Faculty Bibliography

Medical errors and adverse events are unavoidable. The effect of adverse outcomes on providers can be devastating. An intraoperative adverse event is often directly attributable to surgeon's technical error or suboptimal intraoperative judgment. To prevent the potential devastating psychological consequences that cases with adverse outcome pose on the surgeons involved it is essential to provide adequate support to the individuals involved in cases with intraoperative adverse events. Common reactions to adverse events, individual and organizational strategies to support clinicians through the aftermath are reviewed. The goal of this commentary is to create awareness of the mental health impact and to describe options to help physicians involved in intraoperative adverse events to recover from their experience related to bad surgical outcomes.

BACKGROUND:Physician well-being impacts both doctors and patients. In light of high rates of physician burnout, enhancing resilience is a priority. To inform effective interventions, educators need to understand how resilience develops during residency. METHODS:A qualitative study using grounded theory examined the lived experience of resilience in residents. A cohort of obstetrics and gynecology residents were selected as a purposive, intensity sample.. Eighteen residents in all years of training participated in semi-structured interviews. A three-phase process of open coding, analytic coding and thematic analysis generated a conceptual model for resilience among residents. RESULTS:Resilience among residents emerged as rooted in the resident's calling to the work of medicine. Drive to overcome obstacles arose from personal identity and aspiration to professional ideals. Adversity caused residents to examine and cultivate coping mechanisms. Personal connections to peers and mentors as well as to patients and the work helped buffer the stress and conflicts that present. Resilience in this context is a developmental phenomenon that grows through engagement with uncertainty and adversity. CONCLUSION/CONCLUSIONS:Resilience in residents is rooted in personal and professional identity, and requires engagement with adversity to develop. Connections within the medical community, finding personal fulfillment in the work, and developing self-care practices enhance resilience.

BACKGROUND /UNASSIGNED:Graduate medical education programs employ reflection to advance a range of outcomes for physicians in training. However, the most effective applications of this tool have not been fully explored. OBJECTIVE /UNASSIGNED:A systematic review of the literature examined interventions reporting the use of reflection in graduate medical education. METHODS /UNASSIGNED:. No language or date limits were applied. The search yielded 1308 citations between inception for each database and June 15, 2015. A total of 16 studies, encompassing 477 residents and fellows, met eligibility criteria. Study quality was assessed using the Critical Appraisal Skills Programme Qualitative Checklist. The authors conducted a thematic analysis of the 16 articles. RESULTS /UNASSIGNED:Outcomes studied encompassed the impact of reflection on empathy, comfort with learning in complex situations, and engagement in the learning process. Reflection increased learning of complex subjects and deepened professional values. It appears to be an effective tool for improving attitudes and comfort when exploring difficult material. Limitations include that most studies had small samples, used volunteers, and did not measure behavioral outcomes. CONCLUSIONS /UNASSIGNED:Critical reflection is a tool that can amplify learning in residents and fellows. Added research is needed to understand how reflection can influence growth in professional capacities and patient-level outcomes in ways that can be measured.

Physician wellness directly affects patient and physician health and has broader implications for our health systems. A summary of what is known about physician wellness in medicine, and obstetrics and gynecology in particular, identifies several areas for future focus. To change our culture and the structure of our academic health centers in a way that promotes resilience, we suggest greater attention to preparedness for practice and attention to work-life integration as well as mentoring and professional development.

OBJECTIVE: To understand the characteristics and career goals of medical students selecting a career in obstetrics and gynecology. METHODS: In 2015-2016, medical students invited for interviews for obstetrics and gynecology residency at the University of Colorado, University of Washington, University of California San Francisco, Loyola University, and New York University received a voluntary 20-item electronic survey regarding factors influencing their choice of medical specialty. RESULTS: Two hundred twenty-six of 356 students responded (63%). Mean age was 27 years, and 88% (n=199) were women. General surgery was the most common alternate specialty (36%, n=81). The most commonly cited drawback to obstetrics and gynecology was "long hours" (66%, n=148). After residency, 157 (70%) applicants planned to complete fellowship training, 127 (56%) pursue international work, 156 (69%) seek an academic position, and 207 (92%) practice in an urban setting. One hundred twenty-four applicants (55%) planned to work 51-60 hours per week and 111 (49%) planned to take 2-3 nights of call per month. Two thirds (n=150) predicted they will have greater than $100,000 educational debt on graduation. CONCLUSION: Contemporary residency applicants have high educational debt and disproportionately plan to pursue fellowship, international work, careers in academic medicine, and work in urban centers. Based on the projected career plans among obstetrics and gynecology applicants, the workforce needs of the population may not be met.

Resident physicians' scores on the REI section of the CREOG exam are traditionally low, and nearly 40% of house staff nation-wide perceive their REI knowledge to be poor. We aimed to assess whether an interactive case-based group-learning curriculum would narrow the REI knowledge gap by improving understanding and retention of core REI concepts under the time constraints affecting residents. A three-hour case-based workshop was developed to address four primary CREOG objectives. A multiple-choice test was administered immediately before and after the intervention and 7 weeks post-workshop, to evaluate both knowledge and confidence. Following the intervention, residents self-reported increased confidence with counseling and treatment of PCOS, ovulation induction cycle monitoring, counseling and treatment of POI, and breaking bad news related to infertility (p < 0.05). The multiple-choice exam was re-administered 7 weeks post-intervention, and scores remained significantly improved compared to pre-workshop scores (p < 0.05). At that time, all residents either strongly agreed (91.7%) or agreed (8.3%) that the case-based interactive format was preferable to traditional lecture-based teaching. In conclusion, a nontraditional curriculum aimed at teaching core REI concepts to residents through interactive case-based learning can be successfully integrated into a residency curriculum, and significantly improves knowledge and confidence of critical concepts in REI.