A small survey of U.S. obstetrics and gynecology residents finds that fewer than one in five receives formal training in menopause medicine, and that seven in 10 would like to receive it.
The Johns Hopkins–led study, described in May in the online version of the journal Menopause, discovered that some American obstetrics/gynecology residency programs fail to offer trainees any formal curriculum or clinical experience focused primarily on women's pre- and post-menopausal health.
"Although our survey reached only a fraction of the approximately 5,000 OB/GYN residents in the United States, our results suggest that to serve a fast-growing population of aging women in the boomer generation and beyond, OB/GYN residency programs need to address this training gap," says senior investigator Wen Shen, an assistant professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine and a board-certified gynecologist who specializes in treating menopausal women. "Residents who participated in our study have stressed that they want more knowledge and experience in this field, and an improved comfort level in treating menopausal symptoms."
The 2010 U.S. census estimates a population of 50 million menopausal women by 2020, an average age of menopause at 51, and a life expectancy for American women of 85. Consequently, Shen notes, an enormous group of women will live one-third of their lives after menopause.
The study used a Web-based survey emailed to 258 OB/GYN residency-training directors identified by the Council on Resident Education in Obstetrics and Gynecology. The training directors were asked to forward the assessment to their residents and confirm that they had done so. Among the 510 residents who responded, only 100 reported that their program had a formal menopause-learning curriculum, and 78 said they had a defined menopause clinic as part of their residency.
"It's clear from the results that the residents who responded admit that their knowledge and clinical management skills of menopause medicine are inadequate," says lead study author Mindy S. Christianson, a clinical fellow in the Division of Reproductive Endocrinology and Infertility in the Department of Gynecology and Obstetrics at the Johns Hopkins University School of Medicine.
Additional results of this study showed that approximately 70 percent of residents stressed that they wanted to obtain more knowledge and expertise in menopause physiology, hormone and nonhormone therapy, menopause-related bone health, cardiovascular disease, and metabolic symptoms. Shen says it was particularly striking that 40 to 60 percent of fourth-year residents who responded to the survey—those soon to complete their postdoctoral training—reported the need to improve knowledge.
"Our study has limitations, and the largest was the low response rate from residency program directors and the residents," Shen says. "Nonetheless, a majority of our study respondents indicated they were barely comfortable in managing women with menopause-specific problems."
Other researchers in the study were Jennifer A. Ducie, a former OB/GYN resident at Johns Hopkins and now a GYN/oncology fellow at Memorial Sloan-Kettering in New York City; Kristiina Altman, an assistant professor of gynecology and obstetrics at Johns Hopkins; and Ayatallah M. Khafagy, of the Johns Hopkins Bloomberg School of Public Health.