2013 Publications

Farrow VS, Anderson B, Chescheir NC, Schulkin J. (2013). Sex differences among obstetrican-gynocologists: A review of survey studies.  Obstetrical and Gynecological Survey, 68, 235- 253.

Whether practice differences exist between the sexes is a question of clinical and educational significance. The obstetrician-gynecologist (ob-gyn) workforce has been shifting to majority women. An examination of sex differences in ob-gyn practice contributes to the discussion about how the changing workforce may impact women’s healthcare. We sought to review survey studies to assess whether there are specific topics in which differences in attitudes, opinions, and practice patterns between male and female ob-gyns are apparent. We conducted a systematic review to identify all survey studies of ob-gyns from the years 2002-2012. A total of 93 studies were reviewed to identify statements of sex differences and categorized by conceptual theme. Sex differences were identified in a number of areas. In general, women report more supportive attitudes toward abortion. A number of differences were identified with regard to workforce issues, such as women earning 23% less than their male counterparts as reported in 1 study and working an average of 4.1 fewer hours per week than men in another study. Men typically provide higher selfratings than women in a number of areas. Other noted findings include men tending toward more pharmaceutical therapies and women making more referrals for medical conditions. Although a number of areas of difference were identified, the impact of such differences is yet to be determined. Additional research may help to clarify the reasons for such differences and their potential impact on patients.

Power ML, Wilson EK, Hogan SO, Loft JD, Williams JL, Mersereau PW, Schulkin J. (2013). Patterns of preconception, prenatal, and postnatal care for diabetic women by obstetrician-gynecologists. J Reprod Med, 58, 7-14.

To assess barriers to and quality of care received by diabetic pregnant women from obstetrician-gynecologists.  A questionnaire was mailed to 1,000 representative practicing Fellows of the American College of Obstetricians and Gynecologists; 74 did not treat pregnant patients and 510 (55.1%) returned completed surveys.  Respondents were divided into 3 groups: maternal-fetal medicine specialists, physicians with high minority/low insurance patient populations, and physicians with low minority/high insurance patient populations.  Reported preconception and prenatal care was generally consistent with guidelines.  Regarding gestational diabetes mellitus patients the three physician groups differed in assessing postpartum glycemic status, counseling about lifestyle changes, and counseling patients to consult a doctor before their next pregnancy.  Patient demographics and perceived barriers to care were similar between maternal-fetal medicine specialists and physicians with high minority/low insurance patient populations.  These two physician groups were more likely to agree that lack of educational materials, arranging specialists’ referrals, patient compliance with recommendations, and patients’ ability to afford healthful food were barriers to quality care. According to physician self-report, pregnant diabetic patients with access to an obstetrician receive quality care regardless of insurance status.  Post-partum care is more variable.  Physicians with high minority/low insurance patient populations may lack access to resources.

Fuller E, Anderson BL, Leddy M, Schulkin J. (2013). Obstetrician-gynecologists’ knowledge, attitudes and practices regarding major depressive disorder.  Journal of Psychosomatic Obstetrics and Gynecology,34(1), 34-8.

Background: Obstetrician-gynecologists (ob-gyns) provide depression screening and treatment, but these practices could be improved. This study investigated the use of depression screening tools and treatment of adolescents with depressive symptoms. Methods: Surveys were sent to 220 members of the American College of Obstetricians and Gynecologists (ACOG) who had responded to a survey on depression in the past two years. Response rate was 66% (n¼145). Questions included those related to standardized depression screening, antidepressant prescribing behavior, use of the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) and knowledge of adolescent depression. Results: A total of 40% use standardized screening tools for depression with 46% using the Beck Depression Inventory-II and only 5% using the Patient Health Questionnaire-2 (PHQ-2). The majority (89%) of ob-gyns do not employ the DSM-IV to confirm a diagnosis of major depressive disorder. Of the ob-gyns indicating treating depression with antidepressants, 97% prescribe selective serotonin reuptake inhibitors. Only 19 respondents do not prescribe antidepressants, and instead refer depressed patients to mental health specialists. Most (79%) ob-gyns identified sexual problems as the primary side effect deterring prescribing of antidepressant medication. Ob-gyns were fairly accurate at estimating the prevalence of adolescent depression. Conclusion: Ob-gyns are not utilizing the recommended validated resources such as the DSM-IV or PHQ-2 for diagnosis of depression or prior to prescribing antidepressants.

