ABSTRACT
Objective@#This correlational study was conducted to determine whether factors of the Gynecologic Oncology subspecialty rotation – such as resident rotators’ sex, year level, training institution, academic aptitude, duration of rotation, learning activities, case load, extent of involvement of teachers, and level of involvement of the residents – are associated with clinical competence. @*Methodology@#Thirty-one residents rotating in subspecialty were given MCQ examination and skills evaluation pre- and postrotation. Logbooks were completed listing all learning activities and number of cases encountered. Difference in scores was determined using paired t-test. Association of factors with clinical competence was determined using chi square and Pearson correlation coefficient. @*Results@#There was a statistically significant increase in the overall and skills scores, but not in the knowledge. Training institution, academic aptitude, and duration of rotation were associated with clinical competence. Conference, outpatient duty, case load, fellows as teachers and active participation were strongly associated with clinical competence. Bedside teaching, inpatient duty, and consultants as teachers were moderately associated with clinical competence. Passive participation was weakly associated with clinical competence. @*Conclusion@#Overall, the residents did not achieve clinical competence in Gynecologic Oncology as a result of the rotation. Residents from a training institution with a Gynecologic Oncology fellowship training program and with academic aptitude > 60% are more likely to achieve clinical competence. Increasing rotation duration to > 2 weeks, time spent in the different activities, case load, fellows and consultants interaction with residents, and active participation may increase likelihood of achieving clinical competence.
Subject(s)
Humans , Female , Clinical CompetenceABSTRACT
@#Uterine carcinosarcoma, also known as malignant mixed mullerian tumor (MMMT) is a rare and aggressive malignancy. It is the only type of uterine carcinoma with both an epithielial-derived carcinoma and a mesodermal-derived sarcoma. Classically, they have been considered as a soft tissue sarcoma, however, recent studies ascertain the pathogenesis of carcinosarcomas as to that of a metaplastic transformation of a carcinoma to give rise to a sarcomatous component. With the paradigm shift on the pathogenesis of disease, treatments have been aligned to follow protocols used in aggressive uterine carcinomas and are in further evaluation for its applicability to the aforementioned carcinosarcoma. This paper presents three cases of MMMT diagnosed in a Private Tertiary Hospital from October 2015 to February 2017. Among the three cases, two cases underwent endometrial sampling with results suggestive of MMMT and one case with an intraoperative frozen section done revealing carcinosarcoma. All cases underwent extrafascial hysterectomy with bilateral salpingo-oophorectomy (EHBSO) and bilateral lymph node dissection (BLND). Post-operatively, two of the cases underwent adjuvant chemotherapy and are currently alive. The one case that did not receive adjuvant chemotherapy succumbed to the disease eight months after diagnosis. With the high propensity of MMMT to metastasis, relapse and recurrence, it is then imperative that all cases are properly managed.