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Sonn T, Fleming AF, Bharghava R, Cox S, Everett EN, Graziano SC, Morgan HK, Madani Sims S, Morosky C, Royce CS, Sutton J, Baecher-Lind L. Encouraging workforce diversity- supporting medical students with mobility and sensory disabilities. Disabil Rehabil 2024; 46:1916-1920. [PMID: 37073781 DOI: 10.1080/09638288.2023.2201511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 04/06/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE This article is prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee and provides educators recommendations for optimizing inclusive education for our students with disabilities. Medical educators are increasingly encountering students with disabilities and have the responsibility of ensuring requirements are met. METHOD Medical education committee members from the US and Canada reviewed the literature on disabilities in medical student education to identify best practices and key discussion points. An iterative review process was used to determine the contents of an informative paper. RESULTS Medical schools are required to develop technical standards for admission, retention, and graduation of their students to practice medicine safely and effectively with reasonable accommodation. A review of the literature and obstetrics and gynecology expert opinion formed a practical list of accommodation strategies and administrative steps to assist educators and students. CONCLUSION Medical schools must support the inclusion of students with disabilities. We recommend a collaborative approach to the interactive process of determining reasonable and effective accommodations that includes the students, a disability resource professional and faculty as needed. Recruiting and supporting medical students with a disability strengthens the diversity commitment and creates a more inclusive workforce.
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Affiliation(s)
- Tammy Sonn
- Department of Obstetrics and Gynecology, Washington University, St. Louis, MO, USA
| | - Angela F Fleming
- Department of Obstetrics and Gynecology, Michigan State University College of Osteopathic Medicine, Farmington Hills, MI, USA
| | - Rashmi Bharghava
- Department of Obstetrics and Gynecology, University of Saskatchewan, Regina, Canada
| | - Sue Cox
- Department of Obstetrics and Gynecology, University of Texas Tyler School of Medicine, Tyler, TX, USA
| | - Elise N Everett
- Department of Obstetrics, Gynecology, and Reproductive Sciences Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Scott C Graziano
- Department of Obstetrics and Gynecology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Helen K Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Shireen Madani Sims
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Christopher Morosky
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Celeste S Royce
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Jill Sutton
- Department of Obstetrics and Gynecology, ECU Brody School of Medicine, ECU Health, Greenville, NC, USA
| | - Laura Baecher-Lind
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Baecher-Lind L, Sutton JM, Bhargava R, Chen KT, Fleming A, Morgan HK, Morosky CM, Schaffir J, Sonn T, Royce CS, Stephenson-Famy A, Madani Sims S. Strategies to Create a More Gender Identity Inclusive Learning Environment in Preclinical and Clinical Medical Education. Acad Med 2023; 98:1351-1355. [PMID: 37478137 DOI: 10.1097/acm.0000000000005334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
ABSTRACT Recognition of the spectrum of gender identities has been a recent phenomenon in the medical profession. Over the past 20 years, medical literature related to gender identity diversity has increased several-fold, yet it more commonly addresses clinical care rather than aspects related to medical education. Medical educators continue to struggle with appropriate language and inclusive approaches when discussing gender-based aspects of medical education. Reproductive health education, including obstetrics and gynecology clerkships, is particularly vulnerable to missteps and anachronisms regarding gender identity.This article aims to provide preclinical and clinical medical educators with strategies to identify and predict situations where missteps related to gender identity inclusivity may occur in their curriculum or learning environment, and to develop approaches to improve gender identity inclusivity within medical education. The authors explore 3 areas that commonly pose challenges for medical educators: inclusive language and terminology, anatomy education, and reproductive genetics and genetic counseling. They hope the tools and strategies provided here will be useful to reproductive health medical educators across specialties to enable the realization of a more inclusive learning environment in reproductive health.
