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To describe anti-obesity bias in medical education including impact on patients, growth of biases over time, and education-based initiatives aimed at reducing bias.We reviewed available literature on anti-obesity bias in medical education and initiatives to address this bias.Information from a wide variety of medical educational settings was included.N/A RESULTS: Anti-obesity bias in healthcare is an independent risk factor for poor health outcomes and is pervasive throughout the culture of medicine. Medical students identify operating rooms as the number one location for anti-obesity comments, and students' biases increase throughout medical school. We propose several interventions (the 6 I's) as the next step in addressing this bias.

We applied Azjen's theory of planned behavior (TPB) and Triandis' theory of interpersonal behavior (TIB) to understand medical students' intention to change behavior based on feedback received during an obstetrics and gynecology clerkship. Both models presume that behavioral intention is strongly related to actual behavior.We collected free-text responses from students during a year-longWe reviewed 1,443 feedback entries from 122 students between July 2, 2018, and May 31, 2019.While

The Association of American Medical College (AAMC) requires all students to demonstrate four core attributes: knowledge, skills, altruism and dutifulness. A formal service-learning curriculum may serve to explicitly foster altruism and dutifulness in the affective domain of Bloom's taxonomy as well as proactively improve student well-being.All Harvard Medical School students enrolled in the Principal Clinical Experience (PCE) programme in the 2018-2019 academic year at Brigham and Women's Hospital were excused from clerkship responsibilities and given the opportunity to participate in a half-day team-based community-service intervention at a not-for-profit organisation in Boston, MA. Following the service-learning initiative, we examined student compassion, civic responsibility, well-being and team cooperativeness using validated survey questions, supplemented by free-text feedback.Forty-five of the 55 PCE students (82%) attended the outing. Overall, 68% of students found the outing to be valuable and 23% somewhat valuable. On a scale of 0-20, students reported very high self-perception of compassion (mean = 19.9), civic responsibility (mean = 19.7) and team development and composition (mean = 19.1), after the event. Students reported lower perceptions of personal well-being (mean = 17.5), but emotional wellness was the most frequently mentioned theme in open response.Incorporation of a team-based service-learning activity contributes to the students' community understanding, empathy and class team building. Utilisation of a published framework in the development of this initiative likely contributed to its success. Given our findings, we plan further expansion of this service learning longitudinally through the 4-year curriculum to potentially strengthen the affective domain for students further.

The mistreatment of trainees is known to lead to burnout, loss of empathy, and career changes. Medical students in particular are vulnerable to mistreatment due to their lack of seniority and frequent transitions to new teams. Traditionally, initiatives to eliminate medical student mistreatment have focused on preventing their victimization surrounding verbal, physical, and sexual misconduct. While initiatives to eliminate these types of behaviors are exceedingly important, the most common form of mistreatment that is reported by medical students is not these active forms of abuse. Instead, students on their clinical rotations more frequently report the covert "obstruction of learning" or "exclusion from the medical team" as the most common form of mistreatment experienced. Though the passive neglect of a medical student is not seemingly as serious an offense as active abuse, it can certainly have an impactful, lasting negative effect on student development, morale, and career choice. In this perspective, we recognize the importance of observational learning as a component of medical education, but state that the neglect or exclusion of a medical student should not be considered acceptable and should be labeled what it is-a form of mistreatment. We additionally provide examples for how to prevent medical student neglect by establishing a supportive and inclusive teaching environment.

