bluuebunny/crossref_metadata_2025_split huggingface dataset:
How Does OBGYN Resident Training at Restrictive Faith-based Institutions Impact Subsequent Provision of Reproductive Healthcare for Women? A Qualitative Analysis
Authors: Guiahi Maryam , Hoover Jennifer , Swartz Maryke , Teal Stephanie 
Published: September 2016

Local Mentor: Stephanie Teal, MD, MPH

ASL Advisor: Nancy Hueppchen, MD, MSc

PURPOSE:
To understand how institutional restrictions at faith-based hospitals impact OBGYN trainees who subsequently provide care for women at secular institutions.

BACKGROUND:
OBGYN residency prepares trainees to become experts in women's healthcare. Trainees at faith-based hospitals may not receive adequate training in family planning services.

METHODS:
We set out to conduct semi-structured individual interviews with recent graduates from 10 faith-based hospitals who are generalists at secular institutions. Participants were queried about their experiences, perceived deficiencies, and current provision of family planning services. Three researchers independently coded transcripts using grounded theory; overarching themes and discrepancies were subsequently resolved.

RESULTS:
15/31 graduates from 7 hospitals participated; we reached thematic saturation after analysis of these interviews. None of the participants cited a preference to match at their program based on restrictive family planning policies. All participants reported reproductive healthcare training deficiencies that were partially attenuated by didactic educational activities, variations in on-site restrictions, and off-site training. Participants expressed frustration about inadequate on-site training in postpartum tubal ligations; upon graduation they either avoided provision or required mentorship from partners to achieve competency. A few participants who sought off-site training now provide outpatient D&Cs and/or inpatient D&Es. All participants proposed that faith-based programs improve family planning training by providing routine, opt-out opportunities.

DISCUSSION:
OB-GYNs trained at faith-based institutions feel that religion-based policies negatively impact training experiences and the range of health services they subsequently can provide. Forming collaborations with off-site facilities, particularly for tubal ligation and outpatient uterine evacuation procedures, may improve the reproductive care these physicians provide to women.
Let's Talk About Sex History: Impact of a Communication Curriculum on Medical Student Performance and Perceived Competency
Authors: Stockdale Colleen K. , Rosenbaum Marcy , Kippes John , Elson Marygrace 
Published: September 2016

Local Mentor: Marygrace Elson, MD, MME

APGO Advisor: Nancy Hueppchen, MD, MSc

PURPOSE:
Determine whether medical students (MS) who completed a sexual history communication curriculum performed better during a formal standardized patient based assessment (PBA) at the conclusion of the OB/GYN Clerkship than historical control MS, and assess MS perceptions about taking a sexual history.

BACKGROUND:
Communication is inadequately addressed in undergraduate medical education. Students often feel they are poorly trained in this area due to a lack of opportunities to practice taking sexual histories. Thus, a communication curriculum was implemented to address this gap, including formal small group practice sessions on taking a sexual history during the OB/GYN Clerkship.

METHODS:
Retrospective study comparing 3 specific PBA standardized patient rating questions and 5 questions regarding MS feedback. All (n=66) MS between January and June 2011 were queried at the conclusion of their OB/GYN Clerkship before implementation of the sexual history curriculum in July 2011 with responses compared to all subsequent (n=421) MS through June 2014. Cochran-Mantel-Haenszel was used to compare scores by Clerkship year and block with P<.05 significant.

RESULTS:
There was no change in MS PBA performance or MS perception regarding ability to take a sexual history immediately following implementation of the sexual history communication curriculum. However, in response to “what other instruction or experiences could the clerkship provide to help you gain competency…” the theme was more practical experience.

DISCUSSION:
Learners require different formats to promote and enhance learning, which may not have been measured with the outcomes chosen for this study.
A Contraception Simulation Lab Developed for OB/GYN Residents in Catholic Hospitals
Authors: Wollschlaeger Karin , White Karen 
Published: September 2016

BACKGROUND:
OB/GYN residents in Catholic hospitals are limited in performing procedures involving contraception. This was identified as a deficiency in training, by a needs assessment given to residents at a Catholic residency program. Once the residents graduate they will be expected to offer and perform these procedures for their patients.

