Need to know: the need for cognitive closure impacts the clinical practice of obstetrician/gynecologists.

BACKGROUND: Need for cognitive closure (NFCC) has been shown to be a consistent and measurable trait. It has effects on decision making and has been associated with more rapid decision making, higher reliance on heuristics or biases for decision making, reduced tolerance for ambiguity, and reduced interest in searching for alternatives. In medical practice, these tendencies may lead to lower quality of decision making. METHODS: This study measured NFCC in 312 obstetrician/gynecologists using a survey-style approach. Physicians were administered a short NFCC scale and asked questions about their clinical practice. RESULTS: Obstetrician/gynecologists with high NFCC were found to be less likely to address a number of clinical questions during well-woman exams, and were more likely to consult a greater number of sources when prescribing new medications. CONCLUSIONS: NFCC of physicians may have an important impact on practice. It is possible that increased training during residency or medical school could counteract the detrimental effects of NFCC, and steps can be taken through increased use of electronic reminder systems could orient physicians to the appropriate questions to ask patients.

Amount and quality of sleep: exploring the role of stress and work experience in a sample of obstetrician-gynecologists.

INTRODUCTION: Sufficient sleep is necessary for optimal performance and the delivery of safe and effective health care. To establish an empirical understanding of physician fatigue, the present study investigated the factors that contributed to the amount and the quality of sleep among obstetricians and gynecologists (ob-gyns). METHODS: A survey of personal and work experiences was sent to 495 eligible physicians belonging to the American College of Obstetricians and Gynecologists (ACOG). Data were obtained from 287 ob-gyns for a response rate of 58.0%. Associations between sleep-related items and measures of stress and work-related factors were explored. RESULTS: Ob-gyns in our sample reported sleeping an average of 6.5 hours a night with 29.2% indicating that they received very or fairly bad quality of sleep. Average amount and quality of sleep were found to be independently related to the hours worked weekly, colleague support for a work-home balance, practice setting, perceived work-control, physician-specific stressors and perceived stress. In summary models, hours worked and perceived stress scores consistently emerged as predictors of amount of sleep. CONCLUSIONS: Overall, findings explained a small portion of the variance in sleep. Considering the multitude of factors that contribute to sleep, subtle associations warrant further investigation.

Screening for History of Childhood Abuse: Beliefs, Practice Patterns, and Barriers Among Obstetrician-Gynecologists.

BACKGROUND: A history of childhood abuse is strongly linked to adult health problems. Obstetrician-gynecologists will undoubtedly treat abuse survivors during their careers, and a number of patient presenting problems may be related to a history of childhood abuse (e.g., chronic pelvic pain, sexual dysfunction, mental health disorders, obesity, and chronic diseases). Knowledge of abuse history may assist with treatment planning and the delivery of trauma-informed care. The current study sought to explore obstetrician-gynecologists' training, knowledge, beliefs, practice patterns, and barriers around screening for history of childhood abuse in their adult patients. METHODS: Eight hundred Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists were sent an electronic survey; 332 viewed recruitment emails. Data were analyzed with SPSS 24.0, including descriptive statistics, χ2, and t tests. RESULTS: One-hundred forty-five physicians completed the survey. The majority of responding providers believe that assessment of abuse history is important and relevant to patient care, yet few reported screening regularly. Most did not have formal training in screening for childhood abuse or its effects, although those who completed their training more recently were more likely to report training in these areas, as well as more likely to screen regularly. The majority of respondents noted they were not confident to screen. Barriers to screening were identified. CONCLUSIONS: Greater education and training about screening for childhood abuse history and the effects of childhood abuse are needed. The integration of mental health providers into practice is one method that may increase screening rates.

Women's healthcare providers' range of services and collaborative care.

Physician shortages and healthcare reform are important topics in the healthcare field today. The utilization of the skills and professional competencies of nonphysician healthcare providers, as well as collaboration between physicians and nonphysician healthcare providers may in part provide a solution to some current healthcare concerns. The purposes of this study were to describe the range of services provided by nonphysician women's healthcare providers (WHCPs), and to begin to explore the collaborative relationship between obstetrician-gynecologists (ob-gyns) and WHCPs. Questionnaires were sent to ob-gyns, certified nurse-midwives, certified midwives, nurse practitioners (NPs), and physician's assistants (PAs) with questions regarding the types of services WHCPs provide, as well as collaboration between ob-gyns and WHCPs. Overall, 62.1% of ob-gyns employ WHCPs. NPs are the most common type of WHCP employed in our sample. WHCPs are more likely to be younger than ob-gyns, and an overwhelming majority of WHCPs in our sample are female. Most reported that they are anticipating an expansion in the roles and services they provide over the next 5 years. In an era of healthcare reform, WHCPs may in part provide a solution to the growing physician shortage. Collaboration between ob-gyns and WHCPs is a key aspect of the changing healthcare environment.

