Sexual Health Education in Obstetrics and Gynecology (Ob-Gyn) Residencies-A Resident Physician Survey.

BACKGROUND: Many women will experience a sexual health concern and present to their Obstetrics and Gynecology (Ob-Gyn) care provider, yet a large portion of graduating Ob-Gyn resident physicians in the United States may not feel comfortable helping patients with some sexual health issues. AIM: To perform a cross-sectional study of U.S. Ob-Gyn resident physicians that assesses sexual health education didactic sessions and comfort level with sexual health clinical vignettes. METHODS: A 32-item anonymous survey was sent to all 4,065 Ob-Gyn residents on June 7, 2016. Respondents voluntarily completed the survey electronically. OUTCOMES: The primary outcome measures are the comfort level of Ob-Gyn resident physicians in taking a sexual history and providing counseling to patients represented in clinical vignettes, which were based on sexual health learning objectives from the Council on Resident Education in Obstetrics and Gynecology (CREOG). RESULTS: Of the 4,065 eligible U.S. examinees, 968 (23.8%) agreed to participate in the study, and 802 (19.7%) completed the survey and were included in the final analysis. Nearly two-thirds of the residents indicated that sexual health training was a priority in residency. However, more than half were not able to describe the disorders of sexual function or list common medications that effect sexual function. When posed with clinical vignettes, residents felt very comfortable obtaining a sexual history (98.5%) and providing counseling (97.0%) for a 16-year-old seeking contraception, yet fewer felt very comfortable obtaining a history and providing counseling for a 26-year-old who is a refugee from Somalia (77.2% and 73.8%). Smaller cohorts felt prepared to take a sexual history and provide counseling for a 17-year-old who discloses that she is a victim of sex trafficking (61.2% and 57.7%), and for a 58-year-old transgender patient planning hormone therapy and surgery (49.9% and 37.9%). In logistic regression analysis, the factors that were influential in an Ob-Gyn resident physician's program to prepare them to describe the disorders of sexual function were post-graduate year (OR 1.387, 95% CI 1.189, 1.618; P = .0001), those that rated the importance of a sexual health curriculum highly (OR 0.701, 95% CI 0.569, 0.864; P = .0012), and a greater number of didactic sessions on sexual health in the residency curriculum (OR 0.685, 95% CI 0.626, 0.750; P < .0001). CONCLUSION: These findings highlight strengths in the comfort of Ob-Gyn resident physicians about sexual health and illustrate areas of opportunity to engage resident learners by improving the sexual health curriculum. Worly B, Manriquez M, Stagg A, et al. Sexual Health Education in Obstetrics and Gynecology (Ob-Gyn) Residencies-A Resident Physician Survey. J Sex Med 2021;18:1042-1052.

Compliance with Postpartum Diabetes Screening Recommendations for Patients with Gestational Diabetes.

BACKGROUND: The role of provider type and level of training have not been examined in regard to impact on postpartum testing for patients with gestational diabetes mellitus (GDM). OBJECTIVE: We sought to determine rates of testing in urban GDM patients and to determine factors associated with diabetes screening compliance, focusing especially on provider type. METHODS: Class A1 or A2 GDM patients were identified by chart review. Outcomes included ordering and/or performance of postpartum testing for diabetes mellitus. Chi-squared and multivariate logistic regression analyses were performed. RESULTS: Of the 118 patients identified (55% class A1), 58% were African American, 52% had medical assistance insurance, and 83% attended the postpartum visit. Diabetes testing was discussed at 68% of all postpartum visits, but was only ordered at 55% of visits. The 2-hour glucose tolerance test was ordered at 42 of the 98 (43%) of postpartum visits; however, only 16 tests were completed. Patients seeing resident physicians or midwives were more likely to be tested. CONCLUSIONS: Rates of postpartum testing for GDM patients are low. Provider and patient compliance with diabetes screening recommendations are inadequate. Increased education and training of providers and patients may improve screening for diabetes among GDM patients.

Obstetrics and Gynecology Resident Interest and Participation in Global Health.

