J. Ryan Stewart, DO

There has been increasing awareness of a need for creating a more patient-centered experience with outpatient gynecology; however, very little data exist about what interventions are important to patients. Given social media’s ease of use and ability for widespread access to a diverse group of users, it has the potential to be a powerful tool for qualitative research questions without the difficulties of cost, transportation, transcription, etc. required of a focus group. Crowdsourced public opinion also has the advantage of producing qualitative metrics in the form of “likes” that, at scale, can provide a reliable measure of public support or engagement for a particular concept.¹ Particularly for topics that are controversial or novel, X (formerly Twitter, and referred to as Twitter intermittently throughout this article based on the time the study was conducted), with 300 million monthly users,² has become a popular tool for general and health care ̶ focused content and sentiment analysis.^3,4 This study presents a qualitative analysis of themes from a crowdsourced request on Twitter to design the ideal outpatient gynecologic experience that subsequently went “viral”.^5,6

Why the need for our research question on patient-centered gyn care

While the body of literature on patient-centered health care has grown rapidly in recent years, a patient-centered outpatient gynecology experience has not yet been described in the medical literature.

Patient-centered office design, driven by cultural sensitivity, has been shown in other studies to be both appreciated by established patients and a viable business strategy to attract new patients.⁷ Topics such as pain control, trauma-informed care in gynecologyclinics,⁸ and diverse representation in patient materials and illustrations⁹ have been popular topics in medicine and in the lay press. Our primary aim in our research was to utilize feedback from the question posed to quantify and rank patient-centered interventions in a gynecology office. These themes and others that emerged in our analysis were used to suggest best-practice guidelines for the outpatient gynecology experience (see “Checklist for ObGyn outpatient experience improvement").

What we asked social media users. The survey query to social media users, “I have the opportunity to design my office from scratch. I’m asking women: How would you design/optimize a visit to the gynecologist’s office?” was crowd-sourced via Twitter on December 5, 2021.⁵ Given a robust response to the query, it provided an opportunity for a qualitative research study exploring social media users’ perspectives on optimizing outpatient gynecologic care, although the original question was not planned for research utilization.

What we found

By December 27, 2021, the original tweet had earned 9,411 likes; 2,143 retweets; and 3,400 replies. Of this group, we analyzed 131 tweets, all of which had 100 or greater likes on Twitter at the time of the review. The majority of analyzed tweets earned between 100 ̶ 500 likes (75/131; 57.3%), while 22.9% (30/131) had 501 ̶ 1,000 likes, 11.5% (15/131) had >2,000 likes, and 8.4% (11/131) had 1,001 ̶ 1,999 likes.

Identified themes within the tweets analyzed included: medical education, comfort improvements, continuity of care, disability accommodations/accessibility, economic accessibility, nonbinary/transgender care and inclusivity, general layout/floorplan, hospitality, aid for intimate partner violence, childcare accessibility, multi-disciplinary care access, pain/anxiety control, sensitivity toward pregnancy loss/fertility issues, privacy issues, professionalism, representation (subdivided into race, LGBTQIA+, age, and weight/body type), trauma-informed care, and acknowledgement of voluntary nulliparity/support for reproductive choices (TABLE 1). TABLE 2 lists examples of popular tweets by selected themes.

Frequent themes. The most frequently occurring themes within the 131 analyzed tweets (FIGURE 1) were:

• hospitality (77 occurrences)
• comfort improvements (75 occurrences)
• general layout/floorplan (75 occurrences)
• pain/anxiety control (55 occurrences)
• representation (53 occurrences).

Popular themes. Defined as those with more than 1,000 likes at the time of analysis (FIGURE 2), the most popular themes included:

• privacy issues (48.5% of related tweets with >1,000 likes)
• voluntary nulliparity (37.0% of related tweets with >1,000 likes)
• general layout/floorplan (33.4% of related tweets with >1,000 likes)
• representation (32.1% of related tweets with >1,000 likes)
• hospitality (31.3% of related tweets with >1,000 likes).

A sub-analysis of themes related to specific types of representation—race, LGBTQIA+, age, and weight/body type was performed. Tweets related to diverse weight/body type representation occurred most frequently (19 code occurrences; FIGURE 3). Similarly, tweets related to the representation of diverse races and the LGBTQIA+ community each comprised 26% of the total representation-based tweets. In terms of popularity as described above, 51.4% of tweets describing racial representation earned >1,000 likes (FIGURE 4).

Tweet demographics. Seven (7/131; 5.3%) of the tweet authors were verified Twitter users and 35 (35/131; 26.7%) authors reported working in the health care field within their Twitter profile description.

Continue to: Implementing our feedback can enhance patient experience and care...

Our study provides a unique view of the patient perspective through analyzed crowdsourced public opinion via Twitter. To our knowledge, an optimized patient-centered outpatient gynecology experience has not previously been described in the medical literature. Optimizing the found domains of hospitality, comfort measures, pain and anxiety control, privacy, and diverse representationin the outpatient gynecologic experience within the outpatient care setting may ultimately result in improved patient satisfaction, patient well-being, and adherence to care through maximizing patient-centered care. We created a checklist of suggestions, including offering analgesics during office-based procedures and tailoring the floorplan to maximize privacy (FIGURE 5), for improving the outpatient gynecology experience based on our findings.

Prior data on patient satisfaction and outcomes

Improving patient satisfaction with health care is a priority for both clinicians and hospital systems. Prior studies have revealed only variable associations between patient satisfaction, safety, and clinical outcomes. One study involving the analysis of clinical and operational data from 171 hospitals found that hospital size, surgical volume, and low mortality rates were associated with higher patient satisfaction, while favorable surgical outcomes did not consistently correlate with higher Hospital Consumer Assessment of Healthcare Provers and Systems (HCAHPS) scores.¹⁰ Smaller, lower-volume hospitals earned higher satisfaction scores related to cleanliness, quietness, and receiving help measures.¹⁰ It has also been shown that the strongest predictors of patient satisfaction with the hospital childbirth experience included items related to staff communication, compassion, empathy, and respect.¹¹ These data suggest that patient satisfaction is likely more significantly impacted by factors other than patient safety and effectiveness, and this was supported by the findings of our analysis. The growing body of literature associating a sense of psychological and physical safety within the health care system and improved patient outcomes and experience suggests that the data gathered from public commentary such as that presented here is extremely important for galvanizing change within the US health care system.

