bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the Impact of Repeated Simulation of 4th Degree Lacerations on Resident Competency
Authors: Brazell Hema , Wheeler Thomas , Swift Steven 
Published: September 2018

Faculty Advisor:

Steven Swift, MD

PURPOSE:
To determine if a periodic educational intervention on 4th degree perineal laceration leads to improved resident procedural competency in a simulated environment as evaluated by a task-specific objective structured assessment of technical skills (OSATS) checklist.

BACKGROUND:
Improper repair of 3rd or 4th degree perineal lacerations can lead to detrimental long-term sequelae. Given the lack of adequate resident exposure to such lacerations, improved education may be essential in decreasing adverse outcomes. A technique to provide experience and assess competency with rare procedures is the simulation lab employing a task-specific OSATS checklist. This involves using simulation models and can be implemented as a teaching tool to reliably and validly assess procedural skills in a formal, structured manner outside of the clinical setting. Current literature is limited by short follow-up and lack of an appropriate control group.

METHODS:
Participants were randomized into a control or intervention group. All participants completed a validated task-specific OSATS pre-test followed immediately by an educational intervention on 4th degree lacerations. Those randomized to the intervention group received a second educational session whereas those in the control group did not. All participants then completed a post-test six months after study initiation.

RESULTS:
Six participants were in the control group and seven in the intervention group. There was no difference in the change of mean scores (5.5 vs. 3.9, respectively) between groups (P=.66).

DISCUSSION:
In this study with a small sample size, a supplementary educational intervention did not affect OSATS scores over a 6-month time period.
Objective Assessment of Proficiency in Vaginal Cuff Closure Using Sensor Technology
Authors: King Cara , Giles Dobie , Mohamadipanah Hossein , Kwan Calvin , Peterson Katherine , Pugh Carla 
Published: September 2018

Faculty Advisor:

Karen Noblett, MD

PURPOSE:
Establish concurrent and construct validity of motion analysis in differentiating laparoscopic psychomotor skills when suturing laparoscopically on a validated vaginal cuff model.

BACKGROUND:
Surgical simulation is most useful when it provides metrics that are accurate and meaningful to the learner. Motion analytics provides objective data that allows a comprehensive evaluation to assist with deconstructing complex tasks. This information may assist with formative feedback and deliberate practice.

METHODS:
Participants were divided based on number of laparoscopic vaginal cuff closures after hysterectomy. 15 Early Novices (0-20 procedures), 5 Advanced Novices (21-50 procedures), and 15 Experts (>51 procedures) in conventional laparoscopy and 24 Early Novices, 4 Advanced Novices, and 7 Experts in robotic-assisted laparoscopy were instructed to secure three stitches on a previously validated vaginal cuff model. A motion sensor was attached to each instrument, which subsequently recorded the hand movement of each participant. Each task was graded using the Global Operative Assessment of Laparoscopic Skills scale and a validated laparoscopic suturing checklist.

RESULTS:
Comparison analysis indicated Experts in conventional laparoscopy operated with less hand movement (P<.01) and higher hand smoothness (P<.01) compared to Early Novices. Advanced Novices did not show any significant difference to Experts in terms of hand movement (P>.01) or smoothness (P>.01). In contrast, Experts in robotics did not show a difference between Early or Advanced Novices in either of these metrics.

DISCUSSION:
Using a validated vaginal cuff model, hand movement and smoothness were found to correlate with experience for conventional laparoscopy. Robotic experience did not correlate with improved hand movement or smoothness on a conventional laparoscopic simulator.
Development and Validation of an Objective Assessment Tool for Abdominal Hysterectomy Competency
Authors: Lau Trevin , James Kaitlyn , Bengtson Joan , York-Best Carey 
Published: September 2018

Faculty Advisor:

Erika Banks, MD

PURPOSE:
To develop and validate a competence assessment tool for total abdominal hysterectomy.

BACKGROUND:
Surgical education traditionally relied on a volume-based apprenticeship model, but the paradigm has shifted towards an outcomes-based competency-based model. Assessment of surgical competence is a challenge as few standardized, validated tools exist. There is currently no validated, objective, surgical skills assessment tool for the total abdominal hysterectomy (TAH) in the literature.

