Search

This study was conducted to examine experiences and attitudes of midwifery student tutors during scheduled class time. Sixty-one students from 2016 to 2019, who passed the gynecology and infertility course, participated in this study as student tutors and tutees. Students' experiences were investigated with a five-point Likert-type rating scale questionnaire including 17 items in six domains. The average score, frequency, and percentage of positive and negative attitude were calculated in each domain. All participants were female with an average age of 26.3 years. Average student experiences were favorable, and their attitudes towards peer teaching were overwhelmingly positive in all domains. Class-time peer tutoring programs where students change their roles as teacher and student may be regarded as an alternative to traditional peer tutoring programs.

Contemporary design education seeks to prepare students for the workplace through studiobased learning that replicates real world practice. Design problems in the workplace have become increasingly complex and one example of this is within the area of design for healthcare, which requires multidisciplinary collaboration between various stakeholders to build knowledge in order to create new products, services systems and spaces. The complexity of these roles creates challenges for design educators in preparing students for the workplace. This paper presents a hybrid approach to address this challenge by presenting a real-world approach to design education. This entails a bottom-up approach to facilitate design research in a clinical setting to gather rich insights and needs of the clinical setting along with a top-down industry collaboration with sponsored briefs to guide students through the requirements of developing solutions in a heavily regulated field. The paper outlines examples of this process and how it was achieved in a blended model that was predominantly online in response to the changed environment caused by the COVID-19 pandemic. The advantages of this model are threefold, students gain deep knowledge and skills through collaborating with a variety of stakeholders within health care, they gain the opportunity to validate their designs through testing and feedback with these partners and lastly students develop the connections to create opportunities for further partnerships and employment.

In Obstetrics and Gynecologic operating room emergencies, the surgeon cannot both operate and lead a suddenly expanded and redirected team response. However, one of the most often used approaches to interprofessional continuing education designed to improve teams' ability to respond to unanticipated critical events still emphasizes surgeon leadership. We developed Explicit Anesthesia and Nurse Distributed (EXPAND) Leadership to imagine a workflow that might better distribute emergency leadership task responsibilities and practices. The purpose of this exploratory study was to investigate teams' responses to distributing leadership during an interprofessional continuing education simulated obstetrical emergency. We used interpretive descriptive design in a secondary analysis of teams' post-simulation reflective debriefings. One-hundred sixty providers participated, including OB-Gyn surgeons, anesthesiologists, CRNAs, scrub technicians, and nurses. Using reflective thematic analysis, we identified three core themes: (1) The surgeon is focused on the surgical field, (2) Explicit leadership initiates a nurse transition from follower to leader in a hierarchical environment, and (3) Explicit distributed leadership enhances teamwork and taskwork. Continuing education which uses distributed leadership to improve teams' ability to respond to an obstetric emergency is perceived to enhance team members' response to the critical event. The potential for nurses' career growth and professional transformation was an unexpected finding associated with this continuing education which used distributed leadership. Our findings suggest that healthcare educators should consider ways in which distributed leadership may improve teams' response to critical events in the operating room.

Clerkships are defining experiences for medical students in which students integrate basic science knowledge with clinical information as they gain experience in diagnosing and treating patients in a variety of clinical settings. Among the basic sciences, there is broad agreement that anatomy is foundational for medical practice. Unfortunately, there are longstanding concerns that student knowledge of anatomy is below the expectations of clerkship directors and clinical faculty. Most allopathic medical schools require eight "core" clerkships: internal medicine (IM), pediatrics (PD), general surgery (GS), obstetrics and gynecology (OB), psychiatry (PS), family medicine (FM), neurology (NU), and emergency medicine (EM). A targeted needs assessment was conducted to determine the anatomy considered important for each core clerkship based on the perspective of clinicians teaching in those clerkships. A total of 525 clinical faculty were surveyed at 24 United States allopathic medical schools. Participants rated 97 anatomical structure groups across all body regions on a 1-4 Likert-type scale (1 = not important, 4 = essential). Non-parametric ANOVAs determined if differences existed between clerkships. Combining all responses, 91% of anatomical structure groups were classified as "essential" or "more important." Clinicians in FM, EM, and GS rated anatomical structures in most body regions significantly higher than at least one other clerkship (p = 0.006). This study provides an evidence-base of anatomy content that should be considered important for each core clerkship and may assist in the development and/or revision of preclinical curricula to support the clinical training of medical students.

Traditionally, anatomy was one of the basic pillars of medical training. However, due to the expansion of medical science and medical knowledge in general, anatomy teaching has steadily declined and the way anatomy is taught has changed. These changes go hand in hand with growing literature about a perceived and proven lack of anatomical knowledge. While anatomy is important for all doctors, these developments seem to be more worrying for surgical residents. At the same time, little is known about how clinicians use anatomy in daily practice. The primary aim of this study was to increase understanding of the role of anatomy in the daily practice of gynecologists. An explorative qualitative study was performed to answer the question "What is the tangible utility of solid anatomical knowledge in the daily practice of the gynecologist"? Semi-structured interviews with gynecologists and obstetrics and gynecology (ObGyn) residents from Belgium and the Netherlands were held and the responses were analyzed using a phenomenographic inductive coding approach. Anatomical knowledge was important and used for technical skills and non-technical achievements in the daily practice of gynecologists, and three themes were distinguished. Specifically, anatomical knowledge was important and used (1) for daily activities, (2) for the feeling of self-efficacy, and (3) to gain a respected name as a doctor. These findings are discussed in light of (perceived) insufficient anatomical knowledge, and recommendations are made for the postgraduate education of ObGyn doctors.

