Current Women's Health Reviews - Volume 13, Issue 2, 2017

Background: Mentoring minority faculty in academic medicine is not a new strategy for remedying the lack of diversity in this field [1, 2]. However, beyond achieving the necessary goal of workforce diversity in medicine and science, faculty development leaders in academic medical center settings appear to lack a clear roadmap on how to authentically develop minority faculty and position them towards high impact leadership positions. Objective: To address the need for a well-defined roadmap for individualized mentorship and career development, the authors present their work in developing and sustaining a longstanding highly individualized minority faculty career mentoring program within an academic medical center setting. Methods: In this article, the authors describe the program, its participants, and the impact on program participants and on the institution within which it is housed. Six specific coaching points are distinguished for faculty leaders to consider for program design and execution which involve the development of the ability to reveal the career “blind spots”, developing the “professional muscle”, the promotion and use of block time, learning to be “where the action is”, the use of a “positioning” over a “planning” approach to career development, and the development of a healthy and just sense of “professional selfishness.” Results: The authors share intermediary outcomes data on the impact of the program, six coaching points, and three critical success factors that contribute greatly to the longstanding sustainability of the program. Conclusion: The intersection of these coaching points and critical success factors in practice across the academic medicine landscape may offer a roadmap for faculty development leaders to remain accountable for a diverse leadership workforce.

Objective: To evaluate the impact of the Clinical Topics Tool Book on students' academic and clinical performance during Ob/Gyn clerkship. Methods: The purpose of this study was to evaluate the impact of the Clinical Topics Tool Book (CTTB) on students' academic and clinical performance during Ob/Gyn clerkship. In academic year 2006-07, a new teaching tool called the CTTB was implemented in the Obstetrics and Gynecology clerkship at Robert Wood Johnson Medical School (RWJMS). A primary literature review and retrospective analysis were conducted on the National Board of Medical Examiners subject exam scores, clinical grades, and core competency evaluations of 634 third year medical students at RWJMS, between July 2004 and June 2011. Results: Students who used the clinical topics tool book earned overall higher scores on their national percentile NBME subject examination, clinical grade, overall grade, and in their core competencies: interpersonal skills and medical knowledge. There was a marked difference in NBME Percentile Rank between students who did not use the tool book and students who did, 57.8% (0 topics) 67.8 % (10-17 topics). The number of topics completed were directly correlated to higher clerkship performance. Conclusions: The Clinical Topics Tool Book is an effective and valuable educational method for third year medical students in the Ob/Gyn clerkship. Future students will be encouraged to utilize this learning opportunity to enhance their OB/GYN clinical and academic performance.

Introduction: Over the past two decades, the Accreditation Council for Graduate Medical Education and the Residency Review Committee included a focus on training OB/GYN resident physicians with the knowledge of research principles and methodology. OB/GYN Residency Programs complied with these requirements with curriculum innovations. The aim of this paper is to evaluate the medical literature since 2000, from the perspective of a Resident (Research) Program Director, and identify areas of successful curricular innovation and opportunities, in order to augment current resident research programs. Methods: This article examines Residency Research Curricula in North America with a critical review of the literature. PubMed, MeSH, Medline, and Web of science were searched for English language abstracts pertaining to this topic, and found 471 abstracts. Twenty original pertinent articles were found. Cross-referencing provided an additional 4 articles. Results: Themes from this literature review of 24 scientific, published articles include a nearuniversal adoption of a resident research project requirement for OB/GYN resident programs (99%), as Program Directors understood the importance of research training for future attending physicians. Many successful OB/GYN Resident Research Programs have faculty mentors, a structured resident research curriculum that includes study design and analysis, protected resident research time, research funding, and a Resident Research Program Director. A disconnect was seen in lack of research curriculum structure (over half of all programs), resident knowledge, and resident attitudes to research. Many innovations attempt to overcome these attitudinal and curricular barriers, however rigorous scientific methods have not been used to fully evaluate these changes, thus preventing meta-analysis. Conclusion: While critical curricular infrastructure has been established in many OB/GYN residency programs and many challenges have been recognized, these innovations have not yet been scientifically evaluated in a manner that allows for best practices to be recommended.