METHODS:
A contraception simulation program was developed. It included 4 stations: IUDs and Nexplanons (high fidelity models), hysteroscopic Essure (high-fidelity virtual reality model), laparoscopic tubal ligation (low fidelity box trainer), and abdominal postpartum tubal ligation (PPTL) (low fidelity box trainer) training. The program started with a pre-test consisting of 27 questions. The residents were divided into groups and rotated through each station. They discussed answers pertaining to the specific questions for that station. The procedure was demonstrated and residents were given time to practice. After rotating through all stations, a post-test was given and again 2 weeks later.

RESULTS:
The results were analyzed using a Wilcoxon signed-rank test. Both OB/GYN residents (12) and medical students (8) participated. The average pre-test score for the residents was 63%, medical students 50%. After reviewing questions and simulation practice, the average post-test score for the residents was 93%, medical students 87%. The average 2 weeks post-test score for the residents was 91%, medical students 82%.

DISCUSSION:
This curriculum resulted in developing skills, improved knowledge about the procedures and showed excellent short term retention.
Assessment of Faculty and Resident Views on Resident Surgical Feedback
Authors: Biscette Shan , Ollendorff Arthur , Gaskins Jeremy 
Published: September 2016

BACKGROUND:
Expert feedback has been identified as an important tool for acquisition of technical skill. The aim of this study is to assess the resident and faculty perceptions regarding operative feedback.

METHODS:
Faculty (academic and community practices) and residents were asked to take an anonymous survey regarding surgical feedback. The survey addressed the timing, amount, specificity, satisfaction, definition and importance of feedback. Participants were also questioned regarding the importance and frequency of feedback in areas such as pre-operative planning, intra-operative communication, respect for tissue, efficiency, instrument handling, knowledge of procedural steps and knowledge of anatomy.

RESULTS:
There were 23 study respondents (17 residents, 6 academic faculty, 0 community faculty). There was a significant difference in faculty and resident scores in the survey overall (P<.0001). Faculty perception on the timing of feedback was higher than that of residents (P=.0146). There was no difference in perception of the importance of feedback with regards to pre-operative planning, efficiency, instrument handling and knowledge of anatomy, however there was a difference in faculty and resident perception of the actual provision of feedback in all but one area of feedback (all P values<0.05).

DISCUSSION:
Faculty and residents both agree on the importance of surgical feedback, however there is a difference in the perception of provision of surgical feedback between faculty and residents. Perhaps this disparity can be rectified by implementation and adherence to procedure specific assessment tools by both faculty and residents.
Development of a Needs Assessment Tool to Guide Surgical Training
Authors: Braun Kelli , Stepleman Lara , Swift Steven 
Published: September 2016

BACKGROUND:
Needs assessments are an effective process for addressing educational training gaps. Given the absence of a standardized one for Ob-Gyn surgical training, the new Ob-Gyn milestones, and an increase in simulation, we developed an assessment tool to align our curriculum with perceived resident and faculty needs; studies demonstrate these groups do not always agree on those needs.

METHODS:
Development of the needs assessment tool utilized a systematic multi-step process. Literature review and informal interviews with faculty generated an initial outline. Content areas included feedback, surgical preparation, intra-operative performance, simulation, and the Ob-Gyn milestones procedures for Obstetrics and Gynecology technical skills. The procedures were assessed for: 1) current satisfaction with training and 2) perceived helpfulness of simulation to improve procedure performance. The iterative item reduction and refinement process of the initial tool included receiving feedback from two Ob-Gyn experts and a psychometric expert with subsequent revisions. One faculty and one resident also completed the needs assessment survey to ensure item clarity.

RESULTS:
A final 50-item tool was developed. Two equivalent versions were written to capture faculty and resident perceptions.