Power ML, Henderson Z, Behler JE, Schulkin J. (2013). Attitudes and practices regarding late preterm birth among American obstetrician-gynecologists. J Womens Health, 22, 167-172.

Background: Late preterm birth (LPTB) accounts for most preterm births and has been increasing, associated with increases in cesarean sections and inductions at this gestational age. Methods: A self-administered survey, consisting of questions about opinions, knowledge, and practices regarding LPTB, was mailed to 1232 American College of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows in Practice in May–July 2010. Results: Surveys were returned by 520 practicing obstetricians. Two thirds of respondents correctly defined LPTB (34–36 weeks completed gestation). Most responding physicians (87%) were aware of the evidence regarding morbidity and mortality of infants born at 34–36 weeks; 81% considered such evidence sufficient to make a clinical judgment. Although 84% were concerned about long-term health problems in these infants, many disagreed that LPTB infants were at increased risk of long-term neurodevelopmental outcomes. Most agreed that the increase in LPTB in the United States is due to increasing rates and complications of multifetal pregnancies and maternal disorders. Almost all responding physicians agreed that certain clinical indications (e.g., severe preeclampsia, placental abruption, premature rupture of the membranes [PROM]) were appropriate reasons for early delivery, and most disagreed with delivering late preterm infants for logistical reasons or convenience. Half of responding physicians reported that concerns about malpractice risks contribute to their decision to induce labor or perform a cesarean section at 34–36 weeks. Conclusions: Many obstetricians underestimate long-term neurodevelopmental outcomes among infants born late preterm and may have a lower threshold to deliver some infants late preterm for indications that are not evidence based. Additional educational efforts regarding LPTB are needed.

Leddy M, Anderson BL, Schulkin J. (2013).  Cognitive-behavioral therapy and decision science.  New Ideas in Psychology, 31(3), 173-83.

In recent decades cognitive-behavioral therapy (CBT) and decision science (DS) have emerged within the field of psychological science. Though these are two vastly different areas of study, they are similar in that they address human information processing, cognition, behavior, and the link between them. In this article, we provide brief summaries of CBT and decision science, discuss their similarities and differences, and discuss how future research can identify ways in which these fields can inform each other. Several CBT techniques that might be of use to the efforts of the decision science field to prevent cognitive biases are suggested. Research that integrates these two fields may lead to the improvement of both.

Raglan GB, Anderson BL, Lawrence H, Schulkin J. (2013). Obstetrics and gynecology practices and patient insurance type. Women's Health Issues, 23, e161-5.

Background: Despite research on health disparities based on insurance status, little is known about the differences in practice patterns among physicians who cater to privately and non-privately insured patients. The aim of this study was to assess how obstetrician-gynecologists (ob-gyns) who primarily see patients with private insurance differ from those who see mainly uninsured or publicly insured patients. This could be informative of the needs of these two groups of physicians and patients. Methods: A questionnaire was mailed or emailed to 1,000 members of the American College of Obstetricians and Gynecologists, 600 of whom participate in the Collaborative Ambulatory Research Network. Findings: A 56.4% response rate was obtained. Of the valid responders, the 335 reported providing care to a majority of patients with private insurance ("private group") and the 105 reported providing care to mostly publicly insured or uninsured patients ("non-private group") were included in our analyses. Differences between groups included that the private group was more likely to see patients before their becoming pregnant and spent more time on well-woman care. The private group was more likely to see patients who are White, Asian, or between the ages of 45 and 64. The non-private group was more likely to see Hispanic patients and those under age 18. Conclusion: Results reveal that ob-gyns who see mostly privately insured patients have different clinical experiences than those who see mainly uninsured or publicly insured patients in terms of patient characteristics, preconception care, distribution of time on activities, and the of likelihood performing certain procedures and screening tests.

Perkins RB, Anderson BL, Sheinfeld Gorn S, Schulkin J. (2013). Challenges in cervical cancer prevention: a survey of Obstetrician-Gynecologists. American Journal of Preventive Medicine, 45, 175–181.

