bluuebunny/crossref_metadata_2025 huggingface dataset:
Tamil Militancy in Sri Lanka and the Role of Religion
Authors: Frydenlund Iselin
Published: September 2018

From the late 1970s to its defeat by the Government of Sri Lanka in 2009, the Liberation Tigers of Tamil Eelam (LTTE) fought for Tamil independence in Sri Lanka. The ultimate aim of what was often considered to be one of the world’s most disciplined and efficient insurgency groups was to create an independent Tamil homeland (which they called Tamil Eelam) in the northern and eastern parts of the island. The LTTE based itself on a unique mix of Tamil nationalist, socialist, and feminist visions of a new future for the marginalized Tamil communities of Sri Lanka. The LTTE became feared for its extensive use of suicide missions, carried out by soldiers of both Hindu and Catholic backgrounds. Because of the marginalization of the Tamil-speaking Muslims from the Tamil nationalist project, none of the LTTE soldiers were Muslims. Generally speaking, religion played—and in the 21st century continues to play—a minor role in the ultimate nationalist goal of establishing Tamil Eelam. Tamil nationalism in Sri Lanka centers around Tamil culture, language, literature, and regional identity, not religion. The LTTE’s official ideology was strictly secularist, expressing a clear separation between religion, the state, and politics. The LTTE accepted individual religious practices in its ranks—for example, having a personal crucifix or a holy picture within military camps, but did not facilitate institutionalized religious practice. Yet religious formations, controversies, and practices have been important, if not crucial, to Tamil separatism and, ultimately, to the LTTE itself. In a short period of time, the LTTE developed a unique martial culture and martyr cult, drawing on numerous cultural and religious sources in Tamil society. This martyr cult encompassed references to the Christian tradition of martyrdom, Hindu bhakti (devotional) literature, and classic Tamil heroic poetry. Each martyr’s self-sacrifice formed part of a symbolic universe that was fundamentally nationalistic, but Christian and Hindu references and ritual language were employed to help to legitimize the sacrificial act. The ideology of martyrdom transcended the martyrs’ religious backgrounds, and instead of a place in paradise or release from the cycle of reincarnation, it promised eternal life in the memory of the nation. Within the cultural and political universe of the LTTE, the nation and its territory became sacralized, and the LTTE’s meticulously articulated martial culture began to take on quasi-religious qualities. At the ideological level, the LTTE propaganda machinery managed to balance secularism, deep religious sentiment, and religious diversity, and religion functioned as a multilayered concept used for a variety of purposes by military and political leaders. Religion can also be identified as various “fields” within the movement: “civil religious,” “Śaiva religious,” and “Tamil Catholic religious,” allowing for overlapping yet distinct Hindu, Catholic, or nonreligious identities under the sacred canopy of Tamil nationalism.
Human Rights and the Mexican Student Movement of 1968
Authors: Carey Elaine
Published: September 2018

The 1968 Mexican student movement remains essential to the formation of the modern Mexican human rights movement. Mexico has had a long tradition of revolutionary activity, rural social movements, and an active labor movement that sought to gain basic human rights such as education, adequate housing, decent wages, and access to land. In 1968, students drew inspiration from leaders of the revolution, labor movements, and rural social activists. They echoed their demands, they used their images, and they insisted that the government respect the 1917 constitution. Despite their efforts to build a nonviolent social movement, they met violence at the hands of the government, which brutally suppressed the movement on October 2, 1968.

Following the massacre and into 1970, the government imprisoned students while others fled into exile to avoid prison. By the 1970s, the government initiated a “democratic opening” in which former activists were released from prison and others returned from exiles. While some former leaders entered government service, others questioned the impunity of the government and demanded answers. In their writings, films, and public presentations, they made connections to the struggles of the past. Like their counterparts in Europe and the United States, their struggles matured and evolved, and they became the leaders of the feminist, LGBTQ, and the modern human rights movements.
Digital Resources: The Hijuelas Collection
Authors: Butler Matthew , Bliss David A.
Published: September 2018

The Hijuelas project is a multi-domain international collaboration that makes available in digital form a large and valuable source on nineteenth-century indigenous history––the so-called libros de hijuelas or deed books recording the statewide privatization of indigenous lands in Michoacán, Mexico. These deed books, 194 in total, have been digitized and described over a two-year period by a team of History students from Michoacán’s state university, the Universidad Michoacana de San Nicolás Hidalgo (UMSNH), trained by and working under the supervision of archivists of the Lozano Long Institute of Latin American Studies-Benson Latin American Collection of (LLILAS Benson) of the University of Texas at Austin. Additional logistical support has been provided by the Centro de Investigaciones y Estudios Superiores en Antropología Social (CIESAS) as a partner institution in Mexico of the University of Texas at Austin and by the state government of Michoacán via the Archivo General e Histórico del Poder Ejecutivo de Michoacán (AGHPEM), which is custodian of the hijuelas books. The project was generously funded by the British Library through its Endangered Archives Programme (EAP 931, “Conserving Indigenous Memories of Land Privatization in Mexico: Michoacán’s Libros de Hijuelas, 1719–1929”).

