bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Motion Tracking to Analyze Forceps Paths During Standardized Simulated Operative Vaginal Deliveries
Authors: Holbert Michael , Altman Alan , Bramblet Rachel 
Published: September 2018

Local Mentor:

Steven Johnson, MD

APGO Advisor:

Jody Steinauer, MD

OBJECTIVE:
The purpose of this study is to evaluate the ability of motion tracking to discern variation in forceps paths during standardized simulated operative vaginal deliveries among experienced and inexperienced obstetric providers.

METHODS:
This is a pilot study involving 24 Obstetrics and Gynecology residents and six faculty at a single institution. Each participant was filmed performing standardized simulated forceps assisted vaginal deliveries on a high-fidelity model. Motion tracking software was used to track the path of the forceps blade and this data was analyzed for total path length, total x plane displacement, total y plane displacement, and final forceps angle. One-way ANOVA was used to evaluate for statistically significant differences between groups based upon education year, with Tukey's HSD post-hoc test to identify interactions.

RESULTS:
There were statistically significant differences noted between groups in the total path length (F=7.57, P<.001) and total y plane displacement (F=5.79, P<.001). In the post-hoc analysis, this included faculty-PGY1 (P<.001) and faculty-PGY2 (P=.004) for total path length and faculty-PGY1 (P=.001) and faculty-PGY2 (P=.022) for total y plane displacement. There were no statistically significant differences noted between groups for total x plane displacement (F=0.89, P=.475) and final forceps angle (F=2.45, P=.052).

CONCLUSION:
Motion tracking of standardized simulated operative vaginal deliveries identifies statistically significant differences between experienced and inexperienced obstetric providers. This suggest that motion tracking can be used to design an educational intervention to improve forceps technique among Obstetrics and Gynecology residents.
Improving Clerkship Feedback With a New Evaluation form, a Retrospective Comparison
Authors: Lackritz Katie , Wolf Abigail , Braverman Andrea , Mercier Rebecca 
Published: September 2018

Local Mentor:

Abigail Wolf, MD

APGO Advisor:

Lee Learman, MD, PhD

OBJECTIVE:
To determine if a new evaluation process resulted in longer student evaluations by faculty.

METHODS:
After receiving IRB exemption a retrospective review of completed evaluations from third year obstetrics and gynecology clerkship students was completed. All students at a single institution were included from two academic years for 526 total evaluations. The control group was evaluated with a standard institutional form. The intervention group received a supplemental evaluation that the students distributed electronically to individual faculty they worked with. Student t-test and Chi squared analysis compared the word counts, the clinical grades, and the word count by location of the rotation. Grade distribution between the two years was also analyzed.

RESULTS:
The length of the comments increased by 49% (144 words to 216), two-tailed P-value <.01. Analyzing clinical grades showed: “good” comments decreased by 17% (162 to 134), “excellent” comments increased by 69% (110 to 186), “honors” comments increased by 61% (165 to 267). Nine of the ten sites showed word count increases ranging from 20-198%. Grade distribution showed no change in the clinical grade of “good”, the clinical grade of “excellent” decreased from 66% to 59% of the class and “honors” increased from 29% to 36%. No students received a marginal or failing grade.

CONCLUSION:
Changing the evaluation process yielded longer comments from the obstetrics and gynecology clerkship. Students with higher clinical grades had the longest comments; students with the lowest clinical grade had the shortest comments. This may reflect that it is easier to give positive than negative feedback. With the intervention, a higher proportion of students received the clinical grade of honors.
Outcomes of Performance Based Assessments With Varied Sexual History Communication Curricula
Authors: Shaffer Sarah , Gnade Colette , Kreiter Clarence , Stockdale Colleen K. 
Published: September 2018

Local Mentor:

Colleen K. Stockdale, MD, MS

APGO Advisor:

Hope Ricciotti, MD

OBJECTIVE:
Evaluate the effect of differing sexual history communication curricula as assessed by a standardized performance examination administered at the end of the Obstetrics and Gynecology clerkship. Differences in specific types of communication skills were considered based on varied training in sexual history-taking as experienced by medical students.

