Sondra Summers

Addressing OB/GYN family planning educational objectives at a faith-based institution using the TEACH program ☆ ☆☆ ★

BACKGROUND Traditionally family planning education is limited for obstetrics and gynecology residents training at faith-based institutions. We describe the first formalized educational program to teach contraception, sterilization, and abortion at a Catholic institution. STUDY DESIGN We used a six-step curricular development process to design this formal educational intervention. We created a multiple-choice test that participants completed before and after the workshop. We compared average test scores using one-way analyses of variance and assessed psychometric properties of the test. RESULTS All 16 obstetrics and gynecology residents at this institution participated in the one-day educational program entitled Teaching Everything About Contraceptive Health (TEACH). Residents improved their pre-test scores, on average, from 57% prior to the workshop to 89% immediately after completion of TEACH (p < .001). Improvement persisted 10 months after completion of the program (p < .001). Psychometric assessment supported the use of the instrument with adequate question difficulty and high discrimination. CONCLUSIONS A one day curriculum designed to introduce family planning learning objectives at a Catholic obstetrics and gynecology residency program is feasible and results in improved resident knowledge.

Cervical Cancer Screening Rates in a Chart Review of Adolescent Patients at an Academic Institution before and after the Publication of the 2009 American College of Obstetricians and Gynecologists' Recommendations

OBJECTIVE Evaluation of compliance with ACOG guidelines against screening for cervical cancer in women before age 21; identification of factors associated with lack of compliance with guidelines. METHODS A review of 799 charts of women age 14-21 seen for care at our institution in 2009-2010 to determine baseline cervical cytology rates, compliance with publication of 2009 ACOG guidelines recommending against testing in this age group. Clinical data was gathered to identify patient and physician characteristics associated with testing. RESULTS The baseline rate of cervical cytology testing for women age 14-21 in our chart review (20%, 2009) dropped significantly (10.8%, 2010, P < .005) after publication of new guidelines. Among those patients tested, factors associated with higher screening rates included: patients seen by obstetrician/gynecologist (59% patients tested 2009/38% 2010), who were sexually active (83%/88%) and seen for routine care (68%/95%). Other associated factors: prior screening (61% all patients tested), hormonal contraceptives (58%), private insurance (72%). Patients with history of previous cervical intraepithelial neoplasia had cytology testing done at high rates (72%). CONCLUSION The rate of cervical cytology screening in women ages 14-21 was higher than expected given ACOG recommendations. There was a significant decrease in screening rates after publication of guidelines. Patient and physician characteristics were identified which were associated with an increased screening rate. There are no databases that track cervical cancer testing in this age group. This information can be utilized for physician and patient education in order to improve compliance.

Robotic objective structured assessment of technical skills: a randomized multicenter dry laboratory training pilot study.

Study Objective The goal of this study was to determine if a robotic dry laboratory curriculum for gynecology and urology residents improved their basic robotic skills. Methods After the institution-specific institutional review board approval or exemption, 165 residents from 8 gynecology and/or urology programs were enrolled. Residents underwent standardized robotic orientation followed by dry laboratory testing on 4 unique robotic tasks. Residents were block randomized by program to unstructured or structured training programs. Regardless of group, residents were expected to practice for 15 minutes twice monthly over 7 months. Errors, time to completion, and objective structured assessment of technical skills global rating scores were recorded for each task before and after the training period. Statistics were calculated using the Student t tests, Pearson correlation, and analysis of variance with STATA systems (version 11.2). Results A total of 99 residents completed both the pretraining and posttraining testing. A mean of 4 (range, 0–15) 15-minute training sessions per resident was self-reported. The structured group had faster posttraining times on the transection task, although the unstructured group had higher posttraining scores on the knot-tying task. Conclusions Overall, the residents’ robotic skills improved after participating in a dry laboratory curriculum; however, robotic availability, duty hour restrictions, and clinical responsibilities limit the curriculum implementation.

Chronic Pelvic Pain

The evaluation of chronic pelvic pain (CPP) can be challenging for many clinicians and requires an understanding of the interactions between organs of the pelvis, including reproductive, genitourinary, and gastrointestinal as well as psychosocial components associated with chronic pain disorders. It is also important to recognize the role that musculoskeletal structures in the pelvis can contribute to CPP. Treatment should be individualized with best results achieved with a multidisciplinary approach involving behavior and physical therapists and medical therapy. Surgical approaches to CPP can be indicated, especially for structural growths such as endometriosis, uterine leiomyoma, and adenomyosis.

Pelvic Pain Associated with a Gynecologic Etiology

Healthcare practitioners often treat women with coexistent gynecological pelvic pain which may be attributed, by the patient, to a pelvic floor disorder. This chapter presents an algorithm for categorizing pelvic pain disorders into acute and chronic, based on the duration of the symptoms. Further categorization is based on the location of the pain.