The project seeks to be innovative in two ways. As a post-custodial archiving project, first and foremost, it uses digital methods to make easily accessible to historians, anthropologists, and indigenous communities the only consolidated state-level record of the land privatizations (reparto de tierras) affecting Mexican indigenous communities in the 19th century. It therefore projects digitally a key source for historians and one that possesses clear identitarian and agrarian importance for indigenous communities. It also makes widely available a source that is becoming physically unstable and inaccessible because of the difficult public security conditions affecting Michoacán. As a collaboration involving diverse institutional actors, furthermore, the project brings together institutions from three different countries and is an example of what may be achieved through equitable international collaborations.
Oliveira Lima and the Oliveira Lima Library at the Catholic University of America
Authors: Henrich Nathalia
Published: September 2018

Manoel de Oliveira Lima (b. Recife, December 25, 1867–d. Washington DC, March 24, 1928) was one of the most prestigious men of letters of his generation. As a historian, diplomat, literary critic, journalist, writer, and professor, he maintained an intense intellectual activity. His strong and often controversial views galvanized public opinion and gathered as many admirers as detractors. The “Fat Don Quixote” and the “Intellectual Ambassador of Brazil” were at the same time deemed a “Diplomatic Torpedo” with an “incontinent pen.” Lima became a renowned scholar and public speaker thanks to his expertise on Latin American history, especially on the history of Brazil. He was the author of numerous books and articles published in Europe and the Americas, and a lecturer at Harvard, Stanford, and the Sorbonne. He was a founding member of the Brazilian Academy of Letters. His career as a diplomat began in 1891, the same year he married Flora de Oliveira Lima (neé Cavalcanti de Albuquerque, b. Cachoeirinha, October 26, 1863, d. August 12, 1940, Washington, DC), his lifelong companion and collaborator. Together they lived in Portugal, Germany, the United States, Great Britain, Japan, Venezuela, and Belgium until his retirement. A devoted bibliophile, Oliveira Lima donated his rich collection of rare books, artwork, manuscripts, prints, photographs, and documents from his personal archive to the Catholic University of America in 1916. In 1920, he established residence in Washington, DC to oversee the organization of the university’s library, which was inaugurated in 1924. He taught international law and acted as librarian at CUA until his death in 1928. The Oliveira Lima Library (OLL) is currently considered one of the finest collections of Luso-Brazilian materials and one of the most important Brasilianas in the world.
Natural Hazards Governance in Canada
Authors: Lindsay Jack
Published: September 2018

The responsibility for hazard governance in Canada is indirectly determined by the division of subjects in the Constitution Act of 1867. This is because emergency management is not a distinct constitutional subject, and therefore it is a matter of assessing which subjects are most related to the practices of emergency management. As a result of this uncertainty both the provincial and federal governments have emergency management legislation. The various provincial legislation and the federal Emergencies Act of 1988 are primarily focused on providing for the use of extraordinary powers as part of crisis response. The federal Emergency Management Act 2008 does take a more comprehensive approach that includes hazard mitigation, but its reach only extends to federal departments.

The governance tools most applicable to hazard management, such as land-use planning and zoning, are normally found within the Provinces’ planning or municipal legislation. The planning legislation empowers local authorities to manage development and its interaction with the natural environment. However, these powers are seldom directed towards hazard mitigation. If there is a reference to natural hazards in the planning legislation it is usually to specific risks, such as flooding or slope failure, that are spatially bounded risks to development.

This separation of hazard governance in the legislation is reflected in local government practices. In most provinces emergency managers are not required by their respective legislation to incorporate hazard mitigation into community emergency programs. The planning legislation, however, seldom extends the community planner’s mandate for mitigation beyond the concerns for safe building sites and the separation of incompatible land uses. The responsibility to prevent human development from interacting with the extremes of the natural environment, or more succinctly “hazard governance,” is not clearly assigned in Canada.
Going Online to Stay Connected: Online Social Participation Buffers the Relationship Between Pain and Depression
Authors: Ang Shannon , Chen Tuo-Yu
Published: September 2018

Objectives

Maintaining offline social participation (i.e., face-to-face social interaction) is key for healthy aging, but older adults who experience pain tend to restrict their social activity outside of the home. The onset of pain may set off a downward spiral where lowered social participation increases the risk of depression and vice versa. This study thus assesses whether online social participation (i.e., the use of online social network sites) moderates the effect of pain on depression, possibly functioning as a compensatory mechanism for reduced offline social participation for those in pain.

Method

Logistic regression models with a lagged dependent variable were used with panel data from the National Health and Aging Trends Study. An interaction term was included to assess the moderating effect of online social participation.

Results

We find that online social participation buffers the detrimental effect of pain on depression. However, the effect of pain on online social participation was not statistically significant.

Discussion

Findings show that online social participation can alleviate the negative effects of pain on mental well-being, and suggest that online social participation can supplement attempts to maintain offline social participation in later life, especially for those whose social activity may be limited by pain.
Immunogenicity and Reactogenicity of 13-Valent Pneumococcal Conjugate Vaccine Among Infants, Toddlers, and Children in Western Burkina Faso: Results From a Clinical Trial of Alternative Immunization Schedules
Authors: Moïsi Jennifer C , Yaro Seydou , Kroman Sita S , Gouem Clarisse , Bayane Dramane , Ganama Seydou , Meda Bertrand , Nacro Boubacar , Njanpop-Lafourcade Berthe-Marie , Ouangraoua Soumeya , Ouedraogo Issaka , Sakande Souleymane , Sawadogo Francois , Zida Sylvie , Ouedraogo Jean-Bosco , Gessner Bradford D
Published: September 2018

Background

Many African countries have introduced pneumococcal conjugate vaccine (PCV) into their routine immunization program to reduce the burden of morbidity and death that results from Streptococcus pneumoniae infection, yet immunogenicity and reactogenicity data from the region are limited for the 2 available PCV products.

