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Holistic review of residency applications is touted as the gold standard for selection, yet vast application numbers leave programs reliant on screening using filters such as United States Medical Licensing Examination scores that do not reliably predict resident performance and may threaten diversity. Applicants struggle to identify which programs to apply to, and devote attention to these processes throughout most of the fourth year, distracting from their clinical education. In this perspective, educators across the undergraduate and graduate medical education continuum propose new models for student-program compatibility based on design thinking sessions with stakeholders in obstetrics and gynecology education from a broad range of training environments. First, we describe a framework for applicant-program compatibility based on applicant priorities and program offerings, including clinical training, academic training, practice setting, residency culture, personal life, and professional goals. Second, a conceptual model for applicant screening based on metrics, experiences, attributes, and alignment with program priorities is presented that might facilitate holistic review. We call for design and validation of novel metrics, such as situational judgment tests for professionalism. Together, these steps could improve the transparency, efficiency and fidelity of the residency application process. The models presented can be adapted to the priorities and values of other specialties.

Holistic review of residency applications is touted as the gold standard for selection, yet vast application numbers leave programs reliant on screening using filters such as United States Medical Licensing Examination scores that do not reliably predict resident performance and may threaten diversity. Applicants struggle to identify which programs to apply to, and devote attention to these processes throughout most of the fourth year, distracting from their clinical education. In this perspective, educators across the undergraduate and graduate medical education continuum propose new models for student-program compatibility based on design thinking sessions with stakeholders in obstetrics and gynecology education from a broad range of training environments. First, we describe a framework for applicant-program compatibility based on applicant priorities and program offerings, including clinical training, academic training, practice setting, residency culture, personal life, and professional goals. Second, a conceptual model for applicant screening based on metrics, experiences, attributes, and alignment with program priorities is presented that might facilitate holistic review. We call for design and validation of novel metrics, such as situational judgment tests for professionalism. Together, these steps could improve the transparency, efficiency and fidelity of the residency application process. The models presented can be adapted to the priorities and values of other specialties.

Objective To describe education on transgender health provided by obstetrics and gynecology residency programs and to identify the facilitators and barriers to providing this training. Methods We conducted a cross-sectional survey to evaluate transgender health education in residency among a representative sample of 100 of the 236 obstetrics and gynecology residency programs listed in the 2015 Electronic Residency Application Service catalogue. We compared programs that did and did not offer transgender education on demographics, presence and type of transgender education offered, and reasons for and barriers to offering transgender health education using χ or Fisher's exact testing. Results We found that 31 out of 61 (51%, 95% CI 38-64%) programs completing the survey offered transgender health education in residency. Compared with programs that offered no education, residency programs offering education were more likely to report that transgender health education was very important (19/31, 61% [95% CI 42-78%] vs 7/30, 23% [95% CI 9-42%]), resident interest (20/31, 64% [95% CI 45-81%] vs 11/30, 37% [95% CI 20-56%]), and the presence of a transgender population requesting services (28/31 or 90% [95% CI 74-98%] vs 16/30 or 53% [95% CI 34-72%]). Among the 31 programs that offered transgender health education, 30 (97%; 95% CI 83-99%) provided formal didactic sessions and 20 (64%; 95% CI 45-81%) offered health screening for both male-to-female and female-to-male transgender patients, but 17 (55%; 95% CI 36-73%) did not offer gender-affirming hormone therapy. Among the 30 programs that did not currently offer transgender health education, 24 (80%; 95% CI 61-92%) planned to establish a transgender education program in the next year. Conclusion Our survey of obstetrics and gynecology residency programs highlights the interest in transgender health education for a systemically underserved population of patients.

