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The COVID-19 pandemic has stressed healthcare systems in the United States and globally. Limited hospital resources, increasing patient surge, and growing demands on healthcare providers have led to the United States Surgeon General and the Centers for Medicare & Medicaid Services calling for suspension of all nonessential adult elective surgery and medical procedures. As of March 27, 2020, 30 states had issued similar declarations related to elective procedures in the setting of the continuing COVID-19 pandemic. Two major questions have emerged as these events have unfolded: (1) What is the definition of an "elective" procedure? and (2) Are there specialty-specific considerations for obstetric and gynecologic procedures? This article provides insights into each of these questions and provides a working framework for obstetrician/gynecologists to advocate for their patients and coordinate with their hospital systems to develop "elective" procedure guidelines that incorporate considerations for women's and maternal health.
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This article, from the "To the Point" series prepared by the Association of Professors of Gynecology and Obstetrics (APGO) Undergraduate Medical Education Committee (UMEC), provides educators with an overview of the use of simulation in undergraduate medical education in the field of obstetrics and gynecology. Simulation plays an important role in the education of medical students. Students are increasingly serving as clinical observers and providing less direct patient care. Simulation can help standardize education and ensure quality and comparability across an enlarging educational environment. This article summarizes the expanding role of simulation in undergraduate medical education in obstetrics and gynecology and its effect on important learner outcomes such as confidence, knowledge, skills, workplace behaviors, and translation to patient care.
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Educação de Graduação em Medicina/métodos , Ginecologia/educação , Obstetrícia/educação , Treinamento por Simulação/métodos , Competência Clínica , Humanos , Estados UnidosRESUMO
This article is from the "To The Point" series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee. The purpose of this review was to provide an overview of the importance of well-being in medical education. A literature search was performed by a Reference Librarian who used Ovid/MEDLINE to identify scholarly articles published in English on learner well-being, using the search terms "burnout," "resilience," "wellness," and "physicians" between 1946 and January 11, 2019. The accreditation expectations and standards, available assessment tools for learner well-being, existing programs to teach well-being, and some key elements for curriculum development are presented. This is a resource for medical educators, learners, and practicing clinicians from any field of medicine.
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Esgotamento Profissional/prevenção & controle , Currículo , Educação Médica/métodos , Nível de Saúde , Saúde Mental , Resiliência Psicológica , Esgotamento Profissional/diagnóstico , Esgotamento Profissional/terapia , Dieta Saudável , Educação de Pós-Graduação em Medicina/métodos , Educação de Graduação em Medicina/métodos , Exercício Físico , Humanos , Internato e Residência , Atenção Plena , Sono , Estudantes de Medicina/psicologiaRESUMO
This article, from the "To The Point" series that was prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, provides an overview of the characteristics of millennials and describes how medical educators can customize and reframe their curricula and teaching methods to maximize millennial learning. A literature search was performed to identify articles on generational learning. We summarize the importance of understanding the attitudes, ideas, and priorities of millennials to tailor educational methods to stimulate and enhance learning. Where relevant, a special focus on the obstetrics and gynecology curriculum is highlighted.
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Educação de Graduação em Medicina/métodos , Educação de Graduação em Medicina/tendências , Ginecologia/educação , Obstetrícia/educação , Instrução por Computador/métodos , Instrução por Computador/tendências , Currículo/tendências , Ginecologia/tendências , Humanos , Relação entre Gerações , Aprendizagem , Obstetrícia/tendências , Mídias Sociais/tendências , Estados UnidosRESUMO
Gender differences in performance on the obstetrics and gynecology clerkship have been reported, with female students outperforming male students. Male students report that their gender negatively affects their experience during the clerkship. Additionally, there are fewer male students applying for obstetric/gynecology residency. This "To The Point" article by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee will describe the gender differences that have been found, examine factors that could be contributing to these issues, and propose measures to correct these disparities.
