- Most anatomy models previously used in medical training had male bodies as the default.
- But not all bodies are male. By centering education around that default, it affects how people are treated and how conditions are diagnosed.
- Elsevier is aiming to change this with the release of a new app-based, 3-D female anatomy model that has been made available for medical training.
- The company claims this is “the most advanced” 3-D female anatomy model to date.
Alondra Diaz, a second-year medical student at the University of Illinois School of Medicine, said she’s always struck by the reality that study after study shows that women as patients “do not get equitable healthcare.”
There are many reasons for this, one being that, traditionally, when prospective medical doctors study medicine, it is often drawn from the perspective and understanding of the male body.
Most anatomy models used in medical training use cisgender male bodies as the default.
For a student like Diaz, this doesn’t offer what she calls an “accurate perspective” of the wider spectrum of differences that exist in human anatomy.
Not all bodies are male. By centering education around that default, it has wider implications for how people are treated and how conditions are diagnosed.
Just last month, one company released a product it hopes can change this paradigm.
Research publishing and information analytics company Elsevier launched what it’s calling “the most advanced” 3-D full female anatomy model made available for medical training.
This new model is part of Complete Anatomy, the company’s existing 3-D human anatomy platform.
Diaz told Healthline she has used other app-based anatomy models in her training, but once she gave Complete Anatomy and its female model a try, she found it was “one of the most realistic ones” she’s come across.
“Once they launched the female model, it was not just as simple as putting a male-looking face on this model, or a female-looking face on this model. It was a drastic change in terms of the proportions and the relationship of the organs to each other,” Diaz explained. “That was helpful when studying different diseases in the classroom as well.”
Irene Walsh, director of product, design, and content at 3D4Medical from Elsevier, told Healthline that we are currently playing a very delayed game of “catch-up as a society” when it comes to accurately representing and understanding how non-male bodies work.
As a medical tech startup, she said it was important to address how to “provide the needs that educators are asking for right now.”
Walsh said the standard approach in medical training and the design of anatomy models is for the male body to be the default and the only aspect that is female is “the reproductive areas.”
In designing the new model, Walsh said designers and researchers at Elsevier had to go back to the principles of medical anatomy models and “look at anthropological data scans, specialists’ texts, academic papers, and customer feedback,” giving the company’s 3-D artist team all the materials they needed to create the most accurate model imaginable.
The model can be accessed through the company’s app, which is currently the top-selling “medical category app” on iPad in the United States and also has more than 20 million global downloads.
The new female model gives educators and students the chance to do everything from examine the complete human female skeletal system — including the differences between female and male skeletons — and study accurate portrayals of the muscles in female bodies.
It also provides detailed female-specific areas of the body, like breast tissue, that can be quartered to reveal underlying issues.
Users can also switch back and forth between male and female models to “compare sexual differences and reveal the origin and distribution of nerves” as well as take quizzes, view instructional videos, and take a look at an atlas inspired by the reference book “Gray’s Anatomy,” according to the company’s press release.
When it came to how medical educators received the new model, Walsh said there were “two schools of thought.”
On one hand, through the company’s research, she said some “were comfortable” with how the human anatomy was presented traditionally (in other words, they were fine with the male-based models) and “weren’t as aware of how important representation is.”
“But then you have the flip side with a vocal number of educators who… wanted to tell [their students] the full story of how the female anatomy operates, and they weren’t able to do that successfully before,” she said.
Lead subject matter expert on this updated model Yasmin Carter, PhD, an assistant professor of translational anatomy at the UMass Chan Medical School, told Healthline it was “normalizing” to be able to introduce students to this model, which is sobering given that more than half the population identifies as female.
“That says so much to me that we have essentially been ignored for such a really long time,” Carter explained. “It’s like, ‘Hey, you’re a human being, I’m a human being, we should just learn how you work before we do any medical interventions whatsoever.’”
When asked why we are only seeing a model like this in 2022, Carter said she seems to find men are shocked by the realization that women and people who have more marginalized genders tend to say, “‘Oh, that explains a lot.’”
The fact that we have mostly had male-centric human anatomy learning models is just part of the greater whole of gender and sex inequities embedded in medicine and society at large.
“Yes, it absolutely should have happened 100 years ago, 1,000 years ago, because women’s bodies, female bodies have been in existence for forever,” Carter said.
“People are born with female traits, people are born with intersex traits, but what’s changed? When we look at the history of medicine, what we see is pretty much from a male perspective.”
Carter said early Western medical understanding of human anatomy was designed by men, and men were often not allowed to interact with the female body to create their anatomical materials.
That has carried through the centuries to today. She cited the reality that in 2019, demographics of medical students started to reflect a change. For the first time, just over half (about 51 percent) of medical students identified as female.
Carter said this shift in the makeup of the medical profession results in a reality where doctors and prospective doctors are saying “this is not representative of my experience, of my body, of my anatomical inventory” and that “those voices have really made a difference.”
