Nadine T. Katz

To the point: medical education review of the role of simulators in surgical training

Simulation-based training (SBT) is becoming widely used in medical education to help residents and medical students develop good technical skills before they practice on real patients. SBT seems ideal because it provides a nonthreatening controlled environment for practice with immediate feedback and can include objective performance assessment. However, various forms of SBT and assessment often are being used with limited evidence-based data to support their validity and reliability. In addition, although SBT with high-tech simulators is more sophisticated and attractive, this is not necessarily superior to SBT with low-tech (and lower cost) simulators. Therefore, understanding the types of surgical simulators and appropriate applications can help to ensure that this teaching and assessment modality is applied most effectively. This article summarizes the key concepts that are needed to use surgical simulators effectively for teaching and assessment.

Simulation training improves medical students' learning experiences when performing real vaginal deliveries.

Objective: To determine the relationship between simulation training for vaginal delivery maneuvers and subsequent participation in live deliveries during the clinical rotation and to assess medical students’ performance and confidence in vaginal delivery maneuvers with and without simulation training. Methods: Medical students were randomized to receive or not to receive simulation training for vaginal delivery maneuvers on a mannequin simulator at the start of a 6-week clerkship. Both groups received traditional didactic and clinical teaching. One researcher, blinded to randomization, scored student competence of delivery maneuvers and overall delivery performance on simulator. Delivery performance was scored (1–5, with 5 being the highest) at weeks 1 and 5 of the clerkship. Students were surveyed to assess self-confidence in the ability to perform delivery maneuvers at weeks 1 and 5, and participation in live deliveries was evaluated using student obstetric patient logs. Results: Thirty-three students were randomized, 18 to simulation training [simulation group (SIM)] and 15 to no simulation training [control group (CON)]. Clerkship logs demonstrated that SIM students participated in more deliveries than CON students (9.8 ± 3.7 versus 6.2 ± 2.8, P < 0.005). SIM reported increased confidence in ability to perform a vaginal delivery, when compared with CON at the end of the clerkship (3.81 ± 0.83 versus 3.00 ± 1.0, respectively, P < 0.05). The overall delivery performance score was significantly higher in SIM, when compared with CON at week 1 (3.94 ± 0.94 versus 2.07 ± 1.22, respectively, P < 0.001) and week 5 (4.88 ± 0.33 versus 4.31 ± 0.63, P < 0.001) in the simulated environment. Conclusions: Students who receive simulation training participate more actively in the clinical environment during the course of the clerkship. Student simulation training is beneficial to learn obstetric skills in a minimal risk environment, demonstrate competency with maneuvers, and translate this competence into increased clinical participation and confidence.

e-Professionalism: a new frontier in medical education.

Background: This article, prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, discusses the evolving challenges facing medical educators posed by social media and a new form of professionalism that has been termed e-professionalism. Summary: E-professionalism is defined as the attitudes and behaviors that reflect traditional professionalism paradigms but are manifested through digital media. One of the major functions of medical education is professional identity formation; e-professionalism is an essential and increasingly important element of professional identity formation, because the consequences of violations of e-professionalism have escalated from academic sanctions to revocation of licensure. Conclusion: E-professionalism should be included in the definition, teaching, and evaluation of medical professionalism. Curricula should include a positive approach for the proper professional use of social media for learners.

Preeclampsia: An Obstetrician's Perspective

Preeclampsia is a pregnancy-specific syndrome that usually develops after 20 weeks gestation. The exact pathogenic mechanisms remain uncertain and are likely multifactorial. Preeclampsia is a heterogeneous condition with potentially maternal and fetal consequences. As part of the spectrum of hypertensive disorders of pregnancy, preeclampsia may progress rapidly and is a leading cause of maternal and perinatal morbidity and mortality worldwide. In the United States, the incidence of preeclampsia has increased. Clinical manifestations are highly variable and may occur antepartum, intrapartum, or postpartum. Hypertension and proteinuria are the traditional hallmarks for the diagnosis of preeclampsia. These signs may occur with or without multisystem dysfunction and fetal involvement. Risk factors have been identified for the development of preeclampsia; however, ideal methods for prevention, screening, and treatment remain elusive. Preeclampsia resolves after delivery of the fetus, but patients may still have hypertension postpartum. Women and fetuses affected by preeclampsia are at higher risk of developing long-term health issues. There appear to be risk factors common to hypertensive disorders of pregnancy and cardiovascular disease seen later in adulthood. Physicians providing healthcare to women are urged to recognize potential risk factors that arise from patient obstetric histories so that optimal long-term health surveillance is provided.

