Curriculum change in an obstetrics-gynecology residency program and its impact on pregnancy in residency

OBJECTIVE: Our purpose was to determine whether pregnancy was better tolerated by the individual female resident and the program as a whole after changes in the curriculum. STUDY DESIGN: The 1983 through 1992 graduates of an obstetrics-gynecology residency program were questioned to assess the stress experienced by all residents and by the pregnant female residents. The level of agreement to statements expressing support and resentment for pregnancy in residency was measured. RESULTS: Resentment among residents toward their pregnant colleagues was significantly greater in 1983 through 1987 than in 1988 through 1992. Male residents expressed more resentment toward pregnancy in their colleagues than did female residents, but they were perceived by the pregnant female residents as equally supportive as female residents. The level of stress experienced by the 1983 through 1987 graduates was greater than by those from 1988 through 1992. CONCLUSION: Reducing the workload in training programs is associated with a decrease in the resentment of the residents toward pregnant residents and in the overall stress of the program. (AM J Obstet Gynecol 1994;170:1658-65.)     

Pap smear noncompliance among female obstetrics-gynecology residents

OBJECTIVES: We wish to determine how well female obstetrics and gynecology (OB/GYN) residents in the United States follow recommendations for routine Pap smears in managing their own health care and to identify the reasons for noncompliance. METHODS: A survey was mailed to 1693 female OB/GYN residents in the U.S. Factors associated with noncompliance were determined by chi-square. Logistic regression analysis was used to identify independent prognostic factors and calculate the odds ratio (OR). RESULTS: Six hundred eleven (36%) surveys were returned with compliance information. Noncompliance was reported by 33%. Lack of time or inconvenience was cited as the most common reason (93%) for noncompliance, followed by consideration of themselves as low risk for cervical disease (41%) and fear of or embarrassment in seeing a doctor (14%). On multivariate analysis, independent risk factors for noncompliance during residency included noncompliance prior to residency (OR 4.6, P<0.0001) and Asian ethnicity (OR 2.1, P = 0.02), whereas East Indian ethnicity (OR 3.0, P = 0.06) and having no children (OR 1.6, P = 0.07) were near significant. CONCLUSIONS: A substantial proportion of female OB/GYN residents do not follow standard recommendations for routine Pap smears. Although the principal reason for noncompliance given was lack of available time and/or inconvenience during residency, this behavior predated residency and was associated with specific ethnic groups.     

Dealing with Female Sexuality: Training,Attitude, and Practice of Obstetrics and Gynecology Residents from a Developing Country

IntroductionThere is little research on how obstetrics and gynecology (Ob/Gyn) residents deal with female sexuality, especially during pregnancy.AimThe aim of this study was to assess the training, attitude, and practice of Ob/Gyn residents about sexuality.MethodsA cross-sectional survey of Brazilian Ob/Gyn residents enrolling in an online sexology course was conducted. A questionnaire assessed their training in sexuality during medical school and residency and their attitude and practice on sexual issues during pregnancy.Main Outcome MeasuresTraining, attitude, and practice of Ob/Gyn residents regarding sexuality were the main outcome measures.ResultsA total of 197 residents, from 21 different programs, answered the online questionnaire. Mean age was 27.9 ± 2.2, most were female (87%), single (79%), and had graduated in the last 5 years (91%). Almost two-thirds (63%) stated that they did not receive any training at all and 28% reported having only up to 6 hours of training about sexuality in medical school. Approximately half of the respondents (49%) stated that they had received no formal training about sexuality during their residency up to that moment and 29% had received ≤6 hours of training. Over half (56%) never or rarely took a sexual history, 51% stated that they did not feel competent or confident to answer their pregnant patients’ questions about sexuality, and 84% attributed their difficulties in dealing with sexual complaints to their lack of specific knowledge on the topic.ConclusionThe vast majority of Brazilian Ob/Gyn residents enrolling in a sexuality course had little previous formal training on this topic in medical school and during their residency programs. Most residents do not take sexual histories of pregnant patients, do not feel confident in answering questions about sexuality in pregnancy, and attribute these difficulties to lack of knowledge. These findings point to a clear need for additional training in sexuality among Brazilian Ob/Gyn residents. Vieira TCSB, de Souza E, da Silva I, Torloni MR, Ribeiro MC, and Nakamura MU. Dealing with female sexuality: Training, attitude, and practice of obstetrics and gynecology residents from a developing country. J Sex Med 2015;12:1154–1157.     

