bluuebunny/crossref_metadata_2025 huggingface dataset:
Molecular Assessment of the Introduction and Spread of Potato Cyst Nematode, Globodera rostochiensis, in Victoria, Australia
Authors: Blacket Mark J. , Agarwal Arati , Wainer John , Triska Maggie D. , Renton Michael , Edwards Jacqueline
Published: September 2018

Potato cyst nematodes (PCN) are damaging soilborne quarantine pests of potato in many parts of the world. There are two recognized species, Globodera pallida and G. rostochiensis, with only the latter species—the golden cyst nematode—present in Australia. PCN was first discovered in Australia in 1986 in Western Australia, where it was subsequently eradicated and area freedom for market access was reinstated. In Victoria, PCN was first detected in 1991 east of Melbourne. Since then, it has been found in a small number of localized regions to the south and east. Strict quarantine controls have been in place since each new detection. It has previously been speculated that there were multiple separate introductions of PCN into Victoria. Our study utilized a historic (years 2001 to 2014) PCN cyst reference collection to examine genetic variability of Victorian PCN populations to investigate potential historical origins and subsequent changes in the populations that might inform patterns of spread. DNA was extracted from single larvae dissected from eggs within cysts and screened using nine previously described polymorphic microsatellite markers in two multiplex polymerase chain reaction assays. Sequence variation of the internal transcribed spacer region of the DNA was also assessed and compared with previously published data. A hierarchical sampling strategy was used, comparing variability of larvae within cysts, within paddocks, and between local regions. This sampling revealed very little differentiation between Victorian populations, which share the same microsatellite allelic variation, with differences between local regions probably reflecting changes in allele frequencies over time. Our molecular assessment supports a probable single localized introduction into Victoria followed by limited spread to nearby areas. The Australian PCN examined appear genetically distinct from populations previously sampled worldwide; thus, any new exotic incursions, potentially bringing in additional PCN pathotypes, should be easily differentiated from existing established local PCN populations.
Experiences in DOCS Clinic: Direct Observation of Clinical Skills
Authors: Royce Celeste , McKeon Bri Anne , Bookman Laura , Vicari Lucia , Dalrymple John
Published: September 2018

PURPOSE:

To investigate the efficacy of an assessment tool for core entrustable professional activities (EPAs) in obstetrics and gynecology.

BACKGROUND:

Medical education is moving toward competency-based assessment. EPAs standardize proficiency levels for learners and provide assessment frameworks, but require direct observation. Students report little direct observation of history taking or physical exam skills in clerkships. We implemented a standardized clinical experience and assessment tool to assess student progress on EPAs.

METHODS:

We developed an assessment tool for history, physical exam, and counseling, with behavioral anchors to describe achievement levels. Participants included OBGYN clerkship students in 2016-2017. Students conducted patient encounters with direct observation and feedback by faculty. Students then conducted a separate patient encounter with an experienced educator, who rated performance using the assessment tool.

RESULTS:

Forty-two of 63 students participated. 98% rated emerging or entrustable level in history-taking (EPA 1A) and physical exam (EPA 1B). Students who were assessed on differential diagnosis (EPA2), and ordering/interpreting tests (EPA 4) were rated pre-entrustable or emerging. All students demonstrated entrustability in collaboration and teamwork (EPA 9).

DISCUSSION:

Most students were rated emerging or entrustable in EPA 1; all demonstrated entrustability in EPA 9. Our assessment tool provided a framework to ensure consistency in assessment of EPAs. Our study was limited by availability of clinical educators. We plan to refine the assessment tool to develop standards for each EPA. Faculty development is required as clinical educators are not familiar with this framework. Change in the educational culture is needed for EPAs to be successful.
“Guiding Light” to Reduce Incidence of Medical Student Refusal in the Obstetric & Gynecology Clinic
Authors: Bremer Kristin , Thayer Mackenzie , Verhoef Katee , Waldschmidt Noelle , Weaver Corbin , Boevers Emily
Published: September 2018

PURPOSE:

Characterize and reduce the frequency at which medical students are 'cast off' from patient care in the Ob-Gyn clerkship.

BACKGROUND:

For optimal medical education and patient care, it is imperative to have 'all hands on deck'. Review of the literature shows that medical student refusal is an issue nationally in Ob-Gyn as well as other clerkships (1-3). Review of our Ob-Gyn clerkship data shows that students report that patients refuse their involvement in 14% of patient interactions. Furthermore, in 19% of interactions, students felt refusal was related to their gender.

METHODS:

Beginning in 2017, surveys measuring medical students' perception of refusal were administered upon completion of our Ob-Gyn clerkship. Interventions to reduce refusal of these 'castaways' were implemented with each subsequent clerkship. Faculty mentors: Sarah Shaffer DO & Colleen Stockdale MD, MS.

RESULTS:

Data collection is on-going. To date, 85% reported exclusion from a patient interaction on the Ob-Gyn clerkship due to being a medical student. Twenty-three percent reported greater than five episodes of exclusion from patient care. Forty-three percent perceived that restricted participation was related to their gender with multiple qualitative responses describing patient discomfort with the presence of male 'comrades'.

