bluuebunny/crossref_metadata_2025 huggingface dataset:
Video Curriculum for Gynecologic Surgery
Authors: Johnson Christina , Stroup Caroline , Gujral Harneet , Wright Kelly , Baecher-Lind Laura
Published: September 2018

PURPOSE:

To evaluate the efficacy of a surgical video curriculum versus standard learning throughout the rotation.

BACKGROUND:

With decreasing surgical volume, training time restrictions, and more routes to approach individual cases, efficient and effective tools for surgical learning are essential. We developed several videos teaching pelvic anatomy and steps of common gynecologic procedures.

METHODS:

The video curriculum was presented to alternating groups of students completing their OBGYN clinical rotation compared with standard rotation exposure. Participants knowledge of relevant anatomy and surgical steps was assessed at baseline, the rotation end, and immediately after exposure in the video group. Mean score assessment scores, overall impressions, and learning preferences were evaluated.

RESULTS:

All 42 participants had similar training, case exposure, and baseline scores. At the end of the rotation, the mean rotation-end scores were 34% and 46% for control and video groups (P=.005), and the difference remained significant when corrected for baseline score (P=.012). The mean post-test score rose to 49% compared to a baseline mean of 25% (P<.001). Seventy-four percent of participants preferred video over text, 86% reported the series was a useful educational tool, 90% would use the videos for case preparation, and 55% felt more engaged during surgery.

DISCUSSION:

The video series improved students' performance on assessment of anatomy and surgical steps. Overall impressions of the video series were positive and most students reported they preferred video to text format. Moving forward, videos like these can be used and examined as adjunctive tools for acquisition of specific surgical knowledge and skills.
Recent Ob/Gyn Residency Graduates' Experience With Hysterectomy
Authors: Cadish Lauren A. , Muffly Tyler M.
Published: September 2018

Local Mentor:

Carol Major, MD

APGO Advisor:

Jody Steinauer, MD

OBJECTIVE:

To estimate the average hysterectomy volume performed by Obstetrician-Gynecologists in their first five years following residency graduation

METHODS:

This is a retrospective cohort study of recent residency graduates. Provider-identified, patient-deidentified case mix data from 2004-2014 were obtained from the Massachusetts Center for Health Information Analysis statewide database. Data were crosslinked to demographics, year of residency graduation, and fellowship training. Data were narrowed to simple hysterectomies by Ob/Gyn specialists within five years of graduation. Mean hysterectomy numbers performed in each of the first five full calendar years following residency were determined by descriptive statistics and stratified by modality. A veteran cohort of physicians completing residency training 20 or more years earlier but younger than 65 served as a comparison group.

RESULTS:

Case mix data revealed 89,026 hysterectomies performed by 1,909 physicians from January 1, 2004 to December 31, 2013. Of these 1,359 were simple hysterectomies performed by 85 recent residency graduates practicing as Ob/Gyn specialists. For this cohort, the mean number of hysterectomies performed annually was 4.7, 4.6, 4.7, 4.3, and 4.1 in each of the first five full calendar years respectively following training. Recent graduates most commonly chose the abdominal route (41.6%), with laparoscopic (32.4%), laparoscopically assisted vaginal (11.1%) and vaginal (14.7%) chosen less commonly. Hysterectomy volume did not change significantly over the first five years. Procedures performed in 2014, and comparison to the veteran cohort will be included in the final analysis (see poster presentation).

CONCLUSION:

Recent graduates perform an average of 4 hysterectomies annually, most often abdominally.
Simulation in the Obstetrics and Gynecology Clerkship: A Systematic Review of the Literature
Authors: Hunt Rebecca , Hostage Jean
Published: September 2018

Local Mentor:

Robert Trowbridge, MD

APGO Advisor:

Kimberly Kenton, MD

CONTEXT:

Simulation is increasingly being used in medical education at all levels - to teach, train, and practice. Since time, effort, and resources are budgeted toward that training, it would be helpful to know if simulation is useful in obstetrics and gynecology clerkship, and if so, to what degree.

OBJECTIVE:

The purpose of this systematic review of the literature is to present what is known about the use of simulation in the Obstetrics and Gynecology clerkship. The review outlines the core surgical and procedural skills that are addressed by simulation, what simulations exist, and what has been found to be satisfactory, cost conscious, and effective. By identifying gaps, we shall be able to develop new simulations in the future that will be useful to medical students and their teachers.

DATA SOURCE:

A search was made in the databases of MEDLINE, Cochrane, MedEd Portal, BioMed Central and ScienceDirect, 1996 to present.

STUDY SELECTION:

Articles in English describing or evaluating simulation in obstetrics and gynecology clerkships. Search terms included: obstetrics, gynecology, simulation, clerkship, reproductive system, undergraduate medical education, high-fidelity sim training, patient simulation.

EXCLUDED:

Focus on 4th years or non-medical students, general surgery, virtual patients requiring only standard computer equipment, human patient actors.

DATA EXTRACTION:

Review of the articles is pending.

