Fellow Perceptions of Residency Training in Obstetrics and Gynecology

A National Survey of Obstetrics and Gynecology Resident Perspectives on Their Preparedness to Provide Care for Underserved Patients with Gynecologic Malignancies

Obstetrics and Gynecology (Ob/Gyn) residents will encounter, screen for, and diagnose gynecologic malignancies. This survey assessed residents' confidence in providing NCCN Guidelines-based care to Gynecologic Oncology patients of differing racial/ethnic backgrounds and insurance statuses while accounting for residents' backgrounds. An anonymous, novel Qualtrics survey was disseminated to current US Ob/Gyn residents, with multiple-choice questions about subject demographics and Likert scale questions about their readiness to care for diverse patients. Differences in responses between racial groups were analyzed using the Kruskal-Wallis Rank Sum test. Differences in responses between ethnic groups were evaluated using the Wilcoxon Rank Sum test. Regardless of their backgrounds, residents feel "somewhat prepared" to care for diverse patients. There was no statistical between ethnic groups regarding confidence in caring for racial minorities or insurance types. Similarly, there was no statistical difference between racial groups regarding caring for racial minorities, but a difference did exist for insurance types (p = 0.027). No significant racial/ethnic differences were found in opinions on trial enrollment or chemotherapy delays, though most residents agreed that racial/ethnic minorities face delays in chemotherapy. Finally, resident ethnicity and race both impacted resident perceptions of difficulties for Medicaid and minority patients in obtaining non-operative gynecologic care (p = 0.044; p = 0.017) and scheduling outpatient appointments (p = 0.016; p = 0.032). Ob/Gyn residents feel prepared to provide NCCN Guidelines-based care to socioeconomically diverse patients with gynecologic malignancies, though differences exist when accounting for residents' racial/ethnic backgrounds. These results reflect the importance of emphasizing on culturally competent care in residency, particularly for patients with cancer.

Exposure to the reproductive endocrinology subspecialty among obstetrics and gynecology residency programs

PURPOSE

Prior studies found that Ob-gyn trainees believe they have inadequate experience in the REI subspecialty. We evaluated the amount of time devoted to REI within the 4-year rotation schedule of ACGME-accredited Ob-gyn residency programs.

METHODS

A list of current Ob-gyn residency programs, both with and without REI fellowships, was created using ACOG and ACGME databases. The programs' websites were reviewed, or the program coordinator was queried to determine the length and year of REI rotation, and the career or fellowships pursued by alumni. Wilcoxon rank sum test was utilized to assess differences in total REI rotation time between REI-affiliated and non-affiliated programs. Spearman's correlation was utilized to assess the association between total REI exposure and the percentage of alumni pursuing REI fellowships.

RESULTS

Cumulative length of REI rotations throughout residency ranged from 0 to 20 weeks. Mean cumulative rotation length was greater in non-REI than in REI-affiliated programs (7.4 weeks vs. 6.1 weeks, p = 0.007). However, REI-affiliated programs had greater exposure to REI rotations during the first 2 years of residency (3.9 weeks vs 3.1 weeks, p = 0.042). Among all programs, 24% had the REI rotation in PGY-1, 61% in PGY-2, 50% in PGY-3, and 16% in PGY-4. The proportion of alumni matching in REI fellowship was significantly greater in REI-affiliated programs than non-REI affiliated programs (9.5% vs. 3.1%, p < 0.001).

CONCLUSION

Compared to non-REI affiliated programs, Ob-gyn residencies affiliated with REI fellowships spend less time throughout residency training in REI rotations while sending a greater proportion of residents to REI fellowships.

Doubling down on the future of gynecologic oncology: The SGO future of the profession summit report

The original vision of the field of gynecologic oncology was to establish a multidisciplinary approach to the management of patients with gynecologic cancers. Fifty years later, scientific advances have markedly changed the overall practice of gynecologic oncology, but the profession continues to struggle to define its value-financial and otherwise. These issues were examined in full at the Society of Gynecologic Oncology (SGO) Future of the Profession Summit and the purpose of this document is to summarize the discussion, share the group's perceived strengths, weaknesses, opportunities, and threats (SWOT) for gynecologic oncologists, further educate members and others within the patient care team about the unique role of gynecologic oncologists, and plan future steps in the short- and long- term to preserve the subspecialty's critical mission of providing comprehensive, longitudinal care for people with gynecologic cancers.

