Sarah A. Wagner

Global health training in US obstetrics and gynaecology residency programmes: perspectives of students, residents and programme directors

Background Benefits of exposure to global health training during medical education are well documented and residents’ demand for this training is increasing. Despite this, it is offered by few US obstetrics and gynaecology (OBGYN) residency training programmes. Objectives To evaluate interest, perceived importance, predictors of global health interest and barriers to offering global health training among prospective OBGYN residents, current OBGYN residents and US OGBYN residency directors. Methods We designed two questionnaires using Likert scale questions to assess perceived importance of global health training. The first was distributed to current and prospective OBGYN residents interviewing at a US residency programme during 2012–2013. The second questionnaire distributed to US OBGYN programme directors assessed for existing global health programmes and global health training barriers. A composite Global Health Interest/Importance score was tabulated from the Likert scores. Multivariable linear regression was performed to assess for predictors of Global Health Interest/Importance. Results A total of 159 trainees (77%; 129 prospective OBGYN residents and 30 residents) and 69 (28%) programme directors completed the questionnaires. Median Global Health Interest/Importance score was 7 (IQR 4–9). Prior volunteer experience was predictive of a 5-point increase in Global Health Interest/Importance score (95% CI −0.19 to 9.85; p=0.02). The most commonly cited barriers were cost and time. Conclusion Interest and perceived importance of global health training in US OBGYN residency programmes is evident among trainees and programme directors; however, significant financial and time barriers prevent many programmes from offering opportunities to their trainees. Prior volunteer experience predicts global health interest.

Obstetric team simulation program challenges

OBJECTIVE To describe the challenges associated with the development and assessment of an obstetric emergency team simulation program. DESIGN The goal was to develop a hybrid, in-situ and high fidelity obstetric emergency team simulation program that incorporated weekly simulation sessions on the labor and delivery unit, and quarterly, education protected sessions in the simulation center. All simulation sessions were video-recorded and reviewed. SETTING Labor and delivery unit and simulation center. PARTICIPANTS Medical staff covering labor and delivery, anesthesiology and obstetric residents and obstetric nurses. MEASUREMENTS Assessments included an on-line knowledge multiple-choice questionnaire about the simulation scenarios. This was completed prior to the initial in-situ simulation session and repeated 3 months later, the Clinical Teamwork Scale with inter-rater reliability, participant confidence surveys and subjective participant satisfaction. A web-based curriculum comprising modules on communication skills, team challenges, and team obstetric emergency scenarios was also developed. MAIN RESULTS Over 4 months, only 6 labor and delivery unit in-situ sessions out of a possible 14 sessions were carried out. Four high-fidelity sessions were performed in 2 quarterly education protected meetings in the simulation center. Information technology difficulties led to the completion of only 18 pre/post web-based multiple-choice questionnaires. These test results showed no significant improvement in raw score performance from pre-test to post-test (P=.27). During Clinical Teamwork Scale live and video assessment, trained raters and program faculty were in agreement only 31% and 28% of the time, respectively (Kendalls W=.31, P<.001 and W=.28, P<.001). Participant confidence surveys overall revealed confidence significantly increased (P<.05), from pre-scenario briefing to after post-scenario debriefing. CONCLUSION Program feedback indicates a high level of participant satisfaction and improved confidence yet further program refinement is required.

The Postendometrial Ablation Endometrium: Reassessment With Biopsy and Ultrasonography

INTRODUCTION: The objectives of this study were 1) to describe a series of patients who required endometrial sampling after endometrial ablation; and 2) to examine the feasibility of endometrial sampling after endometrial ablation. METHODS: All patients who underwent an endometrial ablation from January 1, 2005 to December 31, 2012, at a university and community hospital were identified using the electronic medical record. Demographic variables, preablation tissue sampling, and ablation methods were extracted. Postendometrial ablation care for each patient was reviewed including type and success of endometrial sampling, hysterectomy, and pathology reports. Successful sampling was defined as a tissue sample that contained endometrium. Data were tabulated using SPSS 19. RESULTS: Three hundred three patients were identified. Forty-five percent were obese, 70% were hypertensive, and 12% were diabetic. Twenty-nine patients underwent one or more endometrial evaluations with either office endometrial biopsy or dilation and curettage under anesthesia for a combined 43 tissue samples; there was a 40% failure rate. Seventy-four percent of samples were obtained by endometrial biopsy with a 38% failure rate. The remaining samples were by dilation and curettage with a 45% failure rate. Ninety-nine pelvic ultrasound examinations were performed. The endometrial stripe ranged from 2 to 27 mm. In 12% of ultrasound examinations, the endometrial demarcation was inexact; stripe measurement was not reported. Thirty-four patients underwent hysterectomy. All hysterectomy specimens contained endometrial tissue, and one had endometrial cancer not detected by sampling. CONCLUSION: This study suggests that endometrial sampling after an endometrial ablation is frequently infeasible. A 40% failure rate in assessing abnormal bleeding, the most common symptom of endometrial carcinoma, is both high and concerning.

Advising and Interview Patterns of Medical Students Pursuing Obstetrics and Gynecology Residency

OBJECTIVE: To describe the advising practices at medical schools and interview patterns among medical students pursuing obstetrics and gynecology residency training. METHODS: A voluntary, anonymous survey was distributed to all applicants interviewing for obstetrics and gynecology residency during the 2014–2015 cycle at the University of Colorado, University of Washington, University of California, San Francisco, and Loyola University. Demographic data were obtained. The survey explored student advising in the residency application process including number of applications and interviews recommended by advisors. Data are reported as percentage for each survey item and compared by select demographics using an exact &khgr;2. RESULTS: Among 315 unique possible applicants, 73% (n=230) responded. Students were most commonly advised by the obstetrics and gynecology clerkship director (33%) with recommendations to apply to 21–30 programs (48%). Thirty-four percent of students applied to 21–30 programs, 32% to 31–40 programs, and 30% to greater than 40 programs. Students were advised (70%) and planned (55%) to interview at 10–14 programs. Concern over competitiveness of the applicant pool was the most important factor (31%) in determining the number of applications. The number of programs advised to or plan to interview at was greater for those in the couples match (P<.001). CONCLUSION: Medical students pursuing obstetrics and gynecology are most likely to be advised by obstetrics and gynecology clerkship directors and concern over the competitiveness of the applicant pool results in students applying to large numbers of programs. This practice may adversely affect the obstetrics and gynecology match process for both programs and applicants through the requirements of managing additional applications and potentially needing to complete a greater number of interviews.