bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Systematic Review and Meta-Analysis of Simulation in Obstetrics Training
Authors: Nitsche Joshua , Nae Ana-Maria , Chen Haiying , Brost Brian 
Published: September 2018

PURPOSE:
To summarize the available data on the benefits of the use of simulation in training obstetric providers.

BACKGROUND:
Although simulation is being increasingly used to train obstetric providers, its overall benefit has not been systematically assessed.

METHODS:
A systematic search of MEDLINE was performed from May 2011 until April 2017 to identify research evaluating simulation in obstetrics. Data regarding provider type, instructional design, outcomes, and research quality, using the medical education research study quality index (MERSQI) and Newcastle-Ottawa Scale for Education (NOS-E), was abstracted. The average weighted Hedges g effect size was calculated.

RESULTS:
1423 articles were identified, of which 63 met inclusion criteria. 39 were excluded because they were 1 group pretest-posttest studies (which nearly always show positive effects), and 5 were excluded because they did not contain sufficient information to calculate effect size, leaving 19 articles in the meta-analysis. Of the selected articles 15 were randomized, 3 were nonrandomized, and 1 was a cross-over study. Provider satisfaction was assessed in 2 studies, knowledge in 1, simulated skills in 11, clinical behaviors in 4, and patient effects in 1. The average MERSQI and NOS-E quality scores were 13.3±23 (out of 18) and 5±0.8 (out of 6), respectively. The weighted average effect size for the 19 studies was 0.71 (95% CI, 0.58-0.83).

DISCUSSION:
Simulation training in obstetrics is associated with moderate effects in provider satisfaction, knowledge, skills, behaviors, and impact on patients. The effects sizes described here were slightly smaller and methodological quality slightly higher compared to previous meta-analyses in Anesthesiology and Emergency Medicine.
Assessment of Low-cost, Intrauterine Contraception Simulation Training for Preclinical Students
Authors: Field Carlie , Benson Lyndsey , Stephenson-Famy Alyssa , Prager Sarah 
Published: September 2018

PURPOSE:
To assess whether a low-cost didactic workshop on intrauterine devices (IUDs) improves preclinical medical students' knowledge and comfort with counseling patients on IUDs.

BACKGROUND:
Medical school reproductive health curricula often lack teaching regarding IUDs. Preclinical medical students have insufficient knowledge and training to counsel patients about IUDs.

METHODS:
Preclinical medical students completed a survey before and after a voluntary IUD didactic workshop at the University of Washington. The session consisted of a 45-minute lecture and 45-minute hands-on simulation of IUD insertion. The primary outcome was comfort level with IUD counseling.

RESULTS:
Ninety-eight students completed both pre- and post-workshop surveys. Most students planned to enter primary care specialties. More than half of students had seen at least one IUD inserted and almost all students (91%) had an IUD themselves or knew someone personally who had one. The proportion of students scoring 75% or higher on the IUD knowledge questions increased from 55% prior to the workshop to 91% after completing the workshop (P<.001). The proportion of students who felt comfortable counseling patients on IUDs increased from 31% to 90% (P<.001).

DISCUSSION:
A simple, low-cost workshop increases medical students’ knowledge and comfort with IUDs. This workshop could serve as a framework for medical schools to ensure students receive appropriate education and hands-on learning related to IUDs prior to entering their clinical rotations and for their future careers.
Continued Validation for a Task Trainer and Targeting Curriculum for Ultrasound Guided Invasive Procedures
Authors: Nitsche Joshua , Conrad Sarah , Hoopes Sarah , Carrel Meredith , Bebeau Katherine , Brost Brian 
Published: September 2018

PURPOSE:
To assess the effect of training and the inter- and intra-rater variability of a targeting curriculum for ultrasound guided invasive procedures.

BACKGROUND:
We previously demonstrated the content, face, and construct validity of our curriculum. Here we assess its inter- and intra-rater reliability.