She said this sense of inequity, of not fully understanding the female body in medical education, has clinical ramifications too.
Delayed diagnoses and misdiagnoses for female bodies are high. Women and other marginalized groups are 20 to 30 percent more likely to be misdiagnosed in clinical settings.
Carter said that if a healthcare professional has only learned the male body and been instructed in medicine by way of a male perspective, then of course it will take longer to figure out what is wrong with a non-male patient who comes into a clinic and is showing symptoms, for instance.
She stressed that 50 percent of heart attacks in women are missed or misdiagnosed because women have completely different symptoms.
Additionally, long COVID is seeming to show different symptoms for women than men.
“To me it seems so obvious that in order to fix the systemic issue, you have to go back to the basics. So, to me, ‘the basics’ is medical education,” Carter added. “If we do not teach medicine equally, then how can we expect healthcare to be equal?”
Dr. Abigail Winkel, associate professor in the department of obstetrics and gynecology at NYU Langone Health, told Healthline it is a “reasonable concern” that physicians be instructed in ways that are more inclusive of sex and race.
She said one of the best examples is cardiac physiology.
For a long time, medical institutions just examined cardiac disease in how it presents in men. Winkel explained that it took the efforts of women’s health physicians to center the ways in which women present cardiac disease and how that differs from men.
“When you have an assumed default that’s actually not the norm for every patient is when you get into trouble,” Winkel said.
“Look at how we discuss hypertension. We know it presents differently in Black patients and we have these norms that default along majority lines that aren’t representative of all experiences.”
Winkel is not affiliated with Elsevier or the new model. She said she studied anatomy during a time when students were instructed in “general anatomy,” and “reproductive anatomy” was taught “one day toward the end of the course.”
“I’m an OB-GYN and it’s of course very important for me to understand the female reproductive system, and it’s not just the anatomy but the physiology,” she said.
She pointed to the fact that at her office they finally got their first “Black mother and baby birth simulator,” which was crucially important for training.
“We deliver Black mothers all the time, and I think the fact that we didn’t have that in our default — all of our simulators were white — subtly underscores this idea that there are ‘norms,’ there is the ‘expected thing,’ and anyone else who falls outside that is ‘a deviation from the norm,’” Winkel said.
Walsh, of Elsevier, said this new female anatomy model is a step in the right direction, but it’s just one step of many needed ones.
She said the company is currently working on projects around the diversification of skin tone and facial characteristics in their models.
Right now, they still have a very “primarily European research base” that some of the models are built from. As a result, they are undertaking an initiative to make sure that “we are better representative of all the ways — from the outside in, not just in sex but in skin tone and characteristics,” Walsh explained.
Beyond this, she said it’s important that human anatomy models be more inclusive of the wide sex spectrum that exists.
She said right now there is a “binary application” in how biological sex is approached in anatomy models. The company knows this isn’t representative of society as a whole.
“We have a long way to go, but all of this is on the table in discovery,” she said.
Carter said she and her students spend a lot of time talking about LGBTQIA+ health. Her teams of medical students are “well primed for discussions about diversity,” and she said it is important to see how those kinds of conversations translate out of the classroom to the clinic or the doctor’s office.
“How do we make systemic change? By continually dropping pebbles in a pond,” Carter added.
Winkel said the biases a doctor or medical student might have can filter into the clinical space and allow people to “fall into traps where we miss things.”
“Making change in how people learn foundational anatomy can draw the viewer back a little bit in their viewfinder and have the awareness of, ‘Does this patient’s sex affect the way this disease might present?’
“It’s a question that might not have been explicitly asked or consciously configured, but just having that idea enforced by educational models, just having that foundation anatomy, I think it allows people to keep a broader lens on what they are thinking about when trying to make these medical decisions,” Winkel explained.
She did caution that products that tout changes to how medicine is taught have to be more than superficial. They can’t just be a way to market something as more inclusive; it has to be backed up by science, rigorous research, and not just be a “product” marketed to a medical school.
Walsh said the importance of her company’s product is not just representation, but it’s having students also “see the opposite of themselves” — having a broader awareness of the scope of bodies different from their own.
When asked what she’d like to see 5 years from now, Carter said she wants the discussion to extend “outside the gender binary” and a view of race and ethnicity that is filtered solely through an understanding of whiteness as the default.
“When you look out at people, there aren’t two pigeonholes you can put people in. People exist on this incredible, individual spectrum of different things that make them them,” Carter said.
For Diaz, the medical student, the presence of models like this one, and the reality of more women entering the medical field, the realm of medicine can change for the better.
“All of these things combined can really ultimately lead to better treatment to all kinds of patients, not just men or whatever the case may be,” she said. “There’s definitely some hope that by focusing on more diverse models, it will lead to better diagnoses and better healthcare overall.”