Faculty Bibliography

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.

OBJECTIVE:Enhancing physician resilience has the promise of addressing the problem of burnout, which threatens both doctors and patients and increases in residents with each year of training. Programmes aimed at enhancing physician resilience are heterogeneous and use varied targets to measure efficacy, because there is a lack of clarity regarding this concept. A more robust understanding of how resilience is manifested could enhance efforts to create and measure it in physicians in training. METHODS:A qualitative study used grounded theory methodology to analyse semi-structured interviews with a purposive, intensity sample of obstetrics and gynaecology residents in an urban academic health centre. Longitudinal engagement through two sets of interviews 3-6 months apart allowed for variations in season and context. Thematic saturation was achieved after enrollment of 18 residents representing all 4 years of postgraduate training. A three-phase coding process used constant comparison, reflective memos and member checking to support the credibility of the analysis. RESULTS:A conceptual model for resilience as a socio-ecological phenomenon emerged. Resilience was linked to professional identity and purpose served to root the individual and provide a base of support through adversity. Connections to others inside and outside medicine were essential to support developing resilience, as was finding meaning in experiences. The surrounding personal and professional environments had strong influences on the ability of individuals to develop personal resilience. CONCLUSIONS:Physician resilience in this context emerged as a developmental phenomenon, influenced by individual response to adversity as well as surrounding culture. This suggests that both programmes teaching individual skills as well as systematic and cultural interventions could improve a physician's capacity to thrive.

OBJECTIVE:To evaluate the impact of a simulation-based elective on medical student preparedness for obstetrics and gynecology (OB/GYN) residency. METHODS:A two-week, simulation-based elective course for post-clerkship medical students was developed, and 10 students participated at a single academic institution in 2016 and 2017. Using standardized patients and team-based training, students practiced procedural and surgical skills, as well as the diagnosis, management, and work-up of commonly seen problems. Close coaching with a low student-faculty ratio was employed for each session, allowing for individualized feedback in real time. Prior to and after completing the elective, student knowledge was evaluated using the Preparation for Residency Knowledge Assessment tool (PrepForRes). Written course evaluations were also completed by students at the end of the course. RESULTS:Mean scores on the PrepForRes exam increased from 63.6% to 75.3% (p=0.0136). Notably, the average post-course score improved to a passing level, and all but one student achieved a passing score on the post-course test. Course evaluations and student feedback showed high satisfaction rates with the course. CONCLUSIONS:This study demonstrates that a simulation-based elective course is an effective tool for helping medical students transition to OB/GYN residency. As medical schools work to facilitate the transition from undergraduate to graduate medical education, simulation can bridge gaps during this transition in order for students to meet entry-level residency requirements.