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Maya M Hammoud1, Helen K Morgan1, Mary E Edwards2, Jennifer A Lyon2, Casey White31Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA; 2Health Sciences Center Libraries, University of Florida, Gainesville, FL, USA; 3Graduate Medical Education, Faculty Affairs and Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USAPurpose: To determine if video review of student performance during patient encounters is an effective tool for medical student learning.Methods: Multiple bibliographic databases that include medical, general health care, education, psychology, and behavioral science literature were searched for the following terms: medical students, medical education, undergraduate medical education, education, self-assessment, self-evaluation, self-appraisal, feedback, videotape, video recording, televised, and DVD. The authors examined all abstracts resulting from this search and reviewed the full text of the relevant articles as well as additional articles identified in the reference lists of the relevant articles. Studies were classified by year of student (preclinical or clinical) and study design (controlled or non-controlled).Results: A total of 67 articles met the final search criteria and were fully reviewed. Most studies were non-controlled and performed in the clinical years. Although the studies were quite variable in quality, design, and outcomes, in general video recording of performance and subsequent review by students with expert feedback had positive outcomes in improving feedback and ultimate performance. Video review with self-assessment alone was not found to be generally effective, but when linked with expert feedback it was superior to traditional feedback alone.Conclusion: There are many methods for integrating effective use of video-captured performance into a program of learning. We recommend combining student self-assessment with feedback from faculty or other trained individuals for maximum effectiveness. We also recommend additional research in this area.Keywords: feedback tools, self-assessment of performance, self-directed learning with feedback, feedback and self-assessment, video review of performance with feedback

Medical education has long relied upon the inherent rewards of teaching to secure necessary educators. In an era of increasing emphasis upon clinical productivity, the expectation of faculty engagement in medical education has been upended. In addition, the demands and stressors of modern medical education has contributed to the perceived cost of teaching by faculty. This article describes the factors that have coalesced to change the environment in which medical education has long succeeded and provides strategies that can be employed to help mitigate these forces, increase perceived value in teaching, and better support the academic faculty upon which medical education depends.

Faculty career advisors who guide applicants applying to obstetrics and gynecology residency programs need updated information and resources, given the constant changes and challenges to the residency application process. Initial changes included standardization of the application timeline and interview processes. More recent changes included the utilization of a standardized letter of evaluation, initiation of program signaling, second look visit guidelines, and updated sections in the Electronic Residency Application Service. Challenges in advising include the unmatched applicant and the applicant who is couples matching in the era of program signaling. Additional considerations include applying with the current status of reproductive health law restrictions and preparing for a new residency application platform. The Undergraduate Medical Education Committee of the Association of Professors of Gynecology and Obstetrics provides this updated guide of the prior 2021 resource for advisors to increase confidence in advising students, boost professional fulfillment with advising activities, and aid in satisfaction with advising resources. This guide covers the continuing challenges and future opportunities in the resident application process., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Mistreatment from patients is prevalent and has far-reaching negative consequences., Aim: To develop a practice-based curriculum on patient-initiated mistreatment and examine participant perceptions before and after the curriculum., Setting: Single medical school in the United States., Participants: 306 senior medical students from classes 2022 and 2023., Program Description: A single patient-initiated mistreatment session delivered during specialty-specific residency preparation courses (RPCs) featuring a literature discussion, a response framework, and patient-actor skills practice., Program Evaluation: Between February 2022 and October 2023, 22 sessions occurred. Electronic surveys were delivered before, following, and approximately eight months after each session. A total of 257 (84.0%) and 174 (56.9%) participants completed pre- and post-session surveys, respectively. Significant increases in mean scores were noted for confidence in recognizing mistreatment (pre-session 4.25, post-session 4.68; p < 0.001) and comfort in addressing mistreatment personally (pre-session 2.86, post-session 4.30; p < 0.001) and as a bystander (pre-session 2.98, post-session 4.27; p < 0.001). In the follow-up survey, participants noted that the session was useful in preparing them for residency., Discussion: A novel patient-initiated mistreatment curriculum empowered students, resulting in enhanced confidence in responding and sustained skill usage. Medical schools may consider including this training for all graduating students., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Background: As part of the residency application process in the United States, many medical specialties now offer applicants the opportunity to send program signals that indicate high interest to a limited number of residency programs. To determine which residency programs to apply to, and which programs to send signals to, applicants need accurate information to determine which programs align with their future training goals. Most applicants use a program's website to review program characteristics and criteria, so describing the current state of residency program websites can inform programs of best practices., Objective: This study aims to characterize information available on obstetrics and gynecology residency program websites and to determine whether there are differences in information available between different types of residency programs., Methods: This was a cross-sectional observational study of all US obstetrics and gynecology residency program website content. The authorship group identified factors that would be useful for residency applicants around program demographics and learner trajectories; application criteria including standardized testing metrics, residency statistics, and benefits; and diversity, equity, and inclusion mission statements and values. Two authors examined all available websites from November 2011 through March 2022. Data analysis consisted of descriptive statistics and one-way ANOVA, with P<.05 considered significant., Results: Among 290 programs, 283 (97.6%) had websites; 238 (82.1%) listed medical schools of current residents; 158 (54.5%) described residency alumni trajectories; 107 (36.9%) included guidance related to the preferred United States Medical Licensing Examination Step 1 scores; 53 (18.3%) included guidance related to the Comprehensive Osteopathic Medical Licensing Examination Level 1 scores; 185 (63.8%) included international applicant guidance; 132 (45.5%) included a program-specific mission statement; 84 (29%) included a diversity, equity, and inclusion statement; and 167 (57.6%) included program-specific media or links to program social media on their websites. University-based programs were more likely to include a variety of information compared to community-based university-affiliated and community-based programs, including medical schools of current residents (113/123, 91.9%, university-based; 85/111, 76.6%, community-based university-affiliated; 40/56, 71.4%, community-based; P<.001); alumni trajectories (90/123, 73.2%, university-based; 51/111, 45.9%, community-based university-affiliated; 17/56, 30.4%, community-based; P<.001); the United States Medical Licensing Examination Step 1 score guidance (58/123, 47.2%, university-based; 36/111, 32.4%, community-based university-affiliated; 13/56, 23.2%, community-based; P=.004); and diversity, equity, and inclusion statements (57/123, 46.3%, university-based; 19/111, 17.1%, community-based university-affiliated; 8/56, 14.3%, community-based; P<.001)., Conclusions: There are opportunities to improve the quantity and quality of data on residency websites. From this work, we propose best practices for what information should be included on residency websites that will enable applicants to make informed decisions., (© Paulina M Devlin, Oluwabukola Akingbola, Jody Stonehocker, James T Fitzgerald, Abigail Ford Winkel, Maya M Hammoud, Helen K Morgan. Originally published in JMIR Medical Education (https://mededu.jmir.org).)

Background Despite national attention on resident well-being, challenges persist. Effective solutions require greater understanding of personal and program factors. Objective To explore burnout, resilience, self-reported mental health, and perceptions of the learning environment in a national sample of obstetrics and gynecology (OB/GYN) residents. Methods An observational cross-sectional survey of OB/GYN residents taking the January 2022 national in-training examination included an abbreviated 2-item Maslach Burnout Inventory, a short version of the Connor-Davidson Resilience Scale, and subjective experience of other factors. Kruskal-Wallis and chi-square tests explored differences in outcomes and associations between variables. Results Among 5761 residents taking the examination, 3741 (64.9%) participated, with 2425 of 3741 (64.8%) reporting burnout, 2138 (57.2%) depression, 2651 (70.9%) anxiety, and 147 (3.9%) suicidal ideation. Women fared worse than men in terms of burnout (2105 of 3147, 66.9% vs 281 of 496, 56.7%, P <.001), depression (1843 of 3147, 58.6% vs 256 of 496, 51.6%, P =.004), anxiety (2318 of 3147, 73.7% vs 294 of 496, 59.3%, P <.001), and resilience (5.9±2.1 vs 6.2±2.1, P =.006). More nonbinary residents considered leaving residency (17 of 49, 34.7% vs 676 of 3147, 21.5% [women] and 108 of 496, 21.8% [men], P =.008). Race-based differences were seen in depression, suicidal ideation, and thoughts of leaving residency. Increased binge drinking was reported with increasing postgraduate year. Among 614 residents reporting that well-being was not a priority in their program, 539 of 614 (87.8%) reported burnout, 469 of 614 (76.4%) depression, and 508 of 614 (82.7%) anxiety. Conclusions Residents report high rates of mental health concerns, and these are worse among women, gender nonconforming individuals, Black residents, and those who perceive well-being is not a priority in their training program.

