American Board Of Obstetrics And Gynecology Research Articles

Editorial introductions.

Current Opinion in Obstetrics and Gynecology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of obstetrics and gynecology is divided into ten sections that are reviewed once a year. Each section is assigned one or more Section Editors. They are the leading authorities in their area, who identify the most important topics at that time. Here we are pleased to introduce the Journal's Editor and Section Editors for this issue. EDITOR IN CHIEF Jonathan S. BerekJonathan S. BerekJonathan S. Berek, MD MMSc, is the Laurie Kraus Lacob Professor at Stanford University, Stanford University School of Medicine; Director, the Stanford Women's Cancer Center; and Senior Advisor, Stanford Cancer Institute, USA. He is the Faculty Director, Health Communication, Stanford Center for Health Education, Stanford University. He served as the Chair of the Stanford Department of Obstetrics and Gynecology from 2005–2017. Dr Berek is well known as a scholar, clinician, surgeon, researcher and educator in the field. He is highly regarded for his investigations on the clinical management of gynecologic cancers and translational research related to these malignancies. He has published over 360 research papers, and several hundred contributed articles, book chapters and monographs. He is especially noted for two of the leading books in the field, Berek & Hacker's Gynecologic Oncology, 7th edition, and Berek & Novak's Gynecology, 16th edition. Dr Berek earned his undergraduate and graduate degrees from Brown University, USA, his Doctor of Medicine degree at Johns Hopkins University School of Medicine, USA, and he was elected to Phi Beta Kappa and Alpha Omega Alpha Honor Societies. He completed his residency at the Harvard Medical School, Brigham and Women's Hospital, USA, and his fellowship in Gynecologic Oncology at the UCLA School of Medicine, USA. For over two decades prior to moving to Stanford, he was a Professor and Vice Chair of Obstetrics and Gynecology at UCLA, where he was also the Chair of the College of Applied Anatomy and Chief of Staff at the UCLA Medical Center. Dr Berek is the Group Chair and Principal Investigator for the Women's Cancer Research Network-Cooperative Gynecologic Oncology Investigators (WCRN-COGI), a member of the Gynecologic Cancer InterGroup (GCIG). He served as Principal Investigator for the Gynecologic Oncology Group (GOG) for more than two decades. His primary research interest is in the immunology and immunotherapy of ovarian cancer, and through the development of experimental models and clinical trials, his initial studies encouraged the development of innovative biologic therapy strategies. Through collaborative work, his group focuses on the development of monoclonal antibodies and targeted immunotherapies for ovarian cancer. Dr Berek has had grant support from the National Institute of Health (NIH) and the Ovarian Cancer Research Foundation (OCRF). In 2022, Dr Berek received a Lifetime Achievement Award from the International Gynecologic Cancer Society (IGCS). In 2019, the American Cancer Society honored his lifetime of achievement for his many contributions to women's cancer care and research. Dr Berek is the recipient of the prestigious Sherman Mellinkoff Award and the Excellence in Education Award by the David Geffen School of Medicine at UCLA, and the 2010 John C. Fremont Pathfinder Award. He received the President's Award from the Society of Gynecologic Oncologists (SGO) and has delivered numerous distinguished lectureships. He is regularly listed among America's Best Doctors for Gynecology & Gynecologic Oncology. Dr Berek is board certified by the American Board of Obstetrics and Gynecology (ABOG), and the ABOG's Division of Gynecologic Oncology. He is a Fellow in the American College of Obstetricians and Gynecologists (FACOG), the American College of Surgeons (FACS), the American Society of Clinical Oncologists (FASCO), and the Society of Pelvic Surgeons (SPS). He has served as an examiner for the American Board Obstetrics and Gynecology (ABOG) and for the Council on Resident Education in Obstetrics and Gynecology (CREOG). Dr Berek is Past-President of the Council of University Chairs of Obstetrics and Gynecology (CUCOG), and Past President of the International Gynecologic Cancer Society (IGCS). He has served on many national committees for the National Institutes of Health (NIH), the National Cancer Institute (NCI), the American College of Surgeons (ACS), the Society of Gynecologic Oncologists (SGO), the American College of Obstetricians and Gynecologists (ACOG), and the American Society of Clinical Oncology (ASCO). He is the Editor-in-Chief of Current Problems in Obstetrics and Gynecology, Past Editor-in-Chief of ASCO Connections, and past Senior Editor of the International Journal of Gynecologic Cancer. He has served as an Editor of Prolog and Précis for the American College of Obstetricians and Gynecologists, and on the editorial boards of the Journal of Clinical Oncology, Gynecologic Oncology, and the Journal of the Society for Gynecologic Investigation. SECTION EDITORS Gottfried E. KonecnyGottfried E. KonecnyGottfried E. Konecny is Professor of Medicine and Obstetrics and Gynecology at the University of California Los Angeles (UCLA), USA. He is the Lead Clinician for gynecologic oncology in the Department of Medicine at UCLA. He obtained his medical degree and completed his residency training in obstetrics and gynecology at the University of Munich, Germany. Following his specialist training, he focused on clinical breast cancer research and decided to move to the US to pursue postdoctoral studies in the laboratory of Dennis J. Slamon to participate in laboratory and clinical research that led to the approval of new breast cancer drugs such as trastuzumab and lapatinib. He subsequently undertook subspecialty training in gynecologic oncology by completing a gynecologic oncology fellowship at Mayo Clinic in Rochester Minnesota, USA. In 2007 he was recruited back to the University of California as a group leader to the Department of Medicine and the Translational Oncology Research Laboratory of UCLA, to establish a preclinical and clinical drug development program for gynecologic malignancies. As a physician-scientist, his work primarily focuses on translating the revolution in our understanding of the molecular underpinnings of cancer into novel treatment approaches, in which the right patient is being treated with the right drug at the right time.

