A structured curriculum for teaching early pregnancy loss counseling improved student performance on standardized Objective Structured Clinical Examinations compared with traditional instruction. Providing these counseling tools improved their confidence and empathy ratings in caring for patients with early pregnancy loss.

INTRODUCTION: Elective abortion is a widely performed procedure in the United States. The number of physicians who perform abortions however has decreased due to diminishing availability of training. The purpose of this study is to identify the factors associated with residents’ attitudes about providing elective abortion and whether personal beliefs influence residents’ willingness to be trained and perform these procedures. METHODS: Anonymous surveys were sent out to all obstetrics and gynecology residents. The survey included demographic information and rated factors influencing their decision to perform abortion using a Likert scale. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). The factors associated with abortion provision were compared using chi square analysis. RESULTS: Of the 201 respondents (67% response rate), 83% planned to perform elective abortion. In a multivariable analysis; religion, age, gender, ethnicity and marital status were found to be not statistically significantly associated with plans to provide terminations. Residents’ attitude regarding providing abortion was dependent on the reasons for abortion with the most influential being “pregnancy has potential medical risks on the mother” (OR 8.2; 95% CI 6-14.3) followed by “fetus with congenital anomalies” (OR 6.7; 95% CI 3.7-11.6) and “gestational age” (OR 2.3; 95% CI 1.6-7.9). “Recent laws regarding abortion” and “maternal age” were the least influential factors. CONCLUSION: Providing elective abortions is an important element of women’s healthcare. In order to optimize integration of abortion training into residency programs it is important to identify resident attitudes and obstacles to providing elective abortions.

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BACKGROUND: Lower urinary tract injuries present serious challenges for the obstetrician gynecologist. Recently, innovative surgical techniques have been employed to improve visualization and dissection of pelvic anatomy. Despite these advances, lower urinary tract injury during hysterectomy is still our greatest peril. Intraoperative recognition and immediate surgical repair can greatly reduce post-operative morbidity and medical-legal ramifications. METHODS: Participants were junior residents (PGY-1 and PGY-2) in the OBGYN Residency Program at Inova Fairfax Medical Campus. The cystoscopy curriculum consisted of a 1 hour didactic session and a 3 hour simulation session. The didactic session examined characteristic properties of the bladder, including an overview of the procedure. The simulation session incorporated a skills workshop with repeated practice on low fidelity models. Pre- and post-assessments included a cognitive exam, a confidence survey, and validated checklists (OSATS). After 6 months, final acquisition of skill was tested in the operating room. RESULTS: PGY-1 and PGY-2 residents showed significant cognitive (P=.0008/.003) and confidence (P=.04) improvement, with no difference between groups. For checklist items, there was significant improvement within groups for Cystoscope Assembly (P=.007), Bladder Survey (P=.0002), Total Score (P<.0001), Global Rating (P<.0001), with no differences between groups. DISCUSSION: The simulation based curriculum was effective in training junior residents the basic skills of cystoscopy. This curriculum can be utilized as a teaching tool for residents to become confident and proficient in the aspects of diagnostic cystoscopy.

INTRODUCTION: The management of amniotic fluid embolism and maternal cardiac arrest requires coordinated time-sensitive teamwork skills. The study objective was to determine the effectiveness of teaching amniotic fluid embolism and maternal cardiac arrest management to residents using simulation. METHODS: Obstetrics and gynecology residents received instruction using a highly interactive team-based simulation curriculum for the management of amniotic fluid embolism and maternal cardiac arrest with perimortem Cesarean-Section. The curriculum consisted of a didactic session followed by high-fidelity simulations of two scenarios. A 21-point checklist was used for baseline teamwork performance assessments. Outcomes were measured using pre-post knowledge tests and confidence surveys in the management of obstetrical respiratory emergencies. Paired t-tests and repeated measures were used for data analysis. RESULTS: Twenty-one residents participated in the four-hour curriculum. Mean pre-post knowledge test scores demonstrated statistically significant improvement (75.0%, 94%, p less than 0.0001). Mean pre-post confidence levels rose in the management of amniotic fluid embolus (52.33%, 78.33%, p less than 0.0001) and maternal cardiac arrest (56.0%, 81.67%, p less than 0.0001). Incidentally, residents involved in the simulation curriculum experienced a real life maternal cardiac arrest with perimortem Cesarean-Section the same afternoon and commented that their experience in simulation contributed to the clinical outcome. CONCLUSION: Training in both amniotic fluid embolism and maternal cardiac arrest with perimortem Cesarean-Section management is essential for obstetrical providers. Interactive team-based simulation training of these events improves knowledge, performance and confidence even when exposure to real-life obstetrical respiratory emergencies is rare.

INTRODUCTION: Eclampsia is an obstetrical emergency of hypertensive disorders in pregnancy, which can lead to significant morbidity and mortality. The objective of this study was to demonstrate and quantify the effect of simulation training on knowledge, performance and confidence levels of providers in managing eclampsia. METHODS: A 3 month study was performed using 6 obstetrics and gynecology residents and a standardized simulation program with a high-fidelity manikin. Pre- and post-testing were performed using knowledge tests, validated performance checklists and confidence surveys. An interval performance assessment was conducted at three months to quantify retention of skills. Statistical analysis was performed using chi-squared analyses. RESULTS: Significant improvement was noted in all domains. Knowledge scores increased from 36.67% to 96.67% post simulation, p less than 0.0004. Performance assessment increased from 31.75% to 94.67%, p less than 000.1. Confidence levels demonstrated statistically significant improvements in all areas with the greatest in managing an eclamptic seizure, ordering eclampsia medications and managing magnesium sulfate toxicity, p less than 0.0001. Retention scores at 3 months indicated that performance remained strong at 91.67%, p less than 0.0001. Participant comments included the benefit of practicing this rare event in simulation which then occurred in real life the next day. CONCLUSION: Simulation-based training for eclampsia management improves knowledge, performance and confidence levels. Repeated simulation training demonstrates retention of learning. Simulation is a valuable tool in preparing physicians for managing eclampsia and maintaining knowledge and skills for when these rare emergencies occur in reality.