OBJECTIVE: To evaluate obstetrics and gynecology resident interest and participation in global health experiences and elucidate factors associated with resident expectation for involvement. METHODS: A voluntary, anonymous survey was administered to U.S. obstetrics and gynecology residents before the 2015 Council on Resident Education in Obstetrics and Gynecology in-training examination. The 23-item survey gathered demographic data and queried resident interest and participation in global health. Factors associated with resident expectation for participation in global health were analyzed by Pearson χ tests. RESULTS: Of the 5,005 eligible examinees administered the survey, 4,929 completed at least a portion of the survey for a response rate of 98.5%. Global health was rated as "somewhat important" or "very important" by 96.3% (3,761/3,904) of residents. "Educational opportunity" (69.2%) and "humanitarian effort" (17.7%) were cited as the two most important aspects of a global health experience. Residents with prior global health experience rated the importance of global health more highly and had an increased expectation for future participation. Global health electives were arranged by residency programs for 18.0% (747/4,155) of respondents, by residents themselves as an elective for 44.0% (1,828/4,155), and as a noncredit experience during vacation time for 36.4% (1,514/4,155) of respondents. Female gender, nonpartnered status, no children, prior global health experience, and intention to incorporate global health in future practice were associated with expectations for a global health experience. CONCLUSION: Most obstetrics and gynecology residents rate a global health experience as somewhat or very important, and participation before or during residency increases the perceived importance of global health and the likelihood of expectation for future participation. A majority of residents report arranging their own elective or using vacation time to participate, suggesting that residency programs have limited structured opportunities.

A successful model of collaborative practice in a university-based maternity care setting.

When building an integrated practice, the ability of each team member to work comfortably with other professionals is key. Midwives need to understand departmental expectations for participation in resident/student education, be willing to provide midwifery care in a high-acuity setting with limited opportunities for low-intervention care, and understand expectations for clinical leadership. Physicians need to build on the group expectation of mutual respect and best use of each group member. Confusion about midwifery and physician roles in maternity care still exists.

Impact of the medical liability crisis on postresidency training and practice decisions in obstetrics-gynecology.

INTRODUCTION: The liability crisis may affect residency graduates' practice decisions, yet structured liability education during residency is still inadequate. The objective of this study was to determine the influence of medical liability on practice decisions and to evaluate the adequacy of current medical liability curricula. METHODS: All fourth-year residents (n  =  1274) in 264 Accreditation Council for Graduate Medical Education-accredited allopathic and 25 osteopathic US obstetrics and gynecology residency training programs were asked to participate in a survey about postgraduate plans and formal education during residency regarding liability issues in 2006. Programs were identified by the Council on Resident Education in Obstetrics and Gynecology directory and the American College of Osteopathic Obstetricians and Gynecologists residency program registry. Outcome measures were the reported influence of liability/malpractice concerns on postresidency practice decision making and the incidence of formal education in liability/malpractice issues during residency. RESULTS: A total of 506 of 1274 respondents (39.7%) returned surveys. Women were more likely than men to report "region of the country" (P  =  .02) and "paid malpractice insurance as a salaried employee" (P  =  .03) as a major influence. Of the respondents, 123 (24.3%) planned fellowship training, and 229 (45.3%) were considering limiting practice. More than 20% had been named in a lawsuit. Respondents cited Pennsylvania, Florida, and New York as locations to avoid. In response to questions about medical liability education, 54.3% reported formal education on risk management, and 65.2% indicated they had not received training on "next steps" after a lawsuit. DISCUSSION: Residents identify liability-related issues as major influences when making choices about practice after training. Structured education on matters of medical liability during residency is still inadequate.

Work life balance?

How do we balance "work" and "life"? Are they completely separate? For a physician, can they be separated? Is there such a thing as "balance"?

Duty hour restrictions, ambulatory experience, and surgical procedural volume in obstetrics and gynecology.

BACKGROUND: Prior studies of resident experience in gynecology looked only at the year before and after adoption of ACGME duty hour standards. This study sought to determine whether procedure volume differed after completion of a 4-year residency training program, before and after work hour reform. METHOD: Inpatient and outpatient procedures performed by MetroHealth Medical Center/Cleveland Clinic program residents from 1998 to 2006 were obtained from Annual Reports of Institutional and Resident Experience. Four-year experience before and after duty hour restrictions were compared: hours worked were collected from resident schedules, ambulatory hours and procedures were compared directly, surgical procedures and deliveries were compared using a 2-tailed t test. Data were also obtained for institutional volume changes, and a corrected value, based on the rates of resident cases per available cases, was analyzed. RESULTS: Ambulatory hours worked per resident decreased after implementing work hour reform from 674 to 366 hours. The types of ambulatory and surgical procedures performed varied over time. Overall, basic surgical and obstetrical volume per resident did not change before and after work hour reform (mean before reform, 723 ± 117, mean after reform, 781 ± 200, P  =  .58 for gynecologic procedures; mean before reform, 611 ± 107, mean after reform, 535 ± 73, P  =  .18 for basic obstetrics and vaginal and cesarean deliveries). Institutional volume did not change significantly, although the percentage of the institutions' cases performed by residents did decrease for some procedures. CONCLUSION: The ACGME duty hour restrictions do not limit the overall ambulatory or surgical procedural volume in an obstetrics and gynecology residency-training period.

A multicenter study to determine motivating factors for residents pursuing obstetrics and gynecology.