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Morgan HK, Baecher-Lind L, Bhargava R, Cox S, Everett E, Fleming A, Graziano S, Morosky C, Royce C, Sonn T, Sutton J, Sims SM. Obstetrics and gynecology clerkship directors' experiences advising residency applicants. AJOG Glob Rep 2023; 3:100268. [PMID: 37868823 PMCID: PMC10585629 DOI: 10.1016/j.xagr.2023.100268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND The evolving landscape of application processes for obstetrics and gynecology residency applicants poses many challenges for applicants and advisors. The lack of data coordination among national groups creates crucial gaps in information for stakeholder groups. OBJECTIVE This study aimed to identify the current state of the advising milieu for obstetrics and gynecology residency applicants and their career advisors, the annual Association of Professors of Gynecology and Obstetrics survey focused on US clerkship directors' experiences advising students through these processes. STUDY DESIGN A 23-item anonymous survey was developed that asked respondents about demographics and outcomes for the students that they advised through the 2021 application process and their experiences with dual applicants and students not matching. The survey was sent electronically to all obstetrics and gynecology clerkship directors with active Association of Professors of Gynecology and Obstetrics memberships in April 2021. RESULTS Of 224 total clerkship directors, 143 (63.8%) responded to the survey, Of the 143 respondents, almost all (136 [95.1%]) served as career advisors, and 50 (35.0%) were aware of students dual applying. Furthermore, obstetrics and gynecology was rarely the backup to a more competitive specialty. For the 2021 application cycle, 79 of 143 respondents (55.2%) reported having students not successfully match into obstetrics and gynecology, with "academic concerns" followed by "poor communication skills" as the primary reasons cited for students not matching. CONCLUSION This snapshot of clerkship directors' experiences advising students in the residency application process reveals notably high rates of dual applicants and students not matching into obstetrics and gynecology. This work fills key gaps in our knowledge of current processes and highlights the importance of career advising at multiple points during the application process.
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Affiliation(s)
- Helen K. Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Morgan)
| | - Laura Baecher-Lind
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA (Dr Baecher-Lind)
| | - Rashmi Bhargava
- Department of Obstetrics and Gynecology, Regina College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan (Dr Bhargava)
| | - Susan Cox
- School of Medicine, University of Texas Health Science Center at Tyler, Smith County, TX (Dr Cox)
| | - Elise Everett
- Department of Obstetrics and Gynecology, Larner College of Medicine, University of Vermont, Burlington, VT (Dr Everett)
| | - Angela Fleming
- Michigan State University College of Osteopathic Medicine, East Lansing, MI (Dr Fleming)
| | - Scott Graziano
- Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL (Dr Graziano)
| | - Chris Morosky
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT (Dr Morosky)
| | - Celeste Royce
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA (Dr Royce)
| | - Tammy Sonn
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (Dr Sonn)
| | - Jill Sutton
- Department of Obstetrics and Gynecology, East Carolina University Brody School of Medicine, Greenville, NC (Dr Sutton)
| | - Shireen Madani Sims
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL (Dr Sims)
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Schaffir J, Morgan HK, Bhargava R, Baecher-Lind L, Chen KT, Fleming A, Morosky C, Royce CS, Sims SM, Sonn T, Stephenson-Famy A, Sutton JM. To the Point: optimizing the learning environment in labor and delivery. Am J Obstet Gynecol MFM 2023; 5:101090. [PMID: 37437693 DOI: 10.1016/j.ajogmf.2023.101090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 07/14/2023]
Abstract
The labor and delivery floor is a unique learning environment that poses challenges to teaching medical students, with a potentially detrimental effect on their evaluations of the obstetrics and gynecology clerkship. This article, from the "To the Point" series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, offers specific suggestions for improving undergraduate medical education in obstetrics with attention to student preparation, faculty development, nonphysician staff involvement, and patient education. Optimizing the learning environment in labor and delivery would improve student experiences and perceptions of our specialty.
