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wpo


Research Agenda for Psychosocial and Behavioral Factors in Womens Health: Education and Training Agenda

Guiding Principles
Education and Training Priorities

Major changes are needed in approaches to education and training in the health professions if we are to produce health scientists and professionals with the knowledge, skills, and sensitivity required to generate and apply new knowledge concerning the health needs of women from all ethnic groups over the life cycle and in diverse social and cultural contexts. In particular, a comprehensive approach is required that both critiques traditional approaches and provides innovative and exciting alternatives, and that is responsive to women's diverse sociocultural contexts and identities.

Guiding Principles

Guiding principles for the development of curricula for the training of health professionals include the following:

  • Training health professionals to recognize and value diversity is of paramount importance to ensure the quality of health care.
  • Institutions that offer health education should actively enhance the diversity of their curriculum, student bodies, faculty, administration, and governing bodies.

  • Health professionals should be taught to value equalitarianism and collaboration with their clients, patients, and research participants.
  • The goal is to enable patients to become active collaborators in the health-promoting process and to make the most informed judgments about participating in the health enterprise.

  • A model of human behavior that assumes individuals are active and adaptive (rather than passive victims) leads to more effective health interventions.
  • Blaming or pathologizing women and other subordinate groups for the manner in which they cope with the challenge of surviving in a sexist, racist, classist, homophobic, "ablist", and violent environment is a poor intervention strategy. Health professionals need to be taught to recognize the dynamics and sequelae of the many coping strategies developed by relatively powerless individuals, their cultural components and validity.

  • Lectures, textbooks, and other pedagogical materials should challenge negative stereotyped thinking and assumptions regarding individual, cultural, and other differences in the framing of research and other questions, interpretations of research findings, characterizations of peoples and illnesses, and therapeutic possibilities.
  • Educators of health professionals need to create or adapt mechanisms that encourage students/trainees to collaborate, to respect and value themselves and their fellow students/trainees, to be intolerant of sexual, racial, or any other harassment, and to interrupt such behavior should it occur.

  • Health professionals should be encouraged to see themselves as part of a larger social system which creates, exacerbates, or ignores health problems as well as diminishes or eliminates them.
  • Training in awareness, analysis, and amelioration of these problems should be intrinsic to the education of all health professionals.

  • There should be continuous evaluation of and reflection on values, ethics, and practices.
  • In particular, health professionals need to examine accepted practices that benefit or accommodate themselves more than those they serve (e.g., self-referrals, unnecessary surgeries, skimming the cream of a pool of research participants to maximize favorable outcomes for therapeutic evaluations). Supercilious attitudes toward nontraditional and indigenous therapies need reexamination.

  • Health is a complex function of the interaction of economic, political, cultural, biological, psychological, physiological, spiritual, and familial factors.
  • Health prevention and intervention efforts that do not take into account this complexity will be less effective than they could be.

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    Education and Training Priorities

  • Include health professionals from all health-related fields and subfields in transformation efforts.
  • Design programs targeted to multiple educational levels from undergraduate to postdoctoral, and to diverse training settings, encompassing universities, hospitals, community health centers, clinics, medical schools, other professional schools, vocational schools, and continuing education venues.
  • Make the conceptual model for a women's health curriculum a biopsychosocial one that is interdisciplinary in nature, crossing departmental boundaries.
  • In addition, medical schools should provide an integrated clinical experience in women's health across the four years of their programs.

  • View curriculum development as a dynamic process; design it to be responsive to new psychosocial and behavioral research theories, methods, and findings.
  • Transform all aspects of the education and training experience, including content, process, and climate.
  • Content. Educators need to develop appropriate lectures, textbooks, and other materials, including videos, films, computer-assisted instruction, electronic classroom bulletin boards, and instrumentation for use in the classroom and the laboratory; establish on-line resources, including syllabi banks and other resource materials (WMST-L and the Women's Studies on-line resources at the University of Maryland at Baltimore provide a model for these actions); and make women better consumers of health care and more self-care and self-help oriented.