Mastering clinical practice is one of the hardest tasks of nursing school. It is necessary to combine professional theoretical courses with clinical nursing practice in order to qualify competent and qualified nurses. The connection between the theoretical training and clinical nursing practice, however, has not been the subject of any research. Therefore, the aim of this study was to ascertain the connection between obstetrics and gynecology theoretical courses and obstetrics and gynecology clinical practice. To assess theoretical and Clinical Practice Correlations of Comprehensive nursing students' performance in an Obstetrics and Gynecology Nursing Course at Woldia University, Ethiopia. A retrospective cross-sectional study employing a quantitative data collection method was carried out. The data was obtained using a data extraction checklist between September 01/2022 and September 20/2022. A total of 252 people were involved in the study, including 136 regular nursing students, 93 summer nursing students, and 23 post-basic students. Data was gathered by three nursing department academic staff members. EPI data was used to enter the obtained data, which was then exported to SPSS version 22 for analysis. Bivariate and multivariable analyses were performed, and the Spearman's rho correlation (rs) and coefficient of determination (coef) were declared significant at a p-value of 0.05 and a 95% confidence interval (CI). A total of 252 study participants comprised 174 (69.1%) male and 74 (30.9%) female nursing students included in the current study. Clinical success in obstetrics and gynecology was strongly and favorably correlated with academic success in obstetrics and gynecology theoretical courses (rs = 0.7-0.89), p < 0.05. Moreover, linear regression results revealed 37.45% to coefficient determination for regular students, 38.2% to 47.3% for summer nursing students and 18.1% to 33% post-basic nursing students. To sum up, a significant positive association existed between students' achievements in theoretical and clinical practice of obstetrics and gynecology nursing courses. Improving students' academic performance in obstetrics and gynecology can also enhance their performance in clinical obstetrics and gynecology. However, the variance in performance in obstetrics and gynecology clinical practice was explained by academic achievement in obstetrics and gynecology theoretical courses by 22.35%.

The perineal body is located where four muscles (the superficial anal sphincter, the bulbospongiosus and both superficial transverse perineal muscles) have a common insertion at a nondescript point between the vagina or penile bulb and the anus. Health professions students have difficulty identifying its location and do not have a full appreciation of its function. Clinically, it provides support for the pelvic organs, especially in women. To help clarify the function of the perineal body, a demonstration can be performed which uses three student volunteers and a faculty member. By using one of their hands to represent the perineal muscles, a "perineal body" can be formed. As each person pulls in their respective direction, tension on the "perineal body" is formed; illustrating the concept that the perineal body provides pelvic organ support. During the demonstration, the faculty member discusses the clinical importance of the perineal body. The whole high yield demonstration takes less than two minutes to complete.

Background: The diverse nature of parenting among people with intellectual disabilities can be affected by many factors, including stereotypes, experiencing social isolation, living in poverty, suffering from chronic diseases and limited access to health care. Because of these factors, people with intellectual disabilities are not readily viewed as potential parents by society. Method: The research was conducted using the photovoice method, which analyses photographs taken by participants--seven mothers with intellectual disabilities (aged 22-43). Results: Thematic analysis yielded six main areas: pregnancy and childbirth, household duties--everyday life, caring for children, the importance of motherhood for a woman, parenting problems and difficulties, and types and forms of assistance. Conclusion: Raising a child has become a life goal for the interviewed women. However, there were also difficulties in their lives, which have not been solved by formal and informal support. Individual support for mothers should include tailor-made sexual education, access to gynaecological care or long-term family support.

Youth with autism spectrum disorder often have complex medical needs. Disruptions of healthcare during the transition from pediatric to adult healthcare may put youth with autism spectrum disorder at higher risk of medical emergencies and high medical costs. We conducted a study among transition-age youth (14-25 years old) receiving healthcare at Kaiser Permanente Northern California during 2014-2015. We examined the differences in healthcare utilization and costs among youth with autism spectrum disorder (n = 4123), attention deficit and hyperactivity disorder (n = 20,6015), diabetes mellitus (n = 2156), and general population controls (n = 20,615). Analyses were also stratified by age and sex. Youth with autism spectrum disorder had the highest utilization of outpatient primary care, mental health, and psychotropic medications and the lowest utilization of obstetrics/gynecology and urgent care. Costs for youth with autism spectrum disorder were higher than those for attention deficit and hyperactivity disorder and general population peers and lower than for diabetes mellitus. Utilization patterns varied by age. Transition-age youth with autism spectrum disorder generally utilize healthcare at higher rates relative to attention deficit and hyperactivity disorder and general population peers but at similar or lower rates than diabetes mellitus peers, indicating this group's complex combination of psychiatric and medical healthcare needs. The relatively high utilization of psychiatric services and low utilization of women's health services in transition-age youth with autism spectrum disorder may have implications for long-term health and warrants additional research.

Objective: This exploratory study sought to assess transgender college students' experiences accessing primary, gynecological, and/or mental health care through university health services (UHS). Participants and methods: Individual interviews were conducted with eleven transgender undergraduate students attending a large public university in the United States in Spring 2017. Results: The structure, organization, and practices of UHS are not adequately meeting transgender college students' health care needs. Students reported being repeatedly misgendered and addressed by the incorrect name by staff at UHS. Some providers asked inappropriate and irrelevant questions about their gender identity during clinical encounters. These and related experiences deterred many participants from returning to UHS for health care services. Conclusion: UHS could improve health care delivery to transgender college students by adopting standardized and inclusive practices consistent with those recommended by The Fenway Institute.

