Commentary: How can we make our medical students enthusiastic about a future in obstetrics and gynaecology?

The early determinants of career choices for medical students following an obstetrics and gynaecology placement: Mixed methods study

OBJECTIVE

To explore the impact of attending a clinical placement in considering a career in obstetrics and gynaecology.

DESIGN

Mixed methods study.

SETTING

London Medical School.

POPULATION

Fifth year medical students attending a clinical placement in obstetrics and gynaecology.

METHODS

Between January 2021 and January 2022, questionnaires were used and semi-structured focus groups conducted, which were audio-recorded. Descriptive statistics were conducted and a framework analysis on transcribed focus groups.

MAIN OUTCOME MEASURE

The impact of the clinical placement on career choice.

RESULTS

Six main themes were identified from the analysis; three contributing to considering a career in obstetrics and gynaecology; pregnancy is not an illness, extraordinary experience of observing childbirth and variable specialty and three themes emerged contributing to not considering a career; lack of work-life balance, high stakes specialty and the emotional toll. Even at an undergraduate level, medical students exhibited concerns about the long-term feasibility of achieving work-life balance and avoiding professional burnout, which was partly attributed to the responsibility of looking after both the woman and their baby.

CONCLUSIONS

Obstetrics and gynaecology is perceived as an exciting and variable speciality by medical students. Students' experiences on the labour ward during a clinical placement appear to contribute to the consideration of a career in obstetrics and gynaecology. Students should be given opportunities to discuss their concerns about obstetrics, particularly over the potential psychological impact of adverse/traumatic birth events. It is crucial to provide a realistic introduction to obstetrics, to recruit enthusiastic junior doctors who will be resilient to the pressures of the speciality, to avoid burnout and minimise attrition rates.

To be or not to be an Obstetrician / Gynaecologist

Objectives

This qualitative study aimed to explore motivational sources of physicians, at the time of selection and while pursuing ObGyn career. Secondary aim was to explore challenges and strategies adapted by these physicians to overcome these challenges.

Methods

This is qualitative study with constrictive worldview. ObGyn residents and consultants of Aga Khan University, Karachi, were interviewed from July 2017 till Jan 2019, after ethical approval, using purposeful maximum variation sampling. Analysis were conducted by identifying keywords and phrases, these unedited verbatim with no assumptions provided basis for codes, which then clustered as trends. Emerging findings were discussed among authors and themes were finalized with consensus. Conclusion was formulated by linking these themes.

Results

Four themes emerged were, 'grounds for selecting ObGyn as career', 'Motivational Factors', 'Demotivating Factors' and 'Strategies to Cope with Challenges'. Results showed that aptitude and passion not only have pivotal role in career selection but also helped in pursuance. Personal fulfilment and hands-on experience satisfy emotional needs, while family and friends supported participants in maintaining work-life balance and in over-coming challenges.

Conclusions

Considering personal preference and aptitude at the time of career selection helps in endurance and keep motivations high, while challenges in pursuance can be overcome by strong support system.

Medical students learning experiences of the labour ward: a qualitative research study

OBJECTIVE

To study the educational value to medical students of a labour ward rotation.

DESIGN

Qualitative research study was performed in two tertiary level obstetric hospitals attached to a large medical school in Dublin. Medical students attending a six-week rotation in Obstetrics and Gynaecology in University College Dublin were invited to participate. As part of this rotation, students spend one week as part of the clinical team working on the labour ward. Focus groups were held in order to identify common themes and experiences of medical students during this labour ward week. Grounded theory with thematic analysis was used. The main outcome measures were the educational experience and value of a labour ward rotation to medical students.

RESULTS

Five distinct themes developed from the focus groups of 19 students. A high value was placed on patient centred bedside teaching. Midwives were identified as excellent teachers and facilitators of learning. There was a clear sense of teamwork and belonging by the students. However, students reported frustration with unclear learning objectives. Students identified extra pre-learning with pre-specified learning aims before the labour ward week as being important.

CONCLUSION

Bedside teaching was highly valued as it advanced student's knowledge of obstetrics theory and improved communication skills. In general, medical students reported a positive experience from working in the labour word but there is scope for improvement.

Impact of educational messages on patient acceptance of male medical students in OB-GYN encounters

INTRODUCTION

Although training in obstetrics and gynecology is a key part of medical education, male students receive less extensive experience, due in part to patient refusals. However, there is limited work seeking to reduce patient refusal rates of male students. The current study examined the efficacy of two messages at increasing male medical student acceptance into a well-woman visit.

METHODS

A total of 656 college women participated in a simulation study where they viewed a video of a nurse asking for permission to have a male medical student participate in their well-woman visit. The 30.5% of women who refused student participation (n = 181) were randomly assigned to view a video of the nurse either describing students' medical knowledge and technical skills training (e.g. training in performing pelvic exams) or empathic skills training (e.g. training in communication about sensitive issues). They were again asked if they would be willing to have the student participate.

RESULTS

Both messages similarly increased student acceptance with 44.8% of those receiving the empathic skills training message and 48.9% of those who received the medical/technical skills training message accepting student participation, χ(2) (1, N = 181) = 0.3, p = 0.58.

