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Ramírez SI, Partin M, Snyder AH, Ko E, Aruma J, Castaneda MC, Casas RS. A Scoping Review of Obstetrics and Gynecology Curricula in Primary Care Residency Programs. J Gen Intern Med 2024:10.1007/s11606-024-08987-1. [PMID: 39187722 DOI: 10.1007/s11606-024-08987-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 07/30/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND While Women's Health (WH) is a priority for primary care, (Family Medicine (FM), Internal Medicine (IM), Pediatrics (Peds), and combined Medicine/Pediatrics (Med/Peds)), residency curricula remain heterogeneous with deficits in graduates' WH expertise and skills. The overall objective of this study was to assess the quality of WH curricula at primary care residency programs in the United States (US), with a focus on topics in obstetrics and gynecology (OBGYN). METHODS PubMed®, ERIC, The Cochrane Library, MedEdPORTAL, and professional organization websites were systematically searched in 2019 and updated in 2021. Included studies described OBGYN educational curricula in US primary care residency programs. Following abstract screening and full-text review, data from eligible studies was abstracted and quality assessed using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS A total of 109 studies met the inclusion criteria. Over a quarter of studies were interdepartmental or interdisciplinary. The most common single-department studies were IM (38%) and FM (26%). Twenty (25%) studies addressed comprehensive OBGYN curricula; the most common individual topics were cervical and breast cancer screening (31%) and contraception (16%). Most studies utilized multiple instructional modalities, most commonly didactics (54%), clinical experiences (41%), and/or simulation (21%). Most studies included self-reported outcomes by residents (70%), with few (11%) reporting higher-level assessments (i.e., patient, or clinical outcomes). Most studies were single-group pre- and post-test (42%) with few randomized controlled trials (4%). The mean MERSQI score for studies with sufficient data (90%) was 9.8 (range 3 to 15.5). DISCUSSION OBGYN educational curricula for primary care trainees in the US was varied with gaps in represented residents, content, assessments, and study quality.
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Affiliation(s)
- Sarah I Ramírez
- Department of Family and Community Medicine, Penn State College of Medicine, 500 University Drive; HP 11, Hershey, PA, 17033, USA.
| | - Michael Partin
- Department of Family and Community Medicine, Penn State College of Medicine, 500 University Drive; HP 11, Hershey, PA, 17033, USA
| | - Ashley H Snyder
- Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Elizabeth Ko
- Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Jane Aruma
- Anesthesiology, Northwestern University, Evanston, IL, USA
| | - Marie C Castaneda
- Harrell Health Sciences Library: Research and Learning Commons, Penn State College of Medicine, Hershey, PA, USA
| | - Rachel S Casas
- Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
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McClintock AH, Rusiecki J, Casas RS, Henrich JB, Schwarz EB, Kwolek DG. Special Report: Entrustable Professional Activities in Sex- and Gender-Based Women's Health. J Gen Intern Med 2024:10.1007/s11606-024-08843-2. [PMID: 38858342 DOI: 10.1007/s11606-024-08843-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/22/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND A set of core competencies in sex- and gender-based women's health (SGWH) has been endorsed by the Society of General Internal Medicine (SGIM), but many residencies lack the resources to implement curricula and clinical assessments that would support achievement of these competencies. AIM Develop entrustable professional activities (EPA) to support implementation and assessment of clinical care for SGIM's SGWH Core Competencies. PROGRAM DESCRIPTION Members of SGIM's SGWH Education Interest Group developed 18 SGWH EPAs for internal medicine residents. A team of clinician educators coordinated the preparation, drafting, quality control, and curriculum alignment of the SGWH EPAs through a rigorous process aligned with best practices for EPAs. All EPAs are mapped to the larger competency domains from the Accreditation Council for Graduate Medical Education (ACGME), for use with ACGME Milestones. The authors provide suggestions for the implementation of the EPAs into residency training. CONCLUSION As residency education moves towards a competency-based structure, EPAs are needed to translate broad competencies into observable clinical skills. The SGWH EPAs provide a rigorously developed and ready-made tool for programs to link the SGWH core competencies to residency curriculum development, clinical assessment, and program evaluation.
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Affiliation(s)
| | | | - Rachel S Casas
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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Henrich JB, Richman I, Rabin TL, Gielissen KA, Dhond M, Canarie JX, Hirschman AF, Windham MR, Maya S, McNamara C, Pathy S, Bernstein P, Smith R, Vasquez L. It Takes a Village: An Interdisciplinary Approach to Preparing Internal Medicine Residents to Care for Patients at the Intersection of Women's Health, Gender-Affirming Care, and Health Disparities. J Womens Health (Larchmt) 2024; 33:152-162. [PMID: 38190490 DOI: 10.1089/jwh.2023.0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
Objective: To create an interdisciplinary curriculum to teach key topics at the intersection of women's health, gender-affirming care, and health disparities to internal medicine (IM) residents. Materials and Methods: A core team of faculty from IM, Obstetrics and Gynecology, and Surgery partnered with faculty and fellows from other disciplines and with community experts to design and deliver the curriculum. The resulting curriculum consisted of themed half-day modules, each consisting of three to four inter-related topics, updated and repeated on an ∼3-year cycle. Health equity was a focus of all topics. Module delivery used diverse interactive learning strategies. Modules have been presented to ∼175 residents annually, beginning in 2015. To assess the curriculum, we used formative evaluation methods, using primarily anonymous, electronic surveys, and collected quantitative and qualitative data. Most surveys assessed resident learning by quantifying residents' self-reported comfort with skills taught in the module pre- and postsession. Results: Of 131 residents who completed an evaluation in 2022/23, 121 (90%) "somewhat" or "strongly" agreed with their readiness to perform a range of skills taught in the module. In all previous years where pre- and postsurveys were used to evaluate modules, we observed a consistent meaningful increase in the proportion of residents reporting high levels of comfort with the material. Residents particularly valued interactive teaching methods, and direct learning from community members and peers. Conclusion: Our interdisciplinary curriculum was feasible, valued by trainees, and increased resident learning. The curriculum provides a template to address equity issues across a spectrum of women's and gender-affirming care conditions that can be used by other institutions in implementing similar curricula.
