bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Online Resources by OB/GYN Student Interest Group Officers and Advisors [2M]
Authors: Arnold Kate , Flint Caroline J. 
Published: April 2018

INTRODUCTION:
OB/GYN medical student interest groups (SIGs) provide the first exposure for students to ACOG and APGO. Both organizations have resources for medical students on their websites, however, we hypothesize that many SIG leaders are unaware of these resources. The objective of our study is to assess SIG leader awareness of and perceived utility of online resources.

METHODS:
An IRB approved survey of 23 questions was sent to SIG leaders. One reminder was sent, then data collection was closed two weeks later.

RESULTS:
Online resources were underutilized with 30-40% of respondents being unaware of four out of five websites including the ACOG resident resource page, APGO residency directory, APGO clerkship guide, and the ACOG medical student Facebook page. All respondents had been to the ACOG website, however, only 31% had shared it with their SIG. Of note, 17% of SIG officers were not members of ACOG. Twenty-one percent of respondents were unaware that ACOG meetings often included medical student events.

CONCLUSION:
Our results show that there is much to be done in terms of disseminating information from our professional organizations to our future leaders. This would serve two purposes: First, it would engage leaders early and help foster their development; Second, it would help ACOG and APGO reach a larger audience. To increase awareness and utilization, we suggest sending SIG leaders, both medical student officers and faculty advisors, a welcome letter that includes a list of the resources in addition to the names of their ACOG fellow and junior fellow representatives for the state.
Quality As A Habit: Quality Improvement Training Curriculums In Obstetrics and Gynecology [6M]
Authors: Dhaliwal Amareen , Preet Mohan 
Published: April 2018

INTRODUCTION:
With the advancement of To Err Is Human and Crossing the Quality Chasm, medical institutions have recognized the need to implement succinct Quality Improvement (QI) programs into the already packed Obstetrics and Gynecology (Ob/Gyn) residency curricula. While several residents conduct projects to teach quality improvement (QI), establishing QI methodology as a habit in Ob/Gyn requires several further integrated measures in the curricula.

METHODS:
This study aims to conduct a qualitative review of 84 articles in the last 30 years of literature through scientific databases on topics regarding Ob/Gyn QI training, outcomes, and education in order to propose a novel integrated framework for education in Ob/Gyn.

RESULTS:
Of 321 abstracts determined, 84 articles were analyzed. There are currently multiple training methods including simulations, audio and video seminars and webinars are in practice to improve QI. The review establishes methods to efficiently integrate such models into day-to-day teaching rather than single projects. The framework suggests for reducing gaps between determinants for improvements in QI training, the emerging characteristics of a system that enables trainees to learn hands on skills and broaden their horizon to predict upcoming challenges, and the measures of qualitative and quantitative efficiency in Ob/Gyn.

CONCLUSION:
The proposed integrated framework provides an evidence-based curriculum for improvement of QI training in the Ob/Gyn setting. In turn, this will assist in the training of Ob/Gyn residents to use QI measures as a habit, rather than a method of action.
An Educational Program to Address Maternal Health Disparities and High Infant Mortality in North Carolina [7M]
Authors: Patel Reena , Jones Rebecca , Sutton Jill 
Published: April 2018

INTRODUCTION:
Infant mortality remains of significant concern in the United States. North Carolina infant mortality rates surpass national averages, while Pitt County exceeds the state average. Various factors have been shown to impact infant mortality, including prenatal care, breastfeeding, and socioeconomic status. Prenatal support and education can have an advantageous effect, particularly for vulnerable populations. This project seeks to demonstrate positive effects of prenatal support and education on anxiety, confidence, and lifestyle for mothers and partners in Pitt County, as analyzed through longitudinal prenatal education.

METHODS:
A curriculum was developed to cover topics including pregnancy health, breastfeeding, infant care, and safety. Participants completed pre- and post-class surveys, including the Spielberger State-Trait Anxiety Inventory, Lifestyle Indicator Questionnaire (Godwin), and skill confidence assessments. These items were scored and analyzed.

