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Study Objective Develop a Pediatric and Adolescent Gynecology (PAG) curriculum, appropriate pelvic model for teaching examination skills, and an objective structured clinical examination (OSCE) for evaluation. Compare OSCE performance between residents with clinical training in PAG vs those that completed the curriculum vs those without either experience. Design Prospective cohort study. Setting Obstetrics and Gynecology (Ob/Gyn) residency program in an urban academic center. Participants Senior Ob/Gyn residents. Interventions A simulation-based teaching curriculum was created to teach PAG skills. A pediatric mannequin with anatomic pre-pubertal genitalia was developed for teaching and assessment of skills. Main Outcome Measures Performance on a PAG-based OSCE as assessed by 2 observers using a 40 point checklist. Results 17 residents participated in the OSCE; 5 completed the curriculum, 6 completed a clinical rotation, and 6 were controls. The teaching curriculum group had the highest median composite OSCE score (75.0%) compared to the clinical group (73.1%) and control group (55.3%). There was no statistical difference between the scores of the teaching and clinical groups, but the teaching group scored statistically higher than controls ( P = .0331). Scores for each OSCE component were compared. The teaching and clinical groups outperformed controls on assessment and procedures. There was no difference in scores on history taking or physical examination. Conclusion An interactive teaching curriculum incorporating simulation and a realistic pediatric pelvic model can be used to teach PAG clinical skills. Using an OSCE to evaluate skills shows that residents completing the curriculum perform as well as those with clinical experience and better than controls.

Participants: Patients younger than 22 years of age with chronic pelvic pain from January 2009 to December 2009. Main Outcome Measures: Results of operative laparoscopy including stage and description of endometrial lesions. Presenting symptoms of those with endometriosis was also evaluated. Results: Ninety-eight percent (115/117) of the study population was found to have endometriosis. The median age of the subjects at the time of laparoscopy was 16 years old (range 12 to 21). All subjects had either stage I or II disease as determined by the American Society for Reproductive Medicine's classification system. The median age of first symptoms was 13 (range 10-18) and the median age of menarche was 12 (range 9-14). The nature of pain in subjects with endometriosis was cyclic only in 58/115 (50.4%), acyclic only in 12/115 (10.4%), and both cyclic and acyclic in 45/115 (39.1%). Other presenting symptoms included gastrointestinal in 18 (15.7%), urinary in 3 (2.6%), irregular menses in 9 (7.8%), and menorrhagia in 4 (3.5%). Seventy-six percent (44/58) of participants of which we have data had a family history of endometriosis, severe dysmenorrhea, and/or infertility. Conclusions: Adolescents with chronic pelvic pain not responsive to conventional medical management have a significantly higher rate of endometriosis than previously perceived. These patients should be referred to gynecologists experienced with subtle laparoscopic findings of atypical endometriosis for diagnosis of etiologies of pelvic pain and for appropriate postoperative management. Several factors may account for this increase in diagnosis of endometriosis at our institution. These include improved laparoscopic optics, improvements in visualization of endometrial lesions using “close tip” and “underwater” techniques, biopsy of visually negative pelvises, and increasing experience of the surgeon. Further studies are needed to determine if early diagnosis and treatment prevents progression of endometriosis and infertility.

Abstract 819 Background. HbSC is characterized by increased red cell density and clinical complications but has rarely been the target of therapeutic trials. The CHAMPS Trial was a prospective, randomized, double-blinded, multi-center Phase II study of HU and Mg in children and adults with HbSC conducted by the Comprehensive Sickle Cell Centers Clinical Trials Consortium. HU is clinically efficacious in HbSS, but its value has not been demonstrated for HbSC; Mg reduces cation transport activity and improves hydration of HbSS erythrocytes. The primary objective of the trial was to measure the ability of HU and Mg individually and in combination to reduce the density of HbSC erythrocytes. Secondary objectives were to determine the effects of the 2 agents on hematologic parameters and red cell pathobiology, to identify toxicities of HU and Mg, and to record adverse events. Methods. Eligible subjects had HbSC and at least 1 vaso-occlusive event in the previous 12 months (but none in the 4 weeks before study entry) and were ≥ age 5 years. After providing informed consent and baseline evaluations, subjects were randomized to 1 of 4 arms: (A) HU (20 mg/kg/d PO) and Mg (0.6 mEq/kg/d PO in 2 doses), (B) HU and placebo for Mg, (C) HU placebo and Mg, or (D) placebos for both. Subjects were evaluated at 2 or 4 week intervals for 11 months (15 visits). In addition to physical exams, blood counts and chemistry profiles, subjects had central lab evaluations [including measurements of red cell density (by Advia instrument), HbF, red cell cation content, KCl co-transport and Gardos channel activity, cell adhesion to endothelial cells and laminin, and erythrocyte membrane phosphatidyl serine (PS exposure)] at baseline (twice) and weeks 8, 16, 24, and 44. The primary endpoint was red cell density measured at week 8. Results. Forty-four subjects (median age 13.6 years, range 5-53, 73% < age 16) had baseline evaluations and were randomized, 36 reached the primary endpoint and 22 completed 11 months on study drugs. The trial was halted prematurely because of slow enrollment. Subjects in the HU groups (A and B) had increased red cell MCV, cell Hb and HbF compared to baseline and to groups C and D at week 8 (p Conclusions. HU had significant effects on HbSC erythrocytes, including increased HbF and MCV, with increasing response over 6 months. Mg at a dose of 0.6 mEq/kg/d had no measurable effect on red cell properties or endothelial interactions, either alone or in combination with HU. This may have been related to suboptimal dosing, since the maximum tolerated dose was recently found to be 0.9 mEq/kg/d. Differences in acute events, although not significant, suggest a need for studies with larger enrollment. These data provide a basis for performing clinical efficacy trials using HU, perhaps at higher doses, in subjects with HbSC disease. Disclosures: Off Label Use: Hydroxyurea is being tested for its effects on red blood cells in persons with HbSC disease. Magnesium pidolate is being tested for its effects on red blood cells in persons with HbSC disease.