The Current State of Pediatric and Adolescent Gynecology Residency Training in Canada: Summary of Educational Resources to Enhance the Achievement of Pediatric and Adolescent Gynecology Objectives

A previous study determined that Obstetrics and Gynecology (ObGyn) residency Program Directors (PD) endorse mandatory Pediatric and Adolescent Gynecology (PAG) training to achieve national PAG objectives. Although barriers exist that limit the achievement of PAG objectives, this paper presents existing PAG tools and curricula. These include the North American Society for Pediatric and Adolescent Gynecology (NASPAG) short and long curricula, a wide variety of PAG electives available across Canada, more than 25 online clinical cases, and a simulation curriculum. This paper details these resources and provides a 4-week PAG schedule to accommodate ObGyn residency training programs.     

Impact of a Pediatric and Adolescent Gynecology Curriculum on an Obstetrics and Gynecology Residency

Study ObjectiveTo determine the effectiveness of a new pediatric and adolescent gynecology (PAG) curriculum for improving obstetrics/gynecology resident physician knowledge and comfort level in patient management and to describe the current deficiencies in resident physician knowledge and comfort level in PAG.DesignA PAG curriculum was implemented for the obstetrics/gynecology resident physicians (n = 20) at the University of South Florida in July 2013. Before and after the curriculum was introduced, resident physicians and recent graduates of the residency program completed a survey to assess their comfort level and a knowledge assessment consisting of 20 case-based questions.SettingUniversity-based residency program.ParticipantsResident physicians and recent resident physician graduates in the Department of Obstetrics and Gynecology.InterventionsIntroduction of a PAG curriculum during the 2013-2014 academic year.Main Outcome MeasuresImprovement in resident physicians' comfort level and knowledge in PAG.ResultsAfter the curriculum was introduced, comfort increased in examining the genitals of a pediatric gynecology patient (median difference = 1.5; P = .003) and history-taking, physical examination skills, and management (median difference = 1; P = .002) compared with before the curriculum. There was no significant difference in overall quiz score (15.5 ± 1.87 vs 15.8 ± 1.3; P = .78).ConclusionA curriculum in PAG did improve resident comfort level in managing PAG patients, but did not significantly improve knowledge of this topic.     

Forceps and vacuum delivery: expectations of residency and fellowship training program directors.

The objective of this study is to compare current forceps training practices in North American obstetrical residency training programs with that in maternal-fetal medicine fellowship programs. We sent a survey to all obstetrics and gynecology residency training programs and to all maternal-fetal medicine fellowship programs in North America. After sending out 354 questionnaires, 219 were returned for a response rate of 62%. The response rate for fellowship programs (52 of 59; 88%) was significantly greater than that of residency training programs (167 of 295; 56.6%) (p < 0.05). All fellowship training programs were using the 1988 ACOG forceps classification system, as were 98% of the residency training programs. Eighty-five percent of fellowship directors and 80% of residency directors felt the same system should be used for vacuum deliveries. All residency and fellowship directors expected proficiency with both instruments for outlet deliveries. For low deliveries requiring < or =45 degrees of rotation, at least 92% expected proficiency with both instruments. For low-forceps deliveries with >45 degrees of rotation, 82% of fellowship directors and 80% of residency directors expected proficiency. For low-vacuum deliveries with >45 degrees of rotation, 80% of fellowship directors and 76% of residency directors expected proficiency. Significantly more fellowship directors expected midforceps proficiency (47%) than did residency program directors (38%) (p < 0.05). Midvacuum proficiency was expected by 73% of fellowship directors and 69% of residency directors. The ACOG 1988 forceps classification system has now achieved wide acceptance and is taught by both residency and fellowship program directors. Most program directors favor using the same classification system for vacuum extraction deliveries. In general, the expectations of the residency program directors mirror those of maternal-fetal medicine fellowship directors. While outlet and low operations with < or =45 degrees of rotation are taught and proficiency is expected, most programs no longer expect proficiency in midforceps delivery, but do expect proficiency in midvacuum delivery. Proficiency in low operations with rotations < or =45 degrees is still expected.     

