Into the Unknown: Navigating a Path as an Early-stage Physician-scientist in Obstetrics and Gynecology.

This piece is a reflection of one early-stage physician-scientist's professional journey. It highlights a few challenges of navigating this path while calling for continued investment and support for physician-scientists to enhance maternal and child lifelong health.

PAs in the Bulgarian healthcare system.

ABSTRACT: This article examines the importance of the physician associate/assistant (PA) profession in the healthcare system in Bulgaria. PAs in the country primarily work in emergency medicine and surgery, and are needed in other clinical settings, such as obstetrics and gynecology and psychiatric clinics, that are experiencing challenges because of physician shortages.

Surgical coaching in obstetrics and gynecology: an evidence-based strategy to elevate surgical education and promote lifelong learning.

The American Board of Medical Specialties, of which the American Board of Obstetrics and Gynecology is a member, released recommendations in 2019 reimagining specialty certification and highlighting the importance of individualized feedback and data-driven advances in clinical practice throughout the physicians' careers. In this article, we presented surgical coaching as an evidence-based strategy for achieving lifelong learning and practice improvement that can help to fulfill the vision of the American Board of Medical Specialties. Surgical coaching involves the development of a partnership between 2 surgeons in which 1 surgeon (the coach) guides the other (the participant) in identifying goals, providing feedback, and facilitating action planning. Previous literature has demonstrated that surgical coaching is viewed as valuable by both coaches and participants. In particular, video-based coaching involves reviewing recorded surgical cases and can be integrated into the physicians' busy schedules as a means of acquiring and advancing both technical and nontechnical skills. Establishing surgical coaching as an option for continuous learning and improvement in practice has the potential to elevate surgical performance and patient care.

Time to make some noise about a quiet revolution.

'Tomorrow belongs to those who can hear it coming' David Bowie. Language is a living entity that moves and changes. Use of gender-neutral language in medical literature is increasingly common. It is time for obstetricians and gynaecologists in Australia and New Zealand to interrogate their own bias and desire to maintain the status quo, and to consider reasons for change.

Domestic violence in the clinical practice of gynecologists and obstetricians.

The issue of domestic violence is neglected in current medical practice and the dia-gnosis associated with it thus escapes the attention of medical professionals. In this case report, we demonstrate rare and typical diseases of abused women, which should become warning signs for physicians (red flags) and lead them to screen domestic violence and intervene early. Failure to recognize domestic abuse as the cause of chronic health problems leads to lasting consequences and economically and personally burdens the health care system. Healthcare professionals of all specialties encounter abused women during their clinical practice and can thus actively participate in the prevention of domestic violence. However, it is women of reproductive age who are most at risk, so educating gynecologists and obstetricians on this issue is crucial. The aim of this article with a case study is to demonstrate the syndrome of a battered woman, its recognition and the possibility of immediate and brief intervention.

Subspecialty training in Europe: a report by the European Network of Young Gynaecological Oncologists.

BACKGROUND: ESGO (European Society of Gynaecological Oncology) and partners are continually improving the developmental opportunities for gynaecological oncology fellows. The objectives of this survey were to evaluate the progress in the infrastructure of the training systems in Europe over the past decade. We also evaluated training and assessment techniques, the perceived relevance of ENYGO (European Network of Young Gynaecological Oncologists) initiatives, and unmet needs of trainees. METHODOLOGY: National representatives of ENYGO from 39 countries were contacted with an electronic survey. A graduation in well/moderately/loosely-structured training systems was performed. Descriptive statistical analysis and frequency tables, as well as two-sided Fisher's exact test, were used. RESULTS: National representatives from 33 countries answered our survey questionnaire, yielding a response rate of 85%. A national fellowship is offered in 22 countries (66.7%). A logbook to document progress during training is mandatory in 24 (72.7%) countries. A logbook of experience is only utilized in a minority of nations (18%) for assessment purposes. In 42.4% of countries, objective assessments are recognized. Trainees in most countries (22 (66.7%)) requested additional training in advanced laparoscopic surgery. 13 (39.4%) countries have a loosely-structured training system, 11 (33.3%) a moderately-structured training system, and 9 (27.3%) a well-structured training system. CONCLUSION: Since the last publication in 2011, ENYGO was able to implement new activities, workshops, and online education to support training of gynaecological oncology fellows, which were all rated by the respondents as highly useful. This survey also reveals the limitations in establishing more accredited centers, centralized cancer care, and the lack of laparoscopic training.