Objective To estimate the rate of erroneous and unverifiable publications in applications for an obstetrics and gynecology residency and to determine whether there were associated characteristics that could assist in predicting which applicants are more likely to erroneously cite their publications. Methods This was a review of the Electronic Residency Application Service applications submitted to the University of Washington obstetrics and gynecology residency for the 2008 and 2009 matches. Publications reported to be peer-reviewed articles and abstracts were searched by querying PubMed, Google, and journal archives (first tier), topic-specific databases (second tier), and by e-mailing journal editors (third tier). Errors were categorized as minor, major, and unverified. Results Five-hundred forty-six (58%) of 937 applicants listed a total of 2,251 publication entries. Three-hundred fifty-three applicants (37.7%) listed 1,000 peer-reviewed journal articles and abstracts, of which 751 were reported as published and 249 as submitted or accepted. Seven-hundred seventy (77.0%) publications were found by a first-tier search, 51 (5.1%) were found by a second-tier search, 23 (2.3%) were found by a third-tier search, and 156 (15.6%) were unverified. Of the 353 applicants listing peer-reviewed articles or abstracts, 25.5% (90 of 353) committed major errors, 12.5% (44 of 353) committed minor errors, and 24.1% (85 of 353) had articles or abstracts that were unverified. Conclusion Most applicants reported their publications accurately or with minor errors; however, a concerning number of applicants had major errors in their citations or reported articles that could not be found, despite extensive searching. Reported major and unverified publication errors are common and should cause concern for our specialty, medical schools, and our entire medical profession.

The gynecologic surgeon should be knowledgeable about the normal physiologic changes associated with aging and skilled at assessing baseline medical comorbidities, neuropsychiatric, nutritional, social, and functional status as increasing numbers of older women seek and undergo surgical interventions to improve their quality of life. A multidisciplinary approach to the perioperative care of the older woman, aiming for prevention and early intervention, can help minimize both typical surgical complications and "geriatric" complications.

Inherited mutations in BRCA1 and BRCA2 lead to 20-50% lifetime risk of ovarian, tubal, or peritoneal carcinoma. Clinical recommendations for women with these genetic mutations include the prophylactic removal of ovaries and fallopian tubes by age 40 after child-bearing. Recent findings suggest that many presumed ovarian or peritoneal carcinomas arise in fallopian tube epithelium. Although survival rate is

Documentation and coding principles are intimately linked and affect patient care, reimbursement, and compliance. An understanding of the principles is required for the successful practice of medicine today. All physicians should receive formal education and practical training in chart documentation and coding of medical services. As with other medical knowledge, this education must begin early in training and be continually updated. This article will discuss documentation and coding in the ambulatory setting using Health Care Finance Administration and Current Procedural Terminology guidelines.

OBJECTIVES We present a case of metastatic placental site trophoblastic tumor (PSTT) and review the English literature on this entity. MATERIALS AND METHODS In addition to the case presentation, literature review describes 23 additional cases with differing treatments and length of survival. RESULTS The patient is free of disease more than 5 years after diagnosis. She received multimodality treatment including surgery, chemotherapy, and radiotherapy. Eleven other patients survived the disease from 12 to 36 months after initial diagnosis. CONCLUSION Metastatic PSTT has a poor prognosis and requires aggressive treatment. ▪.

The goal of this study was to determine how increasing levels of residency training as well as a documentation and coding curriculum affected coding accuracy in the continuity clinic setting.All postgraduate year (PGY) 2 through PGY 4 residents (n=22) participated in a mandatory 3-module curriculum. Residents completed mock charge tickets in the obstetrics and gynecology continuity clinic for every patient encountered 1 month before and 1 month after the curriculum. An audit of 5 random charts per resident (n=110) compared chart documentation with the billing levels noted on the mock charge tickets.We found a significant reduction in the number of undercoded charts for everyone except PGY 4 residents. In addition, all residents correctly coded more charts after the curriculum (from 30 to 46 charts, P=0.03).The first phase of our documentation and coding curriculum study demonstrated that significant improvements in coding accuracy are achieved when implemented among PGY 2 and PGY 3 residents. Refinements in the basic foundation of knowledge may help prevent overcoding errors.