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.     

The Leadership Landscape: The Role of Gender in Current Leadership Positions in Obstetrics and Gynecology Departments

Study ObjectiveTo describe the proportion of female faculty in departmental administrative and educational leadership roles in Obstetrics and Gynecology departments.DesignCross-sectional observational study (II-3).SettingAccredited Obstetrics and Gynecology residency programs.ParticipantsA total of 288 accredited residency programs were identified from 2019 to 2020 with 1237 individuals in leadership positions.InterventionsSimilar to a 2012 to 2013 survey by Hofler et al, residency program websites and corresponding fellowships (Maternal Fetal Medicine, Female Pelvic Medicine and Reconstructive Surgery, Reproductive Endocrinology and Infertility, and Gynecologic Oncology), departmental websites, and divisional websites were queried for those in administrative and educational leadership positions. Information regarding gender (as determined by the surrogates of name and photographic gender expression), medical and academic degrees, academic rank, and subspecialty certification was abstracted.Measurements and Main ResultsWithin administrative leadership roles, women comprised 29% of chairs, 46% of vice chairs, and 47% of division directors, all significantly lower than men in administrative leadership (p <.001). In educational leadership, women made up 71% of medical school clerkship directors, 58% of residency directors, and 50% fellowship directors. Women were more likely to hold educational leadership positions (56% vs 40%; p <.001), although men were more likely to hold administrative leadership positions (68% vs 52%; p <.001). Among subspecialties, there was greatest gender equity within Female Pelvic Medicine and Reconstructive Surgery. Female leaders were more likely to have received additional academic degrees (e.g. MBA, MPH) than their male counterparts (19% vs 13%; p = .002).ConclusionWomen continue to be underrepresented in administrative leadership positions. Compared with 2012 to 2013, there is only a 9% increase in proportion of women chairing and 10% vice chairing Obstetrics and Gynecology departments; however, the increase is more substantial in other positions, such as division directors (17%). Our findings demonstrate ongoing gender disparity in the highest levels of departmental leadership and the need to further improve on diversity and gender equity within leadership roles.     

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

The degree of exposure to Pediatric and Adolescent Gynecology (PAG) varies across academic programs in Obstetrics and Gynecology, Pediatrics, and Adolescent Medicine. Nevertheless, these programs are responsible to train residents and provide opportunities within their training programs to fulfill PAG learning objectives. To that end, North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG resident education by disseminating the Short Curriculum with specific learning objectives and list of essential resources where key concepts in PAG can be covered.     

Reliability Study for Pediatric and Adolescent Gynecology Case-Based Learning in Resident Education

ObjectiveTo assess web-based teaching as a tool for resident education in pediatric and adolescent gynecology.Study DesignProspective Cohort involving 12 third year OB/GYN residents in a large university-based program. A second look reliability study on a previously utilized, web-based teaching case series in Pediatric and Adolescent Gynecology topics was evaluated. Residents' knowledge regarding the subject matter was assessed by pretest. After completion of the web-based teaching tool, a post test was administered. Residents were also given an opportunity to provide feedback regarding improvements to address future case series development for the tool and resident satisfaction in using this resource for resident education.ResultsThe pre-test group mean score was 11.2 (58.9%), SD = 1.9. The post-test group mean score was 15.2 (80%), SD = 1.70. (P = 0.0002). Resident participants universally reported the case series was a useful teaching tool. Pooled results from 2005–2006 and 2007–2008 also yielded statistically significant scores from pre test to post test (power of >80% at the 95% confidence interval).ConclusionA computer-based learning tool is an effective resource to improve baseline knowledge among ob-gyn residents in the subspecialty field of Pediatric and Adolescent Gynecology.     

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.     

Does the North American Society for Pediatric and Adolescent Gynecology Short Curriculum Increase Resident Knowledge in Pediatric and Adolescent Gynecology?

