Obstetrics And Gynecology Residents Research Articles

Use of Fundamentals of Laparoscopic Surgery Testing to Assess Gynecologic Surgeons: A Retrospective Cohort Study of 10-Years Experience

To compare the Fundamentals of Laparoscopic Surgery (FLS) exam scores between obstetrics and gynecology (OBGYN) and general surgery (GS) providers. This is a retrospective cohort study at a single institution from July 2007 to May 2018. Categorical and continuous variables were analyzed with χ2 test, t test, and Wilcoxon rank sum test. Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, a tertiary care academic medical center. All providers who took the FLS exam at the Carl J. Shapiro Simulation and Skills Center at BIDMC. FLS certification. A total of 205 BIDMC trainees and faculty took the FLS exam between July 2007 and May 2018, of which 176 were identified to be OBGYN or GS providers. The FLS certification pass rate was high for both specialties (97.0% OBGYN vs 96.1% sGS, p = .76). When comparing all providers, no significant difference was found in the mean manual skill test scores between surgical specialties (594.9 OBGYN vs 601.0 GS, p = .59); whereas, a significant difference was noted in the mean cognitive scores, with GS providers scoring higher than OBGYN providers (533.8 OBGYN vs 583.4 GS, p <.001). However, when adjusting for several variables in a multivariate linear regression model, surgical specialty was not a predictor for cognitive scores. In the multivariate analysis, age, sex, and test year were predictors for cognitive scores, with higher scores associated with younger age, male sex, and advancing calendar year. None of the variables were significant predictors of manual scores. Both OBGYN and GS providers had extremely high FLS pass rates. In the multivariate analysis, surgical specialty was not a predictor for higher FLS test scores for either manual or cognitive test scores. Although OBGYN residency programs offer fewer years of training, OBGYN trainees demonstrate the capacity to perform well on the FLS exam.

Evaluation of a Laparoscopic Multi-approach Training for Obstetrics and Gynecology Residents.

To analyze the applicability and efficiency of a multi-approach laparoscopic training in improving basic laparoscopic skills of obstetrics and gynecology (OBGYN) residents. Cross-sectional, observational and descriptive study, developed at the Experimentation and Surgery Training Center (CETEC, in the Portuguese acronym) of the Hospital Israelita Albert Einstein with OBGYN residents. Theoretical and practical tests were applied to 24 OBGYN residents to assess their laparoscopic skills before and after their participation in an 8-week course. The course involved theoretical lectures and practical laparoscopic surgery exercises developed using rubber models, black boxes, virtual simulators and animal models (pigs). There was an overall improvement in the ability of the residents, with an increase in the number of correct answers in the theoretical evaluation and decrease in the time needed to perform practical tests (needle holder assembly and laparoscopic node). The course was evaluated by the students as highly relevant for both improving their surgical skills and motivating them to continue practicing. Laparoscopic training using multiple approaches resulted in significant improvement of surgical skills with a high satisfaction level of the participants. Further studies are still needed to measure the long-term retention of these acquired skills.

Implementation and Initial Construct Validity Evidence of a Tool, myTIPreport, for Interactive Workplace Feedback on ACGME Milestones

To describe implementation of myTIPreport for milestone feedback and to initiate construct validity testing of myTIPreport for milestones. myTIPreport was used to provide workplace feedback on Accreditation Council for Graduate Medical Education required milestone sets. Performance of senior learners (postgraduate year [PGY]-4s) was compared to that of junior learners (PGY-1s) to begin the process of construct validity testing for myTIPreport. A convenience-based site selection of Obstetrics and Gynecology (OBGYN) residency programs. OBGYN residents and faculty. Amongst the 12 participating OBGYN residency programs, there were 444 unique learners and 343 unique faculty teachers. A total of 5293 milestone feedback encounters were recorded. Mean PGY-4 performance was rated higher than mean PGY-1 performance on all 25 of the compared milestone sets, with statistically significant differences seen for 19 (76%) of these 25 milestone sets and nonsignificant differences in the predicted direction observed for the other 6 milestone sets. myTIPreport detected differences between senior and junior learners for the majority of compared feedback encounters for OBGYN residents. Findings support the emerging construct validity of myTIPreport for milestone feedback.