DISCUSSION

Educational messages about medical student training delivered in an engaging fashion by a credible source are a potentially effective tool to increase male student acceptance into sensitive patient encounters. Future work should test these messages in real-world settings as part of a focus on patient education to increase comfort with student participation.

Gender bias in training of medical students in obstetrics and gynaecology: a myth or reality?

OBJECTIVE

To investigate the experience of medical students during a clinical attachment in obstetrics and gynaecology (O&G).

STUDY DESIGN

A questionnaire was distributed to medical students who completed their O&G posting between August 2012 and August 2013. The first part included basic demographic details (age, gender, and ethnicity) and frequency of actual clinical experience; the second part explored students' perception of their training and their relationship with other staff, in particular feeling of discrimination by specified groups of medical personnel. The responses were recorded using a Likert scale and were recategorised during analysis.

RESULTS

A total of 370 questionnaires were distributed, and 262 completed questionnaires were returned, giving a response rate of 71%. Female students had a significantly higher median (IqR) number of vaginal examinations performed 0.25(0.69) (p=0.002) compared to male students. Male students experienced a higher proportion of patient rejections during medical consultation, 87% vs. 32% of female students (p<0.001), a higher rate of refusal for clerking (71.4% vs. 57.5% of females, p=0.035) and a higher rate of patients declining consent for internal examination (93.3% vs. 67.6% of females, p<0.001). The majority of male students felt that their gender negatively affected their learning experience (87% vs. 27.4% of the female students, p<0.001). Male students reported a significantly higher proportion of discrimination against their gender by medical officers (p=0.018) and specialists/consultants (p<0.001) compared to females but there was no discrimination between genders by staff nurses or house officers. A majority (58%) of female students stated an interest in pursuing O&G as a future career compared to 31.2% of male students.

CONCLUSIONS

Our study confirmed that gender bias exists in our clinical setting as male students gain significantly less experience than female students in pelvic examination skills. We also demonstrated that compared to female students, male students experience higher levels of discrimination against their gender by trainers who are medical officers and specialists/consultants. Trainers must improve their attitudes towards male students, to encourage them and make them feel welcome in the clinical area. We must minimize gender discrimination and educational inequities experienced by male students, in order to improve their learning experience.

Evaluation of a strategy to improve undergraduate experience in obstetrics and gynaecology

CONTEXT

Poor interprofessional relationships in maternity units have resulted in a number of suboptimal outcomes: students are reluctant to pursue careers in obstetrics and gynaecology (O & G); trainees feel bullied, and poor communication between professionals results in avoidable adverse events. Interprofessional learning has been advocated to improve interprofessional relationships, but recent interventions have not been successful at undergraduate level. This study aimed to address this issue locally and then to disseminate our lessons, successes and challenges.

METHODS

A strategy for interprofessional team-working was developed in a large maternity unit in the UK, with a variety of interprofessional interventions spanning the attachment and opportunities to participate in specific task or research teams. These interventions were evaluated before the strategy proceeded to large-scale implementation, with a validated attitudes questionnaire (Pollard) and a reaction survey.

RESULTS

Interprofessional relationships improved significantly (P < 0.05) after the O&G attachment. There was also some improvement of borderline significance (P = 0.05) in interprofessional teamwork and communication, as well as a non-significant improvement in perceptions of interprofessional interactions. Most (17/27, 63%) students stated that O&G was their primary career intention after the attachment. They did not witness any bullying or interprofessional difficulties.

CONCLUSIONS

Contrary to findings in other studies, in which initial idealism has been reported to have collapsed after working with students from other professions, we achieved a positive reaction to the O&G attachment, harnessing students' initial positivity towards interprofessional learning and cementing it into real optimism. Our promising initial results suggest that more work is needed to further increase the impact of such strategies and to determine whether the improvements in attitudes translate to improved clinical behaviour and thence patient outcomes.

Postgraduate obstetrics and gynaecology experience: The role for early exposure

BACKGROUND

The early postgraduate years provide the opportunity for junior doctors to gain a range of experience and determine their focused areas of interest. Internship thus requires experience in medicine, surgery and the emergency department. Obstetrics and gynaecology (O & G) is not offered as an internship rotation, despite its suitability as such. A cross-sectional analysis of junior doctors was performed to assess residents' views on the suitability of an O & G rotation for career decision-making and for achieving sufficient clinical experience.

METHODS

Fifty-two resident medical staff in their second postgraduate year were recruited and each was given an anonymous survey for completion. Visual analogue scales (VAS) were used for participant responses.

RESULTS

For whether internship without an O & G rotation provides sufficient experience to include or exclude O & G as a career choice, the average participant response was 2.1 (on a VAS out of 10) (P<0.0001). For whether an O & G internship rotation would provide adequate medical, surgical or emergency department experience, the average response was 7.9 (on the VAS out of 10) (P<0.0001). As to whether participants would have preferred to undergo an O & G rotation during internship, the average response was 7.7 (P<0.0001).

CONCLUSION

The present study demonstrated a perception by residents that an O & G rotation during internship would achieve adequate clinical competencies and assist in career decision-making in O & G, with residents preferring to have undergone an O & G rotation during internship.