Women's Health Curriculum Research Articles

Using the Jigsaw Teaching Method to Enhance Internal Medicine Residents' Knowledge and Attitudes in Managing Geriatric Women's Health.

IntroductionAlthough studies surveying internal medicine (IM) residency program directors identify geriatric women's health as an essential curriculum topic, there are limited published women's health curricula for IM residents. Our IM residency program performed a needs assessment, which revealed that the majority of residents were unsatisfied with our current curricula and most were not confident managing geriatric women's health. We developed and assessed a structured curriculum to improve IM residents’ knowledge and confidence in addressing geriatric women's health.MethodsThis 2-hour interactive workshop used the jigsaw teaching method (a cooperative learning strategy where peers deliver specific content in teams) to teach 84 categorical IM residents of all PGY levels about the diagnosis and management of menopause, osteoporosis, urinary incontinence, and abnormal uterine bleeding. Participants completed a pretest and immediate posttest to assess knowledge and confidence about the targeted topics. We compared baseline and postworkshop responses using chi-square and Wilcoxon signed rank tests.ResultsSeventy-four (88%) IM residents completed the pretest, and 62 (74%) completed the posttest. Mean knowledge scores improved from 51% to 69% (p < .0001). Residents who reported feeling somewhat confident or confident in addressing women's health topics increased from 14% to 44% (p < .0001). The majority were satisfied or very satisfied with the workshop (94%) and requested additional women's health education (92%).DiscussionOur results suggest that workshops using the jigsaw teaching method can effectively increase IM resident knowledge and confidence in managing geriatric women's health.

Musculoskeletal Women's Health Education in Physiatry: A Mismatch in Residency Education and Clinical Practice.

Musculoskeletal Women's Health (MSK WH) is a niche subspecialty within physical medicine & rehabilitation (PM&R). Women make up 50.7% of the population of the United States but are burdened with higher rates of musculoskeletal disease compared to men. MSK WH topics are not included in PM&R or Primary Care Accreditation Council for Graduate Medical Education (ACGME) program requirements. Given the comprehensive training provided in PM&R, physiatrists are ideal candidates to diagnose, treat, and provide education on MSK WH conditions. To identify the prevalence of formalized MSK WH education and of WH physiatrists at ACGME-accredited PM&R residency programs. Cross-sectional survey design. Computer-based survey. ACGME-accredited residency programs (N = 86; as of February 2017). A single, multiple choice, computer-generated Research Electronic Data Capture (REDCap) survey with branching logic was sent to all ACGME-accredited PM&R residency programs (N = 86). The primary outcome was to assess the prevalence of women's health curricula at ACGME-accredited PM&R residency programs in the United States. The secondary outcome was to assess the prevalence of WH physiatrists at these programs. Eighty-six ACGME-accredited PM&R residency programs were contacted with 55 completed responses (64% response rate). Only six programs (11%) reported the presence of a formal WH curriculum at their residency program. In contrast, 25 programs (45%) reported having WH physiatrists at their institutions, and 36 programs (65%) reported that general physiatrists were providing WH-related care. The study findings identify a mismatch between the prevalence of MSK WH residency education (11% of programs) and the prevalence of physiatrists providing MSK WH care (66% of programs). Physiatrists are ideally suited to manage MSK WH care. Based on the findings of this cross-sectional study, residency programs and governing bodies should evaluate these trends and consider the addition of topics pertinent to women's musculoskeletal health into PM&R graduate medical education. III.

Women's Health Curricula in Internal Medicine Residency Programs: A Scoping Review.

