Gynecology Training Programs Research Articles

Improving Diversity in a Rural Academic Obstetrics and Gynecology Training Program

Both the Accreditation Council for Graduate Medical Education and the American College of Obstetricians and Gynecologists advocate for greater diversity within our workforce, which starts with recruiting and retaining a diverse residency pool. Historically, applicants who are underrepresented in medicine have been more likely to apply to residency programs located in urban locations, as opposed to a rural training environment. In this commentary, we discuss a novel strategy used to attract underrepresented in medicine applicants to a rural academic obstetrics and gynecology training program. The strategy encompassed a virtual weeklong elective with the goals of bolstering their residency applications and showcasing our faculty and residency training.

Two years in a post- Dobbs world: clinical, social and professional consequences.

Dobbs v Jackson Women's Health Organization revoked the decades-old precedent that pregnancy termination is a constitutional right. This review article explores the research landscape describing the consequences of overturning Roe v Wade for patients and providers. To date, fourteen states have enforced total bans on abortion, with seven more restricting abortion access to levels not seen since before Roe. Dobbs has had immediate and swift consequences from clinical, social and professional perspectives, with increases in maternal mortality and demand for long-acting and permanent contraception, matched by declines in both access to methotrexate and applications to Obstetrics & Gynecology training programs. Eighteen million patients now live in states where abortion access is highly if not completely inaccessible. Abortion restrictions have profound implications beyond those desiring pregnancy termination; future research should continue to explore the ways Dobbs has affected clinical care, public health and social practices.

Advances in gynecologic simulation: implementation, validity, and new resources.

Simulation plays an integral role in gynecological surgical training that will continue and grow in the future. It aims to supplement surgical training as residents are experiencing decreased surgical volumes. It has also been recognized as a means for assessing a trainee's capabilities to the point of being incorporated into the board certification process. This review will highlight the recent updates in research and resources available for gynecologic surgery simulation. The literature reviewed demonstrated that, across the board, participants in simulation find it beneficial. A variety of low-fidelity and high-fidelity models, virtual reality programs, and artificial intelligence technology have been developed recently. As the field advances, researchers have started to investigate methods to increased engagement and provide feedback without the need for direct observation, the logical next step considerations to maximize the impact and availability of simulation. Gynecologic surgery training programs must stay abreast of the wide variety of simulation training available. Efforts should continue to be made to investigate the impact of simulation patient outcomes. The academic medicine community has a responsibility to ensure high-quality simulation is available to all surgical trainees to avoid disparities between low-resource and high-resource programs.

A Framework for Diversifying Obstetrics and Gynecology Training Programs.

There is an urgent need to diversify the physician workforce in obstetrics and gynecology to serve a diverse patient population and mitigate disparities in care. There is a paucity of data on how to improve recruitment of individuals from underrepresented minoritized groups to the field of obstetrics and gynecology. This article outlines important steps for sharing the department's commitment to diversity, equity, and inclusion; addresses ways to attract a diverse applicant pool; and reviews the importance of and need to perform a holistic review of applicants. This commentary also shares some approaches to support faculty and trainees that may lead to sustained increases in diversity. Using this framework, the authors successfully increased the diversity of their obstetrics and gynecology residency program.

Estimated frequency of instrumented vaginal delivery in Colombia between 2015 and 2019. Population registry-based cross-sectional study

To assess the frequency of instrumented delivery in Colombia and by regions between 2015 and 2019. Cross-sectional study based on population registries. Records of women with a gestational age of more than 28 weeks and vaginal delivery were included. Consecutive sampling was used. The information was taken from live birth certificates of the National Administrative Department of Statistics (DANE). Sociodemographic and clinical variables were described. The frequency of instrumented deliveries was calculated and described by year and by department. Overall, 3,224,218 live birth records were included. Of these 1,719,405 (53.33 %) were vaginal deliveries and 1,468,726 (45.55 %) were cesarean births. At a national level, the frequency of instrumented deliveries between 2015 and 2019 was 36,087 births (1.11 %); Antioquia and Bogotá, D.C. were the places with the highest occurrence, with 16,201 (4.5 %) and 13,686 (2.52 %), respectively. The occurrence of instrumented vaginal delivery in Colombia is the lowest and tends to diminish. Training of healthcare professionals in this approach during labor must not be abandoned, particularly in Obstetrics and Gynecology training programs. Further studies should be conducted to determine whether the increased adequate use of this technique could contribute to a lower rate of cesarean sections, and also to describe the clinical setting in which its use is safe for both the mother and the fetus. Prospective studies are required to identify the causes leading to the lower use of this obstetric tool as well as the risks and benefits in terms of maternal and perinatal outcomes.

