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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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von Waldenfels G, Beck MH, Semmler J, Gerber A, Hennigs A, Vochem R, Blohmer JU, Schmalfeldt B, Pietzner K, Sehouli J. Training in obstetrics and gynecology between reality and vision: results of a JAGO-NOGGO survey in 601 physicians (NOGGO-Monitor-12 trial). Arch Gynecol Obstet 2024:10.1007/s00404-024-07508-z. [PMID: 38625545 DOI: 10.1007/s00404-024-07508-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 04/03/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE The primary objective of this study was to establish a benchmark by collecting baseline data on surgical education in obstetrics and gynecology in Germany, including factual number of operations performed. MATERIALS AND METHODS A nationwide anonymous survey was conducted in Germany between January 2019 and July 2019 utilizing a specially designed questionnaire which addressed both residents and senior trainers. RESULTS A total of 601 participants completed the survey, comprising 305 trainees and 296 trainers. The trainees reported performing a median of 125 non-obstetric surgeries (IQR: 41-332) and 75 obstetric procedures (IQR: 27-168) independently. While most last-year residents managed to meet the targeted numbers for minor surgical procedures outlined in the logbook, they fell short of achieving the required numbers for major operations, such as hysterectomies or more complex laparoscopies. Although both trainees and trainers emphasized the significance of surgical training, the overall quality of the training was rated poorly, particularly by trainees. This was attributed to a high proportion of administrative tasks and a deficiency in teaching time within the operating theater. External fellowship and mentoring programs, as well as the implementation of regular, centralized reviews of residency training, were identified as potentially beneficial by both trainees and trainers. CONCLUSION The findings of this survey should serve as a wake-up call both within and outside of Germany, highlighting the importance of comprehensive and structured surgical training to enhance long-term patient care and increase satisfaction among obstetrics and gynecology trainees.
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Affiliation(s)
- Gabriel von Waldenfels
- Department of Gynecology, Breast Center, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany
| | - Maximilian Heinz Beck
- Department of Gynecology, Breast Center, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany.
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany.
- Department of Gynecology, Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Janina Semmler
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany
- Department of Obstetrics, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Annika Gerber
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany
- Fertility Doctors Berlin, Berlin, Germany
| | - André Hennigs
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Ruth Vochem
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany
- TFP Kinderwunsch Klagenfurt, Klagenfurt, Austria
| | - Jens-Uwe Blohmer
- Department of Gynecology, Breast Center, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Barbara Schmalfeldt
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Society of Gynecology and Obstetrics (DGGG), Berlin, Germany
| | - Klaus Pietzner
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany
- Department of Gynecology, Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jalid Sehouli
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany
- Department of Gynecology, Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Guigue PA, Meyer R, Thivolle-Lioux G, Brezinov Y, Levin G. Performance of ChatGPT in French language Parcours d'Accès Spécifique Santé test and in OBGYN. Int J Gynaecol Obstet 2024; 164:959-963. [PMID: 37655838 DOI: 10.1002/ijgo.15083] [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: 05/07/2023] [Revised: 08/06/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVES To evaluate the performance of ChatGPT in a French medical school entrance examination. METHODS A cross-sectional study using a consecutive sample of text-based multiple-choice practice questions for the Parcours d'Accès Spécifique Santé. ChatGPT answered questions in French. We compared performance of ChatGPT in obstetrics and gynecology (OBGYN) and in the whole test. RESULTS Overall, 885 questions were evaluated. The mean test score was 34.0% (306; maximal score of 900). The performance of ChatGPT was 33.0% (292 correct answers, 885 questions). The performance of ChatGPT was lower in biostatistics (13.3% ± 19.7%) than in anatomy (34.2% ± 17.9%; P = 0.037) and also lower than in histology and embryology (40.0% ± 18.5%; P = 0.004). The OBGYN part had 290 questions. There was no difference in the test scores and the performance of ChatGPT in OBGYN versus the whole entrance test (P = 0.76 vs P = 0.10, respectively). CONCLUSIONS ChatGPT answered one-third of questions correctly in the French test preparation. The performance in OBGYN was similar.
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Affiliation(s)
- Paul-Adrien Guigue
- University Claude Bernard Lyon I, Lyon, France
- Lady Davis Institute for Cancer Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Cedar-Sinai Medical Center, Los Angeles, California, USA
| | - Gaetan Thivolle-Lioux
- University Claude Bernard Lyon I, Lyon, France
- Centre de Recherche en Cancérologie de Lyon (CRCL), Lyon, France
| | - Yoav Brezinov
- Lady Davis Institute for Cancer Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Gabriel Levin
- Lady Davis Institute for Cancer Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
- The Department of Gynecologic Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Shipchandler FT, Huntley ES, Holder TF, Ali T, Behnia F, Chauhan SP, Huntley BJF. Maternal and Neonatal Outcomes of Gunshot Wounds in Pregnancy: A Systematic Review of Case Reports. Am Surg 2024; 90:279-291. [PMID: 37864523 DOI: 10.1177/00031348231207298] [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] [Indexed: 10/23/2023]
Abstract
A systematic review was performed to compare adverse maternal and neonatal outcomes among pregnant patients with gunshot wounds (GSW) to the abdominopelvic vs other region(s) at > 20 weeks gestation. A search of Medline Ovid, Elsevier Embase, EBSCO CINAHL, and Cochrane Library in July 2022 and reference searches resulted in 1742 studies, which were screened. The 41 included studies reported outcomes for 59 pregnant patients with GSW, of which 31 (52.5%) had an isolated abdominopelvic GSW and 28 (47.5%) had an extremity, thorax, head/neck, back/spine, poly-site, or other/unknown GSW. Stillbirth occurred in 26.7% of abdominopelvic GSW and 26% of non-abdominopelvic GSW. Maternal death occurred in 3.7% of abdominopelvic GSW and 10.7% of non-abdominopelvic GSW. Neonatal death occurred in 9.1% of abdominopelvic GSW and 5.3% of non-abdominopelvic GSW. Further research is needed to standardize the approach for the evaluation and management of patients with GSW in pregnancy.
