The Level of Anatomical Knowledge, Hard to Establish: a Systematic Narrative Review.

Objective: This literature review aimed to gain more insight into the level of anatomical knowledge based on published measurements among medical students, residents, fellows, and specialists. Methods: We performed an extensive literature search in three online databases: Medline (using PubMed), Web of Science, and Education Resources Information Centre (ERIC). Results: A total of 30 relevant studies were found. In these studies, participants took different anatomy tests, and their mean/median scaled scores range from 22.5 to 82.4% on a 0 to 100% scale. Conclusion: This review provides an overview of what is known about measured anatomical knowledge. After critically reviewing the literature, we have to conclude that the existing literature confirms that anatomical knowledge is hard to establish, mainly due to the lack of standardisation.Further research should focus on ways to define and assess 'desired anatomical knowledge' in different contexts. In a next phase, we can discuss if anatomical knowledge is lacking and if interventions are needed.

Anatomy (knowledge) in postgraduate obstetrics and gynaecology training: Is it sufficient enough?

BACKGROUND: Due to the importance, anatomy training is worldwide recognizable in virtually all undergraduate curricula and many postgraduate surgical curricula (Estai and Bunt, 2016; Older, 2004). The postgraduate curriculum of Obstetrics and Gynaecology (O&G) is such a surgical curriculum. It is a diverse branch of medicine and the role of anatomy in O&G is versatile. In the Netherlands nor in Europe the expectations of knowledge on anatomy are specified in the current training program, making trainees insecure about their performance in anatomy knowledge ("Better Education for Obsetrics and Gynaecology,"). Therefore, we recently performed a Delphi study to determine which anatomical structures should be taught to ensure safe and competent practice among general gynaecologists (Koppes et al., 2020). The aim of this study is the determination of the anatomical knowledge level in postgraduate training for O&G. Our hypothesis is that the trainees possess a good knowledge of anatomy and on average at least 80% of correct answers on core knowledge is shown. METHODS: A longitudinal knowledge analysis was performed under Dutch Trainees Obstetrics and Gynaecology. The anatomy questions of the annual progress tests from 2010 to 2019 were analysed. Anatomy questions were selected and assessed on relevance based on the previous performed Delphi study which identified 86 structures which are essential to perform safe and competent practice as a general gynaecologist. Scores on relevant anatomy questions were calculated. RESULTS: In 10-year 3136 trainees performed the annual progress test. 54 Anatomy related questions were asked on a total of 1637 questions (3.3%). Of these 54 questions, 38 (70%) were concerned as relevant questions. Overall 10-year score was 64.5%. CONCLUSIONS: The anatomy knowledge of trainees' Obstetrics and Gynaecology is insufficient. Our results are a step in the awareness of testing and improving anatomy knowledge of postgraduate O&G training.

Clinical value of polymerase chain reaction in detecting group B streptococcus during labor.

AIM: To reduce the intrapartum use of antibiotics in women with prolonged rupture of the membranes (PROM) by restriction of antibiotics to women who are colonized with group B streptococci (GBS), as identified with the Cepheid Gene Xpert polymerase chain reaction (PCR) for detecting GBS. METHODS: We conducted a randomized controlled trial among full-term delivering women with PROM. Fifty-four women were enrolled, based on a power calculation with a significance level of 5% and a power of 95%. Twenty-seven women received the standard treatment (rectovaginal swab [RVS] for bacterial culture and antibiotics). For another 27 women PCR was performed on the RVS and antibiotics were used only when the PCR was positive. The primary outcome was reduction in antibiotic use, defined as the percentage of women who received antibiotics during labor. RESULTS: 54 Women were enrolled in the study between 1 May and 18 November 2014. There were no significant differences in baseline characteristics. In total, 10 of the 54 women were GBS positive (18.5%). Of those 10 women, three were identified on bacterial culture and seven on PCR. In the bacterial culture group all the women received antibiotics. In the PCR group 10 women (37%) received antibiotics (P = 0.002). Two false-positive PCR tests were identified. There were no false-negative PCR tests. CONCLUSION: Real-time identification of GBS on PCR reduces the intrapartum use of antibiotics in women with PROM.