PLANNED MATRIX:

Training level, clinical topic, location (Sim center or clinical), study design, number of students exposed, method of group assignment, outcomes, methodological quality, (using MERSQI), IRB, and whether applies to a Milestone or APGO Objective.

CONCLUSION:

Pending review and data abstraction.
Effects of a Stress Management Workshop on Medical Students' Knowledge and Self-Awareness of Coping With Stress
Authors: Johnson Natasha R. , Chen Justin , Meyer Fremonta , Chen Xiaodong (Phoenix)
Published: September 2018

Local Mentor:

John Dalrymple, MD

APGO Advisor:

Nancy Hueppchen, MD

OBJECTIVE:

To investigate the effects of a stress management workshop on medical students' knowledge and self-awareness of stress and potential coping strategies.

METHODS:

A two-hour workshop was given to medical students before starting their clerkships consisting of a one hour didactic followed by a panel discussion and small group breakouts. Topics included stress in clinical medicine, learning challenges, competition with colleagues, self-care, handling stressful events, and recognizing burnout symptoms. A longitudinal survey design was utilized to measure pre-, post-, and long-term (3-month) post-workshop students' reported changes in 4 domains: knowledge (impact of stress on their own health, learning, and patient care), confidence, perceived skills, and attitude (towards utilizing adaptive coping strategies to prevent burnout). Surveys were distributed to all students (N=135) participating in the workshop. Paired t-test and multivariate analyses were performed to assess the differences between survey responses on a 5-point Likert scale. IRB approval was obtained.

RESULTS:

The survey response rate was 79.5% (pre- 90.4%, post-77%, long-term post- 71.1%). Compared to the pre-workshop, students reported significant improvement in all 4 domains immediately after the workshop: knowledge (4.4 vs. 4.7, P<.05), confidence (3.6 vs. 3.9, P<.05), perceived skills (3.3 vs. 3.7, P<.05), and attitude (2.6 vs. 2.8, P<.05). Compared to the immediate post-workshop, students' scores slightly decreased at 3 months, but were overall significantly higher than the pre-workshop scores.

CONCLUSIONS:

A stress management workshop can improve medical students' knowledge towards the impact of stress as well as their confidence, perceived skills, and attitude of using adaptive stress coping strategies.
Development of a “Teaching to Teach” Curriculum for Residents
Authors: Kirton Donald
Published: September 2018

Local Mentor:

Heather Sankey, MD

APGO Advisor:

Nancy Hueppchen, MD

OBJECTIVES:

To develop a Resident as Teachers (RAT) Curriculum for the Ob/Gyn residency at UMMS-Baystate. To demonstrate improvement in resident teaching skills, confidence of our residents in teaching, and ability to provide feedback for students.

METHODS:

This IRB exempt project was performed using a single-group pretest posttest design. A needs assessment was performed utilizing three focus groups of Ob/Gyn residents and faculty to outline the curriculum content. Local interdisciplinary faculty were identified to create and implement 8 educational sessions. Residents were surveyed about comfort level in teaching and feedback skills before and after the curriculum was implemented. Medical student assessments of resident teaching for 6 blocks prior to the intervention were compared to evaluations for 6 months post-intervention.

RESULTS:

Only 2 residents had received prior teacher training. All aspects regarding confidence in teaching and giving feedback showed improvement (mean pre-scores 3.57 and 3.56, post-scores 3.93 and 3.94, respectively). Student evaluations of residents showed improvement in effectiveness as teacher (4.3 to 4.68), giving feedback (4.1 to 4.65), being respectful (4.45 to 4.86), learning environment (4.3 to 4.78), being supportive (4.27 to 4.76) and acting as role model (4.35 to 4.84). Identifying the need to improve teaching skills decreased from 24% to 7%.

CONCLUSION:

The RAT curriculum showed improvement in all domains regarding confidence in teaching and giving feedback. The curriculum has resulted in improvement in student evaluations of residents in regards to teaching skills and giving feedback. The teaching skills sessions will be incorporated into the Educational Sessions for our OB/GYN residency program going forward.
Needs Assessment for Integration of Supportive Care Into Obstetrics and Gynecology Practice
Authors: Nugent Elizabeth
Published: September 2018

Local Mentor:

Pamela Promecene, MD

APGO Advisor:

Kimberly Kenton, MD

PROBLEM:

Supportive medicine provides comprehensive care for patients with life-limiting illness, focusing on symptom management and quality of life. Obstetrician gynecologists provide lifelong care to their patients, necessitating their ability to provide these services. No standardized curriculum for palliative care is available for obstetrician gynecology learners.

INTERVENTION:

This intervention sought to comprehensively identify learner's needs as a first step to developing a teaching curriculum specific to supportive medicine for obstetrician gynecologists.

CONTEXT:

A comprehensive assessment was performed which included a literature review of available curricula in other fields and focus groups with a variety of specialists in palliative care (ICU, supportive care, gynecologic oncology, general OB/GYN, NPs, social work). A survey was distributed to local OB/GYN residents and fellows to determine learner comfort with supportive medicine skills and their value for future practice. Then information was synthesized and reviewed to ensure validity.