The Accreditation Council for Graduate Medical Education (ACGME) milestones and the core Entrustable Professional Activities (EPAs) provide guiding frameworks and requirements for assessing residents' progress. The Mini-Clinical Evaluation Exercise (Mini-CEX) is a formative assessment tool used to provide direct observation after an ambulatory or clinical encounter. This study aimed to investigate the feasibility and reliability of the Mini-CEX in the authors' obstetrics and gynaecology (OB/GYN) residency program and its ability to measure residents' progress and competencies in the frameworks of ACGME milestones and EPAs.OB/GYN residents' 5-academic-year Mini-CEX performance was analyzed retrospectively to measure reliability and feasibility. Additionally, realistic evaluation was conducted to assess the usefulness of Mini-CEX in the frameworks of ACGME milestones and EPAs.A total of 395 Mini-CEX evaluations for 49 OB/GYN residents were analyzed. Mini-CEX evaluation data significantly discriminated among residents' training levels (P0.003). Residents had an average of 8.1 evaluations per resident completed; 10% of second-year residents and 28% of third-year residents were evaluated 10 or more times per year, whereas no postgraduate year 1 or postgraduate year 4 residents achieved this number. Mini-CEX data could contribute to all 6 primary measurement domains of OB/GYN milestones and 8 of 10 EPAs required for first-year residents.The Mini-CEX demonstrated potential for measuring residents' clinical competencies in their ACGME milestones. Faculty time commitment was the main challenge. Reform is necessary for the current feedback structure in Mini-CEX, faculty development, and operational guidelines that help residency programs match residents' clinical competency ratings with ACGME milestones and EPAs.

Resident feedback and program evaluation are essential to ACGME-accredited training programs. We sought to integrate these requirements into our program by creating a systematic process for program improvement focusing on personal learning plans (PLPs). Residents completed a PLP tool every 6 months, followed by an evaluation completed with the program director. Among respondents, 96% reported the PLP process provided useful feedback. A majority found the PLP process useful in developing learning strategies and modeling lifelong learning. The integrated PLP/program improvement process serves as an effective strategy for quickly identifying and capitalizing on both individual and program opportunities for improvement. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40670-019-00853-8) contains supplementary material, which is available to authorized users.

Objectives To investigate the effects of a stress management workshop on medical students’ knowledge of stress and potential coping strategies. Methods A panel discussion with small group breakouts on stress in clinical medicine, learning challenges, competition with colleagues, handling stressful events, and recognizing burnout symptoms was conducted with medical students entering clerkships. A longitudinal survey design was utilized to measure pre-, post-, and long-term (3-month) changes in knowledge (impact of stress on personal health, learning, and patient care), confidence, perceived skills, and attitude (towards utilizing adaptive coping strategies) among participating students (N = 135). Paired t test and multivariate analyses were performed to assess the differences between survey responses on a 5-point Likert scale. Results Survey response rates were pre-90.4%, post-77%, and long-term post-71.1%. Compared to pre-workshop, students reported significant improvement in all four domains immediately post-workshop: knowledge (4.4 vs. 4.7, p

Phenomenon: Obstetrics and gynecology can be a high-stress clinical environment for medical students due to the specialty’s fast-paced and unpredictable nature. Little is known about learni...

Introduction Learners consistently report insufficient feedback, despite interventions to improve the quantity and quality of feedback. Effective feedback requires a dynamic partnership and a trusting relationship between students and teachers. Methods We developed and implemented a faculty and student program called Feedback Focused on the OB/GYN clerkship with learner- and faculty-centered teaching materials. We evaluated the curriculum's impact on the frequency and quality of feedback exchange through comparison of end-of-clerkship evaluations before and after implementing the Feedback Focused program and assessed student satisfaction from written responses on clerkship evaluations. Results A total of 1,912 feedback folio entries were recorded during the curriculum timeframe, representing an average of 19 entries per student. Of students, 85% turned in their feedback folios at the end of the clerkship. There was a marked increase in reported frequency of feedback with the initiative, with 28% of students reporting receiving feedback four or more times per month before the start of our program, compared to 64% after its completion. The percentage of students who reported faculty provided direction and constructive feedback always or very often remained roughly the same before and after the program (69% vs. 70%, respectively). Over 60% of students provided positive feedback on written open response questions. Discussion We successfully developed and implemented a multipronged approach to effectively change the learning environment culture within our OB/GYN clerkship program. Our evaluation demonstrated that the Feedback Focused program was well received and increased frequency of feedback.