RESULTS:
The data indicated a decrease in mean anxiety from pre- to post-class (pre-class score: 33.8 vs. post-class score: 27.9; P<0.001). The data also showed increased mean confidence scores in multiple areas: breastfeeding from 1.9 to 2.9, infant CPR from 1.7 to 3.6, and infant choking rescue from 1.8 to 3.7 (P<0.001). Corresponding infant CPR and rescue assessment scores increased from a mean of 44.0 % to 98.0% (P<0.001). In qualitative analysis, 11 individuals reported specific healthy lifestyle changes throughout the series.

CONCLUSION:
This data suggests that prenatal support and education can decrease anxiety, increase confidence, and contribute to beneficial lifestyle changes, which can assist in decreasing infant mortality. Future research will further investigate longitudinal data to better understand program benefits and adapt strategies to improve effects.
Obstetric Residents’ and Nurses’ Critical Thinking Skills and Their Attitudes towards the Baby Friendly Initiative [9M]
Authors: Paul Rachel , Robbins Camaryn Chrisman 
Published: April 2018

INTRODUCTION:
The Baby Friendly Hospital Initiative (BF) is shown to improve breastfeeding outcomes. Systems thinking (ST), a subset of critical thinking, helps individuals make inferences about behavior by developing a deeper understanding of underlying structure. The objectives of this project were to 1) explore characteristics of Ob/Gyn residents and nurses and their opinion of BF, 2) analyze the relationship between their ST skills and opinion of BF, adjusting for differences between residents and nurses.

METHODS:
Participants completed a survey assessing 1) opinions of BF 2) ST using the Systems Thinking Scale and 3) demographics. A linear regression examined the relationship between ST and BF scores, adjusting for factors significantly associated with the scores in univariate analysis.

RESULTS:
Thirty residents and 86 nurses participated. Residents had more males (p=.003), were less likely to have children of their own (p<.001), and were younger (p<.001). ST scores were not significantly different between residents and nurses (median=63 vs. 66, p=.93); however, residents had higher BF scale scores, indicating a more favorable opinion of the policy (median= 28 vs 24, p<.001). Higher ST scores were related to higher BF scores after adjusting for group (resident or nurse) and age (β=.218, p<.001).

CONCLUSION:
ST is significantly related to both residents’ and nurses’ opinions of BF; residents have a higher baseline for the relationship due to higher BF scores. Hospital administration can leverage this relationship by incorporating more ST into continuing education, resulting in more favorable opinions of new policies among their workforce and greater investment in the policy’s success.
Long-Acting Reversible Contraceptive Knowledge and Use in Medical Students [10M]
Authors: Fox Hannah , Zhao Songzhu , Hade Erinn , Isley Michelle 
Published: April 2018

INTRODUCTION:
We assessed medical student use and knowledge of long acting reversible contraceptive (LARC) methods.

METHODS:
Medical students were surveyed electronically about their use and knowledge of LARC methods. A total LARC knowledge score was calculated by summing of the scores for all questions (range 0 to 8). LARC knowledge scores were compared between preclinical and clinical medical students, and further stratified by gender. The Cochran-Mantel-Haenszel (CMH) test was used to test the association between groups of total scores (0-3, 4-5, 6-8) and preclinical and clinical years among male and female students, controlling for age.

RESULTS:
Medical students use LARC methods more than the general population (30.1%, 95% CI: 24.7, 36.8 compared to 11.6% in the US population). LARC use increased from preclinical to clinical years (46% vs. 75% in the highest score group, CMH test p-value <0.0001, adjusting for age and gender). Knowledge scores were higher for preclinical years (mean score 5.25 vs 3.93, p-value=0.0016), but no significant difference for clinical years (mean score 6.54 vs 6.05, p-value=0.1621) when comparing female with male medical students. Both genders demonstrated increased LARC knowledge from pre-clinical to the clinical years, (p-value<0.0001 for both comparisons).

