bluuebunny/crossref_metadata_2025 huggingface dataset:
Dietary Euphorbia hirta Extract Improved the Resistance of Sharptooth Catfish Clarias gariepinus to Aeromonas hydrophila
Authors: Sheikhlar Atefeh , Meng Goh Yong , Alimon Razak , Romano Nicholas , Ebrahimi Mahdi
Published: September 2017

Aqueous and methanol extracts of lemon Citrus limon peel, Euphorbia hirta (aerial parts), and fenugreek Trigonella foenum-graecum seeds were tested for their in vitro antimicrobial activities against the bacterium Aeromonas hydrophila. A swab paper disk method showed that the methanol extract of E. hirta (EHE) had the largest inhibition zone and the lowest minimal inhibitory concentration compared to all other herbal extracts. Based on these results, EHE was included in the diets of Sharptooth Catfish Clarias gariepinus at 0 (control), 2, 5, or 7 g/kg of diet (experiment 1). Each treatment was conducted in triplicate, with 30 fish (mean weight ± SE = 9.4 ± 0.4 g) in each replicate. After 30 d, the growth, feed intake, hepatosomatic index (HSI), and plasma biochemical parameters were measured. With a separate batch of Sharptooth Catfish, the efficacy of the EHE diets in conferring fish resistance to A. hydrophila over 30 d was compared to that of a diet containing oxytetracycline (OTC; experiment 2). Six treatments were conducted in triplicate groups of 30 fish (mean weight ± SE = 9.0 ± 0.3 g); the Control fish were fed the control diet and were not injected with A. hydrophila, while the Control-AH and OTC-AH groups were infected with A. hydrophila and were fed either the control diet or the diet containing OTC at 1 g/199 g. The other three treatments included fish that were injected with A. hydrophila but fed diets with increasing EHE at 2, 5, or 7 g/kg. Experiment 1 showed no change to growth, feeding efficiency, HSI, or plasma biochemical parameters. In experiment 2, however, fish that were fed dietary EHE at 5 g/kg had significantly lower mortality than the Control-AH group, with further resistance observed for fish fed EHE at 7 g/kg. Dietary OTC was more effective than EHE as a prophylactic to A. hydrophila infection in Sharptooth Catfish. Nevertheless, EHE can potentially be a valuable dietary supplement to improve the resistance of Sharptooth Catfish to A. hydrophila infection.

Received May 3, 2017; accepted August 24, 2017 Published online October 31, 2017
Flavonoid compounds related to seed coat color of wheat
Authors: Kohyama Noriko , Chono Makiko , Nakagawa Hiroyuki , Matsuo Yosuke , Ono Hiroshi , Matsunaka Hitoshi
Published: September 2017

In red wheat, reddish-brown pigments accumulate in testa of mature seeds. Half-cut wheat seeds were immersed in p-dimethylaminocinnamaldehyde (DMACA) reagent that stains flavanol structures blue. Testa of 10–40 days after flowering (DAF) in red wheat (“Norin 61” and “Satonosora”) seeds were stained blue and the reagent color changed to blue with 10–25 DAF seeds. No blue staining was observed in white wheat (“Tamaizumi”) seeds during maturation. “Norin 61” seed coats at 10 DAF contained dihydroquercetin, dihydromyricetin, (+)-catechin, procyanidin B3, and prodelphinidin B3, which were identified by HPLC-diode array detector and LC-MS/MS analyses. These five components began accumulating 7 DAF, reached maxima at 10 or 15 DAF, and then decreased in red wheat seeds, but were not detected in white wheat seeds. These results suggest that flavanol and proanthocyanidins are possible precursors of the reddish-brown pigments of red wheat seeds, and are converted to insoluble compounds as the seeds mature.
TALEN-mediated targeted editing of the GDE5 gene suppresses fibroblastic cell proliferation
Authors: Nakamura Minako , Kumrungsee Thanutchaporn , Sakuma Tetsushi , Yamamoto Takashi , Yanaka Noriyuki
Published: September 2017

In this study, we investigated the physiological function of glycerophosphodiesterase 5 (GDE5) in the proliferation of NIH3T3 fibroblasts. We used transcription activator-like effector nuclease (TALEN) in NIH3T3 cells with an intron targeting-mediated GDE5 gene knockout. The heterozygously GDE5-targeted NIH3T3 fibroblasts were isolated and showed decreased cell proliferation and up-regulation of EGFR mRNA expression, indicating that GDE5 modulates fibroblastic cell proliferation.
ICAMs support B cell interactions with T follicular helper cells and promote clonal selection
Authors: Zaretsky Irina , Atrakchi Ofir , Mazor Roei D. , Stoler-Barak Liat , Biram Adi , Feigelson Sara W. , Gitlin Alexander D. , Engelhardt Britta , Shulman Ziv
Published: September 2017

