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Medical training is a high-stress period, and residents in surgical specialties face elevated risk for depression due to demanding schedules, intensity of training, persistent mistreatment, and long work hours. Obstetrics and gynecology (OBGYN) is the only surgical specialty predominantly composed of women, who face higher rates of depression than men and greater increases in depressive symptoms during internship. These challenges, compounded by work-family conflict and policy pressures, contribute to workforce strain in a specialty already facing a projected shortage. Understanding the mental health burden is critical to supporting both trainee well-being and long-term workforce sustainability, yet depressive symptoms, risk factors, and treatment-seeking have not been systematically studied in OBGYN trainees. (s): To assess the prevalence of depressive symptoms and mental health treatment-seeking among OBGYN first-year residents and identify associated demographic, psychological, and workplace factors. First-year OBGYN residents enrolled in the longitudinal Intern Health Study between 2009 and 2024 completed surveys at enrollment and quarterly throughout internship. Depressive symptoms were measured using the 9-item Patient Health Questionnaire (PHQ-9). Pearson correlations, χ2 tests, stepwise linear regression, and generalized estimating equation (GEE) models were used to identify baseline and internship-related predictors of depressive symptoms. Sample weights were applied to address nonrepresentative sampling and attrition biases. Of 1,603 enrolled OBGYN interns (86.5% women; median age 27 years), 1,271 (79.3%) completed at least one internship assessment and were included in the analysis. During internship, 35.6% screened positive for depression on the PHQ-9 at one or more assessments, yet fewer than one-third of those affected sought mental health treatment. Baseline predictors of increased depressive symptoms included history of depression, higher baseline depressive symptoms, neuroticism, a difficult early family environment, and not being in a committed relationship. Internship-related factors associated with worsening symptoms included fewer sleep hours, longer work hours, and reported medical errors. (s): More than one-third of OBGYN residents screened positive for depression on the PHQ-9 during their first year, yet treatment-seeking remained critically low. Both pre-existing vulnerabilities and modifiable workplace stressors contributed to depressive symptoms. These findings are particularly notable given the female-predominant composition of the OBGYN field and the growing representation of women in surgical specialties. The low treatment-seeking rate highlights the urgent need for improved mental health access, including opt-out service models. Structural interventions targeting workload and sleep are essential to support trainee well-being and long-term workforce sustainability in OBGYN.

Many countries in South America and the Caribbean face an unacceptably high maternal mortality rate and a shortage of Obstetrician Gynecologists. Our objective was to address both challenges in Guyana with the development of an in-country Obstetrics and Gynecology (OBGYN) residency training program. A four-year OBGYN residency program began in Guyana in 2012 using curriculum formalized at US academic institutions and modified to suit local needs and capabilities. Partnerships between multiple academic institutions have allowed for participation of faculty across North America in educating the first in-country specialty trained OBGYN physicians in Guyana. A total of 32 physicians have completed the OBGYN training program in Guyana and 30 of these graduates are currently practicing in-country. There are 18 residents currently enrolled. Full time staff are present in Guyana with support from visiting faculty members from collaborating academic institutions. Evidence-based clinical guidelines specific to this setting were developed and institutionalized to improve quality of care and patient safety. The maternal mortality ratio at program inception was 135 in 2012 and the most recent measurement has fallen to 75 in 2023. Program success was due in large part to the shared vision of local institutions, establishment of partner organizations, investment in resident leadership development, and concomitant infrastructure change and systems-based improvement. Guyana's first OBGYN residency program can be used as a model for future academic partnerships in low- and middle-income countries. Creation of sustainable training programs in Obstetrics and Gynecology is key to decreasing global maternal mortality.