Methods

We conducted a randomized trial of 13-valent PCV (PCV13) in Bobo-Dioulasso, Burkina Faso. Infants received 3 doses of PCV at 6, 10, and 14 weeks of age or at 6 weeks, 14 weeks, and 9 months of age; toddlers received 2 doses 2 months apart or 1 dose beginning at 12 to 15 months of age; and children received 1 dose between 2 and 4 years of age. We measured each participant’s serotype-specific serum immunoglobulin G concentration and opsonophagocytic activity before and after vaccination. For each age group, we compared immune responses between study arms and between the standard schedule in our study and the PCV13-licensing trials.

Results

In total, 280 infants, 302 toddlers, and 81 children were assigned randomly and underwent vaccination; 268, 235, and 77 of them completed follow-up, respectively. PCV13 resulted in low reactogenicity in all the study arms. The vaccine elicited a strong primary immune response in infants after 2 or more doses and in children aged 1 to 4 years after 1 dose. Infants who received a booster dose exhibited a robust memory response. Immunogenicity was higher than or comparable to that observed in the PCV13-licensing trials for a majority of serotypes in all 3 age groups.

Conclusions

PCV13 has a satisfactory immunogenicity and reactogenicity profile in this population. Our findings will help support decision making by countries regarding their infant and catch-up vaccination schedules.
Repeated False-Positive HIV Test Results in a Patient Taking HIV Pre-Exposure Prophylaxis
Authors: Stekler Joanne D , Violette Lauren R , Niemann Lisa , McMahan Vanessa M , Katz David A , Baeten Jared M , Grant Robert M , Delaney Kevin P
Published: September 2018

Regular HIV testing is required to ensure the safety of HIV pre-exposure prophylaxis (PrEP). We describe and discuss a series of false-positive HIV test results from an individual receiving PrEP. The expansion of PrEP will likely result in greater numbers of false-positive test results that may pose challenges for interpretation.
The Eustachian Tube as a Landmark for Early Identification of the Abducens Nerve During Endonasal Transclival Approaches
Authors: Revuelta Barbero Juan M , Subramaniam Somasundaram , Noiphithak Raywat , Yanez-Siller Juan C , Otto Bradley A , Carrau Ricardo L , Prevedello Daniel M
Published: September 2018

BACKGROUND

Expanded endonasal approaches have the potential to injure the abducens nerve (cranial nerve [CN] VI). The nerve's root entry zone (REZ) and cisternal segment (CS) are particularly prone to injury during the clivus resection and dural incision of transclival approaches.

OBJECTIVE

To investigate the role of the eustachian tube (ET) as a surgical landmark for the REZ and CS of CN VI.

METHODS

Transclival expanded endonasal approaches were performed bilaterally in 6 fresh-frozen cadaveric specimens (12 sides). Anatomic relationships between ET and CN VI were documented with neuronavigation.

RESULTS

The mean vertical distance from the inferior brainstem point to the horizontal projection of CN VI REZ, CS midpoint, and interdural segment (ID) were 26.38 mm (95% confidence interval [CI] 17.36-35.4), 38.61 mm (95% CI 25.61-51.61), and 42.68 mm (95% CI 30.14-55.22), respectively. The relative vertical distance from the ET to the horizontal projections of the REZ, CS midpoint, and its ID were 6.43 mm (95% CI 3.25-9.61), 18.66 mm (95% CI 11.52-25.8), and 22.72 mm (95% CI 16.02-29.42), respectively. In the axial plane the angles between the ET and (1) the REZ and its midline horizontal projection point, (2) the midpoint and its midline horizontal projection point, and (3) ID and its midline horizontal projection point were 9.81 ± SD 5.20°, 18.50 ± SD 4.87°, and 24.71 ± SD 6.21°, respectively.

CONCLUSION

The ET may serve as a constant landmark to reliably predict the position of the REZ and CS of CN VI.
Thriving in Scrubs: Understanding OBGYN Resident Resilience
Authors: Winkel Abigail , Honart Anne , Robinson Annie , Jones Aubrie-Ann , Squires Allison
Published: September 2018

PURPOSE:

To understand how resilience manifests during the critical developmental time of residency.

BACKGROUND:

Physician well-being has been connected with outcomes for the health of physicians and also their patients' safety and satisfaction. Better understanding of resilience could guide interventions aiming to relieve burnout.