Background: As the gender demographics of medical students have evolved over the past decades, it is important to understand potential stressors and challenges that may affect clinical learning experiences. This study investigated the prevalence of prior sexual assault (SA) and interpersonal violence (IPV) in medical students and how these affect their clinical clerkship experiences., Methods: A survey was distributed to third- and fourth-year medical students at a single institution in August 2022 querying respondents on demographics and prior experiences with SA/IPV at any point in their lives. Respondents who indicated they had previously experienced SA/IPV were directed to questions about how these experiences affected clerkships., Findings: Of 419 students, 125 responded to the survey (30.8% response rate). Forty (31.1%) reported a history of SA/IPV-32 (80.0%) women, five (12.5%) men, and three (7.5%) who did not report gender or identified as non-binary. Of the 40 respondents with a history of SA/IPV, 20 (50.0%) reported that their prior history affected their overall clinical experience, and nine (22.5%) felt that it affected their performance. Only seven (17.5%) reported using any resources, such as counselling, during their clerkships. Narrative responses discussed significant effects on performing physical exams, taking a history, interacting with team members, and engaging during clerkships., Discussion: This work demonstrates the high number of students affected by SA/IPV and how these prior experiences affected core components of their clerkship experiences., Conclusions: Institutions must be proactive to create better supports for learners with histories of trauma, including SA/IPV., (© 2024 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Clerkship directors must balance the mental wellbeing of their medical students with the demanding schedule that rotations in procedural specialties such as surgery and obstetrics and gynecology require. In this paper, the Undergraduate Medical Education Committee of the Association of Professors of Obstetrics and Gynecology argues the importance of maintaining adequate clinical exposure for learners. Involving students in overnight call provides additional clinical involvement, improved relationships with the clinical team, and a better perspective on specialist lifestyle. Educators should improve the experience for students by promoting resilience and creating a welcoming learning environment. Preparing medical students for the rigorous requirements of these clerkships allows them to thrive in the learning environment while still providing a realistic preview of the clinical experiences and demands of these specialties., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: Although approximately one-fifth of obstetrics and gynecology (OBGYN) residents matriculate from osteopathic or international medical schools, most literature regarding the transition to residency focuses on allopathic medical school graduates. To create comprehensive interventions for this educational transition, we must understand the needs of all incoming residents. Our objective was to examine OBGYN residents' perceptions of their transition to residency, and to understand how residents' background and medical school environment influence their perceived sense of readiness., Design: A 16-item survey asked questions about demographics, the transition to residency, resident well-being, burnout, and the transition to fellowship. Perception of preparedness was assessed with the question "I felt that I was well-prepared for the first year of residency" (1=strongly agree, 5=strongly disagree). Chi-squared and Fisher's exact tests and logistic regression explored association of perceived preparedness with residents' backgrounds., Setting: Survey administered at time of the in-training examination in 2022., Participants: All OBGYN residents., Results: Of 5761 eligible participants, 3741 (64.9%) provided consent and completed the survey. Of the 3687 participants who answered the question, 2441 (66.2%) either agreed or strongly agreed that they felt well-prepared. Fewer osteopathic graduates reported feeling prepared compared to allopathic graduates (379/610, 62.1% vs 1,924/2,766, 69.6%) (OR 0.72, 95%CI 0.60-0.86, p < 0.01). International medical school graduates were seven times less likely to report feeling prepared compared to those from allopathic institutions (137/304, 45.1% vs 1924/2776, 69.6%) (OR 0.60, 95%CI 0.53-0.68, p < 0.01). Respondents from underrepresented racial and ethnic backgrounds were less likely to report feeling prepared compared to White respondents (276/535, 51.6% vs 1738/2387, 72.8%) (OR 0.39, 95%CI 0.33-0.48, p < 0.01)., Conclusions: Differences in residents' perceptions of their transition to residency highlight the need to begin offsetting pervasive inequities with comprehensive and accessible resources., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Purpose: Transition to residency (TTR) courses facilitate the medical student-residency transition and are an integral part of senior medical student training. The authors established a common set of skills for TTR courses, and an expected level of entrustment students should demonstrate in each skill on TTR course completion., Method: A modified Delphi approach was used with 3 survey iterations between 2020 and 2022 to establish skills to be included in a TTR course. Nine TTR experts suggested general candidate skills and conducted a literature search to ensure no vital skills were missed. A stakeholder panel was solicited from email lists of TTR educators, residency program directors, and residents at the panelists' institutions. Consensus was defined as more than 75% of participants selecting a positive inclusion response. An entrustment questionnaire asked panelists to assign a level of expected entrustment to each skill, with 1 indicating observation only and 6 indicating perform independently., Results: The stakeholder panel initially consisted of 118 respondents with representation across educational contexts and clinical specialties. Response rates were 54% in iteration 2, 42% in iteration 3, and 33% on the entrustment questionnaire. After 3 iterations, 54 skills met consensus and were consolidated into 37 final skills categorized into 18 clinical skills (e.g., assessment and management of inpatient concerns), 14 communication skills (e.g., delivering serious news or having difficult conversations), 4 personal and professional skills (e.g., prioritization of clinical tasks), and 1 procedural skill (mask ventilation). Median entrustment levels were reported for all skills, with 19 skills having a level of expected entrustment of 4 (perform independently and have all findings double-checked)., Conclusions: These consensus skills can serve as the foundation of a standardized national TTR curriculum framework. Entrustment guidance may help educational leaders optimize training and allocation of resources for TTR curriculum development and implementation., (Copyright © 2024 the Association of American Medical Colleges.)

Introduction: Interprofessional experiences provide critical exposure to collaborative health care teams, yet medical students often lack this experience during clinical clerkships. We created a labor and delivery triage rotation exclusively staffed by certified nurse-midwives in the obstetrics and gynecology clerkship to address this gap. We sought to evaluate the clinical learning experiences of medical students rotating on this midwife-supervised collaborative team., Methods: Between 2018 and 2020, we electronically sent all medical students an evaluation after each required clerkship. Our primary outcome was the quality of teaching score, as defined by level of agreement on a 5-point Likert scale with a statement regarding teaching quality. A secondary outcome evaluated scores from the National Board of Medical Examiners (NBME) Obstetrics and Gynecology subject examination taken by all students at the end of the rotation. Evaluations and assessments were compared between students rotating on labor and delivery triage and those who did not. Evaluation comments from students rotating on labor and delivery triage were collated to identify common themes., Results: Of 374 students, 370 (98.9%) completed the end-of-clerkship course evaluation and 312 (83.4%) completed teaching evaluations. Sixty-seven students (17.9%) rotated in labor and delivery triage; of these, 52 (77.6%) completed both the course and triage rotation evaluations. There were no differences in the mean quality of teaching scores (3.9 ± 1.2 versus 3.8 ± 1.2, p = 0.54) or in NBME Obstetrics and Gynecology subject examination scores between students rotating in labor and delivery triage compared to all other rotations (79.9% ± 7.2% vs 80.2% ± 7.8%, P = 0.436). Comments from teaching evaluations highlighted student exposure to the midwifery philosophy of care model., Discussion: This work demonstrates the feasibility and benefits of this midwife-led authentic interprofessional collaborative experience for medical students. This model can serve as an example of how to implement and evaluate interprofessional collaboration experiences in the clinical setting., (© 2023 The Authors. Journal of Midwifery & Women's Health published by Wiley Periodicals LLC on behalf of American College of Nurse Midwives (ACNM).)