A Survey on the Experience of Singaporean Trainees in Obstetrics/Gynecology and Family Medicine of Sexual Problems and Views on Training in Sexual Medicine.

IntroductionAsian patients may have more difficulty seeking help for their sexual problems because of a largely conservative culture. Residents from both obstetrics and gynecology (OBGYN) and family medicine (FM) departments are ideally placed to address sexual problems.AimThis survey explored the experience of residents from OBGYN and FM in managing sexual problems and their views on training in sexual medicine (SM).MethodAn anonymized questionnaire collecting data on trainee characteristics, exposure to male and female sexual problems, and training in SM was sent to all FM and OBGYN residents in Singapore. These residents had completed their medical registration with the Singapore Medical Council and were at various stages of specialty training in both FM and OBGYN residency programs in Singapore.Main Outcome MeasureTrainees’ exposure to male and female sexual problems and their views on training in Sexual Medicine.ResultsThe overall response from the survey was 63.5% (122/192)—54% (70/129) and 69% (52/75) of FM and OBGYN residents responded, respectively. 63% were female, with 22% being senior residents, and 55% attended Singaporean medical schools. About one quarter (30/122) of the respondents encountered patients with sexual problems at least monthly. Most would refer these patients directly to specialists, psychologists, and sex therapists. More than 80% of residents were not confident in managing sexual problems in either sex (89% for male problems; 83% for female problems). Among the recognized categories, only 30% felt confident to manage erectile dysfunction, 26% for vaginismus, while less than 10% felt confident to manage libido, arousal, or orgasm disorders. 95% of the residents agreed that SM should be part of both training curricula, with 70% and 25% suggesting at junior and senior residency, respectively. 93% of them were interested to obtain further knowledge and skills in SM through their core training curriculum and from seminars.ConclusionsThis survey reported a significant number of residents in OBGYN and FM departments are regularly exposed to patients with sexual problems but lack the skills to manage them. OBGYN residents were more familiar with managing female sexual problems while FM residents tend to have more experience in male sexual problems. Almost universally, the residents in FM and OBGYN were very keen to acquire skills in SM, and the results support the incorporation of appropriate knowledge and skills into both national residency program curricula.Huang Z, Choong DS, Ganesan AP, et al. A Survey on the Experience of Singaporean Trainees in Obstetrics/Gynecology and Family Medicine of Sexual Problems and Views on Training in Sexual Medicine. J Sex Med 2019;8:107–113.

Clinical Manifestation and Diagnostic Approach Towards ‘TORCH Test’: A Knowledge, Attitude and Practice Study

Introduction:‘TORCH Test’ (Toxoplasmosis, Rubella Cytomegalovirus, Herpes simplex) is usually requisitioned in females having ‘BadObstetrics History (BOH)’ or those who are suspicious of ‘intrauterine infection’ or for neonates having congenital malformation. However, the understanding of the test is lacking amongst the practitioners. Hence, this Knowledge Attitude and Practice (KAP) study was conducted to access the knowledge of resident doctors about the correct way of requesting TORCH test. Aim: To assess the understanding, clinical manifestation and diagnostic approach towards TORCH test amongst the Resident Doctors. Materials and Methods: Four groups of questions were put to Resident Doctors from Obstetrics and Gynecology (ObG), Paediatrics (Paeds) and Microbiology Department to assess their understanding of TORCH test. The questionnaire having 30 questions was divided in four groups A, B, C and D. Group A (Q. 1-4) about the fundamental of TORCH infection; Group B (Q. 5-8) brief clinical manifestation; Group C (Q. 9-12) indication of TORCH test i.e., when torch test should be requested and Group D (Q. 13-30) result interpretation of TORCH profile. Results: Questions as to the full form of TORCH test were correctly answered by almost all participants. As far as questions as to Clinical Manifestation, residents of ObG (72.3%) were more accurate in predicting than that of Paeds residents (48%). Amongst Microbiology residents only 5.2% of them were able to gave correct answers. When questions as to when the TORCH test is to be recommended were asked, only 30.7% residents of Paeds, 59% of ObG and 10.5% of Microbiology were aware about it. Interpretation of the test results amongst the participants was also not that up to the mark as only 36.1% in Paeds, 67.6% in ObG and 29.8% in Microbiology residents were correctly able to predict. To sum up, understanding, clinical manifestation and diagnostic approach towards TORCH test is better amongst the ObG residents (67.7%) as compared to that of the Microbiology Residents (26.7%) and Paeds Residents (42%). Conclusion: It can be understood that since the clinical branch residents of ObG and Paeds are not that thoroughly acquainted with the TORCH test understanding and complete clinical information is necessary. Therefore, it is apparent that the same is being not requisitioned in cases where pregnant women or infants have non-descript illnesses where testing is not necessary at all. It is, therefore, highly recommended that regular seminars and teaching activities are conducted by the concerned respective departments in order to impart TORCH test understanding and complete clinical information regarding it.