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Affiliation(s)
| | - Erin S Huntley
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Travis F Holder
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Talha Ali
- Department of Community Health, Tufts University, Medford, MA, USA
| | - Faranak Behnia
- Obstetrix Maternal-Fetal Medicine Specialists of Houston, Katy, TX, USA
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Benjamin J F Huntley
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
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Cohen A, Alter R, Lessans N, Meyer R, Brezinov Y, Levin G. Performance of ChatGPT in Israeli Hebrew OBGYN national residency examinations. Arch Gynecol Obstet 2023; 308:1797-1802. [PMID: 37668790 DOI: 10.1007/s00404-023-07185-4] [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: 06/11/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE Previous studies of ChatGPT performance in the field of medical examinations have reached contradictory results. Moreover, the performance of ChatGPT in other languages other than English is yet to be explored. We aim to study the performance of ChatGPT in Hebrew OBGYN-'Shlav-Alef' (Phase 1) examination. METHODS A performance study was conducted using a consecutive sample of text-based multiple choice questions, originated from authentic Hebrew OBGYN-'Shlav-Alef' examinations in 2021-2022. We constructed 150 multiple choice questions from consecutive text-based-only original questions. We compared the performance of ChatGPT performance to the real-life actual performance of OBGYN residents who completed the tests in 2021-2022. We also compared ChatGTP Hebrew performance vs. previously published English medical tests. RESULTS In 2021-2022, 27.8% of OBGYN residents failed the 'Shlav-Alef' examination and the mean score of the residents was 68.4. Overall, 150 authentic questions were evaluated (one examination). ChatGPT correctly answered 58 questions (38.7%) and reached a failed score. The performance of Hebrew ChatGPT was lower when compared to actual performance of residents: 38.7% vs. 68.4%, p < .001. In a comparison to ChatGPT performance in 9,091 English language questions in the field of medicine, the performance of Hebrew ChatGPT was lower (38.7% in Hebrew vs. 60.7% in English, p < .001). CONCLUSIONS ChatGPT answered correctly on less than 40% of Hebrew OBGYN resident examination questions. Residents cannot rely on ChatGPT for the preparation of this examination. Efforts should be made to improve ChatGPT performance in other languages besides English.
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Affiliation(s)
- Adiel Cohen
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, P.O.B. 12000, 91120, Jerusalem, Israel.
| | - Roie Alter
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, P.O.B. 12000, 91120, Jerusalem, Israel
| | - Naama Lessans
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, P.O.B. 12000, 91120, Jerusalem, Israel
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Cedar-Sinai Medical Center, Los Angeles, USA
| | - Yoav Brezinov
- Lady Davis Institute for Cancer Research, Jewish General Hospital, McGill University, Montreal, Canada
| | - Gabriel Levin
- Lady Davis Institute for Cancer Research, Jewish General Hospital, McGill University, Montreal, Canada
- The Department of Gynecoloic Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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6
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Mayan D, Melton CS, Sanderford VL, Camps JI, Tomlin KV. Surgical Treatment of Bilateral Tubo-Ovarian Abscess in a Pre-Coitarchal Female. Am Surg 2023; 89:6206-6208. [PMID: 35768199 DOI: 10.1177/00031348221112264] [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] [Indexed: 11/16/2022]
Abstract
Tubo-ovarian abscess (TOA) is a complication of pelvic inflammatory disease that is most commonly seen in sexually active females and seldom in pre-coitarchal adolescents. Initial treatment is generally parenteral antibiotics but often requires more invasive surgical procedures. We present the case of a 12-year-old, non-sexually active adolescent, with bilateral TOA who ultimately underwent a sterilizing bilateral salpingectomy and appendectomy for treatment.
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Affiliation(s)
- Danel Mayan
- University of South Carolina School of Medicine, Columbia, SC, USA
| | | | | | - Juan I Camps
- Department of Pediatric Surgery, Prisma Health Children's Hospital Midlands, Columbia, SC, USA
| | - Kristl V Tomlin
- Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Prisma Health Midlands, Columbia, SC, USA
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7
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Schoppen Z, Morgan HK, Hammoud M, Marzano D, George K, Winkel AF. Applicant Experience in Communication With Residency Programs After the Introduction of Program Signaling. J Surg Educ 2023; 80:1762-1772. [PMID: 37633809 DOI: 10.1016/j.jsurg.2023.08.005] [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] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE Examine the applicant experience after introduction of program signaling for the 2023 obstetrics and gynecology (OBGYN) residency application cycle. DESIGN Responses to an online survey of OBGYN applicants participating in the 2023 match who participated in residency program signaling were compared to responses from a similar survey conducted in 2022. Demographic information included personal and academic background and how applicants and advisors communicated with programs. Numbers of applications and interviews, second look visits, away rotations, manner of contact, and timing of communication was compared. Statistical analysis included ANOVA for interval data, and χ2 and Kruskal-Wallis tests for categorical data. RESULTS A total of 711 of 2631 (27%) applicants responded in 2022 and 606 of 2492 (24.3%) responded in 2023. Approximately 2/3 of gold signals and 1/3 of silver signals led to an interview. There was no change in number of applications or interviews per applicant, but there was a broader distribution of interviews per applicant in 2023. Applicants in 2023 were less likely to engage in preinterview communication or do an away rotation to indicate interest in a program. There was decreased communication between applicants and programs after signaling was introduced. Informal communication continued to differ by racial and medical school background. Applicants from DO programs and international medical graduates (IMG) had more communication with programs than MD applicants but received fewer interview invitations. Fewer Black and Latin(x)/Hispanic applicants had faculty reach out to residency programs on their behalf compared to White and Asian applicants. There were differences in the number of interviews received based on racial and ethnic identity. CONCLUSIONS In the first year after implementation of program signaling, there was a decrease in preinterview communication and a broader distribution of interviews among applicants. Further efforts to create standard means of program communication may help to begin leveling the uneven playing field for applicants.
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Affiliation(s)
- Zachary Schoppen
- Medical College of Wisconsin Department of Obstetrics and Gynecology, Wisconsin.
