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Renee T Sullender,1 Marni B Jacobs,1 Manpreet S Sandhu,2 D Yvette Lacoursiere,1 Carolina Diaz Luevano,1 Charlotte M Pickett,1 Sanjay K Agarwal1 1Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Diego, La Jolla, California, USA; 2University of California at San Diego School of Medicine, La Jolla, California, USACorrespondence: Sanjay K Agarwal, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Diego, 9500 Gilman Drive #0633, La Jolla, California, 92093, USA, Tel +1 858 534-8977, Fax +1 858 534-8856, Email skagarwal@health.ucsd.eduPurpose: The diagnosis of endometriosis often takes several years, delaying appropriate care while patients suffer from pelvic pain, dysmenorrhea, and dyspareunia. Understanding whether residents in obstetrics and gynecology (OB/GYN) are being adequately exposed to and trained in the diagnosis and management of the disease is important for improving care.Methods: We conducted an online cross-sectional survey of OB/GYN residents to investigate their comfort level and familiarity with endometriosis diagnosis and management. Residency program directors and coordinators of 20 OB/GYN residency programs in California, USA were emailed to disseminate the 31-question, anonymous survey in January to February 2023. Responses were collected using Redcap and analysis was conducted using STATA.Results: 67 residents answered at least one non-demographic question and were included. A resident response rate was not calculated because we were unable to determine how many programs distributed the survey. 84% of residents felt they could recognise symptoms of endometriosis but over 30% of senior residents were not comfortable with sonographic diagnosis of endometrioma. Approximately one third of residents felt comfortable managing hypoestrogenic symptoms, osteoporotic risks, and add-back progestin for certain hormonal therapies. Academic-hospital based residents had significantly more exposure to attendings prescribing long-acting reversible contraception, GnRH antagonists, and GnRH agonists but there were no significant differences in trainee prescribing practices or comfort. More respondents would feel comfortable medically managing endometriosis (52%) than surgically managing the disease (26%) if they were in practice today, with only 39% of PGY3-4 residents feeling comfortable surgically managing endometriosis.Conclusion: There is considerable room for improvement in the education of residents in the diagnosis and medical and surgical management of endometriosis.Plain Language Summary: Given the frequent multi-year delay in the diagnosis and proper treatment of endometriosis, we wanted to evaluate whether residents in Obstetrics and Gynecology (OB/GYN) feel adequately trained to manage this disease. Through our survey, we identified that OB/GYN residents are comfortable with diagnosing endometriosis but are less confident with treatment, particularly surgical management. Only 52% of senior residents in their final 2 years of residency training report they would feel comfortable with the medical treatment of endometriosis if they were in practice today, compared to 39% reporting comfort with surgical management. Additional exposure and training during residency are essential for boosting resident comfort with disease management and therefore improving patient care.Keywords: endometriosis, resident education, GnRH antagonists, surgical training, OB/GYN, pelvic pain