Teaching Of Gynecology Research Articles

Knowledge of immediate newborn care and management of complications among midwives in Ghana

ObjectiveMidwives are instrumental in improving maternal/newborn health outcomes. Since complications after childbirth are leading causes of maternal deaths, midwives’ knowledge of how to manage complications and care for the newborn is important. This study assessed midwives’ knowledge of immediate newborn care and management of postpartum complications. DesignA cross-sectional descriptive survey design was used. SettingFour hospitals that provide inpatient maternity services in Tamale, Ghana. Participants245 midwives who worked in the four hospitals. MeasurementsData were collected in December 2018 using an electronic survey questionnaire by the Johns Hopkins Program for International Education in Gynecology and Obstetrics, and analyzed using descriptive, bivariate, and multivariate statistics. FindingsAbout 98% of midwives were female. The mean age of midwives was 31.87 years. The percentage of midwives who responded correctly to questions on newborn care and management of postpartum complications ranged from 29.80% to 89.39%, and 32.17% to 91.43% respectively. Midwives were most knowledgeable about breastfeeding and immediate hemorrhage intervention, and least knowledgeable about cord care, thermal protection, newborn resuscitation, contraindications for vacuum extraction, treating metritis, and performing a cervical repair. Years of experience and age are predictive factors of midwives’ knowledge. Conclusion/ImplicationsThere remains the opportunity for continuing education on complication management. Additional training of midwives on newborn resuscitation is recommended.

Editorial introductions.

Editorial introductions.

“What Do You Do if They Say ‘No’?”: Agency, Materiality, and Justice in Pelvic Exams

ABSTRACT In this defining moments essay, I take up feminist new materialist and reproductive justice theories to explore communication, autonomy, consent, and in/justice in the context of pelvic exams. I use feminist new materialism and reproductive justice to illustrate the ways in which traditional medical education practices, histories of misogynoir, speculums, patient gowns, and more communicate and matter in pelvic exam teaching and practice. In so doing, I move between academic prose and short narratives drawn from my lived experiences as both a patient and a Gynecological Teaching Associate (a role in which I instruct medical students learning to perform pelvic exams). Ultimately, I argue that attending to influence of other-than-humans and adopting relational conceptions of agency can help health communication scholars and practitioners advance equity and justice in pelvic exams.

Birth Preparedness and Complication Readiness among Women in Jugal Hospital, Harar, Ethiopia

Background: The majorities of maternal fatalities are avoidable and are generally blamed on patients delaying seeking care. Delays in deciding to seek treatment if a complication arises, delays in getting to care, and delays in obtaining care all have an impact on the availability and usage of obstetric services to avoid maternal mortality. So Birth preparedness and complication readiness is a crucial strategy for reducing maternal and newborn mortality. This study was aimed to assess the current status of birth preparedness and complication readiness in Harari regional state, Harar, Ethiopia from April 1st to 30th, 2023. Methods: An institution-based cross-sectional research was conducted at Jugal Hospital in Harar, Pregnant women who can hear and communicate and who were voluntary to participate were included. Systematic random sampling technique was used to select 233 pregnant women. The survey tool (questionnaire) used was developed by Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHIEGO). SPSS version 21 was used for analysis. Descriptive analysis was done and the results were presented in the form of narrative and table. Bivariable and multivariable logistic regression was done to identify factors associated with birth preparedness and complication readiness. All variables with p-value less than 0.25 in bivariable logistic regression model were entered to a multivariable logistic regression model for controlling possible confounding and odds ratios and their 95% CIs were computed. Result: Eighty-seven (37.83%), of the respondents mentioned at least two key obstetric danger signs during pregnancy, 92 (40.00%), of the respondents mentioned at least three key obstetric danger signs during childbirth and 66 (28.70%) of the respondents mentioned at least two key obstetric danger signs during postpartum period , 178 (77.39%), 199 (86.52%), 43 (18.70%), 67 (29.13%) and 7 (3.04%) of respondents indicated that they saved money, identified the place of delivery, identified skilled providers, identify means of transport and blood donors, respectively. Conclusion: This study revealed, age of the mother, Educational status, maternal occupation,. Residence, No. of pregnancy, Current ANC visit and History of stillbirth, were significantly associated with birth Preparedness and Complication readiness

