Gynecology Residents Research Articles

Behind the White Coat: The Prevalence of Burnout among Obstetrics and Gynecology Residents in Azerbaijan

Behind the White Coat: The Prevalence of Burnout among Obstetrics and Gynecology Residents in Azerbaijan

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

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

Impact of 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.

Gynaecology, general surgery and urology residents' perspective and exposure to endoscopy training and practice: a cross-sectional study of resident doctors in four residency training centres in Abuja, Nigeria from June to August, 2020.

the use of endoscopy in the surgical management of a wide range of ailments has revolutionised the practice of surgery. Endoscopy however has been underutilised in developing nations. Optimal training exposure during the residency training program is considered as very crucial to the improvement of endoscopy practice in this region. The objective of this study was to evaluate the perception and endoscopy training exposure of resident doctors in gynaecology, general surgery and urology in four residency training centres in Abuja. this was an analytical cross-sectional study of endoscopy exposure of gynaecology, general surgery and urology resident doctors in four residency training centres in Abuja from June through August 2020. Using a structured questionnaire, information was obtained on demography, perception of endoscopy, exposure to and expectations for endoscopy training and practice. Data were analysed with SPSS version 25 (IBM Corp., Armonk, NY, USA). a total of 125 questionnaires were distributed with a 92% response rate. The mean age of the respondents was 36.17±4.62 years with a mean duration of training of 53.91±28.02 months. Eighteen (15.8%) were satisfied with endoscopy practice in their centre and only five respondents (4.4%) had attained competence in operative endoscopy. Twelve trainees (10.5%) reported that they had received formal training in endoscopy outside their workplace and 109 (95.6%) desired to have post-fellowship training. Competence was statistically significantly higher among the senior registrars compared to registrars (Fisher 51.81, P=< 0.001). Lack of funding was the most reported limiting factor to endoscopy training (66.7%) while most (85.1%) desired the incorporation of structured endoscopy training into the residency training curriculum. this study showed poor endoscopy training exposure, a high level of dissatisfaction with the state of endoscopy practice and high expectations of the trainees for improved training facilities and human capacity.

Assessing Nursing Sentiments on Nurse-Resident Physician Collaboration and Administrative Support in the Labor and Delivery Setting

To develop a survey instrument that: 1) investigates the dynamics of collaboration in multidisciplinary care units such as labor and delivery (L&D); and (2) uniquely determines the collaborative relationships between nurses and resident physicians. An effective interprofessional collaboration between healthcare providers is considered a critical component in delivering high-quality care to patients and lies at the root of ensuring positive patient outcomes. Two samples of responses (n = 98) were collected from L&D nurses working in 2 hospitals: 1 with novel obstetrics and gynecology (OB/GYN) residency program and 1 with legacy OB/GYN residency program. Descriptive statistics and reliability statistics (Cronbach's α and item-total correlations) were calculated for each sample. Reliability analysis revealed strong internal consistency of the survey items in both samples even after completing single-item deletion analysis. Findings suggest that our 11-item instrument shows promise in effectively assessing nursing sentiments toward collaboration with resident physicians.

The Equivalent of: Meeting Obstetrics and Gynecology Residency Requirements for Family Planning Training in a Post-Roe Era

The Equivalent of: Meeting Obstetrics and Gynecology Residency Requirements for Family Planning Training in a Post-Roe Era

Credentialing and Patient Safety in Robotic Gynecologic Surgery: Changes over the Last Eight Years.

Robotic gynecologic surgery has outpaced data showing risks and benefits related to cost, quality outcomes, and patient safety. We aimed to assess how credentialing standards and perceptions of safe use of robotic gynecologic surgery have changed over time. An anonymous, online survey was distributed in 2013 and in 2021 to attending surgeons and trainees in accredited obstetrics and gynecology residency programs. There were 367 respondents; 265 in 2013 and 102 in 2021. There was a significant increase in robotic platform use from 2013 to 2021. Percentage of respondents who ever having performed a robotic case increased from 48% to 79% and those who performed > 50 cases increased from 25% to 59%. In 2021, a greater percentage of attending physicians reported having formalized protocol for obtaining robotic credentials (93% vs 70%, p = 0.03) and maintaining credentialing (90% vs 27%, p < 0.01). At both time points, most attendings reported requiring proctoring for 1 - 5 cases before independent use. Opinions on the number of cases needed for surgical independence changed from 2013 to 2021. There was an increase in respondents who believed > 20 cases were required (from 58% to 93% of trainees and 29% to 70% of attendings). In 2021, trainees were less likely to report their attendings lacked the skills to safely perform robotic surgery (25% to 6%, p < 0.01). Greater experience with robotic platforms and expansion of credentialing processes over time correlated with improved confidence in surgeon skills. Further work is needed to evaluate if current credentialing procedures are sufficient.