To the point: Medical education reviewsongoing call for faculty development

This article in the To the Point series will focus on best practices regarding faculty development in medical education in the field of obstetrics and gynecology. Faculty development is an essential component in achieving teacher and learner satisfaction as well as improving learner outcomes. The Liaison Committee on Medical Education requires medical school faculty to have the capability and longitudinal commitment to be effective teachers. Although many programs have been created to address faculty development, there remains a paucity of literature documenting the impact of these programs on learner outcomes. We reviewed the qualities of an excellent medical educator, expectations regarding medical school teaching faculty, elements of comprehensive faculty development programs, and outcome measures for evaluating the effectiveness of these programs.

Alliance for Clinical Education Perspective Paper: Recommendations for Redesigning the “Final Year” of Medical School

Background: Although medical school typically lasts 4 years, little attention has been devoted to the structure of the educational experience that takes place during the final year of medical school. Summary: In this perspectives paper, we outline goals for the 4th year of medical school to facilitate a transition from undergraduate to graduate medical education. We provide recommendations for capstone courses, subinternship rotations, and specialty-specific schedules, and we conclude with recommendations to medical students and medical schools for how to use the recommendations contained in this document. Conclusions: We provide an overview of general competencies and specialty specific recommendations to serve as a foundation for medical schools to develop robust 4th-year curricula and for medical students to plan their 4th-year schedules.

The obstetrics and gynaecology resident as teacher.

In this article we discuss the role residents play in the clinical training and evaluation of medical students. A literature search was performed to identify articles dealing with research, curriculum, and the evaluation of residents as teachers. We summarize the importance of resident educators and the need to provide appropriate resources for house staff in this role, and we review evidence-based literature in the area of residents as teachers. Specific attention is given to the unique circumstances of the obstetrics and gynaecology resident, who is often faced with teaching in an emotionally charged and stress-filled environment. We present examples of curricula for residents as teachers and describe barriers to their implementation and evaluation.

To the point: A primer on medical education research

This article, from the To the Point series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, provides educators with an introduction to medical educational research by describing the framework of educational scholarship, discussing the similarities and differences between clinical and educational research, reviewing the key steps in educational research, and providing examples of well-designed studies in the field of obstetrics and gynecology.

Case-based Nutrition Teaching for Medical Students

*Address for correspondence: Ashlesha K. Dayal, MD, Department of Obstetrics and Gynecology and Women’s Health, Jack D. Weiler Hospital of the Albert Einstein College of Medicine, 1825 Eastchester Road, 7 Floor, Bronx, NY 10461; Phone: (718) 904-2767; Fax: (718) 904-2799; E-mail: ashdayal@yahoo.com This paper was presented as a poster at the annual meeting of CREOG-APGO on March 2-5, 2005 in Salt Lake City, Utah. doi: 10.1016/j.jneb.2007.09.010

A comprehensive review to establish priority learning objectives for medical students in the obstetrics and gynecology clerkship

OBJECTIVE This study was undertaken to describe the process used to identify, externally validate, and establish the priority learning objectives for medical students on the obstetrics and gynecology clerkship. STUDY DESIGN We conducted a review of the APGO Medical Student Objectives in Obstetrics and Gynecology to establish which of these objectives should be given first priority. We used recommendations from external references to assess the validity of these selected objectives. We compared the distribution of objectives with levels of expected competency from Millers pyramid. RESULTS From a list of 267 unique learning objectives we identified 134 (50.2%) Priority 1 objectives students must master by the end of the clerkship. The recommendations from 17 external references were compared with this set of objectives, which demonstrated a significant correlation between the 2 (P < or = .001). Priority 1 objectives were associated with advanced levels of competency. CONCLUSION External sources validated and helped prioritize the learning objectives.