Exploring Gender Perspectives in Medical Education: Latent Semantic Analysis of Israeli First-Year Medical Students' Reflections.

The participants were first-year medical students enrolled in the 4-year medical program at the Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel. They attended a mandatory sex- and gender-based medicine course as part of their curriculum. All students provided written reflections on their experiences and learning outcomes, which constituted the textual dataset for analysis. This study adhered to ethical guidelines for educational research. Written informed consent was obtained from all students before data collection. Institutional ethical approval was granted by the Human Subjects Institutional Review Board at Bar-Ilan University, Safed, Israel (approval number 040325496). Participation was entirely voluntary, and students’ reflections were anonymized and used solely for academic and research purposes. The course Sex- and Gender-Based Medicine was designed to introduce and deepen understanding of key concepts, theories, and practices in sex- and gender-sensitive medicine, emphasizing how sociocultural and institutional determinants shape health disparities. Over 7 structured first-year sessions, each consisting of a 90-minute plenary lecture followed by a 90-minute small-group practice, students developed both conceptual and applied competencies for integrating a sex- and gender-aware perspective into clinical practice and medical research. Using Bloom’s taxonomy [ 19 ], the learning progression moved from remembering (defining sex and gender; describing biological, social, and cultural determinants) and understanding (explaining how sex and gender influence biological systems, disease manifestation, health-seeking behavior, and access to care) to applying (using a sex- and gender-sensitive lens to analyze case studies such as women with chest pain or men with breast cancer), analyzing (identifying bias in biomedical research design and interpretation), evaluating (assessing the impact of policy, feminist theories, and global perspectives on health care delivery), and creating (formulating strategies to address inequities and adapt medical innovations for diverse populations). Learning activities combined plenary lectures with small-group sessions featuring case-based discussions, simulations with standardized patients, podcast analyses, and reflective exercises. The curriculum integrated national and global perspectives, traced the historical evolution of feminist thought and its influence on medicine, examined gender gaps in research, and critically analyzed the effects of bias on health care delivery and innovation. Students were required to attend at least 80% of sessions and submit a written reflection, for instance, applying a sex- and gender-sensitive framework to a clinical scenario, thereby demonstrating mastery of course objectives across multiple levels of cognitive engagement. At the conclusion of the Sex- and Gender-Based Medicine course, students were required to submit a 1-page written reflection as a mandatory graded assignment. The prompt invited them to describe and critically analyze their learning experience, drawing on lectures, small-group discussions, case-based exercises, or personal experiences relevant to sex- and gender-sensitive medicine. Students were encouraged to focus either on a specific event or on their overall experience, integrating description, interpretation, and self-analysis. The assignment was structured around the DIEP (Describe, Interpret, Evaluate, and Plan) model guiding students to (1) describe the chosen experience or case; (2) interpret the actions, motives, emotions, and contextual factors involved; (3) evaluate their own responses and the quality of their engagement; and (4) plan how to apply the insights gained to future academic, clinical, or research contexts. To support the reflective process, students were given stepwise guidance: identifying the experience, describing the learning process, engaging in introspection, recognizing shifts in perspective or values, and directing the reflection toward future practice. They were encouraged to write in the first person and connect their reflections to personal perspectives and professional aspirations. Model phrases were provided to help articulate reflective thinking (eg, “This experience made me aware of...”, “Looking back at what happened...”). All submissions received individualized feedback aimed at deepening reflective skills. The dataset consisted of written responses submitted by students at the conclusion of the