Sarah M. Page-Ramsey

To the point: medical education, technology, and the millennial learner

&NA; This article, from the “To The Point” series that was prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, provides an overview of the characteristics of millennials and describes how medical educators can customize and reframe their curricula and teaching methods to maximize millennial learning. A literature search was performed to identify articles on generational learning. We summarize the importance of understanding the attitudes, ideas, and priorities of millennials to tailor educational methods to stimulate and enhance learning. Where relevant, a special focus on the obstetrics and gynecology curriculum is highlighted.

Prevalence of group B Streptococcus colonization in subsequent pregnancies of group B Streptococcus-colonized versus noncolonized women.

OBJECTIVE To determine whether group B Streptococcus (GBS)-colonized pregnant women have an increased prevalence of GBS colonization in subsequent pregnancies. STUDY DESIGN This retrospective cohort study compared the prevalence of GBS colonization in initial and subsequent pregnancies of 158 women with two or more deliveries at a Midwest institution since the initiation of universal screening for GBS. RESULTS The GBS colonization rate in index pregnancies was 20%. Colonization rate in subsequent pregnancies for initially GBS-colonized women was 42% compared with 19% for women who were not colonized with GBS in the index pregnancy (p = 0.009). The relative risk for GBS-colonized women to be GBS-colonized in subsequent pregnancies was 2.2 (confidence interval = 1.3 to 3.8). CONCLUSION Previous GBS colonization is a risk factor for GBS colonization in subsequent pregnancies. Consideration of intrapartum chemoprophylaxis in women with a history of GBS colonization, assuming current colonization status is unknown, warrants further investigation.

Pelvic and breast examination skills curricula in United States medical schools: a survey of obstetrics and gynecology clerkship directors

BackgroundLearning to perform pelvic and breast examinations produces anxiety for many medical students. Clerkship directors have long sought strategies to help students become comfortable with the sensitive nature of these examinations. Incorporating standardized patients, simulation and gynecologic teaching associates (GTAs) are approaches gaining widespread use. However, there is a paucity of literature guiding optimal approach and timing. Our primary objective was to survey obstetrics and gynecology (Ob/Gyn) clerkship directors regarding timing and methods for teaching and assessment of pelvic and breast examination skills in United States medical school curricula, and to assess clerkship director satisfaction with current educational strategies at their institutions.MethodsOb/Gyn clerkship directors from all 135 Liaison Committee on Medical Education accredited allopathic United States medical schools were invited to complete an anonymous 15-item web-based questionnaire.ResultsThe response rate was 70%. Pelvic and breast examinations are most commonly taught during the second and third years of medical school. Pelvic examinations are primarily taught during the Ob/Gyn and Family Medicine (FM) clerkships, while breast examinations are taught during the Ob/Gyn, Surgery and FM clerkships. GTAs teach pelvic and breast examinations at 72 and 65% of schools, respectively. Over 60% of schools use some type of simulation to teach examination skills. Direct observation by Ob/Gyn faculty is used to evaluate pelvic exam skills at 87% of schools and breast exam skills at 80% of schools. Only 40% of Ob/Gyn clerkship directors rated pelvic examination training as excellent, while 18% rated breast examination training as excellent.ConclusionsPelvic and breast examinations are most commonly taught during the Ob/Gyn clerkship using GTAs, simulation trainers and clinical patients, and are assessed by direct faculty observation during the Ob/Gyn clerkship. While the majority of Ob/Gyn clerkship directors were not highly satisfied with either pelvic or breast examination training programs, they were less likely to describe their breast examination training programs as excellent as compared to pelvic examination training—overall suggesting an opportunity for improvement. The survey results will be useful in identifying future challenges in teaching such skills in a cost-effective manner.

Undergraduate obstetrics and gynecology medical education: why are we underrated and underappreciated?

Obstetrics and gynecology education is one of the lowestranked medical school experiences by US medical school graduates. The inability to provide students with experiential excellence could be a detriment to our patients. The causes of student dissatisfaction are not unexpected: long work hours, minimal hands-on experience, limited faculty interactions, ineffective teaching by residents/fellows, and mistreatment issues. The purpose of this Viewpoint article is to discuss these clerkship weaknesses identified by national and local survey data. Strategies employed by nationally recognized obstetrics and gynecology educators to develop adaptive behaviors to address these educational shortcomings will be reviewed. Background

Efficiency of Screening for the Recurrence of Antenatal Group B Streptococcus Colonization in a Subsequent Pregnancy: A Systematic Review and Meta-analysis with Independent Patient Data

OBJECTIVE The objective of this study was to evaluate the risk of recurrent group B streptococcus (GBS) colonization in a subsequent pregnancy and to assess clinical characteristics that influence this risk. STUDY DESIGN A systematic review and meta-analysis was performed. Databases were searched from inception through June 2015 using PubMed, Embase, Scopus, Central, and ClinicalTrials.gov. Studies were eligible if they assessed antenatal GBS colonization in two successive pregnancies. The quality of included studies was evaluated. Independent patient data was requested from the authors of the included trials. Unadjusted odds ratios (OR) were pooled using the Mantel-Haenszel fixed effect model. RESULTS In the five studies identified, two studies lacked a nonexposed cohort. GBS colonization in the index pregnancy was associated with a higher risk of recurrence of GBS colonization in a subsequent pregnancy (three studies: 50.2 compared with 14.1%; pooled fixed effects OR, 6.05; 95% confidence interval [CI], 4.84-7.55). When heavy colonization with GBS was compared with colonization by vaginal culture only, an increased risk of recurrence was shown (four studies: 52.0 compared with 45.1%, pooled fixed effects OR, 1.54; 95% CI, 1.02-2.31). CONCLUSION Women colonized with GBS are at significantly higher odds for recurrent colonization in a subsequent pregnancy when compared with women who were not colonized in an index pregnancy. If the individual is considered heavily colonized with GBS, there appears to be an association with an increased risk compared with conventional culture. Subgroup analysis of the variables time interval ≤ 12 months between subsequent pregnancies, body mass index ≥ 30 kg/m(2), race, ethnicity, and primiparous in the subsequent pregnancy showed no effect.

