Getting to the Core of the Women’s Curriculum—It’s Time to Change the Way We Train Our Fellows

Abstract

In the United States, 50.7 percent of the population are women [1]. In 2004 there were an estimated 104 million visits for evaluation and management of a digestive disease, and after adjustment for age the number of visits was 10 percent higher for women than for men, which equates to over 57 million visits per year for women [2]. Although many digestive diseases are the same in men and women, there are also many differences. Research has shown that there are gender differences in epidemiology, response to health and illness, treatment, and complications. Fertility, pregnancy, and the post-partum state pose specific challenges for gastroenterologists. As specialists in digestive diseases, gastroenterologists must have the knowledge and range of skills necessary to care for women with their unique issues.It is challenging to successfully train highly qualified gastroenterologists during the three year fellowship period. An enormous amount of knowledge and procedural skills must be acquired by the end of training, with the instillation of a desire for life-long learning. A program must be well-structured with a committed program director and dedicated faculty in order to accomplish these objectives.Guidelines for training gastroenterology fellows were first published by the Gastroenterology Leadership Council in 1996, but it was not until the Gastroenterology Core Curriculum was updated in 2003 that a women's curriculum in digestive diseases was first outlined. The recommendations specifically addressed three areas: (1) general women's gastroenterology (GI) health issues, including the doctorpatient relationship; cultural, religious, and psychosocial issues; differences in disease presentation; laboratory and diagnostic testing; and the use of complementary and alternative medicine; (2) specific women's GI health issues including gender differences in GI health and disease states, the effects of the menstrual cycle and menopause on GI health and disease states, medication pharmacokinetics, and response to and complications of therapy; and (3) pregnancy and childbearing issues, including fertility, infertility, pregnancy in women with preexisting digestive diseases, diseases unique to pregnancy, medication pharmacokinetics and safety during pregnancy and with breast-feeding, clinical onset of digestive diseases during pregnancy and after delivery, and the effect of pregnancy on healthy mothers. The training recommendations included obtaining the appropriate knowledge and clinical experience through didactic lectures and close alliance with physicians who have an interest and experience in evaluating and managing women's GI health issues, including obstetricians and gynecologists. Another recommendation was that a minimum of 25% of the fellow's panel of patients be women [3].In July 2005, the ACGME adopted these recommendations and now requires formal instruction and clinical experience in women's GI health issues and that in their continuity clinic ''each fellow's panel of patients must include at least 25% of pati...

A blueprint for a new model of sexual and reproductive health care in subspecialty medicine

“…Some subspecialties, such as Gastroenterology, have attempted to integrate women's health/SRH into required training milestones for fellows. However, as these milestones often do not require a demonstration of competency, it is understandable why a national sample of gastroenterology fellows reported that they had received inadequate SRH training during fellowship and did not feel competent to provide SRH to patients 47–49 …”

“…Develop national curricula on SRH and widely disseminate them (e.g., through the American Association of Medical College's MedEdPortal), particularly for training programs that lack local expertise. 48,51 Develop local SRH curricula, done by faculty leaders from ObGyn/MFM and/or experts in subspecialty medicine with expertise in SRH.…”

“…However, as these milestones often do not require a demonstration of competency, it is understandable why a national sample of gastroenterology fellows reported that they had received inadequate SRH training during fellowship and did not feel competent to provide SRH to patients. [47][48][49] More data are needed to clarify the extent to which SRH is integrated into fellowship training across the medicine subspecialties. But at present, it is possible for clinicians to enter independent practice without having received much formal reproductive health care training since their ObGyn rotations in medical school.…”