The germinal center (GC) reaction begins with a diverse and expanded group of B cell clones bearing a wide range of antibody affinities. During GC colonization, B cells engage in long-lasting interactions with T follicular helper (Tfh) cells, a process that depends on antigen uptake and antigen presentation to the Tfh cells. How long-lasting T–B interactions and B cell clonal expansion are regulated by antigen presentation remains unclear. Here, we use in vivo B cell competition models and intravital imaging to examine the adhesive mechanisms governing B cell selection for GC colonization. We find that intercellular adhesion molecule 1 (ICAM-1) and ICAM-2 on B cells are essential for long-lasting cognate Tfh–B cell interactions and efficient selection of low-affinity B cell clones for proliferative clonal expansion. Thus, B cell ICAMs promote efficient antibody immune response by enhancement of T cell help to cognate B cells.
Feature Extraction from Sensor Data Streams for Optimizing Grinding Condition
Authors: Kondo Y , Higashimoto Y , Sakamoto S , Fujita T , Yamaguchi K
Published: September 2017

A visualization method for time-series sensing data was designed to optimize grinding condition. The fluctuation pattern of time-series data streams can be visualized as a white and black pattern by utilizing the spindle power change rate average. The designed visualization method was applied to a condition monitoring in lapping operation. The relation between the fallout abrasive grain content and lapping behaviour was experimentally examined. In the lapping with grinding fluid containing no fallout abrasive, the spindle power decreased in a monotone manner with lapping time, while in the lapping with fallout abrasive, the spindle power decreased with lapping time up to 20s of lapping and then tended to converge on a constant value. The spindle power change rate average displayed as a white and black pattern reproduced the changes of spindle power very well. The appearance probability of white or black pattern has a strong relation with the fallout abrasive content and the designed data processing scheme could make possible to predict the grinding fluid condition from the easy-handling grinding test.
In silico structural modeling of multiple epigenetic marks on DNA
Authors: Krawczyk Konrad , Demharter Samuel , Knapp Bernhard , Deane Charlotte M , Minary Peter
Published: September 2017

There are four known epigenetic cytosine modifications in mammals: methylation (5mC), hydroxymethylation (5hmC), formylation (5fC) and carboxylation (5caC). The biological effects of 5mC are well understood but the roles of the remaining modifications remain elusive. Experimental and computational studies suggest that a single epigenetic mark has little structural effect but six of them can radically change the structure of DNA to a new form, F-DNA. Investigating the collective effect of multiple epigenetic marks requires the ability to interrogate all possible combinations of epigenetic states (e.g. methylated/non-methylated) along a stretch of DNA. Experiments on such complex systems are only feasible on small, isolated examples and there currently exist no systematic computational solutions to this problem. We address this issue by extending the use of Natural Move Monte Carlo to simulate the conformations of epigenetic marks. We validate our protocol by reproducing in silico experimental observations from two recently published high-resolution crystal structures that contain epigenetic marks 5hmC and 5fC. We further demonstrate that our protocol correctly finds either the F-DNA or the B-DNA states more energetically favorable depending on the configuration of the epigenetic marks. We hope that the computational efficiency and ease of use of this novel simulation framework would form the basis for future protocols and facilitate our ability to rapidly interrogate diverse epigenetic systems.

Availability and implementation

The code together with examples and tutorials are available from http://www.cs.ox.ac.uk/mosaics

Supplementary information

Supplementary data are available at Bioinformatics online.
Brightest galaxies as halo centre tracers in SDSS DR7
Authors: Lange Johannes U. , van den Bosch Frank C. , Hearin Andrew , Campbell Duncan , Zentner Andrew R. , Villarreal Antonia Sierra , Mao Yao-Yuan
Published: September 2017

Determining the positions of halo centres in large-scale structure surveys is crucial for many cosmological studies. A common assumption is that halo centres correspond to the location of their brightest member galaxies. In this paper, we study the dynamics of brightest galaxies with respect to other halo members in the Sloan Digital Sky Survey DR7. Specifically, we look at the line-of-sight velocity and spatial offsets between brightest galaxies and their neighbours. We compare those to detailed mock catalogues, constructed from high-resolution, dark-matter-only N-body simulations, in which it is assumed that satellite galaxies trace dark matter subhaloes. This allows us to place constraints on the fraction fBNC of haloes in which the brightest galaxy is not the central. Compared to previous studies, we explicitly take into account the unrelaxed state of the host haloes, velocity offsets of halo cores and correlations between fBNC and the satellite occupation. We find that fBNC strongly decreases with the luminosity of the brightest galaxy and increases with the mass of the host halo. Overall, in the halo mass range 1013–1014.5 h− 1M⊙ we find fBNC ∼ 30 per cent, in good agreement with a previous study by Skibba et al. We discuss the implications of these findings for studies inferring the galaxy–halo connection from satellite kinematics, models of the conditional luminosity function and galaxy formation in general.
To Review Student Data Regarding Clerkship Experience With Change in Curriculum Design
Authors: Kabiru-Musindi Wanjiku
Published: September 2017

BACKGROUND:

The Ob/Gyn clerkship transitioned from a 6-week discipline specific clinical experience to an integrated 15-week surgery and reproduction curriculum. Student perception of clerkship quality across the curriculum is assessed at the end of the 3rd year and in the graduation questionnaire.

METHODS:

Year-end curriculum surveys, NBME Ob/Gyn shelf exam scores and AAMC graduation questionnaire results for students graduating 2012–2016 were examined. End-of-year NBME Ob/Gyn shelf scores were compared by year of graduation. Analysis of variance was used to compare scores in the traditional design (students graduated 2012–2015) and Integrated design (students graduated 2016).

