Obstetrics And Gynecology Residents Research Articles

Pilot Study: Developing Curriculum to Prepare Fourth-Year Medical Students Applying for OBGYN Residency Within the Defense Health Agency.

Obstetrics and gynecology (OBGYN) is becoming increasingly competitive among medical specialties. As a result, many medical schools have frameworks to help their students increase their competitiveness to maximize chances of a successful match. However, "boot camps" have traditionally been geared toward the transition to intern year and not to sub-internships during the fourth year of medical school. We aimed to develop a boot camp for rising fourth-year medical students planning to apply into OBGYN before the initiation of their sub-internships and interview season. Sixteen students enrolled in this course led by faculty OBGYNs at our institution. We utilized a combination of mentorship, coaching, and education to achieve applicant success. The curriculum included formal lectures, surgical skills training, and focused feedback from our applicant development committee. Our response rate was 100% and 94% for the pre-intervention and post-intervention survey, respectively. Before the intervention, the majority of participants felt either neutral (47.4%) or unprepared (21.1%) regarding their knowledge before their sub-internships. However, after the intervention, all reported feeling more prepared for their rotations. All respondents either agreed (60%) or strongly agreed (40%) that the course increased their confidence in performing well on audition rotations. Our match rate increased from 62% for the class of 2022 (before this intervention) to 75% for the class of 2023. In light of the increasing residency match competitiveness, it is crucial to investigate programs that can assist students in developing stronger applications. This reproducible intervention utilizes few resources and can be implemented at most medical schools to better support their OBGYN applicants.

Inequities at the Transition to Obstetrics and Gynecology Residency

Although approximately one-fifth of obstetrics and gynecology (OBGYN) residents matriculate from osteopathic or international medical schools, most literature regarding the transition to residency focuses on allopathic medical school graduates. To create comprehensive interventions for this educational transition, we must understand the needs of all incoming residents. Our objective was to examine OBGYN residents' perceptions of their transition to residency, and to understand how residents' background and medical school environment influence their perceived sense of readiness. A 16-item survey asked questions about demographics, the transition to residency, resident well-being, burnout, and the transition to fellowship. Perception of preparedness was assessed with the question "I felt that I was well-prepared for the first year of residency" (1=strongly agree, 5=strongly disagree). Chi-squared and Fisher's exact tests and logistic regression explored association of perceived preparedness with residents' backgrounds. Survey administered at time of the in-training examination in 2022. All OBGYN residents. Of 5761 eligible participants, 3741 (64.9%) provided consent and completed the survey. Of the 3687 participants who answered the question, 2441 (66.2%) either agreed or strongly agreed that they felt well-prepared. Fewer osteopathic graduates reported feeling prepared compared to allopathic graduates (379/610, 62.1% vs 1,924/2,766, 69.6%) (OR 0.72, 95%CI 0.60-0.86, p < 0.01). International medical school graduates were seven times less likely to report feeling prepared compared to those from allopathic institutions (137/304, 45.1% vs 1924/2776, 69.6%) (OR 0.60, 95%CI 0.53-0.68, p < 0.01). Respondents from underrepresented racial and ethnic backgrounds were less likely to report feeling prepared compared to White respondents (276/535, 51.6% vs 1738/2387, 72.8%) (OR 0.39, 95%CI 0.33-0.48, p < 0.01). Differences in residents' perceptions of their transition to residency highlight the need to begin offsetting pervasive inequities with comprehensive and accessible resources.

Rapid Root Cause Analysis: Improving OBGYN Resident Exposure to Quality Improvement and Patient Safety Curricula.

Introduction Each year, millions of patients in the United States experience harm as a result of the healthcare they receive. One mechanism used by health systems to learn how and why errors occur is root cause analysis (RCA). RCA teams develop action plans to create and implement systemic changes in healthcare delivery in order to prevent future harm. The American Council on Graduate Medical Education (ACGME) recognizes the importance of analyzing adverse events, and it requires that all residents participate in real or simulated patient safety activities, such as RCAs.Often, institutional RCAs necessitate the assimilation of participants on short notice and demand considerable time investment, limiting the feasible participation of graduate medical education (GME) trainees. This presents a gap between ACGME expectations and the reality of resident involvement in patient safety activities. We present the first iteration of a quality improvement project encompassing a three-hour resident physician training course with simulated RCA-experiential learning. The purpose of this project was to produce a condensed, educational RCA experience that adequately trains allGME learners to serve as informed healthcare safety advocates while also satisfying ACGME requirements. Methods The course ("rapid RCA") was conducted during protected weekly academic training. All residents of the San Antonio Uniformed Services Health Education Consortium (SAUSHEC) Obstetrics and Gynecology (OBGYN) residency program who had not previously participated in a real or simulated RCA were required to take the "rapid RCA." Pre- and post-course surveys were completed anonymously to assess baseline knowledge, new knowledge gained from the course, and attitudes toward the course and its importance to resident training. Results Fourteen OBGYN residents attended the "rapid RCA," indicating that 64% (14 out of 22) of the program had no previous experience or opportunity to participate in a real or simulated RCA. Participation in the course demonstrated a significant gain of new knowledge with an increase from 0/14 to 10/14 (71%) residents correctly answering all pre- and post-course questions, respectively (p < 0.001). Additionally, on a Likert scale from 1 to 5, with 5 indicating "expert level," residents indicated they felt more comfortable on patient safety topics after taking the course (mean pre-course score 1.85 to post-course score 3.64,p < 0.001). All participants indicated they would prefer to take the "rapid RCA" as opposed to the only available local alternative option for a simulated RCA, currently offered as a full-day intensive course. Conclusion A meaningful increase in patient safety knowledge and attitudes toward topics covered in an RCA was demonstrated through the implementation of a "rapid RCA" in OBGYN residents. We plan to incorporate this into our annual curriculum to satisfy ACMGE requirements. This format could be adapted for other specialties as applicable.