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Affiliation(s)
- Janet B Henrich
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ilana Richman
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Tracy L Rabin
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Katherine A Gielissen
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mukta Dhond
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, VA Connecticut Health Care System, West Haven, Connecticut, USA
| | - Joseph X Canarie
- Department of Internal Medicine, Anchor Health, Hamden, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Allister F Hirschman
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Surgery, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Mary Ruth Windham
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Susan Maya
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, VA Connecticut Health Care System, West Haven, Connecticut, USA
| | - Cynthia McNamara
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, VA Connecticut Health Care System, West Haven, Connecticut, USA
| | - Shefali Pathy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Paul Bernstein
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ryan Smith
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Luz Vasquez
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, VA Connecticut Health Care System, West Haven, Connecticut, USA
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Henrich JB, Schwarz EB, McClintock AH, Rusiecki J, Casas RS, Kwolek DG. Position Paper: SGIM Sex- and Gender-Based Women's Health Core Competencies. J Gen Intern Med 2023; 38:2407-2411. [PMID: 37079185 PMCID: PMC10117249 DOI: 10.1007/s11606-023-08170-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/10/2023] [Indexed: 04/21/2023]
Abstract
Women's health care has evolved significantly since it was first acknowledged as an integral part of internal medicine training more than two decades ago. To update and clarify core competencies in sex- and gender-based women's health for general internists, the Society of General Internal Medicine (SGIM) Women and Medicine Commission prepared the following Position Paper, approved by the SGIM council in 2023. Competencies were developed using several sources, including the 2021 Accreditation Council for Graduate Medical Education Program Requirements for Internal Medicine and the 2023 American Board of Internal Medicine Certification Examination Blueprint. These competencies are relevant to the care of patients who identify as women, as well as gender-diverse individuals to whom these principles apply. They align with pivotal advances in women's health and acknowledge the changing context of patients' lives, reaffirming the role of general internal medicine physicians in providing comprehensive care to women.
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Affiliation(s)
| | | | | | | | - Rachel S Casas
- Penn State Milton S. Hershey Medical Center, Hershey, USA
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Birru Talabi M, Callegari LS, Kazmerski TM, Krishnamurti T, Mosley EA, Borrero S. A blueprint for a new model of sexual and reproductive health care in subspecialty medicine. Health Serv Res 2023; 58:216-222. [PMID: 36151999 PMCID: PMC9836962 DOI: 10.1111/1475-6773.14074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Mehret Birru Talabi
- Division of Rheumatology and Clinical ImmunologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Center for Innovative Research on Gender Health EquityUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Lisa S. Callegari
- Center for Innovative Research on Gender Health EquityUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Obstetrics and GynecologyUniversity of Washington School of MedicineSeattleWashingtonUSA
- Health Services Research and DevelopmentVA Puget Sound Health Care SystemSeattleWashingtonUSA
| | - Traci M. Kazmerski
- Center for Innovative Research on Gender Health EquityUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of PediatricsUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Tamar Krishnamurti
- Center for Innovative Research on Gender Health EquityUniversity of PittsburghPittsburghPennsylvaniaUSA
- Division of General Internal MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Elizabeth A. Mosley
- Center for Innovative Research on Gender Health EquityUniversity of PittsburghPittsburghPennsylvaniaUSA
- Division of General Internal MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Sonya Borrero
- Center for Innovative Research on Gender Health EquityUniversity of PittsburghPittsburghPennsylvaniaUSA
- Division of General Internal MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
- Center for Health Research and PromotionVA Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
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Farkas AH, Bopp K, Conigliaro RL, DiNardo D, Casas RS. Directory of Internal Medicine Residency and Fellowship Programs in Women's Health, 2022. J Womens Health (Larchmt) 2023; 32:248-251. [PMID: 36576988 DOI: 10.1089/jwh.2022.0448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Amy H Farkas
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Milwaukee VA Medical Center, Milwaukee, Wisconsin, USA
| | - Katherine Bopp
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Rosemarie L Conigliaro
- Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Deborah DiNardo
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rachel S Casas
- Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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McClintock AH, Starks H, Williams M. Women's health for a primary care workforce. CLINICAL TEACHER 2022; 19:251-256. [PMID: 35332666 DOI: 10.1111/tct.13483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 02/23/2022] [Accepted: 03/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Primary care training should include competencies to provide reproductive health services. In the United Sates, primary care is often provided by general internal medicine physicians. Longitudinal training experiences for internal medicine residents in women's health increase knowledge, skills and retention in careers in women's health, but very little literature describes their implementation. The purpose of this paper is to describe the implementation and evaluation of a 2-year women's health training pathway in Internal Medicine. APPROACH Using the Context, Input, Process, Product (CIPP) model, we describe the salient features of a complex, longitudinal educational intervention at the development, planning and evaluation stages within a large academic medical centre. EVALUATION In 2019, we conducted interviews with the pathway participants (N = 6) in the first 3 years of the programme and used the CIPP framework and Kirkpatrick's Model as an a priori codebook for analysis. Participants reported high fidelity and that the training was relevant and appropriate to meet their needs. Practicing clinicians similarly reported that training was relevant and useful and met desired goals for knowledge and integrated approaches to care. Trainees reported unexpected benefits of identity formation and a community of practice. IMPLICATIONS These results suggest that longitudinal training pathways are an effective way to train Internal Medicine residents to provide comprehensive care to women. This study has broader applications for health professions education, providing a model for implementation and evaluation of complex educational interventions in large organisations. Future research should focus on dissemination to train a workforce prepared to offer evidence-based care to women throughout their lifespan.
