Residency Programs In Obstetrics Research Articles

Resident Education Curriculum in Pediatric and Adolescent Gynecology: The Short Curriculum 4.0

Exposure to pediatric and adolescent gynecology (PAG) varies across residency programs in obstetrics and gynecology, family medicine, and pediatrics, as well as both adolescent medicine and PAG fellowship programs. Nevertheless, these programs are responsible for training residents and fellows and providing opportunities to fulfill PAG learning objectives. To that end, the North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG trainee education by creating and maintaining this Short Curriculum. The curriculum outlines specific learning objectives central to PAG education and lists high-yield, concise resources for learners. This updated curriculum replaces the previous 2021 publication with a new focus toward accessible online content and updated resources.

Clinical Simulation in the Training of Obstetrics and Gynecology Resident from the Perspective of Medical Residency Programs.

This study analyzes the role of clinical simulation in internal medical residency programs (IMRP) in Obstetrics and Gynecology (OB/GYN), attributed by the supervisors, in the training of residents in the city of São Paulo (SP). Cross-sectional descriptive, qualitative, and exploratory approach. Semi-structured interviews were performed with ten supervisors of Medical Residency programs in Obstetrics and Gynecology. Interviews were analyzed by means of content analysis under the thematic modality, starting with the core the role of clinical simulation in Obstetrics and Gynecology Medical Residency Programs. RESULTS: Supervisors view Clinical simulation as: a complementary tool for the teaching and learning process, a possibility of a safe teaching and learning environment, an opportunity to learn from mistakes, a support for professional practice committed to patient safety, a learning scenario for teamwork, a scenario for reflection on the work process in Obstetrics and Gynecology, a scenario for evaluative processes in the medical residency. Still according to supervisors, Clinical Simulation favors decision-making and encourages the resident participation in activities. Supervisors recognize Clinical Simulation as a powerful pedagogical tool in the learning process of resident doctors in Obstetrics and Gynecology Residency Programs.

Validity evidence for procedure-specific competence assessment tools in obstetrics and gynecology

The new competency by design framework instituted by the Royal College of Physicians and Surgeons of Canada, emphasizes resident observation, feedback and documentation. For residency programs in Obstetrics and Gynecology (O&G), there is renewed interest in high quality, objective assessment tools to assess performance. Our study aims to comprehensively review the existing literature on procedure-specific competence assessment tools in O&G.

Medical Residents, the Group and the Formation of Professional Identity During the COVID-19 Pandemic.

Residency is still considered the gold standard for quality medical training, and acquiring a professional identity as a specialist is one of its central elements. Residents obtain this identity through both the educational environment and direct interaction with peers and supervisors. However, modifications in health care and educational routines during the recent coronavirus disease 2019 (COVID-19) pandemic have significantly impaired these channels. This study is part of a qualitative research project to analyze professional identity formation in a medical residency program in obstetrics and gynecology at a public hospital in southern Brazil. The authors conducted 28 semi-structured interviews with medical residents and preceptors, as well as a focus group with the residents, which was recorded, transcribed, and analyzed in an effort to construct major analytical categories. Restricted movement and physical contact have forced the use of alternative means of interpersonal interaction, such as communication through social media or instant messaging applications. This has also affected educational activities, such as morning rounds, lectures, and seminars. These changes represent a significant impact, especially in Brazil, where physical proximity is an important cultural feature, even in the work and school environments. We speculate that this new type of virtual interaction will also affect the formation of professional identity among obstetrician-gynecologists. These findings suggest that medical residency programs should be attentive to changes in resident training to ensure that the specialist profile and the expected skills, which are consolidated over many years, are not lost.

Laparoscopic Simulation Training for Residents in Obstetrics and Gynecology Over 12 Months.

