NEEDS ASSESSMENT ?
A longitudinal women's health curriculum: A multi-method,
multiperspective needs assessment
Amy M. Autry, MD, Linda N. Meurer, MD, Vanessa M. Barnabei, MD, PhD, Sandra S. Green, MD, ?
Anna P.Johnson-Masotti, PhD, Laura L. Otto-Salaj, PhD, Dawn St. A. Bragg, PhD, ?
Robert Treat, MS, and Deborah E. Simpson, PhD ?
OBJECTIVES: To define critical competencies in women's health for medical student education and to as ?
sess the degree to which they are taught. ?
STUDY DESIGN: A set of competencies in women's health was developed. A multi-method needs assess ?
ment was implemented. ?
RESULTS: Faculty and student evaluations revealed no major areas of disagreement but did identify major ?
deficits in the basic sciences including the physiologic influence of estrogen on nongynecologic organ sys ?
tems and of androgen on various organ systems, nutrition, and alternative medicine and the difference be ?
tween the sexes in disease processes, presentation, and treatment. In the clinical years, there are important ?
deficits in the teaching of diseases unique to women, limited attention to psychosocial aspects of women's ?
health, and no cohesive teaching of a gender-specific approach to clinical e ~ a l u a t i o n . ?
CONCLUSION: In the medical school curriculum, gender's effect on disease is inadequately addressed. ?
An integrated longitudinal approach to gender-specific medicine is needed. (Am J Obstet Gynecol ?
2002; 187:S12-4,) ?
Key words: Women's health, curriculum needs assessment
Women's health care issues have been defined by the
US Public Health Service as those diseases or conditions
that are unique to women, more prevalent or more seri
ous in women, or those for which risk factors or interven
tions are different in women.! Education in women's
health care has been fragmented and poorly coordi
nated, resulting in significant gaps in physician knowl
edge, skills, and attitudes. Indeed, the Liaison Committee
on Medical Education standards state that medical stu
dents should ~ l e a r n to recognize and appropriately ad
dress gender and cultural biases in health care delivery,"2
yet results from the 2000 Association of American Med
ica) Colleges' Senior Graduation Questionnaire reveal
that 25% of students reported inadequate instruction in
From the Medical College of Wisconsin, Milwaukee,
Supported lry Medical College of Wisconsin Learning Resource Grant
Presented as a poster at the Association of Professors of Obstetrics
and G,vnecology/The Council on ResidenJ Education in Obstetrics
and Gynecology annual meeting, Lake Buena Vista, Fla, March 7
Reprints are not availablefrom the authors,
© 2002, Moslry" Inc. All rights reserved.
0002-9378/2002/$35.00 + 0 6/0/127369
doi: lO,1067/mob.2002, 127369
Gender-specific medicine is a rapidly growing area of
medicine encompassing all disciplines of medical edu
cation. "Diseases may not affect women in the same way
as they affect men and knowledge gained from studying
men is not necessarily applicable to understanding dis
ease occurrence, diagnosis, or treatment in women."4
Traditionally, medical school education has been di
vided into basic science and clinical years with a clinical
experience in obstetrics and gynecology as required by
the Liaison Committee on Medical Education. Al
though a focused experience in obstetrics and gynecol
ogy is an essential part of medical education, it alone
does not meet the need for an integrated, longitudinal
curriculum in women's health. Recently, educators in
traditional curriculum structures have sought to inte
grate basic and clinical sciences to increase learning,
retention, and reinforcement of key concepts (eg, ge
netics, geriatrics, end-of-life) throughout the 4 years of
medical schooL5 Several medical schools have sought
to incorporate women's health into their curriculum,
although few have been successful throughout all 4
years. Most institutions report the development or ad
dition of electives or special presentations rather than
inclusion of women's health within the required
courses or clerkships,
Volume 187, Number 3
Am] Obstet Gynecol
. Autry et al 813
Table 1. Methods of assessment
First and second years
Third year Fourth year
Nu-Dist analysis of co-ops (student notes)
Development of a longitudinal curriculum requires a
systematic approach with a baseline needs assessment for
the identification ofgaps. This article presents the results
ofa multi-method, multiperspective needs assessment for
an integrated women's health curriculum b a ~ e d on a set
oflongitudinal women's health objectives for medical stu
Material and methods
A Women's Health ad hoc committee (\VHC) of the
medical school's Curriculum and Evaluation Committee
(CEC), the faculty oversight committee for medical stu
dent education, was established and received $10,000 in
funding from its Learning Resources Fund. Led by an ex
perienced obstetrics and gynecology faculty member, the
committee included representatives from basic science
and clinical departments with consultation and staff sup
port from the Office of Education Services. Based on a
critical review of the literature and published women's
health objectives, the V,'HC developed a comprehensive
set of competencies in women's health to span all 4 years
'and across disciplines.
