Core Rotation Description
The core is the major component of the program, lasting seven months from mid-September to mid-April. It is intended to encompass a number of learning experiences that can be best gained over a period of months rather than as a short-term intensive rotation, though not all of these experiences need occur for the whole seven month period. It is expected that the resident would develop a weekly schedule (with
some flexibility) comprising of the following:
- Continuing Care Family Medicine:
1-2 days/weekPossible locations for this rotation include North Kingston Community Centre, community physician practices, or Queen's Family Medicine Centre. The resident should be encouraged to meet with potential supervising physicians so that they can "interview" each other to assess suitability towards meeting both resident and service needs. It is expected that the resident will work with minimal supervision, but can use this clinical time to reflect on the implications on particular women's lives, of the theoretical knowledge learned elsewhere. Note that likely female physicians should be sought as supervisors as they tend to have a higher female patient population and can also act as role models for female residents. It is also expected that the resident will see patients other than women.
- Gynecology Clinics:
The resident will be provided with the opportunity to work with gynecologists who specialize in infertility and reproductive technologies, endocrinology, PMS, sexual medicine, gynecological cancers, and incontinence. Because of the learning value of these outpatient clinics there is already a high demand for participation by clinical clerks and other residents, thus coordination of clinic experiences will need to be arranged in advance through the Department of Obstetrics and Gynecology.
- Eating Disorders Clinic:
The resident will participate in the work of the eating disorders clinic in addition to doing appropriate background reading on women's body image, and food and weight preoccupation. The assessment and treatment of individuals with eating disorders will be the focus, and the resident will be able to work at a variety of levels in consultation with the clinic staff.
- Counselling with Supervision:
This is considered a key component of the core program. The resident will counsel a minimum of two women who show interest in having this service (contacts made in their family practice clinics). Supervision of the residents will be by community therapists with particular expertise around women's issues. The therapists may choose to use role-playing, particular readings or other means of instructing the residents during this time. Supervision will take place in the Family Medicine Centre, with use of one-way mirrors. Discussion of the time limits of counselling (depending on how long the resident intends to be available) as well as referral to other appropriate services, if desired, will be important early on in the counselling relationship. It may also be possible for interested residents to involve themselves as co-facilitators in groups run by the Family Medicine social worker. Effective counselling obviously requires a good understanding of the process and one's own perspectives and biases. If desired, residents will be encouraged to pursue further selfawareness.
- Women's Clinic at KGH:
All residents of family practice should become comfortable with "options counselling" for women/couples with an unwanted pregnancy, and be aware of the procedure if a therapeutic abortion is chosen. Residents in the women's health specialty will also be given the opportunity to train in first trimester abortions at the Women's Clinic. It is recommended that they have the equivalent of one month's training (i.e. full-time) if they wish to offer this service in their practices.
- Sexual Assault Call:
In addition to understanding the issues around violence against women, and the attitudes that perpetuate the abuse, residents will be trained how to use the sexual assault kit, and be involved in doing examinations of women who have been assaulted. This will entail developing skills in supportive crisis counselling, in addition to providing a non-threatening physical examination. They will also be exposed to the legal process involved in reporting and testifying in an assault case.
- Community Placements:
The opportunity to do community placements is seen as an important part of the women's health specialty. This provides a greater understanding of community needs, resources, and expertise. Residents should be encouraged to choose one or two placements during their core rotation that they are particularly interested in, and devote three to four hours per week to this work.
- Women's Studies Courses:
This is another key component of the program in which the resident will have the opportunity to learn from and interact with people from other academic disciplines. All residents will be expected to take "Women's Health Issues", Nursing 240. This half course offers a feminist perspective on the "experiential and theoretical basis of women's social, economic and cultural concerns within the Canadian health care system". In addition, it is advised that each resident choose a second course according to their interest, and background. The possibilities include: Women's Studies 100 (historical and theoretical background to feminism), Women's Studies 200 (selected topics in women's studies including health and medicine, with multidisciplinary instruction), Special Topics in Gender Relations - Sociology 431, or Education 857. (The latter is graduate level course which discusses feminist theory and its application to education).
- Teaching Rounds:
This is the component of the women's health specialization that will have the most impact on the residents from the first two years of the program. There are about four rounds per week for family medicine residents on their family practice rotations, and third year residents in the core rotation of the women's health program would also attend (particularly if they had not previously). It is expected that a reasonable proportion of these rounds be focused on issues of relevance to women's health. In addition, it is hoped that women's perspectives can be brought to the remainder of the rounds, ultimately by the residents themselves. It is also anticipated that nutritional education could become a part of the ongoing teaching program offered through the Family Medicine Centre for all residents.
- Feminist Critical Appraisal:
This part of the program is somewhat analogous to traditional "journal clubs". The residents will study feminist research methodology and critiques of medical literature in order to develop their own skills of critical appraisal. Understanding the principles of feminist research will be particularly important for those residents who anticipate that they will partake in research during the program or in their careers. This group will meet at least once a month during the core rotation.
Depending on the quantity of time allotted to the above activities (including required readings for women's studies and the critical appraisal group), some residents may wish to have further clinical experience in a particular area during the core rotation. Other interests could be pursued to make the best use of this horizontal learning experience for each of the residents. In addition, one-time visits to community resources may be appropriate such as the breast screening clinic. To meet the objective of having impact on the education of other residents and medical students, the residents will be encouraged to help plan rounds and/or conferences around women's health issues. They may also choose to assist their mentors in organizing speakers for teaching rounds at the Family Medicine Centre.
Some residents may choose to do a research project as an elective. Rather than wait to do this as a block, a portion of their week could be dedicated to this project and the length of the core rotation be extended. (See Electives)