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Affiliation(s)
- Jonathan Schaffir
- Departments of Obstetrics and Gynecology, The Ohio State University, Columbus, OH (Dr Schaffir).
| | | | | | | | | | | | | | | | | | - Tammy Sonn
- Washington University School of Medicine, St. Louis, MO (Dr Sonn)
| | | | - Jill M Sutton
- Eastern Carolina University Brody School of Medicine, Greenville, NC (Dr Sutton)
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Stephenson-Famy A, Sonn T, Baecher-Lind L, Bhargava R, Chen KT, Fleming A, Kang Morgan H, Morosky CM, Schaffir JA, Madani Sims S, Sutton JM, Royce CS. The Dobbs Decision and Undergraduate Medical Education: The Unintended Consequences and Strategies to Optimize Reproductive Health and a Competent Workforce for the Future. Acad Med 2023; 98:431-435. [PMID: 36347017 DOI: 10.1097/acm.0000000000005083] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The June 2022 U.S. Supreme Court decision on Dobbs v Jackson Women's Health Organization resulted in state-specific differences in abortion care access across the country. The primary concern in the obstetrics and gynecology education community has been the impact on resident and fellowship training programs. However, the impact on undergraduate medical education and the broad implications for future generations of physicians are crucial to address. It is estimated that 48% of matriculants to MD-granting medical schools will receive their medical education in the 26 states with significant abortion restrictions or bans. Undergraduate medical educators need to continue to adequately teach the basic science, clinical care, and population health outcomes of reproductive medicine, including pregnancy and abortion. In addition, students in states with more restrictions on abortion will have less or no clinical exposure, and those in states with few restrictions may be excluded due to overcrowding of learners from restricted states. Students' own health care also needs to be considered, as access to abortion care for themselves or their partners may create applicant pool demographic shifts by state as applicants consider options for where to pursue their medical education. It is important to ensure that teaching of foundational science of pregnancy, abortion, and reproductive health continues throughout the United States. Undergraduate and graduate medical educators will need to closely monitor the downstream impact of decreased clinical exposure of abortion. Further study of the personal health impact of abortion care access for medical students and awareness of the changing applicant pool demographics by state is needed.
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Affiliation(s)
- Alyssa Stephenson-Famy
- A. Stephenson-Famy is associate professor, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
| | - Tammy Sonn
- T. Sonn is professor and vice chair for education, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Laura Baecher-Lind
- L. Baecher-Lind is professor and dean for educational affairs, Tufts School of Medicine, Boston, Massachusetts
| | - Rashmi Bhargava
- R. Bhargava is assistant professor and provincial undergraduate chair, Department of Obstetrics and Gynecology, University of Saskatchewan College of Medicine, Regina, Saskatchewan, Canada
| | - Katherine T Chen
- K.T. Chen is professor and system vice chair of education, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Angela Fleming
- A. Fleming is residency program director, Department of Obstetrics and Gynecology, Beaumont Hospital, Beaumont Health, Farmington Hills, Michigan
| | - Helen Kang Morgan
- H. Kang Morgan is professor, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Christopher M Morosky
- C.M. Morosky is associate professor and clerkship director, Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Jonathan A Schaffir
- J.A. Schaffir is professor, Department of Obstetrics and Gynecology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Shireen Madani Sims
- S. Madani Sims is professor and vice chair of education, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida
| | - Jill M Sutton
- J.M. Sutton is clinical associate professor and director of undergraduate education, Department of Obstetrics and Gynecology, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Celeste S Royce
- C.S. Royce is assistant professor, Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, and director, undergraduate medical education, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Sims SM, Cox SM, Bhargava R, Everett EN, Fleming A, Graziano S, Morgan HK, Baecher-Lind L, Royce C, Sonn TS, Sutton JM, Morosky CM. Clerkship Director Confidence in Medical Student Career Advising in Obstetrics and Gynecology. AJOG Global Reports 2023; 3:100187. [PMID: 37064782 PMCID: PMC10090429 DOI: 10.1016/j.xagr.2023.100187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Given the increasing complexities of the residency application processes, there is an ever-increasing need for faculty to serve in the role of fourth-year medical student career advisors. OBJECTIVE This study aimed to investigate obstetrics and gynecology clerkship directors' confidence and fulfillment with serving in the role of faculty career advisors. STUDY DESIGN A 25-item electronic survey was developed and distributed to the 225 US obstetrics and gynecology clerkship directors in university-based and community-based medical schools with active memberships in the Association of Professors of Gynecology and Obstetrics. Items queried respondents on demographics, confidence in fourth-year advising, satisfaction with this aspect of their career, and resources used for advising. RESULTS Of 225 clerkship directors, 143 (63.6%) responded to the survey. Nearly all clerkship directors (136/143 [95%]) reported advising fourth-year students. A median of 5.0 hours (interquartile range, 3.0-10.0) was spent per student in this advisory role, with 29 of 141 clerkship directors (20.5%) reporting some form of compensation for advising. Confidence in the ability to advise fourth-year medical students correlated significantly with number of years as a faculty, number of years as a clerkship director, and a higher full-time equivalent allotted as clerkship director. Fulfillment as a faculty career advisor was correlated with number of years as a clerkship director and a higher number of students advised. CONCLUSION Obstetrics and gynecology clerkship directors regularly serve in the crucial role of faculty career advisor. Confidence in advising fourth-year students, advising fulfillment, and satisfaction with advising resources were all significantly correlated. We recommend that clerkship directors review resources available for advising and that they be provided academic time to serve as career advisors.
