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.

Changes and Challenges in the Residency Application Process in Obstetrics & 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 utilization of 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 era of program signaling. Additional considerations are applying in the current status of reproductive health laws 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, to boost professional fulfillment with advising activities, and to aid in satisfaction with advising resources. This guide covers the continuing challenges and future opportunities in the resident application process.

The golden tickets: impact of preference signaling on obstetrics and gynecology residency applicants.

BACKGROUND: With the residency selection process becoming more competitive and programs receiving unprecedented numbers of applications, some specialties have introduced preference signaling in an attempt to help applicants target programs of interest. In the 2022-2023 application cycle, obstetrics and gynecology also introduced a 2-tiered system with a limited number of gold signals (n=3) and silver signals (n=15). OBJECTIVE: Given the novelty of preference signaling in the obstetrics and gynecology residency application process, this study aimed to (1) assess the effect of signals on interview offers and match and (2) discuss applicant attitudes toward this preference signaling system. STUDY DESIGN: This was a voluntary cross-sectional survey study conducted in April 2023 that was open to all fourth-year medical students who applied to an obstetrics and gynecology residency in the United States. Self-reported demographics, signaling, interview, and match data were collected. In addition, students were asked about attitudes toward signaling on a 5-point Likert scale. RESULTS: Of the 1507 applicants who entered an obstetrics and gynecology residency via match or Supplemental Offer and Acceptance Program process, 969 (64.3%) completed the survey. Moreover, an additional 22 applicants who did not match responded to the survey. More respondents used all 3 gold tokens (98.3%) and all 15 silver tokens (94.3%). The mean number of applications sent was 74.3±35.1, and the mean number of interviews received per applicant was 12.8±6.6. The interviews or token yields were 64.0%±31.5% for gold tokens, 43.8%±23.1% for silver tokens, and 9.8%±10.0% for no token. Of the survey respondents, 340/951 (35.8%) matched to a gold token program, 338/951 (35.5%) matched to a silver token program, and 244/951 (25.7%) matched to a nontoken program. Furthermore, 499/951 applicants (52.5%) reported feeling slightly positive or very positive about signaling. CONCLUSION: Most obstetrics and gynecology applicants in this survey participated in preference signaling. Gold and silver tokens were associated with high ratios of interview invitations compared with no token. However, the overall number of applications did not decrease in the 2022-2023 cycle, and only half of survey respondents reported feeling positive about the signaling process. These results can inform program directors and students about application number and strategy in upcoming cycles.

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.

Does the Degree Matter? MD and DO Students Who Match Into OB/GYN Report Different Experiences in US Undergraduate Medical Education.

Background: Although allopathic (MD) and osteopathic (DO) students have similar curricular requirements, little is known about differences in MD and DO preparedness for obstetrics and gynecology (OB/GYN) residency. Objective: To assess differences in experiences and confidence of MD vs DO students who matched to OB/GYN. Methods: This cross-sectional survey study was open to all fourth-year medical students who matched to OB/GYN in the United States in April 2021. The survey included demographic data, clinical experiences, confidence (5-point sliding scale), and a 11-item knowledge test. Survey responses were compared to assess for disparities in experiences and confidence. Results: Survey response rate was 72.0% (1057 of 1469) students matched to OB/GYN postgraduate year 1 positions. Of the 871 MD and 175 DO responding students, MDs were more likely to have clerkships ≥6 weeks (78.1% vs 15.4%; P<.001) and a home sub-internship (92.0% vs 53.4%; P<.001). DOs reported more hands-on experiences with procedures (MD median=35 [20-35] vs DO median=40 [25-65]; P=.002). There was no difference in self-reported confidence in knowledge, technical skills, or having a realistic sense of internship, and no difference in baseline knowledge test scores. DOs felt less confident about their medical school preparation (aOR 0.40; 95% CI 0.25-0.66; P<.001) and were more likely to perceive inequity of residency preparation (aOR 1.88; 95% CI 1.18-3.00; P=.002). Conclusions: MD students matched to US OB/GYN residency programs reported longer clerkship and more home sub-internships, while DO students reported more hands-on experiences. Despite reporting similar confidence in knowledge and skills, DO students felt less prepared for internship.

