bluuebunny/crossref_metadata_2025 huggingface dataset:
Critical Incident Debriefing: Impact of a Teaching Module for OB/GYN Residents
Authors: Cutler Abigail , Black Jonathan , Sheth Sangini , Pathy Shefali
Published: September 2016

BACKGROUND:

Healthcare professionals commonly confront suffering and death as well as other unique sources of stress. The cumulative effects of these experiences can be psychologically taxing, particularly on trainees. Debriefing has been proposed as a way to alleviate work-related stress. Minimal data exist about the role of debriefing during medical training.

METHODS:

Eligibility included all OBGYN residents at a single academic hospital. Participants completed surveys immediately prior to and following a 2-hour teaching module on critical incidents in medicine. Using a Likert scale, participants responded to statements that evaluated their perceptions of CI debriefing, familiarity with identifying CI, and comfort with post-incident debriefing. Responses were analyzed using a paired samples t test.

RESULTS:

Twelve participants were enrolled; 46% reported having experienced a CI. Following the teaching module, participants showed increased comfort identifying CI (P=.025), initiating a debriefing (P=.005) and facilitating a debriefing (P=.003). Following the teaching module, participants reported a stronger belief that post-incident debriefing is useful (P=.046), that learning to lead a debriefing is useful to their work (P=.017), and that they could identify situations where team members might require further interventions beyond debriefing (P=.007).

DISCUSSION:

Incidents experienced as critical by OBGYN residents are common. Our teaching module may positively affect how residents confront and process CI. Future studies are needed to assess the long-term impact of debriefing on resident wellbeing and patient care.
Evaluation of Challenger® as an OB/GYN Residency Self-learning Tool
Authors: Sookram Janhvi , Myers John , Jaspan David , Goldberg Jay
Published: September 2016

BACKGROUND:

Challenger® is a commercially available on-line educational package, which offers focused readings on a variety of OB/GYN topics with self-assessments tests. It was utilized during the night float block to comply with duty hour restrictions, while still providing educational enrichment. Each resident completed 2–3 modules weekly, including a pre-test, educational content, and a post-test. The Challenger® program allows supervision and monitoring of resident progress. The total cost of Challenger® was approximately $6,000.

METHODS:

After one year of usage of Challenger®, residents completed a quality assessment questionnaire which evaluated the reading assignments, test questions, and their perception of its usefulness as a learning tool.

RESULTS:

Sixteen residents completed the quality assessment questionnaire on Challenger®. One hundred percent of residents found the reading assignments were easy to understand. Seventy-five percent of residents learned “sometimes/rarely” from the modules. Eighty-one percent of residents rated the question quality as “poor/fair.” Seventy-five percent of residents believed it to not be worthwhile. Eighty-one percent did not believe that it helped to prepare for boards exams. Eighty-eight percent were unlikely to endorse continuation or recommend Challenger® to other residency programs.

DISCUSSION:

Challenger® was not a useful learning tool for OB/GYN resident education. Some readings were outdated. Some questions were of poor quality in assessing knowledge base. As pre- and post-test questions were the same, and residents often finished an entire module's reading section plus the pre- and post-tests within 30 minutes, it is uncertain whether the readings were actually completed.
Impact of a Resident-as-Teachers Objective Structured Teaching Examination (OSTE) on Medical Student Vaginal Delivery Learning Outcomes
Authors: Nuthalapaty Francis , Boland Jill , Tonismae Tiffany
Published: September 2016

BACKGROUND:

One of the most common procedures learned by medical students on the OBGYN clerkship is normal vaginal delivery. Currently, students learn this procedure at the bedside, from residents who have had no formal instruction in optimal teaching methods.

METHODS:

A quasi-experimental time-sequential static group study. Obstetrics and Gynecology (OBGYN) residents were exposed to a RaT curriculum consisting of a didactic session, an OSTE using a standardized student and NOELLE birthing simulator. Third-year medical students on the 6-week OBGYN clerkship logged all vaginal delivery experiences during academic years preceding and following the RaT curriculum, recording their level of involvement in each of 16 procedural steps (Likert-type scale: 1=Observed; 2=Assisted; 3=Performed with assistance; 4=Performed without assistance). The level of involvement ratings for each procedural step, were compared pre and post RaT intervention, using the χ2 test. P<.05 was considered statistically significant.

RESULTS:

A total of 240 and 204 delivery experiences, were recorded by students pre and post the RaT curriculum, respectively. Following the curriculum, a significantly greater proportion of student delivery experiences occurred with chief residents (PGY-4) than prior to the curriculum (19.6% versus 4.6%, P<.01). Mean student level of involvement scores for setting up the delivery table, patient draping, postpartum hemorrhage preventive measures, and inspection of the cervix/vagina/perineum were significantly higher post-curriculum, as compared to pre (2.53 versus 2.02, P<.01; 2.15 versus 1.87, P<.01; 2.56 versus 2.36, P=.01; 2.25 versus 2.05, P<.01).