Teaching vaginal breech delivery and external cephalic version. A survey of faculty attitudes

OBJECTIVE: To ascertain current faculty attitudes regarding teaching of vaginal breech delivery (VBD) and external cephalic version (ECV). STUDY DESIGN: A questionnaire was sent to obstetrics and gynecology residency programs. Respondents were queried regarding demographic parameters, resident and practice experience, and attitudes toward teaching these procedures. RESULTS: Fifty-four (96%) surveys were returned. Sixteen (30%) respondents were female and 38 (70%) male. Sixteen (30%) completed residency prior to 1980, 17 (32%) during the 1980s and 21 (48%) during the 1990s. Nineteen (35%) trained locally. Forty-seven (87%) received training in VBD during residency. Thirty-five (65%) received training in ECV. Thirty-two (60%) had performed VBDs in practice. However, only 18 (33%) continued to perform this procedure. During the proceeding three years, they reported performing an average of five VBDs per chief resident per year. Thirty-seven (69%) performed ECV in clinical practice. The 17 who did not indicated that they referred to others. They reported performing an average of 15 ECVs per chief resident per year. Fifty-two (96%) thought residents should still be taught VBD. All faculty thought that residents should be taught ECV. None of the above parameters exerted a statistically significant effect on these opinions. CONCLUSION: There was nearly universal faculty support for continuing to teach VBD to residents. However, only one-third of faculty members currently perform this procedure. There do not appear to be sufficient numbers of VBDs to teach this procedure utilizing a "hands on" approach. There is universal support for teaching ECV. There appear to be both enough individuals with experience and enough procedures to accomplish this education.     

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 effect of obstetric resident gender on forceps delivery rate

OBJECTIVE: This study was undertaken to examine the effect of obstetric resident physician gender on the forceps delivery rate. Study Design: Analysis was based on >350,000 deliveries performed by >800 residents in obstetrics and gynecology throughout the United States from 1994 to 1998. A chi(2) analysis was performed on resident statistics from residency review committee report forms. RESULTS: The percentage of total deliveries performed with forceps during residency was significantly higher among male residents (P <. 0001), as was the percentage of vaginal deliveries performed with forceps during residency (P <.0001). The percentage of overall operative vaginal deliveries (vacuum plus forceps) was significantly higher for male residents (P <.0001); however, the percentage of vacuum deliveries did not vary according to gender of the resident when considered independently. CONCLUSION: These results strongly suggest that resident gender affects performance of forceps delivery.     

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.     

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.     

Hysteroscopic surgery: Perspectives on skills training

STUDY OBJECTIVE: To assess the current exposure to hysteroscopy in gynecologic residency and daily practice in The Netherlands. DESIGN: Survey (Canadian Task Force Classification III). SUBJECT: Postgraduate year 5 and 6 residents in Obstetrics and Gynecology and gynecologists who finished residency within 1998-2003 in The Netherlands. INTERVENTION: Residents and gynecologists received a survey regarding performance of hysteroscopy, self-perceived competency, and factors influencing hysteroscopic training. MEASUREMENTS AND MAIN RESULTS: Responses were received from 88% of the senior residents and 83% of the gynecologists. All respondents were interested in performing hysteroscopic surgery and performed the procedures taught during residency training. All respondents were interested in performing 1 or more advanced procedures. Depending on type of procedure, fewer respondents (0%-52%) were performing these procedures. Limitation of advanced hysteroscopic skills at the end of residency was found to be due to the lack of having been primary surgeon. It was felt that the preferred level of hysteroscopic surgery after residency could be reached best by hiring an advanced endoscopic gynecologist (49%). CONCLUSION: Implementation of basic, but not advanced, hysteroscopic procedures taught during residency in The Netherlands has been successful to date. Residents and gynecologists are also interested in performing advanced hysteroscopic surgery. However, only a minority of the respondents perform these procedures in their current practice. Residents attain proficiency in advanced hysteroscopic surgery if they have the opportunity to perform these procedures. To improve the exposure to residents and the integration into daily practice, it is of great importance that the skills among the surgical educators improve.     