course. These reflections were collected electronically and compiled into a structured corpus for text mining. The responses varied in length and complexity, reflecting diverse perspectives on gender-related topics in medicine. Before analysis, all textual data underwent preprocessing to ensure the reliability of results. This included tokenization, stop-word removal, stemming, and lemmatization. Text was converted to lowercase, and punctuation and nonalphabetical characters were removed to standardize the dataset. Common medical terminology and gender-related terms were retained to preserve contextual relevance. Preprocessing was performed using the English stopword list and English-language stemming algorithms. This study used latent semantic analysis (LSA) to examine the perceptions and conceptualizations of gender medicine among Israeli first-year medical students. LSA is a computational information-processing method for humanlike, meaning-based cognitive tasks, including the extraction of conceptual meaning from large textual corpora . It addresses the question of “how word and passage meaning can be constructed from experience with language, that is, by what mechanisms—instinctive, learned, or both—this can be accomplished” [ 20 ]. In LSA, “words do not have meanings on their own..., words get their meanings from their mapping” [ 20 ], and it is “the underlying map (that) is (to say) the primitive substrate that gives words meaning, not vice versa” [ 20 ]. LSA recognizes that people rarely communicate using isolated words but typically speak and comprehend clusters of words, often extending beyond a single sentence. Such units of meaning are more accurately represented at the level of paragraph-length discourse. More technically speaking, LSA relies on the “compositional constraint,” which posits that “the representation of any meaningful passage must be composed as a function of the representations of the words it contains” [ 20 ]: “LSA learns about the meaning of a word from every meeting with it and from the composition of all the passages in which it does not occur...Word meaning is latent in the evidence of experience and can be extracted from natural linguistic data” [ 20 ]. The LSA technique has been increasingly applied in health professions education to analyze reflective narratives and explore students’ mental models [ 21 , 22 ]. By identifying patterns of word co-occurrence and reducing linguistic dimensionality, LSA detects latent themes that may not be readily apparent through manual coding alone. It thus offers a scalable, data-driven approach to evaluating the impact of educational interventions, particularly in areas involving subjective and contextually embedded content such as gender. A term-document matrix was constructed using a bag-of-words representation with a minimum term frequency of 2 and a sparsity threshold of 0.975. Singular value decomposition was applied to reduce dimensionality and reveal key semantic relationships between words. The number of topics was determined using an optimal singular value selection approach to capture the most relevant themes without overfitting the data. LSA was first performed on the overall sample to identify global themes and semantic structures, followed by stratified analyses by gender and ethnicity. Following LSA, the resulting topics were manually reviewed and labeled according to their most representative words. Two independent researchers (RKF and NLB) conducted the topic interpretation to ensure reliability, resolving discrepancies through discussion until consensus was reached. A hybrid coding approach was applied: an initial a priori codebook was developed based on the study’s research questions and prior literature on sex- and gender-based medicine. This preliminary framework included categories expected to capture both clinical and sociocultural dimensions of student reflections. The codebook was then iteratively refined in a data-driven manner, consistent with constructivist theory, through manual review of the topic-modeling outputs and a subset of student narratives. This process allowed for the addition of new codes and the consolidation or clarification of existing ones. In doing so, the final set of codes reflected both theoretically informed expectations and emergent themes in the data, thereby enhancing the validity and reproducibility of the analysis. The codebook, including a priori categories, their definitions, and emergent subcodes within each category, is presented in Table 1 . All LSA procedures were conducted using XLSTAT (Lumivero, LLC). Codebook for the thematic analysis.

