Search

Morhaf Al Achkar,1 Mathew Hanauer,1 Elizabeth H Morrison,2 M Kelly Davies,1 Robert C Oh3 1Department of Family Medicine-Indiana University, Indianapolis, IN, USA; 2Health Sciences, University of California, Riverside School of Medicine, Riverside, CA, USA; 3Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA Background: Teaching residents how to teach is a critical part of residents’ training in graduate medical education (GME). The purpose of this study was to assess the change in resident-as-teacher (RaT) instruction in GME over the past 15 years in the US. Methods: We used a quantitative and qualitative survey of all program directors (PDs) across specialties. We compared our findings with a previous work from 2000–2001 that studied the same matter. Finally, we qualitatively analyzed PDs’ responses regarding the reasons for implementing and not implementing RaT instruction. Results: Two hundred and twenty-one PDs completed the survey, which yields a response rate of 12.6%. Over 80% of PDs implement RaT, an increase of 26.34% compared to 2000–2001. RaT instruction uses multiple methods with didactic lectures reported as the most common, followed by role playing in simulated environments, then observing and giving feedback. Residents giving feedback, clinical supervision, and bedside teaching were the top three targeted skills. Through our qualitative analysis we identified five main reasons for implementing RaT: teaching is part of the residents’ role; learners desire formal RaT training; regulatory bodies require RaT training; RaT improves residents’ education; and RaT prepares residents for their current and future roles. Conclusion: The use of RaT instruction has increased significantly in GME. More and more PDs are realizing its importance in the residents’ formative training experience. Future studies should examine the effectiveness of each method for RaT instruction. Keywords: resident as teachers, RaT, graduate medical education, GME, survey

Peripartum emergencies occur in patients with no known risk factors. When the well-being of the fetus is in question, the fetal heart rate pattern may offer etiologic clues. Repetitive late decelerations may signify uteroplacental insufficiency, and a sinusoidal pattern may indicate severe fetal distress. Repetitive variable decelerations suggesting umbilical cord compression may be relieved by amnioinfusion. Regardless of the etiology of the nonreassuring fetal heart pattern, measures to improve fetal oxygenation should be attempted while options for delivery are considered. Massive obstetric hemorrhage requires prompt action. Clinical signs, such as painless bleeding, uterine tenderness and nonreassuring fetal heart patterns, may help to differentiate causes of vaginal bleeding that may or may not require emergency cesarean delivery. The causes of postpartum hemorrhage include uterine atony, vaginal or cervical laceration, and retained placenta. The challenge of managing shoulder dystocia is to effect a rapid delivery while avoiding neonatal and maternal morbidity. The McRoberts maneuver has been shown to be the safest and most successful technique for relieving shoulder dystocia. Eclampsia responds best to magnesium sulfate, supportive care and supplemental hydralazine or labetalol as needed for severe hypertension. [ABSTRACT FROM AUTHOR]

Because the health care system has become more cost-conscious, and because professional organizations vary in their recommendations for women's health maintenance, it is more important than ever to use an evidence-based approach for selecting health maintenance interventions wisely. The Papanicolaou smear is a gold standard for cancer screening if women undergo regular testing; however data, conflict on how often women should be screened and how risk factors for cervical cancer should be interpreted. Postmenopausal estrogen replacement therapy slows osteoporotic bone loss and may decrease a woman's relative risk of coronary artery disease. The relationship of hormone replacement therapy (estrogen plus progestin) to the risk of breast cancer still retains unclear. Although new data suggest that screening mammography may reduce breast cancer mortality by 20 percent for more in women over 40 years of age, its use in women who are 40 or 49 years of age is still controversial. Family physicians, as advocates for women's health, are ideally positioned for leadership roles in the policy making that may utilmately find solutions to these controversial issues. [ABSTRACT FROM AUTHOR]