Women's Health Pathway Introduction Sites and Personnel Goals and Objectives Description of Pathway Pathway Summary Table Textbooks and Learning Resources Evaluation

Introduction

The Women's Health Pathway is divided into acquiring advanced knowledge in both clinical and academic areas of women's health. Students will have required and elective courses in women's health in clinical, basic science, psycho-social and research areas in addition to the Internal Medicine and Neurology courses which are required for graduation. The required course builds further upon students' Ambulatory Care, Primary Care or Internal Medicine Skills and offers a multi-disciplinary approach to health care concerns of the female patient, beyond their reproductive functions.

PLEASE NOTE: The Women's Health Pathway will accept a maximum of eleven students.

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Sites and Personnel

Pathway Director and Site Coordinator:

Drexel University COM
Ana E. Núñez, M.D.
2900 Queen Lane, Suite 228
Philadelphia, PA 19129
(215) 991-8450 Phone
(215) 843-0253 Fax
E-mail: anunez@drexelmed.edu

Kim U. Kahng, M.D., Co-Director
E-mainl: kkahng@drexelmed.edu

Coordinator: Victoria Gracia
2900 Queen Lane, Suite 228
Philadelphia, PA 19129
(215) 991-8450 Phone
(215) 843-0253 Fax
E-mail: vgracia@drexelmed.edu

Associate Pathway Directors, Site Coordinators and Teaching Sites:

Site	Associate Director	Site Coordinator
DUCOM Center for Women's Health	Katherine D. Sherif, M.D.	Christine V. Soutendijk, M.D.

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Goals and Objectives

The Women's Health pathway will be designed to meet the pathway objectives of the DUCOM Senior Pathway program. Additionally, the Women's Health pathway has unique objectives designed to attend to the essential skills, body of knowledge and attitudes needed to deliver high quality, culturally appropriate care for women. They will include that students should know:

Knowledge Components

• Diseases that are unique to or more common in women or for which there are differences in diagnosis and treatment for men or women
• How to take an appropriate history from and know how to perform a complete and sensitive physical exam
• The factors determining "women's wellness" over their life cycle and enable women to participate in disease prevention

Skills Component

• Deliver effective, culturally appropriate women's health care in a multidisciplinary setting.
  Increase their abilities to analyze the literature and incorporate into clinical practice
  Synthesize diverse situations and opportunities in women's health

Attitude Components

• demonstrate an attitude which will ensure appropriate health care for women, especially when the gender of the patient and the physician is different.
• demonstrate an attitude which indicates an appreciation of the power of the physician.
• display an attitude which indicates an understanding of the diversity of women in the community, based on differences in race, culture, ethnicity and social and economic factors and how this impacts on health care.

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Description of Pathway

Menu A. General Elective Rotations

Discipline Areas	Skills or Topic Area
OB/Gyn	Pelvic and breast exam skills, Contraception and Reproductive Options, High risk pregnancy, Fertility, Dysfunctional Bleeding / Endometriosis
Pediatrics	Adolescent, Neonatology, Emergency Medicine, Primary Care Pediatrics
Family Medicine	WH Focused Family Medicine
Behavioral Science for Women	Tailored rotation in behavioral sciences matching students interests and women's health
Community / Preventative Medicine, Public Health	Addiction Medicine, Environmental Medicine, Occupational Medicine, Domestic Violence, Nutrition, Health Policy, Eating Disorders
Internal Medicine	Cardiology, Osteoporosis, Rheumatology, Nephrology, Infectious Disease / HIV
Surgery	Urology, Pelvic Floor Disorders, Breast Health, Dental Health, Cosmetic Surgery, Other Surgical Areas (Opthalmology, Sports Medicine, etc)
Radiology	Radiologic Services for women - (Mammography, USD, CT, etc.
Community Outreach Programming	Independent Project in social service, community based organizations dealing with women's health care
Research	Research Skill in WH Survey Course Research Rotation (encouraged three rotations in research)
Education	Academic Skills to Advance Womens' Health, Principles of Women's Health Education Practicum, Health Care Delivery Education, Culturally Competent Issues in Women's Health Care

The required multidisciplinary ambulatory care rotation includes several major components:

1. Women’s Health Clinical Activities:

• Women’s Health Primary Care: at 219 North Broad Street at the Center for Women’s Health (Dr. Katherine Sherif & Dr. Christine Soutendijk) and with Dr. Núñez in the Executive Health and Wellness program also at 219 North Broad Street. This site allows students to role model with women's health experts and increase their knowledge and skills in clinical care.
• Women’s Health Subspecialty Care – students work with various subspecialists for ½ day to one day per week for the four week rotation. These rotations are tailored to student’s needs and interest. Students will receive assistance in designing experiences that are tailored to areas associated with their future specialty. Students have an opportunity to refine skills such as:
  • interpretation of mammographic findings
  • analysis of pelvic floor dysfunction
  • addressing special needs of women with HIV

2. Academic Activities:

• Journal Club Presentation – all students must participate in journal clubs and presentations.
• Guiding Questions – associated with required syllabus with readings on women’s health in clinical, basic science, psycho-social and research issues. The syllabus is updated to enable students broad and deep understanding of sentinel issues in girls’ and women’s health and professional development, national standards challenges and current controversies.
• Women’s Health Resource Materials – students will create one of two resource materials, either a bulletin board with materials posted outside of the WHEP office that coincides with the IFM Year Two modules (e.g., Cardiovascular, Endocrinology, GI etc.) OR a women’s health newsletter.
• Survey Paper – Students will complete a 3-5 page paper on a particular women’s health topic to be generated based upon student interest with sign-off by the Pathway Director/Advisor.

