Changes and challenges in the residency application process in obstetrics and gynecology.

Faculty career advisors who guide applicants applying to obstetrics and gynecology residency programs need updated information and resources, given the constant changes and challenges to the residency application process. Initial changes included standardization of the application timeline and interview processes. More recent changes included the utilization of a standardized letter of evaluation, initiation of program signaling, second look visit guidelines, and updated sections in the Electronic Residency Application Service. Challenges in advising include the unmatched applicant and the applicant who is couples matching in the era of program signaling. Additional considerations include applying with the current status of reproductive health law restrictions and preparing for a new residency application platform. The Undergraduate Medical Education Committee of the Association of Professors of Gynecology and Obstetrics provides this updated guide of the prior 2021 resource for advisors to increase confidence in advising students, boost professional fulfillment with advising activities, and aid in satisfaction with advising resources. This guide covers the continuing challenges and future opportunities in the resident application process.

Paving the Way for Medical Students: How Smooth Should the Road Be?

Clerkship directors must balance the mental wellbeing of their medical students with the demanding schedule that rotations in procedural specialties such as surgery and obstetrics and gynecology require. In this paper, the Undergraduate Medical Education Committee of the Association of Professors of Obstetrics and Gynecology argues the importance of maintaining adequate clinical exposure for learners. Involving students in overnight call provides additional clinical involvement, improved relationships with the clinical team, and a better perspective on specialist lifestyle. Educators should improve the experience for students by promoting resilience and creating a welcoming learning environment. Preparing medical students for the rigorous requirements of these clerkships allows them to thrive in the learning environment while still providing a realistic preview of the clinical experiences and demands of these specialties.

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.

Strategies to Create a More Gender Identity Inclusive Learning Environment in Preclinical and Clinical Medical Education.

ABSTRACT: Recognition of the spectrum of gender identities has been a recent phenomenon in the medical profession. Over the past 20 years, medical literature related to gender identity diversity has increased several-fold, yet it more commonly addresses clinical care rather than aspects related to medical education. Medical educators continue to struggle with appropriate language and inclusive approaches when discussing gender-based aspects of medical education. Reproductive health education, including obstetrics and gynecology clerkships, is particularly vulnerable to missteps and anachronisms regarding gender identity.This article aims to provide preclinical and clinical medical educators with strategies to identify and predict situations where missteps related to gender identity inclusivity may occur in their curriculum or learning environment, and to develop approaches to improve gender identity inclusivity within medical education. The authors explore 3 areas that commonly pose challenges for medical educators: inclusive language and terminology, anatomy education, and reproductive genetics and genetic counseling. They hope the tools and strategies provided here will be useful to reproductive health medical educators across specialties to enable the realization of a more inclusive learning environment in reproductive health.

To the Point: optimizing the learning environment in labor and delivery.

The labor and delivery floor is a unique learning environment that poses challenges to teaching medical students, with a potentially detrimental effect on their evaluations of the obstetrics and gynecology clerkship. This article, from the "To the Point" series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, offers specific suggestions for improving undergraduate medical education in obstetrics with attention to student preparation, faculty development, nonphysician staff involvement, and patient education. Optimizing the learning environment in labor and delivery would improve student experiences and perceptions of our specialty.

The Dobbs Decision and Undergraduate Medical Education: The Unintended Consequences and Strategies to Optimize Reproductive Health and a Competent Workforce for the Future.

The June 2022 U.S. Supreme Court decision on Dobbs v Jackson Women's Health Organization resulted in state-specific differences in abortion care access across the country. The primary concern in the obstetrics and gynecology education community has been the impact on resident and fellowship training programs. However, the impact on undergraduate medical education and the broad implications for future generations of physicians are crucial to address. It is estimated that 48% of matriculants to MD-granting medical schools will receive their medical education in the 26 states with significant abortion restrictions or bans. Undergraduate medical educators need to continue to adequately teach the basic science, clinical care, and population health outcomes of reproductive medicine, including pregnancy and abortion. In addition, students in states with more restrictions on abortion will have less or no clinical exposure, and those in states with few restrictions may be excluded due to overcrowding of learners from restricted states. Students' own health care also needs to be considered, as access to abortion care for themselves or their partners may create applicant pool demographic shifts by state as applicants consider options for where to pursue their medical education. It is important to ensure that teaching of foundational science of pregnancy, abortion, and reproductive health continues throughout the United States. Undergraduate and graduate medical educators will need to closely monitor the downstream impact of decreased clinical exposure of abortion. Further study of the personal health impact of abortion care access for medical students and awareness of the changing applicant pool demographics by state is needed.