The Impact of Dobbs on US Graduate Medical Education.

The Dobbs decision will directly affect patients and reproductive rights; it will also impact patients indirectly in many ways, one of which will be changes in the physician workforce through its impact on graduate medical education. Current residency accreditation standards require training in all forms of contraception in addition to training in the provision of abortion. State bans on abortions may diminish access to training as approximately half of obstetrics and gynecology residency programs are in states with significant abortion restrictions. The Dobbs decision creates numerous hurdles for trainees and their programs. Trainees in restrictive states will have to travel to learn in a different program in a protective state. As training opportunities diminish, potentially leading to a decline in clinical skills, knowledge, and experience in the provision of abortion, the rate of complications and maternal mortality are likely to rise. This will likely have a disproportionately negative effect on preexisting disparities in reproductive health fueled by a longstanding history of systemic racism and inequities. This work aims to both define the looming problem in abortion training created by Dobbs and propose solutions to ensure that an adequate workforce is available in the future to serve patient needs.

Assessment of knowledge and practice of gynecology/obstetrics residents and midwives towards essential newborn care At Tikur Anbessa Specialized Hospital, Addis Ababa University, Ethiopia

Background: A time-bound and chronologically ordered series of medical interventions that a baby receives at birth are referred to as the "essential newborn protocol." This period of immediate care is critical for the babies' subsequent well-being and adaptation. However, there are still reports of health workers lacking good knowledge and practice with newborn care, which was not investigated in our hospital. &#x0D; Methods: A hospital-based cross-sectional study was conducted in TASH with 114 selected gynecology and obstetrics residents and midwives. Using the SPSS version 25 software package, continuous data were described using the mean and standard deviation, while categorical data were de-scribed using frequency and percentage. To identify factors related to knowledge and practice, multivariable binary logistic regression analyses were used. &#x0D; Result: Eighty-eight residents and 26 midwives were included. Nearly a quarter (24.6%) of participants had good knowledge about essential newborn care. Regarding knowledge level by profession, 31.8% of the residents had good knowledge of essential newborn care, and all the midwives had poor knowledge. The odds of having good knowledge of ENC were 96.3% lower for first-year residents and 90.5% lower for second-year residents as compared to year four. Untrained participants had an 84 percent lower chance of having good knowledge of essential newborn care than trained participants. Regarding practice level by profession, more than two-thirds of 68 (77.3%) residents and 21 (80.8%) midwives had sufficient skill in essential newborn care. &#x0D; Conclusion: A substantial number of healthcare providers lacked essential newborn care knowledge and practice. The availability of service or on-the-job training, as well as the year of residency, were factors influencing newborn care knowledge. In-service training, encouraging supervision, and provisions should be reinforced to improve newborn care activities.

The efficacy of postpartum tubal sterilization training program with minilaparotomy approach in Ob/Gyn residents