In one systematic review, the relationship between patient-centered care and clinical outcomes was mixed, although generally the association was positive.¹² Additionally, patient-centered care was often associated with increased patient satisfaction and well-being. Some studies suggest that patient well-being and satisfaction also may be associated with improved adherence and self-management behaviors.^12,13 Overall, optimizing patient-centered care may lead to improved patient satisfaction and potentially improved clinical outcomes.

Additionally, increasing diverse representation in patient materials and illustrations may help to improve the patient experience. Louie and colleagues found that dark skin tones were represented in only 4.5% of 4,146 images from anatomy texts analyzed in 2018.¹⁴ Similarly, a photogrammetric analysis of medical images utilized in New England Journal of Medicine found that only 18% of images depicted non-white skin.¹⁵ More recent efforts to create a royalty-free digital gallery of images reflecting bodies with diverse skin tones, body shapes, body hair, and age as well as transgender and nonbinary people have been discussed in the lay press.⁹ Based on our findings, social media users value and are actively seeking diversity in representation and imagery during their outpatient gynecology experience.

Opportunities for future study

Our research utilized social media as a diverse and accessible source of information; however, there are significant opportunities to refine the methodologic approach to answering the fundamental question of creating the patient-centered gynecologic experience. This type of study has not yet been conducted; however, the richness of the information from this current analysis could be informative to survey creation. Future research on this subject outside of social media could bolster the generalizability of our conclusions and the ability to report on qualitative findings in the setting of known patient demographics.

Social media remains a powerful tool as evidenced by this study, and continued use and observation of trending themes among patients is essential. The influence of social media will remain important for answering questions in gynecology and beyond.

Our work is strengthened by social media’s low threshold for use and the ability for widespread access to a diverse group of users. Additionally, social media allows for many responses to be collected in a timely manner, giving strength to the abstracted themes. The constant production of data by X users and their accessibility provide the opportunity for greater geographic coverage in those surveyed.⁴ Crowdsourced public opinion also has the advantage of producing qualitative metrics in the form of likes and retweets that may provide a reliable measure of public support or engagement.¹

Future studies should examine ways to implement the suggested improvements to the office setting in a cost-effective manner and follow both subjective patient-reported outcomes as well as objective data after implementation, as these changes may have implications for much broader public health crises, such as maternal morbidity and mortality.

Study limitations. Our study is limited by the inherent biases and confounders associated with utilizing data derived from social media. Specifically, not all patients who seek outpatient gynecologic care utilize social media and/or X; using a “like” as a surrogate for endorsement of an idea by an identified party limits the generalizability of the data.

The initial Twitter query specified, “I’m asking women”, which may have altered the intended study population, influenced the analysis, and affected the representativeness of the sample through utilizing non ̶inclusive language. While non-binary/transgender care and inclusivity emerged as a theme discussed with the tweets, it is unclear if this represents an independent theme or rather a reaction to the non–inclusive language within the original tweet. ●

There has been increasing awareness of a need for creating a more patient-centered experience with outpatient gynecology; however, very little data exist about what interventions are important to patients. Given social media’s ease of use and ability for widespread access to a diverse group of users, it has the potential to be a powerful tool for qualitative research questions without the difficulties of cost, transportation, transcription, etc. required of a focus group. Crowdsourced public opinion also has the advantage of producing qualitative metrics in the form of “likes” that, at scale, can provide a reliable measure of public support or engagement for a particular concept.¹ Particularly for topics that are controversial or novel, X (formerly Twitter, and referred to as Twitter intermittently throughout this article based on the time the study was conducted), with 300 million monthly users,² has become a popular tool for general and health care ̶ focused content and sentiment analysis.^3,4 This study presents a qualitative analysis of themes from a crowdsourced request on Twitter to design the ideal outpatient gynecologic experience that subsequently went “viral”.^5,6

Why the need for our research question on patient-centered gyn care

While the body of literature on patient-centered health care has grown rapidly in recent years, a patient-centered outpatient gynecology experience has not yet been described in the medical literature.

Patient-centered office design, driven by cultural sensitivity, has been shown in other studies to be both appreciated by established patients and a viable business strategy to attract new patients.⁷ Topics such as pain control, trauma-informed care in gynecologyclinics,⁸ and diverse representation in patient materials and illustrations⁹ have been popular topics in medicine and in the lay press. Our primary aim in our research was to utilize feedback from the question posed to quantify and rank patient-centered interventions in a gynecology office. These themes and others that emerged in our analysis were used to suggest best-practice guidelines for the outpatient gynecology experience (see “Checklist for ObGyn outpatient experience improvement").

What we asked social media users. The survey query to social media users, “I have the opportunity to design my office from scratch. I’m asking women: How would you design/optimize a visit to the gynecologist’s office?” was crowd-sourced via Twitter on December 5, 2021.⁵ Given a robust response to the query, it provided an opportunity for a qualitative research study exploring social media users’ perspectives on optimizing outpatient gynecologic care, although the original question was not planned for research utilization.

What we found

By December 27, 2021, the original tweet had earned 9,411 likes; 2,143 retweets; and 3,400 replies. Of this group, we analyzed 131 tweets, all of which had 100 or greater likes on Twitter at the time of the review. The majority of analyzed tweets earned between 100 ̶ 500 likes (75/131; 57.3%), while 22.9% (30/131) had 501 ̶ 1,000 likes, 11.5% (15/131) had >2,000 likes, and 8.4% (11/131) had 1,001 ̶ 1,999 likes.