Resident attrition: is gender a factor?

OBJECTIVE: This study was undertaken to identify the causes of resident attrition from obstetrics and gynecology on the basis of gender. STUDY DESIGN: Two sequential questionnaires were sent to the 246 obstetrics and gynecology residency programs in the United States in March 2001 and May 2002. The programs were asked for the number of residents who left from 1997 to 2001, the postgraduate years, and genders of those residents, the reasons for leaving, and program demographics. Statistical analysis was performed with chi 2 and odds ratio calculations. RESULTS: The rate of attrition was 3% over 4 years. Female residents were 2.5 to 5 times as likely as male residents to leave because of family issues, specifically for reasons related to spouses ( P =.002). Female residents were one quarter as likely to leave to change specialty (P =.002), whereas this was the principal reason of more than half of the male residents who left. CONCLUSION: Important gender differences do exist in the reasons for attrition from obstetrics and gynecology residency programs.     

Pregnancy among obstetricians: a comparison of births before, during, and after residency

Questionnaires were sent to 1025 female board-certified obstetricians, and information was retrieved about pregnancy outcome. A total of 454 pregnancies, one third of which occurred during residency, were evaluated, and the relationship between pregnancy outcome and residency was assessed. Children of primiparous women who were delivered during or after residency had significantly lower mean birth weights than those who were delivered before residency (p less than 0.001 and p less than 0.005, respectively), whereas birth weights of infants born to multiparous women were not significantly different. The low birth weight rate (less than 2500 gm) was significantly increased during residency (p less than 0.002), and infants born during residency were 7.5 times more likely to be growth retarded than those born outside residency (p less than 0.002). The incidence of other pregnancy complications was not found to be increased during residency. Our data suggest a potentially negative impact of residency on the birth weights of infants born to female obstetricians in training.     

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.     

Reversal of diurnal cortisol rhythm and suppression of plasma testosterone in obstetric residents on call

OBJECTIVE: The study was undertaken to quantify the psychologic and physiologic responses to the stresses of an obstetrics/gynecology residency program. METHODS: Six male residents were studied on four occasions: one day during the first 2 weeks of their residency, one day immediately following a vacation period, one day after a night on call in obstetrics, and one day while in the gynecology clinic. Stress was evaluated by validated psychologic instruments and by levels of plasma testosterone, luteinizing hormone (LH), cortisol, and prolactin in morning and afternoon blood samples. RESULTS: Self-reported stress was significantly elevated during the first 2 weeks of the residency after a night on call. Anxiety scores were significantly elevated after a night on call as were depression subscores for some residents. Plasma testosterone was highly significantly suppressed after the obstetrics night on call and during the first 2 weeks of the residency in comparison with the vacation period. Luteinizing hormone levels were also significantly lower after the obstetrics on-call experience. Plasma cortisol levels after a night on call were suppressed in the morning and normal or elevated in the afternoon. In comparison, the gynecology rotation was associated with normal levels of testosterone and lower levels of cortisol. CONCLUSION: In this small sample of residents, we observed an inverse relationship between self-reported stress levels and the concentrations of plasma testosterone and LH. The high levels of stress and anxiety expressed after a night on call also disrupted the normal pattern of plasma cortisol levels.     