DISCUSSION:
We describe the process of developing a needs assessment tool to guide a programs surgical training priorities; the tool will be utilized in academic year 2015, providing further evidence of tool validity. This process can be followed to address other educational gaps.
Evaluation of an Open Surgical Skills Curriculum
Authors: Beasley Anitra , Kilpatrick Charles , Swift Steven 
Published: September 2016

BACKGROUND:
Work-hour limitations and focus on patient safety have necessitated changes to the traditional apprenticeship-based resident education model. This is especially true for surgical specialties where training opportunities must not only increase in efficiency but also shift to settings outside of the operating room. While validated curricula exist for laparoscopic skills, similar curricula for open skills are scare and not well validated across specialties.

METHODS:
The Southwestern Center for Minimally Invasive Surgery open knot-tying and suturing curriculum has been validated in a general surgery sample and consists of 11 standardized tasks using commercially available materials. The full curriculum includes an orientation, video tutorials, proctored baseline assessment, individual practice, and proctored post-testing. We tested elements of the curriculum through baseline assessment.

RESULTS:
Residents from all levels of our program attended orientation and rotated through the skills stations for baseline assessment. With minor exceptions, tasks were able to be performed as described. Baseline performance between intern and upper level trainees was significantly different for basic knot tying and suturing (P<.05).

DISCUSSION:
We were able to provisionally implement a simple yet comprehensive curriculum for open knot-tying and suturing. The differential performance of upper and lower level residents demonstrates construct validity in our sample. We anticipate that skill acquisition will be demonstrated by a majority of trainees by completion of the entire curriculum.
Knowing Operative Tying: The KnOT Study
Authors: Lewicky-Gaupp Christina , Bochenska Katarzyna , Milad Magdy 
Published: September 2016

BACKGROUND:
The purpose of this study was to determine if viewing an expert knot tying training video, in addition to the standard medical student curriculum, will result in more proficient surgical knot tying.

METHODS:
At the start of the clerkship, 20 students were videotaped tying surgical knots for 2 minutes using a board model. Two blinded gynecologic surgeons evaluated proficiency with a standard checklist (score range 0–16) and anchored scoring scale (range 0–20); higher numbers represent better skill. Students were randomized to either (1) expert video or (2) no video. The “video” group was given unlimited access to a knot tying instructional video. At the completion of the clerkship, students were again videotaped and evaluated.

RESULTS:
At initial evaluation, overall the group mean checklist score was 8.7±4.9, and the anchored scale score was 9.9±4.6 (range 0–18). These pre-clerkship scores did not differ between groups (P=.11 and 0.12, respectively). Post-clerkship checklist scores significantly improved in both the non-video group (14.2±1.6, P=.02) and video group (13.5±2.9, P=.003); similarly, anchor scores also improved in both groups (17.1±3.0, P=.004 and 16.5±3.4, P=.003, respectively). Knot board practice frequency was not different between groups (P=.23). In the expert video group, increased practice significantly correlated with higher post-rotation scores on both the checklist (r=0.69, P<.05) and anchored scales (r=0.68, P<.05).

DISCUSSION:
The addition of an instructional video appears to have a positive impact on medical student knot tying proficiency.
Sterilization and Contraception Costs: An Educational Needs Assessment and Intervention
Authors: Martinez Anjali , Weeks Corinne , Keller Jennifer 
Published: September 2016

BACKGROUND:
Understanding the costs associated with healthcare is an essential component of being an effective physician and has been recognized as one of the five essential competencies of systems-based practice. Despite this level of importance, there is little published about assessing knowledge associated with sterilization costs or strategies to educate trainees about cost. This project was designed to perform a needs assessment, create a curriculum to teach residents about costs of sterilization, and to determine the impact of the educational intervention.

METHODS:
Obstetrics and Gynecology residents and faculty were surveyed regarding their baseline knowledge and attitudes of the cost of sterilization and long-term contraceptive options. An interactive curriculum was designed for the residents around cognitive gaps, and the residents were resurveyed after the educational session.

RESULTS:
Twelve residents including PGY-2 (n=3), PGY-3 (n=4) and PGY-4 (n=5) and 15 faculty members participated in the study. Residents considered it important to understand the cost of comparable sterilization options (mean: 4.14; scale: 1–5) but did not feel knowledgeable about these costs (mean: 1.83; scale 1–5). Faculty also felt this topic was important (mean: 4.3; scale 1–5) but felt more knowledgeable (mean: 3.0; scale 1–5). After implementation of the curriculum, residents felt significantly more knowledgeable (mean: 3.25 versus 1.83, P<.01).