Systematic Review of Pelvic Anatomy iOS and Android Applications for Obstetricians and Gynecologists.

IMPORTANCE: Resources for learning and enhancing knowledge in medicine, such as mobile applications (apps), have dramatically increased in recent years; however, there is lack of a valid source for identifying the best and most reliable mobile apps. OBJECTIVES: The goal of this study was to identify the highest scoring available pelvic anatomy apps based on quality, content, and functionality for obstetrician-gynecologists using a validated tool. STUDY DESIGN: This was a systematic evaluation of anatomy apps in the Apple iTunes (iOS) and Google Play (Android) stores. Exclusions included apps that had nonhuman, nonanatomy content, did not include female pelvic anatomy or were deemed inappropriate for postgraduate level. The validated Mobile App Rating Scale (MARS), a mobile-health (mHealth) app scoring system was used to evaluate apps based on both objective and subjective quality. The authors' MARS scores for each variable were compiled, and the objective, subjective, and overall scores were calculated. RESULTS: The search criteria yielded 2,432 apps: 952 (39%) Apple iTunes store and 1,480 (60.8%) Google Play Store apps. After applying the exclusion criteria, 35 (14 iOS, 8 Android, and 13 iOS/Android) apps were included for evaluation using the MARS system. "Complete Anatomy" app, available for both iOS and Android systems, obtained the highest objective, subjective, and overall MARS score. CONCLUSIONS: Although there are numerous anatomy apps available, only a few meet prespecified criteria for functionality, content, quality, and are appropriate for obstetrician-gynecologists. Using a validated scoring system, we present a scored list of female pelvic anatomy apps most appropriate for obstetrician-gynecologists.

Mobile Health Apps for Pregnant Women: Systematic Search, Evaluation, and Analysis of Features.

BACKGROUND: Many pregnant women use the internet to obtain information about pregnancy and childbirth. Over 50% of pregnant women use pregnancy apps and must search through thousands of pregnancy or women's health-related apps available on app stores. The COVID-19 pandemic is changing how women receive prenatal care. Mobile health apps may help maintain women's satisfaction with their prenatal care. OBJECTIVE: Our objective is to identify pregnancy mobile apps and to evaluate the apps using a modified APPLICATIONS (app comprehensiveness, price, privacy, literature used, in-app purchases, connectivity, advertisements, text search field, images/videos, other special features, navigation ease, subjective presentation) scoring system. METHODS: A list of pregnancy apps was identified in the first 20 Google search results using the search term "pregnancy app." After excluding irrelevant, inaccurate, malfunctioning, or no longer available apps, all unique apps were downloaded and evaluated with the modified APPLICATIONS scoring system, which includes both objective and subjective criteria and evaluation of special features. RESULTS: A list of 57 unique pregnancy apps was generated. After 28 apps were excluded, the remaining 29 apps were evaluated, with a mean score of 9.4 points out of a maximum of 16. The highest scoring app scored 15 points. Over 60% (18/29) of apps did not have comprehensive information for every stage of pregnancy or did not contain all four desired components of pregnancy apps: health promotion/patient education, communication, health tracking, and notifications and reminders. Only 24% (7/29) of apps included a text search field, and only 28% (8/29) of apps cited literature. CONCLUSIONS: Our search yielded many high-scoring apps, but few contained all desired components and features. This list of identified and rated apps can lessen the burden on pregnant women and providers to find available apps on their own. Although health care providers should continue to vet apps before recommending them to patients, these findings also highlight that a Google search is a successful way for patients and providers to find useful and comprehensive pregnancy apps.

In Search of Mobile Applications for Urogynecology Providers.