Obstetrics and gynecology (ObGyn) trainees will impact future practice patterns and their cesarean rates. The knowledge, attitudes, and practices (KAP) of ObGyn residents have not been extensively studied. We aimed to assess KAP towards mode of delivery and cesarean-sparing procedures among ObGyn trainees. This is a multicountry study that was conducted in Brazil, Egypt, Ghana, Sweden, Thailand, Uganda, and the United States. A questionnaire was developed, piloted, translated, and adapted for ObGyn trainees in seven countries. The questionnaire was administered to assess knowledge regarding safety of cesarean and vaginal delivery (VD), attitudes towards mode of delivery, and perceived competency in performing cesarean-sparing procedures (forceps and vacuum-assisted VD, external cephalic version [ECV], and breech VD). The outcomes included the KAP of a group of global trainees, including number of procedures towards cesarean sections and cesarean-sparing procedures. Of 744 complete responses, most residents perceive VD as safer than cesarean delivery for the mother (67%) and baby (55%). More trainees in Sweden (92%) and the United States (73%) agree that patients with breech presentation should be offered an ECV, compared with Ghana (8%), Egypt (8%), and Uganda (10%), and only in Sweden do most trainees feel competent with ECV (62%). Trainees in Ghana (86%) and Uganda (78%) report perceived competency with singleton breech VD while few do in Sweden (7%), Thailand (5%), and the United States (2%). Most trainees agreed on the comparative risks of CD versus VD but there is marked variation in self-perceived competency around cesarean-sparing procedures, particularly ECV and breech delivery. These findings can provide useful insights into focus areas for ObGyn training.

Obstetrics and gynecology (OBGYN) internships are emotionally demanding and require nursing students to integrate specialty competence with sustained caring. Evidence on whether unfolding case-based simulation can improve both caring ability and caring behaviors during OBGYN internships remains limited. We conducted a prospective, controlled quasi-experimental study in the OBGYN ward of Shanghai Sixth People's Hospital from June 2024 to March 2025. Final-year undergraduate nursing interns (n = 106) completed a 4-week rotation and were allocated by individual-level lot drawing within naturally occurring rotation cohorts to a control group receiving conventional preceptorship (n = 47) or an intervention group receiving conventional preceptorship plus unfolding case-based simulation (n = 59). Primary outcomes were end-of-rotation Caring Ability Inventory (CAI) and Caring Behaviors Inventory (CBI) scores, analyzed using analysis of covariance with group as the fixed factor and the corresponding baseline score as a covariate. Secondary outcomes included end-of-rotation specialty assessments and teaching satisfaction. Baseline characteristics and baseline CAI and CBI scores were comparable between groups. After adjustment for baseline scores, the intervention group had significantly higher end-of-rotation CAI and CBI total and dimension scores than the control group (all P < 0.001). The intervention group also achieved higher specialty assessment scores and overall teaching satisfaction than the control group (both P < 0.001). Adding unfolding case-based simulation to conventional OBGYN preceptorship was associated with substantial short-term improvements in nursing students' caring ability and caring behaviors, alongside better specialty performance and teaching satisfaction. Further studies using multicenter designs, delayed follow-up, and objective behavioral assessments are needed to determine whether these gains are sustained and transferable to real clinical practice.

The 2022 Supreme Court ruling in Dobbs v. Jackson Women's Health Organization returned regulatory authority over abortion to the states and precipitated a wave of restrictive state-level legislation. This narrative review examines how these state responses have influenced medical residency applications, physician training, and maternal health equity. Existing research indicates that restrictive state laws have contributed to a decline in residency applications to programs in jurisdictions with near-total abortion bans. A growing body of evidence suggests that many medical students, particularly those seeking OBGYN training, prioritize programs in states with fewer restrictions to ensure comprehensive clinical education. These trends may exacerbate existing maternity care deserts by contributing to physician shortages, particularly in underserved and rural areas. The review further explores how the post-Dobbs regulatory environment impacts physician training. Many OBGYN residency programs in restrictive states struggle to provide abortion training, often requiring residents to travel out of state, which creates significant financial and logistical burdens. Additionally, a lack of transparency regarding training availability in these states complicates the ability of prospective residents to assess program offerings. Beyond residency applications, these state-level restrictions have affected practicing physicians, contributing to burnout, legal uncertainties, and ethical dilemmas. Many providers in restrictive jurisdictions report moral distress and legal risks when making clinical decisions, leading some to relocate to states with greater reproductive freedoms. The compounded effects of these laws may widen healthcare disparities, disproportionately affecting marginalized communities, particularly low-income individuals and people of color. Given the limited longitudinal evidence since Dobbs, continued monitoring of OBGYN residency applications, training availability, workforce distribution, and maternal health outcomes is needed to determine the persistence and magnitude of these effects.