Take me to your leader: Reporting structures and equity in academic gynecologic oncology.

OBJECTIVE: Gynecologic oncology includes increasing percentages of women. This study characterizes representation of faculty by gender and subspecialty in academic department leadership roles relevant to the specialty. METHODS: The American Association of Medical Colleges accredited schools of medicine were identified. Observational data was obtained through institutional websites in 2019. RESULTS: 144 accredited medical schools contained a department of obstetrics and gynecology with a chair; 101 a gynecologic oncology division with a director; 98 a clinical cancer center with a director. Women were overrepresented in academic faculty roles compared to the US workforce (66 vs 57%, p < 0.01) but underrepresented in all leadership roles (p < 0.01). Departments with women chairs were more likely to have >50% women faculty (90.2 vs 9.8%, p < 0.01); and have larger faculties (80.4 vs 19.6% >20 faculty, p = 0.02). The cancer center director gender did not correlate to departmental characteristics. A surgically focused chair was also associated with >50% women faculty (85.7 vs 68.3%, p = 0.03); faculty size >20 (85.7 vs 61.4%, p < 0.01); and a woman gynecologic oncology division director (57.6 vs 29.4%, p < 0.01; 68.4 vs 31.7%, p < 0.01) and gynecologic oncology fellowship (50 vs 30.4%, p < 0.01; 59.1 vs 32%, p < 0.01). Gynecologic oncology leadership within cancer centers was below expected when incidence and mortality to leadership ratios were examined (p < 0.01, p < 0.01). CONCLUSION: Within academic medical schools, women remain under-represented in obstetrics and gynecology departmental and cancer center leadership. Potential benefits to gynecologic oncology divisions of inclusion women and surgically focused leadership were identified.

Gender variation in Medicare utilization and payments in gynecologic oncology.

OBJECTIVES: The Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (POSPUF) and Medicare Physician and Other Supplier National Provider Identifier (POS NPI) Aggregate Report are publicly available files from the Center for Medicare and Medicaid Services that include payments to providers who care for fee-for-service Medicare recipients. The aim of this study was to analyze variability in gynecologic oncologists' Medicare reimbursements, with attention to differences in provider gender and time in practice. METHODS: The 2015 POSPUF and POS NPI were analyzed with respect to gynecologic oncologists. We searched external publicly available data sources to confirm subspecialty and to determine each provider's number of years in practice. Evaluation and management (E&M) and procedure/surgery codes were analyzed; drug delivery codes were excluded due to variability in billing by facility/hospital. RESULTS: The POS NPI file included 733 gynecologic oncologist providers receiving $55,626,739 in total payments. Female providers comprised 39% of gynecologic oncologists and received 31% of reimbursements (30% of E&M reimbursements and 24% of surgical reimbursements). During the first ten years in practice, female providers comprised 58% of providers and accounted for 52% of reimbursed services, compared to 38% of providers/26% of reimbursed services (11-20 years), and 18% of providers/19% of reimbursed services (>20 years). CONCLUSION: Male gynecologic oncologists perform more Medicare services than their female counterparts. There is a comparable number of services performed between genders among both the most senior and the most junior providers, with a gender gap in services and reimbursements among mid-career providers.

Employment preferences of obstetricians and gynecologists to work in the district hospitals: evidence from a discrete choice experiment in Nepal.