Obstetrician-gynecologists' knowledge, attitudes, and practice regarding elder abuse screening.

BACKGROUND: Elder abuse is a prevalent and growing social problem with significant consequences on victims' mental and physical health. Unfortunately, many cases of elder abuse go unreported. Elderly women are at increased risk for abuse and, as such, obstetrician-gynecologists (OB/GYNs) are in a unique position to screen for and report abuse. This study intended to determine OB/GYNs' knowledge, attitudes, and practice regarding elder abuse. METHODS: Two hundred Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists (ACOG) received a survey. Analysis was completed with SPSS 20.0. In addition to descriptive statistics, χ(2) analyses were used to determine differences between groups. FINDINGS: In total, 122 fellows responded (61%). Abuse screening rates differed by abuse type. Few "always" screen for abuse, with half assessing only when it is suspected. Most (81%) had never reported a case of abuse. Younger males reported different clinical practice patterns than other groups. Generally, OB/GYNs were knowledgeable about risk factors and facts about elder abuse, but several knowledge gaps were identified. Most reported that elder abuse screening is within their professional purview. Half of the respondents cited time constraints as a barrier to screening. CONCLUSIONS: Greater education about elder abuse screening is needed. Specifically, training regarding available valid and brief screening tools, local abuse reporting laws, and available community resources. This study identified the potential need to target younger male OB/GYNs for additional training.

Psychological impact of stillbirths on obstetricians.

OBJECTIVE: To assess the psychological impact on US obstetricians when they care for women who have suffered a stillbirth and explore whether demographic (e.g. age, gender) and practice (e.g. number of patients, practice type) variables were related to the extent of psychological impact for obstetricians following stillbirth. METHODS: Using a questionnaire that could be completed in about 20 min, we surveyed 1000 American College of Obstetricians and Gynecologists (ACOG) members. Physicians were asked about how stillbirths have affected them personally. RESULTS: Half of those surveyed responded (499) and of those 365 currently practiced obstetrics. Virtually all obstetricians have looked after women who have had a stillbirth. Grief was the most common reaction experienced with 53.7% reporting that they personally "very much" experienced grief. Other common and significant reactions were self-doubt (17.2%), depression (16.9%) and self-blame (16.4%). Significant psychological impact on the obstetrician was associated with older age, solo practice, higher volume practices and higher proportion of Medicaid patients; gender was not found to be associated with psychological impact when controlling for age. Further, greater self-reported performance and training regarding maternal and family counseling, management of stillbirth, and knowledge of stillbirth evaluation was associated with greater levels of grief. CONCLUSION: Physician grief is a common reaction among obstetricians after caring for a patient who has had a stillbirth.

Sex differences among obstetrician-gynecologists: a review of survey studies.

UNLABELLED: Whether practice differences exist between the sexes is a question of clinical and educational significance. The obstetrician-gynecologist (ob-gyn) workforce has been shifting to majority women. An examination of sex differences in ob-gyn practice contributes to the discussion about how the changing workforce may impact women's healthcare. We sought to review survey studies to assess whether there are specific topics in which differences in attitudes, opinions, and practice patterns between male and female ob-gyns are apparent. We conducted a systematic review to identify all survey studies of ob-gyns from the years 2002-2012. A total of 93 studies were reviewed to identify statements of sex differences and categorized by conceptual theme. Sex differences were identified in a number of areas. In general, women report more supportive attitudes toward abortion. A number of differences were identified with regard to workforce issues, such as women earning 23% less than their male counterparts as reported in 1 study and working an average of 4.1 fewer hours per week than men in another study. Men typically provide higher selfratings than women in a number of areas. Other noted findings include men tending toward more pharmaceutical therapies and women making more referrals for medical conditions. Although a number of areas of difference were identified, the impact of such differences is yet to be determined. Additional research may help to clarify the reasons for such differences and their potential impact on patients. TARGET AUDIENCE: Obstetricians and gynecologists, family physicians Learning Objectives: After completing this CME activity, physicians should be better able to determine how the relevance of studying sex differences among physicians, specifically ob-gyns, can help improve patient care, assess whether there are topical areas in which male and female ob-gyns have reported different beliefs, practices, attitudes, and opinions, and examine how the limitations of survey studies and systematic reviews can affect the findings of these studies and reviews.

Obstetrician/gynecologists and postpartum mental health: differences between CME course takers and nontakers.