FORMATION OF PROFESSIONAL COMPETENCE IN OBSTETRICS AND GYNECOLOGY DURING SIMULATION TRAINING

Simulation-based education has been increasingly utilized in medical education to improve clinical skills and enhance patient safety. Obstetrics and gynecology are complex medical specialties that require a high level of technical skill and decision-making ability. In this article, we explore the use of simulation training in developing professional competence in obstetrics and gynecology. The article provides an overview of the concept of professional competence and discusses the key components of obstetric and gynecologic practice. We then explore the advantages of simulation-based education in developing technical and non-technical skills, including communication, teamwork, and decision-making. We discuss the different types of simulators and scenarios used in obstetrics and gynecology training, including low-fidelity, high-fidelity, and virtual reality simulators. Finally, we review the evidence supporting the use of simulation training in obstetrics and gynecology education, including improved patient outcomes, increased confidence and competence among learners, and improved teamwork and communication skills. Overall, this article highlights the importance of simulation-based education in developing professional competence in obstetrics and gynecology. Simulation training provides a safe and controlled environment for learners to develop technical and non-technical skills, ultimately leading to improved patient outcomes and better healthcare delivery.

Exploration and Implementation of Problem Driven Learning Model in Obstetrics and Gynecology Education

Exploration and Implementation of Problem Driven Learning Model in Obstetrics and Gynecology Education

Nutrition education and nutrition knowledge amongst obstetrics and gynecology residents

Nutrition in pregnancy is a component of the Council on Resident Education in Obstetrics and Gynecology (CREOG) core curriculum. Our objective was to assess Ob/Gyn residents’ education and knowledge surrounding nutrition in pregnancy, including 1) amount of dedicated didactic time on nutrition and attitudes on its utility, 2) subjective comfort in counseling patients on nutrition in pregnancy and perceived barriers to providing nutrition counseling, and 3) objective knowledge of pregnancy-related nutrition recommendations.

Impact of an Online Question Bank on Resident In-Training Exam Performance.

In-training exams (ITEs) are administered annually to Obstetrics and Gynecology (OBGYN) residents and have been demonstrated to correlate with success on licensing examinations. Our study objective was to determine the impact of a question bank and mock exam on the performance of Council on Resident Education in Obstetrics and Gynecology (CREOG) ITEs. Secondarily, we investigated the correlation between the extent of question bank usage and performance on the exam. Pre-post intervention study of resident performance on CREOG ITE before and after implementation of the question bank and mock ITE at Indiana University in 2018. Performance was measured as year-to-year improvement in percent correct on ITE exams. Scores were excluded if a resident did not have a prequestion bank score report or if they did not sit for all eligible ITE exams. There were 51 OBGYN residents at Indiana University during the study period, with 38 available for analysis (75%). Before implementation, average year-to-year improvement for PGY1-2, PGY2-3 and PGY3-4 classes were 0.60%, 1.0% and -1.6%, respectively. After implementation, all resident classes had significant improvements in ITE scores of 6.6% (P < .01), 9.0% (P < .01), and 7.2% (P < .01), respectively. There was a moderate program-wide correlation between the number of questions completed and the percent improvement on the ITE of R = 0.36 (P = .046). Our study demonstrated that access to a question bank and mock ITE significantly improved CREOG ITE performance of OBGYN residents at Indiana University.

