Karen E. Adams

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.

How resident unprofessional behavior is identified and managed: a program director survey

OBJECTIVE To determine how unprofessional behavior by residents is identified/ managed within residency programs, and under what conditions concerns are communicated to potential employers. STUDY DESIGN A web-based survey was emailed to 241 directors of US obstetrics and gynecology residency programs. RESULTS 141 program directors (PDs) responded (58%). 84% of PDs indicated that problems with professionalism most commonly come to their attention through personal communication. Methods of addressing the problem included expression of expectation of improvement (95%), psychological counseling (68%), placing resident on probation (59%), and dismissal (30%). The majority of PDs felt remediation was not completely successful. All PDs are willing to communicate professionalism concerns to potential employers, but 42% provide this information only if asked. CONCLUSION Resident unprofessional behavior is a common problem for program directors, and remediation is challenging. PDs are willing to express concerns to potential employers, but a significant percentage indicate concerns only if asked.

Physician reentry: A concept whose time has come

Three retrainees were accepted into an innovative program designed to refresh skills to return physicians to the obstetrics and gynecology workforce after a voluntary leave of absence. The program was constructed in such a way that it did not affect existing training opportunities for medical students and residents. A protocol for application and acceptance was developed that incorporated an admissions committee and a fellowship director. The need for such retraining programs and considerations in structuring, including candidate selection, faculty involvement and support, needs assessment and curriculum development, and a protocol for administration are presented. It is hoped that other training programs with experienced educators and a surplus of clinical cases will use our model to establish their own physician reentry programs, returning these valuable members of the physician workforce to practice.

Applying to subspecialty fellowship: clarifying the confusion and conflicts!

Of graduating obstetrics and gynecology residents, 40% apply for fellowship training and this percentage is likely to increase. The fellowship interview process creates a substantial financial burden on candidates as well as significant challenges in scheduling the multiple interviews for residents, residency programs, and fellowship programs. Coverage with relatively short lead time is needed for some resident rotations, multiple residents may request time off during overlapping time periods, and applicants may not be able to interview based on conflicting interview dates or the inability to find coverage from other residents for their clinical responsibilities. To address these issues, we propose that each subspecialty fellowship within obstetrics and gynecology be allocated a specified and limited time period to schedule their interviews with minimal overlap between subspecialties. Furthermore, programs in close geographic areas should attempt to coordinate their interview dates. This will allow residents to plan their residency rotation schedules far in advance to minimize the impact on rotations that are less amenable to time away from their associated clinical duties, and decrease the numbers of residents needing time off for interviews during any one time period. In addition, a series of formal discussions should take place between subspecialties related to these issues as well as within subspecialties to facilitate coordination.

Ethical and Legal Considerations of Donor Insemination in the United States

Donor insemination (DI) for humans was first reported in 1884, when not even the mother of the child conceived was informed that she had been inseminated with the sperm of another man (1). In 1945, Mary Barton, a gynecologist, published an article in the British Medical Journal about her DI program that copied the already established veterinary practice in animal husbandry (2) and was met with outrage and widespread condemnation of the practice. In response to Barton’s article, committees investigating DI generally recommended that it be considered a criminal offense (3). Reasons for rejecting the procedure included religious concerns, fears of eugenic implications, and the association of DI with agriculture (4). Sperm donors were viewed with suspicion, and the technique remained burdened in secrecy for four decades. It was not until the latter half of the 20th century that a rapid growth occurred in the use of DI for family building (5). By 1988, approx 80,000 women per year utilized DI, and more than 30,000 children were born each year in the United States (6). Despite the widespread use of DI, the majority of adults and children conceived are unaware that the person they know as their father is not their genetic parent. Secrecy continues to surround the practice of DI.