METHODS:
This retrospective cohort study examined “naturally occurring” comparison groups of medical students resulting from curricular changes in sexual history communication training over time. The curricular changes were hypothesized to positively affect practice based assessment (PBA) scores. Other variables considered were medical student sex and year. Outcome measures included items regarding clinical history, physical exam, communication skills and final diagnosis related to sexual history communication curriculum experienced. Group means and paired t-tests were performed for individual variables as well as several composite variables.

RESULTS:
Nine hundred and nine (n = 909) PBA scores were analyzed. Post-hoc power analysis defined minimum group size to be 45, which was exceeded. There was no relationship, positive or negative, between sexual history communication curricula with any outcome measure. Females performed significantly better on the PBA overall (P<.0001) and on several individual communication measures on the PBA checklist (range P 0.0003–0.02). Students who received “double” sexual history communication training compared to those who received “single” or no training showed no difference on any outcome measure (P 0.06).

CONCLUSION:
There appears to be minimal correlation of differing sexual history communication curricula with individual or composite communication skill scores as evaluated with a standardized performance examination administered at the end of the Obstetrics and Gynecology clerkship.
Use of a Mobile Diary App to Influence Narrative Feedback on Medical Student Evaluations
Authors: Todd Rebecca , Martin Jacob , McQuerry Kristen 
Published: September 2018

Local Mentor:

Wendy Hansen, MD and Brady Reynolds, PhD

APGO Advisor:

Jody Steinauer, MD

OBJECTIVE:
To evaluate the impact of using a mobile diary app on the quantity and quality of narrative feedback written on medical student evaluations during medicine, surgery, and ob/gyn rotations at rural and university hospitals.

METHODS:
Narrative feedback written by 46 faculty members was obtained for 6 months during a cohort study (baseline 1-3, comparison 4-6). The intervention (month 3) instructed participants to keep daily notes on student performance using a diary app on their mobile device. Quantity was determined by a simple word count, compared before and after the intervention. Quality was evaluated by 4 blinded raters using The Quality Improvement Instrument (QI) and the Completed Clinical Evaluation Report Rating (CCERR). The study had 80% power to detect a 30% increase in word count. Scores were compared using a T-test.

RESULTS:
Baseline evaluations (n=43) contained an average word count of 43 (range 2 to 216). The baseline mean CCERR score was 16.6 and the Quality Improvement score was 2.8. Preliminary results from the post-intervention evaluations (n=45) included an average word count of 45 (range 5 to 169). The mean CCERR and QI scores were 21.4 and 3.4, respectively. No differences were statistically significant at a P<.5.

CONCLUSION:
Use of a mobile diary app to record daily student performance did not statistically improve the quantity or rated quality of narrative feedback in medical student education. Effort should be focused elsewhere to improve written comments by faculty.
Social Mission Content in U.S. OB/GYN Residency Websites
Authors: Whetstone Sara , Steinauer Jody , Autry Meg 
Published: September 2018

Local Mentor:

Meg Autry, MD

APGO Advisor:

Hope Ricciotti, MD

OBJECTIVE:
A well-trained provider workforce is thought to be essential in caring for underserved US patient populations. We conducted a pilot study to explore how US-based OB/GYN residencies describe their commitment to and training of residents to provide high-quality care in these communities.

METHODS OF STUDY SELECTION:
A convenience sample of 20 US OB/GYN residency programs was chosen based on input of OB/GYN GME leaders and association of programs with public and/or safety net hospitals.

DATA SOURCES:
One author conducted a content analysis of the residency programs’ web-based descriptions, specifically searching for the following terms: diversity/minority, underserved or vulnerable, community health or community based, health disparities, social justice, primary care, and shortage areas.

RESULTS:
Half (10) of the programs described a commitment to training residents to provide care for underserved or diverse patient populations. Seven programs had an explicit statement of valuing care for underserved populations on the residency's home page, often featuring the program director's statement. Several included residents’ comments which served to emphasize the value placed on caring for underserved women and/or addressing health disparities. Programs highlighted their diverse patient populations, clinical sites, and experiences that provided opportunities to care for vulnerable populations locally. Only rarely did programs discuss diversity among trainees/faculty and placement of graduates in health provider shortage areas.