METHODS:
Expert gynecologic surgeons developed the competence assessment tool for TAH (CAT-TAH) using Delphi methodology (Content Validity Indices ≥0.75). CAT-TAH’s ability to differentiate different levels of trainees (construct validity) was assessed in the operating room using the Kruskal-Wallis test, with post-hoc analyses to determine structure of differences. CAT-TAH's inter-rater reliability was assessed by comparing scores provided by the surgeon versus 2 blinded assessors using the pairwise correlation coefficient.

RESULTS:
Six expert surgeons reached consensus on CAT-TAH after 3 rounds of the Delphi process. The tool deconstructed the TAH into 8 steps with descriptors, scored on a scale of 1-5 with anchors. Fourteen trainee assessments were analyzed. Median cumulative scores were significantly higher for fellows than for residents (36 (34.7-40) vs. 26.7 (20-29), P=.04). Median cumulative scores from primary assessor and blinded assessors correlated well (r=0.737, P=.016).

DISCUSSION:
This pilot demonstrated that it is feasible to develop and validate an objective assessment tool to evaluate TAH surgical competence. A larger sample size is necessary to corroborate these observations. A validated CAT-TAH will be useful to residency program directors in assessing graduating residents’ ability to perform TAH.
Low-Fidelity Cystoscopy Simulation in Ob/Gyn Residents and Skills Retention
Authors: Riano Ervin , Banks Erika , To Justin , Lu Chunhua , Movva Vani 
Published: September 2018

Faculty Advisor:

Erika Banks, MD

PURPOSE:
To determine if cystoscopy skills and knowledge can be acquired and retained with a low-fidelity cystoscopy simulation.

BACKGROUND:
Cystoscopy training is done most commonly in the operating room on actual patients. The primary objective of this study was to evaluate whether low-fidelity cystoscopy simulation could help train residents and allow them to retain those skills outside of the operating room.

METHODS:
All residents in a community hospital underwent training, which consisted of pre/post training knowledge test, a 30 minute lecture, one hour simulation where the residents were able to practice assembling and performing cystoscopy on a low fidelity balloon simulator. Residents were then assessed on 1) their ability to assemble the cystoscope with a 10-point check list, the time needed to assemble the cystoscope and 2) their ability to perform a diagnostic cystoscopy via a check list, a Global Rate Scale (GRS) adapted for cystoscopy, and the time needed to perform the procedure. To assess skills retention, the same assessment was repeated 11 months later. Data was analyzed with Pearson-correlation coefficient and Paired T-test.

RESULTS:
Following training, PGY1 residents showed significant improvement for assembly time, GRS scores, and knowledge (P=<.002/.03/.001). PGY2 resident showed significant improvement in knowledge (P=<.001). Assembly time, GRS scores, and pre/post-test scores were also correlated to the level of training. Overall, the training sessions led to significantly improved knowledge test scores in all levels of training (P<.02).

DISCUSSION:
Low-fidelity cystoscopy led to improved knowledge and surgical skills in the junior residents. Also it was able to correlate to each level resident.
Teaching and Sustaining a Shared Mental Model for Intraoperative Communication and Teamwork
Authors: Schiff Lauren , Miele Kate , McCollum Meriel , Li Quefeng , Connolly AnnaMarie 
Published: September 2018

Faculty Advisor:

Nancy Gaba, MD

PURPOSE:
To develop and implement a process to: 1) identify gynecology team-specific barriers to uptake of TeamSTEPPS and 2) design a curriculum that promotes a strategy for effective communication and teamwork in the operating room.

BACKGROUND:
TeamSTEPPS is a structured approach to operating room communication and teamwork to improve patient safety. Adherence to TeamSTEPPS procedures is low.

METHODS:
Attendings, fellows, residents, anesthesiologists, certified nurse anesthetists, nursing staff, and scrub technicians involved in Gynecology Operating Rooms (ORs) at a tertiary care hospital completed the validated Safety Attitudes Questionnaire – OR version (SAQ-OR). Quantitative and qualitative survey data analysis identified barriers to teamwork and communication. A curriculum was designed to teach a shared mental model for OR communication.

RESULTS:
The survey response rate was 64%. The leading identified barriers to teamwork and communication were lack of open communication, team cohesion, and familiarity with team as well as disruptions during cases. Mean scores for the six domains of the SAQ were low: teamwork climate 50.1%, safety climate 48%, job satisfaction 50.3%, stress recognition 39.7%, perceptions of management 48.5%, and working conditions 49%. The curriculum designed taught strategies for communication and teamwork focusing on the identified concerns. Daily adherence to these strategies was 75% at one month. The SAQ will be repeated at 9 months.