Study ObjectiveTo determine if the North American Society for Pediatric and Adolescent Gynecology (NASPAG) Short Curriculum improves self-reported knowledge in pediatric and adolescent gynecology (PAG) among obstetrics and gynecology (Ob/Gyn) residents, at programs without PAG-trained faculty.DesignProspective, cross-sectional exposure to the NASPAG short curriculum with a follow-up questionnaire.SettingOb/Gyn residency training programs without PAG faculty.ParticipantsOb/Gyn residents in training from February 2015 to June 2015.InterventionsExposure to the NASPAG Short Curriculum.Main Outcome MeasuresImprovement in self-perceived knowledge after completion of curriculum.ResultsTwo hundred twenty-seven residents met inclusion criteria; 34 completed the study (15% response). Less than 50% of residents reported adequate knowledge in the areas of prepubertal vaginal bleeding, vulvovaginitis, precocious and delayed puberty, Home environment, Education and Employment, Eating, peer-related Activities, Drugs, Sexuality, Suicide/depression, Safety from injury and violence (HEEADSSS) interview, pelvic pain, and bleeding management in teens with developmental delay. After completion of the curriculum, self-reported knowledge improved in 8 of 10 learning objectives, with no significant improvement in bleeding disorders or Müllerian anomalies. There was no association between pretest knowledge and level of residency training, type of residency program, previous exposure to PAG lectures, and previous exposure to patients with PAG complaints.ConclusionSignificant deficiencies exist regarding self-reported knowledge of core PAG topics among Ob/Gyn residents at programs without PAG-trained faculty. Use of the NASPAG Short Curriculum by residents without access to PAG-trained faculty resulted in improved self-reported knowledge in PAG.     

Operative note dictation: should it be taught routinely in residency programs?

OBJECTIVE: To determine the extent of formal education regarding operative dictation in U.S. Obstetrics and Gynecology residency programs and to prospectively evaluate the effectiveness of formal teaching regarding operative dictation. METHODS: A 1-page questionnaire was mailed to all U.S. Obstetrics and Gynecology residency program directors (n = 270). The operative dictations of all Obstetrics and Gynecology residents at the University of Iowa before and after a 30-minute formal teaching session were evaluated using a scoring system developed by the authors of this study (scale 0-20). RESULTS: A 73% response rate (n = 198) was obtained from the surveys. The results from the survey demonstrated that only 23% of programs provide formal teaching regarding operative dictations; however, 83% of the residency program directors felt that it is an important skill to teach. All 16 obstetrics and gynecology residents at the University of Iowa attended a 30-minute teaching session on operative dictation. The mean scores for all residents improved from 9.06 to 18.56 after a formal teaching session (P <.001). The preteaching scores comparing the 4 classes of residents also varied significantly (ranging from a score of 5.5 for first-year residents to 11.25 for the fourth-year residents, P =.009). There were no differences between scores among the residents after they attended the formal teaching session (P =.11). CONCLUSION: Formal teaching of operative dictation is uncommon in U.S. residency programs but felt to be important by most residency program directors. A brief teaching session is effective and may be useful during residency training. LEVEL OF EVIDENCE: II-3     

The effects of fellowships on residency training in obstetrics and gynecology

The impact of subspecialty fellowships on resident training deserves examination. Program directors responded to a nationwide survey assessing their opinions, their residents' views, and the Residency Review Committee's comments about fellowship effects on the residency. The directors agreed that the fellows' teaching and research contact enhances training. Competition between fellows and residents for scarce, nonroutine surgical cases detracts from this relationship. Residents reportedly benefit from fellows, yet they resent deferring select surgical experiences to them, such as microsurgery and radical pelvic surgery. The majority of the programs the Residency Review Committee reviewed received positive or neutral comments. Programs that grant their fellows junior faculty status and emphasize research over clinical duties recognize the full benefits of a combined residency-fellowship program.     