| | - Helen K Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Maya Hammoud
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - David Marzano
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Karen George
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont, Burlington, Vermont
| | - Abigail Ford Winkel
- NYU Langone Health Department of Obstetrics and Gynecology, New York, New York
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Adams UC, Moulthrop AJ, Malay B, Straube LE, McNaull PP, McGinigle KL, Phillips MR. The Use of Sequential Surveys to Shorten Implementation Time for Healthcare System-Level Enhanced Recovery After Surgery (ERAS) Pathways. Am Surg 2023; 89:5466-5473. [PMID: 36786426 DOI: 10.1177/00031348231156765] [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] [Indexed: 02/15/2023]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) pathways improve healthcare quality, safety, and cost-effectiveness. We hypothesized that the RAND Method (a hybrid Delphi approach), involving anonymous sequential surveys and face-to-face meetings, would allow for more rapid agreement and initiation of new ERAS pathways. METHODS Using the ERAS Society guidelines for cesarean section as a baseline, our institution's ERAS Leadership Team (ELT) compiled published literature and institutional practices to design a 32-component survey that was sent to obstetricians, nurse midwives, anesthesiologists, pharmacists, and nurses. Components that did not reach 90% consensus were included in a second survey the following week, and meetings were held to review results. At the conclusion of this process, time to agreement was retrospectively compared to the colorectal ERAS pathway process at this institution. RESULTS ERAS pathway components were compiled and reviewed by 121 stakeholders at 7 hospitals using iterative surveys with review meetings over a 13-week period. Survey response rates were 61% and 50% in the initial and follow-up surveys, respectively. There was agreement on 28/32 and 32/32 items on the initial and follow-up surveys. Using the RAND Method, time to agreement decreased by 54.1% (24 vs 13 weeks) compared to prior system-wide efforts to standardize the colorectal surgery ERAS pathway. DISCUSSION With rapidly expanding healthcare systems, effective methods to gain consensus and adopt ERAS pathways are critical to implementation of ERAS guidelines. We demonstrate that the RAND Method allows for a transparent and efficient means of agreement across a diverse group of clinicians practicing in several settings.
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Affiliation(s)
- Ursula C Adams
- The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Amy J Moulthrop
- The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Lacey E Straube
- The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Peggy P McNaull
- The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Michael R Phillips
- The University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Ralph OG, Siparsky NF. Necrotizing Vaginitis in a 45-Year-Old Woman With Metastatic Breast Cancer. Am Surg 2023; 89:6331-6333. [PMID: 37144402 DOI: 10.1177/00031348231173962] [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] [Indexed: 05/06/2023]
Abstract
Vaginitis emphysematosa (VE) is a rare, benign, and self-limited condition often diagnosed by the presence of intramuscular vaginal air observed on computed tomography (CT) scan. Although it is a nonpathologic, self-limited condition requiring no intervention, it is important to rule out a more serious infectious pathology. This report highlights a clinical dilemma and the potential consequences of over-reliance on CT in distinguishing benign VE from pathologic necrotizing vaginitis. A high clinical suspicion for infection should be maintained, especially when relevant clinical and laboratory markers suggest a more serious pathology. We describe the case of a 45-year-old woman who presented to the hospital with abdominal pain and vaginal bleeding. CT scan demonstrated intramuscular vaginal air, which was reported as VE. Classic imaging findings of VE falsely reassured clinicians. She died shortly thereafter of necrotizing vaginitis.
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Affiliation(s)
- Oliver G Ralph
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nicole F Siparsky
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
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Shaw TB, Ma B, Barazza M, Sawaya D. Surgical Control of Bleeding From Ovarian Torsion in the Setting of Immune Thrombocytopenic Purpura Without Splenectomy. Am Surg 2023; 89:4884-4887. [PMID: 33866863 DOI: 10.1177/00031348211011128] [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] [Indexed: 11/16/2022]
Abstract
Immune thrombocytopenic purpura (ITP) is a disorder caused by autoimmune antibodies which target glycoprotein IIb/IIIa complex or other platelet membrane antigens leading to platelet destruction. These platelets are then cleared by the spleen resulting in thrombocytopenia. Immune thrombocytopenic purpura affects about 1 to 6.4 cases in 100 000 children making it one of the most common causes of symptomatic thrombocytopenia in the pediatric population. It is rare that children or adolescents present with serious bleeding due to ITP. Common presentations include petechiae, bleeding gums, or bruising. Bleeding requiring hospitalization or transfusions is unusual and only occurs in approximately 5% of children. Even more uncommon is the presentation of severe bleeding complications requiring surgery for resolution. We present a case of a 17-year-old girl with acute ITP complicated by intraperitoneal hemorrhage and refractory thrombocytopenia due to ovarian cyst requiring oophorectomy.
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Affiliation(s)
- Taylor B Shaw
- Department of Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Brenda Ma
- Department of Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mark Barazza
- Department of Surgery, Division of Pediatric Urology, University of Mississippi Medical Center, Jackson, MS, USA
| | - David Sawaya
- Department of Surgery, Division of Pediatric Surgery, University of Mississippi Medical Center, Jackson, MS, USA
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Holt EW, Murarka SM, Zhao Z, Baker MV, Omosigho UR, Adam RA. Investigating disparities in compliance of nursing pain reassessment for obstetrics and gynecology patients. Am J Obstet Gynecol 2023; 229:314.e1-314.e11. [PMID: 37330130 PMCID: PMC10268944 DOI: 10.1016/j.ajog.2023.06.027] [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: 01/02/2023] [Revised: 05/13/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Racial and socioeconomic disparities, exacerbated during the COVID-19 pandemic and surrounding socio-political polarization, affect access to, delivery of, and patient perception of healthcare. Perioperatively, the bedside nurse carries the greatest responsibility of direct care, which includes pain reassessment, a metric tracked for compliance. OBJECTIVE This study aimed to critically assess disparities in obstetrics and gynecology perioperative care and how these have changed since March 2020 using nursing pain reassessment compliance within a quality improvement framework. STUDY DESIGN A retrospective cohort of 76,984 pain reassessment encounters from 10,774 obstetrics and gynecology patients at a large, academic hospital from September 2017 to March 2021 was obtained from Tableau: Quality, Safety and Risk Prevention platform. Noncompliance proportions were analyzed by patient race across service lines; a sensitivity analysis was performed excluding patients who were of neither Black nor White race. Secondary outcomes included analysis by patient ethnicity, body mass index, age, language, procedure, and insurance. Additional analyses were performed by temporally stratifying patients into pre- and post-March 2020 cohorts to investigate potential pandemic and sociopolitical effects on healthcare disparities. Continuous variables were assessed with Wilcoxon rank test, categorical variables were assessed with chi-squared test, and multivariable logistic regression analyses were performed (P<.05). RESULTS Noncompliance proportions of pain reassessment did not differ significantly between Black and White patients as an aggregate of all obstetrics and gynecology patients (8.1% vs 8.2%), but greater differences were found within the divisions of Benign Subspecialty Gynecologic Surgery (Minimally Invasive Gynecologic Surgery + Urogynecology) (14.9% vs 10.70%; P=.03) and Maternal Fetal Medicine (9.5% vs 8.3%; P=.04). Black patients admitted to Gynecologic Oncology experienced lower noncompliance proportions than White patients (5.6% vs 10.4%; P<.01). These differences persisted after adjustment for body mass index, age, insurance, timeline, procedure type, and number of nurses attending to each patient with multivariable analyses. Noncompliance proportions were higher for patients with body mass index ≥35 kg/m2 within Benign Subspecialty Gynecology (17.9% vs 10.4%; P<.01). Non-Hispanic/Latino patients (P=.03), those ≥65 years (P<.01), those with Medicare (P<.01), and those who underwent hysterectomy (P<.01) also experienced greater noncompliance proportions. Aggregate noncompliance proportions differed slightly pre- and post-March 2020; this trend was seen across all service lines except Midwifery and was significant for Benign Subspecialty Gynecology after multivariable analysis (odds ratio, 1.41; 95% confidence interval, 1.02-1.93; P=.04). Though increases in noncompliance proportions were seen for non-White patients after March 2020, this was not statistically significant. CONCLUSION Significant race, ethnicity, age, procedure, and body mass index-based disparities were identified in the delivery of perioperative bedside care, especially for those admitted to Benign Subspecialty Gynecologic Services. Conversely, Black patients admitted to Gynecologic Oncology experienced lower levels of nursing noncompliance. This may be in part be related to the actions of a Gynecologic Oncology nurse practioner at our institution who helps coordinate care for the division's postoperative patients. Noncompliance proportions increased after March 2020 within Benign Subspecialty Gynecologic Services. Although this study was not designed to establish causation, possible contributing factors include implicit or explicit biases regarding pain experience across race, body mass index, age, or surgical indication, discrepancies in pain management across hospital units, and downstream effects of healthcare worker burnout, understaffing, increased use of travelers, or sociopolitical polarization since March 2020. This study demonstrates the need for ongoing investigation of healthcare disparities at all interfaces of patient care and provides a way forward for tangible improvement of patient-directed outcomes by utilizing an actionable metric within a quality improvement framework.