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 #ObGynInternChallenge: Reach, Adoption, Implementation, and Effectiveness of a Microlearning SMS-Distributed Curriculum.

PROBLEM: While many medical schools have implemented bootcamps or specialized curricula to prepare medical students for residency, these programs are neither universal nor consistent in their content. APPROACH: The authors created an electronic, multimodal, short messaging service (SMS)-distributed curriculum, called the #ObGynInternChallenge, to improve learners' medical knowledge, based on the Council on Resident Education in Obstetrics and Gynecology educational objectives. The curriculum was open to all fourth-year medical students who matched into obstetrics and gynecology (Ob/Gyn). Daily messages were delivered to participants' mobile devices via SMS for 25 consecutive weekdays, May 3-June 4, 2021. Each day's message included an introduction with key facts, an infographic, a website link with a podcast and additional reference materials, and at least one question. The authors assessed its reach, adoption, implementation, and effectiveness. OUTCOMES: For reach and adoption, total enrollment for the curriculum was 1,057 (72.0%) of 1,469 filled Ob/Gyn residency positions in the 2021 Match. The total cost of the intervention was $2,503.20 or $2.37 per participant. For implementation, all participants who signed up for the course received the daily messages, and 858/1,057 (81.2%) completed the course. Participants felt the curriculum was an excellent resource for studying (391/426, 91.8%) and the course was enjoyable to use (395/424, 93.2%). For effectiveness, mean score improvement was 11.6% (pre-test: 62.4%, post-test: 74.0%; P < .001). In the multivariate linear regression analysis, high podcast ( P = .02) and website use ( P = .002) were associated with greater score improvement. High social media use was associated with less improvement ( P = .02). NEXT STEPS: This study suggests promise for a low-cost, largely satisfying SMS-distributed curriculum in terms of offering some benefit for short-term knowledge gain. Next steps include expanding such a curriculum to meet standard learning objectives for all fourth-year medical students entering residency.

Volume, Distribution, and Inequities by Race and Gender of Clinical Experiences Reported by Medical Students Entering Obstetrics and Gynecology Residencies.

OBJECTIVE: To assess for inequities by race and gender of fourth year medical students' (MS4s) self-reported clinical experience in obstetrics and gynecology (Ob/Gyn). DESIGN: This was a voluntary, cross-sectional survey. Participants provided demographic data, information regarding their preparation for residency, and self-reported numbers of hands-on clinical experiences. Responses were compared across demographic categories to assess for disparity in pre-residency experiences. SETTING: The survey was open to all MS4s matched to Ob/Gyn internships in the United States in 2021. PARTICIPANTS: The survey was distributed primarily via social media. Eligibility was verified by participants supplying the names of their medical school of origin and their matched residency program prior to completing the survey. 1057/1469 (71.9%) MS4s entering Ob/Gyn residencies participated. Respondent characteristics were not different from nationally available data. RESULTS: Median clinical experience numbers were calculated for hysterectomies (10; IQR 5-20), suturing opportunities (15; IQR 8-30), and vaginal deliveries (5.5; IQR 2-12). Non-White students had fewer hands-on experiences with hysterectomy, suturing, and cumulative clinical experiences when compared to White MS4s (p values <0.001). Female students had fewer hands-on experiences with hysterectomies (p < 0.04), vaginal delivery (p < 0.03), and cumulative experiences (p < 0.002) than male students. When assessed by quartiles, non-White students and female students were less likely to be in the top quartile for experience and more likely to be in the bottom quartile for experience than their White and male counterparts, respectively. CONCLUSIONS: A significant number of medical students entering Ob/Gyn residency have minimal hands-on clinical experience with foundational procedures. Additionally, there are racial and gender disparities in clinical experiences of MS4s matching to Ob/Gyn internships. Future work should identify how biases in medical education may affect the access to clinical experience in medical school, and potential interventions to mitigate inequities in procedures and confidence prior to residency.