CONCLUSION:
Only half of identified OB/GYN residency programs explicitly highlight training providers to care for underserved populations on their websites. More research is needed to explore whether this reflects a lack of training focus.
Surgical Management of Postpartum Hemorrhage—Building a Standardized, Validated Task Trainer
Authors: Chuang Meleen , Smith Heather , Koai Esther , Kaplan Julie , Lerner Veronica , Banks Erika 
Published: September 2018

Faculty Advisor:

Erika Banks, MD

PURPOSE:
To develop a validated, reproducible, cost-effective task-trainer used to teach surgical management of postpartum hemorrhage.

BACKGROUND:
Postpartum hemorrhage is the third leading cause of preventable maternal death. While the use of compression and ligation sutures is infrequent, simulation teaching of skills is important.

METHODS:
Study participants (N=77) consisted of junior residents (35), senior residents (17) and faculty attending physicians (25) at a large, urban academic hospital. Pre and post- test were collected assessing prior experience, comfort, and perception regarding the model. Participants were de-identified and individually filmed performing bilateral O’Leary Stitch and B-Lynch. Two evaluators independently reviewed recordings and completed the task-specific evaluation tools, both the new untested and objective skill-assessment tool (OSAT) and previously validated Global Rating Scale (GRS). Intra-rater and inter-rater reliability were assessed, and validity was tested by comparing OSAT scores stratified by different characteristics to GRS scores.

RESULTS:
Intrarater reliability was demonstrated for both raters across each simulation and scoring tool (P<.0001). Interrater reliability for OSAT showed high agreement (Kappa 0.97 B-Lynch, 0.90 O’Leary). Construct validity was demonstrated for B-Lynch; attendings and seniors scoring higher than juniors on OSATS (17 vs. 16.7 vs. 3, P<.0001) and GRS (5 vs. 23 vs. 25, P<.0001), as well as for O’Leary simulation for both OSATS (15.5 vs. 15.0 vs. 11.0, P<.0001) and GRS (25 vs. 24 vs. 12, P<.0001).

DISCUSSION:
We have shown validation of a simple task-specific trainer that can be used to teach B-Lynch and O’Leary. The respective OSATs are reliable to assess performance.
Managing Hemorrhage After Second-Trimester D&E: Individual Simulation Training for Ob/Gyn Residents
Authors: Deans Elizabeth , Broach Amy , Boardman Amy 
Published: September 2018

Faculty Advisor:

Amy Boardman, MD

PURPOSE:
To evaluate the efficacy of case-based simulation on resident knowledge and retention for management of a rare clinical event.

BACKGROUND:
Abortion is a safe procedure with the risks of complications increasing as gestational age increases. Although rare, hemorrhage is a common cause of mortality with second-trimester abortion. Teaching how to anticipate and manage any rare, potentially catastrophic clinical event is a challenge in medical education.

METHODS:
In our university program of 31 residents, a needs assessment identified management of hemorrhage after D&E as a desired simulation topic. Two different case-based scenarios were developed in which each resident managed the patient encounter alone. After each post-simulation debrief, residents reviewed a management algorithm and topic handout. Pre- and post-tests were completed with both simulations. The interval between the simulations and a retention post-test was approximately 2.4 months.

RESULTS:
Twenty-five residents (81%) completed the first simulation, and 18 residents (58%) completed both simulations. Median baseline pre-test score for PGY1/2 residents was statistically different than PGY3/4s (P=.002). Overall, post-test scores were greater than pre-test scores with both simulation sessions (P<.0001). Pre-test scores of second simulation decreased slightly compared to the first post-test, but not to baseline. The retention score was unchanged from the 2nd simulation post-test (P=.26). Ninety-six percent of evaluations agreed that simulation was an effective, and desirable way to learn management of rare clinical events.

DISCUSSION:
Simulation provides opportunity for resident education of rare clinical events. This low-fidelity, case-based simulation demonstrates improved baseline resident knowledge for management of post-D&E hemorrhage.
Development of a Proficiency-Based Simulation Training Model for Laparoscopic Vaginal Cuff Closure
Authors: Khalilian Sepideh , Robinson James , Hardesty Jessica , Arumala Ruth , Huelsmann Erica , Rezvani Sepideh 
Published: September 2018

Faculty Advisor:

Amy Boardman, MD

PURPOSE:
To evaluate if a low fidelity simulation model and training video will improve resident surgical performance of laparoscopic vaginal cuff closure.

