Department of Family & Community Medicine

Enhanced Skills Program: Women's Health Goals and Objectives

This outlines a 12-month extension to an accredited Canadian 24-month residency-training program in Family Medicine. As such, the following objectives should be seen to be in the context of the two year program plus this third year. Some of the objectives would already have been attained in Canadian two-year family medicine residency programs, and this year builds on that foundation to achieve objectives where the focus and context is women’s health.

This is a one year full-time program beginning July 1st. The year combines clinical work with course work,research and academic activities. Much of the year is elective/selective time which allows the scholars to pursue in depth experience in specific areas of women's health.

Please note: Recognizing that sometimes it is helpful to look at women as a group; individual differences will be considered paramount in this program. Scholars will also be encouraged to consider the differences between women’s health and gender and health.

At the beginning of the year, in accordance with the principles of adult learning, the trainee and
program director will use a learning plan to set individualized clear goals and objectives that will take
into account the overarching objectives of the program as outlined below.

GOALS OF THE PROGRAM:

  1. To develop generalist physicians with a commitment to the four principles of family medicine(CFPC) and the CanMeds Roles with clinical expertise in women’s health.
  2. To advance knowledge and skills that enable graduates to perform equitable health research/scholarship.
  3. To foster leadership and advocacy in women’s health.
  4. To produce exemplary teachers and role models in women’s health.

OBJECTIVES:

(1) Medical Expert

Family physicians with women’s health expertise will be able to:

  • Consider women in a larger framework which includes acknowledgement of their unique biological issues, sociopolitical and historical context, their culture/race or ethnicity, their economic positions including employment, security and access as well as how they are uniquely affected by health care policy and economics.
  • Establish and maintain up to date clinical knowledge, skills and attitudes in areas which may include the following as set out by the individual scholar in consultation with the program director in accordance with the principles of adult learning:
    • Asthma in women
    • Breast health
    • Breast Feeding
    • Brief Psychotherapy for Women
    • Cardiovascular health in women
    • Dermatology in women
    • Foot Care in women
    • Medical Diseases in Pregnancy
    • Nutrition Services
    • Osteoporosis
    • Sport medicine in women
    • Diabetes in women
    • Health education
    • Health promotion in areas of violence against women
    • Infertility & reproductive education
    • Gynecology
    • Body image care
    • HIV in women
    • Health and well-being of immigrant and refugee women Etc.

(2) Communicator

  • Family physicians with women’s health expertise will be able to...
  • Develop rapport, trust and ethical therapeutic relationships with patients and families.
  • Accurately elicit and synthesize relevant information and perspectives of patients and families, colleagues and other professionals.
  • Develop a common understanding on issues, problems and plans with patients and families, colleagues and other professionals to develop a shared plan of care when appropriate.
  • Convey effective oral and written information about their medical encounters.
  • Communicate effectively with patients in an effort to maximize health promotion.

(3) Collaborator

Family physicians with women’s health expertise will be able to:

Participate effectively and appropriately in an interprofessional healthcare team.

Effectively work with other health professionals to prevent, negotiate and resolve interprofessional conflict.

Reconsider traditional models of hierarchy in medicine and medical education.

(4) Manager

Family physicians with women’s health expertise will be able to:

  • Participate in activities that contribute to the effectiveness of healthcare organizations and systems and promote gender equity within them.
  • Manage their practice and career effectively.
  • Allocate finite healthcare resources appropriately.
  • Serve in administration and leadership roles, as appropriate in order to ensure the consideration of women at all levels of governance.
  • Participate as co-managers or team members in health care teams in order to re-consider the usefulness of hierarchy in team work.

(5) Advocate

Family physicians with women’s health expertise will be able to:

  • Respond to individual patient health needs and issues as part of patient care.
  • Respond to the health needs of their own practice community.
  • Promote the health of individual patients, communities and populations.
  • Advocate for women’s health needs as appropriate locally, nationally and /or internationally.

(6) Scholar

Family physicians with women’s health expertise will be able to:

  • Assess research articles for gender bias.
  • Consider the risks associated with research involving pregnant or lactating women and recognize alternative approaches to gathering high quality data in this and other vulnerable populations.
  • Include sex disaggregated data in any/all research initiatives.
  • Recognize and consider other ways of ‘knowing’.
  • Consider menstrual cycle changes, hormonal differences and pre/post menopausal status throughout research and how this may affect pharmacokinetics and other data measurement.
  • Incorporate the above into their role as teachers and role models for colleagues, other health care professionals and students of all genders.

