Faculty Bibliography

OBJECTIVE:To evaluate perceived gaps in preparedness, current on-boarding practices, and need for specialty wide resources in the transition to residency training in obstetrics and gynecology (OB/GYN) DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional survey of current U.S. OB/GYN residents and program directors (PDs) at the time of the resident in-training exam was conducted in 2022. Both groups provide demographic information and identified specific knowledge, skills, and abilities in need of more preparation at the start of residency. PDs were queried on perceptions of readiness for their current first year class, educational on-boarding practices, and their preference for standardized curricular materials and assessment tools. Chi-squared and Kruskal-Wallis tests were used to compare perceptions of skills deficits between PDs and residents, and the relationship of preparedness to program type and resident year in training. RESULTS:Response rates for residents and program directors were 64.9% and 72.6% respectively. A majority (115/200, 57.5%) of program directors agreed or strongly agreed with the statement, "In general, I feel that my new interns are well prepared for residency when they arrive at my program." Both groups agreed that basic suturing and ultrasound skills were deficits. Residents identified a need for better preparation in management of inpatient issues while PDs identified time management skills as lacking. There was considerable heterogeneity of program on-boarding practices across the specialty. Most PDs agreed or strongly agreed that a standardized curriculum (80.5%, 161/200) and assessment tools (75.3%, 150/199) would be helpful. CONCLUSION/CONCLUSIONS:OBGYN PDs feel that not all residents arrive prepared for residency and overwhelmingly support the development of standardized transition curricular and assessment tools, similar to the curriculum developed in general surgery. Based on input from PDs and residents, early curricular efforts should focus on basic surgical, ultrasound, and time management skills and on management of inpatient issues.

INTRODUCTION:The Fundamentals of Laparoscopic Surgery (FLS) program tests basic knowledge and skills required to perform laparoscopic surgery. Educational experiences in laparoscopic training and development of associated competencies have evolved since FLS inception, making it important to review the definition of fundamental laparoscopic skills. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) assigned an FLS Technical Skills Working Group to characterize technical skills used in basic laparoscopic surgery in current practice contexts and their possible application to future FLS tests. METHODS:A group of subject matter experts defined an inventory of 65 laparoscopic skills using a Nominal Group Technique. From these, a survey was developed rating these items for importance, frequency of use, and priority for testing for FLS certification. This survey was distributed to SAGES members, recent recipients of FLS certification, and members of the Association of Program Directors in Surgery (APDS). Results were collected using a secure web-based survey platform. RESULTS:Complete data were available for 1742 surveys. Of these, 1143 comprised results for post-residency participants who performed advanced procedures. Seventeen competencies were identified for FLS testing prioritization by determining the proportion of respondents who identified them of highest priority, at median (50th percentile) of the maximum survey scale rating. These included basic peritoneal access, laparoscope and instrument use, tissue manipulation, and specific problem management skills. Sixteen could be used to show appropriateness of the domain construct by confirmatory factor analysis. Of these 8 could be characterized as manipulative tasks. Of these 5 mapped to current FLS tasks. CONCLUSIONS:This survey-identified competencies, some of which are currently assessed in FLS, with a high level of priority for testing. Further work is needed to determine if this should prompt consideration of changes or additions to the FLS technical skills test component.

OBJECTIVE:To evaluate residency program director views on the purpose and value of an away rotation for students applying to a residency application in Obstetrics and Gynecology (OBGYN). DESIGN, SETTING, AND PARTICIPANTS/METHODS:The Council on Resident Education in Obstetrics and Gynecology administered a 28-question survey to current U.S. program directors in OBGYN in 2022. Program directors were asked if they offered away rotations to visiting medical students and if so, what the purpose the rotation played in their application process and whether rotating students were automatically offered a residency interview. Program characteristics such as program size, geographic location, and program type (university, community, or military based) were ascertained. A test of proportions was utilized to understand the relationship between program description and survey responses. RESULTS:Seventy-nine percent (224/285) of OBGYN PDs responded to the survey and consented to participation. Programs were representative of the types of training program, size of programs, and geographic location. Of respondents, 77.2% (173/224) of PDs indicated that away rotations were offered at their institution, but only 26.6% (46/173) of residency PDs assessed prospective candidates for away electives. The opportunity to provide students an audition for a residency position was the most common reason to offer an elective. Only 34.7% (60/173) of OBGYN PDs guaranteed an interview to students who completed away electives at their institution. The majority (118/173, 68.2%) of PDs indicated less than 25% of their current residents had completed an away rotation with their program. CONCLUSIONS:Many residency programs offered away electives to prospective applicants, but the majority did not personally assess applicants for competitiveness or guarantee interviews to students completing electives. To increase transparency in the application process, programs should publicize the purpose of away rotations and provide information on the number of interviews granted to students who complete away rotations.