Visualising surgical training in O&G following the COVID-19 pandemic - The European view.

Obstetrics and Gynaecology (O&G) training programmes that traditionally relied on the hands-on apprenticeship-training model, became crippled with the global response to the COVID-19 pandemic. Web-based anonymised survey was circulated to trainee members of the European Society for Gynaecological Endoscopy (ESGE) over 8-weeks period commencing June 2021. 213 trainees from 20 countries responded. Trainees from medium Human Development Index (HDI) countries were less represented. 78% (166/213) were in approved training programmes and 81% (174/213) had access to personal PPE. The vaccine uptake was 87% (185/213). 39% (89/213) and 55% (118/213) experienced negative impact on their physical and mental wellbeing with 36% (76/213) COVID-19 related absence. 15% (32/213) were redeployed to areas outside O&G. 25% (53 /213) had negative impact on their obstetric experience compared to 54% (114/213) reported lower gynaecology surgical exposure and 43% (91/213) failed to meet their gynaecology surgical competencies during the pandemic. 64% (137/213) perceived simulation training as an alternative training tool. In the post-pandemic recovery phase, gynaecological societies and national institutes across Europe continue to develop training curricula implementing virtual and hybrid training modules. The aim is to develop a robust blueprint to safeguard the gynaecological surgical training in the future. The ongoing impact on the training in the post pandemic era remains to be evaluated. Our pan Europe survey highlights areas that remain affected from trainees' perspective and assesses differences in the healthcare systems across continent. We then discuss the novel initiatives taken to overcome training gaps.

7945 Time to Separate OB from Gyn? Resident Perspectives on Gynecologic Surgical Training and Subspecialty Tracking in Residency Programs

<h3>Study Objective</h3> This study seeks to assess resident satisfaction with their gynecologic surgical training and their opinions on subspecialty tracking in obstetrics and gynecology training programs. <h3>Design</h3> Cross sectional survey of current obstetrics and gynecology residents. <h3>Setting</h3> The survey was distributed to 258 ACGME accredited obstetrics and gynecology residency program coordinators who were asked to distribute the survey to their current residents. <h3>Patients or Participants</h3> PGY1 - PGY4 residents at ACGME accredited obstetrics and gynecology residency programs. <h3>Interventions</h3> An internet-based survey was distributed via the Qualtrics platform. All responses were anonymous. The survey was distributed on two occasions in March 2022. The data presented in this abstract is preliminary. <h3>Measurements and Main Results</h3> Of the 157 Ob/Gyn residents who responded to the survey, 45% plan to pursue a generalist career, 42% fellowship, and 13% undecided. While 75% are satisfied with their laparoscopic training, only 47% are satisfied with robotic training. When asked if they felt confident in their ability to perform specific surgical procedures independently after graduation, 47% felt confident with robotic-assisted procedures, 39% with laparoscopic myomectomy, and only 32% with complex laparoscopic dissection. The majority of residents (52%) felt that tracking would have a positive impact on training, 18% thought it would have a negative impact, and 30% were unsure or thought it would have no impact. Eighty percent felt that tracking would better prepare residents for fellowship training and 53% felt it would increase minimally invasive skills among residents. Over half of respondents (54%) said they would be interested in participating in a residency program that offered subspecialty tracking. <h3>Conclusion</h3> This study highlights the need for change in gynecologic surgical training. The majority of residents surveyed feel subspecialty tracking would have a positive impact on residency training and would be interested in participating in such a program.

