Patient choice: comparing criteria for selecting an obstetrician-gynecologist based on image, gender, and professional attributes

Understanding the Values, Qualities, and Preferences of Patients in Their Relationships With Obstetrics and Gynecology Providers: Cross-Sectional Survey With a Mixed Methods Approach

BACKGROUND

The patient-provider relationship in obstetrics and gynecology (OBGYN) is uniquely complex due to the sensitive nature of examinations and topics. Patients often prefer health care providers who share similar racial, ethnic, gender, or linguistic backgrounds, particularly in sensitive health care situations, to improve communication and comfort, though historically, specific gender preferences for OBGYNs have not been evident.

OBJECTIVE

This study aims to describe the values, qualities, and preferences of patients in their relationships with OBGYN providers.

METHODS

This cross-sectional survey, conducted from October 2019 to December 2019, involved 1039 US OBGYN patients and used a mixed methods approach, integrating quantitative responses and qualitative insights from open-ended questions. Recruitment was facilitated through targeted social media campaigns, and the survey aimed to capture detailed patient preferences and barriers to care by assessing responses on provider traits, patient experiences, and demographic factors. The study's rigorous data collection and analysis were designed to fill gaps identified in previous research on patient-provider relationships in OBGYN care.

RESULTS

The findings underscore the paramount importance of trust and comfort, with listening skills identified as crucial. A notable finding is the marked preference for same-gender providers, observed in 80.7% (545/675) of participants. Primary barriers to seeking care reported included daily commitments, highlighting the need for accessible and flexible care options.

CONCLUSIONS

The study highlights a significant shift from previous scientific findings in patient preferences toward gender concordance and trust in OBGYN settings, diverging from previous research. These results emphasize the need for patient-centered care and tailored communication strategies to enhance patient experiences and outcomes. Future research should focus on diverse populations to broaden the findings' applicability and explore the impact of recent shifts in health care policies.

Effects of a Gender-Balancing Strategy on Resident Panels in a Primary Care Setting

BACKGROUND

Patients often prefer gender concordance when choosing a primary care practitioner. In a trainee setting, this may lead to unequal training opportunities for male and female resident physicians. Residency leadership may be interested in ways to promote balance in patient empanelment.

OBJECTIVE

To assess the efficacy of an intervention to equalize imbalance in patient gender on resident primary care panels.

DESIGN

Observational cohort study.

PARTICIPANTS

Categorial internal medicine residents beginning residency in 2020.

INTERVENTIONS

The panels of internal medicine residents were manually rebalanced at the beginning of training for a new cohort of residents with the goal of having similar numbers of male and female patients on each resident's panel.

MAIN MEASURES

Panel data was observed for 2 years following intervention. Number of male patients, number of female patients, and overall panel size were compared between male and female residents at baseline, 6 months, and 24 months.

KEY RESULTS

The analysis included 28 female residents and 20 male residents. After rebalancing, baseline panels had similar numbers of male patients (median of 50 on both male and female residents' panels; average panel 54.7% male) and female patients (median of 41.5 on female residents' panels and 41 on male residents' panels; average panel 45.3% female). At the end of the follow-up period, a significant difference was observed in the median number of male patients (59.5 and 43.5; p < 0.001) and female patients (33.5 and 48.5; p < 0.001) between male and female residents, but no difference was observed in overall panel size.

CONCLUSIONS

A steady drift towards gender concordance was observed over 2 years following a rebalancing intervention. Program leadership overseeing primary care empanelment for resident physicians may consider periodic rebalancing of panels in addition to other interventions to ensure equal training opportunities and best prepare residents for future practice.

Identifying the Drivers of Inter-Regional Patients' Mobility: An Analysis on Hospital Beds Endowment

