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This article is from the 'To The Point' series from the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee. The purpose of this review is to provide an understanding of the differing yet complementary nature of interprofessional collaboration and interprofessional education as well as their importance to the specialty of Obstetrics and Gynecology. We provide a historical perspective of how interprofessional collaboration and interprofessional education have become key aspects of clinical and educational programs, enhancing both patient care and learner development. Opportunities to incorporate interprofessional education within women's health educational programs across organizations are suggested. This is a resource for medical educators, learners, and practicing clinicians from any field of medicine or any health-care profession.

This article, from the "To the Point" series by the Undergraduate Medical Education Committee of the Association of Professors of Gynecology and Obstetrics, is a guide for advising medical students applying to Obstetrics and Gynecology residency programs. The residency application process is changing rapidly in response to an increasingly complex and competitive atmosphere, with a wider recognition of the stress, expense, and difficulty of matching into graduate training programs. The coronavirus disease 2019 pandemic and societal upheaval make this application cycle more challenging than ever before. Medical students need reliable, accurate, and honest advising from the faculty in their field of choice to apply successfully to residency. The authors outline a model for faculty career advisors, distinct from mentors or general academic advisors. The faculty career advisor has detailed knowledge about the field, an in-depth understanding of the application process, and what constitutes a strong application. The faculty career advisor provides accurate information regarding residency programs within the specialty, helping students to strategically apply to programs where the student is likely to match, decreasing anxiety, expense, and overapplication. Faculty career advisor teams advise students throughout the application process with periodic review of student portfolios and are available for support and advice throughout the process. The authors provide a guide for the faculty career advisor in Obstetrics and Gynecology, including faculty development and quality improvement.

This study aimed to compare the performance of a pediatric decision support algorithm to detect severe sepsis between high-risk pediatric and adult patients in a pediatric emergency department (PED).This is a retrospective cohort study of patients presenting from March 2017 to February 2018 to a tertiary care PED. Patients were identified as high risk for sepsis based on a priori defined criteria and were considered adult if 18 years or older. The 2-step decision support algorithm consists of (1) an electronic health record best-practice alert (BPA) with age-adjusted vital sign ranges, and (2) physician screen. The difference in test characteristics of the intervention for the detection of severe sepsis between pediatric and adult patients was assessed at 0.05 statistical significance.The 2358 enrolled subjects included 2125 children (90.1%) and 233 adults (9.9%). The median ages for children and adults were 3.8 (interquartile range, 1.2-8.6) and 20.1 (interquartile range, 18.2-22.0) years, respectively. In adults, compared with children, the BPA alone had significantly higher sensitivity (0.83 [95% confidence interval {CI}, 0.74-0.89] vs 0.72 [95% CI, 0.69-0.75]; P = 0.02) and lower specificity (0.11 [95% CI, 0.07-0.19] vs 0.48 [95% CI, 0.45-0.51; P0.001). With the addition of provider screen, sensitivity and specificity were comparable across age groups, with a lower negative predictive value in adults compared with children (0.66 [95% CI, 0.58-0.74] vs 0.77 [95% CI, 0.75-0.79]; P = 0.005).The BPA was less specific in adults compared with children. With the addition of provider screen, specificity improved; however, the lower negative predictive value suggests that providers may be less likely to suspect sepsis even after automated screen in adult patients. This study invites further research aimed at improving screening algorithms, particularly across the diverse age spectrum presenting to a PED.

Introduction Safe, patient-centered, and cost-effective care requires effective collaboration within interprofessional teams. Education programs for health care professionals are often siloed, providing students with limited interprofessional education (IPE) opportunities to learn from, with, and about other professions. Podcasts offer a novel approach to facilitate IPE, allowing for asynchronous conversations with interprofessional colleagues. Methods We developed four podcasts with various health care professionals for 135 preclinical medical students preparing to transition into clinical rotations. The podcasts were coupled with an hour-long interactive session with the podcast interviewees conducted via videoconference. The curriculum explored the distinct education paths, roles, and responsibilities of various health care disciplines. Strategies for communicating effectively with and learning from interprofessional team members were emphasized. Results There were 197 unique downloads of the podcasts, and 95 students attended the interactive session. Most students reported that the podcasts and follow-up live session enhanced their learning (100% and 98% of students who completed the postcurriculum survey, respectively). Responses to the postcurriculum survey revealed students learned strategies for engaging in productive interprofessional conversations, the importance of leveraging the distinct roles and responsibilities of diverse health professionals, the value of learning from other health professionals, and the use of respectful language. Discussion This IPE curriculum built around podcasts enhances medical student learning and represents an innovative approach to improving access to IPE in a virtual learning environment. This modality can be adapted to meet the needs of a wide spectrum of learners and can be coupled with in-person learning.

