Resident Reporters 2018                 

SASGOG was excited to sponsor 11 Resident Reporters at the SASGOG Annual Meeting and ACOG Scientific Session in Austin, Texas in April 2018. These eleven young resident physicians represent the future of SASGOG as they begin their careers as academic specialists in Obstetrics and Gynecology. Through a generous partial grant from Hologic, the Resident Reporters attended the full day of the SASGOG Annual Meeting, where they actively participated in many interactive sessions. As part of their commitment to the program, each Reporter wrote a short essay related to the meeting’s theme of Achieving Your Goals: Tools for Academic Success. We are pleased to post these essays on the SASGOG website, where they may spark interest in other residents who are considering careers as academic generalists and all that SASGOG has to offer them. Please take a few moments to read the reflections of the 2018 Reporters and share them. 
 

Supported by:

 

 

 

Abigail Burns, MD, MSW - Brigham and Women's Hospital & Massachusetts General Hospital
Sharlay Butler, MD - Northwestern University Feinberg School of Medicine
Alex Friedman, MD - Brown University
Stephanie Higgins, MD - University of Connecticut
Sarah Lambeth, MD - Beth Israel Deaconess Medical Center
Caitlin Martin, MD - University of North Carolina Chapel Hill
Kathryn McKenney, MD - Northwestern University Feinberg School of Medicine
Kelsey Rose, MD - UCLA
Brittany Sanford, MD - George Washington University Hospital
Erin Shiv, MD - Naval Medical Center San Diego
Anar Yukhayev, MD - North Shore and LIJ at Northwell Health


 

Abigail Burns, MD, MSW - Brigham and Women's Hospital & Massachusetts General Hospital

Reflections on SASGOG Annual Meeting:
 
"Achieving Your Goals: Tools for Academic Success” – What I learned during the SASGOG meeting to address this theme, what I would want to share with other residents who could not attend, and how I see this knowledge impacting my planned career and how SASGOG can be supportive in reaching these goals.
 

As a first-time SASGOG attendee, I was optimistic but admittedly a little unsure about what I might gather from the experience. I quickly realized, however, that the meeting provided an entrée into what will likely become a lifelong opportunity for mentorship, professional development, and collegial support. At the resident breakfast, one faculty mentor aptly described, “Clinical medicine is who we are, but education is what makes us academic specialists.” From academic department chairs to community-based residency faculty, SASGOG offers Obstetrician-Gynecologists working in academic medicine a shared identity that leverages our common experiences to enhance growth at the individual level as well as at the level of the specialty. 

For me personally, the conference touched on three noteworthy points: (1) a crash-course in thinking about how to intentionally craft my career from the ground up; (2) a set of specific tools for personal and professional development; (3) a personal introduction to the community of residents and faculty who will become my future colleagues and mentors.  

Crafting a career as an academic specialist in Obstetrics and Gynecology 

The resident breakfast and the session with Drs. Adrianne Dade, Marygrace Elson and Lisa Keder titled “Building Your Academic Career—When to Say Yes or No” offered practical advice for thinking about how to launch a career in academic Obstetrics and Gynecology. The faculty offered the simple recommendation to approach our early careers with confidence in our training, reminding us that we have the foundation to contribute even in our initial years out of residency. Similarly, we were reminded to continue to seek out additional learning opportunities, utilizing ACOG, SASGOG and other organizations that provide courses on leadership, advocacy, research and education. Several faculty shared their own processes of working toward promotion, realizing late that they had not completely understood or kept track of the accomplishments that they needed to advance within their institutions. In turn, they advised us to apply our interests in multiple ways—from teaching, to practice, to scholarship. They reminded us to be helpful colleagues and positive change champions within our institutions, and to seek out feedback that we can utilize for career advancement.  

Personal and professional development tools 

Reflecting on my own interdisciplinary background in Social Work, the SASGOG Annual Meeting reminded me that personal and professional development share foundations across disciplines. Specifically, the program highlighted valuable tools for leadership and advocacy. Dr. Patrice Weiss gave a keynote address on “The Role of Emotional Intelligence in Leadership Progression,” describing how emotional intelligence enables us to manage our own emotions and motivate others. She highlighted the key building blocks of emotional intelligence: self-awareness, self-regulation, motivation, empathy, and social skill. She described how good leaders are able to find common ground and build rapport by inspiring individual and institutional purpose. Similarly, the session with Drs. Gellhaus, Ricciotti, and Leininger on “Creating Change—Advocating for Your Patients, Your Learners, Yourself” offered practical tools for shaping a personal and professional identity that embraces advocacy. As Dr. Leininger described, “The best way to get dents out of a can is to kick it from the inside,” advising us to remember our personal and professional obligations to speak up against injustice and inequality. 

Finding inspiration in new mentors and colleagues 

Besides the many engaging sessions, a highlight of attending the SASGOG Annual Meeting was the realization that I share a professional identity with hundreds of other Ob-Gyn faculty and trainees. Residency is a time of intense and often narrow focus on skill and knowledge acquisition; the SASGOG Annual Meeting introduced me to previously unknown colleagues and mentors with whom I suspect I will continue to cross paths with, seek advice from, and collaborate with throughout my career. One faculty member advised us to mentor others as soon as we can, and this embrace of mentorship underscores how SASGOG promotes community-building among Obstetrician Gynecologists across the course of our careers. 

Ultimately, I left the SASGOG meeting more inspired and confident in my decision to pursue a career as an academic specialist in Ob-Gyn. I look forward to building on this foundational experience at future SASGOG conferences and events.

SASGOG/ACOG Scientific Session: Applying the Evidence:
 

ACOG subspecialty session for SASGOG scientific presentations, describe the presentation and how this area of research might apply in my future career as an academic generalist:

The 2018 ACOG/SASGOG Joint Scientific Session encouraged attendees to consider the question: What should routine well-woman preventive care really consist of? Dr. Hope Ricciotti offered a thoughtful presentation on the “Routine Pelvic Examination: An Evidence-Based Approach.” Despite a dearth of evidence on the diagnostic accuracy of pelvic exams for a multitude of common gynecologic ailments from non-cervical cancers to pelvic inflammatory disease, many of us continue to perform pelvic exams as part of a routine annual exam. Dr. 

Ricciotti reviewed recent guidelines from various physician’s groups, including the American College of Physicians (ACP) and United States Preventative Services Task Force (USPSTF) which both recommend against routine pelvic examinations in asymptomatic adult women. ACOG’s Committee Opinion Number 534 on the “Well-Woman Visit,” recently reaffirmed in 2016, stated that “No evidence supports or refutes the annual pelvic examination or speculum and bimanual examination for the asymptomatic, low-risk patient. An annual pelvic examination seems logical, but also lacks data to support a specific time frame or frequency of such examinations. The decision whether or not to perform a complete pelvic examination at the time of the periodic health examination for the asymptomatic patient should be a shared decision after a discussion between the patient and her health care provider.”  

Dr. Ricciotti encouraged attendees to more thoughtfully apply these guidelines. She raised an important issue regarding the potential harms of routine pelvic exams, including data suggesting that women who report pelvic exam pain are less likely to follow-up, and that contraception utilization may be higher when access to contraception is unlinked from a requirement to have an internal pelvic exam. It is helpful to be reminded that what feels routine as a Gynecologist is often far from routine for patients, whose interaction with our specialty can at times be triggering and (re)traumatizing. 

The suggestion to consider uncoupling invasive pelvic exams from routine well-woman visits should not be confused with ignoring the need to perform a thorough evaluation, including a pelvic examination, for patients with specific gynecologic complaints, symptoms, or histories. Rather, for otherwise asymptomatic healthy women, the decision to perform a pelvic exam or not should be based on patient expectations, priorities, and individualized risk assessment. Such personalization could help to leave more time during a limited annual exam visit to offer evidence-based screening and counseling on topics such as HPV vaccination, contraception, and intimate partner violence. 