DISCUSSION:

A residents-as-teachers vaginal delivery OSTE may increase engagement of PGY-4 residents in student teaching and the level of student involvement in certain aspects of actual vaginal delivery experiences.
Job Satisfaction Amongst OB/GYN and Surgical Residents at an Academic Center
Authors: Hutchinson-Colas Juanna , Brug Pamela , Patel Nell Maloney
Published: September 2016

BACKGROUND:

The association with physician burnout has been correlated with increasing perceived medical errors, and decreased productivity and compassion. Major components to satisfaction is work-life balance, ability to engage in desired activities, and ability to have time to unwind away from patient care demands.

METHODS:

This study composed of two independent surveys: The Maslach Burnout Inventory, and the Job Satisfaction Survey. Surveys were distributed to the 278 residents at Robert Wood Johnson Medical School with 190 respondents (68%) Residents surveyed included family medicine, general internal medicine, obstetrics and gynecology, emergency medicine, radiology, psychiatry, general surgery. This aspect of the study was to assess the status of the surgical related residencies programs. Respondents were 23/41 for surgery and 14/18 Ob&Gyn residents.

RESULTS:

There was no statistical difference between the two residency programs in the analysis. Job satisfaction General Surgery (18.9) and Obstetrics and Gynecology (17.4) demonstrating for both below average job satisfaction (15.1–20). Burnout score again was not statistically significant—General Surgery burnout score was 85.5 and Obstetrics and Gynecology score −79.0. There was no statistical difference noted across race, gender, marital status, religion and being a parent.

DISCUSSION:

Surgical related residents demonstrate job dissatisfaction and are a threat for burn out but there were no statistically significant findings between the specialties.
Laparoscopic and Robotic Skills Are Transferable in a Simulation Setting: A Randomized Controlled Trial
Authors: Thomaier Lauren , Abernethy Melinda , Grace Chen Chi Chiung
Published: September 2016

BACKGROUND:

Residents are increasingly being trained on robotic techniques instead of traditional laparoscopy. Although simulation training does provide an effective supplement for traditional surgical training, less is known if skills are transferable between the laparoscopic and robotic platforms.

METHODS:

In a randomized single-blinded controlled trial of 40 simulation-skill-naive medical students, participants completed a baseline evaluation on a robotic pegboard-transfer task (Mimic dV-Trainer) and laparoscopic peg-transfer task (Fundamentals of Laparoscopic Surgery). Skills were evaluated using validated objective and subjective global rating scales (GRS) by two blinded expert surgeons. Participants were randomized to practice on either the robotic (N=20) or laparoscopic (N=20) task. After practice, participants were reevaluated performing both tasks.

RESULTS:

At baseline, there were no significant differences in objective measures (time to task completion, motion metrics) or composite GRS scores on both tasks between the groups. Participants performed their respective tasks faster (P<.001, P<.003), more efficiently (P<.001) and with a higher percent improvement in composite GRS scores (P<.001). The laparoscopic group improved their robotic performance with an increase in mean composite GRS scores of 15–20 but this change did not reach statistical significance (P=.091). Participants who practiced robotically significantly improved their laparoscopic performance with an increase in mean composite GRS scores of 15–19 (P<.02).

DISCUSSION:

Skills learned on either the robotic or laparoscopic platform appear to be transferable; however, robotic skills appear to be more transferable to the laparoscopic platform, than vice versa.
Military Sexual Assault Provider OSCE: Agreement of Self-reported Assessment and Standardized Patient Evaluation in Medical and Graduate Nursing Students
Authors: Lucas Cara , Petersen Scott
Published: September 2016

BACKGROUND:

Sexual assault is one of the most underreported crimes in the U.S. military. Sexual trauma education programs have been successful in increasing awareness of this problem throughout the DoD, however now more emphasis is being placed on provider education early in training. Educators at USU have developed a sexual assault education module in order to improve provider comfort and communication in a crisis situation.

METHODS:

Surveys were designed to evaluate students on the eight essential elements of communication (EEC). A cohort of 179 USU medical and graduate nursing students completed these surveys after participating in an interview with a simulated sexual assault victim. The standardized patient portraying the victim also completed a mirrored survey evaluating student's communication.

RESULTS:

No significant differences in means between medical and graduate nursing student OSCE responses were discovered. Students similarly underrated themselves on encounters. Weighted kappas were calculated and showed fair agreement between self-assessment and standardized patients.

DISCUSSION:

No significant differences in interactions between medical and graduate nursing students were identified. OSCE is an important teaching modality for hands-on application of knowledge; student feedback was helpful in planning future simulations and identified some areas for improvement with this simulation. Exposing students to sensitive encounters and emphasizing importance of communication, especially in these situations, will assist students in their clinical growth and development.
Preparing for the First Milestone: Room for Improvement?
Authors: Jordan Scott , Zhao Huaqing , Ferriss James , Glowacki Carol
Published: September 2016

BACKGROUND:

Specialty specific clinical milestone assessment begins with milestone level one, expected of incoming interns. In 2014, the ACGME required medical schools offer post match in-specialty training with the goal of attaining milestone level one.

