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PubMed1998

Do women medical students outperform men in obstetrics and gynecology?

PURPOSE: To determine whether there is a difference between the performances of women and men students in the study of obstetrics and gynecology. METHOD: 127 students in the classes of 1996 and 1997 at the UMDNJ-School of Osteopathic Medicine studied obstetrics and gynecology as part of a four-week module on human reproduction in the fall of their second year. The module was followed by an 80-question multiple-choice examination. In their third year, the students rotated through a six-week clinical clerkship, during which they were scored on many aspects of their work, including relationships with patients. The present study examined by gender the students' overall clerkship scores, their ability to relate to patients, and their performances on the multiple-choice examination. RESULTS: No significant difference between the scores of the women students and the men students were found for the module's multiple-choice examination or for the clerkship's score on relationships with patients. However, the women scored significantly better than the men in the clerkship's overall score. CONCLUSION: The women students clearly outperformed the men students during the clinical clerkship on obstetrics and gynecology. The reasons for this are not immediately apparent. Further investigation is necessary.

Clinical Clerkship↗
PubMed2000

Patients' attitudes and comfort levels regarding medical students' involvement in obstetrics-gynecology outpatient clinics.

PURPOSE: To identify patients' attitudes toward the role of medical students, their preferences regarding medical student involvement, and their comfort level with a medical student's presence during common clinical situations in obstetrics-gynecology. METHOD: A self-administered questionnaire was distributed to patients waiting for an office visit with the obstetricians or gynecologists who served as preceptors for both male and female medical students. The questionnaire asked patients about their comfort levels with having medical students present during commonly encountered clinical situations. A random subsample of these patients were also asked whether they would allow a medical student to be present during future visits, and why or why not. RESULTS: A total of 229 patients completed the survey and 124 responded to the supplemental survey. Sixteen respondents were excluded due to missing data or a lack of an adequate comparison group. A majority responded they would feel comfortable having a medical student present during most clinical situations. Almost half of the patients preferred to see the doctor and medical student together, while less than a quarter wanted to see just the physician. Patients with more experience with medical students were more likely to favor medical student involvement and would feel more comfortable having a medical student present during obstetrics or gynecology clinical situations. CONCLUSION: Patients are willing to involve and feel comfortable with medical students in the obstetrics-gynecology clinic. However, physicians and clinics need to take steps to ensure that patient willingness and comfort are maintained by asking patients about their comfort with medical student involvement, clearly outlining the roles and responsibilities of participating medical students, and gradually increasing medical students' responsibilities as patients gain more experience with them.

Adult↗
PubMed2001

Effects of perceptions and mentorship on pursuing a career in academic medicine in obstetrics and gynecology.

PURPOSE: To understand the perceptions of residents and Fellows in obstetrics and gynecology about the impacts of race or ethnicity, gender, and mentorship experiences on pursuing careers in academic medicine. METHOD: Two surveys were administered: one to a sample of 2,000 Fellows of the American College of Obstetricians and Gynecologists, and one to the 4,814 obstetrics and gynecology residents taking the 1998 in-training examination. The questionnaires asked about demographics, perceptions about careers in academic medicine, and residents' experiences with mentorship. RESULTS: Response rates were 96.8% for residents and 40.6% for FELLOWS: Of the residents, 26.1% indicated they would not consider a career in academic medicine. First-year women residents were more inclined to pursue careers in academic medicine than were first-year men (p =.042), but their interest declined during residency. Women residents (43%)-especially minorities-felt that men were mentored and recruited more for faculty positions, while men (38%) felt that women were mentored and recruited more. Fellows' reports of recruitment did not differ by gender. Most white residents did not perceive racial or ethnic bias in mentoring or recruiting, while most non-white residents did. Almost one third of non-white women residents felt that supervisors were more likely to condescend to women and minority individuals. CONCLUSIONS: It is likely that neither men nor women residents in obstetrics and gynecology receive adequate mentorship for careers in academic medicine. Perceptions of bias are a serious barrier to developing racial, ethnic, and gender diversity in leadership positions.

Attitude of Health Personnel↗
PubMed2004

The impact of perceived gender bias on obstetrics and gynecology skills acquisition by third-year medical students.

