1. Women’s Health Residencies
and Fellowships:
Priming the Pump for
Women’s Health Researchers
Melissa McNeil, MD, MPH
Professor of Medicine, Obstetrics, and Gynecology
Chief, Section of Women’s Health
University of Pittsburgh and
VA Pittsburgh Health Care System

2. What Makes a Women’s
Health Researcher?
 Understanding of what women’s health
means as a concept:
– Diseases unique to women
– Diseases that are more common in women
– Diseases that are different in women
 Inquiring mind able to ask interesting
questions about important questions
 Joy and passion for research

3. How to Incorporate Women’s
Health into a Curriculum?
Questions to consider:
 What level of training: preclinical medical student,
clinical medical student, resident, fellow
 Separate or integrated educational experiences in
women’s health (eg, teaching in categorical
residency vs women’s health residency track?)
 Elective or mandatory experiences?

4. Goals of Educational
Experiences at Pittsburgh
 Often and early exposure
 Offer both integrated and focused experiences
 Integration is mandatory for ensuring all learners
have exposure to concepts of gender specific
medicine
 Focused experiences important to allow for more
in depth study for those with heightened interest
 Accountability is critical

5. WHT at Pittsburgh
 Instituted at the request of the Dean
 First class recruited in 1994
 Three spots from the categorical residency
designated as “women’s health track”
 Separate match number
 Can expand to accommodate demand from
within the program

6. WHT Curriculum
 Weekly WH Seminar Series
 Unique ambulatory site with “gender based
primary care” precepted by WH faculty
 Specialized rotations in lieu of community based
ambulatory blocks
– Year 1: Urgent Gyne Clinic
– Year 2: Rotating Specialty Block, Mental Health
– Year 3: Rotating Specialty Block, Medical
Complications of Pregnancy, Student Health

7. WHT: Components of
Success
 Buy in from leadership: Program Director,
Division Chief, Chairman, Dean
 Dedicated faculty with General Medicine
 Identify partners within medical
subspecialties: oncology, cardiology,
endocrine, GI, cardiology
 Identify partners in other departments:
obgyne, psychiatry, adolescent medicine

8. WHT: Components of
Success
 First and foremost, goal of the program is to train
high quality internists
 All faculty are internists first; can discuss
hyponatremia as well as contraception
 Avoid the “feminazi” label
 Close mentoring: WH faculty mentor clinics,
senior talks, journal clubs
 Provides a sense of belonging within a large
university residency program

9. WHT as a Springboard for
Interdisciplinary WH Research
 Residents seeking fellowships seek research
opportunities and ways of distinguishing
themselves from the pack
 A WH focus allows for a unique identity
and the ability to consider the depth and
breadth of WH in the care of patients
 Broadens the scope of what WH research
can mean and begins to establish areas of
inquiry

10. Interdisciplinary WH
Research: Medical Students
 What is the best/most satisfactory
anesthesia for women in labor?
 What are the views of medical students
regarding reproductive choice?
 What do women domestic violence victims
want from their providers?
 What is the prevalence of the female athlete
triad syndrome in high school athletes?

11. Interdisciplinary WH Research:
Medical Resident Research
 What is the impact of inflammatory bowel
disease on a woman’s fertility?
 What is the impact of inflammatory bowel
disease on a woman’s sexuality?
 What is the association between cardiac
disease in women and psychosocial
conditions?
 How is congestive heart failure different in
men and women?

12. WHT: Benefits to Program
 Recruiting tool for individuals looking for a
 unique nitch in medicine
 Develops a critical mass of individuals with
similar interests for seminars, lectures, etc.
 “Infiltrative” approach to women’s health in
the rest of the program
 Supports the WH fellowship

13. WHT: Measures of Success
 Continued ability to recruit high quality
residents (currently 16 in the three year
track)
 Chief resident from the program every year
for the last five years
 Success in career choice/fellowship: current
senior resident career choices: endocrine,
rheumatology, GI, WH, CMR

14. Women’s Health Fellowship
 Initiated in 1994
 One of the original VA funded special
fellowship programs
 One fellow each year for a two year
fellowship with opportunity for a third year
of funding
 Goals are to train academic physicians—
either medical educators or researchers

15. Women’s Health Fellowships
 Strong environment
 Educational opportunities: Master's in
Reproductive Epidemiology, Master’s in
Clinical Science, Master’s in Medical
Education
 Content focus available in each master’s
program

16. Women’s Health Fellowships
 Research Opportunities
– Graduate School of Public Health with a focus
on women’s health epidemiology
– Magee Women’s Research Institute
– Pittsburgh Cancer Institute with emphasis on
breast and ovarian cancer programs
– Women’s Heart Program
– Women’s Behaviorcare Program

17. Components of Success
 Dedicated Funding
 Included within the broader general
medicine fellowships
 Strong clinical, educational, and research
environment
 Many mentors
 Critical mass
 Seed money for research

18. Women’s Health Fellowships
 25 % clinical time for research fellows (1/2 day of
clinic precepting and ½ day of own clinic, all in
women’s health program)
 Pursuit of master’s degree with training in clinical
research methodology
 Requirement for research project with
dissemination (poster, oral presentation,
publication)

19. Food for Thought
 How big is the market? How much interest
is there for more and more programs?
 Separate program or recruit from within?
 Should we define competencies for a
certificate of completion of a WHT for
residents or a women’s health fellowship?