University of Pittsburgh

Women's Health

Background

Early studies that helped physicians understand and treat many disease processes were based on data collected mainly in men, with heart disease being a primary example. However, over time, we have come to realize that there are important differences between men and women in the pathophysiology, presentation, diagnosis, and treatment of many illnesses. Furthermore, given that 50% of the population is female, and that a much larger percentage of healthcare utilizers are women, it is essential that providers recognize and are able to care for conditions that affect women with greater frequency, including autoimmune disorders, depression and anxiety, osteoporosis, among many others, as well as those that affect only women, such as pregnancy, menses, menopause, and breast, ovarian, cervical and endometrial cancer. Physicians, regardless of specialty, will need to understand such differences in order to provide appropriate care.

Goal

To prepare students to meet the health care needs of women.

Objectives

  • Students will recognize differences in the physiologic and pathophysiologic mechanisms, evaluation, and treatment of disease based on gender.
  • Students will prepare to provide care for physiologic states or illnesses that affect only women.

Implementation

Women’s health education at UPSOM is considered a longitudinal curriculum and is incorporated into the throughout the four years of medical school. Women’s health content is integrated, as appropriate, into both the pre-clinical courses and clinical clerkship. Understanding and caring for conditions specific to women serves as the primary goal of certain courses and clerkships. For those students wishing to gain additional training in the care of and study of women, a range of electives are offered

The following are examples of where women’s health topics are incorporated into the curriculum.

 

Patient, Physician and Society Block

Beginning during the first week of medical school, students in the Introduction to Being a Physician course start to gain an appreciation of Women’s Health issues when they work in small groups with cancer survivors on the breast cancer case. The case discussion on abortion in the Ethics, Law and Professionalism course helps students begin to understand the sensitive and challenging considerations that physicians and patients face when dealing with this subject. Students learn about women’s experiences with the health care system in sessions on behavior change across cultures, in the first-year Behavioral Medicine course.

 

Fundamentals of Basic Science Block

The Immunology in Health and Disease course covers rheumatologic/ auto-immune diseases, including the prevalence of particular conditions in women. During the Cellular and Pathologic Basis of Disease course, students learn about principles of nuclear receptor action and how Selective Estrogen Receptor Modulators (SERMs) related to treatment of women (e.g., breast cancer, HRT).  The impact of sexually transmitted infections on reproductive health is taught within Medical Microbiology.

 

Organ System Pathophysiology Block

The majority of the Reproductive and Developmental Biology course deals with women’s health. Pregnancy-related changes in pulmonary, cardiac and renal systems are covered within the segments of the Body Fluid Homeostasis course at the beginning of second year. Gender differences in heart disease are also addresses in the cardiology course. Eating disorders are addressed in the Introduction to Psychiatry course. Sessions in the Endocrinology, Pharmacology, and Digestion and Nutrition courses focus attention on specific women’s considerations and conditions.

 

Introduction to Patient Care Block

Students begin to develop breast and pelvic examination skills during the Advanced Physical Examination course during year 2.  The instructional sessions are synchronized to align with related content in the Reproductive and Developmental Biology course.  After a case study in domestic abuse/intimate partner violence, students have an opportunity to rotate through a women’s shelter, in the Clinical Experiences course. 

 

Clinical Rotations

The Obstetrics and Gynecology clerkship provides vital instruction in this area.  The Family Medicine clerkship provides additional instruction on specialized examination skills, and opportunities to participate in obstetrical and gynecologic care.  Non-gynecologic aspects of Women’s Health are the subject of one of the major teaching sessions in the Combined Ambulatory Medicine and Pediatrics clerkship. Clinical electives allow students to rotate in a broad range of related areas, including gynecologic oncology, reproductive endocrinology, breastfeeding, urogynecology, minimally invasive gynecologic surgery, adolescent medicine, women’s health, midlife health, and family planning.

 

Integrated Life Sciences Course

The Infectious Disease in Obstetrics, Gynecology, and Reproductive Medicine Integrated Life Science course is one of the fourth-year courses students may choose to fulfill the ILS requirement. The course incorporates clinical, laboratory and basic science learning that helps students gain a more in-depth understanding of this integrated subject.

 

Area of Concentration - Women’s Health

The Area of Concentration program in Women’s Health provides interested students with an opportunity to pursue this subject in greater depth, including mentoring, experiential learning and support for research activities.

 

Impact

Women’s health education has been integrated in a thoughtful and deliberate manner throughout the UPSOM curriculum. Attention to the care of women has well received by students and faculty and recognized as an essential part of becoming a competent physician. Students at UPSOM leave well-prepared to respond to the unique health care needs of women, regardless of chosen specialty.