Objectives:As gynecology surgical cases are declining across the country, residency programs can benefit by training residents with simulation. We evaluate five Fundamentals of Laparoscopic Surgery (FLS) tasks over 12 months.Materials and Methods:This was a retrospective study of 16 obstetrics and gynecology residents. Residents practiced on a FLS simulation box trainer. They were evaluated on completion time and pass/fail performance for the five tasks of peg transfer, precision cutting, loop ligation, suture with extracorporeal knot, and suture with intracorporeal knot. Resident satisfaction with FLS simulation box training was evaluated.Results:We found improvement of reduced time from baseline to 12 months for the tasks of peg transfer, precision cutting, suture with extracorporeal knot, and suture with intracorporeal knot. No time improvement was noted for loop ligation. We only found increased passing rates for the precision cutting task from baseline to 12 months. Residents agreed that simulation training improves surgical skills, improves patient safety, and improves confidence level in the operating room.Conclusion:We found improvement of decreased time with FLS simulator box training for FLS tasks of peg transfer, precision cutting, suture with extracorporeal knot, and suture with intracorporeal knot. We recommend that routine practice with the FLS simulator box trainer will increase resident confidence level and potentially improve surgical outcomes when in the operating room. We recommend including a dedicated portion of the academic curriculum for simulation training. FLS box training can be an essential tool for residency programs in obstetrics and gynecology.

Resident Education Curriculum in Pediatric and Adolescent Gynecology: The Short Curriculum 3.0.

Exposure to pediatric and adolescent gynecology (PAG) varies across residency programs in obstetrics and gynecology, family medicine, and pediatrics, as well as fellowship programs in adolescent medicine. Nevertheless, these programs are responsible for training residents and fellows and providing opportunities within their programs to fulfill PAG learning objectives. To that end, the North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG education by creating and systematically updating the Short Curriculum. This curriculum outlines specific learning objectives that are central to PAG education and lists essential resources for learners' reference. This updated curriculum replaces the previous 2018 publication with added content, resources, and updated references.

Aplicação do Método de Avaliação 360º em Residentes Médicos de Ginecologia e Obstetrícia

Objetivo: Implementar a avaliação 360º no Programa de Residência Médica em Obstetrícia e Ginecologia de um Hospital de Referência em Obstétrica e Ginecologia, localizado em Belém-PA. Métodos: Pesquisa de caráter exploratório, descritivo, com abordagem quantitativa. Foi desenvolvida nos cenários reais de prática dos médicos residentes e abrangeu todos os setores da tocoginecologia de um hospital de referência em procedimentos obstétricos e ginecológicos, localizado em Belém/PA. Os residentes e preceptores receberam capacitação in loco para participação no estudo. Foi definido como instrumento de avaliação 4 questionários: o Mini Clinical Evaluation Exercise (Mini-CEx), o qual foi utilizado pelos preceptores, além de instrumentos avaliativos do American Board Internal Medicine, que foram utilizados na avaliação pelos pares, pacientes e autoavaliação. Resultados: Foi aplicado um quantitativo total de 92 questionários, sendo 4 tipos diferentes para cada residente, o qual foi possível observar durante uma consulta a sua autoavaliação, a avaliações dos pares, avaliação do preceptor e a avaliação da paciente. Conclusão: Espera-se que esse estudo possa contribuir para futuras possibilidades de ampliação do processo de avaliação dos residentes.

“Without any indication”: stigma and a hidden curriculum within medical students' discussion of elective abortion

Pregnancy termination is a common, beneficial medical procedure, but abortion care in the United States is stigmatized. Language, including categorization of some abortions as elective, may both reflect and convey stigma. We present a history of the term “elective” in reference to abortion, followed by data demonstrating its use by a sample of contemporary medical trainees and an analysis of the term's relationship to abortion stigma, medical training, and patient access to abortion care.We analyzed interviews with 41 U.S. medical students who had applied to residency programs in obstetrics and gynecology. Participants discussed experiences with, and attitudes toward, abortion before and during medical school, and plans to perform abortions in future practice. We inductively coded participants' use of “elective” in reference to abortion and analyzed their meanings.Participants did not use “elective” according to its medical definition, which conveys an absence of urgency for surgery. Instead, “elective” identified a subset of abortions that lacked maternal or fetal medical indications. “Elective” negatively marked and isolated some abortions, and participants used the term to convey judgment about patients' social and reproductive histories. Participants saw medical and psychosocial indications as mutually exclusive, and became confused when interrelated factors influenced patients' abortion decisions. They ignored the voluntary nature of abortion in the setting of medical illness, sexual violence, or fetal complications, and accepted discrimination against women seeking abortion for psychosocial indications as normal and ethical.The term “elective” enables the creation and perpetuation of abortion stigma, and contributes to a hidden curriculum for abortion training in medical education that distracts from core content, incorporates social judgment of patients into medical practice, and promotes normative gender concepts. Our findings support calls to improve the language of abortion care to ensure policies and training environments are consistent with professional standards.