Background: Despite national efforts to expand women's health education, internal medicine (IM) residents remain unprepared to provide comprehensive care to women. The objectives of this scoping review are to provide an overview of published women's health curricula in IM residency programs and to identify potential areas for improvement. Materials and Methods: Studies were identified using PubMed, Embase, Cochrane Library, Scopus, Education Resources Information Center (ERIC), Web of Science, and MedEdPORTAL. Inclusion criteria included the following: (1) women's health as defined by the authors (2) description of a curriculum (3) designed for IM residents (4) based in North America, and (5) published between 1998 and 2018. Data abstracted included content, educational and assessment methods, and quality. Descriptive analysis was used to compare data. Results: Sixteen articles met the inclusion criteria. The most common women's health topics were intimate partner violence (31%) and menopause (31%). Twelve curricula (75%) were implemented in the outpatient setting. Of the teaching methods, didactics (69%) and in-clinic teaching (44%) were most commonly used. All studies that assessed attitudes, knowledge, and/or behavior showed an improvement post-intervention. No studies evaluated patient outcomes. Conclusion: To our knowledge, this is the first review summarizing published women's health curricula in IM residency. There were a limited number of published articles describing women's health curricula. Although content varied, the curricula were effective in improving attitudes, knowledge, and/or behavior with regard to women's health topics. We encourage IM residency programs to develop and disseminate women's health curricula to inform future improvements and advancements in women's health education.

Establishing Consensus on Residency Education in Women's Health.

Internal medicine residents are expected to be able to provide gender-specific care. The objective of this study was to develop a consensus list of core topics and procedural skills in women's health to allow residency program directors to prioritize and standardize educational efforts in women's health. We conducted a two-round Delphi of women's health experts. Participants were given a list of topics and asked to: (1) rank each topic based on how important they felt each topic was for internal medicine residents to be proficient in upon graduation, and (2) identify which topics were critical for a women's health curriculum. Mean importance ratings for all topics and mean agreement ratings for the critical topics were calculated. The list of critical topics mirrored the list of important topics; therefore, our consensus list included any topic that received a mean importance rating of ≥4. Of the 41 experts invited to participate, 46% (19) completed the first round with 100% (19/19) completing the second round. The majority (62.5%, n = 35) of topics received an importance rating of ≥4. The highest-ranking topics included cervical cancer screening, screening for osteoporosis, and diagnosis of sexually transmitted infections (mean rating of 4.95/each). Other highly rated topics included those related to contraception/reproductive planning, breast disease, menopause, and performing the breast and pelvic examinations. The diagnosis of gender-specific conditions was generally rated as more important than the management of the conditions. In addition, pregnancy-related topics were overall deemed as less important for internal medicine training. Our study generated a consensus list of 35 core topics in women's heath that should serve as a guide to residency programs for the development of women's health curricula.

Women's Health Curriculum and Cultural Competence: An IWLC Working Group Report

From a global perspective, there are indisputable ranges of difference on a number of dimensions for women’s health status and women’s health in the curriculum. Underlying conditions tied to resources, economics, politics, and cultural traditions provide forces that both advance and contain

Women's Health Curriculum for Internal Medicine Residents: Development, Implementation, and Evaluation.

Women's health knowledge and skills are important for physicians, but training is often inadequate. The objective of this project was to develop, implement, and evaluate a women's health curriculum for an internal medicine residency program. After assessing institutional factors, we developed a curriculum for a multidisciplinary clinical rotation with a web-based tutorial. We recruited faculty from several specialties relevant to the care of women to precept for the rotation and/or to provide teaching materials for the tutorial. The curriculum for the 1-month rotation covered most of the recommended women's health topics. Internal medicine residents worked in a variety of clinical settings and were assigned to a web-based tutorial and a pretest and posttest. A statistically significant increase was seen in participants' mean posttest (71.7%) versus pretest (61.1%) scores (difference, 10.7%; 95% confidence interval [CI]: 4.7-16.6; P = .0009). No difference was seen in controls' mean posttest (56.5%) versus pretest (57.2%) scores (difference, -0.7%; 95% CI: -12.1-10.7; P = .9). Mean rotation evaluation responses ranged from 7.09 to 7.45 on a 9-point scale. The majority (93%) of survey respondents agreed that the rotation increased their skills in caring for women, and all agreed the program was well organized and that it increased their awareness of women's health issues. A women's health curriculum using a web-based tutorial with a multidisciplinary clinical rotation can be successfully implemented in an internal medicine residency. The curriculum satisfied women's health training requirements, was associated with improvements in learning outcomes, and may be a model for women's health education.