Training for the surgical management of postpartum hemorrhage: a multicenter survey of resident physicians

Background To actively address maternal morbidity and mortality in Mexico, proficiency among obstetrics and gynecology (OBGYN) residents in the surgical management of postpartum hemorrhage (PPH) is a priority. However, the capacity of programs to provide this training is unknown. Objective The self-reported knowledge, education, and proficiency of common surgical techniques for the management of PPH among OBGYN residents in Mexico was evaluated. Educational resources, perceived barriers to acquiring skills, and clinical decision-making were explored. Materials and methods In July of 2018, an anonymous electronic survey was sent to 86 residents at four hospitals throughout Mexico. Surgical techniques queried included uterine tamponade (UT), uterine compression sutures (UCS), uterine devascularization (UD), hypogastric artery ligation (HAL), and gravid hysterectomy (HT). Participants also answered case-based questions about a patient with PPH. Results The survey response rate was 59.3% (51/86). Seventy-nine percent of residents reported understanding the rationale and techniques for the surgical intervention of PPH. However, 43.9% reported limited ability to perform these procedures with autonomy. Eighty-six percent of residents reported exposure to these techniques while performing a rescue procedure during PPH and 49% reported learning these procedures while performing prophylactic techniques in patients without PPH. Only 25.5% had been exposed to simulation training. Lack of a training module for these skills in their curriculum was noted by 74.5%. The majority of the participants chose UCS, UD, HAL, and HT as the first, second, third, and fourth rescue procedures to perform for PPH, respectively. Conclusion Most residents reported theoretical knowledge of surgical interventions for PPH, but their self-rated ability to independently perform such skills and a curriculum focused on PPH management was suboptimal.

Can I Get a Suggestion? Medical Improv as a Tool for Empathy Training in Obstetrics and Gynecology Residents.

Physician empathy is associated with improved patient outcomes. No studies have examined the outcomes of medical improvisational (improv) training on empathy. Our aims were to determine whether an improv workshop is an effective tool to deliver empathy training for obstetrics and gynecology (OB-GYN) residents, and whether that effect is sustained over time. We conducted a prospective cohort study of OB-GYN residents undergoing empathy training through 4 improv games in a 1-hour session. Empathy surveys (score range 20-140) with validity evidence were administered 2 weeks prior to empathy training, immediately after, and 1, 3, and 6 months later. Fisher's exact test, Student's t test, and Wilcoxon rank sum test were used to compare statistical differences at each post-intervention assessment. All 22 invited residents participated in empathy training. Empathy scores improved immediately after (120.0 ± 9.8 versus 113.1 ± 10.6, P = .026), though they regressed toward baseline through 6 months (116.3 ± 11.0 versus 113.1 ± 10.6, P = .43). When asked on a scale of 1-5 how much the workshop would impact their work, there was an increase in scores both immediately after (mean 3.5 versus 4.6, P < .001) and 1 month later (mean 3.5 versus 4.1, P = .039), but this difference disappeared at 6 months. Using improv comedy to deliver empathy training is associated with a minor improvement in empathy scores in OB-GYN residents, which decreased at 6 months. Residents found the activity to be acceptable and reported the training would impact their clinical practice.