RESULTS:

End-of-year clinical curriculum survey response rates ranged between 43.7% and 86.3%. There was a significant increase in response rates in the 2016 class (86.3%). During this period, 211, 209, 217, 242 and 180 students completed the NBME Ob/Gyn shelf exam. The mean clerkship rating increased significantly from 2012 to 2015 (P<.05). There was a decline in the clerkship rating in 2016 (3.85) but it remained higher than in 2012 (3.74). GQ survey results remained above the national mean for the same duration. There was no difference in the mean NBME subject score during this period (P=.525).

DISCUSSION:

Transition from a traditional 6-week Ob/Gyn curriculum to an integrated longitudinal curriculum with surgery resulted improving student evaluation scores and similar NBME performance.
Evaluation of a Case-Based, Community-Engaged LGB-TGNC Health Training Module for Trainees in Obstetrics and Gynecology
Authors: Mehta Pooja , Shakartzi Hannah , Mazul Julio , Potter Jennifer , Abbott Jodi
Published: September 2017

BACKGROUND:

OB/GYN providers are frontline in providing care to LGB-TGNC people. Limited curricula specific to OB/GYN trainees exist. Deficits in competency limit access and quality of care. The AAMC and APGO/CREOG mandate inclusion of population-specific curricula.

METHODS:

Curriculum consisted of two 1-hour modules meeting APGO/CREOG learning objectives, developed in partnership with an LGB-TGNC community health center. Modules integrated role-play, small groups, and cases, focusing on culturally humble vocabulary, disparities, and best practices. We measured learner satisfaction and anticipated behavior change using Likert scales. Knowledge acquisition was assessed using a pre/post survey in a subgroup (n=14). Feedback was elicited using semi-structured questions. Responses were tabulated and de-identified. Statistical analyses was performed in STATA 13.0. Qualitative responses were coded for theme. Learners were residents and 4th-year students at three institutions.

RESULTS:

Eighty-two percent (82/100) participants responded. Eighty-one percent (67/82) highly agreed that stated objectives were worthwhile, 71% (58/82) strongly agreed that objectives were adequately met, 37% (30/82) strongly agreed that curriculum dispelled myths held, and 52% (43/82) strongly agreed and 38% (31/82) agreed that curriculum would impact their work as an OB/GYN. Gradients in pre/post knowledge acquisition were greatest for transgender health-related content. Participants wanted further training on gender-affirming hormone therapy, and legislative context.

DISCUSSION:

LGB-TGNC health is a priority in medical education. We describe an innovative curriculum with high learner satisfaction and knowledge acquisition. Next steps will address curricular limitations and evaluate impact on observed skills and health outcomes.
Evaluation of a Combined Neonatal and Obstetric Resuscitation Program in a Resource-Limited Setting
Authors: Edwardson Jill , Shilkofski Nicole
Published: September 2017

BACKGROUND:

Philippines has some of the highest NMR (14 per 1,000 live births) and MMR (MMR 220 per 100,000 live births) in Asia. Prior studies in limited-resource settings have shown efficacy of simulation-based HBB initiatives in improving education and regional stillbirth rates. The HMS program similarly addresses emergency obstetric care.

METHODS:

Training courses in HBB/HMS were conducted for N=55 midwives in Davao, Philippines, as part of an interventional cohort study. Multiple choice exams and videotaped objective standardized clinical assessments were used to measure knowledge and skills pre- and postintervention. Outcome measures were compared pre- and postintervention using t-test comparison of means.

RESULTS:

Written knowledge tests revealed a 13% relative improvement in posttest scores (P<.001). Skill improvement in maternal resuscitation was demonstrated by decrease in average time to administration of uterotonic agent after birth from 95 to 54 seconds (P<.001) and in neonatal resuscitation by achievement of successful bag mask ventilation by 45% preintervention versus 100% postintervention (P<.001).

DISCUSSION:

Combined training in neonatal and obstetric management resulted in increased knowledge and skills for midwives in this resource-limited setting. Next steps include assessment of skill decay curves, rate of uptake of best practices, and longitudinal analysis of regional NMR and MMR.
Abortion Training in U.S. Obstetrics and Gynecology Residency Programs
Authors: Steinauer Jody , Turk Jema , Pomerantz Tali , Koenemann Katheryn , Simonson Kristin , Landy Uta
Published: September 2017

BACKGROUND:

The Accreditation Council for Graduate Medical Education (ACGME) requires ob-gyn programs include “access to experience with induced abortion.” Yet in 2004 when last studied, only 51% included routine abortion training.

METHODS:

Directors of 240 ob-gyn residency programs were invited to complete an online survey. Training was considered routine when the director reported abortion training was included in a rotation dedicated to family planning and/or dedicated time for abortion training. We assessed program directors' reports of resident experience by training type using χ2, t tests, and logistic regression.

RESULTS:

One hundred ninety (79%) directors responded. Sixty-one percent reported that training was routine, 32% said it was available or optional for residents, and 7% said it was not available. Routine training, compared with optional training, was correlated with higher mean total numbers of abortion procedures per graduating resident (87.2 versus 48.1, P<.001). Seven directors (4%) reported that their program had been cited for inadequate abortion training.