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Estágio Clínico/métodos , Estágio Clínico/estatística & dados numéricos , Ginecologia/educação , Obstetrícia/educação , Fatores Sexuais , Escolha da Profissão , Educação de Graduação em Medicina , Avaliação Educacional , Avaliação de Desempenho Profissional , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Sexismo , Estudantes de Medicina , Inquéritos e QuestionáriosRESUMO
ISSUE: This article, from the "To the Point" series that is prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, is a review of commonly cited barriers to recruiting and retaining community-based preceptors in undergraduate medical education and potential strategies to overcome them. EVIDENCE: Community-based preceptors have traditionally served as volunteer, nonsalaried faculty, with academic institutions relying on intrinsic teaching rewards to sustain this model. However, increasing numbers of learners, the burdens of incorporating the electronic medical record in practice, and increasing demands for clinical productivity are making recruitment and retention of community-based preceptors more challenging. IMPLICATIONS: General challenges to engaging preceptors, as well as those unique to women's health, are discussed. Potential solutions are reviewed, including alternative recruitment strategies, faculty development to emphasize efficient teaching practices in the ambulatory setting, offers of online educational resources, and opportunities to incorporate students in value-added roles. Through examples cited in this review, clerkship directors and medical school administrators should have a solid foundation to actively engage their community-based preceptors.
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Educação de Graduação em Medicina/organização & administração , Mentores , Preceptoria/organização & administração , Estudantes de Medicina/estatística & dados numéricos , Docentes de Medicina/organização & administração , Feminino , Ginecologia/educação , Humanos , Obstetrícia/educação , Faculdades de Medicina/organização & administração , Estudantes de Medicina/psicologia , Estados UnidosRESUMO
OBJECTIVE: The objective of this study was to evaluate the risk of recurrent group B streptococcus (GBS) colonization in a subsequent pregnancy and to assess clinical characteristics that influence this risk. STUDY DESIGN: A systematic review and meta-analysis was performed. Databases were searched from inception through June 2015 using PubMed, Embase, Scopus, Central, and ClinicalTrials.gov. Studies were eligible if they assessed antenatal GBS colonization in two successive pregnancies. The quality of included studies was evaluated. Independent patient data was requested from the authors of the included trials. Unadjusted odds ratios (OR) were pooled using the Mantel-Haenszel fixed effect model. RESULTS: In the five studies identified, two studies lacked a nonexposed cohort. GBS colonization in the index pregnancy was associated with a higher risk of recurrence of GBS colonization in a subsequent pregnancy (three studies: 50.2 compared with 14.1%; pooled fixed effects OR, 6.05; 95% confidence interval [CI], 4.84-7.55). When heavy colonization with GBS was compared with colonization by vaginal culture only, an increased risk of recurrence was shown (four studies: 52.0 compared with 45.1%, pooled fixed effects OR, 1.54; 95% CI, 1.02-2.31). CONCLUSION: Women colonized with GBS are at significantly higher odds for recurrent colonization in a subsequent pregnancy when compared with women who were not colonized in an index pregnancy. If the individual is considered heavily colonized with GBS, there appears to be an association with an increased risk compared with conventional culture. Subgroup analysis of the variables time interval ≤ 12 months between subsequent pregnancies, body mass index ≥ 30 kg/m(2), race, ethnicity, and primiparous in the subsequent pregnancy showed no effect.