Resident Education Curriculum in Pediatric and Adolescent Gynecology: The Short Curriculum 2.0.

The degree of exposure to pediatric and adolescent gynecology (PAG) varies across residency programs in obstetrics and gynecology and pediatrics. Nevertheless, these programs are responsible for training residents and providing opportunities within their programs to fulfill PAG learning objectives. To that end, the North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG resident education by creating and systematically updating the Short Curriculum. This curriculum outlines specific learning objectives that are central to PAG education and lists essential resources for learners' reference. This updated curriculum replaces the previous 2014 publication with added content, resources, and updated references. Additionally, attention to the needs of learners in pediatrics and adolescent medicine is given greater emphasis in this revised North American Society for Pediatric and Adolescent Gynecology Short Curriculum 2.0.

Impact of Video Coaching on Gynecologic Resident Laparoscopic Suturing: A Randomized Controlled Trial

Study ObjectiveTo determine if the addition of video coaching to an obstetrics and gynecology resident laparoscopic simulation curriculum improves acquisition of suturing skills. DesignRandomized controlled trial (Canadian Task Force classification I). SettingAcademic teaching hospital with a residency program in obstetrics and gynecology. PatientsTwenty obstetrics and gynecology residents undergoing a 4-week laparoscopic simulation curriculum were video recorded weekly performing a suturing task on a validated vaginal cuff model. InterventionsResidents were randomized to standard simulation curriculum or standard curriculum plus weekly video coaching by an expert laparoscopic surgeon. Primary outcome measure was comparison of weekly Global Operative Assessment of Laparoscopic Skills plus Vaginal Cuff Metrics (GOALS+) scores of the suturing task. Measurements and Main ResultsBaseline GOALS+ scores did not differ across training groups (p = .406), although “senior” (postgraduate years 3 and 4) residents initially had significantly higher GOALS+ scores than “junior” (postgraduate years 1 and 2) residents (p < .001). GOALS+ scores significantly improved from week 1 to week 2 in the intervention group compared with the control group (p < .05). Junior coached residents had significantly higher GOALS+ scores at week 2 (mean, 28.06; standard deviation, 3.10) compared with the junior control residents (mean, 20.75; standard deviation, 6.38; p < .04). Over the 4-week period all residents showed significant improvement (p = .005), with novice residents improving more than experienced residents (p = .001). The junior coached residents exhibited a significant difference between weeks 1 and 2 when compared with the junior residents undergoing the standard curriculum. ConclusionVideo coaching during laparoscopic simulation training has the greatest impact early in junior learners' skill acquisition, thus providing another tool for simulation training curricula.

Future Career Plans and Practice Patterns of Canadian Obstetrics and Gynaecology Residents in 2011.

The practice patterns of Obstetricians and Gynaecologists continue to evolve with each new generation of physicians. Diversifying subspecialties, changes in resident duty hours, job market saturation, and desire for work-life balance are playing stronger roles. Professional practice direction and needs assessment may be aided by awareness of future Obstetrics and Gynaecology physician career plans and expectations. The objective of this study was to determine the expected career plans and practice patterns of Canadian Obstetrics and Gynaecology residents following residency. The SOGC Junior Member Committee administered its third career planning survey to Canadian Obstetrics and Gynaecology residents electronically in December 2011. The data collected was statistically analyzed and compared to previous surveys. There were 183 responses giving a response rate of 43%. More than one half of all residents were considering postgraduate training (58%). Projected practice patterns included: 84% maintaining obstetrical practice, 60% locuming, and 50% job-sharing. The majority of residents expected to work in a 6 to 10 person call group (48%), work 3 to 5 call shifts per month (72%), work 41 to 60 hours weekly (69%), and practise in a city with a population greater than 500 000 (45%). Only 18% of residents surveyed were in favour of streaming residency programs in Obstetrics and Gynaecology. Canadian resident career plan and expected practice pattern assessment remains an important tool for aiding in resource allocation and strategic development of care and training in Obstetrics and Gynaecology in Canada.

