Women’s Health Residencies and Fellowships: Priming the Pump for Women’s Health Researchers Melissa McNeil, MD, MPHProfessor of Medicine, Obstetrics, and Gynecology Chief, Section of Women’s Health University of Pittsburgh and VA Pittsburgh Health Care System
What Makes a Women’s Health Researcher? Understanding of what women’s health means as a concept: – Diseases unique to women – Diseases that are more common in women – Diseases that are different in women Inquiring mind able to ask interesting questions about important questions Joy and passion for research
How to Incorporate Women’s Health into a Curriculum?Questions to consider: What level of training: preclinical medical student, clinical medical student, resident, fellow Separate or integrated educational experiences in women’s health (eg, teaching in categorical residency vs women’s health residency track?) Elective or mandatory experiences?
Goals of Educational Experiences at Pittsburgh Often and early exposure Offer both integrated and focused experiences Integration is mandatory for ensuring all learners have exposure to concepts of gender specific medicine Focused experiences important to allow for more in depth study for those with heightened interest Accountability is critical
WHT at Pittsburgh Instituted at the request of the Dean First class recruited in 1994 Three spots from the categorical residency designated as “women’s health track” Separate match number Can expand to accommodate demand from within the program
WHT Curriculum Weekly WH Seminar Series Unique ambulatory site with “gender based primary care” precepted by WH faculty Specialized rotations in lieu of community based ambulatory blocks – Year 1: Urgent Gyne Clinic – Year 2: Rotating Specialty Block, Mental Health – Year 3: Rotating Specialty Block, Medical Complications of Pregnancy, Student Health
WHT: Components of Success Buy in from leadership: Program Director, Division Chief, Chairman, Dean Dedicated faculty with General Medicine Identify partners within medical subspecialties: oncology, cardiology, endocrine, GI, cardiology Identify partners in other departments: obgyne, psychiatry, adolescent medicine
WHT: Components of Success First and foremost, goal of the program is to train high quality internists All faculty are internists first; can discuss hyponatremia as well as contraception Avoid the “feminazi” label Close mentoring: WH faculty mentor clinics, senior talks, journal clubs Provides a sense of belonging within a large university residency program
WHT as a Springboard forInterdisciplinary WH Research Residents seeking fellowships seek research opportunities and ways of distinguishing themselves from the pack A WH focus allows for a unique identity and the ability to consider the depth and breadth of WH in the care of patients Broadens the scope of what WH research can mean and begins to establish areas of inquiry
Interdisciplinary WH Research: Medical Students What is the best/most satisfactory anesthesia for women in labor? What are the views of medical students regarding reproductive choice? What do women domestic violence victims want from their providers? What is the prevalence of the female athlete triad syndrome in high school athletes?
Interdisciplinary WH Research: Medical Resident Research What is the impact of inflammatory bowel disease on a woman’s fertility? What is the impact of inflammatory bowel disease on a woman’s sexuality? What is the association between cardiac disease in women and psychosocial conditions? How is congestive heart failure different in men and women?
WHT: Benefits to Program Recruiting tool for individuals looking for a unique nitch in medicine Develops a critical mass of individuals with similar interests for seminars, lectures, etc. “Infiltrative” approach to women’s health in the rest of the program Supports the WH fellowship
WHT: Measures of Success Continued ability to recruit high quality residents (currently 16 in the three year track) Chief resident from the program every year for the last five years Success in career choice/fellowship: current senior resident career choices: endocrine, rheumatology, GI, WH, CMR
Women’s Health Fellowship Initiated in 1994 One of the original VA funded special fellowship programs One fellow each year for a two year fellowship with opportunity for a third year of funding Goals are to train academic physicians— either medical educators or researchers
Women’s Health Fellowships Strong environment Educational opportunities: Masters in Reproductive Epidemiology, Master’s in Clinical Science, Master’s in Medical Education Content focus available in each master’s program
Women’s Health Fellowships Research Opportunities – Graduate School of Public Health with a focus on women’s health epidemiology – Magee Women’s Research Institute – Pittsburgh Cancer Institute with emphasis on breast and ovarian cancer programs – Women’s Heart Program – Women’s Behaviorcare Program
Components of Success Dedicated Funding Included within the broader general medicine fellowships Strong clinical, educational, and research environment Many mentors Critical mass Seed money for research
Women’s Health Fellowships 25 % clinical time for research fellows (1/2 day of clinic precepting and ½ day of own clinic, all in women’s health program) Pursuit of master’s degree with training in clinical research methodology Requirement for research project with dissemination (poster, oral presentation, publication)
Food for Thought How big is the market? How much interest is there for more and more programs? Separate program or recruit from within? Should we define competencies for a certificate of completion of a WHT for residents or a women’s health fellowship?