All 83 students were recruited. Of these, 52 (63%) identified as female and 31 (37%) as male. In terms of ethnicity, 68 participants (82%) identified as Jewish and 15 (18%) as Arab. In the overall sample analysis, LSA ( Table 2 ) revealed a rich and multidimensional thematic structure, highlighting the broad spectrum of gender-related issues perceived by students in the context of medical education and clinical care. In total, 10 distinct topics were identified. Topic 1 exhibited the highest eigenvalue (121.188), accounting for approximately 28.1% of the total variance, and demonstrated high lexical richness (527 terms) as well as strong document representation (75 documents). The primary terms within this topic indicate that students engaged critically with gendered dynamics in patient-doctor interactions, emphasizing gender as a determinant of health and its implications for clinical communication, empathy, and diagnostic equity. Beyond this dominant theme, topic 2, with an eigenvalue of 54.519 (5.68% of the explained variance), reflected students’ awareness of gender-specific health concerns, particularly those disproportionately affecting women. This thematic axis reflects recognition of both the biological and social dimensions of illnesses such as breast cancer and their ramifications for patient care and support systems. Topic 3, with an eigenvalue of 47.175 and accounting for 4.26% of the overall variance, indicates that students considered how religious beliefs and cultural contexts intersect with gender identity and health care experiences, particularly for conditions such as endometriosis that are not only underdiagnosed but also socially stigmatized. This highlights the students’ developing sensitivity to culturally competent care and the complexities of treating individuals within diverse socioreligious frameworks. The subsequent topics (topics 4-10) each accounted for between 3.49% and 1.90% of the variance, with eigenvalues ranging from 42.725 to 31.507. Topic 4 addressed the complex role of gender in shaping professional identities and hierarchies in medicine. This theme was further reflected in topics 7 and 8, which collectively examined gender-based dynamics in medical decision-making, team interactions, and perceived equality in clinical and academic settings. Topic 7 highlighted heightened student awareness of the gendered structures influencing teamwork, authority, and career progression within medicine, while topic 5 underscored students’ growing recognition of transgender health concerns and the structural barriers to inclusive health care delivery. Topic 6 focused on gender pharmacology—particularly the often underappreciated physiological and hormonal differences that affect drug efficacy and therapeutic response. Topic 9 addressed students’ reflections on interpersonal and institutional factors shaping gendered experiences within medical learning environments. Finally, topic 10 conveyed a nuanced consideration of the psychological and normative dimensions of gendered illness narratives, emphasizing students’ awareness of how gender norms shape both the perception and lived experience of illness, as well as the societal frameworks governing the provision of emotional support and care. Labeled topics identified through latent semantic analysis of student reflections following participation in a gender medicine course. Each topic is characterized by its corresponding eigenvalue, percentage of explained variability, key terms, and the thematically assigned label. The LSA of reflections from female medical students ( Table 3 ) revealed that while several key topics were retained from the full-sample analysis, new themes also emerged, and some existing ones underwent lexical refinement and thematic expansion. Topic 1 remained the most dominant, with topic 2 also consistent. Topic 3, however, demonstrated a partial thematic reorientation: while previously aligned with cultural and religious dimensions, it now emphasized communication and generational perceptions over doctrinal belief. Topic 4 incorporated a broader intersectional framing of gender complexity and patient autonomy. Similarly, topic 5 integrated educational and clinical discourse, with a particular focus on conditions such as breast cancer. Distinctively, several new themes emerged uniquely within the female-only dataset. Topic 6 introduced a previously unarticulated theme of Gendered Help-Seeking and Familial Roles, possibly reflecting caregiving norms and informal consultation practices. Topic 7 clarified the psychological and emotional dimensions of gender and health. Topic 8 suggested a pedagogical and developmental framing, while topic 9 reflected an intergenerational perspective on gendered health experiences. Finally, topic 10 revealed a discourse on self-expression, advocacy, and possible resistance to gendered dismissal or invalidation. The LSA of reflections from male medical students ( Table 4 ) showed that while most identified topics were retained, some exhibited lexical drift and partial thematic reorientation. For instance, topic 6 indicated a shift toward a more biologically grounded understanding of gender. Topic 8 appeared to merge interpersonal reflections with the emotional and physical dimensions of team-based care, thereby becoming lexically broader in scope. Two new themes also emerged in the male-only analysis. Topic 9 reflected critical engagement with perceived