Smoking and health: the role of the obstetrician and gynecologist.

PIP: In 1978 cigarette smoking was related to more than 320,000 deaths. A fifth of all cancer deaths are related to smoking. 30% of coronary artery disease, 75% of chronic bronchitis, 80% of emphysema, and 80% of lung cancer are associated with cigarette smoking. The habit costs society about $18 billion every year in lost work time and medical costs. The tobacco industry spends about $450 million annually to sell its product. Women now smoke the same amount as men. From 1969-75 the rate of smoking among girls aged 13-19 increased from 23% to 27%, about a half million new smokers. Over 70% of women under 35 surveyed indicated that their physicians had never mentioned nay of the dangers of smoking. Obstetricians and gynecologists are in an excellent position to counsel women against smoking since they often see teenagers right after they begin smoking. Since infant birth weight is lower when the mother smokes, further physiological effects are expected. The incidence of spontaneous abortion is doubled for the smoker. Between 1968-75, the proportion of physicians who smoked dropped from 29.6% to 21%. In the same 8-year period the percentage of pharmacists who smoked dropped from 34.5% to 27.5%. Nurses smoked 37.3% in 1968 and 38.9% in 1975. The time has come for the physician to take a stand against smoking.^ieng

Evolution of the Gynecology Teaching Associate: an education specialist.

The traditional pelvic examination instruction methods were reviewed and found to be deficient: the student learning experience was compromised by the triangular setting of patient, student, and instructor for early pelvic examination instruction. Over the past decade, a new education specialist, the Gynecology Teaching Associate (GTA), has evolved to help improve the initial gynecology teaching experience. The evolution of the GTA is described. The qualities she brings to the instructional system include sensitivity as a woman, educational skill in pelvic examination instruction, knowledge of female pelvic anatomy and physiology, and, most important, sophisticated interpersonal skills to help medical students learnin in a nonthreatening environment. Reinforcement learning theory is the foundation of this educational system. Student acceptance of this system is documented.