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.

Am I Really Qualified To Be Here: Exploring The Impact Of Impostor Phenomenon On Training And Careers In OB/GYN Medical Education.

OBJECTIVE: Individuals with Impostor Phenomenon (IP) believe they have achieved success by fooling others into thinking they are intelligent/capable and fear they will be discovered. This fear has been shown to cause psychological distress and may affect OB/GYN training. The objective of this study was to investigate the prevalence of IP and correlation with anxiety among OB/GYN trainees and faculty. DESIGN/SETTING: An anonymous cross-sectional survey including a demographic questioner, Clance Impostor Scale, and Generalized Anxiety Disorder 2-items screening tool was distributed to 200 attendees at the 2019 American College of Obstetricians and Gynecologists Annual Meeting. PARTICIPANTS: Eighty-nine medical students, 38 residents, 3 fellows, and 9 attendings completed the survey for a response rate of 72%. RESULTS: The average participant experienced frequent feelings of IP with the mean score of 65 ± 18. Nine (8%) experienced few feelings of IP, 27 (24%) had moderate IP feelings, 55 (50%) had frequent IP feelings, and 20 (18%) had intense IP feeling. There was no difference between IP score and trainee/faculty gender, race, or region of country. The degree of IP was significantly associated with level of medical training with more experienced physicians scoring lower than trainees (F = 6.07, p = 0.001). Finally, an association was found between anxiety and IP; individuals with a positive GAD-2 screen had significantly more feelings of IP compared to individuals with a negative GAD-2 screen (t = 4/79, p < 0.001). CONCLUSION: This study suggests that IP is likely prevalent among OB/GYN trainees and correlate with anxiety. Further discussion is needed regarding the impact of IP on medical education training and career advancement in the field of OB/GYN and other surgical specialties.

Association of Antidepressant Continuation in Pregnancy and Infant Birth Weight.

PURPOSE: The aim of the study was to evaluate the association of antidepressant continuation in pregnancy with infant birth weight among women using antidepressants before pregnancy. METHODS: This retrospective cohort study used electronic health data linked with state birth records. We identified singleton live births (2001-2014) to enrolled women with 1 or more antidepressant prescriptions filled 6 months or less before pregnancy, including "continuers" (≥1 antidepressant fills during pregnancy, n = 1775) and "discontinuers" (no fill during pregnancy, n = 1249). We compared birth weight, small or large for gestational age (SGA or LGA), low birth weight (LBW; <2500 g), and macrosomia (>4500 g) between the 2 groups, using inverse probability of treatment weighting to account for pre-pregnancy characteristics, including mental health conditions. RESULTS: After weighting, infants born to antidepressant continuers weighed 71.9 g less than discontinuers' infants (95% confidence interval [CI], -115.5 to -28.3 g), with a larger difference for female infants (-106.4 g; 95% CI, -164.6 to -48.1) than male infants (-48.5 g; 95% CI, -107.2 to 10.3). For female infants, SGA risk was greater in continuers than discontinuers (relative risk [RR],1.54; 95% CI, 1.02 to 2.32). Low birth weight risk was greater in continuers with 50% or more of days covered (RR, 1.69; 95% CI, 1.11 to 2.58) and exposure in the second trimester (RR, 1.53; 95% CI, 1.02 to 2.29), as compared with discontinuers. CONCLUSIONS: Depending on infant sex, as well as duration and timing of use, continuation of antidepressant use during pregnancy may be associated with lower infant birth weight, with corresponding increases in LBW and SGA.

