Leadership aspirations among residents in obstetrics and gynecology in the United States: a cross-sectional analysis.
ABSTRACT: BACKGROUND:Most residents and faculty in obstetrics and gynecology (Ob/Gyn) are women. However, only a third of Ob/Gyn academic leadership positions are held by women in the United States. METHODS:This is an IRB-approved cross-sectional study of leadership aspirations among Ob/Gyn residents in the U.S. as related to gender and mentorship using an electronic survey distributed nationwide in 2017. The primary outcome was resident interest in academic leadership. Mediator variables included demographics and training environment characteristics. Descriptive statistics and comparative analyses were performed using SPSS. RESULTS:We received 202 completed surveys, for a representative cross-section of 4% of all Ob/Gyn residents in the U.S. The majority (86%) of respondents were women (n?=?174), reflecting the same gender distribution of all Ob/Gyn residents in training. Sixty-seven percent of all respondents reported an interest in pursuing academic leadership (n?=?133). Women reported leadership aspirations less often than men (64% vs 86%, p?
Project description:<h4>Objectives</h4>To identify the role of mentorship and other factors associated with obstetrics and gynecology (OB/GYN) resident interest in pursuing a fellowship in gynecologic oncology.<h4>Methods</h4>A survey link was emailed to U.S. OB/GYN residency program coordinators to disperse to current residents. The 80-item survey asked about plans to pursue fellowship and influencing factors. Participants were stratified based on decision to pursue a fellowship in gynecologic oncology. Student's <i>t</i>-test and Mann-Whitney tests were applied.<h4>Results</h4>Among 236 surveyed residents, 32 (13.6%) were planning to pursue a fellowship in gynecologic oncology. There were no demographic differences favoring the choice of gynecologic oncology; however, trainees at academic programs were more likely to aspire to the subspecialty (p?=?0.01). Residents interested in gynecologic oncology had marginally more mentors than others (p?=?0.06), were more likely to have a gynecologic oncology mentor (p?<?0.01), and were more likely to have cited mentorship as a reason for their career aspirations (p?=?0.01). These residents were also less likely to report obvious burnout among faculty and fellows in their department (p?<?0.01 and p?=?0.01, respectively).<h4>Conclusions</h4>Strong mentor relationships and the display of job satisfaction and work-life balance influence OB/GYN residents' interest in gynecologic oncology fellowships. Programs should consider formal mentorship programs for residents, with priority on matching by subspecialty. The value of fellow and faculty efforts in mentorship should be recognized, and appropriate time should be protected for these relationships, along with efforts to support fellows and faculty at risk for burnout.
Project description:<h4>Objective</h4>As the number of female medical students and surgical residents increases, the increasing number of female academic surgeons has been disproportionate. The purpose of this brief report is to evaluate the AAMC data from 1969 to 2018 to compare the level of female academic faculty representation for surgical specialties over the past four decades.<h4>Design</h4>The number of women as a percentage of the total surgeons per year were recorded for each year from 1969-2018, the most recent year available. Descriptive statistics were performed. Poisson regression examined the percentage of women in each field as the outcome of interest with the year and specialty (using general surgery as a reference) as two predictor variables.<h4>Setting</h4>Data from the American Association of Medical Colleges (AAMC).<h4>Participants</h4>All full-time academic faculty physicians in the specialties of obstetrics and gynecology (OB/GYN), general surgery, ophthalmology, otolaryngology (ENT), plastic surgery, plastic surgery, urology, neurosurgery, orthopaedic surgery and cardiothoracic surgery as per AAMC records.<h4>Results</h4>The percentage of women in surgery for all specialties evaluated increased from 1969 to 2018 (OR 1.04, p<0.001). Compared with general surgery, the rate of yearly percentage change increased more slowly in neurosurgery (OR 0.84; P = .004), orthopaedic surgery (OR 0.82; P = .002), urology (OR 0.59; P < .001), and cardiothoracic surgery (OR 0.38; P < .001). There was no significant difference in the rate of yearly percentage change for plastic surgery (OR 1.01; P = .840). The rate of yearly percentage change increased more rapidly in OB/GYN (OR 2.86; P < .001), ophthalmology (OR 1.79; P < .001) and ENT (OR 1.70; P < .001).<h4>Conclusions</h4>Representation of women in academic surgery is increasing overall but is increasing more slowly in orthopaedic surgery, neurosurgery, cardiothoracic surgery and urology compared with that in general surgery. These data may be used to inform and further the discussion of how mentorship and sponsorship of female students and trainees interested in surgical careers may improve gender equity in the future.
