bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disc origin of broad optical emission lines of the TDE candidate PTF09djl
Authors: Liu F. K. , Zhou Z. Q. , Cao R. , Ho L. C. , Komossa S. 
Published: September 2017

Abstract
An otherwise dormant supermassive black hole (SMBH) in a galactic nucleus flares up when it tidally disrupts a star passing by. Most of the tidal disruption events (TDEs) and candidates discovered in the optical/UV have broad optical emission lines with complex and diverse profiles of puzzling origin. In this Letter, we show that the double-peaked broad H α line of the TDE candidate PTF09djl can be well modelled with a relativistic elliptical accretion disc and the peculiar substructures with one peak at the line rest wavelength and the other redshifted to about 3.5 × 104 km s−1 are mainly due to the orbital motion of the emitting matter within the disc plane of large inclination 88° and pericentre orientation nearly vertical to the observer. The accretion disc has an extreme eccentricity 0.966 and semimajor axis of 340 BH Schwarzschild radii. The viewing angle effects of large disc inclination lead to significant attenuation of He emission lines originally produced at large electron scattering optical depth and to the absence/weakness of He emission lines in the spectra of PTF09djl. Our results suggest that the diversities of line intensity ratios among the line species in optical TDEs are probably due to the differences of disc inclinations.
Establishing Extrapolation Evidence for the MyTIPreport Feedback Application Using a Contemporary Validation Approach
Authors: DeStephano Christopher , Dinh Tri , Seibel Brent , McCullough Deanna , Best Kelly 
Published: September 2017

BACKGROUND:
OB/GYN residencies use myTIPreport to improve resident feedback. Validation is viewed as a process with construct validity established from different levels of evidence. In Kane's validity framework, extrapolation focuses on links between assessment outcomes and other measures of performance.

METHODS:
Single-institution, prospective cohort study of OB/GYN residents (n=24). Using the ACGME case log system and myTIPreport application, associations of PGY level, number of previous hysteroscopies (HSC), total vaginal hysterectomies (TVH), and total abdominal hysterectomies (TAH) with myTIPreport ratings of each procedure when performed in the operating room were assessed using Spearman's test correlation. A pilot study of inexpensive, low technology simulation models was initiated to assess extrapolation evidence for myTIPreport in the simulation setting (n=8).

RESULTS:
Associations (P<.01) existed between PGY level and myTIPreport scores in the OR (r=0.612 for HSC, r=0.763 for TAH, r=0.864 for TVH). Associations (P<.01) existed between number of procedures performed and myTIPreport scores in the OR (r=0.587 for HSC, r=0.681 for TAH, r=0.869 for TVH). An association (r=0.852, P=.031) existed between number of TVHs performed in the OR and myTIPreport scores during simulation, but not for TAH (P=.199) nor HSC (P=.154) due to the small sample size.

DISCUSSION:
The association between myTIPreport TVH performance with PGY level and number of TVHs was the strongest, supporting extrapolation evidence. The associations were weaker for TAH and HSC in both the OR and simulation settings secondary to higher ratings for lower PGY levels and fewer cases.
The Impact of a Postpartum Rounding Video Module on Medical Student Learning During the Obstetrics and Gynecology Core Clerkship
Authors: Friedman M. Alexandra , Tarr Lizzie , Has Phinnara , Hampton B. Star 
Published: September 2017

BACKGROUND:
The 4C-ID model has been adapted for medical education to help students manage significant cognitive loads while developing strategies for improvement. To date, no 4C-ID intervention exists for the wards or postpartum rounding.

METHODS:
Third-year medical students on the OB-GYN core clerkship who agreed to participate were randomized by clerkship block to receive the 20-minute postpartum rounding video module, or standard education. Knowledge and clinical reasoning were assessed during orientation and clerkship conclusion using a clinical scenario (32 points) and the Diagnostic Thinking Inventory (246 points). Satisfaction was assessed using Likert scale questions (0–5, 5=very satisfied/strongly agree).

