMS medical students, with each session delivered by an expert historian or social scientist. The intervention was evaluated using a pre-post mixed-methods design. Three quantitative subscales used 5-point Likert instruments: attitude (22 items; Cronbach’s α = 0.91), learning objectives (9 items; α = 0.84), and post-lecture assessment (10 items). Paired-samples t tests assessed pre-to-post change. Semi-structured focus groups were analyzed using inductive thematic analysis. Twenty-eight students enrolled (mean age 23.8 years; SD = 1.28). Baseline attitude scores were high (M = 3.98, SD = 0.47), although comfort discussing gender-affirming care was lower (M = 3.26, SD = 0.86). Significant pre-to-post improvements followed Lectures 1 and 2 in both attitude and learning objectives (L1: attitude Mdiff = 0.24, p < .001; objectives Mdiff = 0.38, p < .001; L2: attitude Mdiff = 0.27, p = .033; objectives Mdiff = 0.44, p < .01). Changes were small given high baseline scores, suggesting a potential ceiling effect. Lecture 3 changes were not significant, although the analytic sample was underpowered ( n = 5–6). Post-lecture assessment scores were high (M = 4.41, SD = 0.18). Thematic analysis identified four themes: motivation to improve SGD patient care, limited prior historical knowledge, appreciation of history’s clinical relevance, and recommendations for mandatory interactive instruction. This pilot demonstrates the feasibility and learner acceptability of historically grounded instruction on sex, gender, and sexuality within undergraduate medical education, with modest self-reported attitudinal and learning-objective gains following two of three sessions. Limitations include self-selection, small sample size, and single-institution implementation. This framework offers a replicable model for incorporating historically grounded approaches into SGD health education.