Residents In Obstetrics Research Articles

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.

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.

The Role of Simulation Technologies in Ob/Gynecologist Training

To date cardinal transformations have been outlined in the field of medical education and the practice of providing medical care to the population, associated with increased attention on the part of society and the state to the quality of life and the level of people's health, as well as the quality of medical care. Modern research in the field of obstetric and gynecological care shows that traditional methods of training specialists in this area have gradually lost their relevance and effectiveness. This is due both to the development of science, discoveries in the field of modern medicine, and to the increased requirements for the level of professional training of medical personnel and the quality of assistance to the population. In the field of obstetric and gynecological practice, issues of practical diagnostics, interpretation of examination results, appointment of adequate treatment and further support of patients are of paramount importance. In addition, modern technologies of obstetrics and gynecological surgery require mastering in practice the skills of performing obstetric and gynecological manipulations. In this connection, there is a need to change the methodology for training doctors in this area. A special role in the development of all labor activities in the field of professional qualification “obstetrician-gynecologist” is acquired by simulation technologies based on modeling the situation of a real patient reception using dummies, simulators, virtual models, etc. As part of the research work, we assessed the readiness to perform and the level of basic practical skills (according to the passports of stations in the specialty, 2020) of 25 obstetricians and gynecologists (experimental group) with 5 years of work experience in the specialty, who came to the improvement cycle at the Federal Accreditation Center of Novosibirsk State Medical University for a simulation cycle. The control group consisted of 25 doctors who successfully completed their residency in obstetrics and gynecology and passed the primary specialized accreditation in the specialty.

Vaginal delivery of the second twin: A simulation program for residents in obstetrics and gynecology in a type III university maternity hospital

ObjectiveTo implement a vaginal delivery of the second twin simulation program for obstetric and gynecology residents, to reduce maternal-fetal mortality in the management of twin pregnancies in the delivery room. DesignA prospective education program. The session consisted of a theoretical part, a practical part on a mannequin and an evaluation. The model was designed in a simple and reproducible way. The simulation evaluation was done at several levels according to the validated Kirkpatrick model. SettingA tertiary level university maternity hospital. ParticipantsTen obstetric and gynecology residents participated. ResultsThe resident's personal feelings about their ability to perform the maneuvers increased significantly after participation in the simulation session. Their technical skills in performing the maneuvers were assessed in a second step. The majority of the participants considered the model realistic and the session useful. All agreed that the simulation was an essential part of their learning process. ConclusionA simulated vaginal delivery of the second twin session allows residents to be safely trained in these obstetrical maneuvers, which can be difficult to teach and perform.

Editorial introduction.

