Comparison of a U.S. and Zambian Ob/Gyn Residency Training Programme.

Introduction: The major objective of the study was to compare and contrast a U.S. and Zambian Ob/Gyn residency programme, using uniform metrics, as the basis for an initial exploration of perceived inequities in post-graduate medical education between low- and high-income countries. Methods: Measurements of the following procedures were used to indicate whether minimum standards had been met by trainees in their respective postgraduate programmes: vaginal deliveries; C-sections; abdominal, vaginal and laparoscopic hysterectomies; other laparoscopic surgeries; cancer cases; abortions; obstetrical ultrasounds; cystoscopies; incontinence and pelvic floor surgeries. Evaluations were also made with respect to the presence or absence of an official ultrasound rotation, subspeciality and off-service rotations, protected didactic time and exclusive time on obstetrics and gynaecologic clinical services. Comparisons were made relative to these various categories and the average procedural numbers at each level of training to determine differences in trends and degree of exposure. Results: Minimal procedural requirements were met by both the U.S. and Zambian programmes. For open surgical cases, the minimum standards were higher for the Zambian programme, whereas for procedures associated with the use of high-end technology, such as ultrasound and minimally invasive surgery, minimum standards were higher for the U.S. programme. Conclusion: There were no significant differences in the Zambian and U.S. Ob/Gyn post-graduate training programmes, relative to their respective metrics. A more extensive analysis is required to determine the actual competency levels that are produced by the respective training systems.

Immature Teratoma Associated With Anti-N-Methyl-D-Aspartate Receptor Encephalitis.

Gynecologic teratomas commonly present with pelvic symptoms. The authors report a case of teratoma causing acute psychosis, encephalopathy, and sudden-onset seizures in a previously healthy 33-year-old woman. After common organic causes were excluded, investigation revealed an immature teratoma containing brain tissue on her left ovary. Anti-N-methyl-D-aspartate receptor encephalitis was diagnosed and, with excision and medical management, her symptoms resolved and she was discharged home in stable condition. Encephalopathy is not commonly attributed to gynecologic causes, but anti-N-methyl-D-aspartate receptor encephalitis may be caused by ovarian teratomas with a neuronal component. Thorough gynecologic examination should be performed on any female patient presenting with new-onset psychosis, encephalopathy, and seizures, especially in the absence of other organic or structural causes. Thus, it is important to look at the whole patient and not just the symptoms.