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Chen KT, Baecher-Lind L, Morosky CM, Bhargava R, Fleming A, Royce CS, Schaffir JA, Sims SM, Sonn T, Stephenson-Famy A, Sutton JM, Morgan HK. Current practices and perspectives on clerkship grading in obstetrics and gynecology. Am J Obstet Gynecol 2024; 230:97.e1-97.e6. [PMID: 37748528 DOI: 10.1016/j.ajog.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 08/14/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Clerkship grades in obstetrics and gynecology play an increasingly important role in the competitive application process to residency programs. An analysis of clerkship grading practices has not been queried in the past 2 decades in our specialty. OBJECTIVE This study aimed to investigate obstetrics and gynecology clerkship directors' practices and perspectives in grading. STUDY DESIGN A 12-item electronic survey was developed and distributed to clerkship directors with active memberships in the Association of Professors of Gynecology and Obstetrics. RESULTS A total of 174 of 236 clerkship directors responded to the survey (a response rate of 73.7%). Respondents reported various grading systems with the fewest (20/173 [11.6%]) using a 2-tiered or pass or fail system and the most (72/173 [41.6%]) using a 4-tiered system. Nearly one-third of clerkship directors (57/163 [35.0%]) used a National Board of Medical Examiners subject examination score threshold to achieve the highest grade. Approximately 45 of 151 clerkship directors (30.0%) had grading committees. Exactly half of the clerkship directors (87/174 [50.0%]) reported requiring unconscious bias training for faculty who assess students. In addition, some responded that students from groups underrepresented in medicine (50/173 [28.9%]) and introverted students (105/173 [60.7%]) received lower evaluations. Finally, 65 of 173 clerkship directors (37.6%) agreed that grades should be pass or fail. CONCLUSION Considerable heterogeneity exists in obstetrics and gynecology clerkship directors' practices and perspectives in grading. Strategies to mitigate inequities and improve the reliability of grading include the elimination of a subject examination score threshold to achieve the highest grade and the implementation of both unconscious bias training and grading committees.
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Affiliation(s)
- Katherine T Chen
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY.
| | | | - Christopher M Morosky
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT
| | - Rashmi Bhargava
- Department of Obstetrics and Gynecology, University of Saskatchewan College of Medicine, Regina, Saskatchewan, Canada
| | - Angela Fleming
- Department of Obstetrics and Gynecology, Corewell Health, Farmington Hills, MI
| | - Celeste S Royce
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jonathan A Schaffir
- Department of Obstetrics and Gynecology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Shireen Madani Sims
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL
| | - Tammy Sonn
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO
| | | | - Jill M Sutton
- Department of Obstetrics and Gynecology, East Carolina University Brody School of Medicine, Greenville, NC
| | - Helen Kang Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
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Hamilton KM, Konate NN, Meyer R, Golshan J, Wright KN, Siedhoff MT, Scheib SA, Truong MD. Racial and Gender Representation Trends Among National Obstetrics and Gynecology Society Leadership. J Minim Invasive Gynecol 2023; 30:970-975. [PMID: 37562764 DOI: 10.1016/j.jmig.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023]
Abstract
STUDY OBJECTIVE The purpose of this study is to review the trends in racial and gender representation among the various national obstetrics and gynecology societies' presidents over the past 15 years. DESIGN A retrospective cross-sectional study. SETTING Data obtained from publicly available information on official websites of the professional societies studied. PATIENTS Presidents of national societies in obstetrics and gynecology. INTERVENTIONS The study was performed by obtaining publicly available data for past presidents from the official websites of the professional societies studied. Gender and race were inferred based on name and image. Racial classification was selected using the United States Census classification system. Educational background, residency training, and practice type were also collected. Assessment of 15-year trends was completed using linear regression analysis and differences in representation was assessed using analysis of variance and post hoc analysis. MEASUREMENTS AND MAIN RESULTS Over 15 years, there were 134 presidents elected for the 10 obstetrics and gynecology societies. Of those leaders, 85.2% were white, 8.2% Asian, and 5.2% black; 59% were men and 41% were women. During the study period, there was a significantly increasing slope for representation of women (+2.3% per year; 95% confidence interval, 0.4-4.2; p = .016). The representation of nonwhite presidents (+1.5% per year; 95% confidence interval, 0.2-2.8; p = .028) increased significantly during the same time period. CONCLUSION Over the last 15 years, less than 50% of obstetrics and gynecology national societies' presidents were women and most were of white race. However, there has been an increasing trend in the ratio of women to men and nonwhite to white representation among presidents of obstetrics and gynecology national societies.
