bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Predictive Model for the Ob/Gyn Residency Match: Pilot Phase
Authors: Ferriss J.S. , Tristan S , Woody S , Cain L.E. , Vinas E.K. 
Published: September 2018

Local Mentor:

Amy Young, MD

APGO Advisor:

Hope Ricciotti, MD

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

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

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

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

Local Mentor:

Philip Chan, PhD

APGO Advisor:

Lee A. Learman, MD, PhD

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

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

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

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

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

Local Mentor:

Erika Banks, MD

APGO Advisor:

Nancy Hueppchen, MD

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

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

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

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

Local Mentor:

Maya Hammoud, MD, MBA

APGO Advisor:

Nancy Hueppchen, MD

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

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

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

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

Faculty Advisor:

John Fischer, MD

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

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

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

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

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

Faculty Advisor:

John Fischer, MD

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

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

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

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

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

Faculty Advisor:

Erika Banks, MD

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

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

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

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

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

Faculty Advisor:

Karen Noblett, MD

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

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

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

STRATEGIES FOR QUALITY IMPROVEMENT/CHANGE:
If a Curriculum intervention was not found to be useful, it will be modified or eliminated in the upcoming year for perpetual improvement in the overall surgical curriculum.

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

Faculty Advisor:

Nancy Gaba, MD

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

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

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

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

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

Faculty Advisor:

Arthur Ollendorff, MD

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

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

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

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

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

Faculty Advisor:

Steven Swift, MD

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

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

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

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

DISCUSSION:
Residents perceive video simulation as a safe environment to deliberately practice surgical decision-making skills. Faculty and staff perceptions of resident efficiency and competence will be compared over time to resident perceptions. We will expand use of this low fidelity education strategy within our residency program.
Time Out for Teaching: Implementing a Post-Procedure Time Out to Improve Surgical Evaluations
Authors: Straney Jennifer , Gala Rajiv , Ranger Caitlyn , Blosser Emily 
Published: September 2018

Faculty Advisor:

Arthur Ollendorff, MD

PURPOSE:
To increase surgical evaluations by implementing a post-procedure Time Out for teaching.

BACKGROUND:
Compliance with intra-operative resident feedback and use of myTIPreport evaluations is poor. Feedback with completed evaluations is vital to improving surgical competence and compliance with ACGME milestones.

METHODS:
Post procedure Time Out for Teaching was implemented after gynecologic surgery to remind faculty to complete evaluations. A paper myTIPreport evaluation was provided in each operating room. Compliance goal was 80%. Evaluations were completed prior to leaving the operating room. PDSA cycles were used to introduce and evaluate this process. Using T-test, we compared completion rates prior to implementation of the Time Out. We removed the paper evaluations and continued PDSA cycles with the Time Out and electronic evaluations only. We compared completion rates of Time Out with paper evaluations to those with electronic evaluations.

RESULTS:
Implementing the Time Out with paper evaluations significantly improved compliance from 6/101 (5.9%) to 74/90 (82%, P<.01). When paper was removed, there was no significant difference in completed evaluations with Time Out alone (P=.14). Evaluation using chi squared and Fisher's exact tests showed completion rates with paper to be 11.36 times higher than with electronic evaluations (P<.0001).

DISCUSSION:
Adding a Post-procedure Time Out to remind faculty to complete intra-operative evaluations did improve compliance. However, having a paper evaluation proved to increase compliance more than the Time Out with electronic evaluations. We plan to continue the Time Out for Teaching process, but will give faculty the option to complete evaluations on paper.