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Background: Repeat pregnancies after a short interpregnancy interval are common and are associated with negative maternal and infant health outcomes. Few studies have examined the relative effectiveness of postpartum contraceptive choices., Objective: We aimed to determine the initiation trends and relative effectiveness of postpartum contraceptive methods, with typical use, on prevention of short delivery intervals (≤27 months) among women with access to universal healthcare, including coverage that entails no co-payments and allows unlimited contraceptive method switching., Study Design: This retrospective cohort study included women who were enrolled in the United States military healthcare system who were admitted for childbirth between October 2010 and March 2015, with ≥6 months postpartum enrollment. With the use of insurance records, we determined the most effective contraceptive method initiated during the first 6 months after delivery, even if subsequently discontinued. Rates of interdelivery intervals of ≤27 months, as proxies for interpregnancy intervals ≤18 months, were determined with the use of the Kaplan-Meier estimator. Women who were disenrolled, who reached 27 months after delivery without another delivery, or who reached the end of the study period were censored. The influence of sociodemographic variables and contraceptive choices on time to subsequent delivery was evaluated by Cox regression analysis, which accounted for a possible correlation among multiple deliveries by an individual woman., Results: During the study timeframe, 373,840 women experienced a total of 450,875 postpartum intervals. Women averaged 27 (standard deviation, 5.3) years of age at the time of delivery; 33.9% of them were <25 years old; 15.5% of them were active duty service members, and 31.6% of them had insurance sponsors of junior enlisted rank (which suggests lower income). Postpartum contraceptive methods that were initiated included self or partner sterilization (7%), intrauterine device (13.5%), etonogestrel implant (3.4%), depot medroxyprogesterone acetate (2.5%), and pill, patch, or ring (36.8%). Furthermore, 36.7% of them did not initiate a prescription method. Etonogestrel implant initiation increased from 1.7% of postpartum women in the first year of our study to 5.3% in the final year. The estimated short interdelivery interval rate was 17.4%, but rates varied with contraceptive method: 1% with sterilization, 6% with long-acting reversible contraception, 12% with depot medroxyprogesterone, 21% with pill, patch, or ring, and 23% with no prescription method. In a multivariable analysis, the adjusted hazard of a short interdelivery interval was highest among women who were younger, on active duty, or with officer insurance sponsors. Compared with nonuse of any prescription contraceptive, the use of an intrauterine device reduced the hazard of a subsequent delivery (adjusted hazard ratio, 0.19; 95% confidence interval, 0.18-0.20), as did etonogestrel implant (adjusted hazard ratio, 0.21; 95% confidence interval, 0.19-0.23); the pill, patch, or ring had less effect (adjusted hazard ratio, 0.80; 95% confidence interval, 0.78-0.81)., Conclusion: Postpartum initiation of long-acting reversible contraception is highly effective at the prevention of short interdelivery intervals, whereas pill, patch, or ring methods are associated with rates of short interdelivery intervals similar to users of no prescription contraception. This study supports long-acting reversible contraception as first-line recommendations for postpartum women who wish to retain fertility but avoid early repeat pregnancy., (Published by Elsevier Inc.)

Objective: The objective of the study was to describe our experience with the Objective Structured Clinical Exam during the third-year obstetrics/gynecology clerkship., Study Design: Our 8-station Objective Structured Clinical Exam is described in detail. We analyzed grades from the Objective Structured Clinical Exam for overall distribution, comparing among and between groups by year and among exam sites and correlating with the National Board of Medical Examiners subject exam and the final clerkship grades., Results: The Objective Structured Clinical Exam is provided at 3 sites, 1 at a technically advanced simulation center. Most students (54.6%) received a grade of A; however, the mean grade from the Objective Structured Clinical Exam at the simulation center (3.41 on a 4-point grade-point average scale) was lower than that at the clinic sites (3.60, P = .005; 3.73, P < .001). Effect of rotation order was identified only in the first year. Grades from the Objective Structured Clinical Exam were positively but weakly correlated with National Board of Medical Examiners subject exam and final clerkship grades., Conclusion: An Objective Structured Clinical Exam in the obstetrics/gynecology clerkship can be administered with limited resources and provides a valuable assessment method.

Objective: The purpose of this study was to describe the effect of the problem-based learning method on student grade and on student and faculty satisfaction., Study Design: The problem-based learning method was instituted at 2 of 5 obstetrics/gynecology clerkship sites. Students and faculty were surveyed, with the use of a Likert scale, regarding aspects of satisfaction with the clerkship. Responses were compared according to problem-based learning usage. Student performance was also assessed according to problem-based learning usage, with a comparison of several grade components. Statistical analysis involved t-tests and Kendall's tau-C., Results: For the year that was assessed, 54 of 156 students used the problem-based learning method. Mean student satisfaction responses were significantly higher for students who used the problem-based learning method. Faculty satisfaction was also significantly higher for the problem-based learning method, compared with other teaching methods. Mean scores on the National Board of Medical Examiners subject examination were higher for problem-based learning but did not reach statistical significance. Grade distribution was not significantly different for the groups., Conclusion: The problem-based learning method was associated with improved student and faculty satisfaction and did not affect student grades negatively.