Obstetrics and Gynecology Residencies: Education in Preventive and Primary Health Care for Women

Objective: To test the hypothesis that the Residency Review Committee program requirements for obstetrics and gynecology residencies, when properly followed, will result in residents being educated in preventive and primary ambulatory health care for women during their residency training program as specialists in obstetrics and gynecology.Methods: The 60 requisite residency training competencies identified as essential to educate generalist physicians, and viewed by some educators as a benchmarking standard, each were evaluated to determine whether residents in obstetrics and gynecology are now being educated in each of these areas. The answer was considered affirmative if any of the following pertained: 1) the Residency Review Committee program requirements indicate that the competency “must” or “should” be taught, 2) the Residency Review Committee requests numerical verification related to the competency on the accreditation review application, or 3) by virtue of a specific rotation required by the Residency Review Committee it can be assumed that the resident will be educated in the competency. To make our assessment, we identified and listed the section of the Residency Review Committee for Obstetrics-Gynecology program requirements, which, when properly followed, would result in education in the particular competency.Results: Fifty-seven of the 60 competencies were considered applicable to obstetrician-gynecologists (care of infants, care of children, and infant/child preventive care were not), and residents in obstetrics and gynecology were found to be educated in 54 (95%).Conclusion: During their residency training programs as specialists in obstetrics and gynecology, residents are being educated to be able to be providers of preventive and ambulatory primary health care for women.     

Fourth-year medical student rotations and the "pre-residency syndrome"

To assist medical students who wish to pursue a residency training program in obstetrics and gynecology in planning senior-year rotations, a questionnaire was sent to university Department Chairs. Each Chair was asked to construct a curriculum consisting of ten 4-week rotations. The respondents described a balanced general medical education consisting primarily of internal medicine, surgery, and pediatrics. Thirty percent of respondents believed these students should not take any rotations in obstetrics and gynecology, and 47% felt that one rotation in obstetrics and gynecology was sufficient. A "pre-residency syndrome" has been described in the literature, wherein fourth-year medical students take multiple rotations in the specialty in which they are seeking residency training. The majority of university Department Chairs supported a balanced general medical education during the fourth year of medical school rather than a narrow curriculum in which students take multiple electives in obstetrics and gynecology.     

Survey of robotic surgery training in obstetrics and gynecology residency

To examine the status of resident training in robotic surgery in obstetrics and gynecology programs in the United States, an online survey was emailed to residency program directors of 247 accredited programs identified through the Accreditation Council for Graduate Medical Education website. Eighty-three of 247 program directors responded, representing a 34% response rate. Robotic surgical systems for gynecologic procedures were used at 65 (78%) institutions. Robotic surgery training was part of residency curriculum at 48 (58%) residency programs. Half of respondents were undecided on training effectiveness. Most program directors believed the role of robotic surgery would increase and play a more integral role in gynecologic surgery. Robotic surgery was widely reported in residency training hospitals with limited availability of effective resident training. Robotic surgery training in obstetrics and gynecology residency needs further assessment and may benefit from a structured curriculum.     

