Appendix 20
APGO's Women's Health Care Competencies for Medical Students

See http://wheocomp.apgo.org/ for a comprehensive list of competencies.

Graduates of medical schools will be able to:

Competency Area I: Explain sex and gender differences in normal development and pathophysiology as they apply to prevention and management of diseases.

1. Compare differences in biological functions, development, and pharmacologic response in biological functions, development, and pharmacologic response in males and females.
2. Discuss the pathophysiology, etiology, differential diagnosis, and treatment options for conditions that are more common, more serious, or have interventions that are different in women.
3. Discuss the pathophysiology, etiology, differential diagnosis, and treatment options for conditions and functions that are specific to women.

Competency Area II: Effectively communicate with patients, demonstrating awareness of gender and cultural differences.

1. Describe how the patient's ideas, feelings, beliefs, expectations, and experience of illness affect health outcomes. 
2. Describe the correlation between specific communication skills and clinical outcomes. 
3. Describe how sex, sexuality, gender, and sociocultural factors affect communication by and with female patients. 
4. Describe how sex and gender differences affect the power differential and the formation of a therapeutic relationship between the clinician and patient. 
5. Demonstrate how to gather comprehensive information regarding issues that are unique to or manifest differently in women, including menstrual and reproductive history, body image, substance abuse, mental health, sexual history, personal violence, contraception, and incontinence. 
6. Integrate appropriate screening questions for the identification of substance abuse, high-risk sexual activity, and interpersonal violence or abuse in a manner that demonstrates empathy, respect, and cultural sensitivity. 
7. Demonstrate the ability to perform a danger assessment in a woman who discloses violence or abuse. 
8. Demonstrate skills that build trust by addressing contextual factors, such as culture, ethnicity, gender, language/literacy, socioeconomic class, spirituality/religion, age, sexual orientation, disability, and care-giving responsibilities. 
9. Respond to patients' emotions using nonverbal and verbal skills, including reflecting, legitimizing/validating, expressing support, expressing partnership, and expressing respect. 
10. Demonstrate how to share control of the interview by using facilitative nonverbal behavior, using language the patient can understand, eliciting the patient’s concerns and expectations for the encounter, and negotiating a consensual agenda for the encounter. 
11. Demonstrate a strategy to provide counseling about family planning and safe sex methods. 
12. Demonstrate shared responsibility for health decisions by identifying and negotiating areas of agreement and disagreement, and by identifying gender and cultural barriers and enablers to adherence. 
13. Propose a plan to explain both normal and abnormal results in a sensitive manner, and to educate the patient about the follow-up process using words and written information the patient can understand. 

Competency Area III:Perform a sex-, gender-, and age-appropriate physical examination.

1. List contextual factors (e.g., history of personal violence, sexual orientation, body image, gender, cultural expectations, language, and literacy) that affect the clinician's and patient’s perceptions and the quality of the physical exam. 
2. Describe techniques for setting the stage and building rapport during the exam. 
3. Describe techniques to ensure a woman's comfort and the accuracy of the exam in all settings and lifecycle stages, and with any illness or disability (e.g., positioning, draping, and selection and use of instruments). 
4. Describe the variations of normal appearance of the breast, vulva, vagina, and cervix. 
5. Perform a sex-, gender-, and age-appropriate physical exam.
6. Perform an accurate breast exam. 
7. Perform an accurate pelvic exam and describe the size, shape, and position of the uterus. 
8. Explain how to obtain samples for microbiologic assessment in appropriate circumstances.

Competency Area IV: Discuss the impact of gender-based societal and cultural roles, and context on health care and on women.

1. Social and Political Discrimination
2. Poverty
3. Family Caregiver Role
4. Special Populations
   1. Lesbians
   2. Women with Disabilities
   3. Immigrants
   4. Women of Color
5. Allied Health Professionals
6. Impact of Patient and Provider Beliefs and Practices

Competency Area V:Identify and assist victims of physical, emotional, and sexual violence and abuse.

1. Background and Epidemiology
2. Acute and Chronic Clinical Manifestations
3. Screening and Assessment
4. Intervention Options
5. Prevention Strategies
6. Reporting Requirements

Competency Area VI: Assess and counsel women for sex- and gender-appropriate reduction of risk, including lifestyle changes and genetic testing.

1. Cardiovascular Disease
2. Common Malignancies
   1. Breast Cancer
   2. Cervical Cancer (See Comp. I.C.16.(i) Gynecologic Cancers - Cervical Neoplasia)
   3. Colon Cancer
   4. Lung Cancer
   5. Skin Cancer
3. Osteoporosis
4. Diabetes
5. Vision and Hearing
6. Oral Health
7. Mental Health
   1. Depression and Bipolar Disorders (See also Comp. I.B.18. Mental Health)
   2. Anxiety (See also Comp. I.B.18. Mental Health)
   3. Stress Management
   4. Eating Disorders
8. Substance Abuse
   1. Illicit drugs
   2. Misuse of Legal Medications
   3. Tobacco (See also Comp. I.B.18. Mental Health)
   4. Alcohol (See also Comp. I.B.18. Mental Health)
   5. Other Addictions
9. Immunization
10. Exercise
11. Nutrition
12. Preconception and Prenatal Screening
13. High-Risk Sexual Behavior and Sexually Transmitted Diseases (See also Comp. I.B.15. Sexually Transmitted Diseases)
14. Contraceptive Practices, Family Planning, and Unintended Pregnancy
15. Postmenopausal Hormone Replacement Therapy (See also Comp. I.C.14. Menopause and Possible Sequelae)

Competency Area VII: Access and critically evaluate new information and adopt best practices that incorporate knowledge of sex and gender differences in health and disease.

1. Identify potential sources of selection bias, including sex, gender, age, race, socioeconomic status, access to care, and study setting. 
2. Appraise study design and results, including analysis for sex and gender differences, and application to clinical care for women. 
3. Discuss sex and gender differences in the burden of disease and associated preventive care needs. 
4. Demonstrate a focused search to answer a specific woman’s clinical health question. 
5. Outline a plan to apply women’s health practice guidelines to clinical management plans. 
6. Describe disparities in clinical research, access, and delivery of women’s health care and how these affect the health of women. 
7. Discuss the ongoing barriers to the inclusion of women in research studies. 

Competency Area VIII: Discuss the impact of health care delivery systems on populations and individuals receiving health care.

1. Delivery of Health Services to Women
2. Access to Health Care for Women
3. Quality
4. Policy