INTRODUCTION: Thousands of medical applications (apps) are available for mobile devices. Finding accurate, health care provider-centered apps may be time consuming and frustrating for urogynecologists. The objective of this study was to identify and evaluate urogynecology (urogyn) apps using a modified APPLICATIONS scoring system. MATERIALS AND METHODS: Urogyn apps were identified from the Apple iTunes and Google Play Stores using the following 10 MeSH terms: urogynecology, incontinence, prolapse, urinary tract infection, pelvic surgery, fecal incontinence, defecation disorder, voiding disorder, urethral diverticulum, and fistula. Patient-centered and inaccurate apps were excluded. The remaining apps were evaluated with a modified APPLICATIONS scoring system, which included both objective and subjective criteria to determine each app's ability to aid in clinical decision making and to provide informational data. Objective rating components were price, paid subscription, literature referenced, in-app purchases, Internet connectivity, advertisements, text search field, interplatform compatibility and incorporated images, figures, videos, and special features. Subjective rating components were ease of navigation and presentation. RESULTS: Our search yielded 133 and 235 apps in the Apple iTunes and Google Play Stores, respectively. Only 8 apps (4 of which were in both stores) were determined to be accurate and useful; these were evaluated using the modified APPLICATIONS scoring system. The top-rated app was Practical Urology. CONCLUSION: Few accurate clinical decision-making and informational apps exist for urogynecologists. Apps varied by comprehensiveness and quality. This study highlights the importance of systematically reviewing and rating medical apps. It also emphasizes the need for developing accurate apps for urogynecologists that improve health care provider performance and patient outcomes.

In Search of Mobile Applications for Patients With Pelvic Floor Disorders.

OBJECTIVES: The aims of the study were to identify patient-centered applications (apps) in female pelvic medicine and reconstructive surgery and to evaluate them using a modified APPLICATIONS scoring system. METHODS: A comprehensive list of female pelvic medicine and reconstructive surgery search terms was used to identify apps in the iTunes store. Apps that were eligible for scoring were in English, pertinent to the search term, patient centered, and accurate. All five authors independently evaluated eligible apps using a modified APPLICATIONS scoring system and subsequently reconciled differences by discussion. RESULTS: One hundred and fifty-seven terms were generated and searched in the iTunes Store to reveal 4127 apps. Twenty-three eligible apps were scored. Approximately half (47%, 11/23) of the apps were free. Twelve (52%) apps cited scientific literature or expert source. Only 8 (35%) of the apps were also available in the Google Play Store. "Squeezy," "LeakFreeMe," and "Stop UTI" received the highest score of 14. CONCLUSIONS: Few identified apps were accurate and subsequently scored. Our results demonstrate that when searching for apps, patients are likely to obtain information that is not relevant or inaccurate, even if the appropriate search term is used. By carefully excluding inaccurate apps, providers should feel confident that the 23 scored apps can be shared with patients.

In Search of Accurate Fetal Heart Rate Monitoring Mobile Applications.

Background: Regulation of medical applications (apps) has not been rigorous. Concern for inaccurate medical apps with potential health consequences has increased. Objective: To identify mobile apps for fetal heart rate monitoring (FHM) and to evaluate their accuracy through a case report. Methods: A list of FHM apps was found in the Apple iTunes stores using a comprehensive list of search terms. After excluding apps irrelevant to this study, all unique apps were then downloaded and evaluated for necessary purchase of an accessory item, presence of disclaimer regarding medical advice, and accuracy of medical content. Those apps that did not require additional purchases were tested for ability to detect heart rates. Results: A total of 30 unique FHM apps were generated. Of these apps, 1 app required an in-app purchase to use and 7 apps required purchase of an accessory device and thus were not further evaluated. Of the 22 remaining apps, all (100%) of the applications were unable to detect the fetal heart rate. Further data collection revealed additional issues, including duplicates, lack of medical disclaimers regarding medical use of the app, and false information in the app content. Conclusion: Identification of FHM apps that do not require additional purchases revealed that all apps were inaccurate. In addition, some apps did not provide a disclaimer and/or contained false information. Healthcare providers should understand the problems with these FHM apps and educate their patients on the inaccuracies and potential dangers of the use of these applications.

Identification and Evaluation of Medical Translator Mobile Applications Using an Adapted APPLICATIONS Scoring System.

IMPORTANCE: With an increasing number of patients requiring translator services, many providers are turning to mobile applications (apps) for assistance. However, there have been no published reviews of medical translator apps. OBJECTIVE: To identify and evaluate medical translator mobile apps using an adapted APPLICATIONS scoring system. DESIGN: A list of apps was identified from the Apple iTunes and Google Play stores, using the search term, "medical translator." Apps not found on two different searches, not in an English-based platform, not used for translation, or not functional after purchase, were excluded. The remaining apps were evaluated using an adapted APPLICATIONS scoring system, which included both objective and subjective criteria. App comprehensiveness was a weighted score defined by the number of non-English languages included in each app relative to the proportion of non-English speakers in the United States. SETTING: The Apple iTunes and Google Play stores. PARTICIPANTS: Medical translator apps identified using the search term "medical translator." Main Outcomes and Measures: Compilation of medical translator apps for provider usage. RESULTS: A total of 524 apps were initially found. After applying the exclusion criteria, 20 (8.2%) apps from the Google Play store and 26 (9.2%) apps from the Apple iTunes store remained for evaluation. The highest scoring apps, Canopy Medical Translator, Universal Doctor Speaker, and Vocre Translate, scored 13.5 out of 18.7 possible points. CONCLUSIONS AND RELEVANCE: A large proportion of apps initially found did not function as medical translator apps. Using the APPLICATIONS scoring system, we have identified and evaluated medical translator apps for providers who care for non-English speaking patients.