Ovarian Vein Thrombosis, Critical Diagnosis at Al-Hasahisa Obstetrics &amp;amp; Gynecology Teaching Hospital in Geziera State, Sudan

Ovarian Vein Thrombosis, Critical Diagnosis at Al-Hasahisa Obstetrics &amp;amp; Gynecology Teaching Hospital in Geziera State, Sudan

The time is now: addressing implicit bias in obstetrics and gynecology education

Obstetrician-gynecologists can improve the learning environment and patient care by addressing implicit bias. Accumulating evidence demonstrates that racial and gender-based discrimination is woven into medical education, formal curricula, patient-provider-trainee interactions in the clinical workspace, and all aspects of learner assessment. Implicit bias negatively affects learners in every space. Strategies to address implicit bias at the individual, interpersonal, institutional, and structural level to improve the well-being of learners and patients are needed. The authors review an approach to addressing implicit bias in obstetrics and gynecology education, which includes: (1) curricular design using an educational framework of antiracism and social justice theories, (2) bias awareness and management pedagogy throughout the curriculum, (3) elimination of stereotypical patient descriptions from syllabi and examination questions, and (4) critical review of epidemiology and evidence-based medicine for underlying assumptions based on discriminatory practices or structural racism that unintentionally reinforce stereotypes and bias. The movement toward competency-based medical education and holistic evaluations may result in decreased bias in learner assessment. Educators may wish to monitor grades and narratives for bias as a form of continuous educational equity improvement. Given that practicing physicians may have little training in this area, faculty development efforts in bias awareness and mitigation strategies may have significant impact on learner well-being.

Implementing a simulation-based curriculum for hybrid intracavitary/interstitial brachytherapy using a new, commercially available, US/MR/CT-compatible gynecologic phantom

To establish a simulation-based workshop for teaching hybrid intracavitary/interstitial (IC/IS) brachytherapy skills using a new, commercially available US/CT/MRI-compatible gynecologic phantom prototype. The VIOMERSE gynecological trainer phantom consisted of tissue-like colloid material and was US, CT, and MRI-compatible. We designed a hands-on workshop incorporating the phantom prototype to teach skills for hybrid IC/IS brachytherapy including pre-implant planning, procedural steps of implant placement, and post-implant evaluation. The workshop impact was evaluated with pre- and post-workshop surveys and responses were analyzed with Wilcoxon matched-pairs signed-rank test. Thirteen residents, divided into small groups, attended one of three separate 1-h workshop sessions held during the gynecologic education block. Workshop steps included IC applicator placement, tumor mapping and pre-planning desired location and depth of needles for hybrid IC/IS application, IS needle labelling and insertion, image review of needle placements, comparison of IC-alone versus IC/IS brachytherapy plans. Responses to questions ascertaining knowledge, confidence, and ability in planning and executing hybrid IC/IS procedures all demonstrated significant improvement from pre- to post-workshop. In response to whether the session was an effective learning experience, all residents rated the workshop with a score of 9 (n = 1) or 10 (n = 12) out of 10, with a score of 10 indicating "strongly agree." Implementation of a hybrid IC/IS brachytherapy workshop utilizing a new, commercially-available phantom prototype was successful, with clear, subjective benefit for the residents in our program. This experience may inform continued efforts towards standardizing brachytherapy curricula across programs and increasing trainee exposure to interstitial procedures.

Application of online teaching mode combining case studies and the MOOC platform in obstetrics and gynecology probation teaching

ObjectiveTo explore the application effect of the clinical basic integration teaching mode constructed by case studies and the MOOC platform in obstetrics and gynecology internship teaching in the face of public health emergencies.MethodsOne hundred ten clinical medical students of grade 2020 were selected as the experimental group, and 110 clinical medical students of grade 2021 were selected as the control group. The experimental group adopted the online teaching mode combined with case studies and the MOOC platform, while the control group adopted the offline traditional probation teaching method. Comprehensive test and questionnaire were used to evaluate and compare the teaching effect of the two groups of students.ResultsThe experimental group was found to be superior to the control group in the quality assessment of complete medical record writing and the ability assessment of diagnosis and analysis of typical obstetrics and gynecology cases (P < 0. 05). However, the score of professional knowledge was lower than that of the control group (P < 0. 05). The results of questionnaire survey showed that the satisfaction of the experimental group in stimulating learning interest, enhancing problem solving ability, enhancing communication and clinical thinking ability, enhancing team cooperation awareness and independent innovation ability was higher than that of the control group (P < 0.01). The satisfaction of teacher-student interaction was also better (P < 0.05). However, in terms of strengthening theoretical understanding, the satisfaction of the experimental group was lower than that of the control group, but with no significant difference (P > 0.05).ConclusionDuring the epidemic period, we designed a new online teaching mode, which can be applied to the probation teaching of obstetrics and gynecology. In our study, compared with traditional offline teaching, the new online teaching mode could improve students’ ability of case writing and case analysis. However, more teaching practice is needed to complete this online teaching mode.