Purpose: This article is prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee and provides educators recommendations for optimizing inclusive education for our students with disabilities. Medical educators are increasingly encountering students with disabilities and have the responsibility of ensuring requirements are met., Method: Medical education committee members from the US and Canada reviewed the literature on disabilities in medical student education to identify best practices and key discussion points. An iterative review process was used to determine the contents of an informative paper., Results: Medical schools are required to develop technical standards for admission, retention, and graduation of their students to practice medicine safely and effectively with reasonable accommodation. A review of the literature and obstetrics and gynecology expert opinion formed a practical list of accommodation strategies and administrative steps to assist educators and students., Conclusion: Medical schools must support the inclusion of students with disabilities. We recommend a collaborative approach to the interactive process of determining reasonable and effective accommodations that includes the students, a disability resource professional and faculty as needed. Recruiting and supporting medical students with a disability strengthens the diversity commitment and creates a more inclusive workforce.

Purpose: Medical education should prepare learners for complex and evolving work, and should ideally include the Master Adaptive Learner (MAL) model-meta-learning skills for continuous self-regulated learning. This study aimed to measure obstetrics and gynecology (OB/GYN) residents' MAL attributes, assess associations with burnout and resilience, and explore learning task associations with MAL., Method: OB/GYN residents were surveyed electronically at an in-training examination in January 2022. The survey included demographic information, the 2-item Maslach Burnout Inventory, the 2-item Connor-Davidson Resilience Scale, 4 MAL items (e.g., "I take every opportunity to learn new things"), and questions about training and learning experiences., Results: Of 5,761 residents, 3,741 respondents (65%) were included. A total of 1,478 of 3,386 (39%) demonstrated burnout (responded positive for burnout on emotional exhaustion or depersonalization items). The mean (SD) Connor-Davidson Resilience Scale score was 6.4 (1.2) of a total possible score of 8. The mean (SD) MAL score was 16.3 (2.8) of a total possible score of 20. The MAL score was inversely associated with burnout, with lower MAL scores for residents with (mean [SD] MAL score, 16.5 [2.4]) vs without (mean [SD], 16.0 [2.3]) burnout (P < .001). Higher MAL scores were associated with higher resilience (R = 0.29, P < .001). Higher MAL scores were associated with the statement, "I feel that I was well prepared for my first year of residency" (R = 0.19, P < .001) and a plan to complete subspecialty training after residency (mean [SD] of 16.6 [2.4] for "yes" and 16.2 [2.4] for "no," P < .001)., Conclusions: Residents who scored higher on MAL showed more resilience and less burnout. Whether less resilient, burned-out residents did not have the agency to achieve MAL status or whether MAL behaviors filled the resiliency reservoir and protected against burnout is not clear., (Copyright © 2024 the Association of American Medical Colleges.)

Objective: There are few published accounts of the obstetrics and gynecology (OBGYN) specialty-specific experience with a formal signaling program. Prior studies examining other medical specialties' experiences with signaling are quantitative, having not examined the complexity of the residency applicant experience by directly engaging applicants; therefore, this study aimed to describe the lived experiences of OBGYN residency applicants who employed a formal signaling program during the 2022-2023 residency application cycle to assist and guide future residency applicants., Design: A phenomenological approach was chosen to prescribe a common meaning for OBGYN residency applicants' experiences. purposeful sampling was employed to ensure racial, ethnic, and institutional geographic diversity in participant representation. Semi-structured interviews were conducted virtually between April and May 2023., Results: Twenty-five OBGYN residency applicants participated. Fourteen identified as underrepresented in medicine. Four themes emerged: non-uniform decision-making processes, inconsistent guidance, mental health effect, and signaling reflections. Some themes had associated subthemes. Critical aspects of the applicants' journey were revealed, including decision-making dynamics and reliance on trusted advisors. Applicants described tensions and complexities when navigating signaling strategy in relation to abortion education opportunities in a post-Dobbs era. They also conveyed concerns about inconsistencies in signaling guidance, the emotional toll on well-being, and persistent inequities in the application process. They ultimately made recommendations for future directions, including suggestions for more robust advising and improved signaling execution., Conclusions: This study offers a comprehensive exploration of the experiences of OBGYN residency applicants with formal program signaling. To ensure equity and transparency in the residency application process, it is crucial to not only provide OBGYN residency applicants with clear guidance on signaling, but also encourage a standardized approach for its utilization by residency programs., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Importance: State-specific abortion restrictions currently affect the training of approximately 44% of obstetrics and gynecology (OBGYN) residents in the US. Examination of where future trainees apply for residency is important., Objective: To assess changes in the percentage of applicants to OBGYN residency programs by state based on abortion restrictions in place after the Dobbs v Jackson Women's Health Organization (hereafter, Dobbs v Jackson) US Supreme Court decision and examine whether applicants' preference for programs, as suggested by the distribution of application signals that express higher interest, was associated with abortion bans., Design, Setting, and Participants: This serial cross-sectional study used anonymized data for all applicants to OBGYN residency programs in the US during September and October from 2019 to 2023. Data were obtained from the Association of American Medical Colleges Electronic Residency Application Service., Exposures: Applications and program preference signals sent to OBGYN residency programs, analyzed by applicants' self-reported demographics., Main Outcomes and Measures: The primary outcome was differences in the percentage of unique applicants to OBGYN residency programs from 2019 to 2023, with programs categorized by state-based abortion restrictions after the Dobbs v Jackson decision. Secondary outcomes included the distribution of program signals by state abortion ban status., Results: A total of 2463 applicants (2104 [85.4%] women) who applied to OBGYN programs for the 2023 residency match cycle were the focal sample of this study. While overall applicant numbers remained stable between 2019 and 2023, the number of applicants differed significantly by state abortion ban status in the 2022 (F2,1087 = 10.82; P < .001) and the 2023 (F2,1087 = 14.31; P < .001) match cycles. There were no differences in the number of signals received by programs in states with bans after controlling for known covariates such as number of applications received and program size, and there were no differences in the percentage of signals sent by out-of-state applicants to programs in states with different abortion laws than their home states (F2,268 = 2.41; P = .09)., Conclusions and Relevance: In this cross-sectional study, there was a small but statistically significant decrease in the number of applicants to OBGYN residency programs in states with abortion bans in 2023 compared with 2022. However, applicant signaling data did not vary by states' abortion ban status. While OBGYN residency programs almost completely filled in 2023, continued monitoring for the potential consequences of state abortion bans for OBGYN training is needed.

