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Vice Chairs of Education in Obstetrics and Gynecology: Prevalence, Scope, and Ongoing Challenges

Shah, Divya K; Chen, Katherine T; Hammoud, Maya M; Berkowitz, Lori R; Winkel, Abigail Ford
OBJECTIVE:To estimate the prevalence of the Vice Chair of Education (VCE) role in obstetrics and gynecology (OBGYN) departments and to describe the demographics, responsibilities, resource allocation, and challenges faced by individuals in this role. DESIGN/METHODS:A 2-part survey was developed with the Association of Professors of Gynecology and Obstetrics (APGO) Member Engagement Workgroup. SETTING/METHODS:National survey. PARTICIPANTS/METHODS:Part 1 was sent to OBGYN department chairs to identify departments with a VCE and to assess characteristics of departments without 1. Part 2 was sent directly to VCEs to assess characteristics of the department and the individual VCE, including demographics, academic appointments, leadership and educational experience, responsibilities, and institutional support. Chi-squared tests were used to compare departments with and without VCE. RESULTS:196 of 256 OBGYN chairs (76.5%) responded to part 1 of the survey, and 71 of 86 VCEs (82.5%) responded to part 2 of the survey. The prevalence of the VCE role was 43.9%. Departments with a VCE had larger numbers of faculty, residents, and medical students, and were more likely to identify as university-affiliated (all p < 0.001). A majority of VCEs identified as women (82.1%), associate professors (55.0%), and academic specialists (51%), with 62.3% serving as the inaugural VCE in their department. Approximately half of VCEs have a defined job description, and only 35.8% controlled an educational budget. Two-thirds (65.7%) of VCEs received full-time equivalent (FTE) support for the role, with 37.1% receiving 0.2 FTE. CONCLUSIONS:The VCE role remains relatively new in OBGYN. Optimizing success of individuals in this role requires increased job clarity, adequate support, and ongoing opportunities for career development.
PMID: 39426315
ISSN: 1878-7452
CID: 5719022

Best Practices: Burnout Is More Than Binary

Thakore, Nitya L; Lan, Michael; Winkel, Abigail Ford; Vieira, Dorice L; Kang, Stella K
Burnout among radiologists is increasingly prevalent, with the potential for having a substantial negative impact on physician well-being, delivery of care, and health outcomes. To evaluate this phenomenon using reliable and accurate means, validated quantitative instruments are essential. Variation in measurement can contribute to wide-ranging findings. This article evaluates radiologist burnout rates globally and dimensions of burnout as reported using different validated instruments; it also provides guidance on best practices to characterize burnout. Fifty-seven studies published between 1990 and 2023 were included in a systematic review, and 43 studies were included in a meta-analysis of burnout prevalence using random-effects models. The reported burnout prevalence ranged from 5% to 85%. With the Maslach Burnout Inventory (MBI), burnout prevalence varied significantly depending on the instrument version used. Among MBI subcategories, the pooled prevalence of emotional exhaustion was 54% (95% CI, 45-63%), depersonalization was 52% (95% CI, 41-63%), and low personal accomplishment was 36% (95% CI, 27-47%). Other validated burnout instruments showed less heterogeneous results; studies using the Stanford Professional Fulfillment Index yielded a burnout prevalence of 39% (95% CI, 34-45%), whereas the validated single-item instrument yielded a burnout prevalence of 34% (95% CI, 29-39%). Standardized instruments for assessing prevalence alongside multidimensional profiles capturing experiences may better characterize radiologist burnout, including change occurring over time.
PMID: 39016454
ISSN: 1546-3141
CID: 5731902

Burnout and Well-Being in Trainees: Findings From a National Survey of US Obstetrics and Gynecology Residents

Winkel, Abigail Ford; Morgan, Helen K; Hammoud, Maya M; Schatzman-Bone, Stephanie; Young, Omar M; Santen, Sally; Banks, Erika; George, Karen
PMCID:11475436
PMID: 39416405
ISSN: 1949-8357
CID: 5711732

The Role of Obstetrics and Gynecology in Shaping Gender-diverse Leadership in Medicine

Winkel, Abigail Ford; Katz, Nadine T
Gender inequity persists in academic medicine. This article reviews the historical context, ongoing leadership challenges, and societal biases. The persistent barriers to gender equity in leadership roles, pay, and professional recognition are considered through the lens of obstetrics and gynecology where these issues persist despite a significant presence of women in the field. The impact of gender stereotypes, the role of intersectionality, and the need for systemic change are evident. Embracing diverse leadership styles and creating inclusive pathways to leadership will help actualize the potential benefits of a gender-diverse workforce, enhancing health care outcomes and fostering innovation.
PMID: 38666712
ISSN: 1532-5520
CID: 5695632

Inhibiting the P2Y12 Receptor in Megakaryocytes and Platelets Suppresses Interferon-Associated Responses