gender bias in diagnostic processes and biomedical research. Finally, topic 10 introduced a novel legal and ethical discourse on reproductive health, suggesting that at least some male students approached gendered issues through a rights-based and normative framework. Labeled topics identified through latent semantic analysis of student reflections following participation in a gender medicine course in the female-only sample. Labeled topics identified through latent semantic analysis of student reflections following participation in a gender medicine course in the male-only sample. The LSA of reflections from Jewish medical students ( Table 5 ) revealed that the dominant theme, topic 1, accounted for 28.06% of the variance and reinforced the central, cross-cutting theme of Gendered Patient-Doctor Interactions, which consistently emerged as the core axis across all subgroups. Other key full-sample themes—such as gender-specific diseases, transgender health care, gender differences in pharmacology, gender and decision-making, and psychosocial dimensions—were retained in both lexical structure and conceptual scope. However, 2 new themes emerged in the Jewish-only analysis. Topic 5 suggested a discourse on population-level gendered conditions, possibly linking epidemiological thinking to gendered illness patterns, while topic 10 revealed a narrative centered on early socialization, gendered expectation formation, and informal educational settings. The LSA of reflections from Arabic medical students ( Table 6 ) explained 92.2% of the total variance, indicating a semantically rich and cohesive thematic structure. Topic 1, which accounted for 35.95% of the total variance (eigenvalue=58.017), reaffirmed the central theme of Gendered Patient-Doctor Interactions. Topic 2 (13.31% variance) was likewise retained. Topic 3 represented a new theme, characterized by culturally specific terms that suggested heightened sensitivity to modesty, gendered exposure, and familial expectations in clinical contexts. Similarly, topic 5 introduced a novel discourse on paternal authority and structural discrimination, with terms pointing to familial and systemic influences on gender roles and health care access—elements particularly salient in Arabic sociocultural settings. Two other themes were reoriented from their original full-sample conceptualizations. Topic 4 captured procedural aspects of care and implicitly gendered experiences during physical examination and consultation. Topic 7 aligned with the previously defined theme of gendered communication but introduced a spatial and emotional safety dimension, with cultural reframing. Additional new themes were identified in topics 9 and 10. Topic 9 pointed to concerns around reproductive health and perceived vulnerability. Finally, topic 10 captured emotional burden and coping dynamics. Labeled topics identified through latent semantic analysis of student reflections following participation in a gender medicine course in the Jewish-only sample. Labeled topics identified through latent semantic analysis of student reflections following participation in a gender medicine course in the Arabic-only sample.

The findings of this study highlight the complex and multidimensional ways in which first-year medical students in Israel engage with the concept of gender in both educational and clinical contexts. LSA of student reflections revealed a dominant recurring theme—Gendered Patient-Doctor Interactions—across all analyses. This convergence aligns with prior scholarship underscoring the critical role of gender in shaping clinical communication, empathy, and trust [ 23 ]. The centrality of this theme suggests that even early exposure to gender medicine can prompt students to critically reflect on the influence of gender on therapeutic relationships and clinical outcomes [ 24 , 25 ]. In line with the World Health Organization’s assertion that gender is a fundamental social determinant of health [ 5 ], students in this study demonstrated an emerging awareness of how gender shapes illness narratives, health care access, and diagnostic pathways. Their reflections also echoed the “gender mainstreaming” approach promoted in international medical education policy, which advocates for integrating gender considerations at all levels of health care delivery and education [ 5 , 26 , 27 ]. Notably, themes related to transgender health care, gender-specific diseases, and pharmacological differences paralleled the growing literature that underscores the need to dismantle androcentric biases in medical curricula [ 28 , 29 ]. These insights suggest that when given structured opportunities for reflection, learners are capable of recognizing and critically interrogating structural inequities embedded within biomedical discourse and practice. Rather than merely acknowledging the existence of inequities, participants were challenged to examine critically the structural foundations of medical knowledge production, clinical practice, and professional formation. Many expressed dismay at the historical exclusion of female bodies from clinical research and the persistent privileging of male physiology as the normative reference point. As one student succinctly articulated: “We were presented with the historical neglect of female subjects in clinical trials in various fields, and an approach that perpetuated biased medical treatments that favor male physiology as the default