Background: Medical trainees are expected to perform complex tasks while experiencing interruptions, which increases susceptibility to errors of omission. In our study, we examine whether documentation of clinical encounters increases reflective thinking and reduces errors of omission among novice learners in a simulated setting., Methods: In 2021, 56 senior medical students participated in a simulated paging curriculum involving urgent inpatient cross-cover scenarios (sepsis and atrial fibrillation). Students responded to pages from standardized registered nurses (SRNs) via telephone, gathered history, and discussed clinical decision-making. Following the phone encounter, students documented a brief note (documentation encounter). A 'phone' score (number of checklist items completed in the phone encounter) and a 'combined' score (number of checklist items completed in the phone and documentation encounters) were calculated. Data were analyzed for differences between the phone scores (control) and combined scores using T-tests and McNemar test of symmetry., Findings: Fifty-four students (96%) participated. Combined scores were higher than phone scores for sepsis (72.8 ± 11.3% vs. 67.9 ± 11.9%, p < 0.001) and atrial fibrillation (74.0 ± 10.1% vs. 67.6 ± 10.0%, p < 0.001) cases. Important items, such as ordering blood cultures for sepsis (p = 0.023) and placing the patient on telemetry for atrial fibrillation (p = 0.013), were more likely to be present when a note was documented., Discussion: This study suggests that documentation provides a mechanism for learners to reflect, which could increase important diagnostic and therapeutic interventions., Conclusion: Documentation by novice medical learners may improve patient care by allowing for reflection and reducing errors of omission., (© 2023 The Authors. The Clinical Teacher published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

The objectives of this study were to evaluate how obstetrics and gynecology residency program directors used applicant signaling and to understand how two tiers of signals influenced interviews, ranking, and matching into programs. A multimethod, deductive-sequential design was employed using a national survey of residency program directors and a convenience sampling of programs to study how obstetrics and gynecology program directors used program signals in the 2022-2023 residency-application cycle. A total of 80.5% (236/293) of program directors receiving the survey provided information about signaling, and 20 programs provided application outcome data for applicants who signaled them. The majority of program directors (86.9%) opted into signaling, 43.4% used signals as part of their initial screening, and 33.1% used it as a tiebreaker after reviewing applications, with 45.4% feeling it improved their ability to conduct a holistic review and 41.5% inviting applicants they may not have invited previously. Among programs providing applicant data, the influence of signals on the chances of an applicant being interviewed varied, but an overall strong positive effect of signaling was observed across the sample. The mean rank was 42 for gold signals, 45 for silver, and 38 for no signal (F(3)=5.97, P <.001). Signaling was widely used by programs and was an effective tool to allow applicants to communicate real interest in a program. Signaling was associated with an increased likelihood of an applicant's being interviewed but did not influence an applicant's position on the rank list., Competing Interests: Financial Disclosure Abigail Winkel, Helen Morgan, and Maya Hammoud receive grant support through the American Medical Association's Reimaging Residency Grant, Right Resident, Right Program, Ready Day One (RRR). The other authors did not report any potential conflicts of interest., (Copyright © 2023 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Transition to Residency (TTR) courses help ease the critical transition from medical school to residency, yet there is little guidance for developing and running these courses. In this perspective, the authors use their expertise as well as a review of the literature to provide guidance and review possible solutions to challenges unique to these courses. TTR courses should be specialty-specific, allow for flexibility, and utilize active learning techniques. A needs assessment can help guide course content, which should focus on what is necessary to be ready for day one of residency. The use of residents in course planning and delivery can help create a sense of community and ensure that content is practical. While course assessments are largely formative, instructors should anticipate the need for remediation, especially for skills likely to be performed with limited supervision during residency. Additionally, TTR courses should incorporate learner self-assessment and goal setting; this may be valuable information to share with learners' future residency programs. Lastly, TTR courses should undergo continuous quality improvement based on course evaluations and surveys. These recommendations are essential for effective TTR course implementation and improvement., Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Matthew Rustici receives grant funding from the nonprofit Macy Faculty Scholars Program and Zell Family Foundation to optimize Transition to Residency. Lauren A. Heidemann, Andrea Anderson, and Katharyn Atkins receive an honorarium for being a participant on a Transition to Residency Editorial board which is sponsored by the nonprofit Macy Faculty Scholars Program and Zell Family Foundation. Lynn Buckvar-Keltz receives institutional support to direct the WISE online educational programs for medical students and early residents. We declare that each author meets ICMJE authorship criteria. Each author has engaged in substantial contributions to the conception and design of the work, drafting and critical review, final approval of this submitted version, and agrees to be accountable for all aspects of the work. The manuscript has been read and approved by all the authors and each author believes that the manuscript represents honest work., (© The Author(s) 2024.)

Background: Clerkship grades in obstetrics and gynecology play an increasingly important role in the competitive application process to residency programs. An analysis of clerkship grading practices has not been queried in the past 2 decades in our specialty., Objective: This study aimed to investigate obstetrics and gynecology clerkship directors' practices and perspectives in grading., Study Design: A 12-item electronic survey was developed and distributed to clerkship directors with active memberships in the Association of Professors of Gynecology and Obstetrics., Results: A total of 174 of 236 clerkship directors responded to the survey (a response rate of 73.7%). Respondents reported various grading systems with the fewest (20/173 [11.6%]) using a 2-tiered or pass or fail system and the most (72/173 [41.6%]) using a 4-tiered system. Nearly one-third of clerkship directors (57/163 [35.0%]) used a National Board of Medical Examiners subject examination score threshold to achieve the highest grade. Approximately 45 of 151 clerkship directors (30.0%) had grading committees. Exactly half of the clerkship directors (87/174 [50.0%]) reported requiring unconscious bias training for faculty who assess students. In addition, some responded that students from groups underrepresented in medicine (50/173 [28.9%]) and introverted students (105/173 [60.7%]) received lower evaluations. Finally, 65 of 173 clerkship directors (37.6%) agreed that grades should be pass or fail., Conclusion: Considerable heterogeneity exists in obstetrics and gynecology clerkship directors' practices and perspectives in grading. Strategies to mitigate inequities and improve the reliability of grading include the elimination of a subject examination score threshold to achieve the highest grade and the implementation of both unconscious bias training and grading committees., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: Examine the applicant experience after introduction of program signaling for the 2023 obstetrics and gynecology (OBGYN) residency application cycle., Design: Responses to an online survey of OBGYN applicants participating in the 2023 match who participated in residency program signaling were compared to responses from a similar survey conducted in 2022. Demographic information included personal and academic background and how applicants and advisors communicated with programs. Numbers of applications and interviews, second look visits, away rotations, manner of contact, and timing of communication was compared. Statistical analysis included ANOVA for interval data, and χ2 and Kruskal-Wallis tests for categorical data., Results: A total of 711 of 2631 (27%) applicants responded in 2022 and 606 of 2492 (24.3%) responded in 2023. Approximately 2/3 of gold signals and 1/3 of silver signals led to an interview. There was no change in number of applications or interviews per applicant, but there was a broader distribution of interviews per applicant in 2023. Applicants in 2023 were less likely to engage in preinterview communication or do an away rotation to indicate interest in a program. There was decreased communication between applicants and programs after signaling was introduced. Informal communication continued to differ by racial and medical school background. Applicants from DO programs and international medical graduates (IMG) had more communication with programs than MD applicants but received fewer interview invitations. Fewer Black and Latin(x)/Hispanic applicants had faculty reach out to residency programs on their behalf compared to White and Asian applicants. There were differences in the number of interviews received based on racial and ethnic identity., Conclusions: In the first year after implementation of program signaling, there was a decrease in preinterview communication and a broader distribution of interviews among applicants. Further efforts to create standard means of program communication may help to begin leveling the uneven playing field for applicants., (Copyright © 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate perceived gaps in preparedness, current on-boarding practices, and need for specialty wide resources in the transition to residency training in obstetrics and gynecology (OB/GYN) DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional survey of current U.S. OB/GYN residents and program directors (PDs) at the time of the resident in-training exam was conducted in 2022. Both groups provide demographic information and identified specific knowledge, skills, and abilities in need of more preparation at the start of residency. PDs were queried on perceptions of readiness for their current first year class, educational on-boarding practices, and their preference for standardized curricular materials and assessment tools. Chi-squared and Kruskal-Wallis tests were used to compare perceptions of skills deficits between PDs and residents, and the relationship of preparedness to program type and resident year in training., Results: Response rates for residents and program directors were 64.9% and 72.6% respectively. A majority (115/200, 57.5%) of program directors agreed or strongly agreed with the statement, "In general, I feel that my new interns are well prepared for residency when they arrive at my program." Both groups agreed that basic suturing and ultrasound skills were deficits. Residents identified a need for better preparation in management of inpatient issues while PDs identified time management skills as lacking. There was considerable heterogeneity of program on-boarding practices across the specialty. Most PDs agreed or strongly agreed that a standardized curriculum (80.5%, 161/200) and assessment tools (75.3%, 150/199) would be helpful., Conclusion: OBGYN PDs feel that not all residents arrive prepared for residency and overwhelmingly support the development of standardized transition curricular and assessment tools, similar to the curriculum developed in general surgery. Based on input from PDs and residents, early curricular efforts should focus on basic surgical, ultrasound, and time management skills and on management of inpatient issues., (Copyright © 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Abstract: Recognition of the spectrum of gender identities has been a recent phenomenon in the medical profession. Over the past 20 years, medical literature related to gender identity diversity has increased several-fold, yet it more commonly addresses clinical care rather than aspects related to medical education. Medical educators continue to struggle with appropriate language and inclusive approaches when discussing gender-based aspects of medical education. Reproductive health education, including obstetrics and gynecology clerkships, is particularly vulnerable to missteps and anachronisms regarding gender identity.This article aims to provide preclinical and clinical medical educators with strategies to identify and predict situations where missteps related to gender identity inclusivity may occur in their curriculum or learning environment, and to develop approaches to improve gender identity inclusivity within medical education. The authors explore 3 areas that commonly pose challenges for medical educators: inclusive language and terminology, anatomy education, and reproductive genetics and genetic counseling. They hope the tools and strategies provided here will be useful to reproductive health medical educators across specialties to enable the realization of a more inclusive learning environment in reproductive health., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Association of American Medical Colleges.)