Women remain underrepresented in clinical drug development despite their unique biological characteristics and growing disease burden. In China, this disparity is particularly concerning given the rising incidence of gynecologic conditions such as uterine cancer. This study examined the profile and trends of obstetrics and gynecology (OBGYN) drug trials conducted at a large tertiary specialty hospital in China. A retrospective review of interventional drug trials registered between 2019 and 2023 was conducted using data from the Chinese Clinical Trial Registry (ChiCTR) and the hospital's Clinical Trial Management System. All eligible trials conducted at the Women's Hospital, School of Medicine, and Zhejiang University were included. Information on trial design, year of initiation, clinical specialty, drug category, and primary indication was extracted and analyzed descriptively. A total of 59 interventional drug trials were identified. The trial volume increased from 4 studies in 2019 to 11 in 2023, representing 176% growth. Most trials were domestic multicenter studies (68%), and 71% remained ongoing at the end of 2023. Gynecologic oncology accounted for the largest proportion of trials (44%), followed by gynecology (29%). Ovarian cancer was the leading oncologic indication, while endometriosis and assisted reproduction were the most common benign conditions studied. Antibody-drug conjugates, poly(ADP-ribose) polymerase (PARP) inhibitors, and programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors predominated in oncology trials, whereas hormonal and microbial therapies were more common in non-oncologic studies. OBGYN drug research in China has expanded substantially, with a strong focus on gynecologic cancers and chronic gynecologic conditions. However, maternal health-related drug development remains limited. Continued and systematic monitoring of ChiCTR data may help support more balanced and equitable research priorities across women's health.

An estimated 1.3 billion people and over one-fifth of women globally live with a disability (1). Women with disabilities face lower rates of preventative care and higher rates of morbidity and premature mortality compared to persons without a disability. Obstetrics and gynecology care providers (OB/GYN providers) deliver longitudinal care to women across the lifecycle and serve as important stakeholders for bringing clarity and context to conversations about health care accessibility for patients with disabilities (patients), while patients and their advocates are critical contributors, to ensure that information obtained reflects lived experiences. The aim of this study was to compare the experiences and perceptions of patients, OB/GYN providers, and advocates regarding accessibility of OB/GYN care. A quantitative, descriptive, cross-sectional study was conducted using an online survey distributed to patients, OB/GYN providers, and advocates through professional networks, advocacy groups, and social media from August 2024-April 2025. Surveys gathered demographic data as well as perceptions of barriers and facilitators to care and related outcomes. Thematic analysis of open-ended questions was also conducted. A total of 369 participants completed surveys. Most patients had physical (74.4%) or cognitive disabilities (48.2%). Compared to patients, OB/GYN providers and advocates were more likely to report care delays (23.5 vs. 50.7 vs. 30.8%) and rescheduled appointments (18.0 vs. 22.1 vs. 19.4%) and less likely to report appointment cancellations (15.7 vs. 10.2 vs. 12.9%), due to unmet accommodation needs (all p < 0.001). Patients reported wait times of 1 month to 1 year to have a canceled appointment rescheduled; many OB/GYN providers (62.5%) reported rescheduling wait times of < 2 weeks. Most patients (86.7%) reported not receiving needed care when their appointments were canceled without rescheduling, while 14.3% of OB/GYN providers and 50.0% of advocates reported that patients never received care (p < 0.001). Nearly all care providers (94.2%) believed that OB/GYN teams make the effort to prioritize comfort and safety for disabled patients. One-third of providers were unaware of what accommodations their offices provided. Patients identified physical barriers (51.9%) and social barriers (29.2%) as primary factors negatively impacting care in both questionnaire and open-ended responses. Discordant perceptions exist between patients, OB/GYN providers and advocates regarding the prevalence and impact of disruptions in OBGYN care for patients with disabilities and OB/GYN provider sensitivity and care quality provided to affected patients. Engaging key stakeholders with different and valuable perspectives in conversations helps establish a critical framework from which to develop harmonious solutions that can reduce care gaps and improve OBGYN care for patients with disabilities.