BACKGROUND

In a Beveridgean decentralized healthcare system, like the Italian one, where regions are responsible for their own health planning and financing, the analysis of patients' mobility appears very interesting as it has economic and social implications. The study aims to analyze both patients' mobility for hospital rehabilitation and if the beds endowment is a driver for these flows; Methods: From 2011 to 2019, admissions data were collected from the Hospital Discharge Cards database of the Italian Ministry of Health, population data from the Italian National Institute of Statistics and data on beds endowment from the Italian Ministry of Health website. To evaluate patients' mobility, we used Gandy's Nomogram, while to assess if beds endowments are mobility drivers, we created two matrices, one with attraction indexes (AI) and one with escape indexes (EI). The beds endowment, for each Italian region, was correlated with AI and EI. Spearman's test was carried out through STATA software; Results: Gandy's Nomogram showed that only some northern regions had good hospital planning for rehabilitation. A statistically significant correlation between beds endowment and AI was found for four regions and with EI for eight regions; Conclusions: Only some northern regions appear able to satisfy the care needs of their residents, with a positive attractions minus escapes epidemiological balance. The beds endowment seems to be a driver of patients' mobility, mainly for escapes. Certainly, the search for mobility drivers needs further investigation given the situation in Molise and Basilicata.

Factors influencing decisions among the public related to the chosen surgeons for elective surgeries: A nationwide study

Aim

It is a complex decision for patients and their families to select a qualified surgeon who meets their needs. Understanding these needs enables surgeons to build stronger relationship with patients. This study aimed to identify influencing factors, variables, and criteria that individuals consider when selecting surgeons for elective surgeries.

Methods

This is a nationwide cross-sectional study conducted among patients who have undergone elective surgeries in Saudi Arabia. The data were collected with an anonymous self-administered pre-validated questionnaire. The collection of data was carried out through web-based questionnaires using google forms. The questionnaire contains socio-demographic characteristics (i.e., age, gender, education, etc.) and different factors to assess patients' perceptions in choosing a surgeon.

Result

Patients' overall number was 3133 (56.2 % females vs 43.8 % males). The most common age group was 18 to 34 years old (63.7 %). The prevalence of patients who were able to choose the right surgeon to perform an operation was 79.8 %. Patients' top choice when selecting a surgeon was according to the surgeon's manner followed by the qualifications then the reputation. Females are choosing a surgeon according to his/her manner while males are choosing according to his/her qualifications.

Conclusion

Surgeons' manner and qualifications are the most considered factors among when selecting a surgeon while the realistic factors such as accreditation of a facility and surgeon's scientific roles, quality improvement, and patient safety are ignored among the public. This requires condensed educational efforts and further research to determine the advertisements and social media effects on patients' decisions related to their health.

Preference of birth attendant gender and associated factors among antenatal care attendants at Debre Markos town public health facilities, Northwest Ethiopia: A cross-sectional study design 2021

OBJECTIVE

To assess the preference of birth attendant gender and associated factors among antenatal care attendants in Debre Markos town public health facilities, northwest Ethiopia, 2021.

METHOD

A facility-based cross-sectional study was conducted from 8 January 2021 to 28 February 2021 at Debre Markos town public health facilities. A total of 662 study participants were selected by systematic random sampling technique. Pretested interviewer-administered structured questionnaires were used for data collection. Data were entered using Epi Data version 3.1 and analyzed using SPSS version 25. Bivariable and multivariable logistic regression were applied to identify factors associated with birth attendant gender preference. Association was described by the "odd ratio" along with a 95% confidence interval. Finally, a P value < 0.05 in the adjusted analysis was used to declare a significant association.

RESULT

In this study, 644 women participated making a response rate of 97.3%. Of the total study participants, 108 (16.8%; 95% confidence interval: 13.8-19.4) preferred male birth attendants, while 232 (36%; 95% confidence interval: 32.5-39.8) preferred female birth attendants. Age (15-24) (adjusted odds ratio = 4.81, 95% confidence interval: 1.79, 12.94), no formal education (adjusted odds ratio = 2.94, 95% confidence interval: 1.32, 6.52), and primary education (adjusted odds ratio = 2.42, 95% confidence interval: 1.07, 5.47) were significantly associated with female birth attendant preference. A lack of formal education (adjusted odds ratio = 0.08; 95% confidence interval: 0.01, 0.68), secondary education (adjusted odds ratio = 0.34; 95% confidence interval: 0.16, 0.71), and history of assisted vaginal delivery (adjusted odds ratio = 3.72; 95% confidence interval: 1.40, 9.87) were significantly associated with a male birth attendant preference.