ObjectivesTo evaluate the efficacy of postpartum tubal sterilization training program with minilaparotomy approach (PTSMA). Study designFrom September 2020 to November 2021, 24 first-year Obstetrics and Gynecology (Ob/Gyn) residents were randomly allocated into 2 groups of traditional apprenticeship learning (watching video clip) versus apprenticeship learning plus PTSMA attending. The program consisted of didactics followed by self-practicing with 2 stations of postpartum tubal sterilization simulators (PTSS). All participants were allowed to perform their first tubal sterilization under supervision within a few days after training. Their surgical skills were blindly evaluated by 2 experts through the recorded videos. Five domains of direct observation of procedural skills (DOPS) score introduced by Royal Thai College of Obstetricians and Gynecologists were assessed. DOPS score, operative time, blood loss and post-op complication were analyzed and compared. ResultsMedian of total DOPS score in the PTSMA group was higher than the non-PTSMA group (93 vs. 73, p = 0.020). Concerning 2 domains of DOPS score (tubal fishing and tubal sterilization), the PTSMA group had the higher median score than the non-PTSMA group (36 vs. 24, p = 0.045 and 40 vs. 32, p = 0.020). There was no significant difference observed in the median score of 3 other domains (peritoneal cavity accessing, abdominal wall closure and complication prevention), estimated blood loss and operative time. ConclusionPostpartum tubal sterilization training program with minilaparotomy approach using instructive simulators significantly improved the total DOPS score especially tubal fishing and tubal ligation skills in Ob/Gyn residents. ImplicationsThe study evidently showed the benefit of PTSMA with an inexpensive and simple to prepare models. In unexperienced operators, practicing in model prior to surgery should be encouraged to improve their operative skills.

Cross-Sectional Study of Resident-Reported Surgical Experience in Female Pelvic Medicine and Reconstructive Surgery.

Comprehensive surgical training is an essential component of obstetrics and gynecology residency, yet subspecialty experience may be declining. The objective of this study was to describe trends in reported obstetrics and gynecology resident experience in female pelvic medicine and reconstructive surgery (FPMRS). This study was a retrospective analysis of national case log reports from the Accreditation Council for Graduate Medical Education (ACGME) for obstetrics and gynecology residents. From 2013 through 2019, ACGME collected data from a median of 241 programs (range, 239-242) with a median of 1,259 residents (range, 1,213-1,286) reporting annually. There was a 26% decrease in resident-reported experience with incontinence and pelvic floor procedures from 74 ± 38 in 2013 to 55 ± 34 in 2019 ( P < 0.001). Cystoscopy increased by 19% from 43 ± 25 in 2013 to 51 ± 29 in 2019 ( P < 0.001). From 2014 to 2019, vaginal hysterectomy cases decreased by 12% ( P < 0.001). There was a significant decrease in resident-reported FPMRS surgical experience from 2013 to 2019, while cystoscopy numbers increased. After laparoscopic and vaginal hysterectomies were unbundled in 2013, resident vaginal hysterectomy cases decreased from 2014 to 2019. Given that the ACGME Incontinence and Pelvic Floor designation comprises a wide range of procedures, future investigation is needed to elucidate the gaps in FPMRS-specific surgical training during residency and its implication in comprehensive resident surgical training.

Preoperative Simulation of Retropubic Midurethral Sling to Decrease Bladder Perforation Rate Among Obstetrics and Gynecology Residents.

Bladder perforation is an often avoidable complication of retropubic midurethral sling procedures. Bladder injury rates decrease with surgeon experience, but literature on techniques to train novice surgeons is limited. Our objective was to decrease the bladder perforation rate among obstetrics and gynecology residents during retropubic midurethral sling procedures through implementation of an instructional video and low-fidelity simulation. A baseline bladder perforation rate was determined by retrospective chart review. A prospective educational intervention, consisting of a 10-minute instructional video with preoperative simulation using a simple bony pelvis model, was then implemented among residents on the urogynecology service from December 2017 through March 2020. The primary outcome was the change in the bladder perforation rate. Compliance with the intervention protocol was a secondary outcome. Categorical data were evaluated using the χ 2 or Fisher exact test. Continuous variables were assessed using the Student t test or Mann-Whitney U test as appropriate. Two hundred fifteen retropubic midurethral sling cases were included in analysis. There were no significant demographic differences between the patients undergoing surgery preintervention and postintervention. Resident surgeons were in their second (47.4%) and third (52.6%) years of training. The postintervention bladder perforation rate was 6.5%, which is a 35% reduction from the preintervention perforation rate of 10% ( P = 0.19). The instructional video and preoperative simulation were successfully implemented in 193 of 215 (89.8%) eligible cases. Despite high compliance, the combination of the instructional video and preoperative low-fidelity bony pelvis simulation was not effective in reducing tension-free vaginal tape-associated bladder perforations among residents.