An Evaluation of Contraception Education and Health Promotion Applications for Patients.

PURPOSE: Patients use mobile applications (apps) to obtain information about health, including contraception. Providers and health educators may also use apps designed for patients to aid in patient education during the clinical encounter or recommend apps for patient use. Individuals may have a difficult time remaining updated on the number and quality of available apps. The objective of this study is to identify and evaluate contraception apps for patient education and health promotion, so that providers and health educators may recommend accurate apps to patients. METHODS: We systematically searched the Apple iTunes Store using contraception search terms. A master list of apps was created and the apps were divided into categories and subcategories according to intended audience and purpose. Contraception apps for patient education and health promotion were selected and also checked for availability in the Google Play Store. We evaluated these identified apps using an adapted APPLICATIONS scoring system. FINDINGS: Forty-eight apps were identified from the original search. Nineteen of these were excluded because they did not open on an iPhone or iPad, were no longer available, or did not contain educational material on contraception. We excluded 11 additional apps that contained inaccurate information. We evaluated 18 apps. The mean score was 10.6 out of 17 possible points with a range of 7 to 15 points. CONCLUSIONS: Many apps provide contraception information for patients, but some apps are inaccurate. Few apps provide comprehensive information on all available methods, including effectiveness, side effects, and contraindications.

An Evaluation of Mobile Applications for Reproductive Endocrinology and Infertility Providers.

OBJECTIVE: To identify and rate reproductive endocrinology and infertility (REI) mobile applications (apps) targeted toward REI providers. DESIGN: A list of REI apps was found in both the Apple iTunes and Google Play stores using the following seven MeSH terms: reproductive endocrinology, REI, infertility, fertility, In Vitro Fertilization, IVF, and embryology. Patient-centered apps were excluded. The remaining apps were then evaluated for accuracy using reliable references. SETTING: Mobile technology. PATIENTS/INTERVENTIONS: None. MAIN OUTCOME MEASURES: Accurate apps were evaluated for comprehensiveness (the extent of the ability to aid in clinical decision-making) and rated with objective and subjective components using the APPLICATIONS scoring system. RESULTS: Using the seven REI-related MeSH terms, 985 apps and 1,194 apps were identified in the Apple iTunes and Google Play stores, respectively. Of these unique apps, only 20 remained after excluding patient-centered apps. Upon further review for applicability to REI specifically and content accuracy, only seven apps remained. These seven apps were then rated using the APPLICATIONS scoring system. CONCLUSION: Only 0.32% of 2,179 apps reviewed for this study were useful to REI providers. There is potential for further mobile resource development in the area of REI, given the limited number and varying comprehensiveness and quality of available apps.

Identification and Rating of Gynecologic Oncology Applications Using the APPLICATIONS Scoring System.

BACKGROUND: Currently, there are thousands of medical applications (apps) on the market potentially leading to app overload. Finding useful and accurate apps may be time-consuming and frustrating to gynecologic oncologists. INTRODUCTION: The objective of this study is to identify and rate gynecologic oncology (gyn-onc) apps using the APPLICATIONS scoring system. MATERIALS AND METHODS: A list of nonconsumer gyn-onc apps was identified from the Apple iTunes and Google Play Stores. Based on reliable references, inaccurate apps were excluded. The remaining apps were rated with the APPLICATIONS scoring system, which uses both objective and subjective measures. RESULTS: Of 748 apps identified, 11 (1.5%) were found to be both useful and accurate to gyn-onc providers. The apps with the lowest scores were calculator apps, while those with the highest scores were informational apps. DISCUSSION: We found useful and accurate calculator, screening, staging, and informational apps. However, a large number of the apps found were considered inaccurate or non-gyn-onc specific. CONCLUSIONS: Our systematic method for identifying and rating apps with the APPLICATIONS scoring system can be applied within other subspecialties of obstetrics and gynecology and other specialties of medicine to offer providers with apps in clinical care.