A Pilot Study in Fatigue Risk Management Among Obstetrics and Gynaecology Residents at the University of Alberta

ObjectivesCombatting fatigue is an ongoing challenge in surgical residency programs impacting both patient care and resident well-being. There is a gap in understanding the nuances of fatigue perpetuation, especially where it relates to specific on-call duties. This pilot study seeks to explore the extent of sleep deprivation among Obstetrics and Gynecology (OBGYN) residents and identify obstacles to obtaining adequate rest. MethodsA survey was sent out to all OBGYN residents at the University of Alberta, collecting demographic and baseline sleep information and assessing perceived barriers to sleep. Residents then self-selected for participation in the second portion which involved recording all pages in a 12-hour shift and assigning an acuity rating to them. Mixed methods were used including thematic analysis of the page acuity survey and descriptive statistics for the primary survey. ResultsIn total, 21 residents completed the initial survey (67.7%) and 17 12-hour shifts were recorded. While junior residents (postgraduate year 1–2) and those carrying the low-risk pager slept less on call and had less sleep on days without call, barriers to sleep were not different when compared to senior residents and those carrying the high-risk pager. While low-risk and high-risk shifts had different primary contributors to fatigue (volume and acuity, respectively) both groups attributed fatigue to non-urgent pages. On review of pages, 49.4% were perceived as non-urgent. A total of 81% of residents supported the development of problem boards to reduce the number of non-urgent pages. ConclusionsThis pilot study demonstrated residents, regardless of seniority or shift, found non-urgent pages to be a significant contributor to on-call fatigue and supported the use of problem boards to reduce pages. Our approach can provide a framework for other institutions to learn more about resident fatigue and non-urgent paging in their program.

Trends in Obstetrics and Gynecology Residency Applications in the Year After Abortion Access Changes

State-specific abortion restrictions currently affect the training of approximately 44% of obstetrics and gynecology (OBGYN) residents in the US. Examination of where future trainees apply for residency is important. To assess changes in the percentage of applicants to OBGYN residency programs by state based on abortion restrictions in place after the Dobbs v Jackson Women's Health Organization (hereafter, Dobbs v Jackson) US Supreme Court decision and examine whether applicants' preference for programs, as suggested by the distribution of application signals that express higher interest, was associated with abortion bans. This serial cross-sectional study used anonymized data for all applicants to OBGYN residency programs in the US during September and October from 2019 to 2023. Data were obtained from the Association of American Medical Colleges Electronic Residency Application Service. Applications and program preference signals sent to OBGYN residency programs, analyzed by applicants' self-reported demographics. The primary outcome was differences in the percentage of unique applicants to OBGYN residency programs from 2019 to 2023, with programs categorized by state-based abortion restrictions after the Dobbs v Jackson decision. Secondary outcomes included the distribution of program signals by state abortion ban status. A total of 2463 applicants (2104 [85.4%] women) who applied to OBGYN programs for the 2023 residency match cycle were the focal sample of this study. While overall applicant numbers remained stable between 2019 and 2023, the number of applicants differed significantly by state abortion ban status in the 2022 (F2,1087 = 10.82; P < .001) and the 2023 (F2,1087 = 14.31; P < .001) match cycles. There were no differences in the number of signals received by programs in states with bans after controlling for known covariates such as number of applications received and program size, and there were no differences in the percentage of signals sent by out-of-state applicants to programs in states with different abortion laws than their home states (F2,268 = 2.41; P = .09). In this cross-sectional study, there was a small but statistically significant decrease in the number of applicants to OBGYN residency programs in states with abortion bans in 2023 compared with 2022. However, applicant signaling data did not vary by states' abortion ban status. While OBGYN residency programs almost completely filled in 2023, continued monitoring for the potential consequences of state abortion bans for OBGYN training is needed.