Inherited mutations in BRCA1 and BRCA2 cause a 20-50% lifetime risk of ovarian, fallopian tubel, or peritoneal carcinoma. Clinical recommendations for these high-risk women include the prophylactic removal of the ovaries and fallopian tubes by age 40 after child-bearing. Recent findings suggest that many presumed ovarian or peritoneal carcinomas arise in fallopian tube epithelium. Although survival rate is >90% when ovarian cancer is detected early (Stage_I), 70% of women have advanced disease (Stage_III/IV) at presentation when survival is less than 30%. Over the years, effective early detection of ovarian cancer has remained elusive, possibly because screening techniques have mistakenly focused on the ovary as the origin of ovarian carcinoma. Unlike ovaries, the fallopian tubes are amenable to direct visual imaging without invasive surgery, using access through the uterine cervix. To develop future screening protocols, we investigated using our 1.2-mm diameter, forward-viewing, scanning fiber endoscope (SFE) to image luminal surfaces of the fallopian tube before laparoscopic surgical removal. Three anesthetized human subjects participated in our protocol development which eventually led to 70-80% of the length of fallopian tubes being imaged in scanning reflectance, using red (632nm), green (532nm), and blue (442nm) laser light. A hysteroscope with saline uterine distention was used to locate the tubal ostia. To facilitate passage of the SFE through the interstitial portion of the fallopian tube, an introducer catheter was inserted 1-cm through each ostia. During insertion, saline was flushed to reduce friction and provide clearer viewing. This is likely the first high-resolution intraluminal visualization of fallopian tubes Citation Format: Elizabeth M. Swisher, C. David Melville, Richard S. Johnston, Kathy Agnew, Seine Chiang, Eric J. Seibel. In vivo laser-based imaging of the human fallopian tube for future cancer detection. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research: Exploiting Vulnerabilities; Oct 17-20, 2015; Orlando, FL. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(2 Suppl):Abstract nr B36.

BACKGROUND: Postmenopausal uterine inversion is an extremely rare gynecologic complication. We report a case of uterine inversion associated with endometrial polyps alone. CASE: A postmenopausal nullipara with a history of recurrent postmenopausal bleeding was evaluated for persistent vaginal bleeding. Benign endometrial polyps were found, and the patient's symptoms improved after a therapeutic dilation and curettage. She had acute onset of profuse vaginal bleeding 3 months later and a mass protruded from the cervix. A laparotomy revealed an inverted uterus that was resolved by the Haultain technique and was followed by total abdominal hysterectomy. CONCLUSION: Nonpuerperal uterine inversion associated with endometrial polyps was successfully treated surgically.

This resource is a series of resident-guided case discussions in reproductive endocrinology and infertility. It is designed to be an adjunctive curriculum tool to allow trainees in gynecology to improve their comfort with core concepts in reproductive endocrinology and infertility. The sequential cases in this resource include attached questions and reading lists. Clinical experience in reproductive endocrinology and infertility is variable among trainees. Structured case-based learning allows gynecology trainees to be exposed to a core of common concepts in reproductive endocrinology. This exercise provides opportunities for medical trainees to explore ACGME competencies in clinical cases outside of the clinical arena. In addition, it allows senior instructors (such as residents and fellows) the opportunity to formally gain educational skills by teaching clinical concepts in a supervised environment while enhancing their own knowledge of reproductive endocrinology and infertility concepts. The team completing these cases consists of a learner, a teacher, and a faculty mentor. Each case is presented and discussed in 30 minutes. The clinical scenarios are presented in a fashion that mimics clinical dilemmas. The trainees explore the diagnosis, evaluation, management, and other treatment options. A reading list is provided with three or four segments of clinical questioning. Evaluations of teaching/learning skills, as well as ACGME competencies, are attached and completed for both learner and teacher trainees. Feedback from junior and senior gynecology resident trainees has consistently indicated that this is a worthwhile program as it allows for the curriculum to be standardized among the residents and for learning to occur outside of the clinical arena.

To characterize the suicide rates among patients with gynecologic cancer in the Unites States and to identify factors associated with high suicide rates.Subjects with a diagnosis of gynecologic cancer were identified from the Surveillance, Epidemiology, and End Results (SEER) program for the period 1988-2007. Comparison with women in the general US population was based on WHO data 2005, matched for age in 10-year categories. Cox regression models were used to perform multivariate modeling for factors associated with suicide.Among 252,235 patients followed for 1,207,278 person-years, the suicide rate was 8.3 per 100,000 person-years, with a standardized mortality ratio (SMR) of 1.4 (95% CI 1.2-1.7, p0.001). The highest suicide rates were observed in patients with ovarian cancer and within the first year following diagnosis. Suicide risk was associated with younger age at diagnosis, high grade disease and absence of surgical intervention.Patients with gynecologic cancer have an increased suicide risk when compared to the general population. Suicide rates vary by cancer site and time since diagnosis. Effective screening and appropriate treatment of psychosocial stress among women with gynecologic cancer are warranted.

