bluuebunny/crossref_metadata_2025 huggingface dataset:
Translocation of AMPA Receptors in the Dorsal Horn of the Spinal Cord Corresponding to Long-term Depression Following Pulsed Radiofrequency Stimulation at the Dorsal Root Ganglion
Authors: Cho Jang Hyuk , Lee Dong Gyu
Published: October 2019

Objective

Pulsed radiofrequency stimulation at the dorsal root ganglion is used for treatment of radicular pain; however, its mechanism for neuropathic pain treatment has not been fully elucidated. Here, we investigated whether pulsed radiofrequency stimulation affects the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, which play a critical role in synaptic plasticity.

Methods

Neuropathic pain was studied using a radicular neuropathic pain model (43 female Sprague-Dawley rats; 200–250 g). In total, 28 rats were assigned to the following groups for fraction analysis: a control group, a control + pulsed radiofrequency stimulation group, a disc pain group, and a disc pain + pulsed radiofrequency stimulation group. For nonfraction analysis of Glutamate A1 (GluA1) and GluA2 subunits, a total of 15 female Sprague-Dawley rats were assigned to a control group, a disc pain group, and a disc pain + pulsed radiofrequency stimulation group. Pulsed radiofrequency stimulation and subsequent analysis were conducted three days after surgery.

Results

AMPA receptor subunits, GluA1 and GluA2, in the radicular neuropathic pain model were upregulated compared with those in the control group three days after surgery. Pulsed radiofrequency stimulation induced the translocation of GluA1 and GluA2 subunits from the synaptosome to cytosol without a change in the total amount of AMPA receptors in the dorsal horn.

Conclusions

Our results demonstrated that pulsed radiofrequency stimulation affected the synaptic plasticity corresponding to long-term depression. Thus, we show that long-term depression from pulsed radiofrequency stimulation is associated with analgesic effects in the radicular neuropathic pain model following peripheral inflammation.
The relationship of pork carcass weight and leanness parameters in the Ontario commercial pork industry
Authors: Barducci Robson S , Zhou Ziyu Y , Wormsbecher Lisa , Roehrig Colleen , Tulpan Dan , Bohrer Benjamin M
Published: October 2019

This study aimed to examine the correlation of carcass weight, fat depth, muscle depth, and predicted lean yield in commercial pigs. Data were collected on 850,819 pork carcasses from the same pork processing facility between October 2017 and September 2018. Hot carcass weight was reported following slaughter as a head-on weight; while fat and muscle depth were measured with a Destron PG-100 probe and used for the calculation of predicted lean yield based on the Canadian Lean Yield (CLY) equation [CLY (%) = 68.1863 − (0.7833 × fat depth) + (0.0689 × muscle depth) + (0.0080 × fat depth2) − (0.0002 × muscle depth2) + (0.0006 × fat depth × muscle depth)]. Descriptive statistics, regression equations including coefficients of determination, and Pearson product moment correlation coefficients (when assumptions for linearity were met) and Spearman’s rank-order correlation coefficients (when assumptions for linearity were not met) were calculated for attributes using SigmaPlot, version 11 (Systat Software, Inc., San Jose, CA). Weak positive correlation was observed between hot carcass weight and fat depth (r = 0.289; P < 0.0001), and between hot carcass weight and muscle depth (r = 0.176; P < 0.0001). Weak negative correlations were observed between hot carcass weight and predicted lean yield (r = −0.235; P < 0.0001), and between fat depth and muscle depth (r = −0.148; P < 0.0001). Upon investigation of relationships between fat depth and predicted lean yield, and between muscle depth and predicted lean yield using scatter plots, it was determined that these relationships were not linear and therefore the assumptions of Pearson product moment correlation were not met. Thus, these relationships were expressed as nonlinear functions and Spearman’s rank-order correlation coefficients were used. A strong negative correlation was observed between fat depth and predicted lean yield (r = −0.960; P < 0.0001), and a moderate positive correlation was observed between muscle depth and predicted lean yield (r = 0.406; P < 0.0001). Results from this dataset revealed that hot carcass weight was generally weakly correlated (r < |0.35|) with fat depth, muscle depth, and predicted lean yield. Therefore, it was concluded that there were no consistent weight thresholds where pigs were fatter or heavier muscled.
Music to Their Ears: Improving Feedback Students Receive on Written Documentation
Authors: Wagoner Krista , Dempsey Angela , Friesinger Michele
Published: October 2019

PURPOSE:

Improve feedback on student notes in the electronic health record (EHR).

BACKGROUND:

Clinical documentation is a core entrustable professional activity. Feedback on written notes is necessary for skill development. Rapid spread of EHR technology and regulations limits use of student documentation, creating impediments to regular review of student notes.

METHODS:

As part of a multi-phase quality improvement project, medical students were surveyed at the conclusion of the obstetrics and gynecology clerkship regarding their experience writing notes in the EHR. The proportion of students who received feedback on inpatient and outpatient notes and rated the feedback as meaningful was determined at baseline and after implementation of a required formative feedback card. Following student and faculty feedback, we randomized students to utilize a simplified version versus the original detailed formative card and compared outcome measures.

