Background
Sex- and gender-based women’s health (SGWH) addresses the healthcare needs of people assigned female at birth. While SGWH care is integral to internal medicine (IM) education, specialized training in advanced care and procedures is not available in many IM residency programs. Additionally, following the overturn of Roe v. Wade, training options in the full spectrum of reproductive health care are no longer available in all states. Fortunately, residency and fellowship programs exist to support SGWH training for internists. Graduates of these tracks are more likely to remain involved in SGWH care both in clinical practice and academically during their careers.1
Types of SGWH Educational Opportunities
While SGWH care is integral to the core curriculum for IM residency programs, additional opportunities for this training vary widely by program. This content is most often included in didactic or clinical sessions for all residents.2 Additional opportunities available to interested residents may include dedicated SGWH continuity clinics, electives in IM or specialty clinics, and areas of concentration or tracks.
A summary of SGWH residency and fellowship tracks for internists is available in a published directory that is currently in the process of being updated for 2022 by the SGIM Sex- and Gender-Based Women’s Health Education Interest Group.3 These tracks are open by application for interested IM residents/fellows and are based at university and/or VA programs. The tracks generally include focused clinical training in SGWH with additional opportunities for training in research and educational methods (including concurrent degrees such as MPH, MEd, and MSc).
Identifying Programs and Interviewing
Because of the wide variability in experiences offered by SGWH residency and fellowship programs, it is important to consider one’s goals and needs when identifying programs for application and to explore these key areas when interviewing. Of note, terminology may differ by program, with some programs using women’s health to include care of all patients assigned female at birth.
Think about the following when identifying programs for application and during interviews:
For SGWH Residency Tracks:
- How is the track education incorporated into the overall residency training?
- What clinical rotations and/or training are required?
- What are the elective opportunities?
- Does the program also offer a SGWH fellowship?
For SGWH Fellowship Programs:
- Is the program VA- or University-based (or both)?
- Is the fellowship a stand-alone program or a track within a larger program?
- Does the program offer opportunities for training in research and/or education (with option for corresponding advanced degree)?
- What is the balance of clinical, teaching, research, and other responsibilities?
For Both:
- How many residents/fellows participate in the program?
- What is the duration of the program?
- Is there a dedicated SGWH curriculum (didactic series, clinical conference, etc.)?
- What procedural opportunities (such as intrauterine device and contraceptive implants insertion/removals, endometrial biopsies, abortion procedures) are available during training?
- What clinical training opportunities (such as dedicated rotations in SGWH, breast health, pelvic pain clinics) are available during training?
- Is there a section of SGWH within the division or department?
- How many IM faculty specialize in SGWH care?
- Are there mentorship programs that provide opportunities for connection with SGWH faculty?
- Are there opportunities for SGWH learning and collaboration with other departments?
- What scholarship opportunities are available?
- What do graduates do after completing residency/fellowship?
If the residency program does not have a dedicated track, many of the above questions would still be relevant to discuss SGWH training options outside of a track. Additionally, consider asking about elective opportunities and provision of SGWH care within continuity clinic.
Conclusion
In the evolving landscape of access to SGWH care, general internists will be increasingly called upon to fill in care gaps for these patients. Trainees aiming for careers focused in SGWH care should consider seeking out residency and fellowship programs with dedicated education in this area.