OBJECTIVE:To evaluate residents planning fellowship, their preferences for fellowship start date, and the acceptability of resultant gaps in pay and insurance coverage. METHODS:A survey was conducted during the 2022 in-service training examination querying obstetrics and gynecology residents about their desire to pursue fellowship, their preferred fellowship start date (understanding the salary gap), and the acceptability of a medical insurance gap. RESULTS:Survey analysis of respondents planning to pursue fellowship demonstrated that, acknowledging the pay gap that would occur, 93.9% preferred a fellowship start date after July 1, with the majority (65.1%, 593/911) preferring an August 1 fellowship start date. Most respondents (87.7%, 798/910) found the potential resultant gap in medical insurance coverage acceptable. Survey data showed that racial and ethnic identity was not a determining factor in either of these issues. CONCLUSION:The majority of current residents planning to pursue fellowship prefer a delayed fellowship start date, even if it means a gap in salary and insurance coverage. The results of this study, requested by a specialty-wide, consensus-building workgroup, informed a statement signed by the majority (88.9%) of workgroup constituents supporting an August 1 clinical fellowship start date.

Systems of care have been established for obstetrics, trauma, and neonatology. An American College of Obstetricians and Gynecologists Presidential Task Force was established to develop a care system for gynecologic surgery. A group of experts who represent diverse perspectives in gynecologic practice proposed definitions of levels of gynecologic care using the Delphi method. The goal is to improve the quality of gynecologic surgical care performed in the United States by providing a framework of minimal institutional requirements for each level. Subgroups developed draft criteria for each level of care. The entire Task Force then met to reach consensus regarding the levels of care final definitions and parameters. The levels of gynecologic care framework focuses on systems of care by considering institutional resources and expertise, providing guidance on the provision of care in appropriate level facilities. These levels were defined by the ability to care for patients of increasing risk, complexity, and comorbidities, organizing gynecologic care around hospital capability. This framework can also be used to inform the escalation of care to appropriate facilities by identifying patients at risk and guiding them to facilities with the skills, expertise, and capabilities to safely and effectively meet their needs. The levels of gynecologic care framework is intended for use by patients, hospitals, and clinicians in the United States to guide where elective surgery can be done most safely and effectively by specialists and subspecialists in obstetrics and gynecology. The key features of the levels of gynecologic care include ensuring provision of risk-appropriate care and regionalization of care by facility capabilities.

OBJECTIVE:Surgical clerkships frequently include oral exams to assess students' ability to critically analyze data and utilize clinical judgment during common scenarios. Limited guidance exists for the interpretation of oral exam score validity, thus making improvements difficult to target. We examined the development, administration, and scoring of a clerkship oral exam from a validity evidence framework. DESIGN/METHODS:This was a retrospective study of a third-year, end-of-clerkship oral exam in obstetrics and gynecology (OBGYN). Content, response process, internal structure, and relationship to other variables validity evidence was collected and evaluated for 5 versions of the oral exam. SETTING/METHODS:Albert Einstein College of Medicine, Bronx, New York City. PARTICIPANTS/METHODS:Participants were 186 third-year medical students who completed the OBGYN clerkship in the academic year 2020 to 2021. RESULTS:The average number of objectives assessed per oral exam version were uniform, but the distribution of questions per Bloom's level of cognition was uneven. Student scores on all questions regardless of Bloom's level of cognition were >87%, and reliability (Cronbach's alpha) of item scores varied from 0.58 to 0.74. There was a moderate, positive correlation (Spearman's rho) between the oral exam scores and national shelf exam scores (0.35). There were low correlations between oral exam scores and (a) clinical performance ratings (0.14) and (b) formal presentation scores (-0.19). CONCLUSIONS:This study provides an example of how to examine the validity of oral exam scores for targeted improvements. Further modifications are needed before using scores for high stakes decisions. The authors provide recommendations for additional sources of validity evidence to collect in order to better meet the goals of any surgical clerkship oral exam.