A multi-center randomized trial of two different intravenous fluids during labor

Objective: To determine if the intrapartum use of a 5% glucose-containing intravenous solution decreases the chance of a cesarean delivery for women presenting in active labor.Methods: This was a multi-center, prospective, single (patient) blind, randomized study design implemented at four obstetric residency programs in Pennsylvania. Singleton, term, consenting women presenting in active spontaneous labor with a cervical dilation of <6 cm were randomized to lactated Ringer's with or without 5% glucose (LR versus D5LR) as their maintenance intravenous fluid. The primary outcome was the cesarean birth rate. Secondary outcomes included labor characteristics, as well as maternal or neonatal complications.Results: There were 309 women analyzed. Demographic variables and admitting cervical dilation were similar among study groups. There was no significant difference in the cesarean delivery rate for the D5LR group (23/153 or 15.0%) versus the LR arm (18/156 or 11.5%), [RR (95% CI) of 1.32 (0.75, 2.35), p = 0.34]. There were no differences in augmentation rates or intrapartum complications.Conclusions: The use of intravenous fluid containing 5% dextrose does not lower the chance of cesarean delivery for women admitted in active labor.

Trends in Reported Resident Surgical Experience in Hysterectomy

Study ObjectiveTo compare differences in trends in reported surgical experience of residents in obstetrics and gynecology in the United States insofar as abdominal, vaginal, and laparoscopic hysterectomy. DesignRetrospective analysis of the national case log reports from the Accreditation Council for Graduate Medical Education (ACGME) for obstetrics and gynecology cases logged as “surgeon” from 2002 to 2012 (Canadian Task Force classification III). SettingAGCME-accredited residency programs in obstetrics and gynecology. ParticipantsEleven thousand five hundred and eight graduating residents in obstetrics and gynecology (n = 11 508). Measurements and Main ResultsSince 2008, when the ACGME began reporting the 4-year cumulative hysterectomy case load statistics for graduating residents in obstetrics and gynecology, there has been no significant change in the mean (SD) number of hysterectomies performed by residents from 118.1 (38.0) cases in 2008–2009 to 116.1 (31.0) cases in 2011–2012 (p = .16; 95% confidence interval [CI], −0.78 to 4.78). During the past decade, however, the total number of reported abdominal hysterectomies consistently decreased from 89.1 (34.2) cases in 2002–2003 to 59.1 (21.0) cases in 2011–2012 (28% decrease; p <.001; 95% CI, 27.7–32.3). The number of vaginal hysterectomies also trended down from 34.9 (19.2) cases to 19.4 (9.0) cases (40% decrease; p <.001; 95% CI, 14.3–16.7). The ACGME did not report the number of laparoscopic hysterectomies performed by residents until 2008–2009, when residents reported performing 23.4 (17.0) cases. From 2008 to 2012, this number increased to 38.5 (20.0) cases (72% increase; p <.001; 95% CI, 13.6–16.6). The proportion of reported laparoscopic hysterectomies performed with robotic assistance was not separately reported. ConclusionsAlthough the overall number of hysterectomies reported by residents has remained stable since 2008, the predominant modes of hysterectomy during the past decade have changed substantially, with laparoscopic hysterectomy comprising an increasingly large proportion of resident experience. As laparoscopic hysterectomy has become more common, reported cases of abdominal and vaginal hysterectomies have decreased. Additional statistics on the percentage of laparoscopic hysterectomies performed using robotic assistance would be valuable to additionally analyze the effect of this new technology on resident training.

Impact of Robotic Surgery Training Availability on Choice of Obstetrics and Gynecology Residency Program

To assess the potential impact of exposure to robotic surgery during medical school and potential robotics training during residency on where applicants apply, accept interviews, or rank residency programs in obstetrics and gynecology.

Specialist Training in Obstetrics and Gynecology in Singapore: Transition to Structured Residency Program

The article describes the experience of planning and implementing the transition of the residency program in obstetrics and gynecology at Singhealth, Singapore, from a model largely based on British training principles to a new model in accordance with the ACGME-International (ACGME-I) standards. Initial steps in transitioning to the new model entailed (1) identifying faculty with an interest in education to lead the various initiatives and programs and to ensure appropriate educational role models, (2) securing adequate funding, (3) holding focus groups with physicians to identify opportunities for improvement in the new system, and (4) developing a schedule for the phased implementation of key features of the structured system. The program started in July 2011, with 14 residents for a 4-year course of training. The curriculum consisted of 5 modules: (1) general obstetrics and gynecology and ambulatory care, (2) maternal fetal medicine, (3) urogynecology and minimally invasive surgery, (4) reproductive medicine, and (5) gynecology oncology. Faculty was assigned responsibility for teaching and assessing the 6 competencies, and appropriate training was provided through specially designed, professional-development programs. Challenges in the implementation of the new training program included the need to replace clinical service previously provided by trainees, a lack of fit between the traditional qualifying exam and the new model for training, and the need to adapt teaching strategies to new competencies not explicitly taught in the prior program, particularly practice-based learning and improvement and systems-based practice. The strength of the new obstetrics and gynecology residency lies in having a structured, competency-based, closely supervised approach to training with standardized evaluations, timely feedback, and a committed faculty.