Current Opinion in Obstetrics and Gynecology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of obstetrics and gynecology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITOR Emre SeliEmre SeliEmre Seli, MD, is Professor of Obstetrics, Gynecology, and Reproductive Sciences at Yale School of Medicine, USA. Dr Seli received his medical degree from the University of Istanbul, Turkey, and completed his residency in obstetrics and gynecology at Yale University. His postdoctoral training included a fellowship in reproductive endocrinology and infertility as well as a research fellowship in molecular biology, both at Yale University. The primary focus of his research program is to understand and treat infertility. His laboratory characterized mechanisms regulating translational activation of gene expression in the oocyte. Dr Seli and his colleagues also made seminal contributions to our understanding of oocyte and embryo competence in IVF and the potential role of non-invasive diagnostic technologies in this context. Dr Seli is the recipient of many National Institutes of Health (NIH) and pharmaceutical industry-sponsored research grants. He has trained more than 50 pre- and post-doctoral fellows, published more than 100 scientific articles, and received numerous research awards, including the Ira and Ester Rosenwaks New Investigator Award from the American Society for Reproductive Medicine (ASRM), and the President's Achievement Award from the Society for Reproductive Investigation (SRI). Dr Seli's current research focuses on determinants of oocyte and embryo health, and mechanisms of ovarian ageing. Dr Seli is actively involved in professional societies and scientific journals. He served as the Program Director for SRI in 2016, where he is now the Program Committee Chair (2016–2021). He has also been a member of the ASRM Research Committee for the past five years, and served as a member of the SSR Program Committee, where he organized the Ovarian Workshop in 2016 and 2018. He is the Associate Editor for Molecular Human Reproduction, Reproductive Sciences, Journal of Assisted Reproduction and Genetics, and Reproductive Biomedicine Online, and is currently co-editor of Current Opinion in Obstetrics and Gynecology. As an educator, Dr Seli delivered more than 150 invited lectures nationally and internationally, and he is the recipient of the Association of Professors of Gynecology and Obstetrics (APGO) Excellence in Teaching Award based on evaluations of his lectures by Yale Medical Students. Dr Seli edited four books (Non-invasive Management of Gynecologic Disorders, Infertility, Fertility Preservation, and Human Gametes and Pre-implantation Embryos: Assessment and Diagnosis) and is currently co-authoring the 9th edition of the Speroff's Clinical Gynecologic Endocrinology and Infertility. Juan Antonio García VelascoJuan Antonio García VelascoProfessor Juan Antonio García Velasco is Director of IVI RMA-Madrid, Spain. He gained his degree in medicine at Complutense University, Spain, in 1990, before going on to train as a specialist in obstetrics and gynecology at La Paz Hospital, Spain, between 1992 and 1995. Professor García Velasco gained his PhD in medicine and surgery at Autónoma University, Spain, in 1995. He then became a sub-specialist in reproductive endocrinology and infertility at Yale University, USA, in 1998. Professor García Velasco has published 122 scientific articles in impact journals along with 22 chapters and four books. He is the Principal Investigator of projects funded by the Ministry of Education and the Ministry of Health. He is the Co-Editor of Reproductive Biomedicine Online (RBMO) and a member of the Editorial Committee of Fertility & Sterility (ASRM), Society for Gynecologic Investigation (SGI), European Society of Human Reproduction and Embryology (ESHRE), Spanish Society of Obstetrics (SEGO) and Gynecology and Spanish Society of Fertility (SEF).

The Effect of an Educational Intervention on Obstetrics and Gynecology Residents’ Postpartum Depression Knowledge [A45

INTRODUCTION: Up to 15% of women experience postpartum depression (PPD), and maternal suicide is a leading cause of maternal mortality. Obstetrician-gynecologists (ob-gyns) are intimately involved in postpartum care of women and are in a position to help diagnose and manage PPD. Council on Resident Education in Obstetrics and Gynecology (CREOG) learning objectives include goals for residents to diagnose and perform initial management of postpartum complications such as PPD. The objective of this study was to assess if a psychiatry educational intervention (pre-recorded didactic lecture and facilitated discussion) would improve ob-gyn residents’ knowledge and comfort level in diagnosing and managing PPD. METHODS: We performed an educational intervention study including ob-gyn residents at an academic training program. A pre-lecture survey/test was sent to residents. A prerecorded psychiatric didactic session was sent to residents. Participants were instructed to complete the post-lecture survey/test. A facilitated discussion via Zoom at which time presubmitted questions were reviewed and discussed with a psychiatrist was performed. A postdiscussion survey was then sent out. RESULTS: Before the intervention, 32% of residents agreed/strongly agreed that they felt comfortable diagnosing PPD; after the intervention, this increased to 81% of residents. Before the intervention, 25% of residents agreed/strongly agreed that they felt comfortable treating PPD; after the lecture/discussion this increased to 69% of residents. The difference in pre and post test scores was significantly improved (POST-PRE difference of 2.6 with a 95% CI of 1.8-3.5, P<.0001). CONCLUSION: This study helps show the importance of interdisciplinary didactics and interactive learning sessions which can help improve ob-gyn residents’ knowledge and comfort level in diagnosing/managing PPD in patients.