Project description:<h4>Introduction</h4> Leadership positions occupied by women within academic emergency medicine have remained stagnant despite increasing numbers of women with faculty appointments. We distributed a multi-institutional survey to women faculty and residents to evaluate categorical characteristics contributing to success and differences between the two groups. <h4>Methods</h4> An institutional review board-approved electronic survey was distributed to women faculty and residents at eight institutions and were completed anonymously. We created survey questions to assess multiple categories: determination; resiliency; career support and obstacles; career aspiration; and gender discrimination. Most questions used a Likert five-point scale. Responses for each question and category were averaged and deemed significant if the average was greater than or equal to 4 in the affirmative, or less than or equal to 2 in the negative. We calculated proportions for binary questions. <h4>Results</h4> The overall response rate was 55.23% (95/172). The faculty response rate was 54.1% (59/109) and residents’ response rate was 57.1% (36/63). Significant levels of resiliency were reported, with a mean score of 4.02. Childbearing and rearing were not significant barriers overall but were more commonly reported as barriers for faculty over residents (P <0.001). Obstacles reported included a lack of confidence during work-related negotiations and insufficient research experience. Notably, 68.4% (65/95) of respondents experienced gender discrimination and 9.5% (9/95) reported at least one encounter of sexual assault by a colleague or supervisor during their career. <h4>Conclusion</h4> Targeted interventions to promote female leadership in academic emergency medicine include coaching on negotiation skills, improved resources and mentorship to support research, and enforcement of safe work environments. Female emergency physician resiliency is high and not a barrier to career advancement.
Project description:BACKGROUND: Since the legalization of abortion services in the United States, provision of abortions has remained a controversial issue of high political interest. Routine abortion training is not offered at all obstetrics and gynecology (Ob-Gyn) training programs, despite a specific training requirement by the Accreditation Council for Graduate Medical Education. Previous studies that described Ob-Gyn programs with routine abortion training either examined associations by using national surveys of program directors or described the experience of a single program. OBJECTIVE: We set out to identify enablers of and barriers to Ob-Gyn abortion training in the context of a New York City political initiative, in order to better understand how to improve abortion training at other sites. METHODS: We conducted in-depth qualitative interviews with 22 stakeholders from 7 New York City public hospitals and focus group interviews with 62 current residents at 6 sites. RESULTS: Enablers of abortion training included program location, high-capacity services, faculty commitment to abortion training, external programmatic support, and resident interest. Barriers to abortion training included lack of leadership continuity, leadership conflict, lack of second-trimester abortion services, difficulty obtaining mifepristone, optional rather than routine training, and antiabortion values of hospital personnel. CONCLUSIONS: Supportive leadership, faculty commitment, and external programmatic support appear to be key elements for establishing routine abortion training at Ob-Gyn residency training programs.