Background: Bulimia nervosa (BN) is a chronic mental health disorder that can be associated with numerous medical complications. Patients with BN are often impulsive, and they often engage in activities that are harmful towards themselves and others. Objective: To have a firm understanding of the medical complications of BN so that effective medical treatment can be provided in a timely and effective manner to help achieve a successful treatment outcome in BN; To appreciate the medico-legal issues that may arise in patients with BN. Results and Conclusions: The medical complications of BN are secondary to the compensatory purging behaviors used by patients to help prevent weight gain and include self-induced vomiting, over-exercise, and misuse of diuretics, diet pills, and laxatives. Medical complications can be severe, are sometimes irreversible, and can occasionally be life-threatening. It is prudent to make patients aware that medical complications such as syncope and seizures, as well as a propensity for sudden cardiac death, could limit their ability to drive safely, and may lead to unwanted legal consequences should they become impaired while driving and injure another party. Clinicians must also be astute regarding the high risk of self-harm and suicide in patients with BN.

Background: Most studies of Fetal Alcohol Spectrum Disorder (FASD) have focused on children with the disorder. Much less attention has been given to morbidity and mortality among other family members. Objective: To determine if a diagnosis of FASD in a child is a risk marker for premature mortality of the mother, we utilized a systematic review of studies documenting deaths of the mothers in order to estimate their mortality proportion. Methods: A search of Pubmed, Google Scholar, Scopus, Cochrane Library, and the reference list of articles published up to July of 2015 was utilized to identify studies reporting on the death of mothers of children with FASD. We included human studies from any country and in any language translated to English. We excluded studies that did not specifically report on FASD diagnosed in the children. The meta-analysis utilized the weighted mortality proportion from each study. Results: The initial search identified 1,897 studies and 26 were eligible for full text review of which 13 met the study inclusion criteria. For the eight studies that did not include controls the mean of the weighted mortality proportions was 17.04% (95% CI 11.04 to 23.04). For the five studies with controls the mean mortality proportion was 4.97% (95% CI 2.25 to 7.70). The combined mortality proportion for all 13 studies was 11.25%. A cause of death was reported for 47 (35%) of the women (alcohol related causes 31.9%, cirrhosis of the liver 19.1%, cancer 8.5%, and homicide 8.5%). The mean time from the birth of the child with FASD to death of the mother was 8.17 years with a range from 44 days to 24 years. Conclusions: The odds of premature mortality in mothers of people diagnosed with FASD were increased nearly five fold over the expected rate. Thus, a diagnosis of FASD in a child should be considered an important mortality risk marker for these mothers. The mortality risk associated with a diagnosis of FASD in a child may exceed many of the current risk markers used by health care professionals caring for these women. Increased attention to both prenatal alcohol exposure and a history of FASD in their children may identify women in need of close follow up. We estimate that worldwide, about 37,800 birth mothers of children with FASD die prematurely every year.

Background: Only few epidemiological studies have examined the associations between dietary intake of flavonoids and the risk of ovarian and endometrial cancers. Although preliminary, there are some suggestive findings about the protective effects of high consumption of flavone luteolin, flavonol kaempferol, and total or individual isoflavones (daidzein, genistein, glycitein) against ovarian tumorigenesis. Results about the possible role of flavonoid intake on endometrial cancer risk are even more scarce and inverse association may be restricted only to certain female subgroups, such as to lean or postmenopausal women consuming high doses of isoflavones. Objective: To understand the actual state, epidemiological findings about relationships between flavonoid intake and the risk of gynecological malignancies were compiled from the literature and these data are presented and discussed in this minireview. Results and Conclusion: According to the current knowledge, it is possible that high dietary intake of certain flavonoids can contribute to the lower incidence of ovarian (and/or endometrial) cancer. However, considering the high vulnerability of women towards any suggestions to make changes in their dietary pattern, it is crucial that these recommendations would be evidence-based and free of any health risks. Therefore, further prospective studies are highly needed to evaluate association between intake of flavonoids and the risk of gynecological cancers in different populations, with a wide dosing range and various exposure times.

