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

Abstract

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.

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

“…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. 22 Women's Health physicians may also be needed by young women, who do not necessarily need a referral to a gynecologist, whereas WH fellowship-trained physicians specifically help to fill the gap where primary care providers may not have this unique familiarity and can also help fill the gap between primary care medicine and routine OB-GYN practice.…”

“…WH providers can also care for and follow patients with benign breast conditions as well as those with documented breast cancer gene (BRCA) mutations. 21,22 This information is summarized in Table 1.…”

“…Many midlife women complete annual exams with their gynecologists who are often unfamiliar with menopause treatment, 2 chronic disease management, risk assessment, and polypharmacy, which highlights the need for a WH provider to function in the area between gynecology and medicine. 21 Furthermore, since the release of the Women's Health Initiative study in 2002, many providers stopped prescribing HT, and as a result, a decade later most internists lack the core competencies and experience necessary to address menopausal issues and fail to meet the needs of midlife women. 23,24 Santen et al states, ''We believe that this situation is detrimental to women's health, leads to fragmented care, and should change.''…”

Foundations for a Novel Emergency Medicine Subspecialty: Sex, Gender, and Women's Health

“…18 An initial needs assessment and literature search were conducted followed by a review of guidelines and women's health curricula from other specialties and health professions. [19][20][21][22] Core faculty held informational interviews with content experts and developed educational objectives. For example, faculty met with experts in women's cardiovascular disease to identify how gender can affect the presentation, diagnosis, or treatment of cardiac disease in the ED.…”

Training emergency physicians in sex- and gender-based medicine: assessing attitudes of program directors and residency graduates

“…One internal medicine residency program described the development and implementation of a multidisciplinary women’s health program with a small component of content on gender differences and disparities [ 5 ]. Furthermore, curricula integrated into internal medicine training programs have focused on conditions specific to women including breast cancer and gynecological conditions, with a paucity of content on sex and gender differences in conditions that affect both genders [ 5 , 7 ]. With the exception of a recent publication on the development of SGBM curriculum for residents and fellows [ 9 ], the extent to which SGBM and women’s health content has been integrated into emergency medicine (EM) residency curriculum is unknown.…”