Spicing up Scholarly Productivity: Impact of a Structured Resident Research Program

PURPOSE: To evaluate whether implementation of a structured resident research program improved scholarly productivity at an academic obstetrics and gynecology (OB-GYN) program. BACKGROUND: The Accreditation Council for Graduate Medical Education requires resident participation in scholarly activity. Since the 1970s, OB-GYN residents at University of Colorado (CU) have been required to complete a research project. Starting with the graduating class of 2016, the CU OB-GYN program appointed two Assistant Program Directors of Resident Research who instituted a formalized research program including didactics, timelines, detailed protocol review, an expectation of manuscript submission, and an internal grant funding mechanism. METHODS: We compared scholarly productivity related to the required resident research projects for the graduating classes of 2012-2014 (before program implementation) and 2016-2018 (after implementation). Two investigators independently searched for abstracts presented at national meetings, grants received, and publications using PubMed and Google search engines. We also confirmed with the resident or mentor. We compared the proportion of residents who had an accepted abstract or manuscript for their research projects using Fisher’s exact test. RESULTS: Fifty-four residents were included; 27 before and 27 after program implementation. The proportion of residents who had oral presentations at a national meeting remained the same (11%), whereas those with an accepted poster presentation increased from 44% to 89% (p=0.001). The proportion who had manuscript publication increased from 26% to 59% (p=0.03). DISCUSSION: A formalized, structured research curriculum resulted in improved scholarly productivity. Our experience can guide other programs faced with the challenge of improving resident scholarly activity and output.

Community Health Center Engagement and Training During Obstetrics and Gynecology Residency.

Community health centers (CHCs) and federally qualified health centers (FQHCs) are critical health care access points for medically underserved areas in the United States. They also provide opportunities for residents to learn about health system challenges, including workforce shortages, social determinants of health, and health equity. We sought to describe current obstetrics and gynecology (OB-GYN) resident engagement and training in community health settings. We conducted a website review and survey to identify the prevalence and types of OB-GYN resident exposure to CHCs, including FQHCs. We reviewed 241 program websites to identify community health electives or rotations. We then surveyed program administrators regarding departmental affiliations with CHCs, types of resident involvement, and barriers to resident rotations at CHCs. The website review revealed that 18% (44 of 241) of programs offered a community health rotation. Of the 241 programs surveyed, 78 program administrators responded (32%). Forty-three programs (55%) had at least 1 affiliated CHC, and 34 programs (44%) allowed residents to rotate at a CHC. The most common barrier to resident rotations at a CHC was inadequate resident coverage of hospital-based clinical responsibilities. Respondents reported that among 782 graduating residents in the 2016-2017 and 2017-2018 academic years, 76 (10%) planned to pursue a position at a CHC. According to their websites, a small percentage of US OB-GYN residency programs offered a CHC rotation. Of programs responding to a survey on the topic, less than half offered CHC rotations and less than 1 in 10 residents planned to work in CHCs after graduation.

Family Planning Training at Catholic and Other Faith-Based Obstetrics and Gynecology Programs

PURPOSE: To evaluate family planning training at obstetrics and gynecology (OB-GYN) residency programs that primarily train at restrictive religious hospitals. BACKGROUND: Catholic and other religious hospitals face institutional family planning care restrictions, which are in conflict with the training requirements set forth by the Accreditation Council for Graduate Medical Education (ACGME). METHODS: We identified 30 ACGME accredited OB-GYN residency programs in which at least 70% of resident time is in restrictive, faith-based hospitals. We queried program representatives about training using an online survey and follow-up telephone interview. RESULTS: We had an 80% survey response rate. The majorities were program directors (83%), represented Catholic hospitals (75%), and completed telephone interviews (71%). Programs often relied on other sites to accomplish contraceptive (33%), sterilization (71%), and abortion (88%) training. All programs reported adequate training in reversible contraception. 58% reported inadequate sterilization training, most commonly in postpartum and hysteroscopic sterilizations. 67% reported inadequate abortion training, most commonly in D&E. Approximately half (54%) offered “routine” and 13% did not offer any abortion training. Eight programs (33%) received a total of ten Residency Review Committee citations due to insufficient family planning training, and most of these programs (71%) reported using these citations to gain institutional support for off-site training. DISCUSSION: While Catholic and other faith-based OB-GYN residency training programs have developed strategies in response to institutional restrictions, many report ongoing deficiencies and half remain noncompliant with abortion training requirements. Residency Review Committee citations, however, provided an opportunity for programs to leverage support for comprehensive training.