The next time I see an “Annual” on my Gynecology clinic schedule, I will consider Dr. Ricciotti’s advice and try to be more intentional about when I perform a pelvic exam. At the same time, I anticipate more data from leaders in organizations such as SASGOG that can shape a shared decision-making model into better evidence-based practice around the routine pelvic exam.


Sharlay Butler, MD - Northwestern University Feinberg School of Medicine

Reflections on SASGOG Annual Meeting:
 
"Achieving Your Goals: Tools for Academic Success” – What I learned during the SASGOG meeting to address this theme, what I would want to share with other residents who could not attend, and how I see this knowledge impacting my planned career and how SASGOG can be supportive in reaching these goals.
 

The theme of the 2018 SASGOG Annual Meeting was Achieving Your Goals: Tools for Academic Success. While this is a broad topic, the conference did an excellent job in defining key components of the various stages of an academic career and providing guidance on how to navigate those stages successfully. For example, the breakout session entitled the “Business of Medicine” was great in providing junior members a basic background of important topics such as RVUs and how FTE’s are calculated. This was incredibly helpful in making sense of this subject matter. Another breakout session was geared toward developing effective presentations that target adult learning styles. In another session, experienced academic faculty led us through what building an academic career looks like in terms of promotion and tenure criteria. Overall, this conference helped define the role of an academic generalist which is one of multifaceted approaches to education and leadership, adaptability to new technologies, and applying evidence-based practice to promote consistent standards of care for women in all practice settings. The sessions at this conference highlighted tools that an academic generalist needs to further the comprehensive and inclusive education of students, residents, and peers. Academic generalists are key in integrating comprehensive women’s health education with updated practice guidelines and this conference emphasized the crucial role we have as patient advocates as they navigate subspecialists, new technologies, and treatment modalities.

SASGOG/ACOG Scientific Session: Applying the Evidence:
 
ACOG subspecialty session for SASGOG scientific presentations, describe the presentation and how this area of research might apply in my future career as an academic generalist:
 

The topic of the joint ACOG/SASGOG scientific session was “The Well-Woman Exam – What Does the Evidence Show Should be Done?” The session featured several presentations in which evidence was reviewed and discussed regarding various parts of the well-woman exam. The particular scientific session I found most compelling was the session titled “Routine Pelvic Examination: An Evidence-Based Appraisal.” This session was most meaningful because it touched on clinical scenarios that I encounter often and offered an evidence-based approach to navigating those scenarios. The session reviewed that the diagnostic accuracy of the pelvic exam is low overall for detecting conditions such as cervical and ovarian cancer. Additionally, it can result in many false positives and can be psychologically difficult for many patients. Recent evidence has stressed that in light of these facts, it is important to have shared decision making when deciding when to perform a pelvic examination, particularly in asymptomatic women. It was helpful to review these guidelines for young women less than 21 which state pelvic exams can be performed when medically indicated. However, the discussion also touched on the fact that a pelvic exam in this age group is not only a screening test but is a way to teach young women about themselves. Another group that the session focused on was immunocompetent, asymptomatic patients who have had a hysterectomy and bilateral salpingo-oophorectomy for benign indications without other history of gynecologic risk factors. Shared decision making and ongoing communication between the patient and the physician was again highlighted in these scenarios where a low-yield test like the pelvic exam could be reasonably omitted in favor of other important health aspect counseling. Overall, I found this review of the literature very informative and important to my future clinical care of patients. 


Alex Friedman, MD - Brown University

Reflections on SASGOG Annual Meeting:
 
"Achieving Your Goals: Tools for Academic Success” – What I learned during the SASGOG meeting to address this theme, what I would want to share with other residents who could not attend, and how I see this knowledge impacting my planned career and how SASGOG can be supportive in reaching these goals.
 

As a soon-to-be attending, I was thrilled to attend the SASGOG national meeting as a resident reporter. I came to the conference looking for the right set of tools as I embarked on the next step in my career. I was drawn to be an Academic Specialist by the breadth of this career path: the ability to care for women across the lifespan, from the exam room to the operating room, and all in between. I was searching for the perfect complement of skills to be an effective leader, educator, and change-maker: the right recipe for success.

Instead of a formula, I found an incredible variety of approaches and perspectives, with each individual’s career taking its own shape: teaching future generations to provide sensitive care, lobbying on the hill, studying implementation of best practices, or utilizing technology to improve access to care. I learned about the numerous ways Academic Specialists make health care better for our patients, whether directly or through training a new generation of Obstetrician/Gynecologists, and the unique methods they leverage to make change. I further saw how SASGOG is a “tool belt” for Academic Specialists nationally, bringing these unique skills and talents together to facilitate the completion of even larger projects.

We all need clinical skills and knowledge to take excellent care of our patients. We are first doctors, responsible for patients’ medical care and physical health. However, as physicians, we witness the holes in our health care system on a daily basis: whether struggling to get insurance coverage for a woman with abnormal uterine bleeding who needs a hysterectomy, or seeing a patient for the first time in the third trimester because she was unable to access prenatal care, we are constantly reminded of the dysfunction and inefficiency of the health care system we work in. While I love being at the bedside, my passion is for systemic change, striving to improve patient care in the exam room and beyond. I came to medicine driven by the words of my college philosophy professor: “it is alright to work in a broken system, as long as you are working to fix it.”

I was struck by the tools Academic Specialists are using across the country to “fix” our broken system. Dr. Eve Espey highlighted one creative approach to improving health care in her presentation on Project ECHO. She first described the health care landscape in New Mexico, outlining the challenges of caring for a rural population separated by great distances. In this setting, patients are remote from the specialty care services they need. Rather than move patients to providers, Project ECHO empowers primary care physicians to care for patients in their communities through capacity building and education. Specialist “hubs” hold virtual clinics through video conferencing with multiple primary care spokes, using didactic teaching and case review, combined with mentorship to grow the primary care “tool belt.” Dr. Espey and her team have used the Project ECHO platform to address cervical cancer screening in the community, resulting in over 16,000 patients being screened. Additionally, the project has demonstrated improvements in provider self-efficacy, satisfaction and knowledge. Dr. Espey’s team plans to tackle other crucial issues in women’s health across the state, including Long Acting Reversible Contraception and preventing unintended pregnancy. The implications for such work are vast for other women’s health issues and more global outreach.

A very different tool was explored through Dr. Jenkins’ session, “Running Effective Meetings”. I was initially surprised to see this topic on the agenda, and identified with the tongue-in-cheek definition of meetings shared at the beginning of the presentation: “event(s) where the minutes are kept and the hours lost”. In fact, in residency, many of my hours have been lost in meetings of varying length and purpose. Still, every great project, every “fix” to the system must start somewhere, and usually, it is with a meeting. Dr. Jenkins quickly acknowledged the challenge of most meetings: they are frequently low yield and lack engagement. The next fifty minutes, however, focused on how to turn meetings into effective tools for empowerment and productivity. He transformed monotony into drama through suggestions like “find a hook” and “mine for conflict” to create interest. He identified individuals’ differing work styles and how to best involve all participants through assignment of roles, building from an agenda, and ensuring the right people are (and are not) at the table. Through Dr. Jenkin’s methods, meetings become a tool for effective leadership, and in turn, change making.

Academic Specialists are uniquely positioned to advance women’s health for patients, practitioners, and trainees, with their holistic perspective across all aspects of Obstetrics and Gynecology, as well as the woman’s lifespan. From this vantage point, we can see potential solutions to health care systems issues, and begin to address them through research, education and policy. No two career paths are identical, and every practitioner’s tool box contains a unique complement of tools, selected by experience and passion. As I learned at SASGOG, however, the most important tool of all is the connection to similarly driven colleagues, where together we can effect significant change.