METHODS:

An online survey was sent to Ob/Gyn interns nationwide in early 2015 assessing participation in required training and perceived entry-level skill sets. A free response section solicited suggestions for improvement of the milestones program. Of 1,276 interns, 145 (11.4%) responses were received. The χ2 test was used to compare responses between groups.

RESULTS:

Of respondents, 19.31% stated they participated in specialty specific milestones training. Among those taking the course, a statistically significant increase in interns feeling “very prepared” for Labor and Delivery duties was noted (23.08% versus 5.61%) (P=.036). No significant differences were perceived in overall preparedness, gynecologic surgery, or office based Ob/Gyn.

DISCUSSION:

This study highlights a lack of both universal implementation and a standardized curriculum, as well as a misunderstanding of program goals and milestone evaluation criteria. Many respondents suggest better training for triage, obstetrical emergencies, office gynecology, and minor gynecologic procedures. Improved participation and creation of realistic participant expectations at the outset, a greater focus on role playing simulations, and implementation of feedback may improve the effectiveness of the course.
Tabletop Simulation to Assess Teamwork Competency in OB/GYN Resident Candidates
Authors: Ma Mary , Kenny Bronwyn , Feldman Nathalie , Mann Stephanie , Nicholas Cate
Published: September 2016

BACKGROUND:

Selecting new residents for an OBGYN training program is a high-stakes undertaking for both candidates and the programs to which they apply. Determining which candidates would work well within their cohort is of paramount importance to the success of a program. In addition, the quality of patient care has been shown to be positively impacted by inter-professional collaboration and well-functioning healthcare teams.

METHODS:

Mr. Potato Head® tabletop simulation was adapted for use during the UVM OB/GYN Residency Interview Day. Six to 7 candidates were assigned to each team. Candidates were assessed by 2 OBGYN residents who received training on identifying behavioral anchors associated with performance. Results of the team work simulation were included in the holistic review of candidates at the completion of the interview day.

RESULTS:

Seventy-one percent of candidate respondents reported favorable feedback on a post-interview day survey, describing the activity as a unique experience reflecting the value our program places on teamwork. 30/46 candidates met expectations with 6/30 nearly exceeding expectations. 10/46 candidates were rated as borderline meeting expectations and 6/46 failed to meet baseline expectations. Of the 6 candidates rated as not meeting expectations, 3 (50%) were not ranked in our program. 13/14 interviewers found the Potato Head Simulation to be valuable in their assessment of candidates, with 10/14 reporting a moderate to significant influence. Behavior anchors associated with meeting expectations included good listening skills, treating others with respect, the ability to reflect and be open to feedback.

DISCUSSION:

Teamwork is a skill set that is difficult to evaluate. Traditional one on one-interview scenarios rarely provide the opportunity for candidates to demonstrate their ability to function within a team. Tabletop Simulation provides a feasible, engaging and well received activity during the interview day to assists programs in evaluating candidate team work skills.
An Educational Intervention to Improve Physician Confidence and Knowledge About Transvaginal Sonographic Cervical Assessment in Obstetric Patients
Authors: Keiser Sharon D. , Forstein David , Heberlein Emily , Parker Patti
Published: September 2016

Local Mentor: David Forstein, DO

APGO Advisors: Jody Steinauer, MD, MAS, and Sonya Erickson, MD

PURPOSE:

To evaluate the effect of an educational intervention about transvaginal sonographic cervical length (CL) measurement on obstetrics and gynecology residents' confidence and knowledge.

BACKGROUND:

Preterm labor admissions are costly. Transvaginal ultrasound measurement of CL has a high negative predictive value for preterm delivery, and can help triage patients with symptoms. Education about transvaginal CL measurement may increase use of this screening tool when triaging patients with preterm labor symptoms.

METHODS:

This was a before and after study of OB/Gyn residents at a single institution. The intervention consisted of an educational module adapted from a preexisting module from AIUM. Nine pre- and post-test questions evaluated knowledge. Residents were asked about their confidence with each answer and in doing CL measurements. Chi-squared tests were used to compare proportions and ordinal data, and Wilcoxon rank sum test the proportion of correct answers.

RESULTS:

Twenty-one residents participated. The proportion of residents answering 89% or more of the questions correctly increased from 5% before to 81% (P<.01). The level of confidence about answers to knowledge-based questions about the technique increased significantly, (P<.01) however confidence in doing CL measurement did not change, with 52% of residents saying they were not confident before and 38% after the intervention (P=.4).

DISCUSSION:

An educational module can increase knowledge about the utility and performance of cervical length measurement, but does not change confidence in doing the measurement. Future efforts should include curricula to teach the actual measurement.
Developing a Pilot Curriculum to Foster Humanism in Graduate Medical Education
Authors: Howell Jennifer O. , Chuang Alice , Dotters-Katz Sarah , Weil Amy
Published: September 2016

Local Mentor: Alice Chuang, MD

APGO Advisors: Sonya Erickson MD, and Jody Steinauer, MD, MAS

PURPOSE:

To design a pilot curriculum to foster humanism in Graduate Medical Education (GME).

