Abstract
This issue contains a Special Topic on acute gynecologic trauma. Dr. Betsy Dickson, Program Director for the Obstetrics and Gynecology Department at Denver Health, has recruited an outstanding group of authors and assembled an excellent treatise on this important subject. As I read these articles, reviewed ACGME requirements, looked through the literature and reflected on my four decades of involvement in resident training and education, it struck me that gynecological trauma has not received the attention that it deserves.
As a surgical specialty, gynecologists should be the first surgeons involved in the repair of torn or lacerated gynecological tissues or structures. However, major gynecological trauma may require the involvement of other specialists or subspecialists, particularly in the acute phases of injury. How do we become knowledgeable about the treatment of gynecological trauma? As an example, straddle injuries tend to occur in pre-pubescent females. How many general gynecologists are sufficiently familiar with the appropriate surgical management of this population?
Another group of common gynecological injuries are those related to sexual assault. These patients require specialized care—not just for repairing the damaged tissues but for addressing the psychological aftermaths that follow such attacks. While gynecological surgeons may be consulted to address the surgical aspects that are involved, the first responders will be emergency department physicians and their support staff, who must be well-versed in the primary care of these injured patients. It is imperative that the gynecologists who are eventually consulted understand how the patients that they will treat have already been prepared for what will happen.
This Special Topic serves as a call to action. Training in obstetrics and gynecology is complex and time constrained by the RRC requirements that are currently in place. As this issue points out, it is imperative that training programs must include dedicated didactic and simulation sessions on gynecological trauma. Residents need to be automatically included in the evaluation and treatment of traumatized patients, particularly because such cases are most likely to be emergencies rather than scheduled events.
It would be of interest to hear from our readers about thoughts on this important subject.
—Mitchel Hoffman, MD
Editor-in-Chief