NASPAG Pediatric and Adolescent Gynecology Surgery Compensation Survey

IntroductionOver the last decade, the field of pediatric and adolescent gynecology (PAG) has rapidly expanded on the basis of a need for this specialized training to care for children and adolescents with gynecologic concerns. There are 18 PAG fellowship programs within the United States and Canada. Since 2017, which marked the beginning of the American Board of Obstetrics and Gynecology (ABOG) Focused Practice Examination in PAG and PAG Maintenance of Certification program, there has been a growing recognition of this specialty, given the unique population served. However, there is a paucity of information related to compensation in PAG. As the field has grown and more PAG fellow graduates are sought by children's hospitals throughout the United States and Canada, there is an urgent need to ensure that salary is equitable for these specialty PAG providers given the unique skills acquired during fellowship training, beyond that of obstetrics and gynecology (OBGYN) residency. This initial survey aimed to focus on compensation for PAG surgeons in the United States. ObjectivesTo survey NASPAG PAG surgeons in the United States about current benefits, practice metrics, and compensation MethodsA 15-question anonymous survey was sent to PAG surgeons in the United States in February 2022, with 3 reminders sent by email to engage voluntary participation. The survey aimed to understand practice characteristics, current compensation, and relative value unit (RVU) benchmarks. Descriptive statistics were utilized. Compensation means and quartiles were calculated in U.S. dollars for the following categories: assistant professor, associate professor, and full professor. The compensation mean was also calculated for private/hybrid and instructor categories. ResultsAmong 255 eligible members, 88 completed the survey, for a participation rate of 34.5%. Sixty-three point six percent reported having completed a PAG fellowship, whereas one-third reported specializing in this area with no fellowship available at the time. Three-fourths reported having achieved ABOG Focused Practice PAG certification. Most providers were academic (75%) and working full time (82.9%). Among academicians, most were assistant professors (48%) and on the non-tenure track (50.6%). RVU benchmarks varied, with 40.2% reporting OBGYN generalist targets and only 18.3% reporting PAG-specific targets, despite most physicians practicing only PAG (62.5%) and less than 30% practicing PAG plus some adult OBGYN. Salary support varied, with 57% employed by a hospital. Incentives were common, with most receiving a bonus at the end of the year (52.9%). As expected, full professors reported higher mean compensation ($345k) as compared with less senior colleagues ($248k and $302k for assistant and associate professors, respectively). Private practice/hybrid practitioners reported compensation ($251k) similar to that of assistant professors ($248k). Only 2 instructor-level physicians completed the survey. The mean number for this level is skewed and is not a reliable predictor for this academic level. Quartiles could not be calculated for this category. ConclusionThis is the first survey addressing compensation in the field of PAG in the United States. There is an ongoing need to collect this information to prepare PAG fellow graduates for the job market. Additional surveys, including an understanding of the compensation landscape in Canada, are needed in the future to address specific questions related to compensation for those who have less than 50% clinical time.

Editorial introductions.

Current Opinion in Obstetrics and Gynecology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of obstetrics and gynecology is divided into ten sections that are reviewed once a year. Each section is assigned one or more Section Editors. They are the leading authorities in their area, who identify the most important topics at that time. Here we are pleased to introduce the Journal's Editor-in-Chief and Section Editor for this issue. EDITOR-IN-CHIEF Jonathan S. BerekJonathan S. BerekJonathan S. Berek, MD, MMSc, is the Laurie Kraus Lacob Professor at Stanford University, Stanford University School of Medicine; Director, the Stanford Women's Cancer Center; and Senior Advisor, Stanford Cancer Institute, USA. He is the Executive Director, Stanford Health Communication Initiative, Stanford Center for Health Education, Stanford University. He served as the Chair of the Stanford Department of Obstetrics and Gynecology from 2005–2017. Dr Berek is well known as a scholar, clinician, researcher and educator in the field. He is highly regarded for his research on the clinical management of gynecologic cancers and translational research related to these malignancies. He has published over 340 research papers, and several hundred contributed articles, book chapters and monographs. He is especially noted for two of the leading books in the field, Berek & Hacker's Gynecologic Oncology, 7th edition, and Berek & Novak's Gynecology, 16th edition. Dr Berek earned his undergraduate and graduate degrees from Brown University, USA, his Doctor of Medicine degree at Johns Hopkins University School of Medicine, USA, completed his residency at the Harvard Medical School, Brigham and Women's Hospital, USA, and his fellowship in Gynecologic Oncology at the UCLA School of Medicine, USA. For many years, he was a Professor and Vice Chair of Obstetrics and Gynecology at UCLA, where he was also the Chair of the College of Applied Anatomy. Dr Berek is the Group Chair and Principal Investigator for the Cooperative Gynecologic Oncology Investigators (COGI), a member of the Gynecologic Cancer InterGroup (GCIG). He served as Principal Investigator for the Gynecologic Oncology Group (GOG) for more than two decades. His primary research interest is in the immunology and immunotherapy of ovarian cancer, and through the development of experimental models and clinical trials, his initial studies encouraged the development of innovative biologic therapy strategies. Through collaborative work, his group focuses on the development of monoclonal antibodies and targeted immunotherapies for ovarian cancer. Dr Berek has had grant support from the National Institute of Health (NIH) and the Ovarian Cancer Research Foundation (OCRF). Dr Berek is the recipient of the prestigious Sherman Mellinkoff Award and the Excellence in Education Award by the David Geffen School of Medicine at UCLA, and the 2010 John C. Fremont Pathfinder Award. He is regularly listed among America's Best Doctors for Gynecology & Gynecologic Oncology. In 2019, he was given an award by the American Cancer Society in recognition of his lifetime of achievement and for his many contributions to women's cancer care and research. He is board certified by the American Board of Obstetrics and Gynecology (ABOG), and the Division of Gynecologic Oncology. He is a Fellow in the American College of Obstetricians and Gynecologists (FACOG), the American College of Surgeons (FACS), and the American Society of Clinical Oncologists (FASCO). Dr Berek has served as an examiner for the American Board Obstetrics and Gynecology (ABOG) and for the Council on Resident Education in Obstetrics and Gynecology (CREOG). Dr Berek is Past-President of the Council of University Chairs of Obstetrics and Gynecology (CUCOG), and Past President of the International Gynecologic Cancer Society (IGCS). His many honors include receiving the President's Award from the Society of Gynecologic Oncologists (SGO), serving as its Vice President in 1996–1997, and presenting numerous distinguished lectureships. Dr Berek has served on many national committees for the National Institutes of Health (NIH), the National Cancer Institute (NCI), the American College of Surgeons (ACS), the Society of Gynecologic Oncologists (SGO), the American College of Obstetricians and Gynecologists (ACOG), and the American Society of Clinical Oncology (ASCO). He is a member of the Society of Gynecologic Investigation (SGI), and the Society of Pelvic Surgeons (SPS). He is the Editor-in-Chief of Current Problems in Obstetrics and Gynecology, Past Editor-in-Chief of ASCO Connections, and Senior Editor of the International Journal of Gynecologic Cancer. He has served as an Editor of Prolog and Précis for the American College of Obstetricians and Gynecologists, and on the editorial boards of the Journal of Clinical Oncology, Gynecologic Oncology, and the Journal of the Society for Gynecologic Investigation. SECTION EDITOR Gottfried E. KonecnyGottfried E. KonecnyGottfried E. Konecny is Professor of Medicine and Obstetrics and Gynecology at the University of California Los Angeles (UCLA), USA. He is the Lead Clinician for gynecologic oncology in the Department of Medicine at UCLA. He obtained his medical degree and completed his residency training in obstetrics and gynecology at the University of Munich, Germany. Following his specialist training, he focused on clinical breast cancer research and decided to move to the US to pursue postdoctoral studies in the laboratory of Dennis J. Slamon to participate in laboratory and clinical research that led to the approval of new breast cancer drugs such as trastuzumab and lapatinib. He subsequently undertook subspecialty training in gynecologic oncology by completing a gynecologic oncology fellowship at Mayo Clinic in Rochester Minnesota, USA. In 2007 he was recruited back to the University of California as a group leader to the Department of Medicine and the Translational Oncology Research Laboratory of UCLA, to establish a preclinical and clinical drug development program for gynecologic malignancies. As a physician-scientist, his work primarily focuses on translating the revolution in our understanding of the molecular underpinnings of cancer into novel treatment approaches, in which the right patient is being treated with the right drug at the right time.