Project description:<h4>Background</h4>Residency programs have experienced a trend toward decreased work hours and case volumes, negatively affecting the perception of graduating residents' competence. Subspecialty tracks have been proposed to help address these issues.<h4>Objective</h4>We evaluated the perceptions of obstetrics and gynecology (ob-gyn) residency program directors (PDs) on subspecialty tracking during training.<h4>Methods</h4>In 2017, a web-based, anonymous survey with Likert scale and open-ended items was e-mailed to US ob-gyn PDs.<h4>Results</h4>Of 250 PDs surveyed, 169 (68%) responded. More than half (54%) reported tracking would positively affect training of future ob-gyn physicians; 80% agreed it would increase resident preparedness for fellowship. Nearly half (49%) indicated it should be available for interested residents. However, some respondents expressed concerns this would negatively affect resident training (38%) and could decrease the number of ob-gyn generalists (50%). Most (88%) believed that tracking, if implemented, should not be mandatory, and 84% agreed that a tracking curriculum should be accompanied by Accreditation Council for Graduate Medical Education (ACGME) and American Board of Obstetrics and Gynecology changes. Only 31% of PDs felt tracking could be successfully implemented in their programs. Barriers to implementation included too few residents to divide into tracks, challenging administrative logistics, and concerns about meeting ACGME case volume requirements.<h4>Conclusions</h4>PDs have defined but diverse opinions on the implementation of tracking in ob-gyn. Slightly more than half of responding PDs reported tracking would positively affect the training of future ob-gyn physicians, and less than one-third indicated that their program could successfully implement tracking.
Project description:Introduction:Genetics is ubiquitous in OB-GYN. However, data suggest that trainees feel underprepared to counsel patients about genetic testing, the nuances of which are becoming increasingly complicated. We sought to develop and implement a genetics curriculum for OB-GYN residents. Methods:This five-module (screening for fetal aneuploidy, prenatal diagnostic testing, prenatal carrier screening, pedigrees, and cancer genetics), interactive, case-based curriculum is linked to Council on Resident Education in Obstetrics and Gynecology objectives and can stand alone or work as part of an ultrasound or obstetrics rotation. Each module, containing objectives, assigned readings, and cases with answers, is used in a small-group format and can be completed in 20-30 minutes prior to the start of a clinical day. Modules were implemented at two academic centers with first-year OB-GYN residents. Qualitative real-time feedback and summative quantitative feedback from OB-GYN residents were obtained. Results:Twenty-one OB-GYN residents completed the curriculum, which was well received by trainees and program directors. All residents (100%) felt the curriculum increased knowledge of prenatal genetics and felt more comfortable counseling patients after completion. Seventy-three percent enjoyed the discussion/case-based format; associated articles were found helpful by 100% of trainees. Facilitators enjoyed teaching the curriculum and felt learner knowledge improved dramatically. Discussion:These low-cost modules were easy to implement and resulted in increased knowledge and confidence in prenatal and cancer genetics. Designed to stand alone and take as little as 20 minutes, the modules provide a helpful adjunct to a women's health rotation or didactic curriculum.
Project description:<h4>Introduction</h4>Practice patterns in clinical learning environments are an important predictor of the patient care quality that residents will deliver after training. The Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review Evaluation Committee reported that from 2012-2015, residents and fellows rarely engaged in quality improvement (QI) activities. A QI curriculum was created for OB-GYN faculty and trainees to develop and implement best practices and study the resulting improvement in patient outcomes.<h4>Methods</h4>Educational leadership in the Dell Medical School Department of Women's Health designed a five-stage curriculum: (1) learning module describing the curriculum's rationale, (2) clinical practice proposal development, (3) implementation/data analysis for selected proposals, (4) dissemination of proposals and outcomes during a live forum, and (5) evaluation. PGY1 and PGY4 OB-GYN residents collaborated in dyads with selected faculty mentors to draft evidence-based proposals. Dyads identified suggested outcomes measures to be analyzed postimplementation. Remaining faculty analyzed outcomes from the previous year's proposals with PGY2 and PGY3 OB-GYN residents.<h4>Results</h4>Forum participants, including faculty, residents, nursing staff, and private obstetrician-gynecologists, evaluated the activity. In 2017, 15 (35%) completed the evaluation. All respondents intended to change their practice based on findings. In addition, the 2016 ACGME survey indicated significant increases in faculty perception of resident QI from 58% in 2014-2015 to 89% in 2015-2016 (<i>p</i> = .01) and in collaboration in scholarly activity from 50% to 85% (<i>p</i> < .01).<h4>Discussion</h4>This curriculum was effective in engaging OB-GYN faculty and residents in formalized problem-based learning to address QI.