METHODS:
Echogenic targets (wooden dowels, plastic straws, and wooden balls) were placed in water filled buckets covered with simulated skin (ballistic gelatin). We assessed 23 1st year medical students performing two targeting tasks (guiding the needle to multiple targets in a random sequence), held 4 weekly one hour training sessions, and reassessed their performance. Completion time in seconds, errors (as recorded by multiple assessors), and error adjusted time (5 sec penalty/error) were recorded. These measures were compared before and after training using a repeated measures t-test. Inter- and intra-rater inter-class correlation coefficients (ICC) were calculated.

RESULTS:
Completion time, errors, and error adjusted time on the dowel tasks were 176±70, 7.4±, 213±95, respectively before training, and 95±61, 2.7±3.4, and 109±74, respectively after training (all P<.0001). The completion time, errors, and error adjusted time on the straw task were 319±98, 9.4±4.6, and 366±114, respectively before training, and 179±57, 3.1±3.2, and 195±67, respectively after training (all P<.0001). The inter-rater ICC for the dowel and straw tasks were 0.83 and 0.91, respectively. The intra-rater ICCs were 0.93 and 0.90, respectively.

DISCUSSION:
Conclusions: Student performance on the targeting tasks improved markedly after 4 weekly training sessions. The inter- and intra-rater reliability was excellent. This provides additional validity evidence for our novel ultrasound guided invasive procedure task targeting curriculum.
Current Trends in Psychiatry Education Among Obstetrics & Gynecology Residency Programs: A Cross-sectional Survey of Program Directors
Authors: Garbarino Abigail , Kohn Jaden , Coverdale John , Kilpatrick Charles 
Published: September 2018

PURPOSE:
To assess the status of psychiatry education in Ob/Gyn residencies, focusing on perceived barriers in education.

BACKGROUND:
One-third of women in the U.S. receive primary care exclusively from Obstetrician/Gynecologists. Recent literature reveals gaps in recognition of common psychiatric issues by Ob/Gyns.

METHODS:
Program directors (PDs) of all 249 accredited Ob/Gyn residency programs received a 17-item anonymous questionnaire. Analysis of responses included descriptive statistics, Student’s t-tests, and logistic regression.

RESULTS:
111 programs responded to the survey (44.5%); 20 responses were partial. 85% offer didactic instruction in psychiatric topics, of which 82% are taught by Ob/Gyn faculty. Academic institutions were more likely to offer didactics in psychiatry than community institutions (OR=3.2, P=.04). Only 20% of programs offered an elective rotation in mental health. 20% of programs formally evaluate residents on their management of psychiatric disorders. 81% of PDs do not agree that their residents are fully equipped to identify patients; psychiatric needs; however, only 23% believe that mental healthcare should be included as an ACGME milestone. Community programs were more likely to agree with adding a milestone (P=.002). The most common barriers to providing additional psychiatric training were lack of sufficient integration between Ob/Gyn and psychiatry (44%), ACGME surgical requirements (41%), and lack of sufficiently knowledgeable instructors (36%). In addition, valuable qualitative comments were received from respondents.

DISCUSSION:
While most programs deliver didactic training in psychiatric topics, most PDs perceive that residents are not fully equipped to identify psychiatric needs. The most common barrier to providing additional training was lack of integration between Ob/Gyn and psychiatry.
Gender Differences in Academic Performance in the OB/GYN Clerkship
Authors: Mills Mistie , Hoffman Kimberly , Johnson Gina 
Published: September 2018

PURPOSE:
Evaluate gender differences in academic performance within the Obstetrics and Gynecology Clerkship at the University of Missouri.

BACKGROUND:
Unconscious bias, baseline knowledge or access to opportunities that may affect students' overall performance. Therefore, making it necessary to evaluate gender differences in academic performance.

METHODS:
USMLE Step 1 exams, pre-clinical year's evaluations, NBME shelf exam scores, faculty evaluations of students with overall exemplary grades, clerkship grade distribution were compared from 2013-2017 to determine if there was a gender difference in academic performance. Student assessment is standardized. First attempt USMLE and NBME scores were evaluated. An evaluator was included if they performed more than 6 evaluations. 388 students qualified for the study. Independent 2 sample t-test was used assuming unequal variances.