Background The Covid-19 pandemic is straining healthcare systems in the US and globally, which has wide-reaching implications for health. Women experience unique health risks and outcomes influenced by their gender, and this narrative review aims to outline how these differences are exacerbated in the Covid-19 pandemic. Observations It has been well described that men suffer from greater morbidity and mortality once infected with SARS-CoV-2. This review analyzed the health, economic, and social systems that result in gender-based differences in the areas healthcare workforce, reproductive health, drug development, gender-based violence, and mental health during the Covid-19 pandemic. The increased risk of certain negative health outcomes and reduced healthcare access experienced by many women are typically exacerbated during pandemics. We assess data from previous disease outbreaks coupled with literature from the Covid-19 pandemic to examine the impact of gender on women's SARS-CoV-2 exposure and disease risks and overall health status during the Covid-19 pandemic. Conclusions Gender differences in health risks and implications are likely to be expanded during the Covid-19 pandemic. Efforts to foster equity in health, social, and economic systems during and in the aftermath of Covid-19 may mitigate the inequitable risks posed by pandemics and other times of healthcare stress., Highlights • Female caregivers have an increased exposure risk of contracting SARS-CoV-2. • Covid-19 restricts access to family planning and intimate partner violence resources. • Multifactorial stress is uniquely exacerbated among women during Covid-19. • Gender-informed policies are needed to combat health disparities during pandemics.

Objectives To determine if faculty perceive standardized oral examinations to be more objective and useful than the non-standardized format in assessing third-year medical students’ learning on the obstetrics and gynecology rotation. Methods Obstetrics and gynecology faculty at three teaching hospitals were sampled to complete a survey retrospectively comparing the standardized oral examination (SOE) and non-standardized or traditional oral examinations (TOE). A Likert scale (0-5) was used to assess satisfaction, objectivity, and usefulness of SOE and TOE. Wilcoxon signed rank test was performed to compare median Likert scale scores for each survey item. A Spearman’s correlation coefficient was used to investigate the relationship between the perceived level of objectivity and SOE characteristics. For qualitative measures, content analysis was applied. Results Sixty-six percent (n=25) of eligible faculty completed the survey. Faculty perceived the standardized oral examination as significantly more objective compared with the non-standardized (z=-3.15, p=0.002). Faculty also found SOE to be more useful in assessing overall clerkship performance (z=-2.0, p

The primary aim of this study was to investigate whether the types of postgraduate trainees’ teaching barriers would be associated with their experience levels and the four clinical settings in Obstetrics and Gynecology (OB/GYN). Individual semi-structured interviews with 13 OB/GYN residents and Fellows were conducted and followed by an online survey sent to all OB/GYN residents and Fellows in three research sites. Descriptive statistical analysis and thematic analysis were applied. Eleven OB/GYN residents and two Fellows participated in the interviews. Of 93 possible OB/GYN resident and Fellow respondents, 57 (61.3 %) completed the online survey. Limited time was the predominant barrier across OB/GYN trainees’ experience levels. Six factors contributing to the teaching barriers were identified. Major types of teaching barriers perceived by trainees were similar in outpatient and labor and delivery settings, but differed from perceived barriers in the inpatient and operating room settings. Major types of teaching barriers were associated with trainees’ experience levels as well as the four clinical settings in OB/GYN. Findings from this study deepen OB/GYN clerkships and residency programs’ understanding of Trainee-as-Teacher, as well as provide useful information for programs to manage teaching tasks and to further enhance the implementation of Trainee-as-Teacher curricula efficiency.

Objective: The purpose of this pilot study was to examine our hypothesis that enriching workplace emotional intelligence through resident coaches could improve third-year medical students’ adaptability and proactivity on the Obstetrics and Gynecology clerkship. Methods: An observational pilot study was conducted in a teaching hospital. Fourteen 3rd year medical students from two cohorts of clerkships were randomly divided into two groups, and equally assigned to trained resident coaches and untrained resident coaches. Data was collected through onsite naturalistic observation of students’ adaptability and proactivity in clinical settings using a checklist with a 4point Likert scale (1=poor to 4=excellent). Wilcoxon ranksum test was used to compare the differences between these two groups. Results: A total of 280 data points were collected through onsite observations conducted by investigators. All (n=14) students’ adaptability and proactivity performance significantly improved from an average of 3.04 to 3.45 (p=0.014) over 6-week clerkship. Overall, students with trained resident coaches adapted significantly faster and were more proactive in the obstetrics and gynecology clinical setting than the students with untrained coaches (3.31 vs. 3.24, p=0.019). Conclusions: Findings from our pilot study supported our hypothesis that enriching workplace emotional intelligence knowledge through resident coaches was able to help medical students adapt into obstetrics and gynecology clinical settings faster and become more proactive in learning. Clerkship programs can incorporate the concept of a resident coach in their curriculum to help bridge medical students into clinical settings and to help them engage in self-directed learning throughout the rotation.