Sowa, Marcin A; Sun, Haoyu; Wang, Tricia T; Virginio, Vitor W; Schlamp, Florencia; El Bannoudi, Hanane; Cornwell, MacIntosh; Bash, Hannah; Izmirly, Peter M; Belmont, H Michael; Ruggles, Kelly V; Buyon, Jill P; Voora, Deepak; Barrett, Tessa J; Berger, Jeffrey S
The authors investigated the impact of antiplatelet therapy on the megakaryocyte (MK) and platelet transcriptome. RNA-sequencing was performed on MKs treated with aspirin or P2Y12 inhibitor, platelets from healthy volunteers receiving aspirin or P2Y12 inhibition, and platelets from patients with systemic lupus erythematosus (SLE). P2Y12 inhibition reduced gene expression and inflammatory pathways in MKs and platelets. In SLE, the interferon (IFN) pathway was elevated. In vitro experiments demonstrated the role of P2Y12 inhibition in reducing IFNα-induced platelet-leukocyte interactions and IFN signaling pathways. These results suggest that P2Y12 inhibition may have therapeutic potential for proinflammatory and autoimmune conditions like SLE.
PMCID:11494392
PMID: 39444926
ISSN: 2452-302x
CID: 5740042

A Platelet Reactivity ExpreSsion Score derived from patients with peripheral artery disease predicts cardiovascular risk

Berger, Jeffrey S; Cornwell, Macintosh G; Xia, Yuhe; Muller, Matthew A; Smilowitz, Nathaniel R; Newman, Jonathan D; Schlamp, Florencia; Rockman, Caron B; Ruggles, Kelly V; Voora, Deepak; Hochman, Judith S; Barrett, Tessa J
Platelets are key mediators of atherothrombosis, yet, limited tools exist to identify individuals with a hyperreactive platelet phenotype. In this study, we investigate the association of platelet hyperreactivity and cardiovascular events, and introduce a tool, the Platelet Reactivity ExpreSsion Score (PRESS), which integrates platelet aggregation responses and RNA sequencing. Among patients with peripheral artery disease (PAD), those with a hyperreactive platelet response (>60% aggregation) to 0.4 µM epinephrine had a higher incidence of the 30 day primary cardiovascular endpoint (37.2% vs. 15.3% in those without hyperreactivity, adjusted HR 2.76, 95% CI 1.5-5.1, p = 0.002). PRESS performs well in identifying a hyperreactive phenotype in patients with PAD (AUC [cross-validation] 0.81, 95% CI 0.68 -0.94, n = 84) and in an independent cohort of healthy participants (AUC [validation] 0.77, 95% CI 0.75 -0.79, n = 35). Following multivariable adjustment, PAD individuals with a PRESS score above the median are at higher risk for a future cardiovascular event (adjusted HR 1.90, CI 1.07-3.36; p = 0.027, n = 129, NCT02106429). This study derives and validates the ability of PRESS to discriminate platelet hyperreactivity and identify those at increased cardiovascular risk. Future studies in a larger independent cohort are warranted for further validation. The development of a platelet reactivity expression score opens the possibility for a personalized approach to antithrombotic therapy for cardiovascular risk reduction.
PMCID:11336089
PMID: 39164233
ISSN: 2041-1723
CID: 5680632

Anki flashcards: Spaced repetition learning in the undergraduate medical pharmacology curriculum

Magro, Juliana; Oh, So-Young; Košćica, Nikola; Poles, Michael
BACKGROUND:Teaching clinical pharmacology is often a challenge for medical schools. The benefits and popularity of active recall and spaced repetition through Anki flashcards are well-established and can offer a solution for teaching complex topics, but educators are often unfamiliar with this resource. APPROACH/METHODS:We implemented 501 faculty-generated pharmacology flashcards in five modules across the medical preclinical curriculum, available to 104 first-year students. At the end of each module, students were surveyed on the usefulness of this novel resource. The data from the cohort who had access to flashcards was compared with the previous cohort, without access, to analyse whether student use of Anki flashcards changed students' perceptions of the pharmacology curriculum and whether there were changes in pharmacology exam performance. EVALUATION/RESULTS:Seventy-five percent of the respondents rated the Anki pharmacology flashcards as 'very useful' or 'somewhat useful'. Eight hundred and seventy-five responses were analysed with a natural language processing algorithm, showing that fewer students mentioned pharmacology as a difficult topic in the cardiovascular and renal modules, compared with the cohort who did not use Anki flashcards. There was not a statistically significant difference in test scores between the cohorts. IMPLICATIONS/CONCLUSIONS:Anki flashcards were well-received by medical students, which might have impacted their perception of the curriculum, as evidenced by the decrease in mentions of pharmacology being a difficult topic, maintaining consistency in academic performance. Educators should consider providing flashcards to offer spaced repetition opportunities in the curriculum; an additional benefit could be increasing information equality in medical schools.
PMID: 39155059
ISSN: 1743-498x
CID: 5680342

Cardiometabolic Comorbidity Burden and Circulating Biomarkers in Patients with Chronic Coronary Disease in the ISCHEMIA Trials

