Stewart, Kelsey A.

Abstract Introduction: Laparoscopic salpingectomy is a commonly performed procedure and is often one of the first laparoscopic procedures performed by novice residents in Obstetrics and Gynecology (OB/GYN). Opportunities to practice before the operating room can be limited. Methods: We developed an animal tissue model and incorporated it into a laparoscopic salpingectomy simulation for OB/GYN residents in a single academic program. The simulation included a pre-simulation video describing the steps of laparoscopic salpingectomy, the laparoscopic salpingectomy simulation using an electrosurgical device, a post simulation survey, and debriefing with learner targeted feedback. Validity evidence for the simulation model was gathered using the Messick framework. Resident performance was assessed using the Objective Structured Assessment of Laparoscopic Salpingectomy (OSA-LS) and the Global Operative Assessment of Laparoscopic Skills (GOALS). Performance was correlated to the year of training with upper-level residents grouped for analysis. Results: Twenty-five simulations of laparoscopic salpingectomy were performed by 14 learners (first through fourth year). The tool was highly rated by participants. We found a significant correlation between the mean OSA-LS score and surgical experience. The mean GOALS score also increased with experience and was significantly different between 1st and 2nd years and between 1st and upper-level residents. A passing score of 12 was established for each assessment rubric. Discussion: This low-cost surgical model addresses a gap in simulation options for preoperative use of electrosurgical devices. This simulation can be used in OB GYN residency as a method to assess competency or provide feedback.

Purpose of review We present a review of the natural progression, response to hormonal therapy, and risk of malignancy associated with deep endometriosis (DE) to guide evidence-based discussion of conservative treatment. Recent findings Advanced imaging protocols have enhanced nonsurgical detection of DE, allowing noninvasive diagnosis, treatment, and surveillance. While some DE is progressive, 50% of disease appears stable over time, and progression is reduced by half with hormonal treatments (21 versus 12%). Hormonal treatment can reduce the size of DE lesions by 1 cm³, with reductions occurring after 6 months and remaining stable up to 3 years. Most hormonal therapies improve symptoms and quality of life, regardless of changes in DE size, with combined contraceptives and progestins being the most studied. DE may present a higher risk of ovarian and extraovarian cancer than previously hypothesized, though further research is needed to confirm findings. Limitations of DE research include differing imaging strategies, definitions of disease and progression, short follow-up, focus on rectosigmoid DE only, and lack of randomized trials. Summary DE is a subtype of endometriosis that is increasingly diagnosed and treated with noninvasive strategies. Hormonal treatments improve symptoms and reduce progression of DE. Further research on optimal conservative management and risk of malignancy is warranted.

Objectives/Goals: Undergraduate Medical Education (UME) may apply Just-in-Time training (JITT) to provide medical students with learning experiences closely aligned with real-time clinical needs. The purpose of this scoping review is to offer an overview of the implementation of JITT training in UME. Methods/Study Population: Following the five-stage framework by Arksey and O’Malley to methodically collect and analyze studies on JITT in UME, five electronic databases were searched, and a supplemental search for grey literature was conducted. Studies exploring the integration of JITT principles into UME clinical training and their time to follow-up after training were included. Bloom’s Taxonomy was used to assess educational goals of JITT interventions. Results/Anticipated Results: The review yielded 21 studies across 4 countries. The majority were cohort studies (13) and randomized control trials (5). Assessment definitions and use of JITT varied widely. Most studies focused on short-term outcomes, defined by being measured immediately after JITT session (15) or at the end of JITT-based rotation or clerkship (3). Three studies evaluated outcomes at a period longer than 2 weeks after completion of session or clerkship. Attitudes (9), followed by skills (8) were the most common educational goals of intervention. The efficacy and utility of JITT in improving educational goal acquisition was demonstrated in 90% (17/19) of the studies with reported outcomes. Discussion/Significance of Impact: The introduction of JITT in UME has been shown to meet the immediate needs of healthcare environments; however, evidence is limited in the evaluation of longer-term outcomes. Further research to determine the impact of JITT on long-term learning retention and education goal acquisition in UME is merited.