Meeting the Need for Women's Health Training in Gastroenterology: Creation of a Women's Digestive Disorders Program at Brown University

Despite training requirements, knowledge and self-efficacy in women's health issues remain inadequate in many fields. In gastroenterology, nearly 60% of patients are women, and many disorders are more common in women. Adequate training in gastrointestinal (GI) women's health is, therefore, critical for gastroenterologists. (1) To create a core faculty in GI women's health, (2) to develop a GI women's health curriculum, (3) to provide didactic education and clinical experiences in GI women's health, (4) to produce self-efficacy in the evaluation and management of GI women's health issues, and (5) to develop academic gastroenterologists focused on GI women's health. We assembled a multidisciplinary group of GI women's health experts dedicated to training and mentoring GI fellows. We also held focus groups to determine the unmet needs in the management of the GI health of female patients in our community. Results from this needs assessment formed the foci of our program. In 2002, we introduced a 2-month rotation in GI women's health. Then, in 2005, we introduced a 3-year women's health pathway for trainees committed to academic careers. Between 2002 and 2008, 13 fellows who participated in the rotation have graduated from the Brown GI fellowship program, and 1 has completed the track. Satisfaction with the program is high. Postgraduation survey results show that >80% of graduates who participated in the rotation feel prepared to evaluate and treat GI disorders in pregnancy, and nearly 65% feel prepared to address general GI women's health issues. All respondents report the GI women's health rotation provided training that was otherwise not addressed during fellowship. A training experience in GI women's health can be created using local resources and expertise. Gastroenterologists with this training feel prepared to evaluate and manage the spectrum of women's health issues encountered in practice.

AMWA's Role in Women's Health Curriculum

Journal of Women's HealthVol. 17, No. 10 MESSAGE FROM AMWAAMWA's Role in Women's Health CurriculumJanice WerbinskiJanice WerbinskiSearch for more papers by this authorPublished Online:2 Dec 2008https://doi.org/10.1089/jwh.2008.1148aAboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "AMWA's Role in Women's Health Curriculum." , 17(10), p. 1555FiguresReferencesRelatedDetailsCited ByWomen’s Health and Sex- and Gender-Based Medicine: Past, Present, and Future20 January 2021 Volume 17Issue 10Dec 2008 Information© 2008 Mary Ann Liebert, Inc.To cite this article:Janice Werbinski.AMWA's Role in Women's Health Curriculum.Journal of Women's Health.Dec 2008.1555-1555.http://doi.org/10.1089/jwh.2008.1148aPublished in Volume: 17 Issue 10: December 2, 2008Online Ahead of Print:November 12, 2008PDF download

Residents' perspective of women's health curriculum in Internal Medicine and Med-Peds

The purpose of our study was two-fold. First, to determine how relevant the women's health topics and skills listed in the FCIM (Federated Council for Internal Medicine (FCIM) Task Force on the Internal Medicine Residency) Curriculum to our graduates' practices. Second, to address the adequacy of our curriculum in meeting our graduates' learning needs. Postgraduate survey through American College of Physician associate members. This cross-sectional survey was conducted amongst the internal medicine and Med-Peds residents (N = 104) (Academic Internal Medicine Center [19], Med-Peds center [3]). A self-administered questionnaire was mailed to all residents. There were 4 items for need assessment, 6 items covering women health issues managed as outpatient, 6 items addressing skills and adequacy of our women's health curriculum to our graduated learning needs and 1 item for evaluations. Responses were recorded on a 5- point Likert scale. The study and the questionnaire were approved by the American College of Physician, Ohio section. The study was exempted from IRB review. More than 70% of the residents feel that they were not well prepared. The majority of items were considered inadequately taught as the mean adequacy of instruction scores were below 2.0 on the 5-point scale. In reference to our first research question regarding the relevance of the 65 FCIM items to our graduates' practices, approximately two thirds were considered relevant (see attached table with any FCIM item rated 4 or more). In our results, the highest adequacy of instruction was in obtaining a bone densitometry and assessing osteoporosis, managing urinary tract infection and vaginitis, and ordering a urine pregnancy test. The teaching and learning efforts in areas such as normal pelvic exam, obtaining and interpreting Pap smear, Mammogram indication and interpretation, Female sexual dysfunction, menopausal symptoms, and contraceptive management are needed to best prepare our graduates for practice. More than 90% of the residents agree that spending time in ambulatory rotations alone may not be sufficient to prepare residents to provide comprehensive care in this field. More than 98% residents agreed that further study of the effectiveness of a dedicated curriculum in women's health is needed. Use of this survey has allowed us to tailor and prioritize learning issues in women's health to meet the needs of our graduates.

