Education in Female Sexual Function and Dysfunction among American Urogynecologic Society Members: An Unmet Need.

OBJECTIVES: Sexual function is an important component of women's health that has not been traditionally emphasized during medical training, suggesting that further education is needed to provide comprehensive patient care. The purpose of this study was to describe education and interest in female sexual function among urogynecology providers. METHODS: Conducted in 2020, this was a cross-sectional survey of American Urogynecologic Society members assessing educational and clinical experience with female sexual function. RESULTS: Of 642 members who opened the survey, 123 (19%) completed it. Most of the respondents were fellowship trained (70%), and 74% reported ≥10% of their patients had sexual function questions or concerns unrelated to prolapse or incontinence. Most (71%) of the members strongly agreed/agreed that they were comfortable evaluating and managing these patients. This was more common in providers who saw more patients (≥25%) with sexual function concerns (83%) compared with those who saw <25% (65%; P = 0.04). Most of the respondents reported receiving ≤1 lecture on normal sexual function (82%) or sexual dysfunction (85%) during medical training. Most (67%) would expand their practice if they received additional education. The most requested topics were disorders of desire (72%), orgasm (71%), and arousal (67%). The most common reasons for not expanding practice even with additional education were female sexual function not being of significant interest (30%) and time and interruption of practice flow (28%). CONCLUSIONS: Most of the respondents felt comfortable caring for patients with sexual function concerns, but reported that they would expand their practice with additional education. The majority reported having received ≤1 female sexual function/dysfunction lecture during their medical training. This highlights a critical need and desire for more female sexual function education among the urogynecologic provider population.

Pelvic Exam Laws in the United States: A Systematic Review.

Laws regulating patient care are an essential component of protecting patients and doctors alike. No studies have previously examined what laws exist regarding pelvic examinations in the United States (US). This study systematically reviews and compares regulation and legislation of pelvic examinations in the U.S. and provides a comprehensive resource to educate clinicians, patients, and lawmakers. Each of the fifty States in the U.S. was included. The primary outcome was existence of any pelvic or rectal exam laws. Data was obtained for the type of examination defined within the law, exceptions to the law, to whom the law applied to, the type of consent required, and to whom the consent applied to. Laws were identified from each of the individual state legislative websites. All sections of each law pertaining to pelvic examination were reviewed and organized by state. Descriptive statistics were performed for each of the variables, including frequencies of each amongst the fifty states. State regulation for pelvic examinations varied from no law or regulation to laws pertaining to pelvic, rectal, prostate, and breast examination performed in any context. As of November 22, 2022, there are twenty states (40%) with pelvic examination laws applying to anesthetized or unconscious patients. Thirteen additional states (26%) have proposed pelvic exam laws. Seventeen states (34%) do not have any laws regarding pelvic examinations. Regulation of pelvic examinations has become an increasingly important issue over the past few years in response to growing concerns of patient autonomy and the ethical issues raised by such sensitive examinations. While pelvic examination laws that balance protection for patient autonomy and the needs of caregivers and educators exist in much of the U.S., more work needs to continue in consultation with physicians and health care providers to ensure that all states have reasonable laws protecting the autonomy of patients while also maintaining quality of care.

Use of Fundamentals of Laparoscopic Surgery Testing to Assess Gynecologic Surgeons: A Retrospective Cohort Study of 10-Years Experience.