Does Residency Training Improve Cognitive Competence in Obstetric and Gynaecologic Surgery?

ObjectiveTo develop an operative knowledge assessment tool to evaluate the cognitive competence of trainees in obstetric and gynaecologic surgery and to determine the rate of change in competence during a five-year residency program. MethodsTwenty-eight participants in five training groups (PGY-1 to PGY-5) in McGill University’s residency program in obstetrics and gynaecology underwent an evaluation based on surgical cognitive competence (SCC) assessment tools developed for three different obstetric and gynaecologic operations: open total abdominal hysterectomy (TAH), Caesarean section, and laparoscopic bilateral tubal sterilization (BTL). The tools were developed as checklists listing every step in each operation based on techniques described in current surgical texts. Using analysis of variance and linear regressions, statistical significance was established for procedure-specific scores and overall SCC scores. In addition, the rate of change of cognitive competence throughout the training years was calculated. Finally, using a t test, the overall SCC score was compared to a “critical steps score.” ResultsCritical steps scores and overall SCC scores increased with training experience at an average yearly rate of 13.36% (P < 0.001). Procedure-specific scores increased yearly, by 15.73% for TAH (P < 0.001), 8.06% for Caesarean section (P < 0.001), and 16.31% for BTL (P < 0.001). The difference between overall scores and critical steps scores was not statistically significant for the study cohort (P = 0.94). ConclusionSurgical cognitive competence among obstetrics and gynaecology residents can be reliably assessed with our evaluation tool, and it increases proportionally with residency education, reaching maximum scores during the final year of training. This type of information may be helpful in ascertaining how long a residency program should be.

Can Medical School Performance Predict Residency Performance? Resident Selection and Predictors of Successful Performance in Obstetrics and Gynecology

During the evaluation process, Residency Admissions Committees typically gather data on objective and subjective measures of a medical student's performance through the Electronic Residency Application Service, including medical school grades, standardized test scores, research achievements, nonacademic accomplishments, letters of recommendation, the dean's letter, and personal statements. Using these data to identify which medical students are likely to become successful residents in an academic residency program in obstetrics and gynecology is difficult and to date, not well studied. To determine whether objective information in medical students' applications can help predict resident success. We performed a retrospective cohort study of all residents who matched into the Johns Hopkins University residency program in obstetrics and gynecology between 1994 and 2004 and entered the program through the National Resident Matching Program as a postgraduate year-1 resident. Residents were independently evaluated by faculty and ranked in 4 groups according to perceived level of success. Applications from residents in the highest and lowest group were abstracted. Groups were compared using the Fisher exact test and the Student t test. Seventy-five residents met inclusion criteria and 29 residents were ranked in the highest and lowest quartiles (15 in highest, 14 in lowest). Univariate analysis identified no variables as consistent predictors of resident success. In a program designed to train academic obstetrician-gynecologists, objective data from medical students' applications did not correlate with successful resident performance in our obstetrics-gynecology residency program. We need to continue our search for evaluation criteria that can accurately and reliably select the medical students that are best fit for our specialty.

Invited Applicant Evaluation of an Online Interview Scheduler Implemented by a Residency Program in Obstetrics and Gynecology

To assess invited resident applicants' views of the feasibility and acceptability of a point-and-click online interview scheduler. An online program was created for invited applicants to schedule themselves. The program presented the invitees with a series of interview dates with available slots for which they could click and receive immediate confirmation of their selected date. The majority of the invitees were asked to schedule online. These invitees received a brief survey to assess their views of the online scheduler. Eighty-three applicants were invited by e-mail for a resident interview, 71 of whom were offered the online scheduler. Of these 100% booked themselves online within 3-4 days of invitation. After three e-mail reminders 100% of the invitees completed the survey. Sixty-five of the 71 (92%, 95% confidence interval [CI] 85.4-98.6) said they liked the scheduling program, and most (77%, 95% CI 67.2-86.8) preferred to book online rather than telephone or e-mail. Eighty percent (95% CI 70.7-89.3) found the online scheduler easier to use. Overall, 72% (95% CI 60.5-81.6) felt that having an on-line scheduler did not affect their opinion of the quality of the program. Invitees in favor of the scheduler liked the convenience of anytime scheduling, the immediate confirmation, a quick view of available dates and times, and the ability to schedule without depending on someone else. Our online scheduler proved to be easy to use, eliminated phone calls with applicants, and satisfied most of the invitees.