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Affiliation(s)
- Kacey M Hamilton
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology (Drs. Hamilton, Konate, Meyer, Wright, Siedhoff, and Truong and Ms. Golshan), Cedars-Sinai Medical Center, Los Angeles, California.
| | - Ndeye N Konate
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology (Drs. Hamilton, Konate, Meyer, Wright, Siedhoff, and Truong and Ms. Golshan), Cedars-Sinai Medical Center, Los Angeles, California
| | - Raanan Meyer
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology (Drs. Hamilton, Konate, Meyer, Wright, Siedhoff, and Truong and Ms. Golshan), Cedars-Sinai Medical Center, Los Angeles, California
| | - Jasmine Golshan
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology (Drs. Hamilton, Konate, Meyer, Wright, Siedhoff, and Truong and Ms. Golshan), Cedars-Sinai Medical Center, Los Angeles, California
| | - Kelly N Wright
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology (Drs. Hamilton, Konate, Meyer, Wright, Siedhoff, and Truong and Ms. Golshan), Cedars-Sinai Medical Center, Los Angeles, California
| | - Matthew T Siedhoff
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology (Drs. Hamilton, Konate, Meyer, Wright, Siedhoff, and Truong and Ms. Golshan), Cedars-Sinai Medical Center, Los Angeles, California
| | - Stacey A Scheib
- Division of Minimally Invasive Surgery, Department of Obstetrics and Gynecology (Dr. Scheib), Louisiana State University Health, New Orleans, Los Angeles
| | - Mireille D Truong
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology (Drs. Hamilton, Konate, Meyer, Wright, Siedhoff, and Truong and Ms. Golshan), Cedars-Sinai Medical Center, Los Angeles, California
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Richard-Davis G, Morris JR. No longer separate but not close to equal: navigating inclusivity in a burgeoning field built on injustice. Fertil Steril 2023; 120:400-402. [PMID: 36521519 DOI: 10.1016/j.fertnstert.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Gloria Richard-Davis
- Department of Obstetrics and Gynecology and the Division of Diversity of Equity and Inclusion, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Jerrine R Morris
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, San Francisco, California
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Racial and ethnic differences in patients enrolled in the national bronchiectasis and nontuberculous mycobacteria research registry. Respir Med 2023; 209:107167. [PMID: 36804343 DOI: 10.1016/j.rmed.2023.107167] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 01/17/2023] [Accepted: 02/15/2023] [Indexed: 02/18/2023]
Abstract
Demographic and socioeconomic factors are recognized to contribute to disparities in healthcare outcomes. Originally, bronchiectasis was described in a population of predominantly White ethnic group of patients in which racial disparity could not be identified. The U.S. Bronchiectasis Research Registry (BRR), a centralized database of adult patients with bronchiectasis and/or NTM from 18 clinical institutions across the U.S., was created to support the research of this condition. The aim of this study is to describe the racial and ethnic distribution of patients enrolled in the BRR and evaluate factors associated with healthcare disparities within manifestations of and/or the care delivered to this population. At the time of this study, 3600 patients with bronchiectasis and/or NTM were enrolled in the BRR. Of those, 3510 participants were included in these analyses. The population was predominantly non-HispanicWhite (n = 3143, 89.5%), followed by Hispanic or Latino (n = 149, 4.3%), Asian (n = 130, 3.7%) and non-Hispanic Black (n = 88, 2.5%) participants. Testing for cystic fibrosis, immunoglobulin deficiency, and mycobacteria was not different between races, but non-Hispanic Black patients were tested less frequently for alpha-1 antitrypsin (A1AT) deficiency compared to other groups (P = 0.01). The four groups did not differ in the proportion of Pseudomonas aeruginosa or Hemophilus influenzae. There was no statistically significant difference in use of high-frequency chest wall oscillation, pulmonary rehabilitation services, or suppressive macrolide treatment across the groups (P > 0.05). There is a disproportionately high percentage of non-Hispainc White patients compared to non-Hispanic Black patients and Hispanic or Latino patients in the BRR. However, we found an overall similarity of care of BRR patients, regardless of racial and ethnic group.
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Racial disparities in access to reproductive health and fertility care in the United States. Curr Opin Obstet Gynecol 2022; 34:138-146. [PMID: 35645012 DOI: 10.1097/gco.0000000000000780] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To examine the status of racial and ethnic inequalities in fertility care in the United States (U.S.) at inception of 2022. This review highlights addressable underpinnings for the prevalent differentials in access to and utilization of infertility treatments and underscores gaps in preventive care as key contributors to racial and ethnic disparities in risk burden for subfertility and infertility. RECENT FINDINGS Significant gaps in access to and utilization of fertility care are consistently reported among racial and ethnic minorities, particularly Black and Hispanic women. Access to and utilization of contraceptives, human papilloma virus vaccination rates, preexposure prophylaxis use, and differentials in treatment of common gynecologic disorders are relevant to the prevalent racial and ethnic disparities in reproductive health. The spectrum of differential in reproductive wellness and the magnitude of reproductive health burden afflicting racial minorities in the U.S. raise concerns regarding systemic and structural racism as plausible contributors to the prevalent state of affairs. SUMMARY Despite efforts to reform unequal reproductive health practices and policies, racial and ethnic disparities in fertility care are pervasive and persistent. In addition to measures aimed at reducing barriers to care, societal efforts must prioritize health disparity research to systematically examine underpinnings, and addressing structural racism and interpersonal biases, to correct the prevalent racial inequities and mitigate disparities.