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Affiliation(s)
- Shireen Madani Sims
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL (Dr Sims)
- Corresponding author: Shireen Madani Sims, MD.
| | - Susan M. Cox
- School of Medicine, The University of Texas Health Science Center at Tyler, Tyler, TX (Dr Cox)
| | - Rashmi Bhargava
- Department of Obstetrics and Gynecology, University of Saskatchewan College of Medicine, Regina, Saskatchewan, Canada (Dr Bhargava)
| | - Elise N. Everett
- Department of Obstetrics and Gynecology, Larner College of Medicine at The University of Vermont, Burlington, VT (Dr Everett)
| | - Angela Fleming
- Michigan State University College of Osteopathic Medicine, East Lansing, MI (Dr Fleming)
| | - Scott Graziano
- Department of Obstetrics and Gynecology, Loyola University Chicago's Stritch School of Medicine, Maywood, IL (Dr Graziano)
| | - Helen K. Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Morgan)
| | - Laura Baecher-Lind
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA (Dr Baecher-Lind)
| | - Celeste Royce
- Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA (Dr Royce)
| | - Tammy S. Sonn
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (Dr Sonn)
| | - Jill M. Sutton
- Department of Obstetrics and Gynecology, Brody School of Medicine at East Carolina University, Greenville, NC (Dr Sutton)
| | - Christopher M. Morosky
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT (Dr Morosky)
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Buery-Joyner SD, Baecher-Lind L, Clare CA, Hampton BS, Moxley MD, Ogunyemi D, Pradhan AA, Madani Sims SM, Whetstone S, Woodland MB, Katz NT. Educational guidelines for diversity and inclusion: addressing racism and eliminating biases in medical education. Am J Obstet Gynecol 2023; 228:133-139. [PMID: 36113577 DOI: 10.1016/j.ajog.2022.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/23/2022] [Accepted: 09/09/2022] [Indexed: 01/28/2023]
Abstract
Racism and bias contribute to healthcare disparities at a patient and population health level and also contribute to the stagnation or even regression of progress toward equitable representation in the workforce and in healthcare leadership. Medical education and healthcare systems have expended tremendous efforts over the past several years to address these inequities. However, systemic racism continues to impact health outcomes and the future physician workforce. The Association of Professors of Gynecology and Obstetrics called for action to achieve a future free from racism in obstetrics and gynecology education and healthcare. As a result of this call to action, the Diversity, Equity, and Inclusion Guidelines Task Force was created. The mission of the Task Force was to support educators in their efforts to identify and create educational materials that augment antiracist educational goals and prepare, recruit, and retain a talented and diverse workforce. In this Special Report, the authors share these guidelines that describe best practices and set new standards to increase diversity, foster inclusivity, address systemic racism, and eliminate bias in obstetrics and gynecology educational products, materials, and environments.