Creation of Entrustable Professional Activities (EPAs) in obstetrics and gynecology for medical undergraduate students

Abstract: Introduction: This article features “Entrustable Professional Activities (EPAs)” in the Obstetrics and Gynecology field designed for medical undergraduates, aiming to support the teaching/learning process. Objective: The aim is for the graduate to be competent to meet the minimum requirements necessary for the student in this field. Method: In this study, EPAs were created based on an international template already in use and validated using the Delphi technique. The structuring of the EPAs was based on the international literature: “Core Entrustable Professional Activities for Entering Residency: Curriculum Developer’s Guide” from the Association of American Medical Colleges (AAMC). The content for the topics of each EPA was based on the publication “The Obstetrics and Gynecology Milestone Project” from the joint action of the Accreditation Council for Graduate Medical Education (ACGME), the American College of Obstetrics and Gynecology (ACOG) and the American Board of Obstetrics and Gynecology (ABOG). Results: Thirteen EPAs were created with topics for teaching in that field during undergraduate school. A checklist was created for each EPA, aiming to guide the evaluator and the student regarding the performance of the tasks defined in the EPAs. Conclusion: The EPAs with checklists bring an innovative proposal for Obstetrics and Gynecology teaching in medical graduation since they facilitate and operationalize the learning, the development, and the observation of the acquisition of knowledge, skills and attitudes required for the performance of each topic in the area, thus helping the training of a competent professional. At the end of the medical course, the ability to perform all EPAs identifies a competent graduate in Gynecology and Obstetrics regarding the general practitioner.

Can ACGME Milestones predict surgical specialty board passage: an example in Obstetrics and Gynecology.

Background:Multiple tools including Accreditation Council for Graduate Medical Education (ACGME) standardized milestones can be utilized to assess trainee and residency program performance. However, little is known regarding the objective validation of these tools in predicting written board passage.Methods:In this retrospective study, data was gathered on n = 45 Wayne State University Obstetrics and Gynecology program graduates over the five-year period ending July 2018. United States Medical Licensing Examination (USMLE) scores, Council on Resident Education in Obstetrics and Gynecology (CREOG) in-training scores and ACGME milestones were used to predict American Board of Obstetrics and Gynecology (ABOG) board passage success on first attempt. Significance was set at p < 0.05.Results:Written board passage was associated with average CREOGs (p = 0.01) and milestones (p = 0.008) while USMLE1 was not significantly associated (p = 0.055). USMLE1 <217 (Positive predictive value (PPV) = 96%). CREOGs <197 (PPV = 100%) and milestones <3.25 (PPV = 100%), particularly practice-based learning and systems-based practice milestones were most strongly correlated with board failure. Using a combination of these two milestones, it is possible to correctly predict board passage using our model (PPV = 86%).Discussion:This study is the first validating the utility of milestones in a surgical specialty by demonstrating their ability to predict board passage. Residents with CREOGs or milestones below thresholds are at risk for board failure and may warrant early intervention.

Creation of Entrustable Professional Activities (EPAs) in obstetrics and gynecology for medical undergraduate students

Abstract: Introduction: This article features “Entrustable Professional Activities (EPAs)” in the Obstetrics and Gynecology field designed for medical undergraduates, aiming to support the teaching/learning process. Objective: The aim is for the graduate to be competent to meet the minimum requirements necessary for the student in this field. Method: In this study, EPAs were created based on an international template already in use and validated using the Delphi technique. The structuring of the EPAs was based on the international literature: “Core Entrustable Professional Activities for Entering Residency: Curriculum Developer’s Guide” from the Association of American Medical Colleges (AAMC). The content for the topics of each EPA was based on the publication “The Obstetrics and Gynecology Milestone Project” from the joint action of the Accreditation Council for Graduate Medical Education (ACGME), the American College of Obstetrics and Gynecology (ACOG) and the American Board of Obstetrics and Gynecology (ABOG). Results: Thirteen EPAs were created with topics for teaching in that field during undergraduate school. A checklist was created for each EPA, aiming to guide the evaluator and the student regarding the performance of the tasks defined in the EPAs. Conclusion: The EPAs with checklists bring an innovative proposal for Obstetrics and Gynecology teaching in medical graduation since they facilitate and operationalize the learning, the development, and the observation of the acquisition of knowledge, skills and attitudes required for the performance of each topic in the area, thus helping the training of a competent professional. At the end of the medical course, the ability to perform all EPAs identifies a competent graduate in Gynecology and Obstetrics regarding the general practitioner.

Fundamentals of Laparoscopic Surgery Pro Tips Series Part 2: Tasks # 4 & 5

Study Objective This objective of this video is to describe several tips and tricks to help familiarize residents with the Fundamentals of Laparoscopic Surgery (FLS) tasks and to improve their technical skills and efficiency. In part 1 of this 2-part series, we provide specific strategies for the peg board, circle cut, and ligating loop tasks. Design Educational instructional video. Setting N/A Patients or Participants N/A Interventions FLS uses five simulation stations to assess basic laparoscopic surgery skills. It is a reliable and valid curriculum which has been shown to improve intraoperative trainee performance. It was developed in 2004, and since 2009 has been a requirement to qualify for the American Board of Surgery board certification. In 2018, the American Board of Obstetrics and Gynecology (ABOG) announced that FLS will be a prerequisite for specialty board certification for obstetrics and gynecology residents graduating after May 2020. ABOG states that this will “ensure that diplomates possess critical skills for the contemporary practice of obstetrics and gynecology.” Measurements and Main Results N/A Conclusion FLS is now a requirement for all OB/GYN residencies. Mastering the skills requires time and effort on the part of the learners but using these pro tips can help gain confidence and improve efficiency.