OUTCOME/LESSONS LEARNED:

Results demonstrate >50% of learners were uncomfortable with narcotic rotation, management of lymphedema, and management of actively dying adult patients. Fetal concerns included management of seizures and air hunger. Sixty-eight percent of learners felt comfortable giving bad news, but 50% had no method for providing the news and 33% had no formal training. Eighty percent of learners desired additional active training in providing bad news. Learners generally valued palliative care skills and their importance to future practice. Focus groups suggested themes of poor learner understanding of pain management, delivery of bad news, and difficulty with patient planning and preparation for neonatal death.
Development of an Evidence-based Robotic Surgery Curriculum in a Community Based OB/GYN Residency Program
Authors: Patel Ashwin
Published: September 2018

Local Mentor:

Todd Beste, MD

APGO Advisor:

Hope Ricciotti, MD

PROBLEM:

The current robotic surgery training curriculum at our community based Ob/Gyn residency program is fragmented, out-of-date, and not well implemented. The goal of this project is to develop and begin implementing a formalized robotic surgery curriculum utilizing evidence based training modalities and other existing curricular components.

INTERVENTION:

The new curriculum will provide tools to verify the residents' competency of robotic-assisted surgery upon graduation. It will employ existing online training modules, in-service training sessions, virtual reality and real-life simulation exercises. Supervised cases as both the assistant and console surgeon are required and performance will be assessed using a modified, validated evaluation tool.

CONTEXT:

The robotic surgery curriculum will consist of two tracts: Tract 1 is designed to educate and promote safety of robotic-assisted surgery; Tract 2 is designed for residents interested in obtaining a robotic training equivalency certificate. Of the existing robotic curricula available, many have shown the above components to be effective tools for educating trainees. Some of these tools have been validated specifically for a robotic surgery curriculum.

OUTCOME/LESSONS LEARNED:

Implementation of this curriculum was started during the current academic year. Residents with prior training experience will assimilate into the appropriate tract. Using these evaluation methods, assessment of robotic surgical skills will be easier to track and provide feedback for improvement. Future steps will involve a survey of graduated residents prior to and after its implementation to assess the perceived effectiveness of the curriculum, ease of obtaining robotic privileges, and their comfort using robotic assisted surgery after graduation.
OB/GYN Clerkship Learning Environment Themes Identified on Qualitative Review of End-of-Clerkship Evaluations
Authors: Previte Colby
Published: September 2018

Local Mentor:

Ruth Anne Queenan, MD, MBA

APGO Advisor:

Lee,Learman, MD, PhD

PROBLEM:

The OB/GYN learning environment presents unique challenges to learners and educators. Consistent with national trends, the University of Rochester (UR) OB/GYN clerkship ranks lower than other clerkships.

INTERVENTION:

To evaluate clerkship strengths and weaknesses, and narrative themes regarding the student experience, content analysis was performed on 2016-2017 end-of-clerkship evaluations. The evaluation asks students to comment on clinical site “strengths and weaknesses” and “positive and/or negative experiences about the learning environment” of the clerkship.

CONTEXT:

Since 2010, clerkship resources pertaining to learning objectives, expectations, reference resources, orientation materials, weekly didactics, and feedback mechanisms have expanded. Residents participate in yearly teaching, learning, and feedback didactics. Despite updates, student feedback remains consistent that integration into clinical teams and learning in the clinical environment is challenging.

OUTCOME/LESSONS LEARNED:

Consistent with previous literature, negative feedback themes include inconsistent teaching, insufficient hands-on experiences, lack of clarity regarding expectations, and difficulty integrating into clinical teams. Positive themes include diversity of experiences in OB/GYN, relationships with patients and families, and procedural learning. Each UR site possesses unique strengths, including exposure to sub-specialists and care of complex patients, for continuity relationships with nurses, and for interdisciplinary learning with family medicine and midwifery. Open ended questions led to varying lengths and level of detail in students' responses. Feedback themes varied over the course of the academic year. These findings precluded accurate statistical analysis of the content. Faculty development interventions, including a faculty educator series addressing narrative themes, will be developed to guide improvement in the OB/GYN clerkship educational experience.
Integrating Student Reproductive Health Educators into a Hospital-Based OB/Gyn Resident Clinic—Stakeholder Views on Trainee Impact
Authors: Salcedo J , Elia J , Tschann M
Published: September 2018

Local Mentor:

Tod Aeby, MD, MEd

APGO Advisor:

Jody Steinauer, MD, MAS

OBJECTIVE:

To evaluate stakeholder views on the impact of integrating a student reproductive health educator (RHE) program into an OB/Gyn resident clinic on resident and medical student education.

METHODS:

Thirty-seven semi-structured interviews were conducted over three time points. Stakeholders included resident and attending physicians, clinic staff, departmental educational leaders, and RHEs (undergraduate and graduate students). Interviews were double-coded and discrepancies resolved through consensus. The code list and sampling were revised at each time point and key themes were identified through an iterative process.