METHODS:

A qualitative study was performed using grounded theory to analyze the lived experience of resilience in residents. Obstetrics and gynecology residents were selected as an intensity sample, presumed to have an intense but not extreme experience of resilience. Eighteen residents in all years of training participated in semi-structured interviews based on concepts identified by the literature. A three-phase process of open coding, analytic coding and thematic analysis generated a conceptual model for resilience among residents

RESULTS:

Resilience among residents emerged as rooted in the resident's calling to the work of medicine, informed by aspirations to perform work valued by their community and cultivate connections with patients. Drive to overcome obstacles arose from strong affiliation with professional identity and values. Residency itself presented adversity, which caused residents to examine and cultivate coping mechanisms. Strong supports from peers and mentors in medicine as well as connections outside of medicine represented powerful buffers through conflicts presented throughout training.

DISCUSSION:

Resilience among residents is a dynamic and developmental phenomenon, informed by their background and personal goals, and influenced by the surrounding culture. Educational programs that foster deeper connections to the human dimension of the work, and allow residents to attend to their personal needs and development, may enhance resilience.
The Current State of Residency Preparatory Courses in Obstetrics and Gynecology
Authors: Skinner Bethany , Morgan Helen , Marzano Anita , Marzano David , Hammoud Maya
Published: September 2018

PURPOSE:

To describe the prevalence and content of Residency Preparatory Courses (RPCs) for Obstetrics and Gynecology (OB/GYN) in the United States, and to determine if student performance assessments are fed forward to Program Directors (PDs).

BACKGROUND:

Following implementation of the ACGME Milestones, medical schools developed RPCs to facilitate students’ transition to residency. However, data are lacking regarding the prevalence and characteristics of RPCs, and whether student performance assessments are transferred from medical schools to residencies.

METHODS:

An electronic survey evaluating the characteristics of OB/GYN RPCs, assessments used, and transfer of performance assessments was sent to the Association of Professors of Gynecology and Obstetrics' Clerkship Directors email distribution list. Descriptive statistics were tabulated for multiple-choice responses, and free-text responses were qualitatively analyzed.

RESULTS:

The response rate was 44.2% (n=96/217). Only 40.6% of respondents, (n=39/96) offered RPCs. Courses were commonly less than two weeks’ duration (69.2%, n=27/39). Use of milestone-based curricula was common (64.1%, n=25/39). However, only half (n=19/38) assessed Level 1 Milestone sub-competencies. Information regarding student performance was rarely fed forward to PDs (18.4%, n=7/38). Free-text comments revealed high interest in RPC development.

DISCUSSION:

Less than half of OB/GYN Clerkship Directors surveyed currently offer RPCs, but interest in developing these courses is high. Though many report use of milestone-based curricula, only half assess Level 1 Milestone competency, and this information is rarely fed forward to PDs. Further development of RPC curricula, robust Level 1 Milestone assessments, and transfer of assessment information to PDs are needed to improve the transition from medical school to residency.
Retention of Knowledge Learned During a Resident Didactic Session About Billing
Authors: Martinez Anjali , Keller Jennifer
Published: September 2018

PURPOSE:

To evaluate the retention of knowledge after an educational session to teach Obstetrics and Gynecology residents the basics of billing Evaluation and Management visits.

BACKGROUND:

Graduating residents could benefit from having some knowledge about billing and coding; however, they do not often use this knowledge in practice during residency. This study was undertaken to see if residents retained knowledge months after attending a didactic session on that topic.

METHODS:

Obstetrics and Gynecology residents attended a didactic session about billing Evaluation and Management visits. Baseline knowledge was assessed with a pretest, and the same test was administered after the session as a post-test. Ten months later, residents took the same post-test to determine their level of retention. Another group of residents who had not attended the workshop also took the test at the ten month mark and served as a control group.

RESULTS:

11 residents were in the intervention group and 13 residents were in the control group. The exam mean improved from 4.2/10 to 7.9/10 after the session. This improvement was statistically significant (P<.01). Compared to the pretest, the ten-month follow up scores had a statistically significant increase with a mean score of 6.0/10 (P<.01). Those scores were also better than the 4.6/10 mean for the control group (P=.01).

DISCUSSION:

Residents improved on a written examination regarding billing for Evaluation and Management visits months after completing an educational session on the topic. They retained some of the knowledge they learned at the session despite not using the knowledge in the interim.
“On-the-Go” Training: Downloadable Modules to Educate Students in Care for Sexual Assault Survivors
Authors: Siegel Molly , Gonzalez Estela Chen , Wijesekera Olindi , O'Reilly Margaret , March Gail , Bell Shannon
Published: September 2018

PURPOSE:

An innovative approach to train students to provide trauma-informed care for survivors of sexual assault (SA) through independent learning.

BACKGROUND:

All medical providers encounter patients who have experienced SA, and can have significant impact on survivors; long-term health. Training medical students to provide appropriate, trauma-informed care is lacking in most medical school sexual health curricula. Appealing to the millennial learner, we developed three downloadable video/podcast-style modules for on-the-go use.

METHODS:

We worked with interdisciplinary experts in trauma-informed care to develop modules on interviewing patients with recent and distant history of SA and acute medical management. The study group was a cohort of interested medical students. Students completed pre- and post-tests assessing knowledge, and a paired t-test evaluated overall change in knowledge test scores. Students responded to a Likert-style question on self-reported comfort caring for this population, and responses were analyzed with a chi-square test.