SASGOG/ACOG Scientific Session: Applying the Evidence:
 
ACOG subspecialty session for SASGOG scientific presentations, describe the presentation and how this area of research might apply in my future career as an academic generalist:
 

"Do I really have to have that exam?" is a question I frequently hear from my patients when I hand them a gown at their annual visit. Patients’ reasons for wanting to avoid the routine screening pelvic exam are numerous: a patient who has had an uncomfortable exam in the past, a woman with a history of sexual abuse, a transgender patient grappling with anatomy that differs from self-perception. In this moment, patients are asking for a cost-benefit discussion, an explanation of why the discomfort and embarrassment of this experience are necessary. 

As OB/GYNs we help patients through uncomfortable situations on a daily basis: an endometrial biopsy for abnormal uterine bleeding, a cervical check in triage, an IUD insertion. The benefits of these are clear: identify cancer, assess labor, prevent pregnancy. We do not question the utility of these interventions. When we discuss a routine pelvic exam, however, the math is not as clear. The benefits of reassurance and knowing "everything is ok" may pale in comparison to the experience of an invasive exam.

During the ACOG Scientific Session on the Well Women Exam, I was inspired by the thoughtful and reflective perspectives academic specialists shared as they grappled with the necessity of the routine screening pelvic exam. Is no evidence enough evidence to abandon pelvic exams? How do we reconcile the individual patients we know who have benefitted from a screening exam with the population level data that shows no impact? This question highlights the new, more population health focused role physicians are being asked to play: caring simultaneously for the individual and the communities they come from. While we rely on organizations like ACOG and the USPTFS to guide us globally, ultimately, it is our individual conversations with patients that drive care. Our medical knowledge and organizational guidelines can help us to better define the costs and benefits, however, ultimately only our patients can decide how this information weighs into their decision.  I hope to approach my future clinical decisions with the same care and patient-centeredness, remembering the physician role as public health advocate, but most importantly, patient champion. 


Stephanie Higgins, MD, University of Connecticut

Reflections on SASGOG Annual Meeting:
 
"Achieving Your Goals: Tools for Academic Success” – What I learned during the SASGOG meeting to address this theme, what I would want to share with other residents who could not attend, and how I see this knowledge impacting my planned career and how SASGOG can be supportive in reaching these goals.
 

The 2018 SASGOG General Meeting was an amazing experience.  The people I met were passionate, enthusiastic, and dedicated to the world of Academic OBGYN.  The energy at that conference was inspiring, and I left the meeting more determined than ever to become an academic generalist.  The conference made me feel that I had the tools I needed to achieve my goals.

The first session of the morning was a breakfast designed for the resident reporters.  We were fortunate to listen to established academic generalists share their knowledge and experience.  They gave us advice that they wished they had known earlier in their careers.  The most valuable piece of advice I learned from that morning was to always plan ahead for your next career advancement.  When starting a new job, think about what you want the next step in your career to be, and how to get there.  For academic generalists, this usually means moving up the academic ranks through promotion.  Many of the panelists in the room recommended finding out early what your institution’s promotion requirements are.  They also recommended keeping a record of all your academic accomplishments along the way.   That way, when the time comes for promotion you will have everything prepared to present yourself in the best light.  This advice was useful to hear early in my career so that I can be prepared to start practicing these habits now.  Being knowledgeable and well-organized about my own accomplishments will help me be a better self-advocate and negotiator in the workplace.

A later session that afternoon dealt with how and when to say “no” at work.  As a young physician, it is hard to know what projects will help advance your career and which won’t, and it can be tempting to jump into every project that presents itself.  However, spending time on projects outside your area of interest or expertise may not be the best way to further your career. During this session Dr. Adrianne Dade and Dr. Marygrace Elson highlighted several critical questions to help make the decision whether or not to invest time in a new project.  Time is our most valuable resource, and there is a significant opportunity cost associated with taking on any new project.  She encouraged us to be selective and strategic in how we invest our time. 

Overall, the SASGOG Annual Meeting was a wonderful and educational experience.  It opened my eyes to the exciting world of academic general OBGYN and made me aware of what I might need to do to succeed in that world. From several talks, sessions, and discussions, I learned the importance of being thoughtful and strategic in how you invest your time, organized in collecting records of your accomplishments, and capable of saying no to opportunities that are not beneficial to your career path.  These tools will make me a better self-advocate and a more effective leader in the field of academic general OBGYN.

SASGOG/ACOG Scientific Session: Applying the Evidence:
 
ACOG subspecialty session for SASGOG scientific presentations, describe the presentation and how this area of research might apply in my future career as an academic generalist:
 

As OBGYNs, we are frequently asked difficult questions about what is best for our patients.   As physicians we look to the evidence, society guidelines, and to our own experience to answer those questions.  But what do we do when the evidence is unclear and the guidelines conflict?  This year’s ACOG/SASGOG Joint Scientific Session focused on the well woman exam, and what the evidence tells us should be done.  Interestingly, the answer is not always clear.

One of the pillars of women’s preventive health is breast cancer screening.  Dr. Maureen Phipps addressed the benefits and risks of different strategies for breast cancer screening in average risk women.  Although the evidence is clear that mammography saves lives, the evidence is less clear on how early and how often mammography should be done.  The US Preventive Services Task Force, the American Cancer Society, and the American College of Obstetricians and Gynecologists all make different recommendations regarding the frequency and age of initiation of mammography.  These organizations all had access to the same body of evidence, and yet drew different conclusions.  When large task forces with access to all the latest evidence cannot come to an agreement on best practices, how does a clinician reconcile those discrepancies?  How do we make decisions about what is best for a patient when the evidence and guidelines do not give us clear answers?

For me, the controversy in guidelines highlights the importance of shared decision making.  If there is not one clear best practice, then the patient needs to be able to choose what is right for her.   For some, the thought of the unnecessary biopsy that results from a false positive mammogram may be enough to defer screening until age 50 and only screen every other year, as suggested by the USPSTF.  For others, the thought of missing a cancer that could have been caught and treated earlier may be unbearable.  These women may be better served by the ACOG recommendation to undergo annual mammography and clinical breast exams staring at age 40. 

When medical recommendations or society guidelines are inconsistent, we have a responsibility to discuss the options with the patient.  She has a right to understand the limitations of what is known, and how her own values can shape medical decision making.  As physicians, our job is to take the clinical evidence and apply it to the individual patient sitting in front of us.  When the evidence is not clear, the patient needs to be involved in the decision-making process.  The guidelines may leave us with more questions than answers, but after understanding the evidence, the patient may come up with her own answer.  


Sarah Lambeth, MD - Beth Israel Deaconess Medical Center

Reflections on SASGOG Annual Meeting:
 
"Achieving Your Goals: Tools for Academic Success” – What I learned during the SASGOG meeting to address this theme, what I would want to share with other residents who could not attend, and how I see this knowledge impacting my planned career and how SASGOG can be supportive in reaching these goals.
 

The theme of this year’s Annual SASGOG meeting, in Austin, TX, “Tools for Academic Success,” could not have been more fitting. As core educators for the next generation of women’s health providers, academic specialists in general OB/GYN shape how trainees care and advocate for women while also pushing the field forward in improving patient care. One of the most important tools for any type of success is cultivating a community of people who will motivate and support you throughout your career, and that was easy to find at SASGOG.

While the annual meeting took place at the end of ACOG’s annual meeting, the scientific session occurred several days prior, after which all the resident reporters shared a meal together to get to know one another.  We were able to share our experiences as residents, our future aspirations, and started making future career connections for one another – thus already forming our community.