Fetal ultrasound training for obstetrics and gynecology residents

OBJECTIVE: To assess the present state of fetal ultrasound training in the United States from the perspective of obstetrics and gynecology ultrasound program directors and residents. METHODS: One hundred thirty-six ultrasound program directors from 254 accredited obstetrics and gynecology residency programs completed a web-based survey regarding obstetric ultrasound training for residents. Questions were presented in yes-or-no, ranking, short-answer, and open-comment formats that examined general teaching environment and curriculum content. These results were compared with a mandatory fetal ultrasound training survey that was independently administered to 4,666 obstetrics and gynecology residents during the 2003 Council on Resident Education in Obstetrics and Gynecology (CREOG) In-Training Examination. Friedman one-way analysis of variance was used to compare ranked nonparametric data with the Dunn posttest. Statistical significance was taken at the P <.05 level. RESULTS: Fifty-four percent of accredited obstetrics and gynecology residencies responded to the survey of ultrasound directors from November 2000 to April 2003. Nearly all responding directors were obstetrician-gynecologists, many of whom had subspecialty training in maternal-fetal medicine. Full-time faculty and sonographers were the most important individuals contributing to ultrasound training for obstetrics and gynecology residents. Hands-on scanning and observation were the most significant educational activities for ultrasound training. Ultrasound program directors generally rated the overall preparedness of residents as ranging from adequate to excellent. The most important learning obstacles were limited curriculum and faculty time. Most programs evaluated competency by direct observation of scanning skills. According to the CREOG survey, only 16.3% of residents indicated that the performance and interpretation of fetal ultrasound examinations were mandatory program requirements. Nearly two thirds of residents believed that their training would be adequate by the time of graduation. Only 18.4% of residents, however, were planning to perform or interpret fetal ultrasound scans in clinical practice. CONCLUSION: Fetal ultrasound training for obstetrics and gynecology residents is perceived by most ultrasound program directors and residents to be adequate. Future development of standardized guidelines and competency assessment tools should consider that approximately one fifth of obstetrics and gynecology residents are currently planning to use this diagnostic modality in clinical practice. LEVEL OF EVIDENCE: II-2     

A Canadian Survey of Postgraduate Education in Aboriginal Women's Health in Obstetrics and Gynaecology

ObjectiveTo assess Canadian obstetrics and gynaecology residents' knowledge of and experience in Indigenous women's health (IWH), including a self-assessment of competency, and to assess the ability of residency program directors to provide a curriculum in IWH and to assess the resources available to support this initiative.MethodsSurveys for residents and for program directors were distributed to all accredited obstetrics and gynaecology residency programs in Canada. The resident survey consisted of 20 multiple choice questions in four key areas: general knowledge regarding Indigenous peoples in Canada; the impact of the residential school system; clinical experience in IWH; and a self-assessment of competency in IWH The program director survey included an assessment of the content of the curriculum in IWH and of the resources available to support this curriculum.ResultsResidents have little background knowledge of IWH and the determinants of health, and are aware of their knowledge gap Residents are interested in IWH and recognize the importance of IWH training for their future practice. Program directors support the development of an IWH curriculum, but they lack the resources to provide a comprehensive IWH curriculum and would benefit from having a standardized curriculum available.ConclusionA nationwide curriculum initiative may be an effective way to facilitate the provision of education in IWH while decreasing the need for resources in individual programs.     

Practice patterns and attitudes toward education among Canadian obstetricians and gynecologists

A group of 1370 specialists in obstetrics and gynecology were surveyed for information about practice patterns, continuing medical education preferences, and their perception of the adequacy of their own residency training. The overall response rate was 65.7%. More than half were in solo practice, practiced in communities of over 250,000, had been in practice for more than 10 years, or had a full or part-time appointment with a Canadian medical school. A wide range of continuing medical education methods were used. Journals were ranked highest by 41%. It is disturbing that very few physicians (15%) indicated any involvement in practice audit. The quality of residency training was ranked low in a number of areas including genetic counseling, ultrasound, neonatology, intensive care, colposcopy, sexual dysfunction, marital counseling, and hysteroscopy. The survey highlights a number of areas that merit the attention of Canadian programs in postgraduate and continuing medical education in obstetrics and gynecology.     