CONCLUSION:
Our results suggest that medical school curricula impart accurate knowledge of LARC methods, translating into increased use compared to the general population as well as increased use and knowledge across their medical education. The gender discrepancy in LARC knowledge suggests that curricula need to be improved to ensure that both male and female medical students take away similar knowledge.
Cervical Cancer Screening in Underserved Populations: Reflex versus Co-Testing for Cervical Cancer [16M]
Authors: Heller Michaela , Cottrell Connie , Fish Barry , Powell Angela 
Published: April 2018

INTRODUCTION:
Cervical cancer is the second most common cause of cancer mortality among women worldwide. Several studies concluded that cervical cancer screening and intervention programs should target communities with lower socioeconomic status due to lower rates of screening and knowledge. The Women's Health Center (WHC) at Akron General Cleveland Clinic hosts free bi-annual cervical cancer screenings. All patients are screened with simultaneous cytology and HPV testing as opposed to specific age and HPV reflex guidelines. The primary objective of this study is to determine the rate of positive HPV results in underserved women with normal cervical cytology to evaluate the benefit of initial co-testing.

METHODS:
Patients’ charts were reviewed from inception of the program in October of 2006 to October 2014 to review cytology and HPV DNA results. Analysis was completed using descriptive statistics, which included prevalence rates of normal cytology with positive HPV testing.

RESULTS:
512 women participated in the free screening program. Of the 512 women participating, 94% did not have insurance and 63.7% of them never had a previous pap smear. Of those, 70 had positive HPV results. The prevalence of negative cytology among women with positive HPV was 47% (n=33). Of these 72% (n=24) tested positive for high risk HPV strains and 22% (n=9) were positive for low risk HPV.

CONCLUSION:
Findings from this study have important implications in developing free and effective cervical cancer screening programs for lower socioeconomic women and the potential benefit for initial co-testing.
Impact of Mental Health Services on Prenatal Care Adherence [19M]
Authors: Valji Farida , Nguyen Diem-Tran , Prescott Jessica E. , Ihenacho Ugonna , Sobrinho Giovanna , Dossett Emily C. 
Published: April 2018

INTRODUCTION:
Pregnancy is an opportunity to identify and begin treatment for mental illness, yet obstetric clinics aren’t always equipped to diagnose and treat mental illness. The Obstetrics Mental Health (OBMH) clinic provides integrated mental health services in an academic, safety-net medical center’s prenatal care clinic. We evaluated whether adherence to OB Mental Health appointments increased adherence to prenatal medical care.

METHODS:
Data was retrospectively abstracted from the electronic medical record from July 2014 to October 2016. Included in the study were non-incarcerated pregnant women over 18 years of age who had attended an OBMH intake appointment. Engagement with OBMH care was defined as attending at least one OBMH appointment after the initial intake appointment. Adherence to prenatal care was defined per the ACOG recommended visit schedule.

RESULTS:
Of the 138 women that met the inclusion criteria, 50.7% were prenatal care adherent, 55.1% were OBMH adherent, and 35.8% were adherent to both. Fisher’s exact test demonstrates an association between OBMH adherence and increased prenatal care adherence with a two-tailed p value of 0.0396.

CONCLUSION:
Our results show a significant association between women who were OBMH adherent and increased prenatal care adherence compared to women that were not OBMH adherent (p<0.05). This suggests that addressing women’s mental health needs in a prenatal care setting encourages them to comply with prenatal medical care. Women receiving mental health care may be more emotionally and cognitively able to comply, more trusting of providers, or motivated by the convenience. Further research of collaborative care models can explore postpartum outcomes.
Patient Views on the USPSTF Statement Regarding the Annual Screening Pelvic Exam [23M]
Authors: Shelton Justin A. , Style Alyssa , Horn Philip , Goldberg Jay 
Published: April 2018

INTRODUCTION:
The screening pelvic exam has been an integral part of the gynecologic annual well-woman visit. A recent US Preventative Services Task Force (USPSTF) statement states that there is insufficient evidence to support or refute the performance of annual screening pelvic exams in asymptomatic, non-pregnant adult women.

METHODS:
Patients in an outpatient gynecologic resident continuity clinic were asked to complete a 14-question survey inquiring about their views on annual screening pelvic exams, as well as demographic information. Statistical analysis was performed using the Student’s t-test.

RESULTS:
100 female patients, ranging from 15 to 64 years of age, completed the survey. 81% identified as African American or Hispanic/Latino. 63% were insured by either Medicaid or Medicare. 94% reported an annual household income < $50,000. 69% were unaware of the recent statement regarding annual screening pelvic exams made by the USPSTF. 66% believed that the annual screening pelvic exam was necessary, even in asymptomatic women. 33% were concerned that something would be overlooked or missed if they did not receive a pelvic exam. Of the patients with an annual household income < $50,000, 67% believed that the annual screening pelvic exam was necessary versus 100% with an annual household income > $50,000 (p < 0.05).