When we rejoined to kick off the 6th SASGOG Annual Meeting, I was immediately struck with the camaraderie of the crowd – everyone in attendance was eager to catch up with their colleagues from across the country, while welcoming in all new attendees with open arms. During the networking reception, it quickly became clear that SASGOG is a lifelong community of passionate clinicians and educators, thriving off and learning from one another. As a resident getting ready to launch her career as a specialist in general OB/GYN, the conference was an invaluable stream of formal and informal advice and mentorship, unmatched by any conference I’ve ever attended.

This continued as we started the second day of the meeting with a roundtable breakfast, “Shoulda, woulda, coulda.” At this session, academic generalists in many stages of their careers passed on their experiences and wisdom of what they wish they had known at the beginning. Dr. Jody Stonehocker reminded us that “you can do it all, but it doesn’t have to be right now,” and Dr. Lee Learman impelled us to “roll with all the firsts of being a new attending.”

In addition to a strong community, another tool for academic success is advocacy. At the panel discussion, entitled “Creating Change: Advocating for your patients, your learners, yourself,” Doctors Gellhaus, Leininger, and Ricciotti empowered us to bring different types of advocacy into our busy lives with even a few minutes a day. As academic generalists we have stories to tell, and these stories are the cornerstone to any advocacy work.

The breakout sessions throughout the day spanned the breadth of the academic generalist, connecting back to the meeting’s theme of “Tools for Academic Success.” Doctors Audra Williams and Ashley Wright covered implementing ERAS protocols in OB/GYN while Doctors Kim Gesci and Toby Ogburn educated junior faculty on the business of medicine. Later in the day, Doctors Arthur Ollendorff and Bryan Rone lead a rousing discussion on “Optimizing Teaching in the O.R.,” filled with pearls for current trainees up through senior faculty. The afternoon also covered crucial topics for any academic generalist including improving presentations and abstracts, building an academic career, and opportunistic salpingectomies. Academic success carries a different definition for different people – publications, teaching, improvement in patient care, career promotion, self-fulfillment, but the meeting managed to touch on all of these in one short day.

As academic generalists, we are the backbone of the OB/GYN specialty, uniquely positioned to lead educational, research, and policy missions within the field. As I begin my career as an academic generalist, I am grateful for the opportunity to become part of SASGOG, as it has become a community from which I can launch my career and also support the careers of others.  By providing opportunities for academic generalists early in their careers and in residency, SASGOG upholds a model of collaboration over competition, striving for the success of all involved. I left the meeting inspired and energized for my next steps, and I am already looking forward to attending next year’s meeting as a junior attending.

SASGOG/ACOG Scientific Session: Applying the Evidence:
 
ACOG subspecialty session for SASGOG scientific presentations, describe the presentation and how this area of research might apply in my future career as an academic generalist:
 

This year’s SASGOG Scientific Session reviewed an evidence-based approach to the Well Woman Exam. The entire session peaked my interest, as this component of our profession is where OB/GYNs practice both as specialists and as primary care providers. However I was most struck with Dr. Hope Ricciotti’s presentation “Routine Pelvic Examination: An evidence-based appraisal”, as this component of the Well Woman Exam has the largest gap in evidence and is an area we as OB/GYNs can be leaders within preventative medicine. Dr. Ricciotti, lead us through a thought provoking discussion, making me re-examine my approach to the yearly routine pelvic exam.

Historically, women had yearly pelvic exams with cervical cancer screening, however now that new ASCCP guidelines have most women having this screening on a 3-5 year interval, the need for a yearly routine pelvic exam has been brought into question. ACOG currently recommends that the routine pelvic exam be performed on a yearly basis in women aged 21 years or older, however the American College of Physicians and USPSTF both recommend against it in asymptomatic women. The Well Woman Task Force falls between these two organizations, recommending a shared decision making approach between patients and their providers.

When discussing the need for this exam as a screening tool, it is important to remember that it refers to asymptomatic women. The evidence available for the exam is limited, but from what we do know, the diagnostic accuracy for ovarian and non-cervical gynecologic cancers is low. During the presentation, Dr. Ricciotti reviewed a number of studies on the positive predictive value (PPV) of routine pelvic exams in detecting ovarian cancer and all had PPV results of <4%. An additional study by Padilla et al., published in the International Journal of Gynecology and Obstetrics in 2004, found a moderate PPV (55-64%) for adnexal masses or abnormal uterine size/contour, however this was for exams performed under general anesthesia. Additionally, the exam carries with it other potential harms such as false positives, leading toward unnecessary tests or procedures, and potential psychological impacts on patients. With this said, the exam may be an opportunity for providers to educate patients about their anatomy, answer questions patients may have, or prompt further discussion about sexual function or incontinence – but what Dr. Ricciotti asked us to evaluate for ourselves and as providers is do we need the exam to do this?

There are no clear answers on routine yearly pelvic exams at this point in time.  However, as I enter my career as a specialist in general OB/GYN, I hope to help my patients navigate the complex nuances of preventative medicine by encouraging a dialogue that promotes evidence-based care within a framework that includes their personal healthcare goals and values.


Caitlin, Martin, MD - University of North Carolina Chapel Hill

Reflections on SASGOG Annual Meeting:
 
"Achieving Your Goals: Tools for Academic Success” – What I learned during the SASGOG meeting to address this theme, what I would want to share with other residents who could not attend, and how I see this knowledge impacting my planned career and how SASGOG can be supportive in reaching these goals.
 

Nine years ago in my medical school personal statement I weaved together stories of my role as a patient advocate on the labor floor and how my physician scientist mentor had shaped my passion for women’s health into accomplishments and well-articulated ambitions. In my last sentences, I said “To me, medicine is a life-long process. In this journey, I will join a community of health care workers who continually strive to improve the human condition through education, research and patient care.” Even though it seems ages ago that I wrote those words as now I am on the other side of my clinical training, my dedication to that journey has persisted and matured since then.

Before attending the 2018 Annual SASGOG meeting, I was already looking forward to further defining my role on this path to be an academic general obstetrician-gynecologist, but now I am able to better channel that same excitement into action. The SASGOG meeting did an excellent job integrating content tailored for individuals at all levels of training and experience so all could take away valuable lessons to apply towards refining our tools for academic success. Simultaneously, the meeting also highlighted how each of us, from residents to department chairs, can fulfill a unique role within the teams, projects and taskforces at our home institutions when we effectively sell ourselves and our visions with those around us. For example, the opening Panel Discussion entitled Creating Change: Advocating for your Patients, your Learners, Yourself brought together speakers discussing how to integrate advocacy efforts into our daily lives and our career development efforts. From those desiring to use their expertise to take the next step towards effective political advocacy to those ready to reform their negotiation skills in advancing their careers, the motivational energy plus practical advice was invaluable. Key lines, references, and concepts kept my hand busy as I vividly took notes which I have already shared with my co-residents in hopes to inspire them to use this time in training to start molding their advocacy and negotiation tactics. Altogether, though, this session highlighted to me that my ‘place’ within SASGOG is starting now as a resident but as time goes on and my career matures, I will be able to continue to work alongside other academic general OBGYNs across levels dedicated to the same journey of supporting our specialty.

The SASGOG meeting also reinvigorated my drive to develop the career I envisioned for myself when I wrote my medical school personal statement: an academic career involved in patient care, research and teaching. I like many other resident reporters, admitted that we have been told more than once that we “can’t do it all.” This has come as ‘advice’ from those along the way through our training trying to convince us to change our paths in their own genuine efforts to help us succeed. At SASGOG, though, this message attempted to be ingrained in me started to break down. While interacting one on one with faculty role models at different institutions, I got to meet those carrying out such a career in their current positions. Further, the invigorating words of Dr. Weiss during the joint CUCOG session The Role of Emotional Intelligence in Leadership Progress: Birthing Babies to the Boardroom reinforced that I can (and should) “do it all” if I apply the right tools to my success. Naturally, then, the SASGOG meeting took this revived energy and outlined for me a path I can start taking to effectively build a foundation for such a career. Particularly, the breakout sessions on The Business of Medicine: The Basics for Junior Faculty, How to Develop an Effective Presentation and Building your Academic Career – When to say Yes or No! were all rich in content that I have already starting putting into action in my career development.