RESULTS:

The response rate was 99%. Baseline data revealed 23% and 38% of clerkship students received no feedback on written notes in the inpatient and outpatient settings, respectively, while 44% of students reported that feedback did not improve documentation skills. Use of the formative card increased feedback (p<0.0001); 98% and 92% of students received feedback in the inpatient and outpatient settings, respectively, and 88% rated it as meaningful. There was no difference (p=0.3) in outcomes between the simplified or detailed cards.

DISCUSSION:

Implementation of a formative card increased the quantity and quality of written note feedback clerkship students received in all settings. A less detailed card achieved comparable outcomes and increased faculty satisfaction.
Resident Self-Entrustment and Expectations of Autonomy: OB > GYN?
Authors: Smith Brentley , Woelfel Ingrid , Salani Ritu , Hartzman Alan , Chen Xiaodong
Published: October 2019

PURPOSE:

The goal of this study was to identify the definition and expectations of autonomy from residents’ perspective, as well as the self-entrustment of their surgical competencies in obstetrics (OB) and gynecologic (GYN) procedures.

BACKGROUND:

Entrustment in the operating room (OR) is a two-way street. Resident self-entrustment of their surgical competencies closely associates with their OR training experience and granted autonomy. Some recent studies have investigated how attending surgeons determined and entrusted OB/GYN residents in the OR. There is little to no data, however, in examining these issues from the resident perspective.

METHODS:

We conducted three focus group interviews with 20 OB/GYN residents across four post-graduate year (PGY) levels. Audio recordings of each interview were transcribed, iteratively analyzed, and emergent themes identified, using a framework method.

RESULTS:

A total of 123 minutes of interviews were recorded. Eight junior residents (PGY1-2) and twelve senior residents (PGY3-4) participated. Our data illustrated that 1) the definition of autonomy shifted significantly throughout residency training; 2) residents demonstrated higher expectations and self-entrustment for OB surgical procedures than for GYN surgical procedures upon graduation; 3) case volume, modalities of OR teaching (e.g., teaching style, attending experience, rotation site) and mutual communication are three factors influencing resident self-entrustment of their surgical competencies.

DISCUSSION:

Residents showed disparities in their self-entrustment and expectations of autonomy between OB and GYN surgical procedures. Better understanding these differences and the three influencing factors could help programs develop a potential solution for improvement in resident entrustment and autonomy upon graduation.
RAD Times in the Big Easy: Race, Access, and Diversity in Abortion Training
Authors: Brown Katherine , Turk Jema , Jackson Andrea , Steinauer Jody
Published: October 2019

PURPOSE:

To explore residents’ interest in doing abortions with a focus on ethnic diversity.

BACKGROUND:

Abortion training is critical to increase access for the 39% of US women who live in the 90% of counties with no abortion care. Racial/ethnic minority physicians are more likely than white physicians to care for poor and minority patients and practice in underserved areas. We explored racial and ethnic differences in residents’ interest in providing abortions in ob/gyn, the most racially diverse ACGME residency.

METHODS:

Using Ryan Residency Program post-rotation survey data collected in 2015-2018, we assessed intention to provide abortion and training participation by resident race/ethnicity.

RESULTS:

The majority of residents (658, 79%) completed surveys. Respondents were: 412 (65%) white, 50 (8%) black, 27 (4%) Hispanic/Latino, 118 (19%) Asian, and 24 (4%) other. Overall, 57% intended to provide abortion for all indications and 82% for pregnancy complications. The proportions that planned to provide abortions by race/ethnicity were: 70% of Asian, 63% of Latino, 54% of white and 48% of black. While in bivariate analysis Asians were more likely than whites to intend provision (p 0.003), there were no difference by race/ethnicity when controlling for religion and abortion attitudes, which were both associated with intention (p<0.05). There was also no difference in training participation by race/ethnicity.

DISCUSSION:

The majority of residents overall planned to include abortion in their practice. Increasing resident diversity may close the abortion access gap in the US by providing care in underserved areas.
A Randomized Trial to Improve Clinical Estimation of Fetal Weight Through Self-Evaluations via Text Messages
Authors: Morales Pedro , Legg Avery , Connelly Emma
Published: October 2019

PURPOSE:

To evaluate if weekly text messages with self-evaluations improve the accuracy of clinical fetal weight estimation in OB GYN interns.

BACKGROUND:

Estimation of fetal weight by palpation is a basic and very important skill that can influence the mode of delivery in laboring patients. Research in this area has focused almost exclusively on clinical factors that influence the accuracy of this method but little is known about ways to improve this important skill. The purpose of this study is to improve the accuracy of this estimation in OB GYN interns with a simple and inexpensive intervention.

METHODS:

We randomized the incoming intern class to either an intervention group that received weekly text messages with self-evaluations of their weight estimations or a control group that received self-evaluations of unrelated aspects of their performance. The primary outcome was accuracy of weight estimates within 10% of the actual birth weight. A sample of 100 estimates for each group was calculated in order to find a 20% (40 to 60%) difference. Chi-square was used to determine difference in proportions of this outcome between the study groups.

RESULTS:

Clinical factors that could influence fetal weight estimation by palpation (Age, BMI, cervical dilation, fetal weight distribution, parity, and recent ultrasound) were similar between the groups (P>.05). Accuracy in the intervention group was 63% vs 42% in the control group (p<.05).

