Assessment of lesbian, gay, bisexual, transgender, and questioning experiences within a large southeast training program.

The USA has become increasingly diverse resulting in greater strides to improve workforce diversity and inclusivity. The objective of this study is to compare the experiences of trainees in Graduate Medical Education who identify as Lesbian, Gay, Bisexual, Transgender or Questioning (LGBTQ) to the experiences of non-LGBTQ trainees within the medical workplace. We conducted a cross-sectional, exploratory survey from 1 December 2020 to 14 January 2021 at a single, large teaching institution.

The effects of offering immediate postpartum placement of IUDs and implants to pregnant patients with heart disease.

Objective: To evaluate the effects of offering immediate postpartum long-acting reversible contraception to pregnant patients with heart disease.

Study Design: Retrospective cohort of pregnant patients with cardiac disease managed by a Comprehensive Pregnancy & Heart Program. Patients were divided into 2 cohorts: pre-immediate postpartum LARC Program implementation (March 2015 to January 2017) and post-implementation (February 2017 to June 2019).

Smartphone Use and the Perception of Professionalism Among Medical Students and Surgical Faculty.

Objective: To understand the perception of professionalism surrounding smartphone use (wards/educational activities) among medical students and surgical faculty.

Design: A prospective cohort study was conducted using an electronic survey and distributed to third- and fourth-year medical students, obstetrics/gynecology, and surgery faculty members. Five cases were randomly presented; participants were asked to review and rate the clinician's behavior on a 5-point Likert scale.

Test of integrated professional skills: objective structured clinical examination/simulation hybrid assessment of obstetrics-gynecology residents' skill integration.

Background: Assessment of obstetrics-gynecology residents' ability to integrate clinical judgment, interpersonal skills, and technical ability in a uniform fashion is required to document achievement of benchmarks of competency. An observed structured clinical examination that incorporates simulation and bench models uses direct observation of performance to generate formative feedback and standardized evaluation.

Methods: The Test of Integrated Professional Skills (TIPS) is a 5-station performance-based assessment that uses standardized patients and complex scenarios involving ultrasonography, procedural skills, and evidence-based medicine.

To the point: reviews in medical education--the Objective Structured Clinical Examination.

This article, the eighth in the To the Point Series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, discusses the effectiveness of the Objective Structured Clinical Examination (OSCE) for assessment of learners' knowledge, skills, and behaviors. The OSCE has also been used for the appraisal of residents and physicians undergoing licensure examinations; herein we focus on its application to undergraduate medical education. We review evidence for best practices and recommendations on effective use of the OSCE and requirements for and challenges to its implementation, including creative ways to design an OSCE program with a limited budget.

Midpregnancy vaginal fluid defensins, bacterial vaginosis, and risk of preterm delivery.

Objective: To assess relations among midpregnancy vaginal defensin levels, a component of the host innate immune response, bacterial vaginosis, and risk of preterm delivery. These relations are compared across race groups because previous studies have repeatedly shown that the prevalence of bacterial vaginosis and the risk of preterm delivery are greater in African-American women compared with that in white women.

Methods: Data are from a prospective study that enrolled pregnant women from 52 clinics in five Michigan communities.

To the point: medical education review of the role of simulators in surgical training.

Simulation-based training (SBT) is becoming widely used in medical education to help residents and medical students develop good technical skills before they practice on real patients. SBT seems ideal because it provides a nonthreatening controlled environment for practice with immediate feedback and can include objective performance assessment. However, various forms of SBT and assessment often are being used with limited evidence-based data to support their validity and reliability.

A comprehensive review to establish priority learning objectives for medical students in the obstetrics and gynecology clerkship.

Objective: This study was undertaken to describe the process used to identify, externally validate, and establish the priority learning objectives for medical students on the obstetrics and gynecology clerkship.

Study Design: We conducted a review of the APGO Medical Student Objectives in Obstetrics and Gynecology to establish which of these objectives should be given first priority. We used recommendations from external references to assess the validity of these selected objectives.

The Alabama Preterm Birth Study: umbilical cord blood Ureaplasma urealyticum and Mycoplasma hominis cultures in very preterm newborn infants.

Objective: This study was undertaken to evaluate the frequency of umbilical cord blood infections with Ureaplasma urealyticum and Mycoplasma hominis in preterm 23- to 32-week births and to determine their association with various obstetric conditions, markers of placental inflammation, and newborn outcomes.

