Sloane York

Residency Training in Neonatal Circumcision: A Pilot Study and Needs Assessment

PURPOSE Routine neonatal circumcision is one of the most commonly performed procedures in a neonate. Residents are expected to acquire the skills to properly evaluate the neonate and gain proficiency in performing circumcision despite significant variability in training. We performed a needs assessment to evaluate obstetric-gynecology residency training in neonatal circumcision. MATERIALS AND METHODS We performed an online self-assessment survey of obstetric-gynecology residents at Prentice Hospital, Chicago, from November 2008 to February 2009. Using images of uncircumcised penises residents were asked to identify which patients were candidates for routine neonatal circumcision. RESULTS Of 36 obstetric-gynecology residents 27 responded to the survey. Most respondents planned to perform neonatal circumcision when in practice, 44% had no formal training in circumcision and most were comfortable performing routine neonatal circumcision. Overall respondents were less comfortable evaluating whether the a newborn penis could undergo circumcision safely. When presented with 10 pictures of penises and asked to determine whether the neonate should undergo circumcision, 0% of respondents correctly identified all contraindications to neonatal circumcision with an average of 42% of contraindications identified correctly. Of the respondents 77% listed practical experience as the first choice to learn a procedure with an online module preferred by 55% as the second choice. CONCLUSIONS Although most residents feel competent to technically perform the procedure, they are not confident in their ability to judge the appropriate contraindications to neonatal circumcision. This needs assessment highlights the necessity for further curriculum development and formalized training in this domain.

Creation and initial assessment of a second-trimester uterine model

Introduction Training for obstetrics and gynecology residents in second-trimester dilation and evacuation (D&E) procedures is extremely limited despite the Accreditation Council for Graduate Medical Education mandating all residents to receive abortion training. Simulation-based training improves surgical competence, but no second-trimester uterine models exist. The purposes of this study were to create a realistic, low-cost model and to assess the prototype. Methods A uterine model was created with 6 silicone cervixes of varying texture and dilations that are interchangeable. The uterus is neoprene and opens to allow for objects to be placed within it for extraction. At a national meeting, experienced D&E surgeons assessed the prototype by using the model and then completing a questionnaire. Results Twenty-one expert surgeons completed the questionnaires. Participants rated the prototype as “useful” or “very useful” for teaching extraction skills and for training in general. Subjects agreed this represented a clinical scenario they were likely to encounter and the model allowed for practicing the necessary steps for performing D&Es. The model cost approximately

Development and evaluation of cesarean section surgical training using computer-enhanced visual learning

35 to fabricate. Conclusions Expert surgeons believe that this model accurately and realistically replicates a second-trimester uterus and cervix. This prototype may be used in simulation environments to train obstetrics and gynecology residents.

Surgical Uterine Evacuation for Pregnant Women With Leukemia in the First and Second Trimesters

Abstract Background: Skilled performance of cesarean deliveries is essential in obstetrics and gynecology residency. A computer-enhanced visual learning module (CEVL Cesarean) was developed to teach cesarean deliveries. Methods: An online module presented cesarean deliveries as a series of components using text, audio, video and animation. First-year residents used CEVL Cesarean and were evaluated intra-operatively by trained raters, then provided feedback about surgical performance. Clinical outcomes were collected for approximately 50 cesarean deliveries for each resident. Results: From 2010 to 2011, 12 first-year residents participated in the study. About 406 unique observed cesarean deliveries were analyzed. Procedures up to each resident’s 70th case were analyzed by grouping cases in 10 s (cases 1–10 and 11–20), or deciles. Resident performance significantly improved by decile [χ2(6) = 47.56, p < 0.001]. When examining each resident’s performance, surgical skill acquisition plateaued by cases 21–30. Procedural performance, independent of resident, also improved significantly by decile [χ2(6) = 186.95, p < 0.001], plateauing by decile 4 (cases 31–40). Throughout the observation period, operative time decreased by 3.84 min (p = 0.006). Conclusions: Pre-clinical teaching using computer-based modules for cesarean sections is feasible to develop. Novice surgeons required at least 30 procedures before performing the procedure competently. When residents performed competently, operative time and complications decreased.

Adolescents with Disabilities

INTRODUCTION: Acute and chronic leukemia affect one in 75,000–100,000 pregnancies and frequently requires immediate treatment on diagnosis. Based on the scant evidence available, both leukemia and its treatment can have detrimental effects on maternal-fetal health in pregnancy, and pregnant women with leukemia may opt for pregnancy termination or experience a fetal demise requiring surgical uterine evacuation. No existing literature deals specifically with this subset of patients. The objective of this study was to review the management of pregnant leukemic patients undergoing surgical uterine evacuation at a single tertiary care academic medical center from 2000–2012 to provide insight into the surgical management of these complex patients. METHOD: Retrospective chart review. RESULTS: Of the six patients who met all study criteria, all underwent safe surgical uterine evacuation with two receiving perioperative platelet transfusion, one having retained products of conception necessitating reaspiration, and all receiving perioperative antibiotics. CONCLUSION: Although the study population is limited, surgical uterine evacuation in pregnant leukemic patients can be safely performed. This is the first study that we are aware of to examine the surgical care of pregnant leukemic patients needing uterine evacuation. As such it can be used by hematologists, oncologists, and obstetrician–gynecologists in the counseling of pregnant patients with leukemia diagnoses.

Characteristics of presumptive idiopathic disseminated intravascular coagulation during second-trimester induced abortion.

Young women with disabilities comprise a large and diverse group of people with unique reproductive health needs. These patients often encounter physical, communication, economic, and programmatic barriers to health care, along with myths about their reproductive or sexual functioning or their ability to parent. Girls with disabilities constitute an “at-risk group” whose health-care providers often underestimate the risk of unintended pregnancy and sexually transmitted infection. Contraceptive agents help adolescents with disabilities to avoid pregnancy, manage menstrual hygiene, and lessen moliminal behavioral changes. When prescribing contraception to disabled patients, providers must consider the patients’ needs, their physical abilities, and common medical comorbidities.