Project description:Gender disparities exist in academic emergency medicine (EM). We developed and implemented a female EM physician group - Women in Academic Emergency Medicine (WAM) - to support female EM residents, fellows, and faculty. The goal of WAM is to provide a support system through mentorship, education, and outreach. A targeted needs assessment was completed to identify goals and objectives specific to our department. In the first full year of implementation, WAM hosted eight events, including three topical dinners and one formal panel. Of 42 female faculty and residents, 40 (95%) attended at least one WAM event, and all (20/20) of the female faculty strongly supported WAM. WAM advocated for increased female physician representation on the department's Physician Executive Leadership Group and preservation of dedicated lactation space in the emergency department. Using a needs assessment, the process of developing WAM can be replicated in any department to create a female physician group.
Project description:<h4>Objectives</h4>To explore the current status to which Canadian obstetrics and gynaecology (Ob-Gyn) programmes teach residents about pregnancy in patients with physical disabilities, and to assess the level of interested in providing formal education sessions in this field. This study also assesses the residents' perception of their knowledge and their comfort level caring for women with physical disabilities (WWPD), which will further determine the need for incorporation of this topic into the residency curriculum.<h4>Design</h4>Cross-sectional survey.<h4>Setting</h4>All Canadian English accredited Ob-Gyn residency programmes.<h4>Participants</h4>Programme directors and residents.<h4>Main outcome measures</h4>The current self-reported education and exposure Canadian Ob-Gyn residents have surrounding WWPD in pregnancy, and if there is an interest in further education in this area.<h4>Methods</h4>An online survey was developed and distributed to all Canadian English accredited Ob-Gyn residency programme directors and residents. Answers were collected over a 2-month period in 2017, which consisted of an initial email and two email reminders. Questions were in three key areas: demographic characteristics, knowledge gap and level of interest in a formal method of education.<h4>Results</h4>Eighty-four residents and nine programme directors participated in the surveys. Eighty-six per cent of residents and all programme directors responded that there are no formal scheduled training sessions on WWPD as part of the residency curriculum. Two-thirds of the residents reported being uncomfortable with the management issues surrounding a woman with a disability in pregnancy. A vast majority of residents (91.67%) and all programme directors have an interest in incorporating this topic into the residency curriculum to meet the need of pregnant women with disabilities.<h4>Conclusions</h4>This survey indicated that there is both a need for and interest in education in the area of pregnancy and physical disability in the Canadian Ob-Gyn residency programme. This information suggests that the development of educational materials in this area should be considered to address an unmet need with the ultimate goal of improving the care provided to WWPD in pregnancy. Future projects in this area should focus on content development taking into account the CanMEDS and competency-based medical education framework.
Project description:<b><i>Introduction:</i></b> Mentorship is a key component to success in academic medicine. Women are under-represented in leadership positions within medicine. Women are less likely to identify mentors than men. Speed mentoring is an innovative strategy to facilitate mentorship in academic medicine. <b><i>Materials and Methods:</i></b> A speed mentoring event for women faculty members in an academic anesthesiology department was held, followed by a second event for trainees. Attendees completed surveys about mentorship experiences at baseline and in follow-up. Questions were rated on a 7-point Likert scale with 1 = strongly disagree and 7 = strongly agree with values reported as median (1st, 3rd quartile). <b><i>Results:</i></b> Baseline surveys indicated poor satisfaction with mentoring in the prior 6 months as 4.5 (3, 5.25). Twelve months later, mentees reported increased satisfaction with mentoring 6 (6, 6). Mentors and mentees felt their time was well spent during both events. There was an increase in the number of mentors identified after the events by both groups. <b><i>Conclusions:</i></b> Our results suggest speed mentoring is well received and impactful with minimal time and monetary investment. The attendees of the events identified an increased number of mentors after speed mentoring events, and this effect was maintained at 6-12 months. Speed mentoring may be one path to providing support for women to advance their careers in academic medicine. More research is warranted to better evaluate effectiveness of formats such as speed mentoring to facilitate improved mentorship for women in academic anesthesiology.