DISCUSSION:

Data from our institution suggests that exclusion from patient care in the Ob-Gyn clerkship occurs for the majority of medical students queried. Further, gender-based exclusion is likely a related problem. Future exploration includes analysis of trends after the implementation of interventions designed to keep patients and staff 'abreast' of the presence and role of medical students.
Assessment of Postpartum Visits: Creating a Checklist to Improve Comprehensiveness
Authors: Hecker Erin , Wieneke Carrie
Published: September 2018

PURPOSE:

The aim of this project is to create a template for residents to use to evaluate their documentation during postpartum visits and assess if pertinent issues during the postpartum period are addressed. Thus, allowing residents to self-evaluate and identify areas for improvement while allowing for self-directed learning and outcomes analysis.

BACKGROUND:

The postpartum period typically brings excitement but is also filled with numerous challenges and adaptations to several physical, emotional, and social changes. All women should attend a postpartum visit that addresses these matters and ensures the transition to a primary care provider to begin management of chronic health conditions.

METHODS:

A checklist of 17 key postpartum components was developed from ACOG Committee Opinion 666. A retrospective chart review of postpartum visits from each PGY was performed to assess documentation of these key components prior to template implementation. Post-implementation retrospective chart review was performed by residents after a 6-month time period. Percentage of template items documented adequately (≥90%), mediocrely (21-89%) and deficiently (≤20%) was calculated for both pre and post implementation data.

RESULTS:

Post implementation documentation was statistically significantly improved from pre-implementation documentation. Pre-implementation data revealed only 6 items were adequately addressed while post-implementation data revealed 8 items were adequately addressed, followed by an improvement in moderately addressed items and a decrease in deficiently addressed items.

DISCUSSION:

The postpartum visit is the ideal time to address multiple aspects of maternal health. Our data shows that providing residents with a template of key items to be discussed improves addressing these items and their documentation.
Development of an Effective Comprehensive Curriculum Regarding the Patient and Provider Experience of Stillbirth
Authors: Fay Emily , Amory Josephine , Gravett Michael , Alexander Sarah , Delaney Shani , Stephenson-Famy Alyssa
Published: September 2018

PURPOSE:

To develop and evaluate a comprehensive curriculum about stillbirth focused on both the patient and the provider experience with this difficult topic.

BACKGROUND:

Pilot data from our institution showed that OB/GYN residents felt ill prepared to care for patients with stillbirth, and that training about the patient experience of stillbirth was impactful but emotionally distressing. We sought to develop a comprehensive stillbirth curriculum that included knowledge, communication skills, and emotional domains.

METHODS:

A four-part curriculum was created including: 1. Medical management, 2. A stillbirth panel discussion with patients/families, 3. Simulation training in delivering serious news, and 4. Workshop on resiliency. OB/GYN residents completed pre- and post-testing for each session. Five-point Likert scales were compared using the Wilcoxon signed rank test (alpha = 0.05).

RESULTS:

All 28 residents participated in parts of the curriculum, with 85% attending two or more sessions. Following the curriculum, we found statistically significant self-reported improvements in multiple aspects of the stillbirth training: general knowledge (P<.01), appropriate tests to order (P<.05), interpretation of placental pathology (P<.01), genetic evaluation (P<.01), comfort conveying sympathy (P<.05), expressing emotion (P<.01), and confidence in delivering serious news (P<.001). In the resiliency workshop, residents shared ideas about how faculty can support them during difficult clinical situations.

DISCUSSION:

A comprehensive stillbirth curriculum which addressed the cognitive, emotional, and skills aspects of this topic was well received and effective. Long-term data is needed to evaluate whether these improvements persist and can enhance resident satisfaction with other challenging topics within OB/GYN.
Do Entering Ob Gyn Interns Understand How to Navigate Today's Complex Health Care Systems?
Authors: Mann Stephanie , McNamara Tristan
Published: September 2018

PURPOSE:

We sought to determine the baseline QI/PS and population health knowledge for new obgyn interns in comparison to new interns from other specialties.

BACKGROUND:

The ACGME requires residents to be trained in practice-based learning and improvement (PBLI) as well as systems-based practice (SBP). In an effort to establish a formal curriculum for graduate medical education, several residencies at our institution are piloting a novel QI/PS/population health curriculum that will ensure residents are educated in SBP and PBLI.

METHODS:

Baseline knowledge of all new interns was assessed with the Quality Improvement Knowledge Application Tool-Revised (QIKAT-R), a self-assessment questionnaire and a Population Health Knowledge Application tool (POPKAT). Mean score differences for each intern group were measured with ANOVA. Interrater reliability was assessed using Cohen's k.

RESULTS:

Preliminary assessments of incoming obgyn interns compared to all new interns at our institution suggests they are equally familiar with the principles of QI (PBL1, PBL2 level 2) and PS (SBP level 2) but have a slightly higher baseline knowledge of population health (SBP2 level 3). Interrater reliability for total scores and individual categories on the QIKATR and POPKAT was consistent.