CONCLUSION

A female birth attendant is preferred by almost one-third of pregnant mothers, while one-sixth preferred a male. The clients who were younger in age and lower in educational status were more likely to prefer female birth attendants, whereas those who had a history of assisted vaginal delivery were more likely to prefer male birth attendants. To have a mother in the continuum of care, it is crucial to take her preferences into account when providing services.

Responding to patient requests for women obstetrician-gynecologists

Patients may request care from a woman obstetrician-gynecologist for various reasons, including privacy concerns, religious or cultural reasons, and in some cases, a history of abuse. They should be given the opportunity to voice their reasons for requesting a woman obstetrician-gynecologist but should not be compelled to do so. Respect for patient autonomy is a compelling reason to consider honoring a patient's gender-based request. When a patient requests a woman obstetrician-gynecologist, efforts should be made to accommodate the request if possible. However, medical professionals and institutions are not ethically obligated to have a woman obstetrician-gynecologist on call or to make one available at all times. If it is not feasible for a woman obstetrician-gynecologist to provide care because of staffing or other system constraints or patient safety concerns, accommodation is not required, and physicians do not have an overriding responsibility to ensure that patients receive gender-concordant care. Patients have the right to decline care and may choose to seek care elsewhere if their requested healthcare provider type is not available. Institutions and medical clinics should have policies and procedures in place for managing patient requests for women obstetrician-gynecologists, and patients should be made aware of these policies preemptively. These policies and procedures should include information about whom to contact for assistance and how to document the encounter. They should also be accessible and familiar to physicians and trainees. Care should be taken to ensure that adequate educational opportunities in obstetrics and gynecology are available for all medical trainees, regardless of gender.

Assessment of Prenatal Care Providers’ Competencies From the Perspective of Pregnant Women: An Iranian Study

Background: Pregnant women have expectations from their providers; sometimes their expectations are somewhat different from the current situation. Objective: to assess of competencies of prenatal care providers according to the views of pregnant women in Iran. Method: This is a descriptive-analytical study. Sampling were 300 pregnant women. A researcher-made questionnaire with appropriate validity and reliability was used. These competencies were divided into 4 dimensions of professional skills, communication skills, individual characteristics of prenatal care providers, and the characteristics of pregnancy and childbirth centers. Results: The percentage of the expected status of professional skills’ score of prenatal care providers (97.17) did not significantly differ from the current status (96.07). Nevertheless, there was a significant difference between the percentages of scores of expected (95.61) and the current statuses (90.89) of communication skills. The percentage of expected status (94.74) and the current status (84.17) scores of individual characteristics of prenatal care providers. The percentages of the expected status scores (95.24) and the status quo (89.61) of characteristics of pregnancy and childbirth centers were a significant difference. Conclusion: It is needed to upgrade some competencies of prenatal care providers. So, providers should focus their efforts on strengthening the expected skills of their pregnant women.

Gender bias in the medical education of obstetrician-gynaecologists in the United States: A systematic review

Background

The number of men entering obstetrics and gynaecology (Ob/Gyn) residencies and general Ob/Gyn practice is decreasing. Gender biases against their participation may affect career decisions.

Objective

This systematic review examines: (i) female patients’ gender preferences and perceptions of men as Ob/Gyns and/or medical students; and (ii) the influence of gender on students’ education and career decisions.

Search strategy

We identified relevant research via PubMed using variations of three concepts in combination: Ob/Gyn care, gender bias/preference, and medical education or career. We conducted the initial review in 2018 and repeated the search in March 2021, adding additional references via citation review of included research.

Selection criteria

We restricted the review to original research from the United States between 2000–2021.

Data collection

Fifteen studies met inclusion criteria, categorised into three groups: (i) patient’s gender preference for Ob/Gyns; (ii) patient’s gender preference for medical students during the Ob/Gyn clerkship; and (iii) influence of gender bias on Ob/Gyn career decisions.

Main results

Patients prioritised their physician’s care attributes (eg technical skill, compassion, experience) over gender when choosing Ob/Gyns; however, provider gender was prioritised for medical students. Male medical students more commonly reported exclusion from clinical opportunities, although objective clinical exposure was like that of female counterparts. Despite perceived gender bias, male medical students reported increased Ob/Gyn interest post‐clerkship; interest did not translate into residency applications. These findings are limited by study quality and heterogeneity.