STUDY OBJECTIVE: To compare the Fundamentals of Laparoscopic Surgery (FLS) exam scores between obstetrics and gynecology (OBGYN) and general surgery (GS) providers. DESIGN: This is a retrospective cohort study at a single institution from July 2007 to May 2018. Categorical and continuous variables were analyzed with χ2 test, t test, and Wilcoxon rank sum test. SETTING: Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, a tertiary care academic medical center. PATIENTS: All providers who took the FLS exam at the Carl J. Shapiro Simulation and Skills Center at BIDMC. INTERVENTIONS: FLS certification. MEASUREMENTS AND MAIN RESULTS: A total of 205 BIDMC trainees and faculty took the FLS exam between July 2007 and May 2018, of which 176 were identified to be OBGYN or GS providers. The FLS certification pass rate was high for both specialties (97.0% OBGYN vs 96.1% sGS, p = .76). When comparing all providers, no significant difference was found in the mean manual skill test scores between surgical specialties (594.9 OBGYN vs 601.0 GS, p = .59); whereas, a significant difference was noted in the mean cognitive scores, with GS providers scoring higher than OBGYN providers (533.8 OBGYN vs 583.4 GS, p <.001). However, when adjusting for several variables in a multivariate linear regression model, surgical specialty was not a predictor for cognitive scores. In the multivariate analysis, age, sex, and test year were predictors for cognitive scores, with higher scores associated with younger age, male sex, and advancing calendar year. None of the variables were significant predictors of manual scores. CONCLUSION: Both OBGYN and GS providers had extremely high FLS pass rates. In the multivariate analysis, surgical specialty was not a predictor for higher FLS test scores for either manual or cognitive test scores. Although OBGYN residency programs offer fewer years of training, OBGYN trainees demonstrate the capacity to perform well on the FLS exam.

Hiding in Plain Sight: Resident Remediation in Obstetrics and Gynecology.

OBJECTIVE: Residents who are in need of remediation are prevalent across residency programs and often tend to be deficient in multiple competencies that the American Council for Graduate Medical Education (ACGME) has established. The purpose of this study was to determine the prevalence of residents requiring remediation, understand the scope of the challenges in resident remediation, and assess what resources were used to aid in remediation in obstetrics and gynecology programs. DESIGN: An anonymous survey was emailed to obstetrics and gynecology program directors. Survey responses were summarized through descriptive statistics. SETTING: Obstetrics and gynecology residency program directors were invited to respond to this survey. PARTICIPANTS: Thirty-nine respondents out of 241 residency training programs responded (16%). RESULTS: The majority (84.6%) of programs had placed a resident on remediation. The most common area requiring remediation was professionalism (75.8%), followed by medical knowledge (72.7%), interpersonal communication (60.6%), laparoscopic technical skills (54.6%), and inpatient care (42.4%). Residents who required remediation were identified in a number of ways, most commonly through feedback from the Clinical Competency Committee (87.8%) and faculty feedback (84.8%). Program directors utilized a variety of resources, most commonly prior remediation plans from the program, to create remediation plans. Sixty percent of programs had residents who failed remediation. CONCLUSION: This study highlighted the prevalence of resident remediation in obstetrics and gynecology training programs and the importance of faculty in identifying residents in need of remediation, evaluating residents, and mentoring residents.

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

IMPORTANCE: Comprehensive surgical training is an essential component of obstetrics and gynecology residency, yet subspecialty experience may be declining. OBJECTIVE: The objective of this study was to describe trends in reported obstetrics and gynecology resident experience in female pelvic medicine and reconstructive surgery (FPMRS). STUDY DESIGN: 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. RESULTS: 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). CONCLUSIONS: 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.

An Inside Look: Qualitative Study of Underrepresented in Medicine Recruitment Strategies used by OB-GYN Program Directors.