Low-cost low-fidelity task trainer for fetal scalp blood sampling

Fetal blood scalp sampling (FBS) is a critical obstetrical procedure used to assess intrapartum fetal well-being. Unfortunately, standardized task trainers for training Obstetrics and Gynecology (OB-GYN) residents in this technique are currently lacking. In response to this gap, we present a cost-effective task trainer designed to assist trainees in mastering the art of performing FBS. We provide a step-by-step guideline for the development of a cost-effective task trainer tailored for simulating FBS. Six OB-GYN residents underwent a structured theoretical session followed by practical training with the task trainer. Pre- and post-training questionnaires were administered to evaluate the simulator’s efficacy as an educational tool. All participants acknowledged the task trainer’s efficacy in enhancing their understanding of the procedure, resulting in elevated knowledge and confidence across all assessed aspects. Furthermore, every participant endorsed the training for fellow trainees and “agreed or strongly agreed” that the simulator faithfully replicated the procedural experience. This low-cost simulation model for FBS is a valuable training tool with high acceptance and satisfaction rates among participants. Its use has the potential to improve patient safety and increases participants confidence in performing the procedure.

Designing a Multidisciplinary Cardio-obstetrics Curriculum for General Cardiology and Obstetrics Residents: A National Survey of Educational Needs

BackgroundThe increasing and potentially preventable cardiac events in pregnant patients have led to calls to enhance multidisciplinary cardio-obstetrics education. To design a multidisciplinary cardio-obstetrics curriculum for general cardiology and obstetrics and gynecology (OBGYN) residents, we need to define educational needs from the perspectives of both cardiology and OBGYN residents. Our study characterizes the educational needs of Canadian cardiology and OBGYN residents. MethodsCanadian cardiology and OBGYN residents were surveyed on clinical exposures, perceived needs for topics, unperceived needs for topics (multiple-choice questions) and preferences for educational formats. High priorities were defined as ≥ 50% of responses indicating a perceived need or ≥ 50% indicating an unperceived need. ResultsA total of 154 residents participated (cardiology n = 44, OBGYN n = 110). Residents reported insufficient clinical exposure to nearly all cardiac disorders, with 33% of exposures occurring in multidisciplinary contexts. All topics aside from gestational hypertension were rated as high priority on perceived needs by both specialties. High-priority unperceived needs were congenital heart disease (both specialties), pre-existing acquired heart disease (both specialties), medication safety (OBGYN), peripartum management (OBGYN), and pregnancy-related heart disease (OBGYN). Cardiology and OBGYN residents shared preferences for in-person simulation, virtual simulation, and online modules. ConclusionsResidents in both specialties reported low clinical exposure to most cardiac disorders during pregnancy, identified high-priority perceived needs in multiple topics, and shared 2 high-priority unperceived needs. OBGYN residents identified 3 additional high-priority unperceived needs. These data can inform design of multidisciplinary cardio-obstetrics curricula for general cardiology and OBGYN residents.

Modification of Fundamentals of Laparoscopic Surgery Manual Tasks Simulation Curriculum With the Addition of the Vaginal Cuff Closure Training

Fundamentals of Laparoscopic Surgery (FLS) is a multiple-choice test and a manual skills exam using simulation that Obstetrics and Gynecology (OBGYN) residents must pass to qualify for board certification. There is insufficient validity evidence supporting the use of FLS as a high-stakes exam. This study examines the correlation between OBGYN residents' performance on the FLS manual tasks and simulated vaginal cuff closure. We compared residents' performance on FLS tasks with simulated vaginal cuff suturing on a model. During the first coached simulation session, after completion of training on the standard 5 FLS tasks, residents were coached on vaginal cuff closure using a simulated model placed inside the standard FLS box trainer. At a subsequent session, their performance was scored using the Global Operative Assessment of Laparoscopic Skills Scale (GOALS) and a second task-specific metric, and these scores were compared to their official FLS score. Twenty-nine residents completed the vaginal cuff simulation training between June 2019 and November 2021. Nineteen of the 29 were able to complete the cuff closure with the mean time to completion being 14.5 minutes. We found no correlation between official manual skills FLS scores and vaginal cuff GOALS scores (rho = -0.02, p = 0.90) or cuff closure assessment tool score (rho = -0.015, p = 0.048). There was also no correlation between time to completion for any FLS task and vaginal cuff closure OSAT scores. All residents reported that they found the cuff to be a useful addition to the FLS curriculum. Our study demonstrated that trainee performance on a simulated vaginal cuff closure model did not correlate with official FLS manual tasks skills. This finding adds to the body of evidence disputing the use of FLS as a high-stakes exam to assess laparoscopic skills in gynecology in the relationship with other variables category.