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Affiliation(s)
- Edwin W Holt
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN.
| | - Shivani M Murarka
- Division of Female Pelvic Medicine and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Zhiguo Zhao
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Mary V Baker
- Division of Female Pelvic Medicine and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Ukpebo R Omosigho
- Division of Female Pelvic Medicine and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Rony A Adam
- Division of Female Pelvic Medicine and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, TN
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Joglekar R, DeSantis AJ, Lynch C, Lorch S. Postoperative Capnocytophaga Sputigena Presenting as Diffuse Recalcitrant Intra-abdominal Abscesses. Am Surg 2023; 89:3902-3903. [PMID: 37170816 DOI: 10.1177/00031348231175094] [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] [Indexed: 05/13/2023]
Abstract
Capnocytophaga sputigena is rarely implicated as the cause of postsurgical intra-abdominal abscess because it is almost exclusively found in oral flora. Despite its rarity in intra-abdominal infection, there are examples of this atypical presentation, and an awareness of this organism as a potential etiology of surgical infection is relevant for both obstetric and general surgeons. We report a case of a young female who presented just over a week after an uncomplicated C-section with complaint of abdominal discomfort and fevers. Imaging revealed multiple intra-abdominal fluid collections and cultures revealed the presence of C. sputigena. Percutaneous drainage and intravenous antibiotics were unable to provide significant source control, so she underwent surgical exploration with a multi-specialty team of obstetric and acute care surgeons. Although postsurgical pelvic abscesses are rarely due to C. sputigena, this organism has been documented to serve as a source of intra-abdominal infection.
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Affiliation(s)
- Ria Joglekar
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Anthony J DeSantis
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Catherine Lynch
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Steven Lorch
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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Ma CD, Bonkovsky HL. Elagolix is porphyrogenic and may induce porphyric attacks in patients with the acute hepatic porphyrias. Mol Genet Metab Rep 2022; 33:100915. [PMID: 36105850 PMCID: PMC9465260 DOI: 10.1016/j.ymgmr.2022.100915] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Elagolix is an FDA-approved treatment for moderate-to-severe pain associated with endometriosis but has been associated with increased acute porphyric attacks in women with the acute hepatic porphyrias (AHPs). A fluorescence-based screening assay for drug porphyrogenicity in LMH cells indicates that elagolix is porphyrogenic; thus, elagolix should be avoided or used with caution in patients with the AHPs.
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Affiliation(s)
- Christopher D Ma
- Department of Internal Medicine, Section on Gastroenterology and Hepatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Herbert L Bonkovsky
- Department of Internal Medicine, Section on Gastroenterology and Hepatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Armstrong A, Kroener L, Cohen JG, Han CS, Nitti VW, Rible R, Brennan K. Faculty and applicant perceptions of virtual interviews on subspecialty fellowship match in obstetrics and gynecology. Med Educ Online 2022; 27:2068993. [PMID: 35473575 PMCID: PMC9067945 DOI: 10.1080/10872981.2022.2068993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/14/2021] [Revised: 03/23/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND In response to COVID-19, the AAMC recommended that hospitals conduct interviews in a virtual setting. OBJECTIVE To evaluate whether fellowship video conference interviews (VCIs) are an acceptable alternative to in-person interviews from both the applicant and program perspectives. METHODS Applicants and faculty from a single academic institution with five OBGYN subspecialty fellowship programs were invited to complete surveys regarding their experience using VCIs during the 2020 interview season. Survey responses used a 5-point Likert scale (strongly disagree to strongly agree). Comparative analyses between faculty and applicants responses to survey questions were performed with two-tailed Student's t-tests. RESULTS 45 faculty members and 131 applicants received the survey. Response rate for faculty members and applicants was 95.6% (n = 43) and 46.6% (n = 61), respectively. Faculty and applicants agreed that the VCIs allowed them to accurately represent themselves (83.7% vs. 88.6%, p = 0.48). Most applicants (62.3%, n = 38) reported a fundamental understanding of the fellowship's culture. The majority of applicants (77.1%, n = 47) and faculty (72.1%, n = 31) agreed that they were able to develop connections during the virtual interview (p = 0.77). Faculty and applicants stated that VCIs assisted them in determining whether the candidate or program, respectively, was a good fit (83.7% vs. 67.2%, p = 0.98). CONCLUSIONS The VCI fellowship recruitment process allowed OBGYN fellowship applicants and programs to accurately represent themselves compared to in-person interviews. Most applicants and faculty were able to develop relationships over the virtual platform. Although not explicitly assessed, it is possible that the virtual interviews can achieve a suitable match between applicant and program across all OBGYN subspecialty fellowships. The VCI process may be a long-term resolution to minimize both the financial burden and time commitment presented by traditional in-person interviews. Follow-up studies should assess the performance of the virtually selected fellows compared to those selected in previous years using traditional in-person interviews.