PURPOSE: To investigate the perceptions of third-year medical students about how their acquisition of skills during their obstetrics and gynecology clerkship may be affected by their gender. METHOD: From January 1999 to December 2001, all third-year students at one school completing their obstetrics and gynecology rotation were given an anonymous questionnaire addressing whether gender had a positive, negative, or neutral effect on their learning experience. Students were also asked to enumerate procedures they had performed (e.g., deliveries and speculum examinations) and to rate their ability to counsel women on several clinical problems. To further investigate the perceptions of gender discrimination, a focus group of 12 fourth-year students was held. RESULTS: A total of 263 questionnaires (95%) were returned. Of the respondents, 78% of the men felt their gender adversely affected their experience, and 67% of women felt gender had a positive affect. All but five of the remaining students were in the neutral group. Those students who reported a positive gender effect performed significantly more speculum examinations (15.5 versus 12.3), labor coaching (8.7 versus 6.2), and independent deliveries (3.4 versus 2.7) than did the negative gender-effect group. The positive gender-effect group felt more confident of counseling skills. The neutral group did not differ from the negative group. The overall numerical differences among groups were small, and all groups, on average, performed adequate numbers of skills to meet clerkship objectives. CONCLUSIONS: There is a strong perception among medical students that gender influences experience on their obstetrics and gynecology clerkship, but the differences are actually small. Possible reasons for such strong feelings are addressed and related to the history of sexism in reproductive health care and to the ethics of patients' preferences.

Clinical Clerkship↗
PubMed1998

Care of the obstetric patient in the traditional intensive care unit.

Obstetric patients have long been a source of fear for nurses in the intensive care unit (ICU) setting. Several hospitals have moved toward having obstetric ICUs, but most do not have the volume to justify such units, leaving the care of these patients to nurses in traditional ICU settings. Collaboration of care may occur, but it is still imperative that ICU nurses have a basic understanding of the physiologic changes and care necessary to provide optimal outcomes for obstetric patients. Physiologic changes of pregnancy and basic care for pregnant and immediate postpartum patients are reviewed.

Adult↗
PubMed1996

Scanning techniques in obstetrics and gynecology.

Using the appropriate scanning techniques and knowing the advantages and disadvantages of ultrasound equipment, the clinically useful pictures that enable better care of the obstetric and gynecologic patient can be generated. The extra advantage of applying the best possible scanning technique may enable the clinician or the imaging specialist to arrive at the correct diagnosis, despite problems created by anatomic circumstances, such as body habitus. The widespread use of ultrasound in general and transvaginal sonography in particular substantially has changed obstetric and gynecologic practice. High frequency transducer probes enable the creation of a crisp detailed picture that facilitates a more accurate and faster diagnostic procedure. Transvaginal sonography should be considered the first choice laboratory tool in the diagnosis of an increasing number of obstetric and gynecologic entities.

Female↗
PubMedDate not supplied

Developing an arrhythmia course for obstetric nurses.

The need has increased for high-risk obstetric nurses to interpret cardiac rhythms, owing to the potential cardiovascular side-effects of tocolytic therapy in premature labor. The cardiovascular critical care nurse, educator, and clinical specialist are important to obstetric nurses as consultants for arrhythmia interpretation. These authors describe how to plan, develop, and implement an arrhythmia course for staff nurses working in obstetric units.

Arrhythmias, Cardiac↗
PubMed1997

Twenty-five years of obstetric patient satisfaction in North America: a review of the literature.

The North American literature on obstetric patient satisfaction of the past 25 years was reviewed using two major computerized databases. The articles identified by these searches were supplemented with other research articles identified in reference lists. The review highlights the difficulties inherent in the use of many different methodologies to study obstetric patient satisfaction. The main methodologies have been mailed questionnaires, telephone interviews, and semistructured interviews, with data collection periods ranging from 24 hours to 2 years postpartum. The various approaches to data collection make comparison of results among studies exceedingly difficult. The reluctance of patients to criticize their caregivers has been problematic and is evidenced by satisfaction ratings that are positively skewed. Factors that have been reported to be most influential in obstetric patient satisfaction include communication, control, participation in decision making, presence of a support person, information/prenatal classes, nursing care services, length of stay, and physical environment. The relative importance of these factors, however, has not been ascertained.

