The perceived impact of curricular and non-curricular factors on specialty interests and choice during medical school at a single center in the United States.

BACKGROUND: Limited information exists regarding how medical students' specialty interests evolve throughout medical school, particularly interest in surgical versus non-surgical specialties. Our objective was to identify medical students' specialty interests before and after medical school and the most important curricular and non-curricular factors that shaped their specialty choice. METHODS: An online 22-question voluntary, anonymized survey was designed to assess specialty interests and factors impacting specialty choice at a single medical school in the United States. The study was pilot-tested with focus groups. The final questionnaire was distributed to final-year medical students from the Classes of 2020 and 2021. Responses were measured on a 5-point Likert scale (1 = strong negative impact to 5 = strong positive impact). RESULTS: 102 of 184 students (55%) from Class of 2020 and 85 of 174 students (49%) from Class of 2021 participated. Of 187 respondents, the majority (60%) decided on their specialty during third year. 74 of 147 students (50%) pursued a specialty among their initial specialty interests. Students with initial surgical interests were significantly (p < 0.001) less likely to choose surgical specialties (42%) compared to students with initial non-surgical interests choosing non-surgical specialties (79%). Pre-clinical years (3.67 ± 0.96) were perceived to have a significantly (p < 0.001) less positive impact on specialty interests and choice compared to clinical years. Among pre-clinical factors, physician shadowing (3.80 ± 0.83) was perceived to have the significantly (p < 0.001) greatest positive impact. During clinicals, 34% of respondents indicated that order of clerkships impacted specialty choice. 112 of 171 respondents (65%) indicated that mentorship impacted specialty choice. Physicians in the chosen specialty were perceived to have the strongest impact (4.67 ± 0.49). 65 of 171 respondents (38%) indicated that peers impacted specialty choice with classmates (3.98 ± 0.87) and near-peers (3.83 ± 0.74) perceived to have a positive impact. CONCLUSIONS: Specialty interests changed during medical school for a significant portion of students (50%). Those with initial surgical interests were more likely to change their specialty interests. Pre-clinicals were reported to have less impact on specialty choice compared to clinicals. Implementing factors such as shadowing and physician/peer mentorship, which may positively impact specialty choice, into pre-clinical curricula warrants further investigation.

Obstetrician Attitudes, Experience, and Knowledge of Planned Home Birth: An Exploratory Study.

BACKGROUND: The incidence of planned home birth is increasing in the United States. The American College of Obstetricians and Gynecologists acknowledges a woman's right to make an informed choice about place of delivery, including home birth. This exploratory study measures obstetricians' attitudes, experiences, and knowledge about planned home birth, identifies associations between these factors, and compares obstetricians' responses in Ohio to those in Arizona and New Mexico. METHODS: A survey about attitudes, experiences, and knowledge of planned home birth was distributed to obstetricians in Ohio, Arizona, and New Mexico. Attitude and knowledge scores were calculated for each respondent and used to evaluate associations through linear regression. Attitude and knowledge scores in states that have regulation of direct entry midwives (Arizona and New Mexico) were compared to a state which does not (Ohio). RESULTS: Obstetricians in all three states reported little experience and knowledge of planned home birth and overall negative attitudes. Obstetricians with stronger knowledge did not differ in their attitudes from those with less knowledge. No statistically significant differences were found when comparing attitude and knowledge scores in Ohio to Arizona and New Mexico, but Ohio obstetricians responded most negatively to the attitude questions. CONCLUSIONS: Obstetricians have limited knowledge and experience and hold very negative attitudes about planned home birth. Research is necessary to determine: 1) whether negative obstetrician attitudes would be modified by exposure to home birth education and experience, and, 2) whether negative obstetrician beliefs deter safe and timely transfer from home or compromise hospital care for transferred parturients.

Best practices for the pregnant neurosurgical resident: balancing safety and education.