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Affiliation(s)
- Adelaide H McClintock
- Division of General Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Helene Starks
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington, USA
| | - Meagan Williams
- Division of General Internal Medicine, University of Washington, Seattle, Washington, USA
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Primary Care-Based Cardiovascular Disease Risk Management After Adverse Pregnancy Outcomes: a Narrative Review. J Gen Intern Med 2022; 37:912-921. [PMID: 34993867 PMCID: PMC8734553 DOI: 10.1007/s11606-021-07149-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/08/2021] [Indexed: 12/20/2022]
Abstract
Several common adverse pregnancy outcomes can reveal subclinical or latent cardiovascular disease (CVD) risk, transiently exposed through the physiologic stress of pregnancy. The year after pregnancy may be a singular opportunity to identify and initiate treatment for CVD risk, even before the onset of traditional CVD risk factors. However, clinical guidance regarding CVD risk management after adverse pregnancy outcomes is lacking. We therefore conducted a systematic review of US clinical practice guidelines and professional society recommendations to inform primary care-based CVD risk management after adverse pregnancy outcomes. We identified 13 relevant publications. While most recommendations were based on limited or weak evidence, we identified several areas of consensus. First, individuals with an adverse pregnancy outcome associated with future CVD are likely to benefit from CVD risk assessment-accompanied by education, counseling, and support for lifestyle modification-beginning within the first postpartum year. Second, among clinicians, clear and consistent documentation about adverse pregnancy outcomes and recommended follow-up is important to coordinate care after pregnancy. In addition, patients need to be informed about their pregnancy complications and associated CVD risks, so that they can make informed health care and lifestyle decisions. Finally, in general, CVD prevention in the year after an adverse pregnancy outcome focuses on lifestyle modification, reserving pharmacotherapy for the highest-risk patients and those with traditional CVD risk factors. While postpartum lifestyle interventions show promise for reducing CVD risk after adverse pregnancy outcomes, continued research to determine the optimal content, timing, and long-term effects of such interventions is needed.
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White M, Shroff S. A Closer Look at Women's Health Centers: Historical Lessons and Future Aims. J Womens Health (Larchmt) 2021; 31:408-414. [PMID: 34610250 DOI: 10.1089/jwh.2021.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Women's Health Centers (WHC) have evolved over the last few decades as comprehensive centers for women's health care. This article reviews the history and evaluation of WHC, as well as opportunities for women's health training. Prior studies comparing WHC with traditional primary care and obstetrics/gynecology clinics have found that WHC offer at least similar levels of preventative care, may increase access to care for a more diverse patient population, and improve patient/provider relationship satisfaction. WHC also increase women's health providers' education and research opportunities. There is still a gap in women's health education and training, although residency and fellowship programs have aimed to address this through women's health tracks and fellowships. The coronavirus disease 2019 (COVID-19) pandemic and its negative impact on women's access to care have further highlighted the potential of WHC to meet women's health care demands. WHC can provide comprehensive, convenient, and single-site care for women. The increased opportunities for women's health training through WHC give rise to more representation in leadership and investment in women's health. New research is needed to reassess and further evaluate health outcomes of WHC compared with traditional care models.