DISCUSSION:

Understanding baseline knowledge of new interns can help PDs obtain a baseline assessment of entering residents; SBP and PBLI. After implementation of a QI/PS/population health directed curricula, resident acquisition of knowledge for SBP and PBLI can be quantitated. A quantitative holistic assessment of knowledge utilizing validated knowledge tools will give programs an opportunity to evaluate the impact of their QI/PS/population health focused curricula.
Do Obgyn Residents and the CCC Reach the Same Competency Conclusions? A Comparison of Resident Versus Faculty Milestone Assessments
Authors: Mann Stephanie , Burns Timothy
Published: September 2018

PURPOSE:

Our objective was to compare resident self-assessments to CCC evaluations within the milestone framework.

BACKGROUND:

Resident progress across 28 milestones are evaluated biannually by a clinical competency committee (CCC). We sought to determine the correlation in milestone assessment between the CCC and individual resident's self-assessment.

METHODS:

Retrospective study that compares resident self-assessment of milestone competency to that of the CCC. Milestone assessment differences were calculated by subtracting the resident score from the faculty score. A negative value indicates that the CCC evaluated residents at a lower level than the resident's self-assessment. Kruskal Wallis test was used to identify differences between self-evaluations and corresponding CCC evaluations for each competency. Dunn's post hoc test was used to determine specific differences. Major disparities were defined as a mean disparity >0.5 in either direction. The association between assessment disparity and PGY year was analyzed using non parametric χ2.

RESULTS:

15 residents participated. Overall, 32% (129/409) of the time residents and CCC were in agreement. The global median assessment difference was significant [−0.20 (−0.5 to 0.5), P<.003] suggesting residents evaluated themselves at a higher level than the CCC did. 19% evaluations had a mean overall assessment difference >−0.5 (residents assessed at a higher level than CCC), whereas 8% had a difference >0.5. Positive self-evaluations were more common for medical knowledge and patient care. There was no association between PGY year and CCC agreement.

DISCUSSION:

Ob/Gyn residents within our program trended toward perceiving a greater level of patient care and medical knowledge and underestimated their competency in PBLI, SBP and ICS. Understanding these differences will help PDs at their biannual progress meetings with residents.
OB/GYN Residency Training in Transgender Healthcare: A Survey of U.S. Program Directors
Authors: Rush Shannon , Vinekar Kavita , Chiang Seine , Schiff Melissa
Published: September 2018

PURPOSE:

To characterize transgender healthcare training during OB/GYN residency.

BACKGROUND:

Professional medical organizations increasingly recognize the importance of transgender healthcare, but the training currently offered in OB/GYN residencies is not well understood.

METHODS:

We conducted a cross-sectional survey of a regionally representative random sample of 100 from 236 OB/GYN residency program directors between August 2016 and June 2017. Questions addressed demographics, presence and type of resident transgender healthcare training. We compared attitudes, barriers and facilitators between programs that did and did not offer transgender healthcare training using chi-squared testing.

RESULTS:

Among 61 responding program directors, 50.8% (N=31) reported offering transgender healthcare training, Region of country, program type and size did not differ between those offering and not offering training. Of those offering clinical training in transgender healthcare, 41.9% did so in generalist and 22.6% in specialist OBGYN clinics, 32.3% provided hormone therapy, and 16.1% learned about gender reassignment surgery techniques. Programs offering training were more likely to report a transgender community requesting services (90.3% versus 53.3%, P=.001), interested faculty (45.2% versus 20.0%, P=.03), time allotted for training (29.0% versus 0%, P=.001) and resident interest (64.5% versus 36.7%, P=.03). The most significant barrier to providing training was lack of interested faculty, reported by 73.3% of programs that did not versus 38.7% that did offer training (P=.006).

DISCUSSION:

Only half of responding residency programs offer transgender healthcare training. CREOG named transgender healthcare an educational objective in 2013 and should support this by identifying interested faculty and resident champions who can lead implementation at all OB/GYN residency programs.
RWJBarnabas Health System: System-wide Obstetrics Collaborative. The Clinical, Research and Teaching Implications and Benefits
Authors: Bachmann Gloria , Graebe Robert , Bonamo John , Holecek Nancy , Spernal Suzanne
Published: September 2018

PURPOSE:

The eight perinatal hospitals in the RWJBarnabas health care system, with ∼25,000 deliveries annually, utilize bi-monthly interdisciplinary meetings to update all sites on quality outcomes, evidence-based best practice, research initiatives and education. This model trains Ob/Gyn residents, as well as the entire health care team on an overall approach to maternity care.

BACKGROUND:

In 2015, the perinatal practices at each of the hospitals were functioning independently, which resulted in variation in clinical practice and outcomes, scant research and different approaches to patient care models for resident education. The RWJBarnabas Health leadership recognized the benefit of a systematic approach to optimize this service and to best utilize the strengths and experience of all its health care obstetrical providers. This would also translate into a stronger model to enhance resident education. This approach was promoted by Dr. Asch who stated in the September 23, 2009 JAMA that the best function Ob-Gyn attendings in NY and FL came from residency programs that emphasized the best-practice of evidence-based medicine in a culture of patient safety. Thus, creating a win-win scenario for quality patient care and resident education.

METHODS:

Supported by corporate leadership the RWJBarnabas Health Ob Collaborative was initiated. The obstetrical department chairs and the Ob nursing administrators from each site met bi-monthly to review pooled data, develop clinical bundles and institute standards of practice at each medical site based on a common EMR. From the pooled data, clinical practice changes and research ideas were also introduced that the health care team and the learners could initiate/participate in.

