Role of video self-assessment in laparoscopic simulation training: a randomized pilot trial.

BACKGROUND: Residency programs have implemented simulation training to compensate for reduced operating room exposure. Video recording is an educational tool that can be utilized for coaching, telepresence, and self-assessment during simulation training. Data is limited on the utility of video recording and self-assessment for laparoscopic training in Ob/Gyn residency programs.. OBJECTIVE: This study aimed to determine the role of video self-assessment as an educational tool in laparoscopic simulation training and to establish the feasibility of our study design for a larger randomized controlled trial. STUDY DESIGN: This was a prospective pilot study with a parallel, randomized, trial design that occurred in the Department of Obstetrics and Gynecology at the Mount Sinai Hospital. Subject participation took place in a surgical simulation training room. A total of 23 subjects were recruited (7 medical students, 15 residents, 1 fellow) voluntarily. All participants completed the study. All the subjects completed a pretest survey. The surgical simulation room contained a single Fundamentals of Laparoscopic Surgery box trainer and video-recording station. For session #1, each participant performed 2 Fundamentals of Laparoscopic Surgery tasks (A, peg transfer; B, intracorporeal knot tie). Participants were video recorded during session #1 and were randomized to either receive or not receive their video recording. The video group (n=13) and control group (n=10) repeated the Fundamentals of Laparoscopic Surgery tasks 7 to 10 days later (session #2). The primary outcome was percentage change in completion time between sessions. Secondary outcomes were percentage change in peg and needle drops between sessions. RESULTS: The participant characteristics (video vs control) were as follows: average training level (6.15 vs 4.90 years), self-assessment (1=poor, 10=excellent) of surgical skill (4.8 vs 3.7), and laparoscopic skill (4.4 vs 3.5). Training level was inversely correlated with completion time for tasks A and B (r, -0.79 and -0.87; P<.0001). Less experienced trainees required the maximum time allotted for each task in session #1 (A, 3; B, 13). Regarding the primary outcome, the video group improved less than the control group (A, 16.7% vs 28.3%; B, 14.4% vs 17.3%). After controlling for training level (residents only), the video group improved more in the primary outcome (A, 17% vs 7.4%; B, 20.9% vs 16.5%) and secondary outcomes (A, 0.0% vs -194.1%; B, 41.3% vs 37.6%). CONCLUSION: Video self-assessment has a potential role in simulation training for obstetrics-gynecology residents. With key improvements, the feasibility of our study design was demonstrated in preparation for a future definitive trial.

Cesarean Section Scar Ectopic Pregnancy in the Second Trimester: An Underrecognized Complication of Cesarean Deliveries.

The aim of this paper is to present a case of a cesarean section ectopic pregnancy (CSP) diagnosed in the second trimester and perform a literature review of current guidelines for the management of CSP in the second trimester. This was exempt from the Mount Sinai IRB. This is a case is of a 35-year-old P1122 at 13w4d who presented to our hospital with vaginal spotting and abdominal pain. The patient was found to have a cesarean section ectopic pregnancy with placenta increta. There are no management guidelines for second trimester CSP, and the published material is minimal. A literature review was completed and demonstrated two cases and one case series published on management of existing literature on management of second trimester CSP. Our patient underwent an uncomplicated total laparoscopic hysterectomy with bilateral salpingectomy, bilateral ureterolysis, and cystoscopy. She had an uncomplicated postoperative course and was discharged on postoperative day three with an unremarkable recovery at her two-week postoperative visit.

Personality factors in the Long Life Family Study.

OBJECTIVES: To evaluate personality profiles of Long Life Family Study participants relative to population norms and offspring of centenarians from the New England Centenarian Study. METHOD Personality domains of agreeableness, conscientiousness, extraversion, neuroticism, and openness were assessed with the NEO Five-Factor Inventory in 4,937 participants from the Long Life Family Study (mean age 70 years). A linear mixed model of age and gender was implemented adjusting for other covariates. RESULTS: A significant age trend was found in all five personality domains. On average, the offspring generation of long-lived families scored low in neuroticism, high in extraversion, and within average values for the other three domains. Older participants tended to score higher in neuroticism and lower in the other domains compared with younger participants, but the estimated scores generally remained within average population values. No significant differences were found between long-lived family members and their spouses. DISCUSSION: Personality factors and more specifically low neuroticism and high extraversion may be important for achieving extreme old age. In addition, personality scores of family members were not significantly different from those of their spouses, suggesting that environmental factors may play a significant role in addition to genetic factors.