RESULTS:

Residents should demonstrate competence in providing the patient education supported by RHEs before delegating such responsibilities. RHE support may be most valuable to senior residents, allowing them to focus on other patient issues and relieving clinic time pressure. RHEs should be fully integrated into the residency program curriculum by participating in mock counseling sessions and serving as patient education mentors early in residency. RHE-type programs provide residents with skills in team-based healthcare. Medical students are not adequately equipped to provide patient education in reproductive health and serve primarily in a shadowing role in the clinic. The RHE program should be fully integrated into student education; students can observe RHE education sessions and provide education with RHE support. Adequate patient volume ensures that an RHE program will not detract from student education.

CONCLUSION:

Student reproductive health educator programs are viewed by stakeholders as potentially valuable to both resident and medical student education and should be fully integrated into the curriculum of participating training programs.
Making CLER Clear: A Novel Approach to CLER Education
Authors: Seidel Sharon L. , Brooks Parker A. , Battistini Stephanie S. , McAlpin Lindsey M. , Golla Shalini
Published: September 2018

Local Mentor:

Julie Z. DeCesare, MD

APGO Advisor:

Kimberly Kenton, MD

PROBLEM:

The Clinical Learning Environment Review (CLER) program is a component of NAS for which all ACGME accredited institutions must undergo. At our institution, understanding of the CLER program and the importance of interdisciplinary teams varies because not all clinical service lines have a residency-training program. Multidisciplinary collaboration is important across all clinical service lines in order achieve safe and high-quality patient care. We set out to create a hospital wide initiative to promote an institutional understanding of CLER.

INTERVENTION:

This project aims to develop an online CLER curriculum for our leadership council. Six online modules will be created to address each CLER focus area and corresponding pathways. Once the modules are created, a subset of the institutional leadership council will complete the modules along with knowledge assessment before and after each module. This cohort will be queried regarding their perception of module effectiveness and utility. This feedback will be used to improve the module design.

CONTEXT:

Once the final modules are designed, all members of the leadership council will complete the online modules and knowledge assessment before and after each module. Subsequent data analysis will render individual improvement and effectiveness of this model of CLER education. If proven an effective educational tool, this resource will be shared with institutions to promote institutional awareness of a CLER culture.

OUTCOMES/LESSONS LEARNED:

Modules are still being created at present.
Transvaginal Hysterectomy Error Identification: A Pilot Study of OBGYN Residents
Authors: Wood Sara C. , Seiler Katherine B. , Wegleitner Elizabeth , Gala Rajiv B. , Veronikis Dionysios K.
Published: September 2018

Local Mentor:

Dionysios K. Veronikis, MD

APGO Advisor:

Nancy Hueppchen, MD

OBJECTIVE:

To investigate the ability of obstetrics and gynecology (OBGYN) residents to identify the potential errors that occur during transvaginal hysterectomy (TVH).

METHODS:

A cognitive task analysis (CTA) on TVH with critical decision points and potential error was utilized as the framework for a cross-sectional questionnaire that was disseminated to OBGYN residents at a community-based residency program. They were provided the critical decision points and asked to identify the error and their confidence to avoid, recognize, and manage the error. Residents identified their post-graduate year (PGY) level and “surgeon” experience with TVH based on case logs. An iterative process was performed with three OBGYN faculty and one resident to score the resident answers as incorrect, partially correct, or correct. A predictive model was created to analyze the data.

RESULTS:

There were 21 responses with similar representation of PGY levels. The proportion of surgical errors accurately identified and PGY level was positively correlated (P=.002) with the greatest change between PGY2 and PGY3 (P=.012). There was a significant increase in the accurate identification of errors after 21 cases as “surgeon” (P=.013), which was the mean volume of PGY3 case experience. A significant association was noted between the number of TVH performed and accurate error identification in anterior entry and uterosacral and cardinal pedicle procurement (P<.05).

CONCLUSION:

Progression from PGY2 to PGY3 and 21 cases is associated with an increased accuracy in identification of TVH. The resident experience in performing TVH is the driving factor in a resident’s overall ability to accurately identify potential surgical error.
Preoperative Checklist Effects on Surgical Resident and Attending Physician Satisfaction
Authors: Betcher R. Edward , Kothapalli Akhila
Published: September 2018

Faculty Advisor:

Amy Boardman, MD

PURPOSE:

Evaluate if a pre-operative checklist and huddle can improve surgeon satisfaction, efficiency, and safety in an academic tertiary referral center.

BACKGROUND:

Aviation has demonstrated the benefits of checklists to improve safety. A pre-operative checklist/huddle is part of the WHO Surgical Safety Protocol but isn’t widely used beyond the surgical timeout. Negative connotations are frequently associated with patient safety protocols. What if they could make surgery go smoother thereby improving surgeon satisfaction? Would this increase the likelihood of adaptation?

METHODS:

A brief (<3 minutes) checklist was developed incorporating patient issues, anesthesia issues, equipment issues, and miscellaneous for the use in surgical suites. Before implementation, a 10 question (scale of 1-10) survey about OR satisfaction was sent to all surgical/anesthesia residents and attending physicians. After a one-month implementation of the checklist, a second similar survey was sent out for comparison. Average case time, number of cases, turn over time, on time starts, and complication rates were also measured before and after implementation. Statistical analysis using student t-test was used for significance.

