Applicant Experience in Communication With Residency Programs After the Introduction of Program Signaling.

OBJECTIVE: Examine the applicant experience after introduction of program signaling for the 2023 obstetrics and gynecology (OBGYN) residency application cycle. DESIGN: Responses to an online survey of OBGYN applicants participating in the 2023 match who participated in residency program signaling were compared to responses from a similar survey conducted in 2022. Demographic information included personal and academic background and how applicants and advisors communicated with programs. Numbers of applications and interviews, second look visits, away rotations, manner of contact, and timing of communication was compared. Statistical analysis included ANOVA for interval data, and χ2 and Kruskal-Wallis tests for categorical data. RESULTS: A total of 711 of 2631 (27%) applicants responded in 2022 and 606 of 2492 (24.3%) responded in 2023. Approximately 2/3 of gold signals and 1/3 of silver signals led to an interview. There was no change in number of applications or interviews per applicant, but there was a broader distribution of interviews per applicant in 2023. Applicants in 2023 were less likely to engage in preinterview communication or do an away rotation to indicate interest in a program. There was decreased communication between applicants and programs after signaling was introduced. Informal communication continued to differ by racial and medical school background. Applicants from DO programs and international medical graduates (IMG) had more communication with programs than MD applicants but received fewer interview invitations. Fewer Black and Latin(x)/Hispanic applicants had faculty reach out to residency programs on their behalf compared to White and Asian applicants. There were differences in the number of interviews received based on racial and ethnic identity. CONCLUSIONS: In the first year after implementation of program signaling, there was a decrease in preinterview communication and a broader distribution of interviews among applicants. Further efforts to create standard means of program communication may help to begin leveling the uneven playing field for applicants.

Developing Committed Resident Leaders: A Survey of the Administrative Chief Resident Experience in Surgical Fields.

OBJECTIVE: Administrative chief residents (ACRs) are integral to residency programs, however little research has been done on the experiences, training, and support of ACRs in surgical fields. The objective of this study was to define the challenges and experiences of surgical ACRs and identify support needed to make them successful. DESIGN: A Qualtrics survey was electronically distributed to participants. Response styles included multiple choice questions, yes/no, Likert scales, and short answers. Question topics included demographics, ACR duties, support, and experiences. SETTING: Obstetrics & Gynecology and General Surgery residency programs in the United States. PARTICIPANTS: Current and past administrative chief residents (2019-2020; 2018-2019) and program directors from Obstetrics & Gynecology and General Surgery residency programs. RESULTS: Seventy-nine surveys were completed by 48 (61%) ACRs and 31 (39%) program directors. The majority (52%) were from academic programs with a median of 6 residents and 2 ACRs per year. On a 10-point Likert scale, mean perceived support from faculty, program director, administration, and other residents was 7.0, 8.8, 6.7, and 7.7 respectively; however, mean stress level was also perceived to be high. Regarding preparation for the role, 56% of administrative chief residents do not receive a job description, 41% do not have a formal handoff process, 42% do not have formal leadership training, and only 61% agreed or strongly agreed that the administrative chief role was clear prior to starting. Common challenges reported by ACR's are limited preparation and training, conflict resolution, and workload management. Many ACRs felt they would benefit from formal leadership training and protected time. CONCLUSIONS: These results summarize the experiences of ACRs in surgical residencies. Best practices and formal training in identified challenge areas should be added to residency curriculum and used to develop toolkits to support ACRs nationwide.

Evaluation of a precise and measurable model for learning laparoscopic tissue handling.

INTRODUCTION: Laparoscopic tissue handling is quite difficult to measure using virtual-reality laparoscopic simulators and box-trainer exercises, and therefore, completion time is the predominant performance measure for simulation-based laparoscopic training exercises. The purpose of this study was to evaluate the construct validity of a training and assessment model for precise laparoscopic handling of delicate tissue. METHODS: Participants (n = 35) completed 2 progressively challenging laparoscopic tissue translocation exercises using delicate foam pieces and templates. Deidentified performances were scored using objective measures for tissue damage, accuracy, percentage complete, and completion time. Evaluation included multiple analysis of variance with repeated measures among the 3 groups as follows: medical students, residents and faculty who perform laparoscopic surgery less than once per week, and faculty members who perform laparoscopic surgery at least once per week. RESULTS: The model demonstrated significant construct validity by discriminating performances between the types of shapes and templates and across the levels of surgical experience on all dimensions. A significant interaction effect between the level of expertise and the difficulty of the exercise revealed excellent discrimination between experienced laparoscopic surgeons and others. DISCUSSION: This low-cost model provides an alternative or adjunct platform for laparoscopic training and assessment that requires precise and measurable handling of a delicate tissue.

