Gynecology Residency Training Programs Research Articles

Needs assessment of menopause education in United States obstetrics and gynecology residency training programs.

This study aimed to assess the variance in menopause education, educational resources, and the needs of obstetrics and gynecology (ObGyn) residency programs by conducting a national survey of program directors (PDs). In 2022, an institutional review board-approved Web-based Qualtrics survey was designed and distributed electronically to 145 US ObGyn residency PDs. The survey consists of 15 questions. The main outcomes are reported using descriptive statistics. The survey was completed by 99 of 145 PDs (68.3%). Almost all participants (92.9%) strongly agreed that residents nationwide should have access to a standardized menopause curriculum that could be utilized in their programs. Only 31.3% reported having a menopause curriculum in their residency program. Of the programs with a menopause curriculum, 96.8% reported using lectures, 77.4% reported assigned readings, and 74.2% had either dedicated menopause clinics or other clinics with a high volume of menopausal patients. Of all programs surveyed, only 29.3% reported that trainees had dedicated time assigned to a menopause clinic. A total of 83 of 99 PDs agreed or strongly agreed that their programs needed more menopause educational resources, and most (89.7%) stated they were likely or very likely to use self-paced menopause modules that include performance feedback if available. Data from the needs assessment questionnaire revealed that menopause education and resources vary across residency programs, with the majority lacking a dedicated menopause curriculum. Most PDs expressed a desire for more educational resources and standardized training materials, and preferred to access an online national menopause curriculum.

Exploring the hidden curriculum in the University of Alberta postgraduate obstetrics and gynecology residency training program

Following accreditation of the University of Alberta Obstetrics and Gynecology residency training program, concerns regarding the informal teaching environment, known as “hidden curriculum” (HC) were identified. The ongoing research aims to identify, understand, and rectify the HC through positive change within the department.

Elimination of 24-Hour Call Shifts in an Obstetrics and Gynecology Residency Training Program [ID: 1375098

INTRODUCTION: Resident duty hour restrictions have resulted in improved resident safety with mixed results on patient safety. There are limited data about 24-hour shifts in obstetrics and gynecology. This project studies resident wellness and performance after eliminating 24-hour call shifts. METHODS: This is a preliminary analysis of a quality improvement project. Physicians were surveyed before and after implementation of a call schedule that reduced 24-hour shifts to 14-hour shifts. Resident performance was assessed by self-reported and attending-reported ability to perform tasks. RESULTS: At preintervention survey, 13 out of 16 residents and 8 out of 17 attendings favored eliminating 24-hour call shifts. Attendings had more confidence in residents' performance on 24-hour shifts than residents did (P<.02) when stratified by task and residency year. At 3-month follow-up, all residents (19/19) preferred 14-hour shifts. Residents reported improvements in wellness (13/13), sleep (13/13), and burnout (10/13). Residents felt more confident in their ability to perform a vaginal delivery (11/13), cesarean birth (12/13), or communicate effectively (11/13) with 14-hour compared to 24-hour shifts. Thematic analysis showed that residents felt happier and better able to care for patients. Two residents cited improved ability to learn, while only one resident cited lost learning opportunities. CONCLUSION: Data suggest that obstetrics and gynecology residency programs should eliminate 24-hour shifts to improve resident wellness and performance, while decreasing burnout. Final follow-up data (to be collected March 2023) will assess whether attendings see a change in resident performance.

Classroom-Based Learning in an Academic Obstetrics and Gynecology Residency Training Program.

Classroom-based learning such as academic half days (AHDs) are complementary to workplace learning in postgraduate medical education. This study examined three research questions: the purpose of AHDs, elements of an effective AHD, and factors that make AHD sustainable. We conducted a case study of the AHD in a large Obstetrics and Gynecology residency program at the University of British Columbia. Residents were interviewed in 2013 (n = 11) and 2018 (n = 7) and the program administrator was interviewed in 2018. The themes in each research question were identified by modified inductive analysis. Residents expressed that the purposes of AHD included: providing organization and an overview for their knowledge acquisition; preparation for their Royal College specialty exam; and to provide a venue for peer support and mentorship. Elements of an effective AHD include the repetition of key concepts; formative assessments such as quizzes, a suitable balance of faculty input and resident active participation, and protection from clinical duty during AHD. Regarding the sustainability of AHD, themes included: addressing barriers to faculty participation, providing administrative support for logistical needs, and providing feedback to faculty. This work provides important insights into the purpose, effectiveness, and sustainability of AHDs for those who design and implement classroom learning for residents.

