Guided outcomes in learned efficiency model in clinical medical education: a randomized controlled trial of self-regulated learning.

OBJECTIVE: The guided outcomes in learned efficiency (GOLE) model emphasizes the use of evidence-based resources to understand the diagnosis, treatment, follow-up, and prevention of disease. We seek to determine whether presentations created using the GOLE model are superior to an unstructured approach in achieving Accreditation Council for Graduate Medical Education (ACGME) Core Competencies. STUDY DESIGN: Consenting medical students were randomized to GOLE or control groups to individually research a self-selected clinical topic. A validated survey instrument was used prepresentation and postpresentation to assess perceived improvement in knowledge. Subjects completed self-evaluations at enrollment and after presentation of their chosen clinical topic. Other students, residents, and a faculty member also completed evaluations after each student presentation. Standard statistical methods (analysis of variance, 2-tailed t test) were used to determine if a statistically significant difference existed between intervention and control groups. RESULTS: Self-assessments were similar in the GOLE and control groups. Externally perceived presentation scores were greater in the GOLE group (ACGME global P < .0001, presentation global P = .07), which demonstrated a significant improvement in 5 core competencies. Time spent preparing the presentation and resources utilized did not differ between groups. CONCLUSION: The presentations prepared using the GOLE model were rated higher by observers than those prepared using traditional techniques.

Citalopram in the treatment of women with chronic pelvic pain: an open-label trial.

OBJECTIVE: To determine the efficacy of citalopram in the treatment of chronic pelvic pain by measuring changes in pain severity, depressive symptoms and functional disability. STUDY DESIGN: Fourteen women between 18 and 50 years of age with chronic pelvic pain were enrolled in a 12-week, open-label, flexible-dose study. Following a single-blind washout, placebo nonresponders were treated with citalopram (20-60 mg/d). RESULTS: Twelve patients completed the study. Depression scores decreased significantly on the Hamilton Psychiatric Rating Scale for Depression (p = 0.006), pain severity showed a trend toward improvement on the McGill Pain Intensity Scale (p = 0.096), but there was no significant differences on the Pain Disability Index (p = 0.158). Eleven of 12 (91.7%) patients elected to continue taking citalopram after study completion. CONCLUSION: Citalopram is effective in reducing depressive symptoms, shows a statistical trend toward improvement in pain intensity in women with chronic pelvic pain and is well tolerated. It appears minimally effective in reducing disability. Larger, controlled studies are needed to evaluate the role of citalopram in treating chronic pelvic pain.

A comparison of an interactive computer-based method with a conventional reading approach for learning pelvic anatomy.

OBJECTIVE: This study was undertaken to assess the impact of interactive, computer-based versus conventional, paper-based format in student, resident, and fellow learning and retention of anatomy knowledge. STUDY DESIGN: Randomized longitudinal cohort design with scores repeated as pre-, post-, and follow-up tests. Subjects were randomly assigned to an anatomy module in computer-based (CD-ROM) format and 1 in paper-based format. A follow-up examination was administered 3 weeks after the posttest to evaluate retention of knowledge. Tests results were analyzed by using Student t tests and analysis of variance. RESULTS: Thirty-nine subjects completed all testing. Regardless of instructional method, pretest to posttest scores improved (P < .01), and posttest to follow-up test scores decreased among all levels of training (P < .01). Student satisfaction was highest with CD-ROM format. CONCLUSION: Improvement and retention of anatomy knowledge was not significantly different when comparing a new CD-ROM interactive approach with a traditional paper-based method.

Assessment of a 360-degree instrument to evaluate residents' competency in interpersonal and communication skills.

OBJECTIVE: To test the reliability of the 360-degree evaluation instrument for assessing residents' competency in interpersonal and communication skills. METHOD: Ten-item questionnaires were distributed to residents and evaluators at Monmouth Medical Center in Long Branch, New Jersey, in March/April, 2002. The scoring scale was 1-5; the highest score was 50. Data were maintained strictly confidential; each resident was assigned a code. Completed data sheets were collated by category and entered into a spreadsheet. The total and mean scores by each category of evaluator were calculated for each resident and a rank order list created. Shrout-Fleiss (model 2) intraclass correlation coefficients measured reliability of ratings within each group of evaluators. Reliability/reproducibility among evaluators' scores were tested by the Pearson correlation coefficient (p <.05). RESULTS: Intraclass correlation coefficients showed a narrow range, from.85-.54. The highest ranked resident overall ranked high and the lowest was low with most evaluators. The rank order among fellow residents was markedly different from other evaluator categories. Pearson correlation coefficients showed significant correlation between faculty and ancillary staff, (p =.002). Patients as evaluators did show intraclass correlation, but did not correlate significantly with other categories. Scores from colleagues correlated negatively with all other categories of evaluators. CONCLUSIONS: The 360-degree instrument appears to be reliable to evaluate residents' competency in interpersonal and communication skills. Information from the assessment may provide feedback to residents. Areas of improvement identified by the scores would suggest areas for improvement and further ongoing assessment.