RESULTS:

This model has been very effective in improving patient satisfaction, quality and patient safety. This is especially notable in Pain Management, the reduction of SSI and C/Section rates and increased TOLAC/VBAC rates. In addition, medical education for residents includes utilization of standardized evidenced based practices developed by the collaborative across all the sites. The specifics of the data collection will be discussed.

DISCUSSION:

Not only have there been benefits in the core missions of clinical care, teaching and research, but this model has inspired a joint effort by others within the health care system to further improve outcomes through collaborative educational venues.
Setting New Directions for Medical Student Clerkship Evaluations
Authors: Whitis Avery , Waldschmidt Noelle , Hardy-Fairbanks Abbey , Stockdale Colleen
Published: September 2018

PURPOSE:

Compare the number of medical student evaluations with mean evaluation scores, shelf exam scores, and final clerkship grades.

BACKGROUND:

The University of Iowa OBGYN clerkship requires 6 evaluations for each student: 2 assigned and 4 requested by student. Many students request more evaluations than required, contributing to a delay in the grading process.

METHODS:

Medical student evaluations from 2014 to 2016 were analyzed. 3 groups were created based on the number of evaluations an individual student received. Group 1 received 3-4 evaluations (n=73), Group 2 received 5-6 evaluations (n=240) and Group 3 received 7-16 evaluations (n=222). Paired T-test was used to compare mean evaluation scores and chi-square test was used to compare mean shelf exam scores and percentages of pass, near honors, and honors grades.

RESULTS:

535 students completed the OBGYN clerkship. While mean evaluation scores were similar (86.8-89.1) for each group, compared to group 1, groups 2 and 3 means were statistically greater (P<.01, and .02, respectively). Shelf grade percentages for honors, near honors, and honors were similar for each group; with no difference in group means (P>.05). Likewise, rates of pass, near honors, and honors grades between groups were similar for each group (P>.05).

DISCUSSION:

Increased number of requested evaluations did not translate to differences in rates of pass, near honors, and honors grades for medical students on their OBGYN clerkship, indicating that decreasing the mandatory evaluations per student would not be detrimental to student outcomes and would potentially expedite the grading process.
Teaching Cystotomy Repair: Low Fidelity Model Provides Effective Simulation at Minimal Cost
Authors: Braun Kelli , Ray Chadburn , Stager Robert , Rungruang Bunja
Published: September 2018

PURPOSE:

To develop an inexpensive bladder model that can be used to teach Ob-Gyn Residents open and laparoscopic cystotomy repair.

BACKGROUND:

Recognition of cystotomy and repair is a requirement of Ob-Gyn surgical milestones. Simulation products currently exist for cystoscopy but not for cystotomy repair.

METHODS:

Pilot study of a novel low fidelity bladder model that can be used for simulation of both open and laparoscopic cystotomy repair. A cystotomy model was created using the following materials: small whoopee cushion “bladder mucosa”, shelf liner “bladder muscularis” and Press'n Seal® for “serosa.” Markings were placed inside the cushion to represent the trigone with ureteral orifices. Residents were asked to identify the model’s anatomic landmarks and rate their confidence in identifying cystotomy and performing both and open and laparoscopic cystotomy repair, pre- and post-simulation.

RESULTS:

16 bladder models were constructed for approximately $1.50 per model. The model is reusable and manipulated well with surgical instruments and suture both open and laparoscopically; the model was a bit large for the laparoscopic trainer and lighting became a challenge for suturing. All participating residents correctly identified the anatomic structures post-simulation compared to 12/13 pre-simulation. Change in mean resident confidence was statistically significant for identifying cystotomy (pre M=3.1/5 vs. post M=4.2/5, P=.009) and performing open cystotomy repair (pre M=2.4/5 vs. post M=4/5, P=.03) but not for laparoscopic repair (pre M=1.6/5 vs. post M 3.1/5, P=.09).

DISCUSSION:

Our bladder model is easily constructed and inexpensive. It performs well for open cystotomy repair but has been decreased in size to better perform laparoscopically.
Teaching Lesbian, Gay, Bisexual, Transgendered, and Queer Family Building in a Third Year OBGYN Clerkship
Authors: Lackritz Katherine , Braverman Andrea , Leubner Emily , Wolf Abigail
Published: September 2018

PURPOSE:

To explore third year medical students' fund of knowledge and attitudes about LGBTQ family building and third party reproduction.

BACKGROUND:

Medical student knowledge and attitudes about family building for LGBTQ families and third party reproduction (TPR) varies based on student prior experience and pre-clinical teaching. The OBGYN clerkship is a unique opportunity for students to learn medical knowledge and reflect on attitudes about this subject.

METHODS:

A quantitative study of knowledge and attitude among third year medical students done after IRB approval. The intervention consisted of a one hour lecture on TPR and participating in a group discussion about LGBTQ family building. Students (231) completed a survey asking about their knowledge and attitudes prior to starting the rotation and 178 completed the survey following the intervention. Survey respondents rated items using a Likert scale and completed a knowledge assessment. Changes in knowledge scores were investigated using t-tests.