A Novel Cervical Cerclage Model for Resident Training

PURPOSE: This study aimed to assess a novel cervical cerclage model for resident training. BACKGROUND: Vaginal suturing can be challenging to teach and to learn due to limited operative field visualization by the surgical assistant, but is a required skill for cervical cerclage placement. There is limited data on resident training and comfort with cerclage placement using models.1,2 METHODS: Residents in Obstetrics and Gynecology (OBGYN) at George Washington University were recruited to participate in a pre and post-test survey during a cerclage simulation training with a novel model. A cervical cerclage model was assembled using a 1 L water bottle, sutures and a “hair bun” maker. Continuous variables were compared using 2 tailed paired t tests. RESULTS: A total of 20 residents participated with a median of 2 ± 1.6 years of OBGYN residency. 95% of residents reported no prior cerclage simulation training; however, 60% reported previously placing cerclages in practice. Pre and post-test analysis showed a decrease in the perception of need for further training (4.05 ± 1.07 vs. 3.45 ± 0.86; p = 0.024) and resident reported more comfort performing the procedure with decreasing supervision (2.05 ± 1.02 vs. 2.3 ± 1.01; p = 0.021). 90% reported learning to place a cerclage was easy after the simulation, versus 45% beforehand. DISCUSSION: A novel cervical cerclage model in a training session significantly increased resident knowledge of and comfort regarding cerclage placement. Future research should replicate this study, focusing on learner achievement of clinical competency and evaluate clinical outcomes.

Promoting Health Equity Through Purposeful Design and Professionalization of Resident Global Health Electives in Obstetrics and Gynecology

To design an Obstetrics and Gynecology (OBGYN) residency elective in global health that meets ACGME standards and simultaneously promotes health equity. A 4-week elective was established for US residents in a high-volume African district hospital that served as a site for OBGYN rotations for the national internship training program. Clear clinical, operative, and teaching requirements were delineated for US OBGYN residents. Resident formal didactic outputs were incorporated into the intern OBGYN curriculum. The program was evaluated through assessment of resident experience and contribution to local training, as well as assessment of intern competency in OBGYN. Scottish Livingstone Hospital, a public district hospital in Molepolole, Botswana. Second- to fourth-year OBGYN residents from US training programs, working with Batswana medical interns under on-site faculty supervision. From May 2016 to June 2018, 18 residents from 9 US OBGYN residency programs participated in the elective. Under supervision, US residents performed 116 major and 77 minor gynecologic surgeries, and teach-assisted Batswana interns and medical officers in 76 cesarean deliveries. Residents led or contributed significantly to 25 didactic education sessions as part of the formal intern OBGYN curriculum. During this period, 24 Batswana interns rotated through the hospital's department of OBGYN, and all 24 trainees met required OBGYN competencies prior to completing their internship. Matching US resident demand for global health experiences to equitable global health programming while maintaining ACGME training guidelines poses a challenge to OBGYN residency training programs. This elective provides a model OBGYN global health elective that addresses host-identified needs, broadens residents' skills, and meets standards for postgraduate OBGYN training. Purposeful global health electives for US residents embedded in longitudinal programs provide an opportunity for residents to contribute to broader global health efforts that promote health equity.

Effects of an in situ instructional design based postpartum hemorrhage simulation training on patient outcomes: an uncontrolled before-and-after study