Fundamentals of Laparoscopic Surgery Exam: A Cross-Sectional Survey of in-Training Obstetricians and Gynecologists

Study ObjectivePhysicians seeking specialty certification in Obstetrics and Gynecology are now required to successfully complete the Fundamentals of Laparoscopic Surgery (FLS) exam in order to meet the American Board of Obstetrics and Gynecology (ABOG) certification requirement. We conducted a survey of U.S Obstetrics and Gynecology physicians in training in an attempt to assess their laparoscopic surgical training and perceived barriers and limitations to successfully obtain FLS certification.DesignObservational.SettingInternet-based survey of United States Obstetrics and Gynecology residency programs.Patients or ParticipantsU.S Obstetrics and Gynecology residents.InterventionsParticipants were asked to self-evaluate their confidence in conducting laparoscopic procedures.Measurements and Main ResultsOf the 237 U.S Obstetrics and Gynecology programs, 146 residents responded. Seventy-one (48%) respondents completed the FLS exam and reported a 93% pass rate. All those who did not pass reported poor performance on the manual skills portion. Sixty-six (93%) respondents felt the laparoscopic box trainer was most helpful in preparation for the FLS exam. Fifty-five (79%) respondents felt the cognitive portion of the exam was not at all or slightly representative of subjects taught in residency. Thirty-three (47%) respondents felt the skills portion was moderately reflective of laparoscopic skills needed in gynecologic surgery. Thirty-eight (54%) respondents felt preparing for this exam was not at all or slightly helpful in clinical or surgical practice.ConclusionThe laparoscopic box trainer appears to be most useful in preparation for the FLS exam. Most respondents agree the skills portion of the exam represents skills required in Obstetrics and Gynecology. Concern remains whether the cognitive portion of the exam is applicable to Obstetrics and Gynecology residents or if residency programs need to broaden their laparoscopic education. Alterations likely need to be made to the exam to more specifically evaluate fundamental laparoscopic surgical skills in gynecologic surgeons.

Gender inequality in leadership and academic rank in academic reproductive endocrinology programs.

To identify gender differences in leadership and academic rank within academic reproductive endocrinology (REI) programs with fellowships in the USA. Official institutional websites of the 2017-2018 American Board of Obstetrics and Gynecology (ABOG)-accredited reproductive endocrinology fellowship programs were reviewed, and gender representation at each leadership position and academic rank (Division and Fellowship Director and Full, Associate, and Assistant Professor) was recorded. Univariate comparisons were performed using Chi-square tests, with significance at p<0.05. Among 49 ABOG-accredited reproductive endocrinology programs, 263 faculty were identified, 129 (49.0%) male and 134 (51.0%) female. Division directors were 69.3% male and 30.7% female (p = 0.006). Similarly, fellowship directors were 65.3% male and 34.6% female (p = 0.03). Full professors (n = 101) were more frequently male (70.3% vs. 29.7%, p < 0.001). There was no difference in gender among associate professors (n = 60, 51.7% male vs. 48.3% female, p = 0.79), while significantly more assistant professors were female than male (n = 102, 73.6% vs. 26.4%, p < 0.001). While a majority of residents in obstetrics and gynecology and half of reproductive endocrinology academic faculty are female, women are still underrepresented among leadership positions and full professors in academic reproductive endocrinology programs with fellowship programs.

Effectiveness of ABOG’s Article-Based Questions on Diplomates’ Retention of Knowledge [10G]

INTRODUCTION: As part of continuing certification, the American Board of Obstetrics and Gynecology (ABOG) diplomates complete article-based assessments annually. Diplomates read articles, respond to article questions, and must score above a certain threshold to demonstrate competence in their understanding. There is a paucity of evidence that diplomates retain the information after reading articles. The study objective was to evaluate the effectiveness of the two question types (understanding and application) at measuring diplomates’ retention of knowledge over time. METHODS: A sample of 344 diplomates who chose selected articles between January-March 2019 volunteered for the study. Diplomates completed article questions in a business-as-usual setting (with article access) and were assessed again during summer 2019 (without article access). Each participant received 2 questions (one of each type) from 5 of the selected articles, for a total of 10 questions. The timed summer assessment was used as a proxy for retention. Diplomates’ scores, by item type, from each assessment setting were compared using a t-test to determine whether information was retained from the articles. RESULTS: The information assessed by application items was retained at a significantly higher rate (80.58%) than understanding items (60.75%), as demonstrated by mean scores on the assessment (P&lt;.05). CONCLUSION: Application items yielded a higher knowledge retention rate. Understanding items ensure diplomates comprehend the article while application questions ensure diplomates can generalize and apply their understanding from the article. A combination of both item types for article-based assessments is necessary and this study demonstrates that diplomates retain the information they read from articles.

