To investigate the association between online activities and the number of new obstetrics and gynecology senior residents.
A nationwide web-based, self-administered anonymous survey was conducted to investigate recruitment and clerkship activities during the coronavirus disease 2019 pandemic. An online questionnaire was sent to 576 obstetrics and gynecology training institutions in Japan between December 21, 2020, and January 31, 2021. Overall, 334 institutions that gave valid responses were included (response rate: 58.0%). Multivariate logistic regression analysis examined the association between online activities, including recruitment and clerkship activities, and the number of new obstetrics and gynecology senior residents in 2021. The stratified analysis by implementing face-to-face activities was conducted to clarify the association.
The number of new senior residents increased in 187 facilities (56.0%) and decreased in 147 facilities (44.0%). The facilities that implemented face-to-face and online activities were 185 (55.4%) and 120 (35.9%), respectively. In multivariate logistic regression analysis, an increased number of new obstetrics and gynecology senior residents was significantly associated with face-to-face activities (adjusted odds ratio (AOR)=2.58, 95% confidence interval (CI): 1.11–5.97, p<.001) but not with online activities. In the stratified analysis, online activities were significantly associated with an increased number of new obstetrics and gynecology senior residents among the facilities without face-to-face activities (AOR=3.81, 95% CI: 1.40–10.32, p=.009) but not among those with face-to-face activities (AOR=0.87, 95% CI: 0.42–1.78).
Online activities were associated with an increased number of new obstetrics and gynecology senior residents among the facilities that did not conduct face-to-face activities.
Sexual and Reproductive Health and Rights (SRHR) for women are incorporated into the Sustainable Development Goals and are important for peace and prosperity in all nations. To achieve SRHR, obstetricians and gynecologists play a crucial role; thus, ensuring an increased number of new obstetricians and gynecologists is a global issue.
Choosing a specialty is an important decision for medical doctors. Most medical students are interested in deciding on a specialty when they enter university, but some develop the interest through clerkships or working as junior residents.
Online education is one of the methods utilized to counteract the lack of real interaction caused by the COVID-19 pandemic. A survey of 3348 medical students in Libya regarding the use of e-learning six months after the COVID-19 pandemic began showed that 65% (n = 2176) of the students participated in online study groups and discussions, and 54.1% (n = 1811) reported that two-way communication was possible online.
Using online tools may positively impact specialty selection because they enable medical students or junior residents to experience the appeal of OB-GYN and to collect information on the specialty. However, no studies have focused on the association of online activities with specialty selection during the COVID-19 pandemic. In this study, we conducted a nationwide hospital-based survey to determine the association between online activities and the number of new senior residents majoring in OB-GYN.
We used the data from a nationwide web-based, self-administered anonymous survey to investigate the recruitment activities under the COVID-19 pandemic conducted by The Japanese Society of Obstetrics and Gynecology (JSOG) between December 21, 2020, and January 31, 2021. The questionnaire was provided to all 576 obstetrics and gynecology training facilities from the JSOG as online participants, and a letter was sent to the training directors of the facilities as a reminder. These facilities ranged from urban perinatal centers to regional obstetric care facilities and covered eastern and western parts of Japan. Of 576 participating facilities, 334 facilities (response rate: 58.0%) that sent valid responses were included in this study. Completion of the web-based questionnaires implied informed consent. All the data were collected anonymously in that survey, and no correspondence table exists. Since this study used data that had already been unlinked and anonymized prior to the study, and informed consent was obtained upon completion of the web-based questionnaire, Ethics Review Board approval was not required.
The primary interest outcome, the number of new OB-GYN senior residents, was asked by using the following question: "How did the number of people who decided to come to your hospital for obstetrics and gynecology training change this year compared with previous years? " Please choose the opinion that most closely matches your own: include no one, under 0.5 times, 0.5 to less than 1.0 times, same as average years, 1.0 to less than 1.5 times, 1.5 to less than 2.0 times, and more than twice. The reasons for asking the percentage compared with previous years rather than the number of new OB-GYN residents were as follows: some of the participating OB-GYN training facilities have many residents yearly. In contrast, others admit almost no new residents. We asked each facility for the percentage of new residents compared with that in previous years rather than the exact number to clarify the association between online activities and the number of new OB-GYN applicants during the COVID-19 pandemic. We defined a >1.0-fold increase as an increase and <1.0-fold increase as a decrease.
