Rudi Ansbacher

Assembling the optimal mentor team.

Mentoring has long been a critical component of medical training. Traditionally, medical training was an apprenticeship, where physicians learned their trade through apprenticeships with practicing physicians. Subspecialization and diversified training programs have altered the traditional medical mentoring model. As the field of obstetrics and gynecology has developed, the role of the mentor has evolved as well.

Atypical glandular cells of undetermined significance histologic findings and proposed management

OBJECTIVEnTo increase understanding of the clinical significance of atypical glandular cells of undetermined significance (AGUS) on cervical cytology and to suggest a management plan.nnnSTUDY DESIGNnAll Pap smears classified as AGUS over a period of five years at the University of Michigan Medical Center were reviewed and the diagnosis confirmed. The charts of these patients were reviewed for demographics, significant previous medical history, symptoms, diagnostic studies performed and final histologic diagnoses.nnnRESULTSnIn 1993-1998, a total of 208,041 Pap smears were read. Two hundred seven smears from 189 patients were classified as AGUS, for an incidence of 0.1%. There were 136 patients with follow-up information and 114 patients with histologic diagnoses. In 55 of the 114 patients (48%), significant histologic abnormalities were observed, including 11 endometrial cancers, 1 invasive adenocarcinoma of the cervix, 3 adenocarcinomas in situ of the cervix, 18 CIN 3 lesions and 5 CIN 2 lesions. Among 20 patients with Pap smears subclassified as atypical glandular cells of undetermined significance, favor benign process, there were two CIN 2, five CIN 3 and one adenocarcinoma in situ of the cervix.nnnCONCLUSIONnA diagnosis of AGUS requires an aggressive workup because of the high rate of cancer and precancerous lesions. The evaluation, at the very least, should include colposcopy with directed biopsies and endocervical curettage. Postmenopausal patients, those with irregular bleeding and those with high risk characteristics should also undergo endometrial biopsy.

Animal surgery: An adjunct to training in obstetrics and gynecology

A resident in obstetrics and gynecology obtains adequate experience in basic gynecologic surgery during a 3-year training program, but the technical skill acquired in surgery of the bowel, bladder, ureters, and pelvic vessels is limited by the clinical material available. A program is described in which 3 animal models (dog, rabbit, cat) were used to expand the surgical skills of gynecology residents. The increased surgical competence and professional stimulation provided the residents by this program are shown to be both cost- and time-effective.