CONCLUSION:
The majority of women disagreed with the recent USPSTF statement that the annual screening pelvic exam may be unnecessary.
The Benefits of Cancer Genetic Panel Testing in At-Risk Women: A Single Institution Experience [24M]
Authors: Frost Anja S. H. , Toaff Miriam C. , Biagi Tara , Stark Elizabeth , McHenry Allison , Kaltman Rebecca 
Published: April 2018

INTRODUCTION:
The scope of panel testing for hereditary cancer syndromes is expanding rapidly. We sought to evaluate the role of panel testing in identifying actionable genetic mutations in high-risk or affected women, beyond BRCA-limited testing.

METHODS:
A retrospective chart review was conducted of all patients presenting to a multi-disciplinary cancer program at George Washington University for genetic counseling from 1/2015 and 12/2016. The results of testing and management implications, based on NCCN guidelines, were recorded.

RESULTS:
Of 673 patients that underwent single site, BRCA-limited, or panel testing, 17% (n=116) were found to have at least one deleterious mutation, of which 96% (n=111) had changes in clinical management. Over one half (65%, n=65) of patients who tested positive for a mutation had undergone panel testing and three-quarters (n=49) of those individuals were diagnosed with non-BRCA mutations. The latter group represents patient’s whose mutations would have been missed without a broader panel test. Ninety-six percent of those testing positive for a mutation (n=111) had significant increase in clinical surveillance and/or management. All of the true negative individuals (n=45) were able to decrease their surveillance and/or management.

CONCLUSION:
Despite concern that the results of panel testing do not translate into clinically impactful management of high-risk individuals, our data indicates that guideline-based management is frequently altered by such testing. Obstetrician-gynecologists should incorporate detailed family histories into their routine visits, and counsel patients on the availability and utility of genetic panel testing when appropriate.
Evaluation of Physician Communication Skills During Simulated Vacuum-Assisted Deliveries [29M]
Authors: Mella Maria Teresa , Lee Yuo-yu , Bernstein Peter , Atallah Fouad , O'Neill Loraine , Friedman Frederick 
Published: April 2018

INTRODUCTION:
The objective of this study was to determine if a targeted education program using a mannequin-simulated vacuum-assisted delivery could improve the communication skills of obstetricians.

METHODS:
This study involved a concurrent assessment of the performance of obstetricians during vacuum-assisted vaginal deliveries using synthetic models. All obstetricians within an existing Obstetric Quality Improvement Collaborative with operative vaginal delivery privileges were enrolled in the study. All evaluators underwent a rigorous training program to ensure uniformity. Demographic information including years in practice and simulation experience were recorded. Eight communication skills and an overall assessment were scored using a standardized checklist. Performance on all variables was evaluated before and after a targeted training session.

RESULTS:
288 obstetricians participated across the 5 study hospitals. The majority (69%) of subjects was female, and most (70%) had greater than 10 years of training. For all 8 communication skills measured and for the overall performance, there were statistically significant improvements following the simulation and targeted education session. Communication skills did not vary by sex of the participant. Obstetricians with an intermediate level of experience (6-10 years) appeared to perform best across all parameters.

CONCLUSION:
Our data show that a simulation training program including a targeted education session in vacuum assisted-deliveries improves obstetrician communication skills.
Prep for Residency: Can Students and Interns Benefit from the Same Simulation-based Curriculum in Obstetrics? [30M]
Authors: Garrison Etoi , Ware Jamie , Dewey Charlene M. 
Published: April 2018

INTRODUCTION:
Residency programs struggle to provide trainees with opportunities for formative assessments of their knowledge and skill. The purpose of this study is to determine if a simulation based training in obstetrics can be used to teach and assess APGO/CREOG knowledge/procedural skill competencies to medical students and interns with varying experience.

