Reactions of residency directors to primary care requirements in obstetrics and gynecology training.

OBJECTIVE: To determine the opinions of obstetrics and gynecology residency program directors regarding the Residency Review Committee mandate, requires 6 months of primary care training in obstetrics and gynecology. METHODS: A ten-question survey was mailed to the 272 accredited obstetrics and gynecology programs in the United States and Puerto Rico. Program directors were asked about the adequacy of 6 months of primary care training, whether educational deficiencies in obstetrics and gynecology will develop as a result of the mandate, and whether residency programs should be lengthened to encompass primary care. RESULTS: The response rate for the survey was 92.3% (251/272). University-affiliated, community, and military-based programs were surveyed and all geographic areas of the country were represented. Of program directors responding, 53.4% agreed with the mandate, 43.0% disagreed, and 3.6% declined to answer this question or both agreed and disagreed. Fifty-one percent considered 6 months of primary care training to be adequate, and 60.2% of program directors thought that educational deficiencies would develop in obstetrics and gynecology training programs. Whereas 66.1% responded that extension of obstetrics and gynecology training programs beyond 4 years was unnecessary, 32.7% thought program length should be increased. CONCLUSION: The results of this survey demonstrate that a substantial proportion of U.S. residency directors do not agree with the Residency Review Committee mandate for primary care training and think that deficiencies in obstetrics and gynecology training will develop as a result of these changes.

Open laparoscopy simplifies instrumentation required for laparoscopic oophorectomy and salpingo-oophorectomy.

Eight consecutive cases of open laparoscopic oophorectomy and salpingo-oophorectomy are reported. A modified technique that requires fewer specialized instruments and includes removal of the intact adnexa is demonstrated. Patients were not included if there was any suspicion of malignancy. Indications for surgery included chronic pelvic pain after hysterectomy (N = 5), endometriosis (N = 1), estrogen receptor-positive metastatic breast carcinoma that had not responded to chemotherapy (N = 1), and tuboovarian ectopic pregnancy (N = 1). No intraoperative or postoperative complications occurred. The average hospital stay was 1.1 days, and patients were released 3-14 days postoperatively. Five of the six patients with chronic pelvic pain had prompt resolution of their symptoms. In one patient who had a unilateral salpingo-oophorectomy, a contralateral procedure was required 3 months later because of continued chronic pelvic pain; her pain subsequently resolved. Laparoscopic salpingo-oophorectomy has the potential to decrease morbidity as compared with laparotomy in appropriately selected cases.