DISCUSSION:
Identifying department-specific barriers to teamwork and communication allowed for development of a curriculum to address the specific concerns of the team members and may lead to improved uptake of teamwork and communication strategies. This process will be repeated hospital system-wide.
Kidney transplant wait list
Authors: Clayton Lindsay M. , Rizzolo Denise , Nair Vinay 
Published: September 2018

ABSTRACT
Renal transplantation is the treatment of choice for patients with end-stage renal disease. Improved success of renal transplantation has led to a growing number of US patients waiting for a transplant and longer waits to obtain kidneys. This article discusses the process and challenges of getting on the wait list, kidney organ allocation, and areas being explored to increase available organs for renal transplantation.
Overshadowed by Assessment: Understanding Trainee and Supervisor Perspectives on the Oral Case Presentation in Internal Medicine Workplace-Based Assessment
Authors: Melvin Lindsay , Rassos James , Panisko Daniel , Driessen Erik , Kulasegaram Kulamakan M. , Kuper Ayelet 
Published: September 2018

Purpose
The oral case presentation (OCP) is an essential part of daily clinical practice in internal medicine (IM) and a key competency in medical education. It is not known how supervisors and trainees perceive OCPs in workplace-based learning and assessment.

Method
Using a constructivist grounded theory approach, 26 semistructured interviews were held with trainees and supervisors (18 clinical clerks and first- through third-year postgraduate trainees, and 8 supervisors) on the IM clinical teaching unit at the University of Toronto, 2015–2016. Interviews focused on how the OCP was viewed by both trainees and supervisors in clinical practice as a tool for patient care, learning, and assessment. Iterative, constant comparative techniques were used to analyze the interviews and develop a framework to understand trainee and supervisor perspectives.

Results
Supervisors and trainees viewed the OCP as an important part of informal trainee assessment in IM. Supervisors used OCPs to understand the patient through trainee-demonstrated skills including the use of narratives, information synthesis, and management of uncertainty. However, because of awareness of assessment, trainees sought to control the OCP, viewing it as a performance demonstrating their competence, mediated by senior residents and tailored to supervisor preferences.

Conclusions
Preoccupied with assessment around OCPs, trainees often lost sight of the valuable learning taking place. Use of OCPs in assessment necessitates optimization of the educational activity for trainees. Providing explicit direction to both trainees and supervisors, defining expectations, and clarifying the assessment activity of the OCP can optimize the encounter for best educational practice.
Moving the United States Medical Licensing Examination Step 1 After Core Clerkships: An Outcomes Analysis
Authors: Jurich Daniel , Daniel Michelle , Paniagua Miguel , Fleming Amy , Harnik Victoria , Pock Arnyce , Swan-Sein Aubrie , Barone Michael A. , Santen Sally A. 
Published: September 2018

Purpose
Schools undergoing curricular reform are reconsidering the optimal timing of Step 1. This study provides a psychometric investigation of the impact on United States Medical Licensing Examination Step 1 scores of changing the timing of Step 1 from after completion of the basic science curricula to after core clerkships.

Method
Data from four schools that recently moved the examination were analyzed in a pre–post format using examinee scores from three years before and after the change. The sample included scores from 2008 through 2016. Several confounders were addressed, including rising national scores and potential differences in cohort abilities using deviation scores and analysis of covariance (ANCOVA) controlling for Medical College Admission Test (MCAT) scores. A resampling procedure compared study schools’ score changes versus similar schools’ in the same time period.

Results
The ANCOVA indicated postchange Step 1 scores were higher compared with prechange (adjusted difference = 2.67; 95% confidence interval: 1.50–3.83, P < .001; effect size = 0.14) after adjusting for MCAT scores and rising national averages. The average score increase in study schools was larger than changes seen in similar schools. Failure rates also decreased from 2.87% (n = 48) pre change to 0.39% (n = 6) post change (P < .001).

