An Objective Structured Clinical Exam on Breaking Bad News for Clerkship Students: In-Person Versus Remote Standardized Patient Approach.

Introduction: Telemedicine training for medical students is critical as that modality becomes integral to patient care. This formative standardized patient (SP) objective structured clinical exam (OSCE) lets students discuss miscarriage diagnosis and treatment virtually. Methods: The SP OSCE was a mandatory session during the obstetrics and gynecology clerkship. Students received immediate feedback and optional individual reviews with clerkship directors. Students completed a nonmandatory survey at the end to describe their experience. SPIKES protocol student responses (i.e., proportion of correct responses) from in-person and remote SP versions were compared. Results: Between July 2019 and March 2020, 79 students completed the in-person OSCE. Between July 2020 and June 2021, 149 students completed the remote SP encounter OSCE. Students who participated in the remote versus the in-person OSCE were more likely to admit their lack of knowledge when not equipped (p = .02), be seated during the encounter (p = .03), show listening body language (p = .13), assess the SP's perception (p = .19) and understanding (p = .20), and correct the SP's misunderstandings (p = .14). Of 84 students from eight rotations, including both in-person and remote formats, 99% believed learning objectives were clear, 91% felt preparation material was adequate, 95% thought the instructor summarized important points, 97% learned something in caring for gynecological patients, and 96% perceived the OSCE to be a worthwhile educational experience. Discussion: The remote OSCE was well received by students. Breaking bad news virtually met assessment goals. Telemedicine training should be incorporated into medical school curricula.

Nail Changes during Pregnancy: A Cross-Sectional Survey of Patients at an Academic Center.

Introduction: Physiological changes in skin and hair are common during pregnancy. There are limited data on nail changes during pregnancy. Therefore, our study objectives were to determine prevalence and types of nail changes in pregnant women. Methods: A prospective study was conducted in the Weill Cornell Obstetrics and Gynecology waiting room, where a 32-question survey was administered to pregnant and nonpregnant patients. Results: There was a total of 167 subjects (73 pregnant, 94 nonpregnant). Nail changes were reported by 25/73 (34.2%) and 12/94 (12.8%) pregnant and nonpregnant women, respectively (p < 0.05). Onychocryptosis and leukonychia were more common in pregnant (12.3% and 13.7%, respectively) versus nonpregnant women (5.3% and 0%, respectively) (p < 0.05). The majority of patients reported no changes in nail growth, thickness, brittleness, during their pregnancies. Discussion/Conclusion: Most nail changes in pregnant and nonpregnant women are similar. Physicians should educate women that onychocryptosis and leukonychia are common and benign findings during pregnancy.