DISCUSSION:

The accuracy of clinical fetal weight estimates by OBGYN interns can be significatively improved by reminding them to self-evaluate the progression of their skills through text messages.
Addressing Patient Fears in Perinatal Substance Use Treatment
Authors: Mullins Nathan , Ramage Melinda , Ostrach Bayla , Leiner Catherine
Published: October 2019

PURPOSE:

To inform obstetricians of potential barriers to engagement in perinatal substance use treatment, as reported by patients in a comprehensive program.

BACKGROUND:

Opioid use disorder in pregnancy diagnoses have rapidly increased, 127% from 1998 to 2011. Comprehensive perinatal substance use treatment including medication-assisted treatment (MAT) is recommended to reduce risks for the mother-baby dyad: however, access to this treatment remains limited. While OUD is a pervasive perinatal health issue, Ob/Gyns may lack awareness of their patients’ needs and concerns related to it.

METHODS:

This qualitative study combined semi-structured interviews and participant-observation with patients in a comprehensive perinatal substance use treatment program, in a largely rural Appalachian region. Sampling was opportunistic and purposive; all data were analyzed using modified Grounded Theory.

RESULTS:

Twenty-seven MAT patients participated in prenatal and/or postpartum interviews, and were observed (along with a larger cohort in care during the four-month study period) in the clinical setting. Participants described the importance of receiving supportive care in a non-judgmental clinical setting, in contrast with past experiences of stigmatizing treatment. Many participants reported concerns about social services involvement with the current pregnancy or existing children, as a factor influencing their comfort seeking substance use treatment during pregnancy.

DISCUSSION:

Concerns about the external consequences of substance use treatment shape women’s experience seeking clinical care. Clinicians addressing patient concerns about social services involvement and a non-judgmental approach overall facilitate engagement with care. With the increase of OUD in pregnancy, obstetric faculty benefit from understanding patient perspectives on barriers to care.
An Intervention to Improve CREOG Scores
Authors: Das Anita , Robinson Christopher
Published: October 2019

PURPOSE:

To examine the effect of an educational intervention on OB/GYN CREOG in-training exam (ITE) scores.

BACKGROUND:

Recent reports have correlated performance on the ITE to passing the qualifying board exam (QBE). Residents at risk for failing may benefit from an educational intervention to increase their chance of successfully passing their QBE.

METHODS:

A retrospective pretest/posttest paired subject intervention study was conducted. Residents selected for inclusion were those with an ITE score of < 200 on their most recent attempt. The educational intervention was a four hour test taking strategy workshop completed two months prior to the ITE. Validation of proper implementation of the method was verified with follow up performance reports. Following completion of the intervention, the next ITE score was obtained and recorded. The statistical analysis was completed for non-parametric matched pairs with Wilcoxon Signed Rank testing with alpha set at 0.05.

RESULTS:

21 PGY-3 and 4 residents met inclusion criteria for enrollment. The mean ITE baseline score was 192.4. Following the educational intervention, the mean ITE score was 212.4. The mean difference between groups was 19.9 points + 2.29 (p<0.001). All but one resident demonstrated improvement in all subjects. All of the residents subsequently passed their QBE.

DISCUSSION:

Our findings suggest that this particular test taking strategy augments CREOG ITE scores by 20 points in residents who score below 200. This pilot study demonstrates that a concentrated two month effort can lead to significant improvements for residents at risk of failing their qualifying board exam in OB/GYN.
Impact of Shortened Obstetrics and Gynecology Clerkship on Medical Student Grades, Shelf Scores, and Satisfaction
Authors: Hutto Sarah , Mackenthun Stephanie , Tessier Katelyn , Egger-Smith Deborah
Published: October 2019

PURPOSE:

To determine if shortening the length of an obstetrics and gynecology clerkship impacts medical student grades, shelf scores, and satisfaction with the clerkship.

BACKGROUND:

The obstetrics and gynecology clerkship at the University of Minnesota was shortened from 6 to 4 weeks to allow third year medical students to complete all required clerkships. Studies examining clerkships decreased from 8 to 6 weeks suggest a decline in student shelf scores. There are no studies to date evaluating the impact a 4 week clerkship has on student grades, shelf scores or student satisfaction.

METHODS:

Two-sample t-tests were performed to evaluate the difference in Clerkship grades and shelf exam scores between the 6 and 4 week clerkships. Chi-square tests were completed to test association between satisfaction survey responses and clerkship length.

RESULTS:

There were significant differences in mean clerkship grades and shelf scores (p<0.01, p0.02), and mean satisfaction scores (p<0.01) between students completing 6 versus 4 week clerkships. The difference in mean satisfaction scores between 6 and 4 week clerkships included satisfaction of learning environment, organization, educational value, teaching, feedback, experience as team member, balance of supervision versus autonomy and recommending the clerkships to others.

DISCUSSION:

Shortening the obstetrics and gynecology clerkship had a significant negative impact on student performance and satisfaction. This along with the low national rating of obstetrics and gynecology clerkships compared to other specialties may affect how students perceive women’s health as a specialty and recruitment to residency programs. Further studies examining this question are underway.
Impact of the Indicated Delivery Calculator on Obstetric Residents’ Clinical Decision-Making
Authors: Asarch Samantha , Morikawa Erika , Nguyen Tina , Sridhar Aparna
Published: October 2019

PURPOSE:

Evaluating the utility of an indicated delivery calculator (IDC) in assisting residents’ determination of delivery timeline for complex obstetric scenarios.