Pediatric Residency Preparedness for Pediatric Emergency Medicine Fellowship

OBJECTIVE

The aim of the study was to examine the perception of pediatric emergency medicine (PEM) program directors (PDs), associate PDs (APDs) and first-year fellows regarding the preparedness of new PEM fellows who have graduated from pediatric residency programs.

METHODS

Unique surveys were created and electronically distributed to PEM PDs/APDs and first-year PEM fellows. Individual and institutional demographic information was collected. Using a 5-point Likert scale, survey items centered the perceived preparedness of first-year PEM fellows within 5 domains: professionalism, independence/autonomy, psychomotor skills, clinical evaluation and management, and academia/scholarship.

RESULTS

Forty percent (48/119) of eligible PDs and APDs and 56% (82/147) of eligible first-year PEM fellows responded. Most PDs/APDs strongly agreed or agreed that incoming fellows perform adequately in areas of professionalism, independence/autonomy, and clinical evaluation and management. The PDs/APDs perceived fellows to be less prepared in the academia/scholarship domain and several psychomotor skills. Most first-year PEM fellows perceived themselves as prepared in areas of professionalism and clinical evaluation and management. Fellows had varied feelings of preparedness in the domains of independence/autonomy, psychomotor skills, and academia/scholarship. Overall, most PDs/APDs (54%) and fellows (84%) feel that pediatric residency training was strong or very strong.

CONCLUSIONS

Most respondents in both groups felt that in general, pediatric residency programs adequately train residents for PEM fellowship. Both groups felt that the strengths of general pediatric training were among the domains of professionalism and clinical evaluation and management, whereas psychomotor skills and academia and scholarship were areas of improvement. These findings may be used by general pediatric residency and PEM fellowship programs to guide curriculum development.

Current Practices and Preferences of Fellows and Program Directors on Taking the Certifying Examination During Subspecialty Fellowships

OBJECTIVE

Fellows in obstetrics and gynecology subspecialties often take their oral specialty certifying examination (referred to here as generalist certifying examination [GCE]) during fellowship. We sought to compare the opinions of current fellows and program directors (PDs) regarding their program's handling of GCE during fellowship.

METHODS

In this online, survey-based study, fellows and PDs currently affiliated with an accredited fellowship in maternal-fetal medicine, reproductive endocrinology and infertility, female pelvic medicine and reconstructive surgery, or gynecologic oncology (GO) received the link to an unvalidated survey. This survey was open for 8 weeks, between April and June 2020; eligible participants were contacted through their programs, society Listserv, and social media and received 3 reminder e-mails.

RESULTS

Final analysis included 408 (408/834; response rate, 49%) fellows and 163 (163/223; response rate, 73%) PDs across the 4 subspecialties. There were significant differences in whether fellows responded that they were required or encouraged to take the GCE (52% maternal-fetal medicine, 65% reproductive endocrinology and infertility, 39% female pelvic medicine and reconstructive surgery, 8% GO; P < 0.01) during fellowship. Fewer GO fellows noted that they were permitted to use educational funds for GCE when compared with the other subspecialties (P < 0.01). Most fellows responded that the inability to take GCE during fellowship would decrease their satisfaction with fellowship, and this was significantly higher than PD estimates (78% vs 39%, P < 0.01).

CONCLUSIONS

There are significant differences in reported ability to take GCE during fellowship across different obstetrics and gynecology subspecialty fellowships. Program directors significantly underestimate fellow dissatisfaction with inability to take GCE during fellowship.

Resident Self-Entrustment and Expectations of Autonomy: OB > GYN?