DISCUSSION:

Abortion training in ob-gyn residency programs has substantially increased from 12% in 1992 to 61% in 2014, and as in other studies, routine training is associated with greater clinical competence (Almeling R, Tews L, Dudley S. Fam Plann Perspect 2000;32:268–71, 320. MacKay HT, MacKay AP. Fam Plann Perspect 1995;27:112–5. Eastwood KL, Kacmar JE, Steinauer J, Weitzen S, Boardman LA. Obstet Gynecol 2006;108:303–8). In a third of programs, residents needed to seek out training themselves, and 7% of programs offered no opportunity for training, falling short of meeting the ACGME requirement.
An Educational Intervention to Improve HPV and Cervical Cancer Knowledge Among African American College Students
Authors: Staples Jeanine , Wong Melissa
Published: September 2017

BACKGROUND:

Although the overall incidence of cervical cancer in the United States is low, African American women carry a disproportionate burden of the disease. The incidence among Black women is nearly 50% higher than in Caucasians, and Black women are more likely than any other group to die from the disease. In order to eliminate such disparities and eradicate a virtually preventable cancer, education is crucial.

METHODS:

We completed a total of five lectures at four Historically Black Colleges. Each session included a lecture and a hands-on interactive review of HPV and cervical cancer. Participants were given a pre- and postlecture survey that assessed knowledge and beliefs related to cervical cancer, HPV, and HPV vaccination.

RESULTS:

A total of 57 students completed the surveys. Ninety-six percent of students reported knowledge of the HPV vaccine; however, only 52% reported receiving the vaccine. About 77% of students older than 21 years of age reported having a Pap test. Of the 16 knowledge-based questions, correct response rates significantly increased (74% versus 91%, P=.02) with the intervention.

DISCUSSION:

Community outreach interventions emphasizing primary prevention and early detection are necessary to reduce racial inequalities in cervical cancer morbidity and mortality. The educational intervention utilized in this study was successful in improving knowledge about HPV and cervical cancer. Further examination of the critical components for educational intervention in this population should be explored.
Divergent Perceptions of Gender Interactions in a Medical Teaching Environment
Authors: Sousa Denise , Matthews Alexandra , Yousif Mairy , Jesse Michelle , Elshatanoufy Solafa , Richardson David
Published: September 2017

BACKGROUND:

There are limited data that suggest that female residents believe that nurses preferentially give more assistance to the male colleagues. There are no data on how nurses or medical students perceive these interactions.

METHODS:

Cross-section surveys of residents (n=490), nurses (n=1,100), and Y-3 medical students (n=80) on perceptions as to whether they found it easier to work with a specific gender, if gender impacted assistance, if one gender ask for more assistance, and gender differences in degree of compassion/empathy toward patients.

RESULTS:

The response rate was residents 39%, nurses 29%, and students 98%. Female residents reported it was easier to work with male nurses (P .002). Neither male nor female nurses felt that they showed preference or that it was easier to work with a specific gender of resident. Female residents felt males asked for more assistance (P .56), and male residents that females needed more help (P .032). Both male (32%) and female (54%) residents perceived nurses were more willing to assist male residents (P .005). Female medical students felt male nurses gave preference toward female residents (P .019) and female nurses toward male residents (P .005).

DISCUSSION:

Residents of both genders and female medical students perceived that gender bias was present in workplace interactions with nursing. Neither male nor female nurses perceived a gender preference in their behaviors.
Examining Unprofessional Behavior in the OBGYN Clerkship: A Qualitative Study of Essays Written by Students
Authors: Lackritz Katherine , Braverman Andrea , Rana Maheen , Gaspari Brooke , Wolf Abigail
Published: September 2017

BACKGROUND:

Hearing directly from students, in the midst of the rotation, provides a unique view of students' experiences and developing professionalism.

METHODS:

We conducted an IRB-approved qualitative study analyzing professionalism themes from essays written on the required OBGYN Clerkship. Essays were analyzed from a total of 220 students and coded into eight domains with subcategories. Inter-rater reliability was established, with two coders with high levels of correlation (Kappa agreement 0.73, 95% CI 0.57–0.88). Frequencies were used for descriptive purposes.

RESULTS:

Most students chose to write about negative incidents of professionalism that they observed. The most common domain themes were: medical team dynamics (37%), patient interactions (39%), and inappropriate remarks about a patient (28%). A third of the essays also included an observation of a positive demonstration of professionalism, most commonly about prioritizing the patient's needs.

DISCUSSION:

Third-year students often struggle with their transition to the wards. At this time, students also start to demonstrate decreased empathy. Repeated exposures to faculty behaviors shape student clinical behavior and can normalize unprofessional behavior. These essays provide a window into students' real-time experiences and insight into how these experiences shape professional development. The act of writing requires that students process and reflect which creates an opportunity to improve the culture of professionalism. This study provides concrete examples to drive resident and faculty development and to reduce unprofessional behavior in the future.
Obstetric Skills Competency Curriculum for Residency Preparation
Authors: Marko Emily , Downing David , Buery-Joyner Samantha , McLeod Francine , Nieves Kelsey
Published: September 2017

BACKGROUND:

A joint task force designed resident competency milestones from levels 1 to 5. Medical students entering residency will need to be competent at level 1 and progress through level 2 during internship.

METHODS:

A curriculum of nine obstetric skills modules for level 1 and 2 milestones was evaluated over a 3-year period. Instructional methods included team-based learning and skills workshops using low-fidelity simulated models. Assessment was performed using objective structured clinical exam. Forty-eight medical students from two campuses were given pre-/posttests, competency assessments, and confidence surveys. Follow-up surveys were collected after starting residencies.