INTRODUCTION: Continuing medical education (CME) courses are an essential component of professional development. Research indicates a continued need for understanding how and why physicians select certain CME courses, as well as the differences between CME course takers and nontakers. PURPOSE: Obstetrician-gynecologists (OB-GYNs) are health care providers for women, and part of their purview includes mental health, such as postpartum depression (PPD) and psychosis (PPP). This study evaluated OB-GYNs' knowledge, attitudes, and behavior (KAB) regarding PPD/PPP, and compared characteristics of CME course takers and nontakers. METHOD: A survey was sent to 400 OB-GYNs. RESULTS: Response rate was 56%. One-third had taken a CME course on PPD/PPP. Those who consider themselves a "specialist" were less likely to have taken a CME course on postpartum mental health than those who consider themselves "both primary care provider and specialist." Non-CME course takers rely on clinical judgment more. They also are less likely to track patients' psychiatric histories and they utilize validated assessments less frequently. However, CME course takers and nontakers did not differ on knowledge or belief items. CONCLUSION: CME courses on PPD/PPP were associated with increased screening and utilization of validated assessments. There was no association between having taken a course and several knowledge questions. It is unclear if CME courses are effective in disseminating information and altering KAB.

Ethical concerns and career satisfaction in obstetrics and gynecology: a review of recent findings from the Collaborative Ambulatory Research Network.

UNLABELLED: Obstetricians-gynecologists (ob-gyns) are frequently confronted with situations that have ethical implications (e.g., whether to accept gifts or samples from drug companies or disclosing medical errors to patients). Additionally, various factors, including specific job-related tasks, costs, and benefits, may impact ob-gyns' career satisfaction. Ethical concerns and career satisfaction can play a role in the quality of women's health care. This article summarizes the studies published between 2005 and 2009 by the Research Department of the American College of Obstetricians and Gynecologists, which encompass ethical concerns regarding interactions with pharmaceutical representatives and patient safety/medical error reporting, as well as ob-gyn career satisfaction. Additionally, a brief discussion regarding ethical concerns in the ob-gyn field, in general, highlights key topics for the last 30 years. Ethical dilemmas continue to be of concern for ob-gyns. Familiarity with guidelines on appropriate interactions with industry is associated with lower percentages of potentially problematic relationships with pharmaceutical industries. Physicians report that the expense of patient safety initiatives is one of the top barriers for improving patient safety, followed by fear of liability. Overall, respondents reported being satisfied with their careers. However, half of the respondents reported that they were extremely concerned about the impact of professional liability costs on the duration of their careers. Increased familiarity with guidelines may lead to a decreased ob-gyn reliance on pharmaceutical representatives and free samples, whereas specific and practical tools may help them implement patient safety techniques. The easing of malpractice insurance and threat of litigation may enhance career satisfaction among ob-gyns. This article will discuss related findings in recent years. TARGET AUDIENCE: Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVES: After the completing the CME activity, physicians should be better able to analyze how interactions with pharmaceutical industry may pose ethical dilemmas, examine current barriers to implementing patient safety initiatives, and evaluate the factors that influence career satisfaction among obstetrician-gynecologists.

Family problems among recently returned military veterans referred for a mental health evaluation.

CONTEXT: Existing evidence suggests that military veterans with mental health disorders have poorer family functioning, although little research has focused on this topic. OBJECTIVE: To test whether psychiatric symptoms are associated with family reintegration problems in recently returned military veterans. DESIGN: Cross-sectional survey of a clinical population. Respondents who were referred to behavioral health evaluation from April 2006 through August 2007 were considered for the survey. SETTING: Philadelphia Veterans Affairs Medical Center, Pa. PARTICIPANTS: 199 military veterans who served in Iraq or Afghanistan after 2001 and were referred for behavioral health evaluation from primary care (mean age = 32.7 years, SD = 9.1). MAIN OUTCOME MEASURES: Measures included the Mini-International Neuropsychiatric Interview for psychiatric diagnoses, the 9-item Patient Health Questionnaire for depression diagnosis and severity, and screening measures of alcohol abuse and illicit substance use. A measure of military family readjustment problems and a screening measure of domestic abuse were developed for this study. RESULTS: Three fourths of the married/cohabiting veterans reported some type of family problem in the past week, such as feeling like a guest in their household (40.7%), reporting their children acting afraid or not being warm toward them (25.0%), or being unsure about their family role (37.2%). Among veterans with current or recently separated partners, 53.7% reported conflicts involving "shouting, pushing, or shoving," and 27.6% reported that this partner was "afraid of them." Depression and posttraumatic stress disorder symptoms were both associated with higher rates of family reintegration problems. CONCLUSIONS: Mental health problems may complicate veterans' readjustment and reintegration into family life. The findings suggest an opportunity to improve the treatment of psychiatric disorders by addressing family problems.