Does gender discrimination exist in a gynecology training program in a private hospital?

PURPOSE: Does gender discrimination by attending physicians exists in a residency in regard to residents' opportunities to perform complete/operative management of hysterectomies versus just being surgical assistants? MATERIALS AND METHODS: The program studied is a 4-year program in obstetrics and gynecology residency with 3 residents per year. All cases involving a resident were recorded in a computer program designed by one of the authors (C.S.M.) to collect data for Residency Review Committee reports. Data were able to be sorted in a variety of methods including level of management, date of procedure, Physicians' Current Procedural Terminology codes, and attending physician name or resident name. Only intrafascial and extrafascial hysterectomies for benign disease were included in the study. Data were collected from July 1, 1996 to March 31, 1997. RESULTS: Five hundred and forty-nine hysterectomies with residents participating as primary surgeon (complete/operative management) or surgical assistant were performed during the study period. Complete/operative management was performed by the resident in 82.5% of cases while the resident was surgical assistant in 17.5%. Male residents were responsible for complete/operative management in 81.6% of cases and female residents in 83.2% of cases (P = 0.33). Male attending physicians were more likely to allow residents (male or female) to participate as the primary surgeon in abdominal hysterectomies (95.3%) and vaginal hysterectomies (68.5%) than female attending physicians (abdominal, 87.0% and vaginal, 57.3%) (P < 0.001 and P = 0.006, respectively). CONCLUSIONS: Although male attending physicians were more likely than female attending physicians to allow residents to perform complete/operative management, there was no discrimination as to whether the resident in question was male or female. PRECIS: When determining the level of management private gynecologists will allow residents to perform they do not practice gender discrimination.

Clear cell carcinoma of the ovary: poor prognosis compared to serous carcinoma.

BACKGROUND: A review of literature comparing the survival of patients with clear cell carcinoma of the ovary to patients with serous carcinoma reveals divided opinions. No studies of statistical significance have demonstrated worse survival in a cohort of patients with clear cell carcinoma matched stage for stage with patients with serous carcinoma of the ovary. The purpose of this study was to compare survival in a cohort of clear cell carcinoma patients to a cohort of serous carcinoma patients matched for stage, age, treatment, and cytoreduction. METHODS: All cases of clear cell carcinoma and serous carcinoma of the ovary operated on by the gynecology oncology service from January 1, 1981 to December 31, 1989 were evaluated for patient age, length of survival and level of primary cytoreduction, as well as FIGO stage and histology. RESULTS: Twenty-two patients with clear cell carcinoma found in the years noted were compared to a cohort of 22 patients with serous carcinoma matched for stage (I, 18.2%; II, 9.1%; III, 63.6%; IV, 9.1%), age (clear cell carcinoma 58 years, serous carcinoma 60 years (p = 0.330)), and level of primary cytoreduction (optimal in 63.6% of both clear cell carcinoma and serous carcinoma cohorts and non-optimal in 36.4% of both groups). Survival in the clear cell carcinoma cohort (16 months) was worse than in the serous carcinoma cohort (36 months) (p = 0.045). CONCLUSION: Patients with clear cell carcinoma have a significantly worse prognosis than patients with serous carcinoma when matched for age, stage, and level of primary cytoreduction.

Trends in the frequency of cesarean delivery. A 21-year experience, 1970-1990.

Cesarean delivery rates in the United States increased from about 5% in 1965 to 24.7% in 1988, with the majority attributed to four indications: dystocia, fetal distress, previous cesarean delivery and breech presentation. This study calculated one hospital's cesarean delivery rate over a 21-year period to examine the trends in the rate and in their clinical indications. From 1974 to 1979, dystocia was responsible for 39.1% of the 151.2% overall increase in cesarean deliveries at the study hospital, followed by repeat cesarean deliveries (30.1%), fetal distress (8.7%) and breech presentation (3.5%). The percentage of all repeat cesarean deliveries increased, from 6.2 in 1981 to 8.0 in 1990, while the percentage of previous cesarean patients having another cesarean delivery declined from 96.6 in 1981 to 85.5 in 1990. Although there has been a reduction in the proportion of women having repeat cesarean delivery, the number of previous cesarean patients presenting for another delivery has been increasing. The cesarean experience at individual hospitals needs to be examined to provide a better understanding of the reasons for changes in their cesarean delivery rates.

Postgraduate medical education in obstetrics and gynecology.

In a survey mailed to all obstetric and gynecologic residents in January 1978, the content of residency training programs was evaluated in regard to quantity of procedures and quality of supervision. The interaction of family practice residents, nurse midwives, and nurse clinicians was explored as it related to residency training in obstetrics and gynecology. A resident's assessment of his or her training program and an evaluation of the various opportunities of continuing medical education were also included in the survey. The results confirmed the known lack of training in human sexuality problems and practice management, although it was demonstrated that nearly all residency programs provide adequate clinical experience in all other areas of obstetrics and gynecology. Family practice residents do not appear to be altering the quality of obstetric and gynecologic residency training. The survey also indicated that, in most cases, the wide variety of postgraduate educational material is being used by residents.