RESULTS:
Seventy-eight of 79 eligible students participated. The only significant baseline difference between groups was greater knowledge of physical exam skills in the intervention group (4.8/7, 4.1/7 P=.049). Students in the intervention group demonstrated higher postintervention improvement in knowledge (8.9, 4.5 P=.0011). Both groups increased clinical reasoning, however there was no significant difference between groups pre- or postintervention (160.1, 160.5 P=.92,165.0, 168.8 P=.34). Students in the control group reported a better clerkship experience (3.9, 3.5 P=.04). Students who received the video would recommend the video to their peers (3.7).

DISCUSSION:
A postpartum video based in the 4C-ID model of education increased student knowledge in the 3rd-year medical student OB-GYN core clerkship. Video learning is acceptable to medical students, and can be easily incorporated into specialty rounds at any institution.
Teaching Vaginal Hysterectomy: Low Fidelity Trainer Provides Effective Simulation at Low Cost
Authors: Braun Kelli , Henley Barbara , Ray Chadburn , Stager Robert , Rungruang Bunja 
Published: September 2017

BACKGROUND:
Decline in hysterectomies and provider comfort have led to decreased exposure to total vaginal hysterectomy (TVH) during residency training. Commercial simulation products exist but are cost-prohibitive for consistent use in training.

METHODS:
Pilot study of a novel low fidelity TVH trainer. A complete vaginal hysterectomy trainer was modified from previously published models to include vulva (for operating in confined space) and more realistic-feeling materials. Items used included: “pelvic base”- flower pot and board; “vulva”- pink foam cowboy hat; uterine insert (suspended within pelvic base) composed of “uterus”- pool noodle, “uterosacral ligaments”- elastic bands, “round ligament and fallopian tubes”-long balloons, “ovaries”- round balloons, “vessels and ureters”-pipe cleaners, and “peritoneum”- Press'n Seal. Residents rated confidence in performing TVH, pre- and postsimulation with trainer.

RESULTS:
Five reusable pelvic bases ($10/base) and 16 replaceable uterine inserts ($2/insert) were constructed. The trainer functioned well with surgical instruments and suture, although reloading the pelvic base was time consuming. All participating residents (n=14) successfully performed the steps of TVH. Change in mean resident confidence was statistically significant pre- (M=2.08/5) and post- (M=3.17/5) simulation, P=.004.

DISCUSSION:
Our trainer is easily constructed for minimal cost. It can be used in residency training programs to simulate total vaginal hysterectomy and improve resident confidence in performing TVH. We have since updated the base to a flip-top trashcan to facilitate reloading.
Senior Obstetrician Supervision Improves Resident Labor and Delivery Rotation Experience
Authors: Bardos Jonah , Fox Nathan , Loudon Holly , Rekawek Patricia , Brodman Michael , Wagner Brian 
Published: September 2017

BACKGROUND:
In December 2012, the Mount Sinai Hospital implemented a program to have senior obstetricians, with experience in forceps-assisted vaginal delivery, supervise residents on labor and delivery during the day hours. The objective of this study was to estimate the effect of this program on resident satisfaction with the Labor and Delivery rotation.

METHODS:
This was a retrospective cohort study from July 2011 to June 2015. We compared resident satisfaction prior to and after December 2012 using Student's t test. Over the course of the study period, residents were routinely surveyed regarding their rotation experience. Each rotation block was 6 weeks for the PGY-1, and 7 weeks for PGY-2 and PGY-4 residents who rotated. Surveys were sent anonymously through an online program. Surveys consisted of eight questions (scaled 1–5) including whether the rotation fostered development of relevant medical knowledge, an improvement in physical examination skills, whether the rotation improved residents’ ability to manage relevant problems and the overall quality of the educational experience.

RESULTS:
Ninety-four percent of the residents completed the rotation evaluations. Comparing responses prior to and after December 2012, resident overall satisfaction for the rotation significantly improved (2.3–4.2, P<.05), with increased reporting of meeting the intended goals and objectives in the senior level residents (2.1–4.7, P<.05). Additionally, PGY-1 residents reported a significant increase in their physical exam skills (2.0–4.1, P<.05) and the ability to formulate a differential diagnosis (2.1–4.0, P<.5). After December 2012, there was a significant increase in forceps deliveries among residents from 0.6% to 2.6% of all deliveries (aOR 8.41, 95% CI 3.1, 23.0).

