Residency Training in Pediatric and Adolescent Gynecology Across Obstetrics and Gynecology Residency Programs: A Cross-Sectional Study

Study ObjectiveTo estimate the prevalence of Pediatric and Adolescent Gynecology formal training in the United States Obstetric and Gynecology residency programs.DesignProspective, anonymous, cross-sectional study.ParticipantsUnited States program directors of Obstetrics and Gynecology residency programs, N = 242; respondents 104 (43%).Results104 residency programs responded to our survey. Among the 104 residency programs, 63% (n = 65) have no formal, dedicated Pediatric and Adolescent Gynecology clinic, while 83% (n = 87) have no outpatient Pediatric and Adolescent Gynecology rotation. There is no significant difference in the amount of time spent on a Pediatric and Adolescent Gynecology rotation among residents from institutions with a Pediatric and Adolescent Gynecology fellowship (P = .359), however, the number of surgeries performed is significantly higher than those without a Pediatric and Adolescent Gynecology fellowship (P = .0020). When investigating resident competency in Pediatric and Adolescent Gynecology, program directors reported that residents who were taught in a program with a fellowship-trained Pediatric and Adolescent Gynecology faculty were significantly more likely to be able to interpret results of selected tests used to evaluate precocious puberty than those without (P = .03).ConclusionsResidency programs without fellowship trained Pediatric and Adolescent Gynecology faculty or an established Pediatric and Adolescent Gynecology fellowship program may lack formal training and clinical exposure to Pediatric and Adolescent Gynecology. This information enables residency directors to identify deficiencies in their own residency programs and to seek improvement in resident clinical experience in Pediatric and Adolescent training.     

Reflection of Trainee Class Gender Proportion in the Leadership of Minimally Invasive Gynecologic Surgery Fellowships

Study ObjectiveTo describe the gender makeup of historic fellow classes, as well as those in the roles of associate program director and program director. To determine the representation ratio of the current fellowship program leadership related to historic fellowship class gender proportion.DesignRetrospective observational study.SettingFellowship in minimally invasive gynecologic surgery (FMIGS) sites.ParticipantsNo patient data were captured or used in this study. The subjects included all FMIGS fellows, program directors, and associate program directors for whom there was publicly available data from 2001 to present.InterventionsNot applicable.Measurements and Main ResultsMost FMIGS fellow classes have consisted of mostly female surgeons ranging from 40% to 89% female. The representation ratios for the current program leadership are 0.57, 0.82, and 0.71 for program directors, associate program directors, and all leadership positions, respectively.ConclusionRepresentation ratios indicate that the current gender makeup of program leadership is not representative of the gender makeup of graduated fellow classes.     

Tenure of academic chairs in obstetrics and gynecology: a 25-year perspective

OBJECTIVE: To assist in predicting future leadership needs, this longitudinal study examines turnover and net retention rates among chairs at university obstetrics and gynecology departments between 1981 and 2005. METHODS: A database of appointment dates and tenure of chairs at each of 125 Association of American Medical Colleges-approved United States medical schools was collated using membership listings from the Association of Professors of Gynecology and Obstetrics and from the Council of University Chairs in Obstetrics and Gynecology. Complete data from 118 departments were confirmed by selective correspondence at individual departments and further review by the investigators. RESULTS: A total of 260 individuals (232 men, 28 women) became new chairs between 1981 and 2005. The annual turnover rate increased gradually from 6.0% to 12.7%. Five-year net retention rates remained steady between 1982 and 1997 but dropped after 1997 (85.6% compared with 63.2%; P=.03). A chair's tenure ranged widely (1 to 23 years; median 8 years), regardless of gender or school type, size, or location. Approximately one half of interim chairs became permanent chairs, usually at their own institution. The number of new women chairs increased from none in 1981 to 17 (15.2% of total chairs) in 2005. CONCLUSION: Academic chair positions in obstetrics and gynecology experienced a doubling in annual turnover rates, while retention rates declined. The proportion of chairs occupied by women increased progressively. LEVEL OF EVIDENCE: II-2.     

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     

Resident attrition in obstetrics and gynecology.