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Affiliation(s)
- Mary White
- Women's Primary and Specialty Care, Internal Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Swati Shroff
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Williams MS, McClintock AH. Preparing Internal Medicine Residents to Provide Primary Care for Women: Gender-Specific Clinics May Be the Answer. J Gen Intern Med 2021; 36:2859-2860. [PMID: 32583343 PMCID: PMC8390614 DOI: 10.1007/s11606-020-05985-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/12/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Meagan S Williams
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Adelaide H McClintock
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
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Anderson NN, Gagliardi AR. Medical student exposure to women's health concepts and practices: a content analysis of curriculum at Canadian medical schools. BMC MEDICAL EDUCATION 2021; 21:435. [PMID: 34407817 PMCID: PMC8371837 DOI: 10.1186/s12909-021-02873-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/04/2021] [Indexed: 05/12/2023]
Abstract
BACKGROUND Women's health (WH) includes a broad array of concerns and challenges that affect health across the lifespan. Considerable research shows that women continue to experience disparities in access to and quality of care. Apart from surveys of medical trainees and faculty, little research and none in Canada examined medical curriculum for WH. This study assessed how Canadian medical schools integrate WH in their curriculum. METHODS We used deductive and summative content analysis to describe instances and the nature of WH topics in program and course descriptions that were publicly-available on web sites of Canadian medical schools. We reported results using summary statistics and text examples. We employed a framework, tested in our prior research, that included mention of women's health principles and practices relevant to any health concern or condition including factors (e.g. sex, gender, social determinants) that influence health, and access to or quality of care. RESULTS We retrieved 1459 documents from 16 medical schools (median 49.5, range 16 to 301). Few mentioned WH (125, 8.6 %), and the quantity of mentions varied by school (range 0.0-37.5 %). Pre-clerkship course documents more frequently mentioned WH (61/374, 17.3 %, chi square 43.2, p < 0.00001) compared with clerkship course documents (58/1067, 5.4 %). Core course documents more frequently mentioned WH (72/542, 13.3 %, chi square 29.0, p < 0.00001) compared with elective course documents WH (47/899, 5.2 %). Overall, documents more frequently referred to the WH domain of social determinants of health (88, 70.4 %). Few documents addressed women's health (21, 16.8 %), sex or gender (19, 15.2 %), other considerations (15.2 %) or principles/components of women's health (2, 1.6 %). Most documents that mentioned WH provided little detail about what those concepts referred to or how to optimize WH. CONCLUSIONS Based on program and course descriptions, WH may not be well-integrated at Canadian medical schools, and future physicians may not be consistently exposed to the full breadth of WH. This reveals opportunities for enhancing WH in the medical curriculum. Future research is needed to engage stakeholders including women in developing, implementing and evaluating competencies and corresponding curriculum that reflect the full range of WH concepts and practices.
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Affiliation(s)
- Natalie N Anderson
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street. 13EN-228, M5G2C4, Toronto, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street. 13EN-228, M5G2C4, Toronto, Canada.
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Murray Horwitz ME, Molina RL, Battaglia TA. Preventing Chronic Diseases After Complicated Pregnancies in the COVID-19 Era: a Call to Action for PCPs. J Gen Intern Med 2021; 36:2127-2129. [PMID: 33782883 PMCID: PMC8006867 DOI: 10.1007/s11606-021-06734-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/16/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Mara E Murray Horwitz
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown 1, Boston, MA, 02118, USA.
| | - Rose L Molina
- Division of Global and Community Health, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tracy A Battaglia
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown 1, Boston, MA, 02118, USA
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Shrivastava S, Gandhi A, Spencer AL. Integrating Women's Health Education into the Internal Medicine Residency Program Curriculum. South Med J 2021; 114:116-122. [PMID: 33537794 DOI: 10.14423/smj.0000000000001211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES National guidelines and the American Board of Internal Medicine have highlighted critical areas of women's health (WH) that are important to the training of Internal Medicine (IM) residents. Our objective was to assess and improve WH education in a large academic community-based IM residency program. METHODS An anonymous online survey was sent to IM residents to assess their perceived comfort, knowledge, and importance, and exposure to 34 WH topics identified as critical to the training of an internist. To meet the critical learning needs of our residents, a new longitudinal WH curriculum was designed using active instructional methods. Retrospective pre-post surveys were conducted after interactive education workshops to measure their effectiveness. RESULTS IM residents identified 13 of 34 WH topics that were critically important to their training. Of these, residents believed they had insufficient clinical exposure to prescribing contraceptives, evaluating breast symptoms, managing menopause, performing Papanicolaou tests and pelvic examinations, and polycystic ovary syndrome. Residents identified osteoporosis as their single greatest learning need. There was a strong and statistically significant correlation between residents' knowledge, comfort, and clinical exposure to WH topics. In response to these findings, the curricular methods we developed, such as problem-based learning workshops, multidisciplinary case conferences, and small-group case discussions, were found to be effective. CONCLUSIONS Our study highlighted significant gaps in our WH curriculum. Based on our findings, we redesigned our educational and experiential WH curriculum to augment knowledge, comfort, perceived importance of, and exposure to areas of need. Enhancing education and increasing clinical exposure to fundamental WH issues will promote higher quality care for women patients.
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Affiliation(s)
- Sneha Shrivastava
- From the Division of General Internal Medicine, Northwell Health, Glen Oaks, New York, the Department of Computer Science, SUNY Stony Brook University, Stony Brook, New York, and the Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Anshul Gandhi
- From the Division of General Internal Medicine, Northwell Health, Glen Oaks, New York, the Department of Computer Science, SUNY Stony Brook University, Stony Brook, New York, and the Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Abby L Spencer
- From the Division of General Internal Medicine, Northwell Health, Glen Oaks, New York, the Department of Computer Science, SUNY Stony Brook University, Stony Brook, New York, and the Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
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Ng P, Kranz K, Abeles R, Schwartz D, Lane S. Using the Jigsaw Teaching Method to Enhance Internal Medicine Residents' Knowledge and Attitudes in Managing Geriatric Women's Health. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:11003. [PMID: 33117889 PMCID: PMC7586752 DOI: 10.15766/mep_2374-8265.11003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 06/02/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Although 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. METHODS This 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. RESULTS Seventy-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%). DISCUSSION Our results suggest that workshops using the jigsaw teaching method can effectively increase IM resident knowledge and confidence in managing geriatric women's health.