Study Design: 351 mother/infant dyads with deliveries between 23 and 32 weeks' gestational age who had cord blood cultures for U. urealyticum and M.

Clinical trial of interconceptional antibiotics to prevent preterm birth: subgroup analyses and possible adverse antibiotic-microbial interaction.

Objective: The purpose of this study was to explore whether endometrial microbial colonization and plasma cell endometritis are risk factors for adverse pregnancy outcomes, and whether these outcomes are influenced by interactions between interconceptional antibiotics and the micro-flora.

Study Design: Subgroup analyses of data from a double-blind, randomized, placebo-controlled trial of a course of metronidazole plus azithromycin given every 4 months to women with a prior preterm delivery to prevent recurrent preterm delivery. Endometrial cultures and histology were obtained at randomization and repeated 2 weeks after the first treatment.

The Alabama Preterm Birth Study: diffuse decidual leukocytoclastic necrosis of the decidua basalis, a placental lesion associated with preeclampsia, indicated preterm birth and decreased fetal growth.

Objective: Laminar necrosis, a band-like distribution of coagulative necrosis, has been reported at the choriodecidual interface of the free membranes of placentas of women with various adverse neonatal outcomes. Our goal in this study was to evaluate the frequency of an equivalent feature in the decidua basalis, diffuse decidual leukocytoclastic necrosis (DDLN), a diffuse coagulative necrosis admixed with karyorrhectic debris, in preterm births <32 weeks, and to determine its association with various obstetric conditions, markers of placental inflammation, and newborn outcome.

Study Design: Four hundred and forty-six mother/infant dyads who delivered between 23 and 32 weeks gestational age (GA) had their medical records abstracted, a variety of placental and cord blood cultures performed, cord interleukin-6 (IL-6) levels determined, and the placentas evaluated histologically by a single pathologist (OFP).

Early second-trimester inflammatory markers and short cervical length and the risk of recurrent preterm birth.

This study aimed to analyze the associations between serum and cervicovaginal inflammatory markers and recurrent spontaneous preterm birth in a cohort study of 62 pregnant women with > or =1 prior early spontaneous birth. Serum samples and cervicovaginal swabs from the women were obtained at enrollment in early second trimester (week 12-25). Cervical length was measured by ultrasound and dicotomized in to short (< or =25 mm) and long cervices (>25 mm).

Impact of interconception antibiotics on the endometrial microbial flora.

Objective: The purpose of this study was to evaluate the impact of an interconception antibiotic regimen on endometrial microbial flora and histologic type.

Study Design: This was a secondary analysis of a double-blind randomized placebo-controlled trial of prophylactic metronidazole plus azithromycin that was given to 241 women (antibiotics, 118 women; placebo, 123 women) with a previous preterm delivery to prevent recurrent preterm delivery. Endometrial cultures and histologic types were obtained at randomization and 2 weeks after treatment.

The Alabama preterm birth study: corticosteroids and neonatal outcomes in 23- to 32-week newborns with various markers of intrauterine infection.

Objective: Intrauterine inflammation/infection is cited as a contraindication to the use of corticosteroids (CS). Our goal was to determine if CS given prenatally to enhance fetal maturity were harmful to infants with various indications of intrauterine infection.

Study Design: This was a retrospective analysis of data obtained from 457 consecutively enrolled infants delivered between 23 and 32 weeks.

The Alabama Preterm Birth study: polymorphonuclear and mononuclear cell placental infiltrations, other markers of inflammation, and outcomes in 23- to 32-week preterm newborn infants.

Objective: The purpose of this study was to better understand the relationship between placental polymorphonuclear and mononuclear cell infiltrations with bacterial cultures, markers of inflammation, and preterm outcomes.

Study Design: This was a prospective study in 446 women who were delivered of a singleton infant at <32 weeks of gestational age. Five placental sites were categorized as having polymorphonuclear or mononuclear infiltrations.

The Alabama Preterm Birth Project: placental histology in recurrent spontaneous and indicated preterm birth.

Objective: For unknown reasons, a previous preterm birth (PTB) is a major risk factor for PTB in the current pregnancy. Our goal is to evaluate placental histology for clues related to the recurrent nature of PTB.