OBJECTIVE To monitor demographics and factors associated with quality of life among obstetrics and gynecology clerkship directors. A secondary goal was to compare current demographics and survey responses to a 1994 survey of clerkship directors. METHODS A 36-item electronic survey was developed and distributed to the 182 U.S. clerkship directors with active memberships with the Association of Professors of Gynecology and Obstetrics. Items queried respondents on demographics, attitudes about being a clerkship director, quality of life, and burnout. RESULTS A total of 113 of the 182 (62%) clerkship directors responded to the survey. The mean full-time time equivalent allocated for clerkship director responsibilities was 25%. When compared with clerkship directors from 1994, current clerkship directors are younger, work fewer total hours per week, spend more time on patient care, and less time on research. Notably, 78% (87) of respondents were female compared with 21% (31) of respondents in 1994. Overall, most current clerkship directors responded optimistically to quality of life and burnout measures, with 25% (28) reporting symptoms of high emotional exhaustion and 17% (19) reporting symptoms of depersonalization. Clerkship directors' perception of support from their medical school was significantly correlated with increased personal fulfilment and positive quality of life, as well as decreased burnout and emotional exhaustion measures. CONCLUSION The gender demographics of obstetrics and gynecology undergraduate medical education leadership have dramatically shifted over the past 25 years; however, many of the changes are not correlated with quality of life and burnout. The association between perceived support from the medical school and multiple quality of life measures point to the vital importance of support for our medical educators.

Introduction Learners consistently report insufficient feedback, despite interventions to improve the quantity and quality of feedback. Effective feedback requires a dynamic partnership and a trusting relationship between students and teachers. Methods We developed and implemented a faculty and student program called Feedback Focused on the OB/GYN clerkship with learner- and faculty-centered teaching materials. We evaluated the curriculum's impact on the frequency and quality of feedback exchange through comparison of end-of-clerkship evaluations before and after implementing the Feedback Focused program and assessed student satisfaction from written responses on clerkship evaluations. Results A total of 1,912 feedback folio entries were recorded during the curriculum timeframe, representing an average of 19 entries per student. Of students, 85% turned in their feedback folios at the end of the clerkship. There was a marked increase in reported frequency of feedback with the initiative, with 28% of students reporting receiving feedback four or more times per month before the start of our program, compared to 64% after its completion. The percentage of students who reported faculty provided direction and constructive feedback always or very often remained roughly the same before and after the program (69% vs. 70%, respectively). Over 60% of students provided positive feedback on written open response questions. Discussion We successfully developed and implemented a multipronged approach to effectively change the learning environment culture within our OB/GYN clerkship program. Our evaluation demonstrated that the Feedback Focused program was well received and increased frequency of feedback.

As hospitals and medical schools confronted coronavirus disease 2019 (COVID-19), medical students were essentially restricted from all clinical work in an effort to prioritize their safety and the safety of others. One downstream effect of this decision was that students were designated as nonessential, in contrast to other members of health care teams. As we acclimate to our new clinical environment and medical students return to the frontlines of health care, we advocate for medical students to be reconsidered as physicians-in-training who bring valuable skills to patient care and to maintain their status as valued team members despite surges in COVID-19 or future pandemics. In addition to the contributions students provide to medical teams, they also serve to benefit from the formative experiences of caring for patients during a pandemic rather than being relegated to the sidelines. In this commentary, we discuss factors that led to students' being excluded from this pandemic despite being required at the bedside during prior U.S. public health crises this past century, and we review educational principles that support maintaining students in clinical environments during this and future pandemics.

Objectives To determine if faculty perceive standardized oral examinations to be more objective and useful than the non-standardized format in assessing third-year medical students’ learning on the obstetrics and gynecology rotation. Methods Obstetrics and gynecology faculty at three teaching hospitals were sampled to complete a survey retrospectively comparing the standardized oral examination (SOE) and non-standardized or traditional oral examinations (TOE). A Likert scale (0-5) was used to assess satisfaction, objectivity, and usefulness of SOE and TOE. Wilcoxon signed rank test was performed to compare median Likert scale scores for each survey item. A Spearman’s correlation coefficient was used to investigate the relationship between the perceived level of objectivity and SOE characteristics. For qualitative measures, content analysis was applied. Results Sixty-six percent (n=25) of eligible faculty completed the survey. Faculty perceived the standardized oral examination as significantly more objective compared with the non-standardized (z=-3.15, p=0.002). Faculty also found SOE to be more useful in assessing overall clerkship performance (z=-2.0, p

