bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performance on the Obstetrics and Gynecology National Board of Medical Examiners Subject Exam: Does Practice Help?
Authors: Kohl-Thomas Belinda M. , Ray Kelly A. , Kuehl Thomas J. , Allen Steven R. 
Published: September 2016

Local Mentor: Steven R. Allen, MD

APGO Advisor: John L. Dalrymple, MD

PURPOSE:
To evaluate whether a practice NBME examination for Ob/Gyn clerkship third year medical students (MS3s) improves scores on the final NBME examination.

BACKGROUND:
NBME scores provide a measure of students' knowledge.

METHODS:
We compared two groups of MS3s on the Ob/Gyn clerkship at three clinical campuses. Group 1 (n=252) took the NBME examination without a practice exam (6/2012–1/2014), and group 2 (n=271) took the examination after implementation of the practice exam (3/2014–10/2015). Group 2 was surveyed anonymously regarding the practice exam. Outcomes include comparison of final scores between groups using Student t test, comparison of practice and final scores in group 2 using paired Student t test, and proportion of each group scoring ≥70% (“pass”) using χ2 test. ANOVA was used to compare scores at different sites and of different blocks of students.

RESULTS:
Mean raw NBME scores do not differ among campuses (75.7, 74.9, 75.6, P=.61). Across the study period, scores were lower during the first half of the academic year, with blocks 6, 7 and 8 differing from 2 and 4 (P=.006). Group 2 demonstrated an improvement (P<.001) of 5.9 points from practice to final NBME. Scores are higher for group 2 than group 1 (76.7, 74.1, P=.001) and 17.1% more group 2 students scored ≥70% (P=.001). Student survey results support the use and continued inclusion of the practice exam.

DISCUSSION:
A practice exam improves students' NBME score, and increases the number of students who pass. Students recommend continued use of the practice NBME exam.
Smartphones: Are They REALLY a Smart Idea?
Authors: Patel Silka , Lidor Anne , Sanyal Abanti , Hueppchen Nancy 
Published: September 2016

Local Mentor: Nancy Hueppchen, MD

APGO Advisor: Alice Goepfert, MD

PURPOSE:
To understand the perception of professionalism surrounding smartphone use (wards/educational activities) among medical students and surgical faculty.

BACKGROUND:
Smartphones are ubiquitous and their uses numerous: personal messages, patient care, emails and entertainment. It is difficult to determine which of these functions the user is engaged in at any one time during work at healthcare facilities. Students and faculty (Ob/Gyn and Surgery) are motivated to exhibit professional behavior and are evaluated on this measure. Given changes in generational norms and implications of unprofessional behavior it is important to understand how use of this technology is perceived in the workplace.

METHODS:
A prospective cohort study was conducted using an electronic survey and distributed to 3rd and 4th year medical students, Ob/Gyn and Surgery faculty members. Five cases were randomly presented; participants were asked to review and rate the clinician's behavior on a 5 point Likert scale.

RESULTS:
One hundred twenty-three students (51% response) and 73 faculty (Ob/Gyn with 54% response; Surgery with 21% response) completed the survey. In 3 of 5 scenarios, students and faculty had significant differences in perception of professionalism (P<.05). Faculty were more likely to find behaviors unprofessional compared to students. The acceptability of certain behaviors was correlated with how participants reported using their smartphones.

DISCUSSION:
There is a difference in perception of professional behavior surrounding smartphone use among medical students and surgical faculty. Acceptability of a behavior is also correlated to personal use of technology. Future studies should be designed to further define professional use of smartphone technology.
A Pilot Study: An Online Teaching Tool for Standardization of Gynecologic Oncology Fellowship Curriculum
Authors: Langstraat Carrie , Cliby William 
Published: September 2016

BACKGROUND:
Learning objectives for gynecologic oncology (GO) fellowships have been created, however a standard curriculum does not exist. There is interest amongst program directors to develop a standardized curriculum with online teaching tools. This study was conducted to determine the learning needs of GO fellows and to assess the use of web-based teaching in this group of learners.

METHODS:
An 18 minute teaching module on surgical management of vulvar cancer was created and validated by experts. The module was then emailed to fellows with a pre and post-module survey. The survey assessed the learners needs, the learners knowledge and the usefulness of the module.