DISCUSSION:
Residents recognize the knowledge deficit associated with sterilization costs and consider understanding costs to be important. Using an educational intervention, we demonstrate improved knowledge about costs and plan to reassess in 6 months to determine retention.
The Labor Games
Authors: Bou Nemer Laurice , Kalin Dawn , Fiorentino Desiree , Garcia Jorge J. , Estes Christopher M. 
Published: September 2016

OBJECTIVE:
To develop and evaluate a simulation laboratory designed to stimulate learning and increase medical students' preparedness for an obstetrics and gynecology clinical clerkship.

METHODS:
Ninety-seven medical students participated in the games during their obstetrics and gynecology clerkship in 1 year. Using the resident-as-teacher model, students rotated through seven stations, each with a simulated obstetric task. Points were awarded at each station, and the student with the highest score won. Self-perceived proficiency level and general preparedness for the clerkship were evaluated through paired pregame and postgame assessments.

RESULTS:
Postassessment results showed statistically significant (P<.001) increases in self-perceived competence performing all tested skills including reading fetal heart tracings, knot-tying, measuring cervical dilation, amniotomy, estimating fetal weight, and estimating blood loss. Approximately 97% enjoyed The Labor Games, 97.9% reported increased knowledge, and 96.9% learned valuable skills. Students also reported feeling more prepared for the obstetrics and gynecology rotation (2.6 compared with 3.3, P<.001).

DISCUSSION:
The Labor Games improved medical students' self-confidence and self-perceived skill level on obstetric tasks. Students also felt more prepared for the obstetrics and gynecology clerkship. This study creates a low-cost and reproducible simulation laboratory that is identified as effective by medical students in teaching skills, knowledge, and preparedness for an obstetrics and gynecology clerkship.
Resuscitation and Treatment of Shock
Authors: Beltran Michael J. , Becker Tyson E. , Hurley Richard K. , Gurney Jennifer M. , Hayda Roman A. 
Published: September 2016

Summary:
Hemorrhage continues to be the most common cause of death among service members wounded in combat. Injuries that were previously nonsurvivable in previous wars are now routinely seen by combat surgeons in forward surgical units, the result of improvements in body armor, the universal use of field tourniquets to control extremity hemorrhage at the point of injury, and rapid air evacuation strategies. Combat orthopaedic surgeons remain a vital aspect of the forward surgical unit, tasked with assisting general surgical colleagues in the resuscitation of patients in hemorrhagic shock while also addressing traumatic amputations, open and closed long bone fractures, and mechanically unstable pelvic trauma. Future military and civilian trauma research endeavors will seek to identify how the advances made in the past 15 years will translate toward the emerging battlefield of the future, one where forward surgical units must be lighter, smaller, and more mobile to address the changing scope of military combat operations.
Debridement and Irrigation: Evolution and Current Recommendations
Authors: Erdle Nicholas J. , Verwiebe Eric G. , Wenke Joseph C. , Smith Christopher S. 
Published: September 2016

Summary:
Debridement is an integral step in the orthopaedic management of traumatic wounds, from open soft tissue injuries and routine open fracture care to the management of extensive high-energy blast injuries. While the necessity of debridement has been well established, the level of energy and degree of contamination of blast wounds encountered in recent armed conflict has offered a challenge and a new opportunity for military surgeons to revisit the most recent literature to guide our practice with the best evidence currently available. While the core tenants of removing the nonviable tissue and preserving the viable to maintain the best functional outcome have not changed, new wound care therapies and advances in prosthetics and salvage techniques and the ability to rapidly evacuate casualties have changed the approach to care provided on the front lines. This paper seeks to review the core principles of debridement and guide treatment using evidence-based methods that can be applied to contaminated open injuries on the battlefront and disaster and intentional violence injuries abroad and at home.
Preventing Seal Leak During Negative Pressure Wound Therapy Near External Fixators: A Technical Tip
Authors: Mannino Brian J. , Pullen Michael W. , Gaines Robert 
Published: September 2016