Conclusions

Real and perceived gender bias among female patients and male medical students in Ob/Gyn may underlie declining numbers of men entering the field.

Delivering Healthcare Through Teleconsultations: Implications for Offline Healthcare Disparity

In this study, we focus on the largely overlooked but important topic: social value created by teleconsultations. Many countries suffer from the geographic imbalance of their medical professionals: there are abundant resources in urban cities but too few in rural areas. Teleconsultations have emerged as a promising solution to reduce this disparity because they can remotely deliver healthcare without relocating medical professionals. Yet it is unclear whether teleconsultations actually mobilize healthcare to underserved areas. To answer this question, we collaborate with a large online healthcare platform and analyze its teleconsulting data together with offline healthcare and regional data. Our results indicate that teleconsultations tend to connect physicians in resourceful regions with patients in underserved areas—a desirable pattern that alleviates the geographic healthcare disparity. However, we also find that social, information, and geography frictions persist. For instance, teleconsultations are less likely to occur as regions become farther apart, and financial and information constraints limit rural patients’ access to teleconsultations. We uncover the underlying mechanisms that drive such frictions and provide recommendations to reduce the frictions that hinder teleconsultations.

Effect of Resident Gender and Surname Origin on Clinical Load: Observational Cohort Study in an Internal Medicine Continuity Clinic

BACKGROUND

Studies show patients may have gender or racial preferences for physicians.

OBJECTIVE

To determine the degree to which physicians' gender and name characteristics influenced physician clinical load in medical practice, including patient panel size and percent of slots filled.

DESIGN

Observational cohort study of a continuity clinic site in Rochester, MN, from July 1, 2015 to June 30, 2017 ("historical" period) and July 1, 2018 to January 30, 2020 ("contemporary" period).

PARTICIPANTS

Internal medicine resident physicians.

MAIN MEASURES

Resident gender, name, and race came from residency management system data. Panel size, percent of appointment slots filled ("slot fill"), panel percent female, and panel percent non-White came from the electronic health record. Multivariable linear regression models calculated beta estimates with 95% confidence intervals and R² for the impact of physician gender, surname origin, name character length, and name consonant-to-vowel ratio on each outcome, adjusting for race and year of residency.

KEY RESULTS

Of the 307 internal medicine residents, 122 (40%) were female and 197 (64%) were White. Their patient panels were 51% female (SD 16) and 74% White (SD 6). Female gender was associated with a 5.3 (95% CI 2.7-7.9) patient increase in panel size and a 1.5% (95% CI -0.6 to 3.7) increase in slot fill. European, non-Hispanic surname was associated with a 5.3 (95% CI 2.6-7.9) patient increase in panel size and a 4.3 percent (95% CI 2.1-6.4) increase in slot fill. Race and other name characteristics were not associated with physician clinical load. From the historical to contemporary period, the influence of name characteristics decreased from 9 to 4% for panel size and from 15 to 5% for slot fill.

CONCLUSIONS

Female gender and European, non-Hispanic surname origin are associated with increased physician clinical load-even more than race. While these disparities may have serious consequences, they are also addressable.

Measurement Model of Women's Preferences in Obstetrician and Gynecologist Selection in the Private Sector: Exploratory and Confirmatory Factor Analysis

Background:

The purpose of this study is to construct and validate a measurement model of women’s preferences in Obstetrician and Gynecologist (OB/GYN) selection in the private sector of non-clinical parameters.

Methods:

This methodological study included 462 respondents in OB/GYN’s offices to a researcher-made questionnaire. The patients visited 57 offices of OB/GYNs in the city of Mashhad in Iran and completed women’s preferences in OB/GYN selection questionnaire over a 2-month period from January to February 2018. Exploratory Factor Analysis (EFA) was conducted to verify the instrument’s construct validity. Confirmatory Factor Analysis (CFA) was used to test whether the data fit our hypothesized model obtained from EFA model.

Results:

The first draft of the questionnaire was prepared with 118 items based on literature review. The outcome of content validity assessment was a 51-item questionnaire. Scale-Content Validity Index (S-CVI) turned out to be 0.80. The results of EFA yielded an instrument with 33 items in six domains, which explained 52.657% of the total variance of the questionnaire. With performing CFA, the 6-factor model with 29 items demonstrated a good fit with the data (CFI=0.952, CMIN/DF=1.613, RMSEA=0.036). Availability and Accessibility, Communicational Skills, Office Environment, Recommendation by Others, Special Services, and Cost and Insurance were found to define the women’s preferences in OB/GYN selection in private sector, Iran.