BACKGROUND:

The American College of Obstetrics and Gynecologists (ACOG) mobile application includes an IDC to provide decision-making support when considering conditions that may necessitate early delivery. The utility of this IDC has not yet been studied.

METHODS:

After IRB exemption, obstetric residents at our academic center (n=28) were asked to determine delivery timing for fifteen scenarios, with and without use of the IDC. A mixed effects logistic regression model assessed the change in proportion of test items correct. We conducted semi-structured interviews of the residents’ experience utilizing the calculator. Their responses were subjected to content analysis.

RESULTS:

Residents’ ability to identify the gestational age at delivery for the obstetric scenarios significantly improved after use of IDC (47% pre to 86% post; p<0.01). Positive feedback included the calculator being “user-friendly,” “convenient,” and “well-organized.” The ability to enter multiple conditions was thought to be the best feature of the application. Residents expressed desire to incorporate this tool into their practice. Criticism about the calculator included desire for more robust yet streamlined complication list, more evidence-based references and elimination of prompt for estimated due date/gestational age.

DISCUSSION:

ACOG’s IDC was effective in improving accuracy of residents’ clinical decisions regarding delivery timelines for complex obstetric scenarios. Users quickly adapted to the tool and successfully navigated the features. Streamlining the input prompts and complication choice list may improve efficiency and increase use.
Not Quite so Happy Hour: Associations of Alcohol Use With Wellness Problems Among OBGYN Residents
Authors: Winkel Abigail , Woodland Mark , Mahany Erica , Dow Margaret , Palmer James , Morgan Helen
Published: October 2019

PURPOSE:

To explore associations between residents’ personal habits and problems with wellness.

BACKGROUND:

It will be essential that we develop evidence-based interventions to improve burnout and wellness problems in our resident physicians.

METHODS:

A voluntary, anonymous survey was administered to all US OBGYN residents at the time of the 2017 CREOG examination. Symptoms of burnout and problems with wellness were queried with the question, “during your residency training, have you personally experienced any of the follow issues?” Respondents also reported how often they engaged in activities that they felt helped to maintain wellness in their lives. Associations between reporting wellness problems and participation in common activities were examined using chi-squared tests. Significance was defined as p<.004 using a Bonferroni correction based on the number of comparisons.

RESULTS:

Of the 5855 residents, 4999 completed the survey (85% RR). 3065 (61.3%) residents endorsed problems with wellness, including burnout (51.2%), depression (32.0%), and binge drinking (12.6%). The most common wellness activities reported were social activity (n=4320, 93.2%), watching TV (n=3614, 77.1%), cooking (n=3614, 52.4%), exercise (n=2228, 47.3%), and drinking alcohol (n=2132, 45.6%). Respondents who indicated alcohol as a wellness activity had an increased odds ratio of 2.10 of also having a wellness problem (Χ2(1)=29.6, p<0.001). Respondents who indicated heavy drinking (“Often (4+ times)”/week) had a higher odds ratio of 3.30 (Χ2(1)= 40.3, p<.001.).

DISCUSSION:

Despite social norms, residency programs should use caution when choosing alcohol as the basis for social events or stress release, as our data suggest that it is associated with increased negative outcomes for resident wellness.
Perceptions Regarding Medical Students Performing Pelvic Examinations on Anesthetized Female Patients
Authors: Rice Elizabeth , Chase White , Myers John , Ko Janet , Goldberg Jay , Jaspan David
Published: October 2019

PURPOSE:

The purpose of this study was to determine perceptions regarding medical students performing pelvic examinations on anesthetized female patients.

BACKGROUND:

Pelvic exams performed under anesthesia continues to be a controversial topic, but studies looking at medical staff are lacking.

METHODS:

An internet based survey was distributed to OB/GYNs, OR nurses/techs, anesthesiologists/CRNAs, and medical students at multiple hospitals and medical schools. Demographic data were collected. Non-demographic answers to questions were recorded on a 5-point scale. Characteristics between the respondent groups were statistically compared using Chi-squared test for independence and the Fisher’s Exact Test.

RESULTS:

337 surveys were completed. 72% of respondents believed permission should be obtained from patients prior to the performance of EUAs by medical students on anesthetized female patients. 30% of respondents believed prior consent was usually obtained. 50% believed patients would agree to have the exams performed. 80% thought patients would be upset if an EUA by a medical student was performed on them without their prior consent. 32% of nurses believed medical students should be allowed to examine anesthetized patients. Medical students were less likely to believe it was appropriate for a student to examine a patient, there was an educational benefit, and that patients would consent.

DISCUSSION:

Despite the perception of all OB/GYN OR team members that consent should be obtained before medical students perform pelvic examinations on anesthetized female patients, this does not usually occur. Almost 50% of medical students would not encourage their female relatives to consent to medical students performing such pelvic examinations.
Simulated Paging Curriculum to Assess and Improve Communication Skills
Authors: Kempner Samantha , Heidemann Lauren , Blaszczak Julie , Malone Anita , Bell Carrie , Morgan Helen
Published: October 2019

PURPOSE:

To examine the impact of a simulated paging curriculum for senior medical students on physician-nurse communication skills.