METHODS:
A pilot curriculum to assess basic obstetric knowledge and skill was developed by medical school/residency faculty. Trainees were asked to manage a term labor patient in three simulated scenarios: (1) membrane rupture, (2) preeclampsia and third trimester bleeding and (3) SVD with basic neonatal evaluation. Checklists and global rating scales were used for performance assessments. Pre- and post surveys assessed trainee knowledge/confidence. Statistical analysis was performed using paired t- tests and chi square analysis.

RESULTS:
Eight graduating medical students, 6 advanced interns, and 9 day 1 interns from two medical schools participated in a Preparation for Residency workshop April-July 2017. Knowledge/procedural deficiencies were identified for students and day 1 interns. Advanced interns struggled with neonatal resuscitation despite proficiency with vaginal delivery, preeclampsia, and membrane rupture. Confidence improved in all areas tested for junior trainees (p<0.05). Two scenarios were expanded to assess advanced interns in basic ultrasound skills and the management of postpartum hemorrhage. Significant improvements in advanced intern confidence were noted (p<0.05).

CONCLUSION:
Simulation provides opportunities for formative assessment of learners as they begin residency training. Faculty feedback was used to identify optimal targets for deliberate practice-based improvement for each trainee regardless of skill level and experience.
Forceps Assisted Vaginal Delivery Simulation Training: Changes in Resident Confidence, Knowledge and Skill [31M]
Authors: Rose Kelsey , Afshar Yalda , Jensen Kirsten 
Published: April 2018

INTRODUCTION:
Simulation is a powerful learning tool for low frequency events. In 2015, 3.1% of all deliveries were operative vaginal deliveries and only 0.56% were forceps assisted vaginal deliveries (FAVD). The aim of this study is to create a simulation-based curriculum on FAVD and evaluate resident knowledge, confidence, and performance before and after training.

METHODS:
An IRB-approved prospective cohort study was conducted. Obstetrics and gynecology residents participated in three hours of a three-part simulation training including a video, didactic teaching, and hands-on simulation practice during the 2016-2017 academic year. A 26 item pre- and post-survey and skills assessments was conducted to assess confidence, knowledge, and ability to perform a forceps delivery. Our primary outcome was improvement in resident confidence and skill.

RESULTS:
Twenty residents consented to participate and 14 surveys were completed (70%). There was a 28.5% increase in self-perceived confidence before and after training for all residents (P<.001). Significant differences in perceived confidence between resident classes were seen pre-simulation (P<.001). Junior residents demonstrated an increase in perceived confidence (P<.001), while senior residents did not (P=.13). There was an overall improvement in the percentage of residents who performed the required skills for an accurate forceps delivery post-simulation (P=.001).

CONCLUSION:
Our developed forceps simulation curriculum improves resident perceived confidence and skill. Additional simulation training will involve consenting training sessions. Future analysis will look at the number of forceps deliveries at our institution since the initiation of the simulation-based training curriculum.
Evaluation of Physician Technical Skills During Simulated Vacuum-Assisted Deliveries [33M]
Authors: Friedman Frederick , Teresa Mella Maria , Bernstein Peter , Atallah Fouad , Lee Yuo-yu , Sandler Raymond 
Published: April 2018

INTRODUCTION:
The objective of this study was to determine if a targeted education program using a mannequin-simulated vacuum-assisted vaginal delivery could improve the technical skills of obstetricians.

METHODS:
This study involved a concurrent assessment of the technique obstetricians employed while performing vacuum-assisted vaginal deliveries using synthetic models. Study enrollees consisted of all obstetricians within an existing Obstetric Quality Improvement Collaborative who maintain operative vaginal delivery privileges. All evaluators underwent a rigorous training program to ensure uniformity. Technical skills and an overall assessment were scored using a standardized checklist of 14 tasks. Data points were collected while assessing the subjects’ technique both before and after a targeted training session.

RESULTS:
Complete assessment was available for 288 obstetricians across the 5 participating hospitals. The majority (69%) of subjects was female, and most (70%) had greater than 10 years of training. For 8 of the technical skills, as well as for the overall assessment, there was statistically significant improvement following the simulation and the targeted education session. When comparing overall technical skills based on sex of the obstetrician and years in practice, there were no differences in degree of improvement following the educational session.

CONCLUSION:
Our data show that a simulation training program including a targeted education session in vacuum assisted-deliveries improves obstetrician technical skills.