Resident data collection: do the numbers add up?

OBJECTIVES: Our purpose was to investigate methods for standardization of data collection across residency training programs in obstetrics and gynecology. STUDY DESIGN: A survey was developed and sent to all accredited residency programs in the United States and Canada. It assessed each program's current data collection method and whether the system could track discrepancies, account for completeness of data, or collect primary care data. The second part of the survey was designed to assess program director consistency in assignment of resident responsibility. RESULTS: In 78.5% of programs residents used a paper-based system. Only 27.1% and 31.3% of the residency programs, respectively, had systems for resolving resident responsibility conflicts or determining accuracy percentages. Few (8.3%) program directors were able to collect primary care data. There were wide variations among program directors in assignment of resident responsibility in the simulated cases, indicating different interpretations of Residency Review Committee reporting criteria. CONCLUSIONS: Most resident data systems in use do not promote or require standardization of data collection; therefore comparisons between programs would be difficult. The ideal system would be flexible, require standardization of data collection, enable direct transfer to Residency Review Committee forms, be translatable to any residency program, and allow meaningful intraprogram and interprogram comparisons.

The impact of mandated in-hospital coverage on primary cesarean delivery rates in a large nonuniversity teaching hospital.

OBJECTIVE: Our purpose was to determine whether attending physician call status affected the primary cesarean delivery rates of the resident or private services after institution of in-hospital coverage. STUDY DESIGN: Data for the study year, during which in-hospital attending coverage was in place, were compared with those of the previous year, during which in-hospital attending coverage of residents was not in place. Birth records were analyzed retrospectively for physician and patient factors. RESULTS: For the year before in-hospital coverage the institutional total cesarean rate was 24.9%, with a primary cesarean section rate of 17.6%. In the first year of coverage the total cesarean delivery was 21.7%, with a decrease in the primary rate to 15.3%. The resident service primary cesarean delivery rate was 10.6% during the study year, which was unchanged from 10.9% the prior year and did not contribute to the overall decrease. Conversely, the private service primary cesarean rate decreased from 18.0% in the prestudy year to 13.4% when the attending physician was on call in the hospital but remained higher at 17.5% when the attending physician was on call not in the hospital. CONCLUSIONS: In-hospital attending physician coverage lowered individual attending physicians' private service primary cesarean rates. Resident service primary cesarean rates were lower than private service and were unaffected by the initiation of in-hospital coverage.

Markers of human immunodeficiency virus infection in pediatric bronchoalveolar lavage samples.

Pulmonary cells and fluid obtained by bronchoalveolar lavage (BAL) from 19 pediatric acquired immunodeficiency syndrome (AIDS) patients with pneumonia were examined for markers of human immunodeficiency virus (HIV-1) infection. The HIV-1 DNA was detected in BAL cells by polymerase chain reaction (PCR) in 14 of 15 patients (93.3 percent). Immunostaining of cytocentrifuged cell preparations of six specimens revealed that HIV-1 antigen was associated with from five percent to 95 percent of the alveolar macrophages. Analysis of the 22 cell-free BAL fluids by enzyme immunoassay (EIA) showed that samples from three patients (15.8 percent) contained HIV-1 p24 antigen. One sample, with a dilution factor of 15.1 relative to serum, contained a markedly elevated antigen concentration (106 pg per ml) compared to the serum concentration (41.6 pg per ml). Antibodies to HIV-1 were present in the BAL fluids of six patients (31.6 percent) at levels detectable by EIA. By Western blot analysis, three samples yielded more intense gp120 bands compared to bands observed with matched serum samples. Our results suggest that HIV-1 and antibodies to this virus are frequently present in the lungs of children with AIDS and that the serum antigen and antibody profile of some patients does not reflect local pulmonary levels.

Profile of student clerkship administration in obstetrics and gynecology.

To determine a current profile of clerkships in obstetrics and gynecology, a national survey was conducted. The average clerkship director is 48 years old and has held that post for 6 years. Board certification has been accomplished by 91%, of whom 23% are also certified in a subspecialty. An advanced degree in education is held by 14%. Of full-time faculty, 81% are actively involved with medical student teaching; of part-time faculty, 62% teach students. The average number of 16 students completing the clerkship each 7 weeks is similar to that in previous reports. Evaluation of student performance varies but generally involves assessment of clinical activities (98% of programs), a written examination (96%), and an oral examination (54%). Clerkship directors find the responsibility of coordinating undergraduate education an important task from which they derive personal satisfaction.