Associations between inpatient psychiatric admissions during pregnancy and adverse obstetrical and birth outcomes.

BACKGROUND: Previous research supports an association between psychiatric diagnoses and adverse obstetrical and neonatal outcomes including low birthweight, preterm birth, and preeclampsia. Women who are admitted for inpatient psychiatric care are regarded as having more acute illnesses than those who are able to be managed as outpatients. Previous research has not yet investigated how the severity of psychiatric illness, as indicated by type of antenatal psychiatric care received, is associated with adverse obstetrical outcomes. OBJECTIVE: This study examines whether the rates of adverse birth and obstetrical outcomes vary with the type of antenatal psychiatric care received when psychiatric care is indicated. STUDY DESIGN: Using a retrospective, observational design, information about women who gave birth between January 1, 2006, and December 31, 2016 was captured from electronic medical records. Women were grouped as follows: (1) those who received antepartum inpatient psychiatric treatment (n=148), (2) those with documented psychiatric history without antepartum inpatient treatment (n=301), and (3) those with no documented psychiatric history or antepartum treatment (n=301). Linear and logistic regression predicted the odds of birth and obstetrical outcomes including gestational age at birth, birthweight, mode of delivery, time to delivery, preterm premature rupture of membranes, meconium-stained amniotic fluid, and 5-minute Apgar score. Measured covariates included maternal age, race, parity, body mass index, maternal medical comorbidities, smoking tobacco, gestational age at first prenatal visit, and psychotropic medication use during pregnancy. RESULTS: Women with a psychiatric history, despite receiving any type of antepartum psychiatric care, had higher rates of adverse outcomes than women without documented psychiatric history. However, women who received antepartum inpatient psychiatric care had longer gestational lengths (38.05±3.0 vs 37.19±4.23 weeks [P<.05]) and gave birth to heavier babies (3047.84±591.99 vs 2906.48±851.85 g [P<.01]) than women with a psychiatric history who did not receive antepartum inpatient care even when adjusting for measured covariates. CONCLUSION: Receiving antepartum inpatient psychiatric care may promote positive birth outcomes for women with acutely severe psychiatric conditions.

Clinical anatomy and surgical skills training (CASST): development of a multicenter, multidisciplinary program.

OBJECTIVE: The aim of this program was to develop a multicenter, multidisciplinary anatomy and surgical skills training program for junior residents in obstetrics and gynecology and urology. STUDY DESIGN: After administering a needs assessment, we developed a collaborative clinical anatomy and surgical skills training program for junior residents in obstetrics and gynecology and urology at 3 academic medical centers in Chicago. RESULTS: Thirty-two residents participated in the program. Needs assessment results indicated that all residents felt they could benefit by more formal training in basic surgical skills. Learning objectives were developed for each of the 5 3-hour sessions that dealt with basic surgical skills, anterior abdominal wall anatomy, opening and closing the abdomen, female pelvic anatomy, and perineal anatomy and laceration repair. The cost of training each of the residents was approximately 600 dollars. Forty-five percent of the costs were one-time "start-up" costs for abdominal trainers and surgical instruments. CONCLUSION: By including multiple centers and disciplines, we were able to reduce costs of teaching basic surgical skills and anatomy and maximize faculty teaching time and effort.

Development and testing of a robotic surgical training curriculum for novice surgeons.

A robotics practice curriculum was developed utilizing dry lab skills and testing parameters based upon the objective structured assessment of surgical tasks (OSATS) to determine its effectiveness in training novice surgeons. We recruited 20 medical students who were oriented to the DaVinci S console and instrumentation. They were pre-tested with four dry lab skills including manipulation, transection, suturing and knot tying. A control group was instructed to practice once weekly to attain proficiency and the intervention group was provided specific instructions regarding practice goals. Each subject was post-tested after a 6-week time. There were 17 students who completed the post-testing. All participants showed significant improvement in pre-test and post-test scores for manipulation (6.6-11.2, p < 0.0005), transection (3.5-6.9, p < 0.0005), knot tying (0.4-1.7, p = 0.003), and suturing (2.0-3.5, p = 0.001). There was no significant difference in pre-test and post-test scores between the control and intervention groups in manipulation, transection, knot tying, and suturing (p = 0.700, 0.782, 0.682, 0.605, respectively). Our study shows that novice surgeons such as medical students can improve dry lab robotics skills with instruction and practice.

Cervical Cancer Screening Rates in a Chart Review of Adolescent Patients at an Academic Institution before and after the Publication of the 2009 American College of Obstetricians and Gynecologists' Recommendations.

