The Department of Emergency Medicine at The Warren Alpert Medical School of Brown University has a Division of Sex and Gender in Emergency Medicine (SGEM), responsible of an SGEM Fellowship and an SGEM (Resident) Elective Education.

Alyson J. McGregor et al. (2014)1 described the rationale, methods and solutions used to develop the curriculum (learning objectives, competencies and activities/recommendations) and to cope with barriers for stablishing an SGEM training programme based in a department of Emergency Medicine (EM). Their paper presents suggestions for establishing elective and fellowship experiences that could serve as a framework for similar programs. Incorporating curricula in women’s health, and sex- and gender-based medicine more formally within emergency medicine, is a first step toward recognition as a subspecialty. Additionally, these programs can be a strategic asset, serving as a resource for education, clinical care, and research. Establishing additional programs will benefit departments seeking to develop experts in women’s health and sex- and gender- based medicine who can lead the next generation. (p.1476)
 

Introduction

Sex- and gender-specific medicine (SGM) is a rapidly developing field rooted in women’s health. […] EM is an ideal specialty to cultivate this new field because of its broad interdisciplinary nature, increasing numbers of patient visits, and support from academic medical centres to promote expertise in women’s health. (p. 1469)

In 2013, The Journal of Womens Health published a Directory of Residency and Fellowship Programs in Womens Health,listing 23 fellowship programs in the United States dedicated to providing subspecialty training in womens health. Identifying the educational gap that none were sponsored by departments of EM […] a curriculum for EM residents on sex, gender, and womens health [….] was developed at the Alpert Medical School of Brown University also identifying areas where emergency care, gender-specific medicine, and clinical research overlap to contribute to the growing body of scholarship on womens health beyond reproductive issues. The curriculum subsequently evolved into a novel postgraduate training program designed to meet the need for focused and intensive training in womens health and SGM in the context of EM. The program draws on local resourcesin medical education, research, and clinical careto provide a unique specialty training experience. (p. 1470)

The decision to establish a women’s health/SGM fellowship evolved from positive experiences with the EM elective, favorable institutional conditions, and the need to develop leaders in the field of women’s health and SGM. (p. 1471)

Objectives

To develop the Women’s Health/SGM elective curriculum for EM residents, 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. Additionally, core faculty held informational interviews with content experts and developed educational objectives. […] Focus groups with local educational stakeholders were conducted to refine the learning objectives and identify available resources. The process resulted in a distinct educational goal: To teach residents how to improve emergency medical care of women through discovery of the biological, physiological, pathological, and therapeutic differences between men and women and how that influences emergency care for all. Learning objectives were then developed that broadly reflect the important topics for EM residents to learn on a women’s health/SGM elective. The Learning Objectives established for the Women’s Health/SGM Resident Elective were:

  1. Recognize sex and gender differences in the acute presentation and management of common EM conditions.
  2. Explain the scientific evidence behind current controversies in the diagnosis and management of sex-specific conditions, such as emergency urological, gynecological, and obstetric conditions.
  3. Identify risk factors and effective screening tools for intimate partner violence (IPV) and sexual assault, as well as best practices for treating victims of IPV and sexual assault.
  4. Understand the unique medical and mental health needs of transgender or gender variant patients, including barriers to health care access. (pp. 1470-1471)

Developing the curriculum for the Women’s Health/SGM Fellowship followed a rigorous process, similar to that of creating the resident elective, but with emphasis on advanced clinical proficiency, research skills, teaching abilities, and leadership. The goal for this kind of Fellowship is to develop physician-leaders with the specialized knowledge and skills for clinical care, education, research, and advocacy in women’s health and SGM. […] It was designed as a 2-year experience with adequate time to achieve the following objectives:

  1. Gain the skills necessary to practice comprehensive SGM emergency care.
  2. Develop research skills to address evidence gaps in SGM emergency care.
  3. Complete a master’s degree in public health or other related advanced degree coursework.
  4. Identify teaching, leadership, research, and advocacy opportunities in women’s health/SGM.
  5. Recognize the unique challenges associated with the care of gay, lesbian, and transgender patients in the ED. (pp.1470-1471)

Details

Focusing on the Women’s Health/SGM Fellowship, the selection process seeks to identify EM residents with demonstrated interest and aptitude for academic medicine. Non-EM graduates may also be considered, with options to complete their clinical experience in primary care or urgent care settings. This flexibility allows a program to accommodate candidates with various training backgrounds and support career interests that include acute care, but perhaps not EM. A 2-year program provides sufficient breadth and allows fellows to customize some aspects of the experience. The fellowship will likely be less structured than the resident elective to allow for exploration of specific interests. Depending on their specific goals, fellows may choose to spend more time focusing on either teaching or research activities, especially during their second year. (p.1471)

Fellowship Core Competencies have an emphasis on research, teaching, and the routine incorporation of sex and gender into clinical practice. The fellowship extends beyond EM, promoting a broader understanding of sex, gender, and women’s health through experiences in public health and population research. […] Key fellowship elements include clinical work, formal research training through coursework, hands-on research experience, teaching opportunities, leadership development, and ongoing self-directed learning. (p.1473)

For more information on this programme: http://www.rhodeislandhospital.org/services/emergency-department/sex-gender-in-emergency-medicine-SGEM.html;

 

*The quotations are extracted from the paper:  Alyson J. McGregor, Tracy E. Madsen, Brian Clyne, 2014. Foundations for a Novel Emergency Medicine Subspecialty: Sex, Gender, and Women’s Health. Academic Emergency Medicine 2014;21:1469–1477.

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