Identified themes within the tweets analyzed included: medical education, comfort improvements, continuity of care, disability accommodations/accessibility, economic accessibility, nonbinary/transgender care and inclusivity, general layout/floorplan, hospitality, aid for intimate partner violence, childcare accessibility, multi-disciplinary care access, pain/anxiety control, sensitivity toward pregnancy loss/fertility issues, privacy issues, professionalism, representation (subdivided into race, LGBTQIA+, age, and weight/body type), trauma-informed care, and acknowledgement of voluntary nulliparity/support for reproductive choices (TABLE 1). TABLE 2 lists examples of popular tweets by selected themes.

Frequent themes. The most frequently occurring themes within the 131 analyzed tweets (FIGURE 1) were:

• hospitality (77 occurrences)
• comfort improvements (75 occurrences)
• general layout/floorplan (75 occurrences)
• pain/anxiety control (55 occurrences)
• representation (53 occurrences).

Popular themes. Defined as those with more than 1,000 likes at the time of analysis (FIGURE 2), the most popular themes included:

• privacy issues (48.5% of related tweets with >1,000 likes)
• voluntary nulliparity (37.0% of related tweets with >1,000 likes)
• general layout/floorplan (33.4% of related tweets with >1,000 likes)
• representation (32.1% of related tweets with >1,000 likes)
• hospitality (31.3% of related tweets with >1,000 likes).

A sub-analysis of themes related to specific types of representation—race, LGBTQIA+, age, and weight/body type was performed. Tweets related to diverse weight/body type representation occurred most frequently (19 code occurrences; FIGURE 3). Similarly, tweets related to the representation of diverse races and the LGBTQIA+ community each comprised 26% of the total representation-based tweets. In terms of popularity as described above, 51.4% of tweets describing racial representation earned >1,000 likes (FIGURE 4).

Tweet demographics. Seven (7/131; 5.3%) of the tweet authors were verified Twitter users and 35 (35/131; 26.7%) authors reported working in the health care field within their Twitter profile description.

Continue to: Implementing our feedback can enhance patient experience and care...

Our study provides a unique view of the patient perspective through analyzed crowdsourced public opinion via Twitter. To our knowledge, an optimized patient-centered outpatient gynecology experience has not previously been described in the medical literature. Optimizing the found domains of hospitality, comfort measures, pain and anxiety control, privacy, and diverse representationin the outpatient gynecologic experience within the outpatient care setting may ultimately result in improved patient satisfaction, patient well-being, and adherence to care through maximizing patient-centered care. We created a checklist of suggestions, including offering analgesics during office-based procedures and tailoring the floorplan to maximize privacy (FIGURE 5), for improving the outpatient gynecology experience based on our findings.

Prior data on patient satisfaction and outcomes

Improving patient satisfaction with health care is a priority for both clinicians and hospital systems. Prior studies have revealed only variable associations between patient satisfaction, safety, and clinical outcomes. One study involving the analysis of clinical and operational data from 171 hospitals found that hospital size, surgical volume, and low mortality rates were associated with higher patient satisfaction, while favorable surgical outcomes did not consistently correlate with higher Hospital Consumer Assessment of Healthcare Provers and Systems (HCAHPS) scores.¹⁰ Smaller, lower-volume hospitals earned higher satisfaction scores related to cleanliness, quietness, and receiving help measures.¹⁰ It has also been shown that the strongest predictors of patient satisfaction with the hospital childbirth experience included items related to staff communication, compassion, empathy, and respect.¹¹ These data suggest that patient satisfaction is likely more significantly impacted by factors other than patient safety and effectiveness, and this was supported by the findings of our analysis. The growing body of literature associating a sense of psychological and physical safety within the health care system and improved patient outcomes and experience suggests that the data gathered from public commentary such as that presented here is extremely important for galvanizing change within the US health care system.

In one systematic review, the relationship between patient-centered care and clinical outcomes was mixed, although generally the association was positive.¹² Additionally, patient-centered care was often associated with increased patient satisfaction and well-being. Some studies suggest that patient well-being and satisfaction also may be associated with improved adherence and self-management behaviors.^12,13 Overall, optimizing patient-centered care may lead to improved patient satisfaction and potentially improved clinical outcomes.

Additionally, increasing diverse representation in patient materials and illustrations may help to improve the patient experience. Louie and colleagues found that dark skin tones were represented in only 4.5% of 4,146 images from anatomy texts analyzed in 2018.¹⁴ Similarly, a photogrammetric analysis of medical images utilized in New England Journal of Medicine found that only 18% of images depicted non-white skin.¹⁵ More recent efforts to create a royalty-free digital gallery of images reflecting bodies with diverse skin tones, body shapes, body hair, and age as well as transgender and nonbinary people have been discussed in the lay press.⁹ Based on our findings, social media users value and are actively seeking diversity in representation and imagery during their outpatient gynecology experience.

Opportunities for future study

Our research utilized social media as a diverse and accessible source of information; however, there are significant opportunities to refine the methodologic approach to answering the fundamental question of creating the patient-centered gynecologic experience. This type of study has not yet been conducted; however, the richness of the information from this current analysis could be informative to survey creation. Future research on this subject outside of social media could bolster the generalizability of our conclusions and the ability to report on qualitative findings in the setting of known patient demographics.

Social media remains a powerful tool as evidenced by this study, and continued use and observation of trending themes among patients is essential. The influence of social media will remain important for answering questions in gynecology and beyond.

Our work is strengthened by social media’s low threshold for use and the ability for widespread access to a diverse group of users. Additionally, social media allows for many responses to be collected in a timely manner, giving strength to the abstracted themes. The constant production of data by X users and their accessibility provide the opportunity for greater geographic coverage in those surveyed.⁴ Crowdsourced public opinion also has the advantage of producing qualitative metrics in the form of likes and retweets that may provide a reliable measure of public support or engagement.¹

Future studies should examine ways to implement the suggested improvements to the office setting in a cost-effective manner and follow both subjective patient-reported outcomes as well as objective data after implementation, as these changes may have implications for much broader public health crises, such as maternal morbidity and mortality.

Study limitations. Our study is limited by the inherent biases and confounders associated with utilizing data derived from social media. Specifically, not all patients who seek outpatient gynecologic care utilize social media and/or X; using a “like” as a surrogate for endorsement of an idea by an identified party limits the generalizability of the data.

