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Racism and bias contribute to healthcare disparities at a patient and population health level and also contribute to the stagnation or even regression of progress toward equitable representation in the workforce and in healthcare leadership. Medical education and healthcare systems have expended tremendous efforts over the past several years to address these inequities. However, systemic racism continues to impact health outcomes and the future physician workforce. The Association of Professors of Gynecology and Obstetrics called for action to achieve a future free from racism in obstetrics and gynecology education and healthcare. As a result of this call to action, the Diversity, Equity, and Inclusion Guidelines Task Force was created. The mission of the Task Force was to support educators in their efforts to identify and create educational materials that augment antiracist educational goals and prepare, recruit, and retain a talented and diverse workforce. In this Special Report, the authors share these guidelines that describe best practices and set new standards to increase diversity, foster inclusivity, address systemic racism, and eliminate bias in obstetrics and gynecology educational products, materials, and environments.

The June 2022 U.S. Supreme Court decision on Dobbs v Jackson Women's Health Organization resulted in state-specific differences in abortion care access across the country. The primary concern in the obstetrics and gynecology education community has been the impact on resident and fellowship training programs. However, the impact on undergraduate medical education and the broad implications for future generations of physicians are crucial to address. An estimated that 48% of matriculants to MD-granting medical schools will receive their medical education in the 26 states with significant abortion restrictions or bans. Undergraduate medical educators need to continue to adequately teach the basic science, clinical care, and population health outcomes of reproductive medicine, including pregnancy and abortion. In addition, students in states with more restrictions on abortion will have less or no clinical exposure, and those in states with few restrictions may be excluded due to overcrowding of learners from restricted states. Students' own health care also needs to be considered, as access to abortion care for themselves or their partners may create applicant pool demographic shifts by state as applicants consider options for where to pursue their medical education. It is important to ensure that teaching of foundational science of pregnancy, abortion, and reproductive health continues throughout the United States. Undergraduate and graduate medical educators will need to closely monitor the downstream impact of decreased clinical exposure of abortion. Further study of the personal health impact of abortion care access for medical students and awareness of the changing applicant pool demographics by state is needed.

Infertility is a common condition which causes substantial patient distress and prompts patients to seek care in outpatient gynecologic offices. The evaluation and treatment of infertility can be costly and insurance coverage for these services varies widely. Obstetrician-gynecologists and other women's health care professionals often struggle with the approach for patients without insurance coverage for infertility care. This article reviews the status of insurance coverage for infertility services, reviews options for both the evaluation and management of infertility for patients who do not have infertility insurance coverage, and provides resources for ongoing advocacy and support for these patients.

BACKGROUND: Given the increasing complexities of the residency application processes, there is an ever-increasing need for faculty to serve in the role of fourth-year medical student career advisors. OBJECTIVE: This study aimed to investigate obstetrics and gynecology clerkship directors’ confidence and fulfillment with serving in the role of faculty career advisors. STUDY DESIGN: A 25-item electronic survey was developed and distributed to the 225 US obstetrics and gynecology clerkship directors in university-based and community-based medical schools with active memberships in the Association of Professors of Gynecology and Obstetrics. Items queried respondents on demographics, confidence in fourth-year advising, satisfaction with this aspect of their career, and resources used for advising. RESULTS: Of 225 clerkship directors, 143 (63.6%) responded to the survey. Nearly all clerkship directors (136/143 [95%]) reported advising fourth-year students. A median of 5.0 hours (interquartile range, 3.0–10.0) was spent per student in this advisory role, with 29 of 141 clerkship directors (20.5%) reporting some form of compensation for advising. Confidence in the ability to advise fourth-year medical students correlated significantly with number of years as a faculty, number of years as a clerkship director, and a higher full-time equivalent allotted as clerkship director. Fulfillment as a faculty career advisor was correlated with number of years as a clerkship director and a higher number of students advised. CONCLUSION: Obstetrics and gynecology clerkship directors regularly serve in the crucial role of faculty career advisor. Confidence in advising fourth-year students, advising fulfillment, and satisfaction with advising resources were all significantly correlated. We recommend that clerkship directors review resources available for advising and that they be provided academic time to serve as career advisors.

