Years in the Making: A Call to Increase the Length of Obstetrics and Gynecology Training [ID 1453]

INTRODUCTION: There are challenging trends in obstetrics and gynecology (ob-gyn) training that leave graduating residents unprepared for generalist practice and fellowship. Introducing a fifth year into residency is an important step in addressing the challenges our specialty faces. METHODS: We reviewed Accreditation Council for Graduate Medical Education (ACGME) case log data, national hysterectomy and case volume data, research about alternative residency curriculums and resident preparedness for fellowship, and editorials and reviews examining challenges in residency training. RESULTS: After work-hour restrictions, residents today work approximately 20% fewer hours than trainees did in the past. They have less surgical experience, reflected in their case logs, due to rates of hysterectomy decreasing by one-third since the early 2000s. However, residents are required to develop more surgical skills, including an additional approach to hysterectomy. When factoring in decreasing case volumes, this leaves them less practiced in all three modes of hysterectomy than past residents. Fellowship directors across subspecialties report that new fellows are unable to independently perform procedures required of a generalist, like hysterectomy and myomectomy. Some suggest tracking as the answer to these challenges; however, tracking privileges residents planning to pursue subspecialty and is not adequate to develop a skilled generalist. CONCLUSIONS/IMPLICATIONS: An extension of residency to 5 years combined with continued innovation in surgical education techniques and strategies would both improve the skills of generalists and allow those interested in pursuing fellowship to do so fully prepared. The ACGME, Council on Resident Education in Obstetrics and Gynecology, and the American Board of Obstetrics and Gynecology should seriously consider increasing the length of ob-gyn residency to 5 years. Advocacy can help make this necessary change.