standard.” This statement reflected not only an awareness of bias but also a structural critique of the biomedical canon, echoing feminist analyses of knowledge systems that render women invisible or anomalous within clinical reasoning. Importantly, the student’s reference to “perpetuated biased medical treatments” underscored an understanding that these are not merely vestiges of the past but ongoing epistemic and clinical injustices. The course further encouraged students to reevaluate their professional identity and the ethics of care through a gender-responsive lens. Many participants described how the training reshaped their conception of good medical practice—shifting from a mechanistic, one-size-fits-all model to a more nuanced, context-sensitive, and individualized approach. One student reflected: “I learned about the importance of listening to patients and the need to treat them as individuals, and not just as representatives of a particular gender.” This shift marks a clear departure from biomedical reductionism, highlighting the importance of relational ethics and embodied listening—practices central to feminist clinical pedagogy. Importantly, the course also created space for critical emotional and identity work, particularly among male students. While some initially reacted with defensiveness or discomfort, perceiving gender-sensitive discourse as accusatory or polarizing, dialogical engagement and pedagogical scaffolding helped transform these affective responses into opportunities for deeper, transformative learning. As one male student candidly recounted: “At the beginning of the ‘Sex and Gender-Aware Medicine’ course, I felt, as a man, uncomfortable and even indirectly attacked...However, in small group exercises, the learning experience changed. The instructors helped me understand that the goal is not to blame, but to train us to be better doctors.” This reflection illustrates how pedagogical designs grounded in openness and dialogic learning can transmute resistance into productive introspection. The student’s movement from a sense of personal indictment toward professional growth signals a successful pedagogical intervention—one that shifts affective orientations while fostering ethical self-positioning. Crucially, the course did not stop at generating cognitive insights; it also catalyzed concrete commitments to behavioral change. Several students described actionable strategies for integrating sex- and gender-aware practices into their future patient encounters. One such example reads: “Following the course, I intend to ask more focused questions about the medical history of my patients, taking gender differences into account. I also intend to continue to stay up-to-date with research and literature in the field of gender medicine, in order to provide my patients with the best possible care.” Here, we witness the internalization of gender mainstreaming not as an abstract principle but as a guiding framework for everyday clinical decision-making and professional formation. Some students even extended their reflections beyond the medical curriculum , engaging with the broader sociocultural implications of gendered behavior and ethics. One student, for example, recounted a personal experience in which a pregnant woman was ignored on public transport, using this incident as a lens to interrogate gendered expectations, moral responsibility, and social awareness. While not strictly clinical, such reflections highlight the pervasiveness of gendered norms and underscore the importance of cultivating ethical responsiveness that transcends disciplinary boundaries. The gender-stratified analysis revealed meaningful differences in both the conceptual emphasis and emotional tone of student reflections. Female students more frequently highlighted relational and affective dimensions of gender, including intergenerational caregiving roles, informal consultation, and communicative dynamics in health care. These findings align with prior research indicating that female medical students often adopt a relational epistemology and are more inclined to reflect on their positionality and ethical responsibilities in clinical practice [ 30 ]. By contrast, male students tended to engage more with the biomedical, legal, and structural dimensions of gender, raising issues such as diagnostic bias and reproductive rights. This pattern reflects what prior literature has described as a more abstract and normative framing of social issues among male learners [ 30 ]. Moreover, this study reveals that students construct divergent understandings of gender medicine through identity lenses deeply shaped by religion, ethnicity, ideology, and sociopolitical context. One particularly compelling reflection came from a student who described the course as exposing “the tumultuous reality in our small country, which is caught in the middle of a clash between East and West, between religion and liberalism.” The student reflected on the tension between their conservative upbringing and the realities of contemporary clinical practice, asking: “Is there room for the religious beliefs upon which my upbringing is based, or do I need to re-examine or abandon my personal beliefs and open up to secularism and liberalism?” These questions encapsulate the internal negotiation learners face when confronted with dissonant ideas that challenge their foundational schemas. Similarly, ethnic subgroup