Teaching of bioethics within a residency program in obstetrics and gynecology

A formal curriculum for the teaching of bioethics was instituted within an obstetric and gynecologic residency program. The curriculum included an introductory lecture series, an ongoing series of case presentations, and occasional grand rounds on particular issues. An emphasis was placed on physician responsibilities within contemporary bioethical parameters. A summary of the first year of such an effort is presented.     

Impact of work hour restrictions on resident case experience in an obstetrics and gynecology residency program

OBJECTIVE: The purpose of this study was to evaluate senior resident case experience before and after enactment of work hour restrictions. STUDY DESIGN: Obstetrics and gynecology experience from 2 postgraduate year 4 classes were evaluated before and after adoption of work hour restrictions. Data were limited to experience obtained during the fourth year of residency. Data were analyzed with the 2-sample t test and Wilcoxon rank sum test, and adjusted for changes in institutional procedural volume. RESULTS: There were significant decreases in resident experience in total abdominal hysterectomy ( P = .018), procedures for genuine stress urinary incontinence ( P = .004), and hysteroscopy ( P = .006). Decreases were seen in resident experience in vaginal birth after cesarean section ( P = .011), primary cesarean section ( P = .31), and vacuum delivery ( P = .007), despite increase in institutional volume. CONCLUSION: Work hour restrictions have had impact on resident case experience in obstetrics and gynecology. Variance in institutional case numbers account for only some of these changes.     

A program of instruction in operative laparoscopy in a residency in obstetrics and gynecology

Operative laparoscopy has found an increasingly innovative role in contemporary gynecologic practice. Residency programs must now formulate protocols for training in laparoscopic surgery on which subsequent credentialling may be safely recommended. This report describes a program of instruction in operative laparoscopy and the number of procedures required to develop technical skills at each year level of a 4-year residency. The objective of the program was to develop clinical judgment and technical skills in operative laparoscopy during the first 3 resident years. The main outcome measurement was the safe performance of complicated operative laparoscopy during the fourth resident year. This program emphasized progressive, graded responsibility in operative laparoscopy to develop skills in both the principles and practice of laparoscopic surgery. Principles were taught through didactic sessions in laparoscopic instruments and techniques, assignment of reading lists for each year level, and a review of videotapes to assist in decision making for each procedure. Skills in technique and development of manual dexterity were taught over 4 years as follows. Postgraduate year (PGY) 1: restricted to diagnostic procedures emphasizing the development of basic eye-hand coordination using a video monitor system; PGY2: incorporation of principles of laparoscopic hemostasis and laparoscopic tubal ligation; PGY3: operative laparoscopy using multiple puncture sites, sharp dissection, and suture techniques; PGY4: progressively more complicated procedures to include salpingectomy, salpingostomy, and segmental resection for ectopic pregnancies; oophorectomy for benign disease, appendectomy, and adhesiolysis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Invited applicant evaluation of an online interview scheduler implemented by a residency program in obstetrics and gynecology

OBJECTIVE: To assess invited resident applicants' views of the feasibility and acceptability of a point-and-click online interview scheduler. METHODS: An online program was created for invited applicants to schedule themselves. The program presented the invitees with a series of interview dates with available slots for which they could click and receive immediate confirmation of their selected date. The majority of the invitees were asked to schedule online. These invitees received a brief survey to assess their views of the online scheduler. RESULTS: Eighty-three applicants were invited by e-mail for a resident interview, 71 of whom were offered the online scheduler. Of these 100% booked themselves online within 3-4 days of invitation. After three e-mail reminders 100% of the invitees completed the survey. Sixty-five of the 71 (92%, 95% confidence interval [CI] 85.4-98.6) said they liked the scheduling program, and most (77%, 95% CI 67.2-86.8) preferred to book online rather than telephone or e-mail. Eighty percent (95% CI 70.7-89.3) found the online scheduler easier to use. Overall, 72% (95% CI 60.5-81.6) felt that having an on-line scheduler did not affect their opinion of the quality of the program. Invitees in favor of the scheduler liked the convenience of anytime scheduling, the immediate confirmation, a quick view of available dates and times, and the ability to schedule without depending on someone else. CONCLUSION: Our online scheduler proved to be easy to use, eliminated phone calls with applicants, and satisfied most of the invitees.     

A method to limit working hours and reduce sleep deprivation in an obstetrics and gynecology residency program

We adopted a system in which a team of residents works at night and all other residents work during the day. This system allows us to limit resident work time to 75 hours a week. Residents never work more than 24 hours in a 36-hour period, and usually no more than 13 hours in a 24-hour period. All residents have 1 day off each week and at least one weekend in three off. We did not have to obtain additional residents or ancillary personnel, and residents have the same exposure to operative cases as they did under the old system. The system can work with as few as 12 residents. Sleep deprivation is reduced, resident morale is improved, and resident learning, as reflected by in-training examinations, appears to be enhanced.     

