The golden tickets: impact of preference signaling on obstetrics and gynecology residency applicants.

BACKGROUND: With the residency selection process becoming more competitive and programs receiving unprecedented numbers of applications, some specialties have introduced preference signaling in an attempt to help applicants target programs of interest. In the 2022-2023 application cycle, obstetrics and gynecology also introduced a 2-tiered system with a limited number of gold signals (n=3) and silver signals (n=15). OBJECTIVE: Given the novelty of preference signaling in the obstetrics and gynecology residency application process, this study aimed to (1) assess the effect of signals on interview offers and match and (2) discuss applicant attitudes toward this preference signaling system. STUDY DESIGN: This was a voluntary cross-sectional survey study conducted in April 2023 that was open to all fourth-year medical students who applied to an obstetrics and gynecology residency in the United States. Self-reported demographics, signaling, interview, and match data were collected. In addition, students were asked about attitudes toward signaling on a 5-point Likert scale. RESULTS: Of the 1507 applicants who entered an obstetrics and gynecology residency via match or Supplemental Offer and Acceptance Program process, 969 (64.3%) completed the survey. Moreover, an additional 22 applicants who did not match responded to the survey. More respondents used all 3 gold tokens (98.3%) and all 15 silver tokens (94.3%). The mean number of applications sent was 74.3±35.1, and the mean number of interviews received per applicant was 12.8±6.6. The interviews or token yields were 64.0%±31.5% for gold tokens, 43.8%±23.1% for silver tokens, and 9.8%±10.0% for no token. Of the survey respondents, 340/951 (35.8%) matched to a gold token program, 338/951 (35.5%) matched to a silver token program, and 244/951 (25.7%) matched to a nontoken program. Furthermore, 499/951 applicants (52.5%) reported feeling slightly positive or very positive about signaling. CONCLUSION: Most obstetrics and gynecology applicants in this survey participated in preference signaling. Gold and silver tokens were associated with high ratios of interview invitations compared with no token. However, the overall number of applications did not decrease in the 2022-2023 cycle, and only half of survey respondents reported feeling positive about the signaling process. These results can inform program directors and students about application number and strategy in upcoming cycles.

Taking the Express Lane: Student Attitudes Towards Tracking in Ob/Gyn Residency.

We sought to determine the subspecialty interests of fourth-year medical students (MS4s) matched to Ob/Gyn and evaluate their attitudes towards residency tracking. Matched MS4s completed a survey regarding subspecialization, confidence in that choice, and desire for tracking. A total of 922 MS4s completed the survey. Of these, 474 (51.4%) desired subspecialty training, but were less confident in their choice compared with those desiring generalist careers (60.0/100 vs. 64.9/100, P =0.003). Those seeking subspecialty training were more likely to desire tracking (15.2% vs. 39.5%, P <0.001). In conclusion, 51% of MS4s desired subspecialty training over generalist careers. Almost 40% of these students are interested in tracking.

COVID 19: A Cause for Pause in Undergraduate Medical Education and Catalyst for Innovation.

As the world held its breath for news surrounding COVID-19 and hunkered down amidst stay-at-home orders, medical students across the U.S. wondered if they would be called to serve on the front lines of the pandemic. Medical school administrators faced the challenge of protecting learners while also minimizing harm to their medical education. This balancing act raised critical questions in medical education as institutions reacted to changing guidelines. COVID-19 has punctuated already contentious areas of medical education and has forced institutions and organizations to take quick action. From the perspectives of a recent medical school graduate and current resident (ES) and a practicing clinician-educator (SHG), we examine the pandemic's impact on undergraduate medical education through an ethical lens. First, we explore the value of medical education, what drives this value, and how COVID-19 may alter it. We next consider student choice and how shifts toward utilitarianism in healthcare during a pandemic may affect learning and career exploration. Then, we inquire how access to technology may impact the experience of medical students from diverse backgrounds and varied institutions during a rapid shift to socially distanced learning. We identify vulnerabilities for students at several phases of the journey: premedical, preclinical, clinical, and preparation for residency. Finally, we address the hidden curriculum of COVID-19, its potential erosion of empathy among current medical students, and possible long-term consequences for future physicians and patients.

Use of In-Training Examination Scores as a Fellowship Candidate Evaluation Metric: Time for a Change.