Aligning undergraduate and early postgraduate clinical training remains challenging. We evaluated a tiered competency checklist ("Step Ladder System") implemented in an obstetrics-gynecology (OBGYN) rotation using a mobile assessment platform. We retrospectively analyzed 74 learners (41 final-year medical students, 33 first-year residents) who completed an OBGYN rotation at a Japanese university hospital (April 2022-November 2024). The Step Ladder System includes 93 workplace-based tasks across obstetrics, gynecology, and general practice, organized into three progressive steps (Steps 1-3). Outcomes were stepwise completion rates, gender differences, supervisor ratings, and app-recorded feedback. We also identified "seamless" tasks and "low-achievement" tasks to inform curriculum improvement. Students achieved higher completion than residents in Step 1 (82.4% vs. 73.2%, p&#x2009;<&#x2009;0.05), similar completion in Step 2 (59.2% vs. 54.4%, ns), and lower completion in Step 3 (17.1% vs. 22.1%, p&#x2009;<&#x2009;0.05). Female learners showed higher completion in several knowledge-focused Step 2 tasks, while a small number of procedural tasks favored males. Supervisor ratings were predominantly positive (4-5/5), supported by encouraging narrative comments. Ten "seamless" tasks (high completion in both groups with minimal between-group differences) indicated similar achievement patterns across learner groups, whereas "low-achievement" tasks (low completion across learners) clustered in advanced Step 3. A mobile, stepwise competency checklist provides a structured framework for clinical training and enables real time documentation and feedback. Completion data may serve as a curriculum diagnostic tool by highlighting stable competencies and potential gaps.

To describe the development, implementation, and outcomes of a simulation-based educational intervention to teach the B-Lynch uterine compression suture technique to Obstetrics and Gynecology (OBGYN) residents. This multicenter prospective interventional study included 217 residents across seven programs in S&#xe3;o Paulo State, Brazil. The 130-min intervention comprised a theoretical module followed by supervised hands-on practice using a low-fidelity simulator. The outcomes were participants' reaction to the training and changes in knowledge and self-confidence regarding the indication and performance of the technique. Most participants were in the first or second year of training (71.9%). While 88.5% reported previous knowledge about the B-Lynch technique and 56.2% had participated in at least one case that used the technique, only 12.9% had received prior structured training. Reaction to the intervention was highly positive, with more than 90% of participants reporting high satisfaction across evaluated domains. Knowledge scores increased significantly after training, from 60.3% to 85.7%, corresponding to an absolute gain of 25.4 percentage points (95% confidence interval [CI]: 22.9-27.9; P&#x2009;<&#x2009;0.001). The proportion of residents who did not feel confident about the indication and the performance of the technique decreased significantly after the intervention (65.9% vs. 5.1%, and 71% vs. 7.0%, respectively, P&#x2009;<&#x2009;0.001). A short simulation-based educational intervention using a low-fidelity simulator was well accepted and significantly improved the knowledge and self-confidence of OBGYN residents in performing the B-Lynch technique.

Surgeons face major occupational stressors that increase the risk of burnout and suicide, yet the true prevalence of suicidal ideation and suicide among U.S. surgeons remains uncertain. A comprehensive search of Databases identified studies reporting suicidal ideation or suicide among U.S. surgeons. Random-effects models generated pooled prevalence estimates, and subgroup analyses assessed differences by specialty, gender, and training level. Fourteen studies, including 52,671 surgeons, met the criteria. The pooled prevalence of suicidal ideation was 6%, with significant variation across specialties (p&#x202f;=&#x202f;0.02); orthopaedic surgeons had the highest rate (13%), and OBGYN the lowest (1%). The pooled prevalence of suicide was 5% (95% CI: 0.03-0.07). Attending surgeons showed higher suicidal ideation (11%) than residents (4%), though this difference was not statistically significant. Suicidal ideation and suicide remain pressing concerns among U.S. surgeons, with rates varying by specialty and sex. These findings emphasize the need for targeted prevention efforts and improved access to mental healthcare.