Residents’ experience and training in obstetric anal sphincter injury repair in the United States

With the reduction in obstetric anal sphincter injuries (OASIS) cases, it is unknown if learning and exposure to their repair is compromised during obstetrics and gynecology (OBGYN) residency in the United States (US). The aim of this study was to evaluate the exposure and confidence level of the US OBGYN residents to OASIS repair. Residents’ education on OASIS repair was also assessed. This was a cross sectional online survey that collected residents’ demographics, characteristics of residency program, the number of deliveries and OASIS repairs performed, the site and technique of OASIS repair, post-repair care provided, residents’ confidence level in OASIS repair and their education on the repair. Descriptive analyses, Fisher’s Exact tests, Ordinal regression models and Spearman’s correlation were performed. Response from 160 residents (11% response rate) was obtained. Confidence was higher with increasing level of training (OR = 3.442, 95% CI, 2.473-4.791, p&lt;0.004), a greater number of deliveries (OR=2.672, 95% CI, 1.511-4.723, p&lt;0.001), third-degree repairs (OR=5.522, 95%CI, 3.67-8.308, p&lt;0.001) and fourth-degree repairs (OR=4.364, 95% CI, 2.785-6.837, p&lt;0.001) performed. Exposure to lecture or/and simulation improved confidence than no exposure to either (OR= 0.225, 95% CI, 0.092-0.545, p&lt;0.001). Residents’ confidence level increased with a greater number of simulations attended (r=0.368, p&lt; 0.001). Lectures and simulations enhance residents’ knowledge and skills in OASIS repair. Surgical skill curriculum is essential to maintain good quality training, prompt recognition, and meticulous perineal repair among OBGYN physicians despite the declining OASIS cases.

Evaluation of Online Distant Synchronous Interprofessional Simulations.

Formative interprofessional education is an accreditation standard for health professional student populations. This study examined the perception of midwifery students and obstetrics and gynecology (OB-GYN) residents participating in distance synchronous interprofessional simulation. Students participated in an interprofessional simulation in an interactive video conferencing environment. Participants were midwifery students and OB-GYN residents from unaffiliated, geographically distant educational programs. Students' feedback was collected with a survey after the simulation session. Eighty-six percent of midwifery students strongly agreed they felt better prepared for team-based care in future practice after the simulation, whereas 59% of OB-GYN students strongly agreed. Seventy-seven percent of midwifery students strongly agreed they were more clear on the scope of practice of the other profession after the simulation, whereas 53% of OB-GYN students strongly agreed. Eighty-seven percent of midwifery students and 74% of OB-GYN residents strongly agreed the distance synchronous simulation was a positive learning experience. This study demonstrated that midwifery students and OB-GYN residents valued the experience of distance synchronous interprofessional education. Most learners reported feeling better prepared for team-based care and gained a better understanding of each other's scope of practice. Distance synchronous simulations can increase midwifery students' and OB-GYN residents' access to interprofessional education.

Learning Curves of OBGYN Residents Preparing for the FLS Manual Skills Exam

To describe obstetrics and gynecology (OBGYN) resident practice patterns and learning curves as they prepare for the Fundamentals for Laparoscopic Surgery (FLS) manual skills exam and to assess the importance of meeting proficiency, based on published standards, for passing the FLS manual skills exam. This is a prospective observational study of OBGYN resident physicians from July 2018 to January 2022. Residents recorded details about their FLS practice sessions and proficiency metrics for each task repetition. Manual skills exam scores were then compared to task practice variables. Learning curves were developed from resident practice patterns. Fifty OBGYN residents participated in the study. The median number of repetitions per FLS manual skills task ranged from 3.5 (interquartile range [IQR] 2-7) (Task 3) to 7.5 (IQR 3-14) (Task 1). The average number of hours spent practicing was 5.4 hours (SD 3.4 hours), with a median of 3.7 sessions with faculty and/or fellow guidance and 1 self-practice session. All residents passed the FLS manual skills exam. Only for Task 2 (95% confidence interval [CI] 0.24, 5.21) and for the total number of repetitions for all tasks (95% confidence interval [CI] 0.22, 3.74) was a greater number of practice repetitions associated with higher FLS manual skills exam scores. Notably, postgraduate year, number and type of practice sessions, and the number of hours were not associated with higher scores. For all tasks, learning curves showed the greatest rate of improvement in the first 10 to 15 repetitions before diminishing returns. Greater number of practice hours and sessions were not associated with better manual exam scores in a cohort of OBGYN residents with a high proportion of supervised practice sessions. Achieving more advanced proficiency at certain FLS tasks may allow for better performance on the exam.

