Directory of Internal Medicine Residency and Fellowship Programs in Women's Health,2022

Introduction

With the expansion of medical knowledge and evolution of existing health disparities, the clinical significance of sex- and gender-based differences has become increasingly apparent. The health care needs of patients assigned female at birth continue to lag behind those of men. Maternal mortality and morbidity remain unacceptably high; with the overturn of Roe the full spectrum of reproductive health care is no longer available in every state. Beyond reproductive needs, sex- and gender-based health care needs remain undertreated across a broad spectrum of care, from cardiovascular disease to cancer screening. ^{1 –5}

Medical trainees and residency directors recognize the importance of offering comprehensive care to women. ^6,7 However, despite efforts from residency programs to include gender-specific curricula, dedicated women's health education for internal medicine residents remains far from comprehensive. ⁸ Approximately one quarter of residency programs do not offer a dedicated women's health experience and there are significant discrepancies between the content that program directors identify as core women's health topics and implemented curricula. ⁶ Residents and residency graduates often do not feel prepared to provide comprehensive gender-specific care to women. ⁹ To address this deficiency and to meet the health care needs of women, internal medicine residencies have established specific women's health training programs. Beyond residency, there are dedicated women's health fellowships for those who wish to continue their training in gender-specific care.

These residencies and fellowship programs produce clinicians who are uniquely qualified to provide gender-specific care. ^{10 –12} Beyond clinical care, graduates of these programs are more likely to become leaders in women's health and teach women's health to the next generation of physicians, thus helping to address the educational gaps that currently exist in medical training in this area. ^10,11 Previously, a regularly updated directory of women's health training programs was published to advise medical trainees interested in women's health care. However, the last update to this directory was in 2015. ¹³ The goal of this study is to provide an updated centralized and comprehensive list of internal medicine women's health residency and fellowship programs.

Methods

We identified active women's health residency and fellowship programs for internal medicine trainees through several methods.

Starting with the residency and fellowship programs identified in the 2015 directory, we reviewed the websites to confirm program and contact information. For residency training programs, we then used the publicly available Electronic Residency Application Service (ERAS) to identify and obtain contact information for internal medicine residencies with women's health tracks. In addition, because the Veterans Health Administration (VHA) sponsors several women's health fellowships, we reviewed the VHA's listing of women's health fellowships. Once we had our initial list of training programs, we shared it with a national group of internal medicine women's health educators at the Society for General Internal Medicine national meeting and solicited additional programs not already on our list.

All identified programs were then sent an electronic survey using Qualtrics asking for confirmation that they offered a women's health training program and for details about the program, including program contact information, website, number of trainees per year, educational offerings, and program highlights. At the end of the survey, respondents were presented with a list of the identified programs and asked if they were aware of any additional training programs. Additional programs were then contacted and sent the electronic survey. This study received a designation of nonresearch for IRB exemption by the Milwaukee VA Medical Center.

Results

We identified a total of 25 training programs, including 12 residencies and 13 fellowships, 7 of which are offered by the VHA. These programs are listed in Table 1 (residencies) and Table 2 (fellowships), with the program contact information. Additional details about each program are available in the Supplementary Appendix.

Discussion and Conclusion

This directory identified 25 internal medicine women's health training programs, confirming that women's health education is still an important and viable clinical training option. Compared with the 2015 directory, the number of residency programs with women's health tracks has increased from 8 to 12, although there has been movement in track closures (Massachusetts General, Stony Brook, Virginia Commonwealth) and openings (Allegheny, Ascension, Mayo, Medical College of Wisconsin, University of Chicago, University of Miami). ¹³

The overall number of fellowship programs is lower in this directory (13) compared with 2015 (26), in part because we excluded programs that were not available to internal medicine residency graduates. Of the programs open to internists, those at Columbia, MacNeal Hospital, Portland VHA, and University of Michigan are no longer available, and a new program is available at Northwell Health. ¹³ Additional research would be needed to further explore the broad and more individual contributors to track and fellowship closures.

We aim for this updated directory to disseminate women's health program information and awareness, with the goal of fostering and enhancing graduate medical education in this important area. We recognize that not all existing and developing women's health programs may be captured in this directory. Although women's health training can encompass the knowledge needed to provide care to patients with a variety of gender identities, we recognize that there is a growing number of programs in sex- and gender-based medicine, including specific LGBTQ+ fellowships that are not captured in this directory. With the continuing gaps in gender-based medical care, this directory may serve as a reference to guide interested learners, program directors, and mentors in training the next generation of physicians to provide comprehensive care to women.