Program Website Evaluation of Canadian Obstetrics and Gynaecology Residency and Fellowship Programs

ObjectiveThe purpose of our study was to assess the comprehensiveness of Canadian obstetrics and gynaecology residency and fellowship program websites to understand the quality of information available to prospective students and make recommendations, if needed.MethodsAll active residency and fellowship program websites (as of May 2020) were evaluated and compared using 72-point criteria in the following domains: Recruitment, Faculty, Current Residents/Fellows, Research and Education, Surgical Procedures, Clinical Work, Benefits and Incentives, Wellness, and Environment. Programs without websites were excluded from the study. Program website information availability was compared by geographic region.ResultsOut of the identified 80 residency and fellowship programs, 68.75% (55) were from central Canada, 6.25% (5) from Atlantic Canada, and 25% (20) from western Canada. The mean score for residency websites was 25.4 ± 7.59 (35.6% of criteria complete). The domains with the highest and lowest inclusion rates were Research and Education (46.3% criteria complete) and Current Residents (16.2% criteria complete). The mean score of fellowship websites was 27.9 ± 8.89 (38.8% criteria complete). For fellowship websites, Wellness had the highest inclusion rate (66.0% criteria complete), while Current Fellows had the lowest (13.2% criteria complete). Overall, fellowship websites scored higher than residency websites (27.9 ± 8.89 and 25.4 ± 7.59 out of 72 criteria, respectively).ConclusionOverall, Canadian postgraduate obstetrics and gynaecology program websites include information on many topics relevant to prospective students, such as research, education, and wellness. Programs should provide more information about work hours, call schedules, and current trainees. Lastly, there is an opportunity for programs in western and Atlantic Canada to increase the comprehensiveness of their websites.     

Pediatric and Adolescent Gynecology Learned via a Web-Based Computerized Case Series

Study ObjectiveTo increase resident knowledge in pediatric and adolescent gynecology via a Web-based self-tutorial.Study DesignProspective cohort involving 11 third- and fourth-year residents in a large university program. Residents were asked to complete a Web-based teaching series of cases involving common topics of pediatric and adolescent gynecology (PAG). A pretest and a posttest were completed to assess knowledge gained. Residents were asked to give feedback regarding improvements to the Web-based series for future case development.SettingUniversity-affiliated residency program in a major metropolitan area.ParticipantsResident physicians in the Department of Obstetrics and Gynecology.InterventionsIntroduction of a Web-based teaching series to enhance resident education.Main Outcome MeasuresImprovement of resident knowledge in PAG.ResultsAll residents improved their knowledge in PAG after reviewing the series of cases. The pretest group mean score was 50%. The posttest group score was 69% (P < .05). All (100%) of participants said that this tool was an effective way to improve resident knowledge in PAG.ConclusionA computer-based self-tutorial in pediatric and adolescent gynecology is a feasible and satisfactory teaching adjunct to PAG.     

Managed health care and resident education

OBJECTIVE: We wished to determine the impact of managed health care on resident education in obstetrics and gynecology. STUDY DESIGN: A multiquestion survey was mailed to program directors of the 267 obstetrics-gynecology resident training programs in the United States. The questions ascertained departmental philosophy regarding the role of obstetrician-gynecologists as primary care versus specialist physicians, the extent of involvement with managed health care companies, educational curriculum content, the effect of managed care on patient volume, faculty time available for resident teaching, and the effect of managed care on resident education. RESULTS: Completed surveys were received from 210 (79%) program directors. One hundred twenty-six (63%) program directors responded that obstetrician-gynecologists should be primary care physicians for women, and 120 (60%) believed that the role of subspecialists will be reduced in the near future. In 1996, 177 (94%) programs had managed care contracts; many (57%) had >20 contracts. All programs participate with other specialties to teach primary care to their residents. One hundred twelve (59%) programs have had a decrease in patient volume, prompting 90 (45%) programs to increase their number of teaching sites. Of concern, 54 (26%) program directors noted that managed care companies discourage but do not restrict resident participation in the care and treatment of managed care patients, and 41 (20%) programs had some restrictions placed on such resident involvement. Budgetary constraints have decreased resources to 97 (47%) programs and threaten the time available for faculty teaching. CONCLUSIONS: Managed health care is having an effect on many resident teaching programs. Program directors are integrating managed care concepts into the educational curriculum and are negotiating with managed care organizations to involve residents in the care and treatment of managed care patients. (Am J Obstet Gynecol 1998;178:1157-64.)     