RESULTS:

32 pre-intervention and 21 post-intervention surveys were received. They showed no improvement in surgeon satisfaction (P=.84) and surgical team dynamics. Average case length was increased by 2 minutes. Number of cases increased by 117/month. Turn over time remained unchanged. On time starts reduced from 52% to 46%. Operating Room variances decreased by 9%.

DISCUSSION:

The use of a pre-operative checklist demonstrated no improvement in surgeon satisfaction. Additionally, it resulted in minimal impact to surgical efficiency and variance rate.
Assessing the Impact of Repeated Simulation of 4th Degree Lacerations on Resident Competency
Authors: Brazell Hema , Wheeler Thomas , Swift Steven
Published: September 2018

Faculty Advisor:

Steven Swift, MD

PURPOSE:

To determine if a periodic educational intervention on 4th degree perineal laceration leads to improved resident procedural competency in a simulated environment as evaluated by a task-specific objective structured assessment of technical skills (OSATS) checklist.

BACKGROUND:

Improper repair of 3rd or 4th degree perineal lacerations can lead to detrimental long-term sequelae. Given the lack of adequate resident exposure to such lacerations, improved education may be essential in decreasing adverse outcomes. A technique to provide experience and assess competency with rare procedures is the simulation lab employing a task-specific OSATS checklist. This involves using simulation models and can be implemented as a teaching tool to reliably and validly assess procedural skills in a formal, structured manner outside of the clinical setting. Current literature is limited by short follow-up and lack of an appropriate control group.

METHODS:

Participants were randomized into a control or intervention group. All participants completed a validated task-specific OSATS pre-test followed immediately by an educational intervention on 4th degree lacerations. Those randomized to the intervention group received a second educational session whereas those in the control group did not. All participants then completed a post-test six months after study initiation.

RESULTS:

Six participants were in the control group and seven in the intervention group. There was no difference in the change of mean scores (5.5 vs. 3.9, respectively) between groups (P=.66).

DISCUSSION:

In this study with a small sample size, a supplementary educational intervention did not affect OSATS scores over a 6-month time period.
Objective Assessment of Proficiency in Vaginal Cuff Closure Using Sensor Technology
Authors: King Cara , Giles Dobie , Mohamadipanah Hossein , Kwan Calvin , Peterson Katherine , Pugh Carla
Published: September 2018

Faculty Advisor:

Karen Noblett, MD

PURPOSE:

Establish concurrent and construct validity of motion analysis in differentiating laparoscopic psychomotor skills when suturing laparoscopically on a validated vaginal cuff model.

BACKGROUND:

Surgical simulation is most useful when it provides metrics that are accurate and meaningful to the learner. Motion analytics provides objective data that allows a comprehensive evaluation to assist with deconstructing complex tasks. This information may assist with formative feedback and deliberate practice.

METHODS:

Participants were divided based on number of laparoscopic vaginal cuff closures after hysterectomy. 15 Early Novices (0-20 procedures), 5 Advanced Novices (21-50 procedures), and 15 Experts (>51 procedures) in conventional laparoscopy and 24 Early Novices, 4 Advanced Novices, and 7 Experts in robotic-assisted laparoscopy were instructed to secure three stitches on a previously validated vaginal cuff model. A motion sensor was attached to each instrument, which subsequently recorded the hand movement of each participant. Each task was graded using the Global Operative Assessment of Laparoscopic Skills scale and a validated laparoscopic suturing checklist.

RESULTS:

Comparison analysis indicated Experts in conventional laparoscopy operated with less hand movement (P<.01) and higher hand smoothness (P<.01) compared to Early Novices. Advanced Novices did not show any significant difference to Experts in terms of hand movement (P>.01) or smoothness (P>.01). In contrast, Experts in robotics did not show a difference between Early or Advanced Novices in either of these metrics.

DISCUSSION:

Using a validated vaginal cuff model, hand movement and smoothness were found to correlate with experience for conventional laparoscopy. Robotic experience did not correlate with improved hand movement or smoothness on a conventional laparoscopic simulator.
Development and Validation of an Objective Assessment Tool for Abdominal Hysterectomy Competency
Authors: Lau Trevin , James Kaitlyn , Bengtson Joan , York-Best Carey
Published: September 2018

Faculty Advisor:

Erika Banks, MD

PURPOSE:

To develop and validate a competence assessment tool for total abdominal hysterectomy.

BACKGROUND:

Surgical education traditionally relied on a volume-based apprenticeship model, but the paradigm has shifted towards an outcomes-based competency-based model. Assessment of surgical competence is a challenge as few standardized, validated tools exist. There is currently no validated, objective, surgical skills assessment tool for the total abdominal hysterectomy (TAH) in the literature.

METHODS:

Expert gynecologic surgeons developed the competence assessment tool for TAH (CAT-TAH) using Delphi methodology (Content Validity Indices ≥0.75). CAT-TAH’s ability to differentiate different levels of trainees (construct validity) was assessed in the operating room using the Kruskal-Wallis test, with post-hoc analyses to determine structure of differences. CAT-TAH's inter-rater reliability was assessed by comparing scores provided by the surgeon versus 2 blinded assessors using the pairwise correlation coefficient.

