Faculty Bibliography

OBJECTIVE:To develop, implement, and assess the utility of a standardized letter of evaluation (SLOE) for OBGYN residency applicants in the US. DESIGN/METHODS:OBGYN program directors (PDs) were surveyed over 2 consecutive years and asked to estimate the percentage of applicants submitting an SLOE and to indicate its helpfulness compared to traditional letters of recommendation. Sub-group analysis by program type was performed. In 2023, comments for improvement were collected and analyzed for themes using a large language model. SETTING/METHODS:OB/GYN residency programs in the United States. PARTICIPANTS/METHODS:OB/GYN PDs in the United States. RESULTS:The survey was completed by 254 of 293 (86.7%) of PDs in 2022 and 253/293 (86.3%) in 2023. From 2022 to 2023, there was no difference in the estimated percentage of applicants who submitted an SLOE to a program (median 50%-74%), though in 2023, university and combined university-community programs estimated receiving higher percentage of applicants submitting SLOEs compared to community and military programs (p < 0.001). Over the study period, the favorability of the SLOE improved, and feedback indicates a need for continued improvement in the SLOE process, including faculty development, standardization, and more honest assessment of applicants. CONCLUSIONS:An SLOE was submitted by most applicants to OBGYN residency programs. Iterative modification of the SLOE based on PD, applicant, and faculty advisor feedback is needed to assess its utility in the application process.

A pilot online, video-based abortion care curriculum nationally positively affected obstetrics-gynecology residents' clinical knowledge, providing residency programs with a useful, centralized educational resource.

OBJECTIVE:To examine the rates of and reasons for presenteeism amongst obstetrics and gynecology (OBGYN) residents and program directors (PDs). METHODS:A national survey regarding presenteeism was administered to OBGYN residents and PDs. Sociodemographic data and residency program characteristics were collected from both groups. A Z test of independent proportions was used to investigate differences in reported presenteeism between residents and PDs. Bivariate analyses were performed to examine key outcomes of interest by sociodemographic and program characteristics. Kappa coefficients were calculated to assess agreement in program culture support for resident versus attending absence when unfit for duty. Multivariable linear regression analyses were performed to examine effects of hypothesized predictors of PD job satisfaction. RESULTS:A greater proportion of residents (51.3%) compared to PDs (21.2%) reported presenteeism (p < 0.001). The most common reasons reported by residents for presenteeism were concerns about forcing colleagues to cover (83.1%) and responsibility to care for patients (11.3%); while for PDs, they were responsibility to care for patients (35.6%) and residency administrative responsibilities (35.6%). In the resident survey, we found significant differences in rates of presenteeism by geographic region (p < 0.001), program type (p = 0.003), and training year (p = 0.001). We also found significant differences in program culture support for resident/attending/fellow leaves of absence when unfit for work by geographic region (p < 0.001). Lastly, we found significant differences in expectations for residents to "pay back" covered shifts during sick leave by geographic region (p < 0.001), and training year (p = 0.014). In the PD survey, we found significant differences in availability of emergency childcare by program size (p < 0.001) and program type (p = 0.003). We observed fair agreement between ratings of program culture support for resident versus attending absence when unfit for work (κ = 0.259, p <0.001). In adjusted analyses, we observed a negative effect of PD presenteeism (p = 0.044) and a positive effect of program culture support for attending absence (p = 0.007) on PD job satisfaction. CONCLUSIONS:Presenteeism was reported by a greater proportion of residents compared to PDs. A supportive culture for attending absence positively correlated with PD job satisfaction, whereas PD presenteeism had a detrimental effect. These findings suggest that institutional policies and support systems may have a critical impact on mitigating presenteeism and enhancing job satisfaction within residency programs, highlighting the need for targeted interventions to foster a supportive work environment for both residents and PDs.

Separation of patients by insurance status in ambulatory care settings is a long-standing practice in academic medicine. This payer-based segregation of patients between resident and faculty outpatient practices may lead to inequitable quality of care. Informed by replies to a free-response text question for residents and program directors within the 2023 U.S. obstetrics and gynecology in-service examination, we provide commentary on this structural inequity within obstetrics and gynecology. The purpose of this commentary is to discuss the differences in patient population served, gaps in resources in resident clinics, quality of care and moral injury, limited continuity of care, and training and supervision. Further work is needed to guide systemic integration efforts and to explore the effects of program integration on patient health outcomes. We nonetheless urge academic medical centers to consider organizational shifts toward payer-integrated care.