Summary:
Negative pressure wound therapy is an effective tool for the treatment of open wounds. Occasionally these wounds are associated with injuries or procedures that require treatment with an external fixator. This article shows how a simple, inexpensive, and commercially available product can be used to prevent loss of suction around external fixator pins within the negative pressure wound treatment area.
Graf Type-IV Hips Have a Higher Risk of Residual Acetabular Dysplasia at 1 Year of Age Following Successful Pavlik Harness Treatment for Developmental Hip Dysplasia
Authors: Novais Eduardo N. , Sanders Julia , Kestel Lauryn A. , Carry Patrick M. , Meyers Mariana L. 
Published: September 2016

Background:
We asked whether patient-specific factors and ultrasound (US) measurements of hip dysplasia severity at initial examination influence short-term residual acetabular dysplasia in patients successfully treated with Pavlik harness for developmental hip dysplasia.

Methods:
After IRB approval, 134 hips (84 patients) successfully treated by the Pavlik method between August 2011 and October 2014 with follow-up at 12 months of age were identified. Early successful treatment was defined as normal examination and US after approximately 12 weeks of Pavlik treatment. Multivariate linear and logistic regression models were used to identify factors associated with acetabular index (AI) measurements at 12 months as well as factors associated with an increase in AI between the 6- and 12-month timepoints (dysplastic progression).

Results:
The study consisted of 134 hips (84 patients). The distribution of dysplastic, Barlow, and Ortolani hips was 44.8% (N=60), 30.6% (N=41), and 24.6% (N=33), respectively. The crude incidence of residual dysplasia at the 6-month visit (AI>30 degrees) was 11.7% (12/102). The incidence of residual dysplasia at the 12-month visit (AI>28 degrees) was 11.8% (13/111). Graf type was the only variable associated with AI values at the 12-month visit (mean difference: Graf type-IV—Other, 2.6; 95% confidence interval, 0.3-4.9; P=0.026).

Conclusions:
The risk of residual acetabular dysplasia after normal hip US following Pavlik treatment is not negligible. Radiographic surveillance is warranted to monitor and screen for dysplasia progression. Patients with dislocated Graf type-IV hips at diagnosis are at increased risk of residual acetabular dysplasia at 1 year after successful treatment with the Pavlik method.

Level of Evidence:
Level III—therapeutic study.
A New Subtype of Lichen Planopilaris Affecting Vellus Hairs and Clinically Mimicking Androgenetic Alopecia
Authors: Abbasi Ali , Kamyab-Hesari Kambiz , Rabbani Ramin , Mollaee Farzaneh , Abbasi Sheida 
Published: September 2016

BACKGROUNDLichen planopilaris (LPP) is a follicular variant of lichen planus. A new subtype of LPP mimicking androgenetic alopecia (AGA) may be misdiagnosed. Inappropriate medical therapy or hair transplantation may exacerbate this subtype.OBJECTIVETo introduce clinicopathologic findings of a new subtype of LPP that selectively affects vellus hair in the pattern of AGA.MATERIALS AND METHODSIn a cross-sectional study, 433 (66.6%) men and 217 (33.4%) women with alopecia who were candidates of medical treatment or hair transplantation were included. Gross and microscopic attributes of their diseases were investigated.RESULTSAmong the total of 650 patients, 58 (8.9%; 95% confidence interval, 6.7%–11.1%) patients, including 52 women and 6 men, had LPP. We identified a distinct category of LPP presenting with diffuse hair loss in the pattern of AGA with predominant terminal hair, significant decrease in vellus hair, and minute punctuate scars in histopathology. Vellus hair follicles were the main sites of involvement. Perifollicular fibrosis and mild fibrosis with lichenoid lymphocytic infiltration around infundibular area of vellus hair follicles were present.CONCLUSIONThere is a new form of LPP with clinical features similar to AGA. This form is histopathologically similar to LPP but selectively affects vellus hair follicles.