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Resident well-being is a significant issue affecting our future physicians' abilities to fulfill their potential in training and practice. In the 2017 Council on Resident Education in Obstetrics and Gynecology National Wellness Survey, residents identified many challenges to wellness and had the opportunity to provide free-text responses about these issues. Secondary analysis of these responses revealed clusters of symptoms associated with mood disorders, including high rates of reported anxiety and depression symptoms, and even suicidality. The prevalence of these self-reported symptoms underscores the importance of targeting wellness programming efforts, improving health care work environments, advancing access to care, and destigmatizing mental health concerns for our learners.

Background: Clinical exposure to Pediatric and Adolescent Gynecology (PAG) varies amongst residency programs 1,2. In areas such as PAG where clinical exposure may be limited, residents need solid evidence-based practice (EBP) skills to guide future independent practice. The OSCE format presents an opportunity to simulate a clinical scenario that residents may not encounter in their training, objectively assess performance, and increase learner motivation to continue building skills. This study evaluates resident performance on an EBP OSCE station based on a core PAG topic in order to evaluate its ability to provide program-level evaluation of the skills of evidence-based practice in PAG and provide actionable feedback to learners.
Method(s): A hybrid simulation/OSCE station was developed to assess core skills of EBP in the management of labial adhesions. A behaviorally anchored scoring checklist was developed for each component of the station and scored separately and independently by a single medical librarian and standardized patient. Mixed methods evaluation of performance by residents of all levels of residency training was done, focusing on quantitative analysis of EBP performance with thematic analysis of qualitative evaluation data.
Result(s): 30 Obstetrics and Gynecology residents participated in the PAG EBP OSCE station (9 PGY1, 10 PGY2, 6 PGY3, 5 PGY4). The overall mean score for all residents was 57% (+/- 18 SD). Mean scores by PGY increased between first and second year, but did not increase further in later years of training with the largest variation in performance in the PGY4 year (Figure 1). Thematic analysis of the qualitative feedback on residents' search strategies revealed useful insights at a programmatic level (Table 1). Upper level residents often used a less robust search strategy of the literature, instead opting for a database they had some familiarity with to guide their recommendations without searching for corroborating evidence or additional sources.
Conclusion(s): OSCE provides a feasible standardized way to observe, assess and encourage development of core EBP skills. A slight developmental trend was seen with improving scores among junior residents between the first and second years of training. However, this trend did not continue between the final years of training. The fact that scores did not increase linearly suggests that clinical training may not reinforce EBP skills. The importance of EBP skills is magnified in PAG where clinical exposure and experience amongst trainees may be limited. In addition to improving resident education in PAG, medical educators must continue to develop and implement interventions to teach and reinforce EBP skills to trainees to bring to future independent practice. [Formula presented] [Formula presented]
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OBJECTIVES/OBJECTIVE:Trainee well-being is a core component of ACGME program requirements and the SGO has recognized the high incidence of burnout among gynecologic oncologists and its negative impact. To foster a culture of wellness throughout the SGO community we sought to engage current fellows along with fellowship directors in a structured didactic program designed to teach wellness. We evaluated the feasibility of and preliminary responses to a pilot curriculum designed to teach skills that promote wellness and prevent burnout. METHODS:The SGO Wellness Taskforce developed a curriculum with topics based on established evidence as well as specialty specific stressors such as end of life discussions. Faculty leaders from 15 pilot-sites attended a full-day training course and then taught four modules over four months. Interactive modules engaged fellows through reflective writing, guided discussion, and multimedia presentations. Fellows completed the Perceived Stress Scale pre- and post-implementation and provided feedback regarding attitudes toward wellness and the individual modules. Faculty curriculum leaders completed surveys regarding their attitudes toward the curriculum as well as their trainees' reactions. RESULTS:Among 73 participating gynecologic oncology fellows, 95% (69/73) and 52/73 (71%) completed the pre-and post-surveys, respectively. Only 34/73 (49%) respondents reported that there was wellness programming at their institution prior to the initiation of the SGO curriculum. At institutions where such programming was available, 35% (12/34) reported not utilizing them. Fifty-five (80%) fellows had PSS scores greater than 12 compared to 39 (75%) post-intervention. After the curriculum, the percentage of fellows comfortable discussing wellness topics increased from 63 to 74%. Prior to the curriculum, 75% felt they could identify symptoms of burnout or psychosocial distress. This increased to 90% post-intervention. The modules were well received by fellows, and the time spent addressing wellness was widely appreciated. CONCLUSIONS:A structured curriculum to promote wellness among gynecologic oncology fellows is feasible and was associated with observed decreased reported stress among fellows at participating programs. This curriculum addresses ACGME requirements regarding trainee well-being, and showed potential for more programmatic, nationwide implementation. Fellowship culture change was not directly measured, but may have been one of the most significant positive outcomes of the wellness program. Further longitudinal studies will be necessary to understand the natural course of fellow burnout and the impact of structured wellness programming.