Impact of an Online Question Bank on Resident In-Training Exam Performance.

In-training exams (ITEs) are administered annually to Obstetrics and Gynecology (OBGYN) residents and have been demonstrated to correlate with success on licensing examinations. Our study objective was to determine the impact of a question bank and mock exam on the performance of Council on Resident Education in Obstetrics and Gynecology (CREOG) ITEs. Secondarily, we investigated the correlation between the extent of question bank usage and performance on the exam. Pre-post intervention study of resident performance on CREOG ITE before and after implementation of the question bank and mock ITE at Indiana University in 2018. Performance was measured as year-to-year improvement in percent correct on ITE exams. Scores were excluded if a resident did not have a prequestion bank score report or if they did not sit for all eligible ITE exams. There were 51 OBGYN residents at Indiana University during the study period, with 38 available for analysis (75%). Before implementation, average year-to-year improvement for PGY1-2, PGY2-3 and PGY3-4 classes were 0.60%, 1.0% and -1.6%, respectively. After implementation, all resident classes had significant improvements in ITE scores of 6.6% (P < .01), 9.0% (P < .01), and 7.2% (P < .01), respectively. There was a moderate program-wide correlation between the number of questions completed and the percent improvement on the ITE of R = 0.36 (P = .046). Our study demonstrated that access to a question bank and mock ITE significantly improved CREOG ITE performance of OBGYN residents at Indiana University.

Current Communication Practices Between Obstetrics and Gynecology Residency Applicants and Program Directors

In order to equitably improve the residency application process, it is essential to understand the problems we need to address. To determine how obstetrics and gynecology (OBGYN) applicants and faculty communicate applicants' interest to residency programs, and how program directors report being influenced by these communications. This survey study was conducted with email surveys of OBGYN application stakeholders in 2022. Included participants were OBGYN applicants, clerkship directors, and residency program directors in medical education associations' email listservs. Surveys sent by the American Association of Medical Colleges, Association of Professors of Gynecology and Obstetrics, and Council on Resident Education in Obstetrics and Gynecology. Whether applicants themselves, or faculty on their behalf, communicated to residency programs, and the influence program directors reported placing on these communications for their decision-making. Descriptive statistics and χ2 tests were used to analyze differences. A total 726 of 2781 applicants (26.1%) responded to the survey and were included in analysis (79 of 249 [31.7%] clerkship directors; 200 of 280 [71.4%] program directors). The self-reported racial and ethnic demographics of the 726 applicant respondents were 86 Asian (11.8%), 54 Black (7.4%), 41 Latinx (5.6%), 1 Native Hawaiian or Pacific Islander (0.1%), 369 White (52.2%), 45 with multiple racial identities (6.2%), and 91 (21.5%) preferring not to answer. The majority of applicants (590 [82.9%]) sent communications at some point in the application process. Applicants who identified as White (336 [88.7%]) or Asian (75 [87.2%]) were more likely than those who identified as Black (40 [74.1%]) or Latinx (33 [80.5%]) to reach out to programs (P = .02). There were also differences in type of medical school, with 377 of 427 MD applicants (88.3%), 109 of 125 DO applicants (87.2%), and 67 of 87 International Medical Graduate applicants (77.7%) reporting sending communications (P = .02). Approximately one-third (254 applicants [35.7%]) had faculty reach out to programs on their behalf. White (152 [40.1%]) and Asian (37 [43.0%]) applicants were more likely to have faculty reach out compared with Black (6 [11.1%]) and Latinx (12 [29.3%]) applicants (P = .01). Program directors reported that preinterview communications from faculty they knew (64 [32.2%]) and other program directors (25 [12.6%]) strongly influenced their decisions, and otherwise rarely reported that communications strongly influenced their decisions. The current state of communications may increase inequities in residency application processes; differences between faculty communications for applicants from different racial and ethnic backgrounds are particularly concerning given that program directors are more likely to weigh communications from faculty in their decision-making. A centralized, equitable means for applicants to signal their interest to programs is urgently needed.

Challenges imposed by the COVID-19 pandemic on the Obstetrics and Gynecology residency program: a mixed-methods Swedish survey in the COPE Staff cohort study