RESULTS:

Survey respondents were 51% female, 48% male, 1% gender non-conforming; heterosexual 93%; and partnered 59%. Comfort with same sex couples was endorsed by 92%. 56% of students felt that opting out of assisting a patient with family building was not an option. Fertility knowledge increased from after intervention significantly (P<.0001). Some students, 29%, thought that infertility was hard to discuss, but 67% felt it would be hard to discuss for same sex couples.

DISCUSSION:

Medical students' fund of knowledge was increased with lecture and small group discussion about TPR and LGBTQ patients. Students report being comfortable with TPR and LGBTQ families but have some discomfort with varied pathways to parenthood. Most feel that opting out of care for LGBTQ families is not an option.
Wellness Challenges and Burnout Contributors: A Systematic Approach to Issue Identification & Program Development
Authors: Connolly AnnaMarie
Published: September 2018

PURPOSE:

To implement an institutionally-specific process to: A: Identify wellness challenges/burnout contributors. B: Develop a systematic approach to wellness programming prioritized by Maslow need level.

BACKGROUND:

Addressing wellness challenges/burnout contributors (WC/BC) is critically important to both providers and the patients they treat.

METHODS:

A representative task force was assembled. Using mind-mapping, members developed a comprehensive list of WC/BC issues and related factors. These were then mapped by members to Maslow need levels ranging from physiologic (level 1) to transcendence (level 8). PDs were then queried regarding wellness programming in their residencies to generate a “menu” of institutionally-available programming. Gaps were then identified by mapping WC/BC issues to available PD-reported programming. Highest priority was given to program development for WC/BC issues with lowest Maslow levels for which there was no programming available.

RESULTS:

From October 2016–May, 2017, the task forced include 20 representatives from 7 departments and the GME Office and included residency/fellowship PDs, residents, and staff. Through mind-mapping work, 12 categories of WC/BC issues and 38 related factors were identified. While all GME program directors reported having WC/BC programming in place, the majority (57%) of this was informal support around “healthy lifestyles.” For 34 of 38 factors (89%) identified, no programming was reported. Notably, when mapping factors to Maslow need level, 30 of 38 (80%) mapped to basic Maslow levels 1-4. Program development was recommended for WC/BC factors with lowest Maslow levels for which no institutional programming was in place.

DISCUSSION:

An institutionally-specific approach to identifying WC/BC issues and prioritizing them for resource development by Maslow level was successfully implemented.
A Predictive Model for the Ob/Gyn Residency Match: Pilot Phase
Authors: Ferriss J.S. , Tristan S , Woody S , Cain L.E. , Vinas E.K.
Published: September 2018

Local Mentor:

Amy Young, MD

APGO Advisor:

Hope Ricciotti, MD

OBJECTIVE:

To develop and test a statistical model allowing students to estimate their competitiveness in the Obstetrics and Gynecology residency match.

METHODS:

After IRB approval, a survey of matched US seniors provided a student perspective on the match. Separately, a random selection of Ob/Gyn program directors were surveyed for program-specific data regarding interview and match strategies. These data were used to refine an algorithmic model based on Bayesian Additive Regression Trees (BART). Our program's 2015 ERAS data served as the training set, and the 2016 data were used to test the internal validity of the model.

RESULTS:

Thirty-two medical students (denominator unknown) and 28/100 program directors responded to the email survey. There were 573 applicants in the training set, and 585 in the validation set. Only one student out of those ranked went unmatched, precluding prediction of match status. Therefore, the model was evaluated on ability to accurately predict invitation for an interview. The resulting specificity was 84.8%, sensitivity 71.2%, positive predictive value 34.4%, and negative predictive value 96.3%. The overall accuracy of the model was 83.4%. Factors that were most predictive of invitation were board scores, membership in Alpha Omega Alpha and geography.

CONCLUSIONS:

A model for the prediction of an interview invitation is feasible. In practice, our model would have accurately informed a student if they were unlikely to be chosen for an interview at our program. Future work will focus on expanding the dataset to include other residency programs and creating an interface for testing by students.
GDM as a Risk Factor for the Development of Type 2 Diabetes: An Educational Opportunity for Primary Care Providers
Authors: Hart Elaine , Im Taylin
Published: September 2018

Local Mentor:

Philip Chan, PhD

APGO Advisor:

Lee A. Learman, MD, PhD

OBJECTIVE:

Lack of awareness that gestational diabetes (GDM) increases the risk of subsequent Type 2 Diabetes by 20–60% may impede early screening in primary care. We reviewed the English-language literature to evaluate how frequently gestational diabetes (GDM) is identified as a risk factor for the development of Type 2 Diabetes at least 1 year beyond the postpartum period.

DATA SOURCE:

Pub Med, Web of Science and CINAHL were searched for English-language articles ever published with key words “gestational diabetes”, “diabetes screening” and “beyond postpartum.”

METHODS OF STUDY SELECTION:

4330 publications were identified and two investigators independently reviewed their titles, abstracts and articles to determine how many addressed the search objective.

TABULATION, INTEGRATION AND RESULTS:

153 articles were found that mentioned GDM as a risk factor for developing Type 2 Diabetes. Articles included were categorized according to the area of specific focus including additional risk factors, interventions, specific tests to diagnose and prevention. 197 articles relating to risk factors for Type 2 Diabetes did not include GDM. Articles that excluded GDM as a risk were carefully reviewed to assure there was no GDM-associated wording.