RESULTS:
Males scored higher on the USMLE Step 1 exam with statistically significance. There was no difference of performance within genders during the pre-clinical years. Females scored higher on the NBME shelf exam, clinical evaluations, faculty assessments and final clerkship grade evaluations.

DISCUSSION:
There are notable gender differences in academic performance within the Obstetrics and Gynecology Clerkship, favoring females. Preexisting personal knowledge and a higher number of females expressing interest and entering OB/GYN residency may give females a slight advantage over their male counterparts. Assuming that standardized assessments demonstrate knowledge gained by students, the results may reflect that females are gaining more experiences or opportunities during their clerkship. It is important to critically review the data to ensure males and females are achieving the same training and opportunities.
Leadership Aspirations Among OB/GYN Residents in the United States
Authors: Bavan Brindha , Chavez Jordan , Saravanabavanandhan Briana , MacLaughlan David Shannon 
Published: September 2018

PURPOSE:
To assess the role of gender and mentorship in identifying leadership as a career goal among residents in Obstetrics and Gynecology (OB/GYN) in the United States (US).

BACKGROUND:
Within the field of OB/GYN in the US, women are underrepresented in leadership positions despite representing the majority of physicians. We hypothesized that women do not identify leadership as a career goal as often as men do while in OB/GYN training and examined other associated factors.

METHODS:
We evaluated US OB/GYN resident goals via an IRB-approved survey emailed to the US OB/GYN Residency Program Coordinator listserv. Data were collected in REDCap. Cross-sectional descriptive and comparative analyses were completed.

RESULTS:
A total of 198 US OB/GYN residents completed the survey, including 170 women (86%) and 28 men (14%). The majority of respondents were from university programs (70%). Two-thirds of respondents reported an interest in pursuing a leadership position (n=133, 67%). Women were less likely to identify leadership as a goal compared to men (64% vs. 86%, P=.024). OB/GYN residents who reported receiving specific mentorship about leadership were more likely to report interest (81% vs. 53%, P<.001). Finally, women in programs in which three or more leadership positions were held by women were more likely to report interest in such roles themselves (76% vs. 60%, P=.047).

DISCUSSION:
Gender disparity among leadership is identifiable in goal-setting as early as residency training in OB/GYN. We recommend addressing this gap with specific mentorship and leadership-development curricula within OB/GYN residencies.
Medical Student Abuse—An Obstetrics and Gynecology Perspective
Authors: Holmstrom Shelly , Klocksieben Farina , Zreibe Damien , O'Brien Kevin 
Published: September 2018

PURPOSE:
To evaluate medical student mistreatment in obstetrics and gynecology rotations as perceived by physicians and medical students using standardized video-taped vignettes.

BACKGROUND:
Medical student mistreatment is pervasive and typically occurs during the third year of medical school. While most events are minor, the ramifications for the mistreated medical student are real and include increased risk of anxiety, depression, substance use, suicidal ideation, burnout, avoidance of the specialty where the mistreatment occurred and leaving medicine entirely.

METHODS:
Three video vignettes were filmed portraying possible medical student abuse in obstetrics/gynecology clinical settings. Attending physicians, resident physicians and rotating medical students were asked about their personal experience with mistreatment and then asked to view the three videos. After each video, participants were asked if they believed the vignette represented medical student mistreatment and to rate the level of severity.

RESULTS:
Eight attending physicians, ten resident physicians and ten medical students participated in this study. Fourteen participants (50%) reported previous mistreatment as a student, all of which occurred during third year of medical school. Neither previously mistreated participants, women participants nor ethnic minority participants were not more likely to view the scenarios as abuse or rate the scenarios as more severe. Medical students were not more likely to view the vignettes as mistreatment or more severe as compared to resident and attending physicians.

DISCUSSION:
In our small pilot study, medical students, resident physicians and attending physicians generally agreed which video vignettes represented medical student mistreatment and the level of severity of the abuse.
Multidisciplinary Severe Maternal Morbidity Reviews Can Teach the Clinical Learning Environment Review Focus Areas of Patient Safety and Quality
Authors: Ogunyemi Dotun , Hage Natalie , Sun Kim , Friedman Perry 
Published: September 2018

PURPOSE:
To describe a resident focused multidisciplinary severe maternal morbidity (SMM) review program.