EMIG Simulation Systems Construct Validation Trial: Laparoscopic Component

Study Objective Construct validation of the EMIG Laparoscopic Surgery Simulation System. Design A prospective, controlled cohort comparison. Setting Thirteen teaching institutions in the US and Canada and an AAGL Congress Patients or Participants 221 subjects who fit one of 4 categories of exposure to laparoscopic surgery and surgical simulation: 77 novices within 100 days of starting posgraduate year 1 (PGY-1); 71 within the first 100 days of starting PGY-3; 30 American Board of Obstetrics and Gynecology (ABOG) certified and no additional fellowship training (“Proficient”); 43 who had completed the two-year Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS). Interventions Subjects were oriented to the simulation system and then tested under proctor supervision on the 5 EMIG laparoscopic exercises. These included the sleeve to peg transfer (L-1); the circular pattern cut (L-2); extracorporeal knotting (L-3); intracorporeal knotting (L-4); and a running suture (L-5). Time and accuracy scoring were entered electronically on site, but sessions were video recorded and study materials such as cutting and suturing targets were labeled and stored for subsequent review to optimize data quality. Measurements and Main Results Each exercise was timed, and a number of objective metrics recorded that reflected cutting and suturing accuracy and technique. Each exercise had a “time cap”; if a subject had not completed the exercise by the end of the allotted time, they were categorized “Did Not Complete” and the maximum time was entered for data analysis. Preliminary data analysis demonstrates that the novice group consistently demonstrated the poorest performance and the FMIGS cohort consistently the best. The PGY-3 and “Proficient” cohorts were generally similar to each other but each performed better than the PGY-1 group and well below the FMIGS group. Conclusion The EMIG Laparoscopic Simulation System can be used to distinguish amongst PGY-1, PGY-3, Proficient and FMIGS subjects. FMIGS-trained subjects consistently had the best results with almost no “Did not Complete” outcomes. Construct validation of the EMIG Laparoscopic Surgery Simulation System. A prospective, controlled cohort comparison. Thirteen teaching institutions in the US and Canada and an AAGL Congress 221 subjects who fit one of 4 categories of exposure to laparoscopic surgery and surgical simulation: 77 novices within 100 days of starting posgraduate year 1 (PGY-1); 71 within the first 100 days of starting PGY-3; 30 American Board of Obstetrics and Gynecology (ABOG) certified and no additional fellowship training (“Proficient”); 43 who had completed the two-year Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS). Subjects were oriented to the simulation system and then tested under proctor supervision on the 5 EMIG laparoscopic exercises. These included the sleeve to peg transfer (L-1); the circular pattern cut (L-2); extracorporeal knotting (L-3); intracorporeal knotting (L-4); and a running suture (L-5). Time and accuracy scoring were entered electronically on site, but sessions were video recorded and study materials such as cutting and suturing targets were labeled and stored for subsequent review to optimize data quality. Each exercise was timed, and a number of objective metrics recorded that reflected cutting and suturing accuracy and technique. Each exercise had a “time cap”; if a subject had not completed the exercise by the end of the allotted time, they were categorized “Did Not Complete” and the maximum time was entered for data analysis. Preliminary data analysis demonstrates that the novice group consistently demonstrated the poorest performance and the FMIGS cohort consistently the best. The PGY-3 and “Proficient” cohorts were generally similar to each other but each performed better than the PGY-1 group and well below the FMIGS group. The EMIG Laparoscopic Simulation System can be used to distinguish amongst PGY-1, PGY-3, Proficient and FMIGS subjects. FMIGS-trained subjects consistently had the best results with almost no “Did not Complete” outcomes.

EMIG Simulation Systems Construct Validation Trial: Hysteroscopic Component

<h3>Study Objective</h3> Construct validation of the EMIG Hysteroscopic Surgery Simulation System. <h3>Design</h3> A prospective, controlled cohort comparison. <h3>Setting</h3> Thirteen teaching institutions in the US and Canada and an AAGL Congress. <h3>Patients or Participants</h3> 240 subjects who fit one of 4 categories of exposure to hysteroscopic surgery and surgical simulation: 76 novices within 100 days of starting posgraduate year 1 (PGY-1); 69 within the first 100 days of starting PGY-3; 27 American Board of Obstetrics and Gynecology (ABOG) certified and no additional fellowship training ("Proficient"); 43 who had completed the two-year Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS). <h3>Interventions</h3> Subjects were oriented to the simulation system and then tested under proctor supervision on the 2 EMIG hysteroscopic exercises. These included the Targeting Exercise (H-1); and the Polyp Removal Exercise (H-2). Time and accuracy scoring were entered electronically on site, but sessions were video recorded and stored for subsequent review to optimize data quality. <h3>Measurements and Main Results</h3> Each exercise was timed, and a number of objective metrics recorded that were designed to assess accuracy, efficiency and technique. Each exercise had a "time cap"; if a subject had not completed the exercise in by the end of the alloted time, they were categorized as "Did Not Complete" and the maximum time was entered for data analysis. Preliminary data analysis demonstrates that for both H-1 and H-2 the novice group consistently demonstrated the poorest performance and the FMIGS cohort consistently the best. The PGY-3 and "Proficient" cohorts were generally similar to each other but each performed better than the PGY-1 group and well below the FMIGS group. <h3>Conclusion</h3> The EMIG Hystroscopic Simulation System can be used to distinguish amongst PGY-1, PGY-3, Proficient and FMIGS subjects. FMIGS-trained subjects consistently had the best results.

Design of a Laparoscopic Curriculum for Obstetrics and Gynecology Residents

PROBLEM: The American Board of Obstetrics and Gynecology (ABOG) announced in January, 2018 it is requiring completion of the Fundamentals of Laparoscopic Surgery (FLS) program as prerequisite for board certification for residents graduating after May, 2020. Currently, our residency program has no formalized laparoscopic curriculum and has never required residents to participate in the FLS program. INTERVENTION: Needs assessment was performed to survey faculty in the residency program regarding residents’ current skill levels and faculty perspectives of level-appropriate laparoscopic skills by training year. A comprehensive laparoscopic curriculum was designed to support resident progression through different competency milestones required to ultimately be able to perform laparoscopic hysterectomies as the surgeon. The laparoscopic curriculum addresses a parallel group of requirements designed to assist residents in successful completion of the FLS curriculum. CONTEXT: The laparoscopic curriculum was designed in the context of an academically-based obstetrics and gynecology residency program. The residency program has 9 residents a year who rotate at 5 different clinical sites and work with over 50 faculty who perform laparoscopic procedures. OUTCOMES/LESSONS LEARNED: The curriculum will be implemented in July 2019 with the new academic year. The curriculum will be assessed in several ways: formal testing of residents with FLS skills by the program administration, time takes resident to progress through the competency milestones for laparoscopy, the FLS pass rate, and scores of our residents. Main lesson learned through the design process was how to manage the varying resident and faculty expectations for surgical skills training.

CREOG In-Training Examination Results: Contemporary Use to Predict ABOG Written Examination Outcomes.

The in-training examination (ITE) offers formative assessments of residents' developing medical knowledge. Identification of an ITE performance level associated with success on the specialty board examination allows identification of "at risk" residents. This study sought to identify a threshold score for obstetrics and gynecology residents' performance on the Council on Resident Education in Obstetrics and Gynecology (CREOG) ITE that predicts successful performance on the American Board of Obstetrics and Gynecology (ABOG) written examination. We analyzed ITE and ABOG results of 80 residents who completed 4 years of CREOG ITEs at 2 institutions between 2002 and 2012. We assessed the level of performance associated with successful performance on the ABOG written examination. Data analyzed included scores for 71 of 80 residents (89%), with an overall pass rate of 82%. A postgraduate year (PGY) 4 score of 200 on the CREOG ITE or twice in any of the PGY training years was associated with a 100% ABOG pass rate. Scoring ≥ 205 in any PGY also was associated with a 100% pass rate. Residents who did not attain a score of 200 had a 35% to 45% chance of failing the ABOG written examination, depending on the PGY of the ITE performance. Our findings suggest that a CREOG ITE score of at least 200 twice, or as a PGY-4, offers assurance of successful performance on the ABOG examination. Scores lower than this threshold may be used to identify "at risk" residents for added learning and provide program elements in need of improvement.