Tagged: The Use of Social Media in the Recruitment of Obstetrics and Gynecology Residents, Pre- and Post-pandemic [A62

INTRODUCTION: As the residency application process adapts, social media may provide insight to the community behind a residency program. No studies have assessed applicant’s perception of the utility of social media as a tool during the pursuit for their match into obstetrics and gynecology residency. METHODS: Applicants who interviewed at a single academic institution during the 2019-2020 and 2020-2021 interview seasons completed an anonymous online survey. Responses were analyzed using chi-squared and Mann-Whitney statistical analysis. RESULTS: The survey response rate was 64.6% (n=45) of 65 applicants in 2019 and 80% (n=48) of 60 applicants in 2020 who interviewed at this institution. All applicants reported using some type of social media, with Facebook and Instagram being the most utilized. Social media was used to learn about residency programs significantly more in 2020 (P=.001). Applicants used social media significantly more to look up programs prior to applying/interviewing at that institution in 2020 (P=.000). Applicant perception of a program was felt to be significantly impacted by social media presence in 36% (n=15) of those surveyed in 2019, compared to 60% (n=29) in 2020 (P=.031). Significantly more applicants felt that a residency program social media presence was an important recruitment strategy in 2020 compared to 2019 (P=.006). The virtual match increased applicant uses of social media in the application process in 80% of respondents (n=38). CONCLUSION: Social media is a novel and essential tool for residency programs to showcase their culture. Our study highlights the utility of social media for resident applicant recruitment in the ever changing post-pandemic application milieu.

The Impact of X-Waiver Training Within Obstetrics and Gynecology Residency Programs on Improving Access to Medication-Assisted Treatment in Pregnancy [A51

INTRODUCTION: The opioid epidemic is a crisis within the country, with 136 Americans dying daily from opioid overdose. One of the hardest hit areas is the Appalachian region. Despite medication-assisted treatment (MAT) with methadone or buprenorphine being considered standard of care, studies find that pregnant women in this region face significant barriers to receiving this lifesaving treatment from both insurers and providers. While the number of providers in the country with X-waivers has increased dramatically, the availability of providers willing to prescribe in pregnancy is disproportionate to the severity of the epidemic. METHODS: We surveyed 91 obstetrics and gynecology residency programs within Appalachian states to assess if X-waiver training was a part of their residency training. We then collected the geographic locations of program graduates from 2016 to 2021 to assess the impact that this training could have provided to the region. RESULTS: Despite working in regions disproportionately impacted by the opioid epidemic, the majority of obstetrics and gynecology residency programs do not provide X-waiver training to their residents. Many residents who train in residency programs located in the Appalachian regions work/have worked in the region after graduation. Our results will be displayed graphically along with mapping illustrations. CONCLUSION: Residents of the Appalachian region face barriers accessing adequate health care. This disparity is more prevalent among pregnant women. Coordinated efforts by obstetrics and gynecology residency programs to allow access to X-waiver licensure among residents in training could make a significant impact by improving access to MAT among pregnant women and lead to improved maternal and fetal outcomes.

The Effects of the United States Medical Licensing Examination STEP 1 Pass/Fail Scoring Change for Obstetrics and Gynecology Residency Applicants [A58

INTRODUCTION: The National Board of Medical Examiners (NBME) recently approved the transition of the United States Medical Licensing Examination (USMLE) STEP 1 exam from a three-digit numeric scoring to a pass/fail format, effective January 26, 2022. The change will ideally result in a more holistic review of residency applicants, but the realized impacts remain to be seen. We aimed to examine the implications of the scoring change on future obstetrics and gynecology residency applicants. METHODS: Surveys were distributed to obstetrics and gynecology residency program directors (PD) for all 291 Accreditation Council for Graduate Medical Education-accredited residency programs. The survey assessed their viewpoints about the STEP 1 exam and asked respondents to rank the importance of variables used in assessment of potential applicants before and after the change to pass/fail. The survey was approved by the University of Alabama at Birmingham Institutional Review Board. RESULTS: We received 70 responses (response rate=24.0%). While most (60%) PDs believe that STEP 1 scores do not accurately predict a resident’s clinical performance, the majority (68.6%) disagreed that students will be better prepared clinically following the change to pass/fail. Clerkship grades were ranked as the most important variable in evaluating applicants both before and after the transition to pass/fail. Number of abstracts/presentations/publications and volunteer experiences saw the greatest increases in rank of importance with pass/fail as opposed to before. CONCLUSION: Despite the shortcomings of the STEP 1 exam in predicting clinical performance and the opportunity for more holistic review, obstetrics and gynecology PDs are skeptical of a transition to pass/fail scoring. The change will necessitate that alternative variables play a greater role in evaluation of residency applicants.