BACKGROUND:

Humanistic values have been recently emphasized in medical education with the advent of professionalism competencies. Few curriculum interventions affect humanistic professional development at the GME level.

METHODS:

OB/GYN and Internal Medicine residents' narratives regarding challenges to humanistic behavior were analyzed as a needs assessment with three themes identified: compassion fatigue, communication challenges, and work-life balance. Three curriculum sessions focusing on these themes were chosen from an existing faculty development course. Ten subjects participated in the curriculum, and these ten participants and 10 control residents completed baseline and 60-day follow-up questionnaires that assessed burnout, compassion satisfaction, the ability to practice psychological medicine (Psychological Medicine Inventory [PMI]), and the number of ethical missteps made within the last 30 days4. The mean differences in scores between the control and intervention subjects were compared using a two-tailed χ2 test. The success of the intervention was also measured with 5-point Likert satisfaction surveys.

RESULTS:

The curriculum met course objectives and was successfully incorporated into the residents' practice (mean score 4.8) There was a trend toward improved burnout and compassion satisfaction for the intervention group versus the control group (P=.13). There was no difference in PMI or reported ethical missteps.

DISCUSSION:

A pilot humanism curriculum for residents was well received. Participants showed a trend towards improved burnout and compassion satisfaction compared with non-participants. Development and evaluation of an expanded curriculum would further explore the feasibility and effectiveness of this type of intervention.
Formative Assessment by Direct Observation of Clinical Skills on the OB/GYN Clerkship Rotation
Authors: McNaught Jenna
Published: September 2016

Local Mentor: Margaret Burnett, MD, FRCSC

APGO Advisor: John Dalrymple, MD

PURPOSE:

To determine the impact of requiring that medical students be observed taking a history or performing a pelvic examination by a physician during their OB/GYN clerkship rotation.

BACKGROUND:

One of the LCME standards for accreditation of a medical school is having physicians directly observe medical students in their clinical activities in order to provide formative feedback. Since 2009, 29.7–52.9% of each class of Manitoba medical graduates report having been observed taking a history on their OB/GYN clerkship rotation; 45.2–70.4% for observed physical examination.

METHOD:

Clerks are surveyed on the last day of their OB/GYN rotation to determine the number of observed histories and/or pelvic examinations. In September 2015, observed histories and pelvic examinations became a rotation requirement. A mini-CEX tool was developed and included in the student's logbook to facilitate documentation and provide feedback. The reported number of observed histories and pelvic examinations are compared before and after implementation of this process.

RESULTS:

Thirty-five percent of 69 students surveyed before implementation report having been observed performing a history by a physician. This rose to 64% (of 28 students) following implementation. All of them report being observed performing a pelvic examination, before and after, however only 53% documented this on the assessment tool.

DISCUSSION:

The number of observed histories has increased however there is room for further improvement. This may require additional faculty education and/or scheduled assessment for some students. The number reporting an observed pelvic examination continues to be 100% but improved documentation of this must be encouraged.
Labor and Delivery as a Learning Environment: Results From a Survey of Medical Students and Their Instructors
Authors: Hoffman Mark
Published: September 2016

Local Mentor: Wendy Hansen, MD

APGO Advisors: Sonya Erickson, MD, and Jody Steinauer, MD, MAS

PURPOSE:

To evaluate labor and delivery as a learning environment during the third-year medical school obstetrics and gynecology course.

BACKGROUND:

Labor and delivery is a teaching environment for medical students during their third year OB/Gyn rotation. Based on the end-of-year student evaluations of the clerkship, labor and delivery was noted to be an area in need of improvement.

METHODS:

After IRB approval, the validated learning environment survey was sent to all third-year medical students who rotated through the labor and delivery unit at a single university hospital. Surveys were also sent to instructors who worked directly with students on labor and delivery, including OB/Gyn faculty, residents and nurses. De-identified responses were collected through Qualtrics software. Descriptive analyses were performed to identify differences in student and instructor responses.

RESULTS:

The overall response rate for the survey was 42% (77/183), with 85% (11/13) of faculty, 63% (10/16) of residents, 40% (38/95) of students and 31% (18/59) of nurses responding. Student and instructor responses were statistically different for 16/39 questions (41%). The section titled “Motivation/learning skills,” which included topics such as “I am eager to learn” and “I come to the clinical session prepared and ready,” contained the most significant difference in responses between students and teachers.

DISCUSSION:

Survey results reveal that students and instructor had different opinions of students' experiences on labor and delivery. The results of this survey will help clerkship leaders identify areas in need of improvement.
Performance on the Obstetrics and Gynecology National Board of Medical Examiners Subject Exam: Does Practice Help?
Authors: Kohl-Thomas Belinda M. , Ray Kelly A. , Kuehl Thomas J. , Allen Steven R.
Published: September 2016

Local Mentor: Steven R. Allen, MD

APGO Advisor: John L. Dalrymple, MD

PURPOSE:

To evaluate whether a practice NBME examination for Ob/Gyn clerkship third year medical students (MS3s) improves scores on the final NBME examination.

BACKGROUND:

NBME scores provide a measure of students' knowledge.

