Amy S. Gottlieb

Reproductive coercion and co-occurring intimate partner violence in obstetrics and gynecology patients.

OBJECTIVE Reproductive coercion is male behavior to control contraception and pregnancy outcomes of female partners. We examined the prevalence of reproductive coercion and co-occurring intimate partner violence among women presenting for routine care at a large, urban obstetrics and gynecology clinic. STUDY DESIGN Women aged 18-44 years completed a self-administered, anonymous survey. Reproductive coercion was defined as a positive response to at least 1 of 14 questions derived from previously published studies. Women who experienced reproductive coercion were also assessed for intimate partner violence in the relationship where reproductive coercion occurred. RESULTS Of 641 women who completed the survey, 16% reported reproductive coercion currently or in the past. Among women who experienced reproductive coercion, 32% reported that intimate partner violence occurred in the same relationship. Single women were more likely to experience reproductive coercion as well as co-occurring intimate partner violence. CONCLUSION Reproductive coercion with co-occurring intimate partner violence is prevalent among women seeking general obstetrics and gynecology care. Health care providers should routinely assess reproductive-age women for reproductive coercion and intimate partner violence and tailor their family planning discussions and recommendations accordingly.

Intimate partner violence: a clinical review of screening and intervention

One in four American women will be physically assaulted or raped by an intimate partner during her lifetime. Such exposure has wide-ranging health effects. Abused women have an increased risk of cardiac, gastrointestinal, gynecologic, musculoskeletal, neurologic and psychological complaints. They also have a greater utilization of medical services and are more likely to access outpatient primary care and specialty care, emergency departments and mental health and substance abuse services than women without a history of partner violence. Most major US medical organizations recommend routine screening of all women for partner abuse. Offering abused women empathy and validation along with referral to local resources is encouraged. Physicians should also document the abuse in the victims medical record.

Systematic review of ED-based intimate partner violence intervention research

Introduction Assessment reactivity may be a factor in the modest results of brief interventions for substance use in the emergency department (ED). The presence of assessment reactivity in studies of interventions for intimate partner violence (IPV) has not been studied. Our objectives were to identify ED IPV intervention studies and evaluate the presence of a consistently positive effect on the control groups. Methods We performed a systematic search of electronic databases for English=language intervention studies addressing IPV in the ED published since 1990. Study selection and assessment of methodologic quality were performed by two independent reviewers. Data extraction was performed by one reviewer and then independently checked for completeness and accuracy by a second reviewer. Results Of 3,620 unique manuscripts identified by database search, 667 underwent abstract review and 12 underwent full-text review. Only three met full eligibility criteria; data on the control arm were available for two studies. In these two studies, IPV-related outcomes improved for both the experimental and control condition. Conclusion The paucity of controlled trials of IPV precluded a robust evaluation for assessment reactivity. This study highlighted a critical gap in ED research on IPV.

Interpersonal violence screening for ambulatory gynecology patients.

OBJECTIVE: To estimate the effects of patient and health care provider variables on rates of interpersonal violence screening in an ambulatory gynecology practice. METHODS: A cross-sectional study of 300 patients were chosen randomly from annual health care visits during 2007 at a university-affiliated ambulatory gynecology clinic. All encounters were recorded on a standardized health history form, which included questions about abuse history. Data on patient and health care provider characteristics were collected. The association of health care provider screening with selected patient variables was assessed using multivariable logistic regression. RESULTS: The median age of the study population was 29 years (range 15–73 years). The cohort was racially and ethnically diverse, and the majority was on government assistance. Sixty-seven percent (194 of 291) had children living at home, and 57% (164 of 286) were single. Of the 300 patients, 243 (81%) had documentation of abuse screening in their medical records. Variables previously found to be associated with higher rates of partner abuse such as younger age or increased parity did not influence whether patients were screened. Similarly, differences in screening by health care provider type (nurse practitioner or resident) or health care provider gender did not emerge. Patients were, however, significantly more likely to be questioned about partner violence when they received other preventive screening (adjusted odds ratio 2.50, 95% confidence interval 1.26–4.99) or presented with a somatic pain complaint (adjusted odds ratio 2.55, 95% confidence interval 1.12–5.83). CONCLUSION: Ambulatory gynecology patients were more likely to be screened for interpersonal violence when health care providers performed other preventive health screening using a standardized health history form. LEVEL OF EVIDENCE: II

The Career Advising Program: A Strategy to Achieve Gender Equity in Academic Medicine.