The Evolution of Women's Health Education: The Cleveland Clinic's Women's Health Fellowship as a Model

Our goal in this paper is twofold. First, it provides a brief overview of the macrotrends in women's health education over the last 25 years. Second, these trends are a backdrop for a discussion of women's health education as exemplified by a detailed review of the curriculum for the Women's Health fellowship at the Cleveland Clinic Foundation. We have termed the underpinning of the curriculum the "leadership triad" consisting of (1) clinical skills, (2) focused research, and (3) interdisciplinary education. These elements are presented in a detailed curriculum for a 2-year fellowship program. We see these elements as fundamental to the Cleveland Clinic's fellowship program, and a useful model for those contemplating or refining their advanced women's health curriculum.

What Women Want from Their Physicians: A Qualitative Analysis

Despite increased efforts to improve the education of trainees in women's health, little information exists about what women want from their healthcare providers. Existing information from studies focuses on patient care and medical knowledge rather than on all six competencies mandated by the Accreditation Council of Graduate Medical Education (ACGME). To identify what adult female patients want their physicians to know and be able to do in all ACGME competency areas in order to guide development of graduate women's health curricula. We conducted two focus groups with 18 volunteer adult female patients and one focus group with 5 community advocates. Questions addressed all six competency areas. The same female researcher moderated all three sessions. Two researchers analyzed session transcriptions for themes. Female patients and community advocates consistently stressed the need for their physicians to be able to navigate the healthcare system and to be their advocates. They also noted the need for physicians skilled in working with patients from a variety of cultures and for developing and maintaining respectful doctor-patient relationships, including good interpersonal communication. Patients' expectations of physicians extend beyond medical knowledge and patient care into the areas of communication, systems-based practice, and professionalism. Curricular changes in women's health at the postgraduate level should emphasize skills in these competencies, and needs assessment processes would do well to include patient viewpoints in the future.

Vulvovaginitis and Cervicitis: Pathogenesis, Diagnosis, and Treatment

Abstract This case-based lecture was designed for small groups of medical students and residents as part of a women's health curriculum. The format is case-based with questions and answers followin...

Web-based curriculum

To address the need for women's health education by designing, implementing, and evaluating a self-study, web-based women's health curriculum. Cohort of students enrolled in the ambulatory portion of the medicine clerkship with comparison group of students who had not yet completed this rotation. Third- and fourth-year medical students on the required medicine clerkship (115 students completed the curriculum; 158 completed patient-related logs). Following an extensive needs assessment and formulation of competencies and objectives, we developed a web-based women's health curriculum completed during the ambulatory portion of the medicine clerkship. The modules were case based and included web links, references, and immediate feedback on posttesting. We discuss technical issues with implementation and maintenance. We evaluated this curriculum using anonymous questionnaires, open-ended narrative comments, online multiple-choice tests, and personal digital assistant (PDA) logs of patient-related discussions of women's health. Students completing the curriculum valued learning women's health, preferred this self-directed learning over lecture, scored highly on knowledge tests, and were involved in more and higher-level discussions of women's health with faculty (P<.001). We present a model for the systematic design of a web-based women's health curriculum as part of a medicine clerkship. The web-based instruction resolved barriers associated with limited curriculum time and faculty availability, provided an accessible and standard curriculum, and met the needs of adult learners (with their motivation to learn topics they value and apply this knowledge in their daily work). We hypothesize that our web-based curriculum spurred students to later discuss these topics with faculty. Web-based learning may be particularly suited for women's health because of its multidisciplinary nature and need for vertical integration throughout medical school curricula.

Women's health education initiatives: why have they stalled?