(7) Professional

Family physicians with women’s health expertise will be able to:

  • Demonstrate a commitment to their patients, profession, society and the population of women through ethical practice.
  • Demonstrate a commitment to their patients, profession, society and the population of women through participation in profession-led regulation.
  • Demonstrate a commitment to physician health and sustainable practice through the balancing of personal and professional priorities, striving to heighten personal and professional awareness and insight and recognizing other professionals in need and respond appropriately.

THE FOUR PRINCIPLES OF FAMILY MEDICINE IN A WOMEN’S HEALTH CONTEXT:

PRINCIPLE–The Family Physician is a Skilled Clinician

Family Physicians have demonstrated competence in the patient-centered clinical method; they integrate a sensitive, skillful, and appropriate search for disease. They demonstrate an understanding of patients’ experience of illness (particularly their ideas, feelings, and expectations) and of the impact of illness on patients’ lives.

Family physicians use their understanding of human development and family and other social systems to develop a system based approach to the management of health and disease that is family focused and is in the context of the community in which the patient resides.

Family physicians are also adept at working with patients to reach common ground on the definition of problems, goals of treatment, and the roles of the physician and the patient in management. They are skilled at providing information to patients in a manner that respects patient autonomy and empowers the patient to “take charge” of their own health care and make decisions in their own best interests.

Family Physicians working specifically with the female population have an expert knowledge of the wide range of common problems that affect women and the complex interactions of the social determinants of health which influence and are influenced by these problems. Their approach to health care is based on the best scientific evidence available. Family physicians collaborate with members of health care teams and other professionals and agencies to achieve the best possible outcomes with patients in the most effective and efficient manner possible.

Family physicians act as scholars to advance their own knowledge and skills, as well as advancing the discipline of family medicine with respect to women’s health.

PRINCIPLE–The Patient-Physician Relationship Is Central To the Role of the Family Physician

Family physicians through their training, experience and communication skills develop an understanding and appreciation of the human condition, especially the nature of suffering and patients’ response to sickness. They are aware of their strengths and limitations and recognize when their own personal issues interfere with effective care.

Family physicians respect the privacy of the person. The patient-physician relationship has the qualities of a covenant—a promise, by physicians, to be faithful to their commitment to patients’ well-being, whether or not patients are able to follow through on their commitments. Family physicians are cognizant of the power imbalance between doctors and patients and the potential for abuse of this power. Family physicians commit to the highest standards of professionalism.

Family physicians respect the need of their patients for continuity of care. They use the close ongoing contact with patients to build on the patient-physician relationship and to promote the healing power of interactions. Over time, the relationship takes on special importance to patients, their families, and the physician.

PRINCIPLE–The Family Physician is a Resource to a Defined Practice Population

The family physician considers her/his practice as a ‘population at risk’ and organizes medical services to ensure that their patients’ health is optimal. Such organization requires the ability to evaluate new information and its relevance to specific patients who identify with certain groups (i.e. immigrants, refugees, women with HIV etc.). This organization also requires the knowledge and skills to assess the effectiveness of care provided and the appropriate use of medical information systems and resources. Also included is the ability and willingness to plan and implement policies that will enhance patients’ health.

Family physicians have effective strategies for self-directed, lifelong learning.

Family physicians have the responsibility to advocate for public policy that promotes their patients’ health.

Family physicians accept their responsibility in the overall health care system for wise stewardship of resources.

Family physicians consider the needs of the individual, the community and the health care system.

PRINCIPLE – Family Medicine is a Community-Based Discipline

Family practice is based in the community and as such is significantly influenced by community factors. As a member of the community, the family physician is able to respond to populations of peoples’ changing needs, to adapt quickly to changing circumstances, and to lead the mobilizing and management of appropriate resources to address patients’ needs. The family physician may also take care of patients in the home, other health care facilities or in hospital. Family physicians see themselves as part of a community network of health care providers and are skilled as managers of micro (patient-provider team) and macro (hospital-community) systems. As well they collaborate with other components of the health care system.

Description of the Program

Goal of the Program:

To provide philosophical and practical enrichment in Women’s Health based on a whole person approach in order to foster advocacy and develop leaders in the health care of Women. The Women’s Health Scholar Program provides opportunities for learning in health promotion, health education, clinical issues in women’s health, the provision of equitable research and scholarship, program design and theoretical principles.