CONCLUSION:

The majority of publications found did not address the elevated risk of women with GDM by recommending Type 2 diabetes screening beyond the postpartum period. Our findings suggest that education is needed to increase the awareness of this important risk factor in primary care settings.
Developing a Tool to Evaluate Resident Clinical Outcomes
Authors: Powell K , Doulaveris G
Published: September 2018

Local Mentor:

Erika Banks, MD

APGO Advisor:

Nancy Hueppchen, MD

OBJECTIVE:

To evaluate a tool used to provide residents feedback on their own patient outcomes.

METHODS:

46 Residents were asked to complete a pre- and post-survey related to performing a Maintenance of Certification type activity related to surgical site infection rates. They were asked to read three articles related to perioperative practices aimed at reducing surgical site infections and then review a ten-patient chart check to evaluate their current practices and outcomes. The pre- and post-survey covered questions related to general knowledge regarding standard of care, estimates of personal surgical site infection rates, and attitudes related to completing the activity. Residents were also surveyed regarding their knowledge of the ACGME milestone and ACGME survey question regarding personal patient outcomes.

RESULTS:

46 residents were asked to participate in the survey. All residents were asked to complete readings and chart check. 44 residents completed the pre-survey, 41 completed the chart checks, and 37 the post-survey. 86% of residents reported that the activity changed their perception of their own patient outcomes and 65% reported that it changed their estimate of their surgical site infection rate. 62% reported that the time required to complete the activity felt appropriate and 75% reported that this was a useful way to monitor their own outcomes.

CONCLUSION:

A self-guided activity consisting of review articles and a chart check can be a useful tool to fulfill ACGME requirements for resident outcome monitoring.
Development and Initial Content Validation of a Simulation Model for Laparoscopic Colpotomy
Authors: Skinner Bethany , Reynolds Kevin , Rooney Deb , Hammoud Maya
Published: September 2018

Local Mentor:

Maya Hammoud, MD, MBA

APGO Advisor:

Nancy Hueppchen, MD

PROBLEM:

No validated simulation model exists for teaching colpotomy for laparoscopic hysterectomy outside the operating room.

INTERVENTION:

A simulation model for laparoscopic colpotomy was developed, with revisions made after review by expert gynecologic surgeons. For initial content validation, cognitive task analysis was performed. Four expert surgeons who perform total laparoscopic hysterectomy were queried regarding the detailed tasks required to perform laparoscopic colpotomy. The tasks identified were distributed to other experienced gynecologic surgeons, who were asked to rate the relevance of each task in measuring simulated performance of laparoscopic colpotomy and provide any additional steps which may have been omitted. They were provided with the options proposed to assess resident ability when performing laparoscopic colpotomy (not done, done incorrectly, or done correctly), and asked if they believe these options adequately reflect the full range of resident ability for this skill. Responses were used to generate a final cognitive demands table to be used for subsequent portions of the validation process and for future trainee performance analysis.

CONTEXT:

Clinical simulation center with input from medical education faculty and obstetrics and gynecology faculty.

OUTCOMES/LESSONS LEARNED:

Review and feedback by experts prompted important revisions in the laparoscopic colpotomy model to improve its functionality. Cognitive task analysis allowed for inclusion of critical steps of laparoscopic colpotomy in the model; however, the model remains limited to components that can be performed in a simulation center. Further validation is planned by soliciting trainee and expert evaluation of the model after performing simulated laparoscopic colpotomy using the model.
Simulation Model for Retroperitoneal Dissection: Can Improve Surgical Skills for Complicated Open Laparotomy
Authors: Bowles-Johnson Gloria , Tunnage Irina , Caiseda David , Khalilian Sepideh , Al Refaie Waddah , Fischer John
Published: September 2018

Faculty Advisor:

John Fischer, MD

PURPOSE:

To develop a low fidelity model for retroperitoneal dissection and identification of the ureter to improve resident's confidence and competency in the operating room.

BACKGROUND:

Work hour restrictions and few open laparotomies have created barriers to confident resident performance of retroperitoneal dissections. While simulation training models have been developed for laparoscopy, few have been created and validated for open laparotomies.

METHODS:

OB/GYN residents were divided into case (PGY3) and control (PGY4). A pretest questionnaire assessed operative experience. Both groups performed a videotaped low fidelity simulated retroperitoneal dissection that included identifying the course of the ureter. An instructional video was introduced and repeat simulation was performed by PGY3 trainees only. Three expert gynecologists independently scored performances using a checklist and global rating scale of operative performance (OSAT). PGY3 pretest/posttest scores were compared to PGY4 scores using the Wilcoxon rank sum test. Paired t-test was used for comparison of cases. P<.05.

RESULTS:

Median pretest checklist score for PGY4 was significantly increased compared to PGY3 (7.3 vs. 6.3, P=.0314) however the median pretest OSAT score was not. A statistically significant increase in average PGY3 scores between pre vs. post final checklist scores and final OSAT scores was noted. A statistically significant increase in the median scores between PGY4 pretest (control) vs. PGY3 posttest (case) final checklist scores and final global scores (7.3 vs. 9.2, P=.0052) and (24.2 vs. 28.2, P=.0042) was noted.