Pregnancy Has No Clinically Significant Effect on the Pharmacokinetics of Bupropion or Its Metabolites.

BACKGROUND: Bupropion (BUP) is a chiral antidepressant and smoking cessation aide with benefits and side effects correlated with parent and active metabolite concentrations. BUP is metabolized by CYP2B6, CYP2C19, and CYP3A4 to hydroxy-BUP (OH-BUP) as well as by 11ß-hydroxysteroid dehydrogenase-1 and aldo-keto reductases to threohydrobupropion (Threo) and erythrohydrobupropion (Erythro), respectively. As pregnancy alters the activity of drug-metabolizing enzymes, the authors hypothesized that BUP metabolism and BUP metabolite concentrations would be altered during pregnancy, potentially affecting the efficacy and safety of BUP in pregnant women. METHODS: Pregnant women (n = 8) taking BUP chronically were enrolled, and steady-state plasma samples and dosing interval urine samples were collected during pregnancy and postpartum. Maternal and umbilical cord venous blood samples were collected at delivery from 3 subjects, and cord blood/maternal plasma concentration ratios were calculated. The concentrations of BUP stereoisomers and their metabolites were measured. Paired t tests were used to compare pharmacokinetic parameters during pregnancy and postpartum. RESULTS: No significant changes were observed in the steady-state plasma concentrations, metabolite to parent ratios, formation clearances, or renal clearance of any of the compounds during pregnancy when compared with postpartum. The umbilical cord venous plasma concentrations of BUP and its metabolites were 30%-60% lower than maternal plasma concentrations. CONCLUSIONS: This study showed that there are no clinically meaningful differences in the stereoselective disposition of BUP or its metabolites during pregnancy, indicating that dose adjustment during pregnancy may not be necessary. The results also showed that the placenta provides a partial barrier for bupropion and its metabolite distribution to the fetus, with possible placental efflux transport of bupropion and its metabolites.

Maternal Gestational Weight Gain in Relation to Antidepressant Continuation in Pregnancy.

OBJECTIVE: Both excessive and inadequate gestational weight gain (GWG) are associated with adverse health outcomes for the woman and her child. Antidepressant use in pregnancy could affect GWG, based on evidence in nonpregnant women that some antidepressants may cause weight gain and others weight loss. Previous studies of antidepressant use and GWG were small with limited ability to account for confounding, including by maternal mental health status and severity. We assessed the association of antidepressant continuation in pregnancy with GWG among women using antidepressants before pregnancy. STUDY DESIGN: Our retrospective cohort study included singleton livebirths from 2001 to 2014 within Kaiser Permanente Washington, an integrated health care system. Data were obtained from electronic health records and linked Washington State birth records. Among women with ≥1 antidepressant fill within 6 months before pregnancy, women who filled an antidepressant during pregnancy were considered "continuers;" women without a fill were "discontinuers." We calculated mean differences in GWG and relative risks (RR) of inadequate and excessive weight gain based on Institute of Medicine guidelines. Using inverse probability of treatment weighting with generalized estimating equations, we addressed differences in maternal characteristics, including mental health conditions. RESULTS: Among the 2,887 births, 1,689 (59%) were to women who continued antidepressants in pregnancy and 1,198 (42%) were to discontinuers. After accounting for confounding, continuers had similar weight gain to those who discontinued (mean difference: 1.3 lbs, 95% confidence interval [CI]: -0.1 to 2.8 lbs) and similar risks of inadequate and excessive GWG (RR: 0.95, 95% CI: 0.80-1.14 and RR: 1.06, 95% CI: 0.98-1.14, respectively). Findings were comparable for specific antidepressants and trimesters of exposure. CONCLUSION: We did not find evidence that continuation of antidepressants in pregnancy led to differences in GWG. KEY POINTS: · Antidepressant use is associated with weight change in nonpregnant populations.. · Prior evidence on whether antidepressant use in pregnancy affects gestational weight gain is sparse.. · We accounted for confounding by characteristics such as mental health conditions and their severity.. · We found no association between pregnancy antidepressant continuation and gestational weight gain..

