Disparities in Treatment Decisions for Abnormal Uterine Bleeding.

Background: Abnormal uterine bleeding (AUB) affects ∼1.4 million women in the United States each year. This study sought to identify differences in treatment decisions for managing noncancer-related AUB. Materials and Methods: IRB approval was obtained. This retrospective study analyzed data for all women 21-60 years old, diagnosed with AUB from July 1, 2013 through June 30, 2017, in an Obstetrics and Gynecology residents' clinic serving mostly underinsured patients. Patients with a diagnosis of postmenopausal bleeding or any gynecologic cancer were excluded. Two multivariable logistic regression models were used to identify variables independently associated with receiving surgical (vs. medical) treatment and any (vs. no) treatment. Results: Of 2,154 patients with AUB, 1,705 women met all inclusion criteria and had complete data for analysis. In the model examining receipt of surgical (vs. medical) treatment, women ages 41-60 were 4.8 times more likely than women 21-40 years old to receive surgical treatment. Women designated as "Other" (non-White) race/ethnicity were 80.8% less likely than Black/African American patients to receive surgery. Body mass index (BMI) and insurance type were not independently associated with receiving surgical treatment. In the model examining any (vs. no) treatment, women ages 41-60 (vs. 21-40) and of unknown (vs. Black/African American) race/ethnicity were 69.6% and 50.8% less likely to receive any treatment, respectively. BMI and insurance status were not independently associated with receiving any treatment. Conclusion: Management of AUB differed significantly by age and race/ethnicity, but not BMI or insurance. Further investigation among larger diverse populations is warranted to test the generalizability of these findings.

Exposure to COVID-19 patients increases physician trainee stress and burnout.

The coronavirus disease 2019 (COVID-19) pandemic has put considerable physical and emotional strain on frontline healthcare workers. Among frontline healthcare workers, physician trainees represent a unique group-functioning simultaneously as both learners and caregivers and experiencing considerable challenges during the pandemic. However, we have a limited understanding regarding the emotional effects and vulnerability experienced by trainees during the pandemic. We investigated the effects of trainee exposure to patients being tested for COVID-19 on their depression, anxiety, stress, burnout and professional fulfillment. All physician trainees at an academic medical center (n = 1375) were invited to participate in an online survey. We compared the measures of depression, anxiety, stress, burnout and professional fulfillment among trainees who were exposed to patients being tested for COVID-19 and those that were not, using univariable and multivariable models. We also evaluated perceived life stressors such as childcare, home schooling, personal finances and work-family balance among both groups. 393 trainees completed the survey (29% response rate). Compared to the non-exposed group, the exposed group had a higher prevalence of stress (29.4% vs. 18.9%), and burnout (46.3% vs. 33.7%). The exposed group also experienced moderate to extremely high perceived stress regarding childcare and had a lower work-family balance. Multivariable models indicated that trainees who were exposed to COVID-19 patients reported significantly higher stress (10.96 [95% CI, 9.65 to 12.46] vs 8.44 [95% CI, 7.3 to 9.76]; P = 0.043) and were more likely to be burned out (1.31 [95% CI, 1.21 to1.41] vs 1.07 [95% CI, 0.96 to 1.19]; P = 0.002]. We also found that female trainees were more likely to be stressed (P = 0.043); while unmarried trainees were more likely to be depressed (P = 0.009), and marginally more likely to have anxiety (P = 0.051). To address these challenges, wellness programs should focus on sustaining current programs, develop new and targeted mental health resources that are widely accessible and devise strategies for creating awareness regarding these resources.

Attrition in residents entering US obstetrics and gynecology residencies: analysis of National GME Census data.

OBJECTIVE: We sought to identify risk factors for attrition among obstetrics and gynecology residents. STUDY DESIGN: We analyzed 2001-2006 American Medical Association Graduate Medical Education (GME) Census data for all residents who entered obstetrics and gynecology in 2001 to characterize residents who did not complete a 4-year training period in their initial programs ("attrition"). Multivariable logistic regression models identified predictors of attrition from among age, gender, race, Hispanic ethnicity, medical school type, and medical school graduation year. RESULTS: Of 1055 residents entering obstetrics and gynecology in 2001, 228 (21.6%) were in the "attrition" group (133 changed obstetrics and gynecology programs and/or completed training on atypical cycles; 75 changed specialty; 20 discontinued GME). Residents who were older, underrepresented minority race, Asian race, osteopathic- or international medical school graduates were more likely to be in the "attrition" group (each P < .05). CONCLUSION: Analysis of a national cohort of obstetrics and gynecology residents identified substantial attrition and demographic risk factors.

Are entering obstetrics/gynecology residents more similar to the entering primary care or surgery resident workforce?