OBJECTIVE: This study was undertaken to determine why residents choose obstetrics and gynecology. STUDY DESIGN: Applicants to obstetrics and gynecology residency programs were surveyed; a 5-point scale (5 = most important) was used to rate various aspects of the specialty. Univariate statistics were performed. Bivariate analysis comparing results that were based on gender and timing of decisions was completed with Student t test, chi2, and Kruskal-Wallis tests. RESULTS: A total of 153 applicants (42% response rate) from 10 programs participated; 85.3% of respondents were female. Surgical opportunities, variety of clinical experience, and fast-paced/high-acuity experiences attract applicants to obstetrics and gynecology. When considering programs, resident camaraderie, gynecologic experience, and commitment to education were most important. Over 70% of residents decided to pursue obstetrics and gynecology during or after their third-year clerkship. CONCLUSION: Surgical opportunities and clinical variety appeal to applicants. The majority choose obstetrics and gynecology during or after their core clerkship. In addition, program dynamics are important when choosing a residency.

Outcomes of women presenting in active versus latent phase of spontaneous labor.

OBJECTIVE: To evaluate outcome differences between women presenting in latent and active labor. METHODS: We evaluated all low-risk women with term, singleton, vertex gestations who presented in active phase or latent phase labor at MetroHealth Medical Center from January 1993 to June 2001. Baseline characteristics were compared. Labor outcomes were assessed by logistic regression, controlling for parity. RESULTS: A total of 6,121 active phase and 2,697 latent phase women met the study criteria. More latent phase women were nulliparous (51 compared with 28%). Latent phase women had more cesarean deliveries (nulliparas 14.2% compared with 6.7%, multiparas 3.1% compared with 1.4%). Controlling for parity, latent phase women had more active phase arrest (odds ratio [OR] 2.2), oxytocin use (OR 2.3), scalp pH performed (OR 2.2), intrauterine pressure catheter placed (OR = 2.2), fetal scalp electrocardiogram monitoring (OR = 1.7), and amnionitis (OR 2.7) (P < .001 for each). CONCLUSION: It is uncertain whether inherent labor abnormalities resulted in latent phase presentation and subsequent physician intervention or early presentation and subsequent physician intervention are the cause of labor abnormalities.

Impact of work hour restrictions on resident case experience in an obstetrics and gynecology residency program.

OBJECTIVE: The purpose of this study was to evaluate senior resident case experience before and after enactment of work hour restrictions. STUDY DESIGN: Obstetrics and gynecology experience from 2 postgraduate year 4 classes were evaluated before and after adoption of work hour restrictions. Data were limited to experience obtained during the fourth year of residency. Data were analyzed with the 2-sample t test and Wilcoxon rank sum test, and adjusted for changes in institutional procedural volume. RESULTS: There were significant decreases in resident experience in total abdominal hysterectomy ( P = .018), procedures for genuine stress urinary incontinence ( P = .004), and hysteroscopy ( P = .006). Decreases were seen in resident experience in vaginal birth after cesarean section ( P = .011), primary cesarean section ( P = .31), and vacuum delivery ( P = .007), despite increase in institutional volume. CONCLUSION: Work hour restrictions have had impact on resident case experience in obstetrics and gynecology. Variance in institutional case numbers account for only some of these changes.

The effect of house staff working hours on the quality of obstetric and gynecologic care.

OBJECTIVE: To measure the effect of house staff working hours reforms on the quality of obstetric and gynecologic care. METHODS: Sentinel events, medication errors, maternal and neonatal outcomes, and decision making were measured before and after the Accreditation Council of Graduate Medical Education work-hour reforms. Data sources consisted of the perinatal database at MetroHealth Medical Center (Case Western Reserve University, Cleveland, OH), incident reports filed in the hospital department of risk management, the patient-satisfaction database at MetroHealth Medical Center, and the pharmacy medication error database. Two reviewers examined all incident reports separately, and discrepancies were resolved by mutual agreement. RESULTS: Patient demographics did not change across the 2 time periods. Obstetric outcomes were the same for third- and fourth-degree lacerations, umbilical arterial pH less than 7, fever, and the need for general anesthesia. Postpartum hemorrhage and neonatal resuscitations were significantly decreased over time (2% before versus 1% after work-hour restrictions [P =.008], and 30% before versus 26% after work-hour restrictions [P <.001], respectively). The rate of primary cesarean delivery rose from 14% to 16%, a nonsignificant difference (P <.06). There were no differences in rates of cesarean delivery for nonreassuring fetal status, failed induction, labor abnormality, or repeat cesarean delivery. Reported medication errors associated with resident performance were too rare for comparison across time periods. The number of incident reports directly involving residents before and after work-hour restrictions were 3 and 10, respectively-too few to reach statistical significance. CONCLUSIONS: Although problems in physician performance may be underreported, resident work-hour restrictions show minimal evidence of improvement in quality of care. LEVEL OF EVIDENCE: II-3