Surgical training of gynecologic oncology fellows: Long-term trends and implications for future education.

OBJECTIVES: The surgical training of gynecologic oncology (GO) fellows is critical to providing excellent care to women with gynecologic cancers. We sought to evaluate changes in techniques and surgical volumes over an 18-year period among established GO fellowships across the US. METHODS: We emailed surveys to 30 GO programs that had trained fellows for at least 18 years. Surveys requested the number of surgical cases performed by a fellow for seventeen surgical procedures over each of five-time intervals. A One-Way Analysis of Variance was conducted for each procedure, averaged across institutions, to examine whether each procedure significantly changed over the 18-year span. RESULTS: 14 GO programs responded and were included in the analysis using SPSS. We observed a significant increase in the use of minimally invasive (MIS) procedures (robotic hysterectomy (p < .001), MIS pelvic (p = .001) and MIS paraaortic lymphadenectomy (p = .008). There was a concurrent significant decrease in corresponding "open" procedures. There was a significant decrease in all paraaortic lymphadenectomies. Complex procedures (such as bowel resection) remained stable. However, there was a wide variation in the number of cases reported with extremely small numbers for some critical procedures. CONCLUSIONS: The experience of GO fellows has shifted toward increased use of MIS. While these trends in care are appropriate, they do not diminish the need in many patients for complex open procedures. These findings should help spur the development of innovative training to maintain the ability to provide these core, specialty-defining procedures safely.

Current practices and perspectives on clerkship grading in obstetrics and gynecology.

BACKGROUND: Clerkship grades in obstetrics and gynecology play an increasingly important role in the competitive application process to residency programs. An analysis of clerkship grading practices has not been queried in the past 2 decades in our specialty. OBJECTIVE: This study aimed to investigate obstetrics and gynecology clerkship directors' practices and perspectives in grading. STUDY DESIGN: A 12-item electronic survey was developed and distributed to clerkship directors with active memberships in the Association of Professors of Gynecology and Obstetrics. RESULTS: A total of 174 of 236 clerkship directors responded to the survey (a response rate of 73.7%). Respondents reported various grading systems with the fewest (20/173 [11.6%]) using a 2-tiered or pass or fail system and the most (72/173 [41.6%]) using a 4-tiered system. Nearly one-third of clerkship directors (57/163 [35.0%]) used a National Board of Medical Examiners subject examination score threshold to achieve the highest grade. Approximately 45 of 151 clerkship directors (30.0%) had grading committees. Exactly half of the clerkship directors (87/174 [50.0%]) reported requiring unconscious bias training for faculty who assess students. In addition, some responded that students from groups underrepresented in medicine (50/173 [28.9%]) and introverted students (105/173 [60.7%]) received lower evaluations. Finally, 65 of 173 clerkship directors (37.6%) agreed that grades should be pass or fail. CONCLUSION: Considerable heterogeneity exists in obstetrics and gynecology clerkship directors' practices and perspectives in grading. Strategies to mitigate inequities and improve the reliability of grading include the elimination of a subject examination score threshold to achieve the highest grade and the implementation of both unconscious bias training and grading committees.

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.

Advances in gynecologic simulation: implementation, validity, and new resources.

PURPOSE OF REVIEW: Simulation plays an integral role in gynecological surgical training that will continue and grow in the future. It aims to supplement surgical training as residents are experiencing decreased surgical volumes. It has also been recognized as a means for assessing a trainee's capabilities to the point of being incorporated into the board certification process. This review will highlight the recent updates in research and resources available for gynecologic surgery simulation. RECENT FINDINGS: The literature reviewed demonstrated that, across the board, participants in simulation find it beneficial. A variety of low-fidelity and high-fidelity models, virtual reality programs, and artificial intelligence technology have been developed recently. As the field advances, researchers have started to investigate methods to increased engagement and provide feedback without the need for direct observation, the logical next step considerations to maximize the impact and availability of simulation. SUMMARY: Gynecologic surgery training programs must stay abreast of the wide variety of simulation training available. Efforts should continue to be made to investigate the impact of simulation patient outcomes. The academic medicine community has a responsibility to ensure high-quality simulation is available to all surgical trainees to avoid disparities between low-resource and high-resource programs.