OBJECTIVE:To evaluate implementation of a patient decision aid for symptomatic uterine fibroid management to improve shared decision-making at five clinical settings across the United States. METHODS:We used a type 3 hybrid effectiveness-implementation stepped-wedge design and the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) planning and evaluation framework. We conducted clinician training, monthly reach tracking with feedback to site clinical leads, patient and clinician surveys, and visit audio-recordings. Implementation strategies included assessment of organizational readiness for shared decision-making, synchronous clinician training, audit and feedback of decision aid reach, and access to multiple decision aid formats. Outcomes and analyses included patient-level reach, clinician-level adoption, and associations of patient-reported decision aid exposure (as treated) and setting-level implementation (intention-to-treat) with patient-reported (collaboRATE measure) and observed (OPTION-5 measure) shared decision-making. We also designed and assessed setting-level plans for sustainability and other factors impacting sustained decision aid use. RESULTS:The decision aid was adopted by 72 of the 74 eligible gynecologists (97%) and reached 2553 patients across five settings. CollaboRATE scores improved among patients who reported receiving the decision aid (as-treated analysis, 69% vs. 59%; OR 1.6, 95% CI 1.16-2.27). CollaboRATE scores remained consistent before and after setting-level decision aid implementation (intention-to-treat analysis, 64% vs. 63%; OR 0.86, 95% CI 0.61-1.22). Participants would prefer to receive a decision aid at multiple time points (91.9% before the visit, 90.7% during the visit, 86.5% after the visit). Shared decision-making experiences did not improve when comparing pre vs. post-implementation collaboRATE scores across included settings (intention-to-treat, 64% vs. 63%; OR 0.86, 95% CI 0.61-1.22). CONCLUSION:When patients with symptomatic uterine fibroids are given decision aids, they report higher shared decision-making scores. However, the differences we observed between the as-treated and intention-to-treat results suggest that unaddressed implementation challenges continue to limit the extent to which patients receive decision aids and likely hinder their overall impact. Future efforts to implement decision aids should explore enhancing their integration into clinical workflows and standard operating procedures, supported by organizational incentives that prioritize shared decision-making. TRIAL REGISTRATION:ClinicalTrials.gov NCT03985449; registered 6 June 2019.

PURPOSE/OBJECTIVE:Medical education should prepare learners for complex and evolving work, and should ideally include the Master Adaptive Learner (MAL) model-meta-learning skills for continuous self-regulated learning. This study aimed to measure obstetrics and gynecology (OB/GYN) residents' MAL attributes, assess associations with burnout and resilience, and explore learning task associations with MAL. METHOD/METHODS:OB/GYN residents were surveyed electronically at an in-training examination in January 2022. The survey included demographic information, the 2-item Maslach Burnout Inventory, the 2-item Connor-Davidson Resilience Scale, 4 MAL items (e.g., "I take every opportunity to learn new things"), and questions about training and learning experiences. RESULTS:Of 5,761 residents, 3,741 respondents (65%) were included. A total of 1,478 of 3,386 (39%) demonstrated burnout (responded positive for burnout on emotional exhaustion or depersonalization items). The mean (SD) Connor-Davidson Resilience Scale score was 6.4 (1.2) of a total possible score of 8. The mean (SD) MAL score was 16.3 (2.8) of a total possible score of 20. The MAL score was inversely associated with burnout, with lower MAL scores for residents with (mean [SD] MAL score, 16.5 [2.4]) vs without (mean [SD], 16.0 [2.3]) burnout (P < .001). Higher MAL scores were associated with higher resilience (R = 0.29, P < .001). Higher MAL scores were associated with the statement, "I feel that I was well prepared for my first year of residency" (R = 0.19, P < .001) and a plan to complete subspecialty training after residency (mean [SD] of 16.6 [2.4] for "yes" and 16.2 [2.4] for "no," P < .001). CONCLUSIONS:Residents who scored higher on MAL showed more resilience and less burnout. Whether less resilient, burned-out residents did not have the agency to achieve MAL status or whether MAL behaviors filled the resiliency reservoir and protected against burnout is not clear.