METHODS:

We compared two groups of MS3s on the Ob/Gyn clerkship at three clinical campuses. Group 1 (n=252) took the NBME examination without a practice exam (6/2012–1/2014), and group 2 (n=271) took the examination after implementation of the practice exam (3/2014–10/2015). Group 2 was surveyed anonymously regarding the practice exam. Outcomes include comparison of final scores between groups using Student t test, comparison of practice and final scores in group 2 using paired Student t test, and proportion of each group scoring ≥70% (“pass”) using χ2 test. ANOVA was used to compare scores at different sites and of different blocks of students.

RESULTS:

Mean raw NBME scores do not differ among campuses (75.7, 74.9, 75.6, P=.61). Across the study period, scores were lower during the first half of the academic year, with blocks 6, 7 and 8 differing from 2 and 4 (P=.006). Group 2 demonstrated an improvement (P<.001) of 5.9 points from practice to final NBME. Scores are higher for group 2 than group 1 (76.7, 74.1, P=.001) and 17.1% more group 2 students scored ≥70% (P=.001). Student survey results support the use and continued inclusion of the practice exam.

DISCUSSION:

A practice exam improves students' NBME score, and increases the number of students who pass. Students recommend continued use of the practice NBME exam.
Smartphones: Are They REALLY a Smart Idea?
Authors: Patel Silka , Lidor Anne , Sanyal Abanti , Hueppchen Nancy
Published: September 2016

Local Mentor: Nancy Hueppchen, MD

APGO Advisor: Alice Goepfert, MD

PURPOSE:

To understand the perception of professionalism surrounding smartphone use (wards/educational activities) among medical students and surgical faculty.

BACKGROUND:

Smartphones are ubiquitous and their uses numerous: personal messages, patient care, emails and entertainment. It is difficult to determine which of these functions the user is engaged in at any one time during work at healthcare facilities. Students and faculty (Ob/Gyn and Surgery) are motivated to exhibit professional behavior and are evaluated on this measure. Given changes in generational norms and implications of unprofessional behavior it is important to understand how use of this technology is perceived in the workplace.

METHODS:

A prospective cohort study was conducted using an electronic survey and distributed to 3rd and 4th year medical students, Ob/Gyn and Surgery faculty members. Five cases were randomly presented; participants were asked to review and rate the clinician's behavior on a 5 point Likert scale.

RESULTS:

One hundred twenty-three students (51% response) and 73 faculty (Ob/Gyn with 54% response; Surgery with 21% response) completed the survey. In 3 of 5 scenarios, students and faculty had significant differences in perception of professionalism (P<.05). Faculty were more likely to find behaviors unprofessional compared to students. The acceptability of certain behaviors was correlated with how participants reported using their smartphones.

DISCUSSION:

There is a difference in perception of professional behavior surrounding smartphone use among medical students and surgical faculty. Acceptability of a behavior is also correlated to personal use of technology. Future studies should be designed to further define professional use of smartphone technology.
A Pilot Study: An Online Teaching Tool for Standardization of Gynecologic Oncology Fellowship Curriculum
Authors: Langstraat Carrie , Cliby William
Published: September 2016

BACKGROUND:

Learning objectives for gynecologic oncology (GO) fellowships have been created, however a standard curriculum does not exist. There is interest amongst program directors to develop a standardized curriculum with online teaching tools. This study was conducted to determine the learning needs of GO fellows and to assess the use of web-based teaching in this group of learners.

METHODS:

An 18 minute teaching module on surgical management of vulvar cancer was created and validated by experts. The module was then emailed to fellows with a pre and post-module survey. The survey assessed the learners needs, the learners knowledge and the usefulness of the module.

RESULTS:

One hundred ninety GO fellows were surveyed, 72 (38%) responses were received. Most participants were in their second year of clinical fellowship (42%). The majority of GO fellowships have a weekly teaching conference with faculty participation. Resources utilized by fellows for learning are textbooks and journal articles, with all responders ranking these as their first or second preferred resource. The teaching module was an effective teaching tool as demonstrated by improved scores across the four content based questions. The webinar was well received by the fellows, with 92% saying they liked this teaching tool and 46/48 (96%) felt that they would view additional presentations if provided. In addition 45/49 (92%) felt that this type of teaching filled a need in GO fellowship.

DISCUSSION:

Many GO fellowships utilize faculty directed teaching conferences. This online teaching tool improved fellow knowledge and additional modules would be well received in this population of learners.
Can a Low-Fidelity Surgical Model Simulating Loss of Vessel Control During Uterine Artery Ligation Induce Stress Among Gynecologic Residents?
Authors: Rone Bryan , Ollendorff Arthur , Qi Ya
Published: September 2016

BACKGROUND:

Low-fidelity surgical simulation models are being used more often in surgical education. It is unclear whether or not residents have the same stress level during low-fidelity simulations compared to an actual surgery.