A Roadmap for Training in Urogynecology: IUGA International Initiative.

INTRODUCTION AND HYPOTHESIS: Training in urogynecology is an important mission of the International Urogynecological Association (IUGA). Promoting official training programs in countries around the world is an integral part of this mission. METHODS: The IUGA established the Fellowship Development Committee to develop a roadmap to assist countries to develop a professional training program in urogynecology. Two focus groups were created: the curricula topics focus group and the survey focus group. The curricula topics focus group is aimed at developing a list of subjects that can be the basis for a training syllabus. The survey focus group is aimed at understanding the main steps and the difficulties in establishing an official training program by interviewing representatives from both accredited and non-accredited countries and developing a roadmap for an official training program recognized by the local authorities. RESULTS: The fellowship development committee included 13 members. The curricula topics focus group developed a format for the description of each included topic. Each topic had to include a description of the required related skills and procedures. Two curricula topics lists were created: one for basic training and a second for advanced training. The survey focus group conducted two table discussions with representatives from countries with accredited training programs and countries without accredited training programs. The comments of these meetings were summarized in documents submitted to the IUGA board of directors. CONCLUSION: The fellowship development committee studied the main hurdles to developing an official training program in urogynecology. The roadmap document should form the basis of the IUGA international initiative to assist countries around the world to develop an official training program in urogynecology recognized by the local authority.

Excluding Male Trainees in Obstetrics and Gynecology: Why We Do It and Why It's Wrong.

This article explores the current landscape of clinical education in obstetrics and gynecology for medical students, residents, and fellows who identify as male. Academic, clinical instruction should be inclusive for the betterment of the training experience for all, but most importantly, for the betterment of women's health.

The Future of Basic Science: Development of the Next Generation of Mechanistic Researchers in Female Pelvic Medicine.

INTRODUCTION AND HYPOTHESIS: The International Urogynecological Association (IUGA) brought together senior and junior members actively engaged in scholarly and educational activities for a consensus conference centered on developing a strategy for sustainable training of the next generation of mechanistic researchers in female pelvic medicine. METHODS: Four a priori identified major foci were explored in a half-day virtual consensus conference. Participants included representatives from various countries and disciplines with diverse backgrounds-clinicians, physician-scientists, and basic scientists in the fields of urogynecology, biomechanical engineering, and molecular biology. Following a keynote address, each focus area was first tackled by a dedicated breakout group, led by the Chair(s) of the most relevant IUGA committees. The break-out sessions were followed by an iterative discussion among all attendees to identify mitigating strategies to address the shortage of mechanistic researchers in the field of female pelvic medicine. RESULTS: The major focus areas included: research priorities for IUGA basic science scholar program; viable strategies for sustainable basic science mentorship; core competencies in basic science training; and the challenges of conducting complex mechanistic experiments in low-resource countries. Key gaps in knowledge and core competencies that should be incorporated into fellowship/graduate training were identified, and existing training modalities were discussed. Recommendations were made for pragmatic approaches to increasing the exposure of trainees to learning tools to enable sustainable training of the next generation of basic science researchers in female pelvic medicine worldwide. CONCLUSIONS: The attendees presented multiple perspectives to gain consensus regarding critical areas of need for training future generations of mechanistic researchers. Recommendations for a sustainable Basic Science Scholar Program were developed using IUGA as a platform. The overarching goal of such a program is to ensure a successful bench-to-bedside-and-back circuit in Urogynecology and Pelvic Reconstructive Surgery, ultimately improving lives of millions of women worldwide through scientifically rational effective preventative and therapeutic interventions.

Procedure-specific simulation for vaginal surgery training: A randomized controlled trial.