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Affiliation(s)
- Abigail Armstrong
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Lindsay Kroener
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Joshua G. Cohen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Christina S. Han
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Victor W. Nitti
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Radhika Rible
- Division of Family Planning, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Kathleen Brennan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
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15
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Menhaji K, Pan S, Hardart A. Sexual Harassment Prevalence Among OBGYN Trainees and Cultural Climate of their Training Programs: Result From a Nationwide Survey. J Surg Educ 2022; 79:1113-1123. [PMID: 35484059 DOI: 10.1016/j.jsurg.2022.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 02/26/2022] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Sexual harassment has many short- and long-term consequences and greatly impacts the clinical work environment, job satisfaction, job performance, and mental wellbeing of the individual. Data on prevalence of sexual harassment in a women-majority field such as Obstetrics and Gynecology (OBGYN) are limited. This national cross-sectional study sought to determine the prevalence of sexual harassment among OBGYN trainees in the United States (U.S.) and assess the associated departmental cultural climate. DESIGN, SETTING, PARTICIPANTS This study was a cross-sectional, anonymous, voluntary, national survey of OBGYN residents and fellows in the U.S. conducted from May 1, 2019 to June 30, 2019. The validated Sexual Experience Questionnaire was administered via an online survey. Trainees were also queried regarding wellbeing, work satisfaction, and departmental/institutional reporting structure. Demographic data were also gathered. The main outcome was prevalence of sexual harassment among U.S. OBGYN trainees. RESULTS An email including the survey link was distributed to 1473 OBGYN trainees from 60 programs; 366 completed it (24.8% response rate). The mean age of survey respondents was 30.5 (SD 2.9) years. The majority of respondents were women (86%), White (64.1%), and residents (PGY 1-4, 80.2%). The prevalence of sexual harassment among respondents was 69.1% (69.6% of men and 68.7% of women). The prevalence of sexual harassment by race/ethnicity was: Hispanic/Latina 75.0%, White 68.7%, Asian 68.6%, and Black 47.4% trainees. The majority of respondents' program directors were women (66.4%, 227/342) and the majority of department chairs were men (68.9%, 235/341). The prevalence of sexual harassment did not differ based on the gender of the respondents' program directors and chairs (p-value 0.93). CONCLUSIONS There is a high prevalence of sexual harassment among U.S. OBGYN trainees. Action is required to improve institutional and departmental cultures.
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Affiliation(s)
- Kimia Menhaji
- Department of Obstetrics and Gynecology and Reproductive Sciences, Female Pelvic Medicine and Reconstructive Surgery Division, Icahn School of Medicine at Mount Sinai Hospital, New York, New York.
| | - Stephanie Pan
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Anne Hardart
- Department of Obstetrics and Gynecology and Reproductive Sciences, Female Pelvic Medicine and Reconstructive Surgery Division, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
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16
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Siddiqi M, Guiab K, Roberts A, Evan T, Nahar T, Patel V, Capron G, Brigode W, Starr F, Bokhari F. Maternal Outcomes After Trauma in Pregnancy: A National Database Study. Am Surg 2022; 88:1760-1765. [PMID: 35333642 DOI: 10.1177/00031348221083940] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Trauma is an important non-obstetric cause of mortality in pregnant females. METHODS The National Trauma Databank (NTDB) was queried between 2017 and 2018. Pregnant women >20 weeks gestation, who underwent trauma, were included. They were categorized into different age groups from 12-18, 18-35, and 36-50 years of age. The primary outcome measure was 30-day mortality. RESULTS 1,058 pregnant trauma patients were included. Mean age was 26.7 ± 6 years. Of those 94.5% had blunt and 3.8% had penetrating injuries. Median GCS and ISS were 15 (15, 15) and 2 (1, 5), respectively. Penetrating trauma patients required more operative intervention (57.5%) than blunt trauma patients (24.6%). Univariate analysis comparing age groups 12-18, 19-35, and >36 years revealed differences. (P < .05) in ED systolic blood pressure (110.9 ± 19.7 vs 117.3 ± 20.3 vs 129.1 ± 29.3 mmHg, P = .01) and diabetes mellitus (.0 vs 2.7% vs 6.6% P = .03). There was no difference in HLOS (P = .72), complications (P = .279), and mortality (P = .32). Multivariate logistic regression analysis revealed that compared to patients 12-18 years old, patients 19 to 35 (P = .27) or those >36 (P = 1.0) did not show a significant difference in mortality. Patients with high ISS had higher complication rates (OR 1.09; 95% CI 1.04-1.15) and prolonged HLOS (OR 1.00; 95% CI 1.07-1.15). CONCLUSION On average pregnant women (>20 weeks gestation) who presented to trauma centers had minor injuries and maternal age or mechanism of injury did not affect mortality. Despite a low ISS, a significant number of these patients required operative procedures.
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Affiliation(s)
- Mahwash Siddiqi
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Keren Guiab
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Andrew Roberts
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Teresa Evan
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Tanzilan Nahar
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Vidhi Patel
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Gweniviere Capron
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - William Brigode
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Frederic Starr
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Faran Bokhari
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
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Patel NR, Curfman KR, Morrissey SL. Round Ligament Varicocele Masquerading as an Inguinal Hernia During Pregnancy. Am Surg 2021:31348211031850. [PMID: 34233122 DOI: 10.1177/00031348211031850] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hernia is an exceedingly common pathology, to which inguinal hernias are frequently diagnosed. Though this entity is regularly seen, in pregnancy a different diagnosis must be excluded: round ligament varicocele (RLV). Round ligament varicocele has a similar presentation to inguinal hernia, and therefore is often misdiagnosed. Though misdiagnosis potentially occurs from a lack of knowledge of the disease, RLV has shown that it's at least as common as inguinal hernia in pregnancy. The issue with misdiagnosis occurs as there is significant difference in management; hernia may require operative intervention, while RLV follows a conservative course. Therefore, an accurate diagnosis is essential, and an incorrect diagnosis can be associated with an unnecessary operation and consequence. We present the case of a patient in her second trimester who was referred for surgery due to suspicion of an inguinal hernia, and review the literature for evaluation recommendations, appropriate diagnostic strategies, and management tactics for RLV.