S ignificant gender disparities in academic rank exist at US medical schools, even after controlling for age, time since training, specialty, and measures of productivity, and despite increasing numbers of women entering medicine over the past 30 years. Within internal medicine nationally, only 19% of full professors are women. Moreover, only 12% of internal medicine department chairs are female, and women lead a minority of general internal medicine or hospitalist divisions., 2 Given that women now constitute half of US medical school graduates, identifying strategies to support their career development in order to capitalize on the untapped leadership potential of this large segment of our health care workforce is critical. Other industries have addressed similar gender gaps in part by creating formal sponsorship programming. Academic medicine could follow suit. Specialty societies like the Society of General Internal Medicine (SGIM) are well-positioned to spearhead efforts to cultivate underutilized female talent by providing them the access to senior leaders and professional networks that is so important to advancement. We describe SGIM’s novel sponsorship initiative, the Career Advising Program, and how it might serve as a model for this type of endeavor. Attempts to improve the status of women in academic medicine must first account for their professional context. Perhaps because so few women are in leadership positions, certain biases may persist within organizations. Structural bias, also termed institutional bias, is the tendency for policies, procedures, or practices of an institution to advantage certain groups and potentially contributes to gender inequities in salary and research support within academic medicine. This disparity begins upon entry into the workforce through initial offers of lower-ranked positions (e.g., instructor in lieu of assistant professor), lower starting salaries, and smaller start-up packages. Implicit bias, or unconscious attitudes and stereotypes, is developed during childhood and informs assumptions about adult gender roles. Assumptions of women’s primary roles in child rearing or housekeeping, men’s superiority in leadership capability, or women’s inclination to work part-time are just a few examples. These implicit biases may influence whether women are considered for leadership responsibilities in the workplace and how fairly women’s contributions are appraised compared with those of their male counterparts. Finally, socialization and consistent discrimination may lead women to internalize some of these negative beliefs. After a professional lifetime of being marginalized, they themselves may feel inadequate and be less likely to seek leadership roles, self-nominate for committees, or negotiate for a fair salary. Sponsorship differs from mentorship in its focus on spotlighting and advocating for highly talented individuals. By definition, a sponsor must have significant organizational influence and a seat at the table where important decisions are made. A sponsor publicly advocates for his/her protegees with regard to competitive assignments, leadership opportunities, and high-impact committee membership. He or she also enhances a protegee’s credibility, visibility, and professional networks. In contrast, mentorship typically centers on personal and professional development, particularly related to skillbuilding and goal-setting. An effective mentor is a guide who takes time to listen, provide constructive feedback, and offer specific expertise. The impact does not necessarily depend on a mentor’s rank or position within an institution. Research from the business community demonstrates that sponsorship programming systematically enhances women’s ability to gain promotion, increases satisfaction with the rate of advancement, facilitates stretch assignments, creates upward pressure in pay, and improves gender parity in career advancement. As such, it may be an important strategy for mitigating the biases described above and accelerating women’s professional advancement within academic medicine. Since professional medical societies are an ideal platform for offering access to senior leaders and networks of colleagues, SGIM’s Women and Medicine Task Force launched a model sponsorship initiative, the Career Advising Program (CAP), in 2013. CAP is a longitudinal experience intended to foster advancement of women in medicine by helping female junior faculty successfully navigate the academic promotion process. Specific objectives focus on curriculum vitae preparation, highReceived August 23, 2016 Revised November 23, 2016 Accepted December 14, 2016 Published online January 3, 2017

Domestic violence: a clinical guide for women's healthcare providers

Domestic violence is common among obstetric and gynaecology patients and is a leading cause of maternal mortality. Reproductive coercion involves male attempts to control female fertility; long‐acting contraception should be considered in these cases. Past domestic violence and late booking for antenatal care are associated with abuse during pregnancy. Healthcare providers should ask women about domestic violence directly and in private, assess victims’ safety, offer referrals to community‐based organisations and document abuse in the hospital or office record (not necessarily in the hand‐held record).

Job Negotiations in Academic Medicine: Building a Competency-Based Roadmap for Residents and Fellows

Negotiation skills are critical to career success, yet many physicians feel ill-equipped to negotiate for professional opportunities. Enhancing competencies in this arena may be especially critical for women and underrepresented minorities to reduce disparities in compensation and resources that begin upon entry into the workforce as junior faculty. This perspective offers a comprehensive overview of negotiation strategies and the job search process for individuals finishing medical training and seeking first-time employment. First, we extrapolate lessons from clinical medicine to provide a negotiation roadmap for residents and fellows. We use both a clinical and an employment scenario to illustrate the concept of principled negotiation in which negotiating partners elicit each other’s values and interests and identify options for mutual gain. We then describe approaches to seeking and negotiating job opportunities and discuss typical timelines for these activities. We supply a list of professional needs to consider before a negotiation begins and introduce the concept of a best alternative to negotiated agreement to help ensure essential requirements are met in a final employment offer. Finally, we explore the utility of third-party assistance and published benchmarks and offer best practices for negotiating.Negotiation skills are critical to career success, yet many physicians feel ill-equipped to negotiate for professional opportunities. Enhancing competencies in this arena may be especially critical for women and underrepresented minorities to reduce disparities in compensation and resources that begin upon entry into the workforce as junior faculty. This perspective offers a comprehensive overview of negotiation strategies and the job search process for individuals finishing medical training and seeking first-time employment. First, we extrapolate lessons from clinical medicine to provide a negotiation roadmap for residents and fellows. We use both a clinical and an employment scenario to illustrate the concept of principled negotiation in which negotiating partners elicit each other’s values and interests and identify options for mutual gain. We then describe approaches to seeking and negotiating job opportunities and discuss typical timelines for these activities. We supply a list of professional needs to consider before a negotiation begins and introduce the concept of a best alternative to negotiated agreement to help ensure essential requirements are met in a final employment offer. Finally, we explore the utility of third-party assistance and published benchmarks and offer best practices for negotiating.

Intimate Partner Violence

Intimate partner violence (IPV) is characterized by a pattern of coercive behaviors (e.g., repeated battering and injury, psychological abuse, sexual