Council on Resident Education in Obstetrics and Gynecology In-Training Examination Results

BACKGROUND: The Council on Resident Education in Obstetrics and Gynecology (CREOG) In-Training Examination (ITE) was designed to serve as a tool to provide feedback on resident progress along with training program strengths and weaknesses. OBJECTIVE: The objective of this study was to identify predictive factors for success on American Board of Obstetrics and Gynecology (ABOG) Written Examination using CREOG ITE scores. METHODS: CREOG ITE and ABOG written examination results collected from 2002 to 2012, inclusive, from Reading Hospital and Greenville Health System residents who took the CREOG ITE exam for 4 years. Data were analyzed using logistic regression to identify key factors in predicting ABOG written examination outcomes. Categorical data were analyzed using χ2. RESULTS: Seventy-one residents were included for analysis, of whom 68.9% were female. Gender differences existed. For women, a low score starting in postgraduate year (PGY)-1 was correlated with ABOG failure (P<.001), but it was not associated in men (P=NS) until PGY-3. Results showed that while each year's score contributed to the chance of pass–fail, the contribution increased each year. For every point increase in year 4 examination score, chances of passing increased by 21.5% (P=.001). Calculations using all 4 years resulted in an area-under-the-curve (AUC) of 0.920, significantly better (P<.001) than the null hypothesis of 50%. CONCLUSION: Results indicate that the score of each subsequent PGY is more important than the previous PGY's score. CREOG ITE scores could be a useful tool for identifying residents requiring structured interventions.

If a Man Needs a Gynecologist, Will He Be Able to Find One?

In September 2013, the American Board of Obstetrics and Gynecology (ABOG) revised its definition of “obstetrician-gynecologist.” With few exceptions, gynecologists risked losing their board certification if they treated men. Anoscopy (on men) and vasectomy were explicitly prohibited (1). Pressure from the public and media (1), National Institutes of Health (NIH) and private letter-writing campaigns (2) resulted in the ABOG’s reversing its stance step by step until it fully reversed itself in January 2014 (2, 3, 4). Although it may seem that restricting specialists in women’s medicine to treating only women should create neither hardship nor protest, it is in fact a problem. Gynecologists often provide essential treatment that men cannot easily obtain from other practitioners—for example, high-resolution anoscopy (HRA). The incidence of anal cancer is increasing in both women and men and is especially high in HIV-infected men who have sex with men (5). HRA-directed biopsy is an important part of the diagnostic evaluation for anal cancer and its precursors. A relatively new procedure, HRA utilizes advanced colposcopic skills and requires significant training and experience. Gynecologists, with their expertise in colposcopy, have been the quickest to master HRA and thus make up a large percentage of the limited number of clinicians qualified to perform the procedure in this country (1). Gynecologists also play an important role in performing vasectomies. Although it is one of the safest and most cost-effective methods of contraception, vasectomy accounts for only 1 of 3 sterilizations in this country and is utilized preferentially by high-income white men (6). In rural and low-income areas, insufficient access to providers is one of the primary barriers to vasectomy. Gynecologists trained in the procedure during a family planning fellowship may be the only qualified, accessible providers in these areas (7). There are other situations in which gynecologists are the most appropriate physicians for men. For example, debilitating pelvic pain can affect men (albeit less prevalently than women). With their wider exposure to this problem, gynecologists are often the only practitioners able to properly diagnose and treat pelvic pain in men (8). Although, as noted, the ABOG has reversed all of these restrictions, we are troubled by the fact that a specialty board would attempt to limit the otherwise lawful and ethical practice of its diplomates. These restrictions raise ethical problems that go well beyond a simple public relations failure. Indeed, it is only in the context of an ethical failure that the ABOG’s attempted policy initiative can be fully understood. First, the restrictions relied on an untenable distinction between men and women. A division of humans into 2 sexes or genders is perforce arbitrary. Any such classification must account for at least 4 factors: chromosomal sex, genitalia present at birth, genitalia currently present, and lived identity (which may or may not be made to conform to expected appearances with hormones or other means). It is not necessary to list all of the possible combinations of these factors to see that only 2 unequivocally fit the male–female dichotomy the ABOG’s edict created—intersexuality and transsexuality are completely unaccounted for. Although this may seem to be only an intellectual or practical problem, it is also an ethical one. By ignoring intersexual and transsexual persons when limiting the practice of gynecology, the ABOG ensured that such patients would be treated, or not treated, arbitrarily—in other words, unfairly. That the ABOG’s policy had an exception for the treatment of “transgender conditions” (webpage no longer active) did not solve the problem. This exception was sufficiently vague it was unclear who could be treated for what. Moreover, it did not seem to cover intersexual nor transgender persons who may feel more comfortable with a gynecologist treating matters not related to their “transgender conditions.” By failing to account for these groups, the ABOG betrayed the trust of a vulnerable group of patients, who often receive their care from gynecologic endocrinologists. Second, the ABOG’s restrictions compeled individual practitioners to abandon active patients who may not have had adequate alternatives for care (1, 8). By forcing a physician to put identifiable patients at unnecessary risk, it goes to the heart (and abridges) the physician–patient relationship. In addition to being unethical (9), it could be considered malpractice (10). Third, the restrictions discriminated against specific disadvantaged groups. As noted, gynecologists are especially important providers of vasectomy in underserved areas. In the case of HRA, those at greatest risk for anal cancer, and thus most in need of skilled HRA providers, are HIV-infected men who have sex with men. A fourth issue is that the ABOG’s action could have interfered with important NIH-sponsored research. Although HRA has been increasingly accepted as an important part of screening for anal cancer, optimal management of anal cancer precursors is unknown. A major NIH-funded study of HRA in anal cancer prevention is about to start, and restricting investigators to enrolling only women threatens the integrity of the study. The ABOG’s reversal has resolved this problem, but its willingness to scuttle a valuable study of public interest should raise serious concern. Nor did the ABOG’s stated reasons for their action support the restriction they imposed. The ABOG wanted to address the problem of gynecologists branching out into practices for which they are not trained and that are not covered by their board certification, such as administering testosterone injections to men and practicing cosmetic medicine (1, 3). Many physicians performing these procedures are apparently claiming that they are board-certified without indicating that their certification is in gynecology, which is irrelevant to those areas (3). In addition to protecting the public, the ABOG wanted to protect its specialty’s reputation from gynecologists who perform procedures for which they are unqualified (1). The ABOG also wanted to ensure an adequate supply of physicians to treat women and that women’s health is not short-changed in research (3). However, none of these concerns justified a ban on treating men. If the goal was restricting gynecologists from performing procedures in which they are untrained or not board-certified, then that should have been the prohibition. A ban on treating men still allowed the problematic behavior to occur with female patients. Those few gynecologists treating male patients would not have materially reduced the number of physicians treating women, nor would it have affected research agendas or funding. For all of these reasons, we believe that the ABOG’s initial decision to impose restrictions on its diplomates’ practice was deeply flawed, and are pleased it has made a full reversal. The ABOG should not have prohibited gynecologists from treating patients who need their help by performing skilled procedures for which these physicians are uniquely qualified. Medicine is constantly evolving, and arbitrary limitations on practice inhibit this development. The primary function of a medical board is to evaluate candidates in its primary specialty and to certify those qualified as “diplomates” of that board. In this way patients can be assured that a board-certified physician has kept up with the changes in his specialty. Medical boards should not attempt to interfere with qualified physicians rendering appropriate care to their patients.