Obstetrician-gynecologists can improve the learning environment and patient care by addressing implicit bias. Accumulating evidence demonstrates racial and gender-based discrimination are woven throughout medical education, in formal curricula, patient/provider/trainee interactions in the clinical workspace, and all aspects of learner assessment. Implicit bias negatively impacts our learners in every space. Strategies to address implicit bias at the individual, interpersonal, institutional, and structural level to improve the well-being of learners and patients are needed. The authors review an approach to addressing implicit bias in obstetrics and gynecology education, which includes 1) curricular design using an educational framework of anti-racism and social justice theories 2) bias awareness and management pedagogy throughout the curriculum, 3) elimination of stereotypical patient descriptions from syllabi and exam questions 4) critical review of epidemiology and evidence-based medicine for underlying assumptions based on discriminatory practices or structural racism which unintentionally reinforce stereotypes and bias. The movement toward competency-based medical education and holistic evaluations may result in decreased bias in learner assessment. Educators may wish to monitor grades and narratives for bias as a form of continuous educational equity improvement. As practicing physicians may have little training in this area, faculty development efforts in bias awareness and mitigation strategies may have significant impacts on learner well-being.

Institutions should develop, implement, and monitor processes to ensure transparency and appropriate consent from patients for medical students performing pelvic examinations under anesthesia., The pelvic examination is a critical tool for the diagnosis of women's health conditions and remains an important skill necessary for students to master before becoming physicians. Recently, concerns regarding student involvement in pelvic examinations—specifically those performed while a woman is under anesthesia—have been raised in the scientific, professional, and lay literature. These concerns have led to calls to limit or halt the performance of pelvic examinations by students while a woman is under anesthesia. Although ensuring adequate informed consent for teaching pelvic examinations is a priority, we must not lose sight of the critical pedagogical value of teaching pelvic examination in familiarizing students with the female anatomy and instilling a physician workforce with confidence in pelvic examination skills. A compromise that addresses all of these values is possible. In this commentary, we review the educational and legal aspects of the pelvic examination under anesthesia, then provide strategies that individuals and institutions can consider to optimize processes regarding consent for pelvic examination under anesthesia.

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.

SUMMARY While metabolic changes are considered a cancer hallmark, their assessment has not been incorporated in the detection of early or precancers, when treatment is most effective. Here, we demonstrate that metabolic changes are detected in freshly excised human cervical precancerous tissues using label-free, non-destructive imaging of the entire epithelium. The images rely on two-photon excited fluorescence from two metabolic co-enzymes, NAD(P)H and FAD, and have micron-level resolution, enabling sensitive assessments of the redox ratio and mitochondrial fragmentation, which yield metrics of metabolic function and heterogeneity. Simultaneous characterization of morphological features, such as the depth-dependent variation of the nuclear:cytoplasmic ratio, is demonstrated. Multi-parametric analysis combining several metabolic metrics with morphological ones enhances significantly the diagnostic accuracy of identifying high-grade squamous intraepithelial lesions. Our results motivate the translation of such functional metabolic imaging to in vivo studies, which may enable improved identification of cervical lesions, and other precancers, at the bedside., Graphical Abstract, In Brief Reprogramming of cellular metabolism is an emerging cancer hallmark. Pouli et al. show that metabolic dysfunction can be detected in live human cervical biopsies using high-resolution autofluorescence images of the metabolic coenzymes NAD(P)H and FAD. The authors use morphological and functional metrics to successfully distinguish healthy tissues from precancerous lesions.

To demonstrate the feasibility of a regional Obstetrics and Gynecology (Ob/Gyn) Transition to Residency Course (TRC) through compliance, satisfaction, and sustainability.We implemented a two-week, multi-institutional regional TRC (RTRC) for fourth-year medical students matched in Ob/Gyn or Family Medicine from four New England medical schools. Curriculum was developed to meet Ob/Gyn Milestone One (M1) and Core Entrustable Professional Activity (CEPA) objectives. Compliance, satisfaction, and sustainability were identified as feasibility outcomes.From 2015-2018, a total of 63 fourth-year students have participated. The number of students remained stable each year. All students attended 100% of sessions. There was an average of9/10 in all satisfaction metrics all four years. The number of faculty members from each institution remained stable over the four years.A RTRC is feasible as measured through compliance, satisfaction and sustainability.

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.