Immunization is one of the most effective ways to prevent infectious diseases. However, vaccination rates are suboptimal in the United States. Obstetric providers are critical in influencing vaccine decision making among pregnant women, as trust between a patient and provider may facilitate willingness to accept vaccination. Little is known about how power between a patient and provider affects vaccine acceptance. This study explored pregnant women's trust in obstetric providers within the context of vaccines. Using concepts from the relational theory of power, we conducted 40 in-depth interviews with a purposive sample of pregnant women from four Ob-Gyn practices each in Georgia and Colorado. Results suggest that to enhance trust, providers could gain distributive power by conveying empathy. Designated power through medical experience was associated with both trust and distrust, as some women trusted their providers because of their authority and medical credentials, while others viewed authority and experience as reasons to distrust their provider. To increase acceptance, providers should acknowledge the underlying power dynamics within these interpersonal relationships and strengthen rapport with patients through empathy and dialogue.

In postgraduate medical education, required competencies are described in detail in existing competency frameworks. This study proposes an alternative strategy for competency-based medical education design, which is supported by change management theories. We demonstrate the value of allowing room for re-invention and creative adaptation of innovations. This new strategy was explored for the development of a new generic competency framework for a harmonised European curriculum in Obstetrics and Gynaecology. The generic competency framework was developed through action research. Data were collected by four European stakeholder groups (patients, nurses, midwives and hospital boards), using a variety of methods. Subsequently, the data were analysed further in consensus discussions with European specialists and trainees in Obstetrics and Gynaecology. These discussions ensured that the framework provides guidance, is specialty-specific, and that implementation in all European countries could be feasible. The presented generic competency framework identifies four domains: 'Patient-centred care', 'Teamwork', 'System-based practice' and 'Personal and professional development'. For each of these four domains, guiding competencies were defined. The new generic competency framework is supported by European specialists and trainees in Obstetrics and Gynaecology, as well as by their European stakeholders. According to change management theories, it seems vital to allow room for re-invention and creative adaptation of the competency framework by medical professionals. Therefore, the generic competency framework offers guidance rather than prescription. The presented strategy for competency framework development offers leads for implementation of competency-based medical education as well as for development of innovations in postgraduate medical education in general.

Objective: To estimate the prevalence of female sexual dysfunction (FSD) among women attending college (18-29 years of age) presenting for routine gynecological care at a university-based student health center. Participants: Location: University affiliated women's health care clinic. Methods: Study design: Descriptive, cross sectional study. Primary endpoint: Estimated prevalence of FSD in the 18-29-year-old population. A subanalysis between those with and without recent sexual activity was performed. Logistic Regression was performed to identify potential predictors of FSD among those affected. Results: Of 310 women, FSFI was estimated as ranging from 35.5% (not sexually active) to 42.3% (sexually active). Those of younger age (18-21), with prior mental health diagnosis, and self-reported problems with arousal were at increased risk for FSD. Conclusion: Screening for FSD in the 18-29-year-old population is justified and recommended.

Introduction: Most studies lump Black immigrants (BIs) and African Americans (AAs) as "Black/African American" during investigation. Such categorization assumes that the sociocultural determinants that influence BIs are the same as for AAs. This study attempts to disentangle the AA and BI subgroups to recognize the differences in cancer-related psychosocial characteristics and health behaviors. Methods: Merged data from the Health Information National Survey (2011-2017) were used. Two groups were created: those who identified as AA and those who identified as AA but were born outside the United States (BI). Between-group differences were assessed with Mann-Whitney "U" and chi-square tests. Results: Positive communication patterns with health care providers were significantly higher among AAs (M [mean] = 3.41, SD [standard deviation] = 0.68) compared with BIs (M = 3.28, SD = 0.71) (p = 0.004). A greater proportion of BIs indicated that their health was excellent (14.2%), compared with AAs (7.9%). AAs reported higher cancer family history (75.1%) than BIs (46.5%). More AAs had smoked at least 100 cigarettes in their lifetime (41.5%) than BIs (16.7%). BIs consumed significantly more fruits each day (M = 2.77, SD = 1.43) than AAs (M = 2.40, SD = 1.44) (p < 0.001). BIs also reported more physical activity (M = 2.62, SD = 2.15) than AAs (M = 2.37, SD = 2.18) (p = 0.030). AA women were more likely to have had a pap smear test (M = 2.07, SD = 1.44) compared with BI women (M = 1.73, SD = 1.21) (p = 0.002). Discussion: Evidence suggests the need to disentangle the "Black/African American" ethnic grouping. Lumping the BI populations together with the AAs, who have been in the United States for generations, may limit the ability to uncover and consequently address culturally driven disease prevention efforts and promote understanding of the biological, environmental, and psychosocial risk factors within Black heterogeneous populations.

Sexuality is an important part of normal human functioning. Gynecological cancer diagnosis and treatment has devastating effect on Sexual issues. Study aim was to investigate Oncology Nurses knowledge and attitudes in Relation to Provision of Sexual Health Care to Women Diagnosed with Gynecological Cancer. The study setting was conducted at oncology center, at Mansoura University Hospitals after obtaining hospital director approval. A Subject was consisted of 72 nurses who worked in gynecological oncology department. Tools: four tools were used by the researchers to collect pertinent data consisted of 1st The Self Administered Structured Schedule, 2nd tool, Sexual Health Care Scale-Attitude, 3rd tool, Facilitators about Sexuality Issue Discussion in nursing practice and 4th tool, Barriers about Sexuality Issue Discussion in Nursing Practice. Results revealed that 100% of nurses were having poor knowledge score regarding sexual health care with mean score 7.3 ±2.5. There was statistically significant relation between knowledge score and discomfort in providing sexual health care and Afraid of college's negative response (P< 0.05). While there were no statistical significant relation between knowledge score and Feeling uncertain about patient's acceptance and Lack of environmental support (P> 0.05). Majority of nurses reported that limited resources, patient embarrassment, staff shortages, patients having more things to be concerned about than having sex, inadequate education preparation, are the most important barriers to provide health sexual education. Provisions of relevant training, availability of private environment, having good nurse patient relationship, good communication are factors which facilitate provision of sexual health care. Conclusion oncology nurses have poor knowledge score and decrease feeling of discomfort domain was the most representative nurses attitude in provision of sexual health care, there are many of issues act as barriers and facilitators affecting nurses for providing sexual health care. Recommendations It is important to put sexual health education into the curriculum of nursing, in order to assess the sexual health of patients within the health care system, continuing education activities and availability of education materials could assist nurses to adequately address sexual concerns while caring for patients with cancer and More research is needed on training of the nurses to overcome the barriers and guidelines or procedures in place for dealing with sexuality-related issues with patients.