The ABCs of a gynaecological teaching associate (GTA) programme

Gynaecological/Male Urogenital Teaching Associate (GTA/MUTA) methodology is considered the gold standard of invasive genital examination technique. Lay persons are trained in the technique of invasive genital examinations and patient-centred, trauma informed communication, and autonomously instruct learners on how to comfortably perform this examination using their own bodies as a teaching tool. GTAs/MUTAs function simultaneously as an autonomous instructor and a simulated patient during the exam. GTAs and MUTAs instruct clinical invasive examination techniques in a structured educational setting with a predetermined curriculum on which they have been trained, while letting learners perform these exam techniques on their bodies. Existing alternatives to GTA/MUTA education include the use of anesthetized patients, cadavers, plastic anatomical models (task trainers) and/or voluntary examinations on peers. There are unique benefits to the GTA/MUTA programme from both an institutional and learner perspective. Learner’s benefits unique to GTA/MUTA education include decreased learner anxiety [1], immediate feedback on examination technique with regard to patient’s physical comfort, and the opportunity to practise patient communication skills while performing such examinations. Institutional benefits unique to GTA/MUTA methodology are that after the initial setup cost, funds are saved removing the need for faculty to perform the examination instruction. Learner proficiency is higher compared to learners taught by physicians [1], and increased proficiency saves time and cost associated with learners being taken off clinical rotation to receive supplemental genital examination technique instruction. The use of simultaneous patient-instructors also introduces ‘elements of sensitivity and humanism’ to the examination [2] by having students learn to involve their patient and incorporate their perspective with regard to comfort and patient education information. By learning this examination from GTAs/MUTAs, a new model of physician patient relationship is taught, with GTAs/MUTAs functioning as informed collaborators rather than docile, uninformed patients [3]. In order to implement such a programme in an institution, among the first tasks is to obtain funding. This funding can be sought from grants or via institutional funds. Institutions may even choose to grow their GTA/MUTA programme to contract with outside institutions where this clinical examination instruction is needed. Other preparatory steps include establishing a curriculum, observing an established GTA/MUTA programme session to assess the format, and recruitment and training of GTAs and MUTAs. Once the programme is established, a clinical skills training day may be implemented. Implementing such a programme improves the learners’ experience and provides them with an increased understanding of sound technique that will benefit their patients in the long term. 1. Theroux R, Pearce C. Graduate students’ experiences with standardized patients as adjuncts for teaching pelvic examinations. Journal of the American Academy of Nurse Practitioners. 2006;18(9):429–35. 2. Kretzschmar RM. Evolution of the Gynecology Teaching Associate: an education specialist. American Journal of obstetrics and gynecology. 1978;131(4):367–73. 3. Underman K. Feeling Medicine: How the Pelvic Exam Shapes Medical Training. New York, New York University Press; 2020.

The Dobbs Decision and Undergraduate Medical Education: The Unintended Consequences and Strategies to Optimize Reproductive Health and a Competent Workforce for the Future.