RESULTS:

All students achieved level one competency by the end of the program. Test scores were significantly improved for each module, with the greatest improvements noted in obstetric emergencies (+56.54, P=.0001), spontaneous vaginal delivery (+42.65%, P=.0001), perineal lacerations (+34.50, P=.000), obstetric ultrasonography (+34.40%, P=.0001), and cervical assessment (+33.33%, P=.0001). Student confidence levels showed greatest improvements in obstetric emergencies (+63.14, P=.0001), perineal lacerations (+53.80%, P=.0001), and surgical principles (+46.20%, P=.0001). Follow-up surveys (1=high, 5=low) indicated that the program prepared them well in knowledge (1.73), surgical skills (2.0), obstetric skills (1.53), patient assessment (2.13), and patient management (2.4). Moreover, 86.67% of participants felt more prepared for residency than their fellow interns.

DISCUSSION:

This simulation-based curriculum for obstetric skills was effective at improving the knowledge, skills and attitudes of medical students matched into obstetric residencies. This program offers tools for milestone competencies and effectively prepared interns for day 1.
Post-call Faculty Work Restriction: A Balance Between Patient Safety and Physician Workload & Satisfaction
Authors: Dinh Tuan , Hunter Krystal , Kim Yonsook , Mama Saifuddin
Published: September 2017

BACKGROUND:

Work hour restrictions for trainees are now commonplace, this suggests that work hour restrictions for clinical faculty may be of value in assuring patient safety, but this has to be balanced taking into account physician workload and productivity and physician perception of autonomy and satisfaction.

METHODS:

In August 2015, the department of Obstetrics & Gynecology at Cooper University Hospital instituted a no-clinical-work policy following faculty night on call. A survey of 12 questions with Likert scales was sent to all faculty in the department involved in night call. The survey was repeated at 2, 6, and 10 months after the policy change. Factors assessed included faculty concern regarding productivity (RVUs), stress level, resident teaching, autonomy, and ability to function after a difficult call. Statistical analysis was done with χ2 test.

RESULTS:

Twenty faculty started this project. The data were averaged over all three survey time points. Fifty-six percent believed that their clinical production (RVUs) worsened, conversely 66% felt that resident teaching improved after the policy change. Of the respondents, 59% felt it was unsafe to work the day after call, 48% felt it was difficult to work in the office setting after a difficult call and 73% felt it was not safe to perform complex surgical procedures after call. Improvement in family life was reported by 73% and 54% felt it would extend their careers.

DISCUSSION:

This survey shows that physician satisfaction is improved and teaching is enhanced, but work productivity is decreased in the setting of a required postcall faculty work restriction.
Preparing Fourth-Year Medical Students to Collaborate With Nurses: An Innovative Paging Curriculum
Authors: Lawrence Emma , Bell Carrie , Malone Anita , Morgan Helen
Published: September 2017

BACKGROUND:

Effective communication and collaboration between physicians and nurses improves patient care outcomes, decreases costs, and is a crucial aspect of new interns' responsibilities. However, little formal training is provided to graduating medical students.

METHODS:

A simulated paging curriculum was administered to 4th-year medical students participating in an OBGYN residency preparation elective. Certified Nurse Midwives administered the pages, and simulated the role of a floor nurse. Students completed a survey before and after the curriculum. Students indicated on a 100 mm visual analogue scale (1=not comfortable at all, 100=extremely comfortable) their comfort gathering information, their comfort providing patient care management, and their comfort collaborating on patient care with a nurse. Pre- and postresponse means were compared utilizing paired t tests.

RESULTS:

Eleven students completed the paging curriculum, and eight (72%) responded to the survey. After the curriculum, students felt more comfortable gathering information from a nurse (before 57.1, after 87.5; P=.0071), providing patient care management with a nurse (before 47.8, after 85.6; P=.0038), and collaborating on patient care with a nurse (before 66.1, after 93.6; P=.0015).

DISCUSSION:

Medical students felt more comfortable collaborating with nurses on patient care after participating in a simulated paging curriculum. Although a limitation of our study is the small sample size, these pilot data suggest that improvement in the nursing-resident interaction can be made with innovative simulated paging curricula.
Residents as Teachers: Analysis of Performance on End-of-Clerkship Questionnaire and Correlation With Graduation Questionnaire Outcomes
Authors: Waldman Ian , Foley Evan , D'Agata Carie , Wagner Steve , MacNeill Colin
Published: September 2017

BACKGROUND:

Several reports indicate ObGyn medical education is one of the lowest-rated of 3rd-year the core clerkships. Resident teaching is among the lowest of the areas rated. Following our department's low rating in 2012–2013 we sought to determine how resident performance as teachers (RAT) changed after instituting a series of improvements, and to validate performance changes by correlation with student comments and GQ survey outcomes.

METHODS:

Medicine and ObGyn End of Clerkship survey responses to the statement, “Residents were interested in teaching, spent time with students and treated students as valuable members of the health-care team” were collapsed into two groups (disagree or neutral, and agree or strongly agree) and compared using the Pearson χ2 Test. Differences between each year’s performance were considered significant if P<.05. Medicine clerkship responses served as a control.