Controversies in Medical Ethics: Training in Abortion

St. Mary’s Hospital is a Roman Catholic owned and operated teaching hospital located down town. The hospital has several internship and residency programs and medical student rotations, including one in obstetrics/gynecology. The administrator of the hospital learns that part of the requirements for an accredited residency program in obstetrics and gynecology is that all residents learn the indications, processes, and procedures for performing therapeutic abortions. The administrator issues a ruling saying that this is completely unacceptable and that no abortions will be done in St. Mary’s Hospital. Furthermore, the administrator states that it is completely unacceptable to have medical students or residents rotate across the street at Municipal Hospital to perform abortions. He simply does not want his obstetrics/gynecology learners participating in abortions at any location if they are to have an affiliation with his hospital. The American College of Obstetrics and Gynecology (ACOG), on the other hand, insists that to maintain an accredited residency program, the residents must learn this procedure. What is to be done? Is it appropriate for St. Mary’s Hospital to maintain an obstetrics/gynecology residency program or should they close it? One of the residents in the program, Dr. Mary Smith, insists that she is being denied complete training in her specialty by virtue of St. Mary’s policy. She is threatening legal action. What is to be done? Should you continue the medical student rotation at St. Mary’s?

Resident Attrition: Is Gender a Factor?

This study was conducted to investigate the differences in resident attrition between male and female residents in obstetrics and gynecology. Two different questionnaires were sent, one in March 2001 and one in May 2002, to the residency directors or coordinators of the 246 accredited residency programs in obstetrics and gynecology in the United States. In the first mailing, questions were asked about the numbers of residents who left the program between 1997 and 2001, the postgraduate year upon leaving, their gender, and their reasons for leaving. The categories of reasons for leaving were involuntary dismissal, change of specialty, family (most often spousal) issues, change to another obstetrics and gynecology program, and miscellaneous factors. In addition to these questions, the second questionnaire asked for demographic information about the program, and the distribution of male and female residents in each year. In March 2001, 46% of the questionnaires were completed and returned (113 of 246). Twenty-two of the responding programs (21%) had not lost any residents between 1997 and 2001. The remaining programs reported losing 167 residents over the 4-year period (3.6% attrition rate). Seventy-four percent (124) of those who left the program were women compared with 25% (43) who were men (P = 0.029). Over half (60%) of those who dropped out of a residency program left at the end of the first year. These percentages were similar for men and women. Nearly half of female residents (48%), but only one fourth of male residents (25%), left their residency for family reasons (P = 0.012). Conversely, 55% of men and 26% of women left for a change of specialty (P = 0.001). Equal numbers of men and women were involuntarily dismissed from their program (15% and 17%, respectively) or changed to another obstetrics and gynecology residency (5% each). Analysis of the data acquired in the first questionnaire found that women were more than twice as likely as men to leave a residency for family reasons (odds ratio [OR], 2.64; 95% confidence interval [CI], 1.22–5.70). Women were significantly less likely to leave a residency in obstetrics and gynecology for another specialty (OR, 0.275; 95% CI, 0.13–0.56). The response rate was lower for the second questionnaire (30%, 74 of 246), but the responses were similar to the first mailing. Sixteen percent of programs reported no losses, and 84% reported losing 138 residents of whom one third were men and two thirds were women (difference not significant). The attrition rate in May was 2.7%. Family considerations were cited by 52% of female residents and only 17% of male residents as the reason for leaving their training program (P = 0.002; OR, 5.16; 95% CI, 1.71–15.60). Change of specialty was the reason for leaving in 24% of female residents compared with 50% of male residents (P = 0.002; OR, 0.31; 95% CI, 0.12–0.80). The percentages of men and women who were involuntary dismissed from their program or who changed to another obstetrics and gynecology program were similar.