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OBJECTIVE: To identify the current challenges in obstetrics and gynecology residency education and propose solutions to overcome these obstacles. METHODS: The American College of Obstetricians and Gynecologists (ACOG) hosted the first National Summit on Women's Health on May 31 and June 1, 2017, with a follow-up meeting December 20-21, 2017, at ACOG headquarters in Washington, DC. Invitees from 20 related societies briefly presented their organizations' perspectives and discussed focused questions about specific challenges, proposed solutions, and anticipated obstacles. Finally, participants summarized their top two recommendations to improve current residency training. RESULTS: Summit participants identified four primary areas of focus: 1) align curriculum with relevant topics to practice, 2) ensure faculty have the necessary resources and time to teach effectively, 3) consider using the final months of medical school to get a jump start on residency fund of knowledge and skills, and 4) use better assessments during the course of residency. CONCLUSION: Representatives of the Council on Resident Education in Obstetrics and Gynecology, the American Board of Obstetrics and Gynecology, and the Accreditation Council for Graduate Medical Education must work together to address these priorities and reach consensus on the curricular content of core training in obstetrics and gynecology.
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Ginecología/tendencias , Obstetricia/tendencias , Ginecología/educación , Obstetricia/educación , Salud de la MujerRESUMEN
The practice of obstetrics and gynecology continues to evolve. Changes in the obstetrician-gynecologists workforce, reimbursement, governmental regulations, and technology all drive new models of care. The advent of the obstetric hospitalist is one new model, and the development of team-based care is another. Increasingly, obstetrician-gynecologists are becoming employees of health care delivery systems, and others are focusing the scope of their practices to subspecialites. As new practice models emerge, the specialty of obstetrics and gynecology will continue to change to meet the health care needs of women.
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Atención a la Salud/organización & administración , Ginecología/organización & administración , Fuerza Laboral en Salud/organización & administración , Modelos Organizacionales , Obstetricia/organización & administración , Atención a la Salud/métodos , Femenino , Ginecología/métodos , Médicos Hospitalarios/organización & administración , Humanos , Obstetricia/métodos , Grupo de Atención al Paciente/organización & administración , EmbarazoAsunto(s)
Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Federación Internacional para la Paternidad Responsable/legislación & jurisprudencia , Servicios de Salud Reproductiva/legislación & jurisprudencia , Servicios de Salud para Mujeres/legislación & jurisprudencia , Femenino , Humanos , Federación Internacional para la Paternidad Responsable/economía , Estados Unidos , Salud de la MujerRESUMEN
Deaths and injuries related to firearms constitute a major public health problem in the United States. In response to firearm violence and other firearm-related injuries and deaths, an interdisciplinary, interprofessional group of leaders of 8 national health professional organizations and the American Bar Association, representing the official policy positions of their organizations, advocate a series of measures aimed at reducing the health and public health consequences of firearms. The specific recommendations include universal background checks of gun purchasers, elimination of physician "gag laws," restricting the manufacture and sale of military-style assault weapons and large-capacity magazines for civilian use, and research to support strategies for reducing firearm-related injuries and deaths. The health professional organizations also advocate for improved access to mental health services and avoidance of stigmatization of persons with mental and substance use disorders through blanket reporting laws. The American Bar Association, acting through its Standing Committee on Gun Violence, confirms that none of these recommendations conflict with the Second Amendment or previous rulings of the U.S. Supreme Court.
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Política Pública , Heridas por Arma de Fuego/epidemiología , Heridas por Arma de Fuego/prevención & control , Armas de Fuego/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud , Humanos , Comunicación Interdisciplinaria , Notificación Obligatoria , Servicios de Salud Mental , Organizaciones , Relaciones Médico-Paciente , Sociedades , Estados Unidos/epidemiología , Violencia , Heridas por Arma de Fuego/mortalidadRESUMEN
Demographic changes across the country are leading to an increased proportion of older Americans. This shift will likely lead to changes in the patient population seen by obstetrician/gynecologists, and practices may need to adapt to the needs of older women. This article looks at mental health, sexual health, bone loss, cardiovascular disease and cancer as areas in which obstetrician/gynecologists may experience changes with the increasing age of patients. While this is by no means a comprehensive list of changing areas of practice, it offers a guide for reflecting on the future of obstetrician/gynecologists training, and the importance of considering the needs of older patients in practice.