Background: The evolving landscape of application processes for obstetrics and gynecology residency applicants poses many challenges for applicants and advisors. The lack of data coordination among national groups creates crucial gaps in information for stakeholder groups., Objective: This study aimed to identify the current state of the advising milieu for obstetrics and gynecology residency applicants and their career advisors, the annual Association of Professors of Gynecology and Obstetrics survey focused on US clerkship directors' experiences advising students through these processes., Study Design: A 23-item anonymous survey was developed that asked respondents about demographics and outcomes for the students that they advised through the 2021 application process and their experiences with dual applicants and students not matching. The survey was sent electronically to all obstetrics and gynecology clerkship directors with active Association of Professors of Gynecology and Obstetrics memberships in April 2021., Results: Of 224 total clerkship directors, 143 (63.8%) responded to the survey, Of the 143 respondents, almost all (136 [95.1%]) served as career advisors, and 50 (35.0%) were aware of students dual applying. Furthermore, obstetrics and gynecology was rarely the backup to a more competitive specialty. For the 2021 application cycle, 79 of 143 respondents (55.2%) reported having students not successfully match into obstetrics and gynecology, with "academic concerns" followed by "poor communication skills" as the primary reasons cited for students not matching., Conclusion: This snapshot of clerkship directors' experiences advising students in the residency application process reveals notably high rates of dual applicants and students not matching into obstetrics and gynecology. This work fills key gaps in our knowledge of current processes and highlights the importance of career advising at multiple points during the application process., (© 2023 The Authors.)

Objective: To evaluate residency program director views on the purpose and value of an away rotation for students applying to a residency application in Obstetrics and Gynecology (OBGYN)., Design, Setting, and Participants: The Council on Resident Education in Obstetrics and Gynecology administered a 28-question survey to current U.S. program directors in OBGYN in 2022. Program directors were asked if they offered away rotations to visiting medical students and if so, what the purpose the rotation played in their application process and whether rotating students were automatically offered a residency interview. Program characteristics such as program size, geographic location, and program type (university, community, or military based) were ascertained. A test of proportions was utilized to understand the relationship between program description and survey responses., Results: Seventy-nine percent (224/285) of OBGYN PDs responded to the survey and consented to participation. Programs were representative of the types of training program, size of programs, and geographic location. Of respondents, 77.2% (173/224) of PDs indicated that away rotations were offered at their institution, but only 26.6% (46/173) of residency PDs assessed prospective candidates for away electives. The opportunity to provide students an audition for a residency position was the most common reason to offer an elective. Only 34.7% (60/173) of OBGYN PDs guaranteed an interview to students who completed away electives at their institution. The majority (118/173, 68.2%) of PDs indicated less than 25% of their current residents had completed an away rotation with their program., Conclusions: Many residency programs offered away electives to prospective applicants, but the majority did not personally assess applicants for competitiveness or guarantee interviews to students completing electives. To increase transparency in the application process, programs should publicize the purpose of away rotations and provide information on the number of interviews granted to students who complete away rotations., Competing Interests: CONFLICT OF INTEREST The authors report no conflict of interest., (Copyright © 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

The labor and delivery floor is a unique learning environment that poses challenges to teaching medical students, with a potentially detrimental effect on their evaluations of the obstetrics and gynecology clerkship. This article, from the "To the Point" series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, offers specific suggestions for improving undergraduate medical education in obstetrics with attention to student preparation, faculty development, nonphysician staff involvement, and patient education. Optimizing the learning environment in labor and delivery would improve student experiences and perceptions of our specialty., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Competing Interests: Financial Disclosure J. Tony Ogburn reports receiving payment from SASGOG, ACOG, ABOG, and the ACGME. The other authors did not report any potential conflicts of interest.

Obstetrician-gynecologists can improve the learning environment and patient care by addressing implicit bias. Accumulating evidence demonstrates that racial and gender-based discrimination is woven into medical education, formal curricula, patient-provider-trainee interactions in the clinical workspace, and all aspects of learner assessment. Implicit bias negatively affects 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 antiracism and social justice theories, (2) bias awareness and management pedagogy throughout the curriculum, (3) elimination of stereotypical patient descriptions from syllabi and examination questions, and (4) critical review of epidemiology and evidence-based medicine for underlying assumptions based on discriminatory practices or structural racism that 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. Given that practicing physicians may have little training in this area, faculty development efforts in bias awareness and mitigation strategies may have significant impact on learner well-being., (Copyright © 2022 Elsevier Inc. All rights reserved.)

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., (© 2023 The Authors.)