Communication↗
PubMed1988

Comparative costs of a cooperative care program versus inpatient hospital care for obstetric patients.

The cost of obstetric care delivered in a cooperative care unit was compared with the cost for similar patients treated in a traditional inpatient maternity unit. The study sample contained 1,683 consecutive patients representing 23 diagnosis categories. The analysis indicates that cooperative care patients had significantly lower total hospital costs. This cost savings persisted even when we controlled for case severity. The only exception was for the obstetric patient requiring intra-abdominal surgery. For fiscal year 1986, hospital cost savings for the 576 patients who used the cooperative care unit was +80,640 or approximately +105,000 in total patient charges. The majority of the savings came from a reduction in routine nursing services that are directly attributable to the cooperative care unit. We conclude that cooperative care can be an economically feasible alternative for most obstetric patients.

Adult↗
PubMed1990

Determinants of rural travel distance for obstetrics care.

This study examines the distances traveled for inpatient obstetrics care by women residing in rural Alabama in 1983 and 1988. During that time 23 rural hospitals in the state stopped providing obstetrics services and mean travel distances increased by 6.8 miles. However, in 1988 50% of rural pregnant women bypassed the nearest rural hospital still providing obstetrics services. Multivariate techniques are used to examine the effects of distance and service offerings of rural hospitals and their substitutes on the actual distance traveled for care. Patient characteristics are also considered. The most important finding is that a 5% increase in per capita income in the woman's home county is associated with a 20% increase in actual travel distance, other things equal. Implications for rural health policy are discussed.

Alabama↗
PubMed2001

Practice trends in outpatient obstetrics and gynecology: findings of the Collaborative Ambulatory Research Network, 1995--2000.

UNLABELLED: Historically, obstetrics and gynecology has been a medical/surgical specialty focusing on women's health and reproductive concerns during the childbearing years. Newer responsibilities-for example, in primary care, gerontology, and genetics-require Ob-Gyns to draw upon a base of medical knowledge that traditionally was not considered germane to their practices. Ob-Gyns are increasingly providing more primary care services to their patients; consequently, the field has expanded considerably. The Collaborative Ambulatory Research Network (CARN) was created in 1990 as a vehicle for investigating issues pertinent to women's health and to the practice of obstetrics and gynecology in the outpatient setting. This article summarizes the findings of CARN studies from 1995 to 2000, covering a range of topics related to women's health across the life cycle, including, but not limited to perinatal care. Topics include nutrition, infectious disease, hormone replacement therapy, psychosocial issues, and genetic testing in obstetric and gynecologic practice. Each study produced a picture of current practice patterns and knowledge of the physicians surveyed. Findings on knowledge, attitudes, and practices varied widely. Overall, Ob-Gyns were knowledgeable and consistent in more traditional areas of practice. Conversely, inconsistencies were observed in newer areas. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES: After completion of this article, the reader will be able to define what the Collaborative Ambulatory Research Network (CARN) involves, describe how CARN obtains its data, and summarize some of the findings of CARN from the years 1995 to 2000.

Adult↗
PubMed1998

Neuroma-in-continuity resection: early outcome in obstetrical brachial plexus palsy.

The short-term effect of neuroma-in-continuity resection in obstetrical brachial plexus palsy was evaluated to test the hypothesis that the neuroma does not contribute to useful limb function. Twenty-six patients with obstetrical brachial plexus palsy underwent resection of the neuroma-in-continuity and interpositional nerve grafting, and 17 patients underwent neurolysis only. The preoperative and postoperative active movement scores were recorded using an eight-point scale for 15 joint motions in each patient. Data analysis examined the change in total limb motion scores over time within patients undergoing neuroma-in-continuity resection and a comparison with those patients undergoing neurolysis. Compared with preoperative assessment, limb motion scores after neuroma resection were significantly decreased at 6 weeks, not significantly different by 3 months, and significantly improved at 12 months postoperatively. In comparison to patients undergoing neurolysis only, limb motion scores after neuroma resection were not significantly different at 3, 6, and 12 months postoperatively. These findings are unlikely to be accounted for by axonal regeneration across interpositional nerve grafts. Nerve regeneration or recovery in the nongrafted segment of the plexus must be sufficient to reproduce preoperative motion. Resection of the neuromas-in-continuity in obstetrical brachial plexus palsy does not significantly diminish motor activity.

