The Match: How ACOG Is Helping Reduce Stress around Entering Residency

While graduating medical school is a huge milestone in a future ob-gyn’s career, it comes with its own stressors, such as matching to a residency program. The match process can be difficult and stressful for many medical students—and that pressure only increases when students consider everything they need to do to prepare for residency itself.

So what makes the matching process so stressful? To start, United States Medical Licensing Examination (USMLE) results can be overemphasized, which may cause medical students to focus on test results to the point of neglecting other educational and curricular opportunities. And although the number of residency positions has increased over the last five years, the number of residency applications that programs receive has drastically increased, making matching more competitive than ever before. This is especially problematic when you consider that each program has a designated number of interview spots. Interviews can also be logistically difficult, financially burdensome, and time-consuming for students and programs, a problem confounded by the fact that because each student will only select one program, training programs may need to repeat interview processes to fill all openings. The difficulties don’t stop once you’re matched, either: PGY-1s can vary in skill level on day one of residency and may need extra resources to shore up their knowledge in different areas.

ACOG recognizes the challenges that medical students face and is committed to helping the future leaders of our profession succeed. We’re considering ways to change the match process itself. Indeed, many issues with the transition to residency could be alleviated by restructuring the process. We are also actively working to ensure that medical students are informed about the ob-gyn specialty and have the resources they need to be prepared to enter the profession. The Step Up to Residency Program, developed by CREOG and the Association of Professors of Gynecology and Obstetrics, is a partial post-match curriculum that helps PGY-4s hone the skills and knowledge they’ll need in the early stages of residency. Step Up to Residency features hands-on training and covers fetal monitoring, the basics of ultrasound, neonatal resuscitation, and more. PGY-4s will also have the chance to discuss the aspects of residency that extend beyond the hospital; for example, resident wellness, financial planning, and career planning. CREOG is also launching a comprehensive post-match curriculum for all soon-to-be residents that will build the specific knowledge base and skill set that ob-gyn interns can use before the first day of residency.

Finally, ACOG offers a residency fair at our Annual Meeting and local medical student days, provide students with hands-on support as they prepare for residency, through our Districts and Sections.

Preparing for and transitioning to residency can be daunting, but the initiatives ACOG is involved in will help pave the way for medical students to become confident, informed, and well-prepared residents. ACOG is committed to being a valuable resource for all its members, starting with your first steps of training and continuing throughout your entire career.

A Rewarding Journey as ACOG’s President

When I started my term as ACOG’s 67th president last May, I wanted to make a difference in the lives of our members and patients, ensure ACOG’s continued growth, and lift our voice as the leading specialty organization in the nation. In many ways, what we have accomplished in 12 short months has far surpassed my expectations given the complexity of the issues we’ve had to deal with and the extraordinary circumstances we’ve had to navigate and overcome. So, in my last month, I’d like to revisit some of the things that have made this such an impactful year and taken me around the globe.

When I initially laid out my priorities for advocacy and global women’s health, there was no way to know the challenges we would face to protect women’s continued access to reproductive and maternal health care, both domestically and abroad. As my tenure progressed and new challenges presented themselves, increased member engagement became even more essential. So, we leveraged my All-in for Advocacy campaign, an effort to amplify and expand our voice with state and federal policy makers through our member stakeholders. In 2016 and 2017, I traveled throughout the country doing presentations at Grand Rounds and participating in state lobby days and was wowed by the energy and eagerness of our advocates to make positive changes in their home states.  Physicians led efforts to support our patients and our practices, successfully advancing legislation from maternal mortality to Zika and defeating legislation affecting the sacred patient-physician relationship and restricting reproductive health rights.

Also, because of ACOG’s excellent government relations team, we launched the State Legislative Action Center, where ob-gyns are able to learn more about their legislature and elected officials, search active legislation, and find opportunities to take action. And this certainly was the year for action! Ob-gyns had an important voice in the discussions on health care reform and urged policy makers not to turn back the clock on women’s health by repealing the Affordable Care Act. We fought for our patients to have continued access to affordable insurance coverage, comprehensive maternity care, no-cost preventive services such as contraceptives, and consumer protections that would prohibit insurers from denying coverage based on pre-existing conditions or setting annual or lifetime benefit caps. And while the fight is not over, the defeat of the American Health Care Act this past March is evidence that we made a tremendous impact.