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Portador Sadio/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Infecções Estreptocócicas/diagnóstico , Streptococcus agalactiae , Feminino , Humanos , Programas de Rastreamento , Razão de Chances , Gravidez , RecidivaRESUMO
BACKGROUND: Learning to perform pelvic and breast examinations produces anxiety for many medical students. Clerkship directors have long sought strategies to help students become comfortable with the sensitive nature of these examinations. Incorporating standardized patients, simulation and gynecologic teaching associates (GTAs) are approaches gaining widespread use. However, there is a paucity of literature guiding optimal approach and timing. Our primary objective was to survey obstetrics and gynecology (Ob/Gyn) clerkship directors regarding timing and methods for teaching and assessment of pelvic and breast examination skills in United States medical school curricula, and to assess clerkship director satisfaction with current educational strategies at their institutions. METHODS: Ob/Gyn clerkship directors from all 135 Liaison Committee on Medical Education accredited allopathic United States medical schools were invited to complete an anonymous 15-item web-based questionnaire. RESULTS: The response rate was 70%. Pelvic and breast examinations are most commonly taught during the second and third years of medical school. Pelvic examinations are primarily taught during the Ob/Gyn and Family Medicine (FM) clerkships, while breast examinations are taught during the Ob/Gyn, Surgery and FM clerkships. GTAs teach pelvic and breast examinations at 72 and 65% of schools, respectively. Over 60% of schools use some type of simulation to teach examination skills. Direct observation by Ob/Gyn faculty is used to evaluate pelvic exam skills at 87% of schools and breast exam skills at 80% of schools. Only 40% of Ob/Gyn clerkship directors rated pelvic examination training as excellent, while 18% rated breast examination training as excellent. CONCLUSIONS: Pelvic and breast examinations are most commonly taught during the Ob/Gyn clerkship using GTAs, simulation trainers and clinical patients, and are assessed by direct faculty observation during the Ob/Gyn clerkship. While the majority of Ob/Gyn clerkship directors were not highly satisfied with either pelvic or breast examination training programs, they were less likely to describe their breast examination training programs as excellent as compared to pelvic examination training-overall suggesting an opportunity for improvement. The survey results will be useful in identifying future challenges in teaching such skills in a cost-effective manner.
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Estágio Clínico/normas , Currículo , Educação de Graduação em Medicina/normas , Ginecologia/educação , Obstetrícia/educação , Exame Físico , Faculdades de Medicina , Estudantes de Medicina , Mama , Avaliação Educacional , Feminino , Humanos , Pelve , Exame Físico/normas , Estados UnidosRESUMO
This article, from the "To the Point" series that is prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, is a review of considerations for teaching the medical student in the operating room during the obstetrics/gynecology clerkship. The importance of the medical student operating room experience and barriers to learning in the operating room are discussed. Specific considerations for the improvement of medical student learning and operating room experience, which include the development of operating room objectives and specific curricula, an increasing awareness regarding role modeling, and faculty development, are reviewed.
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Estágio Clínico/métodos , Educação de Graduação em Medicina/métodos , Ginecologia/educação , Obstetrícia/educação , Currículo , Humanos , Salas CirúrgicasRESUMO
OBJECTIVE: Nearly half of obstetrics and gynecology (OB/GYN) residency programs in the United States lost access to local training in abortion care following the 2022 Dobbs v Jackson Supreme Court decision. We aimed to determine whether OB/GYN residency candidates who desire abortion training apply to programs in states where abortion is restricted/banned. STUDY DESIGN: In 2023, we conducted an anonymous electronic survey of residency interviewees at three large academic OB/GYN programs about the importance of various program characteristics in their selection process. We chose to represent both very restrictive and protective environments for abortion care. We stratified respondents by importance of abortion training in applying to programs (essential or very important [high preference group] vs moderately, slightly, or not important [low preference group]). RESULTS: We analyzed 175 completed surveys (response rate 56%). Of 175 respondents, most (n = 115, 66%) stated that access to abortion training was essential (33%) or very important (33%) when applying to programs. Both high preference group (82%) and low preference group respondents (98%) applied in states where abortion is banned or restricted. Respondents applied in banned/restricted states due to geography, concern about applying to too few programs, and expectation that the program would provide out-of-state training nonetheless. CONCLUSION: The majority of survey respondents who reported that access to abortion training during residency is essential or very important applied to programs where abortion training is not locally available. Most of these applicants expected programs in restricted states to provide training regardless. IMPLICATIONS: Residency programs should be aware of the importance of abortion training to applicants, as well as abortion training expectations, and work to develop opportunities and strengthen training networks in abortion care to meet candidates' needs and ensure adequate learning opportunities exist for all.
