The role of an electronic mail system in the educational strategies of a residency in obstetrics and gynecology.

Computerized electronic mail (E-mail) systems provide a rapid means of data sharing and are used in a variety of commercial and industrial settings for the widespread distribution of memoranda. We adapted an E-mail system to our program to determine the feasibility of incorporating such a system into didactic resident education in obstetrics and gynecology and to assess resident response to this form of computer-based learning. The system was programmed to distribute one review question per day to 24 resident physicians for 60 days. Residents were given 24 hours to respond and comment. Each question was discussed and appropriate references distributed within 48 hours of presentation. All questions and responses were then stored in an electronic file folder for later review. An examination was given at completion of the project (post-test), and these scores were compared to performance during the project (pre-test). An anonymous questionnaire was distributed upon completion of the project to assess the residents' overall satisfaction with the program. The system was well received by the residents. On a scale of 1 to 6 (1 = lowest; 6 = highest), resident satisfaction was high, with an overall average rating of 5.0. Using this scale, residents assessed their frustration level as 1.5. Average daily participation was 85%. An average of 9 minutes was required to complete each question and review prior responses and discussion; this interval was not significantly different among the postgraduate years. Scores on the examination at project completion were significantly higher than performance during the project.(ABSTRACT TRUNCATED AT 250 WORDS)

A program of instruction in operative laparoscopy in a residency in obstetrics and gynecology.

Operative laparoscopy has found an increasingly innovative role in contemporary gynecologic practice. Residency programs must now formulate protocols for training in laparoscopic surgery on which subsequent credentialling may be safely recommended. This report describes a program of instruction in operative laparoscopy and the number of procedures required to develop technical skills at each year level of a 4-year residency. The objective of the program was to develop clinical judgment and technical skills in operative laparoscopy during the first 3 resident years. The main outcome measurement was the safe performance of complicated operative laparoscopy during the fourth resident year. This program emphasized progressive, graded responsibility in operative laparoscopy to develop skills in both the principles and practice of laparoscopic surgery. Principles were taught through didactic sessions in laparoscopic instruments and techniques, assignment of reading lists for each year level, and a review of videotapes to assist in decision making for each procedure. Skills in technique and development of manual dexterity were taught over 4 years as follows. Postgraduate year (PGY) 1: restricted to diagnostic procedures emphasizing the development of basic eye-hand coordination using a video monitor system; PGY2: incorporation of principles of laparoscopic hemostasis and laparoscopic tubal ligation; PGY3: operative laparoscopy using multiple puncture sites, sharp dissection, and suture techniques; PGY4: progressively more complicated procedures to include salpingectomy, salpingostomy, and segmental resection for ectopic pregnancies; oophorectomy for benign disease, appendectomy, and adhesiolysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Education on breast disease in an obstetrics and gynecology training program: a multidisciplinary approach.

Breast cancer affects one in ten women during their lifetime. Recognizing the importance of early detection in the prognosis of this condition, the American Board of Obstetrics and Gynecology has stated guidelines encouraging breast disease education in obstetrics and gynecology training programs. To fulfill this academic responsibility, we have organized a multidisciplinary Breast Disease Detection and Treatment Clinic where patients with abnormal mammograms or any breast-related complaints are evaluated and managed. In cooperation with the radiology department and general surgery service, a mammogram review conference has been instituted. Abnormal mammograms are reviewed with a radiologist. Our activities have been coordinated such that a general surgery staff member and resident are present during the breast clinic hours to review mammograms and to examine the patients with the gynecologist, providing immediate consultation. Needle aspiration of breast cysts, repeat imaging studies, and general surgery referrals for breast biopsies are performed as indicated. The patient receives integrated care of her breast problem in one visit, and our residents gain the experience of diagnosing and managing breast problems which, before establishment of this clinic, were referred to the general surgery department. This multidisciplinary approach developed in our institution helps us provide the most efficient care to our patients, while providing our residents with integrated teaching and training concerning the diagnosis and management of breast disease.

Antenatal screening for thalassemia minor.

This report describes the findings of a screening program of 918 obstetric patients for thalassemia minor. Patients with erythrocyte mean corpuscular volume (MCV) less than 80 fL on initial complete blood count were evaluated with serum iron, total iron binding capacity, quantitative hemoglobin electrophoresis, and trial of iron replacement. A diagnosis of thalassemia minor was made when microcytosis persisted after exclusion of iron deficiency or other causes of erythrocyte microcytosis. Twenty-six women (2.8% of those screened) had an initial MCV less than 80 fL. Three cases of previously unsuspected thalassemia minor were detected (one alpha-thalassemia, two beta-thalassemia). Of 17 well-documented cases of iron deficiency, 16 had a hemoglobin level above 11 g/dL on initial complete blood count and would not have been otherwise detected until much later in gestation. A simple screening program can effectively identify pregnant women with unrecognized thalassemia minor and can also detect patients with iron deficiency before they become anemic.

Searches for ova in the human uterus and tubes. II. Clinical and laboratory data on nine successful searches for human ova.

PIP: Case reports of 9 patients from whom tubal ova, including 1 fertilized pronuclear ovum, were recovered from uterus and tubes after hysterectomy are presented. The 9 ova are described along with the clinical data which include menstrual data, BBT, histology of the endometrium and corpus luteum and time of operation. Ovular morphological characteristics were not found to provide a good criterion of the time of ovulation.^ieng

Searches for ova in the human uterus and tubes. I. Review, clinical methodology, and summary of findings.

PIP: In 132 searches for tubal ova from the fallopian tubes removed concurrent with hysterectomy from selected patients, 9 tubal ova were recovered. 6 were recovered on Days 1-3, 2 on Day 4 following ovulation, and 1 from a ligated oviduct. 8 ova were unfertilized and 1 was at the pronuclear phase of fertilization.^ieng