BackgroundTo outline how the training program and work situation of residents in Obstetrics and Gynecology (OB-GYN) was affected by the pandemic and to illuminate how residents experienced these changes.MethodsAs part of the COVID-19 in Pregnancy and Early Childhood Staff (COPE Staff) cohort study, between January and May 2021, all participating residents were invited to answer a 28-question online Resident Survey focusing on their specialist education, work situation and experiences during the COVID-19 pandemic. Descriptive statistics were given in percentages for categorical variables and means and standard deviations (SD) for continuous variables. Univariate comparative analyses were performed with the use of the Pearson’s Chi-2-test for dichotomous data. The association between residents’ worry about the quality and length of their specialist training, with extra clinical hours and transfer to other healthcare institutions were assessed by multivariate logistic regression. Free text responses were analyzed by content analysis.ResultsOf the 162 participating OB-GYN residents, 69% expressed concern that the pandemic would have a negative impact on their training. Ninety-five (95%) reported cancellation/postponement of educational activities, 70% performed fewer surgeries and 27% had been transferred to other healthcare institutions where about half reported having gained more general knowledge as a physician. Working extra clinical hours was reported by 69% (7.4 ± 5.3 hours per week) and 14% had considered changing their profession due to the pandemic. Senior residents, compared to junior residents, more often experienced cancelled/postponed clinical rotations (30% vs 15%, P=0.02) and reported performing fewer surgeries (P=0.02). The qualitative analysis highlighted the lack of surgical procedural training as a major concern for residents.ConclusionThe COVID-19 pandemic has strongly impacted the training program and work situation of OB-GYN residents in Sweden. Residents were concerned over the negative impact of the pandemic on their training program and senior residents reported more missed educational opportunities as compared to junior residents. Program directors, head of institutions and clinical supervisors can use the problem areas pinpointed by this study to support residents and compensate for missed educational opportunities. While hands-on-training and operating time cannot be compensated for, the authors hope that the findings of the study can help develop new strategies to minimize the negative impact of the current and future pandemics on resident education and work situation.

Combing pre-workshop, web-based learning and hands-on workshop as a flipped classroom clinical skill training model during the COVID-19 pandemic

ObjectiveDue to the COVID-19 pandemic, there is a dramatic drop in in-person residency training due to the implementation of isolation and triage measurements. Here, we propose a new flipped classroom clinical skill training model utilizing a combination of pre-workshop, web-based learning and hands-on workshop that shortens in-person contact time to maintain residency training during the pandemic. Effectiveness of this training model was evaluated with a pre-test and post-test skills competency assessment, two-way feedback, and a five-point Likert scale structured survey questionnaire. Materials and methodsThe workshop was conducted in a flipped classroom fashion by the obstetrics and gynecology (OBGYN) department of a single tertiary teaching medical center covering topics from five OBGYN subspecialities. Every topic consisted of a pre-workshop, web-based, mini lecture (PWML) followed by a hands-on workshop (HW). All first to fourth year OBGYN residents were invited to attend the workshop. All the trainees were required to complete the PWML prior to the day of HW. The workshop consisted of rotational station for each topic and was conducted within one afternoon. A 0-100-point scale pre-test and post-test skills competency evaluation were performed for each station and was assessed by the attending doctor or fellow doctor of each subspeciality. Two-way feedback was done after the post-test evaluation. A five-point Likert scale structured survey instrument consisting of participant’s perceptions of the workshop design, relevance to clinical practice, and quality of instructors and materials was created during the curriculum development process and sent to each participant one month after the workshop. ResultsA total of 19 residents including five first-year, six second-year, three third-year, and five fourth-year residents completed the entire pre-workshop lecture, workshop, pre-test, and post-test. For all residents, the average post-test score of 5 stations was 95 and was significantly higher than the pre-test score of 60 (p < 0.001). For both junior residents and senior residents, the average post-test scores of 5 stations were also significantly higher than pre-test scores (p < 0.001). Survey generated one month after the workshop showed a high overall satisfaction with the workshop instructors on their professional knowledge, communication skills, and interactions between the instructors and trainees. The average satisfaction scores for manipulation of vaginal breech delivery (VBD), semen analysis (SA), cervical conization (CC), obstetrics anal sphincter injury (OASIS), and laparoscopic suture techniques (LST) were 4.84, 4.96, 4.92, 4.88, and 4.92, respectively The average score for practical application of the training materials, class design and teaching method, overall satisfaction of the session, and time scheduling was 4.84, 4.96, 4.96, and 4.48, respectively. The entire HW was completed within 180 min and was carried out within half a day. ConclusionWith the implementation of isolation and triage measures in the COVID-19 pandemic, there is a dramatic drop in in-person exposure to all aspects of the residency training, in particular, non-emergent surgeries. Utilization of PWML saved 1/3 of in-person time and the entire workshop was completed within 180 min that could be carried out within half a day. The decrease of person-to-person contact time during the COVID-19 pandemic is necessary while still providing curriculum-based residency training in spite of decreased hands-on experience.