The transition to residency in obstetrics and gynecology is difficult, threatening the well-being of residents as well as their preparedness to care for patients. In addition to essential foundational knowledge and skills, obstetrics and gynecology interns must develop professional identity and a growth mindset toward learning to acquire the self-directed learning skills required of physicians throughout their careers. The transition to residency is a critical opportunity for learning and development. A group of educators and learners from around the country created a preparedness program building on available resources. The result is a national curriculum for improving the transition to obstetrics and gynecology residency on three levels: self-directed learning, facilitated small-group workshops, and coaching. Sharing tools for preparing matched applicants for residency in obstetrics and gynecology ensures adequate residency preparation for all interns, independent of medical school attended. This program aims to address potential threats to equity in the training of our future workforce and to ensure that all obstetrics and gynecology interns are prepared to thrive in residency training.

Importance:In order to equitably improve the residency application process, it is essential to understand the problems we need to address. Objective:To determine how obstetrics and gynecology (OBGYN) applicants and faculty communicate applicants' interest to residency programs, and how program directors report being influenced by these communications. Design, Setting, and Participants:This survey study was conducted with email surveys of OBGYN application stakeholders in 2022. Included participants were OBGYN applicants, clerkship directors, and residency program directors in medical education associations' email listservs. Exposures:Surveys sent by the American Association of Medical Colleges, Association of Professors of Gynecology and Obstetrics, and Council on Resident Education in Obstetrics and Gynecology. Main Outcomes and Measures:Whether applicants themselves, or faculty on their behalf, communicated to residency programs, and the influence program directors reported placing on these communications for their decision-making. Descriptive statistics and χ2 tests were used to analyze differences. Results:A total 726 of 2781 applicants (26.1%) responded to the survey and were included in analysis (79 of 249 [31.7%] clerkship directors; 200 of 280 [71.4%] program directors). The self-reported racial and ethnic demographics of the 726 applicant respondents were 86 Asian (11.8%), 54 Black (7.4%), 41 Latinx (5.6%), 1 Native Hawaiian or Pacific Islander (0.1%), 369 White (52.2%), 45 with multiple racial identities (6.2%), and 91 (21.5%) preferring not to answer. The majority of applicants (590 [82.9%]) sent communications at some point in the application process. Applicants who identified as White (336 [88.7%]) or Asian (75 [87.2%]) were more likely than those who identified as Black (40 [74.1%]) or Latinx (33 [80.5%]) to reach out to programs (P = .02). There were also differences in type of medical school, with 377 of 427 MD applicants (88.3%), 109 of 125 DO applicants (87.2%), and 67 of 87 International Medical Graduate applicants (77.7%) reporting sending communications (P = .02). Approximately one-third (254 applicants [35.7%]) had faculty reach out to programs on their behalf. White (152 [40.1%]) and Asian (37 [43.0%]) applicants were more likely to have faculty reach out compared with Black (6 [11.1%]) and Latinx (12 [29.3%]) applicants (P = .01). Program directors reported that preinterview communications from faculty they knew (64 [32.2%]) and other program directors (25 [12.6%]) strongly influenced their decisions, and otherwise rarely reported that communications strongly influenced their decisions. Conclusions and Relevance:The current state of communications may increase inequities in residency application processes; differences between faculty communications for applicants from different racial and ethnic backgrounds are particularly concerning given that program directors are more likely to weigh communications from faculty in their decision-making. A centralized, equitable means for applicants to signal their interest to programs is urgently needed.