Louis Weinstein

Improving patient safety and uniformity of care by a standardized regimen for the use of oxytocin

Oxytocin is 1 of the most commonly used drugs in labor and has been associated with adverse maternal and fetal outcomes. In an attempt to improve patient safety, we constructed a standardized protocol for labor induction with oxytocin. We reviewed the numerous publications regarding oxytocin use for either induction or augmentation of labor in order to determine if there was a protocol available that would maximize success of delivery and minimize the adverse maternal and fetal effects of the drug. Using the literature review and the specific pharmacokinetics of oxytocin, we developed a standardized approach for the dilution and administration of oxytocin in order to improve patient safety, develop uniformity of the drug use, maximize its benefits, and minimize its side effects. We suggest that a standardized approach to oxytocin use be adopted that uses an oxytocin dilution of 10 mU/mL, initial dose of 2 mU/min (12 mL/hr), incremental increase of 2 mU (12 mL) every 45 minutes until adequate labor with the maximum dose being 16 mU/min (96 mL/hr).

Survey of obstetric and gynecologic hospitalists and laborists

OBJECTIVEnThe objective of the study was to obtain descriptive information about obstetricians/gynecologists who currently are practicing as hospitalists or laborists.nnnSTUDY DESIGNnA survey was emailed to all actively practicing member Fellows of the American College of Obstetricians and Gynecologists in April 2009. A second emailing of the survey was sent in May 2009.nnnRESULTSnObstetrician/gynecologist hospitalists and laborists are significantly younger than the rest of the obstetrician/gynecologist sample by age and years in residency and have a high rate of career satisfaction. There was a great deal of variation in work schedules and compensation of the respondents.nnnCONCLUSIONnWe analyzed the rapidly growing hospitalist/laborist model of care within the obstetrician/gynecologist specialty. The laborists and hospitalists model provides an alternative type of practice for obstetricians/gynecologists, and it is associated with high career satisfaction. It is important that we continue to monitor the needs of this burgeoning field of clinical practice.

A unique solution to solve the pending medical school tuition crisis

The increasing cost of undergraduate medical education and the decreasing availability of financial aid have resulted in the accumulation of a large debt for medical students that requires a reasonable solution. After reviewing suggested solutions to alleviate medical student debt, we have developed a unique proposal. The Strategic Alternative for Funding Education (SAFE) has the practicing physician pay for his or her medical school education after completion of residency/fellowship over a 10-year time interval when income will likely be rising. The amount paid yearly is calculated as a percent of the physicians professional income. A strategic alternative for funding education has the potential to alleviate the pending crisis in medical student debt, allows medical schools to compete for students based on the educational experience offered, and allows a student of any socioeconomic status to attend medical school and choose a medical specialty based solely on ability and desire.

Faculty Satisfaction and Retention in Obstetrics and Gynecology

Given the resources that medical schools expend in developing their faculty, the academic medicine community has a longstanding interest in faculty satisfaction and retention. This chapter investigates retention rates of first-time assistant professors in obstetrics and gynecology (i.e., faculty with no prior appointments at or above the rank of assistant professor) compared with other core clinical specialties.

A SPECIAL programme to revitalise the senior physician while improving the clinical education and mentoring of medical students and residents

The clinical practice and teaching of medicine to residents and students has changed dramatically during my 35-year academic career. Medical school faculties have incurred a noticeable increase in demands for clinical and research productivity with both functions having a huge impact on their time available for teaching/ mentoring. The increasing lack of control over the daily work environment of practicing physicians has resulted in a negative impact on their physical and mental health. This, along with a noticeable decrease in life and job satisfaction, has become the leading cause for the epidemic of burnout (Weinstein et al. Obstet Gynecol 2007;109:1181–3). Similar findings resulting in the phenomena of burnout are seen in a recent survey of UK physicians (Orton et al. BMJ Open 2012;2:e000274).