Experience with a novel laparoscopic gynecologic curriculum in Haiti: lessons in implementation.

BACKGROUND: An estimated one-third of the world's burden of disease requires surgical treatment. In many high-income nations, a large proportion of critical surgical procedures are performed laparoscopically due to a number of advantages the technique offers. There is forward progress in the global surgery field to increase access to laparoscopic techniques in low and middle-income settings (LMIC), with potential benefits to both patients and surgeons. METHODS: A week long laparoscopic surgery curriculum for surgeons and hospital staff was designed and implemented in a low-resource setting. An iterative design was used to adapt the curriculum on the ground. RESULTS: The local laparoscopic team was able to independently perform two laparoscopic procedures since the course was administered. CONCLUSIONS: Implementing laparoscopic surgery programs may be feasible in many LMIC settings. Access to this care may benefit patients. Lessons learned for the global laparoscopist are described.

Medical Student Perspectives on the Ethics of Pelvic Exams Under Anesthesia: A Multi-Institutional Study✰.

OBJECTIVE: Pelvic examinations under anesthesia (EUAs) are routine components of gynecologic surgery and often used to educate students about female pelvic anatomy. This multi-institutional survey study aims to describe students' experiences with conducting educational pelvic EUAs and their attitudes around the ethics of informed consent for these exams. DESIGN: An anonymous survey of Likert and open-text response questions about institutions' practices around educational pelvic EUAs was sent to medical students. SETTING: Medical schools included Vanderbilt University School of Medicine, Indiana University School of Medicine, Emory University School of Medicine, University of New Mexico School of Medicine, Meharry Medical College, and Warren Alpert Medical School of Brown University. PARTICIPANTS: A total 305 medical students who had completed their obstetrics and gynecology (OB/GYN) clerkship between June 2019 and March 2020 filled out the survey (33% response rate). RESULTS: Overall, 84% of students performed at least 1 pelvic EUA during their clerkship. Of the 42% (142) of students that observed patient informed consent processes most or every time, 67% reported they never or rarely witnessed an explicit explanation that a medical student may perform a pelvic EUA. Analysis of open-text responses found that students wanted to uphold patient autonomy but felt they did not have the personal autonomy to object to performing pelvic EUAs that they believed were unconsented. They faced significant emotional distress when consent processes were at odds with their personal ethos and professional ethical norms. Students favored more standardized and explicit patient consent processes for educational pelvic EUAs. CONCLUSIONS: While students regularly perform pelvic EUAs, their involvement is inconsistently disclosed to patients, causing significant distress to students and risking erosion of students' attitudes about upholding patient autonomy and informed consent. Medical institutions must develop consistent, ethical, and patient-centered processes for trainee disclosure around pelvic EUAs.