A survey of specialty choice among obstetrics and gynecology residents in Japan, Korea, and Taiwan.

The percentage of medicine graduates opting for residency in obstetrics and gynecology (OB/GYN) has been decreasing in developed countries, including in Taiwan, Japan, and Korea. This multicountry study surveyed the OB/GYN residents affiliated with the Taiwan Association of Obstetrics and Gynecology (TAOG), the Japanese Society of Obstetrics and Gynecology (JSOG), and the Korean Society of Obstetrics and Gynecology (KSOG) to evaluate the factors affecting the choice of pursing OB/GYN. A 17-item questionnaire surveying the factors influencing the choice of pursuing a major medical specialty was translated into Japanese, Korean, and Chinese and administered to postgraduate OB/GYN residents between July 1, 2020, and August 31, 2020. Data on the participants' sex, age, and level of residency were collected. Responses were compared between countries and sexes. Residents of all three countries chose OB/GYN based on personal interest, and a sense of accomplishment in saving people's life. Other positive factors include improved quality of life; higher salaries; and more opportunity for new techniques, research, and promotion. The negative factors included medical litigations, longer work hours, and unsafe working environments. Korean residents had lower ratings in several items, including "support from family," "safety of working environment," and "effectiveness of the alternative dispute resolution system," which, unlike Japan and Taiwan, is not a no-fault compensation system for childbirth accidents. The study findings can guide strategy making, such as decreasing workload and yet maintain training quality, to increase the number of medical students pursuing OB/GYN residency.

Development and implementation of a comprehensive postgraduate ultrasound curriculum for residents in obstetrics and gynecology: a feasibility study

BackgroundIn obstetric and gynecological practice, ultrasound is the essential diagnostic tool. Nevertheless, few clinics have standardized and structured training curricula for young obstetricians in the field of obstetric and gynecological ultrasound. Since ultrasound is best learned hands-on in small supervised groups, we developed and implemented a comprehensive ultrasound curriculum for all postgraduate residents of our department using a peer-teaching concept.MethodsWe used Kern‘s six-step model of curricular development comprising (1) problem identification and general needs assessment, (2) needs assessment of the targeted learners, (3) goals and objectives, (4) educational strategies, (5) implementation, and (6) evaluation and feedback.ResultsAssistant physicians in the 1st and 2nd year of training received a theoretical and practical ultrasound basic course (six modules) in addition to their obligatory clinic rotations. The six main topics were prioritized according to service relevance and included the main features according to DEGUM, EBCOG and ISUOG. The units focused on a three-level training based on the AMEE levels: theoretical knowledge, well-founded theoretical knowledge and basic practical skills under guidance and self-employment of practical skills.ConclusionStructured and standardized sonographic training allows young gynecology and obstetrics residents to conceptually grasp and practically implement topic-related themes. Furthermore, the course concept demonstrates the high inter-rater agreement among DEGUM-certified examiners. More research is needed to analyze the learning outcomes for residents and the improvement of the patient's outcome by establishing such an ultrasound curriculum.

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

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

It was tough, but necessary. Organizational changes in a community based maternity care system during the first wave of the COVID-19 pandemic: A qualitative analysis in the Netherlands.