OBJECTIVE: Our goal was to determine the rate of attrition from obstetrics and gynecology residency programs. STUDY DESIGN: The Council on Resident Education in Obstetrics and Gynecology sent questionnaires to all 295 obstetrics and gynecology residency program directors in the United States and Canada. These programs represent 4306 postgraduate-year 1 through 4 (or 5) resident positions each year. The program directors were asked the number of residents who left voluntarily or were dismissed in a 2-year period and the reasons they left. RESULTS: In a 2-year period 299 residents left or were dismissed (6.94% over 2 years, or 3.47% per year). Only 88 (1% per year) left specifically because they decided they preferred a different discipline. CONCLUSION: The rate of attrition from obstetrics and gynecology residency programs is not excessively high.     

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.     

The role of gender in an obstetrics and gynecology residency program

A brief historical review of the role of female medical students and female physicians in American medicine is presented. The 1985-1986 Council on Resident Education in Obstetrics and Gynecology Residency Data Bank was analyzed for gender distribution. Questionnaire studies were undertaken to study the possible effect of the increasing number of female residents in an obstetrics and gynecology residency program. Queries were sent to current and former residents, the attending staff, and the nursing and anesthesiology staffs. In order to evaluate the national scene, letters were mailed to directors of programs with 20 or more residents. The overall results indicated female residents have a positive effect on residency training.     

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.     

Primary care in obstetrics and gynecology resident education: a baseline survey of residents' perceptions and experiences.

OBJECTIVE: To determine the perceptions and practices of American obstetrics and gynecology residents concerning primary care immediately before the institution of Residency Review Committee Special Requirements for Obstetrics and Gynecology. METHODS: The Council on Resident Education in Obstetrics and Gynecology In-Service Examination in 1995, given to 4361 residents, who represented all programs in the country, included a questionnaire on whether obstetrics and gynecology was primary care and whether they planned to do primary care after residency. Primary care services were categorized by counseling and screening, as defined by the U.S. Preventive Health Services Task Force. Variables included gender, residency level (upper or lower), and type of residency (community or university based). Data were analyzed using the chi2 text and multiple analyses of variance. RESULTS: The response rate was 94% (4099 of 4361), representing a nationwide complement. Eighty-seven percent of the respondents believed that obstetrics and gynecology was primary care and 85% planned to practice accordingly after residency. Residents spend less than 25% of their time counseling on nongynecologic subjects and less than 25% of their time screening for nongynecologic entities, so their perception as primary care providers focused on traditional obstetric and gynecologic counseling and screening services. When assessments were made by gender, level of training, and type of residency, significant differences were found in many variables regarding counseling and screening practices. CONCLUSION: Our survey results suggest that most American obstetrics and gynecology residents consider obstetrics and gynecology primary care but that there were limitations in the educational venues for learning about nongynecologic primary care before the implementation of the Residency Review Committee Special Requirements. Improvement in nongynecologic primary care teaching is a reasonable expectation because residency programs have had 3 years to institute the mandated changes and provide it to residents.     

Endoscopy teaching in Canada: a survey of obstetrics and gynecology program directors and graduating residents

OBJECTIVE: To examine the current state of basic and advanced gynecologic endoscopy teaching in Canadian Obstetrics and Gynecology (Ob/Gyn) residency programs. METHODS: On Institutional Research Board approval, 2 pretested anonymous questionnaires were developed: one distributed to all Canadian Ob/Gyn program directors and a second to graduating residents (Canadian Task Force classification III). Two mailings were sent to maximize response, and some department chairs received personal telephone calls by the senior author to encourage participation. Residents on maternity leave were excluded from the study. RESULTS: Fifteen of 16 (94%) program directors, and 47 of 62 (76%) residents participated. Directors expect all residents to be knowledgeable and competent performing basic endoscopic procedures on graduation. However, considerable variation exists among programs that teach advanced endoscopy. Some of the more important factors limiting integration of advanced endoscopic teaching include paucity of trained faculty, lack of attending interest, scarcity of operating time, and financial constraints. Most graduating residents consider undertaking additional gynecologic endoscopy fellowships. CONCLUSION: Most Ob/Gyn program directors and graduating residents consider endoscopic surgery essential to contemporary practice. There is consensus to improve resident teaching in gynecologic endoscopy and commitment to better prepare future practitioners to ensure patient safety. Paucity of trained faculty and fiscal constraints appear to be important limiting factors.     

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.     