Perceived proficiency in endoscopic techniques among senior obstetrics and gynecology residents

STUDY OBJECTIVES: To assess current training methods in laparoscopic surgery employed in United States obstetrics and gynecology residency programs, level of proficiency in various minimally invasive surgery procedures amongst senior obstetrics and gynecology residents, and ways in which training in minimally invasive surgery can be improved. DESIGN: Survey (Canadian Task Force classification III). SETTING: Accredited obstetrics and gynecology programs in the United States. SUBJECTS: All fourth-year residents in accredited obstetrics and gynecology programs in the United States. INTERVENTION: Residents received a survey regarding their perceived proficiency performing various laparoscopic procedures and the type of training they received in these techniques. MEASUREMENTS AND MAIN RESULTS: Responses were received from 133 programs (52.4%) and 295 residents (26.8%). Of these, 67% of residents thought emphasis on laparoscopic surgery training should be increased or greatly increased; 87% thought laparoscopic skills were important for building a successful practice. Formal teaching methods were clearly associated with improved perception of proficiency, and those with higher perception of proficiency expected to perform more laparoscopic procedures after graduation. Residents lacked perceived competency in most advanced laparoscopic procedures. CONCLUSION: Residents seem to benefit significantly from a formal curriculum in minimally invasive surgery, but they do not feel competent performing some advanced procedures on graduation. In our opinion, more emphasis should be placed on training in laparoscopic surgery in United States obstetrics and gynecology programs.     

A 5-year residency curriculum in obstetrics, gynecology, and family medicine.

OBJECTIVE: To develop a curriculum for residents in obstetrics and gynecology that also provides training in family medicine. METHODS: We designed a 5-year curriculum with 36 months of obstetrics and gynecology, 12 of which are as chief resident, with a 4-month rotation through family medicine to meet the primary care requirements, and rotations of 1 month each in geriatrics and emergency medicine. The curriculum includes the 30 months of required rotations mandated by family medicine (three of which are in obstetrics and gynecology), with the 6 months' available elective time allocated to obstetrics and gynecology. RESULTS: The Residency Review Committee for Obstetrics and Gynecology accredited the curriculum, which meets the Accreditation Council for Graduate Medical Education Special Requirements for Family Medicine, in August 1996. CONCLUSION: This 5-year residency curriculum educates physicians in both obstetrics and gynecology, and family medicine, and graduates are eligible to pursue board certification in both specialties.     

Residency training in colposcopy: a survey of program directors in obstetrics and gynecology and family practice

OBJECTIVE: Our goal was to identify how colposcopy is being taught to residents in obstetrics and gynecology and family practice programs and to see if the program directors think their residents receive sufficient clinical exposure to be adequately trained in colposcopy. STUDY DESIGN: A 30-question survey was sent to all obstetrics and gynecology and family practice residency program directors. The survey included questions about the didactic nature of the colposcopy curriculum, the type of supervision, how resident skills are evaluated, estimates of the numbers and types of patients evaluated, the numbers and types of procedures being done by each resident, and the program director's perception of residents' competence in colposcopy. RESULTS: The overall response rate was 485 of 752 program directors (64.5%). Significantly fewer family practice than obstetrics and gynecology program directors thought they had adequate numbers of colposcopy patients to train their residents. By their program directors' estimates, 86% of family practice residents evaluate 10 or fewer patients with high-grade lesions (versus 16.5% of obstetrics and gynecology residents); 51.4% evaluate 10 patients or fewer with low-grade lesions (versus 6.7% of obstetrics and gynecology residents), and 40.6% evaluate 10 patients or fewer with atypical squamous cells of undetermined significance (versus 3% of obstetrics and gynecology residents). Experience with vulvar disease is also limited. Program directors thought their residents' colposcopy skills were roughly comparable with their general obstetrics and gynecology skills. CONCLUSIONS: It is possible that many program directors underestimate the number of colposcopic examinations required to achieve and maintain colposcopic skills. Many training programs have insufficient clinical volume to properly train residents in colposcopy.     