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Affiliation(s)
- Patricia Ng
- Assistant Professor of Clinical Medicine, Department of Medicine, Renaissance School of Medicine at Stony Brook University
| | - Kimberly Kranz
- Assistant Professor of Clinical Medicine, Department of Medicine, Renaissance School of Medicine at Stony Brook University
| | - Ruth Abeles
- Assistant Clinical Professor, Department of Medicine, University of California, San Diego
| | | | - Susan Lane
- Professor, Department of Medicine, Renaissance School of Medicine at Stony Brook University
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Batur P, Phipps M, Qaseem A. The Women's Preventive Services Initiative Well-Woman Chart: A Helpful Tool for the Practice of Internal Medicine. Am J Med 2020; 133:1122-1125. [PMID: 32565259 DOI: 10.1016/j.amjmed.2020.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 11/29/2022]
Abstract
The Women's Preventive Services Initiative (WPSI) is a national coalition of 21 professional organizations and patient representatives that develops, reviews, updates, and disseminates evidence-based clinical recommendations for women's preventive health care services, from adolescence into the postreproductive years. The aim of the WPSI is to provide a clinically useful tool for practicing clinicians to help them identify and implement recommended preventive care services. The Well-Woman Chart (WWC) was created to serve as a central reference of the evidence-based reviews and recommendations. The chart provides a quick summary of screening, risk assessment, and counseling recommendations, along with links to obtain further clarification. The topics included are updates to the 2011 Institute of Medicine recommendations, as well as any other topics that were deemed relevant to the well-being of women. A brief summary of preventive services recommended during the pregnancy and postpartum periods are also included, though the WWC is not meant to be a comprehensive guide for perinatal care. We encourage clinicians to familiarize themselves with the contents of the WWC and use this tool to educate others to ensure women receive optimized preventive services.
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Affiliation(s)
- Pelin Batur
- Ob-Gyn & Women's Health Institute, Cleveland Clinic, Department of Women's Health, Cleveland, Ohio; Cleveland Clinic Journal of Medicine, Cleveland, Ohio.
| | - Maureen Phipps
- American College of Obstetricians and Gynecologists, Washington DC
| | - Amir Qaseem
- The American College of Physicians, Philadelphia, Penn
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Sorpreso ICE, Figueiredo FWDS, Silva ATMD, Zangirolami-Raimundo J, Silva BKR, Adami F, Zuchelo LTS, Baracat EC, Soares Júnior JM, Abreu LCD. Diagnosis and referral flow in the single health system for climacteric women. Rev Assoc Med Bras (1992) 2020; 66:1036-1042. [PMID: 32935795 DOI: 10.1590/1806-9282.66.8.1036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/22/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The association between gynecological diagnoses and their distribution across healthcare sectors benefits health promotion and the identification of topics for continued education of gynecological care. This study aimed to identify healthcare diagnoses and referral flow in climacteric women. METHODS This is a cross-sectional study conducted at the Women's Health Clinic of the University Hospital, University of São Paulo, with a reference to gynecology and training for Residents of Family and Community Medicine, between 2017 and 2018. The medical records of 242 women whose sociodemographic and clinical information, gynecological diagnoses, and distribution of healthcare services (primary, secondary, and tertiary) had been processed were collected. Statistical analysis included the chi-square test and odds ratio. RESULTS Smoking (OR = 2.27, 95% CI 1.05-4.89; p = 0.035) was associated with the referral of climacteric women to higher complexity services. Considering the distribution of non-oncological diagnoses in climacteric patients, the chance of women being referred to medium- and high-complexity health services presented a 2-fold increase in cases of breast diseases, a 2.35-fold increase in cases of noninflammatory disorders of the female genital tract, and a 3-fold increase in cases of inflammatory diseases of the pelvic organs. CONCLUSION Climacteric women aged over 55 years, postmenopausal women, and smoking women were most frequently referred to medium- and high-complexity outpatient surgery.