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Affiliation(s)
- Samantha D Buery-Joyner
- University of Virginia School of Medicine Inova Campus, Falls Church, VA; Department of Obstetrics and Gynecology, Inova Fairfax Medical Campus, Falls Church, VA.
| | | | - Camille A Clare
- Department of Obstetrics and Gynecology, College of Medicine and School of Public Health, Downstate Health Sciences University, Brooklyn, NY
| | - B Star Hampton
- Departments of Obstetrics and Gynecology and Medical Sciences, Warren Alpert Medical School of Brown University, Providence, RI
| | - Michael D Moxley
- Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC; Roper St. Francis Healthcare, Charleston, SC
| | - Dotun Ogunyemi
- Arrowhead Regional Medical Center and California University of Science and Medicine, Colton CA; University of California, Riverside, CA
| | - Archana A Pradhan
- Department of Obstetrics, Gynecology, and Reproductive Health Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Sara Whetstone
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA
| | - Mark B Woodland
- Department of Obstetrics and Gynecology, Reading Hospital/Tower Health, West Reading, PA; Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA; Pennsylvania State Board of Medicine, Harrisburg, PA
| | - Nadine T Katz
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, New York City, NY; Montefiore Medical Center, Einstein Hospital Campus, Bronx, NY
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Royce CS, Morgan HK, Baecher-Lind L, Cox S, Everett EN, Fleming A, Graziano SC, Sims SM, Morosky C, Sutton J, Sonn T. The time is now: addressing implicit bias in obstetrics and gynecology education. Am J Obstet Gynecol 2022; 228:369-381. [PMID: 36549568 DOI: 10.1016/j.ajog.2022.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/29/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
Obstetrician-gynecologists can improve the learning environment and patient care by addressing implicit bias. Accumulating evidence demonstrates that racial and gender-based discrimination is woven into medical education, formal curricula, patient-provider-trainee interactions in the clinical workspace, and all aspects of learner assessment. Implicit bias negatively affects learners in every space. Strategies to address implicit bias at the individual, interpersonal, institutional, and structural level to improve the well-being of learners and patients are needed. The authors review an approach to addressing implicit bias in obstetrics and gynecology education, which includes: (1) curricular design using an educational framework of antiracism and social justice theories, (2) bias awareness and management pedagogy throughout the curriculum, (3) elimination of stereotypical patient descriptions from syllabi and examination questions, and (4) critical review of epidemiology and evidence-based medicine for underlying assumptions based on discriminatory practices or structural racism that unintentionally reinforce stereotypes and bias. The movement toward competency-based medical education and holistic evaluations may result in decreased bias in learner assessment. Educators may wish to monitor grades and narratives for bias as a form of continuous educational equity improvement. Given that practicing physicians may have little training in this area, faculty development efforts in bias awareness and mitigation strategies may have significant impact on learner well-being.
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Affiliation(s)
- Celeste S Royce
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
| | - Helen Kang Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Laura Baecher-Lind
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA
| | - Susan Cox
- Department of Medical Education, The University of Texas at Tyler School of Medicine, Tyler, TX
| | - Elise N Everett
- Department of Obstetrics, Gynecology and Reproductive Sciences, Robert Larner College of Medicine, The University of Vermont, Burlington, VT
| | - Angela Fleming
- Department of Obstetrics and Gynecology, Michigan State University College of Osteopathic Medicine, East Lansing, MI
| | - Scott C Graziano
- Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Shireen Madani Sims
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL
| | - Christopher Morosky
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT
| | - Jill Sutton
- Department of Obstetrics and Gynecology, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Tammy Sonn
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO
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Baecher-Lind L, Fleming AC, Bhargava R, Cox SM, Everett EN, Forstein DA, Madani Sims S, Morgan HK, Morosky CM, Royce CS, Sonn TS, Sutton JM, Graziano SC. Enhancing interprofessional collaboration and interprofessional education in women's health. Med Educ Online 2022; 27:2107419. [PMID: 35924355 PMCID: PMC9359162 DOI: 10.1080/10872981.2022.2107419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 05/05/2022] [Accepted: 07/26/2022] [Indexed: 08/05/2023]
Abstract
This article is from the 'To The Point' series from the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee. The purpose of this review is to provide an understanding of the differing yet complementary nature of interprofessional collaboration and interprofessional education as well as their importance to the specialty of Obstetrics and Gynecology. We provide a historical perspective of how interprofessional collaboration and interprofessional education have become key aspects of clinical and educational programs, enhancing both patient care and learner development. Opportunities to incorporate interprofessional education within women's health educational programs across organizations are suggested. This is a resource for medical educators, learners, and practicing clinicians from any field of medicine or any health-care profession.