RESULTS:
One hundred ninety GO fellows were surveyed, 72 (38%) responses were received. Most participants were in their second year of clinical fellowship (42%). The majority of GO fellowships have a weekly teaching conference with faculty participation. Resources utilized by fellows for learning are textbooks and journal articles, with all responders ranking these as their first or second preferred resource. The teaching module was an effective teaching tool as demonstrated by improved scores across the four content based questions. The webinar was well received by the fellows, with 92% saying they liked this teaching tool and 46/48 (96%) felt that they would view additional presentations if provided. In addition 45/49 (92%) felt that this type of teaching filled a need in GO fellowship.

DISCUSSION:
Many GO fellowships utilize faculty directed teaching conferences. This online teaching tool improved fellow knowledge and additional modules would be well received in this population of learners.
Can a Low-Fidelity Surgical Model Simulating Loss of Vessel Control During Uterine Artery Ligation Induce Stress Among Gynecologic Residents?
Authors: Rone Bryan , Ollendorff Arthur , Qi Ya 
Published: September 2016

BACKGROUND:
Low-fidelity surgical simulation models are being used more often in surgical education. It is unclear whether or not residents have the same stress level during low-fidelity simulations compared to an actual surgery.

METHODS:
The low-fidelity uterine artery ligation simulator was fabricated with a 3D printed model uterus and consists of materials to form the cardinal ligament and tubing to fabricate functioning uterine arteries. The resident filled out a pretest questionnaire which assessed their perceived or actual stress level (1–4) while losing control of the uterine artery during an abdominal hysterectomy. The residents then performed ligation of the uterine artery on the model with instructions to control any bleeding that occurred. The experimental model simulated bleeding of the uterine artery independent of their ligation technique. The residents controlled the bleeding and then filled out a post-test questionnaire measuring their stress level during the simulation.

RESULTS:
The results were evaluated by calculating the average difference between the residents pre and post-test subjective stress level. This difference was then compared via t test with zero (the expected average difference if the stress level was equal). The average difference was 1.11 (P<.0001), standard error or 0.1.

DISCUSSION:
On average, the residents reported one less level of stress after the low-fidelity simulation than they perceived they would feel or have felt during an actual surgery. This model was unable to induce the stress that is likely to be encountered in a similar situation in a real surgery.
Evaluation of Dry Lab Training on Residents Knowledge of Robotic Instrumentation and Surgical Preparation
Authors: Rohl Jacqueline , Hade Erinn 
Published: September 2016

BACKGROUND:
Current studies of robotic surgery training are focused primarily on education and evaluation of surgical skills acquisition. However, a component not well studied is knowledge of instrumentation and surgical preparation (port placement, docking, and console knowledge).

METHODS:
Evaluation of residents knowledge was completed by a short pre and post-test consisting of 16 questions on patient positioning (maximum of 2 points), docking/patient cart information (maximum of 16 points) and the surgeon console (maximum of 12 points). The total score is calculated as the sum of these three components (range: 0–30). Residents demographics, pre-test, post-test and recall test total scores are summarized by descriptive statistics. The comparison of scores before and after training is made by the Wilcoxon signed-rank test and through regression on the ranks of the scores. Rank regression models allow adjustment of residents demographics characteristics on the change in scores.

RESULTS:
Twenty-seven residents participated in the dry lab training session. There was a significant increase in test scores after the dry lab in comparison to test scores before (pre-test score: median=24, range (7–28) versus post-test score: median=29, range (22–30); Wilcoxon rank sum test P=.002).

DISCUSSION:
Test scores after the dry lab significantly increased in comparison to before the lab. However, tests at 3–4 months were lower than tests after the lab, especially for more junior residents. This indicates that although there was knowledge attained from the dry lab, it may need more reinforcement throughout the year.
Impact of an Educational Module Addressing the Cost of Disposable Surgical Equipment in Gynecologic Surgery
Authors: Swan Kimberly , Piszczek Jackie , Flanery Brian 
Published: September 2016

BACKGROUND:
Disposable surgical equipment is an expensive part of all cases. We sought to determine if an educational module could impact knowledge, attitudes and behaviors of providers in regards to disposable laparoscopic equipment.

