Pursuit of accredited subspecialties by graduating residents in obstetrics and gynecology, 2000-2012.

OBJECTIVES: To estimate whether there has been an increase in resident graduates pursuing fellowship training in the currently accredited subspecialties and to compare whether any trend toward subspecialization is similar to those seen in other specialties. METHODS: This descriptive study examined data from the National Residency Match Program for academic years 2000-2012. Annual comparisons were made between the numbers of residents who either pursued careers in their specialty or were accepted into fellowship training in an accredited subspecialty. We compared the numbers in each group who took the American Board of Obstetrics and Gynecology (ABOG) written board examination and who became board-certified. RESULTS: Although the annual number of residency graduates in obstetrics and gynecology remained essentially the same (1,185 ± 56), the proportion of graduates accepted into fellowships increased steadily in all subspecialties (from 7.0% in 2000 to 19.5% in 2012). All other core specialties saw higher proportions of their graduates pursuing subspecialties except for family medicine. Coincident with rises in fellowship programs and positions was eventual increase in trainees who took the ABOG written examination for the first time in the three established subspecialties (maternal-fetal medicine, gynecologic oncology, reproductive endocrinology and infertility) and who became board-certified. CONCLUSION: Like with residents in other specialties, more graduates in obstetrics and gynecology are pursuing accredited subspecialty fellowship training, adding to the complexities of workforce planning. The percent of obstetrics and gynecology residents who pursued accredited subspecialty fellowship training was lower than all but one other specialty.

Education and experience with breast health maintenance and breast cancer care: a study of obstetricians and gynecologists.

Breast cancer is one of the most common malignancies in the United States. A survey regarding the practice, training, and knowledge of breast health maintenance and cancer screening was conducted with a response rate of 59%. Most respondents reported adequate knowledge and that continuing educational efforts were at least adequate. Most recognize the importance of family history and incorporate patient inquiry and referral to genetics practitioners into their practice. A considerable portion does not inquire about hereditary risk factors and feel "not qualified" to manage genetic counseling and screening. Continued training is needed about hereditary predisposition to breast disease.

Obstetrician-gynecologists and primary care: training during obstetrics-gynecology residency and current practice patterns.

PURPOSE: To assess obstetrician-gynecologists' perceptions of their residency training in primary care, document health issues assessed at annual visits, and identify practice patterns of both generalist and specialist obstetrician-gynecologists. METHOD: Questionnaires were mailed to a random sample of 1,711 American College of Obstetricians and Gynecologists Young Fellows in September 2005. Information was gathered on perceptions about adequacy of residency training, how well training prepared obstetrician-gynecologists for current practice, and typical practice patterns for various medical diagnoses. Data were analyzed using univariate analysis of variance, t tests, and chi-square tests. RESULTS: Of 935 respondents (55% response rate), physicians estimated that 37% of private, nonpregnant patients rely on them for routine primary care. Approximately 22% report that they needed additional primary care training, specifically for metabolism/nutrition and dermatologic, cardiovascular, and psychosexual disorders. A wide range of topics, except for immunizations, were typically discussed at annual visits. Patients with pulmonary diseases, vascular diseases, and nongenital cancers were most often referred to specialists, whereas patients with urinary tract infections, sexually transmitted infections, or who are menopausal are most often managed totally. Self-identification as a generalist or specialist was associated with some practice patterns. Respondents were neutral about the role of primary care in obstetrics-gynecology residency training. CONCLUSIONS: For several primary care issues, obstetrician-gynecologists assumed sole management for obstetric patients but deferred to a primary care physician for gynecological patients. There is a continuing need for primary care training in obstetrics-gynecology residency, although it is unclear whether current training is adequate to meet their needs.

Resident performance on the Council on Resident Education in Obstetrics and Gynecology (CREOG) In-Training Examination: years 1996 through 2002.

OBJECTIVE: This study was undertaken to evaluate the Council on Resident Education in Obstetrics and Gynecology (CREOG) In-Training Examination scores for significant trends. STUDY DESIGN: The percent-correct scores for each of the 6 published examination objectives from 7 consecutive years were analyzed. The data set was analyzed by multivariate analysis of variance using gender, examination year, and postgraduate year as categorical variables, and each year was analyzed separately by gender and postgraduate year. Scores of residents who took the examination for 4 consecutive years were analyzed by using repeated measures analysis of covariance. RESULTS: Variation by examination year appeared random, although scores monotonically increased with postgraduate year for all objectives and all years. The mean relative scores of women were higher than men on the primary/preventive care objective, but the reverse was true for the general considerations objective. CONCLUSION: The CREOG In-Training Examination appears to be a dependable measure of residents' improvement in cognitive knowledge.

Management of diabetes mellitus by obstetrician-gynecologists.

OBJECTIVE: To compare practice patterns of the American College of Obstetrician and Gynecologists (ACOG) Fellows for the diagnosis and treatment of gestational diabetes mellitus (GDM) and type 1 diabetes mellitus with current ACOG recommendations and prior published series. METHODS: We sent a questionnaire to 1,398 practicing ACOG Fellows and Junior Fellows, 398 of whom comprise the Collaborative Ambulatory Research Network. Responses were evaluated by age and sex to assess differences in practice. RESULTS: Younger physicians were more likely to treat pregnant patients. Ninety-six percent of obstetricians routinely screen for GDM, nearly all by using a 50-g glucose 1-hour oral test. Nearly 60% of respondents establish the diagnosis of GDM using the National Diabetes Data Group criteria. In addition to medical nutrition therapy, almost 75% of respondents recommend exercise for patients with GDM. Approximately 60% of respondents reported that all of their patients with GDM self-monitor their blood glucose. When medical nutrition therapy is ineffective for their patients with GDM, 82% of respondents initially prescribe insulin, whereas 13% begin with glyburide. Nearly 75% of respondents routinely perform a postpartum evaluation of glucose tolerance in the patient with GDM. Most obstetricians manage the glucose control of their patients with type 1 diabetes mellitus themselves. CONCLUSION: Practicing obstetrician-gynecologists have incorporated recent recommendations into their practice patterns for both GDM and type 1 diabetes mellitus, including patients' self-monitoring of blood glucose, exercise, and postpartum testing in GDM. LEVEL OF EVIDENCE: III

Duty hours and pregnancy outcome among residents in obstetrics and gynecology.

OBJECTIVE: To assess the present status of resident duty hours in obstetrics and gynecology, identify existing policies concerning work schedules during pregnancy, and evaluate pregnancy outcome in female house officers. METHODS: A questionnaire-based study was administered to residents taking the 2001 Council on Residency Education in Obstetrics and Gynecology examination. RESULTS: More than 90% of the residents reported that their institution had a maternity leave policy. The leave was usually 4-8 weeks long and was paid. Nearly 95% of residents reported that they had to take over the work of residents on maternity leave. Most women residents worked more than 80 hours weekly throughout pregnancy, and few took time off before delivery. Most pregnancies occurred during the fourth year of training and did not seem to be adversely affected by the long work hours. CONCLUSION: This study, performed before the institution of the new Accreditation Council for Graduate Medical Education resident duty hour policies, demonstrated that, although women house officers continued to work more than 80 hours per week during pregnancy, most had a good pregnancy outcome. Nevertheless, there was a higher frequency of preterm labor, preeclampsia, and fetal growth restriction in female residents than in spouses or partners of male residents.