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Affiliation(s)
- Laura Baecher-Lind
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA, USA
| | - Angela C. Fleming
- Department of Obstetrics and Gynecology, Beaumont Hospital, Novi, MI, USA
| | - Rashmi Bhargava
- Department of Obstetrics and Gynecology, University of Saskatchewan College of Medicine, Regina, SK, Canada
| | - Susan M. Cox
- Department of Obstetrics and Gynecology, Dell Medical School, Austin, TX, USA
| | - Elise N. Everett
- Department of Obstetrics and Gynecology, Larner College of Medicine at the University of Vermont, Burlington, VT, Canada
| | - David A. Forstein
- Department of Obstetrics and Gynecology, Rocky Vista College of Osteopathic Medicine, Parker, CO, USA
| | - Shireen Madani Sims
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Helen K. Morgan
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Christopher M. Morosky
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Celeste S. Royce
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Tammy S. Sonn
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jill M. Sutton
- Department of Obstetrics and Gynecology, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Scott C. Graziano
- Department of Obstetrics and Gynecology, Loyola University Medical Center, Hines, IL, USA
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Pouli D, Thieu HT, Genega EM, Baecher-Lind L, House M, Bond B, Roncari DM, Evans ML, Rius-Diaz F, Munger K, Georgakoudi I. Label-free, High-Resolution Optical Metabolic Imaging of Human Cervical Precancers Reveals Potential for Intraepithelial Neoplasia Diagnosis. Cell Rep Med 2020; 1. [PMID: 32577625 PMCID: PMC7311071 DOI: 10.1016/j.xcrm.2020.100017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
While metabolic changes are considered a cancer hallmark, their assessment has not been incorporated in the detection of early or precancers, when treatment is most effective. Here, we demonstrate that metabolic changes are detected in freshly excised human cervical precancerous tissues using label-free, non-destructive imaging of the entire epithelium. The images rely on two-photon excited fluorescence from two metabolic co-enzymes, NAD(P)H and FAD, and have micron-level resolution, enabling sensitive assessments of the redox ratio and mitochondrial fragmentation, which yield metrics of metabolic function and heterogeneity. Simultaneous characterization of morphological features, such as the depth-dependent variation of the nuclear:cytoplasmic ratio, is demonstrated. Multi-parametric analysis combining several metabolic metrics with morphological ones enhances significantly the diagnostic accuracy of identifying high-grade squamous intraepithelial lesions. Our results motivate the translation of such functional metabolic imaging to in vivo studies, which may enable improved identification of cervical lesions, and other precancers, at the bedside.