RESULTS:

Medicine resident teaching performance did not change over 4 years. ObGyn performance was significantly lower than Medicine in the first year of evaluation and dropped further in the second year. Following initiation of a RAT program, ObGyn performance improved significantly and correlated with an improvement in GQ performance. Typical student responses include “I found this a great opportunity to get a lot of hands-on experience and the residents I worked with were exceptional” and “Fantastic learning experience, feel lucky to have had the opportunity and a wonderful resident supervisor.”

DISCUSSION:

Student rating of resident teaching performance improved significantly after instituting a RAT program, demonstrating that teaching performance can improve.
Diagnosis and Lifestyle Modification Counseling for Adolescents With PCOS: An Assessment of Learning Needs in OBGYN, Pediatrics, and Family Medicine Residents
Authors: Dassow Jeanie , Wood Sarah Jeanne , Raper Mandi , Holcombe Jenny M. , Fore Robert , Learman Lee A.
Published: September 2017

OBJECTIVE:

To assess the knowledge gaps in residents of three disciplines to both accurately diagnose polycystic ovary syndrome (PCOS) and use lifestyle modification counseling with adolescents who have PCOS.

METHODS:

A 21-question survey was administered several months before and then 2 weeks after an interactive didactic session with resident physicians in Pediatrics, Family Medicine, and OBGYN at Erlanger Health System, to assess knowledge of disease mechanism, knowledge of treatment options, focus of counseling, adequacy of resources, and potential barriers to counseling. Basic descriptive and frequency analyses were conducted on all items.

EVALUATION:

Most residents, regardless of specialty, did not feel confident diagnosing PCOS in adolescents and this confidence decreased after the didactic session, presumably with increased knowledge of the complexity of PCOS. Although more than two thirds of residents acknowledged lifestyle modification as first-line management, most spent 5 minutes or less counseling on lifestyle changes. This trended consistently toward spending more time in the second survey. Most did not understand that 5% weight loss often restores menses. Residents felt barriers to counseling could be addressed via quick text links for the EHR media resources, patient didactic sessions on eating and exercise, and educational pamphlets. They expressed an interest in having such resources provided. The overall interest in lifestyle counseling increased statistically after the intervention.

DISSEMINATION:

A motivational interviewing curriculum will be developed, implemented and evaluated to address the learning needs identified by the survey, followed by repeat collection of survey data. Patient resources will be part of this. It will be submitted to the MedEd Portal.

REFLECTIVE CRITIQUE:

This needs assessment was conducted in residency programs at one institution including the three types of specialists who treat teens with PCOS. It demonstrated a need to educate these residents and equip them to better educate their adolescent patients with PCOS.
Effectiveness of a Focused Faculty Development Program on the Written Comments Component of Resident Evaluations
Authors: Dodds Robert , Deighton-Collins Sarah , Flora Robert , Steinauer Jody
Published: September 2017

OBJECTIVE:

Evaluate effectiveness of faculty development program combined with focused feedback on quality of written comments in resident evaluations.

METHODS:

Faculty were educated to improve quality of written comments on resident evaluations. Monthly evaluations concurrently changed, requiring comments before ratings. Quality was determined using validated CCERR (Completed Clinical Evaluation Report Rating) on de-identified evaluations, final scores representing median score from both authors. CCERR scores vary from nine to 45 correlating with quality. Baseline data were abstracted from the last half of 2015. Faculty development seminar took place May 2016. Faculty then received feedback at the monthly faculty meetings as well as individual coaching. After 9 months, a survey of faculty and residents will gauge comfort writing comments. CCERR scores were compared using nonparametric test, P<.05 defining significance.

RESULTS:

Two hundred five evaluations (50% with written comments) comprised the baseline with 22, 28, 38, 27, 28, 32 and 23 evaluations completed (May through November). The median CCERR score increased from baseline of 10–22.5, 20, 20, 21, 22, 21 and 19 (May through November, P<.0001).

CONCLUSION:

Previous studies confirm CCERR validity, eight points representing meaningful change. Educational sessions and ongoing feedback individually have been shown to increase scores, but not meaningfully. We achieved meaningful change, but our baseline was lower than previous studies. Ongoing feedback was not effective at generating further improvement. It is not clear if the improvement seen resulted from faculty development or changes in the structure of monthly evaluations requiring comments.
Breast Care 101: A Teaching Tool to Educate Ob/Gyn Students and Residents in Breast Care
Authors: Miller Jennifer Griffin , Kinney Sonja , Hueppchen Nancy
Published: September 2017

OBJECTIVE:

To develop breast educational videos to prepare learners for educational experiences in breast care.

METHODS:

As part of a prior research study, a needs assessment was completed (presented at APGO/CREOG Meeting 2012) indicating insufficient educational resources in breast care topics for Ob/Gyn residents. For this project, three brief (6–12 minute) videos were developed in the following content areas: breast tools including physical exam, breast cancer risk assessment, and understanding breast imaging results. Resident learners were exposed to these videos in preparation for breast care educational experiences (breast clinic.) After utilizing the videos, learners were assessed on their confidence in evaluating patients with breast complaints.

In addition, the videos were presented to medical students prior to their clerkship lecture on Breast Complaints. Videos can be accessed at the present time via You Tube: Evaluation of Breast complaints at https://youtu.be/ruydjeJumag; Breast Risk Assessment at https://youtu.be/VAh71__LhL8; and Breast Imaging and Diagnosis at https://youtu.be/Cmn2KA7Kv-k.