The primary exposure was online activities, including some recruitment and clerkship activities, which could affect the specialty choices of junior residents, such as information sessions, hospital tours, interviews, hands-on seminars, convivial parties, lectures, and clinical practice in inpatient or outpatient settings, such as physical or pelvic examination, ultrasound, surgery, and surgical training (e.g., ligation, suture, or dry box training for laparoscopic surgery).
As covariates, data on the location of the hospital, hospital status (i.e., university hospital or general hospital), the number of full-time obstetricians and gynecologists, and implementation of face-to-face activities were collected using an online questionnaire. The implementation of face-to-face activities was assessed using the same question for the implementation of online activities described above.
In addition, to examine the effect of the pandemic on recruitment activity, the following questions were asked: "Do you think the COVID-19 pandemic has affected the way you recruit obstetricians and gynecologists? please select each of the following: not at all, not significantly, partially, and significantly." "To what extent you were able to convey the appeal of obstetrics and gynecology to students and residents rotating at your hospital this year compared to previous years? Please indicate this on a scale of 0–10,"
The chi-square test and Student's t-test were used to examine discrete and continuous variables, respectively. They compared background characteristics stratified by the number of new obstetrics and gynecology senior residents in that year compared with previous years. We then performed simple and multiple logistic regression analyses to examine the association between online activities and the number of new obstetrics and gynecology senior residents. In these analyses, two models were utilized. In model 1, we considered the institution's area, type, and number of full-time obstetricians and gynecologists in each facility. This was because these factors can affect lifestyle,
In model 2, we considered the variables used in model 1 and the implementation of face-to-face activities as covariates because face-to-face activities such as clerkships and hands-on seminars are well-known factors that positively affect the increased number of applicants for obstetrics and gynecology residencies.
The background characteristics of the facilities and results of the questionnaire are shown in
| Activity | Facilities with increase in residents in 2021 (n=187) | Facilities with decrease in residents in 2021 (n=147) | p-value |
|---|---|---|---|
| N (%) | N (%) | ||
| Face-to-face activity* | 123 (65.78) | 62 (42.18) | <0.01 |
| Online activity* | 78 (41.71) | 42 (28.57) | 0.01 |
| Type of facilities | 0.98 | ||
| University Hospital | 60 (32.09) | 47 (31.97) | |
| Others† | 127 (67.91) | 100 (68.03) | |
| Number of obstetricians and gynecologists | 0.08 | ||
| 1-5 | 35 (18.72) | 48 (32.65) | |
| 6-10 | 64 (34.22) | 48 (32.65) | |
| 11-15 | 39 (20.86) | 19 (12.93) | |
| 16-20 | 27 (14.44) | 14 (9.52) | |
| 21-25 | 10 (5.35) | 8 (5.44) | |
| 26-30 | 4 (2.14) | 3 (2.04) | |
| 31 or more | 8 (4.28) | 7 (4.76) | |
| Location of the institutions | 0.61 | ||
| Hokkaido | 4 (2.14) | 7 (4.76) | |
| Tohoku | 12 (6.42) | 10 (6.80) | |
| Kanto | 40 (21.39) | 33 (22.45) | |
| Tokyo | 20 (10.70) | 21 (14.29) | |
| Hokuriku | 13 (6.95) | 5 (3.40) | |
| Chubu | 16 (8.56) | 12 (8.16) | |
| Kinki | 37 (19.79) | 25 (17.01) | |
| Chugoku | 16 (8.56) | 7 (4.76) | |
| Shikoku | 8 (4.28) | 9 (6.12) | |
| Kyusyu/Okinawa | 21 (11.23) | 18 (12.24) | |
| Feeling of the success in conveying the appeal of obstetrics and gynecology compared with the average year‡ |
4.24 (1.68) | 3.50 (1.49) | <0.01 |
| Feeling of the influence on recruit activity by the COVID-19 pandemic | 0.93 | ||