Low-hanging fruit: a clementine as a simulation model for advanced laparoscopy.

INTRODUCTION: Low-cost, high-fidelity models for training in advanced laparoscopic surgery techniques are not currently available. The objective of this study was to evaluate a model and assessment protocol for developing associated fine, precise laparoscopic dissection skills with accompanying surgical decision making. METHODS: Novice to expert laparoscopists (n = 41) were asked to remove the peel of a clementine in as few pieces as possible, separate and remove all albedo from and between all fruit segments, and return the clementine to as close to its natural state as possible with completely closed skin (sutured). Clinical decision making included deciding when unacceptable segment damage would result by removing difficult-to-extract albedo, analogous to treating lesions or metastases through other methods, rather than risking damage to vital anatomic structures. Faculty assessed deidentified video-recorded performances. Data analyses included analysis of variance with Bonferroni post hoc. RESULTS: A single-performance construct (operative ability) with 2 scoring dimensions (surgical skills and clinical judgment) was confirmed through factor analysis. There were significant performance differences between all experience levels (F2,41 = 59.175, P < 0.000). There were no statistical time differences between the groups. CONCLUSIONS: Validation of this low-cost, easily facilitated model for developing advanced laparoscopic surgical skills may support the preparation of residents and fellows and provide a platform for skill acquisition, assessment, and basic critical thinking for performing laparoscopic tasks.

Simulation and team training.

The use of simulation-based methods for clinical and team training provides an opportunity for health care professionals to develop and maintain the skills required to effectively manage patient care. This is especially true for those rare events when emergency interventions require urgent, accurate, and cohesive team functioning. We present a framework for considering simulation-based training, examine contextual factors and the outcomes of research conducted to date in this area, and provide suggestions for selecting simulation-based approaches for developing obstetrics and gynecology teams in multiple contexts.

Management of Bartholin duct cysts and abscesses: a systematic review.

OBJECTIVE: To review systematically the literature, published in English, on recurrence and healing after treatment of Bartholin duct cysts and abscesses. DATA SOURCES: We searched PubMed, EMBASE, CINAHL, LILACS, Web-of-science, the Cochrane database, and POPLINE from 1982 until May 2008. We searched the internet, hand-searched reference lists, and contacted experts and authors of relevant papers to detect all published and unpublished studies. METHODS OF STUDY SELECTION: We included any study with at least 10 participants, addressing either frequency of recurrence or healing time after treatment of Bartholin duct cyst or abscess. We followed MOOSE (meta-analysis of observational studies in epidemiology) guidelines. Of 532 articles identified, 24 studies (5 controlled trials, 2 cohort studies, and 17 case series) met all inclusion criteria. Study size ranged between 14 and 200 patients. TABULATION, INTEGRATION, AND RESULTS: The interventions included: (1) Silver nitrate gland ablation, (2) cyst or abscess fenestration, ablation, or excision using carbon dioxide (CO(2)) laser, (3) marsupialization, (4) needle aspiration with or without alcohol sclerotherapy, (5) fistulization using a Word catheter, Foley catheter, or Jacobi ring, (6) gland excision, and (7) incision and drainage followed by primary suture closure. The reported frequency of recurrence varied from 0% to 38%. There was no recurrence after marsupialization in available studies. Recurrence after other treatments varied, and was most common after aspiration alone. Healing generally occurred in 2 weeks or less. CONCLUSION: There are multiple treatments for Bartholin duct cysts and abscesses. A review of the literature failed to identify a best treatment approach. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES: After completion of this article, the reader should be able to identify seven different treatments for Bartholin duct cysts or abscesses, contrast treatment choice complications and recurrence risks for the different options for treatment of Bartholin duct cysts or abscesses, and point out the limited quality and quantity of data upon which to choose best practices.

The bartholin gland cyst: past, present, and future.

Bartholin gland cysts account for 2% of all gynecologic visits per year. The treatment of Bartholin gland cysts has evolved from a complicated, bloody procedure requiring general anesthesia to, most recently, a simple puncture of the cyst and placement of a drain performed in the office. Although treatments for Bartholin gland cysts seem simple on the surface, recurrent cysts as well as diagnosing simple cysts versus abscesses versus malignant tumors can complicate treatment for this common problem. This article exams a history of the treatment of Bartholin gland cysts, including the use of the traditional treatments of excision, fistulization, marsupialization, as well as cauterization with carbon dioxide laser and silver nitrate. Modern variations are discussed, including the use of hydrodissection for excision, as well as the application of magnetic resonance imaging use in devising treatment for recurrent cysts.