Since the U.S. Congress first requested an assessment of women's health content in medical school curricula ten years ago, surveys indicate at least a two-fold increase in the number of schools with a women's health curriculum and no change in the number that offer a women's health clinical elective or rotation. Despite a marked increase in the number of schools with an office or program responsible for integration of women's health and gender-specific content into curricula, change has been modest. Reasons for this slow progress include uncertainty about the domain of women's health and what should be included in a curriculum, a lack of practical guidelines for implementation, and institutional resistance to change. The dominant factors that will influence future curriculum development are the increasing scientific knowledge base on sex and gender differences and the emerging scientific field of sex-based biology, both of which have potential to benefit the health of women. Evidence-based data on significant sex and gender differences will provide compelling reasons for schools to integrate this information into curricula, and new educational initiatives must further develop educational models to help implement change. As women's health becomes synonymous with the term "sex and gender differences," the challenge to schools is to address equally in their curricula those unique aspects of women's health that were part of the original intent of the congressional mandate.

Women be Healthy: Evaluation of a Women's Health Curriculum for Women with Intellectual Disabilities

AbstractBackground Insufficient attention has been paid towards treating the unique health needs of women with intellectual disabilities. This paper describes an 8‐week curriculum, ‘Women Be Healthy’, developed for women with intellectual disabilities to help them become more equal partners in their health care. The curriculum includes psycho‐education, coping skills training, exposure to the medical setting and assertiveness training.Materials and methods Twenty‐two women completed assessments of health knowledge, health behaviour beliefs and coping strategies, prior to and following participation in the 8‐week curriculum, which took place in a group setting at a clinic for people with intellectual disabilities.Results Women showed significant improvements in health knowledge, health behaviour beliefs and coping strategies following intervention, and maintained some of these treatment gains (health knowledge and health behaviour beliefs) at a 10‐week follow‐up.Conclusions ‘Women Be Healthy’ is an example of a group‐based intervention that helps women with intellectual disabilities become more knowledgeable and perhaps more comfortable with health‐care procedures.

Development of an Interdisciplinary Women???s Health Training Model

In response to expanded residency training requirements in women's health, faculty from internal medicine, obstetrics/gynecology, and psychiatry at Yale University School of Medicine established an interdisciplinary women's health training and education model, the Interdisciplinary Women's Health Clinic (IWHC). The model was one component of a larger, comprehensive women's health program at Yale funded by the Department of Health and Human Services between 1996 and 2000 under the National Centers of Excellence in Women's Health (CoE) designation. This article describes the structure and function of the model, its value to residents and the institution, and its limitations that led to its closure when Department of Health and Human Services support ended. The IWHC was designed as a consultation service that augmented the primary care provided to low-income, minority-group women in an established outpatient primary care setting. An interdisciplinary team of residents and faculty provided and coordinated a range of services for patients and participated in a weekly core curriculum. The model was an important resource to residents and provided high-level integrated care to patients. The combined educational experience helped refine a core interdisciplinary women's health curriculum. Despite these benefits, the IWHC could not be sustained outside the financial and programmatic structure of the larger CoE program. This experience suggests that longitudinal models where residents from different disciplines train in a shared educational and clinical setting may be more durable. Interdisciplinary models are effective ways to train residents and provide integrated care to women. The model's success depends on highly developed collaborative relationships between faculty, nonclinical sources of support, and long-term institutional commitment.

Establishing a Women's Health Curriculum Using the Delphi Method

A Women's Health Initiative Task Force was formed with the collaboration of five primary care medical specialties at the University of Texas Medical Branch (UTMB) at Galveston to address the education of medical students about important issues related to women's health. To identify and prioritize key concepts in issues related to women's health Methods: Literature review and three generational Delphi Method. The content was identified for development of a curriculum in Women's Health for medical students and resident physicians. Objectives, tasks, skills, learning opportunities, and learning materials were defined, and the curriculum is being designed to produce, within all specialties, parallel and consistent opportunities to educate students about issues important for women's health. The rankings of topics gathered though the Delphi Method will be used to develop a curriculum in Women's Health Issues that defines objectives, tasks, skills, learning opportunities, and learning materials for the purpose of educating UTMB medical students and resident physicians about the health needs of women.