Background:  Current cervical cancer prevention recommendations include human papillomavirus (HPV) vaccination, Pap and HPV co-testing, and Pap testing at 3- to 5-year intervals. Purpose:  To examine attitudes, practice patterns, and barriers related to HPV vaccination and cervical cancer screening guidelines among U.S. obstetrician-gynecologists. Methods:  In 2011-2012, a national sample of members of the American Congress of Obstetricians and Gynecologists responded to a 15-item (some with multiple parts) questionnaire assessing sociodemographic characteristics, clinical practices, and perceived barriers to HPV vaccination and cervical cancer screening. Multivariate logistic regression was used to identify factors associated with guideline adherence. Analyses were conducted in 2012. Results:  A total of 366 obstetrician-gynecologists participated. Ninety-two percent of respondents offered HPV vaccination to patients, but only 27% estimated that most eligible patients received vaccination. Parent and patient refusals were commonly cited barriers to HPV vaccination. Approximately half of respondents followed guidelines to begin cervical cancer screening at age 21 years, discontinue screening at age 70 years or after hysterectomy, and appropriately utilize Pap and HPV co-testing. Most physicians continued to recommend annual Paps (74% aged 21-29 years, 53% aged ≥30 years). Physicians felt that patients were uncomfortable with extended screening intervals and were concerned that patients would not come for annual exams without concurrent Paps. Solo practitioners were less likely to follow both vaccination and screening guidelines than those in group practices. Conclusions:  This survey of obstetrician-gynecologists indicates persistent barriers to the adoption of HPV vaccination and cervical cancer screening guidelines. Interventions to promote guideline adherence may help improve the quality of cervical cancer prevention.

Anderson BL, Pearlman M, Griffin J, Schulkin J. (2013).  Conflicting and changing breast cancer screening recommendations: Survey study of a national sample of ob-gyns after the release of the 2009 USPSTF guidelines. Journal of Healthcare Quality, 35, 25-35.

Objective: To assess obstetrician-gynecologists' (ob-gyns') use of multiple conflicting guidelines assess after the release of the 2009 U.S. Preventive Services Task Force (USPSTF) breast cancer screening recommendations. Study Design: A nationally representative sample of American College of Obstetricians and Gynecologists (ACOG) Fellows were invited to complete a survey. Results: A total of 235 of 399 ob-gyns responded (59% response rate). Twenty percent and 89% indicated that USPSTF and ACOG guidelines influence their practice, respectively, 84% are influenced by more than one guideline. The plurality of respondents was able to correctly identify ACOG and USPSTF guidelines on 10 of 12 questions. One-third agreed with both ACOG's and USPSTF's recommendations regarding mammography screening for women 40-49 years old. A total of 42% of the sample made at least one change in their practice after the release of the 2009 USPSTF breast cancer screening guidelines. Conclusion: Some ob-gyns made changes to their practices after the release of the USPSTF guidelines. When multiple guidelines exist, as in the case with breast cancer screening, physicians utilize multiple, and at times conflicting, guidelines. More research will be needed to better understand the impact (negative or positive) of multiple guidelines on the quality of healthcare.

Farrow V, Goldenberg RL, Fretts RC, Schulkin J. (2013). Psychological impact of stillbirths on obstetricians. American of Maternal-Fetal and Neonatal Medicine, 26, 748-52.

Objective: To assess the psychological impact on US obstetricians when they care for women who have suffered a stillbirth and explore whether demographic (e.g. age, gender) and practice (e.g. number of patients, practice type) variables were related to the extent of psychological impact for obstetricians following stillbirth. Methods: Using a questionnaire that could be completed in about 20 min, we surveyed 1000 American College of Obstetricians and Gynecologists (ACOG) members. Physicians were asked about how stillbirths have affected them personally. Results: Half of those surveyed responded (499) and of those 365 currently practiced obstetrics. Virtually all obstetricians have looked after women who have had a stillbirth. Grief was the most common reaction experienced with 53.7% reporting that they personally "very much" experienced grief. Other common and significant reactions were self-doubt (17.2%), depression (16.9%) and self-blame (16.4%). Significant psychological impact on the obstetrician was associated with older age, solo practice, higher volume practices and higher proportion of Medicaid patients; gender was not found to be associated with psychological impact when controlling for age. Further, greater self-reported performance and training regarding maternal and family counseling, management of stillbirth, and knowledge of stillbirth evaluation was associated with greater levels of grief. Conclusion:  Physician grief is a common reaction among obstetricians after caring for a patient who has had a stillbirth.