Surgical experiences and training of residents: perspective of experienced gynecologic oncologists.

OBJECTIVE: The aim of this study was to report the opinions of experienced gynecologic oncologists concerning the surgical education and experiences of residents. METHODS: The 1997 membership directory of the Society of Gynecologic Oncologists was used to identify individuals who were members for at least 5 years and on the faculty of residency training programs. One hundred seventy members were identified and a nine-question survey was mailed to them. RESULTS: One hundred nineteen (70%) surveys were returned. One hundred seventeen individuals were on the faculty of residency training programs and involved in the surgical training of residents. Ninety-six percent reported that gynecologic oncologists were a major resource for surgical education at their institution. Eight-nine (76%) reported a change in the volume of major abdominal and vaginal surgical procedures performed for noninvasive disease over the past 5 years. Of these 89, 16 (18%) reported that surgical volume at their institution decreased by 10%, 38 (43%) reported that surgical volume decreased by 10-25%, and 17 (19%) reported that surgical volume decreased by more than 25%. Sixty-three percent of all respondents reported that residents were not as well versed in pre- and postoperative care when compared to those of 5 years ago. Sixty-five percent of all respondents reported that graduating residents were less prepared in surgical techniques when compared to those of 5 years ago. Seventy-five percent of respondents reported that the primary care requirements of the RRC have decreased the amount of surgical experience, ICU rotations, and anesthesia rotations. Sixty percent of all respondents operated with other attending surgeons on more difficult cases, and 29% had changed to this practice within the past 5 years. Eighty-two percent believed that more time during residency training needs to be devoted gynecologic surgical experience. CONCLUSIONS: Experienced gynecologic oncologists on the faculty of residency training programs report a decrease in surgical skills and surgical experiences when compared to residents trained 5 years ago.     

Sexual communication skills in residency training: the Robert Wood Johnson model

Few medical schools or residency programs offer adequate training in sexual medicine. Using the experience gained in our long-standing program in human sexuality for medical students, we have pilot tested a half-day intensive workshop curriculum for residents that focuses on sexual communication skills and management of sexual problems. Unlike our medical school program, this residency course was offered on an elective, one-day basis. The current report describes the successful implementation of our pilot program with 46 medical residents from subspecialty and primary care residency programs. Before the workshop, 22 (48%) residents indicated that they were uncomfortable with open discussion of sexual issues and would not feel comfortable in addressing the topic with their patients. A number of factors were identified as barriers to communication, including lack of time, inadequate training, and personal discomfort. After the workshop, the participants rated themselves as more comfortable with the topic and as more likely to address sexual issues with their patients. The participants evaluated the workshop positively overall and responded well to the interactive format and audience-response components. Most of the participants showed interest and willingness to participate in further training in sexual medicine skills. Our program offers a model for training of residents in communication skills and management of sexual problems. The difficulties in implementation and overcoming institutional barriers to curriculum reform are addressed.     

Resident job satisfaction: will 80 hours make a difference?

OBJECTIVE: This study was undertaken to assess job satisfaction and quality of life among obstetrics and gynecology residents before the 80-hour work week. STUDY DESIGN: We administered a job satisfaction survey to residents before July 1, 2003, assessing satisfaction with residency training, indicators of current quality of life, and predictions for the effect of reduced work hours. RESULTS: Residents were satisfied with training, with important outliers, including leisure time, ability to pursue educational reading, and surgical experience. We created job satisfaction facets that were generally reliable constructs and valid predictors for overall residency satisfaction. Residents predict more free time and a healthier lifestyle under the new requirements, but do not anticipate using additional time to study or teach. CONCLUSION: Job satisfaction facets for residents are proposed here and may be refined through further study. Lower scores for surgical experience are of concern in light of decreasing work hours. Educators must monitor self-directed learning efforts under new work hours.     