Medicine is ever transforming as it adapts to advances in technology, our understanding of diseases and how healthcare is delivered. In OBGYN, this is leading to amazing progress throughout the specialty and subspecialties. As this growth is coming at lightning speed, the roles general obstetrician-gynecologists play in its evolution is vital to ensure these advancements remain clinically relevant for all women across the entire lifecourse. Thus, as I stated in my subsequent residency personal statement, the future role of the academic generalist is to join side by side with others across specialties on this ever changing “journey to improve women’s health in all aspects.” With the community I joined at SASGOG, I am now even more equipped and looking forward to taking on upcoming challenges ahead on this journey.

SASGOG/ACOG Scientific Session: Applying the Evidence:
ACOG subspecialty session for SASGOG scientific presentations, describe the presentation and how this area of research might apply in my future career as an academic generalist:
 
At the joint SASGOG-ACOG scientific session, hearing the emerging research about Disparities in Treatment Decisions for Women with Abnormal Uterine Bleeding in a Resident Clinic Population was a great insight into the unique perspective academic generalists can bring to research. This project highlighted differences that exist across sociodemographic subgroups with regards to the options that are presented to and chosen by women for treatment of abnormal uterine bleeding in a diverse outpatient population. An issue such as abnormal uterine bleeding is one that affects women across their lives, from dysmenorrhea in teenagers to irregular bleeding in the perimenopause period. Disparities in treatment utilization do exist but how these disparities take form likely differ between these groups. To truly understand how such disparities affect populations, it is key to not just look at these disparities among women across all ages and demographic groups together as one but rather examine how the disparity of interest intersects with each population at different times across the lifespan. Further, this study highlighted the importance of utilizing patient centered outcomes in research in order to set ones study findings up for successful translation into intervention. As with defining a study’s exposure of interest that is appropriate to the population of interest and its life stage, defining the appropriate patient centered outcome that captures the essence of what should be targeted to achieve effective change also is key for successful translational research. Utilizing such a lifecourse approach in this sense is crucial when designing research meant to find solutions for women’s health that will be practical and clinically meaningful. General obstetrician-gynecologists are poised to do this, taking a step back and examining how such an issue morphs in its effects on women’s quality of life at different reproductive life stages.

Kathryn McKenney, MD - Northwestern University Feinberg School of Medicine

Reflections on SASGOG Annual Meeting:
 
"Achieving Your Goals: Tools for Academic Success” – What I learned during the SASGOG meeting to address this theme, what I would want to share with other residents who could not attend, and how I see this knowledge impacting my planned career and how SASGOG can be supportive in reaching these goals.
 

I went to the SASGOG meeting aiming to find the tools to launch a career as an academic generalist, and I came away with many. Seasoned academic generalists provided a lot of excellent advice that will influence the way I proceed with career building and navigate through my early career. At the residents’ welcome breakfast, seasoned general OB/GYN faculty gave words of wisdom about things they wished they had known when beginning their careers. At the panel discussion on Creating Change, speakers gave advice about advocacy for patients, learners, and ourselves. At breakout sessions, I learned about mentorship, surgical education, and career building. At the residents’ breakfast, at panel discussions, and in breakout sessions, key themes were flexibility, mentorship, documenting success, and pursuing opportunities for growth.

The advice to “be flexible” was one that pervaded both the residents’ breakfast and the panel discussion on Creating Change. This piece of advice was especially relevant for me as I begin the pursuit of my first faculty position. This emphasis on flexibility feels easy now while my career goals are still somewhat fluid and my position is not yet well-defined, but I will be well-served to remember to be flexible as my role becomes more established. Leaders suggested that while developing a “niche” is an important element of the academic OB/GYN’s role, it is important to remain open to opportunities that do not necessarily fit that niche at first glance. Sometimes an opportunity that seems tangential to one’s career path may ultimately become a defining experience, or at least a catalyst for growth. Similarly, in negotiating for a new position or promotion, one should bring in mind a “best alternative to negotiated agreement” as a back up plan and grounds for “brainstorming” a compromise that benefits both parties.

Another valued piece of wisdom that speakers conveyed was to pursue opportunities for growth. One leader suggested designating time specifically to foster one’s academic ideas and to-do list – it is otherwise easy for career growth to become neglected in favor of obligations to others. Specific opportunities of interest to me that were proposed include leadership conferences such as the Congressional Leadership Conference and the Cefalo Leadership Conference, as well as the Exxcellence Course in Research for fellows and junior faculty. Another speaker proposed that one should always “make one thing into many things—” that is, for anything that requires significant effort, consider whether a small amount of additional effort might broaden the success in another realm. For instance, beginning a regular themed educational meeting at one’s home institution could be presented at a national conference, its effect studied in order to generate educational literature, and used as an opportunity for networking and mentorship.

Several leaders emphasized the importance of keeping a history of one’s successes. Anything that could be considered a career achievement, however minor, should be catalogued in such a way to support an application for promotion. Criteria for career advancement at one’s institution should be elucidated early such that these milestones can be incorporated into plans for career growth.

The piece of advice I cherish most from SASGOG this year is to “mentor as soon as you can.” I have learned the value of mentorship from those in more senior roles, from residents in the class ahead of me to seasoned faculty who with little incentive have been incredibly generous of their time. I have in turn already felt the value of my efforts to mentor junior residents and students during my first year as a senior resident in watching their growth and success. It inspires me to see those I have mentored fostering their own juniors as well. One way to formalize this mentorship is to develop assessment and feedback skills. One speaker quoted Maya Angelou – “people will never forget how you made them feel.” I hope to develop my ability to deliver assessment in an emotionally neutral and productive way, and I plan to seek out resources to optimize this skill.

Attendings at SASGOG shared so much hard-earned wisdom that I feel will enhance my early career building. I am grateful to have had the opportunity to attend. I have already employed much of the advice that was given to me at the conference in my current role in resident education at my institution as well as in the early stages of my job search. I know that I will circle back to my SASGOG network and the annual conference as a means to navigate early career growth and a way to give to the academic community that has already supported me. 

SASGOG/ACOG Scientific Session: Applying the Evidence:
ACOG subspecialty session for SASGOG scientific presentations, describe the presentation and how this area of research might apply in my future career as an academic generalist:
 

This year, the SASGOG scientific session gave a review of the evidence for the Well Woman Visit. Leaders in our field provided an overview of various women’s preventive services. They discussed formulation and content of recommendations about when and which services to provide to women. They reviewed how development of these recommendations differs between organizations. Dr. Hope Ricciotti described the differences between guidelines about routine screening pelvic examination from various organizations. She discussed ACOG’s recommendation for routine screening pelvic exam in patients over 21 based on expert opinion alone, the American College of Physicians’ statement that harms exceed benefits in asymptomatic patients, and the United States Preventive Services Task Force’s draft “I” statement noting there is insufficient evidence to support the practice. She summarized the current evidence, which suggests that screening pelvic examination rarely detects cancers, has uncertain accuracy for diagnosis of benign disease, and may lead to harm through false positives or by creating a barrier to women seeking care because of the associated discomfort. She referenced a quick reference publication in development by the Well Woman Task Force/Women’s Preventive Services Initiative that will prompt providers to focus on high-yield services supported by good evidence. She summarized by noting that since we know of so many other interventions with good supporting evidence, perhaps the well-woman visit could be better spent than on an uncomfortable screening examination with limited evidence to support its clinical value. Dr. Ricciotti suggested the decision about whether to perform annual screening pelvic exam should be shared with patients in a way that includes discussion of the possible benefits and harms, since there is limited evidence to guide us. In my future practice, I hope to use the understanding of how medical organizations make recommendations to influence how I interpret the recommendations and communicate about them with my patients. I also hope to share the decision about services with uncertain benefit from my patients in a way that incorporates their own preferences and desires into their care.