METHODS:
An online education module was developed addressing the cost of disposable surgical equipment at the Kanas University Hospital. Gynecologic laparoscopic attending physicians and the gynecology operating room support staff completed a pretest, viewed an educational module and completed a post-test. The cost of disposable equipment per laparoscopic hysterectomy case was determined by utilizing the hospital inventory management software. The cost per case for the 3-month period prior to the intervention and the 3-month period afterwards was collected.

RESULTS:
A total of 24 providers participated in the study over a one-month period. Prior to the intervention participants were able to identify the most expensive option 43% of the time and the least expensive 55%. Afterwards participants were able to identify the most expensive option 85% of the time and least expensive 89% (P=.0008; P=.0177). The average cost of disposable surgical equipment per laparoscopic hysterectomy case from May to July 2015 was $1,502 for 20 cases, which was significantly higher than the average cost of $1,306 for 29 cases from September to November 2015 (P=.0381).

DISCUSSION:
An educational module has the ability to impact a providers knowledge about the cost of disposable surgical equipment and this knowledge may translate into potential cost savings in surgical cases.
Instrument Training for Gynecologic Laparoscopy: A Pilot-Scale Randomized Control Trial to Improve Women's Safety
Authors: Lewis Mark , Islam Mohammad , Hesson Ashley , Shellgren Madeline , Collier Deborah , Milad Magdy 
Published: September 2016

BACKGROUND:
Inadequate technical proficiency in laparoscopy has a substantial negative effect on the safety of laparoscopic gynecologic procedures. Of errors due to lack of technical competence, 58% have been attributed to a deficiency in proper instrument training.

METHODS:
Forty-two medical trainees were randomized to standard training (ST, N=20) versus enhanced training (ET, N=22). ST participants were shown a 31 seconds instructional video akin to a typical industry briefing, while ET participants viewed a 2:42 seconds video incorporating additional safety information. Participants were then given a ten-question quiz and practice time with the instrument (1 minute for ST, 5 minutes with a tissue sample for ET) followed by a standardized laparoscopic simulator assessment using the instrument on chicken skin models.

RESULTS:
Quiz scores were significantly higher for ET participants (mean=6.3/10) as compared to ST participants (mean=4.1/10; P<.01). ET participants' psychomotor task times were also significantly faster than ST times (ET mean=113.4 seconds, ST mean=186.7 seconds; P=.02). A significant negative correlation was noted between quiz scores and task times (P=.01); ie, participants that performed better on the quiz tended to complete the task faster.

DISCUSSION:
This study demonstrates that a brief, structured training intervention improves both competence and efficiency on a laparoscopic instrument, suggesting that interventions designed to optimize cognitive proficiency and psychomotor skill in situ may decrease morbidity associated with new devices in the operating room.
Integration of Cystoscopy Into OBGYN Junior Residency Curriculum: A Simulation-Based Approach
Authors: McLeod Francine , Tabbarah Rami , Rice Dana , Sheridan Michael , Nieves Kelsey 
Published: September 2016

BACKGROUND:
Lower urinary tract injuries present serious challenges for the obstetrician gynecologist. Recently, innovative surgical techniques have been employed to improve visualization and dissection of pelvic anatomy. Despite these advances, lower urinary tract injury during hysterectomy is still our greatest peril. Intraoperative recognition and immediate surgical repair can greatly reduce post-operative morbidity and medical-legal ramifications.

METHODS:
Participants were junior residents (PGY-1 and PGY-2) in the OBGYN Residency Program at Inova Fairfax Medical Campus. The cystoscopy curriculum consisted of a 1 hour didactic session and a 3 hour simulation session. The didactic session examined characteristic properties of the bladder, including an overview of the procedure. The simulation session incorporated a skills workshop with repeated practice on low fidelity models. Pre- and post-assessments included a cognitive exam, a confidence survey, and validated checklists (OSATS). After 6 months, final acquisition of skill was tested in the operating room.

RESULTS:
PGY-1 and PGY-2 residents showed significant cognitive (P=.0008/.003) and confidence (P=.04) improvement, with no difference between groups. For checklist items, there was significant improvement within groups for Cystoscope Assembly (P=.007), Bladder Survey (P=.0002), Total Score (P<.0001), Global Rating (P<.0001), with no differences between groups.