INTRODUCTION: Since 2019, the Accreditation Council for Graduate Medical Education has mandated that all residency programs develop initiatives to recruit underrepresented in medicine (URiM) applicants to increase diversity among physicians. The literature has described a variety of recruitment strategies, but the underlying viewpoints of leaders most responsible for these efforts have not been characterized. We aimed to describe the experience and perspective of program directors around URiM recruitment. METHODS: We conducted a qualitative analysis of 14 semi-structured interviews with OB-GYN program directors recruited electronically about their perspectives on URiM recruitment between August 2018 and October 2019. We coded audio transcripts from these interviews in an independent and iterative fashion. Using inductive content analysis, we derived several themes. RESULTS: Fourteen OB-GYN program directors participated. Themes arising from data included an acknowledgement of the contextual nature of diversity, which included not just race but also other forms of self-identity; the visual nature of recruitment efforts; the lack of consistent support for programs despite shared goals in workforce diversity; the imperative of upending traditional approaches to recruitment (e.g., undue emphasis on Step 1 scores); and finally, the prerequisites of a critical mass of URiM residents, faculty diversity and supportive culture for successful URiM recruitment. DISCUSSION: Our findings shed light on the motivations and obstacles that program directors face in URiM recruitment, underscoring a need for more broad-based initiatives to ensure that society is served by a healthcare workforce reflecting the diversity of our patients.

Improving the Obstetrics and Gynecology Learning Environment Through Faculty Development.

Introduction: The learning environment is shaped by both formal and hidden curricula. Faculty play a critical role in the learning environment but may not be prepared to address the hidden curriculum. This workshop teaches faculty how to manage the hidden curriculum's challenges. Methods: Medical students' end-of-clerkship evaluations revealed low ratings in the domains of feedback, respectful interactions, professional language use, and empathy. We created a virtual 60-minute case-based faculty development workshop to highlight the role of faculty in improving the learning environment. A preworkshop survey was emailed to participants. At the workshop, following a brief introduction, participants were divided into groups to discuss the cases and develop strategies to improve the learning environment. A postworkshop survey was used to assess the workshop. Results: Sixty faculty members attended the seminar. Fifty-seven percent completed a preworkshop survey, and 33% completed the postworkshop survey. After the workshop, more faculty felt well prepared to engage students and residents. The majority of participants (85%) reported being more aware of issues around the learning environment. Most (85%) felt that their interactions with medical students would change in a positive way after the workshop. Ninety percent agreed the workshop was relevant to their needs, 70% agreed they learned a new skill in the workshop, and 80% committed to creating an inclusive learning environment after the workshop. Discussion: This workshop was well received by participants and was associated with an improvement in learning environment ratings. Faculty development seminars are an efficient tool to improve the learning environment.

Striving for Diversity: National Survey of OB-GYN Program Directors Reporting Residency Recruitment Strategies for Underrepresented Minorities.

OBJECTIVE: To characterize strategies among OB-GYN residency programs to recruit underrepresented minorities in medicine, the relative effectiveness of these approaches, and the associated barriers to recruitment. DESIGN: We conducted a survey to solicit strategies from OB-GYN PDs at 253 United States (U.S.) accredited programs for recruiting underrepresented minorities in medicine (URiM) applicants. We also sought their relative effectiveness and barriers to recruitment. SETTING: A national survey of U.S. accredited residency programs in OB-GYN in 2017-2018. RESULTS: A total of 56 (22% response rate) PDs responded. Programs reported either "some" or "significant emphasis" on URiM recruitment (77%), with only 32% employing specific recruitment strategies. Fifteen (83%) reported using race and/or ethnicity data in the U.S.'s centralized electronic residency application service, 10 (56%) recruiting applicants from URiM association events, 9 (50%) meeting with potential URiMs prior to official interviews, and 5 (28%) offering a second visit. Efforts perceived to be most effective were second visits (39%), identifying race/ethnicity in electronic residency application service (33%), URiM recruitment events (28%), and individual phone calls (22%). Barriers included the lack of applicant pool (32%), lack of department diversity (29%) and lack of institutional diversity (30%). CONCLUSIONS: This systematic collation of URiM recruitment practices and perceptions of their effectiveness represents a toolbox of options for residency programs to consider in diversifying their workforce.

Discrimination, Microaggressions, and Perceptions of Institutional Response in an Academic Obstetrics and Gynecology Department.