METHODS:

The low-fidelity uterine artery ligation simulator was fabricated with a 3D printed model uterus and consists of materials to form the cardinal ligament and tubing to fabricate functioning uterine arteries. The resident filled out a pretest questionnaire which assessed their perceived or actual stress level (1–4) while losing control of the uterine artery during an abdominal hysterectomy. The residents then performed ligation of the uterine artery on the model with instructions to control any bleeding that occurred. The experimental model simulated bleeding of the uterine artery independent of their ligation technique. The residents controlled the bleeding and then filled out a post-test questionnaire measuring their stress level during the simulation.

RESULTS:

The results were evaluated by calculating the average difference between the residents pre and post-test subjective stress level. This difference was then compared via t test with zero (the expected average difference if the stress level was equal). The average difference was 1.11 (P<.0001), standard error or 0.1.

DISCUSSION:

On average, the residents reported one less level of stress after the low-fidelity simulation than they perceived they would feel or have felt during an actual surgery. This model was unable to induce the stress that is likely to be encountered in a similar situation in a real surgery.
Evaluation of Dry Lab Training on Residents Knowledge of Robotic Instrumentation and Surgical Preparation
Authors: Rohl Jacqueline , Hade Erinn
Published: September 2016

BACKGROUND:

Current studies of robotic surgery training are focused primarily on education and evaluation of surgical skills acquisition. However, a component not well studied is knowledge of instrumentation and surgical preparation (port placement, docking, and console knowledge).

METHODS:

Evaluation of residents knowledge was completed by a short pre and post-test consisting of 16 questions on patient positioning (maximum of 2 points), docking/patient cart information (maximum of 16 points) and the surgeon console (maximum of 12 points). The total score is calculated as the sum of these three components (range: 0–30). Residents demographics, pre-test, post-test and recall test total scores are summarized by descriptive statistics. The comparison of scores before and after training is made by the Wilcoxon signed-rank test and through regression on the ranks of the scores. Rank regression models allow adjustment of residents demographics characteristics on the change in scores.

RESULTS:

Twenty-seven residents participated in the dry lab training session. There was a significant increase in test scores after the dry lab in comparison to test scores before (pre-test score: median=24, range (7–28) versus post-test score: median=29, range (22–30); Wilcoxon rank sum test P=.002).

DISCUSSION:

Test scores after the dry lab significantly increased in comparison to before the lab. However, tests at 3–4 months were lower than tests after the lab, especially for more junior residents. This indicates that although there was knowledge attained from the dry lab, it may need more reinforcement throughout the year.
Impact of an Educational Module Addressing the Cost of Disposable Surgical Equipment in Gynecologic Surgery
Authors: Swan Kimberly , Piszczek Jackie , Flanery Brian
Published: September 2016

BACKGROUND:

Disposable surgical equipment is an expensive part of all cases. We sought to determine if an educational module could impact knowledge, attitudes and behaviors of providers in regards to disposable laparoscopic equipment.

METHODS:

An online education module was developed addressing the cost of disposable surgical equipment at the Kanas University Hospital. Gynecologic laparoscopic attending physicians and the gynecology operating room support staff completed a pretest, viewed an educational module and completed a post-test. The cost of disposable equipment per laparoscopic hysterectomy case was determined by utilizing the hospital inventory management software. The cost per case for the 3-month period prior to the intervention and the 3-month period afterwards was collected.

RESULTS:

A total of 24 providers participated in the study over a one-month period. Prior to the intervention participants were able to identify the most expensive option 43% of the time and the least expensive 55%. Afterwards participants were able to identify the most expensive option 85% of the time and least expensive 89% (P=.0008; P=.0177). The average cost of disposable surgical equipment per laparoscopic hysterectomy case from May to July 2015 was $1,502 for 20 cases, which was significantly higher than the average cost of $1,306 for 29 cases from September to November 2015 (P=.0381).

DISCUSSION:

An educational module has the ability to impact a providers knowledge about the cost of disposable surgical equipment and this knowledge may translate into potential cost savings in surgical cases.
Instrument Training for Gynecologic Laparoscopy: A Pilot-Scale Randomized Control Trial to Improve Women's Safety
Authors: Lewis Mark , Islam Mohammad , Hesson Ashley , Shellgren Madeline , Collier Deborah , Milad Magdy
Published: September 2016

BACKGROUND:

Inadequate technical proficiency in laparoscopy has a substantial negative effect on the safety of laparoscopic gynecologic procedures. Of errors due to lack of technical competence, 58% have been attributed to a deficiency in proper instrument training.

METHODS:

Forty-two medical trainees were randomized to standard training (ST, N=20) versus enhanced training (ET, N=22). ST participants were shown a 31 seconds instructional video akin to a typical industry briefing, while ET participants viewed a 2:42 seconds video incorporating additional safety information. Participants were then given a ten-question quiz and practice time with the instrument (1 minute for ST, 5 minutes with a tissue sample for ET) followed by a standardized laparoscopic simulator assessment using the instrument on chicken skin models.

RESULTS:

Quiz scores were significantly higher for ET participants (mean=6.3/10) as compared to ST participants (mean=4.1/10; P<.01). ET participants' psychomotor task times were also significantly faster than ST times (ET mean=113.4 seconds, ST mean=186.7 seconds; P=.02). A significant negative correlation was noted between quiz scores and task times (P=.01); ie, participants that performed better on the quiz tended to complete the task faster.