Analyzing trends in obstetrics and gynecology fellowship training over the last decade using the normalized competitive index

BACKGROUNDThe objective and relative competitiveness of obstetrical and gynecologic subspecialty training programs remain understudied. Traditional metrics, such as match rate or program fill rate, fail to standardize the application environment. This limits their applicability when examining demographic trends or when comparing data between different fellowship matches. The normalized competitive index was introduced to serve as a comprehensive metric of competitiveness by incorporating disparate indicators and normalizing to enable more detailed analyses.OBJECTIVEThis study aimed to analyze trends in the competitiveness across obstetrical and gynecologic subspecialty fellowship matches during the last decade.STUDY DESIGNThe results and data reports from the National Resident Match Program fellowship for 2010 to 2019 were used to collect data on multiple metrics of competitiveness for 6 obstetrical and gynecologic subspecialties. These data were used to determine the normalized competitive index. Subanalyses were conducted to identify trends over the last decade.RESULTSAmong fellowship programs in obstetrics and gynecology, the overall specialty match rate was 67.6%. The overall specialty program fill rate was 95.7%. According to the normalized competitive index metric, minimally invasive gynecologic surgery was the most competitive fellowship match (normalized competitive index=1.31; P=.002). Maternal-fetal medicine was the least competitive (normalized competitive index=0.94; P≤.005). When comparing the first and second half of the decade, no specialty experienced a significant decrease in match rate. The only significant increase in match rates occurred for female pelvic medicine and reconstructive surgery (P=.035). Subanalyses of the normalized competitive index metric and other indicators of competitiveness demonstrated a strong negative correlation between the normalized competitive index and the subspecialty match rate (r=−0.9444) and a moderately positive correlation between the normalized competitive index and the program fill rate (r=0.4047).CONCLUSIONThe normalized competitive index offers trainees a more quantitative understanding of the fellowship application environment. By incorporating multiple metrics and normalizing the result, it uniquely enables comparison between the subspecialty matches and the match process over time. The same standardization offers the potential for future comparisons of competitiveness within a single subspecialty match based on geographic region, applicant demographics, and other important determinants of a diverse and vibrant training environment.

Postgraduate Training in Pediatric and Adolescent Gynecology: Trainees' Perspectives

The purpose of this study was to evaluate resident trainees' perspectives on the pediatric and adolescent gynecology (PAG) training in obstetrics and gynecology training programs in Europe. This study was a cross-sectional survey using an online questionnaire, on the basis of the PAG training in obstetrics and gynecology section of the European Board & College of Obstetrics and Gynaecology Project of Achieving Consensus in Training curriculum. We aimed to survey the national programs in 35 European Network of Trainees in Obstetrics and Gynaecology (ENTOG) member countries. Taking part in the survey was voluntary. The questionnaire was shared on the ENTOG online platforms. Ninety obstetrics and gynecology trainees in 33 of 35 countries responded to our questionnaire. Of the 35 ENTOG member countries, 33 participated in the survey, and a total of 90 responses were collected, giving a response rate of 9% of all European trainees and representing 94% of the member countries. Only 27% of trainees reported having a PAG rotation during their training program, and a PAG elective was only available to 34% of the trainees. Forty-one percent reported that PAG training was not included in their curriculum (no official rotations or lectures planned). Despite the lack of formal training, 72% of trainees felt able to diagnose and manage prepubertal vaginal bleeding and adnexal masses in children and adolescents by the end of their training. Most (58%) also confirmed that they could determine indications for treatment of vulval, vaginal, perineal, and rectal conditions. However, despite scoring positively for the management and counseling of subjects that often overlap with adult patients, such as "contraception in adolescents with health problems," "acute abdominal pain," "menstrual abnormalities," and "vaginal discharge," the study revealed poorer scores when the trainees were asked about more specific PAG topics such as "premature puberty" and "developmental disorders of the genital tract." Most core training programs across Europe do not include formal PAG training, and trainees reported a need to improve the provision of core PAG training in Europe.