BACKGROUND:
The Joint Commission defined SMM as peri-partum blood transfusion of 4 units or admission to ICU and recommends multidisciplinary reviews to determine opportunities for improvement in care

METHODS:
An ongoing process detects cases of SMM with root-cause-analysis performed if case qualifies as a sentinel event. Data is extract and presented quarterly to, a multidisciplinary committee to determine contributory factors, opportunities to alter outcome, best practices and recommendations.

RESULTS:
Forty-five SMM cases were reviewed from 1/15 to 6/17 by residents 67%, fellows 9%, nurses 7%, and MFM faculty 17%. Opportunities to alter care were determined to be strong in 9% and possible in 62%. System/provider could alter outcome in 53% while the patient could have altered outcome in 33% of cases. Outcomes could have been altered by contraception/sterilization in 13%, patient compliance 11%, early prenatal care 20%, referral/consultations 9%, improved documentation 7%, early recognition 33%, team communication 4% and management 31%. Good practices recognized included multidisciplinary teamwork/communication 60%, evidence-based response 36%, timely recognition 24%, documentation 20%, quality obstetric care 22%, timely referral 13%, expertise care 9%, and patient-centered-care 7%. Strong opportunity to alter outcome was present with hypertensive crisis (P=.026). Significant opportunities to alter outcomes were: preterm SMM cases by contraception/sterilization (P=.036); patient compliance in Medicaid insured (P=.01) and younger women (P=.04). Transfusions were recognized for the good practice of timely recognition (P=.045).

DISCUSSION:
Residents' involvement in SMM reviews can determine care improvement opportunities and provide training on safety and quality.
Navigate Stormy Seas With Effective Simulation Training in Delivering Serious News
Authors: Fay Emily , Amory Josephine , Hurd Caroline , Stephenson-Famy Alyssa 
Published: September 2018

PURPOSE:
To evaluate the change in obstetrics and gynecology (OB/GYN) resident’s self-confidence in delivering serious news after a communication simulation workshop.

BACKGROUND:
Although OB/GYN residents regularly disclose serious news to patients, formal training on best communication practices is lacking. Using the VitalTalk framework, we developed and evaluated a workshop for delivering serious news in OB/GYN.

METHODS:
OB/GYN residents attended a 3-hour small group workshop, with didactic and drills (1 hour) followed by practice delivering serious news with simulated patients (2 hours). Change in self-confidence pre- and post-workshop was measured using a 5-point Likert scale (1 is lowest, 5 is highest) and was compared using Wilcoxon signed rank test (alpha = 0.05).

RESULTS:
Twenty-five residents completed the training. Residents agreed that delivering serious news requires a discrete set of skills (89%) and is a procedure all residents should learn (96%). Following the workshop, residents expressed greater confidence explaining medical information (P<.01), identifying and responding to emotion cues (P<.01), delivering serious news (P<.001), and teaching learners about how to facilitate delivering serious news (P<.001). Residents felt that it taught them skills they plan to use (96%), that simulated practice prepared them better than clinical experience alone (92%), that observing other residents improved their own communication skills (80%) and that they would recommend the workshop (96%).

DISCUSSION:
This workshop was well received and associated with improvement in self-confidence in delivering serious news. Longer-term observation is needed to see if this confidence persists and translates into improved patient care.
Reliable Assessment of Medical Student Performance on the Obstetrics and Gynecology Clerkship
Authors: Skinner Bethany , Zaidi Nikki , Kempner Samantha , Morgan Helen , Santen Sally , Hammoud Maya 
Published: September 2018

PURPOSE:
To determine the number of assessors needed to reliably assess medical students' overall clinical performance during the OB/GYN clerkship.

BACKGROUND:
Reliable assessment of students' clinical performance during clerkships provides important information for decisions regarding grades and advancement. However, the assessment ratings students receive can vary based on many factors, and there are no clear data regarding the number of assessors needed to obtain a reliable assessment of students' clinical performance on the OB/GYN clerkship.