| not at all | 6 (3.21) | 5 (3.40) | |
| not so much | 56 (29.95) | 41 (27.89) | |
| partially | 76 (40.64) | 65 (44.22) | |
| strongly | 49 (26.20) | 36 (24.49) |
*Face-to-face or online activities included lectures, information sessions on facilities, hospital tours, interviews, hands-on seminars, convivial parties, and clinical practice on inpatient or outpatient activities; †City hospital, a medical clinic with bed; ‡10-point scale, 5-point scale: same to average years
| Activity and facilities | Crude OR [95% CI] | Model 1 (OR [95% CI]) * | Model 2 (OR [95% CI]) † | p-value |
|---|---|---|---|---|
| Implementation of online activities | 1.79 (1.13-2.84) | 1.94 (1.15-3.26) | 1.66 (0.97-2.84) | 0.07 |
| Implementation face-to-face activities | 2.63 (1.69-4.11) | - | 2.67 (1.60-4.44) | <0.01 |
| Type of facilities | ||||
| Others | reference | reference | reference | |
| University hospital | 0.99 (0.62-1.58) | 1.89 (0.92-3.89) | 2.12 (1.00-4.48) | <0.01 |
| Number of full-time obstetricians and gynecologists | ||||
| 1-5 | reference | reference | reference | |
| 6-10 | 1.83 (1.03-3.25) | 1.98 (1.08-3.66) | 1.81 (0.96-3.41) | 0.07 |
| 11-15 | 2.82 (1.40-5.67) | 3.67 (1.65-8.16) | 3.82 (1.69-8.66) | <0.01 |
| 16-20 | 2.64 (1.21-5.76) | 4.04 (1.53-10.67) | 3.09 (1.13-8.43) | 0.03 |
| 21-25 | 1.71 (0.61-4.79) | 2.85 (0.80-10.15) | 2.18 (0.59-8.03) | 0.24 |
| 26-30 | 1.83 (0.38-8.69) | 3.41 (0.60-19.40) | 2.88 (0.49-16.99) | 0.24 |
| more than 30 | 1.57 (0.52-4.73) | 2.16 (0.54-8.61) | 1.57 (0.38-6.45) | 0.53 |
| Location of the institutions | ||||
| Tokyo | reference | reference | reference | |
| Hokkaido | 0.60 (0.15-2.37) | 0.94 (0.22-4.04) | 0.91 (0.20-4.09) | 0.91 |
| Tohoku | 1.26 (0.45-3.56) | 1.76 (0.57-5.40) | 1.29 (0.41-4.06) | 0.66 |
| Kanto | 1.27 (0.59-2.74) | 1.55 (0.69-3.52) | 1.53 (0.66-3.52) | 0.32 |
| Hokuriku | 2.73 (0.82-9.06) | 3.69 (1.04-13.15) | 3.35 (0.92-12.2) | 0.07 |
| Chubu | 1.40 (0.53-3.68) | 1.31 (0.47-3.69) | 1.45 (0.51-4.16) | 0.49 |
| Kinki | 1.55 (0.70-3.44) | 1.87 (0.79-4.40) | 1.73 (0.72-4.18) | 0.22 |
| Chugoku | 2.40 (0.82-7.06) | 3.35 (1.07-10.52) | 3.09 (0.97-9.87) | 0.06 |
| Shikoku | 0.93 (0.30-2.90) | 1.54 (0.46-5.16) | 1.65 (0.47-5.76) | 0.43 |
| Kyusyu/Okinawa | 1.22 (0.51-2.95) | 1.66 (0.65-4.22) | 1.40 (0.54-3.63) | 0.49 |
| Interaction effect | ||||
| Online activity× Face-to-face activity | 0.26 (0.09-0.76) | 0.01 |
*Model 1: adjusted by type of facilities, number of obstetricians and gynecologists, and pandemic area †Model 2: adjusted by covariates used in model 1 and face-to-face activities
The interaction effect of the implementation of online and face-to-face activities was observed (AOR=0.26, 95%CI: 0.09–0.76, p for interaction=.01). Other covariates were not associated with such an increase. In the stratified analysis, the implementation of online activities was significantly associated with an increase in the number of new OB-GYN senior residents among the facilities that did not conduct face-to-face activities (AOR=3.81, 95% CI: 1.40–10.32, p=.01) but not among those that conducted face-to-face activities (
| Activities | n (%) | Adjusted OR [95% CI] * | p-value |
|---|---|---|---|
| Face-to-face activities (-) | |||
| Online activities (-) | 115 (77.1) | reference | |
| Online activities (+) | 34 (22.82) | 3.81 (1.40-10.32) | 0.01 |
| Face-to-face activities (+) | |||
| Online activities (-) | 99 (53.51) | reference | |
| Online activities (+) | 86 (46.49) | 0.87 (0.42-1.78) | 0.70 |
*Covariates: type of facilities, number of obstetricians and gynecologists, pandemic area