OBJECTIVE:To investigate associations between activities residents reported doing to support their own well-being and perceived experience of burnout and mental health problems. DESIGN/METHODS:A single-group, multi-institutional cross-sectional survey explored physician well-being using six questions. Self-report of burnout was the primary outcome of the original analysis. This secondary analysis aims to understand whether self-report of burnout and other problems (depression, binge drinking, eating disorder, drug use, etc.) differed based on residents' personal practices (e.g., hobbies, recreational activities, substance use). Activities done at least twice a week were considered "regular" activities. Chi-squared tests examined the associations between these activities and the likelihood of residents reporting any problem. SETTING/METHODS:An anonymous, voluntary, electronic questionnaire was distributed at the time of the Council on Resident Education in OBGYN (CREOG) examination in 2017. PARTICIPANTS/METHODS:Among 5376 US OBGYN residents, 4999 (93%) provided consent and completed complete data for the analysis. RESULTS:Of 5376 residents offered the survey, 4999 (93%) residents provided complete data for the analysis. The majority, 3065 (61.3%) reported experiencing at least one wellness issue. When queried about the activities residents did to support their own well-being, most of the activities did not improve reported wellness, but rather had no association, or a negative association with well-being. Among the common regular activities, only exercise was associated with a reduction in self-reporting of problems (OR 0.68, p < 0.001). Almost half of residents reported regular alcohol use (2132 [45.6%]). Alcohol use was associated with an increased likelihood of self-report of other problems (odds ratio [OR] 2.10, p < 0.001). Those residents who reported drinking 4 or more times a week had a stronger association. (OR 3.30, p < 0.001). CONCLUSIONS:Most activities that OBGYN residents reported doing to support their own wellbeing were not associated with reduced reporting of burnout or mental health problems, except for exercise. Alcohol use was commonly reported and is associated with increased reporting of burnout or other mental health problems.

PURPOSE: To explore associations between residents' personal habits and problems with wellness. BACKGROUND: It will be essential that we develop evidence-based interventions to improve burnout and wellness problems in our resident physicians.
METHOD(S): A voluntary, anonymous survey was administered to all US OBGYN residents at the time of the 2017 CREOG examination. Symptoms of burnout and problems with wellness were queried with the question, "during your residency training, have you personally experienced any of the follow issues? " Respondents also reported how often they engaged in activities that they felt helped to maintain wellness in their lives. Associations between reporting wellness problems and participation in common activities were examined using chi-squared tests. Significance was defined as p<.004 using a Bonferroni correction based on the number of comparisons.
RESULT(S): Of the 5855 residents, 4999 completed the survey (85% RR). 3065 (61.3%) residents endorsed problems with wellness, including burnout (51.2%), depression (32.0%), and binge drinking (12.6%). The most common wellness activities reported were social activity (n=4320, 93.2%), watching TV (n=3614, 77.1%), cooking (n=3614, 52.4%), exercise (n=2228, 47.3%), and drinking alcohol (n=2132, 45.6%). Respondents who indicated alcohol as a wellness activity had an increased odds ratio of 2.10 of also having a wellness problem (chi2(1)=29.6, p<0.001). Respondents who indicated heavy drinking ("Often (4+ times) "/week) had a higher odds ratio of 3.30 (chi2(1)= 40.3, p<.001.). DISCUSSION: Despite social norms, residency programs should use caution when choosing alcohol as the basis for social events or stress release, as our data suggest that it is associated with increased negative outcomes for resident wellness

In this unique time of technological advancement in medicine and the culture of public discourse that surrounds it, trainees in obstetrics and gynecology require more intensive education in medical ethics to appropriately guide patient decision-making and to become more responsible voices in such an ethically complex field.

Half of medical school graduates are women, but female doctors experience significant professional tensions. Low numbers of women in leadership roles, high burnout and attrition, and continued harassment suggest a culture that undermines the contributions of women. This manuscript explores research from sociology, business and medicine through a personal lens. Understanding the way gender influences the complex state of women in medicine suggests changes are needed in the architecture of the modern medical workforce. Individuals, mentors and organizations can make changes that would improve the way that the working environment cultivates a diverse workforce to reach its full potential.

OBJECTIVE:To examine U.S. obstetrics and gynecology residents' perceptions of wellness, burnout, and perceived effectiveness of wellness programming. METHODS:In January 2017, a six-item survey was administered at the time of the Council on Resident Education in Obstetrics and Gynecology in-training examination. Respondents voluntarily completed the survey electronically before starting the examination, and responses were anonymous and only linked to postgraduate year. RESULTS:Of the 5,376 eligible U.S. examinees, 4,999 (93%) completed the survey, provided residency year status, and were included in the analysis. There was a high prevalence of self-identified wellness problems (burnout 51.2%, depression 32.0%, binge drinking 12.6%, eating disorder 4.7%, drug use 1.1%, and suicide attempt 0.4%). First-year residents were most likely to state that wellness was a priority in their program. The number of residents reporting any problem with wellness increases significantly between the first year (49.8%) and second year (63.7%, P<.001), after which it remains elevated throughout training. Residents who responded that wellness was not a priority in their program were more likely to report wellness issues and burnout (P<.001). When asked what single intervention all residency programs should provide, 41.2% (2,059) felt that dedicated time for wellness maintenance was the most important intervention. CONCLUSION/CONCLUSIONS:These findings highlight the high prevalence of wellness problems in obstetrics and gynecology residents, and how essential it will be to engage learners in the development of effective, evidence-based interventions.