BACKGROUND:
Laparoscopic surgical complexity and resident work-hour restrictions have increased the need for surgical simulation in OBGYN residencies. Evidence of transfer of acquired surgical skills from simulation to the operating room (OR) is limited.

METHODS:
This prospective, randomized study compares resident surgical skills acquisition after low-fidelity simulation training of vaginal cuff closure versus no intervention. Study phases include development of a vaginal cuff closure training video; video documentation of resident lab performance; and video assessment of resident surgical skill by blinded surgical experts using I – GOALS, II – error events, and III – surgical checklist.

RESULTS:
OBGYN residents (N=18) from MedStar Georgetown and Washington Hospital Center were randomized to control group (N=7) or intervention group (N=11). Intervention group reviewed the training video on laparoscopic vaginal cuff closure. All residents then used the low-fidelity cuff closure model and recorded baseline videos. Three surgeons scored the videos with an inter-rater reliability of 0.585, 0.531, and 0.825 for tests I, II, and III. Wilcoxon Rank Sum test was used to evaluate differences between groups by averaging all raters’ scores. There was significant difference between the control and intervention groups for Test II (P=.01) but no difference between the control and intervention groups for tests I and III.

DISCUSSION:
Simulation training of laparoscopic vaginal cuff closure reduces error events after immediate exposure. Continued research will evaluate if acquired skills transfer to OR performance.
The Hysterectomy Teaching Program: How Can We Improve Quality and Consistency of Teaching in the Operating Room?
Authors: Pradhan Tana , Simpson Desiree 
Published: September 2018

Faculty Advisor:

Arthur Ollendorff, MD

BACKGROUND:
Since the numbers of hysterectomies performed is declining nationally, there is an increased need to maximize the effectiveness of real-time surgical teaching.

ASSESSMENT OF PROBLEMS:
Faculty members have increased pressures of maintaining clinical volume, performing excellent patient care and being responsible for surgical teaching. Therefore, a hysterectomy teaching program was implemented with: 1) a novel, universal teaching checklist which was to be utilized for all modes of hysterectomy, 2) prompting to use the checklist by emails and texting, 3) faculty development sessions. The teaching checklist was reviewed by 3 expert surgeons and was available on the MyTipsReport evaluation tool.

RESULTS OF ASSESSMENT/MEASUREMENT:
After IRB exemption, 172 scheduled elective hysterectomy cases and four faculty development sessions were included over 9 months. When compared to a cohort in the past 6 months prior to implementation, there was no statistically significant change in patient ASA class, total OR time or relevant milestone data. Of PGY III/IV who were surveyed—75% (6 of 8) found the checklist “helpful” and 1 found it “more helpful than they thought.” Of residents, 50% (4/8) found the checklist most useful for facilitating feedback at the end of the case followed by 37.5% (3/8) found it helpful in learning the steps. Resident perceived improvement in surgical confidence and real-time feedback was not statistically significant (n=12). Faculty physicians found the checklist most helpful in setting surgical goals for the case (6/8, 75%) followed by facilitating feedback (4/8, 50%).

STRATEGIES FOR QUALITY IMPROVEMENT/CHANGE:
The hysterectomy teaching program is feasible. Additional longitudinal data and validation in a multi-site initiative would be necessary. Finally, from attending surveys, a needs assessment for robotic teaching is necessary as the checklist was least helpful for complex robotic cases.

LESSONS AND MESSAGES:
A simple universal teaching tool with prompting may increase consistent teaching by faculty.
Abdominal point tenderness and an impending aneurysmal rupture
Authors: Smith David A. , Kaplan Lewis J. 
Published: September 2018

ABSTRACT
Although isolated iliac artery aneurysms are rare and occur in only 2% of patients, isolated internal iliac artery aneurysms are even more uncommon. Patients with these aneurysms require urgent vascular surgery consultation and evaluation; untreated aneurysms have a high propensity to increase in size and rupture. Providers should be aware of this critical incidental finding on CT scan and MRI and know when to initiate an emergency workup and therapy.
A call to action on prediabetes
Authors: Dugan Joy , Cantillep Alegria , Newberry Kathryn , Shubrook Jay 
Published: September 2018