analyses highlighted the intersection of gender and cultural identity. Reflections from Jewish students revealed a tendency to extrapolate personal experiences to broader public health framings, often invoking themes such as epidemiological patterns and gendered health behaviors. This ability to connect micro-level experiences with macro-level perspectives aligns with what Cruess et al [ 31 ] describe as the development of the physician’s “professional identity.” Meanwhile, reflections from Arabic students revealed a deeper engagement with culturally embedded norms surrounding modesty, familial authority, and structural barriers to health care access—patterns consistent with scholarship on the intersection of gender, religion, and medicine in collectivist cultures [ 32 ]. Notably, these students also voiced affectively charged concerns related to reproductive health, vulnerability, and emotional burden, underscoring the cultural and emotional labor involved in reconciling conflicting expectations within clinical spaces [ 33 , 34 ]. Taken together, these reflections—shaped by diverse positionalities—illustrate how pedagogical encounters with gender can elicit complex and, at times, conflicting epistemic trajectories. Overall, this study adds to the growing body of scholarship calling for the integration of gender and cultural competence into medical education. The themes identified suggest that structured gender curricula, when paired with reflective pedagogy and systematic evaluation, can cultivate critical consciousness and social responsiveness in future physicians [ 35 ]. Reflection—especially when systematically analyzed through computational methods—can serve as both a pedagogical and evaluative tool, enabling the assessment of not only cognitive but also affective and ethical dimensions of learning [ 36 ]. The findings of this study carry important implications for the design and implementation of gender medicine curricula, particularly in culturally and identity-diverse contexts. The subgroup differences observed—for instance, female students’ greater emphasis on relational and affective dimensions, or Arabic students’ focus on culturally embedded norms and structural constraints—demonstrate that learners do not uniformly assimilate gender medicine content. Rather than passively absorbing knowledge, students actively interpret and reframe new information through the lens of prior experiences, sociocultural background, and identity. This process reflects constructivist learning theory, which emphasizes that learning is active, situated, and coconstructed. Gender and ethnic identity often function as interpretive filters, amplifying certain issues while diminishing others. Such identity-based perspectives can enrich the learning environment by contributing diverse viewpoints, yet they may also generate tensions when personal or cultural values conflict with curricular content. From a pedagogical perspective, these findings underscore the importance of embedding structured opportunities for students to articulate and critically examine their own perspectives. Dialogical learning spaces, culturally responsive facilitation, and peer-to-peer engagement can help learners navigate potentially dissonant concepts and integrate them into their emerging professional identity. Such strategies may bridge the gap between abstract knowledge of gender medicine and its practical application across diverse clinical contexts. At the institutional level, embedding gender medicine within an explicitly intersectional framework ensures that the interwoven effects of gender, ethnicity, religion, and other social determinants are systematically addressed. This approach can strengthen both cultural competence and the ability to provide equitable, patient-centered care to heterogeneous populations. Nonetheless, while the results are promising, caution is warranted. The interpretability of LSA findings is contingent on robust preprocessing, linguistic clarity within the student corpus, and careful topic labeling. Although this study benefited from certain strengths, including stratification by gender and ethnicity, the limited sample size precluded a comprehensive intersectional analysis. Furthermore, the reflections were collected at a single time point and situated within a specific institutional and sociocultural context, which may constrain the transferability of findings. Longitudinal studies are needed to assess whether these conceptual gains translate into sustained behavioral change and improved clinical competence in gender-sensitive care. In addition, comparative research across medical schools and national contexts could illuminate how curricular design, institutional culture, and sociopolitical environments shape the uptake and integration of gender medicine. This study underscores the importance of embedding gender-sensitive content within medical education and demonstrates the utility of LSA as an analytic tool for examining how learners engage with complex sociomedical themes. The findings highlight the need for an intersectional, contextually attuned approach to curriculum design that actively considers students’ diverse identities and lived experiences. By fostering reflexivity, empathy, and critical literacy, gender medicine education holds the potential to shape future physicians who are better equipped to provide equitable, inclusive, and socially responsive health care.