DISCUSSION:
Implementing a program with senior obstetrician supervision of residents on Labor and Delivery significantly increases the resident satisfaction and overall educational experience. This may be partly due to increased training in operative deliveries. Our data suggest that a small change in resident supervision can have a major impact on resident education.
A Comparative Analysis Using Endoscopic Simulation to Assess Surgical Skill of OB/GYN Residents
Authors: Duarte Jhonathan , Patruno Joseph , Pellini Timothy , Martino Martin , Corsi Taylor , Bonner Shannon 
Published: September 2017

BACKGROUND:
Endoscopic skill curriculums using simulation tools have proven to be efficacious in training and in evaluating competency in residents performing endoscopic procedures. OB/GYN residents in a single institution were evaluated using various modalities in the simulation setting. There are few data on the value of endoscopic simulation in assessing efficiency, dexterity, and technical ability and how it compares with actual OR performance of trainees.

METHODS:
This study was a prospective, observational study, assessing skill in simulation exercises in hysteroscopy, laparoscopy, and robotics. Performance results were compared to surgical experience based on residents' OPLOG data, NewInnovation surgical evaluation scores, and endoscopy-specific milestone assessment. The study included all OB/GYN residents from a single training program. Testing was performed in 11 different exercises using simple box trainers and computer simulators for laparoscopy (Symbionix) and robotics (Mimic). Scoring included time, with alteration for errors or dangerous movements, and efficiency based on path of motion.

RESULTS:
When comparing PGY year versus total time, the average total time decreased as PGY level increased for all exercises except for the Symbionix laparoscopic trainer. This trend was also consistent for efficiency and motion metrics. These performance metrics were also better in residents who had completed a larger number of actual operative procedures. Resident performance in the simulated setting, however, did not correlate well with prior surgical evaluations or endoscopic milestone assessments.

DISCUSSION:
Implementation of a multimodal simulation curriculum focused on endoscopic procedures could provide a safe, and objective means than may be used to evaluate endoscopic performance of residents. Performance on simple skill correlates positively with level of training and prior experiential numbers. There was little correlation between resident performance and past resident surgical evaluations used in our institution. Based on these data, we are considering surgical evaluation paradigm that combines both simulation and actual procedural performance metrics.
An 8-Week Mindfulness-Based Stress Reduction Course for Ob/Gyn Residents: A Pilot Study
Authors: Cavanaugh Erin , Rose Marisa 
Published: September 2017

BACKGROUND:
Studies have linked improved physician well-being with better patient outcomes. Despite the documentation of growing job dissatisfaction, burnout, and depression among OBGYN residents, few interventions have been studied. Mindfulness-based stress reduction (MBSR) has been shown to significantly improve personal well-being and job satisfaction in primary care specialties, but has not been investigated in obstetrics and gynecology.

METHODS:
An 8-week MBSR course specifically designed for medical professionals was created and led by a certified Mindfulness Teacher. Participants completed a pre- and postintervention survey measuring burnout, anxiety, mindfulness, resilience, stress, and depression by validated scales. McNemar's test was used to assess changes in outcome measures.

RESULTS:
All 21 of the eligible residents participated in four or more of the eight weekly 1-hour lectures. At the 2-month postintervention survey, participants demonstrated statistically significant improvements in stress, anxiety, and focus. Residents showed no statistical improvement in depression or burnout scores.