INTRODUCTION: Vaginal surgery has a superior outcome profile compared with other surgical routes, yet skills are declining because of low case volumes. Graduating residents' confidence and preparedness for vaginal surgery has plummeted in the past decade. The objective of the present study was to investigate whether procedure-specific simulation skills, vs usual training, result in improved operative competence. MATERIAL AND METHODS: We completed a randomized controlled trial of didactic and procedural training via low fidelity vaginal surgery models for anterior repair, posterior repair (PR), vaginal hysterectomy (VH), recruiting novice gynecology residents at three academic centers. We evaluated performance via global rating scale (GRS) in the real operating room and for corresponding procedures by attending surgeon blinded to group. Prespecified secondary outcomes included procedural steps knowledge, overall performance, satisfaction, self-confidence and intraoperative parameters. A priori sample size estimated 50 residents (20% absolute difference in GRS score, 25% SD, 80% power, alpha 0.05). CLINICALTRIALS: gov: Registration no. NCT05887570. RESULTS: We randomized 83 residents to intervention or control and 55 completed the trial (2011-23). Baseline characteristics were similar, except for more fourth-year control residents. After adjustment of confounders (age, level, baseline knowledge), GRS scores showed significant differences overall (mean difference 8.2; 95% confidence interval [CI]: 0.2-16.1; p = 0.044) and for VH (mean difference 12.0; 95% CI: 1.8-22.3; p = 0.02). The intervention group had significantly higher procedural steps knowledge and self-confidence for VH and/or PR (p < 0.05, adjusted analysis). Estimated blood loss, operative time and complications were similar between groups. CONCLUSIONS: Compared to usual training, procedure-specific didactic and low fidelity simulation modules for vaginal surgery resulted in significant improvements in operative performance and several other skill parameters.

The outcomes of team-based learning vs small group interactive learning in the obstetrics and gynecology course for undergraduate students.

INTRODUCTION: Team-based learning (TBL) is a well-established active teaching method which has been shown to have pedagogical advantages in some areas such as business education and preclinical disciplines in undergraduate medical education. Increasingly, it has been adapted to clinical disciplines. However, its superiority over conventional learning methods used in clinical years of medical school remains unclear. The aim of this study was to compare TBL with traditional seminars delivered in small group interactive learning (SIL) format in terms of knowledge acquisition and retention, satisfaction and engagement of undergraduate medical students during the 6-week obstetrics and gynecology clerkship. MATERIAL AND METHODS: The study was conducted at Karolinska Institutet, a medical university in Sweden, and had a prospective, crossover design. All fifth-year medical students attending the obstetrics and gynecology clerkship, at four different teaching hospitals in Stockholm (approximately 40 students per site), in the Autumn semester of 2022 were invited to participate. Two seminars (one in obstetrics and one in gynecology) were designed and delivered in two different formats, ie TBL and SIL. The student:teacher ratio was approximately 10:1 in the traditional SIL seminars and 20:1 in the TBL. All TBL seminars were facilitated by a single teacher who had been trained and certified in TBL. Student knowledge acquisition and retention were assessed by final examination scores, and the engagement and satisfaction were assessed by questionnaires. For the TBL seminars, individual and team readiness assurance tests were also performed and evaluated. RESULTS: Of 148 students participating in the classrooms, 132 answered the questionnaires. No statistically significant differences were observed between TBL and SIL methods with regard to student knowledge acquisition and retention, engagement and satisfaction. CONCLUSIONS: We found no differences in student learning outcomes or satisfaction using TBL or SIL methods. However, as TBL had a double the student to teacher ratio as compared with SIL, in settings where teachers are scarce and suitable rooms are available for TBL sessions, the method may be beneficial in reducing faculty workload without compromising students' learning outcomes.

Filling a gap in OBGYN education: a pilot lecture series on perinatal mental health.

Perinatal mood and anxiety disorders (PMADs) are one of the most common complications in the peripartum period. The Council for Resident Education in Obstetrics and Gynecology (CREOG) includes diagnosis and management of PMADs as educational objectives, but no formal curriculum for trainees exists. Consequently, providers often struggle to identify and treat these disorders. We aimed to assess the effects of a pilot lecture series on obstetrics and gynecology (OBGYN) residents' knowledge and comfort in the diagnosis and management of PMADs. As part of an educational cross-sectional study, a Qualtrics survey was distributed to OBGYN residents at a single center in New York City. Residents were exposed to a 10-h virtual lecture series on perinatal mental health, and a follow-up survey was distributed. Initially, few residents were familiar with screening tools (45%), and few felt comfortable providing resources (5-45%), diagnosing (0-55%), and managing (0-30%) patients with the PMADs presented. After the pilot, improvement was seen in residents' familiarity with screening tools (86%), and their comfort in providing resources (11-67%) and diagnosing (11-78%) PMADs. However, comfort in management did not improve (0-22%). The majority of trainees (75%) found the virtual setting appropriate. There is a deficit in OBGYN residents' knowledge and comfort regarding diagnosis and discussion of PMADs that can be improved with a focused lecture series, though a greater emphasis on treatment is needed. The majority of OBGYN learners found the virtual setting conducive to learning this material. Their preferences should guide the development of a formal, national curriculum.