Development and Validation of a Laparoscopic Sacrocolpopexy Simulation Model for Surgical Training

Study ObjectiveTo develop a valid laparoscopic sacrocolpopexy simulation model for use as an assessment and learning tool for performing this procedure.DesignSimulation study (Canadian Task Force classification II-2).SettingTwo tertiary academic centers.InterventionA training model was developed to simulate performance of a laparoscopic sacrocolpopexy. Construct validity was measured by comparing observed masked performances on the model between experienced Female Pelvic Medicine and Reconstructive Surgeons (experts) and upper level trainees. All videotaped performances were scored by 2 surgeons who were masked to subject identity and using the valid and reliable Global Operative Assessment of Laparoscopic Skills scale.Measurements and Main ResultsThe expert group included Female Pelvic Medicine and Reconstructive Surgeons (n = 5) experienced in laparoscopic sacrocolpopexy, and the trainee group (n = 15) included fourth-year gynecology residents (n = 5) and fellows in Female Pelvic Medicine and Reconstructive Surgery and in Minimally Invasive Gynecologic Surgery (n = 10). The experts performed significantly better than the trainees in total score and in every domain of the Global Operative Assessment of Laparoscopic Skills scale (median [range] score: expert group, 33 [30.5–39] vs trainee group, 20.5 [13.5–30.5]; p = .002). Previous surgical experience had a strong association with performance on the model (rho > 0.75). Most subjects “agreed” or “strongly agreed” that the model was authentic to the live procedure and a useful training tool. There was strong agreement between masked raters (interclass correlation coefficient 0.84).ConclusionThis simulation model is valid and reliable for assessing performance of laparoscopic sacrocolpopexy and may be used for practicing key steps of the procedure.     

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.     

Sexual Health Education in Obstetrics and Gynecology (Ob-Gyn) Residencies—A Resident Physician Survey

BackgroundMany women will experience a sexual health concern and present to their Obstetrics and Gynecology (Ob-Gyn) care provider, yet a large portion of graduating Ob-Gyn resident physicians in the United States may not feel comfortable helping patients with some sexual health issues.AimTo perform a cross-sectional study of U.S. Ob-Gyn resident physicians that assesses sexual health education didactic sessions and comfort level with sexual health clinical vignettes.MethodsA 32-item anonymous survey was sent to all 4,065 Ob-Gyn residents on June 7, 2016. Respondents voluntarily completed the survey electronically.OutcomesThe primary outcome measures are the comfort level of Ob-Gyn resident physicians in taking a sexual history and providing counseling to patients represented in clinical vignettes, which were based on sexual health learning objectives from the Council on Resident Education in Obstetrics and Gynecology (CREOG).ResultsOf the 4,065 eligible U.S. examinees, 968 (23.8%) agreed to participate in the study, and 802 (19.7%) completed the survey and were included in the final analysis. Nearly two-thirds of the residents indicated that sexual health training was a priority in residency. However, more than half were not able to describe the disorders of sexual function or list common medications that effect sexual function. When posed with clinical vignettes, residents felt very comfortable obtaining a sexual history (98.5%) and providing counseling (97.0%) for a 16-year-old seeking contraception, yet fewer felt very comfortable obtaining a history and providing counseling for a 26-year-old who is a refugee from Somalia (77.2% and 73.8%). Smaller cohorts felt prepared to take a sexual history and provide counseling for a 17-year-old who discloses that she is a victim of sex trafficking (61.2% and 57.7%), and for a 58-year-old transgender patient planning hormone therapy and surgery (49.9% and 37.9%). In logistic regression analysis, the factors that were influential in an Ob-Gyn resident physician's program to prepare them to describe the disorders of sexual function were post-graduate year (OR 1.387, 95% CI 1.189, 1.618; P = .0001), those that rated the importance of a sexual health curriculum highly (OR 0.701, 95% CI 0.569, 0.864; P = .0012), and a greater number of didactic sessions on sexual health in the residency curriculum (OR 0.685, 95% CI 0.626, 0.750; P < .0001).ConclusionThese findings highlight strengths in the comfort of Ob-Gyn resident physicians about sexual health and illustrate areas of opportunity to engage resident learners by improving the sexual health curriculum.Worly B, Manriquez M, Stagg A, et al. Sexual Health Education in Obstetrics and Gynecology (Ob-Gyn) Residencies—A Resident Physician Survey. J Sex Med 2021;18:1042–1052.     