ABSTRACT: In the field of obstetrics and gynecology (OB/GYN), the Council on Resident Education in Obstetrics and Gynecology (CREOG) administers an annual in-training examination to all OB/GYN residents as a formative educational tool for assessing medical knowledge and promoting self-improvement. Although the CREOG examination is not designed or intended for knowledge certification, many OB/GYN subspecialty fellowship programs request and use CREOG examination scores as a metric to evaluate fellowship candidates. Among the 57 gynecology-based urogynecology fellowship programs, 30 programs (53%) request CREOG examination scores to be submitted by candidates, as of March 2023. Although the use of CREOG examination scores as an evaluation metric may constitute a minor component within the fellowship match process, this practice fundamentally contradicts the intended purpose of the examination as an educational self-assessment. In addition, it introduces the potential for bias in fellowship recruitment, lacks psychometric validity in predicting specialty board examination failure, and shifts the CREOG examination from its original intention as low-stakes self-assessment into a high-stakes examination akin to a certification examination. For these reasons, we call upon the urogynecology community to prioritize the educational mission of the CREOG examination and reconsider the practice of requesting or using CREOG examination scores in the fellowship match progress.

Bridge to M4 (B2M4): An innovative residency application preparation curriculum.

BACKGROUND: The medical residency application process is daunting, time-consuming, and variable, making mentorship in preparation for this process important. In light of changes to the residency application process due to the COVID-19 pandemic, medical students identified a need to create a formal residency application preparation curriculum. The curriculum focused on reflection, while also furthering professional development and preparing for the nuances of the residency application cycle through structured advising. APPROACH: Bridge to M4 (B2M4) included reflective activities to help guide curriculum vitae (CV) refinement, personal and professional values clarification, residency program exploration, elevator pitch formation, personal statement development, mentor identification, guidance on requesting letters of recommendation, and virtual residency interview preparation. EVALUATION: The B2M4 elective first took place in June 2020 with 36 rising fourth year students enrolled. Perceived effectiveness of the curriculum was assessed by having student cohorts evaluate the importance of the CV, personal statement, general preparation, and residency program selection before and after the course. Student feedback was reviewed with content analysis, which highlighted the usefulness of a structured residency preparation course that was rooted in reflection and incorporated faculty mentorship and feedback. IMPLICATIONS: This student-driven, innovative curricular design provided students the opportunity to prepare for the residency application process through reflective activities including values clarification, strengths identification, and goal setting. B2M4 demonstrates a process that can be used not only during the Residency Match process, but also throughout graduate medical education and future career decisions.

Volume, Distribution, and Inequities by Race and Gender of Clinical Experiences Reported by Medical Students Entering Obstetrics and Gynecology Residencies.

OBJECTIVE: To assess for inequities by race and gender of fourth year medical students' (MS4s) self-reported clinical experience in obstetrics and gynecology (Ob/Gyn). DESIGN: This was a voluntary, cross-sectional survey. Participants provided demographic data, information regarding their preparation for residency, and self-reported numbers of hands-on clinical experiences. Responses were compared across demographic categories to assess for disparity in pre-residency experiences. SETTING: The survey was open to all MS4s matched to Ob/Gyn internships in the United States in 2021. PARTICIPANTS: The survey was distributed primarily via social media. Eligibility was verified by participants supplying the names of their medical school of origin and their matched residency program prior to completing the survey. 1057/1469 (71.9%) MS4s entering Ob/Gyn residencies participated. Respondent characteristics were not different from nationally available data. RESULTS: Median clinical experience numbers were calculated for hysterectomies (10; IQR 5-20), suturing opportunities (15; IQR 8-30), and vaginal deliveries (5.5; IQR 2-12). Non-White students had fewer hands-on experiences with hysterectomy, suturing, and cumulative clinical experiences when compared to White MS4s (p values <0.001). Female students had fewer hands-on experiences with hysterectomies (p < 0.04), vaginal delivery (p < 0.03), and cumulative experiences (p < 0.002) than male students. When assessed by quartiles, non-White students and female students were less likely to be in the top quartile for experience and more likely to be in the bottom quartile for experience than their White and male counterparts, respectively. CONCLUSIONS: A significant number of medical students entering Ob/Gyn residency have minimal hands-on clinical experience with foundational procedures. Additionally, there are racial and gender disparities in clinical experiences of MS4s matching to Ob/Gyn internships. Future work should identify how biases in medical education may affect the access to clinical experience in medical school, and potential interventions to mitigate inequities in procedures and confidence prior to residency.

The #ObGynInternChallenge: Reach, Adoption, Implementation, and Effectiveness of a Microlearning SMS-Distributed Curriculum.