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Aborto Induzido , Ginecologia , Internato e Residência , Obstetrícia , Obstetrícia/educação , Estados Unidos , Humanos , Ginecologia/educação , Aborto Induzido/educação , Aborto Induzido/legislação & jurisprudência , Feminino , Inquéritos e Questionários , Gravidez , MasculinoRESUMO
OBJECTIVE: To determine whether group B Streptococcus (GBS)-colonized pregnant women have an increased prevalence of GBS colonization in subsequent pregnancies. STUDY DESIGN: This retrospective cohort study compared the prevalence of GBS colonization in initial and subsequent pregnancies of 158 women with two or more deliveries at a Midwest institution since the initiation of universal screening for GBS. RESULTS: The GBS colonization rate in index pregnancies was 20%. Colonization rate in subsequent pregnancies for initially GBS-colonized women was 42% compared with 19% for women who were not colonized with GBS in the index pregnancy (p = 0.009). The relative risk for GBS-colonized women to be GBS-colonized in subsequent pregnancies was 2.2 (confidence interval = 1.3 to 3.8). CONCLUSION: Previous GBS colonization is a risk factor for GBS colonization in subsequent pregnancies. Consideration of intrapartum chemoprophylaxis in women with a history of GBS colonization, assuming current colonization status is unknown, warrants further investigation.
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Complicações Infecciosas na Gravidez/epidemiologia , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae , Adulto , Estudos de Coortes , Feminino , Humanos , Gravidez , Prevalência , Reto/microbiologia , Recidiva , Estudos Retrospectivos , Vagina/microbiologia , Adulto JovemRESUMO
OBJECTIVE: To assess the change in competitiveness of obstetrics and gynecology programs over 20 years using a normalized competitive index. METHODS: Obstetrics and gynecology match data were obtained from the National Resident Matching Program (NRMP) for 2003-2022. Applicant metrics (United States Medical Licensing Examination scores, score percentiles, research output and experiences, and work and volunteer experiences) were obtained from the NRMP and the Association of American Medical Colleges (2007-2021). The competitive index was calculated using the number of positions available divided by match rate each year between 2003 and 2022. The normalized competitive index was calculated by dividing the yearly competitive index by the average competitive index over 20 years. Data were analyzed using univariate analysis and linear regressions. RESULTS: When comparing the two decades (2003-2012 vs 2013-2022), applicants (1,539±242 vs 1,902±144; P <.001), positions (1,173±31 vs 1,345±98; P <.001), and number of programs ranked per applicant (13±1.4 vs 15±0.6; P <.001) have increased. While the match rate did not significantly change from 2003 to 2022 (75.5%±9.9% vs 70.5%±1.6%; P =.14), the normalized competitive index increased (R 2 =0.92, P <.001), indicating increased competitiveness. Applicant metrics increased over time, including research output (2.4±0.8 vs 5.0±0.7; P =.002) and work experiences (2.9±0.2 vs 3.6±0.1; P =.002; R 2 =0.98, P< .001). CONCLUSION: Despite an increase in obstetrics and gynecology applicants and applicant metrics, match rates remain unchanged. However, the competitiveness of programs has significantly increased, as demonstrated by the normalized competitive index, applicants per position, and applicant metrics. The normalized competitive index is a useful metric for applicants to determine program or applicant competitiveness, especially when used alongside applicant metrics.
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Ginecologia , Internato e Residência , Obstetrícia , Humanos , Estados Unidos , Benchmarking , Modelos LinearesRESUMO
BACKGROUND: The COVID-19 pandemic decreased the operative case volume for surgical residents. Our institution implemented Entrustable Professional Activities (EPAs) in all core surgical training programs to document the competency of graduating residents. Continuation of this project aimed to improve implementation. METHODS: This project occurred at a large academic center with eight surgical specialties during the 2020-21 (Year 1) and 2021-22 (Year 2) academic years. Each specialty chose five EPAs, and residents were asked to obtain three micro-assessments per EPA. After the initial pilot year, program directors were surveyed regarding perceptions of EPA utility and barriers to implementation. RESULTS: Seventy senior residents completed 732/906 (80.8%) micro-assessments. Of these, 99.6% were deemed practice ready. Total micro-assessment completion rates in four specialties, four specific EPAs (including one EPA identified "at risk" due to the COVID-19 pandemic), and overall were significantly higher in Year 2 than Year 1 (p â< â0.05) CONCLUSIONS: Implementing EPAs in all core surgical specialties at an institution is achievable, though expectedly initially imperfect. An ongoing quality collaborative initiative focused on barriers to implementation can improve completion rates.