The initial Twitter query specified, “I’m asking women”, which may have altered the intended study population, influenced the analysis, and affected the representativeness of the sample through utilizing non ̶inclusive language. While non-binary/transgender care and inclusivity emerged as a theme discussed with the tweets, it is unclear if this represents an independent theme or rather a reaction to the non–inclusive language within the original tweet. ●

There has been increasing awareness of a need for creating a more patient-centered experience with outpatient gynecology; however, very little data exist about what interventions are important to patients. Given social media’s ease of use and ability for widespread access to a diverse group of users, it has the potential to be a powerful tool for qualitative research questions without the difficulties of cost, transportation, transcription, etc. required of a focus group. Crowdsourced public opinion also has the advantage of producing qualitative metrics in the form of “likes” that, at scale, can provide a reliable measure of public support or engagement for a particular concept.¹ Particularly for topics that are controversial or novel, X (formerly Twitter, and referred to as Twitter intermittently throughout this article based on the time the study was conducted), with 300 million monthly users,² has become a popular tool for general and health care ̶ focused content and sentiment analysis.^3,4 This study presents a qualitative analysis of themes from a crowdsourced request on Twitter to design the ideal outpatient gynecologic experience that subsequently went “viral”.^5,6

Why the need for our research question on patient-centered gyn care

While the body of literature on patient-centered health care has grown rapidly in recent years, a patient-centered outpatient gynecology experience has not yet been described in the medical literature.

Patient-centered office design, driven by cultural sensitivity, has been shown in other studies to be both appreciated by established patients and a viable business strategy to attract new patients.⁷ Topics such as pain control, trauma-informed care in gynecologyclinics,⁸ and diverse representation in patient materials and illustrations⁹ have been popular topics in medicine and in the lay press. Our primary aim in our research was to utilize feedback from the question posed to quantify and rank patient-centered interventions in a gynecology office. These themes and others that emerged in our analysis were used to suggest best-practice guidelines for the outpatient gynecology experience (see “Checklist for ObGyn outpatient experience improvement").

What we asked social media users. The survey query to social media users, “I have the opportunity to design my office from scratch. I’m asking women: How would you design/optimize a visit to the gynecologist’s office?” was crowd-sourced via Twitter on December 5, 2021.⁵ Given a robust response to the query, it provided an opportunity for a qualitative research study exploring social media users’ perspectives on optimizing outpatient gynecologic care, although the original question was not planned for research utilization.

What we found

By December 27, 2021, the original tweet had earned 9,411 likes; 2,143 retweets; and 3,400 replies. Of this group, we analyzed 131 tweets, all of which had 100 or greater likes on Twitter at the time of the review. The majority of analyzed tweets earned between 100 ̶ 500 likes (75/131; 57.3%), while 22.9% (30/131) had 501 ̶ 1,000 likes, 11.5% (15/131) had >2,000 likes, and 8.4% (11/131) had 1,001 ̶ 1,999 likes.

Identified themes within the tweets analyzed included: medical education, comfort improvements, continuity of care, disability accommodations/accessibility, economic accessibility, nonbinary/transgender care and inclusivity, general layout/floorplan, hospitality, aid for intimate partner violence, childcare accessibility, multi-disciplinary care access, pain/anxiety control, sensitivity toward pregnancy loss/fertility issues, privacy issues, professionalism, representation (subdivided into race, LGBTQIA+, age, and weight/body type), trauma-informed care, and acknowledgement of voluntary nulliparity/support for reproductive choices (TABLE 1). TABLE 2 lists examples of popular tweets by selected themes.

Frequent themes. The most frequently occurring themes within the 131 analyzed tweets (FIGURE 1) were:

• hospitality (77 occurrences)
• comfort improvements (75 occurrences)
• general layout/floorplan (75 occurrences)
• pain/anxiety control (55 occurrences)
• representation (53 occurrences).

Popular themes. Defined as those with more than 1,000 likes at the time of analysis (FIGURE 2), the most popular themes included:

• privacy issues (48.5% of related tweets with >1,000 likes)
• voluntary nulliparity (37.0% of related tweets with >1,000 likes)
• general layout/floorplan (33.4% of related tweets with >1,000 likes)
• representation (32.1% of related tweets with >1,000 likes)
• hospitality (31.3% of related tweets with >1,000 likes).

A sub-analysis of themes related to specific types of representation—race, LGBTQIA+, age, and weight/body type was performed. Tweets related to diverse weight/body type representation occurred most frequently (19 code occurrences; FIGURE 3). Similarly, tweets related to the representation of diverse races and the LGBTQIA+ community each comprised 26% of the total representation-based tweets. In terms of popularity as described above, 51.4% of tweets describing racial representation earned >1,000 likes (FIGURE 4).

Tweet demographics. Seven (7/131; 5.3%) of the tweet authors were verified Twitter users and 35 (35/131; 26.7%) authors reported working in the health care field within their Twitter profile description.

Continue to: Implementing our feedback can enhance patient experience and care...

Our study provides a unique view of the patient perspective through analyzed crowdsourced public opinion via Twitter. To our knowledge, an optimized patient-centered outpatient gynecology experience has not previously been described in the medical literature. Optimizing the found domains of hospitality, comfort measures, pain and anxiety control, privacy, and diverse representationin the outpatient gynecologic experience within the outpatient care setting may ultimately result in improved patient satisfaction, patient well-being, and adherence to care through maximizing patient-centered care. We created a checklist of suggestions, including offering analgesics during office-based procedures and tailoring the floorplan to maximize privacy (FIGURE 5), for improving the outpatient gynecology experience based on our findings.

