Exploring the skin-to-skin contact experience during cesarean section.

PURPOSE: To explore and describe the mother's experience of holding her neonate in skin-to-skin contact (SSC) immediately after cesarean delivery during surgical closure and recovery. DATA SOURCES: Eleven women between the ages of 23 and 38 years, who had achieved 39.1-40.2 weeks gestational age, participated in an ethnographic study using observations and interviews with the mothers conducted at 24-48 h postdelivery. Interviews were transcribed verbatim and content analysis of both observational notes and transcripts were used to analyze the data. CONCLUSIONS: Findings from this study describe the mother's experience of SSC during cesarean section. The primary theme that emerged was mutual caregiving: the mother-neonatal interaction and their shared and reciprocal relationship and benefits during SSC. Two contextual issues also were illuminated (a) the father's influence on the SSC experience and (b) the cesarean environment. IMPLICATIONS FOR PRACTICE: With cesarean section the most common surgical procedure among American women, advanced practice nurses are in a unique position to encourage and educate women on the use of SSC for their benefit and that of their newborn. Advanced practice nurses are also empowered to influence institutional policy on SSC during cesarean deliveries at the local and national level.

Survey of obstetrics and gynecology residents' training and opinions on robotic surgery.

To investigate obstetrics and gynecology residents' access to training in robotics and their opinions of its utility and future in gynecologic surgery a 31-item questionnaire was developed and distributed to Ob/Gyn residents in the United States via email. Results were tabulated via SurveyMonkey.com(©). A total of 470 residents representative of all ACOG districts and PGY levels responded. A total of 72% of residents reported ≥3 staff surgeons performing robotic gynecologic surgery at their institution and 70% had participated in robotic surgery in the past 12 months. Robotic hysterectomy (81%) and oncologic surgery (76%) were the most frequently performed procedures. A total of 79% believe their institution should provide formal training in robotics, but only 38% report access to it. A total of 23% have operated at the surgeon console, and 44% plan to incorporate robotic surgery into their practice after completing residency. A total of 3.6% feel equipped to perform robotic surgery without additional training. A total of 63% believe robotic surgery in gynecology will continue to increase in popularity. Exposure to gynecologic robotic procedures during residency is increasing. Although residents believe robotics has a place in gynecology, many feel formalized training has not been successfully implemented into their residency. Development of a structured program for training residents in robotics merits further investigation.

Seasonal variation in medical student experience in an obstetrics and gynecology clerkship.

OBJECTIVE: Our objective was to determine whether the medical student clinical experience varies during the academic year. STUDY DESIGN: Third-year medical students completing their obstetrics and gynecology clerkship were asked to complete a questionnaire about their clinical experience. The survey evaluated their experience with examinations and procedures using Likert-scale responses. The study was approved by the local institutional review board. RESULTS: A total of 90.5% of the students completed the questionnaire. Statistically more procedures were performed in the middle and late time periods than early in the year. This included the number of cervical examinations (P < or = .001), speculum examinations (P < or = .05), delivery of placentas (P < or = .001) and partial delivery of infant with delivery of placenta (P < or = .01), partial repair of an episiotomy (P < or = .01), and number of ultrasounds (P < or = .05) performed by the students. CONCLUSION: For some obstetrical and gynecological procedures, student hands-on experience increased during mid- and late-year clerkship rotations.

The effect of parenthood on perceived quality of life in teens.

OBJECTIVE: To describe the perceived quality of life of teen mothers. STUDY DESIGN: The Medical Outcomes Survey-Short Form 36, version 2 is a scale that measures a subject's perception of 8 health dimensions. The Medical Outcomes Survey-Short Form 36, version 2 and a demographics survey were completed by women during obstetric or gynecologic visits to a resident continuity clinic. Mean scores were compared between women with children and those without. RESULTS: There was no significant difference between adults or teens, with or without children, in any health component scale with the exception of social functioning. When compared with the normative population age, all groups in our population scored significantly on physical functioning and role-physical subscales. In addition, teens with children scored lower on the role-emotional subscale. CONCLUSION: Perceived quality of life in teen mothers does not appear to be lower than quality of life in teens without children or adult women.

Racial bias in patient selection of an obstetrician.

OBJECTIVE: The objective of this study was to determine racial bias in patient selection of an obstetrician. METHODS: Obstetrical patients referred for genetic counseling at a community hospital were included. Self-reported patient race/ethnicity were compared with obstetrician's race/ethnicity. RESULTS: The patient population (n = 1,519) was 27.8% white, 25% Hispanic, 22.5% black, 20.5% Asian, and 4.3% other. Physician race/ethnicity was 47.8% white, 28.8% Asian, 14.4% Hispanic, and 9% black. Patient race/ethnicity and physician race/ethnicity were correlated (contingency coefficient = 0.54, P < 0.001). White and Asian patients were more likely to select obstetricians of their own racial background (72.7% and 66.6%) than were Hispanic or black patients (36% and 24.6%, P < 0.001). Patients of all races were more likely to be under the care of a physician of their own race than of a different race. CONCLUSIONS: In an urban community with a racially diverse population, there is a strong racial bias in patient selection of an obstetrician.

Former-resident self-assessment: a tool for residency program curriculum evaluation in obstetrics and gynecology.