DISCUSSION:

The development of a low fidelity model for retroperitoneal dissection and use of an instructional video may complement traditional learning for this core competency.
Implementation of myTIPreport Application Improves Resident Perception of Feedback on Surgical Skills
Authors: Green Minda , Fischer John
Published: September 2018

Faculty Advisor:

John Fischer, MD

PURPOSE:

To improve how faculty provide resident feedback with addition of an evaluation tool of gynecologic surgical skills performance.

BACKGROUND:

Surgical education and evaluation of residents needs to adapt as our learners evolve. A needs assessment revealed resident consensus showing a perception of lack of consistent feedback when it comes to faculty evaluating gynecologic surgical performance. myTIPreport application is a validated tool for surgical skills feedback in resident education.

METHODS:

Surveys were given to residents and faculty before and after use of myTIPreport application for surgical feedback in gynecologic procedures. Post-implementation surveys were given to assess the value of the myTIPreport application.

RESULTS:

Surveys of 24 residents in our program revealed a perception of inconsistent surgical feedback of gynecologic cases by faculty. myTIPreport application was introduced as a new evaluation tool of resident performance during gynecologic surgeries. Surveys given 1 year after implementation reveal most residents believe addition of the application has improved faculty feedback. Faculty want to continue use of the application. Residents and faculty think time constraints are the main obstacle to completing more evaluations.

DISCUSSION:

The majority of residents state the myTIPreport application is easy to use. Residents report that the myTIPreport application has improved how faculty give feedback for evaluating surgical skills. Although faculty think it is a useful evaluation tool, there has been difficulty with consistent use. There is some ambiguity about whose responsibility it is to initiate the process of feedback and use of the myTIPreport application.
Formal Shared Decision-Making Training and Evaluation Tools for OBGYN Residency Curriculum
Authors: Kandadai Padma , Bell Shannon , Abbott Jodi
Published: September 2018

Faculty Advisor:

Erika Banks, MD

PURPOSE:

To introduce formal shared decision-making (SDM) training to OBGYN residency and compare evaluation tools.

BACKGROUND:

Specific tools to evaluate resident competency in SDM are lacking, leading some specialties to use patient satisfaction surveys for evaluation. A government-issued ratings survey, the Consumer Assessment of Healthcare Providers and Services (CAHPS) contains SDM questions (SDM-CAHPS). A formal training framework for SDM (SDM-T) includes an evaluation tool with a 10-item checklist (SDMCL) of “essential components” (Role, Context, Nature, Alternatives, Pros/Cons, Uncertainty, Understanding, Preferences, Input, and Teach-Back). While SDM-CAHPS also includes these components, it has not been compared to the SDMCL.

METHODS:

A pre-implementation survey of faculty and trainees in OBGYN indicated interest in formal SDM training for all resident levels. OBGYN trainees attended a 30-minute SDM-T session, followed by a 15-minute standardized patient (SP) encounter with a clinical scenario requiring SDM. SPs completed the SDMCL (SDMCL-SP) and the SDM-CAHPS. Self-assessment using the SDMCL was completed by trainees (SDMCL-T). SP checklist responses were compared to both SDM-CAHPS and trainee answers for concordance, defined as same response for each component.

RESULTS:

16 trainees participated. Item-concordance between SDMCL-SP and SDMCL-T ranged from 69-100%, with the least concordance for Uncertainty (69%). Item-concordance between SDMCL-SP and SDM-CAHPS ranged from 56-100%, also with the least concordance for Uncertainty (56%).

DISCUSSION:

Responses between SDMCL and SDM-CAHPS were highly concordant for some components, but discordant for others. These tools may be useful to evaluate resident competency in SDM, but further validation of both in SP and real patient encounters are needed.
Minimally Invasive Surgery Gynecology Resident Curriculum
Authors: Nejad Bahareh , Wilson Machelle , Steen Claire , Jacobs Linsey
Published: September 2018

Faculty Advisor:

Karen Noblett, MD

BACKGROUND:

The field of Obstetrics and Gynecology is facing challenges nation-wide due to declining surgical volume, increasing surgical complexity, and work-hour restrictions. Residents at the University of California, Davis provided feedback that more gynecology education is needed. Using dedicated didactic time, a Gynecology curriculum using a combination of lectures, dry labs, and wet labs was implemented.

ASSESSMENT OF PROBLEMS:

Surveys were generated to assess comfort level and knowledge before and after each gynecology curriculum intervention in academic year 2016-17. These surveys were de-identified except for the year of residency (1st-4th). Training level was dichotomized with residency years 1, 2 (early) and years 3, 4 (advanced). The assessment determined whether resident learners found the intervention useful, and if tangible knowledge was gained. The Kruskal-Wallis test was used to compare differences between the treatment groups in their Likert scale comfort responses, and the percent correct in the knowledge responses.

RESULTS OF ASSESSMENT/MEASUREMENT:

Early training participants improved in their comfort level in the vendor fair, LEEP, vaginal histology, and morcellation labs, compared to the advanced participants who only improved in comfort for the vendor fair. Both early and advanced participants improved in knowledge for the LEEP and morcellation labs only.

