Deborah Bartz

Preparing Students for College: The Implementation and Impact of the Early College High School Model

As implemented in North Carolina, Early College High Schools are small, autonomous schools designed to increase the number of students who graduate from high school and are prepared for postsecondary education. Targeted at students who are underrepresented in college, these schools are most frequently located on college campuses and are intended to provide students with 2 years of college credit upon graduation from high school. This article reports on preliminary 9th-grade results from 285 students in 2 sites participating in a longitudinal experimental study of the impact of the model. These early results show that significantly more Early College High School students are enrolling and progressing in a college preparatory course of study. This expanded access, however, is associated with somewhat lower pass rates for some courses, suggesting the need for strong academic support to accompany increased enrollment in more rigorous courses. Implementation data collected on one school indicate that it is successfully implementing the models components.

Intrauterine Device Knowledge and Practices: A National Survey of Obstetrics and Gynecology Residents

Objectives The primary objective of this study was to assess the current intrauterine device (IUD) knowledge and counseling practices of US obstetrics and gynecology chief residents. The secondary objective was to evaluate the current IUD experience of obstetrics and gynecology residents. Methods A Web-based survey about IUD knowledge and practices was sent to US obstetrics and gynecology residents in January 2010. An analysis of responses by postgraduate year was completed using descriptive statistics. Results We received 699 surveys (36%) from a pool of 1922 residents in 96 different residency programs. A total of 654 respondents (94%) had placed an IUD during residency and 88% had received formal teaching about IUDs during residency. Only 53% of respondents knew that the copper IUD could be used for emergency contraception. Less than 65% of respondents would routinely recommend the IUD to adolescents or immediately after first trimester abortion. Conclusions Many US obstetrics and gynecology residents lack knowledge about IUD benefits and do not counsel all eligible women to use IUDs. We should continue to evaluate our training and educational programs to ensure that women’s health providers do not act as a barrier to IUD use.

Women's preferences for pain control during first-trimester surgical abortion: a qualitative study

BACKGROUND To explore womens preferences for pain control during first-trimester surgical abortion. STUDY DESIGN Pre- and postoperative semistructured individual interviews were conducted with 40 women divided into eight strata by anesthesia choice, age and prior vaginal delivery status. We identified key themes in the interviews and analyzed baseline characteristics and responses to close-ended questions within and across the strata. RESULTS For most women, pain control options were not the primary concern in choosing a clinic for an abortion. Women who received intravenous (IV) sedation had lower pain scores and were more likely to report that they would recommend that method to a friend than women who received local anesthesia alone. Women described the pain as a cramping, tugging, pulling and scraping sensation. Respondents recommended IV sedation for a woman who was very anxious or could not tolerate pain, even though more nausea and vomiting may occur. CONCLUSIONS Most women felt that pain control decisions should be individualized.

Gynecologic Simulation Training Increases Medical Student Confidence and Interest in Women's Health

Background: Exposure to commonly performed gynecologic procedures via simulation has potential to improve medical student knowledge and foster confidence with procedures. Purposes: To implement and evaluate a gynecologic simulation curriculum for 3rd-year medical students during their obstetrics and gynecology core clerkship. Methods: A gynecologic simulation curriculum was implemented for medical students during their obstetrics and gynecology clerkship. Participants completed pre-and postsurveys to assess learner confidence; effect on interest in a surgical field, womens health, and obstetrics and gynecology as a career; and whether the session met their learning needs. Results: Fifty-nine students participated. Improved confidence in performing the procedures was noted when comparing mean survey scores before and after the simulation for IUD insertion and removal (1.9 pre, 4.3 post, p < .0001), for dilatation and curettage (1.7 pre, 3.8 post, p < .0001), and basic laparoscopy skills (2.1 pre, 4.3 post, p < .0001). An increase in pursuing a surgical field (3.3 pre, 3.6 post, p < .003) and interest in womens health (3.7 pre, 4.9 post, p < .004) was noted among students after the simulation session. The curriculum strongly met the students learning needs with a mean score of 4.54 on the 5-point scale. Conclusions: Gynecologic simulation training for medical students can increase confidence in procedures, interest in pursuing a surgical field and womens health, and was highly effective in meeting student learning needs.

Young children communicate their ignorance and ask questions

Children acquire information, especially about the culture in which they are being raised, by listening to other people. Recent evidence has shown that young children are selective learners who preferentially accept information, especially from informants who are likely to be representative of the surrounding culture. However, the extent to which children understand this process of information transmission and actively exploit it to fill gaps in their knowledge has not been systematically investigated. We review evidence that toddlers exhibit various expressive behaviors when faced with knowledge gaps. They look toward an available adult, convey ignorance via nonverbal gestures (flips/shrugs), and increasingly produce verbal acknowledgments of ignorance (“I don’t know”). They also produce comments and questions about what their interlocutors might know and adopt an interrogative stance toward them. Thus, in the second and third years, children actively seek information from interlocutors via nonverbal gestures or verbal questions and display a heightened tendency to encode and retain such sought-after information.

