Douglas W. Laube

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.

Can a structured, behavior-based interview predict future resident success?

OBJECTIVE To determine whether a structured, behavior-based applicant interview predicts future success in an obstetrics and gynecology residency program. STUDY DESIGN Using a modified pre-post study design, we compared behavior-based interview scores of our residency applicants to a postmatch evaluation completed by the applicants current residency program director. Applicants were evaluated on the following areas: academic record, professionalism, leadership, trainability/suitability for the specialty, and fit for the program. RESULTS Information was obtained for 45 (63%) applicants. The overall interview score did not correlate with overall resident performance. Applicant leadership subscore was predictive of leadership performance as a resident (P = .042). Academic record was associated with patient care performance as a resident (P = .014), but only for graduates of US medical schools. Five residents changed programs; these residents had significantly lower scores for trainability/suitability for the specialty (P = .020). CONCLUSION Behavioral interviewing can provide predictive information regarding success in an obstetrics and gynecology training program.

Primary care in obstetrics and gynecology resident education : A baseline survey of residents' perceptions and experiences

OBJECTIVE To determine the perceptions and practices of American obstetrics and gynecology residents concerning primary care immediately before the institution of Residency Review Committee Special Requirements for Obstetrics and Gynecology. METHODS The Council on Resident Education in Obstetrics and Gynecology In-Service Examination in 1995, given to 4361 residents, who represented all programs in the country, included a questionnaire on whether obstetrics and gynecology was primary care and whether they planned to do primary care after residency. Primary care services were categorized by counseling and screening, as defined by the U.S. Preventive Health Services Task Force. Variables included gender, residency level (upper or lower), and type of residency (community or university based). Data were analyzed using the chi2 text and multiple analyses of variance. RESULTS The response rate was 94% (4099 of 4361), representing a nationwide complement. Eighty-seven percent of the respondents believed that obstetrics and gynecology was primary care and 85% planned to practice accordingly after residency. Residents spend less than 25% of their time counseling on nongynecologic subjects and less than 25% of their time screening for nongynecologic entities, so their perception as primary care providers focused on traditional obstetric and gynecologic counseling and screening services. When assessments were made by gender, level of training, and type of residency, significant differences were found in many variables regarding counseling and screening practices. CONCLUSION Our survey results suggest that most American obstetrics and gynecology residents consider obstetrics and gynecology primary care but that there were limitations in the educational venues for learning about nongynecologic primary care before the implementation of the Residency Review Committee Special Requirements. Improvement in nongynecologic primary care teaching is a reasonable expectation because residency programs have had 3 years to institute the mandated changes and provide it to residents.

Cosmetic Therapies in Obstetrics and Gynecology Practice : Putting a Toe in the Water?

A obstetricians and gynecologists capable of providing cosmetic therapy as women’s health care physicians? I believe it is time that our specialty assesses the issue directly with as much objectivity as possible. This aspect of health care is not addressed in the reproductive health care literature frequently read by our obstetric and gynecologic colleagues, yet women provide the patient base for the majority of Americans who are interested in cosmetic therapy. Obstetricians and gynecologists are more frequently encountering patients who are interested in esthetic treatment, and a growing number of them are beginning to offer some of these treatments as part of their practice. A variety of influences have a bearing on whether the obstetrician– gynecologist can or should provide cosmetic therapy for women. These issues include a rapidly growing consumer demand, a relatively small number of practitioners in other specialties who are certified to provide these therapies, the education and training necessary to provide quality care, the potential for increased physician liability, the economic sustenance of an obstetric or gynecologic practice as a business strategy, and the ethical framework in which such practice might be defined.

Maternal healthcare needs assessment survey at Rabia Balkhi Hospital in Kabul, Afghanistan

Since the Department of Health and Human Services chose Rabia Balkhi Hospital (RBH) in Kabul, Afghanistan, as a site for intervention in 2002, the status of womens health there has been of interest. This study created a tool to assess accessibility and quality of care of women admitted from May to July, 2005.

Physician accountability and taking responsibility for ourselves: washing the dirty white coat, one at a time.

