Background

After 24 hours of call, delivering 4 babies, saving a woman’s life by surgically removing an ectopic pregnancy, and performing a handful of emergency room and inpatient consults, we are told that we are rated poorly by the medical students. Why? The annual data from the Graduate Questionnaire (GQ) of the Association of American Medical Colleges (AAMC) show 79% of graduating medical students in 2014 rate the overall quality of the obstetrics and gynecology (ob-gyn) clerkship as good or excellent as compared to 91.6% in internal medicine ( P < .002). Most core clerkships are rated above ob-gyn, including surgery ( Table ), which has many similar characteristics to our specialty. A focus group of clerkship directors from the Undergraduate Medical Education Committee, Association of Professors of Gynecology and Obstetrics (APGO) reviewed their individual clerkship evaluations and came up with several common themes regarding medical student evaluations of the ob-gyn clerkship. Medical students reported several unappealing elements: long work hours, minimal hands-on experience, limited faculty interactions, ineffective teaching by residents/fellows, and mistreatment issues. The purpose of this Viewpoint article is to discuss strategies to develop adaptive behaviors to address these educational shortcomings. Best practices described on student surveys and by medical schools with ob-gyn clerkships that perform above the GQ national averages are reviewed.

Long work hours

The Liaison Committee on Medical Education requires medical schools to have policies to limit student work hours. Most policies follow Accreditation Council for Graduate Medical Education guidelines in which residents are not allowed to work >80 hours per week. Regardless of work hour limits, many medical students comment on the difficulty of overnight calls and long shifts. Several studies have cited income and lifestyle as key elements identified by our current medical students in the decision to pursue a specialty. Ob-gyn is perceived as a specialty with an uncontrollable lifestyle.

Acknowledging the challenging hours as a field-specific characteristic, and one each student should experience, can potentially frame their role on the labor floor as one needed for students to both fully participate in births and to understand the context of obstetric care. Additionally, it is important to educate medical students that the lifestyle of a resident in not necessarily the life of a practicing ob-gyn.

Long work hours

The Liaison Committee on Medical Education requires medical schools to have policies to limit student work hours. Most policies follow Accreditation Council for Graduate Medical Education guidelines in which residents are not allowed to work >80 hours per week. Regardless of work hour limits, many medical students comment on the difficulty of overnight calls and long shifts. Several studies have cited income and lifestyle as key elements identified by our current medical students in the decision to pursue a specialty. Ob-gyn is perceived as a specialty with an uncontrollable lifestyle.

Acknowledging the challenging hours as a field-specific characteristic, and one each student should experience, can potentially frame their role on the labor floor as one needed for students to both fully participate in births and to understand the context of obstetric care. Additionally, it is important to educate medical students that the lifestyle of a resident in not necessarily the life of a practicing ob-gyn.

Decreased hands-on experience

Another factor as to why students rate our specialty lower is that medical students are given less autonomy on the rotation. In a study by Grasby and Quinlivan, 38% of ob-gyn patients refused involvement of students. Female patients are more likely to refuse involvement of a student in their medical care due to the sensitive nature of the physical examination. Data support “that female supervisory physicians prioritized patients’ autonomy above students’ learning needs.” As educators, we must find ways to incorporate innovative techniques to supplement the volume of clinical experiences.

Although the sensitive nature of our field will never change, there are several successful ways to increase a student’s comfort and expertise with gynecological exams and basic obstetrical procedures. Utilization of standardized patients and gynecological teaching associates to teach gynecological history taking and pelvic examination skills are keys to a successful ob-gyn clerkship. Low- and high-fidelity simulation drills to train students on spontaneous vaginal deliveries are immersive educational experiences designed to improve both patient safety and quality of medical education. Assigning students specific elements of patient counseling (ie, medication counseling) will include them as team members. Additionally, longitudinal experiences such as weekly clinics with the same preceptor or centering groups with the same patients allow faculty to watch a student’s development and permit the student to learn a particular attending’s practice style. These strategies help students develop a sense of confidence, and faculty members feel more comfortable including medical students in patient care. Consequently, medical students gather more hands-on experience.