Conclusion:

The developed measurement model considers the patient’s preferences that influence decision-making process on OB/GYN selection. It can provide useful knowledge for OB/GYNs and policymakers to design appropriate and efficient marketing strategies according to the consumer preferences priority.

To the point: gender differences in the obstetrics and gynecology clerkship

Gender differences in performance on the obstetrics and gynecology clerkship have been reported, with female students outperforming male students. Male students report that their gender negatively affects their experience during the clerkship. Additionally, there are fewer male students applying for obstetric/gynecology residency. This "To The Point" article by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee will describe the gender differences that have been found, examine factors that could be contributing to these issues, and propose measures to correct these disparities.

Effects of patients' motives in choosing a provider on determining the type of medical institution

BACKGROUND

Primary care is relatively weak in the Republic of Korea. As the referral system is not well established, patients can freely choose from among clinics, hospitals, and tertiary hospitals. This study was conducted to determine the factors influencing patients' choice of providers.

METHODS

A survey was conducted of 999 Korean adults aged 19-59 years. An exploratory factor analysis was performed on nine factors influencing their motives in choosing a medical provider. The factors derived from this analysis and the types of medical institutions were used as the independent and dependent variables, respectively, in logistic regression analysis. Adjustments were made for region, gender, age, educational level, income, type of insurance, and chronic diseases.

RESULTS

The results showed that patients preferred clinics when considering the importance of accessibility, staff kindness, and patient-centeredness; they preferred hospitals when considering cleanliness; and tertiary hospitals when considering the reputation and structural factors. When considering structural factors, clinics and hospitals were less preferred; however tertiary hospitals were less preferred when considering accessibility, staff kindness, and patient-centeredness.

CONCLUSION

It is necessary to provide more accessible and patient-centered services in order to strengthen the primary health care role of clinics. In addition, efforts are needed to improve the quality of health care of tertiary hospitals in order to meet patient expectations.

Choosing a Surgeon: An Exploratory Study of Factors Influencing Selection of a Gender Affirmation Surgeon

Purpose: Selecting a healthcare provider is often a complicated process. Many factors appear to govern the decision as to how to select the provider in the patient–provider relationship. While the possibility of changing primary care physicians or specialists exists, decisions regarding surgeons are immutable once surgery has been performed. This study is an attempt to assess the importance attached to various factors involved in selecting a surgeon to perform gender affirmation surgery (GAS). It was hypothesized that owing to the intimate nature of the surgery, the expense typically involved, the emotional meaning attached to the surgery, and other variables, decisions regarding choice of surgeon for this procedure would involve factors other than those that inform more typical healthcare provider selection or surgeon selection for other plastic/reconstructive procedures.

Methods: Questionnaires were distributed to individuals who had undergone GAS and individuals who had undergone elective plastic surgery to assess decision-making.

Results: The results generally confirm previous findings regarding how patients select providers.

Conclusion: Choosing a surgeon to perform gender-affirming surgery is a challenging process, but patients are quite rational in their decision-making. Unlike prior studies, we did not find a preference for gender-concordant surgeons, even though the surgery involves the genital area. Providing strategies and resources for surgical selection can improve patient satisfaction.

Surgical trends in the correction of female stress urinary incontinence in academic centers within the United States

AIMS

There is a lack of data describing the current state of stress urinary incontinence (SUI) procedures in academic centers. Urologists, gynecologists, and urogynecologists perform these operations, but the relative volume each group accounts for is unknown. The purpose of this study was to evaluate the distribution of cases in academic centers between specialties and associated patient characteristics.

METHODS

A hospital consortium database was used to identify patients treated surgically for SUI between 2009 and 2014. Patient and surgeon variables were evaluated. Patient variables (age, region, insurance, race) and surgeon volume were analyzed. Sub-analysis was conducted to determine concomitant prolapse repairs.