PROBLEM: While many medical schools have implemented bootcamps or specialized curricula to prepare medical students for residency, these programs are neither universal nor consistent in their content. APPROACH: The authors created an electronic, multimodal, short messaging service (SMS)-distributed curriculum, called the #ObGynInternChallenge, to improve learners' medical knowledge, based on the Council on Resident Education in Obstetrics and Gynecology educational objectives. The curriculum was open to all fourth-year medical students who matched into obstetrics and gynecology (Ob/Gyn). Daily messages were delivered to participants' mobile devices via SMS for 25 consecutive weekdays, May 3-June 4, 2021. Each day's message included an introduction with key facts, an infographic, a website link with a podcast and additional reference materials, and at least one question. The authors assessed its reach, adoption, implementation, and effectiveness. OUTCOMES: For reach and adoption, total enrollment for the curriculum was 1,057 (72.0%) of 1,469 filled Ob/Gyn residency positions in the 2021 Match. The total cost of the intervention was $2,503.20 or $2.37 per participant. For implementation, all participants who signed up for the course received the daily messages, and 858/1,057 (81.2%) completed the course. Participants felt the curriculum was an excellent resource for studying (391/426, 91.8%) and the course was enjoyable to use (395/424, 93.2%). For effectiveness, mean score improvement was 11.6% (pre-test: 62.4%, post-test: 74.0%; P < .001). In the multivariate linear regression analysis, high podcast ( P = .02) and website use ( P = .002) were associated with greater score improvement. High social media use was associated with less improvement ( P = .02). NEXT STEPS: This study suggests promise for a low-cost, largely satisfying SMS-distributed curriculum in terms of offering some benefit for short-term knowledge gain. Next steps include expanding such a curriculum to meet standard learning objectives for all fourth-year medical students entering residency.

Does the Degree Matter? MD and DO Students Who Match Into OB/GYN Report Different Experiences in US Undergraduate Medical Education.

Background: Although allopathic (MD) and osteopathic (DO) students have similar curricular requirements, little is known about differences in MD and DO preparedness for obstetrics and gynecology (OB/GYN) residency. Objective: To assess differences in experiences and confidence of MD vs DO students who matched to OB/GYN. Methods: This cross-sectional survey study was open to all fourth-year medical students who matched to OB/GYN in the United States in April 2021. The survey included demographic data, clinical experiences, confidence (5-point sliding scale), and a 11-item knowledge test. Survey responses were compared to assess for disparities in experiences and confidence. Results: Survey response rate was 72.0% (1057 of 1469) students matched to OB/GYN postgraduate year 1 positions. Of the 871 MD and 175 DO responding students, MDs were more likely to have clerkships ≥6 weeks (78.1% vs 15.4%; P<.001) and a home sub-internship (92.0% vs 53.4%; P<.001). DOs reported more hands-on experiences with procedures (MD median=35 [20-35] vs DO median=40 [25-65]; P=.002). There was no difference in self-reported confidence in knowledge, technical skills, or having a realistic sense of internship, and no difference in baseline knowledge test scores. DOs felt less confident about their medical school preparation (aOR 0.40; 95% CI 0.25-0.66; P<.001) and were more likely to perceive inequity of residency preparation (aOR 1.88; 95% CI 1.18-3.00; P=.002). Conclusions: MD students matched to US OB/GYN residency programs reported longer clerkship and more home sub-internships, while DO students reported more hands-on experiences. Despite reporting similar confidence in knowledge and skills, DO students felt less prepared for internship.

A Cross-sectional Pilot Cohort Study Comparing Standard Urine Collection to the Peezy Midstream Device for Research Studies Involving Women.

OBJECTIVES: The expanded quantitative urine culture protocol was used to compare the microbial abundance and diversity of voided urines obtained using a standard urine collection or using the Peezy midstream device versus paired periurethral specimens. METHODS: Sixty-two female participants were assigned to 1 of 3 cohorts. One cohort used a standard clean catch midstream urine protocol that included a castile soap wipe, the second cohort used a Peezy midstream collection device with castile soap wipe and the third used the Peezy device without a castile soap wipe. Each participant watched a video that detailed the collection method. Before using the castile soap wipe, a periurethral swab was obtained to measure periurethral microbial abundance. Demographics and pelvic floor symptoms were assessed by validated questionnaires. Microbes were detected using expanded quantitative urine culture. Diversity within each sample was analyzed using alpha diversity measures. RESULTS: Paired periurethral and urine samples for each woman were analyzed and compared for species abundance, richness, and diversity. Bacterial profiles of Peezy-collected urines differed significantly by multiple diversity indices and had significantly reduced colony-forming units compared to paired periurethral swabs. In contrast, within the standard clean catch cohort, voided urine had higher abundance and richness than paired periurethral swabs. CONCLUSIONS: Compared with standard clean catch method, the Peezy urine collection device with and without the castile soap wipe resulted in urine with lower bacterial abundance that was distinct from the periurethra. Voided urine collected by Peezy may reduce postbladder microbial contribution.

How Should a Physician Counsel a Vegan Patient With IBD Who Might Benefit From Supplements?

Veganism has grown in popularity in recent years. We argue that physicians should share the best available evidence on the efficacy of such diets while respectfully trying to understand the perspectives of patients who choose vegan diets. The first section establishes the need for physicians to understand reasons behind patients' dietary and health preferences. The second section considers evidence, or lack thereof, for nutritional supplementation in special populations, such as those practicing veganism.