Impact of COVID-19 pandemic on obstetrics and gynecology residency training program in India: A national online survey.

ObjectiveThe goal of this study was to analyze how the COVID‐19 pandemic affected the Obstetrics and Gynecology (OBG) residency program in India.Study DesignThis was a cross‐sectional questionnaire‐based online survey aimed to assess the impact of the pandemic on the residency training program in Obstetrics and Gynecology. The questionnaire consisted of five sections: demographic details, information regarding COVID‐19 status, clinical work load, teaching and research, and psychological impact.ResultsThe questionnaire was completed by 280 OBG trainees from different medical colleges from India. Training activity in general was reduced considerably during the pandemic, according to 79.6% (n = 223) respondents. According to 13.21% (n = 37) and 5% (n = 14) respondents, reduction in training activity were due to cancelation of elective operations and reduced patient foot fall respectively. In 74.3% (n = 208) of cases, trainees reported worry about meeting the goals of their specialty training. Logistic regression showed that the extent of training reduction was not significantly associated with residents' age (p = 0.806), gender (p = 0.982), marital status (p = 0.363), and status of their duty in COVID‐19 dedicated hospitals (p = 0.110). However, year of residency was a significant predictor of the perception about degree of training reduction.ConclusionThe pandemic imposed a significant impact on OBG residency training in India. During the pandemic, exposure to learning opportunities, surgeries, and teaching were reduced, which may result in a decline in the quality of care offered to women in the future if training deficit is not overcome. At the same time, pandemic also gave birth to newer insights of learning and interaction by online mode.

Provision of infertility care for the underserved in reproductive endocrinology and infertility practices associated with obstetrics and gynecology residency training programs in the United States

ObjectiveTo survey practice patterns designed to increase access to infertility care and evaluate the exposure of obstetrics and gynecology residents to infertility care for the underserved.DesignCross-sectional.SettingReproductive endocrinology and infertility (REI) practices associated with Accreditation Council for Graduate Medical Education-accredited obstetrics and gynecology residency training programs.Patient(s)None.Intervention(s)Questionnaire survey.Main Outcome Measure(s)Presence of clinical programs designed to improve access to REI care, resident involvement in such programs, and perceived barriers to expanding access to care.Result(s)Clinical initiatives to expand access included discounted infertility services (38%, n = 30), utilization of a low-cost in vitro fertilization (IVF) program (28%, n = 22), and utilization of a resident- and/or fellow-staffed clinic to provide infertility care (39%, n = 31). The most commonly discounted infertility services were IVF (73%, n = 22), clinical consultation (70%, n = 21), and intrauterine insemination (53%, n = 16). The provision of discounted prices was correlated with the increasing practice size (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.23–4.24) and number of assisted reproductive technology cycles performed annually (OR, 3.65; 95% CI, 1.48–9.02). Academic REI practices (OR, 3.6; 95% CI, 0.98–13.25) were more likely to have a low-cost IVF program. Less than half of obstetrics and gynecology residency programs (39%, n = 31) had an associated REI clinic in which obstetrics and gynecology residents provide direct infertility care to the medically underserved. Frequency and services offered in trainee clinics varied. Multiple barriers to expanding access to care were reported.Conclusion(s)Reproductive endocrinology and infertility practices associated with obstetrics and gynecology residency programs utilize a diverse range of approaches to provide infertility care to the underserved in the backdrop of considerable challenges and barriers, but significant gaps persist.

A call to assess the performance of international medical graduates in Obstetrics and Gynecology residency training programs in the United States

International medical graduates contribute to an important section of the practicing physicians in the United States. However, there is not enough data to understand their performance in Obstetrics and Gynecology residency training programs of the United States. International medical graduates who apply to residency programs, including those with previous clinical experience, are often disfavored by most Obstetrics and Gynecology residency training programs, based on the theoretical inferior performance of these applicants during their residency years. The previous experience obtained by the international medical graduate-applicants are often valued by other developed countries that were reported to have better healthcare system in women health compared to that of the United States. Studying the performance of international medical graduate-residents in Obstetrics and Gynecology training programs could help set a standard that aid the program leaders choosing their potential residents and could also protect the rights of these international medical graduate-applicants. This is especially important amid recent changes in certifying exams, volatile immigration system of the United States, and the increasing number of medical graduates.