Kelsey Rose, MD - UCLA

Reflections on SASGOG Annual Meeting:
 
"Achieving Your Goals: Tools for Academic Success” – What I learned during the SASGOG meeting to address this theme, what I would want to share with other residents who could not attend, and how I see this knowledge impacting my planned career and how SASGOG can be supportive in reaching these goals.
 

The SASGOG meeting was a wonderful melting pot of thoughts, tool and ideas to further one’s own academic career, to improve teaching skills and to advance leadership abilities, all of which are integral for academic success. 

First, as someone who will hopefully be starting an academic career in a little over a year, hearing now what junior faculty can do to ensure success and movement in their careers was invaluable. It provides me with a toolbox already set up for the future. Seeking out early on what is needed to get promoted will allow me to have an organized box or folder compiling the various things I have done from the start of my career. This “box” will include everything from an event that taught knot tying to resident lectures to papers published. Additionally, recognizing the work that I am already doing and figuring out how to make it scholarly and publishable, will allow that “box” to be cohesive and to tell a story, thus allowing me to find my niche. As was said, “turn everything into many things.” 

In order to be successful, whether in residency or once out working as an academic generalist, having mentors is crucial. The best mentor will be someone I want to be like; someone from whom I can soak up everything that they have to teach. Mentors are individuals that I can use as a resource all the way along during my young career to learn and help me get to the next level. Having multiple mentors is okay and it is important to remember that I can outgrow mentors. SASGOG is a wonderful resource for finding mentors and colleagues with similar interests to my own. 

Second, learning how to be an effective teacher is an important tool for success. The breakout session on teaching in the OR provided concrete resources for improvement. Teaching was broken down into pre-operative teaching, intra-operative teaching and post-operative teaching. In order to be an effective pre-op teacher, I must make the choice to come prepared and willing to teach. Additionally, I should set expectations and do this in conjunction with the residents. I should ask the learner what they need to work on and talk through the case before we begin, creating a plan together. Pre-operative planning allows trouble spots to be addressed before issues actually arise. Once in the operating room, successful teaching can include showing residents one side of the case and then having them do it on their own side, asking them why and asking “what if” questions. Learning how to provide clear directions on movements, rather than saying up and down, allows residents to feel like they can understand and successfully complete the task asked of them. Post-operative teaching revolves around feedback, unbundling the case and identifying what went well and want didn’t. 

Lastly, the ability to lead is fundamental to success, both as a resident and as an academic generalist. The joint SASGOG and CUCOG talk on emotional intelligence was excellent. It described well a number of key attributes to help be an effective leader. Self-awareness is the capability to recognize and understand myself and to be confident, yet realistic, in my own abilities. Self-regulation is the ability to control or redirect disruptive impulses and to suspend judgment on others. Motivation, or passion to work for reasons beyond money and status, is integral to success. Leaders must be empathetic, understanding the emotional makeup of others and how to adjust to an individual’s emotional needs. Strong social skills is another important quality of a leader, as one must be able to manage relationships, build networks and effect change. Thoughtfully learning about these five characteristics and how they apply to leadership and emotional intelligence, was extremely constructive, as it provided concrete concepts to focus on. 

The SASGOG conference itself was a toolbox filled with tangible and specific devices and ideas on how to be successful as a teacher and academic generalist. All the tips, tricks and tools discussed at the meeting will help me to begin to integrate these concepts into my role as a chief resident this year and be more versed and successful at the start of my career as an academic generalist. As I embark on my career, it is a terrific resource to have mentors and other individuals from SASGOG who have experienced using these tools. The people you meet and the experiences they share with you, as I experienced at the SASGOG meeting, are amazing resources.

SASGOG/ACOG Scientific Session: Applying the Evidence:
ACOG subspecialty session for SASGOG scientific presentations, describe the presentation and how this area of research might apply in my future career as an academic generalist:
 

The ACOG SASGOG combined session was an excellent presentation on the evidence for how we, as providers, should practice when it comes to the various aspects of the well woman exam. Shared decision-making was a central theme that ran through each discussion. I found the importance of discussing this concept to be invaluable. When treating patients, it is not uncommon to tell them that we will not force them to do anything and ask them to agree or disagree with our recommendations. However, true shared decision-making includes a complete review of all the facts and balances both the risks and benefits with patient preferences.

I specifically enjoyed the presentation on breast cancer screening by Dr. Phipps. As mentioned, no one will try to deny that breast cancer screening saves lives. The question is who, when and how to screen women. There are a number of different organizations, including ACS, USPSTF and ACGO with slightly different recommendations.

The Women’s Preventative Services Initiative, or WPSI, utilizes the evidence from USPSTF and ACS to come up with its own recommendation. Using the evidence and guidelines presented, I plan to continue with candid discussions with my patients and make a shared decision on when to start mammography and how often. I will explain that while screening at age 40 may reduce breast cancer mortality in average risk women, it can potentially cause more harm with false positive tests and over testing of indolent lesions. Hopefully with these honest discussions we can determine if it is best for each woman to start testing at age 40 or 50 and if it will be annually or biannually if started before age 50.

I intend to use what I have learned about the evidence behind the well woman exam, including breast cancer screening, to educate my patients and make decisions together, advocating for both their health and their voice. Breast cancer screening saves lives, but there is not a single correct way to screen. Embracing this and teaching it to future generations of OBGYNs will allow for flexibility, shared decision-making and better patient care. 


Brittany Sanford, MD - George Washington University Hospital

Reflections on SASGOG Annual Meeting:
 
"Achieving Your Goals: Tools for Academic Success” – What I learned during the SASGOG meeting to address this theme, what I would want to share with other residents who could not attend, and how I see this knowledge impacting my planned career and how SASGOG can be supportive in reaching these goals.
 

The SASGOG 6th Annual Meeting filled me with excitement and promise for the future of Academic Obstetricians and Gynecologists. As the meeting began and physicians from across the country were congregating, you could feel the enthusiasm for the conference build. In the initial opening remarks, resident reporters were reminded that SASGOG is just 6 years old, but in our careers as resident physicians, we have never been without SASGOG as a guiding light for academic general OB/GYNs.

The conference focused on finding tools for academic success and I believe SASGOG achieved this goal. The morning of the first day of the meeting started with the Resident Reporter breakfast with discussion about all the “shoulda, coulda, woulda’s” from many academic generalists. As residents, we were exposed to relevant advice about pursuing a career in academic OB/GYN. We were advised to keep a current running list of all of our involvement in teaching, research, speaking engagements, etc. This can help with updating your CV while applying for academic promotion. We were also encouraged to say “yes” to opportunities that present themselves, but to know that you can’t do everything at once, and to pace yourself. Another point of wisdom came from Dr. Woodland, who reminded us that we should “turn everything we do into many things.”

The day continued with a plenary panel discussion on “Creating change by advocating for your patients, your learners, and yourself.” We heard from Dr. Gelhaus, Dr. Leininger, and Dr. Ricciotti.  One of the major themes is represented in this quote from Dr. Gelhaus-- “Advocacy is telling a story to create a clear picture of legislative bills or regulatory action.” We must be the experts to tell our story and we cannot let others tell it. Dr. Ricciotti focused on self-advocacy, and teaching how to “tell your story” as a physician. She recommended that instead of negotiating, we should approach meetings with our leaders as an opportunity to brainstorm. She also emphasized the importance of being likeable and that building relationships is extremely valuable.  This would be highlighted again later in the day. 