Study Design: Four hundred fifty-seven mother/infant dyads delivering between 23 and 32 weeks were first classified as having a spontaneous (S) or indicated (I) PTB, and then sorted into the following mutually exclusive categories by pregnancy history: 1) nulliparous; 2) having no previous PTB; 3) having any previous IPTB; or 4) having a previous SPTB.

The Alabama Preterm Birth Study: intrauterine infection and placental histologic findings in preterm births of males and females less than 32 weeks.

Objective: The objective of the study was to determine whether there are differences in the placental histology and various markers of infection/inflammation between preterm male and female fetuses.

Study Design: The placentas and umbilical cords of 446 infants born at 23 to 32 weeks were examined histologically, cultured for aerobic and anaerobic bacteria and mycoplasmas, and the interleukin-6 levels in cord blood determined.

Results: Male infants were significantly more likely to have positive placental cultures than female infants (63.

Association of asymptomatic bacterial vaginosis with endometrial microbial colonization and plasma cell endometritis in nonpregnant women.

Objective: This study was undertaken to determine whether asymptomatic bacterial vaginosis (BV) is associated with an increased risk of endometrial microbial colonization or plasma cell endometritis in nonpregnant women.

Study Design: In this observational cohort study conducted between August 1995 and August 2001, microbial cultures (n = 769) and histopathology (n = 482) were performed on endometrial specimens obtained from women with a recent preterm or term delivery (83 +/- 16 days). Endometritis was defined as the presence of plasma cells.

Early mid-trimester serum relaxin, soluble CD163, and cervical length in women at high risk for preterm delivery.

Objective: The purpose of this study was to evaluate the relationship between serum concentrations of relaxin and soluble CD163 with cervical length and preterm delivery in women with previous spontaneous preterm delivery.

Study Design: Sixty-one of 69 pregnant women with a previous spontaneous preterm had serum relaxin and soluble CD163 measured at week 16 (range, 12-25 weeks). End points were cervical length and gestational age at delivery.

Are women with recurrent spontaneous preterm births different from those without such history?

Objective: This study was undertaken to determine whether women with recurrent spontaneous preterm births (rSPBs) have different clinical characteristics or systemic markers than those with isolated preterm (iSPBs) or recurrent term births (rTBs), when assessed remote from delivery.

Study Design: We compared clinical characteristics and findings (including cervical ultrasound, bacterial vaginosis, fetal fibronectin), maternal plasma markers obtained at 22 to 24 weeks' gestation (inflammatory cytokines, cortisol, and corticotrophin-releasing hormone), between women with rSPBs (2 or 3 consecutive SPBs and no TBs), iSPBs (1 SPB and 1 or 2 TBs), and rTBs (2 or 3 consecutive TBs and no SPBs).

Results: A total of 1257 women met our inclusion criteria; 47 rSPBs, 241 iSPBs (80 current and 161 prior iSPBs), and 969 rTBs.

To the point: medical education reviews--dealing with student difficulties in the clinical setting.

Learners with cognitive and behavioral difficulties are particularly challenging in the clinical setting. Cognitive difficulties in the clinical realm may relate to knowledge deficits and/or weak problem solving skills. Behavioral difficulties resulting from attitudinal or motivational problems may manifest themselves as specific unprofessional acts either committed or omitted in the course of caring for patients as well as in unprofessional behavior.

Do factors that are important during obstetrics and gynecology residency program selection differ by applicant gender?

Objective: The purpose of this study was to examine the relationship between applicant gender and factors that influence obstetrics and gynecology residency program selection.

Study Design: A national survey was conducted of graduates of US allopathic medical schools who were registered with the Electronic Residency Application Service for the year 2003 and who indicated that obstetrics and gynecology was their primary specialty choice. The selection prevalence of 20 possible influential factors was analyzed by gender.

Differences in inflammatory cytokine and Toll-like receptor genes and bacterial vaginosis in pregnancy.

Objective: This study was undertaken to estimate the frequency of inflammatory cytokine and Toll-like receptor gene polymorphisms in women with and without bacterial vaginosis (BV) in pregnancy.

Study Design: A secondary analysis was performed of pregnant women at less than 30 weeks' gestation enrolled as part of 2 multicenter studies. Eight hundred eighty-five women were assessed for BV (defined as Nugent's vaginal Gram stain score 7-10 and a pH > 4.