Effect of longitudinal clerkship model and preceptor continuity on student learning and skills in obstetrics and gynecology

Objective To design and conduct objective structured clinical examination (OSCE) in professional postgraduates in obstetrics and gynecology, and to investigate the improvement measures for the teaching of professional postgraduates in obstetrics and gynecology by analyzing the performance of postgraduates in OSCE. Methods In October 2017, OSCE was performed for postgraduates in obstetrics and gynecology in the classes of 2016 and 2017 to evaluate their clinical ability. This OSCE consisted of the following four aspects: inquiry of standardized patients, basic practical skills in obstetrics and gynecology, utilization and interpretation of auxiliary examinations, and case analysis. The postgraduates were scored according to the following six items: doctor-patient communication skills, completeness of inquiry, basic practical skills in obstetrics and gynecology, utilization of auxiliary examinations, competence of clinical thinking, and mastery of medical knowledge. SPSS 18.0 was used for statistical analysis, and the t-test was used for comparison between groups. Results A total of 27 postgraduates participated in this OSCE. Among the six scoring items, completeness of inquiry had the lowest score (78±6), and utilization of auxiliary examinations had the highest score (85±3). Among the 27 postgraduates, 7 (25.9%) lacked doctor-patient communication skills, 6 (22.2%) showed serious problems in basic practical skills in obstetrics and gynecology, and 6 (22.2%) lacked the scientific thinking of clinical diagnosis. Conclusion In the training of professional postgraduate students in obstetrics and gynecology, doctor-patient communication skills and clinical thinking should be emphasized, and basic clinical skill training should be strengthened. Key words: Objective structured clinical examination; Obstetrics and gynecology; Professional postgraduate student

Objective To explore the value of OSCE system combined with intelligent network in-formation platform in clinical skills assessment of obstetrics and gynecology. Methods 112 clinical medical students who participated in the practice of gynecology and obstetrics in Second Military Medical University in 2017 were randomly divided into the experimental group (network information OSCE) and the control group (traditional OSCE). The teaching results were evaluated by the questionnaire survey of teachers and students and the examination results as well. The statistical analysis was made with the Chi-square test and the t test respectively. Results According to the questionnaire survey of two skills assessment methods, the satisfaction index of the experimental group was higher than that of the control group in both teachers and students, and the difference was statistically significant (P 0.05). Conclusion OSCE combined with the network information system has an unparalleled advantage in the assessment of the obstetrics and gynecology department. The system will promote clinical education of obstetrics and gynecology and the evaluation of the clinical ability of the medical students to a new height, which deserves popularization. Key words: Objective structured clinical examination (OSCE); Network information; Obstetrics and gynecology

Antenatal and postnatal care practices among mothers in rural Bangladesh: A community based cross-sectional study

Introduction: Simulation and coaching have become increasingly important in laparoscopic skills acquisition. This study was designed to evaluate if access to the recorded audio and video feedback after a single proctored session improves the acquisition of laparoscopic suturing skills in obstetrics and gynecology (OB/GYN) residents.Methods: Twenty OB/GYN residents received a single face-to-face coaching session on a laparoscopic vaginal cuff closure model. The session was recorded and residents were randomized to access either the video-only or the audio and video recording of the proctored session. The primary outcome measure was comparison of Global Operative Assessment of Laparoscopic Skills plus Vaginal Cuff Metrics (GOALS+) scores of the vaginal cuff closure prior to and following the proctored session.Results: Only 30% of residents accessed the recorded sessions with junior residents most likely to access the recording. Baseline GOALS+ scores were significantly higher in senior residents (mean 21.7, SD 3.9) as compared to junior residents (mean 14.7, SD 3.2) (p<.001). While all learners' GOALS+ scores significantly improved after proctoring the intervention (p<.001), the senior residents continued to have significantly higher GOALS+ scores at the final assessment (mean 28.3, SD 4.2, p=.01) when compared to their junior residents (mean 24.0, SD 3.1).Conclusion: Due to the low uptake of the review of recorded proctored sessions among OB/GYN residents across skill and year levels, we were unable to assess the effect of recorded audio and video feedback on resident performance. However, the intervention of a single proctored session of simulated laparoscopic vaginal cuff closure significantly improved resident performance as assessed with GOALS+ scores.