Improving Resident Knowledge in Pediatric and Adolescent Gynecology: An Evaluation of the North American Society for Pediatric and Adolescent Gynecology Short Curriculum

Study Objective

Resident education in pediatric and adolescent gynecology (PAG) is challenging. It encompasses patients from neonates to young adults with different disorders involving multiple subspecialties. Residents have inadequate exposure to PAG topics and report lack of knowledge in this area. The objective of this study was to determine if the North American Society for Pediatric and Adolescent Gynecology (NASPAG) Short Curriculum improves self-reported knowledge in PAG among obstetrics and gynecology (ObGyn), family medicine, and pediatric residents.

Professionalism in obstetrics-gynecology residency education: the view of program directors

OBJECTIVE: To define the qualities of professionalism emphasized in obstetrics-gynecology residencies and identify existing means of evaluating them. METHODS: A survey, designed to assess the importance of professionalism in residency programs and what means are utilized for its development, was sent to all 270 obstetrics-gynecology residency program directors in the United States. RESULTS: Two hundred thirteen surveys were returned (79%). Ninety-seven percent of all respondents indicated that they thought the development of professionalism was necessary for training obstetrics-gynecology residents, and 84.3% thought that formal educational training time should be devoted to this development. Over 85% endorsed faculty examples and mentoring as their methods of teaching professionalism. Respondents ranked honesty; accountability to patients, colleagues, and society; respect for patients; integrity; and excellence as the most important qualities of professionalism. Almost 79% believed those qualities were as important and as necessary as qualities of skill and knowledge in residency training. Almost 80% of respondents thought that the establishment of formal professionalism guidelines would be valuable in their training programs. CONCLUSION: A critical quality in resident education is professionalism, which receives emphasis in training programs largely through faculty example and mentoring. The variability inherent in such methods might be reduced by residency wide guidelines for uniform application of standards and to avoid arbitrariness in enforcement.     

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.     

Residents’ Confidence in Performing Robotic Hysterectomy in Obstetrics and Gynecologic Training Programs

Study ObjectiveTo compare residents’ perceptions of readiness to perform robotic-assisted laparoscopic hysterectomy with the perceptions of residency program directors in obstetrics and gynecology programs throughout the United States.DesignA survey was administered to all residents taking the 2019 Council on Resident Education in Obstetrics and Gynecology Exam and concurrently to program directors in all Accreditation Council for Graduate Medical Education–accredited training programs.SettingThe survey was designed to assess resident confidence to perform robotic hysterectomies by the time of graduation.PatientsNo patients were included in the study.InterventionsThe only intervention was administration of the survey.Measurements and Main ResultsDe-identified survey data were analyzed using chi-squared and Fisher's exact tests. A total of 5473 resident respondents and 241 residency program directors were included in the study. Fifty-two percent of graduating residents reported that they felt they were given surgical autonomy to perform robotic hysterectomies, and 53.7% reported that they could perform one independently (if it was an “emergency” and they had to). By the time of graduation, only 59% of residents reported confidence performing a robotic hysterectomy, and only 56% reported they felt that it would be an important procedure for their future career. Program directors were significantly more likely to report that their residents were given autonomy to perform robotic hysterectomy by graduation (61.0% [95% confidence interval (CI), 54.3–67.3]), could perform a robotic hysterectomy independently (60.9% [95% CI, 53.9–67.6]), or could perform a robotic hysterectomy by graduation (70.2% [95% CI, 63.5–76.3]) than residents themselves (38.6% [95% CI, 37.2–40.0], 22.8% [95% CI, 21.6–24.0], 62.6% [95% CI, 61.2–64.0], respectively).ConclusionAt the time of graduation, residents’ confidence in performing robotic hysterectomy independently is lower than their confidence in performing all other approaches to hysterectomy.