P physician accountability lies at the core of medical professionalism. The last few years have brought into focus the need for assessing and documenting competency by the Liaison Committee for Medical Education in medical schools and the Accreditation Council for Graduate Medical Education (ACGME) for residency programs. Practicing physicians work under 50 separate jurisdictions which are, by and large, ineffective to deal with all but the most egregious behaviors, so that it takes felony acts, multiple malpractice occurrences, or both to place an individual in the National Practicioner Data Bank. State Board actions thus become the end point of poor professional behavior rather than the guardian of the public good through continual assessment of professionalism. In turn, this should generate the need for much more thorough assessment of professionalism begun much earlier (in medical school and through residency) and with more consequence attached, such as failures in coursework, nonpromotion, lack of certification, and limited licensure or even non-licensure. States then will need to take a hard look at a physician’s record of professionalism, which will, in turn, have begun in medical school, continued through residency and into practice, eventuating with a strict Maintenance of Licensure. This is a difficult scenario to envision as numerous barriers will need to be overcome, not the least of which are imposed by a economically driven health care system embracing profits over principle coupled with a stifling legal climate in which the aggrieved can disappear amid volumes of legal gibberish. Oversight officials cave in to less expensive settlements while poor professional behavior goes unchecked. Educational institutions are now challenged with providing evidence that programs are making datadriven improvements by documenting learner performance. Of the six prescribed competency domains including patient care, medical knowledge, practice base learning and improvement, interpersonal and communication skills, professionalism, and systemsbased practice, the most difficult to document are those involving interpersonal and communication skills and professionalism. Historically, the heart of the medical education system for measuring physician achievement has been in the assessment of medical knowledge, the most easily documented aspect of physician achievement through standardized testing. As such, medical knowledge has been taken as a surrogate for defining competent physicians and educational institutional excellence by those responsible for accreditation, licensure, certification, and recertification. Although medical knowledge is important to provide good patient care, equally important are professionalism and communication skills necessary to be good doctors. An earlier article discussed aspects of professionalism, quality care, and professional self-regulation.1 The authors made reference to professional liability issues revolving around high-claim physicians and their failure to communicate to or show lack of respect for patients and their families. While assessing quality outcomes and meeting expected academic standards are important, additional areas related to the selection and assessment of individual behaviors are also important as a matter of risk management as they relate to professionalism and ethical behavior. Various models of accountability in health care have been developed to include the professional model that guides the physician–patient relationship, Corresponding author: Douglas W. Laube, MD, MEd, University of Wisconsin Medical School, Department of Obstetrics and Gynecology, 1 South Park Street, Suite 555, Madison, WI 53715; e-mail: dwlaube@wisc.edu.

Transcending politics to promote women's health.

To the Editor: We applaud the editors of Obstetrics & Gynecology for publishing “Transcending Politics to Promote Women’s Health.” Dr. Colleen McNicholas makes a persuasive case against the rash of dangerous legislation offered by politicians across the country that interferes with our practices. She points out that such legislation “is clearly not about what is right for the patient but instead about creating obstacles based on ideologic differences.” This month, the American Congress of Obstetricians and Gynecologists (ACOG) took strong steps to make this same case in an open letter to the Texas legislature that called out all of the medical mistruths in the bills to restrict abortion that they have been debating. For those ACOG members who agree with these arguments and who feel moved to action, we want to let you know about the work we do. At Physicians for Reproductive Health, we train doctors to serve as lifelong advocates for comprehensive reproductive health care. Dr. McNicholas is a superb example of our work, as she has gone through our Leadership Training Academy. In this intensive program, we provide skills in talking to state and federal representatives, media training from on-camera interviewing to writing letters to the editor, as well as tools on how to organize within medical and educational institutions to promote sound reproductive health policies. For our graduates, we foster a national network that provides camaraderie and community as we advocate for our patients and for sound, evidence-based practice. We know that entering into the advocacy arena can be a new and intimidating experience. We became doctors to practice medicine, not knock on the doors of legislators. But given the outrageous, unscientific dictates being placed on us by politicians, it is imperative that more physicians speak up. Our patients need our voices to protect them. Our professional integrity and sound science must be defended. We encourage all our colleagues to join their voices with ours and with ACOG’s to ensure that our patients have the best care, free of dangerous legislative interference.

Preface: Cosmetic procedures in gynecology.

This issue describes cosmetic procedures that can be incorporated into gynecologic practice successfully by additional education and training that is readily available through credible post residency educational programs. While it is recognized that typical post graduate training in obstetrics and gynecology does not provide adequate preparation for the inclusion of cosmetic therapies into safe, quality practice, many obstetricians/gynecologists also recognize that there is not only demand by patients, but also other compelling reasons to consider including these procedures into their scope of practice. In addition to a rapidly growing consumer demand, there are other issues that may affect the obstetrician/gynecologist’s decision to learn and provide these treatments, including an ever-expanding unfavorable medical legal climate in providing traditional obstetric and gynecologic services, and the enhanced ability to provide economic sustenance to one’s practice. The scope of practice for the obstetrician/gynecologist has historically included more than reproductive health care, as practitioners have treated such conditions as adolescent pustular acne, hirsuitism, scalp hair loss, and a variety of minor, but unsightly skin lesions. Although the American College of Obstetricians and Gynecologists does not define for the practitioner what her or his scope of practice should be, cosmetic therapy per se is not necessarily excluded provided that the provider has adequate training and experience and functions within an acceptable ethical framework. It would be naı̈ve to assume that financial incentive is not taken into account by the practitioner in considering this type of practice, as consumer demand, industry incentives focused on new devices, and the prospects of a “cash-only” revenue stream have much appeal at a time of diminished revenue through third-party payers. Financial gain

Primary Care in Obstetrics and Gynecology: Health Maintenance and Screening

Within a rapidly changing political and economic environment lies the fundamental need to provide continuity of patient care to decrease morbidity and mortality. Not all women need the same care and an attempt should be made by the clinician to focus on issues specific to high-risk categories and age-related variables (Tables 1.1-1.5). Additionally, scientific and economic documentation of the effectiveness of medical care has become an important issue in both clinical settings and policy-making situations. These concepts will also dictate physician reimbursement.