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Affiliation(s)
- Dimitra Pouli
- Department of Biomedical Engineering, Tufts University, 4 Colby Street, Medford, MA 02155, USA.,Present address: Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02115, USA
| | - Hong-Thao Thieu
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Elizabeth M Genega
- Department of Pathology and Laboratory Medicine, Tufts University School of Medicine, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Laura Baecher-Lind
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Michael House
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Brian Bond
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA.,Present address: Department of Obstetrics and Gynecology, University of Massachusetts School of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Danielle M Roncari
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Megan L Evans
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Francisca Rius-Diaz
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Málaga, 32 Louis Pasteur Boulevard, 29071 Málaga, Spain
| | - Karl Munger
- Department of Developmental, Molecular, and Chemical Biology, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - Irene Georgakoudi
- Department of Biomedical Engineering, Tufts University, 4 Colby Street, Medford, MA 02155, USA.,Lead Contact
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Hammoud MM, Spector-Bagdady K, O'Reilly M, Major C, Baecher-Lind L. Consent for the Pelvic Examination Under Anesthesia by Medical Students: Recommendations by the Association of Professors of Gynecology and Obstetrics. Obstet Gynecol 2019; 134:1303-1307. [PMID: 31764743 PMCID: PMC6882529 DOI: 10.1097/aog.0000000000003560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/20/2019] [Accepted: 08/29/2019] [Indexed: 11/25/2022]
Abstract
The pelvic examination is a critical tool for the diagnosis of women's health conditions and remains an important skill necessary for students to master before becoming physicians. Recently, concerns regarding student involvement in pelvic examinations-specifically those performed while a woman is under anesthesia-have been raised in the scientific, professional, and lay literature. These concerns have led to calls to limit or halt the performance of pelvic examinations by students while a woman is under anesthesia. Although ensuring adequate informed consent for teaching pelvic examinations is a priority, we must not lose sight of the critical pedagogical value of teaching pelvic examination in familiarizing students with the female anatomy and instilling a physician workforce with confidence in pelvic examination skills. A compromise that addresses all of these values is possible. In this commentary, we review the educational and legal aspects of the pelvic examination under anesthesia, then provide strategies that individuals and institutions can consider to optimize processes regarding consent for pelvic examination under anesthesia.
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Affiliation(s)
- Maya M Hammoud
- Department of Obstetrics and Gynecology and the Center for Bioethics & Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, Michigan; Oregon Health & Science University, Portland, Oregon; UCI Health, Orange, California; and Tufts University School of Medicine, Boston, Massachusetts
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Yu HY, Everett EN, Baecher-Lind L, Hampton BS. Feasibility of a Regional Approach to an Obstetrics and Gynecology Transition to Residency Course. R I Med J (2013) 2019; 102:51-55. [PMID: 31480822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To demonstrate the feasibility of a regional Obstetrics and Gynecology (Ob/Gyn) Transition to Residency Course (TRC) through compliance, satisfaction, and sustainability. METHODS We implemented a two-week, multi-institutional regional TRC (RTRC) for fourth-year medical students matched in Ob/Gyn or Family Medicine from four New England medical schools. Curriculum was developed to meet Ob/Gyn Milestone One (M1) and Core Entrustable Professional Activity (CEPA) objectives. Compliance, satisfaction, and sustainability were identified as feasibility outcomes. RESULTS From 2015-2018, a total of 63 fourth-year students have participated. The number of students remained stable each year. All students attended 100% of sessions. There was an average of >9/10 in all satisfaction metrics all four years. The number of faculty members from each institution remained stable over the four years. CONCLUSION A RTRC is feasible as measured through compliance, satisfaction and sustainability.
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Affiliation(s)
- Hope Y Yu
- Warren Alpert Medical School of Brown University; Women and Infants Hospital
| | - Elise N Everett
- The Robert Larner, M.D. College of Medicine at the University of Vermont; The University of Vermont Medical Center, Department of Obstetrics, Gynecology, and Reproductive Sciences
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Brindis CD, Freund KM, Baecher-Lind L, Bairey Merz CN, Carnes M, Gulati M, Joffe H, Klein WS, Mazure CM, Pace LE, Regensteiner JG, Redberg RF, Wenger NK, Younger L. The Risk of Remaining Silent: Addressing the Current Threats to Women's Health. Womens Health Issues 2017; 27:621-624. [DOI: 10.1016/j.whi.2017.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 11/17/2022]
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Heard A, Baecher-Lind L, Monahan A, Craigo S. 709: The impact of first trimester risk assessment on timing of aneuploidy diagnosis and termination of pregnancy. Am J Obstet Gynecol 2011. [DOI: 10.1016/j.ajog.2010.10.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Parikh R, Baecher-Lind L, Al-Sinan O, Peterson E. 518: Effect of sexual intercourse on pregnancy outcomes. Am J Obstet Gynecol 2011. [DOI: 10.1016/j.ajog.2010.10.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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