INTRODUCTION

Entrustment is a key component connecting to resident preparedness for surgical practice in the operating room (OR). Residents' self-entrustment of their surgical competencies closely associates with their OR training experience and granted autonomy. Some recent studies have investigated how attending surgeons entrusted residents in the OR. There is little to no data, however, in examining these issues from the resident perspective. The goal of this study was to identify the perception and expectations of autonomy from residents' perspective, as well as the self-entrustment of their surgical competencies in obstetrics (OB) and gynecologic (GYN) procedures.

METHODS

Focus group interviews of OB/GYN residents were performed. Residents were selected by convenience sampling. Audio recordings of each interview were transcribed, iteratively analyzed, and emergent themes identified, using a framework method.

RESULTS

A total of 123 minutes of interviews were recorded. Eight junior residents (PGY1-2) and 12 senior residents (PGY3-4) participated. Our data illustrated that (1) the perception of autonomy shifted significantly throughout residency training; (2) residents demonstrated higher expectations and self-entrustment for OB surgical procedures than for GYN surgical procedures upon graduation; and (3) case volume, modalities of OR teaching and mutual communication are 3 factors influencing resident self-entrustment of their surgical competencies.

CONCLUSIONS

Residents showed disparities in their self-entrustment and expectations of autonomy between OB and GYN surgical procedures. Better understanding these differences and the 3 influencing factors could help programs develop a potential solution for improvement in resident entrustment and autonomy upon graduation.

A fellow-run clinic achieves similar patient outcomes as faculty clinics: A safe and feasible model for gynecologic oncology fellow education

OBJECTIVES

Fellow involvement in patient care is important for education, but effect on patient care is unclear. Our aim was to compare patient outcomes in gynecologic oncology attending clinics versus a fellow training clinic at a large academic medical center.

METHODS

A retrospective review of consecutive gynecologic oncology patients from six attending clinics and one faculty-supervised fellow clinic was used to analyze differences based on patient demographics, cancer characteristics, and practice patterns. Primary outcome was overall survival (OS); secondary outcomes included recurrence-free survival (RFS), postoperative complications and chemotherapy within the last 30 days of life. Survival analyses were performed using Kaplan-Meier curves with log-rank tests.

RESULTS

Of 159 patients, 76 received care in the attending clinic and 83 in the fellow clinic. Patients in the fellow clinic were younger, less likely to be Caucasian, and more overweight, but cancer site and proportion of advanced stage disease were similar. Both clinics had similar rates of moderate to severe adverse events related to surgery (15% vs. 8%, p = .76), chemotherapy (21% vs. 23%, p = .40), and radiation (14% vs. 17%, p = .73). There was no difference in median RFS in the fellow compared to attending clinic (38 vs. 47 months, p = .78). OS on both univariate (49 months-fellow clinic, 60 months-attending clinic vs. p = .40) and multivariate analysis [hazard ratio 1.3 (0.57, 2.75), P = .58] was not significantly different between groups.

CONCLUSIONS

A fellow-run gynecologic oncology clinic designed to provide learning opportunities does not compromise patient outcomes and is a safe and feasible option for fellow education.

Ob/Gyn resident self-perceived preparedness for minimally invasive surgery

BACKGROUND

Very little is known regarding the readiness of senior U.S. Ob/Gyn residents to perform minimally invasive surgery. This study aims to evaluate the self-perceived readiness of senior Ob/Gyn residents to perform complex minimally invasive gynecologic surgery as well as their perceptions of the minimally invasive gynecologic surgery subspecialty.

METHODS

We performed a national survey study of 3rd and 4th year Ob/Gyn residents. A novel 58-item survey was developed and sent to residency program directors and coordinators with the request to forward the survey link along to their senior residents.