DISCUSSION:
The simulation based curriculum was effective in training junior residents the basic skills of cystoscopy. This curriculum can be utilized as a teaching tool for residents to become confident and proficient in the aspects of diagnostic cystoscopy.
Low-Fidelity Vaginal Hysterectomy Simulator Increases Resident Attitudes Towards Performing TVH
Authors: Parks Laura A. , Lowder Jerry 
Published: September 2016

BACKGROUND:
Vaginal hysterectomy is recommended by the American College of Obstetricians and Gynecologists as the gold standard for route of hysterectomy. At our institution, only 28% of hysterectomies are being performed vaginally, while 28% are laparoscopic and 32% are abdominal.

METHODS:
Residents participated in a vaginal hysterectomy surgical skills lab reviewing criteria for a good surgical candidates and using a low fidelity simulator. A pre and post survey was given to participating residents asking about knowledge, attitudes and training of vaginal hysterectomy.

RESULTS:
Twenty residents participated in this project. The pre and post survey asked questions with response choices ranging on a 5 point Likert scale. Sixty-five percent of the residents were R1 (6–30%) and R2 (7–35%) and 35% were R3 (5–25%) and R4 (2–10%.) The residents had a statistically significant improvement in their attitudes of being able to select a good surgical candidate P≤.001 different responses.

DISCUSSION:
Implementation of this new low-fidelity vaginal hysterectomy simulator and brief didactic session was an effective way to increase resident knowledge and positive attitudes of vaginal hysterectomy.
Surgical Competency for Robot-Assisted Hysterectomy: Development and Validation of a Clinical Assessment Tool
Authors: Frederick Peter , Szender James , Aly Ahmed 
Published: September 2016

BACKGROUND:
The purpose of this study was to develop and utilize a clinical assessment tool to objectively measure robotic surgical skills and facilitate robotic surgery training and education.

METHODS:
This was a two-phase study. In phase I, the critical elements of a robotic hysterectomy were deconstructed into 6 key domains to assess technical skills for procedure completion. For each domain, anchor descriptions were developed to match a 5-point Likert scale. Delphi methodology was used for content validation. A panel of five expert robotic surgeons refined this scoring system using the Content Validity Index. In phase II, surgeons with varying degrees of experience performed a robotic hysterectomy. Video recordings were evaluated by blinded expert reviewers using the above scoring system. Descriptive statistics were evaluated for the total scores as well as each domain. Tests of both inter-rater (agreement between the assessors) and test-retest (consistency of scoring over time) reliability were performed with a threshold of significance at P<.05.

RESULTS:
Videos from 16 robotic hysterectomies, with two surgeons evaluated per case, were reviewed by the expert panel. The score for all surgeons was 4.36±0.49 (mean±SD). Scores varied according to surgical domain under assessment, however globally there was no difference between scores for trainees or attendings (P=.83). There was excellent agreement between raters with respect to score in two domains, while disagreements occurred with respect to the other domains.

DISCUSSION:
This pilot study demonstrates the feasibility of utilizing a standardized rubric for clinical skills assessment in robotic hysterectomy.
Neurosteroid Allopregnanolone Suppresses Median Nerve Injury–induced Mechanical Hypersensitivity and Glial Extracellular Signal–regulated Kinase Activation through γ-Aminobutyric Acid Type A Receptor Modulation in the Rat Cuneate Nucleus
Authors: Huang Chun-Ta , Chen Seu-Hwa , Lue June-Horng , Chang Chi-Fen , Wen Wen-Hsin , Tsai Yi-Ju 
Published: September 2016

Abstract

Background
Mechanisms underlying neuropathic pain relief by the neurosteroid allopregnanolone remain uncertain. We investigated if allopregnanolone attenuates glial extracellular signal-regulated kinase (ERK) activation in the cuneate nucleus (CN) concomitant with neuropathic pain relief in median nerve chronic constriction injury (CCI) model rats.