Demographics and Characteristics of US-Based Minimally Invasive Gynecologic Surgery Fellowship Program Directors: A 2023 Descriptive Analysis.

STUDY OBJECTIVE: Fellowship program directors (FPDs) play an important role in the development of fellows and learners, but little is known about their demographics. This cross-sectional study aims to examine the characteristics of minimally invasive gynecologic surgery (MIGS) FPDs. DESIGN: A retrospective cross-sectional study. SETTING: Data obtained from publicly available information on official websites of the program directors studied. SUBJECTS: MIGS fellowship program directors. INTERVENTIONS: All US-based MIGS programs affiliated with the AAGL in 2023 were included. Information about FPD gender, medical school attended and graduation year, residency program attended and graduation year, any additional graduate degrees earned, fellowship programs completed, and the year of their appointment as FPD was collected through publicly available sources. Scholarly activity was measured by peer-reviewed articles and the Hirsch index. MEASUREMENTS AND MAIN RESULTS: Of the 54 FPDs, 28 (51.85%) were female and 26 (48.15%) were male. Male FPDs were significantly older (54.6 ± 8.7 years) than female FPDs (46.2 ± 5.0 years), p <.05. Average age at appointment was 43.1 ± 6.7 years, with female FPDs being appointed at significantly younger ages (39.4 ± 5.1 years) compared to male FPDs (44.5 ± 6.8 years), p <.05. Male FPDs had statistically significant higher Hirsch indices (14 ± 11.4) compared to female FPDs (8 ± 5.8), p <.05. Of the FPDs who completed a fellowship, 27 (50%) did so in MIGS, eight (14.81%) in Gynecologic-Oncology, 6 (11.11%) in Urogynecology, and 4 (7.41%) in Reproductive Endocrinology/Infertility. CONCLUSIONS: MIGS fellowships have a uniquely equal representation of male and female FPDs, as surgical subspecialties historically tend to be male dominant. Notably, there is diversity in the type of fellowship pursued by MIGS FPDs, with nearly half of FPDs completing a fellowship outside of MIGS. The reasons for differences in scholarly contributions, indicated by Hirsch index, of male versus female FPDs is unclear.

COVID Recovery Laparoscopic Simulation Program for Gynecological Registrars-Trainee Perceptions of Regional Model.

STUDY OBJECTIVE: The acquisition of gynecological operating skills can be challenging for trainees given the conflicting demands of clinical work. Alternative models of surgical skill training such as laparoscopic simulation is, therefore, required. This study demonstrates the development of a regional gynecological surgery laparoscopic simulation program and trainee perceptions of such an approach. DESIGN: An intervention-based cohort study. SETTING: A regional model based in West Midlands training region. PATIENTS/PARTICIPANTS: Responses from 64 trainees in the training region who participated in this regional program were included. INTERVENTIONS: A 3-stream curriculum was developed to deliver key training outcomes as required by the Royal College of Obstetricians and Gynaecologists (RCOG) core curriculum as a component of a COVID Recovery Program. Courses were held in 7 teaching hospitals. Courses consisted of both theory and practical teaching. MEASUREMENTS: A structured feedback tool was used to collect trainee perceptions of the program. Trainee satisfaction was measured on the Likert scale of 1 to 3. A qualitative thematic analysis was conducted with rank-order analysis of coded free-text responses. MAIN RESULTS: Overall, the majority of trainees 92% (n = 58/64) were very satisfied with the course. Rank-order analysis demonstrated hands-on-practice to be the key perceived benefit of laparoscopic simulation among basic and intermediate trainees, while feedback on procedural skills was felt most useful among advanced trainees. CONCLUSION: A regional approach to laparoscopic simulation training is both achievable and acceptable. Trainee perceptions of usefulness are altered by seniority and experience. This should be accounted for in the development of laparoscopic simulation programs.

