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OBJECTIVE To quantify the effect of a resident's reputation on the assessment of their laparoscopic skills. METHODS Faculty gynecologists were randomized to receive one of three hypothetical resident scenarios: a resident with high, average, or low surgical skills. All participants were then asked to view the same video of a resident performing a laparoscopic salpingo-oophorectomy that differed only by the resident description and provide an assessment using a modified OSATS (Objective Structured Assessment of Technical Skills) and a global assessment scale. RESULTS From September 6, 2020, to October 20, 2020, a total of 43 faculty gynecologic surgeons were recruited to complete the study. Assessment scores on the modified OSATS (out of 20) and global assessment (out of 5) differed significantly according to resident description, where the high-performing resident scored highest (median scores of 15 and 4, respectively), followed by the average-performing resident (13 and 3), and finally, the low-performing resident (11 and 3) (P=.008 and .043, respectively). CONCLUSION Faculty assessment of residents in gynecologic surgery is influenced by the assessor's knowledge of the resident's past performance. This knowledge introduces bias that artificially increases scores given to those residents with favorable reputations and decreases scores given to those with reputed surgical skill deficits. These data quantify the effect of such bias in the assessment of residents in the workplace and serve as an impetus to explore systems-level interventions to mitigate bias.

Objectives To document evolution of a CC in the first year of the CBD curriculum Methods A process analysis of a CC in a large Ob/Gyn residency program for 2019-2020 Results Challenges and successes were identified that will inform residency program planning such as faculty development, the program of assessment and individualization of curricula. A developmental model was implemented assessing each resident quarterly: reviewing their exam scores: teaching scores: scholarly activity and clinical evaluations. CC processes became more efficient; reducing time to assess each trainee and providing a more nuanced view. CC challenges identified included: 1) collating large volumes of data from multiple assessment platforms 2) resource issues involved in processing this data 3) training committee members in accessing the data. Program challenges identified include 1) Need to educate clinical faculty to provide quality feedback 3) Tailoring rotations to address the needs of trainees requiring additional time to reach competence and rapidly progressing trainees; 3) academic coaching of residents with difficulties. Successes included : 1) Emergence of early identification of trainee deficits in both the Medical Expert and Intrinsic domains leading to earlier intervention/remediation 2) Ability to monitor progress of all residents 3) Improvements in quality/ quantity of faculty assessments. Conclusions The CC process will continue to evolve, working to meet challenges in order to create a comprehensive assessment of each resident. The CC has a large role to play in advising the Residency Program in the ways it can work to serve the department more effectively.

Summary Background A woman's risk of venous thromboembolism during pregnancy is estimated to be two-to-six times higher than her risk when she is not pregnant. Such risk estimates are largely based on pregnancies that result in delivery of a newborn baby; no estimates exist for the risk of venous thromboembolism after induced abortion, another common pregnancy outcome. To fill this knowledge gap, we aimed to assess the risk of venous thromboembolism in women whose first pregnancy ended with induced abortion. Methods We did this propensity score-matched cohort study using data from the universal health-care system of Ontario, Canada. We included primigravid women who had an induced abortion between Jan 1, 2003, and Dec 31, 2015, and used a propensity score to match them to primigravid women who had a livebirth (1:1) or nulligravid women who were not pregnant on the procedure date of their matched counterpart and who did not conceive within 1 year afterwards (5:1). We excluded from our analysis women younger than 15 years or older than 49 years and individuals who had missing or invalid information about their sex, area of residence, residential income, or world region of origin. The primary outcome was risk of any venous thromboembolism within 42 days of the index date (defined as the date of an induced abortion, delivery date for livebirth, or for non-pregnant women the induced abortion date of their matched counterpart). We compared the rate of venous thromboembolism in primigravid women who had an induced abortion with the rate of venous thromboembolism in propensity-score-matched non-pregnant women and propensity-score-matched primigravid women whose pregnancy ended with a livebirth. We generated hazard ratios (HRs) of 42-day risk of venous thromboembolism after induced abortion using Cox proportional hazard models. Findings We identified 194 086 eligible women whose first pregnancy ended with induced abortion, of whom 176 001 (90·7%) could be matched with women whose first pregnancy ended in delivery of a newborn. These 176 001 women were also matched to 880 005 non-pregnant women. The rate of venous thromboembolism within 42 days of an induced abortion was 30·1 (95% CI 22·0–38·2) per 100 000 women compared with 13·5 (11·1–16·0) per 100 000 women in the non-pregnant group (HR 2·23, 95% CI 1·61–3·08). The HR was 0·16 (95% CI 0·12–0·22) when compared with the women in the livebirth cohort, whose venous thromboembolism rate within 42 days postpartum was 184·7 (95% CI 164·6–204·7) per 100 000 women. Interpretation The 42-day risk of venous thromboembolism after an induced abortion is double that of a matched non-pregnant woman, and is significantly lower than after a livebirth. This novel information can inform estimates of peri-procedural risk of venous thromboembolism after induced abortion. Clinicians could consider a lower threshold for ordering a diagnostic test to rule out venous thromboembolism after induced abortion than they would in a non-pregnant woman. Funding Institute for Clinical Evaluative Sciences.

