Development of a medical education podcast in obstetrics and gynecology.

Podcasts are used in medical education to supplement conventional teaching methods such as lectures and reading. We identified a lack of Canadian medical education podcasts covering obstetrics and gynecology (Ob/Gyn) content and created a podcast specific for Canadian medical students and residents. The podcast called "OB-G in YEG" is freely available and currently has fourteen episodes that cover common topics in Ob/Gyn. We describe the process for creating a high-quality medical education resource that is widely accessible to learners that readers may be able to replicate in their own discipline.

Les baladodiffusions sont utilisées dans l'éducation médicale en complément aux méthodes d'enseignement traditionnelles comme les cours magistraux et la lecture de textes. Ayant constaté un manque de baladodiffusions d'enseignement dans les domaines de l'obstétrique et de la gynécologie (OB/GY) au Canada, nous avons créé une telle émission destinée aux étudiants et aux résidents en médecine de ce pays. La baladodiffusion, intitulée « OB-G in YEG ¼, est disponible gratuitement et elle comporte actuellement onze épisodes sur des sujets d'intérêt général touchant à l'obstétrique et à la gynécologie. Nous décrivons le processus de création d'une ressource d'enseignement médical de qualité, qui est largement accessible aux apprenants et que les lecteurs seraient peut-être en mesure de reproduire dans leur propre discipline.

Exploring Faculty Perceptions of Competency-Based Medical Education and Assessing Needs for Implementation in Obstetrics and Gynaecology Residency.

OBJECTIVE: The shift to competency-based medical education (CBME) is associated with changes in the way residents are taught and assessed. Although there are many purported benefits of CBME, an understanding of the preparedness of faculty to meet the needs of this new paradigm is lacking. The aim of this study was to characterize faculty needs to support the transition to CBME. METHODS: An online survey was designed with the aim of characterizing faculty understanding of the principles of CBME and common trainee assessment methods, as well as exploring barriers to the implementation of CBME in obstetrics and gynaecology residency programs across Canada. The survey was sent to faculty across Canada in English and French. RESULTS: A total of 284 responses were collected between September 2015 and December 2016. Although most faculty viewed CBME as a positive change, there were gaps in their knowledge about CBME and workplace-based assessment methods. Barriers to the implementation of CBME included lack of training in assessment of residents and feedback, financial implications, and time constraints. CONCLUSION: To facilitate the transition to CBME, institutions may need to consider establishing faculty training programs and implementing systemic change aimed at addressing faculty needs and barriers during this fundamental shift in the structure of residency training.

The Impact of Bariatric Surgery on Polycystic Ovary Syndrome: a Systematic Review and Meta-analysis.

Bariatric surgery has been proven to be a successful management strategy for morbid obesity, but limited studies exist on its effect on polycystic ovary syndrome (PCOS). A comprehensive search of electronic databases was completed. Meta-analysis was performed on PCOS, hirsutism, and menstrual irregularity outcomes following bariatric surgery. Thirteen primary studies involving a total of 2130 female patients were identified. The incidence of PCOS preoperatively was 45.6 %, which significantly decreased to 6.8 % (P < 0.001) and 7.1 % (P < 0.0002) at 12-month follow-up and study endpoint, respectively. The incidences of preoperative menstrual irregularity and hirsutism both significantly decreased at 12-month and at study end follow-up. Bariatric surgery effectively attenuates PCOS and its clinical symptomatology including hirsutism and menstrual irregularity in severely obese women.

The Obesity-Fertility Protocol: a randomized controlled trial assessing clinical outcomes and costs of a transferable interdisciplinary lifestyle intervention, before and during pregnancy, in obese infertile women.

