Primary Care Program Directors' Perceptions of Women's Health Education: A Gap in Graduate Medical Education Persists

Background: Few studies have examined residents' perspectives on the adequacy of women's health (WH) training in internal medicine (IM). This study sought residents' opinions regarding comfort level managing 13 core WH topics, their perceived adequacy of training in these areas, and the frequency with which they managed each topic. The association between reported comfort level and perceived adequacy of training and management frequency was also assessed. Methods: A 67-item questionnaire was administered from April to June 2009 to 100 (64%) of the 156 residents from the traditional, primary care, and IM-pediatrics residency programs at a single institution. Descriptive and correlation statistics were used to examine the relationships between self-reported comfort level, perceived adequacy of training opportunities, and frequency managing WH issues. Data was stratified by sex, IM program, and post-graduate year (PGY). Results: The majority of residents reported low comfort levels managing 7 of 13 topics. Over half of residents perceived limited training opportunities for 11 of 13 topics. With the exception of cardiovascular disease in women, greater than 75% of residents reported managing the 13 topics five or more times in the prior 6 months. Correlation analysis suggested a linear relationship between low comfort levels and limited training opportunities, and between low comfort levels and low frequency managing WH topics (r = 0.97 and r = 0.89, respectively). Stratified analyses by sex, IM program, and PGY showed no significant differences. Conclusions: Key gaps remain in WH training. Our results emphasize the importance of reinforcing WH training with hands-on management opportunities. Understanding institution-specific strengths and weaknesses may help guide the development of targeted initiatives.

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“…[1][2][3][4][5] Additional studies among IM residency graduates, 6,7 as well as surveys of program directors, 8,9 have reported similar findings.…”

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confidence: 85%

Needs and Priorities in Women's Health Training: Perspectives from an Internal Medicine Residency Program

Hsieh

Nuñez-Smith

Henrich

2013

Journal of Women's Health

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“…Repeated for a final time in 2001, by the Society for Women's Health Research, there was ultimately an increase to 44% of medical schools offering WH curriculum. 2,5 This evidence validates that many students are not getting exposure to women's health early in their medical careers 8 and are lacking a significant experience unless ultimately choosing a residency in obstetrics and gynecology. Early exposure heightens curiosity, learning, and interest in the field and ultimately demonstrates to students and residents that a career in women's health can be achieved through both family medicine and internal medicine, 3 and most comprehensively after the successful completion of a fellowship.…”

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confidence: 81%

“…Midlife should be a time for women to enjoy and improve their health, and WH providers are crucial in achieving and maintaining this lifestyle, as they have focused training that is not affordable by residency training or continuing medical education (CME) classes alone. 20 Multiple studies have shown that gaps in WH training remain, 8,20 and WH specialty providers poses a unique skill set that includes some or all of the following: knowledge of current literature on hormone therapy (HT) and the risk/benefit classifications of prescribing HT; following Pap results; performing office-based minor procedures such as colposcopy, cervical polyp removal, or IUD insertion; medically managing abnormal uterine bleeding; reading bone density scans and prescribing osteoporosis treatment; managing low libido; managing urinary incontinence; and contraception management and a unique understanding of how gender-based medicine plays a role in the management of chronic conditions such as diabetes, heart disease, and depression. 21 Moreover, WH specialty providers have a broad understanding of diseases that are more common in women, such as autoimmune conditions, thyroid disorders, rheumatologic conditions, and chronic pain syndromes; breast cancer survivors as well as those that carry genetic mutations; and cardiovascular conditions.…”

Section: Provider Skillsmentioning

confidence: 99%

“…23 Even program directors of internal medicine residencies are reporting that despite national guidelines endorsing women's health education, they still find a negative discrepancy between what they feel residents should master and what the residents estimate they have mastered. 8 Not only is residency knowledge on HT lacking; studies also show even IM residents lacking in overall contraception knowledge. 25 Even among IM facility there have been reports that knowledge and procedural skills needed to teach necessary WH skills are lacking, 12 again pointing toward the functionality for WH fellowship-trained physicians to function in the gray zone between OB/GYN and IM.…”

Section: Value Of Accreditationmentioning

confidence: 99%

“…10 Long-term follow-up showed that ELAM participants had achieved greater scores on 12 of 15 established leadership indicators, compared with physicians who had not sought any formal leadership training. 10,11 Meanwhile, while medical school and residency exposure to WH outside the lens of obstetrics and gynecology is lacking, 8 the demand for WH providers is increasing, 1 and thus the need to raise awareness of WH fellowships is of optimal importance in order to train experts and educational leaders. 12 Unfortunately, the knowledge of these specialty interdisciplinary WH fellowships is lacking.…”

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confidence: 99%

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Update: A Review of Women's Health Fellowships, Their Role in Interdisciplinary Health Care, and the Need for Accreditation

Foreman

Weber

Thacker³

2015

Journal of Women's Health

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While Women's Health (WH) Fellowships have been in existence since 1990, knowledge of their existence seems limited. Specialized training in WH is crucial to educate leaders who can appropriately integrate this multidisciplinary field into academic centers, especially as the demand for providers confident in the areas of contraception, perimenopause/menopause, hormone therapy, osteoporosis, hypoactive sexual desire disorder, medical management of abnormal uterine bleeding, office based care of stress/urge incontinence, and genderbased medicine are increasing popular and highly sought after. WH fellowship programs would benefit from accreditation from the American Board of Medical Subspecialties and from the American College of Graduate Medical Education, as this may allow for greater recruitment, selection, and training of future leaders in WH. This article provides a current review of what WH trained physicians can offer patients, and also highlights the added value that accreditation would offer the field. Ultimately, accrediting WH fellowships will improve women's health medical education by creating specialists that can serve as academic leaders to help infuse gender specific education in primary residencies, as well as serve as consultants and leaders, and promote visibility and prestige of the field.

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

Bennis

Rho

2019

PM&R

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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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Primary Care Program Directors' Perceptions of Women's Health Education: A Gap in Graduate Medical Education Persists

Cited by 28 publications

References 10 publications

Needs and Priorities in Women's Health Training: Perspectives from an Internal Medicine Residency Program

Needs and Priorities in Women's Health Training: Perspectives from an Internal Medicine Residency Program

Update: A Review of Women's Health Fellowships, Their Role in Interdisciplinary Health Care, and the Need for Accreditation

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

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