Perineal Laceration and Episiotomy Repair Using a Beef Tongue Model.

Introduction: Declining rates of operative vaginal deliveries and routine episiotomy in obstetric practice, along with rising cesarean section rates, have decreased OB/GYN resident experience with episiotomy repair and obstetric anal sphincter injuries (OASIS). Simulation models are valuable educational tools in procedural training. Several models have been reported, each with its own limitations and benefits. Methods: We developed a 1-hour workshop to teach novice OB/GYN residents perineal laceration repair skills on a modified beef tongue model. The model required 5-10 minutes to assemble following written and video instruction, and learners had 30-50 minutes to practice using learner instructions. Learners were evaluated using a procedure checklist and global objective structured assessment of technical skills. To evaluate the session, we surveyed current faculty and residents, as well as residency graduates. Results: Between 2008 and 2017, an estimated 82 OB/GYN residents participated in this activity, and 95 participants and facilitators received the survey. Forty-one (59%) respondents agreed that this model was similar to repairing OASIS in clinical practice. Our trainees reported that the optimal time for simulated OASIS repair was the R2 and R3 years; however, 90% of respondents felt residents should be offered this simulation yearly. Discussion: Based on our survey of trainees, graduates, and faculty, we created a realistic simulated OASIS repair training, despite the limitation that the model lacked a rectum. Learners reported an interest in repeating the simulation frequently during residency to augment their clinical experience and increase perceived competence in third- and fourth-degree laceration repair by their graduation.

Attitudes of Trainees in Obstetrics and Gynecology Regarding the Structure of Residency Training.

OBJECTIVE: To measure future and current resident perspectives on obstetrics and gynecology residency training structure and possible future models. METHODS: Medical students invited for obstetrics and gynecology residency interviews and residents (postgraduate year [PGY]-1-4) at the University of Colorado, the University of Washington, the University of California San Francisco, Loyola University, Saint Joseph's Hospital, and Texas A&M in 2017-2018 received a voluntary, electronic survey regarding possible models for restructuring residency training. Student and resident responses were compared using χ test for categorical and two-sample t-test for continuous items. RESULTS: Applicants (63%, 280/444) and residents (66%, 101/153) had similar response rates (overall response rate 64%). Applicants (24%) and residents (29%) reported having concerns about the current structure of residency training. The ideal residency duration was reported as 4 years by 72% of applicants and 85% of residents. Lack of gynecologic surgical volume was the most frequently reported concern among applicants (75%) and residents (72%). Fourth-year tracking (focusing on training aligned with postgraduation career path) was preferred by 90% of applicants and 77% of residents (P=.002) and 92% among respondents planning fellowship. Most applicants (68%) and residents (75%) preferred not starting fellowship training after the 3rd year of residency. DISCUSSION: The majority of learners surveyed support a 4-year training structure but likewise support individualizing training in PGY-4. It is imperative that obstetrics and gynecology leadership consider this and other feedback from learners when considering modifications to the current training paradigm.

Antidepressant continuation in pregnancy and risk of gestational diabetes.