Goldenberg RL, Farrow V, McClure EM, Reddy UM, Fretts RC, Schulkin J. (2013). Stillbirth: Knowledge and practice among U.S. obstetrician gynecologists. Am J Perinatol.,30(10), 813-20.

Objective: To determine knowledge of U.S. obstetrician-gynecologists (OBGYNs) and individual and institutional practices regarding stillbirth. Study Design: We surveyed 1,000 members of the American College of Obstetricians and Gynecologists regarding their knowledge of risk factors and causes of stillbirth and self-rated performance in stillbirth management. Results: Of the 499 who responded, 365 currently practiced obstetrics. Knowledge regarding epidemiology, risk factors, and effective interventions to reduce stillbirth was only fair. About 30% of respondents were unaware that preeclampsia, advanced maternal age, elevated α-fetoprotein, multiple gestation, cigarette smoking, illicit drug use, and being post-term increased risk. Tests to identify stillbirth causes were not performed consistently. Forty-two percent of respondents did not review test results to determine cause. Most hospitals did not have protocols for stillbirth evaluation nor preprinted forms to obtain appropriate stillbirth tests. Stillbirth audits with feedback were rarely performed. Conclusions: OBGYN knowledge and institutional practice regarding stillbirth could be substantially improved. Residency programs need improved education regarding stillbirth. Hospitals and their OBGYN departments should focus more on stillbirth through continuing education programs and grand rounds and develop stillbirth management protocols and standardized order sheets to appropriately evaluate stillbirths. Audits that evaluate cause of death and preventability with a feedback loop focused on improvement in care should be considered.

Vink J, Anderson BL, Fuchs K, Schulkin J, D'Alton ME. (2013). Opinions and practice patterns of obstetricians-gynecologists regarding amniocentesis in twins. Prenatal Diagnosis, 33(9), 899-903.

Objective: Accurate amniocentesis-related pregnancy loss (ARL) rates for twin gestations remains elusive because of varying ARL definitions in the literature. We examined how OB/GYNs define/counsel women carrying twins about ARL. Methods: A random sample of 1000 American College of OB/GYN (ACOG) fellows and ACOG Collaborative Ambulatory Research Network (CARN) members were mailed surveys about their opinions/practice patterns regarding amniocentesis in twins. There were 208/400 (52%) CARN members and 166/600 (27%) ACOG fellows who returned the survey (37% response rate). Results: Of respondents, 80.8% practiced general OB/GYN, and 9.1% practiced maternal fetal medicine. Of respondents, 72% discussed amniocentesis for prenatal diagnosis. Of these, 91.7% discuss the risk of ARL; however, 47.4% do not quote an ARL rate. Of those who discuss ARL rates, 65% quote a rate greater than for singletons. Regarding monochorionic-diamniotic twins, 12.1% of respondents said the ARL rate was less, 39.6% said equal to, and 38.9% said greater than for dichorionic twins. Table 1 lists the most common clinical definitions/time intervals used to describe ARL. Conclusion: Various definitions/ARL rates are used when counseling about ARL in twins. Further studies using a widely accepted definition of ARL are necessary to improve the counseling of women considering amniocentesis for prenatal diagnosis in twins.

Wright J, Silver R, Bonannno C, Gaddipati S, Lu Y, Simpson LL, Schulkin J, D’Alton M. (2013). Practice patterns and knowledge of obstetricians and gynecologists regarding placenta accreta. The Journal of Maternal-Fetal and Neonatal Medicine, 26(16), 1602-1609.

Objective: We surveyed obstetricians to determine their knowledge, patterns of care and treatment preferences for women with placenta accreta. Methods: A 27-item survey was mailed to fellows of the American College of Obstetricians and Gynecologists. The survey included demographics, questions regarding knowledge and items to examine practice patterns. Results: Among 994 surveyed practitioners 508 responded including 338 who practiced obstetrics. Among generalists, 23.8% of respondents referred patients with placenta accreta to a sub-specialist. Overall, 20.4% referred women to the nearest tertiary center, and 7.1% referred to a regional center. Delivery was recommended at 34–36 weeks by 41.2%. Adjuvant interventions including ureteral stents (26.3%), iliac artery embolization catheters (28.1%), and balloon occlusion catheters (20.1%) were used infrequently. Six or more units of blood were crossed for delivery by only 29.0% of practitioners. Conclusion: There is widespread variation in the care of women with or at risk for placenta accrete.