Establishment of a diverse neurosurgical workforce includes increasing the recruitment of women in neurosurgery. The impact of pregnancy on the training and career trajectory of female neurosurgeons poses a barrier to recruitment and retention of women in neurosurgery. A recent Women in Neurosurgery survey evaluated female neurosurgeons' perception and experience regarding childbearing of female neurosurgeons and identified several recommendations regarding family leave policies. Additionally, pregnancy may carry higher risk in surgical fields, yet little guidance exists to aid both the pregnant resident and her training program in optimizing the safety of the training environment with specific considerations to risks inherent in neurosurgical training. This review of current literature aims to address best practices that can be adopted by pregnant neurosurgery residents and their training programs to improve the well-being of these residents while considering the impact on their education and the educational environment for their colleagues.

A randomized trial comparing 2 outpatient educational settings for clerkship students: private practice office vs hospital clinic.

OBJECTIVE: The purpose of this study was to compare medical students' experiences in 2 outpatient educational settings. STUDY DESIGN: For their 2-week ambulatory rotation, all 76 medical students were randomized to either a hospital clinic or a private office. Seventy students completed the survey. RESULTS: When compared to students working in a private office setting, hospital clinic students reported more breast exams, speculum exams, uterine fundal height measurements, wet mount reading, contraceptive counseling, and first obstetrical and gynecologic patient visits. Students in the hospital clinic were more likely to report having educationally valuable opportunities to interview and examine patients and to discuss the differential diagnosis with their preceptor. Nevertheless, medical students randomized to the private office were more likely to report considering obstetrics and gynecology as a career. CONCLUSION: The hospital clinic provided students with more clinical experiences. Medical students assigned to a private office, however, were more likely to consider obstetrics and gynecology as a career.

Accessory and cavitated uterine mass with functional endometrium in an adolescent: diagnosis and laparoscopic excision technique.

STUDY OBJECTIVE: Accessory and cavitated uterine masses (ACUM) with functional endometrium can be treated successfully with laparoscopic excision. The objectives of this report are to illustrate the surgical technique used for the removal of this uterine wall mass and to discuss the patient's clinical course and outcomes. DESIGN: Surgical technique and description of 1 case. SETTING: Department of Obstetrics and Gynecology, University Hospitals Case Medical Center. PARTICIPANT(S): A 16-year-old adolescent presented with severe dysmenorrhea and pelvic pain. Ultrasonographic examination and MRI demonstrated a cystic uterine wall mass distinct from the endometrial cavity. INTERVENTION(S): Laparoscopic excision of uterine mass. RESULTS: Pathologic examination of the mass was consistent with an accessory and cavitated uterine mass. A 9-month follow-up after surgical excision of the mass confirmed complete symptom resolution. CONCLUSIONS: ACUM is a unique and not uncommon pathologic category in the adolescent and young adult population. It is associated with severe and intractable dysmenorrhea and pelvic pain. Laparoscopic excision of these masses is justifiable, safe and feasible.

Vaginal foreign body presenting as bleeding with defecation in a child.

Symptoms secondary to a vaginal foreign body are responsible for approximately 4% of pediatric gynecologic outpatient visits.(1) The classic symptom is vaginal bleeding, but vaginal discharge, foul odor, irritation, abdominal pain, and hematuria have been described. We are reporting a case of a microscopic vaginal foreign body presenting as hematochezia in a preadolescent girl. This case is unique in that the patient presented with bleeding with defecation, without vaginal bleeding. Vaginal foreign bodies can present with diverse symptomatology. Physicians should consider the diagnosis of vaginal foreign body when presented with a young female patient with unexplained hematochezia.

Uterus didelphys and longitudinal vaginal septum coincident with an obstructive transverse vaginal septum.

A wide variety of Müllerian anomalies has been described in the literature. Various combinations of anomalies may coexist in a single subject. Precise identification of the various components of the anomaly is paramount in choosing and planning the appropriate conservative and surgical treatment. In this report, we present a rare case of combined vertical fusion and transverse canalization defects in a single subject. A review of the literature along with an overview of the pertinent embryologic processes and management concepts for such cases are presented.