An optimal learning climate is crucial for the quality of residency training and may also improve residents' well-being and empathy. We investigated the associations of learning climate with residents' work-related well-being. A multicenter questionnaire study was performed among 271 surgery and gynaecology residents in 21 training programs from September 2012 to February 2013. Residents were asked to complete work-related well-being measurements: work engagement (Utrecht Work Engagement Scale), job and specialty satisfaction (measures from Physician Worklife Study), and physician empathy (Jefferson Scale of Physician Empathy). The Dutch Residency Educational Climate Test was used to evaluate learning climate. Multivariate adjusted linear regression analyses were used to estimate associations of learning climate with work-related well-being measures. Well-being measures were completed by 144 residents (53.1%). Learning climate was evaluated by 193 residents, yielding 9.2 evaluations per training program on average. Overall learning climate score was positively associated with work engagement [regression coefficient b = 0.58; 95% confidence interval (CI) 0.18-0.98; p = 0.004] and job satisfaction (b = 0.80; 95% CI 0.48-1.13; p < 0.001). No associations were found between learning climate and empathy and specialty satisfaction. Residents' work engagement and job satisfaction are positively related to the learning climate and may be further enhanced by improved learning climates of training programs.

Independent academic medical centers (IAMC) are challenged to develop and support a research enterprise and maintain primary goals of healthcare delivery and financial solvency. Strategies for promoting translational research have been shown to be effective at institutions in the top level of federal funding, but not for smaller IAMCs. The research program developed at Maricopa Integrated Health System (MIHS), an IAMC, focused on identifying research enterprise drivers which have an impact on core missions for MIHS and encompassed three domains: (1) Commercial ventures; (2) Clinical practice; and (3) Civic and Community relationships. Specific mechanisms were implemented to promote research, which had an impact on each enterprise driver. Case examples in 2 clinical arenas are described in detail, Pediatrics and Obstetrics/Gynecology, to demonstrate how the strategies were applied to increase translational research and influence the research enterprise drivers. These strategies included: reducing barriers within MIHS and with partner institutions, increasing revenue generated from grants and contracts, providing grant development support, and developing sustainable collaborations with partner institutions. The value in identifying and utilizing external resources is reciprocal as ongoing research collaborations have resulted in more contract and grant awards for both MIHS and partner institutions. (Contains 1 table and 1 figure.)

Collaboration is essential to manage complex real world problems. We used phenomenologic methods to elaborate a description of collaboration between two departments at an academic medical center who considered their relationship to represent a model of effective collaboration. Key collaborative structures included a shared vision and commitment by leaders, rigorous quality improvement, clear delineation of roles with built-in flexibility, ongoing commitment to formal and informal communication channels and conflict resolution, relationship development grounded in respect and responsiveness, and shared training in a supportive learning environment with legitimate participation fostering skill development. This study reveals the complexity and resources required for collaboration which both explains why collaboration is not as easy to achieve and identifies processes that foster collaboration. (Contains 1 table.)

Problem Statement: Annual gynecological exams could be a strategy to increase initiation and completion of HPV vaccination series among female college students. However, few studies have examined the role these exams play in vaccination uptake. This study assesses the association of OB/GYN visitation and HPV vaccine uptake among female college students on a metropolitan campus in the Southeastern United States. Methods: Participants were 356 female students aged 18 to 30, who completed the National College Health Assessment -- II (NCHA-II) during the spring semester of 2010. Descriptive statistics and ?[superscript 2] tests were used to assess OB-GYN visitation and HPV vaccination rates. Logistic regression assessed the magnitude of the association between annual gynecological exam and HPV vaccine uptake. Findings: Among this sample, approximately 63% reported OB/GYN visitations. An HPV vaccination was received by 43% of female college students. Women who visited the OB/GYN during the past 12 months reported 1.82 greater odds of receiving the vaccine compared to non-visitors. Conclusions: OB/GYN visitation may be linked with HPV vaccine uptake among female college students. HPV health prevention programming during OB/GYN visits may be beneficial among college female students. More research is needed to improve access to the HPV vaccine among college students.

Reflective practice has become a core component in higher education studies. In the health sciences, reflective tasks are required throughout the undergraduate programmes, yet many students struggle to find value in these tasks for their present and future professional practice. Benefits that can be derived from the process are undermined by this lack of motivation for reflective engagement. Concern around the static, contained, individualist nature of reflections that often face judgement through assessment can be addressed by opening up the process to generate new potentials. In this paper, I draw on new materialism and the Baradian (2007) philosophy of diffraction to move beyond the reflective practices of representation and sameness by affirmatively working with/through differences. I refer to data collected in an ethics approved research study at the University of Cape Town (UCT), South Africa, to explain a context of unjust practices in which students learn. I demonstrate how students' reflective texts shared online on the Google Drive platform can be productive and transformative material forces that enact new knowledge, valued by students. The apparatus of text-students-events is put to work creating new possibilities to enable a socially just pedagogy in medical education.