Barriers and Strategies to Engaging Our Community-Based Preceptors

ABSTRACT Issue: This article, from the “To the Point” series that is prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, is a review of commonly cited barriers to recruiting and retaining community-based preceptors in undergraduate medical education and potential strategies to overcome them. Evidence: Community-based preceptors have traditionally served as volunteer, nonsalaried faculty, with academic institutions relying on intrinsic teaching rewards to sustain this model. However, increasing numbers of learners, the burdens of incorporating the electronic medical record in practice, and increasing demands for clinical productivity are making recruitment and retention of community-based preceptors more challenging. Implications: General challenges to engaging preceptors, as well as those unique to womens health, are discussed. Potential solutions are reviewed, including alternative recruitment strategies, faculty development to emphasize efficient teaching practices in the ambulatory setting, offers of online educational resources, and opportunities to incorporate students in value-added roles. Through examples cited in this review, clerkship directors and medical school administrators should have a solid foundation to actively engage their community-based preceptors.

To the Point: The expanding role of simulation in Obstetrics and Gynecology medical student education.

&NA; This article, from the “To the Point” series prepared by the Association of Professors of Gynecology and Obstetrics (APGO) Undergraduate Medical Education Committee (UMEC), provides educators with an overview of the use of simulation in undergraduate medical education in the field of obstetrics and gynecology. Simulation plays an important role in the education of medical students. Students are increasingly serving as clinical observers and providing less direct patient care. Simulation can help standardize education and ensure quality and comparability across an enlarging educational environment. This article summarizes the expanding role of simulation in undergraduate medical education in obstetrics and gynecology and its effect on important learner outcomes such as confidence, knowledge, skills, workplace behaviors, and translation to patient care.

To the point: gender differences in the obstetrics and gynecology clerkship

&NA; Gender differences in performance on the obstetrics and gynecology clerkship have been reported, with female students outperforming male students. Male students report that their gender negatively affects their experience during the clerkship. Additionally, there are fewer male students applying for obstetric/gynecology residency. This “To The Point” article by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee will describe the gender differences that have been found, examine factors that could be contributing to these issues, and propose measures to correct these disparities.

To the Point: Integrating Patient Safety Education Into the Obstetrics and Gynecology Undergraduate Curriculum

Abstract This article is part of the To the Point Series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee. Principles and education in patient safety have been well integrated into academic obstetrics and gynecology practices, although progress in safety profiles has been frustratingly slow. Medical students have not been included in the majority of these ambulatory practice or hospital-based initiatives. Both the Association of American Medical Colleges and Accreditation Council for Graduate Medical Education have recommended incorporating students into safe practices. The Accreditation Council for Graduate Medical Education milestone 1 for entering interns includes competencies in patient safety. We present data and initiatives in patient safety, which have been successfully used in undergraduate and graduate medical education. In addition, this article demonstrates how using student feedback to assess sentinel events can enhance safe practice and quality improvement programs. Resources and implementation tools will be discussed to provide a template for incorporation into educational programs and institutions. Medical student involvement in the culture of safety is necessary for the delivery of both high-quality education and high-quality patient care. It is essential to incorporate students into the ongoing development of patient safety curricula in obstetrics and gynecology.

Risk of Recurrence of Group B Streptococcus in Subsequent Pregnancies: A Systematic Review and Meta-analysis [303].

INTRODUCTION: Reports have shown that up to half of women will be recolonized with group B streptococcus (GBS) in a subsequent pregnancy. A systematic review and meta-analysis was conducted to investigate the prevalence and recurrence risk of GBS colonization in a subsequent pregnancy and to determine clinical characteristics that increase the probability of recolonization. METHODS: A search was conducted of the existing literature (PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov) from inception to September 2014. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines were used. RESULTS: Five cohort studies were identified that analyzed 1,150 women in a subsequent pregnancy. The prevalence of recurrent GBS was 44.5% (512/1,150). Colonization with GBS in the index pregnancy (compared with women who were not colonized) was associated with a higher rate of recurrent colonization in a subsequent pregnancy (three studies: 50.2% compared with 14.1%, pooled fixed-effects odds ratio [OR] 6.05, 95% confidence interval [CI] 4.84–7.55, P<.01, I 2=24%). Among all patients colonized with GBS, heavy colonization (either by bacteriuria or more than 80 colony-forming units) was associated with increased risk of recurrence (four studies: 52.0% compared with 45.1%, pooled fixed-effects OR 1.54, 95% CI 1.02–2.31, P=.04, I 2=0%). Subgroup analysis showed no effects of pregnancy interval less than 12 months, body mass index (calculated as weight (kg)/[height (m)]2) greater than or equal 30, primiparous in subsequent pregnancy, or race or ethnicity. CONCLUSION AND IMPLICATION: Colonization with GBS during pregnancy is associated with a high rate of recurrence in the next pregnancy. A higher rate of recurrence is noted in women considered to have heavy genital tract colonization.