RESULTS

Of the 50,315 stress urinary incontinence procedures performed, 22% were performed by urologists. Overall volume dropped 39% and mean surgeon volumes for all three groups decreased with time. Average median volume for urogynecologists (29/year) differed from both urologists (3/year) and non-urogynecologists (2/year). There was a significant difference in rate of concomitant prolapse repairs performed by urogynecologists (56%), gynecologists (54%), and urologists (26%).

CONCLUSIONS

These data portray the changing pattern of SUI procedure practice in academic centers. Academic urologists are performing less than 25% of SUI procedures, with an overall decline in number of procedures across all specialties. Urogynecologists and gynecologists are performing a significantly higher proportion of concomitant prolapse repairs. Neurourol. Urodynam. 36:394-398, 2017. © 2015 Wiley Periodicals, Inc.

Urban Dwelling American Indian Adolescent Girls' Beliefs Regarding Health Care Access and Trust

Indigenous people, specifically American Indians (AI), have historically had a greater mistrust of the medical system compared to their White counterparts. The purpose of this paper is to explore the perceptions of AI adolescent girls living in an urban, Midwest area about health care providers, health care systems, and access to health care as related to sexual health care. Using grounded theory methodology, twenty 15-19 year old AI girls participated in talking circles and individual interviews. Two distinct themes emerged related to sexual health care: 1) AI adolescent girls trust their health care providers and the health care system; and 2) Access to health care is critical to practicing safe sex and obtaining information about healthy sexual practices. These findings are unique and may help health care providers and social workers providing care and support to the urban adolescent AI girl.

Patient preferences for technical skills versus interpersonal skills in chiropractors and physiotherapists treating low back pain

BACKGROUND

Little is known about which characteristics of chiropractors and physiotherapists matter to patients and influence their preferences when seeking care.

OBJECTIVE

To examine the impact of four factors (patient gender, practitioner gender, practitioner specialty-chiropractor or physiotherapist and practitioner reputation-technical ability or interpersonal skills) on patients' choice of therapist to treat low back pain.

METHODS

Questionnaire-based vignette study in which participants sampled from the general population rated the likelihood of consulting eight fictional therapists. Each fictional therapist represented a different combination of the three practitioner factors (e.g. male chiropractor with reputation for good technical ability). The study was administered as a postal survey to a simple random sample of residences in one postal town in England.

RESULTS

Respondents (n = 657) consistently reported that they considered a practitioner's qualifications and technical skills important when choosing either a physiotherapist or a chiropractor; and just less than a third thought it was important that a practitioner was a good listener. As hypothesized, female respondents preferred female practitioners and respondents had a general preference for physiotherapists over chiropractors. Contrary to our hypothesis, the practitioner's reputation had the largest effect on respondents' preferences and all practitioners with a reputation for technical ability were preferred over those with a reputation for interpersonal skills.

CONCLUSION

Similar factors are important to patients whether they are choosing an individual chiropractor or physiotherapist; patients particularly value information about technical competence. An awareness of these factors should help primary care providers to direct patients to relevant information and support their decision-making.

Determinants of patient choice of healthcare providers: a scoping review

BACKGROUND

In several northwest European countries, a demand-driven healthcare system has been implemented that stresses the importance of patient healthcare provider choice. In this study, we are conducting a scoping review aiming to map out what is known about the determinants of patient choice of a wide range of healthcare providers. As far as we know, not many studies are currently available that attempt to draw a general picture of how patients choose a healthcare provider and of the status of research on this subject. This study is therefore a valuable contribution to the growing amount of literature about patient choice.

METHODS

We carried out a specific type of literature review known as a scoping review. Scoping reviews try to examine the breadth of knowledge that is available about a particular topic and therefore do not make selections or apply quality constraints. Firstly, we defined our research questions and searched the literature in Embase, Medline and PubMed. Secondly, we selected the literature, and finally we analysed and summarized the information.

RESULTS

Our review shows that patients' choices are determined by a complex interplay between patient and provider characteristics. A variety of patient characteristics determines whether patients make choices, are willing and able to choose, and how they choose. Patients take account of a variety of structural, process and outcome characteristics of providers, differing in the relative importance they attach to these characteristics.