Methods
We examined the time course and cellular localization of phosphorylated ERK (p-ERK) in CN after CCI. We subsequently employed microinjection of a mitogen-activated protein kinase kinase (ERK kinase) inhibitor, PD98059, to clarify the role of ERK phosphorylation in neuropathic pain development. Furthermore, we explored the effects of allopregnanolone (by mouth), intra-CN microinjection of γ-aminobutyric acid type A receptor antagonist (bicuculline) or γ-aminobutyric acid type B receptor antagonist (phaclofen) plus allopregnanolone, and allopregnanolone synthesis inhibitor (medroxyprogesterone; subcutaneous) on ERK activation and CCI-induced behavioral hypersensitivity.

Results
At 7 days post-CCI, p-ERK levels in ipsilateral CN were significantly increased and reached a peak. PD98059 microinjection into the CN 1 day after CCI dose-dependently attenuated injury-induced behavioral hypersensitivity (withdrawal threshold [mean ± SD], 7.4 ± 1.1, 8.7 ± 1.0, and 10.3 ± 0.8 g for 2.0, 2.5, and 3.0 mM PD98059, respectively, at 7 days post-CCI; n = 6 for each dose). Double immunofluorescence showed that p-ERK was localized to both astrocytes and microglia. Allopregnanolone significantly diminished CN p-ERK levels, glial activation, proinflammatory cytokines, and behavioral hypersensitivity after CCI. Bicuculline, but not phaclofen, blocked all effects of allopregnanolone. Medroxyprogesterone treatment reduced endogenous CN allopregnanolone and exacerbated nerve injury-induced neuropathic pain.

Conclusions
Median nerve injury-induced CN glial ERK activation modulated the development of behavioral hypersensitivity. Allopregnanolone attenuated glial ERK activation and neuropathic pain via γ-aminobutyric acid type A receptors. Reduced endogenous CN allopregnanolone after medroxyprogesterone administration rendered rats more susceptible to CCI-induced neuropathy.
Advising and Interview Patterns of Medical Students Pursuing Obstetrics and Gynecology Residency
Authors: Alston Meredith J. , Autry Amy (Meg) , Wagner Sarah A. , Allshouse Amanda A. , Stephenson-Famy Alyssa 
Published: September 2016

OBJECTIVE:
To describe the advising practices at medical schools and interview patterns among medical students pursuing obstetrics and gynecology residency training.

METHODS:
A voluntary, anonymous survey was distributed to all applicants interviewing for obstetrics and gynecology residency during the 2014–2015 cycle at the University of Colorado, University of Washington, University of California, San Francisco, and Loyola University. Demographic data were obtained. The survey explored student advising in the residency application process including number of applications and interviews recommended by advisors. Data are reported as percentage for each survey item and compared by select demographics using an exact χ2.

RESULTS:
Among 315 unique possible applicants, 73% (n=230) responded. Students were most commonly advised by the obstetrics and gynecology clerkship director (33%) with recommendations to apply to 21–30 programs (48%). Thirty-four percent of students applied to 21–30 programs, 32% to 31–40 programs, and 30% to greater than 40 programs. Students were advised (70%) and planned (55%) to interview at 10–14 programs. Concern over competitiveness of the applicant pool was the most important factor (31%) in determining the number of applications. The number of programs advised to or plan to interview at was greater for those in the couples match (P<.001).

CONCLUSION:
Medical students pursuing obstetrics and gynecology are most likely to be advised by obstetrics and gynecology clerkship directors and concern over the competitiveness of the applicant pool results in students applying to large numbers of programs. This practice may adversely affect the obstetrics and gynecology match process for both programs and applicants through the requirements of managing additional applications and potentially needing to complete a greater number of interviews.
Heterotopic Ossification: A Review of Current Understanding, Treatment, and Future
Authors: Edwards Dafydd S. , Kuhn Kevin M. , Potter Benjamin K. , Forsberg Jonathan A. 
Published: September 2016

Summary:
Heterotopic ossification is the formation of bone at extraskeletal sites. The incidence of heterotopic ossification in military amputees from recent operations in Iraq and Afghanistan has been demonstrated to be as high as 65%. Heterotopic ossification poses problems to wound healing, rehabilitation, and prosthetic fitting. This article details the current evidence regarding its etiology, prevention, management, and research strategies.