A Call for Change in a Changing World.

The practice of obstetrics and gynecology in the United States has changed substantially over the past 50 years, but the structure of our residency programs has not evolved at a comparable pace. The number of hours available for training during the workweek has decreased significantly, whereas the amount of essential material to learn and clinical skills to acquire has increased dramatically. The switch to minimally invasive surgical approaches has reduced the number of open abdominal cases available for training, and the aptitude required to perform difficult laparoscopic and robotic cases for benign disease is such that many programs do not have enough surgical patients to teach all of their residents how to adequately master those procedures. Obstetric patients are older and heavier than those encountered several decades ago, and the comorbidities of some of these women make their antepartum and intrapartum management extremely complex. Furthermore, the explosion of genetic knowledge has made prenatal counseling infinitely more challenging. In this commentary we review these and related issues and then address the question of whether current training programs are preparing our graduates to optimally perform in the clinical arena they will enter after finishing their residencies. Some ways in which the current system could be modified are suggested, and a plea is made for the creation of a high-level task force to address this problem on a national level.