Laparoscopy-to-laparotomy quotient in obstetrics and gynecology residency programs

Introduction  

Laparoscopic skills are indispensable to the practice of present-day gynecologists. Hence, we investigated the share of minimal invasive surgery in the training of obstetricians and gynecologists.     

Former-resident self-assessment: a tool for residency program curriculum evaluation in obstetrics and gynecology

OBJECTIVE: To determine recent residents' confidence in managing problems in obstetrics and gynecology. STUDY DESIGN: All former residents from 1998 to 2002 were invited to participate. They were asked to complete a 32-item survey to assess confidence in obstetric and gynecologic care using Likert-scale responses. The study was approved by the local institutional review board. The t test was used for statistical analysis; p<0.05 was considered significant. RESULTS: Twenty-eight individuals graduated from the program during the study period; 61% responded to the survey. Respondents reported the lowest confidence in the business aspects of medicine, gynecologic ultrasound, laparoscopically assisted hysterectomy, pessary placement and cancer staging. They reported the highest confidence in routine obstetrics, laparoscopic sterilization, contraception, abnormal Pap smears, abdominal surgery and diagnostic laparoscopy, along with other categories. CONCLUSION: Residents are confident about management of most problems in obstetrics and gynecology. Periodic review of graduates' perceptions of training may be useful in modifying the curriculum.     

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.     

Factors detracting students from applying for an obstetrics and gynecology residency

OBJECTIVE: This study compares perception about the characteristics of obstetrics-gynecology (OG) of medical students who choose to pursue a residency in OG and those students who choose to enter another specialty. STUDY DESIGN: Fourth-year medical students were asked to complete a survey addressing their perceptions about OG. Responses were compared of (1) those entering OG to those entering other specialties, (2) those entering OG to those who seriously considered entering OG but chose another discipline, and (3) males to females. Chi-square tests were used for the comparisons. RESULTS: Of the 267 eligible students, 137 (51.1%) completed the survey. Clerkship satisfaction was rated as high by 88.9% of students choosing OG vs 10.2% (P<.0005) of those who chose another discipline. The emerging predominance of female providers detracted 38.5% of males vs 10.2% of females (P<.0005). CONCLUSION: Student perception of an OG clerkship may detract them from pursuing OG as a career.     

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.     

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.     

Practice management in obstetrics and gynecology residency curriculum.

OBJECTIVE: To establish the current level of instruction in practice management in obstetrics and gynecology residency programs; review recommendations of medical school practice management executives and current and former residents on design of practice management instruction programs; and develop recommendations for future management instruction by residency programs in obstetrics and gynecology. METHODS: A questionnaire was sent to 101 practice plan executives of obstetrics and gynecology departments at medical schools in the United States and Canada. A modified version was sent to 44 current obstetrics and gynecology residents and 72 former residents from the University of Tennessee, Memphis. RESULTS: The response rates were 71% (practice executives), 93% (current residents), and 81% (former residents). There were no formal management programs at 87% of responding institutions, although most respondents (62%) thought there should be mandatory participation in management programs, probably given by organizations outside the university. Potential subjects that received high ratings were current procedural terminology and diagnosis coding, managed care, billing procedures, contractual agreements between medical doctors, patient record management, and practice economics. CONCLUSION: Residency programs should establish formal practice management instruction programs and make participation mandatory. Funding should come from the medical school and university. Instructional help should come from extradepartmental organizations and individuals.     

The role of calprotectin in obstetrics and gynecology

The purpose of this article is to create the first complete review concerning the role of calprotectin, a calcium- and zinc-binding protein of the S100/calgranulins family, in obstetrics and gynecology. A Medline search was conducted between 6 and 8 June 2009 using the term calprotectin and its synonyms combined with the following ones: calprotectin, obstetrics and gynecology, breast cancer, ovarian cancer, endometrial cancer, cervical cancer, menstrual cycle, pregnancy, fetal implantation, labor, intra-amniotic inflammation, preeclampsia, HELLP syndrome, Rh(−) incompatibility.We found 46 studies which referred to obstetrics and gynecology. We excluded 11 studies which referred to obstetrics and gynecology but did not include enough information about calprotectin, and another two which referred to calprotectin but were not related to subjects of obstetrics and gynecology. Thus, we ended up with 33 studies which contained sufficient information to extract data for this review. All the articles were written in English. It was found that calprotectin is associated with many physiologic and pathologic processes in obstetrics and gynecology, such as: breast cancer, ovarian cancer, endometrial cancer, cervical cancer, cervical and vaginal physiology, menstrual cycle, pregnancy and labor. The role of calprotectin in these conditions is significant.In conclusion, the role of calprotectin seems to be important in several issues of obstetrics and gynecology. For example, calprotectin could be used as a diagnostic, prognostic or metastatic marker in several types of cancer, as a marker of inflammation and as a pharmaceutical target in many conditions. Further studies must be conducted to elucidate this role.     

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.