DISCUSSION:

This study demonstrates that a brief, structured training intervention improves both competence and efficiency on a laparoscopic instrument, suggesting that interventions designed to optimize cognitive proficiency and psychomotor skill in situ may decrease morbidity associated with new devices in the operating room.
Integration of Cystoscopy Into OBGYN Junior Residency Curriculum: A Simulation-Based Approach
Authors: McLeod Francine , Tabbarah Rami , Rice Dana , Sheridan Michael , Nieves Kelsey
Published: September 2016

BACKGROUND:

Lower urinary tract injuries present serious challenges for the obstetrician gynecologist. Recently, innovative surgical techniques have been employed to improve visualization and dissection of pelvic anatomy. Despite these advances, lower urinary tract injury during hysterectomy is still our greatest peril. Intraoperative recognition and immediate surgical repair can greatly reduce post-operative morbidity and medical-legal ramifications.

METHODS:

Participants were junior residents (PGY-1 and PGY-2) in the OBGYN Residency Program at Inova Fairfax Medical Campus. The cystoscopy curriculum consisted of a 1 hour didactic session and a 3 hour simulation session. The didactic session examined characteristic properties of the bladder, including an overview of the procedure. The simulation session incorporated a skills workshop with repeated practice on low fidelity models. Pre- and post-assessments included a cognitive exam, a confidence survey, and validated checklists (OSATS). After 6 months, final acquisition of skill was tested in the operating room.

RESULTS:

PGY-1 and PGY-2 residents showed significant cognitive (P=.0008/.003) and confidence (P=.04) improvement, with no difference between groups. For checklist items, there was significant improvement within groups for Cystoscope Assembly (P=.007), Bladder Survey (P=.0002), Total Score (P<.0001), Global Rating (P<.0001), with no differences between groups.

DISCUSSION:

The simulation based curriculum was effective in training junior residents the basic skills of cystoscopy. This curriculum can be utilized as a teaching tool for residents to become confident and proficient in the aspects of diagnostic cystoscopy.
Low-Fidelity Vaginal Hysterectomy Simulator Increases Resident Attitudes Towards Performing TVH
Authors: Parks Laura A. , Lowder Jerry
Published: September 2016

BACKGROUND:

Vaginal hysterectomy is recommended by the American College of Obstetricians and Gynecologists as the gold standard for route of hysterectomy. At our institution, only 28% of hysterectomies are being performed vaginally, while 28% are laparoscopic and 32% are abdominal.

METHODS:

Residents participated in a vaginal hysterectomy surgical skills lab reviewing criteria for a good surgical candidates and using a low fidelity simulator. A pre and post survey was given to participating residents asking about knowledge, attitudes and training of vaginal hysterectomy.

RESULTS:

Twenty residents participated in this project. The pre and post survey asked questions with response choices ranging on a 5 point Likert scale. Sixty-five percent of the residents were R1 (6–30%) and R2 (7–35%) and 35% were R3 (5–25%) and R4 (2–10%.) The residents had a statistically significant improvement in their attitudes of being able to select a good surgical candidate P≤.001 different responses.

DISCUSSION:

Implementation of this new low-fidelity vaginal hysterectomy simulator and brief didactic session was an effective way to increase resident knowledge and positive attitudes of vaginal hysterectomy.
Surgical Competency for Robot-Assisted Hysterectomy: Development and Validation of a Clinical Assessment Tool
Authors: Frederick Peter , Szender James , Aly Ahmed
Published: September 2016

BACKGROUND:

The purpose of this study was to develop and utilize a clinical assessment tool to objectively measure robotic surgical skills and facilitate robotic surgery training and education.

METHODS:

This was a two-phase study. In phase I, the critical elements of a robotic hysterectomy were deconstructed into 6 key domains to assess technical skills for procedure completion. For each domain, anchor descriptions were developed to match a 5-point Likert scale. Delphi methodology was used for content validation. A panel of five expert robotic surgeons refined this scoring system using the Content Validity Index. In phase II, surgeons with varying degrees of experience performed a robotic hysterectomy. Video recordings were evaluated by blinded expert reviewers using the above scoring system. Descriptive statistics were evaluated for the total scores as well as each domain. Tests of both inter-rater (agreement between the assessors) and test-retest (consistency of scoring over time) reliability were performed with a threshold of significance at P<.05.

RESULTS:

Videos from 16 robotic hysterectomies, with two surgeons evaluated per case, were reviewed by the expert panel. The score for all surgeons was 4.36±0.49 (mean±SD). Scores varied according to surgical domain under assessment, however globally there was no difference between scores for trainees or attendings (P=.83). There was excellent agreement between raters with respect to score in two domains, while disagreements occurred with respect to the other domains.