Effects of a structural simulation curriculum for the repair of obstetrical anal sphincter injuries.

To assess the short-term and skill-retention effects of a structural simulation curriculum for the repair of obstetrical anal sphincter injuries (OASIS). This prepost experimental study recruited 31 obstetrics and gynecology residents from Peking Union Medical College Hospital. OASIS repair skill evaluations (at all timepoints) comprised a task-specific checklist (TSC), global rating scale (GRS), and pass/fail grade. A beef-tongue model was adopted in the simulation curriculum. After baseline testing, residents completed a structured 1-h workshop. Two weeks later, a second test was performed, followed by a one-to-one teaching workshop, with the proper completion of a checklist as the end-point. Three months later, residents completed a third test. The overall pass rate at baseline was 16.1%, with higher GRS scores (p= 0.035) in senior residents. Additionally, previewing the procedure before class and a history of OASIS repair observation were associated with higher TSC and GRS scores. Significant skill improvement was observed in the second and third tests, with pass rates of 96.8% and 93.5% respectively. Both TSC and GRS scores were improved compared with baseline (p< 0.001). A structural simulation curriculum integrating deliberate practice under supervision improves OASIS repair competence and achieves satisfactory skill retention.

Assessment of the knowledge, attitudes, and perceptions of Filipino obstetrics and gynecology residents on fertility preservation: A cross-sectional study.

As primary reproductive healthcare providers, residents-in-training must be equipped with the knowledge of proven and available methods for fertility preservation. The study evaluated Filipino obstetrics and gynecology residents' current knowledge, attitudes, and perceptions about fertility preservation. A cross-sectional survey was conducted among obstetrics and gynecology residents in the Philippines. A 24-item questionnaire was distributed to the different accredited training institutions of the Philippine Obstetrical and Gynecological Society by electronic mail. Univariate descriptive statistics were reported as mean for continuous variables and frequency with percentage for categorical variables. The chi-square test was used to determine differences in responses. A total of 143 respondents from different year levels of training were enrolled in the study. Most were female trainees (88.11%) from the National Capital Region (44.76%). Most respondents agreed that discussions about childbearing intentions (99.30%) and age-related fertility decline (98.60%) should be initiated during a patient's gynecological consult. Residents were most familiar with oocyte freezing (84.62%), fertility-sparing surgeries (83.22%), and the use of GnRH agonists (80.42%) as fertility preservation techniques. Despite being most familiar with oocyte freezing, the respondents have mainly referred patients for fertility-sparing surgeries (48.95%) and the use of GnRH agonists (48.25%). There was an overall reassuring perception and attitude of obstetrics and gynecology residents on fertility preservation. A standardized curriculum with teaching-learning activities on fertility preservation may be used to improve trainees' knowledge. There was a disparity in the knowledge and actual referral or utilization of the different methods, reflecting the inaccessibility of the procedures specific to their institutions. This highlights the need to improve accessibility and offer fertility preservation as a public health service.

Social factors influence on anxiety, depression level and psychological trauma of obstetrics and gynecology residents during COVID-19 pandemic

Background and aimThe novel coronavirus disease 2019 (COVID-19) has enforced obstetrics and gynecology (ObGyn) residency training process to undergo wide changes including lessons modifications, yet their mental health were not evaluated. Hence, this study aimed to evaluate the influence of social factors on anxiety, depression level, and psychological trauma of ObGyn residents during the COVID-19 pandemic as well as the impact of COVID-19 to residency training program. MethodsA cross-sectional study was conducted in three institutions in Indonesia: the University of Indonesia, the University of Lambung Mangkurat, and the University of Syiah Kuala. A total of 169 ObGyn residents agreed to participate and were enrolled in this study. ResultsTotal 169 residents were eligible with a mean age of 26–42 years. 76.9% of the residents were exposed to COVID-19 patients during clinical rotation. Approximately half of them (52.6%) thought COVID-19 has brought negative effects. Long-distance learning was considered of good quality by 40.2% of participants. The majority experienced enough resting periods, nearly half of them (45.5%) were concerned about the impact of being a less competent specialist. ConclusionOverall, no significant statistical relationship were revealed between social factors and depression, anxiety and psychological trauma in ObGyn residents during COVID-19 pandemic.