RESULTS:

Six expert surgeons reached consensus on CAT-TAH after 3 rounds of the Delphi process. The tool deconstructed the TAH into 8 steps with descriptors, scored on a scale of 1-5 with anchors. Fourteen trainee assessments were analyzed. Median cumulative scores were significantly higher for fellows than for residents (36 (34.7-40) vs. 26.7 (20-29), P=.04). Median cumulative scores from primary assessor and blinded assessors correlated well (r=0.737, P=.016).

DISCUSSION:

This pilot demonstrated that it is feasible to develop and validate an objective assessment tool to evaluate TAH surgical competence. A larger sample size is necessary to corroborate these observations. A validated CAT-TAH will be useful to residency program directors in assessing graduating residents’ ability to perform TAH.
Low-Fidelity Cystoscopy Simulation in Ob/Gyn Residents and Skills Retention
Authors: Riano Ervin , Banks Erika , To Justin , Lu Chunhua , Movva Vani
Published: September 2018

Faculty Advisor:

Erika Banks, MD

PURPOSE:

To determine if cystoscopy skills and knowledge can be acquired and retained with a low-fidelity cystoscopy simulation.

BACKGROUND:

Cystoscopy training is done most commonly in the operating room on actual patients. The primary objective of this study was to evaluate whether low-fidelity cystoscopy simulation could help train residents and allow them to retain those skills outside of the operating room.

METHODS:

All residents in a community hospital underwent training, which consisted of pre/post training knowledge test, a 30 minute lecture, one hour simulation where the residents were able to practice assembling and performing cystoscopy on a low fidelity balloon simulator. Residents were then assessed on 1) their ability to assemble the cystoscope with a 10-point check list, the time needed to assemble the cystoscope and 2) their ability to perform a diagnostic cystoscopy via a check list, a Global Rate Scale (GRS) adapted for cystoscopy, and the time needed to perform the procedure. To assess skills retention, the same assessment was repeated 11 months later. Data was analyzed with Pearson-correlation coefficient and Paired T-test.

RESULTS:

Following training, PGY1 residents showed significant improvement for assembly time, GRS scores, and knowledge (P=<.002/.03/.001). PGY2 resident showed significant improvement in knowledge (P=<.001). Assembly time, GRS scores, and pre/post-test scores were also correlated to the level of training. Overall, the training sessions led to significantly improved knowledge test scores in all levels of training (P<.02).

DISCUSSION:

Low-fidelity cystoscopy led to improved knowledge and surgical skills in the junior residents. Also it was able to correlate to each level resident.
Teaching and Sustaining a Shared Mental Model for Intraoperative Communication and Teamwork
Authors: Schiff Lauren , Miele Kate , McCollum Meriel , Li Quefeng , Connolly AnnaMarie
Published: September 2018

Faculty Advisor:

Nancy Gaba, MD

PURPOSE:

To develop and implement a process to: 1) identify gynecology team-specific barriers to uptake of TeamSTEPPS and 2) design a curriculum that promotes a strategy for effective communication and teamwork in the operating room.

BACKGROUND:

TeamSTEPPS is a structured approach to operating room communication and teamwork to improve patient safety. Adherence to TeamSTEPPS procedures is low.

METHODS:

Attendings, fellows, residents, anesthesiologists, certified nurse anesthetists, nursing staff, and scrub technicians involved in Gynecology Operating Rooms (ORs) at a tertiary care hospital completed the validated Safety Attitudes Questionnaire – OR version (SAQ-OR). Quantitative and qualitative survey data analysis identified barriers to teamwork and communication. A curriculum was designed to teach a shared mental model for OR communication.

RESULTS:

The survey response rate was 64%. The leading identified barriers to teamwork and communication were lack of open communication, team cohesion, and familiarity with team as well as disruptions during cases. Mean scores for the six domains of the SAQ were low: teamwork climate 50.1%, safety climate 48%, job satisfaction 50.3%, stress recognition 39.7%, perceptions of management 48.5%, and working conditions 49%. The curriculum designed taught strategies for communication and teamwork focusing on the identified concerns. Daily adherence to these strategies was 75% at one month. The SAQ will be repeated at 9 months.

DISCUSSION:

Identifying department-specific barriers to teamwork and communication allowed for development of a curriculum to address the specific concerns of the team members and may lead to improved uptake of teamwork and communication strategies. This process will be repeated hospital system-wide.
The ABCs of chronic kidney disease
Authors: Zuber Kim , Davis Jane
Published: September 2018

Management of patients with chronic kidney disease has evolved since the last Kidney Disease Improving Global Outcomes clinical practice guideline was published in 2012. This article reviews the most recent guidelines, common management issues in primary care, kidney risk and outcome calculators, and over-the-counter medications that may cause community-acquired acute kidney injury.
Kidney transplant wait list
Authors: Clayton Lindsay M. , Rizzolo Denise , Nair Vinay
Published: September 2018

Renal transplantation is the treatment of choice for patients with end-stage renal disease. Improved success of renal transplantation has led to a growing number of US patients waiting for a transplant and longer waits to obtain kidneys. This article discusses the process and challenges of getting on the wait list, kidney organ allocation, and areas being explored to increase available organs for renal transplantation.
Overshadowed by Assessment: Understanding Trainee and Supervisor Perspectives on the Oral Case Presentation in Internal Medicine Workplace-Based Assessment
Authors: Melvin Lindsay , Rassos James , Panisko Daniel , Driessen Erik , Kulasegaram Kulamakan M. , Kuper Ayelet
Published: September 2018

Purpose

The oral case presentation (OCP) is an essential part of daily clinical practice in internal medicine (IM) and a key competency in medical education. It is not known how supervisors and trainees perceive OCPs in workplace-based learning and assessment.