Farrow VA, Lawrence H, Schulkin J. (2013). Women's healthcare providers’ range of services and collaborative care. Journal of Healthcare Quality [Epub ahead of print].

Physician shortages and healthcare reform are important topics in the healthcare field today. The utilization of the skills and professional competencies of nonphysician healthcare providers, as well as collaboration between physicians and nonphysician healthcare providers may in part provide a solution to some current healthcare concerns. The purposes of this study were to describe the range of services provided by nonphysician women's healthcare providers (WHCPs), and to begin to explore the collaborative relationship between obstetrician-gynecologists (ob-gyns) and WHCPs. Questionnaires were sent to ob-gyns, certified nurse-midwives, certified midwives, nurse practitioners (NPs), and physician's assistants (PAs) with questions regarding the types of services WHCPs provide, as well as collaboration between ob-gyns and WHCPs. Overall, 62.1% of ob-gyns employ WHCPs. NPs are the most common type of WHCP employed in our sample. WHCPs are more likely to be younger than ob-gyns, and an overwhelming majority of WHCPs in our sample are female. Most reported that they are anticipating an expansion in the roles and services they provide over the next 5 years. In an era of healthcare reform, WHCPs may in part provide a solution to the growing physician shortage. Collaboration between ob-gyns and WHCPs is a key aspect of the changing healthcare environment.

Gaissmaier W, Anderson BL, Schulkin J. (2013). How do physicians provide statistical information about antidepressants to hypothetical patients? Medical Decision Making, doi: 10.1177/0272989x13501720.

Background: Little is known about how physicians provide statistical information to patients, which is important for informed consent. Methods: In a survey, obstetricians and gynecologists (N = 142) received statistical information about the benefit and side effects of an antidepressant. They received information in various formats, including event rates (antidepressant v. placebo), absolute risks, and relative risks. Participants had to imagine 2 hypothetical patients, 1 for whom they believed the drug to be safe and effective and 1 for whom they did not, and select the information they would give those patients. We assessed whether the information they selected for each patient was complete, transparent, interpretable, or persuasive (i.e., to nudge patients toward a particular option) and compared physicians who gave both patients the same information with those who gave both patients different information. Results: A similar proportion of physicians (roughly 25% each) selected information that was 1) complete and transparent, 2) complete but not transparent, 3) not interpretable for the patient because necessary comparative information was missing, or 4) suited for nudging. Physicians who gave both patients the same information (61% of physicians) more often selected at least complete information, even if it was often not transparent. Physicians who gave both patients different information (39% of physicians), in contrast, more often selected information that was suited for nudging in line with the belief they were asked to imagine. A limitation is that scenarios were hypothetical. Conclusions: Most physicians did not provide complete and transparent information. Clinicians who presented consistent information to different patients tended to present complete information, whereas those who varied what information they chose to present appeared more prone to nudging.

Atanasov P, Anderson BL, Cain J, Schulkin J, Dana J. (2013). Comparing physicians personal prevention practices and their recommendations to patients. Journal of Healthcare Quality, doi: 10.1111jhq.12042

Background: Hypothetical choice studies suggest that physicians often take more risk for themselves than on their patient's behalf. Objective: To examine if physicians recommend more screening tests than they personally undergo in the real-world context of breast cancer screening. Design: Within-subjects survey. Participants: A national sample of female obstetricians and gynecologists (N = 135, response rate 54%) from the United States. In total, they provided breast care to approximately 2,800 patients per week. Measures: Personal usage history and patient recommendations regarding mammography screening and breast self-examination, a measure of defensive medicine practices. Results: Across age groups, female physicians were more likely to recommend mammography screening than to have performed the procedure in the past 5 years (86% vs. 81%, p = .10). In respondents aged 40–49 this difference was significant (91% vs. 82%, p < .05), whereas no differences were detected for younger or older physicians. Among respondents in their 40s, 18% had undergone annual screenings in the past 5 years, compared to 48% of their colleagues above 50. Respondents were as likely to practice breast self-examination (98%) as to recommend it (93%), a pattern that was consistent across age groups. A logistic regression model of personal use of mammography significantly predicted recommending the procedure to patients (OR = 15.29, p = .001). Similarly, number of breast self-examinations performed over the past 2 years positively predicted patient recommendations of the procedure (OR = 1.31, p < .001). Conclusions: Obstetricians and gynecologists tended to recommend early mammography screening to their patients, though their personal practices indicated later start than their own recommendations and lower frequency of screening than peers in recent studies have recommended.