Correlations between Accreditation Council for Graduate Medical Education Obstetrics and Gynecology Milestones and American Board of Obstetrics and Gynecology qualifying examination scores: an initial validity study

Since the launch of the Outcome Project in 2001, the graduate medical education community has been working to implement the 6 general competencies. In 2014, all Obstetrics and Gynecology residency programs implemented specialty-specific milestones to advance competency-based assessment. Each clinical competency committee of the Obstetrics and Gynecology program assesses all residents twice a year on the milestones. These data are reported to the Accreditation Council for Graduate Medical Education as part of a continuous quality improvement effort in graduate medical education. This study aimed to evaluate the correlation between the Accreditation Council for Graduate Medical Education Obstetrics and Gynecology Milestones and residency program graduates' performance on the American Board of Obstetrics and Gynecology qualifying (written) examination. We conducted a validity study of all graduating (postgraduate year 4) Obstetrics and Gynecology residents in 2017 within Accreditation Council for Graduate Medical Education-accredited United States training programs (1260 residents from 242 programs). This cohort of residents began receiving milestone assessments during their postgraduate year 2 in 2014; the first-year milestones were implemented for all Accreditation Council for Graduate Medical Education-accredited Obstetrics and Gynecology programs. This cohort completed their sixth and final milestone assessment at graduation in June 2017 for a total of 6 periods of milestone assessments. Data regarding each resident's milestone ratings in each of the 28 Accreditation Council for Graduate Medical Education subcompetencies for Obstetrics and Gynecology were assessed for their association with candidates' American Board of Obstetrics and Gynecology qualifying examination scores using a generalized estimating equation regression model. Data were available and analyzed from 1184 residents from 240 programs, representing 94% of the total academic year 2017 graduates of Obstetrics and Gynecology residency training programs. There was a substantial association between most milestone ratings at the 6 assessment points and candidates' performance on the American Board of Obstetrics and Gynecology qualifying examination. The strongest associations with the American Board of Obstetrics and Gynecology were within all 7 of the subcompetencies of Medical Knowledge (range of slope correlation coefficients at final milestone ratings 3.84-5.17; slope coefficients can be interpreted as the gain in qualifying examination points per unit increase in milestone level). At the final milestone assessment, but more modest associations with the American Board of Obstetrics and Gynecology qualifying examination scores were also seen with 9 of the 11 Patient Care and Procedural Skills subcompetencies, the 2 of 2 Practice-Based Learning and Improvement subcompetencies, the 2 of 2 Systems-Based Practice subcompetencies, and 2 of the 3 Professionalism subcompetencies. Only 1 of the 3 Interpersonal and Communication Skills subcompetencies was associated with American Board of Obstetrics and Gynecology qualifying examination scores. The pattern of associations between the qualifying examination scores and milestone ratings for the 2017 graduating cohort of Obstetrics and Gynecology residents followed a logical pattern, with the strongest associations seen in Medical Knowledge, and lower to no associations in subcompetencies not as effectively assessed on multiple-choice examinations. Although some positive associations were noted for non-Medical Knowledge milestones, these associations could be caused by correlational rating errors with further study needed to better understand these patterns.

Being an obstetrics and gynaecology resident during the COVID-19: Impact of the pandemic on the residency training program

Objectiveto evaluate the impact of the COVID-19 pandemic on the obstetrics and gynecology residency training program in Italy. Study designThis was a cross-sectional survey study aimed to assess the impact of the COVID-19 pandemic on the obstetrics and gynecology residency training program in Italy. An online survey with 45 questions was sent and completed anonymously by residents after accepting an informed consent. The invitation to the online survey was sent to all the Italian residents in obstetrics and gynecology. Those on maternity leave at the time of the study were excluded. Residents were asked about their routinely activity before the COVID-19 pandemic, and to report the reduction in their clinical practice. They were also asked about psychological impact of COVID-19 on their clinical practice. Results933 Italian residents in obstetrics and gynecology, were invited for this survey study. Four-hundred and seventy-six (51 %) completed the survey and were included in the study. Three-hundred and eighty-seven (81.3 %) were female, and 89 (18.7 %) were male. Residents age ranged from 25 to 42. In 71,8 % (342/476) of the cases residents work in a COVID-19 reference Hospitals. One-hundred and eighty-four out of 76 residents (38.6 %) were tested on RT-PCR assay of nasal and pharyngeal swab specimens, and of them 12/184 (6.5 %) were positive to SARS−COV-2. Regarding the use of personal protective equipment (PPE), 267 (56.1 %) reported to receive adequate device, and 379 (79.6 %) felt to be well informed about prevention and management protocols. Three-hundred and thirty-one residents (69.5 %) reported to have managed COVID-19 positive patients. For 54,7 % of respondent residents, training activity in general decreased significantly during the COVID-19 epidemic. A one-third reduction was reported in 31,4 % of the cases, whereas a total suspension of the training in 9,9 % of the cases. In 89,3 % of cases the reduction was caused by the reorganization of work. Anxiety about the professional future was reported in 84 % of the residents, and 59 % of them had the perception that their training was irreversibly compromised. ConclusionsAmong Italian residents in obstetrics and gynecology, COVID-19 pandemic was associated with a significant training impairment.