Diagnostic errors contribute to as many as 70% of medical errors. Prevention of diagnostic errors is more complex than building safety checks into health care systems; it requires an understanding of critical thinking, of clinical reasoning, and of the cognitive processes through which diagnoses are made. When a diagnostic error is recognized, it is imperative to identify where and how the mistake in clinical reasoning occurred. Cognitive biases may contribute to errors in clinical reasoning. By understanding how physicians make clinical decisions, and examining how errors due to cognitive biases occur, cognitive bias awareness training and debiasing strategies may be developed to decrease diagnostic errors and patient harm. Studies of the impact of teaching critical thinking skills have mixed results but are limited by methodological problems.This Perspective explores the role of clinical reasoning and cognitive bias in diagnostic error, as well as the effect of instruction in metacognitive skills on improvement of diagnostic accuracy for both learners and practitioners. Recent literature questioning whether teaching critical thinking skills increases diagnostic accuracy is critically examined, as are studies suggesting that metacognitive practices result in better patient care and outcomes. Instruction in metacognition, reflective practice, and cognitive bias awareness may help learners move toward adaptive expertise and help clinicians improve diagnostic accuracy. The authors argue that explicit instruction in metacognition in medical education, including awareness of cognitive biases, has the potential to reduce diagnostic errors and thus improve patient safety.

Although national attention has been focused on sexual harassment and gender inequity in the United States, leaders within the obstetrics and gynecology community have remained relatively silent. Sexual harassment and gender inequity remain pervasive in our specialty. This article serves as a call to action for leadership as well as physicians within obstetrics and gynecology to implement ethical and evidence-based approaches to reduce gender inequity and improve workplace culture within our specialty.

To determine factors associated with the interruption of outpatient care of HIV-positive patients.Non-concurrent prospective study carried out in a public AIDS referral center in Belo Horizonte, Brazil. Medical records were reviewed in order to assess factors associated with the interruption of clinical care of HIV patients admitted between 1993 and 1995. Patients should have attended at least one follow-up visit within a period of 7 months. Statistical analysis was carried out using Chi-square and relative hazard (RH) with 95% confidence interval (CI) estimated by Cox Regression Model.Cumulative incidence of interruption was 54% among 517 patients included in the study (mean follow-up=24.6 months; 26.5/100 person-years). Multivariate analysis indicated that those individuals who had fewer (2) CD4+ T lymphocyte cell counts (RH=1.94; 95% CI=1.32-2.84) did not have viral load measured (RH=14.94; IC 95%=5.44-41.04), attended7 medical follow-up visits (RH =2.80; IC 95%=1.89-4.14), did not change clinical category (RH =1.40; IC 95% =1.00-1.93) and did not undergo any anti-retroviral therapy (RH =1.43; IC 95% =1.06-1.93) had independently an increased risk of interrupting clinical care.The rate of clinical interruption in this center is high. The results suggest that interruption may be a function of better clinical outcome, i.e. the service may give priority to those patients with more severe clinical condition, and interruption of clinical care may be a marker for future antiretroviral compliance.

Objective This paper describes the adult adaptation of a group of 97 formerly incarcerated male delinquents. Method Follow-up clinical interviews were administered to subjects, approximately 9 years after discharge from uvenile corrections. The records of the correctional school, state police, FBI, state psychiatric hospitals, and state health department also were reviewed. Results All but six had adult criminal records, most for violent crimes. Only 10% were graduated from high school; 30% received minimal job training; most worked sporadically at unskilled jobs. Few married. Although 35 had fathered children, only 5 were living with them. Psychiatric treatment for identified vulnerabilities was negligible. Upon discharge, the most neuropsychiatrically impaired and violent subjects tended to be placed in adult corrections; the most intact were placed in special schools and psychiatric hospitals. Numbers of vulnerabilities continued to contribute most significantly to violent outcome regardless of placement. Placement in families was associated with fewer adult aggressive offenses than was institutional placement, even while controlling for vulnerabilities and early juvenile violence. Conclusions Based on their well-documented early vulnerabilities and needs, this sample of delinquents did not obtain the kinds of supports subsequent to juvenile incarceration that might have enabled them to function independently in society.

Twenty-one female delinquents, neuropsychiatrically evaluated while in a juvenile correctional facility, were followed up to 7 to 12 years later. Compared with a matched sample of male delinquents, they committed fewer and less violent offenses. Unlike the males, early biopsychosocial variables were not predictive of adult criminality; however, most females were seriously impaired neuropsychiatrically. Mortality rates were high. Having come from abusive households, the female delinquents became suicidal, alcoholic, drug addicted, enmeshed in violent relationships, and unable to care for their children.