Objectives Residency is a high stress period in a physician's career attributable to, at minimum, long hours, sleep deprivation, lack of autonomy, and sometimes, a poor work environment. Despite increased awareness of the prevalence of resident burnout and its attributable causes, there is a dearth of actionable guidelines and standards for residency programs to mitigate the personal impact of stress during residency. The University of Toronto Department of Obstetrics and Gynaecology developed a structured Resident Wellness Program in 2011 that includes a number of initiatives focusing on team support, personal relationships, and personal health. A formal evaluation of this program was conducted in order to guide future development of the program. Methods An anonymous 44-item questionnaire was developed and distributed to current and former residents. A total of 40 current and 17 past residents responded. Results 80% of current and 88% of past residents felt satisfied or very satisfied with the Wellness Program, and reported that the most useful components are wellness appointments, personal communication post-adverse event with a Wellness team member, and referrals to counselling services. Some barriers to accessing the Wellness Program persist. Conclusions Overall, the Wellness Program is well received, but opportunities for improvement exist. We propose a model for a Resident Wellness Program that can assist other programs to develop initiatives that promote and support resident wellbeing.

Objectives Surgical coaching has emerged as a new frontier of medical education. New evidence suggests that focused coaching in the operating room (OR) improves technical skill when compared to current residency training. Methods We wanted to develop the surgical coaching competency of faculty and resident members of our department through exposure to the Wisconsin Surgical Coaching Framework. We delivered a workshop jointly to faculty and residents at two academic hospitals. A pre-workshop survey was administered in order to assess awareness of the benefits of surgical coaching. Following the workshop, participants were asked to intentionally apply the Wisconsin Coaching Framework in the operating room using resident and staff physician dyads to evaluate the utility of the tool. Results A total of 28 staff Obstetricians & Gynecologists surveyed reported that time pressure, attitudes towards learners and case difficulty were the most commonly noted barriers to effective surgical coaching. Only 8% of staff physicians report having received formal training in coaching techniques. 67% of residents report pre-operative goals were rarely or never set and coaching of non-technical and cognitive skills rarely or never occurs. Post-intervention, over 90% of staff physicians and residents report setting goals with an increase in the frequency of teaching of non-technical skills. Conclusions In Obstetrics & Gynecology, our trainees have noted significant variation in the teaching skills of surgical teachers. A survey of our faculty and residents showed limited exposure to formal surgical coaching concepts. We have established a need and role for a formalized framework and language surrounding operating room teaching.

This is a response to the article, “A solution to gender inequity in surgery? Better caregiving policies” by Acai and colleagues.[1][1] Their discussion of how caregiving responsibilities and institutional caregiving policies can deter a junior trainee’s desire to enter a surgical specialty is

Objectives The Department of Obstetrics & Gynaecology at the University of Toronto mandates the completion of a resident research project. A thorough evaluation of the Resident Research Program is underway with the goal of improving the program, resident experiences and quality of research output. Methods A web-based survey of 71 current and 55 former residents was conducted. Surveyed information included prior research work, experiences working on a resident research project, research productivity in residency, and general attitudes about the research program. In addition, a bibliographic database was compiled for each resident, including publications and presentations. Results Forty current residents and 18 former residents responded. A total of 93 projects were ongoing or completed. Over half of our residents are involved in two or more projects and many spend 6 or more hours per week on their projects. Most respondents agreed that adding knowledge to the specialty is a motivator and having faculty who do research promotes scholarly activity. Major barriers included time constraints, lack of mentorship and lack of statistical knowledge. The most common project types were retrospective studies, and the fields of study represented all the major fields in the specialty. To date, 40% of respondents had published and 60% had presented their project. Conclusions Residents in our department are successfully engaged in research projects that lead to publication and presentation. The Research program is valued by most, but not all residents. These results will inform a redesign of our resident research program.

Objectives In 2011, the University of Toronto Department of Obstetricsand Gynaecology developed and instituted a structured Resident Wellness Program with initiatives designed to support resident wellbeing. After 7years of anecdotal evidence of success, we wished to more formally evaluate the success of this program in order to obtain resident perspectives and identify opportunities for improvement. Methods An anonymous 44-item questionnaire was developed and distributed to current and former residents. A total of 40 current and 17 past residents responded to the survey. Results 33% of current residents and 20% of former residents reported frequently experiencing burnout. 80% of current and 88% of past residents felt satisfied or very satisfied with the Wellness Program, although some components were valued more than others. Residents reported that the most useful components are wellness appointments, personal communication post-adverse event with a Wellness team member, and referrals to counselling services. The most commonly cited reason for not accessing Wellness Program initiatives included a lack of time and not being able to get away from resident duties. Residents reported that their wellness issues are sufficiently addressed by a combination of the Wellness program and their own personal resources, however systemic issues such as workload, time pressures, and the learning environment continue to impede resident wellness. Conclusions The Wellness Program has been favourably received, however residents are interested in tackling systems issues that impact wellness. Going forward, our resident Wellness Program should advocate on behalf of residents to address systems issues in order to improve resident wellbeing.

Diffuse large cell lymphomas are aggressive tumors of B-cell origin. In some cases they arise from low-grade follicular lymphomas carrying the t(14;18) translocation, an event that leads to the overexpression of the BCL-2 gene product. More frequently, however, they lack the t(14;18) translocation. Rearrangements of the c-MYC proto-oncogene and mutations of the p53 tumor suppressor gene have also been documented in these lymphomas. This study examines the extent to which alterations in the BCL-2, c-MYC, and p53 genes co-exist within individual lymphomas. Eight diffuse large cell lymphoma cell lines and 11 diffuse large cell lymphoma tumors were assessed for genetic alterations in these three genes. Our results indicate that there is a heterogeneity in the oncogene/suppressor gene profile among diffuse large cell lymphomas. Two cell lines and one tumor carried alterations in all three genes, one cell line carried alterations of c-MYC and p53, and one primary tumor and one cell line carried p53 mutations and the t(14;18). Single alterations of BCL-2 and p53 were also observed. Another cell line had no alterations in any of these genes. The heterogeneity indicates that varied mechanisms may be involved in the generation of diffuse large cell lymphomas.