Abortion Training in Obstetrics and Gynecology Residency Training Program Centers in Jeddah, Saudi Arabia

Abortion Training in Obstetrics and Gynecology Residency Training Program Centers in Jeddah, Saudi Arabia

Lactation Education for Resident Obstetricians: Promoting Breastfeeding Advocates for the Future.

Obstetrics and gynecology residency training programs are historically lacking in breastfeeding education and advocacy. Healthy People 2020 supports interventions that promote breastfeeding as a primary care strategy with significant health benefits to the newborn and woman. Midwives are well poised to engage obstetrics and gynecology residents in lactation education. A few educational interventions have been described in the literature to increase knowledge, confidence, and behavior related to lactation among residents. This article describes a breastfeeding education curriculum developed by midwifery faculty at Boston University School of Medicine. The project included 3 lectures and a simulation center workshop covering topics including lactogenesis, prenatal, intrapartum, and postpartum interventions that promote or limit lactation, hands-on latch assistance, hand expression, use of breast pumps and storage of human milk, and common disorders of lactation. Postintervention evaluations demonstrated improvements in knowledge and confidence. Providing breastfeeding education to resident physicians may be an intervention to promote patient breastfeeding education and support and close the gap of disparities in breastfeeding rates.

Family planning training at Catholic and other religious hospitals: a national survey

Catholic and other faith-based hospitals often restrict family planning service provision based on institutional doctrine. Approximately 11% of US accredited obstetrics and gynecology residency programs occur at such hospitals, creating a challenge to educational leaders who must ensure comprehensive family planning training. To evaluate and summarize family planning training at obstetrics and gynecology residency programs that are affiliated with Catholic and other faith-based hospitals that restrict reproductive services. Using an online database search and survey screening questions, we identified 30 of 278 accredited 2017-2018 programs in which at least 70% of resident time is spent in faith-based hospitals that restrict family planning services; Jewish programs were excluded. We queried program leaders between March 2017 and April 2018 about education and training using an online or paper survey, and asked them to report on training settings, provision of family planning services in such settings, and to rate aspects of training as "poor," "adequate," or "strong." We compared responses at Catholic versus other faith-based programs using Fisher exact tests, χ2 analyses, and median tests. Among 30 programs, 25 responded (83%); the majority of respondents were program directors (88%) and represented Catholic hospitals (76%). All reported adequate contraceptive training, with 47% of Catholic programs relying on off-site locations. The majority of Catholic sites (84%) relied on off-site sterilization training sites. Survey respondents from Catholic programs most commonly endorsed concerns for inadequate training in postpartum tubal ligations (53% of Catholic respondents versus 0% of other faith-based program respondents, P= .05). Approximately one-half (56%) offered abortion training as part of the curriculum ("routine"), 32% offered residents the opportunity to arrange training ("elective"), and 12% did not offer; the majority (84%) relied on off-site collaborations. Catholic sites were more likely than other religious programs to report poor abortion training (47% versus 0%, P= .04). Five Catholic programs (26% of Catholic programs) reported that their residents did not meet the graduate training requirement for completion of 20 dilation and curettage procedures. One-third reported a prior Residency Review Committee family planning citation(s), and many commented that these citations helped provide leverage for improved training. Although Catholic and other restrictive, faith-based obstetrics and gynecology residency training programs have developed strategies in response to institutional restrictions, many report ongoing deficiencies, and almost one-half reported they were noncompliant with abortion training requirements. Programs with deficient trainings may benefit from strategic approaches, including enhanced onsite education and collaborations with off-site facilities.

Vulvovaginal Disease Education in Canadian and American Gynecology Residency Programs: A Survey of Program Directors.