The June 2022 U.S. Supreme Court decision on Dobbs v Jackson Women's Health Organization resulted in state-specific differences in abortion care access across the country. The primary concern in the obstetrics and gynecology education community has been the impact on resident and fellowship training programs. However, the impact on undergraduate medical education and the broad implications for future generations of physicians are crucial to address. It is estimated that 48% of matriculants to MD-granting medical schools will receive their medical education in the 26 states with significant abortion restrictions or bans. Undergraduate medical educators need to continue to adequately teach the basic science, clinical care, and population health outcomes of reproductive medicine, including pregnancy and abortion. In addition, students in states with more restrictions on abortion will have less or no clinical exposure, and those in states with few restrictions may be excluded due to overcrowding of learners from restricted states. Students' own health care also needs to be considered, as access to abortion care for themselves or their partners may create applicant pool demographic shifts by state as applicants consider options for where to pursue their medical education. It is important to ensure that teaching of foundational science of pregnancy, abortion, and reproductive health continues throughout the United States. Undergraduate and graduate medical educators will need to closely monitor the downstream impact of decreased clinical exposure of abortion. Further study of the personal health impact of abortion care access for medical students and awareness of the changing applicant pool demographics by state is needed.

Student’s Experience, Satisfaction and Barriers of Hybrid Undergraduate Obstetrics &amp; Gynaecology Teaching During Covid-19 Pandemic

Introduction: Hybrid teaching method has been implemented in majority of medical schools to adapt with the Covid pandemic era. With this integrated method, we aim to determine the student’s experience, satisfaction and barriers of hybrid undergraduate teaching in obstetrics &amp; gynaecology posting. Methods: A cross sectional study was conducted among medical students undergoing hybrid teaching during obstetrics &amp; gynaecology posting in the year of 2020 and 2021. Participants were 112 fourth and fifth year medical students whom were affected by the pandemic. Online questionnaires through Google forms were distributed to all eligible students. The questionnaire consists of four sections: socio-demographic, experience, satisfaction and barriers. Results: The response rate was 75%. Majority (90.2%) of the respondents were satisfied with the hybrid teaching. Among the barriers that sometimes encountered by our students were inability to adjust learning style, lack of technical skills, mental health difficulties, emotional difficulties, unreliable internet access and an unconducive study environment. Among all the demographic data studied, only ethnicity showed a significant association with the satisfaction of the students. Conclusion: Our study found that majority of students were satisfied with hybrid teaching with minimal barriers experienced. Hence its practice can be continued as it can be utilised at any time as compared to traditional teaching.

THE OBGYN RESIDENT EXPERIENCE IN REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY IN 2022: A SURVEY OF RESIDENCY PROGRAM DIRECTORS

Prior publications have highlighted low scores on reproductive endocrinology and infertility (REI) topics on the annual Council on Resident Education in Obstetrics and Gynecology (CREOG) exam as motivation for improving the quality of resident exposure to REI (1). Over the last 30 years, several studies have proposed changes to the resident curriculum related specifically to REI (1-2). The goal of this study is to provide an updated appraisal of resident REI education in OBGYN residency training.

Postgraduate medical education in obstetrics and gynaecology: Where are we now and what do we need for the future? A study on postgraduate training in obstetrics and gynaecology in Germany, Austria and Switzerland.

Objective: In this study, we aim to assess the current situation of postgraduate medical education in obstetrics and gynaecology in Germany, Austria and Switzerland. In addition, we aim to determine transferable advantages amongst the countries. Study design: We performed a survey through a digital questionnaire with a total of 40 questions. The survey was advertised via communication channels of the German, Austrian and Swiss gynaecological societies; the participants were enrolled anonymously. Results: A total of 422 trainees took part in the survey. Differences within the three countries where found regarding the workload and the training of sub-specialties. Generally, the participants described to spend the majority of their daily working hours on documentation. Concerning assessment of current training regulations, more than half of trainees stated that they were actually faced with notable difficulties to fulfil the required obligatory numbers of self-performed interventions being documented. When asked for their intrinsic feeling of safety, around two-third of trainees felt “confident to very confident” during standard interventions. These numbers were up to 12% higher in the group of trainees who experienced simulation training during their education. Conclusion: With the help of this survey, weak points can be identified such as workload and implementation of current training regulations. Projects and ideas as EBCOG PACT, EPAs, the reduction of bureaucracy through digitization and deepening skills through simulation make a valuable contribution to compensate for these deficits and to adapt to future requirements.