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Envejecimiento/fisiología , Enfermedades Cardiovasculares/diagnóstico , Demencia/diagnóstico , Depresión/diagnóstico , Ginecología/tendencias , Neoplasias/diagnóstico , Osteoporosis Posmenopáusica/diagnóstico , Dinámica Poblacional , Disfunciones Sexuales Fisiológicas/diagnóstico , Anciano , Envejecimiento/psicología , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/terapia , Enfermedades Cardiovasculares/terapia , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/terapia , Demencia/terapia , Depresión/terapia , Femenino , Neoplasias de los Genitales Femeninos/diagnóstico , Neoplasias de los Genitales Femeninos/terapia , Humanos , Neoplasias/terapia , Osteoporosis Posmenopáusica/terapia , Rol del Médico , Salud Reproductiva , Disfunciones Sexuales Fisiológicas/terapia , Enfermedades de Transmisión Sexual/prevención & controlRESUMEN
Physician shortages and healthcare reform are important topics in the healthcare field today. The utilization of the skills and professional competencies of nonphysician healthcare providers, as well as collaboration between physicians and nonphysician healthcare providers may in part provide a solution to some current healthcare concerns. The purposes of this study were to describe the range of services provided by nonphysician women's healthcare providers (WHCPs), and to begin to explore the collaborative relationship between obstetrician-gynecologists (ob-gyns) and WHCPs. Questionnaires were sent to ob-gyns, certified nurse-midwives, certified midwives, nurse practitioners (NPs), and physician's assistants (PAs) with questions regarding the types of services WHCPs provide, as well as collaboration between ob-gyns and WHCPs. Overall, 62.1% of ob-gyns employ WHCPs. NPs are the most common type of WHCP employed in our sample. WHCPs are more likely to be younger than ob-gyns, and an overwhelming majority of WHCPs in our sample are female. Most reported that they are anticipating an expansion in the roles and services they provide over the next 5 years. In an era of healthcare reform, WHCPs may in part provide a solution to the growing physician shortage. Collaboration between ob-gyns and WHCPs is a key aspect of the changing healthcare environment.
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Personal de Salud/estadística & datos numéricos , Partería/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Salud de la Mujer , Conducta Cooperativa , Femenino , Ginecología/estadística & datos numéricos , Humanos , Obstetricia/estadística & datos numéricosRESUMEN
BACKGROUND: Despite research on health disparities based on insurance status, little is known about the differences in practice patterns among physicians who cater to privately and non-privately insured patients. The aim of this study was to assess how obstetrician-gynecologists (ob-gyns) who primarily see patients with private insurance differ from those who see mainly uninsured or publicly insured patients. This could be informative of the needs of these two groups of physicians and patients. METHODS: A questionnaire was mailed or emailed to 1,000 members of the American College of Obstetricians and Gynecologists, 600 of whom participate in the Collaborative Ambulatory Research Network. FINDINGS: A 56.4% response rate was obtained. Of the valid responders, the 335 reported providing care to a majority of patients with private insurance ("private group") and the 105 reported providing care to mostly publicly insured or uninsured patients ("non-private group") were included in our analyses. Differences between groups included that the private group was more likely to see patients before their becoming pregnant and spent more time on well-woman care. The private group was more likely to see patients who are White, Asian, or between the ages of 45 and 64. The non-private group was more likely to see Hispanic patients and those under age 18. CONCLUSION: Results reveal that ob-gyns who see mostly privately insured patients have different clinical experiences than those who see mainly uninsured or publicly insured patients in terms of patient characteristics, preconception care, distribution of time on activities, and the of likelihood performing certain procedures and screening tests.