Infertility: A Hidden Cost of Medical Training.

Infertility: A Hidden Cost of Medical Training.

Gynecologic Surgical Training: Current and Future Perspectives

Gynecologic Surgical Training: Current and Future Perspectives

Assessing burnout among Obstetrics & Gynecology residents during night float versus day float in a large academic hospital

BackgroundThe prevalence estimates of burnout among residents vary widely. Resident physicians working overnight have additional stressors and therefore, may be at higher risk of developing burnout.ObjectiveTo determine the rates of burnout among residents working night rotations versus day rotations.MethodsThis is a prospective, cross sectional, survey-based assessment of the prevalence of burnout among Obstetrics and Gynecology (OBGYN) residents on nights versus days rotations conducted at a large academic residency program that spans two separate hospitals in New York. All residents in the residency program were asked to complete the Maslach Burnout Inventory – Human Services Survey for Medical Personnel (MBI-HSS (MP)) after the first rotation of the academic year in 2018, 2019, and 2020. The results for each of the three aspects of the MBI-HSS (MP): emotional exhaustion, depersonalization, and personal accomplishment, were then compared for those on nights versus day rotations using students t-test.ResultsA total of 76 responses were received, 13 from residents on night rotations and 63 from residents on day rotations with a response rate of 61.8%. Comparing resident responses for a night versus day rotation, the residents averaged a low level of emotional exhaustion (a score of 17 ± 9) on day shift, compared to a moderate level of emotional exhaustion (a score of 18 ± 14) on nights (p = 0.37). Similarly, 55.6% of respondents reports low personal accomplishment on days, compared to 76.9% while on nights.ConclusionsEmotional exhaustion scores were lower for residents on daytime rotations (mean score 17, SD 9), compared to those on nights rotations (mean 18, SD 14). Although there was no difference in depersonalization when comparing the day and night shift, 45% of the responses indicated high levels of depersonalization regardless of the type of shift. These results highlight the need to continue efforts to minimize burnout in medical training.

Improving Resident Knowledge of Ergonomics Guidelines

(Obstet Gynecol. 2022;139:1194–1195. doi: 10.1097/AOG.0000000000004814) Surgeons often face musculoskeletal disorders resulting from the work environment. These injuries likely affect surgeons’ well-being and their ability to provide care. By educating obstetricians and gynecologists, injury prevention could prolong and enhance their careers and their patients’ experience. In honor of ACOG Wellness Week, this article outlines their efforts and the effectiveness of educating obstetrician and gynecology residents regarding individual preventative actions.

P013Abortion training preferences of applicants to obstetrics and gynecology residency programs

<h3>Objectives</h3> To assess obstetrics and gynecology (Ob-Gyn) residency applicant preferences for abortion training, perspectives on restrictive abortion legislation, and how they influence applicant decisions regarding residency program choice. <h3>Methods</h3> We surveyed US medical school applicants who applied to Rush University's Ob-Gyn residency program during the 2021–2022 application cycle. Included in the survey were demographic questions, including prior exposure to abortion in medical schools, awareness of current abortion restrictions, and questions on preferences for abortion training at an Ob-Gyn residency program. We asked if they had concerns about abortion restrictions, if this changed how they ranked a residency program and if they felt abortion restrictions will impact their training as an Ob-Gyn. Surveys were completed using RedCap and responses were anonymous. <h3>Results</h3> Of 930 applicants surveyed, 195 responded (21% response rate) who were predominantly cisgender females (92%), White (64%), and had received some education in abortion care (74%). Almost all (87%) planned to participate in abortion care, with 96% stating abortion training was a desirable trait for a program and 95% stating a program would be undesirable if it did not offer abortion training. Almost all respondents (91%) agreed that abortion training is an essential component of Ob-Gyn residency and this influenced how they rank a residency program. Only 16% of applicants agreed that they were comfortable practicing in a state that restricted abortion training. <h3>Conclusions</h3> Preferences for abortion training strongly influenced applicants' decisions regarding Ob-Gyn residency programs during the 2022 Match. Further changes to the legality of abortion at the state level are likely to impact future residency application trends.