Pap smear noncompliance among female obstetrics-gynecology residents.

OBJECTIVES: We wish to determine how well female obstetrics and gynecology (OB/GYN) residents in the United States follow recommendations for routine Pap smears in managing their own health care and to identify the reasons for noncompliance. METHODS: A survey was mailed to 1693 female OB/GYN residents in the U.S. Factors associated with noncompliance were determined by chi-square. Logistic regression analysis was used to identify independent prognostic factors and calculate the odds ratio (OR). RESULTS: Six hundred eleven (36%) surveys were returned with compliance information. Noncompliance was reported by 33%. Lack of time or inconvenience was cited as the most common reason (93%) for noncompliance, followed by consideration of themselves as low risk for cervical disease (41%) and fear of or embarrassment in seeing a doctor (14%). On multivariate analysis, independent risk factors for noncompliance during residency included noncompliance prior to residency (OR 4.6, P<0.0001) and Asian ethnicity (OR 2.1, P = 0.02), whereas East Indian ethnicity (OR 3.0, P = 0.06) and having no children (OR 1.6, P = 0.07) were near significant. CONCLUSIONS: A substantial proportion of female OB/GYN residents do not follow standard recommendations for routine Pap smears. Although the principal reason for noncompliance given was lack of available time and/or inconvenience during residency, this behavior predated residency and was associated with specific ethnic groups.

Oral methotrexate for treatment of ectopic pregnancy.

OBJECTIVE: The purpose of this study was to evaluate oral methotrexate tablets in the treatment of ectopic pregnancy. STUDY DESIGN: Patients with a diagnosis of ectopic pregnancy were offered oral methotrexate tablets rather that intramuscular injection. Oral methotrexate was given in 2 divided doses 2 hours apart at a dose of 60 mg/m(2) with standard 2.5 mg methotrexate tablets. Patients were followed up with the use of the same protocol that was used typically for intramuscular methotrexate. RESULTS: Nineteen of 22 patients (86%) were successfully treated. There was no statistical difference between patients who were treated successfully or unsuccessfully, with respect to initial human chorionic gonadotropin titers (P =.55), ectopic size (P =.77), or methotrexate dose (P =.18). Nineteen of 22 patients (86%) had increased pain during treatment. Outside of pain, gastrointestinal side effects were the most common. Thirty-two percent of patients required more than one treatment cycle. CONCLUSION: Oral methotrexate can be used to treat ectopic pregnancy successfully, but there are few advantages to recommend its use over intramuscular methotrexate.

Efficacy of static magnetic field therapy in chronic pelvic pain: a double-blind pilot study.

OBJECTIVE: The aim of the study was to determine the efficacy of static magnetic field therapy for the treatment of chronic pelvic pain (CPP) by measuring changes in pain relief and disability. STUDY DESIGN: Thirty-two patients with CPP completed 2 weeks and 19 patients completed 4 weeks of randomized double-blind placebo-controlled treatment at a gynecology clinic. Active (500 G) or placebo magnets were applied to abdominal trigger points for 24 hour per day. The McGill Pain Questionnaire, Pain Disability Index, and Clinical Global Impressions Scale were outcome measures. RESULTS: Patients receiving active magnets who completed 4 weeks of double-blind treatment had significantly lower Pain Disability Index (P <.05), Clinical Global Impressions-Severity (P <.05), and Clinical Global Impressions-Improvement (P <.01) scores than those receiving placebo magnets, but were more likely to correctly identify their treatment (P <.05). CONCLUSION: SMF therapy significantly improves disability and may reduce pain when active magnets are worn continuously for 4 weeks in patients with CPP, but blinding efficacy is compromised.