RESULTS:

Thirty-two medical students spanning all years beta-tested the modules and 97% completed the study. Overall, student knowledge scores improved 20% (95% CI=16%-23%, P<.0001). After completing the curriculum, students reported a significantly improved comfort level (P=.0250). Students enjoyed the learning format and reported the modules enhanced their education (72-88%) and were appropriate for their education level (69-97%).

DISCUSSION:

Following completion of modules, students demonstrated improved knowledge and reported increased confidence in caring for this patient population. These modules seek to empower students to step beyond screening in their care for patients with sexual trauma history. Future directions include publication of existing modules and expansion of the module library.
A Systematic Review and Meta-Analysis of Simulation in Obstetrics Training
Authors: Nitsche Joshua , Nae Ana-Maria , Chen Haiying , Brost Brian
Published: September 2018

PURPOSE:

To summarize the available data on the benefits of the use of simulation in training obstetric providers.

BACKGROUND:

Although simulation is being increasingly used to train obstetric providers, its overall benefit has not been systematically assessed.

METHODS:

A systematic search of MEDLINE was performed from May 2011 until April 2017 to identify research evaluating simulation in obstetrics. Data regarding provider type, instructional design, outcomes, and research quality, using the medical education research study quality index (MERSQI) and Newcastle-Ottawa Scale for Education (NOS-E), was abstracted. The average weighted Hedges g effect size was calculated.

RESULTS:

1423 articles were identified, of which 63 met inclusion criteria. 39 were excluded because they were 1 group pretest-posttest studies (which nearly always show positive effects), and 5 were excluded because they did not contain sufficient information to calculate effect size, leaving 19 articles in the meta-analysis. Of the selected articles 15 were randomized, 3 were nonrandomized, and 1 was a cross-over study. Provider satisfaction was assessed in 2 studies, knowledge in 1, simulated skills in 11, clinical behaviors in 4, and patient effects in 1. The average MERSQI and NOS-E quality scores were 13.3±23 (out of 18) and 5±0.8 (out of 6), respectively. The weighted average effect size for the 19 studies was 0.71 (95% CI, 0.58-0.83).

DISCUSSION:

Simulation training in obstetrics is associated with moderate effects in provider satisfaction, knowledge, skills, behaviors, and impact on patients. The effects sizes described here were slightly smaller and methodological quality slightly higher compared to previous meta-analyses in Anesthesiology and Emergency Medicine.
Assessment of Low-cost, Intrauterine Contraception Simulation Training for Preclinical Students
Authors: Field Carlie , Benson Lyndsey , Stephenson-Famy Alyssa , Prager Sarah
Published: September 2018

PURPOSE:

To assess whether a low-cost didactic workshop on intrauterine devices (IUDs) improves preclinical medical students' knowledge and comfort with counseling patients on IUDs.

BACKGROUND:

Medical school reproductive health curricula often lack teaching regarding IUDs. Preclinical medical students have insufficient knowledge and training to counsel patients about IUDs.

METHODS:

Preclinical medical students completed a survey before and after a voluntary IUD didactic workshop at the University of Washington. The session consisted of a 45-minute lecture and 45-minute hands-on simulation of IUD insertion. The primary outcome was comfort level with IUD counseling.

RESULTS:

Ninety-eight students completed both pre- and post-workshop surveys. Most students planned to enter primary care specialties. More than half of students had seen at least one IUD inserted and almost all students (91%) had an IUD themselves or knew someone personally who had one. The proportion of students scoring 75% or higher on the IUD knowledge questions increased from 55% prior to the workshop to 91% after completing the workshop (P<.001). The proportion of students who felt comfortable counseling patients on IUDs increased from 31% to 90% (P<.001).

DISCUSSION:

A simple, low-cost workshop increases medical students’ knowledge and comfort with IUDs. This workshop could serve as a framework for medical schools to ensure students receive appropriate education and hands-on learning related to IUDs prior to entering their clinical rotations and for their future careers.
Continued Validation for a Task Trainer and Targeting Curriculum for Ultrasound Guided Invasive Procedures
Authors: Nitsche Joshua , Conrad Sarah , Hoopes Sarah , Carrel Meredith , Bebeau Katherine , Brost Brian
Published: September 2018

PURPOSE:

To assess the effect of training and the inter- and intra-rater variability of a targeting curriculum for ultrasound guided invasive procedures.

BACKGROUND:

We previously demonstrated the content, face, and construct validity of our curriculum. Here we assess its inter- and intra-rater reliability.

METHODS:

Echogenic targets (wooden dowels, plastic straws, and wooden balls) were placed in water filled buckets covered with simulated skin (ballistic gelatin). We assessed 23 1st year medical students performing two targeting tasks (guiding the needle to multiple targets in a random sequence), held 4 weekly one hour training sessions, and reassessed their performance. Completion time in seconds, errors (as recorded by multiple assessors), and error adjusted time (5 sec penalty/error) were recorded. These measures were compared before and after training using a repeated measures t-test. Inter- and intra-rater inter-class correlation coefficients (ICC) were calculated.