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

The transition to residency in obstetrics and gynecology is difficult, threatening the well-being of residents as well as their preparedness to care for patients. In addition to essential foundational knowledge and skills, obstetrics and gynecology interns must develop professional identity and a growth mindset toward learning to acquire the self-directed learning skills required of physicians throughout their careers. The transition to residency is a critical opportunity for learning and development. A group of educators and learners from around the country created a preparedness program building on available resources. The result is a national curriculum for improving the transition to obstetrics and gynecology residency on three levels: self-directed learning, facilitated small-group workshops, and coaching. Sharing tools for preparing matched applicants for residency in obstetrics and gynecology ensures adequate residency preparation for all interns, independent of medical school attended. This program aims to address potential threats to equity in the training of our future workforce and to ensure that all obstetrics and gynecology interns are prepared to thrive in residency training., Competing Interests: Financial Disclosure Tony Ogburn disclosed receiving funding from ACOG, ABOG, and SASGOG. The other authors did not report any potential conflicts of interest., (Copyright © 2022 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: We sought to identify first-year obstetrics and gynecology residents' perceptions of both support needed at the medical school to residency transition and readiness to address structural racism and bias at the start of residency training., Study Design: Residents were recruited by email and social media for 1:1 interviews from March to June 2021. All interviews were completed by a first-year resident or fourth-year medical student using an interview guide created by the authorship team. Recorded interviews were anonymously transcribed and independently reviewed for themes by two authors., Setting: Virtual interviews on the Zoom platform., Participants: First-year obstetrics and gynecology residents., Results: Interviews were performed with 26 residents, and six themes for support emerged from their narratives: 1) Establishing a residency program community; 2) Relocation resources; 3) Residency preparation content in medical school and residency; 4) Preparedness to address racism and bias; 5) Connecting with peers with similar lived experiences across institutions; and 6) More proactive intentional touchpoints from program leadership early in residency., Conclusions: Resident narratives described multiple crucial opportunities to improve learners' transition to residency. These findings can help define a roadmap of resources and support that residency programs can provide for learners from Match Day through the first few months of residency., Competing Interests: Declaration of Competing Interests The authors report no conflicts of interest., (Copyright © 2022 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Interprofessional experiences during medical school are often delivered during pre-clinical years, but less is known about the value of clinical students. Our institution implemented a specialty-specific interprofessiona curriculum during Residency Preparation Courses (RPCs) for senior students including didactics, clinical experiences, and a simulated paging curriculum. Our aim was to determine whether this intervention improved perceptions of interprofesiona roles. We distributed anonymous surveys before (pre-survey) and after (post-survey, collected within 2 weeks of course completion) the RPC to 90 students with questions related to interprofessional roles using a 5-point scale (1 =  strongly disagree , 5 =  strongly agree ). Three months after the start of residency, we sent follow-up surveys inquiring about the usefulness of RPC components (1 =  not at all useful , 5 =  extremely useful ). Response rates were 84.4% pre-survey, 63.3% post-survey, and 41.1% follow-up survey. Post-surveys indicated improvement in self-reported ability in all domains: understanding one's contributions to interprofessional teams (3.9 to 4.4, p < .0001), understanding other team members' contributions (3.9 to 4.4, p < .0001), learning from interprofessional team members (4.2 to 4.6, p = .0002), accounting for interprofessional perspectives (4.2 to 4.6, p < .0001), and co-developing effective care plans (3.9 to 4.4, p < .0001). Follow-up surveys rated clinical experiences as slightly-to-moderately useful (2.3 ± 1.0) and paging curriculum very-to-extremely useful (4.3 ± 1.0). This study demonstrates the value of interprofessional education for advanced students.

Importance: In order to equitably improve the residency application process, it is essential to understand the problems we need to address., Objective: To determine how obstetrics and gynecology (OBGYN) applicants and faculty communicate applicants' interest to residency programs, and how program directors report being influenced by these communications., Design, Setting, and Participants: This survey study was conducted with email surveys of OBGYN application stakeholders in 2022. Included participants were OBGYN applicants, clerkship directors, and residency program directors in medical education associations' email listservs., Exposures: Surveys sent by the American Association of Medical Colleges, Association of Professors of Gynecology and Obstetrics, and Council on Resident Education in Obstetrics and Gynecology., Main Outcomes and Measures: Whether applicants themselves, or faculty on their behalf, communicated to residency programs, and the influence program directors reported placing on these communications for their decision-making. Descriptive statistics and χ2 tests were used to analyze differences., Results: A total 726 of 2781 applicants (26.1%) responded to the survey and were included in analysis (79 of 249 [31.7%] clerkship directors; 200 of 280 [71.4%] program directors). The self-reported racial and ethnic demographics of the 726 applicant respondents were 86 Asian (11.8%), 54 Black (7.4%), 41 Latinx (5.6%), 1 Native Hawaiian or Pacific Islander (0.1%), 369 White (52.2%), 45 with multiple racial identities (6.2%), and 91 (21.5%) preferring not to answer. The majority of applicants (590 [82.9%]) sent communications at some point in the application process. Applicants who identified as White (336 [88.7%]) or Asian (75 [87.2%]) were more likely than those who identified as Black (40 [74.1%]) or Latinx (33 [80.5%]) to reach out to programs (P = .02). There were also differences in type of medical school, with 377 of 427 MD applicants (88.3%), 109 of 125 DO applicants (87.2%), and 67 of 87 International Medical Graduate applicants (77.7%) reporting sending communications (P = .02). Approximately one-third (254 applicants [35.7%]) had faculty reach out to programs on their behalf. White (152 [40.1%]) and Asian (37 [43.0%]) applicants were more likely to have faculty reach out compared with Black (6 [11.1%]) and Latinx (12 [29.3%]) applicants (P = .01). Program directors reported that preinterview communications from faculty they knew (64 [32.2%]) and other program directors (25 [12.6%]) strongly influenced their decisions, and otherwise rarely reported that communications strongly influenced their decisions., Conclusions and Relevance: The current state of communications may increase inequities in residency application processes; differences between faculty communications for applicants from different racial and ethnic backgrounds are particularly concerning given that program directors are more likely to weigh communications from faculty in their decision-making. A centralized, equitable means for applicants to signal their interest to programs is urgently needed.

Objective: Virtual interviews were widely implemented alongside many other changes in the 2021 residency application process. We investigated how these many interventions may have influenced interview distributions and completions., Design: Cross-sectional survey distributed electronically to obstetrics and gynecology (OBGYN) residency applicants in February 2021. Distributions of interview invitations, interviews completed, and percent of interview offers completed were compared to the previous application cycle. The odds ratios of receiving interviews were calculated based on applicant characteristics including test scores, number of applications, and race/ethnicity., Setting: All OBGYN residency applicants registered through the Electronic Residency Application Service., Participants: The 915 (36%) of 2577 total OBGYN applicants who responded to the survey., Results: US allopathic medical students received fewer interview offers in 2021 (median 13 [interquartile range 9-19]) compared to 2020 (median 15 [interquartile range 11-20]). There was no difference in the absolute numbers of interviews completed. A United States Medical Licensing Exam Step 1 score ≥221 resulted in more than a five-fold increase in adjusted odds of receiving at least 12 interviews for allopathic students. Black or African American US allopathic seniors had a 2.3 odds ratio for receiving at least 12 interview invitations compared to White non-Hispanic or Latino US allopathic seniors, adjusted for Step 1 score and the number of programs applied to. Interview offers released on standardized dates had a mitigating effect on completing more interviews among allopathic seniors with at least 12 interview invitations., Conclusions: Virtual interviews did not change the overall number of interviews completed. Standardization of interview offer dates mitigated excessive virtual interviewing, yet additional measures are needed to curb interview inflation and the effects on interview distributions., (Copyright © 2022 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: To describe the perspectives of obstetrics and gynecology (OBGYN) residency applicants regarding new standards for the 2019 to 2020 application cycle., Design: An anonymous electronic survey was sent to all OBGYN residency applicants to US programs retrospectively evaluating 5 new recommended standards for the application process. This 15-item survey assessed the importance of the proposed standards and their impact on applicants' anxiety., Setting: The OBGYN residency application process is marked by increasing application numbers and no standardization for managing interview offers. The Association of Professors of Gynecology and Obstetrics (APGO) received a 5-year Reimagining Residency grant from the American Medical Association to improve the transition from undergraduate medical education (UME) to graduate medical education (GME) within OBGYN. The multiphase project, "Transforming the UME to GME Transition for Obstetrics and Gynecology- Right Resident, Right Program, Ready Day One (RRR)," began with Standardizing the OBGYN Application and Interview Process (SOAIP). This group recommended 5 new standards for all US OBGYN residency programs and applicants., Participants: Applicants for US OBGYN residency programs for the 2019 to 2020 application cycle completed the survey, with a 904/2508 (36.0%) response rate, including 762 complete responses (30.4%)., Results: Applicants reported that all 5 of the new standards would cause the least self-perceived anxiety (range 76.8% - 96.5%). The impact of the standards on perceived anxiety varied by student group, with International Medical Graduates (IMGs) and students with USMLE Step I scores <200 describing lesser impact compared to others. Despite these differences, all 5 standards were consistently noted to cause the least anxiety for all groups. Despite varying degrees of effects in different groups, the new OBGYN residency application standards caused the least anxiety for all subgroups of applicants., Conclusions: Implementing universal standards for the OBGYN residency application process was favorably perceived by applicants and caused the least anxiety for applicants., Competing Interests: Declaration of Competing Interest The authors have no competing interests to declare., (Copyright © 2022 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Health systems science addresses the complex interactions in healthcare delivery. At its core, health systems science describes the intricate details required to provide high-quality care to individual patients by assisting them in navigating the multifaceted and often complicated US healthcare delivery system. With advances in technology, informatics, and communication, the modern physician is required to have a strong working knowledge of health systems science to provide effective, low-cost, high-quality care to patients. Medical educators are poised to introduce health systems science concepts alongside the basic science and clinical science courses already being taught in medical school. Because of the common overlap of women's healthcare subject matter with health systems science topics, such as interprofessional collaboration, ethics, advocacy, and quality improvement, women's health medical educators are at the forefront of incorporating health systems science into the current medical school educational model. Here, the authors have described the concept of health systems science and discussed both why and how it should be integrated into the undergraduate medical education curriculum. Medical educators must develop physicians of the future who can not only provide excellent patient care but also actively participate in the advancement and improvement of the healthcare delivery system., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: Although parenting responsibilities are correlated with gender disparities in professional development and salary, the nature of parental challenges is not well characterized. The aims of this study were to (1) illuminate faculty physicians' experiences with parenting and (2) identify system challenges and opportunities for improvement., Materials and Methods: In October 2019, a survey about parenting was sent to all physician faculty at a large Midwest academic medical center. Qualitative analysis of free-text response to the survey item "is there anything you wish to share about your experience of pregnancy or parenting as a physician" was performed. Themes were inductively identified and developed from the responses in a team-based iterative approach., Results: Of 2069 total physician faculty, 1085 (52.4%) responded to the survey and 253 (23%) of the respondents provided free-text comments. From these comments, the authors identified three themes as sources of challenges for physician parents: operational constraints, gender biases, and nontraditional or nonheteronormative family structures. Operational factors pertained to lack of scheduling flexibility, childcare challenges, lactation, colleague coverage, and transparency of policies. Responses indicated that gender biases are encountered by all genders, and expectations built on assumptions of "traditional" gender roles and family structure are problematic for many physician parents., Conclusion: Addressing the challenges and opportunities identified in the study is critical to building a more supportive institutional culture around parenting and to increase gender parity in academic medicine., Competing Interests: No competing financial interests exist., (© Hsin Lee et al., 2022; Published by Mary Ann Liebert, Inc.)