METHODS:
During the 2015-2016 OB/GYN clerkship, faculty and residents completed one assessment per student. Using the overall performance score for each student, we performed generalizability analysis to determine the number of assessors needed to achieve an acceptable threshold of reliability (G=0.7).

RESULTS:
Students’ mean overall performance score was 6.38±1.21 (scale of 1-10). 90.1% of variance in scores was attributed to assessors and 9.9% was attributed to students. The generalizability estimate for eight assessors was G=0.469. For other clerkships, G coefficients for eight assessors ranged from 0.000-0.795. Decision studies suggest that 17 assessors were needed to achieve G=0.7 for the OB/GYN clerkship, compared to 4-12 assessors for other clerkships.

DISCUSSION:
Much of the variation in students’ overall performance scores can be attributed to assessors rather than students. We suggest clerkships with high variability among assessment scores find alternative ways to interpret these scores. For example, we currently use each assessor's Z score to determine the number of standard deviations each student's assessment lies from the assessor's mean student evaluation score to adjust for assessor stringency or leniency.
Resident Self Perception of Milestone Level as Compared to the Clinical Competency Committee
Authors: Ward D. Gregory , Miller Collin , McLennan Mary 
Published: September 2018

PURPOSE:
To assess resident perception of Milestone level as compared to the Clinical Competency Committee (CCC).

BACKGROUND:
The Milestone Project was a joint initiative of ACGME, ABOG and ACOG and implemented in July of 2014. The Milestones serve as a descriptive blueprint to guide curriculum development and assessment practices. They allow programs to more accurately evaluate the outcomes of residency education and allow programs to track resident development over time.

METHODS:
The 24 residents of the Saint Louis University Ob/Gyn program were asked to rate themselves on each of the 28 Milestones based on their perception of where they felt they were in their training. This was done independent of the CCC. The CCC met for its semi-annual meeting and completed the Milestone report for each resident in standard fashion. The CCC was not aware that the residents were also rating themselves on each Milestone. Resident and CCC ratings were compared, with differences defined as a discrepancy ≥1 point.

RESULTS:
Overall, there was a close approximation of what the CCC and residents determined to be their Milestone level. Milestone agreement varied slightly by post graduate year, with the greatest agreement observed in PGY-4 (90%) and the least agreement in PGY-3 (79%). When analyzed by Milestone group, the greatest agreement was observed in Interpersonal Communication and Medical Knowledge (90% and 89%, respectively).

DISCUSSION:
Resident self-perception of Milestone level is comparable to the CCC in our program. There tends to be slightly more variation among the PGY-2 and 3 levels across all Milestones.
There Is an APP for That: Vaginal Hysterectomy
Authors: Miyazaki Doug 
Published: September 2018

PURPOSE:
To create an instructional app which includes medical knowledge, procedural steps and assessments based on the ACOG curriculum for vaginal hysterectomy.

BACKGROUND:
Vaginal hysterectomy is the evidence based medicine route of choice when feasible. Significant challenges exist in teaching this procedure due to lack of simulation training, proper assessment of specific techniques and timely instruction prior to performing the procedure. There is also considerable variation in how cases are tracked and assessments of technique are done.

METHODS:
Key features/contents of the application include: 1) ACOG curriculum for vaginal hysterectomy, 2) a complete step by step live and simulated surgical video tutorial, 3) a procedural step by step assessment (10 steps-- 0-10 score), 4) a global surgical rating scale (7 metrics), and 5) a knowledge based assessment (4 metrics, 0-4 scale).

RESULTS:
The data captured on the app can be accessed via IPAD and iPhone mobile devices and is verified by Apple. The evaluations can be directly emailed to any database.

DISCUSSION:
A comprehensive instructional surgery app coupled with real time assessment will provide greater learning efficiency and will more effectively improve surgical skills. This app has the potential to standardize surgical evaluation in the operating room and provide a more efficient method to track surgeon competency using ACOG guidelines. The assessment is currently employed by the ACOG Simulation Consortium Working group during vaginal hysterectomy simulation and is part of a surgical simulation course which certified by the ABOG for MOC credits.