Prior data on patient satisfaction and outcomes

Improving patient satisfaction with health care is a priority for both clinicians and hospital systems. Prior studies have revealed only variable associations between patient satisfaction, safety, and clinical outcomes. One study involving the analysis of clinical and operational data from 171 hospitals found that hospital size, surgical volume, and low mortality rates were associated with higher patient satisfaction, while favorable surgical outcomes did not consistently correlate with higher Hospital Consumer Assessment of Healthcare Provers and Systems (HCAHPS) scores.¹⁰ Smaller, lower-volume hospitals earned higher satisfaction scores related to cleanliness, quietness, and receiving help measures.¹⁰ It has also been shown that the strongest predictors of patient satisfaction with the hospital childbirth experience included items related to staff communication, compassion, empathy, and respect.¹¹ These data suggest that patient satisfaction is likely more significantly impacted by factors other than patient safety and effectiveness, and this was supported by the findings of our analysis. The growing body of literature associating a sense of psychological and physical safety within the health care system and improved patient outcomes and experience suggests that the data gathered from public commentary such as that presented here is extremely important for galvanizing change within the US health care system.

In one systematic review, the relationship between patient-centered care and clinical outcomes was mixed, although generally the association was positive.¹² Additionally, patient-centered care was often associated with increased patient satisfaction and well-being. Some studies suggest that patient well-being and satisfaction also may be associated with improved adherence and self-management behaviors.^12,13 Overall, optimizing patient-centered care may lead to improved patient satisfaction and potentially improved clinical outcomes.

Additionally, increasing diverse representation in patient materials and illustrations may help to improve the patient experience. Louie and colleagues found that dark skin tones were represented in only 4.5% of 4,146 images from anatomy texts analyzed in 2018.¹⁴ Similarly, a photogrammetric analysis of medical images utilized in New England Journal of Medicine found that only 18% of images depicted non-white skin.¹⁵ More recent efforts to create a royalty-free digital gallery of images reflecting bodies with diverse skin tones, body shapes, body hair, and age as well as transgender and nonbinary people have been discussed in the lay press.⁹ Based on our findings, social media users value and are actively seeking diversity in representation and imagery during their outpatient gynecology experience.

Opportunities for future study

Our research utilized social media as a diverse and accessible source of information; however, there are significant opportunities to refine the methodologic approach to answering the fundamental question of creating the patient-centered gynecologic experience. This type of study has not yet been conducted; however, the richness of the information from this current analysis could be informative to survey creation. Future research on this subject outside of social media could bolster the generalizability of our conclusions and the ability to report on qualitative findings in the setting of known patient demographics.

Social media remains a powerful tool as evidenced by this study, and continued use and observation of trending themes among patients is essential. The influence of social media will remain important for answering questions in gynecology and beyond.

Our work is strengthened by social media’s low threshold for use and the ability for widespread access to a diverse group of users. Additionally, social media allows for many responses to be collected in a timely manner, giving strength to the abstracted themes. The constant production of data by X users and their accessibility provide the opportunity for greater geographic coverage in those surveyed.⁴ Crowdsourced public opinion also has the advantage of producing qualitative metrics in the form of likes and retweets that may provide a reliable measure of public support or engagement.¹

Future studies should examine ways to implement the suggested improvements to the office setting in a cost-effective manner and follow both subjective patient-reported outcomes as well as objective data after implementation, as these changes may have implications for much broader public health crises, such as maternal morbidity and mortality.

Study limitations. Our study is limited by the inherent biases and confounders associated with utilizing data derived from social media. Specifically, not all patients who seek outpatient gynecologic care utilize social media and/or X; using a “like” as a surrogate for endorsement of an idea by an identified party limits the generalizability of the data.

The initial Twitter query specified, “I’m asking women”, which may have altered the intended study population, influenced the analysis, and affected the representativeness of the sample through utilizing non ̶inclusive language. While non-binary/transgender care and inclusivity emerged as a theme discussed with the tweets, it is unclear if this represents an independent theme or rather a reaction to the non–inclusive language within the original tweet. ●

3/28/17. DAY 3 AT SGS

Exciting presentations continue, society groups provide updates

The team from Mayo Clinic was still riding high this morning after winning last night’s armadillo race, which was part of the Texas hoedown fundraiser for SHARE.

The seventh scientific session started with a nice presentation by Cara Grimes, MD, entitled, “Evaluating ureteral patency in the post-indigo carmine era: a randomized controlled trial.” Several quality presentations followed before Ike Rahn, MD, updated the society on the work of the Fellows Pelvic Research Network, a group currently celebrating its 10th anniversary.

Drs. Star Hampton and Peter Jeppson then took the stage to share the progress of the SGS Pelvic Anatomy Group as they undertake the daunting task of a systematic review of anatomic terms used in the medical literature.

Leadership transition

Surely the moment that SGS President Vivian Sung, MD, had been waiting for all week was the passing of the gavel to incoming president John Gebhart, MD. On acceptance of his role as the incoming president, Dr. Gebhart’s remarks focused on the honor of serving in that role, and he stated that Dr. Sung, in her usual fashion, set the bar for performance very high.

After the midmorning break, where attendants usually say their temporary goodbyes to friends and mentors, old and new, the eighth and final scientific session began.

Come to next year’s meeting!

If you consider yourself a gynecologic surgeon (and if you’re reading this you probably do), please consider adding attendance at the next SGS meeting to your list of “things to do” in 2018. This family-friendly meeting is filled with opportunities for surgical teaching, learning, rest, relaxation, networking, and reconnecting. Most of all, it is a place where mentoring relationships begin and are nurtured, recognized, and appreciated.

See you in Orlando!

3/28/17. DAY 2 AT SGS

Morning highlights: Prize-winning paper, presidential address

Scholarly activity continued this morning at the Society of Gynecologic Surgeons Annual Scientific meeting at the La Cantera Resort in San Antonio, Texas.  After early morning reviews and coffee with good friends, the scientific program began with a comparison of barbed and nonbarbed sutures, after which Eric Jelovsek, MD, presented the prize-winning paper for the Pelvic Floor Disorders Network, “A Randomized Trial of Uterosacral Ligament Suspension or Sacrospinous Ligament Fixation for Apical Pelvic Organ Prolapse: Five-year Outcomes.”