STRATEGIES FOR QUALITY IMPROVEMENT/CHANGE:

If a Curriculum intervention was not found to be useful, it will be modified or eliminated in the upcoming year for perpetual improvement in the overall surgical curriculum.

LESSONS AND MESSAGES:

Early and advanced learners have varied needs within a training curriculum and educators must plan accordingly.
Abdominal Hysterectomy Simulator With a 3D Printed Uterus
Authors: Pauley Amanda , Yoost Jennie
Published: September 2018

Faculty Advisor:

Nancy Gaba, MD

PURPOSE:

To improve confidence and competence of residents in performing abdominal hysterectomy.

BACKGROUND:

Our institution has a decreasing number of abdominal hysterectomies. Total cases logged by chiefs decreased from 216 in 2013 to 111 in 2016 graduating chiefs.

METHODS:

After obtaining IRB exemption, a 3-D printer was used to produce a model to teach abdominal hysterectomy. The residents were given a pre-test consisting of a Likert scale survey to assess their confidence with the procedure as well as a knowledge assessment. They then underwent the intervention/simulation which included anatomy, instrument identification and procedural steps. The same Likert scale survey and knowledge assessment were given post-intervention. The dependent t-test was used to compare mean knowledge scores. Likert scale questions were dichotomized and compared using a two sample test of proportions.

RESULTS:

We have a small residency program and had a total of eleven residents participating in this study. When broken down by level of training, overall knowledge scores increased by all levels of training, however they were only statistically significant for the third year residents. When broken down into individual categories, instruments/anatomy/incision types/procedural steps, the percent correct increased on all topics. This was statistically significant for anatomy, incision types and procedural steps. When looking at the resident comfort performing abdominal hysterectomy, residents were more comfortable after the simulation.

DISCUSSION:

Implementation of this new abdominal hysterectomy simulator and brief didactic session was an effective way to increase resident knowledge and comfort of abdominal hysterectomy.
Direct Observation vs Video Review of Laparoscopic Gynecologic Cases and their Effect on Evaluation
Authors: Rossi Rocco , Aland Kristen , Kelly Elizabeth
Published: September 2018

Faculty Advisor:

Arthur Ollendorff, MD

PURPOSE:

To demonstrate that delayed video evaluation of laparoscopic procedures is consistent with real time evaluation.

BACKGROUND:

Fewer Gynecologic surgeries are being performed annually in residency, which creates a challenge in evaluating competency for graduating residents. If our hypothesis is affirmed it would allow residents to submit their procedures electronically for evaluation thus allowing for a more comprehensive evaluation of their skills, higher volume of evaluations and more individualized control over the residents' education and development.

METHODS:

Women undergoing a laparoscopic gynecologic surgery in which something was removed from the body were eligible for the study and signed consents to have their cases recorded. After completion of the procedure the attending physician would fill out a GOALS assessment of the case. The video was then uploaded to a secure on-line file storage system and reevaluated by two other attending physicians using the same GOALS assessment sheet. Results of the separate assessments were analyzed using Student's T test.

RESULTS:

A total of 29 real time and 24 video evaluations were performed. The mean composite GOALS scores were not significantly different with 17.14 and 16.30 for real time and video review respectively (P=.30). Among the GOALS individual components only efficiency showed a statistical difference with video review demonstrating lower scoring (P=.03).

DISCUSSION:

Real time and delayed video evaluation of resident skills yield similar results in laparoscopic gynecologic cases.
Burning the Midnight Oil: Resident Surgical Performance in Emergent, Off-Hour Procedures
Authors: Salvo Nicole , Simpson Deborah
Published: September 2018

Faculty Advisor:

Steven Swift, MD

PURPOSE:

To evaluate Ob/Gyn resident perceptions regarding the effectiveness of video simulation to safely practice the clinical decisions associated with various surgical techniques.

BACKGROUND:

Obstetrics and Gynecology residents gain surgical competence and efficiency with repetition making decisions in the clinical environment. Surgical exposure during the night shifts may limit resident competence, efficiency and confidence as these procedures often occur emergently with limited time for structured feedback opportunities. Surgeries for ectopic pregnancies are the most common gynecologic procedures occurring during the night shift at our site.

METHODS:

Aurora resident physicians, faculty physicians and operating room staff completed a survey regarding surgical performance of emergent ectopic pregnancy procedures. Resident physicians participated in a group video simulation and completed a baseline self-assessment of their confidence, competence, independence and comfort. They subsequently completed a self-assessment post intervention.

RESULTS:

All residents reported that the video simulation was very helpful (rating 4-6) in developing confidence in surgical decision-making (6=extremely helpful to 1=not at all helpful) and all residents would prefer to engage in additional video simulations. On average residents showed an increase in comfort, competence, and the ability to make complicated surgical decisions independently post compared to the pre video simulation. Senior residents, compared to junior residents, reported increased efficiency, competence and comfort with independence compared to junior residents.

DISCUSSION:

Residents perceive video simulation as a safe environment to deliberately practice surgical decision-making skills. Faculty and staff perceptions of resident efficiency and competence will be compared over time to resident perceptions. We will expand use of this low fidelity education strategy within our residency program.