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Affiliation(s)
- Nilesh R Patel
- Department of Surgery, 4157Duke LifePoint Conemaugh Memorial Medical Center, Johnstown, PA, USA
| | - Karleigh R Curfman
- Department of Surgery, 4157Duke LifePoint Conemaugh Memorial Medical Center, Johnstown, PA, USA
| | - Shawna L Morrissey
- Department of Surgery, 4157Duke LifePoint Conemaugh Memorial Medical Center, Johnstown, PA, USA
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Abstract
Despite having a good understanding of medicine, doctors lack clinical skills, problem-solving abilities, and the ability to apply knowledge to patient care, particularly in unanticipated circumstances. To overcome this, medical education has evolved into a system-oriented core curriculum with cognitive, psychomotor, and affective learning goals. With an emphasis on problem-based learning, the educator's aim is to establish a long-term, predetermined improvement in the learner's behavior, acquired skills, and attitudes (Datta R, Upadhyay KK, Jaideep CN. Simulation and its role in medical education. Med J Armed Forces India. 2012;68(2):167-172. https://doi.org/10.1016/S0377-1237(12)60040-9 ). However, teaching these disciplines to real patients is almost impossible; this is where simulation comes in. This opinion paper will discuss the relevance and necessity of a simulation-based undergraduate curriculum in obstetrics and gynecology. What are the biggest obstacles that medical schools face in making the most of simulation-based learning, and how can they be overcome?
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19
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Lawrence ER, Yeboah M, Arthur-Komeh J, Stabnick A, Rominski SD. Predictors of burnout: the role of agency among obstetric providers in Kumasi, Ghana. Glob Health Action 2021; 14:1978662. [PMID: 34586033 PMCID: PMC8491728 DOI: 10.1080/16549716.2021.1978662] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Burnout rates among sub-Saharan African healthcare providers are high. In particular, obstetric providers experience unique stressors surrounding poor neonatal and maternal outcomes. This study explores predictors of burnout among obstetric providers at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. A survey was electronically distributed to midwives, house officers, and Obstetrician Gynecologists (OBGYNs) at KATH in Ghana. Demographic and clinical practice information was collected. Burnout was assessed using a 4-point Likert scale. To evaluate perceived agency caring for critically ill obstetric patients, participants responded to three statements and responses were summed to create an Agency Scale. Logistic regression was used to evaluate predictors of burnout. Marginal effects were calculated for factors significantly associated with burnout. Participants were 48 physicians and 222 midwives. Mean age was 32.4 years, mean years in practice was 6.5 years, and 83% had completed their medical training. Nearly half (49.6%) have personal experience with maternal mortality and 28.3% manage more than 5 maternal mortalities annually. The majority of participants (n = 152, 62%) reported feeling burned out from their work. After adjusting for role, number of annual maternal mortalities managed, and personal experience with maternal mortality, participants with more years in practice were 15.8% more likely to report being burned out (marginal effect = 0.158). Even after adjusting for years in practice, participants who scored higher on the Agency Scale had a significantly lower likelihood of reporting burnout (OR 0.76, 95% CI 0.66-0.88, p < 0.001). For each step up the Agency Scale, participants were 6.4% less likely to report they felt burned out. Rates of burnout are high among obstetric providers, particularly among providers who have practiced longer. Supporting provider agency to manage critically ill patients may reduce burnout rates.
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Affiliation(s)
- Emma R Lawrence
- Department of Obstetrics & Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Michael Yeboah
- Directorate of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Johnny Arthur-Komeh
- Directorate of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Anna Stabnick
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah D Rominski
- Department of Obstetrics & Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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20
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Finney RE, Torbenson VE, Riggan KA, Weaver AL, Long ME, Allyse MA, Rivera-Chiauzzi EY. Second victim experiences of nurses in obstetrics and gynaecology: A Second Victim Experience and Support Tool Survey. J Nurs Manag 2020; 29:642-652. [PMID: 33113207 DOI: 10.1111/jonm.13198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/10/2020] [Revised: 10/02/2020] [Accepted: 10/15/2020] [Indexed: 11/30/2022]
Abstract
AIM (S) To investigate second victim experiences and supportive resources for nurses in obstetrics and gynaecology. BACKGROUND Nurses are at risk of developing second victim experiences after exposure to work related events. METHODS Nurses at a single institution were invited to participate in an anonymous survey that included the validated Second Victim Experience and Support Tool to assess symptoms related to second victim experiences and current and desired supportive resources. RESULTS Of 310 nurses, 115 (37.1%) completed the survey; 74.8% had not heard of the term 'second victim'. Overall, 47.8% reported feeling like a second victim during their career and 19.1% over the previous 12 months. As a result of a second victim experience, 18.4% experienced psychological distress, 14.3% turnover intentions, 13.0% decreased professional self-efficacy, and 12.2% felt that institutional support was poor. Both clinical and non-clinical events were reported as possible triggers for second victim experiences. Peer support was the most desired form of support as reported by 95.5%. CONCLUSION(S) Nurses in obstetrics and gynaecology face clinical and non-clinical situations that lead to potential second victim experiences. IMPLICATIONS FOR NURSING MANAGEMENT The second victim experiences of nurses should be acknowledged, and resources should be implemented to navigate it. Educational opportunities and peer supportive interventions specific to second victim experiences should be encouraged.