Despite widely accessible screening, cervical and breast cancer remain prevalent diseases, especially amongst Nepali women. The Dallas-Fort Worth Metroplex in Texas is home to one of the largest Nepali immigrant communities in the United States. This study seeks to understand barriers preventing this population from accessing preventative reproductive healthcare. A mixed-methods survey assessing health beliefs and reproductive cancer screening utilization was completed in English by 58 women and in Nepali by 4 women. Despite most participants reporting knowledge of the importance of reproductive cancer screening (94% breast cancer, 87% cervical cancer, 74% HPV), the rates of receiving obstetric and gynecologic care in the past year (57%), receiving a cervical exam (42%), breast exam (29%), and history of HPV vaccination (47%) were low in comparison. One-way ANOVA showed a significant difference in reproductive health knowledge and having ever seen an OBGYN (p&#x2009;=&#x2009;.018). Education did not correlate with cancer screening behavior as measured by the Health Belief Model (Susceptibility: p&#x2009;=&#x2009;0.091, Severity: p&#x2009;=&#x2009;0.141, Barriers: p&#x2009;=&#x2009;0.38, Benefits: p&#x2009;=&#x2009;0.22). Free-response results yielded comments about modesty, cultural competency, and praise for the American healthcare system as it compares to foreign medical systems. There is a discrepancy between the DFW Nepali immigrant community's reproductive knowledge and their reproductive healthcare utilization. Healthcare providers in DFW should consider exam modification and community outreach to encourage Nepali women to receive cancer screenings and ultimately reduce morbidity and mortality of reproductive cancers in this population.

Obstetrics and Gynecology (OBGYN) residents describe vaginal surgery as challenging to practice during training. While competency at this skillset can be achieved through procedural repetition in the operating room, residents compete for case volume with other learners, such as fellows or recent graduates perfecting their skills, and may not achieve competency by the time of graduation. Here, we provide a step-by-step evidence-based model for implementation of a vaginal surgery curriculum into residency education at a junior level and share our three-year practical experience with required cost, materials and other resources.

Medication abortion is safe and effective and typically involves two medications taken sequentially: mifepristone and misoprostol. In 2023, a regulatory change removed the requirement for mifepristone to be dispensed in-person. Several states also introduced shield laws in 2023, providing certain legal protections for clinicians who provide abortion. This study uses national-level medical claims data to examine trends in mifepristone provision in 2022 and 2023, as well as workforce composition during this period of policy change. Using medical and prescription claims data from IQVIA, a proprietary health information company that includes data for approximately 191 million patients, we identified the number of mifepristone prescriptions and clinicians prescribing mifepristone in 2022 and 2023 in the United States that appear in this national sample. We conducted interrupted time-series analysis of mifepristone medications dispensed in-person and prescriptions from mail pharmacies from January 2022 to December 2023 and compared the proportion of clinicians providing services in 2022 versus 2023 using Pearson chi-squared tests and rate ratios. We identified 71,352 total mifepristone medications/prescriptions in 2022 and 95,527 in 2023. Mifepristone prescriptions via mail pharmacies increased significantly in 2023 (+305.29 per month), while medications dispensed in-person decreased (-295.6 per month). OBGYNs provided less mifepristone in 2023 compared with 2022, while family medicine physicians, nurse practitioners, and midwives provided more. Mifepristone prescriptions in mail pharmacies increased in 2023, and more advanced practice clinicians provided mifepristone in 2023 than 2022. Shifting abortion policies may mean shifts in who is providing that care, particularly advanced practice clinicians.