To the best of our knowledge, this is the first study to investigate the association between online activities and an increase in the number of new obstetrics and gynecology senior residents. Our multiple logistic regression analysis revealed a significant association between the increase in the number of new obstetrics and gynecology senior residents and online activities after adjusting for the institution's location, type, and the number of full-time obstetricians and gynecologists as covariates. However, this association was not found when the implementation of face-to-face activities was adopted as a covariate. The interaction effect and the stratified analysis indicated that online activities were significantly associated with an increase in the number of new obstetrics and gynecology senior residents among the facilities that did not conduct face-to-face activities.
The background characteristics demonstrated that 67.7% (n=226) of the total respondents partially or strongly felt the influence of COVID-19 on recruitment activity. In addition, even facilities with more senior residents in 2021 reported being less capable of conveying their appeal than in previous years. In Japan, clinical training in a hospital begins in most universities' fourth or fifth year of medical school. After six years of medical school and two years of internship after graduation, students begin their specialty training. They select a specialty based on their lifestyle preferences and interest throughout their clerkships and internships.
Online activity was significantly associated with an increase in the number of new obstetrics and gynecology senior residents in the facilities that did not conduct face-to-face activities. However, no association was found in facilities that conducted face-to-face activities. The possible explanation for this result is that face-to-face and online activities positively impacted the recruitment of obstetrics and gynecology senior residents by familiarizing them with obstetrics and gynecology and permitting interaction with senior residents. It has been reported that interaction with senior residents and the provision of information sessions are important in selecting a major.
The strength of this study lies in the fact that it was a nationwide survey conducted within a limited number of facilities in Japan where senior residents can start major training. However, there were some limitations to this study. First, we essentially evaluated the activities of students undergoing clerkships and junior residencies. Given that the decision on a field of major can be influenced by multiple factors and is not made at a certain time, unmeasured factors could have affected the results. Second, since there was no golden standard for the categorization of online activities, we could not examine which type of activities especially had a positive impact on recruiting new OB-GYN senior residents. Third, due to the study design using a self-assessed questionnaire, the study was susceptible to some biases, such as recall, survival, and social desirability. Facilities that did not respond to the questionnaires might not be willing to answer the questionnaire, and those that responded to the questionnaire could report a higher resident number than they had, which may have affected the results. Finally, the increase in new obstetrics and gynecology senior residents was expressed as a percentage of the intake from previous years; thus, we could not evaluate the specific number.
In conclusion, online activities were associated with an increase in the number of new obstetrics and gynecology senior residents in the facilities that did not conduct face-to-face activities. Further studies are warranted to clarify whether face-to-face or online activities are superior, the effect of the combined use of both activities, and the types of online activities that are effective for recruitment.
We are deeply grateful to all the facilities that responded to this survey. Also, we are deeply grateful to statistical experts Masashi Kizuki and Yuiko Nagamine for their statistical advice.
The authors declare that they have no conflict of interest.