OBJECTIVE: We compared demographic characteristics of first-year residents entering obstetrics/gynecology with those entering primary care and surgery. STUDY DESIGN: We analyzed first-year residents from the 1997-2004 National Graduate Medical Education Census. Multivariable logistic regression models identified independent associations between obstetrics/gynecology residency (compared with primary care and surgery) and demographic predictor variables. RESULTS: More than 90% of studied programs completed the National Graduate Medical Education Census for 146,174 first-year residents. Graduates of US allopathic medical schools, women, African Americans, and entering residents in 2003 and 2004 were more likely to enter obstetrics/gynecology than primary care; Asians were less likely to enter obstetrics/gynecology than primary care. Women, African Americans, and Hispanics were more likely to enter obstetrics/gynecology than surgery; trainees who were Asian, "other" race/ethnicity, and entered residency from 1999-2004 were less likely to enter obstetrics/gynecology than surgery. CONCLUSION: Demographic characteristics of incoming obstetrics/gynecology-residents differed significantly from both primary care and surgery residents. Obstetrics/gynecology should be a unique category in physician workforce studies.

Have predictors of obstetrics and gynecology career choice among contemporary US medical graduates changed over time?

OBJECTIVE: We sought to identify predictors of obstetrics and gynecology (OBGYN) specialty choice among US medical graduates over time. STUDY DESIGN: We examined OBGYN specialty choice for its association with 16 items on the 1997, 2000, and 2004 AAMC Graduation Questionnaire (GQ). Multivariate logistic regression identified independent predictors of OBGYN specialty choice for each year. RESULTS: Eighty-three percent of US graduates completed the GQ in the 3 years studied. Fewer responders chose OBGYN over time (1997, 8.2%; 2000, 6.5%; 2004, 6.2%). Women, blacks, and graduates with more positive ratings of the OBGYN clerkship were more likely to choose OBGYN in each year (each P < .001). Graduates reporting more positive beliefs about the practice of medicine and preferring academic careers were less likely to choose OBGYN (each P < .05). CONCLUSION: Predictors of OBGYN specialty choice from among the GQ variables tested have remained stable over time, but with a smaller pool of likely applicants.

Attrition during graduate medical education: medical school perspective.

OBJECTIVE: To identify predictors of attrition during graduate medical education (GME) in a single medical school cohort of contemporary US medical school graduates. DESIGN: Retrospective cohort study. SETTING: Single medical institution. PARTICIPANTS: Recent US allopathic medical school graduates. MAIN OUTCOME MEASURE: Attrition from initial GME program. RESULTS: Forty-seven of 795 graduates (6%) did not complete the GME in their initial specialty of choice. At bivariate analysis, attrition was associated with election to the Alpha Omega Alpha Honor Medical Society, being an MD-PhD degree holder, and specialty choice (all P < .05). Attrition was not associated with graduation year (P = .91), sex (P = .67), or age (P = .12). In a multivariate logistic regression model, MD-PhD degree holder (odds ratio, 3.43; 95% confidence interval, 1.27-9.26; P = .02), election to Alpha Omega Alpha (2.19; 1.04-4.66; P = .04), choice of general surgery for GME (5.32; 1.98-14.27; P < .001), and choice of 5-year surgical specialty including those surgical specialties with a GME training requirement of 5 years or longer (2.74; 1.16-6.44; P = .02) each independently predicted greater likelihood of attrition. CONCLUSION: Academically highly qualified graduates and graduates who chose training in general surgery or in a 5-year surgical specialty were at increased risk of attrition during GME.

Colposcopic accuracy of obstetrics and gynecology residents.

OBJECTIVE: The objective of our study was to determine the accuracy of gynecology residents' colposcopic impressions. METHODS: A retrospective review of colposcopic examinations was performed. Colposcopic impressions were compared to cervical biopsy and the results stratified by level of residency training. kappa Statistics were calculated to determine the strength of correlation between impression and biopsy results. RESULTS: Agreement within one-step between cervical histology and the colposcopic impression was found in 351 (77%) of the subjects. Histology impression agreement occurred in 92% of the nurse practitioner procedures, 77% of the second year resident (R2) cases, 75% of R3 colposcopies and 73% of the R4 procedures. The association between cervical biopsy and impression was highly significant (P<0.0001). However, the strength of the correlation was only slight (kappa=0.197). The kappa value was highest for the nurse practitioners (0.376, fair correlation) and lowest for the R3 residents (0.110, slight correlation). The positive predictive value for the association of any colposcopically detected abnormality with any histologic abnormality was 64.1%. The overall PPV was highest for the nurse practitioners (79.3%) and lowest for the R2 residents (58.7%). CONCLUSIONS: While the colposcopic impressions of gynecology residents were accurate, there was little difference in the accuracy of colposcopic assessment based upon the level of resident training.