The aims of the study were to assess and describe the current vulvovaginal curriculum in gynecology residency training programs in Canada and the United States and to compare this with national training objectives. A 22-question electronic survey was sent to 252 gynecology program directors in Canada and the United States between September 2015 and July 2016 using the platform SurveyMonkey.com. Survey responses were entered into SPSS Version 23, and analysis was performed using descriptive statistics. Overall, 58 (23%) of 252 programs directors responded. Nearly all of the sites provided formal teaching on pain disorders (54/58, 93%), vulvar dermatoses (54/58, 93%), and vulvovaginal infections (57/58, 98%). Exposure to vulvovaginal clinics varied widely. On average, program directors estimated that residents spend a median of 10 hours (0-200) in vulvar pain clinics, 9 hours (0-200) in dermatology clinics, and 50 hours (0-480) in colposcopy clinics during residency training. Most program directors (53/57, 93%) believed that all general gynecologists should be able to manage vulvar disorders in practice. Reported obstacles to treating vulvar disorders included lack of training (41/58, 71%) and lack of interest (35/58, 60%). While most residency programs provided formal education on vulvovaginal diseases, clinical exposure is extremely variable between sites. When it is not possible to increase clinical exposure to vulvovaginal disorders, traditional training methods (lectures, textbooks) should be supplemented with online modules and other means of learning to improve resident knowledge of vulvovaginal diseases.

Simulation in Obstetrics.

Simulation in obstetrics is a widely accepted and valuable tool that benefits all levels of learners from medical students to maternal-fetal medicine subspecialists. What began as an adjunct to medical education now has a rapidly expanding role in acquisition of new and innovative procedures, team and unit training, and safety and quality initiatives. The number of obstetric simulation peer-reviewed reports has increased exponentially in recent years, yet only a small percentage of reports primarily addresses clinical outcomes. Studies link simulation to a reduction in neonatal brachial plexus injury, maternal trauma related to forceps delivery, response to postpartum hemorrhage, efficiency in performing emergent cesarean delivery, and neonatal mortality. Simulation is a required component in accredited obstetrics and gynecology residency training programs. Obstetric simulation has a role in the certification of physicians, and simulation hands-on courses may be used to meet maintenance of certification requirements. As simulation platforms are validated, they are likely to be incorporated into the certification process as a means of assessing technical and communication skills. Accrediting, certifying, professional, quality, and safety organizations have invested in simulation committees, interest groups, curricula, and continuing medical education courses. Support for research, including large multicenter trials, are needed to inform further implementation. Research and development should lead to lower costs and improved simulators. As the public, government, licensing, and credentialing institutions explore means of improving patient safety, expansion of simulation in obstetrics is inevitable.

Abortion training in US obstetrics and gynecology residency programs

Nearly 15 years ago, 51% of US obstetrics and gynecology residency training program directors reported that abortion training was routine, 39% reported training was optional, and 10% did not have training. The status of abortion training now is unknown. We sought to determine the current status of abortion training in obstetrics and gynecology residency programs. Through surveying program directors of US obstetrics and gynecology residency training programs, we conducted a cross-sectional study on the availability and characteristics of abortion training. Training was defined as routine if included in residents' schedules with individuals permitted to opt out, optional as not in the residents' schedules but available for individuals to arrange, and not available. Findings were compared between types of programs using bivariate analyses. In all, 190 residency program directors (79%) responded. A total of 64% reported routine training with dedicated time, 31% optional, and 5% not available. Routine, scheduled training was correlated with higher median numbers of uterine evacuation procedures. While the majority believed their graduates to be competent in first-trimester aspiration (71%), medication abortion (66%), and induction termination (67%), only 22% thought graduates were competent in dilation and evacuation. Abortion procedures varied by clinical indication, with some programs limiting cases to pregnancy complication, fetal anomaly, or demise. Abortion training in obstetrics and gynecology residency training programs has increased since 2004, yet many programs graduate residents without sufficient training to provide abortions for any indication, as well as dilation and evacuation. Professional training standards and support for family planning training have coincided with improved training, but there are still barriers to understand and overcome.

The Effect of Fellowship-Trained Faculty in Minimally Invasive Gynecologic Surgery on an Obstetrics and Gynecology Residency Training Program in a Community Hospital in an Inner-City Setting [126

The Effect of Fellowship-Trained Faculty in Minimally Invasive Gynecologic Surgery on an Obstetrics and Gynecology Residency Training Program in a Community Hospital in an Inner-City Setting [126

Laparoscopic-Assisted Vaginal Hysterectomy (LAVH) Re-Defined: Impact on Resident Surgical Case Log Reporting

In 2012, the Accreditation Council for Graduate Medical Education (ACGME) established minimum surgical procedure thresholds for Obstetrics and Gynecology residency training programs. For surgical case reporting, LAVH was classified in the laparoscopic hysterectomy (LH) category. Recently, however, the ACGME re-defined LAVH as a vaginal hysterectomy (VH) and operative laparoscopy (OL). The purpose of this study was to examine institutional trends in LAVH procedures, and predict expected changes in resident surgical case numbers.