We then heard from Dr. Eve Espey regarding her work with Project ECHO to expand reproductive health education and clinical services to patients and providers outside of major cities. Project ECHO stands for “Extension for Community Healthcare Outcomes” is focused on disseminating knowledge. The project works by having a centralized academic center, or the “hub,” with multiple physicians within surrounding communities as the “spokes.” These community physicians are able to discuss patient cases and gain expert advice from the hub during weekly, hour long, “telementoring” video sessions. This is a way to share best practices across distances. This model can work for reproductive medicine, including contraception, as well as many other important topics in women’s health. This was just one powerful example of how we can work as an academic general OB/GYN and impact the greater good. 

The afternoon was then broken up into three breakout sessions that had multiple options within each session.  Breakout discussions were on a variety of topics that covered areas of interest for Academic OB/GYNs in all phases of their careers. I attended a session on “Enhanced Recovery After Surgery in OB/GYN,” in which we heard from one department that has implemented many ERAS Quality Improvement initiatives. All of the attendants shared ideas on how to make changes at our home institutions in regards to ERAS. The next session I attended was on “Optimizing Teaching in the O.R.—Pearls for Success,” where we discussed ways to improve teaching skills in the OR by drawing parallels between little league and the OR. During the last session I attended, we discussed ways to build an academic career in regards to promotions, as well as CV development. These sessions helped to expand my understanding of the different roles of an academic generalist within teaching, clinical productivity, research, and quality improvement. 

In addition to the sessions that I attended above, there was ample time for networking and gaining insight into a career as an academic OB/GYN during this conference. I met with my SASGOG mentor, Dr. Bazella, with whom I was able to discuss my personal goals for my career as a future academic OB/GYN. I also took the opportunity to learn about my co-resident SASGOG reporters about their interests, their residency programs, and future plans. The opportunities to speak with OB/GYN physicians from other programs that have a shared common interest in improving the field of OB/GYN, as well as educating future OB/GYNs, were invaluable experiences.

The SASGOG sessions, as well as the people I met during this meeting have allowed me to discover my true passions in academics in regards to resident surgical education, improving quality of care for patients, and opportunities for change--such as Project ECHO. Lastly, SASGOG helped me find “my people,” and has created a space where we can continue to connect as colleagues within academic OB/GYN.

SASGOG/ACOG Scientific Session: Applying the Evidence:
ACOG subspecialty session for SASGOG scientific presentations, describe the presentation and how this area of research might apply in my future career as an academic generalist:
 

The theme of the joint ACOG/SASGOG scientific session was about The Well Woman Exam and what evidence there is behind many of the routine components that we perform daily. Dr. Hope Ricciotti chose to focus on the routine pelvic exam which I found to be an interesting topic of discussion. The pelvic exam had been a routine part of annual well woman exams because pap smears were previously recommended at yearly intervals. However, given the changes in cervical cancer screening guidelines, pelvic exams at annual visits are coming into question. The ACOG Committee Opinion on the Well Woman Visit from 2016 discussed that annual pelvic exams for women over the age of 21 should be implemented through shared decision making. Additionally, pelvic exams prior to age 21 should only be performed when indicated. ACOG also states that if a woman has had a hysterectomy and bilateral salpingo-oophorectomy for benign indications, there is no reason for a routine pelvic exam.

Other medical societies, such as the American College of Physicians (ACP) and USPSTF recommend against routine pelvic exams in asymptomatic women because these exams are not shown to reduce morbidity and mortality among women. However, these guidelines are more targeted towards Internal Medicine physicians and not obstetricians since, as obstetrician gynecologists, we are likely more skilled at our pelvic exams in detecting pathology. The ACP guidelines were based on many studies, but one systematic review in particular by Bloomfield et al. (2013) was very influential in the development of their guidelines. They found that routine pelvic exams had low accuracy for ovarian cancer, and harms included unnecessary surgery, fear, anxiety, and pain related to the exam which could make follow up less likely.

So in 2015 ACOG convened a multidisciplinary Well Woman Task Force to evaluate all this research to develop a consensus on routine pelvic exams. The emphasis of this task force was shared decision making, which has been permeating many areas of medicine.  Studies have also found that when we uncouple the pelvic exam from contraception, there is improved compliance to contraception. This is an important reminder that we do not need to perform STI screening prior to initiating contraception.

The overall conclusion from this discussion was that a routine annual pelvic exam may not be indicated as it has not been shown to improve morbidity and mortality. However, it should be a shared decision making item in the annual well woman exam as many patients may expect an exam and feel unsatisfied if they don’t have one performed. Additionally, pelvic exams can allow for a discussion about anatomy, pelvic pain, or dyspareunia that may be incidentally found on an exam. I believe the pelvic exam is an important part of a routine well woman exam and I think a discussion with the patient to offer shared decision making can explain why it may or may not be indicated if she is asymptomatic. 


Erin Shiv, MD - Naval Medical Center San Diego

Reflections on SASGOG Annual Meeting:
 
"Achieving Your Goals: Tools for Academic Success” – What I learned during the SASGOG meeting to address this theme, what I would want to share with other residents who could not attend, and how I see this knowledge impacting my planned career and how SASGOG can be supportive in reaching these goals.
 

The theme for this year’s SASGOG meeting was finding tools for academic success. For different people at different points in their career, this can mean a variety of things. Many of the breakout sessions and general lectures of the meeting addressed this, and provided information to residents, junior, and senior faculty about how they can implement these topics in their own programs at home. Some of these tools included how to initiate an Enhanced Recovery after Surgery program, pursuing positions that will help to advance your career, and finally utilizing Project ECHO to expand the reach of your medical practice through telemedicine. All of these tools are relevant to me and my future career as an academic generalist. 

One of the breakout sessions that I attended was all about implementing an Enhanced Recovery after Surgery (ERAS) program at your own hospital. The presenters did an excellent job of talking about why an ERAS program is important to everyone, and how they can realistically make it happen. The overall goal of ERAS is to both improve the patient experience before, during, and after surgery, and decrease hospitalization time after surgery while also decreasing peri-operative morbidity. An ERAS program has many components and many stakeholders, including the surgical service, nursing, anesthesia, pharmacy, and support services. The process of implementing such a program can be challenging, as it involves coordination with all the involved stakeholders. This breakout session focused less on the specifics of what ERAS is and why it improves patient outcomes and more on how an individual person can initiate the process to implement such a program in order to have a major impact on the patient’s surgical experience. Recently, I have witnessed my own hospital go through a similar process. As someone who is moving from a senior resident to a junior faculty position, I will be looking for my own ways to improve patient care and improve outcomes at my new hospital, all while furthering my academic career. To me, implementing some of the ideas that I learned in this breakout session is an excellent way to do all of these things simultaneously. 

Another breakout session at the annual meeting addressed how to build your academic career in a way that will help you advance and be promoted. This session was helpful in that it showed me all the possible opportunities that are available. Specifically, it addressed when you should say yes and when you should say no. As someone moving into a junior faculty position, it seemed to me that the only right answer when asked to take on any kind of task is “yes.” However, this session made it clear that sometimes saying “no” at the right time is just as important. There are many things that a junior staff can do to advance their academic career, although there are equally as many things that aren’t as helpful and being able to differentiate between these is an important skill to learn. 

Another lecture during the SASGOG meeting that I found particularly inspiring was the Dr. Ken Noller Lecture given by Dr. Eve Espey discussing Project ECHO. Project ECHO is a hub-and-spoke model, where there is a central “hub” of specialty experts, who utilize telemedicine 

technology to communicate and share knowledge with a group of “spoke” clinics, which are mostly made up of primary care physicians. This allows specialty experts to share knowledge and expertise with primary care colleagues so that patients in rural areas who do not have access to specialists can benefit from that medical knowledge. Being in the military, the hub-and-spoke model is one which is already in place, with subspecialists and specialty experts primarily located at the hospital or medical center, and primary care providers located outside the hospital at the outlying smaller branch clinics. I found this lecture particularly inspiring because there are many aspects of women’s health care where we as OB/Gyn specialists rely on our primary care colleagues to be at the front lines. This includes things like family planning, cervical cancer screening, and sometimes even routine prenatal care. Being able to share the most up-to-date evidence-based medicine in OB/Gyn with these primary care providers would inform and empower them to provide better patient care to this population. Because the hub-and-spoke model already exists, adding the telemedicine component seems very possible. 

