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Objective To initiate construct validity testing of myTIPreport for procedural skill assessment in a prospective multicenter evaluation study. Methods Teachers and learners from a convenience-based site selection of obstetrics and gynecology (OBGYN) and female pelvic medicine and reconstructive surgery (FPMRS) training programs performed procedural assessments in myTIPreport. The specifically defined 5-point Dreyfus rating scale describing ability levels from novice to expert was used. Defined as the degree to which a test or measure assesses what it was designed to measure, construct validity of myTIPreport was tested by comparing the medians of procedure-specific overall assessments, by both teachers and learners themselves, of senior learners with junior learners. To minimize type I error, comparisons were performed only when a threshold of 10 or greater feedback encounters per learner group was met. Correlation of teacher assessments and learner self-assessments was examined for myTIPreport. Results From November 2014 to May 2016, 12 OBGYN and 7 FPMRS training programs participated. There were 440 learners and 443 teachers. Feedback was recorded on 5,093 surgical procedures; 4,567 for OBGYN residents and 526 for FPMRS fellows. Each OBGYN procedure had two categories of teacher and learner assessments comparing postgraduate year (PGY)-4 with PGY-1 learner performance. This yielded 48 possible assessment comparisons for the included 24 OBGYN procedures. In all, 28 of these 48 (58%) met the threshold number of observations per learner group. In 28 of these 28 (100%) comparison categories, PGY-4s rated significantly higher than PGY-1s. Similarly, in 16 of 18 (89%) comparison categories meeting inclusion criteria, FPMRS PGY-7s rated significantly higher than FPMRS PGY-5s. Strong correlation was noted of teacher assessments and learner self-assessments in myTIPreport with a Spearman correlation coefficient of 0.89 (P Conclusion As noted for the majority of compared teacher assessments and learner self-assessments, myTIPreport appeared to detect differences between senior and junior learners. These data support the emerging construct validity of myTIPreport for procedural skills assessment.

Objective: To determine which of three methods of cervical ripening resulted in the lowest cesarean rate in women with unfavorable cervices and indications for labor induction. Methods: Consenting women with singleton gestations, vertex presentations, and unfavorable cervices (dilatation under 2 cm and effacement under 75%) were randomly assigned to laminaria and standard intravenous oxytocin, serial doses of intracervical prostoglandin (PG) E2 gel (Prepidil, Pharmacia & Upjohn, Inc., Kalamazoo, MI) 0.5 μg every 6 hours for two doses followed by oxytocin if indicated, or extra-amniotic saline infusion and oxytocin. Results: An interim analysis after recruitment of 321 subjects, 67% of the planned sample, found similar cesarean rates for the three groups (laminaria 36%; PGE2 gel 33%; saline infusion 29%; P = .59); however, the mean randomization-to-delivery interval was significantly longer in the PGE2 group. Stochastic curtailment, as part of the interim analysis, indicated a low likelihood of achieving a statistically significant difference in cesarean rates between PGE2 gel and the other two groups. Therefore, we completed the study with saline infusion and laminaria. The saline infusion and laminaria groups had similar preinduction characteristics. The cesarean rates were similar (saline infusion 25.4% versus laminaria 30.3%; P = .32), but the mean interval from randomization to delivery was shorter in the saline infusion group (18.0 versus 21.5 hours, P = .002). There were no significant differences in selected maternal and neonatal morbidities. Conclusion: Cervical ripening with extra-amniotic saline infusion, PGE2, or laminaria resulted in comparable cesarean rates in women with an unfavorable cervix and indications for labor induction. Extra-amniotic saline infusion had the shortest randomization-to-delivery interval without increasing maternal or neonatal morbidity.

Objective: To determine whether universal routine antenatal human immunodeficiency virus (HIV) testing with patient notification and active refusal (IOM, 1999) would increase HIV screening in our pregnant population. Methods: Since 1995, we have followed ACOG guidelines of universal pretest counseling and voluntary HIV screening of pregnant women. A prospective interventional study was begun August 1, 1999, and results are presented through February 29, 2000. The intervention group included all women receiving an initial antenatal visit in our eight maternity clinics. The primary intervention consisted of educating all maternity providers and requiring patients to actively refuse HIV testing. We also evaluated a more intensive intervention, consisting of the above plus chart reminders, periodic site visits by the investigators, and educational pamphlets at Central Health Clinic (CHC), a clinic with a historically low rate of screening. Controls included all women delivering in the year before the intervention. Results: The 2,105 cases and 4,088 historic controls were similar with respect to age, educational level, risk status, substance abuse, and history of sexually transmitted diseases. HIV testing increased from 74% in the preintervention group to 81% in the postintervention group (P Conclusion: A policy of active patient refusal is effective in increasing HIV screening among pregnant women in a large, urban obstetric clinic population.