Conclusions
Results suggest moving Step 1 after core clerkships yielded a small increase in scores and a reduction in failure rates. Although these small increases are unlikely to represent meaningful knowledge gains, this demonstration of “noninferiority” may allow schools to implement significant curricular reforms.
All Other Things Being Equal: Exploring Racial and Gender Disparities in Medical School Honor Society Induction
Authors: Wijesekera Thilan P. , Kim Margeum , Moore Edward Z. , Sorenson Olav , Ross David A. 
Published: September 2018

Purpose
A large body of literature has demonstrated racial and gender disparities in the physician workforce, but limited data are available regarding the potential origins of these disparities. To that end, the authors evaluated the effects of race and gender on Alpha Omega Alpha Honor Medical Society (AOA) and Gold Humanism Honor Society (GHHS) induction.

Method
In this retrospective cohort study, the authors examined data from 11,781 Electronic Residency Application Service applications from 133 U.S. MD-granting medical schools to 12 residency programs in the 2014–2015 application cycle and to all 15 residency programs in the 2015–2016 cycle at Yale-New Haven Hospital. They estimated the odds of induction into AOA and GHHS using logistic regression models, adjusting for Step 1 score, research publications, citizenship status, training interruptions, and year of application. They used gender- and race-matched samples to account for differences in clerkship grades and to test for bias.

Results
Women were more likely than men to be inducted into GHHS (odds ratio 1.84, P < .001) but did not differ in their likelihood of being inducted into AOA. Black medical students were less likely to be inducted into AOA (odds ratio 0.37, P < .05) but not into GHHS.

Conclusions
These findings demonstrate significant differences between groups in AOA and GHHS induction. Given the importance of honor society induction in residency applications and beyond, these differences must be explored further.
Case-Based Learning in Translational Biomedical Research Education: Providing Realistic and Adaptive Skills for Early-Career Scientists
Authors: Greenberg-Worisek Alexandra J. , Campbell Katherine A. , Klee Eric W. , Staff Nathan P. , Schimmenti Lisa A. , Weavers Karen M. , Ekker Stephen C. , Windebank Anthony J. 
Published: September 2018

Problem
Case-based learning is an established means of educating students in law, business, and medicine; however, this methodology is not often applied to educating translational biomedical researchers. The application of case-based learning to translational biomedical research education allows scholars to actively engage with real-world material and apply their newfound knowledge as it is acquired.

Approach
Through the Mayo Clinic Center for Clinical and Translational Science (CCaTS), three courses were delivered in 2009–2017 which emphasized case-based learning in clinical and translational science, entrepreneurship, and individualized medicine. Quantitative measures collected in student course reviews upon course completion were analyzed. Additionally, products arising from each course were identified, including publications and startups pitched.

Outcomes
Analyses demonstrate that case-based learning techniques are well suited to graduate biomedical research education. Furthermore, case studies can be employed throughout the entire clinical and translational spectrum, from basic and preclinical work through to clinical and population-based learning.

Next Steps
Within CCaTS, next steps include creating case-based courses in regulatory and team science to continue to allow scholars to learn and apply these critical skills to real-world material. The goal is to continue to provide immersive training opportunities in areas of clinical and translational science that cannot be readily learned in a traditional lecture-based class setting.
Contribution of Loss of Large Fiber Function to Pain in 2 Samples of Oncology Patients
Authors: Miaskowski Christine , Paul Steven M. , Mastick Judy , Abrams Gary , Topp Kimberly , Smoot Betty , Kober Kord M. , Chesney Margaret , Schumacher Mark , Conley Yvette P. , Hammer Marilyn , Cheung Steven , Borsook David , Levine Jon D. 
Published: September 2018

Objectives:
Numbness associated with neuropathic pain suggests the loss of function in myelinated, large diameter sensory neurons. The purpose of this study was to examine the relationships between pain severity and subjective (ie, severity of numbness) and objective (ie, loss of light touch sensations, vibration thresholds) measures of loss of large fiber function in adult survivors with chemotherapy-induced peripheral neuropathy (CIPN, n=426) and breast cancer patients with persistent postsurgical pain (n=80).

Material and Methods:
For both samples, average pain and numbness were evaluated using a 0 to 10 numeric rating scale. Loss of light touch sensations in the hands and feet of patients with CIPN and in the upper arm of patients at 5 and 6 months following breast cancer surgery were assessed using Semmes Weinstein monofilaments. Loss of vibration in the hands and feet of patients with CIPN was assessed using a biothesiometer. Pearson Product Moment correlation coefficients were calculated between average pain and the number or percentage of sites with loss of light touch sensations, mean vibration thresholds, and the severity of numbness.