Purpose: Application inflation in the current residency application process leads to congestion, inefficiency, and perceptions of inequity. The authors aimed to assess the interest of key stakeholders on the topic of capping applications and interviews, and their perceptions regarding equity of the process., Methods: An anonymous survey was electronically distributed in March 2021 to Obstetrics and Gynecology (OBGYN) residency applicants, clerkship directors, program directors, and student affairs deans after the submission of the rank order list for the 2021 application cycle and prior to the release of final Match results. Participants answered questions regarding the perceived equity of the current process (no limits on applications submitted or interviews completed) compared with limiting the number of applications and interviews students could submit or complete. Respondents supporting caps reported the number they considered a reasonable cap for applications and interviews. Associations between the profiles of applicants and program directors and their interest in application and interview caps were explored using chi-squared tests for non-parametric statistics and t-tests for normally distributed interval data. The University of Michigan determined the study exempt from IRB review., Results: The overall response rate was 36.0% (1167/3243), including 34.0% of applicants (879/2579), 50.3% of program directors (143/284), 41.8% of clerkship directors (94/225) and 32.9% of student affairs deans (51/155). All groups reported application caps for either all applicants or the most competitive applicants to be more equitable than the current process, and suggested a median application cap ranging from 25 (clerkship directors and program directors) to 40 (applicants). All groups also believed interview caps to be more equitable than the current process, and suggested a median interview cap ranging from 12 (clerkship directors) to 15 (applicants, program directors, and student affairs deans)., Conclusions: Stakeholders in the OBGYN application process consider caps to applications and interviews a promising means to improve equity in the Match., (Copyright © 2021 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background : Current efforts incompletely address the educational, social, and developmental aspects of a learner's transition from medical school to residency. Objective : To determine the feasibility and acceptability of a transition to residency (TTR) coaching program. Designs : In March 2019, we designed, implemented, and evaluated a TTR coaching program for students who matched into residency programs at our institution. Goals were to stimulate reflection on successes and challenges encountered during medical school, develop strategies to problem-solve barriers and address concerns, identify professional and personal resources, improve confidence, and make an action plan. Results : Of eligible learners, 42% (10/24) enrolled in TTR coaching. Learners were most interested in coaching in the following areas: wellbeing (70%, 7/10), interpersonal/communication skills (60%, 6/10), and learning plan development (50%, 5/10). The majority (90%; 9/10) expressed satisfaction with the program and would recommend participation. One month after starting internship, 90% (9/10) of learners stated the program helped facilitate their transition. Learners who did not enroll in TTR cited concerns around the coach selection process (72%, 8/11), upcoming travel (45%, 5/11), insufficient time/competing demands (27%, 3/11), and lack of perceived benefit (18%, 2/11). Conclusion : This pilot study demonstrated preliminary feasibility and acceptability for TTR coaching.

Competing Interests: Financial Disclosure Helen Kang Morgan and Abigail Ford Winkel report that money was paid to their institution from the American Medical Association. The other author did not report any potential conflicts of interest.

Importance: The residency application process is flawed, costly, and distracts from the preparation for residency. Disruptive change is needed to improve the inefficiencies in current selection processes., Objective: To determine interest in an early result acceptance program (ERAP) among stakeholders in obstetrics and gynecology (OBGYN), and to estimate its outcome in future application cycles., Design, Setting, and Participants: Surveys of stakeholders in March 2021 queried interest in ERAP across the US. Respondents included OBGYN residency applicants, members of the Association of American Medical Colleges Group on Student Affairs, OBGYN clerkship directors, and residency program directors. Statistical analysis was performed from March to April 2021., Exposures: Respondents completed surveys sent by email from the Association of American Medical Colleges (to OBGYN applicants and members of the Group on Student Affairs), the Association of Professors of Gynecology and Obstetrics (to clerkship directors), and the Council on Resident Education in Obstetrics and Gynecology (to program directors)., Main Outcomes and Measures: Applicants and program directors indicated their interest in participating in ERAP, and clerkship directors and members of the Group on Student Affairs indicated their likelihood of recommending ERAP using a 5-point Likert scale., Results: Respondents included 879 (34.0%) of 2579 applicants to OBGYN, 143 (50.3%) of 284 residency program directors, 94 (41.8%) of 225 clerkship directors, and 51 (32.9%) of 155 student affairs deans. The majority of respondents reported being either somewhat or extremely likely to participate in ERAP, including 622 applicants (70.7%) and 87 program directors (60.8%). Interest in ERAP was independent of an applicant's reported board scores, medical school type, race, number of applications submitted, or number of interviews completed. Among program directors, those at university programs were more likely to participate. Stakeholders supported a limit of 3 applications for ERAP, to fill 25% to 50% of residency positions. Estimating the outcome of ERAP using these data suggests 26 280 to 52 560 fewer applications could be submitted in the regular match cycle., Conclusions and Relevance: Stakeholders in the OBGYN application process expressed broad support for the concept of ERAP. The majority of applicants and programs indicated that they would participate, with potentially substantial positive impact on the application process. Careful pilot testing and research regarding implementation are essential to avoid worsening an already dysfunctional application process.