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Affiliation(s)
- Robyn E Finney
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, MN, USA
| | - Vanessa E Torbenson
- Department of Obstetrics and Gynecology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic Rochester, Rochester, MN, USA
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic Rochester, Rochester, MN, USA
| | - Margaret E Long
- Department of Obstetrics and Gynecology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Megan A Allyse
- Department of Obstetrics and Gynecology, Mayo Clinic Rochester, Rochester, MN, USA.,Biomedical Ethics Research Program, Mayo Clinic Rochester, Rochester, MN, USA
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Incollingo Rodriguez AC, Smieszek SM, Nippert KE, Tomiyama AJ. Pregnant and postpartum women's experiences of weight stigma in healthcare. BMC Pregnancy Childbirth 2020; 20:499. [PMID: 32854654 PMCID: PMC7457255 DOI: 10.1186/s12884-020-03202-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 08/21/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Weight stigma is a societal phenomenon that is very prevalent in healthcare, precipitating poor patient-provider relationships, discontinuity of care, and delayed cancer screening. Little research, though, has investigated weight stigma in prenatal and postpartum healthcare. To address this gap, this study examined the prevalence and frequency of weight-stigmatizing experiences in prenatal and postpartum healthcare. METHODS 501 pregnant and postpartum women responded to an online survey where they reported whether they had experienced weight stigma in prenatal or postpartum healthcare and, if so, how frequently. Participants also responded to questions about how providers had treated them regarding their weight and their reactions to these experiences. A subset of participants (n = 80) also provided examples of their experiences, and these were subjected to a thematic analysis and coded for overarching themes. RESULTS Nearly 1 in 5 women (n = 92) reported experiencing weight stigma in healthcare settings. Percentages differed by BMI, with 28.4% of participants with pre-pregnancy obesity endorsing healthcare providers as a source of weight stigma. Experiences occurred between "less than once a month" and "a few times a month." Obstetricians were the most commonly-reported source (33.8%), followed by nurses (11.3%). Participants reported feeling judged, shamed, and guilty because of their weight during healthcare visits. Additionally, 37 participants (7.7%) reported having changed providers because of treatment regarding their weight. Many also reported that they expected to feel or had felt uncomfortable seeking help with breastfeeding from a healthcare professional. Finally, thematic analysis of the open-ended examples identified four key themes: (1) negative attitudes and unkind or disrespectful treatment from providers; (2) evaluative comments about their weight; (3) healthcare providers focusing on their high-risk status and potential negative consequences (often when birth outcomes were ultimately healthy); and (4) inappropriate or demeaning comments. CONCLUSIONS Weight stigma may be a common experience in pregnancy and postpartum healthcare. Providers need additional training to avoid stigmatizing their patients and inadvertently undermining patient-provider relationships, quality of care, and health outcomes.
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Affiliation(s)
- Angela C Incollingo Rodriguez
- Department of Social Science and Policy Studies, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA.
| | - Stephanie M Smieszek
- Department of Social Science and Policy Studies, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA
| | - Kathryn E Nippert
- Department of Social Science and Policy Studies, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA
| | - A Janet Tomiyama
- Department of Psychology, University of California, 502 Portola Plaza, Los Angeles, CA, 90095, USA
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Levytska K, Baker K, Ibe C, Putra M. Status of medical genomics and genetics education in maternal-fetal medicine: survey of program directors and clinical fellows in the USA. J Matern Fetal Neonatal Med 2020; 35:921-926. [PMID: 32146863 DOI: 10.1080/14767058.2020.1734924] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: The study aimed to assess the current state of medical genetics and genomics (MGG) education amongst maternal-fetal medicine (MFM) program directors (PDs) and clinical fellows.Methods: An online questionnaire was generated and distributed to all current program directors and fellows in ACGME-accredited MFM fellowships across the USA in 2018.Results: A total of 13 program directors and 54 MFM fellows responded to our survey. Of the respondents, 73% of the MFM fellows mentioned having dedicated structured MGG rotations as part of their training. Only 12% of fellows reported a high level of satisfaction with their programs' structured MGG rotations and almost 40% reported dissatisfaction, compared to 56% of PDs who reported very high satisfaction. Furthermore, 84% of PDs reported high levels of satisfaction with MGG didactics currently in place compared to only 24% of fellows sharing the same opinion. When compared to PDs, fellows reported a significantly lower satisfaction score toward their MGG rotations (p < .05) and didactic sessions (p < .05). More than 62% of PDs were satisfied with the number of MGG-faculty in their division compared to 80% of fellows who thought more faculty is needed. Thirty-eight percent of PDs quoted curricular overload and lack of time as the most important obstacles to MGG education, compared to 43% of fellows citing a limited number of genetics services providers as the most important obstacles to their MGG education.Conclusion: MFM fellows and PDs differ in their satisfaction with the current state of MGG didactics and rotations in their programs, the number of MGG faculty in their divisions, and the perceived obstacles to MGG education . Our study illustrates the need for MGG curriculum development in MFM fellowships as this subspecialty relies heavily on the use of genetics and genomics services.
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Affiliation(s)
- Khrystyna Levytska
- Department of Obstetrics and Gynecology, Carolinas Medical Center-Atrium Health, Charlotte, NC, USA
| | - Kelsey Baker
- Department of Obstetrics and Gynecology, Detroit Medical Center, Detroit, MI, USA
| | - Chiaka Ibe
- Department of Health and Human Biology, Brown University, Providence, RI, USA
| | - Manesha Putra
- Department of Reproductive Biology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Reproductive Biology, MetroHealth Medical Center, Cleveland, OH, USA.,School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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23
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van der Aa JE, Aabakke AJM, Ristorp Andersen B, Settnes A, Hornnes P, Teunissen PW, Goverde AJ, Scheele F. From prescription to guidance: a European framework for generic competencies. Adv Health Sci Educ Theory Pract 2020; 25:173-187. [PMID: 31451981 PMCID: PMC7018687 DOI: 10.1007/s10459-019-09910-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 08/09/2019] [Indexed: 06/01/2023]
Abstract
In postgraduate medical education, required competencies are described in detail in existing competency frameworks. This study proposes an alternative strategy for competency-based medical education design, which is supported by change management theories. We demonstrate the value of allowing room for re-invention and creative adaptation of innovations. This new strategy was explored for the development of a new generic competency framework for a harmonised European curriculum in Obstetrics and Gynaecology. The generic competency framework was developed through action research. Data were collected by four European stakeholder groups (patients, nurses, midwives and hospital boards), using a variety of methods. Subsequently, the data were analysed further in consensus discussions with European specialists and trainees in Obstetrics and Gynaecology. These discussions ensured that the framework provides guidance, is specialty-specific, and that implementation in all European countries could be feasible. The presented generic competency framework identifies four domains: 'Patient-centred care', 'Teamwork', 'System-based practice' and 'Personal and professional development'. For each of these four domains, guiding competencies were defined. The new generic competency framework is supported by European specialists and trainees in Obstetrics and Gynaecology, as well as by their European stakeholders. According to change management theories, it seems vital to allow room for re-invention and creative adaptation of the competency framework by medical professionals. Therefore, the generic competency framework offers guidance rather than prescription. The presented strategy for competency framework development offers leads for implementation of competency-based medical education as well as for development of innovations in postgraduate medical education in general.
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Affiliation(s)
- Jessica E van der Aa
- Department of Research and Education, OLVG Hospital, Amsterdam, The Netherlands.