The highlight of the morning was almost certainly the presidential address in which Dr. Vivian Sung shared with the audience the recipe for the “secret sauce” that makes SGS a special organization:

1. Be everyday leaders and mentors. Do the little things to teach, coach, and encourage others in the field.
2. Maintain a safe environment. Allow others to be brave, be creative, and make mistakes. It will make them more effective.
3. Consider the “WHY.” Focus on why SGS exists and continue to strive for that mission.

Stimulating scientific sessions

After the fifth scientific session, where we learned that prophylactic salpingectomy at the time of vaginal hysterectomy not only is feasible but also cost-effective, participants were treated to the TeLinde Lecture. Dr. Richard Reznick, Dean of Health Sciences and Professor in the Department of Surgery at Queen’s University in Kingston, Ontario, shared exciting and intriguing data regarding competency-based learning in surgical training. The lecture, entitled “Great Expectations: The Promise of Competency-based Education,” sparked questions and conversation that could have gone on for hours. Alas, program director Rob Gutman, MD, kept the program on track and, after a brief break for lunch, the sixth scientific session was underway.

In the sixth session, Dr. Gutman moderated a lively panel discussion that set out to answer the question, “How can we increase the percentage and quality of minimally invasive hysterectomy for benign disease among low/intermediate volume gynecologic surgeons?” Panelists shared thoughts and information—from organizations and institutions around the country—outlining the data on current hysterectomy rates, trends in policymaking, learning through simulation, incremental quality improvement planning, and surgical pathways.

Afternoon fun and a Texas hoedown

The scientific meeting was then adjourned, making way for the SGS business meeting and then an afternoon of well-deserved fun in the Texas sun. 

Evening events included an old-fashioned Texas hoedown—a time for two-stepping, armadillo racing, and camaraderie to raise money for SHARE.  My money’s on the armadillo from the University of New Mexico!

3/27/17. DAY 1 AT SGS

Debate, postgrad courses, videos galore

The Annual Scientific Meeting of the Society of Gynecologic Surgeons, held in San Antonio, Texas, opened to an energetic crowd when SGS President, Vivan Sung, MD, welcomed participants from 10 countries before introducing the society’s 10 newest members. The first scientific session then quickly got underway with oral presentations and videos covering a variety of topics.

Janet Bickel, MS, a national leader in mentorship and faculty development, reinforced the meeting’s theme with her keynote lecture, “Hard Work and Talent Aren’t Enough: Mentoring and Finding Mentors across Career Stages.” She shared with attendees the keys to mentoring women and minorities before outlining the characteristics associated with both effective mentors and mentees. It turns out that many of her key points had been on display just a day earlier during the postgraduate courses in which physicians from around the country were coached by experts on surgical complications, pelvic anatomy and computer modeling, surgical teaching, and enhanced surgical recovery.

After a brief break for lunch at the beautiful La Cantera Resort, attendees returned for a lively debate between Kim Kenton, MD and Geoff Cundiff, MD entitled “Should we separate the O from the G in Obstetrics and Gynecology?” Dee Fenner, MD acted as moderator and referee as both sides passionately shared their convincing arguments. In the end, both parties agreed that this century-old debate would continue as we constantly evaluate the best approach to caring for the female patient.

Promises of popcorn brought attendees back to the meeting hall for the afternoon videofest where 13 videos were presented on a variety of surgical topics.

Specialists learn from each other

Meanwhile, the Fellows Pelvic Research Network had the pleasure a special lecture and Q&A session with Linda Brubaker, MD. Among the many pearls of wisdom she shared was an evergreen piece of advice, “Enthusiasm is good. Focus is better.” The fellows then turned their focus to the review of current projects and evaluation of proposals for new research.

Eight academic roundtables hosted by experts from across the country provided an opportunity for attendees to discuss best practices in various areas of pelvic surgery including bladder pain syndrome, chronic pelvic pain, transgender care, billing and coding, social media, and more.

The day ended with a delightful awards ceremony in which Dr. Sung recognized outstanding scholarly and service activity in the gynecologic surgery community. Notably, Dr. Peter Jeppson was presented with the 2017 Distinguished Service Award. Members then joined meeting sponsors and staff in the exhibit hall for an evening reception—a fitting ending to a phenomenal first day.

Click for more…

For more details about the scientific presentations and to read abstracts of presentations, videos, and posters, see the March 2017 supplemental issue of the American Journal of Obstetrics and Gynecology.

For an up-to-the minute report of the week’s events, follow the #SGS2017 hashtag on Twitter. Be sure to follow @obgmanagement, @gynsurg, and @stuboo as well.

3/28/17. DAY 3 AT SGS

Exciting presentations continue, society groups provide updates

The team from Mayo Clinic was still riding high this morning after winning last night’s armadillo race, which was part of the Texas hoedown fundraiser for SHARE.

The seventh scientific session started with a nice presentation by Cara Grimes, MD, entitled, “Evaluating ureteral patency in the post-indigo carmine era: a randomized controlled trial.” Several quality presentations followed before Ike Rahn, MD, updated the society on the work of the Fellows Pelvic Research Network, a group currently celebrating its 10th anniversary.

Drs. Star Hampton and Peter Jeppson then took the stage to share the progress of the SGS Pelvic Anatomy Group as they undertake the daunting task of a systematic review of anatomic terms used in the medical literature.

Leadership transition

Surely the moment that SGS President Vivian Sung, MD, had been waiting for all week was the passing of the gavel to incoming president John Gebhart, MD. On acceptance of his role as the incoming president, Dr. Gebhart’s remarks focused on the honor of serving in that role, and he stated that Dr. Sung, in her usual fashion, set the bar for performance very high.

After the midmorning break, where attendants usually say their temporary goodbyes to friends and mentors, old and new, the eighth and final scientific session began.

Come to next year’s meeting!

If you consider yourself a gynecologic surgeon (and if you’re reading this you probably do), please consider adding attendance at the next SGS meeting to your list of “things to do” in 2018. This family-friendly meeting is filled with opportunities for surgical teaching, learning, rest, relaxation, networking, and reconnecting. Most of all, it is a place where mentoring relationships begin and are nurtured, recognized, and appreciated.

