共找到 20 条结果
To ensure prioritization and growth of Quality Improvement (QI) work in Obstetrics and Gynecology, attention must be taken to teaching clinicians and learners. Recently, formal curricula and training programs in QI have emerged, as governing bodies endorse education and competence in QI across the spectrum of medical education. However, comprehensive recommendations for teaching QI in Obstetrics and Gynecology are not well established. The authors present best practices, suggestions, and common pitfalls in teaching QI in Obstetrics and Gynecology based on current literature and their own experiences, broken down into curriculum development, implementation into training programs, and mentorship in QI.
A number of physicians during their career consider reducing work hours or leaving obstetrics and gynecology all together. In 2024, obstetrics and gynecology was one of the top 6 specialties with the highest percentage of burnout at 45.8%. With female gender and young age as risk factors for burnout, and 62% of obstetricians and gynecologists being women, it is critical to understand the factors contributing to burnout in the specialty, to understand the necessary steps to address them, and to promote a culture of well-being where OBGYNs feel valued, have autonomy and can practice efficiently.
Colposcopy is an office-based procedure performed to identify precancerous or cancerous lesions of the cervix. In 2017, colposcopy guidelines were developed by the American Society for Colposcopy and Cervical Pathology to standardize terminology, protocolize the procedure, and propose quality metrics. As a result of changes in cervical cancer screening and management guidelines, the volume of colposcopy within the United States has significantly decreased over the past 3 decades, and with the adoption of the human papillomavirus vaccination is anticipated to continue to decline. Therefore, colposcopic quality assessment and improved provider training is of increasing importance.
Public reports offer comparative quality information across providers and have become an accepted way of improving both the accountability and quality of our health care delivery system. Given the continued challenges of maternal morbidity and mortality in the United States, report cards serve as a useful tool for helping drive improvements in care quality. This article provides an overview of public reports of perinatal and women's health in the United States, including which indicators have been developed, which are used in public reports, which entities do the reporting, the successes and challenges of these public reports, and opportunities for improvement.
This article examines the ongoing marginalization of transgender and gender diverse (TGD) populations across social, economic, legal and health care systems. Despite recent progress, TGD individuals continue to face stigma, discrimination, and limited access to quality care. Providers should use inclusive terminology with clear understanding distinctions and definitions for respectful communication. A major barrier remains the lack of provider education, especially in obstetrics and gynecology training. Also, the article reviews a framework for inclusive gender-affirming care emphasizing leadership support, inclusive environment, and patient advocacy to promote equity, dignity, and engagement in health care for TGD communities.
Gender-affirming medical treatment for transgender and gender-diverse individuals effectively aligns secondary sex characteristics with gender identity improving psychological well-being, quality of life, and social functioning. This article focuses on gender-affirming hormone therapy (GAHT) synthesizing current evidence and guideline recommendations for feminizing and masculinizing GAHT, including dosing strategies, monitoring protocols, fertility counseling, and management of common side effects. Future priorities include optimizing low-dosing protocols for nonbinary patients. GAHT, when provided through informed-consent and evidence-based monitoring, represents safe, effective, and life-affirming care. Continued innovation and global research are essential to advance equity and ensure high-quality gender-affirming medicine for all.
The first defense against a medical malpractice lawsuit is avoiding the lawsuit altogether. The probability of being sued can be reduced through compassion and thorough attention to the patient. A proper response to an adverse event or bad result can be crucial to avoidance of later being sued. The content of the medical and hospital chart can support a defense or, at times, can imperil the defense of the physician being sued. Aggrieved patients can pursue multiple theories of liability against an obstetrician or gynecologist.
Over the last 50 years, the percentage of women in medicine has more than doubled. Every medical specialty now has a critical mass of females, defined as ≥15%, and 6 specialties have greater than 50% women. Obstetrics and gynecology (OB/GYN) has undergone an almost complete reversal of the gender makeup of the specialty and soon will have less than a critical mass of men. Certain gender-based inequities persist despite OB/GYN being majority female since 2008. Moving forward, the specialty must continue supporting women's advancement to leadership positions and recruiting male medical students to OB/GYN residency.