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Affiliation(s)
- Isabel Cristina Esposito Sorpreso
- . Disciplina de Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brasil.,. Laboratório de Delineamentos de Estudos e Escrita Científica, Centro Universitário Saúde ABC (FMABC), Santo André, SP, Brasil
| | - Francisco Winter Dos Santos Figueiredo
- . Disciplina de Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brasil.,. Laboratório de Epidemiologia e Análise de Dados, Centro Universitário Saúde ABC (FMABC), Santo André, SP, Brasil
| | | | - Juliana Zangirolami-Raimundo
- . Disciplina de Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brasil.,. Laboratório de Delineamentos de Estudos e Escrita Científica, Centro Universitário Saúde ABC (FMABC), Santo André, SP, Brasil
| | | | - Fernando Adami
- . Laboratório de Epidemiologia e Análise de Dados, Centro Universitário Saúde ABC (FMABC), Santo André, SP, Brasil
| | - Lea Tami Suzuki Zuchelo
- . Disciplina de Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Edmund Chada Baracat
- . Disciplina de Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brasil
| | - José Maria Soares Júnior
- . Disciplina de Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Luiz Carlos de Abreu
- . Laboratório de Delineamentos de Estudos e Escrita Científica, Centro Universitário Saúde ABC (FMABC), Santo André, SP, Brasil.,. Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (Emescam), Vitória, ES Brasil
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Lin L, Feng P, Yu Q. Attitude and knowledge for menopause management among health professionals in mainland China. Climacteric 2020; 23:614-621. [PMID: 32543223 DOI: 10.1080/13697137.2020.1775809] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study aims to understand the attitude of health-care professionals (HPs) in mainland China toward menopause management (MM) as well as the knowledge they have received regarding MM during training. METHODS An anonymous survey recruited 3709 medical workers nationwide (including physicians, orthopedists, obstetricians and gynecologists, and general practitioners) through online surveys and on-site interviews at professional meetings. RESULTS Of the 3709 questionnaires completed, 3426 questionnaires met the inclusion criteria. Of the participants, 1532 HPs had not received menopause management training (MMT) in nearly 1 year. Among the residents and physician assistants, 103 reported they were not familiar with MM. Satisfyingly, 98.3% of HPs considered it very important or essential to accept MM. Although most interviewees replied some correct menopausal knowledge, nearly half of them could not correctly identify the contraindications for menopause hormone therapy (MHT). Additionally, 73.1% of HPs would advise patients with premature ovarian insufficiency to receive hormone replacement therapy at least until the average age of menopause. CONCLUSION This survey indicated that HPs have some knowledge regarding MM, but a gap remains to master the basic theory of MHT. In order to manage the growing menopausal population in China, creating more in-depth educational MMT programs for HPs is necessary.
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Affiliation(s)
- L Lin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Obstetrics and Gynecology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - P Feng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Q Yu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Williams MS, McClintock AH. Bridging the training gap in women's health: Creating a new pathway for residents. MEDICAL EDUCATION 2020; 54:462-463. [PMID: 32180232 DOI: 10.1111/medu.14124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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19
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Manze MG, Calixte C, Romero DR, Roberts L, Perlman M, Langston A, Jones HE. Physician perspectives on routine pregnancy intention screening and counseling in primary care. Contraception 2019; 101:91-96. [PMID: 31881220 DOI: 10.1016/j.contraception.2019.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 11/07/2019] [Accepted: 11/10/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess factors associated with routine pregnancy intention screening by primary care physicians and their support for such an initiative. STUDY DESIGN We conducted a cross-sectional survey study of 443 primary care physicians in New York State. We performed multivariable logistic regression analyses of physician support for routine pregnancy intention screening and implementation of screening in the last year. Predictors included in the models were physician age, sex, specialty, clinic setting, and, for the outcome of support for screening, experience with screening in the last year. RESULTS In this convenience sample, the vast majority of respondents from all specialties (88%) felt pregnancy intention screening should be routinely included in primary care, with 48% reporting that they routinely perform such screening. The preferred wording for this question was one which assessed reproductive health service needs. In multivariable analyses, internal medicine physicians were less likely than family medicine physicians to have provided routine pregnancy intention screening (aOR = 0.15, 95% CI 0.09, 0.25). Only 8% of the sample reported they required more training to implement pregnancy intention screening, but more reported needing training prior to contraceptive provision (17%), contraceptive counseling (16%), and preconception care (15%). More internal medicine and other types of doctors cited a need for this additional training than family medicine physicians. CONCLUSIONS Most responding primary care physicians supported routine integration of pregnancy intention screening. Incorporating additional training, especially for internal medicine physicians, in contraception and preconception care counseling is key to ensuring success. IMPLICATIONS STATEMENT Responding primary care physicians supported routine inclusion of reproductive health needs assessment in primary care. Primary care may become increasingly important for ensuring access to a full range of reproductive health services. Providing necessary training, especially for internal medicine physicians, is needed prior to routine inclusion.
