COVID-19 pandemic is changing profoundly the obstetrics and gynecology (OB/GYN) academic clinical learning environment in many different ways. Rapid developments affecting our learners, patients, faculty and staff require unprecedented collaboration and quick, deeply consequential readjustments, almost on a daily basis. We summarized here our experiences, opportunities, challenges and lessons learned and outline how to move forward. The COVID-19 pandemic taught us there is a clear need for collaboration in implementing the most current evidence-based medicine, rapidly assess and improve the everchanging healthcare environment by problem solving and “how to” instead of “should we” approach. In addition, as a community with very limited resources we have to rely heavily on internal expertise, ingenuity and innovation. The key points to succeed are efficient and timely communication, transparency in decision making and reengagement. As time continues to pass, it is certain that more lessons will emerge.
An 18-year-old female Pacific Islander with abdominal pain, ascites, and fever was transferred to our hospital with suspected ovarian malignancy. These nonspecific clinical features of tuberculous peritonitis in a female frequently contribute to misdiagnosis. Preoperative findings included negative sputums, negative purified protein derivative, and no acid-fast bacilli (AFB) found in peritoneal fluid or fine needle biopsy of the omentum. Tuberculous peritonitis was diagnosed after omental biopsy obtained at mini-laparotomy showed granulomatous inflammation and positive isolation of AFB.
The Accreditation Council for Graduate Medical Education (ACGME) requires U.S. physician training programs to teach and evaluate their trainees in six core competencies. Developing innovative methods to meet the ACGME requirements is an ongoing area of research in medical education. Here we describe the development of the Competency-based Objective Resident Education using Virtual Patients (CORE-VP) system, a web-based virtual patient simulator to teach and measure the ACGME core competencies. The user interface was built on Wavemaker technology including AJAX and javascript. A Flash component allows graphical navigation of the physical exam and linking of digital images and video to desired anatomic areas. The system contains tools for case authorship, management and execution and permits linking of files or web-based hypermedia content. Each case is designed to mimic a real-life patient encounter and includes history, physical exam, laboratory/ radiology, diagnosis and management. Automated, multi-factorial, evaluation metrics were developed for each ACGME core competency. Upon completion of a case trainees receive immediate feedback in the form of an automated Performance Summary. We have developed a web-based virtual patient simulator called CORE-VP to teach and measure the ACGME core competencies. Work is currently underway to test and validate the system
The emergence of SARS-CoV-2 at the end of 2019 sparked the beginning of the COVID-19 pandemic. Even though it was a novel virus, the workup of suspected COVID-19 included standard protocols used for the investigation of similar respiratory infections and pneumonia. One of the most important diagnostic tests in this regard is computed tomography (CT). CT scans have a high sensitivity in diagnosing COVID-19, and many of the characteristic imaging findings of COVID-19 are used in its diagnosis. The role of CT in COVID-19 management is expanding as more and more hospital practices adopt regular CT use in both the initial workup and continued care of COVID-19 patients. CT has helped hospitalists diagnose complications such as pulmonary embolism, subcutaneous emphysema, pneumomediastinum, pneumothoraces, and nosocomial pneumonia. Although mainly used as a diagnostic tool, the prognostic role of CT in COVID-19 patients is developing. In this review, we explore the role of CT in the management of hospitalized patients with COVID-19, specifically elucidating its use as a diagnostic and prognostic modality, as well as its ability to guide hospital decision-making regarding complex cases. We will highlight important time points when CT scans are used: the initial encounter, the time at admission, and during hospitalization.
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