Objective: To compare postpartum hemorrhage (PPH) patient outcomes before and after an in situ instructional design based PPH simulation attended by obstetrics and gynecology (OBGYN) residents.Methods: This uncontrolled before-and-after study was conducted in Recife, Brazil including all 1388 women delivering from June to August 2012 and all 1357 delivering from June to August 2013. The 36 OBGYN residents were divided into13 teams of two or three participants and were trained through ID based PPH simulation training with the following eight steps: (1) prior knowledge activation, (2) video demonstration, (3) dual-coding PPH protocol discussion—an image association during the training, (4) training scenario # 1, (5) debriefing, (6) training scenario # 2 with immediate feedback, (7) training scenario # 3, and (8) debriefing with self-assessment. The training scenarios had an increasing level of complexity. The main goal of the training was the adequate management of PPH and situational awareness improvement—the ability to anticipate, recognize, and intercept unfolding error chains. The primary patient outcomes rates used for the before and after comparison were therapeutic uterotonics use within 24 h of birth and blood transfusion. Secondary outcomes were therapeutic oxytocin mean dosage IU within 24 h of birth, postpartum Hb < 6 g/dL, among others. Chi-square test was used for categorical variables comparison and independent t-test for continuous variables.Results: PPH rates were 100 (7.2% of 2012 deliveries) and 80 cases (5.9% of 2013 deliveries), respectively. Comparison of primary post- and pre-simulation outcomes revealed no significant differences. However, in the comparison for therapeutic oxytocin mean dosage IU within 24 h of birth, there was an increase found after the simulation (15.98 ± 7.4 versus 25.1 ± 12.3; p < .001). For all other outcome measures, there were no statistical differences.Conclusions: In situ ID based PPH simulation leads to an increase in the mean dosage of oxytocin after training, in selected cases. This may indicate better situational awareness when managing women with PPH.

Assessing Work-Related Burnout and Job Satisfaction among Obstetrics and Gynecology Residency Program Coordinators

This study explored the prevalence of and the relationship between job satisfaction and burnout among obstetrics and gynecology residency program coordinators. This cross-sectional study involved members of the American Program Managers of Obstetrics and Gynecology. The Copenhagen Burnout Inventory and Spector's Job Satisfaction Survey were used to measure the participants' burnout and job satisfaction rates respectively. Data were collected between August 2017 and December 2017. The authors used Fisher's exact tests, Spearman's r correlations, and multiple linear regression to analyze the data. There was an 83% (171/207) response rate. Thirteen percent of the coordinators reported high, 70% moderate, and 17% low job satisfaction scores. Thirty-nine percent of the coordinators reported high, 25% moderate, and 36% slight work-related burnout rates. Correlation coefficient showed a significantly negative relationship between job satisfaction and work-rated burnout, (r s [169] = -0.402, p < 0.01). Regression analysis showed co-workers (β = -0.47) and supervision (β = -0.16) domains of the job satisfaction scale were significant predictors of work-related burnout (R = 0.55; F[5, 195] = 11.05; p < .001). The findings highlight the importance of job satisfaction factors, such as support from coworkers and supervisors, in dealing with work-related burnout among residency coordinators.

Impact of Training Specialty on Breastfeeding Among Resident Physicians: A National Survey.

The United States has seen an increasing number of child-bearing women in medical training. We aimed to compare the prevalence of exclusive breastfeeding across varied specialties, whose trainees may face different obstacles to breastfeeding. An online survey querying the duration and barriers to breastfeeding was sent to Accreditation Council for Graduate Medical Education (ACGME) and American Osteopathic Association (AOA) programs. Female residents with at least one living child born during residency were eligible. We compared the prevalence of exclusive breastfeeding for 6 months between Obstetrics and Gynecology (OBGYN), nonsurgical, and non-OBGYN surgical specialties. A multiple regression model correcting for ethnicity, years lived in the United States, medical degree, year of residency at childbearing, geographical location, and clinical hours was performed. There were 708 completed surveys, including 561 nonsurgical, 73 OBGYN, and 74 non-OBGYN surgical residents. More OBGYN residents reported exclusive breastfeeding at 6 months (43/73, 59%) than nonsurgical (217/561, 39%) and non-OBGYN surgical residents (30/74, 41%) (p < 0.01). After adjusting for confounders, OBGYN trainees were twice as likely to breastfeed (adjusted odds ratio [AOR] = 2.18, 95% confidence interval [CI] 1.28-3.72) with no difference between non-OBGYN surgical and nonsurgical residents (AOR = 1.24, 95% CI 0.70-2.19). Less OBGYN residents reported the lack of breastfeeding facilities at work (2.7% versus 17.6%, p < 0.01) and inadequate leave (4.1% versus 17.6%, p = 0.01) than non-OBGYN surgical residents. In this national survey of trainees in accredited programs, OBGYN residents were twice as likely to breastfeed and fewer OBGYN residents cited barriers to breastfeeding compared to other residents.