Educational guidelines for diversity and inclusion: addressing racism and eliminating biases in medical education

Racism and bias contribute to healthcare disparities at a patient and population health level and also contribute to the stagnation or even regression of progress toward equitable representation in the workforce and in healthcare leadership. Medical education and healthcare systems have expended tremendous efforts over the past several years to address these inequities. However, systemic racism continues to impact health outcomes and the future physician workforce. The Association of Professors of Gynecology and Obstetrics called for action to achieve a future free from racism in obstetrics and gynecology education and healthcare. As a result of this call to action, the Diversity, Equity, and Inclusion Guidelines Task Force was created. The mission of the Task Force was to support educators in their efforts to identify and create educational materials that augment antiracist educational goals and prepare, recruit, and retain a talented and diverse workforce. In this Special Report, the authors share these guidelines that describe best practices and set new standards to increase diversity, foster inclusivity, address systemic racism, and eliminate bias in obstetrics and gynecology educational products, materials, and environments.

The COVID-19 pandemic and its impact on medical teaching in obstetrics and gynecology-A nationwide expert survey among teaching coordinators at German university hospitals.

PurposeThe COVID-19 pandemic has imposed severe challenges on medical education at German university hospitals. In this first German nationwide expert survey, we addressed the responsible university teaching coordinators in obstetrics and gynecology departments and investigated their experiences during the pandemic as well as their opinions on future developments, especially with regard to the broader implementation of e-learning in the standard curriculum.MethodsThe questionnaire included 42 items and was disseminated among teaching coordinators at all 41 departments of obstetrics and gynecology at German university hospitals via an email that included a weblink to the online survey provider. Responses were collected between 19 April and 7 June 2021.ResultsIn total, 30 responses were collected from 41 departments across Germany and their respective teaching coordinators in obstetrics and gynecology. The general opinion of the medical teaching provided during the pandemic was positive, whereas the teaching quality in practical skills was considered inferior and not equivalent to the standard face-to-face curriculum. Lectures and seminars had to be substituted by remote-learning alternatives, while clinical clerkships were reduced in length and provided less patient contact. Students in their final year experienced only a few differences in the clinical and teaching routine. Teaching coordinators in obstetrics and gynecology stated that they intend to incorporate more e-learning into the curriculum in the future.ConclusionThe medical educators’ views presented here may help to complement the already-thoroughly investigated experiences of students under the restrictions of the COVID-19 pandemic. Medical educators in obstetrics and gynecology at German university hospitals have successfully established online and hybrid teaching alternatives to their standard face-to-face courses. Building on recent experiences, digitalization could help to improve future medical education.

A Novel Childbirth Simulator for Real-Time Monitoring of Fetal Head During the Active Phase of the Labor

A correct evaluation of the fetus progress into the birth canal during labor is often a complicated task, but it is of fundamental importance for a proper delivery management. Indeed, incorrect assessment of fetal presentation, position and station could lead to severe complications for both the fetus and the mother. Currently, fetus progress assessment during the delivery phase is still performed in the same way of last centuries, namely with a manual vaginal exploration assessed only using two fingers (index and medium fingers). This evaluation is therefore strongly subjective and dependent on clinical experience of the medical doctor; thus, reproducibility is very limited. In this framework, simulation-based training is a valuable instrument for obstetrics and gynecologists learning process, thus for evaluating and improving their abilities. In this work, we introduce a novel integrated childbirth platform which offers a real-time monitoring of fetal head during the active phase of labor. A real-time evaluation of fetal head presentation, position and station is provided, along with a 3D virtual visualization of the childbirth simulation. This kind of platform was conceived as a valid instrument for gynecological teaching and training. Preliminary results demonstrated its usefulness as an instrument for training in obstetrics and gynecology.