Background: Physician burnout is increasing in prevalence across all medical and surgical specialties and is associated with significant decline in the physical and mental health of providers as well as early retirement from the practice of medicine. There are factors unique to women's health that put its providers at significantly increased risk for burnout including the preponderance of female providers and the practice settings, compensation, and call responsibilities inherent in our specialty. As an example, obstetrics is a rapidly changing and medically complex world where providers do not have control over every outcome. Providers work long hours in an unpredictable and at-times chaotic environment where complex and difficult decisions need to be made under significant time pressure at all hours. The lack of priority of women's health within our health systems combined with a constant threat of litigation leads to distress and detachment in providers. Objectives: This article explores the components of burnout, risk factors and workplace issues contributing to its increase. The variation in stressors between different disciplines such as maternal fetal medicine, gynecologic oncology, and abortion providers is also discussed including the toll resulting from responsibility for both medical and surgical care of the patient, death and political biases. Conclusion: Individual strategies including interventions such as commitment to self-care, contemplative practices, management of office flow and establishing peer support are discussed. Burnout is a systemic problem and strategies for its prevention burnout at the individual, departmental and institutional level are explored.

The purpose of the article is to describe an educational intervention for health professionals based on an interprofessional-shared decision making (IP-SDM) model in the women’s prenatal and early postpartum care and to observe whether after the intervention there was an improvement of certain outcomes such as: acquisition of substance use disorder knowledge, stigma reduction, and referrals to an evidenced-based program. Background: Providers might be unaware of this population’s unique issues, such as how women make decisions about recovery, their accessibility to substance use treatment, state child welfare laws regarding prenatal substance use, and information about neonates exposed to substances. Objectives: A training was developed to address perinatal providers' knowledge gaps and reduce stigma. Specific training elements included promoting universal verbal screening, information about treatment during pregnancy, and how to make recovery-related decisions utilizing an IP-SDM model. Methods: This mixed-methods study was conducted with 45 perinatal providers from community health centers across Southern New England. Providers attended a one-hour training and completed pre and posttraining online surveys. Results: The majority of participants who completed the online surveys have worked in obstetrical medicine for more than a decade. The findings demonstrated that providers who participated in this training increased their knowledge of child welfare laws pertaining to prenatal substance use as well as what community resources might be available to this population of women. The increased knowledge was verified through increased referrals to an evidence-based program, Healthy Families America. Moreover, stigma was reduced from pre to posttraining regarding women with substance use disorders. Conclusion: Our results suggest the importance of specified training to address the unique needs of this patient population.

Introduction: Colposcopy examination remains the gold standard in assessment of the patients with abnormal cervical cytology. There is a controversy in performing endocervical curettage (ECC) on satisfactory colposcopy. This study was performed with the aim to investigate the role of ECC as a complementary method, besides colposcopic examination in patients with satisfactory colposcopy. Methods: This descriptive and cross-sectional study was performed on 120 patients with abnormal smear, post coital bleeding or persistent cervicitis in an academic hospital of Mashhad University of Medical Sciences from 2011-2014. All patients underwent colposcopic examination. Besides, cervical biopsy in abnormal findings, ECC was also performed for all patients. Then, positive and negative ECC results were determined in diagnosing of dysplasia lesions in normal and abnormal findings of endocervical colposcopic examination. The patients were followed up for 3 years. Results: The mean age of the patients was 39.3±10.42 yrs. Altogether, 24.2% of the studied patients had a positive ECC. A positive ECC test result was obtained in 15.8% of cases with negative exocervical pathology. 28.3% of those with a satisfactory colposcopy had positive ECC results. The same criteria was 22.3% in patients with an unsatisfactory colposcopy, showing no significant difference based on Pearson test (p=0.367). Among the patients with positive ECC in satisfactory colposcopy, CIN3 was reported in the biopsy of 2 cases (4.3%), and both cases underwent conization. Conclusion: ECC is recommended in all patients with either a satisfactory or un- satisfactory colposcopy.