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Women's Health National Collaborative Core Curriculum Project

Sandra Carr
Department of Obstetrics and Gynaecology
The University of Western Australia
In 1999, the Committee for University Teaching and Staff Development awarded the Project Organisers from Monash University a grant to develop a clear and relevant core curriculum for Women's Health. The Women's Health National Collaborative Core Curriculum (WHNCCC) has been developed by delegates from all eleven medical schools in Australia and two in New Zealand in response to the ever-expanding volume of scientific knowledge and the reduction in time available for teaching undergraduate medical education. The WHNCCC is student centred in that it clearly defines expected learning outcomes according to the domains of knowledge, skills and attitudes.

This curriculum is also 'women-focused' in that it breaks with the traditional limits implied by 'obstetrics and gynaecology'. The National Core Curriculum is formulated with reference to the health care of women from conception to old age, emphasises wellness and maintenance of health and extends beyond sexual and reproductive health. The overall aim of the WHNCCC is to present the undergraduate with a sound appreciation of principles in women's health which takes into account the woman according to her perception of self and as an individual in particular circumstances. The purpose of this round table discussion is to review the process undertaken during the development of this curriculum, present the structure and content of the curriculum, encourage feedback and comment from participants and promote implementation.


Background

The impetus for a Women's Health National Collaborative Core Curriculum originated from two opposing trends in undergraduate medical education: the ever-expanding volume of scientific knowledge and a reduction in time available for education. In December 1999, the Committee for University Teaching and Staff Development (CUTSD) awarded the Project a grant to develop a clear and relevant core curriculum in Women's Health. The document was generated in collaboration with delegates from all eleven Medical Schools in Australia and two in New Zealand, with the support of the Professorial Heads of Obstetrics and Gynaecological Group (PHOGG).

The National Women's Health Core clearly defines the learning outcomes which undergraduate medical students are expected to achieve, according to the domains of knowledge, skills and attitudes. In addition to the expertise of teaching staff from the Medical Schools in question, the venture has consulted with students, community groups, experts in educational design and boards of accreditation. Hence, the National Core Curriculum in Women's Health has been constructed with reference to professional and community expectations of the undifferentiated, competent junior doctor who is adequately prepared both for entering early postgraduate clinical practice and for continuing life-long learning. The emphasis on problem-based learning seeks to encourage opportunity for relevant, context-based learning settings for students to become competent practitioners in Women's Health. However, the Core remains silent on specific teaching- and assessment strategies, which are considered particular to individual institutions.

Acknowledgments

The information presented in this paper is a summary of the complete Women's Health National Collaborative Core Curriculum Project Version 2001-1 document which was written by Ms Anne Ellison from Monash University with contributions from all of the Project Delegates as listed below. In addition to the Committee for University Teaching and Staff Development (CUTSD) grant which funded the Project, the collaboration gratefully acknowledges the financial support of Pharmacia and the emotional support of the Royal Australian and New Zealand College of Obstetrics and Gynaecology.

National Women's Health Core Curriculum Project Organisers: Monash University

David Healy
Robert Burrows
Beverley Vollenhoven
Euan Wallace
Kim Fraser
Lydia Weilert
Anne Ellison

National Women's Health Core Curriculum Project Delegates

Sandra Carr
University of Western Australia
Vivienne O'Connor
University of Queensland
Michael Chapman
University of New South Wales
Judy Searle
Flinders University
Paul Duggan
Adelaide University
Beverley Vollenhoven
Monash University
Martha Finn
Northern Territory Clinical School, Flinders University   
Euan Wallace
Monash University
Janice Georzen
University of Tasmania
William Walters
University of Newcastle
John Grove
University of Tasmania
Peter Wein
University of Melbourne
Michael Humphrey
James Cook University
Jenny Westgate
University of Auckland
Jonathan Morris
University of Sydney
Don Wilson
University of Otago

Philosophy and scope of the course

The character of women's health as a discipline is unique in that the student encounters many patients who are essentially well. Thus, the language of the Core emphasises wellness and maintenance of health, for instance in its view of pregnancy, childbirth and menopause as health presentations. In addition, exposure to the women's health Curriculum provides resources for the student to explore and develop skills in evidence based medicine, statistics, self wellness and ethics.