Principles & Philosophy of Women’s Health:

The program is based at Women’s College Hospital, an academic health centre affiliated with the University of Toronto. The hospital is recognized as an international leader in meeting and promoting the health needs of women. Through its commitment to research, it develops, applies and communicates new knowledge with a focus on women’s health. The Women’s Health Scholar Program uses as its foundation the core values in women’s health developed at Women’s College Hospital.

Equity

We value, promote, and create equitable access and opportunities for achieving optimal health for the communities we serve through research, education, and practice. We build and advance a culture of inclusion and respect for all who work and visit here and we see this as our foundation of excellence.

Safety

We value quality and safety excellence in a learning environment that motivates care and service improvement through research, education, and best practice. We rigorously apply health, safety, and risk management practices to ensure a safe and healthy environment for all who work and visit the hospital.

Innovation

We value a culture of innovation, translating creative ideas, and new discoveries, or adapting previous solutions in new ways that energize the organization, revolutionize care, and contribute to system solutions.

Relationships

We value the collective strength, created through relationships within and beyond our organization, which aligns to support our mandate.

Leadership

We value and develop courageous, innovative, collaborative and accountable leaders whose decision-making is guided by evidence and expertise. We inspire others to achieve their goals and lead by example.

Collaboration

We value cooperative sharing of ideas and information that promote a positive climate and alignment within and across internal and/or external groups/partners and contribute to the development of sustainable, quality, system-integrated care.

Clinical Work:

The Women’s Health Scholars assume a 12-month commitment to work at the Family Practice Health Centre including low risk obstetrics if desired and the Bay Centre for Birth Control at Women’s College Hospital. This is an opportunity to work in clinical programs demonstrating a variety of models of health care delivery including community based, peer supervised, multidisciplinary and non-medical models. It is expected that scholars will attend all of their scheduled clinics with the exception of holidays, elective and unexpected illness. Exceptions may be made for attendance at conferences. Two months advance notice is needed for holidays and elective time. Where possible it is expected that scholars will cover for each other. The scholars will provide back up on-call coverage for the Family Practice Health Centre 3-4 weeks per year.

 

Course Work:

Scholars are required to attend two graduate level courses from the Graduate Collaborative Program in Women’s Studies at the University of Toronto or other graduate level courses in Women’s Studies approved by the Program Director. Courses may be taken for credit or audit. Some scholars have successfully combined this program with a Clinical Teaching Certificate or masters program at the University of Toronto.

Research/Scholarship:

Completion of a project approved by the program director is required. This can include a systematic review of the literature on a topic related to women’s health, or a more investigative project. Other types of creative activity such as program development or advocacy initiatives may be accepted on the approval of the program director.

Scholars are expected to attend research rounds. Once notified by the departments, Naz will send an email to the scholars with various rounds and topics.

Elective Time:

Each scholar is permitted one month of elective time approved by the director. During this elective month, you will not have your Family Practice nor Bay Centre responsibilities.

Selective Time:

There is considerable time for self-directed learning. Scholars can arrange in depth clinical experience in specific areas of women’s health. Possible sessions may be arranged in the following programs at Women’s College Hospital and scholars are also free to pursue outside selective experiences with the agreement of the program director:

Asthma in women Foot Care Centre
Breast Centre Medical Diseases in Pregnancy
Breast Feeding Clinic Nutrition Services
Brief Psychotherapy for Women Osteoporosis Clinic
Cardiovascular Services for women Sexual Assault / Domestic Violence Care Centre
Dermatology Centre Gynecology Clinic
Infertility Reproductive Life Stages Program











 

Academic Rounds/Seminars:

Scholars are required to organize and attend monthly core days in women’s health where speakers present on a broad range of women’s health topics. Additional rounds include department of medicine women’s health rounds, obstetrical rounds, family practice rounds, Bay Centre physician rounds, primary care obstetrics group meetings etc.

Teaching:

Scholars are expected to support undergraduate medical training by assisting in teaching or leading seminars, OSCE’s and facilitating the Community Population and Public Health (CPPH-1) or Arts and Science of Clinical Medicine (ASCM-1) Courses. Scholars will assist in supervision of clerks and family medicine residents at the Bay Centre for Birth Control, will present rounds, seminars and may be called upon to make presentations to community groups.

Program Director: Kymm Feldman, MD, CCFP, MHSc
Founding Director: Helen P. Batty, MD, CCFP, MEd, FCFP