BACKGROUND: A mismatch between the requirement and annual production of obstetricians and gynecologists (OBs-GYNs) was observed in Nepal. On top of that, recruitment and retention of OBs-GYNs is a pressing problem, especially in district hospitals of Nepal. In this connection, evidence on the job priorities and preferences of OBs-GYNs, which is currently lacking in Nepal, would help in policymakers in devising recruitment and retention strategies in these hospitals. This study, therefore, aims at exploring the most relevant job attributes that OBs-GYNs would prefer to work in the district hospitals of Nepal using a discrete choice experiment (DCE) technique. METHODS: Job attributes relevant to design the questionnaire were identified using keyinformant interviews and focusgroup discussions with policymakers and top managers. Then, 48 choice sets were developed using a fractional factorial design. Using these unlabeled choice sets, a DCE was conducted among 189 OBs-GYNs. The multinomial logistic regression model was used to estimate the marginal utilities and other model parameters. The willingness to pay/accept estimates was also measured for each job attribute. RESULTS: OBs-GYNs preferred the presence of a full team at the workplace (OB-GYN, pediatrician, and anesthesiologist), provision of primary and secondary education for children, and opportunity of private practice. On the other hand, a few job attributes such as a higher duration of service in district hospitalsand the provisions of a car allowance were preferred less by the respondents. Results from the marginal utility by the OBs-GYNs would be open to trade among the attributes. CONCLUSIONS: The job attributes identified as incentives in this study should be included in a package to attract OBs-GYNs to serve in district hospitals of Nepal rather than offering a standard incentive package to all health workers. Similarly, this study confirmed the importance of the combination of non-monetary and monetary interventions in attracting and retaining health workers in district hospitals of Nepal.

Substitution of hospital care with Primary Care Plus: differences in referral patterns according to specialty, specialist and diagnosis group.

BACKGROUND: Primary Care Plus (PC+) is an intervention where patients consult specialists in a primary care setting outside the hospital. Two facilities have been founded in the city of Maastricht, the Netherlands. Main aim is to achieve substitution of hospital care with primary care and hence reduce costs. The objective of this study is to evaluate referral patterns per specialty, specialist and diagnosis group, as input for deliberations to optimise substitution. METHODS: Prospectively collected referral data after PC+ consultations between November 2014 and March 2016 was analysed for eight participating specialties. Primary outcomes were differences in referral patterns per specialty, specialist and diagnosis group. Absolute counts and percentages were recorded for categorical variables, means and standard deviations for continuous variables. Statistical analyses were performed using IBM SPSS Statistics 23 (SPSS Inc., Chicago, IL). RESULTS: In total 4536 patients were seen in PC+; 3132 (69.0%) were referred back to the general practitioner (GP), whereas 1275 (28.1%) were referred to secondary care. Referral information of 130 (2.9%) patients was unknown. Large differences in referral numbers to secondary care after PC+ consultation were found between specialties (from 8.6% (gynaecology) to 43.8% (orthopaedic surgery)), specialists (14.5 to 65.2%) and diagnosis groups (11.1 to 93.4%). CONCLUSIONS: Wide variation in referral numbers to secondary care between specialties, specialists and diagnosis groups exists after PC+ consultations. This data indicates that deliberation and further research is needed in order to optimize substitution initiatives like PC+.

Inequality of obstetric and gynaecological workforce distribution in China.

BACKGROUND: Women's health is defined as a continuum throughout their whole lives. In China, women receive life-round preventative and curative health care from the health system, although the universal access to reproductive health has already been basically achieved in China, the situation of women's access to curative health care is still unknown. METHODS: Data from the national maternal and child health human resource investigation were analysed. Lorenz curves, Gini coefficients, and Theil L indexes were drawn and calculated to reflect the inequality. Demographically, we found that the Obstetric and gynaecological (OB/GYN) workforce was the least equitable regarding the distribution of live births. RESULTS: Demographically, we found that the OB/GYN workforce was the least equitable regarding the distribution of live births. The geographic distribution of the OB/GYN workforce was found to be severely inequitable, especially in the West region. Most of the inequality was found to come from inner-regions. CONCLUSION: For the first time, the distribution inequality of OB/GYN workforce in China was analysed. The findings in this study can be adopted in making national or regional OB/GYN workforce allocation policies, but further studies are still needed to reveal the detailed sources of inequality and to provide evidence for local policy-making.