Brachial Plexus↗
PubMed2003

Rates and correlates of alcohol use among pregnant women in obstetrics clinics.

BACKGROUND: The purpose of this study was to demonstrate feasibility of screening and to identify rates and correlates of alcohol use in a large, demographically representative sample of pregnant women across a number of obstetrics clinics, extending previous studies of single or high-risk settings. Identification of harmful alcohol use during pregnancy and of associated factors is critical for the design and implementation of secondary prevention strategies. METHODS: A total of 1131 pregnant women age 18 and older were screened in the waiting areas of eight obstetrics clinics in Southeastern Michigan using a brief (10 min) screening questionnaire. This survey consisted of direct and indirect (TWEAK) measures of alcohol use, as well items assessing demographic characteristics, use of tobacco, and whether participants' physicians discussed alcohol use behavior with them. Women ranged in age from 18 to 46, with a mean age of 28.7 (SD = 5.3). The racial/ethnic distribution of our sample suitably reflects the various racial segments of the Michigan population. RESULTS: We found that 15.1% of the total sample (n = 169) reported any alcohol use during pregnancy, with the majority of those women reporting relatively low levels of alcohol use. One hundred and forty-seven women (13%) scored above the cutoff on the TWEAK (i.e., above a score of 2). Based on multivariate analyses, higher risk alcohol use (defined as binge drinking or greater than one standard drink per week) during pregnancy was predicted by smoking and earlier stage of pregnancy. Caucasian race, smoking, psychological distress, and greater number of drinks during pregnancy predicted scores above a cutoff of 2 on the TWEAK. CONCLUSION: This study demonstrated that screening in busy obstetrics clinics is feasible and acceptable to women and that it may be optimal to use both indirect and direct measures of alcohol use. In addition, brief assessments should be conducted throughout pregnancy and may be targeted or intensified for smokers and for women earlier in their pregnancy.

Adolescent↗
PubMed2004

Small-group discussion versus lecture format for third-year students in obstetrics and gynecology.

OBJECTIVE: To compare lecture and small-group discussion for third-year medical students in obstetrics and gynecology. METHODS: Over a 2-year period, 91 third-year medical students in the obstetrics and gynecology clerkships were given educational sessions on diabetes and hypertension in pregnancy by a single instructor, either in a traditional lecture format or in a small-group discussion. After the instructional sessions, students anonymously completed a 20-question multiple-choice examination on the covered topics. They also completed an evaluation form on the instructional format, using a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). At the completion of each clerkship, students repeated the same multiple-choice examination. RESULTS: There was a significantly higher level of enjoyment (median value 5 versus 4, P <.001) and sense of educational stimulation (median value 5 versus 4, P <.001) in the discussion group, and students in the discussion group were less desirous of the alternate instructional format than those in the lecture group (median value 2 versus 3, P <.001). However, there were no differences in the test scores, either immediately after the instructional sessions or at the end of the clerkships. There was a 90% power to detect a 15% difference in postinstructional test scores. CONCLUSION: Third-year medical students learning about hypertension and diabetes in pregnancy during their obstetrics and gynecology clerkship strongly preferred small-group discussions over traditional lectures. However, this preference did not lead to improved test scores on these subjects.

Adult↗
PubMed2005

Obstetrics and gynecology resident satisfaction with an integrated, comprehensive abortion rotation.