Preparing for the Fundamentals of Laparoscopic Surgery Exam: A Survey of Residents in Obstetrics & Gynecology

To describe the actual work-load and experience for first-time resident test takers preparing to meet the new high stakes cognitive and technical skills testing requirement for board certification in Obstetrics and Gynecology. A retrospective observational study. Participating residents completed a 2 page questionnaire about their preparation for the exam. Results are reported in aggregate. This study was conducted at the University of Texas Southwestern Medical Center, an academic medical school affiliated with both a private and public tertiary hospitals. Residents in obstetrics and gynecology who have completed their Fundamentals of Laparoscopic Surgery (FLS) certification exam between September 1, 2018 and September 31, 2019. Thirty-three PGY-2 and PGY-3 residents completed the survey. Participants spent an average of 6.7 ± 3.1 hours viewing online modules over an average of 3.6 ± 2.1 nonconsecutive days. Utilizing the campus simulation center, residents spent an average of 2.1 ± 2.1 hours on each of the 5 tasks to practice to the established proficiency score. Twenty-two out of 31 residents rated the ligating loop the easiest skill to master and 13/31 residents rated the precision cut the most difficult. The pass rate for the technical skills portion was 100% (33/33 residents) and for the cognitive portion was 93% (31/33 residents). Our data suggest that residents spent upward of 10 hours practicing to proficiency on the simulation tasks, in addition to time spent watching FLS-provided training videos. The 100% pass rate for the technical skills portion at our program may be impacted by a required technical skills curriculum that residents must complete prior to registering for the FLS exam. Obstetrics and gynecology residents and training programs will benefit from understanding the time and resources required for first-time resident test takers preparing to take the Fundamentals of Laparoscopic Surgery exam.

Transvaginal Ultrasonography Numbers Reported by Graduating Residents in Obstetrics and Gynecology Training Programs.

Transvaginal Ultrasonography Numbers Reported by Graduating Residents in Obstetrics and Gynecology Training Programs.

Left-Handedness in Obstetrics and Gynecology: A Nationwide Survey of U.S. Trainees and Educators.

This study aimed to evaluate the views and influence of left-handedness among obstetrics and gynecology (OBGYN) trainees and educators and to identify perceived obstacles in training by left-handed (LH) trainees. An online survey was sent to the U.S. Obstetrics and Gynecology training programs. All participants were asked questions on hand preference for various medical and nonmedical activities, as well as on demographics. Participant responses to handedness and their role as a learner or educator directed them toward further questions. Trainees were surveyed on their experience and outlook as a LH physician in OBGYN. Educators were surveyed on their experience and attitudes in working with LH trainees. LH educators were also surveyed on their experience as a LH physician, similar to the LH trainees. Chi-square or Fisher's exact analysis was used as appropriate, with p-value <0.05 considered statistically significant. Responses were received from 21 training programs, totaling 304 individuals. Participants included 205 learners (156 right handed and 49 left handed), and 99 faculty (82 right handed and 17 left handed). A lack of LH surgical instrument availability (93.6%) and difficulty using right-handed (RH) instruments (83%) were notable obstacles reported by LH learners. The majority of LH learners (57.4%) did not consider their handedness to be disadvantageous but did note added difficulty when training under RH mentors when compared with training under LH mentors (66%). In contrast to LH educators, RH educators endorsed added difficulty in instructing operative procedures to LH learners (32.1 vs. 13.3%, p = 0.012). LH trainees face unique challenges during their OBGYN training. Educators would benefit from guidance on how best to manage these trainees. Educators should work to adapt surgical and procedural techniques to accommodate LH trainees. · LH learners reported more difficulty in training under RH mentors.. · RH mentors reported increased difficulty in educating LH trainees.. · Neither trainees nor educators considered being LH a significant disadvantage..