Clinical clerkships represent a core component of medical education, with the success of this training largely measured by student performance on the NBME subject examinations. This review examines the impact of clerkship length on student performance on the NBME subject examinations. For this systematic review, primary literature was obtained from Pubmed, Google Scholar, PsychInfo, and Scopus databases. Traditional (longer) length clerkships resulted in higher exam scores for IM (p&#x2009;<&#x2009;1.0E-05) and Surgery (p&#x2009;<&#x2009;1.0E-05). Shorter length was favored for the Psychiatry clerkship (p&#x2009;=&#x2009;0.03). We found no statistically significant difference in exam scores for Pediatrics, OBGYN, Family Med, or Neurology. The online version contains supplementary material available at 10.1007/s40670-026-02691-x.

Background and Objectives: Numerous risk factors for both female and male fertility have been established including age, ovarian reserve, infertility cause, occupational and lifestyle factors. The objective of our study was to determine the influence of occupational and lifestyle factors on assisted reproduction (ART) outcomes at a Serbian referral tertiary center. Materials and Methods: The study included all consecutive infertile couples undergoing ART at the Clinic for Ob/Gyn University Clinical Center Belgrade, from January 2019 to January 2022. Inclusion criteria comprised primary and unexplained infertility, age &#x2264; 45 years, body mass index &#x2264; 30 kg/m2 and undergoing fresh autologous ART cycles. All patients filled in the socio-epidemiological questionnaire that analyzed their lifestyle and habits. Medical history data and data regarding the current ART cycle were taken from patient records. The primary outcome was clinical pregnancy. Results: Our study included 501 couples (women and men) with infertility undergoing ART. Clinical pregnancy was achieved in 22.2% of examined patients. Achieving clinical pregnancy in the ART cycle for women was associated with younger age and use of vitamins, minerals, and trace elements, whereas younger age and absence of chronic illnesses were the most important factors for male partners. When women and men were assessed together as couples, achieving clinical pregnancy correlated only with the use of vitamins, minerals and trace-elements by both partners. Conclusions: This study confirmed that some occupational and lifestyle factors were associated with clinical pregnancy after ART in patients with unexplained primary infertility and normal BMI.

Obstetrician-gynecologists (ob-gyns) and other reproductive care professionals are uniquely suited to counsel their patients on human immunodeficiency virus (HIV) screening and HIV preexposure prophylaxis (PrEP) due to their expertise in reproductive health counseling. Ob-gyns and other health care professionals should be obtaining comprehensive sexual health histories, assessing risk behavior, and providing their patients information regarding prevention of sexually transmitted infections such as HIV. When framing their counseling, health care professionals should consider epidemiologic data and HIV prevalence rates for their practice area, and counseling should include discussion of prevention methods. Deciding route of administration and form of PrEP medication should be part of a shared decision-making model between the patient and clinician. By normalizing conversations about HIV prevention, encouraging HIV screening, and ensuring awareness of and access to PrEP, ob-gyns can help reduce disparities in individuals with HIV and those at risk of acquisition.

Abnormal uterine bleeding (AUB) and postmenopausal bleeding (PMB) require systematic evaluation to exclude clinically significant intrauterine pathology, including premalignant and malignant endometrial disease. To provide evidence-based recommendations for the histopathologic evaluation of patients with AUB or PMB undergoing assessment for suspected intrauterine pathology. The American Association of Gynecologic Laparoscopists, European Society of Gynaecological Endoscopy, and Global Community on Hysteroscopy developed a Joint Society Guideline using the PICO framework. Diagnostic hysteroscopy performed in outpatient or inpatient settings, including hysteroscopy alone, hysteroscopy combined with ultrasound, or hysteroscopy with biopsy, was compared with blind endometrial sampling performed without preceding hysteroscopy. Risk of bias and study quality were assessed using established methodological frameworks. The primary outcome was diagnostic accuracy, measured by sensitivity and specificity, using histopathology from endometrial sampling or hysterectomy specimens as the reference standard. Meta-analysis showed that hysteroscopy, with or without concomitant endometrial sampling, had higher diagnostic accuracy than blind endometrial biopsy for detecting and excluding endometrial cancer, endometrial intraepithelial neoplasia, endometrial hyperplasia with or without cytological atypia, endometrial polyps, and submucous myomas. Accuracy estimates were generally higher for detecting than excluding intrauterine pathology. Evidence for endometritis was limited to one comparative study, and no comparative data were available for other conditions, including uterine niches or retained pregnancy tissue. Hysteroscopy is a valuable diagnostic modality for AUB and PMB, particularly when focal pathology is suspected or prior imaging or sampling is inconclusive. When endometrial tissue assessment is indicated, visually directed biopsy performed with hysteroscopic evaluation is favored over blind sampling. Hysteroscopy with or without endometrial biopsy is more accurate than blind endometrial sampling alone for benign structural, premalignant and malignant endometrial pathology. This practice guideline recommends that visually directed biopsy is favored over blind biopsy in the evaluation of AUB or PMB.