Taking responsibility for patients is fundamental to medical education. Supplying opportunities for patient continuity contrasts with the competing goal of decreasing hospital lengths of stay (LOS). The objective of this study was to investigate whether medical students’ perceived appropriate responsibility was influenced by patient LOS and to elucidate other factors associated with responsibility. This was a retrospective analysis of responses of Harvard Medical School students on end-of-clerkship evaluations to the question: “How appropriate was the responsibility you were given for patients?” based on a Likert scale (1 = Excellent; 5 = Poor). Responses were aggregated for the core clerkships from each Principal Clinical Experience site and compared with the average LOS records obtained from affiliated teaching hospitals. Spearman correlation matrices were constructed to investigate factors correlated with students’ perceived appropriate responsibility and LOS; p

We hypothesized that a passive visual distraction would reduce pain and anxiety among women undergoing colposcopy.We assessed the association between exposure to a passive visual distraction during colposcopy and procedure-related pain and anxiety using a nonrandomized intervention design. Women presenting for initial or repeat colposcopy at Brigham and Women's Hospital Colposcopy Clinics were eligible for participation. Women undergoing colposcopy during the first 6 months of the study (n=168) were not exposed to the visual distraction, whereas women undergoing colposcopy during the second 6 months of the study (n=153) were exposed to a pleasing, passive visual distraction consisting of images on a light diffuser installed within the examination room's ceiling light. We used ordinal logistic regression to compare self-reported pain, measured using the visual analog scale, and anxiety, measured using the Spielberger State-Trait Anxiety Inventory-6, among women receiving and not receiving the intervention.Two hundred sixteen women with complete data were included in the final analyses. Women in both groups reported high levels of colposcopy-related anxiety. Compared to women who did not receive the visual distraction, women receiving the visual distraction during colposcopy had a 54% reduction in the odds of experiencing a given level of postexamination pain, holding preprocedure pain constant (odds ratio=0.46, 95% confidence interval=0.28-0.77). Visual distraction was not associated with postexamination anxiety (odds ratio=0.95, 95% confidence interval=0.60-1.51).A passive visual distraction reduced perceived pain, but not anxiety, after colposcopy.

Exposure to commonly performed gynecologic procedures via simulation has potential to improve medical student knowledge and foster confidence with procedures.To implement and evaluate a gynecologic simulation curriculum for 3rd-year medical students during their obstetrics and gynecology core clerkship.A gynecologic simulation curriculum was implemented for medical students during their obstetrics and gynecology clerkship. Participants completed pre-and postsurveys to assess learner confidence; effect on interest in a surgical field, women's health, and obstetrics and gynecology as a career; and whether the session met their learning needs.Fifty-nine students participated. Improved confidence in performing the procedures was noted when comparing mean survey scores before and after the simulation for IUD insertion and removal (1.9 pre, 4.3 post, p.0001), for dilatation and curettage (1.7 pre, 3.8 post, p.0001), and basic laparoscopy skills (2.1 pre, 4.3 post, p.0001). An increase in pursuing a surgical field (3.3 pre, 3.6 post, p.003) and interest in women's health (3.7 pre, 4.9 post, p.004) was noted among students after the simulation session. The curriculum strongly met the students learning needs with a mean score of 4.54 on the 5-point scale.Gynecologic simulation training for medical students can increase confidence in procedures, interest in pursuing a surgical field and women's health, and was highly effective in meeting student learning needs.