Background: Adverse birth outcomes are more common among adolescent versus adult mothers, but little is known about school-based services that may improve birth outcomes in this group. Methods: Data from Waves I and IV of the National Longitudinal Study of Adolescent Health were analyzed. Girls and women who gave birth to singleton live infants after Wave I and before age 20, were still in secondary school while pregnant, and had complete data (N = 402) were included. Mothers reported infants' birthweight and gestational age. School administrators reported whether family planning counseling, diagnostic screening (including sexually transmitted diseases [STDs]), STD treatment, and prenatal/postpartum health care were provided on-site at school at Wave I. Multilevel models adjusted for individual and school characteristics were conducted. Results: Few schools offered reproductive health care services on-site. In multilevel analyses, availability of family planning counseling (Est. ß = 0.21, 95% confidence interval [CI] 0.04-0.38 p < 0.05) and prenatal/postpartum health care (Est. ß = 0.21, 95% CI 0.02-0.40 p < 0.05) were significantly associated with increased infant birthweight. No services examined were significantly associated with increased gestational age. Conclusions: Some school-based reproductive health services may improve subsequent birth outcomes among adolescent mothers. Future analyses should examine the mechanisms by which services impact birth outcomes.

The occurrence of cervix cancer is outstandingly high in Zala County, which is situated in the Western Transdanubian region of Hungary. The aim of our study was to reveal why women do not take the opportunity offered by the state and what reasons there are for the nonattendance at screenings. A total of 1000 Hungarian women aged 15 to 60 years were included in the sample. The results of our study revealed that 13.8% of women participating in our research program have never been to a gynaecological cancer screening. Concerning this fact, the following groups deserve greater attention: 15-19 years old, those only with basic school qualifications, the unmarried and the unemployed. To improve our national mortality indexes, it is necessary to continue the cancer screenings in a well motivated target population. Achieving this in cervix cancer screening, there are available conception and infrastructure alike provided by the health administration. The weakness of the system is the low participation rate of the population.

Faculty development efforts have had varying success in changing the culture of a department or institution. In this paper, we describe a faculty development program using a residents as teachers (RATS) curriculum that we believe effected educational change in a department with a history of suboptimal student evaluations on the clerkship and an overall poor reputation educationally in the medical center. We link the implementation of the RATS program with changes in teaching quality and improvement in the learning climate. We hypothesize how this impact occurred using Kotter's change management theory and propose that this RATS model is generalizable to other programs using the same or similar approach.

The transition to parenthood marks a significant developmental period for the mother. Clinical and preclinical studies evidence neural and hormonal changes that support maternal behavior that is critical to infant survival and development. These changes suggest marked plasticity as a result of reproduction in the mother. Furthermore, multiple reproductive experiences may contribute to long-lasting changes to support more efficient and competent caregiving with subsequent pregnancies and births. However, less is known about neural, hormonal, and behavioral changes that occur as a function of parity--the number of children a woman has. Here, we highlight behavioral, neural, and hormonal changes that occur as women transition to parenthood, with a special emphasis on parity-related changes. Limitations and directions for future research are discussed, as well as clinical implications to be considered in light of parity research.

Validity is critical for meaningful assessment of surgical competency. According to the Standards for Educational and Psychological Testing, validation involves the integration of data from well-defined classifications of evidence. In the authoritative framework, data from all classifications support construct validity claims. The two aims of this study were to develop a categorization method for validity evidence published in support of surgery performance assessments and to summarize the results of applying this methodology to the gynecologic surgery literature. This was a critical analysis of published observations reported as validity evidence in studies with a construct validity claim. Medline and Embase databases were searched using keywords: "surgery" and "construct validity". Parameters included English-language articles published from 2000 to 2012. Gynecologic studies were analyzed for definitions of construct validity and nonstandard terminology. Categorization criteria were developed and applied by the researchers to all observations. Two independent evaluators examined reported observations for compliance with guidelines provided by the Standards. Inter-rater agreement was calculated using weighted kappa. The initial search returned 167 articles. Twenty-five articles were left for inclusion in our analysis. Eighteen (72%) articles defined construct validity as the ability to discriminate between expert and novice levels of proficiency. Within the sample, 80 discrete observations of reported validity evidence were identified and categorized according to standard classifications. Nearly 30% of all published observations intended to demonstrate differences in performance by level of proficiency, 25% described a scoring model, and 14% demonstrated support of assessment content. Not one article contained a statistical correlation between assessment scores and objective outcomes from the authentic surgical environment. Medians for level of rigor ranged from 0 to 1 across all forms of evidence. Weighted kappa values ranged 0.60-0.91. Validity claims in gynecologic surgical assessment over-rely on generalizability evidence. No test-criterion evidence was observed. Increased awareness of current standards and systematic argument development is needed for gynecologic performance assessments.

This paper addresses contemporary reform in postgraduate medical education that aims to standardise training. The reforms are guided by public policy interventions to increase quality of care, objectify performance, and to prepare residents for changing health care needs. This paper draws on an ethnographic study in the Netherlands, studying how new training standards have been incorporated in everyday gynaecology and surgery residency training. Perceiving educational science as a new epistemic culture alongside the traditional professional authority-based epistemic culture, the paper examines how both epistemic cultures have interweaved, fabricating a new training culture that assembles both traditional and "new" elements.

Purpose: Low rates of human papillomavirus (HPV) vaccination among young Asian American and Pacific Islander (AAPI) women need to be addressed, particularly given the high incidence of cervical cancer in this population. The current study aims to investigate predictors of HPV vaccination in young AAPI and non-Latina white (NLW) women. Methods: A secondary data analysis was conducted of a health survey administered to college-aged women (N = 2,270) at a large public university in the Midwest. Andersen's behavioral model of health services utilization guided the study theoretically, and hierarchical logistic regression analysis was conducted to investigate research aim. Results: NLW women had a significantly higher rate of vaccine completion than AAPI women (NLW = 60.7%; AAPI = 38.6%). NLW women also scored higher on all 5 measures of HPV vaccine literacy than AAPI women. Both groups of undergraduate women reported that increasing age, knowledge about HPV, greater use of gynecological services, and knowing someone who had cancer were significant factors related to HPV vaccination completion. In the NLW group, father's income was also found to be a predictor of HPV vaccination completion. Conclusions: Rate and predictors of HPV vaccination completion vary between NLW and AAPI women. Greater promotion of HPV literacy and gynecological service use should be made to young AAPI women to increase their HPV uptake. Further research should examine sociocultural factors that could hinder or promote HPV vaccination in young AAPI women.