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Cobertura del Seguro , Seguro de Salud , Pacientes no Asegurados , Pautas de la Práctica en Medicina , Adulto , American Medical Association , Femenino , Ginecología , Disparidades en Atención de Salud , Humanos , Medicare , Obstetricia , Atención Preconceptiva , Embarazo , Sector Privado , Sector Público , Encuestas y Cuestionarios , Estados UnidosAsunto(s)
Regulación Gubernamental , Legislación Médica , Relaciones Médico-Paciente , Aborto Legal/legislación & jurisprudencia , Revelación/legislación & jurisprudencia , Armas de Fuego/legislación & jurisprudencia , Humanos , Política , Cuidado Terminal/legislación & jurisprudencia , Estados UnidosRESUMEN
The recent focus on health care safety is a response to the central ethical tenet of medicine--to do no harm. The delivery of safe hospital care has led to demonstrable reductions in medical errors, adverse events, and patient injuries. These improvements have led to a commensurate reduction of legal risk and the emotional toll on caregivers as well as families. It also has reinvigorated the reason many physicians went into medicine--to make a difference for women's health. The new, voluntary Safety Certification in Outpatient Practice Excellence (SCOPE) for Women's Health program of the American Congress of Obstetricians and Gynecologists is a means to both evaluate and recognize work in a critical but often neglected arena--the outpatient setting. It builds on infrastructure created for safety programs in hospital settings. Strong physician leadership, the development of an office culture committed to safety, communication and teamwork skills, safety programs for office-based surgery, medication safety, and tracking systems are all important for safe treatment of our patients in the office setting. The SCOPE Program defines the necessary safety goals for ambulatory women's health care and provides an educational pathway to reach those goals. SCOPE certification is an achievement recognizing the commitment of physicians and their staff to the health and safety of their patients.
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Seguridad del Paciente , Salud de la Mujer/normas , Atención Ambulatoria/normas , Femenino , Ginecología/organización & administración , Humanos , Obstetricia/organización & administraciónRESUMEN
The American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society of Clinical Pathologists have released revised consensus recommendations for cervical cancer screening. These new recommendations integrate molecular testing and include significant changes in screening, particularly in women from 30 to 65 years of age without complications who now may be screened every 5 years by co-testing with cervical cytology and high-risk human papillomavirus testing and women 21-29 years who may be screened with cervical cytology alone every 3 years. The revised recommendations include clarification on when to start and stop screening and management of women who have undergone hysterectomy. They also clarify the management of results of co-testing. The new recommendations achieve the same degree of protection against cervical cancer as previous recommendations. They require less screening and will be much more convenient for our patients. They are a further step away from the days of annual Pap tests, and the decreased requirements for cervical cancer screening pose an exciting opportunity for focusing on many other important health issues during the well woman visit.
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Ginecología/tendencias , Infecciones por Papillomavirus/diagnóstico , Neoplasias del Cuello Uterino/diagnóstico , Frotis Vaginal/tendencias , Femenino , HumanosRESUMEN
INTRODUCTION: Obstetrician-gynecologist faculty workforce studies have been limited to faculty at university training programs. Not much is known about the obstetrician-gynecologist faculty workforce at community programs. METHOD: This study assessed the obstetrician-gynecologist faculty workforce in community training programs via administering surveys to the department chairs. The questionnaire assessed number of current faculty by degree, work status (part-time/full-time), rank, and sub-specialty. Out of 125 programs, 65 responded (52% response rate). RESULTS: The mean number of full-time faculty per department in community hospitals was 17 faculty. Two-thirds of community department chairs anticipated an increase in full-time faculty and 43% anticipated an increase in part-time faculty. Like university programs, sub-specialists and Professors (compared to generalists and assistant professors) were more likely to be male. CONCLUSION: There are similarities between the community and university faculty workforce, many of the community program faculty are involved in research. Given the evolving clinical, educational, and research demands on community faculty, it is important to continue to monitor and study community program faculty.