Young children’s developing conception of knowledge and ignorance: work in progress

Abstract When do children acquire an understanding of knowledge and ignorance? We analyzed the early development of children’s spontaneous references to knowing and not knowing and conclude that 2-year-olds talk explicitly and cogently about their own knowledge as well as that of an interlocutor. Two-year-olds also admit their own ignorance. Moreover, consistent with their realization that an informant may know what they do not, 2-year-olds ask many information-seeking questions. Finally, we discuss children’s receptivity and skepticism, especially toward the counterintuitive claims of an adult. We conclude that children’s conception of knowledge and ignorance begins early but undergoes protracted refinement.

Second trimester dilation and evacuation: a risk factor for preterm birth?

Objective:To evaluate whether second trimester pregnancy termination with dilation and evacuation (D&E) vs induction of labor (IOL) affects subsequent risk of preterm birth.Study Design:Our cohort was a retrospective cohort of women undergoing second trimester pregnancy termination for fetal anomalies, fetal death or previable premature rupture of membranes. We analyzed the rates of spontaneous delivery <37 weeks in the first pregnancy following the termination. We also compared preterm birth rates in our cohort with national averages and analyzed by the total number of prior procedures.Result:There were 173 women in our cohort. Women who had undergone a D&E (n=130) were less likely to have a subsequent preterm birth (6.9 vs 30.2%; P<0.01). This held true for a low risk subset without obstetric risk factors. There was no statistical difference in preterm birth rates for women who had undergone a D&E as compared with national averages, nor between the rates of preterm birth for women with 0, 1, 2 or 3 or more prior first or second trimester procedures.Conclusion:We did not find that D&E was a risk factor for preterm delivery when compared with women with a prior IOL or national rates.

Early serum human chorionic gonadotropin (hCG) trends after medication abortion.

OBJECTIVES Despite increased reliance on human chorionic gonadotropin (hCG) for early pregnancy monitoring, there is limited information about hCG trends soon after medication abortion. The purpose of this study was to determine if there is a predictable decline in serum hCG values shortly after medication abortion. STUDY DESIGN This is a retrospective study of women with early intrauterine pregnancies who underwent medication abortion with mifepristone and misoprostol and had a serum hCG level on Day 1 (day of mifepristone) and a repeat value on Day 2 to 6. The percent hCG decline was calculated from baseline to repeat measure, with repeat values from the same patient accounted for through repeated measure analysis of variance. RESULTS Eighty-eight women with a mean gestational age of 5.5 weeks and median baseline hCG of 5220 IU met study criteria over a 3-year period. The mean decline (±SD) in hCG from the Day 1 baseline value was 56.9%±29.5% on Day 3, 73.5%±38.6% on Day 4, 86.1%±8.8% on Day 5, and 92.9%±3.4% on Day 6. Eighty-two women (93% of the cohort) had a complete abortion without further intervention. The least square means hCG decline among these women was 57.6% [95% confidence interval (CI): 50.3-64.9%] on Day 3, 78.9% (95% CI: 75.0-82.8%) on Day 4 and 86.2% (95% CI: 81.3-91.1%) on Day 5. CONCLUSION There is a rapid decline in serum hCG within the first few days after early medication abortion. Further research is needed to delineate how soon after medication abortion this decline may be specific enough to confirm abortion completion. IMPLICATIONS This study provides the largest cohort of patients followed with serial hCG values in the first few days after medication abortion. Our findings demonstrate the trend in hCG decline in this population, which may be predictable by Day 5.

Medical student intrauterine device knowledge and attitudes: an assessment of clerkship training.

BACKGROUND Studies demonstrate that many clinician populations have poor knowledge of and harbor negative attitudes towards intrauterine devices (IUDs). We set out to assess the impact of the clinical clerkship in obstetrics and gynecology on medical student IUD knowledge and attitudes. STUDY DESIGN In this prospective cohort study, students at seven diverse US medical schools were surveyed at the start and completion of their obstetrics and gynecology clinical clerkships regarding IUD exposure, knowledge and attitudes. Subject responses were compared pre- and postclerkship. RESULTS One hundred six students returned completed paired surveys (response rate 82%). The preclerkship mean knowledge percent correct (54%, SD 17%) increased significantly at postclerkship assessment (72%, SD 18%) (p<.0001). The mean attitudes score also increased significantly from pre- (34%, SD 31%) to postclerkship (59%, SD 26%) (p<.0001). CONCLUSIONS US medical student IUD knowledge and attitudes are significantly improved through the obstetrics and gynecology clerkship. However, significant gaps in knowledge persist postclerkship.

Trends in direct-to-consumer advertising of prescription contraceptives

OBJECTIVE Despite much speculation about the role of direct-to-consumer advertising (DTCA) in increasing demand for prescription contraceptives in the United States, there is little published research on this topic. We sought to quantify the prevalence and magnitude of DTCA for prescription contraceptives over the last decade. STUDY DESIGN Using cross-sectional data from January 2005 through December 2014, we performed descriptive analyses on trends in DTCA expenditure for prescription contraceptives. We also quantified the amount of DTCA according to contraceptive method category and individual brand. RESULTS During the study period, pharmaceutical companies spent a total of US