Mismatches between the needs of public health systems and student interests have led to renewed study on the factors predicting career specializations among medical students. While most work examines career and lifestyle values, emotional proclivities may be important; disgust sensitivity may help explain preferences for careers with greater and lesser degrees of procedural content. In the study, 294 students completed measures assessing: (1) demographics, (2) career interest or intention regarding emergency medicine, internal medicine, obstetrics/gynecology, and pediatric medicine, (3) traditional determinants of career intention/interest, and (4) core/bodily product, animal reminder, contamination, and sexual/moral disgust sensitivity. As predicted, logistic regressions controlling for demographics and traditional career predictors, showed that greater animal reminder disgust predicted reduced interest in emergency medicine but greater interest in pediatric medicine. Conversely, greater core/bodily product disgust predicted lower interest in obstetrics/gynecology and pediatric medicine; greater contamination and sexual/moral disgust both predicted increased odds of interest in internal medicine. Overall, specific disgust sensitivities were the best predictors of specialization intention in multivariate models. Specific disgust sensitivities appear to differentially deter and/or predispose self-selection into specific trajectories varying in procedural content. Such findings may permit the early identification of specialty fit and provide guidance in career counseling.

Surgical anatomy is taught early in medical school training. The literature shows that many physicians, especially surgical specialists, think that anatomical knowledge of medical students is inadequate and nesting of anatomical sciences later in the clinical curriculum may be necessary. Quantitative data concerning this perception of an anatomical knowledge deficit are lacking, as are specifics as to what content should be reinforced. This study identifies baseline areas of strength and weakness in the surgical anatomy knowledge of medical students entering surgical rotations. Third-year medical students completed a 20-25-question test at the beginning of the General Surgery and Obstetrics and Gynecology rotations. Knowledge of inguinal anatomy (45.3%), orientation in abdominal cavity (38.8%), colon (27.7%), and esophageal varices (12.8%) was poor. The numbers in parentheses are the percentage of questions answered correctly per topic. In comparing those scores to matched test items from this cohort as first-year students in the anatomy course, the drop in retention overall was very significant (P?=?0.009) from 86.9 to 51.5%. Students also scored lower in questions relating to pelvic organs (46.7%), urogenital development (54.0%), pulmonary development (17.8%), and pregnancy (17.8%). These data showed that indeed, knowledge of surgical anatomy is poor for medical students entering surgical clerkships. These data collected will be utilized to create interactive learning modules, aimed at improving clinically relevant anatomical knowledge retention. These modules, which will be available to students during their inpatient surgical rotations, connect basic anatomy principles to clinical cases, with the ultimate goal of closing the anatomical knowledge gap.

The purpose of this study was to determine whether the introduction of psychosocial services to gynecologic oncology outpatients by a social worker increases service use. During the initial six weeks (phase I), patients were referred for psychosocial services by clinic staff. During the second six weeks (phase II), a nurse introduced available services to each patient with a brochure. During the final 12 weeks (phase III), a social worker introduced services to each patient. The authors then compared psychosocial service referral rates. The sample included 196 patients. During phase III, the probability of a patient-initiated referral increased 3.4-fold (95 percent confidence interval [CI] [1.1, 10.4], p = 0.04) compared with baseline; the probability of any referral rose 2.7-fold (95 percent CI [1.1, 6.3], p = 0.03). The mean time to referral decreased from 79.4 days at baseline to 3.9 days during phase III (p less than 0.001). The phase III intervention was accomplished only in 34 patients (39 percent) because of scheduling conflicts. Of these, eight requested referral, resulting in a 24 percent patient-initiated referral rate after meeting with a social worker. The introduction of psychosocial services by a social worker to gynecologic oncology outpatients increases referral rates and expedites evaluation.

To evaluate risk of suicide of women with invasive gynecologic malignancies, the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (1973-2007) was queried. Suicide per 100,000 women with gynecologic malignancies was compared with that of women with other malignancies; suicide was 30% more likely in those with gynecologic malignancies. Most suicides occurred within 4 years of diagnosis. Better understanding of the descriptive epidemiology of suicide among women with gynecologic malignancies could lead to improved risk assessment, screening, and prevention of this potentially avoidable cause of death. (Contains 1 figure and 1 table.)

Objective: The study objective was to determine whether medical students' attendance at a rehabilitation residence for pregnant women with substance-use disorders yielded changes in their attitudes and comfort levels in providing care to this population. Methods: This randomized educational trial involved 96 consecutive medical students during their obstetrics and gynecology clerkship. In addition to attending a half-day prenatal clinic designed for women with substance-use disorders, every student was randomly assigned either to attend (Study group) or not to attend (Control group) a rehabilitation residence for pregnant women with substance-use disorders. The primary objective was to measure differences in responses to a confidential 12-question survey addressing comfort levels and attitudes, at the beginning and end of the clerkship. Results: Survey responses revealed improvements in students' comfort levels and attitudes toward pregnant women with substance-use disorders by attending the clinic alone or the clinic and residence. Those who attended the residence reported becoming more comfortable in talking with patients about adverse effects from substance abuse, more understanding of "street" terms, and stronger belief that patients will disclose their substance use to providers. Residents expressed more openly their hardships and barriers while trying to set therapeutic goals. Conclusions: Medical students became more comfortable and insightful about pregnant women with substance-use disorders after attending a rehabilitation residence in addition to a prenatal clinic dedicated to this population.