Teeter-Totter or Tapestry: A Life in Academic Medicine.

Constructing a career in academic medicine involves more than a focus on work-life balance. That image of a teeter-totter suggests that life is what happens when you are not working. The nature of the scope of interests (clinical, research, teaching) and values (service, leadership, curiosity, transparency, and honesty) creates a larger framework through which home life and work life become one interwoven tapestry. The author reflects on these perspectives as she looks back on a career in academic medicine.

Improving Sexual Health Across the Life Span Through Integrated Care in Obstetrics and Gynecology.

Sexual health is a vital part of physical, emotional, and relational well-being among adults across the life span. While patients are reluctant to discuss their sexual concerns, Obstetrics and Gynecology providers are especially well positioned to improve sexual functioning and satisfaction through screening, education, prevention and early intervention, treatment, and integrating behavioral health and sexual medicine services in their clinical practices. This article sets out to provide applied information and perspectives to foster the development of interprofessional sexual medicine services in Obstetrics and Gynecology practices in hospital and community settings.

Who's Haywood? Path to Leadership: I Am NO Jackie Robinson.

Having been afforded many opportunities throughout my academic career, I took on the challenges that chronicled my path to leadership. In many instances, I was the first person of color to enter that educational and leadership environment. I am grateful to many mentors who have guided and supported me over the 4 decades since the time of my residency through fellowships and the various institutions to which I have been affiliated. It continues to be a great journey, making a contribution to the Ob Gyn academic community and advocating for quality and equitable women's health care.

Career Reflections: The Winding Path From County Mayo, Ireland to New York City.

Dr. Mary D'Alton's career journey intertwines her upbringing in County Mayo, Ireland, with impactful contributions to Obstetrics and Gynecology in New York City. From childhood lessons in community care to transformative experiences in Canada and prestigious mentorships, her leadership at Columbia University and NewYork-Presbyterian has fostered innovative initiatives addressing maternal health. Philanthropy plays a pivotal role in realizing her vision, including mental health integration within women's health care. International reach, exemplified by a successful fellowship program with Ireland, underscores her commitment to collaboration Dr. D'Alton's reflections illuminate the transformative power of teamwork, mentorship, and innovation in advancing women's health worldwide.

Redesigning Continuous Professional Development: Aligning Learning Needs With Clinical Practice.

Continuous professional development (CPD) in health care refers to the process of lifelong learning including the acquisition of new competencies, knowledge, and professional growth throughout the career of a health care professional. Since implementation, there has seen little change or innovation in CPD. This perspective will review the current state of CPD, including the challenges in traditional CPD models, foundations and strategies for redesign to meet the needs of current and future physicians, and suggestions for changes to modernize CPD. Precision education and the use of technology, including artificial intelligence, and their application to CPD will be discussed.

Contemporary Parental Leave Policies and Practice Among Obstetrics and Gynecology Trainees and Faculty.

This article aims to describe contemporary parental leave among obstetrics and gynecology trainees and early-career faculty. Here, we present results of a survey that collected information about parental leave policies and contemporary practice, as well as beliefs about surgical and clinical experience for those who take leave. Faculty and trainees were equally well represented among respondents, with half of each group self-identifying as a parent. Most reported that childbearing trainees currently take 6 weeks or less of parental leave and believed that childbearing and nonchildbearing residents should be able to take 12 weeks of leave without extending training.

Advancing Equity: Understanding, Addressing, and Mitigating Bias in Assessment in Medical Education.

Despite the growing presence of women and historically underrepresented groups in academic medicine, significant disparities remain. This article examines a key aspect of these disparities: biases in assessment and learning environments. Reviewing current literature, including in OBGYN, reveals persistent gender and racial biases in subjective clinical narrative assessments. The paper then outlines a 2-pronged approach for change: first, enhancing the learning environment, and subsequently, providing targeted recommendations for individuals, academic leaders, and healthcare institutions to effectively address these biases.

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.