Introduction Discrimination in the workplace remains a barrier to advancing diversity and inclusion in the physician workforce. This study sought to examine experiences of discrimination, microaggressions, and perceptions of the institution's response in an academic obstetrics and gynecology department. Method All obstetrics and gynecology faculty, fellows, and residents were invited to complete an anonymous, Institutional Review Board-approved cross-sectional survey from February through June 2019. The survey incorporated questions from multiple validated tools on discrimination, microaggressions, perceptions of the institution's response, and opportunities for comments. Data are presented as the frequency with percent and were analyzed using Stata (StataCorp, College Station, USA); two of the authors reviewed and deductively coded the qualitative data. Results The response rate was 58% (87/151), with 30% of the respondents identifying as trainees and 75% identifying as female. Thirty respondents (35%) identified as non-Caucasian. Fifty-four respondents (62%) had ever experienced discrimination and 63 (72%) reported ever experiencing microaggressions at work; of those, 14 (22%) experienced microaggressions several times per week. Of the 69 respondents (79%) who experienced microaggressions and/or discrimination, 49 (71%) felt their experiences were due to gender, and 26 (38%) felt that they were due to race/ancestry. Only 41 respondents (59%) felt that the institution was fair to all employees, and 17 (25%) did not believe diversity was managed effectively. Conclusion Most physicians in the department experienced microaggressions or discrimination, with gender or race/ancestry as common inciting factors. A small but notable portion of respondents would prefer the institution to manage diversity differently. These findings merit further investigation about how to address discrimination in academic medicine.

Meeting Milestones: Results of a Quality-Improvement Curriculum to Achieve Cost-Conscious Care.

There is a lack of residency education in cost-conscious care. We implemented a costing and quality improvement (QI) curriculum to Obstetrics and Gynaecology trainees using "Time-Driven Activity-Based Costing (TDABC)," and assessed its educational impact. The curriculum included didactic and practical portions. Pre-and post-knowledge surveys were obtained from 24 residents on self-perceived knowledge of key QI principles. Self-perceived knowledge, before and after the curriculum, was scored on a Likert scale from 0 to 5 points (0 is the least knowledge and 5 is the most knowledge). The mean scores reported an increase in knowledge of clinical guideline development (pre = 1.19 vs. post = 3.07, p = 0.0052); confidence in participating in QI work (pre = 1.75 vs. post = 3.42 points, p < 0.0001); and knowledge in communicating QI principles (pre = 1.89, post = 3.17, p < 0.0003). Our educational programme uses the TDABC method and the residents' clinical experience effectively to teach residents cost-conscious care.

Teaching Patient Handoffs to Medical Students in Obstetrics and Gynecology: Simulation Curriculum and Assessment Tool.

INTRODUCTION: Patient handoffs, the communications required for the safe transfer of patient care, are known to be a common source of medical errors. Simulation exercises are effective techniques for teaching the procedures and patient interaction skills involved in a handoff. We developed a teaching tool that allows students to individually interact with a simulated patient, develop a treatment plan, and practice a handoff to another provider. METHODS: The curriculum is a flexible instructional tool to teach patient handoffs in the context of a simulated obstetric emergency for learners at the clerkship through first-year obstetrics and gynecology resident levels. The curriculum secondarily teaches management of first-trimester bleeding with acute blood loss and can be adapted to allow advanced learners to practice obtaining informed consent. To evaluate this simulation for educational effectiveness, we developed a faculty observation assessment tool. RESULTS: The simulation assessments for history taking, fund of knowledge, and interpersonal skills were predictive of subsequent clerkship clinical grades. Eighty percent of students agreed the exercise was realistic, 95% agreed it was relevant to the clinical curriculum, 90% agreed the simulation taught handoff skills, and 73% agreed the simulation increased confidence in handoff skills. Students uniformly found the curriculum to be relevant, realistic, and effective at teaching handoff skills. DISCUSSION: Use of this curriculum has the potential to improve students' communication skills, handoff performance, and confidence during an obstetrics and gynecology clerkship. The assessment tool may allow early identification of students in need of improvement in communication skills.