Assessment of Obstetric and Gynecology Residents: An Assessment of Attitudes before and after Initiation of a Robotic Training Curriculum

Study Objective Surgical training in gynecology is constantly evolvingwith new techniques and practices developing. Surgical training modules are of particular importance in academic training centers. Robotic surgical training poses a challenge to both leaders and learners to provide comprehensive and consistent education for the development of appropriate surgical skills. The purpose of this study was to evaluate for improvement in resident comfort level after initiation of a formal robotics training curriculum. Design This was an IRB exempt survey of residents within an Obstetrics and Gynecology (OBGYN) training program. Two voluntary, anonymous questionnaires were distributed to residents to evaluate their comfort level both before and after initiation of a formal robotic curriculum. A comparative assessment was performed to assess for improved resident comfort levels training on the robotic console. Setting N/A. Patients or Participants Participants in this study included post-graduate years (PGY) 1-4 residents enrolled in the 2019-2020 academic year completed at the University of Florida (UF) Health-Jacksonville Obstetrics and Gynecology (OBGYN) residency program. Interventions A formal robotic surgical training curriculum was introduced which consisted of online modules, documented training on the SimNow robotic simulator and in-person in-service of the DaVinci platform in a non-operative setting. Measurements and Main Results After analyzing results of the surveys, consistent improvement in resident comfort level with regards to robotic surgery was noted in all eight of the subjective questions included on the survey. Participants’ comfort level and understanding statistically improved in response to questions 1-5 and 7 with p value < 0.05. Conclusion Given these findings, we recommend routine implementation of a formal robotic training program for surgical trainees in an academic setting. Implementation of a standardized robotic surgery-training curriculum can accelerate trainee's readiness and their comfort level in performing robotic surgery during residency, therefore optimizing their surgical training prior to graduation. Surgical training in gynecology is constantly evolvingwith new techniques and practices developing. Surgical training modules are of particular importance in academic training centers. Robotic surgical training poses a challenge to both leaders and learners to provide comprehensive and consistent education for the development of appropriate surgical skills. The purpose of this study was to evaluate for improvement in resident comfort level after initiation of a formal robotics training curriculum. This was an IRB exempt survey of residents within an Obstetrics and Gynecology (OBGYN) training program. Two voluntary, anonymous questionnaires were distributed to residents to evaluate their comfort level both before and after initiation of a formal robotic curriculum. A comparative assessment was performed to assess for improved resident comfort levels training on the robotic console. N/A. Participants in this study included post-graduate years (PGY) 1-4 residents enrolled in the 2019-2020 academic year completed at the University of Florida (UF) Health-Jacksonville Obstetrics and Gynecology (OBGYN) residency program. A formal robotic surgical training curriculum was introduced which consisted of online modules, documented training on the SimNow robotic simulator and in-person in-service of the DaVinci platform in a non-operative setting. After analyzing results of the surveys, consistent improvement in resident comfort level with regards to robotic surgery was noted in all eight of the subjective questions included on the survey. Participants’ comfort level and understanding statistically improved in response to questions 1-5 and 7 with p value < 0.05. Given these findings, we recommend routine implementation of a formal robotic training program for surgical trainees in an academic setting. Implementation of a standardized robotic surgery-training curriculum can accelerate trainee's readiness and their comfort level in performing robotic surgery during residency, therefore optimizing their surgical training prior to graduation.

Publication Trends Among Fellows in Minimally Invasive Gynecologic Surgery.

<h3>Study Objective</h3> The goal of this investigation is to provide a baseline assessment of research practices among current and former fellows in Minimally Invasive Gynecologic Surgery training programs. Evaluating publication patterns among fellows may provide information as to whether publication efforts during fellowship are addressing research gaps within our subspecialty <h3>Design</h3> A retrospective analysis amongst fellows of Minimally Invasive Gynecology Surgery (MIGS) was studied over a 10-year period to observe trends in research publications. <h3>Setting</h3> University Health Network. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> The total number of publications by institution, gender, region, study type, study topic and journal were calculated. <h3>Measurements and Main Results</h3> A total of 520 publications were produced by fellows between the years 2010-2020. Of the total, 381 were published by females and 139 by males. Overall, the total number of publications per year has risen, with a 179% growth from 2010 to 2020. The Journal of Minimally Invasive Gynecology was the most prevalent journal for publication with 160 publications representing 31% of publications over the 10-year span. Obstetrics and Gynecology, The American Journal of Obstetrics and Gynecology and The Journal of Laparoendoscopic Surgeons were the next 3 most common journals for publication with 48, 38, and 38 publications, respectively. The most common type of study published overall was a retrospective cohort (114/520). The most common study topic was gynecological surgery representing 48% of the total publications for all years. <h3>Conclusion</h3> Addressing differentiating research trends among geographical location, areas of research being covered, type of studies reaching publication, and journals accepting publication is important to ensure that fellows are continuing to expand and advance the research curriculum. The aim of this study was to assess the overall publication trends and how they have changed over time.

