ASSOCIATION OF PROFESSORS OF GYNECOLOGY AND OBSTETRICS

APGO Global Women’s Health Medical Trainee Objectives

APGO Global Women’s Health Medical Trainee Objectives

Global health for women encompasses multidisciplinary practice and research focused on decreasing disease and health disparities and political and health inequities for all women worldwide going beyond borders in both public health, education and individual clinical care on all issues affecting women’s health.

These competency-based goals and objectives were developed by the Association of Professors of Obstetrics and Gynecology Committee on Global Health to address the lack of standardized objectives specifically addressing women’s health in global settings and for US vulnerable populations including refugee and immigrant communities. Vulnerable populations in the US are those at increased risk for poor health status and health care access (e.g. homeless women, those with substance abuse issues, incarcerated women). These curriculum objectives are intended as a guideline for Obstetrics and Gynecology programs offering organized courses in global health and/or refugee and immigrant health. Organized programs might include all or some of the following:

  • didactic curriculum
  • research experiences
  • hands-on experiences in the global health settings
  • direct clinical (or face-to-face) experiences with refugee and immigrant population
  • other domestic underserved populations
  • programmatic experiences with international health governmental and non-governmental agencies

The curricular objectives are not meant to be prescriptive or encourage requirements for educational programs. Clerkship directors and residency programs directors are encouraged to review these guidelines and adapt them to the needs of the individual program. Additionally, with every objective, learners are encouraged to compare and contrast with experiences at their home US institution. Objectives identified with an asterisk (*) may be met by review of didactic online APGO “Learners in Low Resource Settings” modules.

Educational Objective[1] ACGME Competencies CUGH Competencies[2]
General Global Health Objectives: Global, U.S. Underserved and Refugee/Immigrant Health
1. Define the following terms: health care disparity and health equity. ● MK, SBP ● Health equity and social justice; Socio-cultural and political awareness
2. Describe how globalization contributes to the epidemiology of communicable as well as chronic diseases. ● MK, SBP ● Globalization of health and healthcare
3. Define the terms: refugee, asylee, immigrant.* ● PC, PBLI ● Globalization of health and healthcare; Social determinants of health; Health equity and social justice
4. Compare and contrast the practice of medicine in “technology-rich” settings (such as the majority of the US) and in low resource/“technology-poor” settings (global health setting, underserved area/population in the US). ● PC, SBP ● Professional practice
5. Demonstrate a basic understanding of the relationship between health, human rights, and social/gender inequities. ● SBP, PC ● Health equity and social justice; Social determinants of health
6. Explain the role of gender inequality in the health status of women particularly in global health settings, vulnerable populations in the US and immigrant/refugee communities. ● PC, ISC, PBLI ● Social determinants of health; Health equity and social justice
7. List major social, economic, and environmental determinants of health and their impact on access/quality of health services, particularly maternal morbidity and mortality, in global health settings, vulnerable populations in the US and immigrant/refugee communities. ● PC, SBP ● Social determinants of health; Health equity and social justice
8. Identify cultural practices, values and professional dynamics unique to global health settings and/or within a specific refugee/immigrant population that influence communication and healthcare decision making, including the use of translators/interpreters. ● PC, SBP, PBLI, ISC ● Social determinants of health; Socio-cultural and political awareness; Ethics
9. Articulate barriers to healthcare in global health settings, vulnerable populations in the US and immigrant/refugee communities. ● PC, SBP ● Social determinants of health; Health equity and social justice
10. Demonstrate respect for the unique cultures, values and roles of patients and family members in global health settings and/or within immigrant and refugee communities. ● ISC, P, PC, PBLI ● Collaboration, partnering, communication; Social-cultural and political awareness; Professional practice
11. Describe how different health care delivery systems influence access to care, content of care, and patient participation and empowerment. ● PC, SBP ● Globalization of health and healthcare; Social determinants of health; Health equity and social justice
12. Compare and contrast the roles and responsibilities of professional colleagues (physicians, nurses, social work, etc.) in a global health setting to your home environment. ● SBP, ISC, PBLI ● Collaboration, partnering, communication; Social-cultural  and political awareness
13. Describe how health care providers (those not commonly encountered in the US) such as community health workers and traditional birth attendants contribute to women’s healthcare in global health settings. ● PC, SBP ● Globalization of health and healthcare; Social determinants of health
14. Recognize ethical dilemmas frequently experienced during global health work and/or when working with vulnerable populations ● PC, P, PBLI, ISC ● Ethics; Health equity and social justice; Professional practice
15. Explain the importance of a bidirectional exchange and capacity strengthening in the practice of global health and outline potential pitfalls related to the development of global health partnerships. ● ISC, P, SBP ● Capacity strengthening; Collaboration, partnering,  communication
16. Describe the financing and organization of health care for vulnerable populations in the US at the federal, state and local level.* ● PC, SBP ● Health equity and social justice; socio-cultural and political awareness
17. Identify the major governmental and non-governmental organizations active in global women’s health (WHO, Global Fund, etc.) and give examples of major initiatives and programs (UNFPA Millennium Development Goals) that impact women’s health. Describe how the policies, priorities and funding structures of these organizations impact global women’s health. ● SBP ● Socio-cultural and political awareness
Women’s Health Specific Objectives: Global, US Underserved and Refugee/Immigrant Health
18. Describe the major causes and known effective interventions for prevention and treatment of maternal morbidity and mortality around the world.* ● MK ● Global burden of disease
19. Describe how the epidemiology of maternal morbidity and mortality varies with geography, socioeconomic status, and race.* ● MK ● Global burden of disease; Social determinants of health;  Health equity and social justice
20. Outline the approach (presentation, work-up, management, treatment barriers) to pregnant woman with the following presentations in global health settings, and immigrant and refugee communities:

  • Routine prenatal careLabor
  • Obstructed labor
  • HIV/AIDS*
  • Tuberculosis*
  • Malaria*
  • Malnutrition
  • Anemia
  • Hypertensive disorders of pregnancy
● PC, MK, SBP ● Global burden of disease; Health equity and social justice; Professional practice
21. Discuss the health risks unique to the listed vulnerable populations in the U.S. and describe appropriate adaptations to the well-woman exam:*

  • Women with disabilities
  • Women with substance abuse issues
  • Incarcerated women
  • Homeless women
  • Women veterans
  • Obese women
● MK, PC, SBP ● Social and environmental determinants of health; health equity and social justice; Socio-cultural and political awareness
22. Outline the approach (presentation, work-up, management, treatment barriers) to the non-pregnant woman with the following presentations in global health settings:

  • Ectopic pregnancy
  • Unintended pregnancy
  • Infertility
  • STDs
  • Abnormal bleeding
  • Pelvic pain
  • Vaginal discharge
  • Menopausal symptoms
  • Acute abdomen
  • Cervical dysplasia and gynecologic cancers*
  • Substance abuse
  • Female genital cutting*
  • Obstetric fistula*
● PC, MK, SBP ● Global burden of disease; Health equity and social justice; Professional practice
23. Compare and contrast the presentation and management of the above pregnant and non-pregnant conditions in the US versus global settings. ● PC, MK, SBP ● Global burden of disease; Health equity and social justice; Professional practice; Social determinants of health
24. Discuss availability and barriers to family planning services in global health settings and immigrant and refugee communities.* ● PC, MK ● Global burden of disease; Social determinants of health;  Health equity and social justice
25. Discuss the history of coercive family planning programs and the implications for vulnerable populations in the US and in global health settings ● PC, SBP ● Health equity and social justice; Socio-cultural and political awareness
26. List vaccine-preventable diseases and the recommended immunizations according to theWHO vaccination policy and recommendations. ● PC, MK, SBP ● Global burden of disease; Social determinants of health
27. Describe the indications, risks and benefits of surgical interventions for relevant ob-gyn conditions in the global health setting. ● PC, MK, SBP ● Global burden of disease; Professional practice
28. List required health screening for refugee and immigrant populations before entering the US.* ● MK, PC ● Global burden of disease; socio-cultural and political awareness
29. Identify health concerns that may disproportionately affect vulnerable US populations and refugee/immigrant women such as:*

  • Cervical cancer and need for screening
  • Unmet need for family planning
  • Chronic PID
  • Mental health specifically addressing trauma and PTSD
  • Gender based violence
    ● MK, PC    ●Global burden of disease;
socio-cultural and political awareness

 

ACGME Core Competancies

Medical Knowledge (MK)

Patient Care (PC)

Systems Based Practice (SBP)

Practice Based Learning and Improvement (PBLI)

Interpersonal Skills and Communication (ISC)

Professionalism (P)

Global Health Competency Domains

Global burden of disease

Globalization of health and healthcare

Social and environmental determinants of health

Capacity strengthening

Collaboration, partnering and communication

Ethics

Professional practice

Health equity and social justice

Program management

Socio-cultural and political awareness

Strategic analysis


[1] Adapted from Johns Hopkins University School of Medicine and Global Health Leadership Program objectives

[2] Jogerst K et al. Identifying interprofessional global health competencies for 21st-century health professionals. Annals of Global Health, 2015; 81(2):239–247.