Objective: The goal was to understand both therapist and patient perspectives on alliance and session progress for women in treatment for gynecological cancer. We used a longitudinal version of the one-with-many design to partition variation in alliance and progress ratings into therapist, patient/dyad, and time-specific components. We also evaluated therapist and patient characteristics that predict alliance and session progress. Method: Two hundred and three women and their therapists completed measures of alliance and session progress across a 6-session course of treatment. Participants also completed preintervention measures of self-esteem, depression, cancer-specific distress, emotional expressivity, and use of protective buffering. Results: Patients reported higher alliance and greater progress than did therapists. When therapists reported particularly strong alliance with particular patients, those patients concurred. More experienced therapists reported higher alliances and more progress but their patients did not agree. Patients who began treatment in more difficult psychosocial circumstances tended to have less positive session outcomes on average but evidenced more improvement across therapy sessions. Conclusions: Patients rated their alliance and progress more positively than did their therapists, although there was substantial relative agreement between therapists and patients. Alliance and progress improved over time, particularly among patients who evidenced higher levels of distress and poorer physical functioning. More experienced therapists were more confident in their abilities but their patients did not share this perception. (Contains 5 tables and 3 footnotes.)

In Zambezia province, Mozambique, cervical cancer (CC) screening was introduced to rural communities in 2010. Our study sought to determine whether women would accept screening via pelvic examination and visual inspection with acetic acid (VIA) at two clinical sites near the onset of a new CC screening program. A cross-sectional descriptive study of 101 women was undertaken in two rural communities in north-central Mozambique. We assessed a woman's willingness to be screened, knowledge about CC symptoms and treatment, and her recommendations for best methods to deliver information to other women. After the interview, we offered CC screening. Fully 86% of women accepted VIA screening when it was offered, but uptake was 100% at one clinic and only 68% at another. The cause of CC was thought to be associated with promiscuous activity (49%) and curses placed on the woman (42%). All women in one rural Mozambique clinic and two-thirds at a second clinic underwent CC screening. Knowledge about CC screening was significantly associated with uptake, suggesting educational campaigns need to be undertaken. However, educators need to be cautious about linking screening with high-risk behaviors, as women who understood the link trended toward refusing screening.

Introduction: Continuing medical education (CME) courses are an essential component of professional development. Research indicates a continued need for understanding how and why physicians select certain CME courses, as well as the differences between CME course takers and nontakers. Purpose: Obstetrician-gynecologists (OB-GYNs) are health care providers for women, and part of their purview includes mental health, such as postpartum depression (PPD) and psychosis (PPP). This study evaluated OB-GYNs' knowledge, attitudes, and behavior (KAB) regarding PPD/PPP, and compared characteristics of CME course takers and nontakers. Method: A survey was sent to 400 OB-GYNs. Results: Response rate was 56%. One-third had taken a CME course on PPD/PPP. Those who consider themselves a "specialist" were less likely to have taken a CME course on postpartum mental health than those who consider themselves "both primary care provider and specialist." Non-CME course takers rely on clinical judgment more. They also are less likely to track patients' psychiatric histories and they utilize validated assessments less frequently. However, CME course takers and nontakers did not differ on knowledge or belief items. Conclusion: CME courses on PPD/PPP were associated with increased screening and utilization of validated assessments. There was no association between having taken a course and several knowledge questions. It is unclear if CME courses are effective in disseminating information and altering KAB. (Contains 3 tables and 1 figure.)

Objective: To examine human papillomavirus (HPV) vaccine intent and the effect of an educational intervention on vaccine uptake among female college students. Participants: Females aged 18 to 26 attending a university health service gynecology clinic (n = 256). Methods: Participants were randomized to receive either HPV-specific education with a mailed reminder or standard care. Predictors of HPV vaccine intent and uptake at 6 months following enrollment were identified. Results: At baseline, 41% intended to undergo HPV vaccination. Participants who were currently sexually active and lacked supplemental health insurance had decreased intent. Perceived parental approval regarding HPV vaccination, perceived vulnerability to HPV infection, and belief in health benefits of HPV vaccine were associated with increased intent. HPV vaccine uptake was low (5.5%) and did not differ by study group. However, baseline intent was significantly associated with HPV vaccine uptake. Conclusions: Interventions to increase HPV vaccine uptake in college students should address HPV-related beliefs and broader barriers to vaccination. (Contains 4 tables.)

The authors sought to evaluate the feasibility and acceptability of initiating a Screening, Brief Intervention, and Referral to Treatment (SBIRT) for alcohol and other drug use curriculum across multiple residency programs. SBIRT project faculty in the internal medicine (traditional, primary care internal medicine, medicine/pediatrics), psychiatry, obstetrics and gynecology, emergency medicine, and pediatrics programs were trained in performing and teaching SBIRT. The SBIRT project faculty trained the residents in their respective disciplines, accommodating discipline-specific implementation issues and developed a SBIRT training Web site. Post-training, residents were observed performing SBIRT with a standardized patient. Measurements included number of residents trained, performance of SBIRT in clinical practice, and training satisfaction. One hundred and ninety-nine residents were trained in SBIRT: 98 internal medicine, 35 psychiatry, 18 obstetrics and gynecology, 21 emergency medicine, and 27 pediatrics residents. To date, 338 self-reported SBIRT clinical encounters have occurred. Of the 196 satisfaction surveys completed, the mean satisfaction score for the training was 1.60 (1 = very satisfied to 5 = very dissatisfied). Standardized patient sessions with SBIRT project faculty supervision were the most positive aspect of the training and length of training was a noted weakness. Implementation of a graduate medical education SBIRT curriculum in a multispecialty format is feasible and acceptable. Future efforts focusing on evaluation of resident SBIRT performance and sustainability of SBIRT are needed. (Contains 2 figures and 3 tables.)