Resident and program director confidence in resident preparedness for operative vaginal deliveries in Obstetrics and Gynecology Training Programs in the United States

Operative vaginal delivery is used to expedite a safe vaginal delivery in the second stage of labor and is considered an essential part of residency training in obstetrics and gynecology. To assess the self-reported readiness of obstetrics and gynecology residents in the United States to perform vacuum-assisted vaginal delivery and forceps-assisted vaginal delivery compared with the perceptions of program directors. The Council on Resident Education in Obstetrics and Gynecology surveyed the residents in all US training programs about their readiness to perform forceps-assisted and vacuum-assisted deliveries. The program directors were simultaneously surveyed about the readiness of their cohort to perform operative deliveries with and without attending oversight. The primary outcome of the survey was the residents' self-reported confidence in their ability to autonomously and independently perform operative deliveries. Α total of 5084 out of 5514 (92.9%) resident physicians and 241 out of the 292 (83%) residency program directors completed the survey. Eighty-seven percent (95% confidence interval, 84.9-88.9) of the graduating residents reported feeling that they could autonomously perform a vacuum-assisted vaginal delivery, compared with 49.5% (95% confidence interval, 46.6-52.4) for forceps-assisted vaginal delivery (P<.01). Similarly, whereas 95.9% (95% confidence interval, 94.6-97.0) of the residents felt that they could confidently perform an emergency vacuum-assisted vaginal delivery, only 42.3% (95% confidence interval, 39.4-45.2) felt confident performing an emergency forceps-assisted vaginal delivery (P<.01). The residency program directors significantly overestimated their residents' confidence in independently performing an emergency forceps-assisted vaginal delivery or vacuum-assisted vaginal delivery than the residents themselves (54% [95% confidence interval, 47.1-60.5] vs 24% [95% confidence interval, 22.5-24.9] and 98.6% [95% confidence interval, 97.0-100] vs 71.9 [95% confidence interval, 70.6-73.2] respectively P<.01). Trainees in military-based residency programs and those interested in pursuing a career as generalists or maternal-fetal medicine specialists reported significantly higher preparedness to perform a forceps-assisted vaginal delivery. Graduating obstetrics and gynecology residents report feeling less prepared to independently perform a forceps-assisted vaginal delivery than a vacuum-assisted vaginal delivery. The program directors had more confidence in the ability of their residents to perform an operative vaginal delivery than the residents themselves.

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.

Residents’ Confidence in Performing Robotic Hysterectomy in Obstetrics and Gynecologic Training Programs

To compare residents' perceptions of readiness to perform robotic-assisted laparoscopic hysterectomy with the perceptions of residency program directors in obstetrics and gynecology programs throughout the United States. A survey was administered to all residents taking the 2019 Council on Resident Education in Obstetrics and Gynecology Exam and concurrently to program directors in all Accreditation Council for Graduate Medical Education-accredited training programs. The survey was designed to assess resident confidence to perform robotic hysterectomies by the time of graduation. No patients were included in the study. The only intervention was administration of the survey. De-identified survey data were analyzed using chi-squared and Fisher's exact tests. A total of 5473 resident respondents and 241 residency program directors were included in the study. Fifty-two percent of graduating residents reported that they felt they were given surgical autonomy to perform robotic hysterectomies, and 53.7% reported that they could perform one independently (if it was an "emergency" and they had to). By the time of graduation, only 59% of residents reported confidence performing a robotic hysterectomy, and only 56% reported they felt that it would be an important procedure for their future career. Program directors were significantly more likely to report that their residents were given autonomy to perform robotic hysterectomy by graduation (61.0% [95% confidence interval (CI), 54.3-67.3]), could perform a robotic hysterectomy independently (60.9% [95% CI, 53.9-67.6]), or could perform a robotic hysterectomy by graduation (70.2% [95% CI, 63.5-76.3]) than residents themselves (38.6% [95% CI, 37.2-40.0], 22.8% [95% CI, 21.6-24.0], 62.6% [95% CI, 61.2-64.0], respectively). At the time of graduation, residents' confidence in performing robotic hysterectomy independently is lower than their confidence in performing all other approaches to hysterectomy.