RESULTS:

Completion time, errors, and error adjusted time on the dowel tasks were 176±70, 7.4±, 213±95, respectively before training, and 95±61, 2.7±3.4, and 109±74, respectively after training (all P<.0001). The completion time, errors, and error adjusted time on the straw task were 319±98, 9.4±4.6, and 366±114, respectively before training, and 179±57, 3.1±3.2, and 195±67, respectively after training (all P<.0001). The inter-rater ICC for the dowel and straw tasks were 0.83 and 0.91, respectively. The intra-rater ICCs were 0.93 and 0.90, respectively.

DISCUSSION:

Conclusions: Student performance on the targeting tasks improved markedly after 4 weekly training sessions. The inter- and intra-rater reliability was excellent. This provides additional validity evidence for our novel ultrasound guided invasive procedure task targeting curriculum.
Current Trends in Psychiatry Education Among Obstetrics & Gynecology Residency Programs: A Cross-sectional Survey of Program Directors
Authors: Garbarino Abigail , Kohn Jaden , Coverdale John , Kilpatrick Charles
Published: September 2018

PURPOSE:

To assess the status of psychiatry education in Ob/Gyn residencies, focusing on perceived barriers in education.

BACKGROUND:

One-third of women in the U.S. receive primary care exclusively from Obstetrician/Gynecologists. Recent literature reveals gaps in recognition of common psychiatric issues by Ob/Gyns.

METHODS:

Program directors (PDs) of all 249 accredited Ob/Gyn residency programs received a 17-item anonymous questionnaire. Analysis of responses included descriptive statistics, Student’s t-tests, and logistic regression.

RESULTS:

111 programs responded to the survey (44.5%); 20 responses were partial. 85% offer didactic instruction in psychiatric topics, of which 82% are taught by Ob/Gyn faculty. Academic institutions were more likely to offer didactics in psychiatry than community institutions (OR=3.2, P=.04). Only 20% of programs offered an elective rotation in mental health. 20% of programs formally evaluate residents on their management of psychiatric disorders. 81% of PDs do not agree that their residents are fully equipped to identify patients; psychiatric needs; however, only 23% believe that mental healthcare should be included as an ACGME milestone. Community programs were more likely to agree with adding a milestone (P=.002). The most common barriers to providing additional psychiatric training were lack of sufficient integration between Ob/Gyn and psychiatry (44%), ACGME surgical requirements (41%), and lack of sufficiently knowledgeable instructors (36%). In addition, valuable qualitative comments were received from respondents.

DISCUSSION:

While most programs deliver didactic training in psychiatric topics, most PDs perceive that residents are not fully equipped to identify psychiatric needs. The most common barrier to providing additional training was lack of integration between Ob/Gyn and psychiatry.
Gender Differences in Academic Performance in the OB/GYN Clerkship
Authors: Mills Mistie , Hoffman Kimberly , Johnson Gina
Published: September 2018

PURPOSE:

Evaluate gender differences in academic performance within the Obstetrics and Gynecology Clerkship at the University of Missouri.

BACKGROUND:

Unconscious bias, baseline knowledge or access to opportunities that may affect students' overall performance. Therefore, making it necessary to evaluate gender differences in academic performance.

METHODS:

USMLE Step 1 exams, pre-clinical year's evaluations, NBME shelf exam scores, faculty evaluations of students with overall exemplary grades, clerkship grade distribution were compared from 2013-2017 to determine if there was a gender difference in academic performance. Student assessment is standardized. First attempt USMLE and NBME scores were evaluated. An evaluator was included if they performed more than 6 evaluations. 388 students qualified for the study. Independent 2 sample t-test was used assuming unequal variances.

RESULTS:

Males scored higher on the USMLE Step 1 exam with statistically significance. There was no difference of performance within genders during the pre-clinical years. Females scored higher on the NBME shelf exam, clinical evaluations, faculty assessments and final clerkship grade evaluations.

DISCUSSION:

There are notable gender differences in academic performance within the Obstetrics and Gynecology Clerkship, favoring females. Preexisting personal knowledge and a higher number of females expressing interest and entering OB/GYN residency may give females a slight advantage over their male counterparts. Assuming that standardized assessments demonstrate knowledge gained by students, the results may reflect that females are gaining more experiences or opportunities during their clerkship. It is important to critically review the data to ensure males and females are achieving the same training and opportunities.
Leadership Aspirations Among OB/GYN Residents in the United States
Authors: Bavan Brindha , Chavez Jordan , Saravanabavanandhan Briana , MacLaughlan David Shannon
Published: September 2018

PURPOSE:

To assess the role of gender and mentorship in identifying leadership as a career goal among residents in Obstetrics and Gynecology (OB/GYN) in the United States (US).

BACKGROUND:

Within the field of OB/GYN in the US, women are underrepresented in leadership positions despite representing the majority of physicians. We hypothesized that women do not identify leadership as a career goal as often as men do while in OB/GYN training and examined other associated factors.

METHODS:

We evaluated US OB/GYN resident goals via an IRB-approved survey emailed to the US OB/GYN Residency Program Coordinator listserv. Data were collected in REDCap. Cross-sectional descriptive and comparative analyses were completed.

RESULTS:

A total of 198 US OB/GYN residents completed the survey, including 170 women (86%) and 28 men (14%). The majority of respondents were from university programs (70%). Two-thirds of respondents reported an interest in pursuing a leadership position (n=133, 67%). Women were less likely to identify leadership as a goal compared to men (64% vs. 86%, P=.024). OB/GYN residents who reported receiving specific mentorship about leadership were more likely to report interest (81% vs. 53%, P<.001). Finally, women in programs in which three or more leadership positions were held by women were more likely to report interest in such roles themselves (76% vs. 60%, P=.047).

