Investigating racial/ethnic differences in procedure experience in obstetrics & gynecology trainees at a single academic institution: a retrospective cohort study.

BACKGROUND: Discrimination is common in medical education. Resident physicians of races and ethnicities underrepresented in medicine experience daily discrimination which has been proven to negatively impact training. There is limited data on the impact of resident race/ethnicity on OB/GYN surgical training. The objective of this study was to investigate the impact of race/ethnicity on procedural experience in OB/GYN training. METHODS: A retrospective analysis of graduated OB/GYN resident case logs from 2009 to 2019 was performed at a single urban academic institution. Self-reported race/ethnicity data was collected. Association between URM and non-URM were analyzed using t-tests. Trainees were categorized by self-reported race/ethnicity into underrepresented in medicine (URM) (Black, Hispanic, Native American) and non-URM (White, Asian). RESULTS: The cohort consisted of 84 residents: 19% URM (N = 16) and 79% non-URM (n = 66). Difference between URM and non-URM status and average case volume was analyzed using t-tests. There was no difference between non-URM and URM trainees and reported mean number of Total GYN (349 vs. 334, p = 0.31) and Total OB (624 vs. 597, P = 0.11) case logs. However, compared with non-URM, on average URM performed fewer Total procedures (1562 vs. 1469, P = 0.04). Analyzing individual procedures showed a difference in average number of abortions performed between URM and non-URM (76 vs. 53, P = 0.02). There were no other statistically significant differences between the two groups. CONCLUSIONS: This single institution study highlights potential differences in trainee experience by race/ethnicity. Larger national studies are warranted to further explore these differences to identify bias and discrimination, and to ensure equitable experience for all trainees.

Obstetrics and gynecology resident perception of virtual fellowship interviews.

BACKGROUND: Travel restrictions amidst the COVID-19 pandemic reshaped interviewing for fellowships into a predominantly virtual process. How this impacts Obstetrics and Gynecology (OB/GYN) resident approaches to fellowship application and Match navigation is largely unknown. METHODS: We performed a cross-sectional survey study of fourth year OB/GYN residents in the United States who participated in at least one virtual fellowship interview in 2020. We collected information regarding demographics, application strategy, perceived strengths and weaknesses of virtual interviews, and confidence with rank list creation. Descriptive statistics were used for categorical variables and responses pre- and post-Match were compared using Fisher's exact test. RESULTS: Seventy-five out of an estimated 490 applicants (~ 15% response rate) completed the survey. Of the respondents, 65.3% felt they interviewed at more programs virtually than they would anticipate completing in person, but perceived less confidence in having the necessary information (n = 45, 60%) or understanding the culture of programs (n = 59, 78.7%) to create a rank list. Cost savings were the main benefit of virtual interviews (n = 50, 66.7%), and inability to get a true "feel" for a program was the biggest limitation (n = 43, 57.3%). A majority (46.7%) advocate for a future hybrid interview process. CONCLUSIONS: OB/GYN residents pursuing fellowship reported interviewing at more programs during the virtual season, but had less confidence with rank list creation. Cost savings benefits are weighed against difficulty getting a "feel" for programs virtually. Most would advocate for a future hybrid interview process.

Effect of virtual interviewing on applicant approach to and perspective of the Maternal-Fetal Medicine Subspecialty Fellowship Match.

BACKGROUND: The 2020 application cycle for the Maternal-Fetal Medicine Specialty Fellowship Match was the first to be exclusively virtual. OBJECTIVE: Our study was designed to compare approaches and perspectives of the MFM fellowship candidates who applied with virtual interviews with those of the current Maternal-Fetal Medicine fellows, who applied with in-person interviews in 2017, 2018, or 2019. STUDY DESIGN: A survey was developed by the Society for Maternal-Fetal Medicine Fellowship Affairs Committee to ascertain applicant approaches to and perspectives of the Maternal-Fetal Medicine Fellowship Match and was disseminated after 2020 Maternal-Fetal Medicine interviews ended and completed before Fellowship Match Day. Participants were contacted by means of active Listservs maintained by the Society for Maternal-Fetal Medicine. Current fellows were instructed to complete the survey using their experiences on the application cycle in which they successfully matched. Those who elected to participate entered their survey responses through the electronic link; answers were recorded in a secure Research Electronic Data Capture database. Outcomes were compared between those who applied during the virtual 2020 Maternal-Fetal Medicine interview cycle and those that applied during the in-person interview cycles in 2017, 2018, or 2019. RESULTS: Of the 140 completed surveys, 46 people participated in the 2020 Maternal-Fetal Medicine Match and were categorized as "virtual applicants," whereas the remaining 94 people participated in the 2017 (n=28), 2018 (n=33), or 2019 (n=33) Maternal-Fetal Medicine Match and were categorized as "in-person applicants." The overall distribution of number of programs to which each applicant applied differed between groups (P=.02); for example, nearly 75% of virtual applicants applied to at least 25 fellowship programs, compared with less than 50% of in-person applicants. Although the number of interviews received was similar between virtual and in-person applicants, virtual applicants were significantly less likely to cancel scheduled interviews (n=18 [39.1%] vs n=68 [72.3%]; P<.001). There were also differences between virtual and in-person applicants in terms of overall cost of the fellowship intervention process and total days away from work for interviewing (P<.001 for both). In particular, nearly two-thirds of virtual applicants reported spending less than $1000 in the Maternal-Fetal Medicine fellowship application process, compared with the nearly two-thirds of in-person applicants who reported spending more than $5000. Among the 46 virtual applicants, nearly 80% reported the experience was better or slightly better than expected, and none reported the experience was slightly worse or worse than expected. Nearly two-thirds of the virtual applicants reported that, compared with their in-person residency interviews, they received a comparable representation of Maternal-Fetal Medicine fellowship programs and could effectively assess their "fit" during interviews (60.9% and 63.0%, respectively). Only 20% of virtual Maternal-Fetal Medicine applicants would recommend returning to exclusive in-person interviews should that be possible in future Maternal-Fetal Medicine matches. CONCLUSION: Virtual Maternal-Fetal Medicine fellowship interviewing was viewed favorably by applicants but corresponded with significant changes to their application approaches. The differences between virtual and in-person fellowship applicant tendencies identified in this study should inform next year's application cycle for Maternal-Fetal Medicine and possibly other obstetrics and gynecology subspecialty fellowships.

Educating Trainees to Manage Pregnant Women With Obesity: A Primer.

This review is intended to outline essential resources for trainees in order to optimize education on the care of pregnant patients with obesity. Addressing provider biases, exploring ethical considerations of care and streamlining screening and counseling of patients with obesity will provide an excellent framework for our trainees to care for women with obesity from preconception to postpartum care and beyond.