Female Physicians in Maternal-Fetal Medicine: A 32-Year Perspective.

OBJECTIVE: To examine trends of female physicians either pursuing fellowships or in active practice in maternal-fetal medicine (MFM). METHODS: This observational study examined complete sets of MFM fellows and active members of the Society for Maternal-Fetal Medicine (SMFM) between 1985 and 2016. Databases from SMFM, American College of Obstetricians and Gynecologists (ACOG), and Accreditation Council for Graduate Medical Education were used. Analysis of covariance testing was used to assess interactions over time between groups. RESULTS: The proportion of female MFM fellows increased steadily from 17.1% in 1985 to 72.5% in 2016. The proportion of females grew more rapidly among the MFM fellows than obstetrics and gynecology (ob-gyn) residents (2.1 vs. 1.4% per year; p = 0.001) and among those who were active SMFM members than ACOG Fellows (1.4 vs. 1.2% per year; p = 0.013). Slightly more than half (52.4%) of all SMFM members are now female and will approach two-thirds (64.4%) by 2025 (compared with 53.4% in 2016 and 65.3% in 2025 of ACOG fellows). CONCLUSION: The rising proportion of female MFM fellows is directly related to the high number of female ob-gyn residents. Females comprise slightly more than half of all active SMFM members now and projected to approach two-thirds by 2025.

Women Physicians in Byzantium.

Women were allowed to practice the medical profession during the Byzantine Empire. The presence of female physicians was not an innovation of the Byzantine era but actually originated from ancient Greece and Rome. The studies and the training of women doctors were apparently equivalent to those of their male colleagues. The principal medical specialties of the female doctors were gynecology and midwifery. Byzantine legislation treated relatively equally both female and male doctors. For this reason, it can be assumed that the presence of female doctors was correlated with the position of women in Byzantine society. However, there is not sufficient information in the literature to clarify whether female and male doctors used to earn equal payment for the same service.

European Network of Trainees in Obstetrics and Gynaecology: experiences from the 2016 exchange programme in Turin, Italy.

INTRODUCTION: The European Network of Trainees in Obstetrics and Gynaecology (ENTOG) is an organization representing trainees from 30 European member countries. Together with the European Board and College of Obstetrics and Gynaecology (EBCOG), it seeks to achieve the highest possible standards of training and consequently to improve the quality of medical care in the field of gynaecology and obstetrics. Every year, the ENTOG council meets and holds a scientific meeting in a different European country. To coincide with this, the host country arranges an exchange, to which each member country can send two trainees. This exchange allows trainees to gain insight into both daily clinical work and the structure of the health care system. METHODS: This article reports the experiences of participants in the May 2016 ENTOG exchange to Turin, Italy. The aim is to outline differences in training between Germany and Italy as well as some striking differences with other European countries. PERSPECTIVE: The participants' personal benefit from this unique experience was not only to get familiar with the Italian trainee programme and health care system, but also to exchange experiences among representatives from other European countries and build up a young gynaecological network within Europe.

Diversity of Physician Faculty in Obstetrics and Gynecology.

OBJECTIVE: To investigate physician faculty diversity in obstetrics and gynecology (ob-gyn) and how it compares with other clinical departments and medical student demographics. STUDY DESIGN: Data from the Association of American Medical College's Faculty Roster were extracted to differentiate full-time physician faculty by gender and by underrepresentation in medicine (Black, Hispanic, Native American/ Alaskans, and Pacific Islanders). Whole population data were updated on a rolling basis from the earliest year of reliable data (1973) to the most recent year (2012). RESULTS: The total number of full-time ob-gyn faculty increased from 922 in 1973 to 4,208 in 2012. The increase in proportion of faculty who were women (from 9.9% to 52.7%) contributed to the growth of underrepresented faculty (from 7.7% to 13.3%) during this period. Percentages of ob-gyn faculty who were women and underrepresented in 2012 were higher than in other core clinical departments and similar to those of current medical student matriculants. CONCLUSION: Expansion of physician faculty in ob-gyn over the past 40 years has led to greater diversity than exists in many other departments and is more reflective of medical student demographics.