DISCUSSION:

This pilot study demonstrates the feasibility of utilizing a standardized rubric for clinical skills assessment in robotic hysterectomy.
Neurosteroid Allopregnanolone Suppresses Median Nerve Injury–induced Mechanical Hypersensitivity and Glial Extracellular Signal–regulated Kinase Activation through γ-Aminobutyric Acid Type A Receptor Modulation in the Rat Cuneate Nucleus
Authors: Huang Chun-Ta , Chen Seu-Hwa , Lue June-Horng , Chang Chi-Fen , Wen Wen-Hsin , Tsai Yi-Ju
Published: September 2016

Background

Mechanisms underlying neuropathic pain relief by the neurosteroid allopregnanolone remain uncertain. We investigated if allopregnanolone attenuates glial extracellular signal-regulated kinase (ERK) activation in the cuneate nucleus (CN) concomitant with neuropathic pain relief in median nerve chronic constriction injury (CCI) model rats.

Methods

We examined the time course and cellular localization of phosphorylated ERK (p-ERK) in CN after CCI. We subsequently employed microinjection of a mitogen-activated protein kinase kinase (ERK kinase) inhibitor, PD98059, to clarify the role of ERK phosphorylation in neuropathic pain development. Furthermore, we explored the effects of allopregnanolone (by mouth), intra-CN microinjection of γ-aminobutyric acid type A receptor antagonist (bicuculline) or γ-aminobutyric acid type B receptor antagonist (phaclofen) plus allopregnanolone, and allopregnanolone synthesis inhibitor (medroxyprogesterone; subcutaneous) on ERK activation and CCI-induced behavioral hypersensitivity.

Results

At 7 days post-CCI, p-ERK levels in ipsilateral CN were significantly increased and reached a peak. PD98059 microinjection into the CN 1 day after CCI dose-dependently attenuated injury-induced behavioral hypersensitivity (withdrawal threshold [mean ± SD], 7.4 ± 1.1, 8.7 ± 1.0, and 10.3 ± 0.8 g for 2.0, 2.5, and 3.0 mM PD98059, respectively, at 7 days post-CCI; n = 6 for each dose). Double immunofluorescence showed that p-ERK was localized to both astrocytes and microglia. Allopregnanolone significantly diminished CN p-ERK levels, glial activation, proinflammatory cytokines, and behavioral hypersensitivity after CCI. Bicuculline, but not phaclofen, blocked all effects of allopregnanolone. Medroxyprogesterone treatment reduced endogenous CN allopregnanolone and exacerbated nerve injury-induced neuropathic pain.

Conclusions

Median nerve injury-induced CN glial ERK activation modulated the development of behavioral hypersensitivity. Allopregnanolone attenuated glial ERK activation and neuropathic pain via γ-aminobutyric acid type A receptors. Reduced endogenous CN allopregnanolone after medroxyprogesterone administration rendered rats more susceptible to CCI-induced neuropathy.
Advising and Interview Patterns of Medical Students Pursuing Obstetrics and Gynecology Residency
Authors: Alston Meredith J. , Autry Amy (Meg) , Wagner Sarah A. , Allshouse Amanda A. , Stephenson-Famy Alyssa
Published: September 2016

OBJECTIVE:

To describe the advising practices at medical schools and interview patterns among medical students pursuing obstetrics and gynecology residency training.

METHODS:

A voluntary, anonymous survey was distributed to all applicants interviewing for obstetrics and gynecology residency during the 2014–2015 cycle at the University of Colorado, University of Washington, University of California, San Francisco, and Loyola University. Demographic data were obtained. The survey explored student advising in the residency application process including number of applications and interviews recommended by advisors. Data are reported as percentage for each survey item and compared by select demographics using an exact χ2.

RESULTS:

Among 315 unique possible applicants, 73% (n=230) responded. Students were most commonly advised by the obstetrics and gynecology clerkship director (33%) with recommendations to apply to 21–30 programs (48%). Thirty-four percent of students applied to 21–30 programs, 32% to 31–40 programs, and 30% to greater than 40 programs. Students were advised (70%) and planned (55%) to interview at 10–14 programs. Concern over competitiveness of the applicant pool was the most important factor (31%) in determining the number of applications. The number of programs advised to or plan to interview at was greater for those in the couples match (P<.001).

CONCLUSION:

Medical students pursuing obstetrics and gynecology are most likely to be advised by obstetrics and gynecology clerkship directors and concern over the competitiveness of the applicant pool results in students applying to large numbers of programs. This practice may adversely affect the obstetrics and gynecology match process for both programs and applicants through the requirements of managing additional applications and potentially needing to complete a greater number of interviews.
Heterotopic Ossification: A Review of Current Understanding, Treatment, and Future
Authors: Edwards Dafydd S. , Kuhn Kevin M. , Potter Benjamin K. , Forsberg Jonathan A.
Published: September 2016

Heterotopic ossification is the formation of bone at extraskeletal sites. The incidence of heterotopic ossification in military amputees from recent operations in Iraq and Afghanistan has been demonstrated to be as high as 65%. Heterotopic ossification poses problems to wound healing, rehabilitation, and prosthetic fitting. This article details the current evidence regarding its etiology, prevention, management, and research strategies.