See you in Orlando!

3/28/17. DAY 2 AT SGS

Morning highlights: Prize-winning paper, presidential address

Scholarly activity continued this morning at the Society of Gynecologic Surgeons Annual Scientific meeting at the La Cantera Resort in San Antonio, Texas.  After early morning reviews and coffee with good friends, the scientific program began with a comparison of barbed and nonbarbed sutures, after which Eric Jelovsek, MD, presented the prize-winning paper for the Pelvic Floor Disorders Network, “A Randomized Trial of Uterosacral Ligament Suspension or Sacrospinous Ligament Fixation for Apical Pelvic Organ Prolapse: Five-year Outcomes.”

The highlight of the morning was almost certainly the presidential address in which Dr. Vivian Sung shared with the audience the recipe for the “secret sauce” that makes SGS a special organization:

1. Be everyday leaders and mentors. Do the little things to teach, coach, and encourage others in the field.
2. Maintain a safe environment. Allow others to be brave, be creative, and make mistakes. It will make them more effective.
3. Consider the “WHY.” Focus on why SGS exists and continue to strive for that mission.

Stimulating scientific sessions

After the fifth scientific session, where we learned that prophylactic salpingectomy at the time of vaginal hysterectomy not only is feasible but also cost-effective, participants were treated to the TeLinde Lecture. Dr. Richard Reznick, Dean of Health Sciences and Professor in the Department of Surgery at Queen’s University in Kingston, Ontario, shared exciting and intriguing data regarding competency-based learning in surgical training. The lecture, entitled “Great Expectations: The Promise of Competency-based Education,” sparked questions and conversation that could have gone on for hours. Alas, program director Rob Gutman, MD, kept the program on track and, after a brief break for lunch, the sixth scientific session was underway.

In the sixth session, Dr. Gutman moderated a lively panel discussion that set out to answer the question, “How can we increase the percentage and quality of minimally invasive hysterectomy for benign disease among low/intermediate volume gynecologic surgeons?” Panelists shared thoughts and information—from organizations and institutions around the country—outlining the data on current hysterectomy rates, trends in policymaking, learning through simulation, incremental quality improvement planning, and surgical pathways.

Afternoon fun and a Texas hoedown

The scientific meeting was then adjourned, making way for the SGS business meeting and then an afternoon of well-deserved fun in the Texas sun. 

Evening events included an old-fashioned Texas hoedown—a time for two-stepping, armadillo racing, and camaraderie to raise money for SHARE.  My money’s on the armadillo from the University of New Mexico!

3/27/17. DAY 1 AT SGS

Debate, postgrad courses, videos galore

The Annual Scientific Meeting of the Society of Gynecologic Surgeons, held in San Antonio, Texas, opened to an energetic crowd when SGS President, Vivan Sung, MD, welcomed participants from 10 countries before introducing the society’s 10 newest members. The first scientific session then quickly got underway with oral presentations and videos covering a variety of topics.

Janet Bickel, MS, a national leader in mentorship and faculty development, reinforced the meeting’s theme with her keynote lecture, “Hard Work and Talent Aren’t Enough: Mentoring and Finding Mentors across Career Stages.” She shared with attendees the keys to mentoring women and minorities before outlining the characteristics associated with both effective mentors and mentees. It turns out that many of her key points had been on display just a day earlier during the postgraduate courses in which physicians from around the country were coached by experts on surgical complications, pelvic anatomy and computer modeling, surgical teaching, and enhanced surgical recovery.

After a brief break for lunch at the beautiful La Cantera Resort, attendees returned for a lively debate between Kim Kenton, MD and Geoff Cundiff, MD entitled “Should we separate the O from the G in Obstetrics and Gynecology?” Dee Fenner, MD acted as moderator and referee as both sides passionately shared their convincing arguments. In the end, both parties agreed that this century-old debate would continue as we constantly evaluate the best approach to caring for the female patient.

Promises of popcorn brought attendees back to the meeting hall for the afternoon videofest where 13 videos were presented on a variety of surgical topics.

Specialists learn from each other

Meanwhile, the Fellows Pelvic Research Network had the pleasure a special lecture and Q&A session with Linda Brubaker, MD. Among the many pearls of wisdom she shared was an evergreen piece of advice, “Enthusiasm is good. Focus is better.” The fellows then turned their focus to the review of current projects and evaluation of proposals for new research.

Eight academic roundtables hosted by experts from across the country provided an opportunity for attendees to discuss best practices in various areas of pelvic surgery including bladder pain syndrome, chronic pelvic pain, transgender care, billing and coding, social media, and more.

The day ended with a delightful awards ceremony in which Dr. Sung recognized outstanding scholarly and service activity in the gynecologic surgery community. Notably, Dr. Peter Jeppson was presented with the 2017 Distinguished Service Award. Members then joined meeting sponsors and staff in the exhibit hall for an evening reception—a fitting ending to a phenomenal first day.

Click for more…

For more details about the scientific presentations and to read abstracts of presentations, videos, and posters, see the March 2017 supplemental issue of the American Journal of Obstetrics and Gynecology.

For an up-to-the minute report of the week’s events, follow the #SGS2017 hashtag on Twitter. Be sure to follow @obgmanagement, @gynsurg, and @stuboo as well.

3/28/17. DAY 3 AT SGS

Exciting presentations continue, society groups provide updates

The team from Mayo Clinic was still riding high this morning after winning last night’s armadillo race, which was part of the Texas hoedown fundraiser for SHARE.

The seventh scientific session started with a nice presentation by Cara Grimes, MD, entitled, “Evaluating ureteral patency in the post-indigo carmine era: a randomized controlled trial.” Several quality presentations followed before Ike Rahn, MD, updated the society on the work of the Fellows Pelvic Research Network, a group currently celebrating its 10th anniversary.

Drs. Star Hampton and Peter Jeppson then took the stage to share the progress of the SGS Pelvic Anatomy Group as they undertake the daunting task of a systematic review of anatomic terms used in the medical literature.