Burnout in chairs of obstetrics and gynecology: diagnosis, treatment, and prevention

OBJECTIVE: The purpose of this study was to determine the prevalence of burnout in chairs of academic departments of obstetrics and gynecology, identify important stressors, and develop strategies to treat and prevent burnout. STUDY DESIGN: We performed a cross-sectional study of 131 chairs in the United States and Puerto Rico. We used a 6-part questionnaire focusing on demographics, potential stressors, satisfaction with personal and professional life, self-efficacy, burnout as measured by the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), and support from the spouse/partner and family. Statistical analyses were performed with the chi(2) test for categorical variables and t test or analysis of variance for continuous variables. RESULTS: Questionnaires were returned from 119 chairs, 110 men and 9 women, a response rate of 91%. Chairs had served an average of 7.2 years. They worked an average of 67.4 hours each week, spending 45% of their time in administrative duties, 31% in patient care, 15% in teaching, and 8% in research. Female chairs worked significantly more hours per week than male chairs, 76.9 versus 66.7 hours (P =.005). Chairs who had served >10 years worked significantly fewer hours each week than did those who had been chairs <5 years, 63.2 versus 69.2 hours (P =.04). The most significant stressors were hospital/departmental budget deficits, Medicare/Medicaid billing audits, loss of key faculty, union disputes, and faculty, resident, and staff dismissals. To deal with stress, chairs most often spent time with family and friends. Twenty-two percent of chairs were somewhat-very dissatisfied with their positions. The MBI-HSS revealed a high subscale score for emotional exhaustion, moderate-high for depersonalization, and high for personal accomplishment. High emotional exhaustion was observed in younger chairs, those who worked nearly 70 hours each week, and those with less spouse/partner support. Burnout was more common in new chairs. CONCLUSION: Burnout in chairs of obstetrics and gynecology is characterized by a high level of emotional exhaustion, moderate-high depersonalization, and high personal accomplishment. These findings should be used to develop programs to improve the psychologic well-being of our academic leaders.     

Academic manpower for obstetrics and gynecology in the United States.

All 119 medical schools in the United States provided information for a study of academic manpower conducted by the Association of Professors of Gynecology and Obstetrics (APGO). The average number of full-time faculty members per medical school is 13.2, with 2 positions vacant per school. Subspecialists are concentrated in university medical school departments, which also have large residency programs. A perceived need for 46% more faculty over the next 5 years will probably aggravate the shortage.     

An evaluation of trends in obstetrics and gynecology clerkships in the United States and Canada

OBJECTIVE: The purpose of this study was to provide an updated profile of clerkship directors and third-year clerkships for Departments of Obstetrics and Gynecology at US and Canadian medical schools. STUDY DESIGN: All 142 accredited medical schools in the US and Canada were contacted to identify the individual(s) responsible for third-year medical education in Obstetrics and Gynecology. Additional clerkship sites (n=10) were identified using the Association of Professors in Gynecology and Obstetrics' (APGO) list of current members self-identified as clerkship directors. Written surveys were mailed to the individuals identified above. The survey included questions about demographic and academic profiles, 11 attitude statements, as well as potential interest in a national organization of clerkship directors under APGO and interest in the creation of web-based resources specifically for clerkship directors. RESULTS: One hundred twenty-three (81%) responses were received. Demographic and academic characteristics of clerkship directors were similar to those published 13 (1) and 6 (2) years ago, except that the proportion of female clerkship directors has steadily increased (20% in 1989 [1], 25% in 1994 [2], and 44% in 2000, P <.0001). Thirty-five percent of departments have a specialized division of medical education, and 21% of respondents stated that their affiliated medical school had a formal multidisciplinary women's health care curriculum. Eighty-nine percent of respondents felt that their job as clerkship director was personally fulfilling. Eighty- nine percent supported a national organization of clerkship directors under APGO and the majority supported other activities specific for clerkship directors, including web-based resources. CONCLUSION: The profiles of obstetrics and gynecology clerkships and clerkship directors in the US and Canada have remained relatively stable over the last 13 years. However, the proportion of female clerkship directors continues to increase. Interest in more organized activities specifically for clerkship directors and web-based resources is high.