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OBJECTIVE: To describe the practices of obstetrician-gynecologists who provide routine gynecological care and assess the relative importance of well-woman care to their training and practices. METHODS: A questionnaire was mailed to 1000 members of the American College of Obstetricians and Gynecologists, of whom 600 participated in the Collaborative Ambulatory Research Network. RESULTS: The response rate was 57%. Of these, 403 respondents providing routine obstetric and gynecologic care (OB&Gyn) are included. Obstetricians-gynecologists spend the majority of their time on labor/delivery (22%) followed by well-woman care (14%). It was found that 26% of the respondents rarely or never discuss sexual abuse or domestic violence with non-pregnant patients and only 19% always discuss folic acid with non-pregnant patients during well-woman care. Most (71%) say that 50% or more of their pregnant patients initially contact them once they are pregnant. Respondents rated their training in well-woman care least strong of several areas listed. CONCLUSION: Obstetrician-gynecologists devote a substantial proportion of work time to providing well-woman care, though some important topics are not addressed and training in this area was rated least strong.
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Ginecología/métodos , Obstetricia/métodos , Atención Preconceptiva/estadística & datos numéricos , Práctica Profesional , Salud de la Mujer , Adulto , Violencia Doméstica/prevención & control , Violencia Doméstica/estadística & datos numéricos , Educación Médica/métodos , Educación Médica/estadística & datos numéricos , Educación Médica/tendencias , Femenino , Ginecología/educación , Ginecología/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Obstetricia/educación , Obstetricia/estadística & datos numéricos , Relaciones Médico-Paciente , Atención Preconceptiva/métodos , Embarazo , Atención Prenatal/métodos , Atención Prenatal/estadística & datos numéricos , Práctica Profesional/tendencias , Encuestas y Cuestionarios , Salud de la Mujer/estadística & datos numéricos , Salud de la Mujer/tendenciasRESUMEN
UNLABELLED: Obstetricians-gynecologists (ob-gyns) are frequently confronted with situations that have ethical implications (e.g., whether to accept gifts or samples from drug companies or disclosing medical errors to patients). Additionally, various factors, including specific job-related tasks, costs, and benefits, may impact ob-gyns' career satisfaction. Ethical concerns and career satisfaction can play a role in the quality of women's health care. This article summarizes the studies published between 2005 and 2009 by the Research Department of the American College of Obstetricians and Gynecologists, which encompass ethical concerns regarding interactions with pharmaceutical representatives and patient safety/medical error reporting, as well as ob-gyn career satisfaction. Additionally, a brief discussion regarding ethical concerns in the ob-gyn field, in general, highlights key topics for the last 30 years. Ethical dilemmas continue to be of concern for ob-gyns. Familiarity with guidelines on appropriate interactions with industry is associated with lower percentages of potentially problematic relationships with pharmaceutical industries. Physicians report that the expense of patient safety initiatives is one of the top barriers for improving patient safety, followed by fear of liability. Overall, respondents reported being satisfied with their careers. However, half of the respondents reported that they were extremely concerned about the impact of professional liability costs on the duration of their careers. Increased familiarity with guidelines may lead to a decreased ob-gyn reliance on pharmaceutical representatives and free samples, whereas specific and practical tools may help them implement patient safety techniques. The easing of malpractice insurance and threat of litigation may enhance career satisfaction among ob-gyns. This article will discuss related findings in recent years. TARGET AUDIENCE: Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVES: After the completing the CME activity, physicians should be better able to analyze how interactions with pharmaceutical industry may pose ethical dilemmas, examine current barriers to implementing patient safety initiatives, and evaluate the factors that influence career satisfaction among obstetrician-gynecologists.
