Tracking—A Flexible Obstetrics and Gynecology Residency Curriculum

Sex and Racial/Ethnic Diversity in Accredited Obstetrics and Gynecology Specialty and Subspecialty Training in the United States

OBJECTIVE

To compare trends in racial and gender diversity in Obstetrics and Gynecology (OBGYN) residency and fellowship programs from beginning of program accreditation in 2012 to the most recently published report for 2018.

DESIGN

Data was abstracted in August 2020 from publicly available reports on the Accreditation Council for Graduate Medical Education (ACGME) website. Reports from 2012 to 2018 were compared with Chi-square tests and the Cochran-Armitage trend test assessed trends over time.

PARTICIPANTS

U.S. medical residents and fellows, with a focus on those in accredited OBGYN fellowship programs (Female Pelvic Medicine and Reconstructive Surgery (FPMRS), Gynecologic Oncology (GYNONC), Maternal Fetal Medicine (MFM), and Reproductive Endocrinology and Infertility (REI)).

RESULTS

From 2012 to 2018 men in all residency programs increased 0.88% (from 53.92% male to 54.80%, p < 0.0001). Across all years there were less men in OBGYN (16.89%) compared to all residency programs (54.39%, p < 0.0001). All OBGYN fellowships combined had more men proportionately than OBGYN residencies (24.14% vs. 16.89%, p < 0.0001). MFM had the most men (26.7%) then GYNONC (25.18%), FPMRS (21.36%), and REI (20.09%) (p = 0.024). There were no statistically significant trends in sex or race over time. From 2012 to 2018 residents overall were 42.96% white. OBGYN residents overall were 54.20% white. GYNONC had the highest percentage of white trainees (73.45%), followed by MFM (67.8%), REI (65.62%), then FPMRS (60%) (p = 0.0003).

CONCLUSIONS

According to ACGME core competencies, residents are expected to demonstrate sensitivity and responsiveness to diverse patient populations (professionalism) and advocate for improvements to systems-based practice. These results may suggest systemic issues in the recruitment of women and people of color into competitive sub-specialty programs. Such deficiencies in representation can impact patient care. Future research is needed to assess trends over time as data become available and to evaluate specific barriers to applications and selection of minority applicants.

Surgical coaching in obstetrics and gynecology: an evidence-based strategy to elevate surgical education and promote lifelong learning

The American Board of Medical Specialties, of which the American Board of Obstetrics and Gynecology is a member, released recommendations in 2019 reimagining specialty certification and highlighting the importance of individualized feedback and data-driven advances in clinical practice throughout the physicians' careers. In this article, we presented surgical coaching as an evidence-based strategy for achieving lifelong learning and practice improvement that can help to fulfill the vision of the American Board of Medical Specialties. Surgical coaching involves the development of a partnership between 2 surgeons in which 1 surgeon (the coach) guides the other (the participant) in identifying goals, providing feedback, and facilitating action planning. Previous literature has demonstrated that surgical coaching is viewed as valuable by both coaches and participants. In particular, video-based coaching involves reviewing recorded surgical cases and can be integrated into the physicians' busy schedules as a means of acquiring and advancing both technical and nontechnical skills. Establishing surgical coaching as an option for continuous learning and improvement in practice has the potential to elevate surgical performance and patient care.

Reported case numbers and variability in delivery route and volume by obstetrics and gynecology residents from 2003 to 2019

BACKGROUND

The obstetrical landscape in the United States has changed over the past several decades, during which there has been a decline in the number of operative vaginal deliveries performed. Procedural cases of obstetrics and gynecology residents are tracked in the Accreditation Council for Graduate Medical Education database, with a minimum requirement of 15 operative vaginal deliveries before graduation. Nowadays, it is unknown whether the decreasing numbers of operative vaginal deliveries are affecting the delivery case volume and experience of obstetrics and gynecology residents.

OBJECTIVE

This study aimed to analyze the trends in the number and route of obstetrical deliveries, including operative vaginal deliveries, performed by graduating obstetrics and gynecology residents in the United States as logged within the Accreditation Council for Graduate Medical Education database.

STUDY DESIGN

The Accreditation Council for Graduate Medical Education case log data were examined for graduating obstetrics and gynecology residents between 2003 and 2019. Delivery case volume numbers for spontaneous vaginal delivery, cesarean delivery, forceps-assisted vaginal delivery, and vacuum-assisted vaginal delivery were extracted and analyzed over time using linear regression. To compare the variability in logged cases, residents at the 70th percentile for number of cases logged were compared with residents at the 30th percentile for number of cases logged for each delivery type (spontaneous vaginal delivery, cesarean delivery, forceps-assisted vaginal delivery, and vacuum-assisted vaginal delivery).

RESULTS

Overall, obstetrical delivery data for 20,268 obstetrics and gynecology residents were collected from 2003 to 2019. Over this period, the mean number of spontaneous vaginal deliveries significantly decreased over time by 20% from 320.8±138.7 to 256.1±75.6 (slope, -2.6; P<.001); however, no significant difference was noted in the reported cesarean delivery cases, with an 8% increase from 191.8±80.1 to 206.8±69.7 per graduating resident (slope, 0.136; P=.873). Notably, the mean reported cases of forceps-assisted vaginal deliveries decreased by 75% from 23.8±21.9 to 6±6.8 per graduating resident (slope, -0.851; P<.001). Similarly, the mean logs of vacuum-assisted vaginal delivery decreased by 37% from 23.8±17.1 to 15±9.5 (slope, -0.542; P<.001). The ratio of reported resident case logs comparing the volume at the 70th percentile with the volume at the 30th percentile demonstrated a significant decrease over time for spontaneous vaginal delivery (slope, -0.015; P<.001), cesarean delivery (slope, -0.015; P<.001), and vacuum-assisted vaginal delivery (slope, -0.033; P<.001) but was significantly increased for forceps-assisted vaginal delivery (slope, 0.07, P=.0065).

CONCLUSION

In the reported Accreditation Council for Graduate Medical Education case logs, we identified that the reported number of obstetrical deliveries performed by obstetrics and gynecology residents in the United States is changing, with a significant decline recognized from 2003 to 2019 in logged numbers of spontaneous vaginal deliveries, vacuum-assisted vaginal deliveries, and forceps-assisted vaginal deliveries, without a difference in reported cesarean delivery cases per graduating resident. Furthermore, substantial variation is seen among resident volume nationwide, with the difference in high- and low-volume resident forceps-assisted vaginal delivery experience increasing over time. Awareness of these data should notify the Accreditation Council for Graduate Medical Education and educators about reasonable targets, increased need for simulation, and new ways to teach all modes of deliveries effectively in all residency programs.