OBJECTIVE: To evaluate obstetrics and gynecology resident satisfaction with a comprehensive, integrated abortion rotation. METHODS: The University of California, San Francisco obstetrics and gynecology residency program includes a 6-week PGY-3 family planning rotation at an in-hospital clinic where abortions are provided up to 23 weeks of gestation. Residents annually evaluate the educational value of all clinical rotations on a 5-point Likert scale, with 5 indicating "maximum value," and 1 "no value." Using data from 1998-2003, we compared ratings of the family planning rotation with all other PGY-3 rotations. We also surveyed residents 1 to 3 years after graduation to assess the rotation qualitatively and quantitatively. RESULTS: Forty residents completed the abortion training, none opted out of training, and all completed the evaluations. Of all rotations in the third year, the family planning rotation was the highest rated (4.70), was similar in value to a high-volume surgical rotation (4.51, P > .10) and the elective rotation (4.45, P >.05), and surpassed the average score for all inpatient rotations (4.00, P < .001), continuity clinic (4.10, P < .001), and outpatient clinical experiences (4.06, P <.01). According to residency graduates, the family planning rotation was rated 4.8 (where 5 indicates "far greater value" than other rotations), and 85% of respondents rated it of "maximum learning value". CONCLUSION: Obstetrics and gynecology residents place high value in the University of California, San Francisco PGY-3 family planning rotation during their training and in their first years of practice.

Abortion, Induced↗
PubMed2005

The recruitment phoenix: strategies for attracting medical students into obstetrics and gynecology.

In less than a decade, the popularity of obstetrics and gynecology as a career choice has declined significantly. The American College of Obstetricians and Gynecologists (ACOG) and the Association of Professors of Gynecology and Obstetrics (APGO) are working to develop a multifaceted approach aimed at reversing this trend. We report on the findings and action plan developed by the ACOG Medical Student Recruitment Task Force as well as the current activities of APGO related to recruitment. Strategies include improving the quality of the medical student clerkship, frankly addressing gender and lifestyle issues that dissuade students from choosing obstetrics and gynecology as a career, and engaging students early in their medical school careers through student interest groups and mentoring programs.

Career Choice↗
PubMed2005

Research methodology and analytic techniques used in the Journal Obstetrics & Gynecology.

OBJECTIVE: To quantify trends over time in the research methodology and statistical reporting of published articles in the journal Obstetrics & Gynecology between the years 1991 and 2001. METHODS: We reviewed 226 articles reporting original clinical research in Obstetrics & Gynecology, including 75 consecutive articles from 1991 and 1996 and 76 consecutive studies from 2001. Articles were classified by research methodology and level of evidence: I for randomized trials; II for controlled trials and observational, analytic studies; and III for case reports or case series. We also noted whether the investigators reported a research hypothesis, P values, effect sizes, 95% confidence intervals, and sample size/power calculations. We calculated chi2 for linear trend to evaluate changes over this 10-year period. RESULTS: Seventy-four percent of the 226 studies evaluated were level II. The percentage of randomized trials did not increase from 1991 to 2001. However, level II studies increased from 71% in 1991 to 88% in 2001 (P = .01). During the same period, level III studies (case reports and case series) declined from 19% in 1991 to 1% in 2001 (P < .001). We also noted that a clearly stated research hypothesis, effect measures (and respective confidence intervals), and sample size calculations were more common in more recent years. CONCLUSION: In the journal Obstetrics & Gynecology, we noted that observational, analytic studies increased in frequency, anecdotal reports decreased, and statistical reporting has improved. However, there still exists considerable opportunities for improvement.

Clinical Trials as Topic↗
PubMed2005

Current status of obstetrics and gynecology resident medical-legal education: a survey of program directors.

OBJECTIVE: To assess the level and type of medical-legal education offered to obstetrics and gynecology residents and medical students. METHODS: All obstetrics and gynecology program directors (n = 252) were asked to complete a survey questioning the availability of, type of, and desire for medical-legal education within their programs. RESULTS: Seventy-eight percent of the program directors answered the survey with 86% reporting some degree of formal medical-legal education. The most common formats were didactic lectures (38%), grand rounds (30%), case conferences (19%), mock trials (9%), and other (4%). These sessions most commonly contained information on proper documentation (48%), testifying (25%), and giving a deposition (24%). The average number of sessions per year was 4.1 with a median of 3 sessions per year. Despite this high percentage of some formal education, 88% expressed an interest in pursuing other educational options on these topics. CONCLUSION: Most obstetrics and gynecology residency programs provide some form of medical-legal instruction to residents, but the small number of sessions suggests that this is inadequate. Residency programs may benefit from a larger and more formal resident education program on medical-legal issues.

California↗