BACKGROUND:

New residents are expected to triage and address a high volume of clinical pages yet medical students receive little training in this important skill. Previous studies have evaluated the impact of simulated paging curricula on clinical decision making and student confidence but have not examined the effect on communication skills.

METHODS:

Two trained Registered Nurses (RNs) administered specialty-specific pages to 76 fourth-year medical students enrolled in 4-week residency preparation electives. For each case, RNs evaluated students’ performances on seven communication domains using previously validated 5-point semantic-differentiation scales (1=worst, 5=best) in precision, instruction, assertiveness, direction, organization, engagement, and ability to solicit information. Immediate feedback was provided to the students.

RESULTS:

A total of 351 pages were administered: 144 in week 1, 73 (week 2), 97 (week 3), and 37 (week 4). Students from all specialties improved communication scores throughout the four weeks. Mean communication scores increased from 4.02 to 4.26 from week 1 to week 2 (<0.0001). Improvement was most pronounced for the students going into internal medicine (3.82 to 4.25) and pediatrics (3.95 to 4.38) and less pronounced for the procedural specialties of surgery (4.26 to 4.22) and ob/gyn (4.07 to 4.18). Communication skills continued to improve in weeks 3 and 4 but with inadequate number of pages to power this comparison.

DISCUSSION:

Our data demonstrates that a simulated paging curriculum is a promising platform for teaching and improving physician-nurse communication skills for senior medical students.
Mind Over Bricks: Facilitation of Decision-Making With LEGO® Elements
Authors: Banh David
Published: October 2019

OBJECTIVE:

To examine the feasibility of implementing LEGO® SERIOUS PLAY® (LSP) workshops to improve participant satisfaction with group decision-making in two residency programs as represented by decisional uncertainty.

METHODS:

We used a prospective single-group pre-post study and O’Connor’s validated scale to measure decisional conflict before and after the LSP workshop. Resident physicians at the Texas Tech University Health Sciences Center at the Permian Basin voluntarily attended an LSP workshop, discussing leadership identity based on the participants’ values, to address a contentious decision, i.e., the election of their administrative chief resident. We used the Wilcoxon rank-sum test to evaluate the pre-post change in decisional uncertainty and a two-tailed P value < 0.05 to define a statistically significant change.

RESULTS:

Family Medicine (n=15) and OBGYN (n=9) residents participated in their respective LSP workshops, but only 9 Family Medicine and 6 OBGYN residents responded to the voluntary post-LSP survey. The average decisional conflict scale (DCS) scores at pre- and post-LSP did not show any significant change (n=15, Pre: 37.9 [24.9–51] vs. Post: 37.8 [24.2–51.4]). Regarding the evaluated decision of their chosen administrative chief, 9 (60%) residents persisted in the same decision after attending the LSP workshop, while 6 (40%) residents chose another person.

CONCLUSION:

In our study assessing the feasibility of LSP workshop implementation in two residency programs, the workshop was not associated with an improvement in participants’ satisfaction with the group decision-making process. Limitations of the study include its small size, use of one-decision scenario, and high non-response rate.
Tomorrow’s Women’s Healthcare Leaders: A Needs Assessment for the Development of an OBGYN Resident and Fellow Leadership Curriculum
Authors: Ellington David R. , Bevis Kerri , Boitano Teresa
Published: October 2019

OBJECTIVE:

To conduct a needs assessment of Obstetrics and Gynecology (OBGYN) faculty, fellows, and residents in preparation for the development of a leadership curriculum.

HYPOTHESIS:

Resident and fellow learners recognize the need for a formal leadership curriculum to improve their effectiveness as physician leaders. Faculty perceive a need for and benefit from a formal leadership curriculum.

METHODS:

We conducted a needs assessment of faculty, fellow, and resident learners. The needs assessment was based on previously published data and a Likert-type scale was implemented to assess responses. Descriptive statistics were calculated using frequency for categorical variables and averages for scale variables. The needs assessment was administered via Survey Monkey, Inc. (www.surveymonkey.com).

RESULTS:

Seventy-three percent (66/90) of surveyed faculty, fellows, and residents responded. The majority (64%) of faculty responders agreed that learners needed a moderate to extreme amount of leadership training. Despite 95% of responders self-evaluating their leadership skills as moderately to extremely effective, only 45% were satisfied with their current leadership skills. Perception of a need for leadership training for faculty (77%) and trainees (88%) was similar. The most desired skills for a leadership program were conflict resolution, team building, mentorship, team motivation, and effective evaluation and feedback.

CONCLUSION:

Faculty, fellows, and residents are overall satisfied with their leadership skills; however, faculty and trainees alike perceive the need for more skill acquisition and training. The preferred learning format was case studies and small group exercises with availability of faculty and trainees noted as the most significant barrier to implementation.
Development of a Flipped Classroom Case-Based Curriculum on the Screening and Management of Women With Opiate Dependence in Pregnancy
Authors: Garrison Etoi , Grimm Barry , Foxx Alexandra , Young Jessica , Rodriguez Michelle , Baksh Lindsey , Dewey Charlene
Published: October 2019

PROBLEM:

Opioid use in pregnancy is rising and parallels the national opioid epidemic observed in the United States. Residency programs however, have limited opportunities to offer structured training in the screening and management of women with opiate dependence.

INTERVENTION:

The APGO/CREOG Empower award was used to develop a flipped classroom (FC) case-based curriculum to improve resident knowledge regarding the screening, counseling, and interdisciplinary management of women with opiate use in pregnancy.