BACKGROUND: Obesity in infertile women increases the costs of fertility treatments, reduces their effectiveness and increases significantly the risks of many complications of pregnancy and for the newborn. Studies suggest that even a modest loss of 5-10 % of body weight can restore ovulation. However, there are gaps in knowledge regarding the benefits and cost-effectiveness of a lifestyle modification program targeting obese infertile women and integrated into the fertility clinics. This study will evaluate clinical outcomes and costs of a transferable interdisciplinary lifestyle intervention, before and during pregnancy, in obese infertile women. We hypothesize that the intervention will: 1) improve fertility, efficacy of fertility treatments, and health of mothers and their children; and 2) reduce the cost per live birth, including costs of fertility treatments and pregnancy outcomes. METHODS/DESIGN: Obese infertile women (age: 18-40 years; BMI ≥30 kg/m(2) or ≥27 kg/m(2) with polycystic ovary syndrome) will be randomised to either a lifestyle intervention followed by standard fertility treatments after 6 months if no conception has been achieved (intervention group) or standard fertility treatments only (control group). The intervention and/or follow-up will last for a maximum of 18 months or up to the end of pregnancy. Evaluation visits will be planned every 6 months where different outcome measures will be assessed. The primary outcome will be live-birth rates at 18 months. The secondary outcomes will be sub-divided into four categories: lifestyle and anthropometric, fertility, pregnancy complications, and neonatal outcomes. Outcomes and costs will be also compared to similar women seen in three fertility clinics across Canada. Qualitative data will also be collected from both professionals and obese infertile women. DISCUSSION: This study will generate new knowledge about the implementation, impacts and costs of a lifestyle management program in obese infertile women. This information will be relevant for decision-makers and health care professionals, and should be generalizable to North American fertility clinics. TRIAL REGISTRATION: ClinicalTrials.gov NCT01483612. Registered 25 November 2011.

Use of metformin for ovulation induction in women who have polycystic ovary syndrome with or without evidence of insulin resistance.

OBJECTIVE: To determine whether women with polycystic ovary syndrome (PCOS) and abnormal insulin levels treated with metformin had different rates of ovulation and pregnancy from women with PCOS and normal insulin levels. METHODS: The outcomes of treatment with metformin in 146 infertile women with PCOS were analyzed using a retrospective cohort study design. Baseline characteristics and initial blood work results were recorded. The follow-up period was three months, and the primary outcome was ovulation. RESULTS: Of the 146 women with PCOS, one third had elevated fasting insulin levels. After treatment with metformin, cumulative rates of ovulation were similar in women with elevated fasting serum insulin levels (48.8%) and those with normal levels (44.7%). Rates of ovulation were also similar in women with normal and abnormal glucose to insulin ratios. There was no difference in cumulative pregnancy rates based on fasting insulin levels. A fasting insulin level above 20 mU/L correlated with an abnormal glucose to insulin ratio (98%). CONCLUSION: In anovulatory women with PCOS, fasting insulin levels and glucose to insulin ratios do not predict the ovulatory response to metformin.

SOGC clinical practice guidelines. Hirsutism: evaluation and treatment.

OBJECTIVES: To review the etiology, evaluation, and treatment of hirsutism. EVALUATION: A thorough history and physical examination plus selected laboratory evaluations will confirm the diagnosis and direct treatment. TREATMENT: Pharmacologic interventions can suppress ovarian or adrenal androgen production and block androgen receptors in the hair follicle. Hair removal methods and lifestyle modifications may improve or hasten the therapeutic response. OUTCOMES: At least six to nine months of therapy are required to produce improvement in hirsutism. EVIDENCE: The quality of evidence reported in this guideline has been determined using the criteria described by the Canadian Task Force on the Periodic Health Examination. RECOMMENDATIONS: Hirsutism can be slowly but dramatically improved with a three-pronged approach to treatment: mechanical hair removal, suppression of androgen production, and androgen receptor blockade. Lifestyle changes including weight loss and exercise will lower serum androgen levels and improve self-esteem. The patient should be educated regarding associated health problems or long-term medical consequences of hyperandrogenism, including obesity, irregular menses, anovulation, infertility, pregnancy-induced hypertension, diabetes, hyperlipidemia, hypertension, and heart disease.