Teaching operative dictation. A survey of obstetrics/gynecology residency program directors

OBJECTIVE: To assess current efforts to teach operative dictation in obstetrics and gynecology residency programs. STUDY DESIGN: A survey detailing the didactics of operative dictation was distributed in a single mailing to all program directors listed in the roster of the Council on Residency Education in Obstetrics and Gynecology. RESULTS: Of 274 surveys distributed, 115 (42%) were returned. Ten percent of program directors reported defined curricula related to operative dictation. Using a combination of lectures, personal instruction and review of previous notes, attendings and senior residents share the responsibility for teaching operative dictation in the majority (78%) of programs. Sixty percent of program directors were in favor of more formal guidelines for residency education in the technique of operative dictation, 34% were opposed, and 6% offered no opinion. CONCLUSION: Obstetrics and gynecology residency programs rarely have a structured curriculum for teaching operative dictation, and the majority of program directors support the institution of more formal guidelines.     

Resident Education Curriculum in Pediatric and Adolescent Gynecology: The Short Curriculum 3.0

Exposure to pediatric and adolescent gynecology (PAG) varies across residency programs in obstetrics and gynecology, family medicine, and pediatrics, as well as fellowship programs in adolescent medicine. Nevertheless, these programs are responsible for training residents and fellows and providing opportunities within their programs to fulfill PAG learning objectives. To that end, the North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG education by creating and systematically updating the Short Curriculum. This curriculum outlines specific learning objectives that are central to PAG education and lists essential resources for learners’ reference. This updated curriculum replaces the previous 2018 publication with added content, resources, and updated references.     

Effect of residency program merger on undergraduate medical student education in obstetrics and gynecology.

OBJECTIVE: To evaluate the effect of residency program merger on third-year medical student clerkships using student evaluations of their experiences and standardized subject examination scores. METHODS: End-of-clerkship ratings from student evaluations and National Board of Medical Examiners standardized subject examination scores in obstetrics and gynecology were used from clerkship sites where three separate military residency programs in obstetrics and gynecology recently merged into two new programs. Mean student evaluation scores and subject examination scores for the year preceding and the year following the merger were compared. RESULTS: The mean differences in medical student evaluation scores before and after merger of the residency programs were 0.1 (Mann-Whitney rank sum, P = .1), -0.1 (Mann-Whitney rank sum, P = .8), and 0.2 (Mann-Whitney rank sum, P = .3). The mean differences for subject examination scores before and after merger of the residency programs were -3.5 (95% confidence interval [CI] -33.2, 26.2; paired t test), -30.1 (95% CI -58.9, -1.4; paired t test), and -35.3 (95% CI -74.8, 4.3; paired t test). CONCLUSION: Merger of residency programs in obstetrics and gynecology does not appear to have a deleterious effect on medical students' satisfaction with the clerkship or their performance on standardized subject examinations at our institution.     

Abortion training in Canadian obstetrics and gynecology residency programs

OBJECTIVE: To study abortion training in Canadian obstetrics and gynecology (ob-gyn) residency programs. METHODS: An anonymous questionnaire was sent to all postgraduate year (PGY)-4 and PGY-5 ob-gyn residents (n=130) and residency program directors (n=16) in Canada. The questionnaires inquired about demographic information, details of abortion training, resident participation in training, and intention to provide abortions after residency. RESULTS: Ninety-two of 130 residents (71%) and 15 of 16 program directors (94%) responded. Abortion training is considered routine in approximately half of programs and elective in half. The majority of residents (71%) participated in abortion training, and half plan to do elective abortions after residency. More than half of residents felt competent after training to perform first-trimester aspiration and second-trimester inductions but did not feel competent in first-trimester medical abortions or dilation and evacuation (D&E). Residents were more likely to participate in training if the program arranged the training for residents (P=.04) and were more likely to intend to provide abortions if the training was considered routine (P=.02), while controlling for all significant demographic and training variables. CONCLUSION: Most Canadian ob-gyn programs offer some training in elective abortion, but only half include it routinely in training, and the minority of residents feels competent in D&E and medical abortion. Integrated abortion training was associated with greater resident participation in training and increased likelihood of intention to provide abortions after residency.     