DISCUSSION:

Gender disparity among leadership is identifiable in goal-setting as early as residency training in OB/GYN. We recommend addressing this gap with specific mentorship and leadership-development curricula within OB/GYN residencies.
Medical Student Abuse—An Obstetrics and Gynecology Perspective
Authors: Holmstrom Shelly , Klocksieben Farina , Zreibe Damien , O'Brien Kevin
Published: September 2018

PURPOSE:

To evaluate medical student mistreatment in obstetrics and gynecology rotations as perceived by physicians and medical students using standardized video-taped vignettes.

BACKGROUND:

Medical student mistreatment is pervasive and typically occurs during the third year of medical school. While most events are minor, the ramifications for the mistreated medical student are real and include increased risk of anxiety, depression, substance use, suicidal ideation, burnout, avoidance of the specialty where the mistreatment occurred and leaving medicine entirely.

METHODS:

Three video vignettes were filmed portraying possible medical student abuse in obstetrics/gynecology clinical settings. Attending physicians, resident physicians and rotating medical students were asked about their personal experience with mistreatment and then asked to view the three videos. After each video, participants were asked if they believed the vignette represented medical student mistreatment and to rate the level of severity.

RESULTS:

Eight attending physicians, ten resident physicians and ten medical students participated in this study. Fourteen participants (50%) reported previous mistreatment as a student, all of which occurred during third year of medical school. Neither previously mistreated participants, women participants nor ethnic minority participants were not more likely to view the scenarios as abuse or rate the scenarios as more severe. Medical students were not more likely to view the vignettes as mistreatment or more severe as compared to resident and attending physicians.

DISCUSSION:

In our small pilot study, medical students, resident physicians and attending physicians generally agreed which video vignettes represented medical student mistreatment and the level of severity of the abuse.
Multidisciplinary Severe Maternal Morbidity Reviews Can Teach the Clinical Learning Environment Review Focus Areas of Patient Safety and Quality
Authors: Ogunyemi Dotun , Hage Natalie , Sun Kim , Friedman Perry
Published: September 2018

PURPOSE:

To describe a resident focused multidisciplinary severe maternal morbidity (SMM) review program.

BACKGROUND:

The Joint Commission defined SMM as peri-partum blood transfusion of 4 units or admission to ICU and recommends multidisciplinary reviews to determine opportunities for improvement in care

METHODS:

An ongoing process detects cases of SMM with root-cause-analysis performed if case qualifies as a sentinel event. Data is extract and presented quarterly to, a multidisciplinary committee to determine contributory factors, opportunities to alter outcome, best practices and recommendations.

RESULTS:

Forty-five SMM cases were reviewed from 1/15 to 6/17 by residents 67%, fellows 9%, nurses 7%, and MFM faculty 17%. Opportunities to alter care were determined to be strong in 9% and possible in 62%. System/provider could alter outcome in 53% while the patient could have altered outcome in 33% of cases. Outcomes could have been altered by contraception/sterilization in 13%, patient compliance 11%, early prenatal care 20%, referral/consultations 9%, improved documentation 7%, early recognition 33%, team communication 4% and management 31%. Good practices recognized included multidisciplinary teamwork/communication 60%, evidence-based response 36%, timely recognition 24%, documentation 20%, quality obstetric care 22%, timely referral 13%, expertise care 9%, and patient-centered-care 7%. Strong opportunity to alter outcome was present with hypertensive crisis (P=.026). Significant opportunities to alter outcomes were: preterm SMM cases by contraception/sterilization (P=.036); patient compliance in Medicaid insured (P=.01) and younger women (P=.04). Transfusions were recognized for the good practice of timely recognition (P=.045).

DISCUSSION:

Residents' involvement in SMM reviews can determine care improvement opportunities and provide training on safety and quality.
Navigate Stormy Seas With Effective Simulation Training in Delivering Serious News
Authors: Fay Emily , Amory Josephine , Hurd Caroline , Stephenson-Famy Alyssa
Published: September 2018

PURPOSE:

To evaluate the change in obstetrics and gynecology (OB/GYN) resident’s self-confidence in delivering serious news after a communication simulation workshop.

BACKGROUND:

Although OB/GYN residents regularly disclose serious news to patients, formal training on best communication practices is lacking. Using the VitalTalk framework, we developed and evaluated a workshop for delivering serious news in OB/GYN.

METHODS:

OB/GYN residents attended a 3-hour small group workshop, with didactic and drills (1 hour) followed by practice delivering serious news with simulated patients (2 hours). Change in self-confidence pre- and post-workshop was measured using a 5-point Likert scale (1 is lowest, 5 is highest) and was compared using Wilcoxon signed rank test (alpha = 0.05).