The Impact of a Structured Wellness Curriculum on Burnout Among Obstetrics and Gynecology Residents

PURPOSE: Our primary aim was to evaluate the effects of a formalized wellness curriculum on the rate of burnout among University of New Mexico (UNM) obstetrics and gynecology (OBGyn) residents. Our secondary aim was to evaluate the effect of a wellness curriculum on rates of depression, alcohol abuse and suicide risk. BACKGROUND: Burnout is a pathological syndrome characterized by depersonalization, emotional exhaustion and a low sense of personal achievement. Burnout is a concern for resident physicians due to their heavy workload and low sense of autonomy. METHODS: A structured wellness curriculum was instituted at the start of the 2016 academic year. A 45-item survey, consisting of the Maslach Burnout Inventory Human Services Survey (MBI-HSS), personal health questionnaire-9 (PHQ9), suicide behaviors questionnaire-revised (SBQr), and the alcohol use disorders identification test (AUDIT), was to be administered at the start, midpoint, and end of the academic year. RESULTS: The study included 23 UNM OBGyn residents. Midpoint and end of curriculum surveys were collected as planned and demonstrated no difference in rate of burnout. Upon completion of the 2016 academic year 18 (78.2%) residents reported moderate to severe emotional exhaustion; 13 (59.1%) moderate to severe depersonalization; and 5 (21.7%) low personal achievement. SBQ-R identified 4 (18.2%) residents at high risk for suicide and AUDIT-C identified 15 (68.2%) at high risk for alcohol abuse. DISCUSSION: High rates of burnout, depression, alcohol abuse, and suicide risk did not change between the midpoint and end of a structured wellness curriculum.

The Current State of Ultrasound Training in Obstetrics and Gynecology Residency Programs.

We evaluated the current state of ultrasound training in obstetrics and gynecology (OB-GYN) residency programs across the United States. An electronic survey was sent to OB-GYN residency program directors and OB-GYN residents. Responses were obtained in September 2016. Program directors and residents were asked to reflect on their current ultrasound curriculum. A total of 93 program directors and 437 residents responded. Respondents were mostly from university programs located in tertiary centers. Ultrasound curricula varied: 11% of program directors and 23% of residents did not have any ultrasound-related didactics; of those who did, 27% of program directors and 40% of residents had it yearly or less. Three-quarters had mandatory ultrasound rotations, and few offered ultrasound electives (program directors, 52%; residents, 28%). Most residents were required to perform ultrasound examinations daily or weekly (98%). Most stated that the main focus of the rotation was OB only. Skill was evaluated mainly subjectively by direct observation. Although most program directors stated that residents were satisfactory/excellent in ultrasound, 22% would not treat patients on the basis of ultrasound examinations performed by their senior residents. Similarly, of all postgraduate year 4 respondents (n = 86), 76% stated that they will require additional training to be able to perform or read ultrasound examinations independently, and 43% would not treat a patient on the basis of their own ultrasound examinations without further confirmation. Residents believed that the biggest obstacle in ultrasound training is lack of dedicated faculty time (41%). Recognizing the lack of clearly defined milestones in ultrasound training in OB-GYN residency, this study confirms the substantial heterogeneity in curricula between programs, highlighting a need for a standardized ultrasound curriculum.