The Coronavirus SARS-CoV-2pandemic necessitated several changes in maternity care. We investigated maternity care providers' opinions on the positive and negative effects of these changes and on potential areas of improvement for future maternity care both in times of crisis and in regular maternity care. We conducted nineteen semi-structured in-depth interviews with obstetricians, obstetric residents, community-based and hospital-based midwives and obstetric nurses. The interviews were thematically analysed using inductive Thematic analysis. Five themes were generated: '(Dis)proportionate measures', 'A significant impact of COVID-19', 'Differing views on inter-provider cooperation', 'Reluctance to seek help' and 'Lessons learnt'. The Central Organizing Concept was: 'It was tough but necessary'. The majority of participants were positive about most of the measures that were taken and about their proportionality. These measures had a significant impact on maternity care providers, both mentally and on an organizational level. Most hospital-based care providers were positive about professional cooperation and communication, but some community-based midwives indicated that the cooperation between different midwifery care practices was suboptimal. Negative effects mentioned were a higher threshold for women to seek care, less partner involvement and perceived more fear among women and their partners, especially around birth. The most significant positive effect mentioned was increased use of eHealth tools. Recommendations for future care were to consider the necessity of prenatal and postnatal care more critically, to replace some face-to-face visits with eHealth and to provide more individualised care. Maternity care providers experienced measures and organizational changes during the first wave of the COVID19-pandemic as tough, but necessary. They believed that a more critical consideration of medically necessary care, increased use of e-health and more individualised care might contribute to making maternity care more sustainable during and after the pandemic.

Community-Institutional Partnerships to Strengthen Maternal Health Care: Case Study of the First Obstetrics and Gynecology Specialty Training Program in Liberia.

Despite major setbacks to its health infrastructure and health workforce capacity, Liberia began its first post-graduate training program for physicians in 2013. Specialty training in Internal Medicine, Pediatrics, General Surgery and Obstetrics and Gynecology were the four inaugural Residency programs that recruited graduates from the country's only medical school, A.M. Dogliotti College of Medicine. The Obstetrics and Gynecology residency program was designed to combat the rising maternal mortality and strengthen health systems to improve maternal care. The program adapted in the face of challenges posed by limited financial support, lack of specialist-faculty and general physician shortages and the Ebola virus outbreak. The manuscript discusses the challenges and successes of the program and demonstrates how the shortage of teaching faculty was addressed by developing a collaboration between local government and educational communities, a United States (US) academic institution and volunteers from the Global Health Service Partnership.

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

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

Burden of Women's Infectious Disease and Analysis of Current Awareness and Value Perceived of the Obstetrical and Gynecological Specialty

Aim: Given the relevance of irresistible infections to the wellbeing of women, we intended to evaluate the current attentiveness, interest and relevance of the unresisted obstetrical and gynecological infection among the residents and residents of contemporary obstetrics and gynecology. Methods: Two independent assessments which deal with attention, appreciation. Sub-specialty premiums were also sent out to (1) an irregular 22 percent sample of residents in obstetrics and gynecology and (2) all Gynecology obstetrics mailed out. Results: More than two-thirds of the chief students in the scientific section were aware of the specialty and 68,2% respected compelling disease experts. About a third of the employees were attentive to the specialization. The formal training of clinical specialists in the field of intractable diseases was reported by thirty-six percent of chief residents. Conclusion: Pakistani obstetrics and residents of gynecology and leaders have little knowledge of the sub-specialty. There is an open specialty to formal instruction by practitioners skilled in the field for residents in irresistibly infected object ology and gynecology. These findings may lead to continuous enrollment efforts in obstetrical and gynecology sub-specialties of irresistible diseases. Keywords: Women's Infectious Disease, Obstetrical and Gynecological Specialty, Pakistani Population.

