Failure to achieve the association of professors in gynecology and obstetrics objectives for abortion in third-year medical student curriculum.

OBJECTIVE: To determine if third-year medical students achieve the Association of Professors in Gynecology and Obstetrics (APGO) objectives regarding abortion. STUDY DESIGN: Medical students at the University of Colorado were surveyed at the end of the third year (May 2009) regarding their knowledge and experience in abortion training. Results were analyzed using chi2 and Fisher's exact test. RESULTS: One hundred twenty-seven of 131 surveys were completed. Students scored 47% correct on knowledge-based questions. No formal didactics were reported by 57%, and only 24% rotated through a clinic that provided abortions. Didactics and clinical exposure were not associated with higher scores. Students with "any reading focused on abortion" had higher scores (52% vs. 42%, p=0.02), as did those intending to pursue obstetrics and gynecology residencies (63% vs. 46%, p=0.05). Students were receptive to abortion training: 80% wanted didactics and 45% reported unsatisfactory clinical opportunities. CONCLUSION: The current curriculum does not meet the APGO objectives or the needs of medical students. Given that many students will eventually care for reproductive-age women, focus on meeting these objectives is warranted.

Candid candidate comments: the relationship between residency program selection factors and match list placements from ranked applicants.

OBJECTIVE: The purpose of this study was to explore the relationship between residency program selection factors and placements we received on candidates' match lists. STUDY DESIGN: An annual (2001-2004) telephone survey of applicants (n = 140) ranked for acceptance to the department's residency program addressed 16 program selection factors important in choosing our site. Candidates' comments about these program selection factors were recorded. Logistic regression was conducted with program selection factors as independent variables and program receipt of candidates' top quartile match list rankings as the dependent variable. RESULTS: The overall response rate was 68% (n = 95). Applicants' positive ratings on 3 program selection factors were related to our receipt of top quartile match list rankings: 1) our capacity to meet personal career goals (odds ratio [OR] 4.59); 2) positive faculty-resident relationships (OR 1.97); and 3) suitable location (OR 1.96). CONCLUSION: The single most important factor contributing to receipt of candidates' top quartile match list placements was positive perceptions of our program's abilities to meet their personal career goal needs.

Teaching students to question.

OBJECTIVE: The purpose of the study was to teach medical students the strategies of critical questioning to determine the effect on students' critical thinking skills, confidence in their ability to ask questions, and interaction between student and instructor. STUDY DESIGN: Workshops were developed to teach medical students how to systematically ask critical questions. Sixty-two consenting students in their third-year obstetrics and gynecology clerkship were divided according to alternate rotations to either attend the workshops (n = 28) or not (n = 41). RESULTS: Medical students who attended the workshops scored higher on the California Critical Thinking Skills Test mean total score (study group 25.1 [+/- 0.7 SEM] vs control group 22.9 [+/- 0.6 SEM], P = .028), subscales of inference (12.6 [+/- 0.3 SEM] vs 11.2 [+/- 0.3 SEM], P = .003), and of deductive reasoning (12.7 [+/- 0.4 SEM] vs 10.9 [+/- 0.3 SEM], P = .001). CONCLUSION: Teaching students to ask critical questions improves critical thinking as measured by the California Critical Thinking Skills Test.

Evaluation of pelvic and breast examination skills of interns in obstetrics and gynecology and internal medicine.

OBJECTIVE: The purpose of this study was to evaluate the pelvic and breast examination skills of a group of interns who were entering obstetrics and gynecology and internal medicine and to determine whether previous experience predicts performance. STUDY DESIGN: This was a prospective study that, with the use of an examination with a standardized format of 26 skills, assessed the performance of 10 interns who were entering internal medicine and 9 interns who were entering obstetrics and gynecology. chi(2) analysis and Fisher exact tests were used. RESULTS: There was no significant difference in overall performance on the pelvic and breast examinations between the two groups. The obstetrics and gynecology interns performed significantly better (P<.05) on the three skills that assessed professional conduct. There was considerable variability within each group. There was no correlation between previous clinical experience and performance on the skills assessment, nor was there a correlation between perceived competence and actual performance. CONCLUSIONS: Previous clinical experience does not predict performance in a standardized assessment of pelvic and breast examination skills nor does it account for the great variability in competence levels in interns who are entering obstetrics and gynecology and internal medicine.

Preparing graduates for the first year of residency: are medical schools meeting the need?

PURPOSE: Changes in graduate medical education associated with full implementation of the Balanced Budget Act of 1997 have required medical schools to review and revise their curricula. As limited funding increases pressures to streamline training, residencies will potentially expect an entry level of skill and competence that is greater than that which schools are currently providing. To determine whether medical school curricular requirements correlate with residency needs, this multidisciplinary pilot study investigated expectations and prerequisites for postgraduate specialty training. METHOD: A questionnaire about 100 skills and competencies expected of new first-year residents was sent to 50 U.S. residency directors from surgery, internal medicine, family medicine, pediatrics, and obstetrics-gynecology programs. Each director was asked to state expectations of a first-year resident's competence in each skill at entry to residency and after three months of training. Skills deemed most appropriately acquired in residency were also identified. Competencies included diagnosis, management, triage, interpretation of data, informatics and technology, record keeping, interpersonal communications, and manual skills. RESULTS: A total of 39 residency directors responded, including seven surgery, nine medicine, seven family medicine, eight pediatrics, and eight obstetrics-gynecology. In addition to physical examination skills, 13 competencies achieved more than 70% agreement as being entry-level skills. There was wide variability as to the relative importance of the remaining skills, with residency directors expecting to devote significant resources and time in early training to ensure competence. CONCLUSIONS: Medical schools should consider the expectations of their students' future residency directors when developing new curricula. Assuring students' competencies through focused curricular change should save both time and resources during residency.