Vulvodynia attitudes in a sample of Canadian post-graduate medical trainees

Physicians play a critical role in addressing sexual health in medical practice, including pain during intercourse. Vulvodynia is a prevalent cause of pain, however, related training is limited and variable. In addition, physician attitudes toward pain and sexuality may affect behaviour and therefore patient outcomes. This study's objectives were to: 1) determine whether post-graduate trainees hold more positive attitudes toward women presenting with vulvovaginal pain with (versus without) an identifiable cause; and 2) examine attitudinal predictors of comfort treating vulvodynia and attitudes toward patients with this presentation. Residents in Canadian Obstetrics and Gynecology (OBGYN) and Family Medicine (FM) programs participated in an online survey (N=99). Respondents completed questionnaires related to demographics, sexuality-related training, sexual attitudes, and comfort treating and attitudes toward vulvovaginal pain and its symptoms. Residents reported significantly more positive attitudes toward patients with visible pathology versus no identifiable cause for vulvovaginal pain, regardless of medical specialty, p&lt;.001. In OBGYN residents, general comfort discussing sexuality in medical practice significantly predicted comfort treating vulvodynia and its symptoms (p&lt;.001), and attitudes toward women with vulvodynia (p&lt;.05). Demographic, training, and attitudinal variables did not significantly predict vulvodynia outcome measures in FM residents. This study of medical residents identified different attitudes based on vulvovaginal pain presentation, and identified predictors of attitudes and comfort treating vulvodynia in OBGYN residents. Findings suggest pathways by which health care experiences may influence outcomes in this population, and have important implications for resident training.

Resident Knowledge, Surgical Skill, and Confidence in Transobturator Vaginal Tape Placement: The Value of a Cadaver Laboratory.

The objective of this study is to examine the effect of additional cadaver laboratory use in training obstetrics and gynecology (OBGYN) residents on transobturator vaginal tape (TOT) insertion. Thirty-four OBGYN residents were randomized into 2 groups (group 1, control; group 2, intervention; 17 in each group). Before and after the interventions, written knowledge and confidence levels were assessed. Both groups received didactic lectures using a bony pelvis and an instructional video on TOT insertion; group 2 participated in a half day cadaver laboratory. Surgical skills were assessed by placing 1 arm of the TOT trocar on a custom-designed pelvic model simulator while being graded by an Female Pelvic Medicine and Reconstructive Surgery (FPMRS) board-certified proctor. Demographics were comparable. Baseline knowledge and confidence level before interventions were similar. After interventions, knowledge scores improved for both groups (8.8% for group 1; 14.1% for group 2); TOT insertion scores were significantly higher in group 2 (6.76/15 ± 2.54 group 1; 10.24/15 ± 2.73 group 2, P < 0.01); confidence scores improved in both groups. The pelvic model simulator was rated as the most useful method to learn TOT placement by group 1. Group 2 rated TOT simulation (47%) and cadaver laboratory (41%). All trainees reported that the pelvic model was highly realistic. Cadaver laboratory exposure, along with other educational interventions (lectures and video), improves OBGYN residents' confidence, knowledge, and surgical skills regarding TOT placement. The custom-designed pelvic model allows for a realistic simulation of TOT placement: it can be used to assess resident surgical skills and also aid the training of OBGYN residents.

Ready or Not? Obstetrics and Gynecology Resident Preparedness for Female Pelvic Medicine and Reconstructive Surgery Training.

The aim of this study was to assess the perception of female pelvic medicine and reconstructive surgery (FPMRS) program directors (PDs) and obstetrics and gynecology (OG) FMPRS fellows regarding the adequacy of OG residency as preparation for FPMRS fellowship. Electronic invitations to complete a modified version of a validated survey were extended to FPMRS PDs and their second- and third-year OG FPMRS fellows who had just completed their first or second year of FPMRS fellowship, respectively. The survey consisted of 5 domains; qualitative questions and recommendations for improvement were elicited. Program directors (33%, 16/48) and second-year (64%, 29/45) and third-year (53%, 26/49) fellows completed the surveys. While incoming fellows were deemed professional, serious surgical skill competency issues were identified: (1) PDs felt they could not leave their incoming fellow to operate independently on a major case for 30 minutes while in the next room compared with fellow responses (PDs: 33.3% vs second-year fellows: 67.9%; P = 0.03); (2) no PDs felt their fellows could suture laparoscopically; and (3) there was group consensus that incoming fellows were not proficient at cystoscopy (PDs: 40.0%, second-year fellows: 39.3%, third-year fellows: 32.0%; P = 0.82). Mostly, fellows could clinically evaluate and manage patients. Program directors thought their fellows had better understanding of statistics than fellows believed of themselves (P = 0.05). Increasing FPMRS exposure during residency was favored as the method to better prepare OG residents for fellowship. Quantitative and emerging qualitative outcomes highlight that fellows are professional and are largely able to evaluate and care for patients but that achieving independence, surgical skills, and scholarship requires further training.