Concept mapping: A tool to bridge the disciplinary divide

The American College of Women's Health Physicians has been exploring an on-line educational tool—concept mapping—to facilitate the development of an interdisciplinary and woman-centered women's health curriculum, and to implement The Women's Health Care Competencies for Medical Students. By using an on-line concept map of the menstrual cycle, we have built upon a standard piece of curricula that describes a unique aspect of female physiology and transformed it into a knowledge framework that builds capacity. The concept map highlights relationships between concepts and across disciplines, connecting the competencies to enable meaningful learning so that a learner can adapt their knowledge to multiple settings, incorporate new learning, and generate new knowledge to grow the interdisciplinary field of women's health. The on-line format allows access from multiple sites and courses, and allows the curricula to grow organically over time without upsetting current curricular design. (Am J Obstet Gynecol 2002;187:S41-3.)

A longitudinal women's health curriculum: A multi-method, multiperspective needs assessment

Objectives: To define critical competencies in women's health for medical student education and to assess the degree to which they are taught. Study Design: A set of competencies in women's health was developed. A multi-method needs assessment was implemented. Results: Faculty and student evaluations revealed no major areas of disagreement but did identify major deficits in the basic sciences including the physiologic influence of estrogen on nongynecologic organ systems and of androgen on various organ systems, nutrition, and alternative medicine and the difference between the sexes in disease processes, presentation, and treatment. In the clinical years, there are important deficits in the teaching of diseases unique to women, limited attention to psychosocial aspects of women's health, and no cohesive teaching of a gender-specific approach to clinical evaluation. Conclusion: In the medical school curriculum, gender's effect on disease is inadequately addressed. An integrated longitudinal approach to gender-specific medicine is needed. (Am J Obstet Gynecol 2002;187:S12-4.)

Mixing it up: integrating evidence-based medicine and patient care.

To teach internal medicine residents to use evidence-based medicine (EBM) in their interactions with patients by creating curricula that integrate EBM into clinical topics in internal medicine. The last several years have brought the wide-spread inclusion of EBM in internal medicine training programs in the United States. However, EBM is often taught as an independent topic and is poorly integrated into the clinical teaching of trainees. Most EBM education occurs in a journal-club format, focusing on question development, searching, and critical appraisal. The challenge of discussing the evidence with patients is rarely addressed. We set out to integrate EBM teaching into new curricula in women's health, addiction medicine, and topics in anticoagulation. During the first of two ambulatory blocks of the year, residents participate in an EBM seminar series in which they present cases, generate questions, and critically appraise the evidence. Second-year residents present articles on therapy or diagnosis and third-year residents present articles on diagnosis, meta-analysis, or decision and economic analysis. Both the women's health curriculum and the anticoagulation curriculum are presented during the second ambulatory block of the year as four half-day small-group seminars. The women's health curriculum is presented to the second-year residents and the anticoagulation curriculum is presented to the third-year residents. Both curricula are case-based and emphasize essential skills in patient care, including interview techniques, sensitivity to psychosocial issues, and skills in evidence-based patient care. Teaching EBM is not identified to the residents as a goal of these curricula; instead EBM, psychosocial medicine, and communication skills are woven into the content material and taught in the context of the broader subject matter. Learners are expected to integrate these concepts into actual practice. The curricula utilize clinical vignettes and role-plays to link EBM concepts such as number needed to treat or decision analysis to real-patient decisions. Residents are also asked to apply the evidence in their own patient encounters for further discussion at later sessions. Simpler concepts of therapy and diagnosis are covered during the second year in women's health and the more complex concepts of meta-analysis; decision analysis, and economic analysis are covered during the third year in anti-coagulation. The women's health curriculum was introduced in the spring of 2000; the anticoagulation curriculum was introduced in the spring of 2001. Both have been well received and seem to have impacted the ability of our housestaff to incorporate EBM into patient care. Currently under development in this series is a curriculum in addiction medicine for interns that will use a similar approach to provide an overview of EBM topics and their integration into the flow of patient care. We feel that these educational programs have helped EBM to bridge the gap between the classroom and the exam room.