Introduction

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Residency is a period of supervised clinical training in an accredited tertiary care center that is a prerequisite for medical licensing in the United States (U.S.). Residency lasts from three to six years depending on the specialty. Obstetrics and gynecology as a surgical specialty requires four years of residency training in the U.S. and most countries.
Residency programs are accredited by the Accreditation Council for Graduate Medical Education based on their capacity to provide residents with the fundamental training required to advance their knowledge and skills in the core principles of obstetrics and gynecology. In this paper we study the relationship between faculty structure and basic training of residents in obstetrics and gynecology (OBGYN) residency programs.

Methods

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Data Source
Information on 244 OBGYN residency program were extracted from the Directory of Obstetrics and Gynecology Residency Programs on the website of the Association of Professors of Gynecology and Obstetrics [1]. Data were collected on the faculty size and structure of each residency program as follows:
- Number of general obstetrician-gynecologists.
- Number of maternal-fetal specialists.
- Number of gyn-oncology specialists.
- Number of urogynecology specialists.
- Number of reproductive endocrinologists.
- Number of reproductive genetics specialists.
The training experience of OBGYN residents was provided by the residency programs indicating the role of the resident as the main surgeon (S) or surgical assistant (A) for these types of intervention:
- Spontaneous delivery
- Operative vaginal delivery
- Cesarean delivery
- Surgical procedures on antenatal patients
- Abdominal hysterectomy
- Vaginal hysterectomy
- Laparotomy without hysterectomy
- Surgery for urinary incontinence
- Operative laparoscopy
- Operative hysteroscopy
- Conization
- Vaginal probe ultrasonography (USG)
Statistical Analysis
Pearson correlation between the number of procedures in each category and faculty size per specialty was tested with the help of SPSS 16 (Statistical Package for the Social Sciences, Chicago, IL).
Study Limitation
Data of the Directory of Obstetrics and Gynecology Residency Programs is updated irregularly (from 1 year to 4 years), sporadically (some programs update their data more frequently) and many times incompletely (missing information on one or more variables). However, applying radical changes in faculty structure and resident training experience in a short period of time is difficult; hence our study results can be deemed valid.

Results

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Faculty Structure
In the directory of OBGYN residency programs, not all programs provided full information on their faculty staff. Table 1 shows that general OBGYNs had the highest average number (12) followed by maternal-fetal specialists (5), gyn-oncology (3), reproductive endocrinology (3), urogynecology (2) and the least were reproductive genetics specialists (1).
Resident Experience
Similarly, not all OBGYN residency programs provided data on their resident experience during training period. Table 2 shows that spontaneous delivery (327 as surgeon and 65 as assistant) and cesarean sections (234 as surgeon and 61 as assistant) are the most common procedures practiced by OBGYN residents during their 4 years of training. The least number of procedures practiced by OBGYN residents are surgical interventions on antenatal patients (18 as surgeon and 5 as assistant).
The Relationship between Faculty Structure and Resident Experience
Significant correlation was detected between the number of reproductive genetics specialists and the number of surgical procedures on antenatal patients performed by OBGYN residents as a surgeon (r=.230, p=.018, Figure 1). Likewise, significant correlation was evident between the number of urogynecologists among faculty members and the number of surgical procedures for urinary incontinence performed by OBGYN residents as a surgeon (r=.157, p=.041, Figure 2) or assistant (r=.288, p=.001, Figure 2).

Commentary

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This paper elicits the inhomogeneity of faculty structure in OBGYN residency programs and the impact of subspecialty proportion on procedure allotment for residents. Not all programs have reproductive genetics specialists in their staff; yet a significant correlation between the number of reproductive genetics specialists and the number of antenatal procedures performed by residents as primary surgeon is statistically proven. Antenatal procedures such as amniocentesis and chorionic villus sampling (CVS) are frequently ordered by reproductive genetics specialists in cases of high-risk pregnancies to screen for genetic disorders before birth. The above correlation is important since this type of procedures is the least practiced in OBGYN residency programs. A three-year fellowship in maternal-fetal medicine provides sufficient experience to offer high-quality antenatal care by a specialized OBGYN practitioner.
Another example of the relationship between faculty structure and resident experience is the correlation between the number of urogynecologists and the number of surgical procedures for urinary incontinence performed by residents as primary surgeon or more significantly as surgical assistant. The field of urogynecology is dedicated to the treatment of women with pelvic floor disorders such as urinary incontinence with or without prolapse of pelvic organs.
We conclude that residents can orient their choice of residency programs based on their desired future fellowship subspecialty (maternal-fetal medicine, urogynecology …etc.) or practice specialization if they intend to see a certain category of patients when they open their own practice or join an established clinical practice (general obstetrics, general gynecology, urogynecology … etc.).

References

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1. Directory of Obstetrics and Gynecology Residency Programs, Association of Professors of Gynecology and Obstetrics.

Source(s) of Funding

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None

Competing Interests

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None

Disclaimer

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