We have also made great strides in ACOG’s efforts overseas. Through my own personal work to advance health care in struggling countries, I learned that we as ob-gyns can make a difference in global women’s health by sharing our knowledge and resources. However, extended time away from one’s practice is always very difficult and, for some, next to impossible. One of my goals was to make short-term projects easily accessible and identifiable for ACOG members and I am proud to say that we developed a database of non-profit organizations involved in two-week mission work that allows ob-gyns to get more information and sign up.

We’ve also grown the Alliance for Innovation in Maternal Health (AIM), which creates instructional and educational portfolios, or “safety bundles,” to fight high rates of maternal mortality in the United States. Through the hard work of ACOG’s Office of Global Women’s Health, the AIM safety bundle for postpartum hemorrhage has been instituted into practice in a low resource setting in Malawi at a community health clinic and referral hospital.  And it has meant so much to me to see the progress made and the lives saved because of this initiative. Additionally, ACOG helps educate and train local health providers in underdeveloped countries in various areas of obstetrics and gynecology through several programs, including Health Volunteers Overseas. I’m particularly proud of this work because I firmly believe that the same high standards we have for health care in the United States are the same standards that should apply to other developing countries around the world.

Lastly, another one of my goals this past year was to continue efforts to address the workforce and practice pattern changes we’ve seen in our specialty by improving ob-gyn resident education models. In 2016, the Council on Resident Education in Obstetrics and Gynecology Education Committee embarked on a complete overhaul of the learning objectives for residents. This effort resulted in the release of the Educational Objectives: Core Curriculum in Obstetrics and Gynecology, 11th edition. We are now surveying mid-career practicing ob-gyns to determine which of the core objectives they actually apply in their practices. Although this was an issue without an easy solution, we must continue to work together and discover ways to improve. And I truly appreciate all the hard work of ACOG’s education staff in helping to facilitate this endeavor.

As I pen my last blog, I feel that my time from president-elect nominee to president has been an incredibly rewarding journey that has literally spanned 400,000 miles, according to my frequent flier program. From trips to the nation’s capital to residencies across the country to small community health centers in Africa, each experience taught me so much and it was a great honor to be able to serve ACOG’s members in the process. If I had to impart any advice to ACOG’s incoming president, Dr. Haywood Brown, it would be to enjoy it because it will fly by. (No pun intended.) Enjoy the year, enjoy the people, and listen to their stories. Everyone has a story!

Building a Better Ob-Gyn—Retooling Resident Education

I recently had the honor to speak with some of our specialty’s greatest leaders—the educators and directors of our obstetrics and gynecology programs across the United States.

It was my first time attending the Association of Professors of Gynecology and Obstetrics (APGO)/Council on Resident Education in Obstetrics and Gynecology (CREOG) Annual Meeting. I was rewarded with inspirational and creative presentations on the challenges facing us about how we educate and how we learn. Do we learn best from the standard lecture and exam model? I don’t think so. Even I realized in medical school over 30 years ago—when I was balancing life with a newborn, a medical school heavy on lectures, and tests every few months—that students retain information better with interactive learning and retain more with case examples.

The APGO/CREOG meeting included engaging roundtable discussions on leadership and advocacy. Ob-gyn professors are looking at how best to train students for the next steps in their education. For instance, do we need to prepare students by instituting “boot camps” before they begin their first year in residency? How do we set milestone expectations for residents in their training? Our educators face the ongoing challenges of developing and maintaining ob-gyn resident surgical skills, teaching empathic patient care, and promoting and sustaining strong leadership in ob-gyn.

Residents and medical student attendees presented poster sessions on how they learn, what training was most effective, and the challenges they face. Some of the best parts of the program were the one-on-one discussions I had with these leaders in women’s health who are at the very early stage of their careers. Of course, I took the opportunity to discuss our national maternal health initiative, describe ACOG’s Well-Woman Task Force, and put in a plug for advocacy and our annual Congressional Leadership Conference (CLC).

Educating the future generations of ob-gyns in today’s challenging and quickly-changing health care environment will require the type of creative and provocative ideas that came out of the APGO/CREOG meeting. Here’s to all the ob-gyn professors and residency program directors who have been devoted to education for all the hard work that they do.