Results:
For both pain conditions, average pain scores were significantly correlated with objective measures of large fiber function (r=0.12 to 0.34; all P<0.05) and numbness (r=0.22 to 0.52; all P<0.008).

Discussion:
Our findings, in 2 independent samples of oncology patients, suggest that loss of function of myelinated, large diameter fibers contributes to the severity of neuropathic pain.
Clinician Response to Aberrant Urine Drug Test Results of Patients Prescribed Opioid Therapy for Chronic Pain
Authors: Morasco Benjamin J. , Krebs Erin E. , Adams Melissa H. , Hyde Stephanie , Zamudio Janet , Dobscha Steven K. 
Published: September 2018

Objective:
Urine drug testing (UDT) is recommended for patients who are prescribed opioid medications, but little is known about the various strategies clinicians use to respond to aberrant UDT results. We sought to examine changes in opioid prescribing and implementation of other risk reduction activities following an aberrant UDT.

Methods:
In a national cohort of Veterans Affairs patients with new initiations of opioid therapy through 2013, we identified a random sample of 100 patients who had aberrant positive UDTs (results positive for nonprescribed/illicit substance), 100 who had aberrant negative UDTs (results negative for prescribed opioid), and 100 who had expected UDT results. We examined medical record data for opioid prescribing changes and risk reduction strategies in the 12 months following UDT.

Results:
Following an aberrant UDT, 17.5% of clinicians documented planning to discontinue or change the opioid dose and 52.5% initiated another strategy to reduce opioid-related risk. In multivariate analyses, variables associated with a planned change in opioid prescription status were having an aberrant positive UDT (odds ratio [OR], 30.77; 95% confidence interval [CI], 5.92-160.10) and higher prescription opioid dose (OR, 1.01; 95% CI, 1.01-1.02). The only variable associated with implementation of other risk reduction activities was having an aberrant positive UDT (OR, 0.29; 95% CI, 0.16-0.55).

Discussion:
The majority of clinicians enacted some type of opioid prescribing or other change to reduce risk following an aberrant UDT, and the action depended on whether the result was an aberrant positive or aberrant negative UDT. Experimental studies are needed to develop and test strategies for managing aberrant UDT results.
Clinical Outcomes and Central Pain Mechanisms are Improved After Upper Trapezius Eccentric Training in Female Computer Users With Chronic Neck/Shoulder Pain
Authors: Heredia-Rizo Alberto M. , Petersen Kristian K. , Madeleine Pascal , Arendt-Nielsen Lars 
Published: September 2018

Objectives:
The effects of eccentric exercises on clinical outcomes and central pain mechanisms are unclear in neck/shoulder pain (NSP). The aims were to: (1) evaluate the clinical impact of unilateral eccentric training in female computer users with chronic NSP; (2) compare pressure pain sensitivity, temporal summation of pain (TSP); and conditioned pain modulation (CPM) in female office workers with and without NSP; and (3) assess sensitization and central pain responses after training.

Methods:
In part A, 20 females with NSP were compared with 20 controls. In part B, the NSP group underwent a 5-week upper trapezius eccentric training program. Participants reported their pain intensity and completed the Neck Disability Index, and the Disabilities of the Arm, Shoulder and Hand questionnaire. Pressure pain thresholds (PPTs) were assessed over the neck and forearm. Cuff algometry identified pain detection threshold (PDT) and pain tolerance thresholds (PTT). TSP was evaluated by visual analog scale pain scores during 10 repetitive cuff stimulations. CPM was calculated as the difference in PDT with and without a conditioning painful stimulus. Outcomes were measured at baseline and after intervention. Pain intensities were collected at 3- and 6-month follow-up.

Results:
Pain and disability decreased after intervention (P<0.05) and at follow-ups (P=0.002). The NSP group showed reduced PTT (P≤0.02), but no differences in TSP (P=0.947) or CPM (P=0.059) compared with controls. After training, participants with NSP had improved CPM, PPTs, and PTT at the nontreated side (P<0.05).

Discussion:
Eccentric training improved pain and disability, reduced sensitization, and enhanced CPM efficiency in female computer users with NSP.