Blinded Assessment of Operative Performance After Fundamentals of Laparoscopic Surgery in Gynecology Training

Study ObjectiveTo determine the pass rate for the Fundamentals of Laparoscopic Surgery (FLS) examination among senior gynecology residents and fellows and to find whether there is an association between FLS scores and previous laparoscopic experience as well as laparoscopic intraoperative (OR) skills assessment. DesignProspective cohort study (Canadian Task Force classification II-2). SettingThree gynecology residency training programs. ParticipantsThird- and fourth-year gynecology residents and urogynecology fellows. InterventionsAll participants participated in the FLS curriculum, written and manual skills examination, and completed a survey reporting baseline characteristics and opinions. Fourth-year residents and fellows underwent unblinded and blinded pre- and post-FLS OR assessments. Objective OR assessments of fourth-year residents after FLS were compared with those of fourth-year resident controls who were not FLS trained. Measurements and Main ResultsTwenty-nine participants were included. The overall pass rate was 76%. The pass rate for third- and fourth-year residents and fellows were 62%, 85%, and 100%, respectively. A trend toward improvement in OR assessments was observed for fourth-year residents and fellows for pre-FLS curriculum compared with post-FLS testing, and FLS-trained fourth-year residents compared with fourth-year resident controls; however, this did not reach statistical significance. Self-report of laparoscopic case load experience of >20 cases was the only baseline factor significantly associated with passing the FLS examination (p = .03). ConclusionThe FLS pass rate for senior residents and fellows was 76%, with higher pass rates associated with increasing levels of training and laparoscopic case experience.

Surgical Knot Integrity: Effect of Suture Type and Caliber, and Level of Residency Training

To evaluate if suture type and caliber or level of residency training affects strength and mode of failure of surgical knots. All residents in an obstetrics and gynecology training program were invited to tie knots on a bench model using 2 calibers (0 and 3-0) of 2 types of surgical suture (polyglactin 910 and polydioxanone). The failure load, mode of failure, and loop lengths of the knots were determined. University of Texas Southwestern Medical Center, Dallas, Texas. Physicians enrolled in the University of Texas Southwestern Medical Center Obstetrics and Gynecology residency training program. Seventy-one of 73 residents participated. Knots tied with 0-caliber sutures had a higher mean failure load than those tied with 3-0 caliber sutures. For each type and caliber of suture, there were no differences in failure load between each level of residency training. However, senior residents tied knots with shorter loop lengths and had a lower proportion of knots that unraveled or slipped. Even though there were no differences in failure loads, senior residents tied tighter and more secure knots than their junior counterparts.

Impact of the medical liability crisis on postresidency training and practice decisions in obstetrics-gynecology.

The liability crisis may affect residency graduates' practice decisions, yet structured liability education during residency is still inadequate. The objective of this study was to determine the influence of medical liability on practice decisions and to evaluate the adequacy of current medical liability curricula. All fourth-year residents (n = 1274) in 264 Accreditation Council for Graduate Medical Education-accredited allopathic and 25 osteopathic US obstetrics and gynecology residency training programs were asked to participate in a survey about postgraduate plans and formal education during residency regarding liability issues in 2006. Programs were identified by the Council on Resident Education in Obstetrics and Gynecology directory and the American College of Osteopathic Obstetricians and Gynecologists residency program registry. Outcome measures were the reported influence of liability/malpractice concerns on postresidency practice decision making and the incidence of formal education in liability/malpractice issues during residency. A total of 506 of 1274 respondents (39.7%) returned surveys. Women were more likely than men to report "region of the country" (P = .02) and "paid malpractice insurance as a salaried employee" (P = .03) as a major influence. Of the respondents, 123 (24.3%) planned fellowship training, and 229 (45.3%) were considering limiting practice. More than 20% had been named in a lawsuit. Respondents cited Pennsylvania, Florida, and New York as locations to avoid. In response to questions about medical liability education, 54.3% reported formal education on risk management, and 65.2% indicated they had not received training on "next steps" after a lawsuit. Residents identify liability-related issues as major influences when making choices about practice after training. Structured education on matters of medical liability during residency is still inadequate.