DISCUSSION:
Our pilot study demonstrated that an 8-week MBSR course was associated with improvements in some but not all measured outcomes of burnout, mindfulness, resilience, stress, and depression. We are currently piloting a reformatted course with shortened but more frequent programs to support and improve the well-being of our residents.
Avoiding Poison Apples in the Land of Tomorrow: Patient Satisfaction With Residents Versus Non-Physician Providers in an Obstetrics and Gynecology Academic Medical Center Practice
Authors: Dade Adrianne , Blanchard Anita , Young Danielle , Kupfer Rachel 
Published: September 2017

BACKGROUND:
Non-physician providers (NPPs) [physician assistants (PAs), nurse practitioners (APNs), and certified nurse midwives (CNMs)] may be used to supplement duties traditionally filled by Obstetrics & Gynecology (OB/GYN) residents. NPPs provide high level of care and may help protect resident time without compromising patient satisfaction.

METHODS:
Patients attended to for the majority of their appointments by either NPPs or residents were anonymously surveyed about satisfaction with their health care provider. The survey had 15 questions and was developed in conjunction with a professional survey lab at the University of Chicago. The study was sufficiently powered (80%) to detect equivalency of up to 2.2 points in average scores (out of possible 38) between the NPP and resident group.

RESULTS:
One hundred sixty-nine total patients were surveyed (resident=103, NPP=66). Patients seen by NPPs were younger (P<.001) and more often seen for obstetric or postpartum care (P<.001) compared to patients seen by residents. There was no difference (P=.48) in overall patient satisfaction if seen by an NPP (mean score: 35.21±4.40) or resident (mean score: 34.72±4.08). Small differences were detected in individual questions. A higher proportion of patients reported having all their questions answered by NPPs (100%) than by residents (93.94%) (P=.05) and a slightly higher proportion of patients reported having a “fair amount” or “a lot” confidence in NPPs (98.48%) versus residents (91.26%) (P=.04).

DISCUSSION:
Patients were equally satisfied with NPP and resident providers.
Creating a Sustainable ObGyn Residency in a Resource-Limited Country Improves Maternal Health Outcomes
Authors: Evans Lindsey , Derkenne Ruth , Liu James , Larkins-Pettigrew Margaret 
Published: September 2017

BACKGROUND:
The 2013 maternal mortality ratio (MMR) in Guyana was 250/100,000 live births according to the WHO, compared to a regional average of 68. Inadequate quality of care, shortage of skilled health care professionals, and systemic limitations are contributing factors.

METHODS:
In 2012 University Hospitals/Case Medical Center (UHCMC), Georgetown Public Hospital Corporation (GPHC) and University of Guyana collaborated to develop a 4-year ObGyn training program using curriculum formalized at UHCMC, modified to suit local needs. A multi-academic institutional partnership allowed international faculty involvement in training Guyana's first ObGyn residents (MDG-8). Maternal morbidity and mortality outcomes (MDG-5) were prospectively maintained, analyzed, and compared to rates prior to program implementation.

RESULTS:
Twenty-three residents were trained and five residents completed the program in 2016. Full-time staff are present in Guyana, and 52 faculty from partnering institutions travelled to Guyana to teach and provide patient care. Development of modified evidence-based clinical guidelines improved quality of care and patient safety outcomes. MMR from direct causes decreased country-wide and at GPHC during the 4-year period. Success was due to shared institutional vision, establishment of partner organizations, resident leadership development, and systems-based improvement. Future challenges include trainee retention and continued sustainability.

DISCUSSION:
Guyana’s first ObGyn residency program can serve as a model for similar endeavors in global health. Creation of sustainable training programs in ObGyn through international partnerships is essential progress toward achieving MDGs 5 and 8.
DREAM: Empowering Preclinical Students With Labor Support Training
Authors: Shakartzi Hannah , Pierre-Joseph Natalie , Marino Rachel , Rodrigues Dona , Omer Roy Nicole St. , Abbott Jodi 
Published: September 2017

BACKGROUND:
Preclinical medical education is largely lecture-based with limited patient-experience prior to clinical rotations. Consequently, students begin rotations with low confidence regarding patient communication skills and their utility to the care-team. Minimal clinical exposure, in tandem with intense academic work, likely contributes to student burnout. Furthermore, OB/GYN residencies struggle with recruitment. Concurrently, many pregnant women lack optimal support throughout pregnancy when evidence shows that continuous labor support improves outcomes.