OBJECTIVE: To determine recent residents' confidence in managing problems in obstetrics and gynecology. STUDY DESIGN: All former residents from 1998 to 2002 were invited to participate. They were asked to complete a 32-item survey to assess confidence in obstetric and gynecologic care using Likert-scale responses. The study was approved by the local institutional review board. The t test was used for statistical analysis; p<0.05 was considered significant. RESULTS: Twenty-eight individuals graduated from the program during the study period; 61% responded to the survey. Respondents reported the lowest confidence in the business aspects of medicine, gynecologic ultrasound, laparoscopically assisted hysterectomy, pessary placement and cancer staging. They reported the highest confidence in routine obstetrics, laparoscopic sterilization, contraception, abnormal Pap smears, abdominal surgery and diagnostic laparoscopy, along with other categories. CONCLUSION: Residents are confident about management of most problems in obstetrics and gynecology. Periodic review of graduates' perceptions of training may be useful in modifying the curriculum.

Burnout in residency: a statewide study.

OBJECTIVE: To determine the prevalence of burnout in residents in obstetrics and gynecology through the use of a validated tool. METHODS: The Maslach Burnout Inventory Human Services questionnaire is a previously validated tool that measures burnout. Obstetrics and gynecology residents from Texas were invited to participate in this study in 2002. The Maslach Burnout Inventory Human Services questionnaire and a demographic survey were distributed to each resident. Responses were anonymous and returned by mail. Contingency coefficient and chi2 tests were used for analysis; values of P < 0.05 were significant. RESULTS: Residents (n = 368) from 17 programs in Texas were surveyed. Responses were received from 14 programs (82.4%), with 136 surveys (37%) returned. Overall, 38.2% reported high emotional exhaustion, 47.1% reported high depersonalization, and 19.1% reported reduced personal accomplishment. The number of residents experiencing true burnout (high emotional exhaustion, high depersonalization, and low personal accomplishment) was 17.6% (n = 24). CONCLUSIONS: High levels of emotional exhaustion and depersonalization occur in some residents. Burnout in residents included in this study was approximately 18%.

Job satisfaction among program directors in obstetrics and gynecology: a national portrait.

OBJECTIVES: The purpose of this study was to determine job satisfaction among program directors in obstetrics and gynecology with the use of a validated tool and to identify specific sources of dissatisfaction that might lead to job change. STUDY DESIGN: The program director satisfaction and a global job satisfaction survey were sent to all program directors in the United States. Motivators for seeking a job change were assessed. The chi(2) test, Kruskal-Wallis test, correlation analysis, and multiple linear regression were used. RESULTS: Seventy percent of 254 surveys were completed. Global job satisfaction (minimum, 4; maximum, 16) was 11.9+/-2.9; mean program director satisfaction score was 135+/-25.8 (minimum, 54; maximum, 200). Job satisfaction was highest in chairs, full professors, those whose age was >50 years, and those with >5 years of experience (P=.02) and in facets that were related to work with residents, colleagues, and patients. Dissatisfaction was highest with regard to salary, promotion opportunities, and resources. Forty-six percent of those who responded were considering a job change in 3 years; the most common reason for a job change that was cited was administrative hassles. CONCLUSION: Although job satisfaction is high among program directors, administrative hassles may lead to high rate of rapid turnover.

Work hours for practicing obstetrician-gynecologists: the reality of life after residency.

OBJECTIVE: Recently the Accreditation Council for Graduate Medical Education placed restrictions on all residency programs that limited work hours to 80 hours per week. The objective of this study was to determine the work hours for practicing obstetrician-gynecologists in an urban center. STUDY DESIGN: A questionnaire about physician demographics and work hours was mailed to all obstetrician-gynecologists in Houston in June 2002. Chi(2) testing was used for statistical analysis. RESULTS: One hundred eighty-nine surveys were mailed. One hundred surveys (56%) were returned complete and analyzed. Sixty-two physicians reported working >80 hours per week. Physicians were more likely to work >80 hours per week if they were men or if they were >50 years old. Marital status and having children living at home did not affect work hours. CONCLUSION: Most obstetrician-gynecologists in Houston work longer hours than the number of hours that is imposed by the Accreditation Council for Graduate Medical Education resident work hour guidelines.

Stress in residency: reality or myth?

OBJECTIVE: This study was designed to determine (1) occupational stress in a group of residents in obstetrics and gynecology, (2) whether occupational stress differs between years of training, and (3) whether there is seasonal variation in occupational stress. STUDY DESIGN: The Occupational Stress Inventory was administered to the 44 residents in obstetrics and gynecology at our institution in September 1998. A subgroup of 24 residents were also asked to complete the occupational stress inventory in January and May 1999. T-scores of 40 to 59 are within the normal range; scores of > or =70 on the occupational role questionnaire or the psychologic strain questionnaire suggest significant maladaptive stress; scores of < or =30 on the personal resources questionnaire suggest a significant lack of coping skills. Kruskal-Wallis and repeated-measures analysis of variance were used when appropriate. RESULTS: Forty residents completed the occupational stress inventory in September. The median T-score for each subscale was between 40 and 60. Eleven residents (27.5%) scored > or =70 on at least 1 subscale of the occupational role questionnaire. Three residents (7.5%) scored > or =70 on at least 1 subscale of the psychologic strain questionnaire. Seven residents (17.5%) scored < or =30 on at least 1 personal resources questionnaire subscale. There was no significant difference in occupational adjustment between resident level. In the 24 residents who were followed throughout the academic year, there was no significant difference in stress at different times of the years. CONCLUSION: Occupational stress is relatively common in a group of residents in obstetrics and gynecology. There is no difference in occupational stress or personal coping skills between years of training, and there is no seasonal variation in the academic year.