Coleman-Cowger V, Anderson BL, Mahoney J, Schulkin J (2013). Smoking cessation during pregnancy and postpartum: Practice patterns among obstetrician-gynecologists. Journal of Addiction Medicine.

Objectives: To assess current obstetrician-gynecologist (ob-gyn) practice patterns related to the management of and barriers to smoking cessation during pregnancy and postpartum. Methods: A smoking cessation questionnaire was mailed to 1024 American College of Obstetricians and Gynecologists Fellows in 2012. χ analyses were used to assess for categorical differences between groups, Pearson r was used to conduct correlational analysis, and analysis of variance was used to assess for mean differences between groups. Results: The analyses included 252 practicing ob-gyns who see pregnant patients who returned a completed survey. Ob-gyns estimated that 23% of their patients smoke before pregnancy, 18% smoke during first trimester, 12% during second trimester, and 11% during third trimester. They approximated that 32% quit during pregnancy, but 50% return to smoking postpartum. A large majority of ob-gyns feel that it is important for pregnant and postpartum women to quit smoking, and report asking all pregnant patients about tobacco use at the initial prenatal visit. Fewer ob-gyns follow-up on tobacco use at subsequent visits when the patient has admitted to use at a prior visit. The primary barrier to intervention was reported as time limitations, though other barriers were noted that may be addressable through the provision of additional training and resources offered to physicians. Conclusions: Compared with findings from a similar study conducted in 1998, physicians are less likely to adhere to the 5 A’s smoking cessation guideline at present. As we know that brief intervention is effective, it is imperative that we work toward addressing practice gaps and providing additional resources to address the important public health issue of smoking during pregnancy and postpartum.

Anderson BL, Urban RR, Schulkin J (2013). Obstetrician and gynecologists’ knowledge and opinions about the United States Preventive Services Task Force (USPSTF) and their 2009 breast cancer screening guidelines. Preventive Medicine, doi: 10.1016/j.ypmed.2013.11.008.

Objective: Investigate the knowledge and opinions of obstetrician and gynecologists (ob–gyns) regarding the USPSTF committee and statement, and to assess their reactions to healthcare legislation. Methods: A national cross-sectional survey study of ob–gyns was conducted six months after a controversial USPSTF recommendation statement was released in November 2009. Ob–gyns' opinions about the Women's Health Amendment (WHA) and the Affordable Care Act (ACA) were also assessed. Results: A total of 54% of ob–gyns knew that the USPSTF recommendations do not represent the position of the U.S. government and 40% knew that the USPSTF is not comprised of federal employees. A majority (60%) thought that the USPSTF was influenced by potential costs more than guidelines should be. When examining ob–gyns opinions about new national health policies, 88% support the mammography coverage provided by the WHA but support for the ACA varied. Conclusion: This study provides a snapshot of ob–gyns' knowledge and opinions about the USPSTF and breast cancer screening guidelines at a controversial point in time. Our findings are a unique contribution to larger efforts to understand health and political policy as the culture of medicine continues to evolve.

Domjahn B, Hlavsa MC, Anderson BL, Schulkin J, Leon J, Jones JL. (2013). A Survey of U.S. Obstetrician-Gynecologists’ Clinical and Epidemiological Knowledge of Cryptosporidiosis in Pregnancy. Zoonoses and Public Health doi:10.1111/zph.12078

