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Teaching new physicians that women are not men .... how you can help.

The training that medical students receive about women's health significantly influences the day-to-day decisions your doctor (and any health provider supervised by doctors) makes about your health care. Sadly, medical schools (and the organizations that supervise them) do a lousy job of helping providers under stand and treat their female patients.

The terms "gender-specific medicine and "sex-specific medicine" refer to the biological and physiological differences between the sexes, and the fact that these differences affect individuals' experiences of health and disease. Despite widespread recognition that women are not men, coverage of women's health issues is lacking in medical education. In fact, most educators seem to believe that reproductive health courses are sufficient to fully teach about women's health.

In 1995, the American Association of Medical Colleges collaborated with the National Institutes of Health to conduct the first comprehensive survey on the women's health content of curricula used in the 126 U.S. medical schools. (1) Only 17% reported having a core curriculum in women's health taught across medical school's four years. Medical schools were asked if their curricula included selected topics representing the knowledge, skills. and behaviors that doctors-in-training need to provide women with comprehensive carc. While 95% of schools that responded to the survey taught about sexual and reproductive function, medical interviewing, and exam skills specific to women, only a minority taught about women's leading causes of death and medical disorders that disproportionately affect women.

A 2006 study reported that 75[degrees]0 of medical schools had women's health courses, but only 7% offered interdisciplinary courses that provide a better grounding in women's health. Medical schools with a woman dean or a women's health program were somewhat more likely to have better women's health or gender-specific reformation in the curriculum:

The impact on women's health is negative. The 2010 National Women's Law Center's report card on efforts to meet women's health care needs notes that, while states continue to adopt policies to advance women's health, progress on advancing women's health "has slowed and in some cases stagnated at a time when they still have a long way to go." NWLC concludes that the nation is "still so far from meeting key women's health oblectives that it receives a grade of 'Unsatisfactory' nationally and in 48 of the 50 states." (3) In 2010. an Institute of Medicine report on women's health noted the deficiency m physicians education and stressed the need to "rapidly translate the research findings m women's health into clinical practice and policies." (4)

How can we convince medical schools to do better at teaching womens health? The American College of Womens Health Physicians (ACWHP) was founded to improve medical school women's health curricula--and hence womens health care. ACWHP initially advocated for a new women-s health specialty to integrate knowledge from internal medicine, obstetrics-gynecology, psychiatry, and behavioral sciences, and to encompass cultural ethnic and socio-economics factors that affect women s health. (There are currently 145 medical specialties and subspecialties, including many--such as Aerospace Medicine and Undersea & Hyperbaric Medicine that are much narrower than women's health!)

The outcry was dramatic. Physicians in family medicine, internal medicine, and obstetrics-gynecology protested that they already provided adequate care to women. (Experts would disagree!) ACWHP also encountered resolute opposition from the American Medical Association (AMA) and the American Board of Medical Specialties, which approve new medical specialties. The AMA actually passed a resolution against a Women's Health Specialty that still remains on the books!

ACWH P decided against pursuing an effort to establish the specialty through an act of Congress (the Family Medicine specialty was created this way, in 1969, to address a shortage of primary care physicians). Instead. ACWHP is focusing on improving medical schools' women's health curricula. Its current core project, Advancing Women's Health, is an on-line digital library of women's health resources that can be shared among medical educators and those interested in learning about women's health. ACWHP also advocates for including more comprehensive women's health questions on the national board exams all medical students take If successful, the thinking is that medical schools whose students do poorly on the women's health questions will upgrade their curricula.

We want to mention two noteworthy projects First, another national survey of gender-specific and women's health medical school curricula is currently underway Second, a model project at the Texas Tech University Health Science Center campus in Amarillo is training medical students to momtor and report women's health and gender-specific material in their courses. Both efforts will provide new details about women's health and genderspecific medical education.

You can help as well. Visit Medpedia's section on Advancing Women's Health ( ,groups/444) and tell ACWH P what women's health areas you think need the most attention. And, participate in Raising Women's Voices for the Health Care We Need (, which works for universal access and health policies that meet women's diverse needs.

References are available on-line or by emailing

by Charlea T. Massion, MD & Adriane Fugh-Berman, MD

Charlea T. Massion, MD, is a family physician and cofounder of the American College of Women's Health Physicians; she teaches at Stanford university School of Medicine's Center for Education in Family Medicine.

Adriane Fugh-Berman, MD, is an associate professor in the Georgetown University Medical Center, a former chair of the NWHN, and director of, which educates prescribers about pharmaceutical marketing techniques.
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Title Annotation:Prescription for Change
Author:Massion, Charlea T.; Fugh-Berman, Adriane
Publication:Women's Health Activist
Date:May 1, 2011
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