EVALUATION:

Postintervention surveys were completed by Ob/Gyn residents who had the opportunity to the view the videos regarding satisfaction with format and confidence. Postintervention surveys were completed by M3 students after their breast lecture.

DISSEMINATION:

Plan to distribute video links directly to fellow Ob/Gyn program directors and via AAMC Med Ed Portal.

REFLECTIVE CRITIQUE:

The goal of this project is to create resources that can be utilized in different venues to support education in breast care. Access to self-directed learning to prepare for educational experiences supports the learner’s confidence, skills, and attitudes toward breast care and enhances their educational experiences. Such resources can also be used by learners at the student and resident level in a flipped classroom approach to prepare the learners for case discussion.
Development and Evaluation of an eLearning Module on the Prepubertal Exam and Vaginoscopy for Ob-Gyn Residents
Authors: Huguelet Patricia S. , Palacios-Helgeson Leslie , Guiahi Maryam , Guiahi Maryam , Learman Lee A.
Published: September 2017

OBJECTIVE:

To develop and evaluate a self-study module for Obstetrics and Gynecology (Ob-Gyn) residents to improve knowledge and skills with prepubertal exam and vaginoscopy.

METHODS:

We developed an interactive module to teach CREOG Learning Objectives in pediatric and adolescent gynecology: prepubertal vaginal bleeding evaluation, including prepubertal exam, vaginal culture, office lavage, and vaginoscopy. After pilot-testing with chief residents and recent graduates, we held a focus group to solicit feedback resulting in modifications.

EVALUATION:

After obtaining IRB approval, we offered the revised module to all current Ob-Gyn residents (n=37). We solicited residents by e-mail communication and offered a small incentive. The evaluation tool queried satisfaction, confidence with knowledge and skill in the tested areas, and assessed knowledge of prepubertal bleeding before and after module completion. Of the 37 residents, 26 (70%) participated. Satisfaction with knowledge improved from 30.8% to 100% (P<.0001). Reported confidence in being able to independently perform a prepubertal genital exam improved from 7.7% to 53.8% (P<.001). Reported confidence in in being able to independently perform vaginoscopy did not change significantly (0%–11.5%, P=.24).

DISSEMINATION:

We will submit this module to the AAMC MedEdPORTAL. We aim to design a multi-institutional research study to assess whether the module improves knowledge and skills on this topic at institutions throughout the country.

REFLECTIVE CRITIQUE:

Although residents overall found benefits, improving their confidence with vaginoscopy performance was limited. The module may serve as an introduction to vaginoscopy, but skill acquisition may rely on actual performance.
Characterizing the Culture of a Graduate Medical Education Program
Authors: Lachance Jason A. , Han Paul , Varaklis Kalli , Varaklis Kalli , Kenton Kim
Published: September 2017

OBJECTIVE:

To develop a methodology for exploring the factors that influence local culture in an academic community-based Graduate Medical Education program.

METHODS:

We conducted a group of six structured focus groups with 14 current residents and 15 faculty to exploring local themes that affect the shared values and key characteristics of successful OB/GYN residents and how those factors influence the culture of the residency program.

EVALUATION:

Focus groups were conducted by interviewers trained in qualitative research methodology with the purpose of identifying themes and characteristics that are desirable in both current and potential future residents. Qualitative data were collected and de-identified then analyzed with MAXQDA software to identify common themes that correlated with resident success.

DISSEMINATION:

Results will be submitted to a peer reviewed journal of higher medical education as well as shared at local home institution amongst other GME training programs for similar analysis of their respective program.

REFLECTION:

The work has been most challenging navigating the emerging field of qualitative research. We were ultimately able to successfully narrow the scope of the project, garner IRB approval, secure independent grant funding, and complete the focus groups and data analysis. Collaboration with local experts was immensely helpful and successful. I expanded my knowledge of both qualitative research as well as developed a better understanding of our residency program which has been extremely valuable as I have just begun the role of Program Director.
Ultrasound Assessment of Fetal Head Position
Authors: Morosky Christopher M. , Steinberg Adam , Steinberg Adam , Learman Lee A.
Published: September 2017

OBJECTIVE:

We developed a 1-hour multimedia conference to educate Obstetrics and Gynecology residents on the techniques of digital and ultrasound assessment of fetal head position. We evaluated the curriculum by assessing its impact on resident performance and confidence before and after the conference.

METHODS:

The conference included a 15-minute demonstration video and a supervised skill practice using a simulation mannequin and pelvis. Participants were asked to submit digital documentation of one attempt of ultrasound assessment of fetal head position on a laboring patient.

EVALUATION:

Eleven residents (PGY-1, n=5; PGY-3, n=6) successfully completed the conference and surveys. There was a nonsignificant increase in the resident documentation of fetal head position as part of the labor cervical exam in the 3 months following the start of the conference compared to the same 3 months from the year prior (25.6% versus 20%, P=.48). Mean confidence in the ability to identify fetal head position (5.1 versus 6.9, P=.004), rotate the fetal head (3.5 versus 5.1, P=.013), safely apply a vacuum or forceps (3.9 versus 4.5, P=.054), and use ultrasonography to assist in identification of fetal head position (5.7 versus 6.4, P=.09) improved following the conference.