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Affiliation(s)
- Meredith G Manze
- City University of New York (CUNY), School of Public Health, New York, NY, United States
| | - Cynthia Calixte
- City University of New York (CUNY), School of Public Health, New York, NY, United States; Institute for Family Health, 2006 Madison Ave., New York, NY, United States
| | - Diana R Romero
- City University of New York (CUNY), School of Public Health, New York, NY, United States
| | - Lynn Roberts
- City University of New York (CUNY), School of Public Health, New York, NY, United States
| | - Michele Perlman
- Community Healthcare Network, 60 Madison Ave., New York, NY, United States
| | - Aileen Langston
- NYC Health and Hospitals, Woodhull Medical and Mental Health Center, 760 Broadway, Brooklyn, NY, United States
| | - Heidi E Jones
- City University of New York (CUNY), School of Public Health, New York, NY, United States
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Bachorik A, Nemer MK, Chen GL, Alexander CB, Pelletier SR, Pace LE, Shields HM. Case-Based Curriculum With Integrated Smartphone Applications Improves Internal Medicine Resident Knowledge Of Contraceptive Care. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2019; 10:971-977. [PMID: 31819696 PMCID: PMC6875286 DOI: 10.2147/amep.s221256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/05/2019] [Indexed: 05/22/2023]
Abstract
BACKGROUND Contraception is an essential preventive service for all women. However, the literature suggests that internal medicine residents have low levels of confidence and knowledge of contraceptive care. OBJECTIVE We designed and implemented a novel contraception curriculum promoting active, collaborative learning. We sought to evaluate whether this curriculum improved internal medicine resident knowledge of and comfort with contraceptive care through the administration of pre-/post-surveys. METHODS Our curriculum was delivered in a two-hour session as part of the mandatory ambulatory curriculum for internal medicine interns at our institution in the academic year 2017-2018. Interns were provided with select online resources and two smartphone applications at the beginning of the session, which they then used in case-based small group work. Small group work was followed by a large group case review, co-facilitated by OB/GYN and internal medicine faculty. RESULTS Thirty-eight participants completed surveys assessing knowledge of and comfort with contraceptive care immediately before and after the curriculum; 20 participants completed surveys assessing the same domains 4-6 months after the curriculum. Data from surveys administered immediately post-curriculum demonstrated significant improvements in knowledge about and comfort with counseling about, assessing medical eligibility for, and initiating multiple forms of contraception. Many of these improvements in knowledge and comfort were maintained on follow-up surveys 4-6 months following the curriculum. CONCLUSION Our case-based curriculum with integrated smartphone applications resulted in significant improvements in internal medicine resident knowledge of and comfort with the key skills of contraceptive care. In contrast to active, collaborative learning methodologies such as the flipped classroom, our methodology supports active, collaborative learning without requiring advance learner preparation, and is thus well suited to the time constraints of the graduate medical education setting. Our methodology is readily translatable to other clinical topics and residency curricula.
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Affiliation(s)
- Alexandra Bachorik
- Division of General Internal Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Michelle K Nemer
- Department of Medicine, Metro Health Medical Center, Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Grace L Chen
- Division of Women's Health, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Cristina Baseggio Alexander
- Division of General Internal Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Lydia E Pace
- Harvard Medical School, Boston, MA, USA
- Division of Women's Health, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Helen M Shields
- Harvard Medical School, Boston, MA, USA
- Division of Medical Communications, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
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21
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Swedish KA. Introducing a Women's Health Clinic Improves Resident Comfort and Competence in Performing Women's Health Exams. J Gen Intern Med 2019; 34:1081-1082. [PMID: 30859511 PMCID: PMC6614245 DOI: 10.1007/s11606-019-04914-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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22
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Zhang CM, Insetta ER, Caufield-Noll C, Levine RB. Women's Health Curricula in Internal Medicine Residency Programs: A Scoping Review. J Womens Health (Larchmt) 2019; 28:1768-1779. [PMID: 30794016 DOI: 10.1089/jwh.2018.7317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Christiana M Zhang
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emily R Insetta
- Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Rachel B Levine
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Bennis S, Rho M. Musculoskeletal Women's Health Education in Physiatry: A Mismatch in Residency Education and Clinical Practice. PM R 2019; 11:1151-1158. [PMID: 30746865 DOI: 10.1002/pmrj.12140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/30/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND 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. OBJECTIVE To identify the prevalence of formalized MSK WH education and of WH physiatrists at ACGME-accredited PM&R residency programs. DESIGN Cross-sectional survey design. SETTING Computer-based survey. PARTICIPANTS ACGME-accredited residency programs (N = 86; as of February 2017). METHODS 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). OUTCOMES 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. RESULTS 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. CONCLUSIONS 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. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Monica Rho
- Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL
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Kling JM, MacLaughlin KL, Schnatz PF, Crandall CJ, Skinner LJ, Stuenkel CA, Kaunitz AM, Bitner DL, Mara K, Fohmader Hilsaca KS, Faubion SS. Menopause Management Knowledge in Postgraduate Family Medicine, Internal Medicine, and Obstetrics and Gynecology Residents: A Cross-Sectional Survey. Mayo Clin Proc 2019; 94:242-253. [PMID: 30711122 DOI: 10.1016/j.mayocp.2018.08.033] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/06/2018] [Accepted: 08/27/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate the knowledge of and nature of training for menopause management in postgraduate residents. PARTICIPANTS AND METHODS A cross-sectional, anonymous survey was e-mailed to trainees at all postgraduate levels in family medicine, internal medicine, and obstetrics and gynecology at US residency programs between January 11, and July 4, 2017. The survey was adapted from an existing instrument and included questions regarding knowledge of hormone therapy (HT) and other menopause management strategies, availability and type of training in menopause medicine, and demographic information. RESULTS Of the 703 surveys sent, a total of 183 residents representing 20 US residency programs responded (26.0% response rate). Most trainees were between 26 and 30 years of age (133 of 172 [77.3%]), female (114 of 173 [65.9%]), and believed it was important or very important to be trained to manage menopause (165 of 176 [93.8%]). Although most respondents answered some of the menopause competency questions correctly, important gaps were identified. Of 183 participants, 63 (34.4%) indicated they would not offer HT to a symptomatic, newly menopausal woman without contraindications, and only 71 (38.7%) indicated they would prescribe HT until the natural age of menopause to a prematurely menopausal woman. Of 177 respondents, 36 (20.3%) reported not receiving any menopause lectures during residency, and only 12 of 177 (6.8%) reported feeling adequately prepared to manage women experiencing menopause. CONCLUSION Family medicine, internal medicine, and obstetrics and gynecology residency trainees recognize the importance of training in menopause management, but important knowledge gaps exist. Investing in the education of future clinicians to provide evidence-based, comprehensive menopause management for the growing population of midlife women is a priority.