Author(s): Brindis, Claire D; Freund, Karen M; Baecher-Lind, Laura; Bairey Merz, C Noel; Carnes, Molly; Gulati, Martha; Joffe, Hadine; Klein, Wendy S; Mazure, Carolyn M; Pace, Lydia E; Regensteiner, Judith G; Redberg, Rita F; Wenger, Nanette Kass; Younger, Lorie

Study Objective This study was conducted to characterize pediatricians' current practice patterns and perceived barriers related to adolescent contraception counseling with an emphasis on intrauterine contraception (IUC). Design We performed a mailed survey study to 400 general pediatricians. Setting Surveys were mailed to pediatricians at their individual office locations. Participants General pediatricians belonging to the Massachusetts Pediatric Society were included in the study. Interventions The survey instrument assessed current practice patterns and perspectives as related to contraception counseling for adolescents. Main Outcome Measures Use of contraception among adolescent patients, policy to recommend IUC to adolescents in various clinical scenarios, and barriers to adolescent contraceptive counseling. Results Over 50% of pediatricians considered abstinence their favored method of contraception for adolescents, while fewer than 20% reported discussing IUC as an option. Female pediatricians were more likely to discuss IUC (25% vs 8%, P = .01), as were younger pediatricians (28% vs 14%, P = .13). Given 8 clinical scenarios suitable for IUC use, less than 25% of pediatricians would offer IUC to a teen unless she had a history of a vaginal delivery or abortion. Seventy percent of pediatricians reported lack of training with IUC, and more than 30% reported legal, fertility and parental concerns as barriers to discussing IUC with adolescents. Conclusions Efforts are warranted to improve the education of pediatricians regarding the most current guidelines for proper IUC use in adolescents with the goal to increase the frequency with which this effective contraceptive method is discussed with this vulnerable population.

OBJECTIVE To determine whether the proportion of leadership positions in obstetrics and gynecology held by women is consistent with expectations based on the proportion of women entering residency at the time of current leaders. METHODS Leadership positions were considered as department chairs affiliated with the Council of University Chairs of Obstetrics and Gynecology, editors of the 20 obstetrics and gynecology journals with the highest impact factors [corrected],and presidents of influential professional societies. Publically available data were accessed to determine sex and the year of medical school graduation for each individual holding each leadership position, as well as to determine the number of men and women entering residency in obstetrics and gynecology per year. Actual and expected proportions of leadership positions held by women were compared using χ² tests. RESULTS Women should hold 71 of the total 194 leadership positions based on the proportion of women entering residency during the mean graduation year among leaders. Women actually hold 41 of these leadership positions (21.1%; P

Human reproduction provides unique opportunities for the transmission of infectious agents. Furthermore, the mother and her offspring have distinct susceptibilities to infection at each stage of reproduction, from conception and gestation to parturition and the neonatal period. The impact of pathogens on reproduction can be mitigated or exacerbated depending on timing of acquisition during pregnancy. Similarly, factors such as maternal immune response, nutritional status, or concurrent infection may modify the effect of an infectious agent. In this review, we discuss the evidence--or lack thereof--for associations between infectious agents and reproductive problems at each stage of reproduction. We focus on well-substantiated associations, and consider several emerging or controversial associations. We discuss the challenges, limitations, and opportunities related to epidemiologic research on infectious disease and reproductive outcomes.ObstetriciansGynecologists, Family Physicians.After completion of this article, the reader will be able to describe the potential mechanisms by which infectious agents may impact productive health, explain the public health impact of infectious diseases on reproductive health, and summarize the perinatal risks of infectious disease and relate this to treatment and prevention strategies in practice.

Objective To determine whether language and word choice can reduce patients' perception of pain experienced during colposcopy with biopsies. Materials and methods Women reporting for colposcopy at an academic medical center were randomized to hear standard language or gentle, non-pain-based language during colposcopy with biopsy and/or endocervical curettage. Participants then rated their pain during the procedure on a 10-cm visual analog scale. The pain scores among the 2 groups were compared using a Student t test. Results Both women hearing standard language and those hearing gentle language during colposcopy reported low pain during the procedure (3.1 and 2.9, respectively), which was not significantly different between groups (p=.80). Conclusions Although gentle language has been shown to effectively reduce pain associated with other procedures, it did not reduce the pain associated with colposcopy and biopsies in this study.