Clinical care in low-resource areas and with underserved populations from sovereign nations presents numerous complexities. Not least among these include patients’ ability to obtain care, whether due to poor geographic access, limited availability, or cultural or other barriers to seeking care. Furthermore, once a patient accesses care, limitations may include providers’ access to appropriate resources or knowledge, the accessibility of consultative services, and the acceptability of treatment plans.
The curriculum for clinical training for the WHE Fellows is aimed at equipping Fellows with the tools and partnerships needed to become innovative and collaborative providers of excellent clinical care in low-resource settings in both the US and globally. Fellows will work with women’s health providers at the Fellowship sites in a mutually beneficial relationship to provide and enhance women’s health care at each site.
Clinical skills will focus on the following:
- Comprehensive prenatal care, adapted to local setting, including adaptions related to the local/regional incidence of certain maternal conditions (e.g. pre-eclampsia, infectious disease, advanced maternal age, substance use disorder)
- Comprehensive intrapartum and postpartum care, adapted to the local setting, including comfort with intermittent fetal monitoring intrapartum
- Safe prevention of the primary cesarean, including operative vaginal delivery skills
- Obstetric hemorrhage, including blood bank management, stabilization, and transfer
- Eclampsia management
- Basic and advanced obstetric sonography
- Miscarriage and pregnancy termination management
- Infectious disease in pregnancy
- Cultural competency and partnership around birth practices (e.g. working with and learning from doulas, midwives, etc.)
- Cervical cancer screening and management
- Contraception (simple and complex)
- Menopause management
- Fibroids and adnexal mass management
- Non-obstetric hemorrhage, including blood bank management, stabilization, and transfer
- Endometrial pathology and management
- Vulvar pathology
- Infectious disease and sexually transmitted infections
- Choosing appropriate candidates for hysterectomy and/or bilateral salpingo-oophorectomy
- Appropriate application of minimally invasive techniques for surgical management of common gynecologic problems
The curriculum for the research training for the Fellowship is to equip Fellows with the tools and vocabulary needed to assess literature in the health equities, rural, indigenous, and global health fields. In addition, we will support Fellows in completing their own research project during the time of the fellowship. Given the remote nature of the fellowship, we envision a hybrid curriculum of online and in-person instruction to include several concepts.
- Community-based Participatory Research
- Rural Health Research Basics
- Ethical and cultural engagement around research with native, indigenous, and international communities
- Preparation and presentation of research
- Dissemination of research findings to communities
During the first year, the fellows will identify an area of interest for research, as well as a mentor. We will provide access to projects in process that allow the fellow to utilize their training in biostatistics to complete at least one project during the first year. First year fellows should also produce a project plan for community-based or qualitative research addressing an area of interest in the communities in which they work.
Second year fellows are expected to begin work on their proposed community-based research. Frequently, this type of research moves more slowly, and we anticipate it may not be completed by the completion of fellowship. However, we expect that the project completed in the first year should lead to a publication in a peer-reviewed journal prior to the completion of fellowship.
Master’s Degree Option
As an NIH-sponsored Center for Clinical and Translational Science the University of Utah offers a Master’s in Science of Clinical Investigation (MSCI).
Women’s Health Equity Fellows are encouraged to pursue this master’s option where courses are taught by internationally recognized investigators. The program consists of:
- Formal didactic coursework
- Longitudinal seminar series
- Mentored clinical research project
Cultural and Ethical Components
In order to provide clinical care and perform research in underserved global and rural settings, it is essential to have the training and skills needed to understand how to engage in health care and research in diverse cultures as well as how to navigate unique ethical issues.
The objective of the cultural and ethical curriculum is to provide fellows with the skills needed to respectfully engage, understand and learn about diverse cultures including their beliefs on health care, disease, healing and wellness. These skills will lead to positive collaborative relationships, improving the health of the community through clinical care and research. In addition, fellows will demonstrate knowledge and skills on navigating common ethical issues, accessing local and national ethical code and applying the international standards for the protection of human subjects.
Professionalism and Leadership Components
Given the multidisciplinary nature of healthcare, particularly in international settings, it is vital that the WHE fellow demonstrate strong professionalism and leadership capabilities. Collaborating with various partners throughout the fellowship will provide ample opportunity for fellows to learn, grow and further develop their professional and leadership skills. It is essential that the fellow serves as a professional representative for the University of Utah Department of Obstetrics and Gynecology, a key institution in improving health and well-being for those locally and globally.