METHODS:
Preclinical medical students are trained by hospital-based doulas and midwives to provide holistic prenatal, labor, and postpartum support. Students are paired with doulas for one labor, and one prenatal, postpartum, and home visit, prior to having independent clients.

RESULTS:
Students gained comprehensive OB/GYN knowledge and developed confidence providing comfort, advocacy, and facilitating patient-care-team communication. Reflections like, “I learned how to be there in a very personal and intimate way for someone I hardly knew,” and “now, on my OB/GYN rotation, I feel much more comfortable jumping in and helping women,” confirm preliminary findings. Patient reflections included, “I can't believe that someone who is going to be a Doctor, took the time to spend so much time with me.”

DISCUSSION:
Student-provided labor support is beneficial for both students and patients.
Education on the Go: Studying the Use of Podcasts in Resident Education
Authors: De Los Reyes Samaqntha , Cholakian Diana , Chau Danielle , Forde Braxton , Johnson Clark , Bienstock Jessica 
Published: September 2017

BACKGROUND:
Podcasting has become a mainstream media commodity, although its implementation into medical education has yet to be studied. Podcasting curricula can be readily created and disseminated for educational efficiency.

METHODS:
Four podcasts were created to cover information from American College of Obstetricians and Gynecologists’ Practice Bulletins. All residents in our academic program were randomized to access the bulletins or both podcasts and bulletins. Both groups were offered posteducation quizzes. Outcomes included resident quiz completion as well as overall performance. Analysis was performed using standard statistics in Stata 14, with significance defined as P<.05. This project was IRB-approved.

RESULTS:
Overall, 126 quizzes were administered to 36 residents. Thirty-eight (30.2%) posteducation quizzes were completed, including 16 (27.6%) from residents who received podcasts and 22 (32.4%) from those who did not, a difference that was not statistically significant (P=.56). Similarly there was no significant difference in average quiz scores between podcast and traditional groups (70±22.3% and 80±17.1% respectively, P=.17).

DISCUSSION:
Podcasts have become an efficient and popular way for residents to learn. We noted equivalent participation and comprehension of the curriculum whether or not podcasts were used in conjunction with self-directed reading. The addition of podcasts to a resident curriculum may not significantly improve scores or participation. Future studies may evaluate the efficiency of education through podcasting in the ob/gyn residency given its noninferiority to traditional self-directed learning.
Engaging Residents in Quality Improvement: A Multidisciplinary Collaboration to Decrease the Primary Cesarean Delivery Rate at a New Academic Medical Center
Authors: Williams Liliana Padilla , Harris Roberto Prieto , Hirani Zishan , Ballesteros Carlos , Gonzalez Aida , Hernandez Annabelle 
Published: September 2017

BACKGROUND:
Our facility performs more than 9,000 deliveries per year, with a primary cesarean birth rate of 35% and is the primary teaching site for a new Ob/Gyn residency program. An innovative curriculum includes a formal course in quality improvement methods for new faculty, and active participation of all residents in a QI project. In an effort to decrease the primary cesarean birth rate, a multidisciplinary QI project was developed.

METHODS:
The team was led by two community faculty members and included two residents, nursing and hospital administration. Interventions included mandatory completion of a FHR course, provider education on current terminology and recommended interventions, and monthly reporting of cesarean delivery rates. The team used a fishbone analysis of the steps leading to a cesarean delivery to create a data collection checklist. Charts were reviewed by the residents to confirm the indication for cesarean delivery along with other pertinent variables.

RESULTS:
The primary cesarean birth rate decreased from 35% in the first quarter of 2015 to 27% in the first quarter of 2016, a 24% decrease. The project team continues to meet quarterly to discuss ongoing activities necessary to maintain and increase the improvement observed in the initial quarter. Residents and faculty report a strong sense of accomplishment as a result of the project, and an interest in continued participation in QI activities.

DISCUSSION:
Interdisciplinary partnerships between OBGYN residents, faculty and hospital administration/staff to develop and implement quality improvement projects can improve patient care and provide learners with the knowledge and expertise to engage in quality projects in their future practice.