Laura Baecher-Lind, MD Research Laboratory

Medical students working as third-year clerks within the department of Obstetrics and Gynecology frequently cite patient rejection of their involvement in clinical care as a significant detriment to their perception of the field of Obstetrics and Gynecology. The relatively high rate at which patients decline student involvement in their care during a gynecologic or obsetric visit may also negatively impact graduating medical students' knowledge and experience regarding women's health. No prior studies in the literature explore mechanisms to improve patient acceptance of medical student involvement in their care during a women's health visit. Laura Baecher-Lind conducted a cohort study evaluating the impact of medical student introduction cards on the student acceptance rate by patients seeking care in the outpatient gynecologic clinics. This study followed 104 patient-doctor interactions and found that patients were overall highly accepting of student involvement in their care, however, that the student introduction cards actually decreased patient acceptance of student involvement (87% versus 98% acceptance rate, p=0.03). This suggests that directly asking patients about student involvement in their care is preferable to student introduction cards in order to optimize students’ exposure to outpatient gynecologic care. Findings from this study were presented at the 2013 APGO Annual Meeting, which was supported by a Tufts Medical Center Research Travel Award.

Nationwide, students report high levels of mistreatment during their obstetrics and gynecology clerkships.  According to Tufts University School of Medicine’s internal clerkship evaluation, approximately 10-25% of students report having experienced at least one mistreatment episode during their obstetrics and gynecology clerkship at Tufts School of Medicine.  Efforts to reduce student mistreatment during the obstetrics and gynecology clerkship have been stymied by the difficulty quantifying and thematically evaluating the mistreatment episodes, as well as by understanding the role of students’ expectations and perceptions regarding these mistreatment episodes.  Laura Baecher-Lind is currently conducting a study to better understand reported student mistreatment during the obstetrics and gynecology clerkship, in order to guide interventions to decrease the mistreatment rate. Focus groups will be conducted among students yet to partake in and having completed their obstetrics and gynecology clerkship with a specific emphasis on mistreatment and ideas for mitigating mistreatment episodes. Analysis of survey instruments already in place during the clerkship will be utilized to assess the frequency of and types of mistreatment occurring during the obstetrics and gynecology clerkship. Information gathered from our exploratory research will be used to develop interventions to reduce student mistreatment during obstetrics and gynecology clerkships at our home and affiliated medical centers. In addition, information obtained through our exploratory research can have broader implications for medical education in obstetrics and gynecology, as student mistreatment during obstetrics and gynecology clerkships affect many medical education institutions nationwide. Laura recently received a Tufts Innovations in Education grant to support this research project.

Dr. Baecher-Lind also conducted an evaluation of leadership and gender within the specialty of obstetrics and gynecology. Publically-available data were accessed to determine the gender and year of medical school graduation for 194 field leaders, defined as academic department chairs, influential professional society presidents, and editors of the 20 journals with the highest impact factors. The prevalence of women graduating medical school during the mean year of graduation among leaders was determined using publically-accessible National Resident Matching Program data. Women were found to be under-represented in leadership positions within obstetrics and gynecology, with 21% of leadership positions in obstetrics and gynecology held by women compared with an expected 37% based on NRMP data. Potential explanations for this disparity include social and personal pressures that female physicians face as well as systematic discrimination. Findings from this research study were published in Obstetrics and Gynecology in December 2012, and presented at an ACOG Presidential Task Force on Leadership in the 21st Century in February 2013.