Effects of a professional liability crisis on residents' practice decisions

OBJECTIVE: Pennsylvania, like many states, is in a professional liability crisis characterized by escalating cost and decreasing availability of liability insurance. Medical and surgical specialists have experienced especially large increases in insurance premiums. The objective of this study was to estimate the impact of liability concerns during a professional liability crisis on Pennsylvania residents' decisions regarding their future practice. It was hypothesized that liability concerns would negatively affect Pennsylvania residents' propensity to practice in the state following residency. METHODS: Statewide mail surveys were completed in 2003 by 68 Pennsylvania residency program directors and 360 residents nearing the end of their training in anesthesiology, general surgery, emergency medicine, obstetrics and gynecology, orthopedics, and radiology residencies. RESULTS: One third of residents in their final or next-to-last year of residency planned to leave Pennsylvania because of the lack of availability of affordable malpractice coverage. Although, in general, residents' geographic decisions are influenced by a range of factors, those who are about to leave Pennsylvania named malpractice costs as the primary reason 3 times more often than any other factor. Seventy-one percent of residency program directors reported a decrease in retention of residents in the state since the onset of the professional liability crisis. For some programs the decreases were very large. CONCLUSION: An environment of mounting liability costs in Pennsylvania appears to have dissuaded substantial numbers of residents in high-risk specialties from locating their clinical practices in the state. The impact of decreased resident retention on the future availability of specialist services in high-cost states merits close monitoring.     

Health and wellness in residents who matriculate into physician training programs

OBJECTIVE: The first objective of this study was to evaluate lifestyle changes that occur during residency. The second objective was to determine whether residents in obstetrics and gynecology perceive greater changes compared with residents in other programs. STUDY DESIGN: Residents in selected obstetrics and gynecology, family practice, internal medicine, pediatrics, and surgery fields received surveys. Characteristics addressed before and after residency included eating habits, sleep hours, recreational time, exercise, and missed significant events. Unbalanced analysis of variance and unpaired Student t test were used when appropriate. RESULTS: All specialties noted a significant reduction in low-fat meals consumed, sleep hours, exercise, family interactions, and television viewing (P<.05). Residents noted a significant increase in missed significant events. Residents in obstetrics and gynecology perceived a greater reduction in television viewing compared with residents who were not in obstetrics and gynecology (P<.05). CONCLUSION: Residents perceive significant changes in many areas of health and wellness during residency training. Overall, residents in obstetrics and gynecology do not perceive greater lifestyle alterations compared with other training programs.     

Prevalence and predictors of burnout among obstetrics and gynecology residents in Canada

The aim of this study is to evaluate the prevalence of burnout syndrome among obstetrics and gynecology residents, as well as the relationship between several demographic and work-related characteristics and the prevalence of burnout. We surveyed 143 residents in obstetrics and gynecology programs across eight provinces in Canada using an electronic survey questionnaire and the Maslach Burnout Inventory Human services survey. The prevalence of high emotional exhaustion was 12.6 % higher among younger than older residents and 12.4 % higher among female compared to male residents. The prevalence of high depersonalization was13.0 % higher among male versus female residents. The prevalence of high emotional exhaustion among residents who reported sufficient supervision during the night shift was significantly lower than among those who reported insufficient supervision (95 % CI ?49.7, ?8.6). Additionally, we found that adequate access to food during the night shift was associated with a lower prevalence of any burnout (95 % CI ?31.8, ?0.2). Similar associations were observed for high emotional exhaustion and high depersonalization. We also found a 22.1 % (95 % CI ?60.0, 15.7) lower prevalence of emotional exhaustion among residents who work 60 h/week or less. Our results suggest decreased levels of burnout in resident physicians who reported sufficient staff supervision, adequate access to food during the night shift, and fewer working hours. Future studies should be directed to examine the effectiveness of different strategies to improve the residency training in obstetrics and gynecology.