Future directions for academic obstetrics and gynecology--"... through a glass, darkly ..."

Critical care in obstetrics: a strategy for addressing maternal mortality

The acute rise in maternal morbidity and mortality in the United States is in part because of an increasingly medically complex obstetrical population. An estimated 1% to 3% of all obstetrical patients require intensive care, making timely delivery and availability of critical care imperative. The shifting landscape in obstetrical acuity places a burden on obstetrical providers, many of whom have limited experience in identifying and responding to critical illness. The levels of maternal care definitions by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine designate hospitals based on the availability of obstetrical resources and highlight the need for critical care resources and expertise. The growing need for critical care skills in the evolving contemporary obstetrical landscape serves as an opportunity to redefine the concept of delivery of care for high-risk obstetrical patients. We summarized the key tenets in the prevention of maternal morbidity and mortality, including the use of evidence-based tools for risk stratification and timely referral of patients to facilities with appropriate resources; innovative pathways for hospitals to provide critical care consultations on labor and delivery; and training of obstetrical providers in high-yield critical care skills, such as point-of-care ultrasonography. These critical care-focused interventions are key in addressing an increasingly complex obstetrical patient population while providing an educational foundation for the training of future obstetrical providers.

Die Frauenärztin, der Frauenarzt als «Hausarzt der Frau» – ein Zukunftsmodell?

Obstetrics and gynecology is a unique field that combines preventive and primary care with highly qualified pelvic surgery as well as obstetrics and endocrinology. With the development of managed care, it has been a challenge to fit this field into the standard prima-ry-care paradigm. This approach suggests that to better meet the primary-care needs of both patients and society, obstetricians-gynecologists must continue to improve their skills in preventive care,diagnosis and treatment of self-limited conditions and diagnosis of serious nongynecologic conditions. This article describes a patient-oriented definition of primary care that suggests several issues that need to be addressed by obstetricians-gynecologists to improve their ability to meet the primary-care needs of both patients and society.

Gynaecology in the new millennium

Great challenges await the gynaecologist in the 21st century. While advances in medical technology necessitate that gynaecology move more towards a medical discipline than a surgical one, gynaecologists will be expected to play an increasingly important role in the modern woman's life. This fundamental change is influenced by four main factors, namely, the world's aging population, spread of information technology, advances in molecular based medical therapy, and the changing lifestyle of the woman in the next century. Our role cannot get any lesser as we continue to advise, educate and facilitate the lives of women, and we must aspire a new generation of responsible gynaecologists to continue this ambition.

Reproductive physician-scientists for the twenty-first century

As we enter a new century, departments of obstetrics and gynecology in American medical schools face a number of challenges. A primary concern is the relative dearth of physician-scientists to explore basic mechanisms of cell function and relate these to the diseases of women. The question arises, what can we do to revitalize the spirit of investigation in many of our academic departments? This report reviews three programs designed to develop academic investigators: the Reproductive Scientist Development Program, the American Gynecological and Obstetrical Society/American Association of Obstetricians and Gynecologists Foundation Fellowship Program, and the Women's Reproductive Health Research Career Development Centers. On the basis of a decade of experience with the first two of these programs, the prospects for the third are promising. Clearly, the opportunities for obstetrician-gynecologist basic and clinical scientists are considerable. The question remains: Will leaders in the specialty work together to meet the challenge?

Training of academic staff in obstetrics and gynaecology in the USA

As we enter a new century and millennium, departments of obstetrics and gynaecology in American medical schools face a number of challenges. Of primary concern among these is the relative dearth of physician-scientists to explore and connect the basic mechanisms and clinical aspects of the diseases of women. This report reviews some aspects of three programmes designed to educate such investigators: The Reproductive Scientist Development Program, The American Gynecological and Obstetrical Society--American Association of Obstetricians and Gynecologists Foundation Fellowship Program and the Women's Reproductive Health Research Career Development Centers. Based on a decade of experience with the first two of these programmes, the prospects for the relatively new third programme are promising. Nonetheless, the need for and opportunities for obstetrician-gynaecologist reproductive scientists far exceed the supply.

Restructuring residency training in obstetrics and gynecology

This essay presents a brief review of the history advocating a restructuring of residency training to increase the flexibility of the experience. The advantages for both the general obstetrician-gynecologist and the subspecialist are reviewed.