Needlestick injuries among obstetrics and gynecology trainees: A survey study

ObjectiveTo assess characteristics, incidence, risk factors, and reporting rate of needlestick injuries (NSIs) among Obstetrics and Gynecology trainees. Study designWe performed a nationwide cross-sectional survey study. The 40-items survey Obstetrics Needlestick Injury Questionnaire (ONSI-Q) was used to investigate the prevalence of NSIs, participant attitudes, associated factors, and the NSI reporting rate among trainees in Obstetrics and Gynecology. The target responders were all trainees of Obstetrics and Gynecology training programs in Italy. The trainees were invited between September 2018 and December 2018 via a web-based platform. ResultsAmong 1049 trainees, 1041 (99.2%) completed the survey. Out of 1041 trainees, 639 (61.4%) had at least one NSI, and 90.9% (581/639) experienced at least one during obstetric surgery. The number of NSIs increased with the year of training, with 2.48 NSIs per trainee in the fifth year. 90.6% (579/639) reported details about the most recent NSI, which was during obstetric surgery in 95.3% (552/579) of cases. 57.1% (315/552) experienced the most recent NSI during cesarean section, which was mainly inflicted by someone else (72.4%; 228/315). 42.9% (237/552) of NSIs were during perineal suture, and 84% (199/237) of them were self-inflicted. 77.9% (417/535) of trainees did not report the NSI. Associated factors were non-high-risk patients, self-inflicted NSI, and the first NSI. ConclusionsNSIs are frequent among Obstetrics and Gynecology trainees but not reported, and obstetric surgery is the primary source. These data support the European efforts to improve working practices' safety. The education about protective strategies and reporting should be a priority.

Opioid Education in Obstetrics and Gynecology Training Programs

Our primary objective was to assess the current state of pain and opioid education in obstetrics and gynecology (OBGYN) by performing a detailed review of the national educational curricula guiding OBGYN residency and fellowship training programs in the United States. From 2019 to 2020 we reviewed seven documents created to guide learning and structure educational training for OBGYN residency and fellowship programs in the United States: the Council on Resident Education in Obstetrics and Gynecology (CREOG) Educational Objectives Core Curriculum in Obstetrics and Gynecology, the 2016 Educational Objectives-Fellowship in Minimally Invasive Gynecologic Surgery, and the 2018 Guides to Learning in Complex Family Planning, Female Pelvic Medicine & Reconstructive Surgery, Gynecologic Oncology, Maternal Fetal Medicine, and Reproductive Endocrinology and Infertility. Each document was reviewed by two authors to assess for items referring to pain or opioids. The CREOG educational objectives, used to inform educational curricula for residency programs, were the most comprehensive, mentioning pain and/or opioid educational objectives the highest number of times and including the most categories. The CREOG document was followed by the Guides to Learning for Gynecologic Oncology and for Minimally Invasive Gynecologic Surgery. The Reproductive Endocrinology and Infertility Guide to Learning did not mention pain and/or opioids in the educational objectives. Our study identifies an opportunity for consistent and appropriate opioid and pain management education in OBGYN training.

Complex family Planning: A newly accredited, landmark fellowship

As of July 2020, U.S. Obstetrics and Gynecology training programs can apply for accreditation by the Accreditation Council for Graduate Medical Education (ACGME) in Complex Family Planning (CFP). Formerly known as the Fellowship in Family Planning, first launched 1991 by Dr. Phillip Darney at the University of California in San Francisco, the program subsequently expanded nationally under Dr. Uta Landy’s leadership. The CFP fellowship provides post-graduate obstetrician-gynecologists with additional training in abortion and contraception and opportunities to establish themselves as leaders in clinical care, research, and medical education.