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Affiliation(s)
- Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale AZ.
| | | | - Peter F Schnatz
- Department of OB/GYN and Internal Medicine, Reading Hospital, Reading, PA, and Thomas Jefferson University, Philadelphia, PA
| | - Carolyn J Crandall
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Lisa J Skinner
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Cynthia A Stuenkel
- Department of Medicine, Division of Endocrinology, University of California, San Diego, School of Medicine, La Jolla, CA
| | - Andrew M Kaunitz
- Department of Obstetrics and Gynecology, University of Florida College of Medicine-Jacksonville
| | - Diana L Bitner
- Department of Obstetrics and Gynecology, Spectrum Health/Michigan State University, Grand Rapids, MI
| | - Kristin Mara
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Stephanie S Faubion
- Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN
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Farkas AH, Vanderberg R, McNeil M, Rothenberger S, Contratto E, Dolan BM, Tilstra S. The Impact of Women's Health Residency Tracks on Career Outcomes. J Womens Health (Larchmt) 2018; 27:927-932. [DOI: 10.1089/jwh.2017.6739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Amy H. Farkas
- Department of Internal Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Internal Medicine, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Rachel Vanderberg
- Department of Internal Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Internal Medicine, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Melissa McNeil
- Department of Internal Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Scott Rothenberger
- Department of Internal Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Erin Contratto
- Department of Internal Medicine, Division of General Internal Medicine, University of Alabama Birmingham School of Medicine, Birmingham, Alabama
| | - Brigid M. Dolan
- Department of Internal Medicine, Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine Northwestern University, Chicago, Illinois
| | - Sarah Tilstra
- Department of Internal Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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da Silva ATM, Menezes CL, de Sousa Santos EF, Margarido PFR, Soares JM, Baracat EC, de Abreu LC, Sorpreso ICE. Referral gynecological ambulatory clinic: principal diagnosis and distribution in health services. BMC WOMENS HEALTH 2018; 18:8. [PMID: 29304796 PMCID: PMC5756344 DOI: 10.1186/s12905-017-0498-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 12/15/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The association between gynecological diagnoses and their distribution in the health sectors provides benefits in the field of women's health promotion and in medical and interdisciplinary education, along with rationalization according to level of care complexity. Thus, the objective is analyze the clinical-demographic characteristics, main diagnoses in gynecological ambulatory care, and their distribution in health services. METHOD This is a research project of retrospective audit study design with a chart review of data from 428 women treated at University Ambulatory Clinic of Women's Health, the facility in gynecology and training for Family and Community Medical Residents, São Paulo, Brazil, from 2012 to 2014. Clinical and demographic information, gynecological diagnoses (International Classification of Diseases), and distribution of health services (primary, secondary, and tertiary) were described. RESULTS The female patients present non-inflammatory disorders of the female genital tract (81.07%, n = 347) and diseases of the urinary system (22.66%, n = 97) among the gynecological diagnoses. The chances of having benign breast disease and non-inflammatory disorders of the female genital tract during the reproductive period corresponds to being 3.61 (CI 1.00-16.29) and 2.56 times (CI 1.58-4.16) higher, respectively, than during the non-reproductive period. The non-inflammatory disorders of the female genital tract (93.33%, n = 28) are most related to the tertiary sector. The distribution in health services was the following: 71.30% (n = 305) in the primary sector, 21.70% (n = 93) in the secondary sector and 7% (n = 30) in the tertiary sector. CONCLUSION The studied women presented non-inflammatory disorders of the female genital tract and diseases of the urinary system as determined by gynecological diagnoses. Low-assistance complexity followed in most cases.
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Affiliation(s)
- Adna Thaysa Marcial da Silva
- Division of Gynecology, Medical School, University of São Paulo, São Paulo, SP, Brazil. .,Laboratory of Study Design and Scientific Writing, ABC Medical School, São Paulo, SP, Brazil. .,, Avenida Enéas de Carvalho Aguiar, 255 - 10° andar sala 10166, São Paulo, SP, CEP: 05403000, Brazil.
| | | | | | | | - José Maria Soares
- Division of Gynecology, Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - Edmund Chada Baracat
- Division of Gynecology, Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - Luiz Carlos de Abreu
- Laboratory of Study Design and Scientific Writing, ABC Medical School, São Paulo, SP, Brazil
| | - Isabel Cristina Esposito Sorpreso
- Division of Gynecology, Medical School, University of São Paulo, São Paulo, SP, Brazil.,Laboratory of Study Design and Scientific Writing, ABC Medical School, São Paulo, SP, Brazil
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Hartman SG. The Need to Enhance Women's Health Training Opportunities in Internal Medicine Residency Programs. J Womens Health (Larchmt) 2017; 26:97-98. [DOI: 10.1089/jwh.2016.6131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Scott G. Hartman
- Department of Family Medicine, University of Rochester Medical Center, Rochester, New York
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