Evaluation of Smartphone Menstrual Cycle Tracking Applications Using an Adapted APPLICATIONS Scoring System.

OBJECTIVE: To identify smartphone menstrual cycle tracking applications (apps) and evaluate their accuracy, features, and functionality. METHODS: In this systematic evaluation, we searched the Apple iTunes store for free menstrual cycle tracking apps for patient use. We considered an application accurate if menstrual cycle predictions were based on average cycle lengths of at least three previous cycles, ovulation (when included) was predicted at 13-15 days before the start of the next cycle, and the application contained no misinformation. We modified the APPLICATIONS Scoring System to evaluate the features and functionality of accurate apps. RESULTS: Our search criteria yielded 1,116 apps; 108 remained after excluding duplicate, non-English, nonmenstrual cycle tracking, and priced apps. We further eliminated 88 that did not meet inclusion or accuracy criteria. Of the 20 accurate, free apps, 80% contained information for conception and 50% for contraception. Common features and functionality included password protection (55%); no requirement for Internet connectivity (80%); no advertisements (65%); in-application technical support (70%); medical disclaimers (65%); health education (55%); tracking of menstrual flow (70%), symptoms (70%), and intercourse (75%); alerts for next menses (65%) and fertility (55%); and cycle length information (75%). Forty percent were available for Android. Usefulness for fertility medications (15%), professional involvement (5%), and cited literature (5%) were rare. CONCLUSION: Most free smartphone menstrual cycle tracking apps for patient use are inaccurate. Few cite medical literature or health professional involvement. We list accurate apps to aid health care providers in understanding the key components they can use to evaluate and recommend apps for patients.

An evaluation of contraception mobile applications for providers of family planning services.

OBJECTIVE: We aimed to identify mobile applications (apps) about contraception and to evaluate those targeted toward providers of family planning services in order to assess their quality and comprehensiveness. METHODS: We systematically searched the Apple iTunes Store using contraception search terms. We created a master list of relevant and unique apps and divided the apps into categories and subcategories according to intended audience and purpose. We then checked availability of contraception apps for providers in the Google Play Store. We scored apps on objective and subjective components using the APPLICATIONS scoring system, a tool developed to evaluate health-related mobile apps with a maximum score of 17 points. RESULTS: From a total of 1218 apps found using 41 contraception search terms, 113 were unique and relevant to contraception. We determined that six apps (5.3%) were potentially useful for providers of family planning services and evaluated them. Four apps received 12 points, one received 11 points and one received 8 points. The two free apps were among those with the highest scores. Three of these apps were also available in the Google Play Store. CONCLUSIONS: A small number of contraception apps are targeted toward providers of family planning services. Available apps are variable in quality and comprehensiveness. IMPLICATIONS: There is potential for further mobile resource development in the area of contraception, given the limited number and inconsistent quality of available apps.

Rating Pregnancy Wheel Applications Using the APPLICATIONS Scoring System.

OBJECTIVE: To identify the top-rated pregnancy wheel applications (apps) using a newly developed APPLICATIONS scoring system. METHODS: A list of pregnancy wheel apps was identified. Consumer-based and inaccurate apps were excluded. The APPLICATIONS scoring system was developed to rate the remaining apps. Application comprehensiveness was evaluated. Objective rating components included price, paid subscription, literature used, in-app purchases, connectivity to the Internet, advertisements, text search field, interdevice compatibility, and other components such as images or figures, videos, and special features. Subjective rating components were ease of navigation and subjective presentation. RESULTS: A complete list of 55 pregnancy wheel apps was created from three sources. Thirty-nine (71%) were consumer-based, inaccurate, or both, leaving 16 (29%) for analysis using the APPLICATIONS scoring system. CONCLUSION: More than two thirds of pregnancy wheel apps were excluded from our study secondary to being consumer-based, inaccurate, or both. This highlights the importance of identifying systematically, reviewing critically, and rating the thousands of available apps to health care providers to ensure accuracy and applicability. We propose that our APPLICATIONS scoring system be used to rate apps in all specialties with the goal of improving health care provider performance and thereby patient outcomes. LEVEL OF EVIDENCE: III.

Hypersensitivity to laminaria: a case report and review of literature.

We report a case of laminaria hypersensitivity treated with diphenhydramine and corticosteroids. A literature review identified 10 previously reported cases, with 8 recognized as anaphylaxis, and good outcomes with corticosteroids and antihistamines despite limited epinephrine utilization. Laminaria hypersensitivity is likely IgE mediated with an increased anaphylaxis risk with prior exposure.