How We Do It: Student Perspectives on Changes to the Obstetrics and Gynecology Residency Application Process

To describe the perspectives of obstetrics and gynecology (OBGYN) residency applicants regarding new standards for the 2019 to 2020 application cycle. An anonymous electronic survey was sent to all OBGYN residency applicants to US programs retrospectively evaluating 5 new recommended standards for the application process. This 15-item survey assessed the importance of the proposed standards and their impact on applicants' anxiety. The OBGYN residency application process is marked by increasing application numbers and no standardization for managing interview offers. The Association of Professors of Gynecology and Obstetrics (APGO) received a 5-year Reimagining Residency grant from the American Medical Association to improve the transition from undergraduate medical education (UME) to graduate medical education (GME) within OBGYN. The multiphase project, "Transforming the UME to GME Transition for Obstetrics and Gynecology- Right Resident, Right Program, Ready Day One (RRR)," began with Standardizing the OBGYN Application and Interview Process (SOAIP). This group recommended 5 new standards for all US OBGYN residency programs and applicants. Applicants for US OBGYN residency programs for the 2019 to 2020 application cycle completed the survey, with a 904/2508 (36.0%) response rate, including 762 complete responses (30.4%). Applicants reported that all 5 of the new standards would cause the least self-perceived anxiety (range 76.8% - 96.5%). The impact of the standards on perceived anxiety varied by student group, with International Medical Graduates (IMGs) and students with USMLE Step I scores <200 describing lesser impact compared to others. Despite these differences, all 5 standards were consistently noted to cause the least anxiety for all groups. Despite varying degrees of effects in different groups, the new OBGYN residency application standards caused the least anxiety for all subgroups of applicants. Implementing universal standards for the OBGYN residency application process was favorably perceived by applicants and caused the least anxiety for applicants.

Sexual Harassment Prevalence Among OBGYN Trainees and Cultural Climate of their Training Programs: Result From a Nationwide Survey

Sexual harassment has many short- and long-term consequences and greatly impacts the clinical work environment, job satisfaction, job performance, and mental wellbeing of the individual. Data on prevalence of sexual harassment in a women-majority field such as Obstetrics and Gynecology (OBGYN) are limited. This national cross-sectional study sought to determine the prevalence of sexual harassment among OBGYN trainees in the United States (U.S.) and assess the associated departmental cultural climate. This study was a cross-sectional, anonymous, voluntary, national survey of OBGYN residents and fellows in the U.S. conducted from May 1, 2019 to June 30, 2019. The validated Sexual Experience Questionnaire was administered via an online survey. Trainees were also queried regarding wellbeing, work satisfaction, and departmental/institutional reporting structure. Demographic data were also gathered. The main outcome was prevalence of sexual harassment among U.S. OBGYN trainees. An email including the survey link was distributed to 1473 OBGYN trainees from 60 programs; 366 completed it (24.8% response rate). The mean age of survey respondents was 30.5 (SD 2.9) years. The majority of respondents were women (86%), White (64.1%), and residents (PGY 1-4, 80.2%). The prevalence of sexual harassment among respondents was 69.1% (69.6% of men and 68.7% of women). The prevalence of sexual harassment by race/ethnicity was: Hispanic/Latina 75.0%, White 68.7%, Asian 68.6%, and Black 47.4% trainees. The majority of respondents' program directors were women (66.4%, 227/342) and the majority of department chairs were men (68.9%, 235/341). The prevalence of sexual harassment did not differ based on the gender of the respondents' program directors and chairs (p-value 0.93). There is a high prevalence of sexual harassment among U.S. OBGYN trainees. Action is required to improve institutional and departmental cultures.

Distributions of Residency Interviews With the Implementation of Virtual Interviews and Standardization of Interview Offer Dates

Virtual interviews were widely implemented alongside many other changes in the 2021 residency application process. We investigated how these many interventions may have influenced interview distributions and completions. Cross-sectional survey distributed electronically to obstetrics and gynecology (OBGYN) residency applicants in February 2021. Distributions of interview invitations, interviews completed, and percent of interview offers completed were compared to the previous application cycle. The odds ratios of receiving interviews were calculated based on applicant characteristics including test scores, number of applications, and race/ethnicity. All OBGYN residency applicants registered through the Electronic Residency Application Service. The 915 (36%) of 2577 total OBGYN applicants who responded to the survey. US allopathic medical students received fewer interview offers in 2021 (median 13 [interquartile range 9-19]) compared to 2020 (median 15 [interquartile range 11-20]). There was no difference in the absolute numbers of interviews completed. A United States Medical Licensing Exam Step 1 score ≥221 resulted in more than a five-fold increase in adjusted odds of receiving at least 12 interviews for allopathic students. Black or African American US allopathic seniors had a 2.3 odds ratio for receiving at least 12 interview invitations compared to White non-Hispanic or Latino US allopathic seniors, adjusted for Step 1 score and the number of programs applied to. Interview offers released on standardized dates had a mitigating effect on completing more interviews among allopathic seniors with at least 12 interview invitations. Virtual interviews did not change the overall number of interviews completed. Standardization of interview offer dates mitigated excessive virtual interviewing, yet additional measures are needed to curb interview inflation and the effects on interview distributions.