ABSTRACT
Diabetes and prediabetes have become an epidemic in the United States. The keys to battling this public health challenge are effective screening and evidence-based interventions. Studies show that intensive lifestyle interventions, medications, and weight loss surgery can reduce or delay new-onset type 2 diabetes. This article reviews the steps clinicians can take to help patients stay ahead of this disease.
Opioid use disorder
Authors: Alexander Lisa Mustone , Keahey David , Dixon Katelyn 
Published: September 2018

ABSTRACT
The treatment of patients with acute and chronic pain not attributed to cancer or end-of-life conditions is a challenge for many clinicians. Although CDC guidelines that focus on the primary care setting have provided critical recommendations, evidence-based guidance is lacking on optimal duration of opioid treatment for postoperative and acute care in specialty settings. Over the last 2 decades, the liberal use of opioids has resulted in many unintended consequences, including dependence and abuse, illicit distribution of legally and illegally prescribed opioid medication, progression to IV heroin and an epidemic of overdoses, and most recently an increase in the incidence of HIV among patients sharing syringes, frequently in communities with historically low HIV rates. This article analyzes these complex issues and proposes strategies to help clinicians improve patient care through education and responsible prescribing.
What are the new vaccination recommendations for herpes zoster?
Authors: Mospan Cortney M. , Colvin Natasha 
Published: September 2018

ABSTRACT
A new vaccine to prevent herpes zoster (shingles) has been included in the 2018 Advisory Committee on Immunization Practices' adult immunization schedule as the preferred herpes zoster vaccination for all immunocompetent adults age 50 years and older. This article discusses new vaccination recommendations for herpes zoster.
Preclinical Pharmacology in the Rhesus Monkey of CW 1759-50, a New Ultra-short Acting Nondepolarizing Neuromuscular Blocking Agent, Degraded and Antagonized by L-Cysteine
Authors: Savarese John J. , Sunaga Hiroshi , McGilvra Jeff D. , Belmont Matthew R. , Murrell Matthew T. , Jeannotte Erin , Cooke Farrell E. , Wastila William B. , Heerdt Paul M. 
Published: September 2018

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Structure–activity studies were performed to identify a new neuromuscular blocking agent retaining the ultra-short acting characteristics of gantacurium, including degradation and reversal by l-cysteine, but lacking its histaminoid properties in man. CW 1759-50 has emerged from this program.

Methods
Adduction of CW 1759-50 with l-cysteine was studied by high-performance liquid chromatography and mass spectrometry. Institutional Animal Care and Use Committee–approved comparisons of CW 1759-50 to gantacurium were performed in rhesus monkeys. ED95 for neuromuscular blockade was established. Spontaneous recovery was compared to reversal by l-cysteine in paired studies of boluses or infusions. In addition, changes in mean arterial pressure and heart rate after very large doses of 15 to 60 × ED95 were compared.

Results
The half-time of adduction of l-cysteine to CW 1759-50 in vitro was 2.3 min. The ED95 of CW 1759-50 was 0.069 ± 0.02 mg/kg; ED95 of gantacurium was 0.081 ± 0.05 mg/kg (P = 0.006). Duration of action (recovery to 95% twitch height after 98 to 99% blockade) was as follows: CW 1759-50, 8.2 ± 1.5 min; and gantacurium, 7.4 ± 1.9 min; (n = 8 and 9, P = 0.355). Administration of l-cysteine (30 mg/kg) shortened recovery (i.e., induced reversal) from CW 1759-50 after boluses or infusions (P always less than 0.0001). Recovery intervals (5 to 95% twitch) ranged from 6.1 to 6.7 min (and did not differ significantly) after boluses of 0.10 to 0.50 mg/kg, as well as control infusions (P = 0.426 by analysis of variance). Dose ratios comparing changes of 30% in mean arterial pressure or heart rate to ED95 for neuromuscular blockade (ED 30% Δ [mean arterial pressure or heart rate]/ED95) were higher for CW 1759-50 than for gantacurium.

Conclusions
CW 1759-50, similar to gantacurium, is an ultra-short acting neuromuscular blocking agent, antagonized by l-cysteine, in the monkey. The circulatory effects, however, are much reduced in comparison with gantacurium, suggesting a trial in humans.