Faculty Bibliography

BACKGROUND:Competency-based medical education aims to ensure that physicians develop the skills and knowledge necessary for independent clinical practice through graduated autonomy. Existing competencies in obstetrics and gynecology (OBGYN) residency often fail to capture higher-order transformations in clinical reasoning, professional identity, and emotional maturity. A more nuanced, applicable, and valid articulation of these developmental transitions is needed to better support resident growth and assessment. OBJECTIVE:To identify OBGYN-specific threshold concepts that represent transformative developmental milestones in training, as perceived by leaders in residency education. DESIGN/METHODS:This qualitative study used a constructivist, inductive thematic analysis approach. Interviews explored moments of significant developmental transition, areas of learner struggle, and examples of transformative learning during residency. Audio-recorded interviews were transcribed, deidentified, and independently coded by 2 reviewers using line-by-line analysis. Codes were iteratively organized into themes through consensus, with thematic saturation reached after 9 interviews. Credibility was supported through expert review, member checking, and iterative refinement. SETTING/METHODS:Semistructured, one-on-one interviews were conducted with 11 attending physicians holding formal educational leadership roles within OBGYN residency programs at 4 academic institutions in the New York City metropolitan area. RESULTS:Six threshold concepts were identified that characterize developmental transitions into OBGYN practice: recognition of clinical severity, anticipation and adjustment of surgical technique, ownership of patient care in dynamic settings, empathic collaboration and team management, confidence in independent decision-making, and advanced emotional regulation. These concepts reflected observable shifts in judgment, responsibility, teamwork, and emotional processing that educators consistently associated with readiness for independent practice. In a subsequent survey of n = 78 medical education leaders at a national conference, 90% of respondents endorsed incorporating these threshold concepts into resident assessment frameworks. CONCLUSIONS:This study identifies 6 threshold concepts that capture essential, yet under-recognized, developmental milestones in OBGYN residency training. These concepts offer a complementary framework to existing assessment systems by emphasizing transformative growth in clinical judgment, professional identity, and emotional resilience. Integrating threshold concepts into curriculum design and evaluation may enhance the ability of educators to support learners, identify developmental challenges, and promote readiness for independent practice.

BACKGROUND:Medical training is a high-stress period, and residents in surgical specialties face elevated risk for depression due to demanding schedules, intensity of training, persistent mistreatment, and long work hours. Obstetrics and gynecology is the only surgical specialty predominantly composed of women, who face higher rates of depression than men and greater increases in depressive symptoms during internship. These challenges, compounded by work-family conflict and policy pressures, contribute to workforce strain in a specialty already facing a projected shortage. Understanding the mental health burden is critical to supporting both trainee well-being and long-term workforce sustainability, yet depressive symptoms, risk factors, and treatment-seeking have not been systematically studied in obstetrics and gynecology trainees. OBJECTIVE:To assess the prevalence of depressive symptoms and mental health treatment-seeking among obstetrics and gynecology first-year residents and identify associated demographic, psychological, and workplace factors. STUDY DESIGN/METHODS:tests, stepwise linear regression, and generalized estimating equation models were used to identify baseline and internship-related predictors of depressive symptoms. Sample weights were applied to address nonrepresentative sampling and attrition biases. RESULTS:Of 1603 enrolled obstetrics and gynecology interns (86.5% women; median age 27 years), 1271 (79.3%) completed at least one internship assessment and were included in the analysis. During internship, 35.6% screened positive for depression on the 9-item Patient Health Questionnaire at one or more assessments, yet less than one-third of those affected sought mental health treatment. Baseline predictors of increased depressive symptoms included history of depression, higher baseline depressive symptoms, neuroticism, a difficult early family environment, and not being in a committed relationship. Internship-related factors associated with worsening symptoms included fewer sleep hours, longer work hours, and reported medical errors. CONCLUSION/CONCLUSIONS:More than one-third of obstetrics and gynecology residents screened positive for depression on the 9-item Patient Health Questionnaire during their first year, yet treatment-seeking remained critically low. Both preexisting vulnerabilities and modifiable workplace stressors contributed to depressive symptoms. These findings are particularly notable given the female-predominant composition of the obstetrics and gynecology field and the growing representation of women in surgical specialties. The low treatment-seeking rate highlights the urgent need for improved mental health access, including opt-out service models. Structural interventions targeting workload and sleep are essential to support trainee well-being and long-term workforce sustainability in obstetrics and gynecology.

OBJECTIVE:To examine how abortion policy environments and geographic context are associated with reproductive health outcomes, and to characterize implications for obstetrics and gynecology (OBGYN) care. METHODS:comparisons and Spearman correlations assessed the relationship of these environmental factors with 32 outcomes. RESULTS:= 0.001). CONCLUSIONS:Health disparities associated with restrictive abortion policies and geographic inequities signal regional variation in OBGYN workforce strain, reinforcing the need for systems-level, context-aware strategies to support retention and sustainability.

BACKGROUND/UNASSIGNED:Numerous formal and informal resources exist to support the transition to residency. Little is known about how postgraduate year (PGY) 1 residents perceive and utilize these tools. OBJECTIVE/UNASSIGNED:To explore PGY-1 obstetrics and gynecology (OB/GYN) residents' perspectives on the utility and impact of structured and informal resources supporting the transition to residency. METHODS/UNASSIGNED:We used a qualitative thematic analysis of in-depth interviews with PGY-1 OB/GYN residents using self-determination theory as a framework. In 2024, participants were recruited via email and social media from across the United States. Two residents performed virtual interviews. Three independent coders used inductive coding to analyze the data, then interpreted the patterns that emerged using self-determination theory as an interpretive framework. RESULTS/UNASSIGNED:A total of 11 interviews were performed. Three themes were identified in residents' experience that aligned with the core domains of self-determination theory: the heterogeneity of learning needs as new residents strive towards independence (autonomy), responsibilities for patient care serving as a powerful motivator for learning (competence), and the need for a supportive learning environment (belonging). Residents expressed diverse learning needs, and the abundance of tools often contributed to feelings of being overwhelmed. CONCLUSIONS/UNASSIGNED:Tailoring support strategies to align with learning goals may enhance the effectiveness of transition resources and promote early resident growth and well-being. Educators may help learners identify resources but also allow for learner autonomy in setting learning goals, focus on practical skills to develop competence in clinical duties, and create structures to support a culture of belonging.

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.

The rapid evolution of generative artificial intelligence (AI) is poised to transform medicine and medical education. Large language models (LLMs) have begun to demonstrate capabilities in reasoning, diagnosis, documentation, and patient communication that can rival or exceed those of clinicians. In medical education, AI is reshaping how students learn and how faculty teach-offering individualized, context-sensitive guidance at scale. This article outlines the current state of AI integration in health care, examines how systems can responsibly implement it to enhance patient care and education, and raises critical questions about ethics and safety as we harness its transformative potential.