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Introduction The differential diagnosis for abnormal uterine bleeding (AUB) among reproductive-age women is broad and includes common and life-threatening conditions. Recognition and accurate diagnosis of AUB are important but can be challenging for medical students. We developed a standardized patient (SP) encounter for medical students during their OB/GYN clerkship. Methods We implemented two SP encounters, on AUB and dyspareunia, that included a postencounter note and SP evaluations. Here, we describe the implementation of the SP encounter on AUB. Students received formative feedback on their interpersonal and history-taking skills, differential diagnosis, and management plan from the SP as well as OB/GYN residents and faculty. Student cumulative feedback was obtained mid-clerkship and following the clerkship. Summary statistics and qualitative data for students’ experiences are reported. Results SP cases were implemented at the Duke University School of Medicine with 101 second-year medical students who completed the encounter from September 2018 to July 2019. Regarding the AUB case, SPs identified students as adequate history takers, with a mean evaluation score of 3.45 (SD = 0.15) out of 5. Most students (94%) correctly identified at least one diagnosis and provided evidence. Endometrial cancer/hyperplasia (63%) and uterine leiomyoma (60%) were most likely to be identified. Regarding both SP encounters, of the 82 students (81%) completing the end-of-clerkship survey, 57% indicated that the experience enhanced their overall learning at least adequately well or better. Discussion The AUB case provided students with the opportunity to exercise their diagnostic and management skills.

Introduction Although menopause is a common condition, trainees still express high levels of discomfort with managing climacteric symptoms. Trainees also receive little preparation for conducting telemedicine visits, which have become increasingly important in clinical care. We present a formative standardized patient (SP) encounter to introduce medical students to the diagnosis and treatment of menopausal symptoms and the process of conducting a telemedicine visit. Methods We designed a virtual telemedicine encounter with an SP for medical students. Students received feedback via a post-encounter note on history taking, differential diagnosis, and diagnostics/management and an SP debrief. We collected student input on the experience at the midpoint and end of clerkship and analyzed it for recurring themes. We calculated summary statistics from student post-encounter notes. Results Thirty-two OB/GYN students completed the menopause telemedicine SP encounter between April and June 2020. Students scored a median of 20 out of 45 (interquartile range: 18, 22) on the post-encounter note. All students correctly provided a diagnosis of perimenopause/menopause; however, 50% did not offer any strategy for counseling or managing menopausal symptoms. Students expressed discomfort with using a telehealth format (78%) but found it a useful skill to practice (47%). A majority (66%) found the educational encounter to be of excellent or above-average educational value. Discussion While medical students demonstrated discomfort with both managing menopause and utilizing a telemedicine format, this SP case provided an opportunity for them to practice both skills in a safe learning environment. The majority of participants rated the learning experience highly.

Introduction Several studies have demonstrated effective simulation-based training for laparoscopic procedures in OB/GYN, but limited simulation curricula exist for abdominal procedures, particularly cesarean sections (CSs). Methods We developed a high-fidelity modification of an existing CS model costing about $25 and incorporated it into a 90-minute teaching simulation event for medical students and OB/GYN residents in a single academic program. The simulation included a structured curriculum, pre-/postsimulation surveys, a surgical instrument review, a mannequin with the CS model containing a fetus in breech position, and live video streaming. Our surveys assessed participants' comfort with the procedure and its related components on a 5-point scale, and we used a paired t test to analyze our data. Results Twenty-two learners (eight third-year medical students, one fourth-year medical student, three first-year residents, four second-year residents, one third-year resident, four fourth-year residents, and one unknown level) participated in this simulation. We found a statistically significant improvement in perceived CS instrument knowledge, suturing skills, and satisfaction with the model among all participants. Only third-year medical students had a statistically significant increase in comfort level in performing a CS after the simulation. Video streaming engaged a wider audience, but poor lighting and audio limited its efficacy. Discussion Using this simulation model at the end of medical school or early in residency may have the greatest positive effect on resident comfort with CSs. This low-cost and versatile model can be used across educational settings, including OB/GYN interest group activities, intern boot camp, and interprofessional emergency drills.

Thalidomide is a well-known teratogen, which is experiencing resurgence as new uses are identified. Exposure is classically associated with limb deformities, such as: dysmelia, phocomelia, preaxial hypoplasia and polydactyly, in addition to visceral anomalies that have been documented as well. We report a case of a 38 year-old nulligravid female, who was previously evaluated for primary amenorrhea, and given the presumptive false diagnosis of an imperforate hymen. On magnetic resonance imaging (MRI) exam, she was noted to have uterovaginal agenesis. The implications of thalidomide on women’s health extend beyond external birth defects. Although, most commonly associated with limb deformities, there may also be gynecologic implications of in utero exposure. As this medication is increasingly used for various medical conditions, obstetricians/gynecologists need to remain aware of this potential mullerian teratogenic effect.