Effective labor and delivery care hinges on tightly knit teams, shared goals, and a culture of safety. This article outlines how diverse professionals-from physicians and nurses to anesthesiologists and families-become a functioning unit through clearly defined roles, leadership, and a common mental model. It emphasizes structured tools, standardized language, and safety huddles (bedside and unit) to align care, reduce delays, and manage emergencies. Frameworks like Situation, Background, Assessment, and Recommendation and Illness severity, Patient, Action, Synthesis, Summary support clear communication; color-based cesarean grading clarifies urgency; and a fetal heart rate observer improves monitoring vigilance.
Continuous process improvement at the front lines of care is critical to providing compassionate, high-value care to our patients and their families within our ever-changing health care landscapes. This article aims to serve as a high-level, non-MBA primer on the concepts of Lean and Six Sigma process improvement techniques that can be used to change how individual practices deliver care. By improving the efficiency of the care delivery systems within our office practices, we can enhance patient experience, provide high-value care, improve financial performance, reduce burnout, and bolster work-life balance.
Best practice guidelines for preconception, pregnancy, and postpartum care of transgender men do not exist due to a lack of large-scale data. Decisions about testosterone use in the preconception and postpartum period should be weighed against risks to the pregnancy and exacerbation of gender dysphoria. Because patients' experiences with bodily changes during and after pregnancy can vary from gender-affirming to dysphoric, prenatal and peripartum care should aim to be individualized through a gender-affirming lens. Obstetric outcomes do not seem to be worse in transgender men, but more robust studies are needed for generalizability.
An adequate supply of obstetrician-gynecologists (OB/GYNs) is necessary to best address expanding women's health care needs. As the population grows and diversifies and demands expand, the supply of OB/GYNs is projected to be inadequate in nearly all states, especially in nonmetropolitan communities. Workforce planning should include expanding residencies, retaining the workforce, integrating advanced practice providers, and optimizing care delivery models.
暂无摘要（点击查看详情）
Enhanced recovery after cesarean delivery (ERAC) can be defined as a set of evidence-based interventions to standardize the perioperative care of patients. In this narrative review, the author consider the general principles and perioperative elements of ERAC, standardization of outcome measures for audit, quality improvement and research purposes, and the influence of ERAC on outcomes and recovery.
Transgender and gender diverse (TGD) youth face significant health disparities, underscoring the critical need for equitable, evidence-based care. Based on substantial evidence, the gender-affirming care model remains the standard of care. TGD youth may seek gynecologic expertize for a variety of reproductive health care concerns. This article outlines essential considerations for clinicians when providing gender-inclusive services to pediatric patients. Key areas addressed include creating a safe clinical environment, managing psychosocial comorbidities, administering gender affirming medical therapy, and addressing gynecologic needs such as menstrual suppression, contraception, sexual health screening, and fertility counseling.
暂无摘要（点击查看详情）
Sickle cell disease is a prevalent autosomal recessive hemoglobinopathy with significant maternal and neonatal risks during pregnancy. Pre-pregnancy management involves counseling, baseline health assessment, genetic testing, and medication review. During pregnancy, care focuses on folic acid supplementation, serial growth scans, antenatal testing, and tailored pain management for acute crises and chronic pain. Delivery planning and peri-partum considerations involve timing, mode, and pain control. A multidisciplinary approach is critical for optimizing outcomes.
暂无摘要（点击查看详情）
An inadequate number of obstetrician-gynecologists (OB/GYNs) is apparent in many geographic regions of the United States in relation to the rising and more diverse adult female population. The competitive nature of recruiting OB/GYNs is reflected by rising starting salaries and being one of the most recruited specialties. Many incentives offered by hospitals and medical groups require open discussions and clarity. For this reason, special considerations about salaries and incentives are described to begin constructive and mutually beneficial negotiation.
Cardiovascular diseases complicating pregnancies are major causes of peripartum morbidity and mortality. The field of Cardio-Obstetrics has evolved to treat women with acquired and metabolic-related cardiovascular diseases in addition to congenital heart disease. Peripartum cardiomyopathy (PPCM) is a heart failure etiology specific to pregnant and post-partum women. Pregnancy-associated spontaneous coronary dissection (p-SCAD) is the most common cause of acute myocardial infarction in the pregnant and post-partum population, highlighting the importance of evaluating chest discomfort. Adequate therapy for both PPCM and p-SCAD requires expertise from multiple medical subspecialities, which underscores the necessity of the Cardio-Obstetric team approach.