Common accreditation and educational problems in obstetrics-gynecology residencies

The Accreditation Council for Graduate Medical Education (ACGME) accredits U.S. institutions that offer graduate medical education, including that in obstetrics and gynecology. The ACGME's 23 Residency Review Committees (RRCs) monitor these programs. The RRC for obstetrics and gynecology has identified 18 common problems in obstetrics-gynecology residency programs. Upon identifying one or more of these problems in an obstetrics-gynecology residency program, the RRC can withdraw accreditation or grant probation or continued probation.     

Teaching and evaluating ultrasound skill attainment: competency-based resident ultrasound training for AIUM accreditation

Modern obstetrics and gynecology practice requires the frequent use of ultrasound and ultrasound training as a required component of obstetrics and gynecology residencies. Although programs do offer training in obstetric ultrasound imaging, education in gynecologic imaging is either absent or limited. This article describes a comprehensive ultrasound curriculum for obstetrics and gynecology residents that has been developed and implemented at the University of New Mexico. The curriculum is competency based and qualifies the graduating resident to seek American Institute of Ultrasound in Medicine laboratory accreditation.     

Resident Education Curriculum in Pediatric and Adolescent Gynecology: The Short Curriculum 2.0

The degree of exposure to pediatric and adolescent gynecology (PAG) varies across residency programs in obstetrics and gynecology and pediatrics. Nevertheless, these programs are responsible for training residents and providing opportunities within their programs to fulfill PAG learning objectives. To that end, the North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG resident education by creating and systematically updating the Short Curriculum. This curriculum outlines specific learning objectives that are central to PAG education and lists essential resources for learners' reference. This updated curriculum replaces the previous 2014 publication with added content, resources, and updated references. Additionally, attention to the needs of learners in pediatrics and adolescent medicine is given greater emphasis in this revised North American Society for Pediatric and Adolescent Gynecology Short Curriculum 2.0.     

Evaluating the acquisition of colposcopy skills in an obstetric-gynecologic residency program

Instruction in colposcopic technique is now an integral component of residency training in obstetrics and gynecology. No statistical method for assessing colposcopy skills has been reported on before. The statistical calculations of sensitivity, specificity and kappa were applied to determine if there was any progressive acquisition of colposcopy skills by the colposcopy trainee during the four-year residency program.     

Lactation Education for Resident Obstetricians: Promoting Breastfeeding Advocates for the Future

Obstetrics and gynecology residency training programs are historically lacking in breastfeeding education and advocacy. Healthy People 2020 supports interventions that promote breastfeeding as a primary care strategy with significant health benefits to the newborn and woman. Midwives are well poised to engage obstetrics and gynecology residents in lactation education. A few educational interventions have been described in the literature to increase knowledge, confidence, and behavior related to lactation among residents. This article describes a breastfeeding education curriculum developed by midwifery faculty at Boston University School of Medicine. The project included 3 lectures and a simulation center workshop covering topics including lactogenesis, prenatal, intrapartum, and postpartum interventions that promote or limit lactation, hands‐on latch assistance, hand expression, use of breast pumps and storage of human milk, and common disorders of lactation. Postintervention evaluations demonstrated improvements in knowledge and confidence. Providing breastfeeding education to resident physicians may be an intervention to promote patient breastfeeding education and support and close the gap of disparities in breastfeeding rates.     

Cesarean Section Rates in Teaching Hospitals: A National Survey

ABSTRACT: This survey investigated the cesarean section rate in teaching hospitals in the United States and the factors that may influence it. A national survey was performed by mailing a questionnaire to 277 accredited residency programs in obstetrics and gynecology. The estimated cesarean rate in all hospitals, with residencies in obstetrics and gynecology in the United States in 1990 was 20.3 percent, compared with an overall national rate of 23.5 percent. Women delivering in teaching hospitals were less likely to have a cesarean section than those delivering in hospitals without residency programs (odds ratio = 0.77, 95% CI 0.77–0.78, p = 0.0001). As centers for training and research, teaching hospitals represent an appropriate setting to begin the process of lowering the United States cesarean section rate.