Introduction This training program was developed to help educators train obstetrics and gynecology (OB-GYN) faculty in becoming oral examiners and to implement a consistent process for oral examination in order to assess medical student knowledge and clinical reasoning skills at the end of their core OB-GYN clerkship. Methods The slide presentation is utilized to introduce faculty to the clerkship so they understand how the oral examination fits into the overall assessment of student performance. Videos are then used to familiarize faculty with the performance of students at different levels and how to use the evaluation form. The oral examination sample questions and answers further familiarize faculty with how to ask students standardized questions based upon student case topic selections and how to differentiate students at different levels. Results From 2011–2014, 609 students took the oral examination. Two faculty members graded the students, and a composite of these two grades was used. This was done so that if the faculty differed in their ratings, both grades are accounted for in the final oral examination grade. Thirty-three percent of the learners received two Honors with Distinction grades, 32% received an Honors with Distinction and an Honors grade, and 23% received two Honors grades. Discussion The oral examination has been part of the Harvard Medical School Obstetrics and Gynecology Core Clerkship assessment for over a decade, and a common format for its use at all sites was developed. The implementation of this module has resulted in a standardized assessment across multiple sites.

Background Opportunities for medical students to place intrauterine contraception (IUC) in patients are rare. Our objective was to determine whether participation in an IUC insertion and removal simulation exercise would increase medical students’ comfort level with, attitudes towards, and willingness to recommend IUC. Methods A prospective cohort study was undertaken in all students completing the obstetrics and gynecology clerkship at a major academic hospital during the 2010–2011 academic year. The exposure consisted of a 45-minute interactive didactic session and a 30-minute, hands-on practicum in IUC placement and removal using medical instruments and realistic pelvic models. Both levonorgestrel and Cu380A IUC devices were utilized. Participants completed a pre- and post-simulation survey instrument, designed to examine students’ IUC-specific knowledge, comfort, and attitudes. Pre- and post-simulation responses were compared by McNemar’s test for paired samples. Results Thirty-five paired pre- and post-simulation surveys were analyzed, representing a 78 % response rate. Composite IUC-related knowledge scores increased by a median of 3 out of 10 points after the intervention (p

To estimate cancer outcome and outcome predictors of women with endometrial intraepithelial neoplasia (EIN).Outcomes of women with first diagnosis of EIN ("index biopsy") were determined by follow-up pathology. Patient characteristics were correlated with EIN regression, EIN persistence, and progression to cancer.Fifteen percent (95% confidence interval [CI] 9.8-20.8%, 26 of 177) of index EIN biopsy samples had concurrent cancer. Of the women with cancer-free index EIN biopsy samples and follow-up by hysterectomy or more than 18 months of surveillance, 25% (95% CI 18.4-33.3%, 36 of 142) showed regression, 35% (95% CI 27.4-43.7%, 50 of 142) showed persistence, and 39% (95% CI 31.3-48.0%, 56 of 142) showed progression. Nonwhite ethnicity and progestin treatment reduced cancer outcomes (odds ratio [OR] 0.16, 95% CI 0.03-0.84 and OR 0.24, 95% CI 0.08-0.70, respectively), whereas body mass index greater than 25 increased malignant outcomes (body mass index 25 or higher, OR 3.05, 95% CI 1.10-8.45).Endometrial intraepithelial neoplasia confers a high risk of cancer, but individual patient outcomes cannot be predicted. Management should include exclusion of concurrent carcinoma and consideration of hysterectomy.

To compare physician practices, attitudes, and barriers toward human papillomavirus (HPV) vaccination.A Web-based survey that assessed the practice of HPV vaccination, perceived barriers, and opinions of potential vaccine effects was distributed to obstetrician/gynecologists, internists, and pediatricians within a single health care system. A total of 1,488 physicians located in tertiary, community, and private settings were sent the survey. Data were analyzed using multivariate logistic regression.A total of 424 (28.9%) of 1,488 physicians participated. Of these physicians, 80% offer the vaccine. Female, primary care, and community and private practice physicians were associated with increased vaccination, compared with male, subspecialty, and tertiary care physicians, respectively. Physicians who reported no barriers to vaccination were more likely to offer the vaccine (odds ratio = 1.74, 95% CI = 1.04-2.93, p =.04). The greatest barrier to vaccination was reimbursement concerns.Most physicians offer the HPV vaccine. Addressing barriers to vaccination and resolving practical concerns may increase HPV vaccination.

Vulvar lesions, rashes, and pruritis are common complaints. This chapter includes the differential diagnosis of vulvar symptoms divided among infectious and noninfectious causes and by lesion characteristic (abscesses, blisters or desquamation, ulcers, fissures, and masses). Diagnosis (by history, physical exam, serology, cultures, or biopsy) and management of specific etiologies are discussed.