An Empirical Investigation Into Milestones Factor Structure Using National Data Derived From Clinical Competency Committees.

To investigate whether milestone data obtained from clinical competency committee (CCC) ratings in a single specialty reflected the 6 general competency domains framework. The authors examined milestone ratings from all 275 U.S. Accreditation Council for Graduate Medical Education-accredited categorical obstetrics and gynecology (OBGYN) programs from July 1, 2018, to June 30, 2019. The sample size ranged from 1,371 to 1,438 residents from 275 programs across 4 postgraduate years (PGYs), each with 2 assessment periods. The OBGYN milestones reporting form consisted of 28 subcompetencies under the 6 general competency domains. Milestone ratings were determined by each program's CCC. Intraclass correlations (ICCs) and design effects were calculated for each subcompetency by PGY and assessment period. A multilevel confirmatory factor analysis (CFA) perspective was used, and the pooled within-program covariance matrix was obtained to compare the fit of the 6-domain factor model against 3 other plausible models. Milestone ratings from 5,618 OBGYN residents were examined. Moderate to high ICCs and design effects greater than 2.0 were prevalent among all subcompetencies for both assessment periods, warranting the use of the multilevel approach in applying CFA to the milestone data. The theory-aided split-patient care (PC) factor model, which used the 6 general competency domains but also included 3 factors within the PC domain (obstetric technical skills, gynecology technical skills, and ambulatory care), was consistently shown as the best-fitting model across all PGYs by assessment period conditions, except for one. The findings indicate that in addition to using the 6 general competency domains framework in their rating process, CCCs may have further distinguished the PC competency domain into 3 meaningful factors. This study provides internal structure validity evidence for the milestones within a single specialty and may shed light on CCCs' understanding of the distinctive content embedded within the milestones.

Impact of Question Bank Use for In-Training Examination Preparation by OBGYN Residents – A Multicenter Study

To examine the impact of access to and utilization of a commercially available question bank (TrueLearn) for in-training examination (ITE) preparation in Obstetrics and Gynecology (OBGYN). This was a retrospective cohort study examining the impact of TrueLearn usage on ITE examination performance outcomes. Produced by the educational arm of the American College of Obstetricians and Gynecologists, the Council on Resident Education in Obstetrics and Gynecology (CREOG) exam is a multiple-choice test given to all residents annually. Residency programs participating in this study provided residency program mean CREOG scores from the year prior (2015), and the first (2016) and second (2017) years of TrueLearn usage. Programs also contributed resident-specific CREOG scores for each resident for 2016 and 2017. This data was combined with each resident's TrueLearn usage data that was provided by TrueLearn with residency program consent. The CREOG scores consisted of the CREOG score standardized to all program years, the CREOG score standardized to the same program year (PGY) and the total percent (%) correct. TrueLearn usage data included number of practice questions completed, number of practice tests taken, average number of days between successive tests, and percent correct of answered practice questions. OBGYN Residency Training Programs. OBGYN residency programs that purchased and utilized TrueLearn for the 2016 CREOG examination were eligible for participation (n = 14). Ten residency programs participated, which consisted of 212 residents in 2016 and 218 residents in 2017. TrueLearn was used by 78.8% (167/212) of the residents in 2016 and 84.9% (185/218) of the residents in 2017. No significant difference was seen in the average CREOG scores available on a per- program level before versus after the first year of implementation either using the CREOG score standardized to all PGYs (mean difference 1.0; p = 0.58) or standardized to the same PGY (mean difference 3.1; p = 0.25). Using resident-level data, there was no significant difference in mean CREOG score standardized to all PGYs between users and non-users of TrueLearn in 2016 (mean, 199.4 vs 196.7; p = 0.41) or 2017 (mean, 198.2 vs 203.4; p = 0.19). The percent of practice questions answered correctly on TrueLearn was positively correlated with the CREOG score standardized to all PGYs (r = 0.47 for 2016 and r = 0.60 for 2017), as well as with the CREOG total percent correct (r = 0.47 for 2016 and r = 0.61 for 2017). Based on a simple linear regression, for every 500 practice questions completed, the CREOG score significantly increased for PGY-2 residents by an average (±SE) of 7.3 ± 2.8 points (p = 0.013); the average increase was 0.7 ± 2.5 (p = 0.79) for PGY-3 residents and 5.8 ± 3.3 points (p = 0.09) for PGY-4 residents. Adoption of an online question bank did not result in higher mean CREOG scores at participating institutions. However, performance on the TrueLearn questions correlated with ITE performance, supporting predictive validity and the use of this question bank as a formative assessment for resident education and exam preparation.