RESULTS

We received 158 survey responses with 84 (53.2%) responses coming from 4th year residents and 74 (46.8%) responses from 3rd year residents. Residents who train with graduates of a fellowship in minimally invasive gynecologic surgery felt significantly more prepared to perform minimally invasive surgery compared to residents without this exposure in their training. The majority of senior residents (71.5%) feel their residency training adequately prepared them to be a competent minimally invasive gynecologic surgeon. However, only 50% feel prepared to perform a laparoscopic hysterectomy on a uterus greater than 12 weeks size, 29% feel prepared to offer a vaginal hysterectomy on a uterus 12-week size or greater, 17% feel comfortable performing a laparoscopic myomectomy, and 12% feel prepared to offer a laparoscopic hysterectomy for a uterus above the umbilicus.

CONCLUSIONS

The majority of senior U.S. Ob/Gyn residents feel prepared to provide minimally invasive surgery for complex gynecologic cases. However, surgical confidence in specific procedures decreases when surgical complexity increases.

ACOG Simulation Working Group: A Needs Assessment of Simulation Training in OB/GYN Residencies and Recommendations for Future Research

OBJECTIVE

To evaluate current availability and needs of simulation training among obstetrics/gynecology (OB/GYN) residency programs.

DESIGN

Cross-sectional survey.

SETTING

Accreditation Council for Graduate Medical Education accredited OB/GYN residency programs in the United States.

PARTICIPANTS

Residency program directors, gynecology simulation faculty, obstetrics simulation faculty, and fourth-year residents.

RESULTS

Of 673 invited participants, 251 (37.3%) completed the survey. Among the survey responses, OB procedures were more broadly represented compared to the GYN procedures for simulation teaching: 8 (50%) of 16 OB procedures versus 4 (18.2%) of 22 GYN procedures had simulation teaching. Among the simulated procedures, a majority of residents and faculty reported that simulation teaching was available for operative vaginal delivery, postpartum hemorrhage, shoulder dystocia, perineal laceration repair, conventional laparoscopic procedures, and robotic surgery. There were significant differences between residents and faculty perceptions regarding the availability and needs of simulated procedures with a minority of residents having knowledge of Council on Resident Education in Obstetrics and Gynecology (47.2%) and American College of Obstetrics and Gynecology (27.8%) simulation tools compared to the majority of faculty (84.7% and 72.1%, respectively). More than 80% of trainees and faculty reported they felt the average graduating resident could perform vaginal, laparoscopic, and abdominal hysterectomies independently.

CONCLUSIONS

Simulation is now widely available for both gynecologic and obstetric procedures, but there remains tremendous heterogeneity between programs and the perceptions of residents, program directors, and faculty. The variations in simulation training and readiness for performing different procedures following residency support the need for objective, validated assessments of actual performance to better guide resident learning and faculty teaching efforts.

The perceptions of gynecologic oncology fellows on readiness for subspecialty training following OB/GYNRESIDENCY

A recent survey of fellowship program directors (PD) within gynecologic oncology (GO) noted concerns regarding the abilities of incoming fellows. The objective of this study was to evaluate the perceptions of current and former fellows in gynecologic oncology of their readiness for fellowship training. A previously used survey was modified and distributed in 2016 to current and former fellows in GO. The survey explored domains of independent practice, psychomotor ability, clinical evaluation and scholarship. A standard Likert scale was employed and domains/responses were tailored to the subspecialty. A total of 150 current and recently former fellows responded to the survey, for a response rate of 38.7%. Nearly 70% of respondents reported being able to independently perform a hysterectomy when starting fellowship, and nearly 50% felt they could perform lysis of adhesions either without assistance. Although nearly 95% reported having had the opportunity to develop a plan of action for patients on labor and delivery, only 40.7% felt able to independently manage postoperative complications without assistance. Common themes that emerged in the open-ended responses pertained to self-perception of inadequate surgical skills and knowledge specific to gynecologic oncology. Although the majority of current and former fellows in gynecologic oncology report feeling prepared for fellowship, themes noted in the open-ended responses suggest a lack of confidence in surgical skills and clinical knowledge.

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The majority of current and former GO fellows report feeling prepared for fellowship.

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Discrepancies were noted between our study and results of a prior survey of fellowship directors.

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Open-ended responses suggested lack of confidence in surgical skills and in clinical knowledge.