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Ginecología/ética , Satisfacción en el Trabajo , Obstetricia/ética , Industria Farmacéutica , Guías como Asunto , Humanos , Seguro de Responsabilidad Civil , Responsabilidad Legal , Errores Médicos/ética , Seguridad del Paciente , Estados UnidosRESUMEN
BACKGROUND: Many mental illnesses are more prevalent in women than men (e.g., depression). Obstetrician-gynecologists (ob-gyns) are frequent medical contacts for women, and so can play an important role in screening for mental illness. METHODS: This review summarizes studies published between 2005 and 2009 by the Research Department of the American College of Obstetricians and Gynecologists that encompass depression, anxiety, and eating disorders (EDs). RESULTS: Ob-gyns were more accurate in identifying depression than anxiety. Treatment with antidepressants was reported as a course of action twice as often as referral to a mental health professional. Physicians were moderately confident that they could recognize anxiety, but were less confident regarding treatment. One-fifth routinely screen pregnant patients for anxiety; level of interest in anxiety was the only significant predictor of screening rates. The main barriers to anxiety screening in pregnancy were time constraints and perceived inadequate training. Almost all believed EDs can harm pregnancy outcome, although few ask about ED histories. Only half view assessment of ED as within routine ob-gyn practice. Those who self-identify as primary care providers, and those who more strongly believe EDs can harm pregnancy outcomes, agreed more strongly that ED assessment is within their role. Ob-gyns perceived training regarding EDs to be poor. Knowledge of risks associated with EDs was low. CONCLUSIONS: Ob-gyns view mental health issues as important topics; however, they are not confident in their abilities to diagnose these conditions and are also concerned about the adequacy of their training. Additional training could prepare ob-gyns to incorporate mental health screening into their practices. TARGET AUDIENCE: Obstetricians & gynecologists, family physicians. LEARNING OBJECTIVES: After completion of this educational activity, the obstetrician/gynecologists should be better able to evaluate their role relative to diagnosing and treating mental illness; state the negative consequences and signs of major depressive disorder, anxiety, eating disorder, and premenstrual dysphoric disorder (PMDD) in women; examine their peers' attitudes, referral patterns, and preferred treatment methods for mental disorders; and prevent negative health consequences for women and babies resulting from mental illnesses.
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Ansiedad/diagnóstico , Depresión/diagnóstico , Trastornos de Alimentación y de la Ingestión de Alimentos/diagnóstico , Ginecología , Obstetricia , Complicaciones del Embarazo/psicología , Ansiedad/tratamiento farmacológico , Actitud del Personal de Salud , Depresión/tratamiento farmacológico , Trastornos de Alimentación y de la Ingestión de Alimentos/terapia , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Pautas de la Práctica en Medicina , Embarazo , Derivación y ConsultaRESUMEN
OBJECTIVE: To estimate obstetrician-gynecologists' attitudes and management practices regarding well-woman care. METHODS: A questionnaire was mailed to 1,000 members of the American Congress of Obstetricians and Gynecologists, 600 of whom participate in the Collaborative Ambulatory Research Network. RESULTS: The response rate was 57%. Of these, 513 (91%) respondents provide routine gynecologic care and are the focus of the study. Most obstetrician-gynecologists include an examination of the abdomen (97%) and thyroid and neck (92%) during a well-woman examination, although fewer conduct skin (73%) or mouth (19%) surveys. Asked how they would most likely treat several conditions in nonpregnant patients, respondents would prescribe medications for menopausal issues (69%), hormone therapy (73%), and for generalized anxiety disorder (39%), and they would refer patients to a primary care physician for high blood pressure (73%) and high cholesterol (65%). Female and younger respondents were more likely than male and older respondents to refer patients for several nonreproductive health conditions and were less likely to personally treat them. A majority (61%) of obstetrician-gynecologists define well-woman care within the context of gynecologic practices as care related to overall health and primary care rather than care limited to reproductive health (39%); this majority was less likely to agree that obstetrician-gynecologists should limit their care to reproductive health (15% compared with 62%) and more likely to personally treat most nonreproductive health issues than were those who see care as limited to reproductive health. CONCLUSION: The majority of obstetrician-gynecologists define well-woman care as overall health and primary care, and their opinions and practices reflect this. LEVEL OF EVIDENCE: III.