Cutting Women: Unnecessary cesareans as iatrogenesis and obstetric violence

This article deepens the current understanding of the sources of obstetric violence and iatrogenesis through an analysis of cesareans. The data are drawn from ethnographic research in 2018 at a public maternity hospital in Mexico. Data collection methods included observation, semi-structured interviews, and free lists with 12 senior obstetrics residents. Analysis of the data revealed that: (1) doctors used perceptions of high risk to justify their use of cesareans even when not clearly medically indicated; (2) doctors responded to scarcities of time and resources in the system by viewing cesareans as a less than ideal but acceptable solution; and (3) doctors practiced medicine defensively as a way to control their fear of risk and to pre-empt legal consequences from patients’ demands. The discussion suggests that the relative ease of cesareans and the benefit they provided the doctor and medical system rather than the patient constituted forms of obstetric violence and iatrogenesis. These often arise as a consequence of either too much intervention or not enough in situations in which providers seized on unclear or presumed indications as pretexts to perform cesareans that were not clearly medically indicated.

Effect of Sleep Deprivation on Mood States of Junior Residents in Obstetrics and Gynaecology Department: A Prospective Observational Study

Introduction: Junior residents of highly demanding clinical specialties, like, Obstetrics and Gynaecology, are an integral part in the functioning of hospitals. They work round the clock donning the role of caregiver as well as learner and are in a constant state of stress. Any alteration in mood while working in intensive set ups like labor room and operation theatre can adversely affect not only the physician’s performance but also patient safety. Aim: To evaluate the effect of sleep deprivation on mood states of junior residents in Obstetrics and Gynaecology Department during call duty. Materials and Methods: This prospective observational study was conducted in Department of Obstetrics and Gynaecology at Armed Forces Medical College (tertiary care hospital), Pune, Maharashtra, India, from march 2019 to august 2019. The study included 37 junior residents of Obstetrics and Gynaecology Department, between age range of 25-40 years. Sleep diary was used to record resident’s sleep patterns, Karolinska Sleepiness Scale (KSS) was used to assess the day time sleepiness. Profile of Mood States (POMS) score was calculated during pre-call and post-call duty. This data was used to ascertain any changes in mood post-call due to sleep deprivation. Statistical analysis was done using paired Student’s t-test and Wilcoxon Signed Rank test and p-value <0.05 was considered as significant. Results: Out of 37 participants, 21 were males and 16 females. There was a significant worsening of post-call POMS score (5.24±27.82) from pre-call score (-6.86±23.70) following call duty associated with a decrease in mean night time sleep (p-value<0.001). Likewise increased KSS score was also noted after call duty (pre-call score was 3.03±1.65 vs post-call score was 5.73±2.05; p-value<0.001). This signifies that mood states are adversely affected by sleep deprivation in these residents. Conclusion: The study showed that there was a significant worsening of mood states due to sleep deprivation during call duties. This also mandates review of efficacy and feasibility of current policy regulating work hour schedule of junior residents in India.

The blame game- experiences of female residents in obstetrics & gynecology regarding lapses in patient safety.

Objectives:Primary objective was to explore experiences of female residents of Obstetrics and Gynecology (OB/GYN) regarding lapses in patient safety (PS) while secondary objective was to explore factors hampering or favouring improvement of PS in OB/GYN.Methods:In this qualitative narrative study carried out in OB/GYN department of Combined Military Hospital (CMH) Lahore for six months from 1st April to 30th September 2021, six fourth-year residents were asked to write narratives of their personal experiences of medical error (witnessed or committed) in detail and reflect on those experiences, which were then transcribed. Code labels and themes were assigned manually. Interpretation of these themes was done after thematic content analysis.Results:Six, fourth-year female residents with a mean age of 28.6±1.8 participated in the study. Two main themes with sub-themes were identified: 1) Challenges in patient safety (Personal challenges, Workplace challenges, Barriers to PS), 2) Lessons learnt from experiences (Self-improvement and; Promotion of patient safety culture). Heavy workload with long working hours, lack of communication and teamwork, lack of experience and inadequate supervision were major factors involved in PS lapses experienced by residents.Conclusion:Incidents of Patient Safety (PS) lapses had a strong impact on the emotional and professional life of residents. Formal PS training with improvement of working conditions may help promote PS culture.

Mentalization-Based Treatment for a Physician With Borderline Personality Disorder.

Mentalization-Based Treatment for a Physician With Borderline Personality Disorder.