Although cryptosporidiosis is frequently diagnosed in the U.S., there has been very little assessment of obstetrician-gynaecologist knowledge about this disease. In 2010, we surveyed U.S. obstetricians about the diagnosis, treatment and epidemiology of cryptosporidiosis. Data were examined through univariable analysis and multivariable regression models. Of 1000 obstetrician-gynaecologists surveyed, 431 (43.1%) responded. Only 44.4% of respondents correctly identified that prolonged, intermittent diarrhoea would lead them to consider cryptosporidiosis in a differential diagnosis. Routine ova and parasites (O&P) testing was incorrectly chosen to identify Cryptosporidium in stool by 30.4% of respondents. Questions about nitazoxanide, the only drug approved by the U.S. Food & Drug Administration (FDA) for treatment of cryptosporidiosis, were the most frequently missed questions. Only 9.0% of respondents correctly classified nitazoxanide as an FDA pregnancy Category B drug, and only 5.6% of respondents correctly indicated that FDA approved nitazoxanide for immunocompetent patients aged ≥1 years. Regarding prevention- and control-related knowledge, only 14.1% of respondents correctly indicated that alcohol-based hand sanitizers were not effective at inactivating Cryptosporidium spp., and <10% correctly indicated that cryptosporidiosis is a reportable disease in their state of practice. Multivariable analysis found that ≥19 years in practice was positively associated with O&P diagnostic testing knowledge, while rural and urban non-inner city practice location, compared with suburban practice location, was positively associated with nitazoxanide knowledge. The low level of knowledge among obstetrician-gynaecologists about cryptosporidiosis indicates a need to develop resources for physicians about all aspects of cryptosporidiosis, particularly on diagnosis, treatment and prevention strategies.

Ekert LO, Anderson BL, Gonik B, Schulkin J. (2013).  Reporting Vaccine Complications: What do obstetricians and gynecologists know about the Vaccine Adverse Event Reporting System? Infectious Disease in Obstetrics and Gynecology, Article ID: 285257, doi:10.1155/2013/285257

Background. Obstetrician-gynecologists are increasingly called upon to be vaccinators as an essential part of a woman's primary and preventive health care. Despite the established safety of vaccines, vaccine adverse events may occur. A national Vaccine Adverse Event Reporting System (VAERS) is a well-established mechanism to track adverse events. However, we hypothesized that many obstetrician-gynecologists are naive to the role and use of VAERS. Methods. We devised a ten-question survey to a sample of ACOG fellows to assess their knowledge and understanding of VAERS. We performed descriptive and frequency analysis for each of the questions and used one-way analysis of variance for continuous and chi-squared for categorical variables. Results. Of the 1000 fellows who received the survey, 377 responded. Only one respondent answered all nine knowledge questions correctly, and 9.2% of physicians had used VAERS. Older physicians were less familiar with VAERS in general and with the specific objectives of VAERS in particular (χ2 = 10.7, P = .005). Conclusions. Obstetrician-gynecologist familiarity with VAERS is lacking. Only when the obstetrician-gynecologist is completely knowledgeable regarding standard vaccine practices, including the availability and use of programs such as VAERS, will providers be functioning as competent and complete vaccinators.

Anderson BL, Williams S, Schulkin J. (2013).  Statistical literacy of obstetrics-gynecology residents. Journal of Graduate Medical Education, 5(2), 272-275.

Background: Residents' ability to interpret statistics is important for scholarly pursuits and understanding evidence-based medicine. Yet there is limited research assessing residents' statistical literacy and their training in statistics. Methods: In 2011 we surveyed US obstetrics-gynecology residents participating in the Council for Resident Education in Obstetrics and Gynecology In-Training Examination about their statistical literacy and statistical literacy training. Results: Our response rate was 95% (4713 of 4961). About two-thirds (2980 of 4713) of the residents rated their statistical literacy training as adequate. Female respondents were more likely to rate their statistical literacy training poorly, with 25% (897 of 3575) indicating inadequate literacy compared with 17% (141 of 806) of the male respondents (P < .001). Respondents performed poorly on 2 statistical literacy questions, with only 26% (1222 of 4713) correctly answering a positive predictive value question and 42% (1989 of 4173) correctly defining a P value. A total of 51% (2391 of 4713) of respondents reported receiving statistical literacy training through a journal club, 29% (1359 of 4713) said they had informal training, 15% (711 of 4713) said that they had statistical literacy training as part of a course, and 11% (527 of 4713) said that they had no training. Conclusions: The findings suggest that statistical literacy training for residents could still be improved. A total of 37% (1743 of 4713) of obstetrics-gynecology residents have received no formal statistical literacy training in residency. Fewer residents answered the 2 statistical literacy questions correctly compared with previous studies.


Jay Schulkin, PhD
Mike Power, PhD
Britta Anderson, PhD
Greta Raglan
Katherine Jones