Background: In response to high rates of burnout among trainees, educators in obstetrics and gynaecology introduced a six-session wellness curriculum that improved professional fulfilment and resident burnout in participants with greater attendance. The implementation of the curriculum varied based on local variables and contextual factors., Objective: To analyse the reactions of participants and curriculum leaders across the diverse settings of the pilot experience in order to identify the best practices for implementation of a wellness curriculum., Methods: Twenty-five US OBGYN residency programmes completed the curriculum in the 2017-2018 academic year. OBGYN residents in all the years of training participated. Faculty members and fellows were workshop facilitators and course leaders. All participants completed post-intervention surveys. A qualitative, descriptive thematic analysis explored free-text responses from residents and workshop facilitators., Results: Among 592 eligible resident participants, 387 (65%) responded to the post-intervention survey. Workshop facilitators submitted 65 surveys (47% response) on curriculum elements, rating the activities as 'good' or 'excellent' in 90.8% of cases. Qualitative analysis of workshop facilitators' and resident comments pointed to three themes, namely disagreement about the purpose of the curriculum, the social value of the curriculum in the residency programme and the need to open a broader discussion and take action to address structural barriers to wellness., Conclusions: Residents and faculty members involved in a wellness curriculum pilot had polarised reactions. While participants found value in learning skills and connecting to colleagues, efforts to promote wellness skills should be accompanied by communication and action to address drivers of burnout., (© 2021 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

In the setting of long-standing structural racism in health care, it is imperative to highlight inequities in the medical school-to-residency transition. In obstetrics and gynecology, the percentage of Black residents has decreased in the past decade. The etiology for this troubling decrease is unknown, but racial and ethnic biases inherent in key residency application metrics are finally being recognized, while the use of these metrics to filter applicants is increasing. Now is the time for action and for transformational change to rectify the factors that are detrimentally affecting the racial diversity of our residents. This will benefit our patients and learners with equitable health care and better outcomes., Competing Interests: Financial Disclosure The authors did not report any potential conflicts of interest., (Copyright © 2021 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To determine the impact of specialty-specific guidelines for standardized interview offers on residency applicant behavior towards excessive interviewing., Design: In 2019 to 2020, the Association of Professors of Gynecology and Obstetrics and the Council on Resident Education in Obstetrics and Gynecology (OBGYN) outlined standard dates for residency interview offers. A cross-sectional survey of applicants queried adherence to standardized interview offers, the number of interviews offers received, interviews completed, and application characteristics. Based on data that applicants in OBGYN with a mean number of 12 contiguous ranks are highly likely to match, factors associated with accepting an excessive percentage of interview offers were investigated in applicants with at least 12 interviews, using multiple logistic regression., Setting: All OBGYN applicants were sent an anonymous electronic survey distributed through the Electronic Residency Application Service in February 2020, with the subset of US MD senior respondents selected for this analysis., Participants: There were a total of 1292 US MD senior applicants into OBGYN in 2020, with 505 (39%) providing their interview information through the survey. Three hundred and sixty (71%) of US MD senior respondents received at least 12 interviews., Results: Applicants receiving at least 12 interview offers completed a median of 83% of their interviews, and excessive interviewing was defined as completing greater than this median percentage. Receiving most interview offers on standardized interview offer dates resulted in less excessive interviewing despite controlling for number of programs applied to, applying as a couple, and United States Medical Licensing Exams Step 1 score., Conclusions: The standardization of interview offer dates may mitigate interview inflation by altering applicant behavior. This promising pilot data suggests that applicants may be able to make more informed decisions about which interview offers to accept when all offers are received on predetermined dates., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to examine stakeholder perspectives on recommended standards for the obstetrics and gynecology (OBGYN) residency application and interview processes proposed for the 2019 to 2020 application cycle. The authors aimed to assess the acceptance and perception of key stakeholders on the feasibility of implementing the standards as well as the effect of these changes on applicant anxiety., Design and Setting: The authors electronically distributed an anonymous survey in February 2020 to OBGYN residency applicants, clerkship directors, student affairs deans, program directors, and program managers. Participants received a 15-item survey, with questions assessing the importance and adoption of the guidelines, as well as their effect on perceived applicants' anxiety. Responses were measured on a 5-item Likert scale. Multiple regression analysis was used to explore which residency factors were associated with compliance with the standards. IRB exemption was granted by the University of Michigan., Participants: A total of 1358 participants completed the survey for an overall response rate of 39.26%. Response rates were 36.04% for applicants (904/2508), 46.67% for CDs (105/225), 34.84% for members of GSAs (34/155), 59.43% for program directors (167/281), and 51.03% for program managers (148/290)., Results: The overall response rate was 39.26% (1358/3459) with 36.04% of applicants (904/2508), 46.67% of clerkship directors (105/225), 34.84% of student affairs deans (34/155), 59.43% of program directors (167/281), and 51.03% of program managers (148/290). The recommendations were perceived as important by all stakeholders. More than 90% of program directors reported compliance with some or all of the recommendations and more than 90% of all applicants, clerkship directors and student affairs deans reported that the standards reduced applicant anxiety. All stakeholders rated each guideline to be important to extremely important., Conclusions: This study demonstrates the feasibility and acceptance of universal standards for the residency application process in the field of OBGYN. The vast majority of stakeholders surveyed supported the initiative and participated in the guidelines. Applicant respondents perceived the guidelines to be important and to decrease anxiety surrounding the application and interview timelines. These findings are important for other specialties when considering similar interventions., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Introduction: Postgraduate trainees address outpatient telephone calls (OTCs) with little prior training. This study determines the skills necessary for OTCs and examines whether a video intervention improves medical students' performance on simulated OTCs., Materials and Methods: We utilized a Delphi technique to determine skills needed for OTCs and created a 9-min video teaching these skills. Senior medical students were randomized to Intervention (viewed video) and Control (did not view video) groups. Students were assessed pre-/post-intervention on simulated OTCs. The primary outcome was the between-group difference in improvement., Results: The Delphi yielded 34 important skills with the highest focus on communication ( n  = 13) and triage ( n  = 6). Seventy-two students completed assessments (Control, n  = 41; Intervention, n  = 31). The score (mean ± SD) improved 4.3% in the Control group (62.3 ± 14.3% to 66.6 ± 25.0%) and 12.2% in the Intervention group (60.7 ± 15.2% to 72.9 ± 20.4%, p  = 0.15). The effect size measured by Cohen's d was 0.55, considered effective (> 0.33) for an educational intervention., Conclusions: This project fills a gap in OTC training. The use of the Delphi technique, intervention development based on the results, and evaluation of efficacy is a process that could be reproduced for other educational gaps., Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-021-01331-w., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© International Association of Medical Science Educators 2021.)

Background: Educational handovers can provide competency information about graduating medical students to residency program directors post-residency placement. Little is known about students' comfort with this novel communication., Objective: To examine graduated medical students' perceptions of educational handovers., Methods: The authors created and distributed an anonymous survey to 166 medical students at a single institution following graduation in the spring of 2018. Within this cohort, 40 students had an educational handover sent to their future program director. The survey explored comfort level with handovers (1=very uncomfortable; 5=very comfortable) and ideal content (e.g., student strengths, areas for improvement, goals, grades received after residency application). Respondents self-reported their performance in medical school and whether a handover was sent. Correlation analyses examined relationships between performance and other variables. T-tests examined differences between students who did and did not have a handover letter sent., Results: The survey response rate was 40.4% (67/166) - 47.8% of students felt comfortable with handovers, 19.4% were neutral, and 32.8% were uncomfortable. There was no correlation between self-reported medical school performance and comfort level. Respondents felt most strongly that strengths should be included, followed by goals. Those who had a handover letter sent expressed significantly higher comfort level (3.8 ± 1.0 vs. 2.6 ±1.3, p=0.003) with this communication., Conclusion: Medical students reported varying levels of comfort with educational handovers; however, those who had handovers sent had more positive perceptions. In order to improve the education continuum, it is essential to engage students in the development of this handover communication., (© 2021 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)