Editorial introductions

Current Opinion in Obstetrics and Gynecology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of obstetrics and gynecology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Editor and Section Editors for this issue. EDITOR Jonathan S. BerekJonathan S. BerekDr Berek is the Laurie Kraus Lacob Professor at Stanford, USA, where he is the Chair of the Department of Obstetrics and Gynecology, Stanford University School of Medicine, and the Director of the Stanford Women's Cancer Center at the Stanford Cancer Institute. Dr Berek is well known as a scholar, clinician, researcher and educator in the field. He is highly regarded for his research on the clinical management of gynecologic cancers and translational research related to these malignancies. He has published over 275 research papers, and many contributed articles, book chapters and monographs. He is especially noted for his popular books, Berek & Hacker's Gynecologic Oncology, in its 5th edition, and Berek & Novak's Gynecology, in it's 15th edition. Dr Berek earned his undergraduate degree from Brown, USA, his doctor of medicine degree at Johns Hopkins University School of Medicine, USA, completed his residency at Harvard Medical School, the Brigham and Women's Hospital, USA, and his fellowship in gynecologic oncology at the UCLA School of Medicine, USA. For many years, he was a Professor at UCLA, where he was also the Chair of the College of Applied Anatomy. Dr Berek is the Group Chair and Principal Investigator for the Cooperative Ovarian Cancer Group (COGI), which is a member of the Gynecologic Cancer Intergroup (GCIG). He was a Principal Investigator for the Gynecologic Oncology Group (GOG) for two decades. His primary research interest is in the immunology and immunotherapy of ovarian cancer, and through the development of experimental models and clinical trials, his initial studies encouraged the development of innovative biologic therapy strategies. Through collaborative work, his group focuses on the development of vaccines, monoclonal antibodies and targeted therapies for ovarian cancer. Dr Berek has had grant support from the National Institute of Health (NIH) and the Ovarian Cancer Research Foundation (OCRF). He is the recipient of the prestigious Sherman Mellinkoff Award and the Excellence in Education Award by the David Geffen School of Medicine at UCLA, and the 2010 John C. Fremont Pathfinder Award. He is regularly listed among America's Best Doctors for Gynecology & Gynecologic Oncology. He is board certified by the American Board of Obstetrics and Gynecology (ABOG), and the Division of Gynecologic Oncology. He is a Fellow in the American College of Obstetricians and Gynecologists (FACOG), the American College of Surgeons (FACS), and the American Society of Clinical Oncologists (FASCO). Dr Berek has served as an examiner for the American Board Obstetrics and Gynecology (ABOG) and for the Council on Resident Education in Obstetrics and Gynecology (CREOG). Dr Berek is the immediate Past-President of the Council of University Chairs of Obstetrics and Gynecology (CUCOG), and Past President of the International Gynecologic Cancer Society (IGCS). His many honors include receiving the President's Award from the Society of Gynecologic Oncologists (SGO), serving as its Vice President in 1996–1997, and presenting numerous distinguished lectureships. Dr Berek has served on many national committees for the National Institutes of Health (NIH), the National Cancer Institute (NCI), the American College of Surgeons (ACS), the Society of Gynecologic Oncologists (SGO), the American College of Obstetricians and Gynecologists (ACOG), and the American Society of Clinical Oncology (ASCO). He is a member of the Society of Gynecologic Investigation (SGI), and the Society of Pelvic Surgeons (SPS). He is the Editor in Chief of Current Problems in Obstetrics and Gynecology, ASCO Connections, and was a Senior Editor of the International Journal of Gynecologic Cancer. He has served as an Editor of Prolog and Précis for the American College of Obstetrics and Gynecology, and on the editorial boards of the Journal of Clinical Oncology, Gynecologic Oncology, and the Journal of the Society for Gynecologic Investigation. SECTION EDITORS Anne O. RodriguezAnne O. RodriguezDr Rodriguez received her medical and undergraduate degrees with honors at Northwestern University, USA, and completed her residency in Obstetrics and Gynecology at the University of North Carolina at Chapel Hill, USA. She then completed her fellowship in Gynecologic Oncology at the University of Miami/Jackson Memorial Hospital, USA. She served as Associate Professor and fellowship director of Gynecologic Oncology at the University of California, Davis, School of Medicine, USA and is now in active clinical practice in gynecologic oncology in Ventura and Santa Barbara, CA, with a special interest in fertility preservation in cancer patients. She is part of the teaching program in General Surgery at the Santa Barbara Cottage Hospital and is active in multiple research endeavors. She serves on the Core Planning Committee for the California Ovarian Cancer Awareness Program. Gottfried E. KonecnyGottfried E. KonecnyGottfried E. Konecny is Associate Professor of Medicine at the University of California Los Angeles (UCLA), USA. He is the lead clinician for gynecologic oncology in the Department of Medicine at UCLA. He obtained his medical degree and completed his residency training in obstetrics and gynecology at the University of Munich in Germany. Following his specialist training he focused on clinical breast cancer research and decided to move to the US to pursue postdoctoral studies in the laboratory of Dennis J. Slamon to participate in laboratory and clinical research that led to the approval of new breast cancer drugs such as trastuzumab and lapatinib, which target the specific genetic alteration of HER2 amplification found in about 25 percent of breast cancer patients. He subsequently undertook research and subspecialty training in gynecologic oncology by completing a gynecologic oncology fellowship at Mayo Clinic in Rochester Minnesota, USA. In 2007 he was recruited back to the University of California as a group leader to the Translational Oncology Research Laboratory of UCLA, to establish a laboratory for preclinical drug and clinical trial development in the area of gynecologic malignancies. His initiatives are primarily directed at using the latest and most effective technologies available to query breast, ovarian and endometrial cancer tissues, combined with appropriately characterized and molecularly defined preclinical models to identify new alterations and/or understand the role of known alterations in relevant genes and molecular pathways. His work primarily aims to identify physiologically distinct disease subgroups with their dominant signaling pathways and signaling alterations to develop subtype specific novel treatment approaches for patients diagnosed with breast, ovarian or endometrial cancer. As a physician-scientist his work focuses on translating the incredible revolution in our understanding of the molecular underpinnings of cancer into novel treatment approaches, in which each patient is treated according to the specific genetic alterations of the tumor. He currently serves as a member of the scientific program committee for the American Society of Clinical Oncology and has published his research findings in the likes of Cancer Research, Clinical Cancer Research, Journal of Clinical Oncology, Journal of the National Cancer Institute, Nature Genetics, Gynecologic Oncology and Breast Cancer Research and Treatment.