Background: There is little information available related to the reproductive health of people with intellectual disability (ID). The aims of the present study are to describe caregiver attitudes and to examine determinants of gynaecological health for women with ID. Method: We recruited 1152 caregivers (response rate = 71.87%) and analysed their responses to a mailed-out, self-administered, structured questionnaire. We divided attitudinal perceptions of reproductive health into 4 domains: menstruation, menopause, sex education, and preventive healthcare. Each domain in turn had 5 issues (questions), with scores of 1 to 4 given according to the level of agreement with each issue (low to high score: "strongly disagree," "disagree," "agree," and "strongly agree"). The total sum score for each domain was 5-20 (total score range: 20-80). Results: The respondents' attitudinal mean score was 57.78 plus or minus 4.64 (range: 48-75). The multiple logistic regression model revealed that the factors of "workplace training in reproductive health" (OR = 1.793, 95% CI = 1.31-2.46), "felt satisfied with public reproductive health services for the client" (OR = 0.694, 95% CI = 0.53-0.92), and "scores of reproductive health knowledge" (OR = 1.735, 95% CI = 1.29-2.34) were significantly correlated with attitudinal score level toward gynaecological health for women with ID. Conclusions: The study highlights that service authorities should address health policy initiatives to continue providing workplace training in reproductive health, public reproductive health services. There is also a need for caregivers to increase their knowledge of reproductive health. (Contains 6 tables.)

Project CHOICES developed an integrated behavioral intervention for prevention of prenatal alcohol exposure in women at high risk for alcohol-exposed pregnancies. Settings included primary care, university-hospital based obstetrical/gynecology practices, an urban jail, substance abuse treatment settings, and a media-recruited sample in three large cities. The intervention was based on motivational interviewing and targeted both adoption of effective contraception and reduction of alcohol use. Treatment included 4 manual-guided sessions delivered by mental health clinicians and 1 contraceptive counseling session delivered by a family planning clinician. This paper describes the rationale for treatment; the use of motivational interviewing and the transtheoretical model for a dual-focused approach to behavior change; the development of the Project CHOICES intervention; development of the study protocol and treatment manual; and selection, training, supervision, and monitoring of study counselors. Implications for future applications of the intervention are discussed. (Contains 3 tables.)

Introduction: Evaluations from the health care team can provide feedback useful in guiding residents' professional growth. We describe the significance of 360-degree evaluation of residents by the nursing staff. Methods: A retrospective analysis of 1642 nurses' anonymous evaluations on 26 residents from 2004 to 2007 was performed. Nurses' evaluations of residents on communication with patients, interactions with peers, and professionalism were compared to faculty evaluations and standard medical examination scores. Data were analyzed with the use of the chi-square test, the t test, analyses of variance (ANOVAs), and Spearman's correlation. A P value of less than 0.05 was considered significant. Results: Strong correlations were noted between nursing evaluation categories (r = 0.74-0.80, P less than 0.001), whereas weak correlations occurred between nursing and faculty evaluations (r = 0.065-0.119, P less than 0.001). There were weak negative correlations between nursing evaluations and standard medical examination scores (r = -0.08 to -0.10, P less than 0.001). Specific graduating resident classes, the obstetrical rotation, and senior or male residents were significantly associated with negative nursing evaluations. Discussion: Nursing staff can assess residents on the competencies of interpersonal and communication skills and professionalism. These evaluations provide different perceptions of residents' behavior, which can be useful for formative feedback in residents' development. (Contains 2 tables.)

Context: Past research has documented rural physician and health care professional shortages. Purpose: Rural hospital chief executive officers' (CEOs') reported shortages of health professionals and perceptions about recruiting and retention are compared in Illinois and Arkansas. Methods: A survey, previously developed and sent to 28 CEOs in Illinois, was mailed to 110 CEOs in Arkansas. Only responses from rural CEOs are presented (Arkansas n = 39 and Illinois n = 22). Findings: Physician shortages were reported by 51 CEOs (83.6%). Most reported physician shortages in Arkansas were for family medicine, internal medicine, cardiology, obstetrics-gynecology, general surgery, and psychiatry. Most reported physician shortages in Illinois were for family medicine, obstetrics-gynecology, orthopedic surgery, internal medicine, cardiology, and general surgery. Additionally, registered nurses and pharmacists were the top 2 allied health professions shortages. Multivariate analysis (factor and discriminant analyses) examined community attributes associated with ease of recruiting physicians. Six factors were identified and assessed as to their importance in influencing ease of recruitment, with the state included in the model. Three factors were identified as discriminating whether or not physician recruitment was easy: community supportive for family, community cooperates and perceives a good future, and community attractiveness. Conclusions: Similarities in shortages and attributes influencing recruitment in both states suggest that efforts and policies in health professions workforce development can be generalized between regions. This study further reinforces some important known issues concerning retention and recruitment, such as the importance of identifying providers whose preferences are matched to the characteristics and lifestyle of a given area.

After struggling as a surgical specialty, obstetrics and gynecology initiated its "women's physician" program in the 1970s. This program officially defined the mostly male obstetricians and gynecologists at that time as women's primary care physicians. Using archival data, this article explains this development as a response to the specialty's dishonored position within the medical division of labor. Whatever else it was intended to be, the women's physician program, in its most developed form, aimed to galvanize the various interests within obstetrics and gynecology behind a strategy to restructure the medical division of labor serving women so that obstetricians and gynecologists controlled both the upstream positions responsible for their own case referrals and the downstream positions to which they referred their difficult cases. The article illustrates the importance of integrating insights from both macro-institutional and intra-occupational explanatory frameworks in accounting for significant developments in medicine. (Contains 1 figure and 7 notes.)