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COVID-19 , Internato e Residência , Humanos , Pandemias , Melhoria de Qualidade , Educação Baseada em Competências , Competência Clínica , COVID-19/epidemiologiaRESUMO
BACKGROUND: Gartner duct cysts develop from mesonephric duct remnants. They are usually small and asymptomatic, but complications can arise and are uncommonly reported. CASE: A 44-year-old patient presented with acute pelvic pain and pressure, a new vaginal mass, and urinary retention. Examination and magnetic resonance imaging revealed a large, expanding, complex paravaginal mass with extension into the paracervical and ischiorectal spaces, causing cephalad displacement of the uterus. A vaginal approach to cyst incision, hemorrhage control, and marsupialization resulted in complete resolution of symptoms. Pathology demonstrated a Gartner duct cyst without evidence of malignancy. CONCLUSION: Spontaneous hemorrhage of a Gartner duct cyst, although rare, may cause acute symptoms and a new vaginal mass. This diagnosis should be considered in the evaluation of acute-onset pelvic pressure and pain.
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Cistos , Ductos Mesonéfricos , Feminino , Humanos , Adulto , Ductos Mesonéfricos/patologia , Cistos/complicações , Cistos/diagnóstico , Cistos/cirurgia , Dor Pélvica/etiologia , Imageamento por Ressonância Magnética , Hemorragia/etiologia , Hemorragia/cirurgiaRESUMO
PROBLEM: Residents may experience mistreatment by faculty, peers, nurses, or patients. While faculty are reportedly the primary contributors to mistreatment, residents can also be offenders, which merits study. Forum theatre (FT) is an experiential learning modality requiring a peer group to develop problem-solving strategies. FT was piloted to address mistreatment among residents. The objective was to determine whether FT was feasible, acceptable to resident learners, and could lead to self-reported changes in perceptions or behaviors, providing program directors a focused option to address professionalism as a competency. APPROACH: This initiative was conducted from September 2019 through February 2021 in obstetrics-gynecology and urology residencies at UT Health San Antonio and consisted of 3 phases: a focus group to identify mistreatment experienced by residents, resident volunteers to create and act out the FT scenario, and enactment of the FT scenario during didactic time. Residents completed anonymous retrospective pre- and postsurveys, as well as at 6-8 months after, to assess knowledge, attitudes, and self-reported and observed behaviors. Wilcoxon rank-sum tests and 2-sample t tests for proportions were used to compare variables between groups. OUTCOMES: The FT was completed successfully in both departments during didactic time. Twenty-six residents participated, 24 (92%) responded. Most respondents (23, 96%) would recommend FT to colleagues for teaching professionalism. Behavior changes were reported by 15 (63%) participants after the program. After 6-8 months, self-reported mistreatment behaviors had decreased, including "making fun of others" (15 (63%) to 10 (38%), P = .04) and sending "disparaging texts" (13 (54%) to 7 (27%), P =.02). NEXT STEPS: The use of FT during regularly scheduled didactic times was feasible and well received among residents. The evaluation demonstrated sustained self-reported behavior changes. Plans are ongoing to expand this approach to other medical specialties and professions institutionally.
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Docentes , Grupo Associado , Feminino , Gravidez , Humanos , Projetos Piloto , Estudos Retrospectivos , AutorrelatoRESUMO
This article from the "To the Point" series prepared by the Association of Professors in Gynecology and Obstetrics (APGO) Undergraduate Medical Education Committee (UMEC) provides educators with strategies for inclusion of Lesbian, Gay, Bisexual, Transgender (LGBT)-related content into the medical school curriculum. With a focus on the Obstetrics and Gynecology (OB/GYN) clerkship, we also address ways to enhance visibility of these curricula within existing clinical and teaching experiences.
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The lack of a defined framework for advancement and development of professional identity as a medical educator may discourage faculty from pursuing or progressing through a career in academic medical education. Although career advancement has historically been linked to clinical work and research, promotion for teaching has not been supported at the same level. Despite potential challenges, a career in academic medicine has its share of rewards. This article by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee will describe how to develop as an academic medical educator in obstetrics and gynecology, providing tips on how to start, advance, and succeed in an academic career, and provide an overview of available resources and opportunities.