Hamo, Carine E; Liu, Richard; Wu, Wenbo; Anthopolos, Rebecca; Bangalore, Sripal; Held, Claes; Kullo, Ifitkhar; Mavromatis, Kreton; McManus, Bruce; Newby, L Kristin; Reynolds, Harmony R; Ruggles, Kelly V; Wallentin, Lars; Maron, David J; Hochman, Judith S; Newman, Jonathan D; Berger, Jeffrey S; ,
Cardiometabolic comorbidities, diabetes (DM), hypertension (HTN), and obesity, contribute to cardiovascular disease (CVD). Circulating biomarkers facilitate prognostication for patients with CVD. We explored the relationship between cardiometabolic comorbidity burden in patients with chronic coronary disease (CCD) and biomarkers of myocardial stretch, injury, inflammation, and platelet activity. We analyzed participants from the ISCHEMIA Trials biorepository with plasma biomarkers (NT-proBNP, hs-cTnT, hs-CRP, IL-6, sCD40L, and GDF-15) and clinical risk factors [hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and body mass index (BMI)] at baseline. We defined cardiometabolic comorbidities as DM, HTN, and obesity at baseline. Comorbidity burden characterized by number and severity of comorbidities. Controlled comorbidities were defined as HbA1c <7% for those with DM, SBP <130 mmHg for those with HTN and BMI <30 kg/m2. Severely uncontrolled was defined as HbA1c ≥8%, SBP ≥160 mmHg, and BMI ≥35 kg/m2. We performed linear regression analyses to examine the association between comorbidity burden and log-transformed biomarker levels adjusting for age, sex, eGFR controlled for hemodialysis, and left ventricular ejection fraction. A total of 752 individuals (mean age 66, 19% female, 84% white) were included in this analysis. Self-reported Black race, current smokers, history of MI and HF had greater cardiometabolic comorbidity burden. The presence of ≥ 1 severely uncontrolled comorbidity was associated with significantly higher baseline levels of hs-cTnT, hs-CRP, IL-6, and GDF-15 compared to participants with no comorbidities. In conclusion, increasing cardiometabolic comorbidity burden in patients with CCD is associated with higher levels of circulating biomarkers of myocardial injury and inflammation.
PMID: 38844195
ISSN: 1879-1913
CID: 5665722

The Leicester empathy declaration: A model for implementing empathy in healthcare [Letter]

Howick, Jeremy; Mercer, Stewart; Adams, Jennifer; Levett-Jones, Tracy; Mobley, William; Ward, Andrew; Winter, Rachel; Halpern, Jodi
PMID: 39173478
ISSN: 1873-5134
CID: 5681012

Inequities at the Transition to Obstetrics and Gynecology Residency

Morgan, Helen Kang; Banks, Erika; Gressel, Gregory M; Winkel, Abigail Ford; Hammoud, Maya M; Akingbola, Bukky; George, Karen
OBJECTIVE:Although approximately one-fifth of obstetrics and gynecology (OBGYN) residents matriculate from osteopathic or international medical schools, most literature regarding the transition to residency focuses on allopathic medical school graduates. To create comprehensive interventions for this educational transition, we must understand the needs of all incoming residents. Our objective was to examine OBGYN residents' perceptions of their transition to residency, and to understand how residents' background and medical school environment influence their perceived sense of readiness. DESIGN/METHODS:A 16-item survey asked questions about demographics, the transition to residency, resident well-being, burnout, and the transition to fellowship. Perception of preparedness was assessed with the question "I felt that I was well-prepared for the first year of residency" (1=strongly agree, 5=strongly disagree). Chi-squared and Fisher's exact tests and logistic regression explored association of perceived preparedness with residents' backgrounds. SETTING/METHODS:Survey administered at time of the in-training examination in 2022. PARTICIPANTS/METHODS:All OBGYN residents. RESULTS:Of 5761 eligible participants, 3741 (64.9%) provided consent and completed the survey. Of the 3687 participants who answered the question, 2441 (66.2%) either agreed or strongly agreed that they felt well-prepared. Fewer osteopathic graduates reported feeling prepared compared to allopathic graduates (379/610, 62.1% vs 1,924/2,766, 69.6%) (OR 0.72, 95%CI 0.60-0.86, p < 0.01). International medical school graduates were seven times less likely to report feeling prepared compared to those from allopathic institutions (137/304, 45.1% vs 1924/2776, 69.6%) (OR 0.60, 95%CI 0.53-0.68, p < 0.01). Respondents from underrepresented racial and ethnic backgrounds were less likely to report feeling prepared compared to White respondents (276/535, 51.6% vs 1738/2387, 72.8%) (OR 0.39, 95%CI 0.33-0.48, p < 0.01). CONCLUSIONS:Differences in residents' perceptions of their transition to residency highlight the need to begin offsetting pervasive inequities with comprehensive and accessible resources.
PMID: 38705787
ISSN: 1878-7452
CID: 5668582