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Anderson MR, Hardy EJ, Battle CL. COVID-19 Vaccine Hesitancy during the Perinatal Period: Understanding Psychological and Cultural Factors to Improve Care and Address Racial/Ethnic Health Inequities. Womens Health Issues 2022; 32:317-321. [PMID: 35606247 PMCID: PMC9005361 DOI: 10.1016/j.whi.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Micheline R Anderson
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Women and Infants' Hospital of Rhode Island, Providence, Rhode Island.
| | - Erica J Hardy
- Women and Infants' Hospital of Rhode Island, Providence, Rhode Island; Departments of Medicine and Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cynthia L Battle
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Women and Infants' Hospital of Rhode Island, Providence, Rhode Island; Butler Hospital, Providence, Rhode Island
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Seifer DB, Sharara FI, Jain T. The Disparities in ART (DART) Hypothesis of Racial and Ethnic Disparities in Access and Outcomes of IVF Treatment in the USA. Reprod Sci 2022; 29:2084-2088. [PMID: 35349118 DOI: 10.1007/s43032-022-00888-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/13/2022] [Indexed: 12/17/2022]
Abstract
We propose the Disparities in ART (DART) hypothesis which identifies underlining causes that contribute to racial disparities in access and outcomes of ART treatment in the USA. Reasons for disparities in access and outcomes of ART treatment for infertility are derived from some relative contribution of four identified causes. They are simply stated as delays in obtaining treatment, higher dropout during and following unsuccessful ART treatment, provider factors, and differences in patient biological factors. Each of these causes has a subset of 4-6 factors that contribute to each of the 4 broad categorical causes that are discussed. This hypothesis may serve as a platform for better understanding the scope of the challenges and potential research inquiries that may lead to narrowing of racial/ethnic disparities in access and outcomes in ART.
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Affiliation(s)
- David B Seifer
- Department Obstetrics, Gynecology and Reproductive Sciences, Division of Reproductive Endocrinology and Infertility, Yale School of Medicine, New Haven, CT, USA.
| | - Fady I Sharara
- Virginia Center for Reproductive Medicine, Reston, VA, USA.,Department of Obstetrics and Gynecology, George Washington University, Washington, DC, USA
| | - Tarun Jain
- Department Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern Feinberg School of Medicine, Chicago, IL, USA
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Fertility health information seeking among sexual minority women. Fertil Steril 2021; 117:399-407. [PMID: 34674826 DOI: 10.1016/j.fertnstert.2021.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To qualitatively explore and describe fertility information-seeking experiences of sexual minority women (SMW) couples using assisted reproduction. DESIGN Qualitative thematic analysis of 30 semistructured, in-depth individual and dyadic interviews with SMW couples. SETTING Video conferencing. PATIENT(S) Twenty self-identified lesbian, bisexual, and queer women comprising 10 same-sex cisfemale couples (10 gestational and 10 nongestational partners) using assisted reproduction technology in the United States. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) We describe how SMW came to learn about ways to achieve pregnancy through information seeking, acquisition, appraisal, and use. RESULT(S) Analysis revealed three primary themes. First, uncertainty and information scarcity: SMW have basic knowledge about how to conceive but uncertainty persists due to information scarcity regarding how same-sex couples navigate assisted reproduction. Second, women attempt to collect fragmented information from disparate sources. The participants discussed a mixture of formal and informal, online, textual (books), and in-person seeking, finding, and synthesizing information that ranged from reliable to unreliable and from accurate to inaccurate. Finally, persistent heteronormative communication focused on the needs and conditions of male-female couples who experienced subfertility or infertility, rather than barriers related to social constraints and the absence of gametes that SMW sought to overcome. CONCLUSION(S) These findings support and extend existing evidence that has focused primarily on online fertility information seeking. Our findings suggest that shifts in fundamental assumptions about who seeks assisted reproductive support and why, together with improvements in fertility-related health communication, may result in more inclusive care for this population.
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Legro RS. The African American experience in reproductive medicine: provider, patient, and pipeline perspectives. Fertil Steril 2021; 116:279-280. [PMID: 34353569 DOI: 10.1016/j.fertnstert.2021.06.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 02/06/2023]
Abstract
The goal of this Views and Reviews is to let colleagues and leaders well versed in the African American experience in reproductive medicine address the problems of racism affecting our trainees and patients and, more significantly, propose solutions. The areas in reproductive medicine that will be explored from the African American perspective include the pipeline of providers, health disparities, and access to infertility treatment.
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Affiliation(s)
- Richard S Legro
- Department of Obstetrics and Gynecology and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
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