Pursuit of Accredited Subspecialties by Graduating Residents in Obstetrics and Gynecology, 2000–2012

To estimate whether there has been an increase in resident graduates pursuing fellowship training in the currently accredited subspecialties and to compare whether any trend toward subspecialization is similar to those seen in other specialties. This descriptive study examined data from the National Residency Match Program for academic years 2000-2012. Annual comparisons were made between the numbers of residents who either pursued careers in their specialty or were accepted into fellowship training in an accredited subspecialty. We compared the numbers in each group who took the American Board of Obstetrics and Gynecology (ABOG) written board examination and who became board-certified. Although the annual number of residency graduates in obstetrics and gynecology remained essentially the same (1,185 ± 56), the proportion of graduates accepted into fellowships increased steadily in all subspecialties (from 7.0% in 2000 to 19.5% in 2012). All other core specialties saw higher proportions of their graduates pursuing subspecialties except for family medicine. Coincident with rises in fellowship programs and positions was eventual increase in trainees who took the ABOG written examination for the first time in the three established subspecialties (maternal-fetal medicine, gynecologic oncology, reproductive endocrinology and infertility) and who became board-certified. Like with residents in other specialties, more graduates in obstetrics and gynecology are pursuing accredited subspecialty fellowship training, adding to the complexities of workforce planning. The percent of obstetrics and gynecology residents who pursued accredited subspecialty fellowship training was lower than all but one other specialty.

Surgical education and training program development for gynecologic oncology: American perspective

The purpose of this paper is to provide information about gynecologic oncology fellowship training and guidance in program development. The characteristics necessary for a physician to develop into a successful gynecologic oncologist include an extensive fund of knowledge related to the subspecialty, strong interpersonal skills, the ability to practice within the complex systems required for management of gynecologic cancer patients, surgical expertise, and the clinical ability to provide comprehensive oncologic care for these women. In order for a trainee to acquire these skills, a gynecologic oncology training program must accept only highly qualified individuals as fellows, have a dedicated core faculty, practice in a supportive environment that has appropriate facilities, and provide adequate clinical material. The gynecologic oncology training program must be organized with an emphasis on education of the fellows. Part of the educational program is formal (lectures, assigned reading, basic skill sets, etc.). Training in clinical and surgical skills is a day-to-day process that occurs during the course of patient care. One requirement of The American Board of Obstetrics and Gynecology (ABOG) is that the fellow spends 12 months of protected time doing research. Fellows are also required to take 2 courses, one in biostatistics and one in cancer biology. A thesis of publishable quality is also required. All programs must perform ongoing quality assurance and reassessment of potential areas for improvement. ABOG is responsible for the accreditation and ongoing monitoring of the fellowship programs.

Resident Performance on the In-Training and Board Examinations in Obstetrics and Gynecology: Implications for the ACGME Outcome Project

Background: The Accreditation Council on Graduate Medical Education (ACGME) Outcomes Project has endorsed the in-training examination (ITE) as an example of a multiple-choice question examination that is a valid measure of a resident's attainment of medical knowledge. An outcome measure for performance on the ITE would be the subsequent performance on the board certification examination. However, there are few reports that attempt to correlate a resident's performance on the ITE to subsequent performance on the board certification examination. Purpose: The Council on Resident Education in Obstetrics and Gynecology (CREOG) has administered the ITE annually since 1970. This study tested the hypothesis that the CREOG–ITE score is a valid assessment tool to predict performance on the American Board of Obstetrics and Gynecology (ABOG) written examination. Methods: CREOG–ITE and ABOG written board examination results were collected for 69 resident graduates between the years 1998 and 2005. Logistic regression and receiver operating characteristic analyses were used to estimate the relationship between a resident's score on the CREOG–ITE and subsequent performance on the ABOG written examination. Results: Fifty-seven resident graduates passed (82.6%) and 12 graduates failed (17.4%) the ABOG written examination. The correlation between the CREOG–ITE overall score and performance on the ABOG examination was weak (correlation coefficient =.38, p =.001). Receiver operating characteristic analysis for the CREOG–ITE overall scores and the probability of passing or failing the ABOG examination revealed moderate accuracy (area under the curve = 0.77, 95% CI = 0.62–0.92) with a CREOG–ITE score of 187.5 yielding the best trade-off between specificity (0.79) and sensitivity (0.75). At the cutoff value of 187.5 there was a weak positive predictive value of 43% (i.e., 43% of residents with a score less than 187.5 will fail the ABOG exam) and a strong negative predictive value of 94% (i.e., 94% of the residents with a score above 187.5 will pass the ABOG exam). Logistic regression analysis also revealed a statistically significant relationship between the CREOG–ITE overall score and performance on the ABOG written examination (p = .003). Conclusions: Similar to other specialties, resident performance on the CREOG–ITE is a weak assessment tool to predict the probability of a resident failing the ABOG written examination. Our study highlights the need, in the spirit of the ACGME Outcome Project, for residency and board specialty organizations to coordinate efforts to develop more reliable and correlative measures of a resident's medical knowledge and ability to pass the boards.