RESULTS:

Twenty-five residents completed the training. Residents agreed that delivering serious news requires a discrete set of skills (89%) and is a procedure all residents should learn (96%). Following the workshop, residents expressed greater confidence explaining medical information (P<.01), identifying and responding to emotion cues (P<.01), delivering serious news (P<.001), and teaching learners about how to facilitate delivering serious news (P<.001). Residents felt that it taught them skills they plan to use (96%), that simulated practice prepared them better than clinical experience alone (92%), that observing other residents improved their own communication skills (80%) and that they would recommend the workshop (96%).

DISCUSSION:

This workshop was well received and associated with improvement in self-confidence in delivering serious news. Longer-term observation is needed to see if this confidence persists and translates into improved patient care.
Reliable Assessment of Medical Student Performance on the Obstetrics and Gynecology Clerkship
Authors: Skinner Bethany , Zaidi Nikki , Kempner Samantha , Morgan Helen , Santen Sally , Hammoud Maya
Published: September 2018

PURPOSE:

To determine the number of assessors needed to reliably assess medical students' overall clinical performance during the OB/GYN clerkship.

BACKGROUND:

Reliable assessment of students' clinical performance during clerkships provides important information for decisions regarding grades and advancement. However, the assessment ratings students receive can vary based on many factors, and there are no clear data regarding the number of assessors needed to obtain a reliable assessment of students' clinical performance on the OB/GYN clerkship.

METHODS:

During the 2015-2016 OB/GYN clerkship, faculty and residents completed one assessment per student. Using the overall performance score for each student, we performed generalizability analysis to determine the number of assessors needed to achieve an acceptable threshold of reliability (G=0.7).

RESULTS:

Students’ mean overall performance score was 6.38±1.21 (scale of 1-10). 90.1% of variance in scores was attributed to assessors and 9.9% was attributed to students. The generalizability estimate for eight assessors was G=0.469. For other clerkships, G coefficients for eight assessors ranged from 0.000-0.795. Decision studies suggest that 17 assessors were needed to achieve G=0.7 for the OB/GYN clerkship, compared to 4-12 assessors for other clerkships.

DISCUSSION:

Much of the variation in students’ overall performance scores can be attributed to assessors rather than students. We suggest clerkships with high variability among assessment scores find alternative ways to interpret these scores. For example, we currently use each assessor's Z score to determine the number of standard deviations each student's assessment lies from the assessor's mean student evaluation score to adjust for assessor stringency or leniency.
Resident Self Perception of Milestone Level as Compared to the Clinical Competency Committee
Authors: Ward D. Gregory , Miller Collin , McLennan Mary
Published: September 2018

PURPOSE:

To assess resident perception of Milestone level as compared to the Clinical Competency Committee (CCC).

BACKGROUND:

The Milestone Project was a joint initiative of ACGME, ABOG and ACOG and implemented in July of 2014. The Milestones serve as a descriptive blueprint to guide curriculum development and assessment practices. They allow programs to more accurately evaluate the outcomes of residency education and allow programs to track resident development over time.

METHODS:

The 24 residents of the Saint Louis University Ob/Gyn program were asked to rate themselves on each of the 28 Milestones based on their perception of where they felt they were in their training. This was done independent of the CCC. The CCC met for its semi-annual meeting and completed the Milestone report for each resident in standard fashion. The CCC was not aware that the residents were also rating themselves on each Milestone. Resident and CCC ratings were compared, with differences defined as a discrepancy ≥1 point.

RESULTS:

Overall, there was a close approximation of what the CCC and residents determined to be their Milestone level. Milestone agreement varied slightly by post graduate year, with the greatest agreement observed in PGY-4 (90%) and the least agreement in PGY-3 (79%). When analyzed by Milestone group, the greatest agreement was observed in Interpersonal Communication and Medical Knowledge (90% and 89%, respectively).

DISCUSSION:

Resident self-perception of Milestone level is comparable to the CCC in our program. There tends to be slightly more variation among the PGY-2 and 3 levels across all Milestones.
There Is an APP for That: Vaginal Hysterectomy
Authors: Miyazaki Doug
Published: September 2018

PURPOSE:

To create an instructional app which includes medical knowledge, procedural steps and assessments based on the ACOG curriculum for vaginal hysterectomy.

BACKGROUND:

Vaginal hysterectomy is the evidence based medicine route of choice when feasible. Significant challenges exist in teaching this procedure due to lack of simulation training, proper assessment of specific techniques and timely instruction prior to performing the procedure. There is also considerable variation in how cases are tracked and assessments of technique are done.

METHODS:

Key features/contents of the application include: 1) ACOG curriculum for vaginal hysterectomy, 2) a complete step by step live and simulated surgical video tutorial, 3) a procedural step by step assessment (10 steps-- 0-10 score), 4) a global surgical rating scale (7 metrics), and 5) a knowledge based assessment (4 metrics, 0-4 scale).

RESULTS:

The data captured on the app can be accessed via IPAD and iPhone mobile devices and is verified by Apple. The evaluations can be directly emailed to any database.

DISCUSSION:

A comprehensive instructional surgery app coupled with real time assessment will provide greater learning efficiency and will more effectively improve surgical skills. This app has the potential to standardize surgical evaluation in the operating room and provide a more efficient method to track surgeon competency using ACOG guidelines. The assessment is currently employed by the ACOG Simulation Consortium Working group during vaginal hysterectomy simulation and is part of a surgical simulation course which certified by the ABOG for MOC credits.