The National Core Curriculum in women's health is formulated with reference to the health care of women from conception to old age, acknowledging that the domain of 'women's health' extends beyond sexual and reproductive health. In breaking with the traditional limits implied by 'Obstetrics and Gynaecology', we aim to present the undergraduate with a sound appreciation of principles in women's health a holistic context which takes into account the woman according to her perception of self and as an individual in particular circumstances.

The core curriculum is understood by all within the collaboration to make up a minimum of 80% of any one university's women's health course curriculum. The remaining 20% allows for regional differences in health care needs, expertise and focuses of the various medical schools.

Scope of women's health

  1. Health maintenance
  • fertility control
  • screening (breast, genital)
  • sexual health (male and female - sexuality, education, prevention of STIs)
  • uncomplicated pregnancy and birth
  1. Women in society
    - topics
  • women and work (paid and unpaid)
  • women as carers
  • women in medicine
  • multicultural issues in women's health
    • religious considerations
      • genital mutilation
    • Aboriginal uniqueness
  • social issues in women's health
    • violence against women
      • domestic violence
      • sexual assault
    • modes of sexual expression
    • women with disabilities
    • demands of an ageing population
      • maintenance of health
      • death and dying
      • socio-economic effects in older life
  • mental health in women
    • body image
    • family interaction
    • women and loss and grief
    • depression, anxiety, suicide
    • ante and postnatal mental health
  1. Clinical problems
    in women's health
  • pregnancy, birthing and post partum health issues
  • gynaecological disorders

Aim of the course

The aim of the course is to produce an undifferentiated, competent junior doctor who is adequately prepared to enter early postgraduate years and for life-long learning. The Curriculum may be used as a reference for educators, students and regulatory bodies and adheres to the following key educational concepts and principles: The Curriculum sees within its domain a commitment to encourage women's health issues to be considered across all health disciplines. It aims to inspire and encourage in the medical student an awareness of the benefit to themselves and the community of including women's health issues within their professional development.

Rationale of the document

Document structure

Structure of the Core Curriculum

This section deals with the rationale for the design of the basic template. The curriculum emphasises problem-based learning to encourage relevant, context-based learning settings for students to become competent practitioners in women's health. Each topic is divided into sections designed around the learning outcomes which undergraduate medical students are expected to achieve.

Section 1: Introduction

The first part provides an introduction to the subject. It includes a description of the presentation and a question concerning the topic. This is followed by a series of questions to prompt the student to a) review what he or she already knows about the patient b) review his or her knowledge of the condition. The student can attempt to answer these questions before moving to the next section. The aim of this type of review is to help the student identify gaps and focus on what needs to be learned.

Section II: Template

The second part of the template provides information and prompts that relate to the topic and Question. This section is divided into domains of knowledge, skills, attitudes and experiences. All domains except for experiences are considered core curriculum. As experiences are not uniform across all educational institutions these cannot be standardised and as such are stated here only as suggestions. Each component is written with student learning outcomes in mind. Where the previous section provides an overview and a lead in to the template, this section provides more specific prompts. However, once again it is written in a format to help the student identify learning needs with prompts and links to progressively build knowledge

Section III: Review

In the final section, the student can review his or her progress. At this point, the student should be able to identify areas that require further learning. The student should then work out a learning plan with a clear set of objectives and a means of checking progress.

Generic skills required by the graduate in women's health

Several topics require skills, attitudes and behaviour that can be described as basic to a graduate working in women's health. Rather than repeat these basic skills, attitudes and behaviour throughout the curriculum, they have been flagged in the template as "Generic" with a link to the part of the curriculum that provides detailed information on generic skills, attitudes and behaviour. For example, taking a history is a basic skill for a graduate of women's health. Rather than list the requirements of history taking for each topic, the template will simply state that a generic history is required. It will provide a link to the section that deals with basic skills in taking a history and then it will also provide additional information for taking a history that is relevant to the topic under discussion.