- Athena Institute, Faculty of Science, VU, Amsterdam, The Netherlands.
| | - Anna J M Aabakke
- Department of Obstetrics and Gynaecology, Herlev University Hospital, Herlev, Denmark
- European Network of Trainees in Obstetrics and Gynaecology (ENTOG), Brussels, Belgium
| | - Betina Ristorp Andersen
- Department of Gynaecology and Obstetrics, North Zealand Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Annette Settnes
- Department of Gynaecology and Obstetrics, North Zealand Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter Hornnes
- Department of Gynaecology and Obstetrics, North Zealand Hospital, University of Copenhagen, Copenhagen, Denmark
- European Board and College of Obstetrics and Gynaecology (EBCOG), Brussels, Belgium
| | - Pim W Teunissen
- Department of Obstetrics and Gynaecology, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
- School of Health Professions Education (SHE), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Angelique J Goverde
- European Board and College of Obstetrics and Gynaecology (EBCOG), Brussels, Belgium
- Department of Reproductive Medicine and Gynaecology, University Medical Centre, Utrecht, The Netherlands
| | - Fedde Scheele
- Department of Research and Education, OLVG Hospital, Amsterdam, The Netherlands
- Athena Institute, Faculty of Science, VU, Amsterdam, The Netherlands
- European Board and College of Obstetrics and Gynaecology (EBCOG), Brussels, Belgium
- Department of Obstetrics and Gynaecology, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
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Huang Z, Choong DS, Ganesan AP, Logan S. A Survey on the Experience of Singaporean Trainees in Obstetrics/Gynecology and Family Medicine of Sexual Problems and Views on Training in Sexual Medicine. Sex Med 2020; 8:107-113. [PMID: 31911044 PMCID: PMC7042166 DOI: 10.1016/j.esxm.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 09/27/2019] [Revised: 11/19/2019] [Accepted: 12/05/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction Asian patients may have more difficulty seeking help for their sexual problems because of a largely conservative culture. Residents from both obstetrics and gynecology (OBGYN) and family medicine (FM) departments are ideally placed to address sexual problems. Aim This survey explored the experience of residents from OBGYN and FM in managing sexual problems and their views on training in sexual medicine (SM). Method An anonymized questionnaire collecting data on trainee characteristics, exposure to male and female sexual problems, and training in SM was sent to all FM and OBGYN residents in Singapore. These residents had completed their medical registration with the Singapore Medical Council and were at various stages of specialty training in both FM and OBGYN residency programs in Singapore. Main Outcome Measure Trainees’ exposure to male and female sexual problems and their views on training in Sexual Medicine. Results The overall response from the survey was 63.5% (122/192)—54% (70/129) and 69% (52/75) of FM and OBGYN residents responded, respectively. 63% were female, with 22% being senior residents, and 55% attended Singaporean medical schools. About one quarter (30/122) of the respondents encountered patients with sexual problems at least monthly. Most would refer these patients directly to specialists, psychologists, and sex therapists. More than 80% of residents were not confident in managing sexual problems in either sex (89% for male problems; 83% for female problems). Among the recognized categories, only 30% felt confident to manage erectile dysfunction, 26% for vaginismus, while less than 10% felt confident to manage libido, arousal, or orgasm disorders. 95% of the residents agreed that SM should be part of both training curricula, with 70% and 25% suggesting at junior and senior residency, respectively. 93% of them were interested to obtain further knowledge and skills in SM through their core training curriculum and from seminars. Conclusions This survey reported a significant number of residents in OBGYN and FM departments are regularly exposed to patients with sexual problems but lack the skills to manage them. OBGYN residents were more familiar with managing female sexual problems while FM residents tend to have more experience in male sexual problems. Almost universally, the residents in FM and OBGYN were very keen to acquire skills in SM, and the results support the incorporation of appropriate knowledge and skills into both national residency program curricula. Huang Z, Choong DS, Ganesan AP, et al. A Survey on the Experience of Singaporean Trainees in Obstetrics/Gynecology and Family Medicine of Sexual Problems and Views on Training in Sexual Medicine. J Sex Med 2019;8:107–113.
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Affiliation(s)
- Zhongwei Huang
- Department of Obstetrics and Gynaecology, National University Health Systems, Singapore; Institute of Molecular and Cell Biology, Agency of Science, Technology and Research, Singapore.
| | | | - Adaikan P Ganesan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore
| | - Susan Logan
- Department of Obstetrics and Gynaecology, National University Health Systems, Singapore
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25
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Abstract
OBJECTIVES The United States has seen an increasing number of child-bearing women in medical training. We aimed to compare the prevalence of exclusive breastfeeding across varied specialties, whose trainees may face different obstacles to breastfeeding. MATERIALS AND METHODS An online survey querying the duration and barriers to breastfeeding was sent to Accreditation Council for Graduate Medical Education (ACGME) and American Osteopathic Association (AOA) programs. Female residents with at least one living child born during residency were eligible. We compared the prevalence of exclusive breastfeeding for 6 months between Obstetrics and Gynecology (OBGYN), nonsurgical, and non-OBGYN surgical specialties. A multiple regression model correcting for ethnicity, years lived in the United States, medical degree, year of residency at childbearing, geographical location, and clinical hours was performed. RESULTS There were 708 completed surveys, including 561 nonsurgical, 73 OBGYN, and 74 non-OBGYN surgical residents. More OBGYN residents reported exclusive breastfeeding at 6 months (43/73, 59%) than nonsurgical (217/561, 39%) and non-OBGYN surgical residents (30/74, 41%) (p < 0.01). After adjusting for confounders, OBGYN trainees were twice as likely to breastfeed (adjusted odds ratio [AOR] = 2.18, 95% confidence interval [CI] 1.28-3.72) with no difference between non-OBGYN surgical and nonsurgical residents (AOR = 1.24, 95% CI 0.70-2.19). Less OBGYN residents reported the lack of breastfeeding facilities at work (2.7% versus 17.6%, p < 0.01) and inadequate leave (4.1% versus 17.6%, p = 0.01) than non-OBGYN surgical residents. CONCLUSIONS In this national survey of trainees in accredited programs, OBGYN residents were twice as likely to breastfeed and fewer OBGYN residents cited barriers to breastfeeding compared to other residents.
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Affiliation(s)
- Ankita Gupta
- 1 Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, University of Louisville School of Medicine, Louisville, Kentucky.,2 Department of Obstetrics and Gynecology, Crozer Chester Medical Center, One Medical Center Boulevard, Upland, Pennsylvania
| | - Kate Meriwether
- 1 Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Guy Hewlett
- 2 Department of Obstetrics and Gynecology, Crozer Chester Medical Center, One Medical Center Boulevard, Upland, Pennsylvania.,3 Department of Obstetrics and Gynecology, Cooper University Hospital, Camden, New Jersey
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