PURPOSE: Previous studies observed modestly higher risk of gestational diabetes (GDM) associated with antidepressant use in pregnancy, potentially due to confounding by indication. We assessed the association of antidepressant continuation in pregnancy with GDM, as well as blood glucose levels, after accounting for confounding. METHODS: We conducted a retrospective cohort study of singleton live births from 2001 to 2014 to women enrolled in Kaiser Permanente Washington, an integrated health care delivery system, utilizing electronic health data and linked Washington State birth records. We required that women have ≥1 antidepressant prescription fills ≤6 months before pregnancy. Women with an antidepressant fill during pregnancy were categorized as "continuers" (n = 1634); those without a fill were "discontinuers" (n = 1211). We calculated relative risks (RRs) for GDM and mean differences in screening blood glucose levels using generalized estimating equations with inverse probability of treatment weighting to account for baseline characteristics, including mental health conditions and indicators of mental health severity. RESULTS: Compared with discontinuers, antidepressant continuers had comparable risk of GDM (RR: 1.10; 95% confidence interval [CI], 0.84-1.44) and blood glucose levels (mean difference: 2.3 mg/dL; 95% CI, -1.5 to 6.1 mg/dL). We observed generally similar results for specific antidepressants, with the potential exceptions of risk of GDM associated with sertraline (RR: 1.30; 95% CI, 0.90-1.88) and venlafaxine (RR: 1.52; 95% CI, 0.87-2.68), but neither association was statistically significant. CONCLUSIONS: Our study suggests that overall, women who continue antidepressants in pregnancy are not at increased risk for GDM or higher blood glucose, although further study may be warranted for sertraline and venlafaxine.

Intrauterine Device Training Workshop for Preclinical Medical Students.

Introduction: Medical school reproductive health curricula often lack adequate education regarding intrauterine devices (IUDs). When placed in clinical scenarios, students may have insufficient knowledge and training to counsel patients about IUDs. Methods: We developed a workshop for preclinical medical students and assessed whether it improved knowledge of and comfort with counseling patients on IUDs. The workshop consisted of a 45-minute lecture and a 45-minute IUD simulation training. Each session was taught to groups of 40 to 50 students. The workshop was evaluated between January 2016 and November 2017. Participants completed pre- and postsurveys. The primary outcome was comfort level with IUD counseling. Results: One hundred forty-two students completed the workshop, and 137 completed both pre- and postsurveys (96% response rate). At baseline, more than half (56%, n = 77) had not seen an IUD inserted. Students scoring 75% or higher on the IUD knowledge questions increased from 51% (n = 70) on presurveys to 87% (n = 119) on postsurveys (p < .0001). Students agreeing or strongly agreeing that they felt comfortable counseling patients on IUDs increased from 27% (n = 37) to 92% (n = 122, p < .0001) on postsurveys. All students felt the workshop was worthwhile. Discussion: Preclinical students showed increased knowledge of and comfort with IUDs after a simple IUD simulation. Medical schools could utilize this workshop to ensure students have hands-on training and experience related to IUDs prior to clinical rotations and for their future careers.

Career Expectations of Obstetrics and Gynecology Residents and Future Residents.

OBJECTIVE: To understand contemporary fourth-year medical student and resident career expectations in obstetrics and gynecology. METHODS: Students invited for obstetrics and gynecology residency interviews and residents (postgraduate years 1-4) at the University of Colorado, University of Washington, University of California San Francisco, Loyola University, St. Joseph's Hospital, and Texas A&M in 2016-2017 received a voluntary, electronic survey regarding career expectations. Questions were compared between students and residents using a χ test for category responses and for age a two-sample t test. RESULTS: Response rates were similar between students (68% [277/409]) and residents (63% [97/153]). Residents compared with students were more frequently planning to enter private practice (43% vs 19%) and less frequently planning an academic career (19.4% vs 30.4%) or subspecialties (38% vs 51%) (P<.001). Although most respondents planned to work full-time (96% vs 94.9%), 83% (vs 94%) of residents planned to work greater than 40 hours per week (P<.001). Respondents reported greater than $150,000 in educational debt (65%) and anticipated starting salary greater than $200,000 (89%). More residents planned to retire by age 60 years (23% vs 7%) (P<.001). Thirty-eight percent of residents reported having changed career plans during residency, citing work-life balance as the most important factor (89%). DISCUSSION: Trainees' career expectations appear to evolve over time moving toward a higher likelihood to pursue private practice, work fewer hours, and retire earlier despite large educational debt. It is critical that the specialty understand these trends when planning to address national workforce needs.