Core topics

Defining women's health

The NHMRC states that the health of the population generally is determined by complex biological, social, economic and environmental factors, as well as access to appropriate and effective health services. While women's health encompasses the full range of health issues which affect women, including those which also affect men, women experience particular health problems and health service needs arising from their roles, responsibilities and position in society and from specific biological differences.

Dimensions of female health

As previously stated the Curriculum is organised to follow the life stages of the woman. The Core Topics are addressed within the life stage it most commonly presents. The following pages provide a summary of how the topics have been ordered including an expansion of The Adolescent Years with an example of a Template for Teenage Pregnancy.

Topics and approaches to female health

Topic
Approaches to medical management

The Female Child
The Adolescent
The Middle Years
Preconception
Antenatal Care 1st Trimester
Antenatal Care 2nd Trimester
Antenatal Care 3rd Trimester
Labor and Delivery
Obstetric Emergencies
Neonate
Puerperium
The Later Years

Health Presentation
Health Maintenance
Clinical Presentation

The Adolescent

The adolescent years: Core topics

NormalHealth maintenanceClinical Problems

Breast/genital development
and function

Pelvic pain

ContraceptionVaginal bleeding

Unplanned pregnancy

Screening (Pap smear
Breast Examination)
Assault


Dysuria

Teenage Pregnancy

Question mark icon Presentation:
Pregnancy in a female less than 20 years of age.

Question
What special services and concerns should I have for a teenage pregnancy?

Information gathering

KNOWLEDGE
Review the prevalence of pregnancy among females < than 20 years of age in your region.
Consider cultural and social considerations of teenage pregnancies.
Review female sexual maturation, its sequence and timing with the view to understanding that most pregnant teenagers are biologically mature.
Discuss with specific references to teenagers the health implications of STIs, smoking, alcohol, drug abuse, poor diet, low socio-economic status and the lack of social support.
Discuss the options for antenatal care in teenage pregnancy. Discuss the link between adverse social circumstances, poor antenatal attendance and the need for targeted antenatal care.
Review the legal age for sexual intercourse and marriage. Discuss the medico-legal issues associated with underage informed consent for contraception and operative procedures in pregnancy, including termination of pregnancy.
Discuss the importance of social supports for pregnant teenagers and the need for continuing education.
Discuss the role of social worker.
Discuss strategies for prevention of teenage pregnancy.
SKILLS: Generic
ATTITUDES AND BEHAVIOUR: Generic
EXPERIENCES: Attend antenatal clinics and specific teenage clinics.

Review activity icon Review
  • Where did I perform well?
  • What knowledge do I lack?
  • What skills do I need to practice?
  • How am I going to do that?
  • Where can I get more feedback?
  • What extra resources can I use?

Conclusion

Further examples of templates will be tabled for discussion at the Teaching and Learning Forum where participant comment will be invited. Several universities have trialed the curriculum in second semester 2001. Evaluations of these trials are under way. Other universities have begun the process of restructuring their course objectives to fit with the National Core Curriculum for 2002. The direction for the future is to develop appropriate supporting resources and reference material.

The Project Delegates believe this Curriculum demonstrates the ability for every discipline of medical education to be more collaborative in nature and as such provides opportunities for graduates to be confident that their courses reflect National standards.

Author: Ms Sandra Carr, Senior Lecturer, Department of Obstetrics and Gynaecology, The University of Western Australia. scarr@obsgyn.uwa.edu.au

Please cite as: Carr, S. (2002). Women's Health National Collaborative Core Curriculum Project. In Focusing on the Student. Proceedings of the 11th Annual Teaching Learning Forum, 5-6 February 2002. Perth: Edith Cowan University. http://lsn.curtin.edu.au/tlf/tlf2002/carr.html


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Created 12 Dec 2001. Last revision: 31 Jan 2002. HTML: Roger Atkinson [ rjatkinson@bigpond.com ]