Karen M. Schneider

Burnout in residency: a statewide study.

Objective: To determine the prevalence of burnout in residents in obstetrics and gynecology through the use of a validated tool. Methods: The Maslach Burnout Inventory Human Services questionnaire is a previously validated tool that measures burnout. Obstetrics and gynecology residents from Texas were invited to participate in this study in 2002. The Maslach Burnout Inventory Human Services questionnaire and a demographic survey were distributed to each resident. Responses were anonymous and returned by mail. Contingency coefficient and χ2 tests were used for analysis; values of P < 0.05 were significant. Results: Residents (n = 368) from 17 programs in Texas were surveyed. Responses were received from 14 programs (82.4%), with 136 surveys (37%) returned. Overall, 38.2% reported high emotional exhaustion, 47.1% reported high depersonalization, and 19.1% reported reduced personal accomplishment. The number of residents experiencing true burnout (high emotional exhaustion, high depersonalization, and low personal accomplishment) was 17.6% (n = 24). Conclusions: High levels of emotional exhaustion and depersonalization occur in some residents. Burnout in residents included in this study was approximately 18%.

Work hours for practicing obstetrician-gynecologists: The reality of life after residency

Abstract Objective Recently the Accreditation Council for Graduate Medical Education placed restrictions on all residency programs that limited work hours to 80 hours per week. The objective of this study was to determine the work hours for practicing obstetrician-gynecologists in an urban center. Study design A questionnaire about physician demographics and work hours was mailed to all obstetrician-gynecologists in Houston in June 2002. χ 2 testing was used for statistical analysis. Results One hundred eighty-nine surveys were mailed. One hundred surveys (56%) were returned complete and analyzed. Sixty-two physicians reported working >80 hours per week. Physicians were more likely to work >80 hours per week if they were men or if they were >50 years old. Marital status and having children living at home did not affect work hours. Conclusion Most obstetrician-gynecologists in Houston work longer hours than the number of hours that is imposed by the Accreditation Council for Graduate Medical Education resident work hour guidelines.

Clinical Perspectives on the Role of the Human Papillomavirus Vaccine in the Prevention of Cancer

The role of human papillomavirus (HPV) in the genesis of cervical cancer has been well documented, and an increasing body of literature exists with regard to the role of HPV in other cancers, including cancers of the head and neck. With the recent expansion of the United States Food and Drug Administrations approval of the quadrivalent HPV virus‐like particle vaccine to include men and boys and approval of the bivalent vaccine this year, the controversies regarding who should be vaccinated, at what age is vaccination most appropriate, and the limitations of the available HPV vaccines are increasing. Health care providers are challenged with evaluating the current, but continually changing, clinical evidence when making critical decisions for their patients. A literature search of MEDLINE and SciVerse Scopus was conducted for articles published from 1998–April 2010 regarding HPV, HPV‐related cancers, and HPV vaccines. Although both HPV vaccines were greater than 90% effective in the prevention of cervical cancer precursors in an according‐to‐protocol cohort, both vaccines were significantly less effective in the intent‐to‐treat population. In patients who achieved seroconversion, the geometric mean titers decrease dramatically within the first 2 years after vaccination, and then continue to decline at a slower rate. No effective antibody titer has been defined for either vaccine, and no studies have been conducted with documented HPV exposure after vaccination. With low efficacy rates in an intent‐to‐treat population and the potential for waning immunity, it is imperative for women to continue to receive regular Pap tests and gynecologic examinations. Although vaccine administration was shown to be cost‐effective when administered to adolescent girls, many of these simulations overestimated the durability of protection, efficacy rates in sexually active women, impact of incomplete vaccination, or necessity of boosters in the future. Whereas the introduction of the HPV vaccine was an enormous advancement in the cancer prevention research arena, optimization of its clinical use is still needed.

Job satisfaction among program directors in obstetrics and gynecology: a national portrait.

OBJECTIVES The purpose of this study was to determine job satisfaction among program directors in obstetrics and gynecology with the use of a validated tool and to identify specific sources of dissatisfaction that might lead to job change. STUDY DESIGN The program director satisfaction and a global job satisfaction survey were sent to all program directors in the United States. Motivators for seeking a job change were assessed. The chi(2) test, Kruskal-Wallis test, correlation analysis, and multiple linear regression were used. RESULTS Seventy percent of 254 surveys were completed. Global job satisfaction (minimum, 4; maximum, 16) was 11.9+/-2.9; mean program director satisfaction score was 135+/-25.8 (minimum, 54; maximum, 200). Job satisfaction was highest in chairs, full professors, those whose age was >50 years, and those with >5 years of experience (P=.02) and in facets that were related to work with residents, colleagues, and patients. Dissatisfaction was highest with regard to salary, promotion opportunities, and resources. Forty-six percent of those who responded were considering a job change in 3 years; the most common reason for a job change that was cited was administrative hassles. CONCLUSION Although job satisfaction is high among program directors, administrative hassles may lead to high rate of rapid turnover.

Racial bias in patient selection of an obstetrician.

Objective: The objective of this study was to determine racial bias in patient selection of an obstetrician. Methods: Obstetrical patients referred for genetic counseling at a community hospital were included. Self-reported patient race/ethnicity were compared with obstetricians race/ethnicity. Results: The patient population (n = 1,519) was 27.8% white, 25% Hispanic, 22.5% black, 20.5% Asian, and 4.3% other. Physician race/ethnicity was 47.8% white, 28.8% Asian, 14.4% Hispanic, and 9% black. Patient race/ethnicity and physician race/ethnicity were correlated (contingency coefficient = 0.54, P < 0.001). White and Asian patients were more likely to select obstetricians of their own racial background (72.7% and 66.6%) than were Hispanic or black patients (36% and 24.6%, P < 0.001). Patients of all races were more likely to be under the care of a physician of their own race than of a different race. Conclusions: In an urban community with a racially diverse population, there is a strong racial bias in patient selection of an obstetrician.

Seasonal variation in medical student experience in an obstetrics and gynecology clerkship.

OBJECTIVE Our objective was to determine whether the medical student clinical experience varies during the academic year. STUDY DESIGN Third-year medical students completing their obstetrics and gynecology clerkship were asked to complete a questionnaire about their clinical experience. The survey evaluated their experience with examinations and procedures using Likert-scale responses. The study was approved by the local institutional review board. RESULTS A total of 90.5% of the students completed the questionnaire. Statistically more procedures were performed in the middle and late time periods than early in the year. This included the number of cervical examinations (P < or = .001), speculum examinations (P < or = .05), delivery of placentas (P < or = .001) and partial delivery of infant with delivery of placenta (P < or = .01), partial repair of an episiotomy (P < or = .01), and number of ultrasounds (P < or = .05) performed by the students. CONCLUSION For some obstetrical and gynecological procedures, student hands-on experience increased during mid- and late-year clerkship rotations.