    Process. In addition to training educators in traditional pedagogical techniques, new skills are needed that will equip them to (a) intervene in social dynamics of the laboratory and classroom that undermine the performance of women and ethnic minorities and (b) break through the resistance of colleagues and students who find their values and beliefs challenged by this new knowledge.

    Climate. Educators need to develop positive learning environments for women and minorities (including designing environments that emphasize cooperation and collaboration rather than competition); address issues of sexual harassment and discrimination, preventing their occurrence, ameliorating their effects, and empowering women who have such experiences; provide positive role models and supportive mentoring relationships; and promote women's full participation in policymaking roles in education and training settings, including academic institutions, and accreditation, licensing, and regulatory bodies.

  • Reconceptualize professional roles and career development in the health professions to support integration rather than fragmentation of research, teaching, and practice functions.
  • Design research training experiences in both quantitative and qualitative methods for application to women's health issues including new and innovative research models and methods, collaborative and community-based research approaches, econometric models, and evaluation techniques.
  • Train health professionals for the traditional roles of researcher, practitioner, consultant, teacher, and administrator, as well as for the responsibility of communicating their knowledge to the public and to the media.
  • Communicating effectively with the media is particularly important, given the important role that women's magazines play in educating women about health issues.

  • Train learners in all content areas to (a) consider the relationship of women's multiple identities and circumstances to their health care and (b) appreciate the profound implications for women's health of biological and social factors differentially associated with gender, ethnicity, age, and disability.
  • Communicate knowledge of and sensitivity to the way differences in gender role norms, expectations, and power may affect health promotion and disease prevention in diverse ethnic groups.
  • For example, women may do most of the meal planning and preparation or be the one to make sure dependents visit health care providers. When ill, these women may have difficulty getting sufficient rest because of having to care for dependents' needs.

  • Incorporate new knowledge about women's health into curriculum offerings dealing with diseases/disorders that are common in, unique to, or more prevalent in women.
  • Information on risk factors, etiology, outcomes, and interventions of diseases/disorders all need to be included. Here priority areas include osteoporosis, HIV infection, eating disorders, depression, anxiety disorders, substance abuse, systemic lupus erythematosus, cancer, reproductive-related conditions, and heart disease.

  • Educate health care providers that women may respond differently to drug therapy on the basis of gender-related differences in pharmacokinetics and pharmacodynamics.
  • Drug doses may need adjustment for women of different ages, in different menstrual phases, or of different ethnic group membership. All of these issues require further evaluation in multi-ethnic studies.

  • Design reproductive health curricula to equip health professionals with knowledge and skills that will enable them to help women (a) understand and enjoy their own sexuality; (b) regulate pregnancy and childbearing effectively and safely; (c) remain free of disease, disability, and death associated with sexuality and reproduction; and (d) bear and rear healthy children.
  • Examination of links between inequalities in women's power and status and their sexuality and reproductive health would be included (e.g., violence and unwanted pregnancy; poverty and low birth weight; SES, substance abuse, and AIDS/HIV infection; ethnicity and sexuality).

  • Develop institutional structures to promote interdisciplinary research collaboration and build new biopsychosocial models of women's health over the life cycle and in differing cultural contexts.
  • The establishment of offices that focus on women's issues in various agencies, such as the National Institutes of Health, Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, Food and Drug Administration, and the Veterans Administration, is an important step. To be effective, however, they must be adequately staffed and funded, with the clout needed to have an impact on the funding of other offices as well. Although the concerns of such institutional structures would encompass more than training, they do need to exercise leadership in the training area through the funding of research training workshops, and pre- and postdoctoral fellowships specifically targeted for women's health.

  • Develop training programs specifically focused on women's health and mainstream knowledge into other types of training programs.
  • Develop policy that mandates addressing issues of diversity in programs receiving training grants, including both trainee selection and program content, just as there is policy mandating inclusion of women in study populations.

    Create new training opportunities, including multidisciplinary training centers, specialized training institutes, and faculty/staff development offerings modeled after the National Institute of Mental Health staff college courses on women's mental health of the early 1980s.

  • Expand sources of funding for curriculum development and integration projects, both in the public and private sector.
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