The impact of gender on the self-confidence of practical and surgical skills among OBGYN residents: a trinational survey.

INTRODUCTION: Gender disparities exist in the OBGYN discipline. This study investigates, for the first time, whether gender impacts on the confidence of practical and surgical skills among OBGYN residents, and of being prepared to work as a specialist. METHODS: The gynecological societies of Austria, Germany, and Switzerland established a web-based survey of 30 questions that was sent to all registered OBGYN members-in-training from August to September 2020. Data collection, controlling and analysis were performed by the Swiss Federal Institute of Technology in Zurich (ETH). RESULTS: A total of 422 participants took part in the survey, of which 375 (88.9%) were female, 46 (10.9%) were male, and one (0.2%) was divers. The diverse participant was excluded from further analyses. The gender distribution was comparable in all three countries. Multiple regression analyses showed that gender is an independent variable significantly impacting on the confidence levels in performing standard gynaecological (p = 0.03) and obstetric (p < 0.001) procedures. Similarly, the feeling of confidence in being prepared for working as a specialist in a clinic showed to be gender-dependent (p < 0.001), however, not the feeling of being prepared for working as specialist in an outpatient setting (p = 0.37). The "female factor" significantly decreases the confidence rating for surgical and practical skills and for working in a hospital. Covariates including year of training, country, workload, receiving regular feedback, and implemented simulation training were included in all analyses. DISCUSSION: Improvements of residency programs to promote female doctors to overcome factors reducing their confidence in their own OBGYN skills are highly warranted.

Postgraduate medical education in obstetrics and gynaecology: Where are we now and what do we need for the future? A study on postgraduate training in obstetrics and gynaecology in Germany, Austria and Switzerland.

Objective: In this study, we aim to assess the current situation of postgraduate medical education in obstetrics and gynaecology in Germany, Austria and Switzerland. In addition, we aim to determine transferable advantages amongst the countries. Study design: We performed a survey through a digital questionnaire with a total of 40 questions. The survey was advertised via communication channels of the German, Austrian and Swiss gynaecological societies; the participants were enrolled anonymously. Results: A total of 422 trainees took part in the survey. Differences within the three countries where found regarding the workload and the training of sub-specialties. Generally, the participants described to spend the majority of their daily working hours on documentation. Concerning assessment of current training regulations, more than half of trainees stated that they were actually faced with notable difficulties to fulfil the required obligatory numbers of self-performed interventions being documented. When asked for their intrinsic feeling of safety, around two-third of trainees felt "confident to very confident" during standard interventions. These numbers were up to 12% higher in the group of trainees who experienced simulation training during their education. Conclusion: With the help of this survey, weak points can be identified such as workload and implementation of current training regulations. Projects and ideas as EBCOG PACT, EPAs, the reduction of bureaucracy through digitization and deepening skills through simulation make a valuable contribution to compensate for these deficits and to adapt to future requirements.

Stereotactic Vacuum-Assisted Breast Biopsy in Ductal Carcinoma in situ: Residual Microcalcifications and Intraoperative Findings.

PURPOSE: The question of overtreatment of ductal carcinoma in situ (DCIS) was raised because a significant proportion of especially low-grade DCIS lesions never progress to invasive cancer. The rationale for the present study was to analyze the value of stereotactic vacuum-assisted biopsy (VAB) for complete removal of DCIS, focusing on the relationship between the absence of residual microcalcifications after stereotactic VAB and the histopathological diagnosis of the definitive surgical specimen. PATIENTS AND METHODS: Data of 58 consecutive patients diagnosed with DCIS by stereotactic VAB in a single breast center between 2012 and 2017 were analyzed. Patient records from the hospital information system were retrieved, and mammogram reports and images as well as histopathology reports were evaluated. The extent of microcalcifications before and after biopsy as well as the occurrence of DCIS in biopsy and definitive surgical specimens were analyzed and correlated. RESULTS: There was no correlation between the absence of residual microcalcifications in the post-biopsy mammogram and the absence of residual DCIS in the final surgical specimen (p = 0.085). Upstaging to invasive cancer was recorded in 4 cases (13%) but occurred only in the group that had high-grade DCIS on biopsy. Low-grade DCIS was never upgraded to high-grade DCIS in the definitive specimen. CONCLUSIONS: The radiological absence of microcalcifications after stereotactic biopsy does not rule out residual DCIS in the final surgical specimen. Since upstaging to invasive cancer is seen in a substantial proportion of high-grade DCIS, the surgical excision of high-grade DCIS should remain the treatment of choice.

Feasibility of breast MRI after sentinel procedure for breast cancer with superparamagnetic tracers.

RATIONALE: The gold standard for detection of axillary sentinel lymph nodes uses injection of a radioisotope (99Tc Nanocoll). As an alternative to this method, a magnetometer detecting the superparamagnetic tracer Sienna+® can be applied for detection of sentinel lymph nodes. The goal of this study was to determine whether interpretation of breast MRI is impaired by Sienna+® tracer residues in the operated breast and axillary lymph nodes after a sentinel procedure using this tracer. PATIENTS AND METHODS: 34 patients who received the Sienna+® tracer for marking the sentinel node were invited to undergo a follow-up breast MRI. Native MR images were obtained from breast and axilla. The breast MRIs were evaluated by two independent breast radiologists for Sienna+® tracer related artefacts and for the degree of impairment of the MR imaging. RESULTS: 24 of the 34 invited patients took part in this study. The mean time since injection of Sienna+® was 42 months (40.6-45.4 months). Two patients had bilateral surgery with injections in both breasts, leading to a total of 26 separate cases. One case had to be excluded due to breathing artefacts. In 10 cases (40%), impaired imaging was found. In three cases (12%), the MRI scan reading was impossible due to Sienna+® tracer residues, the other 12 cases (48%) showed no restriction. In the subgroup of patients treated with breast conserving surgery, tracer residue artefacts were found in 13 of 17 patients (76.5%). CONCLUSION: To our knowledge, in this study for the first time MR feasibility after Sienna injection was investigated. Sienna+® impaired breast MRI after a mean follow-up time of 42 months in half of the cases. Further research is needed to investigate time and field-strength dependency of tracer detectability as well as the diagnostic impact of these artifacts on contrast-enhanced imaging in a clinical setting.