CONTEXT:

The Kellogg logic model and curriculum design model by Oliva were used to create three 90- minute case-based teaching modules: 1) Substance use disorder (SUD) screening and medical management, 2) Use of the state-controlled substance monitoring database (CSMD), and 3) Inpatient management and neonatal abstinence syndrome (NAS). A survey was used to measure pre and post module knowledge acquisition, anticipated behavior change, and satisfaction/compliance with the FC case-based format.

OUTCOME/LESSONS LEARNED:

Fourteen residents participated in 2 of 3 teaching modules. Pre and post module knowledge scores improved for SUD screening, NAS, and medical management (p<0.01). Residents agreed or strongly agreed (90%) that the curriculum improved confidence with SUD screening and patient counseling (p<0.01). Residents preferred the flipped format compared to traditional lecture (95%) however only 50% pre-read the primary reference and 35% pre-read the secondary reference. This workshop was well received and associated with improved knowledge and skill regarding SUD/opiate dependence in pregnancy. Next steps will include residents from other residency programs, evaluation of the CSMD curriculum, and longer-term impact on knowledge retention and patient care.
Medical Student Empathy: Any Correlation to Abortion Attitudes?
Authors: Gorelik Kristin , Amdur Richard
Published: October 2019

OBJECTIVE:

Physician and medical student empathy have been well studied, but little empirical research exists relating empathy to abortion care. Abortion is common; all physicians will interact with patients who have had, or considered, abortion. We seek a correlation between students' empathy and their attitudes about abortion. With better understanding of this association, interventions to augment medical trainee empathy can be undertaken.

METHODS:

A literature review identified existing abortion attitude and empathy assessment tools. A cross-sectional survey was sent to GWU undergraduate medical students, comprised of the Jefferson Scale of Physician Empathy (JSPE-S),1 a modified Abortion Attitude Assessment (AAA), and a modified Feelings Thermometer (WARM). Higher numbers correlate with more empathy (JSPE-S) and more favorable abortion attitudes (AAA, WARM). Religiosity was analyzed.

RESULTS:

Two emails were sent, with 20 first- (10.5%), 3 second- (1.7%), 26 third- (15.7%), and 19 fourth-year (13.3%) respondents. 64% were female, 35% male, and 1.4% transgender. 42% identified as not religious, 44% moderately/somewhat, and 10% very religious. Positive correlations were identified between empathy and warmth (r=0.36), empathy and abortion (r=0.31), and between warmth and abortion attitudes (r=0.57). A negative correlation was identified between religiosity and abortion attitudes (r=-0.42).

CONCLUSION:

We found a correlation between the JSPE and abortion attitudes in this small, single-institution study. As expected, religious individuals had more negative abortion attitudes, and a surprising trend toward lower levels of empathy overall. Our main limitation was a low response rate, and student recruitment is ongoing. Future studies should include more students with greater demographic diversity.
Preparing Medical Students for Transition Into OB/Gyn Residency
Authors: Kim Christine
Published: October 2019

PROBLEM:

There is increased focus on supporting medical students’ transitions to internships to improve basic knowledge, efficiency and quality of care. Providing pre-residency education may help improve knowledge, clinical skills, and confidence.

INTERVENTION:

A 2-day preparatory course for OB/Gyn-matched MS4s reviewed topics in the OB/Gyn ACGME Milestone 1 curriculum. The course used lectures, videos, and “hands-on” skills workshops.

CONTEXT:

OB/Gyn-matched MS4s were invited to attend. Students took the APGO Prep for Res knowledge test (scored as percent correct) and completed a survey assessing confidence in Milestone 1 topics (Likert scale, 1=strongly disagree, 5=strongly agree) before and after the course. Students were sent a follow-up survey two months into internship assessing how the course impacted skills and inviting feedback.

OUTCOME/LESSONS LEARNED:

Nine students attended. All 9 completed the pre-test, 7 the post-test, and 8 completed both surveys. The average test score before the course was 73%, and after 79% (p=0.24). No student had lower knowledge score after the course. Average confidence skills were 3.03 before and 4.47 after (p<0.05). Confidence improved most for these skills: applying fetal scalp electrode, repairing a perineal laceration, c-section steps. The least improvement noted for knot tying/suturing, and managing common outpatient gynecologic problems. Post-course confidence was highest for interpreting FHR, managing postpartum hemorrhage and repairing perineal lacerations, and lowest for biopsy skills and labor management. Interns reported the course to be “very helpful” to their transition. Suggestions for the future include: induction of labor, pre-eclampsia, hysteroscopy, contraceptive implant certification, and including students entering family medicine.
Bartholin Gland Cyst Educational Simulation Improves Knowledge and Confidence
Authors: Johnson Kathryn P. , Shelton Sarah , Deisher Heather
Published: October 2019

PROBLEM:

Our institution had an increasing number of ER consults for recurrent Bartholin gland cysts/abscesses between May of 2015 and June of 2016. The majority had incorrect placement of the incision and drainage site or limited or improper Word catheter use. Ob/Gyn, Family Medicine, and ER departments did not have specific training available for this diagnosis and treatment.