3. Community-Based Experience:
Students will work in community outreach settings or in health care settings. These sites provide a unique point of view of women as patients. Students will spend a portion of their time in a community setting that compliments their clinical experience. Students will work with community-based health professionals in attending to social service and clinical care needs. Examples of sites where past students have worked include: Prevention Point needle exchange program, Community Legal Services, and National Immigration Law Center.

4. Mentoring:
Students will attend Women’s Health activities and provide leadership to programming. Example – Women’s Health Seminar Series, women’s health community education sessions, health fairs, workshops, etc.

Student Responsibilities
With the exception of the WH Ambulatory rotation, students may enroll in any rotation for credit as a core pathway elective if they fulfill the following responsibilities:

• meet with the Pathway Director (PD) and develop rotation-appropriate women's health objectives. For example, a student taking a cardiology rotation would develop a learner's contract of objectives to attend to during that rotation. Their clinical faculty member and advisor will receive copies of the learner's contract. Under supervision, students will select from the WH competency checklist, the items for which they will be responsible for by the end of the rotation. For example, a student taking WH Urology would include on their competency checklist, being able to identify technical and diagnostic skills in incontinence and pelvic pain disorders.
• meet all required clinical expectations of the rotation.
• use the WH checklist of competencies and review this with their clinical supervisor.
• develop a WH focused project to be done over the four weeks.
• meet with the PD mid-point in the rotation for formative feedback
• meet with the PD at the end of the rotation for presentation of their project and summative evaluation.

Link to A Guide to 4th Year Medical Student Electives in Women's Health: http://womenshealth.uc.edu/electives.pdf

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Textbooks and Learning Resources

Alexander L.L. & LaRosa J.H. New Dimensions In Women's Health. Boston: Jones and Bartlett, 1994.
Blackwell R.E. Women's Medicine. Binghamton, New York: Blackwell Science, 1996.
Carr P.L., Freund K.M., & Somani S. The Medical Care of Women. Philadelphia: W.B. Saunders Co., 1995.
Jensvold M.F., Halbreich U, & Hamilton J.A. Psychopharmacology and Women: Sex, Gender, and Hormones. Washington D.C.: American Psychiatric Press, 1996.
Johnson C.A., Johnson B.E., Murray J.L., & Apgar B.S. Women's Health Care Handbook. Philadelphia: Hanley and Belfus, 1996.
Mathers L.H., Chase R.A., Dolph J., Glasgow E.F., & Gosling J.A. Clinical Anatomy Principles. St. Louis: Mosby, 1996.
Rosenfeld J.A.. Women's Health in Primary Care. Baltimore: Williams and Wilkins, 1997.
Seltzer V.L., Pearse W.H.. Women's Primary Health Care: Office Practice and Procedures. New York: McGraw Hill, 1995.
Stanton A.L. & Gallant S.J. The Psychology of Women's Health: Progress and Challenges in Research and Application. Washington D.C.: American Psychological Association, 1995.
Wallis, L. Textbook of Women's Health. Philadelphia: Lippincott-Raven Publishers; 1998.
Worcester N. & Whatley M.H. Women's Health: Readings on Social, Economic, and Political Issues. Second Edition. Dubuque, Iowa: Kendall/ Hunt, 1994.

In addition, the Women's Health Education Program Office has:
500+ journal articles on specific women's health issues
150+ primary care and specific textbooks in women's health as well as subscription to WH journals, videos, and reports

Students will have oversight from the Pathway Director and a Pathway Advisor. The Advisor's discipline will match the student's career choice.

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Evaluation

Student Feedback

Students receive feedback and provide input regarding their experiences throughout the Pathway experience. They will meet with the program coordinators mid-rotation during their ambulatory experience and at the conclusion of the ambulatory rotation. All pathway students will also participate in an Exit Interview by the pathway coordinators. The student evaluation program is as outlined below.

Spring semester of Third Year	Students select Women's Health Pathway
Spring semester of Third Year	Students within Pathway participate in Orientation Meeting
Spring to Summer of Third Year	Individual meetings with program coordinators and students to tailor pathway to students' interests and cover essential Women's Health concepts during pathway.
Fall of Fourth Year	Students begin pathway rotations. Mid-rotation evaluations within required Ambulatory Rotation. Paper topic delineated during this session.
Spring semester of Fourth Year	Group Meeting of Pathway Students
Spring to Graduation	Exit Interviews of Individual Students

Student Evaluations
Evaluation of the student will be done by the faculty of each rotation. Depending on the rotation, the evaluation may consist of assessment by an individual preceptor or through a composite from several preceptors. The standard DUCOM evaluation forms will be used.

Standardized Student Rotation Evaluation
In accordance with student evaluations at DUCOM, all Pathway students will evaluate each rotation using the standardized senior evaluation form. Upon competion of the pathway, students will be asked to evaluate their experience.

Remediation
Students identified as deficit based upon attendance, knowledge base or clinical care abilities will be remediated appropriately. Those with attendance deficiencies or clinical care abilities will be given an opportunity to spend additional clinical time in a supervised setting with evaluations done based upon their performance. Student's with deficiencies in their knowledge base will be given additional reading assignments to increment their knowledge and be quizzed on these core women's health competencies.

Program Administration
The administration of this program will be through the staff of the Women's Health Education Program.

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