TCU and UNTHSC School of Medicine.

Background: Obstetrical and Gynecological nursing is a health care profession that focuses on the care of the women and newborn, for that reason nurse interns who receive the training in obstetrical and gynecological should be highly knowledgeable and well-trained caregivers for the overall safety and wellbeing of women, newborn and pregnancy outcome from the moment of menarche to menopause. The aim of the research: was to assess the effect of the training program on nurse intern's knowledge and practice regarding obstetric and gynecological skills. Study design: A quasi-experimental design was used to fulfill the aim of the research. Setting: This study was conducted in Outpatient Clinic, emergency and reception unit, Antenatal ward, delivery unit and Postnatal ward affiliated at Beha university hospital. Study subjects: A purposive sample of 80 internship nursing students one group (pre and post). Tools: two tools were used for collecting data; (1) an interviewing questionnaire sheet; includes two parts, personal characteristics internship nursing students, Assessment of the internship nursing students about obstetric and gynecological knowledge, (2) Nurse interns performance checklist about obstetric and gynecological skills. Results: Before implementation of the program the majority of nurse interns and slightly more than half of them had inadequate practice regarding obstetric skills and poor knowledge (86.3% & 55%, respectively). After the implementation of the program, the highest percentages of nurse interns and slightly more than half of them had adequate practice and good levels of knowledge (80 % & 57.5 % respectively). Conclusion: The present research concluded that implementation of training program for internship nursing students was effective in improving their oobstetric knowledge and skills with considerable variation among pre and post-training of the training time nursing students as regards the total degrees of knowledge and fundamental nursing and generative skills as shown in the logbook. Recommendations: Continuous training educational programs and workshops should be planned on regular basis to nurse interns receiveing training in obstetric and gynecological unit about obstetric skills for enhancing nurse intern’s practice and this programms should made on free days so they don't interfere with nurse interns clinical work schedule to achieve high quality of care.

Penn State College of Medicine.

BackgroundEquity of access to and utilization of healthcare across socio-economic groups is important to achieve universal health coverage. Although the utilization of antenatal and delivery care has been increasing in low- and middle-income countries, inequities in the utilization of antenatal and delivery care have been reported in many countries, but have not yet been studied in Myanmar. This study aimed to determine whether inequities in the utilization of antenatal and delivery care existed in Yangon region, Myanmar.MethodsA community-based cross-sectional survey using multistage sampling was conducted from October to November 2016. A wealth index was selected as the main socioeconomic parameter for measuring inequities with respect to early initiation of antenatal care (ANC), number of antenatal care visits, delivery by a skilled birth attendant (SBA) and delivery by cesarean section (CS). Inequities were evaluated using concentration curves and concentration indexes.ResultsOf the 762 women who gave birth within the 12-month survey period, there was no evidence of inequity in utilization of ANC; however, inequity of at least one antenatal visit among women aged less than 20 years was found with a concentration index of 0.04. The concentration indexes for delivery by SBA and CS were 0.05 and 0.14, respectively. Delivery by CS was disproportionately higher in adolescents and women with higher education than middle school.ConclusionThere was no overall inequity in the utilization of ANC but substantial inequities in delivery by CS and SBA were shown. Social determinants of health, particularly age and education, were associated with inequities in the utilization of delivery care. Adolescent pregnant women were found to be particularly vulnerable, and thus should be a target group for strategic plans to reduce inequities in utilization of delivery care.

Assessment of Developmental Progress Using an Objective Structured Clinical Examination-Simulation Hybrid Examination for Obstetrics and Gynecology Residents

Infertility counseling, evaluation and treatment by obstetrician-gynecologists and family medicine physicians: a survey

University of North Dakota School of Medicine and Health Sciences.

Improving Serious Illness Communication Skills in Obstetrics and Gynecology Residents: A Pilot Study.