DISSEMINATION:

The demonstration video was accepted for presentation at the CREOG & APGO Film Festival 2017 and will be submitted to the AAMC MedEdPORTAL. The curriculum evaluation results will be submitted to the Journal of Graduate Medical Education.

REFLECTIVE CRITIQUE:

We will plan to enroll more residents into the study over the course of the next year.
Resident Practices Regarding Prenatal Contraceptive Counseling
Authors: Patel Pooja , Young Amy , Steinauer Jody
Published: September 2017

OBJECTIVE:

Prenatal contraceptive counseling has been associated with effective postpartum contraceptive use; therefore, proper training in providing this service is paramount. The purpose of this cross-sectional study is to determine obstetrics and gynecology (ob-gyn) residents' prenatal contraceptive counseling practices.

METHODS:

Data were obtained via anonymous surveys completed by University of Texas, Medical Branch in Galveston (UTMB) ob-gyn residents.

RESULTS:

Twenty-one of 25 residents (84%) completed the survey. Five (20%) PGY-1, seven (28%) PGY-2, five (20%) PGY-3, and four (12%) PGY-4 residents participated. With regards to prenatal contraceptive counseling practices, 11 (52%) reported initiating prenatal contraceptive counseling in the third trimester or later, 20 (95%) described spending 10 minutes or less on contraceptive counseling during all prenatal care, and nine (43%) respondents reported counseling about all four major contraceptive categories (oral pills/patches/rings, injections, long-acting reversible contraceptives/IUDs/implant, and sterilization). When asked for reasons for not doing prenatal counseling, residents cited either time-constraints and simply forgetting to counsel. One-third of the residents felt that they “miss[ed] some aspects of proper counseling.” Finally, one 3rd year and one 4th year stated they had no formal training in contraceptive counseling, and only four (16%) residents reported formal didactics on contraceptive counseling specific to the prenatal period.

CONCLUSION:

Prenatal contraception counseling was inadequate in one ob-gyn residency program. Our findings suggest that further research and uniform guidelines regarding resident education on contraceptive counseling are warranted.
Impact of Cesarean Simulation on Medical Education
Authors: Snyder Lindsay , O'Reilly Meg , Friedman Elizabeth , Hawkins Allyson , Schink Julian (Skip) , Schink Julian (Skip) , Goepfert Alice , Kenton Kimberly
Published: September 2017

OBJECTIVE:

To 1) enhance a cesarean delivery educational video and 2) determine the impact of an innovative cesarean delivery simulation model on learners' knowledge.

METHODS:

An innovative program was developed by expanding on an existing cesarean simulation video from Dr. Meg O'Reilly at Oregon Health Services University. Students and interns watched the video, then participated in a 2-hour structured experience. The simulation involved dissection and re-approximation of the abdominal wall and uterus. All participants completed a pre- and posttest immediately before and after their participation.

EVALUATION:

Data were collected from 42 participants, eight interns and 34 medical students. Significantly more questions were answered correctly in the posttest, compared to the pretest (17.3+4.1 versus 11.4+2.9, respectively; P<.001).

DISSEMINATION:

We will submit to AAMC MedEdPortal, and continue to collect data for presentation at future APGO and CREOG meetings.

REFLECTIVE CRITIQUE:

While the immediate responses are promising, the long-term results are unknown. In addition, an ongoing assessment of skill performance needs to be considered for future learners.
Simulation Training Regarding Vaginal Delivery Versus Traditional Medical Student Clinical Education
Authors: Stetzer Brad , Sarfoh Vanessa , Mercer Brian , McKenzie Margaret , Hueppchen Nancy
Published: September 2017

OBJECTIVE:

To assess the impact of birth simulation training on medical student comfort, confidence and anxiety in performing a delivery, and knowledge of normal labor.

METHODS:

In this prospective study of 3rd-year medical students during their 4-week inpatient clinical experience, student groups were randomly assigned to “traditional” teaching versus traditional plus additional “simulation” teaching. All students were immersed in clinical experiences in the delivery room after an initial group education session regarding normal labor and delivery mechanisms and procedures. The group assigned to “simulation” underwent additional supervised simulation training for normal delivery and delivery complications. All groups underwent a pretest before training and a posttest on completion of their clinical rotation. Evaluated variables included: confidence and anxiety regarding performing a delivery; comfort controlling the head, shoulders and body during delivery; comfort in delivering a placenta; and knowledge of cardinal movements and stages of labor. Statistical analyses were accomplished using Pearson χ2 analysis and Student's T tests.

RESULTS:

Sixty students participated. Overall, both traditional teaching and simulation groups demonstrated significant improvements in their scores regarding measures of comfort, anxiety, and knowledge between the pre- and posttests (P≤0.05). However, comparison of posttest responses did not reveal those undergoing additional simulation training to have higher comfort or confidence in performing a vaginal delivery (P>.05), or have lower anxiety at being involved in a vaginal delivery (P>.05). Similarly, knowledge about the cardinal movements of labor and stages of labor at the posttest were similar between groups (P>.05).

CONCLUSION:

In the context of an inpatient clinical rotation in which student comfort, confidence, anxiety, and knowledge regarding vaginal delivery improved significantly with traditional teaching, additional simulation training was not associated with improved outcomes.