INTERVENTION:

We developed a simulation-based curriculum including a didactic presentation on Bartholin gland cyst/abscess diagnosis and treatment options, an instructional video demonstrating the steps of Bartholin gland cyst/abscess drainage with Word catheter placement, and supervised practice on an established Bartholin gland cyst model with feedback. Learner knowledge and confidence were assessed before and after the curriculum, and satisfaction with the simulation model for both I&D and Word catheter placement were assessed after the curriculum.

CONTEXT:

UTMCK has residencies for Ob/Gyn and Family Medicine with protected education time. There is an ER fellowship but most ER providers are ER physicians and PA’s with limited time for group learning.

OUTCOME/LESSONS LEARNED:

Implementation with 26 Ob/Gyn residents and 5 medical students showed increases in learner confidence and some aspects of knowledge. Participants were highly satisfied with the simulation model. Curriculum delivery will need to be tailored to the different specialties. Family Medicine residents are scheduled to complete the group training in January 2019 but the ER providers have requested to complete the training as self-study modules due to shift restrictions.
Identifying the Troubled Test Taker for Early Intervention
Authors: Scott Nicole
Published: October 2019

OBJECTIVES:

To investigate correlations between obstetrics and gynecology residents’ USMLE Step 1 and 2, APGO Prep for Residency Exam, and in-service CREOG training exam scores. To investigate TrueLearn question bank as a tool to improve CREOG performance.

METHODS:

Residents’ examination scores from one obstetrics and gynecology training program were collected. These included their scores for USMLE Step 1 and 2 examinations taken during medical school, APGO Prep for Residency (APP) exam taken when starting residency, and CREOG examination taken during each year of residency. Correlation coefficients between each of the first 3 scores and the CREOG scores were calculated using Pearson correlation testing with STATA. In 2018, TrueLearn question bank was available for resident use in test preparation. Residents’ use of the question bank and percentage of correct questions were collected. Correlation coefficients between each group and the improvement CREOG scores were calculated using Pearson correlation testing with STATA.

RESULTS:

The APP scores positively correlated with the first CREOG exam scores (R=.6506). Similarly Step 1 and Step 2 scores were positively correlated with performance on CREOG (R=.62, R=.66, respectively). Number of practice questions performed significantly correlated with improvement in CREOG performance when separated by postgraduate year of training. (PGY2 R=.68, PGY 3 R=.3, PGY 4 R=.5). The positive correlation diminished with advancing postgraduate year.

CONCLUSION:

USMLE and Prep for Residency Exams are strongly correlated with performance on CREOG exam. Early identification of learners with poor test taking can lead to early intervention. TrueLearn question bank use can improve performance on CREOG in-service exam.
Knowing Is Seeing: Biography Cards Facilitate Students Seeing Patients in Obstetrics and Gynecology
Authors: Singh Tara A. , Seitchik Allison , Harney Kathleen , Dalrymple John , Hirsh David A.
Published: October 2019

OBJECTIVE:

We explored whether patients’ pre-visit receipt of student’s biography cards facilitated patients’ accepting students in their obstetrics and gynecology (OBGYN) care.

METHODS:

Before visits, all patients in our ambulatory OBGYN clinics received student “biography cards” (photo, hobbies, “thank you” statement) for two months. We administered questionnaires to patients who accepted or declined student participation. We asked patient demographics and impact of the card. We surveyed students’ perception of the card’s impact. We used logistic regression models to correlate survey responses and acceptance rates.

RESULTS:

Seeing the card (Wald χ2 = 18.85, p < .001) and having seen a student before (Wald χ2 = 5.49, p = .019) significantly predicted acceptance of the student. Patients who saw a student before were 9.20 times (95% CI: 1.44, 58.93) more likely to include a student. Age, ethnicity, and being a new patient did not predict patient acceptance of students. Patients reported they were happy to have student participation, valued participation, believed students improved the quality of their care and experience. Patients expressed a desire to have a student participate in their care on another day. Eleven of 13 students responded to the survey. Students reported increased patient acceptance after patients read their card, using the card made them feel more involved in patient care, and patients were more likely to involve them when patients knew more about them.

CONCLUSION:

In OBGYN clinics, student biography cards and seeing students previously facilitated patients accepting students—an important affordance for students’ OBGYN learning and experience.
A Joint Curriculum for Surgical Skills Performance and Resident-as-Teacher Training
Authors: Urban Renata R. , Fuchs Esther , Fialkow Michael , Chiang Seine , Goff Barbara
Published: October 2019

PROBLEM:

The simulation experience for residents at our institution does not include longitudinal teaching and assessment of surgical skills. Residents frequently teach during surgical procedures, but do not receive training nor feedback on these teaching skills.

INTERVENTION:

Develop simulation curriculum to improve surgical skills and surgical teaching skills through structured practice, feedback and assessment of all residents, with an emphasis of senior residents as surgical teachers.

CONTEXT:

Needs assessment of faculty and current/graduated residents, was performed to assess perceived surgical abilities of residents, define basic surgical skills, and define relevant teaching skills needed in the operating room. The results were used to define didactic content and to create a supplemental gynecologic surgical skills video. The curriculum backbone included General Surgery videos on surgical skills. Among residents who completed pre and post surveys, 52.1% noted an improvement (≥1 level of confidence) in ≥50% of surgical skills surveyed; 17.4% noted an improvement in all surgical skills surveyed. Nine PGY 3-4 residents completed pre and post surveys pertaining to teaching skills; five (55.6%) noted improvement in all teaching skills surveyed. Six of nine (66.7%) noted improvement in at least one teaching skill.