The competencies were divided into 5 categories: nor
mal biologic and psychosocial differences between men
and women, normal biologic processes and health issues
unique to women, effect of gender on general disease
processes, disease processes unique to women, and a gen
der-specific approach to clinical evaluation and manage
ment. After these objectives were approved by the CEC,
the WHC developed a unique multi-method, multi per
spective needs assessment strategy to evaluate the degree
to which the current medical student curriculum ad
dressed these competencies by focusing on the congru
ency of course and clerkship directors' purported
content and students' perceived content (see Table I).
The WHC reviewed each competency and identified
for each basic science course and clinical clerkship a sub
set of competencies that were congruent with their con
tent and patient mix. Each course and clerkship director
received a tailored set of competencies and was a ~ k e d to
rate the degree to which the competencies were ad
dressed in his or her course or clerkship. Individual com
mittee members were responsible for obtaining course
directors' responses and following up ambiguous or miss
ing responses. We then created a matrix of competencies
by course or clerkship to identify potential areas of over
lap and curriculum gaps.
To detect potential differences in the purported course
content (course!clerkship director's assessment) com
pared with the perceived content (student's perception),
we gathered student data by using 1 of 3 strategies. First,
the student co-ops (note service) were analyzed for the
major courses in the first 2 years to identify all references
to key words associated with the approved objectives by
using a qualitative software analysis program (Nu-Dist;
Qualitative solutions and Research Pty Ltd, Doncaster,
Melbourne, Australia). All "hits" were then individually
evaluated to determine their validity. Second, a survey of
the assigned competencies was given to all third-year stu
dents at the end of their October clerkships asking them
whether the competencies were discussed "not at all, ~
"occasionally," or "frequently." The responses from these
two sources were tabulated and placed in categories of
"covered well," "acceptable," and "poorly covered." These
responses were then compared with the course and clerk
ship directors' matrix.
The third strategy involved the use offocus groups for
in terviewing graduating seniors. Three focus groups were
conducted by the Assistan t Director of the Office ofEdu
cational Services, a trained facilitator, using a structured
focus group protocol.6 The first group consisted of 2
male and 2 female students entering the field of obstet
rics and gynecology. The second group consisted of 2
women not pursuing obstetrics and gynecology special
ties, and the third group consisted of8 men not entering
the fieJd of obstetrics and gynecology. The focus groups
met for 1 to 2 hours in the evening, with one committee
member in attendance. The sessions were audiotaped
and analyzed, and findings were summarized by the facil
Analysis of the matrices from each data collection re
vealed no differences between the course directors' sur
vey, the students' survey, the co-op note analysis, or the
conclusions from the focus group interviews. Results of
the first-year and second-year data revealed that normal
biologic and psychosocial differences between the sexes
are well covered in the basic sciences. Notable deficits in
clude the- physiologic influence of estrogen on riongyne
cologie organ systems and the influence of androgen on
various organ systems. Nutrition is poorly covered with re
spect to changing needs during pregnancy lactation and
in various lifestyles. Alternative medicine is not taught.
814 Autry et at Download full-text
Except for isolated topics, the differences between the
sexes in disease processes, presentation, and treatment
are not taught. Important deficits in the teaching of dis
eases unique to women include premenstrual syndrome,
preconception counseling. postpartum depression, vul
var and vaginal disease, and pediatric and adolescent gy
necology. Psychosocial aspects of women's health
including the impact of poverty on health care and gen
der differences associated with this impact; the societal
burdens ofsexually transmitted diseases, teen pregnaHcy,
aging; and a global perspective of gender-related health
disparity and abuse are lacking. There is no cohesive
teaching of a gender-specific approach to clinical evalua
tion, management, prevention, screening, strategies to
promote wellness, or patient communication and educa
tion. The students displayed limited knowledge of avail
able community resources for all aspects of women's
Students reported that the primarylocation ofgender
specific medicine education occurs in the clinical clerk
Our multi-method, multiperspective needs assessment
offacuIty-purported and student-perceived objectives re
vealed consistent and crucial deficits in the area of
women's health. In November 2000, the Association of
Professors ofGynecology and Obstetrics convened a mul
tidisciplinary retreat, the goal of which was the develop
ment of a set of women's health care competencies for
AmJ Obstet Gynecol
medical students, which were subsequently published
and widely distributed} These competencies, although
grouped differently than the competencies developed
and used as the basis for this study, are highly congruent,
and thus, we believe our needs assessment, methodology,
and results have broad generalizability. Early involvement
of the CEC and course and clerkship directors in the
needs assessment approach and including student evalu
ations as a validity check proved to be an effective strategy
for identifying key areas of curriculum reform specific to
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