Method

Using a constructivist grounded theory approach, 26 semistructured interviews were held with trainees and supervisors (18 clinical clerks and first- through third-year postgraduate trainees, and 8 supervisors) on the IM clinical teaching unit at the University of Toronto, 2015–2016. Interviews focused on how the OCP was viewed by both trainees and supervisors in clinical practice as a tool for patient care, learning, and assessment. Iterative, constant comparative techniques were used to analyze the interviews and develop a framework to understand trainee and supervisor perspectives.

Results

Supervisors and trainees viewed the OCP as an important part of informal trainee assessment in IM. Supervisors used OCPs to understand the patient through trainee-demonstrated skills including the use of narratives, information synthesis, and management of uncertainty. However, because of awareness of assessment, trainees sought to control the OCP, viewing it as a performance demonstrating their competence, mediated by senior residents and tailored to supervisor preferences.

Conclusions

Preoccupied with assessment around OCPs, trainees often lost sight of the valuable learning taking place. Use of OCPs in assessment necessitates optimization of the educational activity for trainees. Providing explicit direction to both trainees and supervisors, defining expectations, and clarifying the assessment activity of the OCP can optimize the encounter for best educational practice.
Moving the United States Medical Licensing Examination Step 1 After Core Clerkships: An Outcomes Analysis
Authors: Jurich Daniel , Daniel Michelle , Paniagua Miguel , Fleming Amy , Harnik Victoria , Pock Arnyce , Swan-Sein Aubrie , Barone Michael A. , Santen Sally A.
Published: September 2018

Purpose

Schools undergoing curricular reform are reconsidering the optimal timing of Step 1. This study provides a psychometric investigation of the impact on United States Medical Licensing Examination Step 1 scores of changing the timing of Step 1 from after completion of the basic science curricula to after core clerkships.

Method

Data from four schools that recently moved the examination were analyzed in a pre–post format using examinee scores from three years before and after the change. The sample included scores from 2008 through 2016. Several confounders were addressed, including rising national scores and potential differences in cohort abilities using deviation scores and analysis of covariance (ANCOVA) controlling for Medical College Admission Test (MCAT) scores. A resampling procedure compared study schools’ score changes versus similar schools’ in the same time period.

Results

The ANCOVA indicated postchange Step 1 scores were higher compared with prechange (adjusted difference = 2.67; 95% confidence interval: 1.50–3.83, P < .001; effect size = 0.14) after adjusting for MCAT scores and rising national averages. The average score increase in study schools was larger than changes seen in similar schools. Failure rates also decreased from 2.87% (n = 48) pre change to 0.39% (n = 6) post change (P < .001).

Conclusions

Results suggest moving Step 1 after core clerkships yielded a small increase in scores and a reduction in failure rates. Although these small increases are unlikely to represent meaningful knowledge gains, this demonstration of “noninferiority” may allow schools to implement significant curricular reforms.
All Other Things Being Equal: Exploring Racial and Gender Disparities in Medical School Honor Society Induction
Authors: Wijesekera Thilan P. , Kim Margeum , Moore Edward Z. , Sorenson Olav , Ross David A.
Published: September 2018

Purpose

A large body of literature has demonstrated racial and gender disparities in the physician workforce, but limited data are available regarding the potential origins of these disparities. To that end, the authors evaluated the effects of race and gender on Alpha Omega Alpha Honor Medical Society (AOA) and Gold Humanism Honor Society (GHHS) induction.

Method

In this retrospective cohort study, the authors examined data from 11,781 Electronic Residency Application Service applications from 133 U.S. MD-granting medical schools to 12 residency programs in the 2014–2015 application cycle and to all 15 residency programs in the 2015–2016 cycle at Yale-New Haven Hospital. They estimated the odds of induction into AOA and GHHS using logistic regression models, adjusting for Step 1 score, research publications, citizenship status, training interruptions, and year of application. They used gender- and race-matched samples to account for differences in clerkship grades and to test for bias.

Results

Women were more likely than men to be inducted into GHHS (odds ratio 1.84, P < .001) but did not differ in their likelihood of being inducted into AOA. Black medical students were less likely to be inducted into AOA (odds ratio 0.37, P < .05) but not into GHHS.

