Farrow, V.S., Anderson, B., Chescheir, N.C., Schulkin, J. (2013). Gender 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.
Greenberg, M., Anderson, BL, Schulkin J, Norton, ME, Aziz N. (2013). A first look at chorioamnionitis management practice variation among US obstetricians. Infect Dis Obstet Gynecol, [Epub ahead of print]
Objective. To examine practice patterns for diagnosis and treatment of chorioamnionitis among US obstetricians. Study Design. We distributed a mail-based survey to members of the American College of Obstetricians and Gynecologists, querying demographics, practice setting, and chorioamnionitis management strategies. We performed univariable and multivariable analyses. Results. Of 500 surveys distributed, 53.8% were returned, and 212 met study criteria and were analyzed. Most respondents work in group practice (66.0%), perform >100 deliveries per year (60.0%), have been in practice >10 years (77.3%), and work in a nonuniversity setting (85.1%). Temperature plus one additional criterion (61.3%) was the most common diagnostic strategy. Over 25 different primary antibiotic regimens were reported, including use of a single agent by 30.0% of respondents. A wide range of postpartum antibiotic duration was reported from no postpartum treatment (34.5% after vaginal delivery, 11.3% after cesarean delivery) to 48 hours of postpartum treatment (24.7% after vaginal delivery, 32.1% after cesarean delivery). No practitioner characteristic was independently associated with diagnostic or therapeutic strategies in multivariable analysis. Conclusion. There is a wide variation in contemporary clinical practices for the management of chorioamnionitis. This may represent a dearth of level I evidence. Future prospective clinical trials may provide more evidence-based practice recommendations for diagnosis and treatment of chorioamnionitis.
Goldenberg, R.L., Farrow, V., McClure, E.M. Reddy, U.M. Fretts, R.C. Schulkin, J. (2013). Stillbirth: Knowledge and practice among US Obstetrician Gynecologists. Am J Perinatol., [Epub ahead of print]
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.
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.
Anderson BL, Pearlman M, Griffin J, Schulkin J. (in press). 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
Farrow, V., Goldenberg, R.L. Fretts, R.C., Schulkin, J. (in press). Psychological impact of stillbirths on obstetricians. American Journal of Perinatology.
Wright, J., Silver, R., Bonannno, C., Gaddipati, Lu, Yu-Shiang, Simpson, L.L., Schulkin, J., D’Alton, M. (in press). Practice patterns of obstetrician gynecologists regarding placenta accreta. The Journal of Maternal-Fetal and Neonatal Medicine.
Farrow VA, Lawrence H, Schulkin J. (in press) Collaborative Care: Obstetrician-Gynecologists and Advanced Health Care Professionals.
Raglan GB, Anderson BL, Lawrence H, Schulkin J. (in press). Obstetrics and Gynecology practices and patient insurance type. Women's Health Issues