To evaluate whether a personal history of having an abortion, or knowing someone close who did, has an impact on how a physician practices. A web-based survey was sent to Ob/Gyn residents asking about personal abortion experience, demographics, religious background, political views, residency program metrics, and intent to provide abortion. Pearson Chi-square and Mann-Whitney U tests were performed to assess whether or not personal history of abortion (PHA) was significantly associated with personal characteristics or training patterns. Ob/Gyn residents with a personal history of abortion were older in age (p&#x2009;=&#x2009;0.002), sought out additional training in family planning (p&#x2009;=&#x2009;0.009), considered it extremely important that their program offers family planning training (p&#x2009;<&#x2009;0.001), and were much more likely to intend to become an abortion provider themselves post-residency (p&#x2009;<&#x2009;0.001). Personal experience is associated with training and practice patterns among Ob/Gyn residents, a finding that has implications for an Ob/Gyn workforce under pressure from increasing legislative restrictions to abortion care. Ob/Gyn residents should be supported in their training goals to combat moral injury associated with the inability to provide evidence-based care.

To compare single- versus double-layer uterine closure after cesarean delivery on cesarean scar outcomes, with uterine rupture or dehiscence in a subsequent pregnancy as the primary outcome, and niche incidence, niche depth, and residual myometrial thickness as secondary outcomes, using a time-stratified meta-analysis of randomized controlled trials. PubMed, Cochrane CENTRAL, Scopus, and Web of Science were searched from database inception to November 10, 2025, using terms related to cesarean delivery and single- or double-layer uterine closure. Randomized controlled trials involving women aged &#x2265;18 years undergoing cesarean delivery that directly compared single-layer versus double-layer uterine closure and reported at least one outcome of interest (niche incidence, niche depth, residual myometrial thickness, or uterine dehiscence). Two reviewers independently screened records, extracted data, and assessed risk of bias using Cochrane RoB 2. Random-effects meta-analyses were performed using risk ratios for dichotomous outcomes and mean differences for continuous outcomes, stratified by follow-up interval (6 weeks, 3 months, 6 months, 12 months); sensitivity analyses addressed heterogeneity. Comparisons were performed within each follow-up interval (same timepoint in both groups), to examine whether the between-technique effect differs by follow-up time. After trustworthiness assessment, twenty-one randomized controlled trials (8564 women) were included. The primary outcome, uterine rupture or dehiscence in a subsequent pregnancy, did not differ significantly between techniques (risk ratio 1.97, 95% confidence interval 0.66-5.94). No significant differences were found in niche incidence at any time point. Double-layer closure was associated with thicker residual myometrial thickness at 6 weeks (mean difference -1.07 mm, 95% confidence interval -1.34 to -0.80) and 6 months (mean difference -1.16 mm, 95% confidence interval -1.79 to -0.54). Single-layer closure was associated with shallower niche depth at 3 months (mean difference -1.29 mm, 95% confidence interval -1.77 to -0.80). Double-layer uterine closure yields greater residual myometrial thickness but does not reduce niche incidence or risk of uterine dehiscence compared with single-layer closure. The clinical significance of improved sonographic markers remains uncertain, underscoring the need for future trials focused on long-term clinical outcomes.