OBJECTIVE: Evaluation of compliance with ACOG guidelines against screening for cervical cancer in women before age 21; identification of factors associated with lack of compliance with guidelines. METHODS: A review of 799 charts of women age 14-21 seen for care at our institution in 2009-2010 to determine baseline cervical cytology rates, compliance with publication of 2009 ACOG guidelines recommending against testing in this age group. Clinical data was gathered to identify patient and physician characteristics associated with testing. RESULTS: The baseline rate of cervical cytology testing for women age 14-21 in our chart review (20%, 2009) dropped significantly (10.8%, 2010, P < .005) after publication of new guidelines. Among those patients tested, factors associated with higher screening rates included: patients seen by obstetrician/gynecologist (59% patients tested 2009/38% 2010), who were sexually active (83%/88%) and seen for routine care (68%/95%). Other associated factors: prior screening (61% all patients tested), hormonal contraceptives (58%), private insurance (72%). Patients with history of previous cervical intraepithelial neoplasia had cytology testing done at high rates (72%). CONCLUSION: The rate of cervical cytology screening in women ages 14-21 was higher than expected given ACOG recommendations. There was a significant decrease in screening rates after publication of guidelines. Patient and physician characteristics were identified which were associated with an increased screening rate. There are no databases that track cervical cancer testing in this age group. This information can be utilized for physician and patient education in order to improve compliance.

Robotic objective structured assessment of technical skills: a randomized multicenter dry laboratory training pilot study.

STUDY OBJECTIVE: The goal of this study was to determine if a robotic dry laboratory curriculum for gynecology and urology residents improved their basic robotic skills. METHODS: After the institution-specific institutional review board approval or exemption, 165 residents from 8 gynecology and/or urology programs were enrolled. Residents underwent standardized robotic orientation followed by dry laboratory testing on 4 unique robotic tasks. Residents were block randomized by program to unstructured or structured training programs. Regardless of group, residents were expected to practice for 15 minutes twice monthly over 7 months. Errors, time to completion, and objective structured assessment of technical skills global rating scores were recorded for each task before and after the training period. Statistics were calculated using the Student t tests, Pearson correlation, and analysis of variance with STATA systems (version 11.2). RESULTS: A total of 99 residents completed both the pretraining and posttraining testing. A mean of 4 (range, 0-15) 15-minute training sessions per resident was self-reported. The structured group had faster posttraining times on the transection task, although the unstructured group had higher posttraining scores on the knot-tying task. CONCLUSIONS: Overall, the residents' robotic skills improved after participating in a dry laboratory curriculum; however, robotic availability, duty hour restrictions, and clinical responsibilities limit the curriculum implementation.

Training at a faith-based institution matters for obstetrics and gynecology residents: results from a regional survey.

BACKGROUND: Prior data suggest that opportunities in family planning training may be limited during obstetrics and gynecology (Ob-Gyn) residency training, particularly at faith-based institutions with moral and ethical constraints, although this aspect of the Ob-Gyn curriculum has not been formally studied to date. OBJECTIVES: We compared Ob-Gyn residents' self-rated competency and intentions to provide family planning procedures at faith-based versus those of residents at non-faith-based programs. METHODS: We surveyed residents at all 20 Ob-Gyn programs in Illinois, Indiana, Iowa, and Wisconsin from 2008 to 2009. Residents were queried about current skills and future plans to perform family planning procedures. We examined associations based on program and residents' personal characteristics and performed multivariable logistic regression analysis. RESULTS: A total of 232 of 340 residents (68%) from 17 programs (85%) returned surveys. Seven programs were faith-based. Residents from non-faith-based programs were more likely to be completely satisfied with family planning training (odds ratio [OR]  =  3.4, 95% confidence limit [CI], 1.9-6.2) and to report they "understand and can perform on own" most procedures. Most residents, regardless of program type, planned to provide all surveyed family planning services. CONCLUSIONS: Despite similar intentions to provide family planning procedures after graduation, residents at faith-based training programs were less satisfied with their family planning training and rate their ability to perform family planning services lower than residents at non-faith-based training programs.

Addressing OB/GYN family planning educational objectives at a faith-based institution using the TEACH program.

BACKGROUND: Traditionally family planning education is limited for obstetrics and gynecology residents training at faith-based institutions. We describe the first formalized educational program to teach contraception, sterilization, and abortion at a Catholic institution. STUDY DESIGN: We used a six-step curricular development process to design this formal educational intervention. We created a multiple-choice test that participants completed before and after the workshop. We compared average test scores using one-way analyses of variance and assessed psychometric properties of the test. RESULTS: All 16 obstetrics and gynecology residents at this institution participated in the one-day educational program entitled Teaching Everything About Contraceptive Health (TEACH). Residents improved their pre-test scores, on average, from 57% prior to the workshop to 89% immediately after completion of TEACH (p < .001). Improvement persisted 10 months after completion of the program (p < .001). Psychometric assessment supported the use of the instrument with adequate question difficulty and high discrimination. CONCLUSIONS: A one day curriculum designed to introduce family planning learning objectives at a Catholic obstetrics and gynecology residency program is feasible and results in improved resident knowledge.