CONCLUSIONS

There is no such thing as the typical patient: different patients make different choices in different situations. Comparative information seems to have a relatively limited influence on the choices made by many patients and patients base their decisions on a variety of provider characteristics instead of solely on outcome characteristics. The assumptions made in health policy about patient choice may therefore be an oversimplification of reality. Several knowledge gaps were identified that need follow-up research.

The effect of student gender on the obstetrics and gynecology clerkship experience

OBJECTIVES

To explore the effects of the students' gender on their perception of quality and quantity of teaching, the amount of experiential learning, and their interest in obstetrics and gynecology.

METHODS

Anonymous, self-administered surveys to third-year medical students rotating on the obstetrics and gynecology clerkship.

RESULTS

Eighty-one of 91 students participated (89% response rate): 33 men, 46 women, 2 declined to reveal their gender. No significant gender differences existed regarding number of interactions with residents and faculty; number of deliveries, surgeries, or examinations performed; perceived quality of teaching; or feeling included as part of the clinical team. Male students were more likely to report performing specific surgical procedures, such as operating the bovie cautery during gynecological surgeries (p = 0.005). More men experienced patients refusing to allow them to participate in the clinical interview (p < 0.0001) and physical examination (p < 0.0001). Male students were also more likely to report feeling that their gender negatively impacted their clerkship experience (p < 0.0001). Although less likely to report preclerkship and postclerkship career interest in obstetrics and gynecology, male students were more likely to report that their interest increased at the end of the clerkship.

CONCLUSIONS

Male students were more likely to experience gender bias from patients on the obstetrics and gynecology service. Male students also described feeling socially excluded from female-dominated clinical teams. Obstetrics and gynecology educators need to consider methods of encouraging patients to accept medical student participation regardless of gender. Obstetrics and gynecology faculty and residents need to be sensitive to subtle forms of gender bias and ensure equal inclusion for both male and female medical students.

What we don't talk about when we don't talk about sex: results of a national survey of U.S. obstetrician/gynecologists

INTRODUCTION

Sexuality is a key aspect of women's physical and psychological health. Research shows both patients and physicians face barriers to communication about sexuality. Given their expertise and training in addressing conditions of the female genital tract across the female life course, obstetrician/gynecologists (ob/gyns) are well positioned among all physicians to address sexuality issues with female patients. New practice guidelines for management of female sexual dysfunction and the importance of female sexual behavior and function to virtually all aspects of ob/gyn care, and to women's health more broadly, warrant up-to-date information regarding ob/gyns' sexual-history-taking routine.

AIMS

To determine ob/gyns' practices of communication with patients about sexuality, and to examine the individual and practice-level correlates of such communication.

METHOD

A population-based sample of 1,154 practicing U.S. ob/gyns (53% male; mean age 48 years) was surveyed regarding their practices of communication with patients about sex.

MAIN OUTCOME MEASURES

Self-reported frequency measures of ob/gyns' communication practices with patients including whether or not ob/gyns discuss patients' sexual activities, sexual orientation, satisfaction with sexual life, pleasure with sexual activity, and sexual problems or dysfunction, as well as whether or not one ever expresses disapproval of or disagreement with patients' sexual practices. Multivariable analysis was used to correlate physicians' personal and practice characteristics with these communication practices.

RESULTS

Survey response rate was 65.6%. Sixty-three percent of ob/gyns reported routinely assessing patients' sexual activities; 40% routinely asked about sexual problems. Fewer asked about sexual satisfaction (28.5%), sexual orientation/identity (27.7%), or pleasure with sexual activity (13.8%). A quarter of ob/gyns reported they had expressed disapproval of patients' sexual practices. Ob/gyns practicing predominately gynecology were significantly more likely than other ob/gyns to routinely ask about each of the five outcomes investigated.

CONCLUSION

The majority of U.S. ob/gyns report routinely asking patients about their sexual activities, but most other areas of patients' sexuality are not routinely discussed.

How patients choose acupuncturists: a mixed-methods project

OBJECTIVES

Patients can have difficulties choosing acupuncturists in the United Kingdom because acupuncturists are not all subject to statutory regulation. Research has identified factors that influence patients' choice of general practitioner. However, how patients choose acupuncturists has not been studied. The aim was to investigate how patients choose acupuncturists and to identify which factors might influence this choice.