Leadership transition

Surely the moment that SGS President Vivian Sung, MD, had been waiting for all week was the passing of the gavel to incoming president John Gebhart, MD. On acceptance of his role as the incoming president, Dr. Gebhart’s remarks focused on the honor of serving in that role, and he stated that Dr. Sung, in her usual fashion, set the bar for performance very high.

After the midmorning break, where attendants usually say their temporary goodbyes to friends and mentors, old and new, the eighth and final scientific session began.

Come to next year’s meeting!

If you consider yourself a gynecologic surgeon (and if you’re reading this you probably do), please consider adding attendance at the next SGS meeting to your list of “things to do” in 2018. This family-friendly meeting is filled with opportunities for surgical teaching, learning, rest, relaxation, networking, and reconnecting. Most of all, it is a place where mentoring relationships begin and are nurtured, recognized, and appreciated.

See you in Orlando!

3/28/17. DAY 2 AT SGS

Morning highlights: Prize-winning paper, presidential address

Scholarly activity continued this morning at the Society of Gynecologic Surgeons Annual Scientific meeting at the La Cantera Resort in San Antonio, Texas.  After early morning reviews and coffee with good friends, the scientific program began with a comparison of barbed and nonbarbed sutures, after which Eric Jelovsek, MD, presented the prize-winning paper for the Pelvic Floor Disorders Network, “A Randomized Trial of Uterosacral Ligament Suspension or Sacrospinous Ligament Fixation for Apical Pelvic Organ Prolapse: Five-year Outcomes.”

The highlight of the morning was almost certainly the presidential address in which Dr. Vivian Sung shared with the audience the recipe for the “secret sauce” that makes SGS a special organization:

1. Be everyday leaders and mentors. Do the little things to teach, coach, and encourage others in the field.
2. Maintain a safe environment. Allow others to be brave, be creative, and make mistakes. It will make them more effective.
3. Consider the “WHY.” Focus on why SGS exists and continue to strive for that mission.

Stimulating scientific sessions

After the fifth scientific session, where we learned that prophylactic salpingectomy at the time of vaginal hysterectomy not only is feasible but also cost-effective, participants were treated to the TeLinde Lecture. Dr. Richard Reznick, Dean of Health Sciences and Professor in the Department of Surgery at Queen’s University in Kingston, Ontario, shared exciting and intriguing data regarding competency-based learning in surgical training. The lecture, entitled “Great Expectations: The Promise of Competency-based Education,” sparked questions and conversation that could have gone on for hours. Alas, program director Rob Gutman, MD, kept the program on track and, after a brief break for lunch, the sixth scientific session was underway.

In the sixth session, Dr. Gutman moderated a lively panel discussion that set out to answer the question, “How can we increase the percentage and quality of minimally invasive hysterectomy for benign disease among low/intermediate volume gynecologic surgeons?” Panelists shared thoughts and information—from organizations and institutions around the country—outlining the data on current hysterectomy rates, trends in policymaking, learning through simulation, incremental quality improvement planning, and surgical pathways.

Afternoon fun and a Texas hoedown

The scientific meeting was then adjourned, making way for the SGS business meeting and then an afternoon of well-deserved fun in the Texas sun. 

Evening events included an old-fashioned Texas hoedown—a time for two-stepping, armadillo racing, and camaraderie to raise money for SHARE.  My money’s on the armadillo from the University of New Mexico!

3/27/17. DAY 1 AT SGS

Debate, postgrad courses, videos galore

The Annual Scientific Meeting of the Society of Gynecologic Surgeons, held in San Antonio, Texas, opened to an energetic crowd when SGS President, Vivan Sung, MD, welcomed participants from 10 countries before introducing the society’s 10 newest members. The first scientific session then quickly got underway with oral presentations and videos covering a variety of topics.

Janet Bickel, MS, a national leader in mentorship and faculty development, reinforced the meeting’s theme with her keynote lecture, “Hard Work and Talent Aren’t Enough: Mentoring and Finding Mentors across Career Stages.” She shared with attendees the keys to mentoring women and minorities before outlining the characteristics associated with both effective mentors and mentees. It turns out that many of her key points had been on display just a day earlier during the postgraduate courses in which physicians from around the country were coached by experts on surgical complications, pelvic anatomy and computer modeling, surgical teaching, and enhanced surgical recovery.

After a brief break for lunch at the beautiful La Cantera Resort, attendees returned for a lively debate between Kim Kenton, MD and Geoff Cundiff, MD entitled “Should we separate the O from the G in Obstetrics and Gynecology?” Dee Fenner, MD acted as moderator and referee as both sides passionately shared their convincing arguments. In the end, both parties agreed that this century-old debate would continue as we constantly evaluate the best approach to caring for the female patient.

Promises of popcorn brought attendees back to the meeting hall for the afternoon videofest where 13 videos were presented on a variety of surgical topics.

Specialists learn from each other

Meanwhile, the Fellows Pelvic Research Network had the pleasure a special lecture and Q&A session with Linda Brubaker, MD. Among the many pearls of wisdom she shared was an evergreen piece of advice, “Enthusiasm is good. Focus is better.” The fellows then turned their focus to the review of current projects and evaluation of proposals for new research.

Eight academic roundtables hosted by experts from across the country provided an opportunity for attendees to discuss best practices in various areas of pelvic surgery including bladder pain syndrome, chronic pelvic pain, transgender care, billing and coding, social media, and more.

The day ended with a delightful awards ceremony in which Dr. Sung recognized outstanding scholarly and service activity in the gynecologic surgery community. Notably, Dr. Peter Jeppson was presented with the 2017 Distinguished Service Award. Members then joined meeting sponsors and staff in the exhibit hall for an evening reception—a fitting ending to a phenomenal first day.

Click for more…

For more details about the scientific presentations and to read abstracts of presentations, videos, and posters, see the March 2017 supplemental issue of the American Journal of Obstetrics and Gynecology.

For an up-to-the minute report of the week’s events, follow the #SGS2017 hashtag on Twitter. Be sure to follow @obgmanagement, @gynsurg, and @stuboo as well.