Conclusions

These findings demonstrate significant differences between groups in AOA and GHHS induction. Given the importance of honor society induction in residency applications and beyond, these differences must be explored further.
Case-Based Learning in Translational Biomedical Research Education: Providing Realistic and Adaptive Skills for Early-Career Scientists
Authors: Greenberg-Worisek Alexandra J. , Campbell Katherine A. , Klee Eric W. , Staff Nathan P. , Schimmenti Lisa A. , Weavers Karen M. , Ekker Stephen C. , Windebank Anthony J.
Published: September 2018

Problem

Case-based learning is an established means of educating students in law, business, and medicine; however, this methodology is not often applied to educating translational biomedical researchers. The application of case-based learning to translational biomedical research education allows scholars to actively engage with real-world material and apply their newfound knowledge as it is acquired.

Approach

Through the Mayo Clinic Center for Clinical and Translational Science (CCaTS), three courses were delivered in 2009–2017 which emphasized case-based learning in clinical and translational science, entrepreneurship, and individualized medicine. Quantitative measures collected in student course reviews upon course completion were analyzed. Additionally, products arising from each course were identified, including publications and startups pitched.

Outcomes

Analyses demonstrate that case-based learning techniques are well suited to graduate biomedical research education. Furthermore, case studies can be employed throughout the entire clinical and translational spectrum, from basic and preclinical work through to clinical and population-based learning.

Next Steps

Within CCaTS, next steps include creating case-based courses in regulatory and team science to continue to allow scholars to learn and apply these critical skills to real-world material. The goal is to continue to provide immersive training opportunities in areas of clinical and translational science that cannot be readily learned in a traditional lecture-based class setting.
Contribution of Loss of Large Fiber Function to Pain in 2 Samples of Oncology Patients
Authors: Miaskowski Christine , Paul Steven M. , Mastick Judy , Abrams Gary , Topp Kimberly , Smoot Betty , Kober Kord M. , Chesney Margaret , Schumacher Mark , Conley Yvette P. , Hammer Marilyn , Cheung Steven , Borsook David , Levine Jon D.
Published: September 2018

Objectives:

Numbness associated with neuropathic pain suggests the loss of function in myelinated, large diameter sensory neurons. The purpose of this study was to examine the relationships between pain severity and subjective (ie, severity of numbness) and objective (ie, loss of light touch sensations, vibration thresholds) measures of loss of large fiber function in adult survivors with chemotherapy-induced peripheral neuropathy (CIPN, n=426) and breast cancer patients with persistent postsurgical pain (n=80).

Material and Methods:

For both samples, average pain and numbness were evaluated using a 0 to 10 numeric rating scale. Loss of light touch sensations in the hands and feet of patients with CIPN and in the upper arm of patients at 5 and 6 months following breast cancer surgery were assessed using Semmes Weinstein monofilaments. Loss of vibration in the hands and feet of patients with CIPN was assessed using a biothesiometer. Pearson Product Moment correlation coefficients were calculated between average pain and the number or percentage of sites with loss of light touch sensations, mean vibration thresholds, and the severity of numbness.

Results:

For both pain conditions, average pain scores were significantly correlated with objective measures of large fiber function (r=0.12 to 0.34; all P<0.05) and numbness (r=0.22 to 0.52; all P<0.008).

Discussion:

Our findings, in 2 independent samples of oncology patients, suggest that loss of function of myelinated, large diameter fibers contributes to the severity of neuropathic pain.
Clinician Response to Aberrant Urine Drug Test Results of Patients Prescribed Opioid Therapy for Chronic Pain
Authors: Morasco Benjamin J. , Krebs Erin E. , Adams Melissa H. , Hyde Stephanie , Zamudio Janet , Dobscha Steven K.
Published: September 2018

Objective:

Urine drug testing (UDT) is recommended for patients who are prescribed opioid medications, but little is known about the various strategies clinicians use to respond to aberrant UDT results. We sought to examine changes in opioid prescribing and implementation of other risk reduction activities following an aberrant UDT.

Methods:

In a national cohort of Veterans Affairs patients with new initiations of opioid therapy through 2013, we identified a random sample of 100 patients who had aberrant positive UDTs (results positive for nonprescribed/illicit substance), 100 who had aberrant negative UDTs (results negative for prescribed opioid), and 100 who had expected UDT results. We examined medical record data for opioid prescribing changes and risk reduction strategies in the 12 months following UDT.

Results:

Following an aberrant UDT, 17.5% of clinicians documented planning to discontinue or change the opioid dose and 52.5% initiated another strategy to reduce opioid-related risk. In multivariate analyses, variables associated with a planned change in opioid prescription status were having an aberrant positive UDT (odds ratio [OR], 30.77; 95% confidence interval [CI], 5.92-160.10) and higher prescription opioid dose (OR, 1.01; 95% CI, 1.01-1.02). The only variable associated with implementation of other risk reduction activities was having an aberrant positive UDT (OR, 0.29; 95% CI, 0.16-0.55).

Discussion:

The majority of clinicians enacted some type of opioid prescribing or other change to reduce risk following an aberrant UDT, and the action depended on whether the result was an aberrant positive or aberrant negative UDT. Experimental studies are needed to develop and test strategies for managing aberrant UDT results.