Attending the SASGOG meeting this year was particularly meaningful and inspiring because it showed me that there is not just one path to achieving academic success. The variety of breakout sessions and keynote lectures all addressed this from different points of view and showed that there is something for everyone as an academic specialist in OB/Gyn. The knowledge and information that I learned at this year’s annual meeting will continue to impact my future career for many years to come. As a generalist OB/Gyn provider in the Navy, my first duty station will soon take me across the globe to Okinawa, Japan, where I will be providing care for Active Duty service members and their families who are stationed there. Although this position will not be one in an academic center, what I have learned both from the SASGOG meeting and by networking with SASGOG members is that academic medicine can take place in any location and does not have to be at an academic center. Wherever I am in the world, I know that SASGOG will always be there, supporting me in my academic career as a general OB/Gyn.

SASGOG/ACOG Scientific Session: Applying the Evidence:
ACOG subspecialty session for SASGOG scientific presentations, describe the presentation and how this area of research might apply in my future career as an academic generalist:
 

The 2018 ACOG subspecialty session for SASGOG was all about the annual Well Woman Exam.  In 2015, ACOG created the Well-Woman Task Force, with the goal of helping clinicians understand the age-based recommendations for components of the well-woman exam. 

During the scientific session, the discussion centered around attempting to simplifying these recommendations into consolidated tables, which can be used to guide counseling at each visit.  This is similar to what has been done by the American Academy of Pediatrics with the Bright Futures program for well child visits.  However, at the same time, there was a call for shared decision making between provider and patient for a number of aspects of the visit, including when to initiate and stop mammograms, and whether or not to perform pelvic exams and when to stop routinely performing them for patients. 

Shared decision making is important because it allows the provider to discuss indications for a specific procedure, and reasons why someone may or may not chose to proceed.  At the same time, the patient is allowed to share their concerns and make a decision regarding what they would like to do.  This is becoming increasingly important in an environment of higher patient health literacy, and a newfound desire from patients to be more involved in their health care decisions.  However, these conversations come at a cost of more time spent with a patient, something that busy clinicians may not have the ability to do.

Although there may be a higher cost due to additional time spent with providers, increased time with patients generally translates to heightened patient satisfaction, which is difficult to assign a dollar amount to.  Although challenging to quantify, improved patient satisfaction is something that we as providers consistently strive for.  As a future academic generalist, this is something that I hope to be able to emphasize and even study, in order to find a better way to quantify patient satisfaction.  Although creating a Well-Woman visit program in the style of Bright Futures allows for providers to structure their visits and cover all aspects of the visit, there should also be an emphasis on shared decision making between provider and patient, which will ultimately lead to increased patient satisfaction with the Well Woman visit. 


 

Anar Yukhayev, MD - North Shore and LIJ at Northwell Health

Reflections on SASGOG Annual Meeting
 
"Achieving Your Goals: Tools for Academic Success” – What I learned during the SASGOG meeting to address this theme, what I would want to share with other residents who could not attend, and how I see this knowledge impacting my planned career and how SASGOG can be supportive in reaching these goals.
 

Academic generalists have their own niche in the field of Obstetrics and Gynecology and with the help of SASGOG we are able to collaborate and share tools essential for achieving academic success. Some of the important aspects that encompass the scope of an academic generalist are advocacy, clinical care, research, and education. We are faced with many barriers that arise both from administrative demands and financial considerations. An essential key to success is collaboration, through which one can learn, develop and hone in on skills essential to achieve one’s goal in a planned career as an academic generalist.

We discussed mentorship which is a foundational building block for any career. Finding a faculty advisor allows one to plot a course for the future and helps set goals that are feasible and attainable. Learning from the experiences of a mentor is essential to avoid pitfalls as well as to build on current and past projects and developments. Networking is essential to find faculty advisors and mentors not only in one’s own institution but across the nation, for collaborating is always better than standing alone.

We focused on educational tools that helped cultivate teaching skills in the operating room. Teaching medical education comes with its own set of challenges, yet teaching in the operating room can be even more difficult to navigate. How does one balance operating, patient care, and teaching medical students and residents simultaneously? How does one teach and stick to the principle of non-maleficence? We discussed teaching by demonstration, and practicing surgical skills outside of the operating room on simulations, etc. We also discussed teaching outside of the operating room and how to give targeted lectures and engaging presentations. Becoming an effective teacher is an important building block on the path to achieving a career as an academic generalist and the various sessions at the SASGOG meeting provided a venue to learn and develop these skills.

We also discussed tools integral to addressing the research component of a career as an academic generalist. We had workshops on writing effective abstracts for our research studies that will help one increase the chances of publishing research which is a key component of any academic generalist’s CV. We also learned tools to help draft grant proposals, which are needed to provide funding for the research and at times to help sustain vital positions in the academic generalist department itself.

Despite the clinical teaching, supervision of residents, research, and advocacy that most academic generalists contribute to their department, we are faced with increasing administrative demands to increase clinical productivity. What makes it even more difficult is trying to navigate the waters of reimbursement models in our complex healthcare system. Health policy and our payment models are constantly evolving and ever changing, so the session on the business of medicine was another important topic that helped hone in on tools necessary to navigate the financial challenges of being an academic generalist. Learning how to maximize RVUs and incentives as well as how to reward academic generalists for work that is often-times not measured by our payment models is essential for one’s career to thrive.

And to put it all together, one of the more helpful sessions for me taught how to properly put all of one’s academic career on paper, including format, what to include and how. We learned how to choose a track within one’s academic institution and how to guide one’s CV based on that specific track. Another important discussion included the pitfalls of submitting too early and how to determine when one has enough to apply for a promotion. Overall, the SASGOG sessions were extremely helpful in providing tools and guidance on how to successfully plan and advance a career as an academic generalist in Obstetrics and Gynecology.

SASGOG/ACOG Scientific Session: Applying the Evidence:
ACOG subspecialty session for SASGOG scientific presentations, describe the presentation and how this area of research might apply in my future career as an academic generalist:
 

The ACOG subspecialty session for SASGOG included a scientific presentation on the well-woman exam and what does the evidence show should be done. I want to specifically mention the evidence behind the annual pelvic exam and how it should guide shared decision making with the patient regarding her healthcare management. The Annals of Internal Medicine published guidelines from the American College of Physicians recommending against performing screening pelvic examination in asymptomatic, nonpregnant, adult women. The American College of Obstetricians and Gynecologists states that the scientific evidence neither supports nor refutes the need for an annual pelvic exam for women, yet still recommends it.

Some of the evidence suggests that the diagnostic accuracy of the annual pelvic exam to diagnose ovarian cancer or pelvic infections is low; however the studies mentioned looked at all physicians including Internal Medicine doctors, Family Medicine specialists, and Obstetricians and Gynecologists. One of the points brought up were that it is logical to assume that the diagnostic accuracy would improve if only OBGYNs were doing pelvic exams. The potential benefit of an annual pelvic examination is an incentive for women to access health care and gynecologic services, such as contraception, screening for sexually transmitted infections, and other care not related to gynecology.

Some of the potential harms on the side of the patient are fear, anxiety, embarrassment, pain, and discomfort. Some of the other harms are false reassurance, overdiagnosis, overtreatment, and diagnostic procedure–related harms. After hearing the current evidence on the annual pelvic exam, I believe as physicians we are obligated to have a conversation with our patients on the potential benefits and harms of performing an annual pelvic exam and make a shared medical decision together.