Alicia Armstrong

Hand-held computer operating system program for collection of resident experience data.

Objective: To describe a system for recording resident experience involving hand-held computers with the Palm Operating System (3 Com, Inc., Santa Clara, CA). Program Description: Hand-held personal computers (PCs) are popular, easy to use, inexpensive, portable, and can share data among other operating systems. Residents in our program carry individual hand-held database computers to record Residency Review Committee (RRC) reportable patient encounters. Each residents data is transferred to a single central relational database compatible with Microsoft Access (Microsoft Corporation, Redmond, WA). Patient data entry and subsequent transfer to a central database is accomplished with commercially available software that requires minimal computer expertise to implement and maintain. The central database can then be used for statistical analysis or to create required RRC resident experience reports. As a result, the data collection and transfer process takes less time for residents and program director alike, than paper-based or central computer–based systems. Conclusion: The system of collecting resident encounter data using hand-held computers with the Palm Operating System is easy to use, relatively inexpensive, accurate, and secure. The user-friendly system provides prompt, complete, and accurate data, enhancing the education of residents while facilitating the job of the program director.

Effect of residency program merger on undergraduate medical student education in obstetrics and gynecology.

OBJECTIVEnTo evaluate the effect of residency program merger on third-year medical student clerkships using student evaluations of their experiences and standardized subject examination scores.nnnMETHODSnEnd-of-clerkship ratings from student evaluations and National Board of Medical Examiners standardized subject examination scores in obstetrics and gynecology were used from clerkship sites where three separate military residency programs in obstetrics and gynecology recently merged into two new programs. Mean student evaluation scores and subject examination scores for the year preceding and the year following the merger were compared.nnnRESULTSnThe mean differences in medical student evaluation scores before and after merger of the residency programs were 0.1 (Mann-Whitney rank sum, P = .1), -0.1 (Mann-Whitney rank sum, P = .8), and 0.2 (Mann-Whitney rank sum, P = .3). The mean differences for subject examination scores before and after merger of the residency programs were -3.5 (95% confidence interval [CI] -33.2, 26.2; paired t test), -30.1 (95% CI -58.9, -1.4; paired t test), and -35.3 (95% CI -74.8, 4.3; paired t test).nnnCONCLUSIONnMerger of residency programs in obstetrics and gynecology does not appear to have a deleterious effect on medical students satisfaction with the clerkship or their performance on standardized subject examinations at our institution.

THE USE OF SCREENING ULTRASONOGRAPHY IN THE EVALUATION OF POSTMENOPAUSAL BREAST CANCER PATIENTS ON TAMOXIFEN : IS ENDOMETRIAL ECHO THICKNESS ENOUGH ?

Abstract This study addresses the efficacy of endometrial echo thickness and uterine volume in predicting endometrial histology in postmenopausal breast cancer patients on tamoxifen citrate. Sixty-four post-menopausal women with breast cancer using tamoxifen for at least 6 months were entered in the study. All subjects underwent transabdominal and transvaginal ultrasonography by a board-certified radiologist as well as having an office endometrial biopsy performed by a gynecologist. Twenty of the 64 patients were evaluated on two separate occasions at least 6 months apart. Histologic findings ranged from atrophic or inactive endometrium (N = 29), proliferative endometrium (N = 6), simple hyperplasia without atypia (N = 9), and scant tissue insufficient for diagnosis (N = 20). Endometrial echo averaged 10.6 mm (range: 1.2–25.0 mm), and mean uterine volume was 105 cm3 (range: 12–600 cm3). The correlation between histology and endometrial thickness was not significant (r = 0.12, P = 0.34). However, the correlation between histology and uterine volume was statistically significant (r = 0.31, P = 0.017). Both uterine volume and endometrial thickness were found to increase with duration of therapy but only uterine volume was found to correlate with the length of treatment. This study suggests that tamoxifen has a universal uterotropic effect stimulating myometrial as well as endometrial growth and, in addition, a uterine volume measurement may be more predictive of endometrial histopathology than endometrial thickness in this patient population.