The purpose of the study was to determine timing of first antenatal care attendance and associated factors among pregnant women in an obstetric health facility in eThekwini district, KwaZulu-Natal Province, South Africa. A Midwives’ Obstetric Unit forms a section of the Cato Manor Primary Health Care clinic that is responsible for providing maternal and childcare services, which include antenatal, intrapartum and postnatal care to women from socioeconomically disadvantaged community living in informal settlements. In South Africa, despite the widespread availability of free antenatal care (ANC) services, most women in underprivilleged settings present late for their first antenatal care and fail to return for ANC follow-up, potentially leading to perinatal and maternal complications. Using a crosssectional survey design, data was collected from 329 pregnant women attending ANC in a Midwives’ obstetric unit at Cato Manor Primary Health Care Clinic in eThekwini District, KwaZulu-Natal. Late booking was a challenge in the primary health care clinic. There was no evidence of association between late ANC booking and most demographic variables except one (planning of pregnancy). This highlights the importance of assisting all women to have their pregnancies planned. The number of pregnant women that initiate ANC before 12 weeks (40-50%) and the few women that still initiate ANC after 24 weeks (less than 10%) suggest an improvement in the trends of timing of ANC bookings for the rural women. There is a need to intensify community awareness programmes and social mobilisation in order to educate pregnant women about the importance of early booking at the ANC (10-12 visits) as stipulated in the guidelines of the Basic Antenatal Care approach (BANC). Keywords: Antenatal care, timing of first attendence, accessibility, primary health care

IntroductionDespite the international emphasis in the last few years on the need to address the unmet health needs of pregnant women and children, progress in reducing maternal mortality has been slow. This is particularly worrying in sub-Saharan Africa where over 162,000 women still die each year during pregnancy and childbirth, most of them because of the lack of access to skilled delivery attendance and emergency care. With a maternal mortality ratio of 673 per 100,000 live births and 19,000 maternal deaths annually, Ethiopia is a major contributor to the worldwide death toll of mothers. While some studies have looked at different risk factors for antenatal care (ANC) and delivery service utilisation in the country, information coming from community-based studies related to the Health Extension Programme (HEP) in rural areas is limited. This study aims to determine the prevalence of maternal health care utilisation and explore its determinants among rural women aged 15–49 years in Tigray, Ethiopia.MethodsThe study was a community-based cross-sectional survey using a structured questionnaire. A cluster sampling technique was used to select women who had given birth at least once in the five years prior to the survey period. Univariable and multivariable logistic regression analyses were carried out to elicit the impact of each factor on ANC and institutional delivery service utilisation.ResultsThe response rate was 99% (n=1113). The mean age of the participants was 30.4 years. The proportion of women who received ANC for their recent births was 54%; only 46 (4.1%) of women gave birth at a health facility. Factors associated with ANC utilisation were marital status, education, proximity of health facility to the village, and husband’s occupation, while use of institutional delivery was mainly associated with parity, education, having received ANC advice, a history of difficult/prolonged labour, and husbands’ occupation.ConclusionsA relatively acceptable utilisation of ANC services but extremely low institutional delivery was observed. Classical socio-demographic factors were associated with both ANC and institutional delivery attendance. ANC advice can contribute to increase institutional delivery use. Different aspects of HEP need to be strengthened to improve maternal health in Tigray.

Objective To investigate and analyze clinical obstetrics and gynecology clinicians' mastery of basic skills, and then find the way to help clinicians master basic clinical skills. Methods A self-designed questionnaire survey was conducted among 310 clinicians working in 1-3 grade hospital from Chongqing, Sichuan, Guizhou, Yunnan provinces anonymously by spot field investigation and letterinvestigations from February 1, 2015 and to March 31, 2015. The data were analyzed by descriptive analysis, using SPSS 19.0 software package for rank sum test analysis. Result Among 310 valid questionnaires, 31.6% (98) clinicians considered having inadequate clinical skills, 26% (81) average and 42.3% (131) expert. All the basic skills obtained had a relationship with the number of operations, working years and professional title. Most of the basic clinical skills were from working in hospitals 85% (270), journal 82% (254), academic conference 58% (174); 94.2% (293) willing to participate in training classes like clinical teaching and training in moulds. Conclusion The gynecology and obstet-rics basic clinical skills have a great relationship with basic skills training. Providing opportunities for the basic clinical skill trainings, academic conferences, inservice education and establishing regional medical source sharing platform can enhance their clinical skills. Key words: Gynecology and obstetrics; Clinician; Clinical skills; Questionnaire survey; Influencing factors