Surgical intervention for both emergency and elective surgeries will Increase as women live longer and maintain active lifestyles. Older women with operable conditions tolerate elective gynecologic and other nonvascular surgery with acceptable morbidity and mortality. However, increased medical comorbidities, with their associated increase in polypharmacy and perioperative risks as women age, make it important to a priori optimize perioperative medical conditions and medication management. Other considerations include assessing functional and cognitive status, since these may be impaired acutely with increased prevalence of drug use during surgical hospitalization. With aging and postmenopausal status, changes associated with aging appear to play a greater role than gender in pharmacologic responses. Surgical outcomes should be optimized to maintain and even improve women's quality of life.

To assess the potential effectiveness and costs of 4 commonly used strategies to manage abnormal early pregnancies (AEPs).A decision analysis model was constructed to compare 4 strategies to manage AEPs: (1) observation, (2) medical management, (3) manual vacuum aspiration (MVA), and (4) dilation and curettage (DC).MVA was the most cost-effective strategy, at dollar 793 per cure, for a total cost of dollar 377 million per 500,000 women and a cure rate of 95%. DC was more effective than MVA, with a cure rate of 99%, but was more expensive (dollar 2,333 per cure, for a total cost of dollar 1.2 billion). DC cured 20,000 more patients than MVA; however, at a substantial cost of dollar 38,925 per additional cure. With other estimates at baseline, MVA remained more cost-effective than DC until the efficacy of MVA was82% or the cost of DC wasdollar 240.MVA is the most cost-effective strategy for managing AEP and would be appropriate in settings in which resources are limited. DC remains a reasonable strategy; however, one must spend dollar 38,925 per additional cure. In the United States, MVA would save dollar 779 million per year relative to DC.

Our purpose was to assess the impact of a curriculum designed to improve third-year medical students' knowledge of sexually transmitted diseases, measured by sexually transmitted disease-related items from the National Board of Medical Examiners subject examination and by a locally developed sexually transmitted disease test.All students (n = 108) were exposed to a new sexually transmitted disease curriculum: a 2-hour laboratory module, lectures, syllabus, and locally developed pretest/posttest with review of the test prior to taking the National Board of Medical Examiners subject examination. Students were randomized to a attend sexually transmitted disease clinic (n = 47) versus no sexually transmitted disease clinic (n = 61).Students performed equal to or better than the national average on 85% of the National Board of Medical Examiners sexually transmitted disease-related items after curriculum institution, compared with 56% of the test items prior ( P.001). Magnitude of improvement was dependent on clerkship timing, with greater improvement in students taking the obstetrics-gynecology clerkship earlier in the third year. Mean postcurriculum test scores of sexually transmitted disease improved significantly ( P.001), independent of clinic site and clerkship timing.The curriculum for sexually transmitted disease produced significant improvement in third-year medical students' knowledge of sexually transmitted disease. This might have an impact on future prevention and control of sexually transmitted diseases in communities in which these students practice.

We sought to describe change in sexual function 2 years after surgery to treat stress urinary incontinence.This analysis included 655 women randomized to Burch colposuspension or sling surgery. Sexual activity was assessed by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) among those sexually active at baseline and 2 years after surgery.Mean PISQ-12 total score improved from baseline 32.23 +/- 6.85 to 36.85 +/- 5.89. After surgery, fewer subjects reported incontinence (9% vs 53%; P.0001), restriction of sexual activity as a result of fear of incontinence (10% vs 52%; P.0001), avoidance of intercourse because of vaginal bulging (3% vs 24%; P.0001), or negative emotional reactions during sex (9% vs 35%; P.0001). Women with successful surgery had greater improvement PISQ-12 scores (5.77 vs 3.79; P.006). Sexually active women were younger, thinner, and had lower Medical, Epidemiological, and Social Aspects of Aging scores (total and urge subscale) than sexually inactive women.Sexual function improves after successful surgery and does not differ between Burch and sling.