Sex and gender are distinct yet interrelated factors that shape health, health care access, and, ultimately, health outcomes in multiple and profound ways [ 1 ]. While sex refers to biological attributes such as chromosomes, hormones, and reproductive anatomy that typically categorize individuals as male or female, gender encompasses the socially constructed roles, behaviors, expressions, identities, and power relationships associated with being a man, woman, or gender-diverse person [ 2 , 3 ]. As a social determinant of health, gender intersects with biological factors as well as with other cultural, societal, and systemic constructs to influence the incidence, prevalence, and manifestation of diseases, diagnostic pathways, therapeutic decisions, clinical interactions, and patient experiences across the care continuum [ 4 - 6 ]. Despite increasing recognition of these dynamics and interwoven interplays, medical education has historically followed a reductionist biomedical model that often underrepresents or insufficiently integrates sex- and gender-sensitive perspectives [ 7 ]. In recent years, sex- and gender-based medicine has emerged as a multidisciplinary field aimed at addressing these gaps by incorporating the complexities of sex- and gender-specific differences into clinical education, research, and practice [ 8 ]. Embedding sex- and gender-based medicine into undergraduate medical curricula is essential for preparing future physicians to recognize and respond to sex- and gender-based disparities in health care delivery, enhance diagnostic accuracy, and foster more equitable patient care [ 9 , 10 ]. However, most medical schools do not offer a formal, integrated curriculum in sex- and gender-sensitive medicine; when included, content is often confined to reproductive health and rarely extends to other specialties such as cardiology, pharmacology, or psychiatry. Educators have expressed concerns about the lack of standardized materials, institutional support, and faculty preparedness, all of which hinder implementation. Students, while generally receptive, often report minimal exposure to these topics, and when presented, content is frequently framed in binary, biologically deterministic terms [ 11 ]. Despite these limitations, increasing evidence shows that structured educational interventions can raise awareness of implicit bias and promote more equitable clinical practice [ 12 , 13 ]. Yet little is known about how students internalize and reflect on sex- and gender-sensitive content when it is presented within a formal curriculum [ 14 ]. This gap underscores the need for qualitative and data-driven evaluations of student perspectives to better inform curriculum design and pedagogical strategies. Narrative reflection provides a window into students’ evolving attitudes and cognitive engagement with sex and gender in clinical contexts [ 14 , 15 ]. It is a tool grounded in constructivist learning theory, which posits that learners actively construct knowledge through experience, reflection, and social interaction rather than passively absorbing facts [ 15 ]. Rooted in the work of Piaget, Vygotsky, and others, constructivism emphasizes that meaning-making is contextual and shaped by prior knowledge, cultural frameworks, and active engagement. In health professions education, constructivist approaches have gained traction as educators recognize the limitations of didactic instruction in preparing students for the complex, value-laden, and relational aspects of clinical care, such as those encountered in sex- and gender-based medicine. Reflective writing further enables learners to make sense of the social and ethical dimensions of medicine, including issues of power, identity, and equity [ 16 ]. By leveraging narrative reflection and a computational linguistic framework, this study aims to elucidate how students conceptualize sex and gender in medical practice and to identify thematic patterns that vary by gender and ethnicity within a diverse multicultural educational context. Through written reflections, students engage in metacognitive processing of sex- and gender-related content presented during the course. These narratives serve not only as evidence of individual meaning-making but also as artifacts that reveal the evolving cognitive, emotional, and ethical dimensions of learners’ understanding. Within the constructivist paradigm, reflection functions as both a tool and a product of learning, enabling students to surface biases, grapple with complexity, and reconcile new information with existing worldviews. Specifically, we asked (1) what thematic patterns emerge in first-year medical students’ reflections following a formal course in sex- and gender-based medicine? and (2) how do these patterns differ by students’ gender and ethnicity? Based on prior literature on sex and gender awareness in medical education [ 12 , 13 , 17 , 18 ], we hypothesized that the reflections would reveal themes capturing both clinical and sociocultural dimensions of sex and gender in medicine. These themes were expected to include recognition of sex- and gender-specific differences in disease incidence, prevalence, presentation, and outcomes; awareness of gender bias in clinical practice as presented during the course; and acknowledgment of the role of sociocultural norms in shaping health care experiences. Given the absence of prior extensive clinical exposure, we anticipated that students’ narratives would primarily integrate knowledge gained from the structured curriculum with their preexisting personal, cultural, and societal perspectives on sex, gender, and health. We further expected thematic emphases to vary by students’ gender, with potential differences in the extent to which narratives addressed interpersonal, affective, and patient-centered aspects of care alongside structural, biomedical, or systems-level considerations. We also anticipated that students from different ethnic backgrounds would foreground culturally specific norms, values, and challenges in applying sex- and gender-based medicine principles. By articulating these differences, this study aims to provide medical educators with evidence to design more culturally responsive and pedagogically effective curricula in sex- and gender-sensitive medicine.