Faculty involvement in simulation training is essential for curriculum development, utilization of their clinical expertise in teaching, and ultimately for validating the importance of the training program. Several barriers to faculty involvement exist, including competing demands on time, the challenges in developing curriculum, and teaching using simulation. Through our experiences in implementing a widely expansive program, we have identified several areas to encourage and engage faculty. Further discussion as a medical education community is needed to support the interaction and involvement of our faculty to support and promote ongoing simulation education.

obstetrics and gynecology :the esswntials of clinical care , obstetrics and gynecology :the esswntials of clinical care , کتابخانه الکترونیک و دیجیتال - آذرسا

Life-threatening uterine hemorrhage can be a presenting symptom in patients with acute promyelocytic leukemia (APML), of which one of the complications is disseminated intravascular coagulopathy.A 44-year-old, previously healthy woman, gravida 3, para 3, presented with a life-threatening uterine hemorrhage. She was subsequently diagnosed with APML by bone marrow biopsy. The uterine hemorrhage was treated with hormonal therapy and uterine artery embolization (UAE), which failed to control the bleeding. Radiofrequency, impedance-controlled endometrial ablation was successfully utilized.Endometrial ablation can be used to effectively treat a life-threatening uterine hemorrhage in patients with APML after failed medical therapy and UAE.

This study was undertaken to compare teaching quality between obstetrics/gynecology resident and faculty preceptors in ambulatory gynecology as determined by medical student evaluation.A prospective assessment of medical student evaluations of resident and faculty preceptors in ambulatory gynecology was conducted at Brigham and Women's Hospital. Forty-eight third-year medical students evaluated preceptors on 15 teaching quality items and recorded their clinical experience during their obstetrics/gynecology clerkship from July 2004 to June 2005 for a total of 138 evaluations.Faculty scores were statistically higher than resident scores on 4 of the 15 teaching quality items; acting as an appropriate clinical role model, emphasizing evidence-based learning, being enthusiastic about teaching and patient care (P.05). Students performed significantly more Papanicolaou tests and pelvic and breast examinations during ambulatory sessions with residents than with faculty (P.001).Residents and faculty contribute important and different aspects of teaching experiences for medical students in ambulatory gynecology.

To review the effects of exercise during pregnancy on fetal and maternal outcomes, a selective literature search was performed using MEDLINE, the Cochrane Database and bibliographies from relevant articles to identify additional references. The data on exercise during pregnancy are limited but suggest that moderate exercise during a low-risk pregnancy does not lead to adverse outcomes for the fetus or mother and improves overall maternal fitness and well-being. The data examining the impact of exercise on labor outcomes, maternal weight gain and fetal weight are conflicting. Moderate exercise in the low-risk pregnancy improves maternal well-being and does not seem to have adverse effects on the fetal or maternal outcome. However, further studies are needed.

OBJECTIVE To describe current practices of chaperone use during pelvic examinations among obstetrician/gynecologists affiliated with a large tertiary care teaching hospital. STUDY DESIGN Questionnaires were distributed at department of obstetrics and gynecology grand rounds to all practicing attending physicians to obtain physician demographic data, including age, years in practice, practice type (solo or group) and whether chaperones were currently used when performing pelvic examinations at the first obstetric or gynecologic office visit. Physicians were also asked whether they were taught to use chaperones for pelvic examinations during medical school or residency. RESULTS Of the 59 attending physicians, 100% responded to the questionnaire. As compared to female physicians, male physicians used chaperones more at the first obstetric examination (76.9% vs. 27.8%, P < .002), at gynecologic office visits (70.0% vs. 22.2%, P < .002) and for breast examinations (51.2% vs. 11.1%, P < .01). Physicians greater than 40 years old, in practice longer than 10 years and taught as medical students or residents to use chaperones were statistically more likely to use chaperones. No attendings, male or female, reported losing a patient to another provider or being sued or threatened with legal action because of not using a chaperone. CONCLUSION Chaperones were used more frequently during pelvic examinations by male physicians, age greater than 40, solo practice, and physicians in practice longer than 10 years. Education affected current practices as specific medical student or residency training influenced the use of chaperones in private practice.