OUTCOME/LESSONS LEARNED:

Sessions resulted in improvements in self-perceived surgical and teaching skills. Challenges to implementation include faculty and resource availability. We plan to repeat the sessions later in the year, with PGY-2 and PGY-3 acting as teachers. A follow-up survey to query residents on their self-perceived surgical skills, and a survey to query faculty on perceived resident surgical technique will be completed.
Evaluation and Improvement of a Formative Standardized Patient Encounter on Post-Partum Fever in the Core Clerkship of Obstetrics and Gynecology
Authors: Waltner-Toews Rebecca , Hohmann Heather
Published: October 2019

BACKGROUND:

Medical students need to be able to recognize post-partum endometritis, which occurs after up to 27% of cesarean births and is an important cause of preventable maternal death worldwide. We incorporated a formative standardized patient (SP) encounter, in which students evaluate a patient with postpartum fever and receive feedback.

METHODS:

We reviewed students’ primary and differential diagnoses, quantitative feedback (Likert scale, 7 very useful and 1 not at all useful), and qualitative feedback. We then made changes and compared the new encounter with the original.

RESULTS:

Of 283 students, 51% listed endometritis as the most likely diagnosis and 59% listed it in the differential. Students rated the encounter as 5.8 out of 7. Based on feedback, we purchased a new pelvic model, incorporated a speculum exam, and added immediate feedback. Students rated the new encounter as 6.1, and approximately the same proportion listed endometritis appropriately in the differential. Students appreciated the in-person feedback following the new encounter.

CONCLUSION:

Students found an SP about post-partum fever acceptable, and they learned to identify endometritis as an important diagnosis in their differential.
Race and Gender in the Obstetrics and Gynecology Clerkship: A Mixed Methods Assessment
Authors: Young Omar M. , Sonn Tammy
Published: October 2019

OBJECTIVE:

To assess perceptions of the obstetrics and gynecology (OBGYN) clerkship and to observe if either race or gender informs selection of specialty.

METHODS:

A prospective cross-sectional study was performed among third and fourth year medical students from February-June 2018. Respondents completed an anonymous and confidential online survey examining their perceptions of the field, the clinical clerkship itself and the potential influence of race and gender during the clerkship. Qualitative responses were coded in an iterative process to evaluate for specific themes. Categorical variables were analyzed using the χ2 test. A p-value of less than 0.05 was considered statistically significant.

RESULTS:

123 out of 229 (53.7%) medical students responded to the survey. Students were more likely to consider OBGYN as a career choice upon completion of the clerkship compared to before (44.9% vs 31.7%, p=0.03). Eleven percent (11%) of respondents reported race personally affecting their clerkship experience whereas 66% identified gender to be a personal influencer on clerkship experience. Male and under-represented minority (URM) students delineated more negative clinical interactions along with fewer meaningful educational experiences on the clerkship due to a perceived lack of cultural inclusivity. The lack of both racial and gender diversity of faculty, residents and ancillary staff was perceived as fostering an environment of discomfort due to displays of both unconscious and conscious bias.

CONCLUSION:

Male and URM medical students have disparate experiences on the OBGYN clerkship as compared those who are female or white, with the racial/gender composition of the clinical environment being contributory.
Breast Cancer Masquerading as a Benign-Appearing Mass
Authors: Storer Lindsey , Lee-Felker Stephanie , Fischer Cheryce , Joines Melissa
Published: October 2019

Most invasive breast cancers appear as irregular or spiculated masses; however, 10% to 20% of breast malignancies can appear relatively circumscribed.1 Less common types of malignant breast masses can present as round or oval masses with predominantly circumscribed margins. These include mucinous carcinoma, medullary carcinoma, papillary carcinoma, malignant phyllodes tumors, high-grade triple-negative invasive ductal carcinoma, lymphoma, and metastases. Consideration of imaging features across all modalities and use of the clinical presentation may suggest one of these diagnoses over more common benign entities.
A Systematic Approach to the Interpretation of the Knee Radiograph to Avoid Common Diagnostic Errors
Authors: Larose Lisa , Bui-Mansfield Liem T.
Published: October 2019

It is estimated that 2.5 million emergency department (ED) visits annually in the United States are attributed to sports-related knee injuries.1 An additional 184,000 ED visits in the United States each year are attributed to occupational knee injuries.2 About 25% of adults older than 55 years suffer from chronic knee pain, an increasing prevalence due to an aging population and increased prevalence of obesity.3
MRI of Urgent Soft Tissue Conditions of the Musculoskeletal System
Authors: Yu Sarah M. , Yu Joseph S.
Published: October 2019

Emergencies that involve the soft tissues of the musculoskeletal system are common; however, these conditions often are difficult to differentiate clinically.1 Early detection and diagnosis have a significant impact on treatment. Although many disorders present with similar symptoms, some laboratory and constitutional findings are helpful in diagnosing specific diseases. MRI is well-established as the preferred imaging modality for evaluation of soft tissue disorders because of its excellent contrast resolution, sensitivity for pathologic fluid accumulation, and depiction of abnormal tissue compartments; thus, recognizing differentiating characteristics enables diagnosis.2
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