DESIGN

A mixed-methods design used an exploratory qualitative study followed by a quantitative study. The qualitative study explored patients' experiences of acupuncture. The quantitative vignette study investigated the impact of patient gender and practitioner factors (gender, training location, and qualifications) on choice of acupuncturist.

METHODS

In the qualitative study, 35 acupuncture patients (recruited through maximum variation sampling from seven clinics and the community) participated in semistructured interviews about their acupuncture experiences. In the quantitative study, 73 participants imagined wanting to consult an acupuncturist for back pain. They rated 8 fictional acupuncturists; ratings were analyzed using analysis of covariance.

RESULTS

Patients wanted qualified, personable acupuncturists and valued recommendations from trusted others. Without such recommendations, potential patients preferred female acupuncturists (F(1,69)=4.504, p<0.05) and those with medical qualifications (F(1,69)=44.832, p<0.01).

CONCLUSIONS

The decision to consult a particular acupuncturist is not straightforward. Acupuncturists' trustworthiness and technical competence are important to (potential) patients; practitioner gender also influenced preferences. Patients need to be informed about proposals concerning statutory regulation in CAM and its implications; conventional practitioners might be able to better support their patients wanting to consult acupuncturists.

Muslim women and medical students in the clinical encounter

CONTEXT

Increasingly, male medical students report being refused by female patients, particularly in obstetrics and gynaecology, which is impacting on recruitment into the discipline. However, little has been documented in terms of Muslim patients and medical students in the clinical consultation.

METHODS

Female Emirati nationals (n = 218) attending out-patient clinics at a public hospital in Al Ain, United Arab Emirates (UAE), were interviewed by medical students. Participants were provided with four hypothetical clinical scenarios (three personal, one concerning a pre-pubertal child) and asked whether they would allow male and female students to be present at a consultation, take a history or perform an examination. They were also canvassed about their past experiences with medical students and their social responsibility to contribute towards the training of Emirati doctors.

RESULTS

Significant differences were recorded in terms of female versus male student involvement for all activities (P < 0.05-0.0005). For gynaecological and abdominal problems, patients would generally refuse male students. More than 50% of interviewees would not allow a male student to examine their face. Students of either gender could, however, examine their 8-year-old child. Although 47% of the women had had previous clinical encounters with students, in only 58% of consultations had the attending doctor asked their permission. Despite this, the women had generally felt comfortable, although satisfaction decreased with increasing age (P = 0.088). Almost 90% of the women believed that Emiratis had a social responsibility to contribute towards the training of Emirati doctors, but this decreased with increasing income (P = 0.004).

CONCLUSIONS

As many medical students will encounter Muslim patients during their training, they need to be sensitive to religious and cultural issues, particularly for personal examinations. In contexts where most patients are Muslim, alternative options (e.g. manikins, international rotations) may be required for male students. In the UAE, patient education may improve history-taking opportunities but will probably not transcend religious and cultural beliefs without intervention from religious leaders.

The role of outpatient facilities in explaining variations in risk-adjusted readmission rates between hospitals

OBJECTIVE

Validate risk-adjusted readmission rates as a measure of inpatient quality of care after accounting for outpatient facilities, using premature infants as a test case.

STUDY SETTING

Surviving infants born between January 1, 1998 and December 12, 2001 at five Northern California Kaiser Permanente neonatal intensive care units (NICU) with 1-year follow-up at 32 outpatient facilities.

STUDY DESIGN

Using a retrospective cohort of premature infants (N=898), Poisson's regression models determined the risk-adjusted variation in unplanned readmissions between 0-1 month, 0-3 months, 3-6 months, and 3-12 months after discharge attributable to patient factors, NICUs, and outpatient facilities.

DATA COLLECTION

Prospectively collected maternal and infant hospital data were linked to inpatient, outpatient, and pharmacy databases.

PRINCIPAL RESULTS

Medical and sociodemographic factors explained the largest amount of variation in risk-adjusted readmission rates. NICU facilities were significantly associated with readmission rates up to 1 year after discharge, but the outpatient facility where patients received outpatient care can explain much of this variation. Characteristics of outpatient facilities, not the NICUs, were associated with variations in readmission rates.

CONCLUSION

Ignoring outpatient facilities leads to an overstatement of the effect of NICUs on readmissions and ignores a significant cause of variations in readmissions.