Abstracts from the Third Annual Kaiser Permanente Obstetrics/Gynecology
Bay Area Resident Research Symposium
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The following Abstracts are selected from presentations at the 2004
Kaiser Permanente Obstetrics/Gynecology Bay Area Resident Research Symposium.
The mission of this annual resident research symposium is to foster
a spirit of scientific inquiry. The goal is to familiarize residents
with research study techniques through first-hand experience in conducting
research and presenting their findings. The hope is that participants
find this academic pursuit invigorating and maintain interest in research
as a cornerstone for professional growth.
The
effects of interview format on residency applicant satisfaction.
Shaffer
LS, Walton DL.
objective:
Currently, there is little data on the interview format for residency
in Obstetrics and Gynecology. In our community-based program, interviews
are traditionally performed in groups of three-to-five applicants. Recently,
our most highly regarded applicants were those who worked closely with
residents and faculty during subinternships or "second look"
visits. Past applicant surveys revealed dissatisfaction with the amount
of time spent with residents. Was the traditional interview format giving
applicants adequate exposure to our residents? Indeed, would an individual
interview day result in the applicant having a better sense of our program
and higher overall satisfaction?
methods: Sixty-six applicants were interviewed for four available
intern positions. Applicants were notified that individual and traditional
interview formats were available during the interview period. Applicants
chose the format based on their preference and availability. In the
individual format, applicants shadowed the residents assigned to labor
and delivery. Those in the traditional format toured the facility, were
presented with a residency overview and had a question and answer session
with residents and faculty. Both underwent a series of one or more formal
interviews. Applicants were given a 13-item questionnaire at the conclusion
of the day and asked to return it anonymously. A five-point (poor through
excellent) scale and one six-item ranking of importance scale were used
to evaluate the factors for applicant satisfaction during the interview
day.
results: Of the 66 applicants who interviewed, 28 questionnaires
were returned and 25 were complete, 12 from the individual and 13 from
the traditional group. All individual and 85% of traditional applicants
ranked time with residents as most important during their interview
(c2 = 2.0, p < 0.2). 83% of individual and 46% of traditional
applicants rated their overall day excellent (c2 =3.74 p
< 0.1). One hundred percent of individual compared with 85% of traditional
applicants responded that residents' availability and eagerness to answer
questions was excellent (c2 =2.0 p < 0.2). Ninety-two
percent of individual versus 46% of traditional applicants rated the
amount of time they spent with residents as excellent (c2
= 11.5 p < 0.001). Finally, 83% of individual and 15% of traditional
applicants rated their "sense of a typical resident day" as
excellent (c2 = 11.5 p < 0.001).
conclusions: Our applicants ranked time with residents as the most
important factor during the interview. While not statistically significant,
we observed that applicants in the individual format were more likely
to rate the overall day and residents' availability as excellent. Compared
to those in the traditional group, applicants in the individual group
rated time spent with residents and the overall sense of a typical resident's
day as excellent. Based on these results, the individual interview format
may be considered to enhance applicant satisfaction and possibly to
improve the "match" of applicant and program.
Effect
of education on the rate of forceps-assisted vaginal deliveries in a
residency program.
Crecelius
AR, Brubaker KL.
objective:
To compare the rate of forceps-assisted vaginal deliveries (FAVDs)
before and after intense education of patients, nurses and physicians
at Kaiser Permanente Santa Clara Obstetrics and Gynecology Residency
Program.
methods: Cumulative case logs of residents' obstetrics experience,
from July 1, 1998 to June 30, 2004, were reviewed. The control group,
from July 1, 1998 to June 30, 2000, represents the baseline number of
FAVDs performed by residents prior to any intervention. Several attending
physicians skilled and willing to teach residents FAVDs were added to
our faculty in July 2000 (study group #1). In July 2002, a historical
overview of FAVD training in residency and the ACOG Practice Bulletin
on operative vaginal deliveries (OVDs) were reviewed with attending
and resident physicians. Labor and Delivery nurses attended in-services
on FAVDs. Patients received an educational handout on OVDs at their
36-week prenatal visit. Names of attending physicians interested in
teaching residents FAVDs were posted in Labor and Delivery (study group
#2).
results: FAVDs accounted for 10.1%, 23.3% and 24.3% of OVDs in control
group, study group #1 and study group #2, respectively. There was an
increase in the rate of FAVDs from 0.9% to 3.7%. The average number
of FAVDs performed by graduating residents increased from 9 to 16.
conclusions: There was a significant increase in the rate of FAVDs
at the institution from 0.9 to 3.7% after the educational process. The
average number of FAVDs performed by graduating residents increased
from 9 (range 5 to 13) to 16 (range 5 to 32) after a concentrated effort
to increase patient and hospital staff knowledge and awareness of FAVDs.
Surveyed attendings recommended an average of 21 FAVDs to be proficient,
and residents came closer to that goal. The rate of FAVDs initially
increased after an influx of faculty interested in instructing residents
in FAVDs. The rate of FAVDs continued to increase with the education
of patients and nurses. Attending physicians experienced in FAVDs are
essential to bolster resident education to maintain this vital skill
in the field of obstetrics.
Prevalence
of neurologic sequelae, congenital cardiac malformations, and mortality
of monochorionic twins.
Lee
P.
background:
It is well known that mono-chorionicity increases the risks of perinatal/neonatal
morbidity and mortality, especially in the cases of twin-twin transfusion
syndrome, and twin reversed arterial perfusion. In some cases monochorionic
twins can have long-term neurologic sequelae in the absence of these
two conditions. Furthermore, monochorionic twins are at increased risk
of congenital cardiac malformation. Most publications on above subjects
are of small numbers and selected population.
objective: To compare the neurologic and cardiovascular outcomes
of monochorionic versus dichorionic twins.
methods: This is a large multicenter population-based descriptive
study from the Kaiser Permanente (KP) Northern California system to
look at the morbidity and mortality of the monochorionic twin pairs.
A twin database maintained by the Regional Genetics/Pathology specialist
was utilized in conjunction with the KP electronic records and chart
review.
results: Four hundred eighty-nine twin pregnancies from 1996 to
2003 were reviewed. Mean gestational age was 35.2 weeks. In this study,
number of pregnancies complicated by TTS was 16.0% and TRAP was 1.4%.
Perinatal/neonatal mortality was 8.5%. Number of infants with neurologic
sequelae (in particular of interests including seizure, developmental
delay, cerebral palsy, audiovisual problems) was as follows: seizure
was 0.5%, developmental delay was 4.7%, cerebral palsy was 1.2%, audiovisual
problems was 1.4%. Number of infants with congenital heart disease was
2.5%. This study showed an association between adverse neurologic outcomes
with monochorionic twins. It also confirmed previous reports of increased
risk of cerebral palsy and congenital cardiac malformations in monochorionic
as compared to dichorionic pregnancies. This information may be helpful
in patient counseling about prognosis. Further studies comparing morbidity
and mortality among monochorionic, dichorionic twins and singleton would
be of interest.
Prevalence
of hormone therapy use in patients with DCIS.
Habel
L, Capra A, Mendez T.
background:
The use of hormone replacement therapy (HRT) in women diagnosed
with breast cancer has been typically avoided due to the concern that
estrogen stimulates cancer growth. Only a few articles have reported
on the prevalence of HRT use among women diagnosed with localized breast
cancer. Data are also limited on use of HRT among women diagnosed with
ductal carcinoma in situ (DCIS).
aim: The purpose of this study was to describe the prevalence of
HRT use among women diagnosed with DCIS.
methods: This is a descriptive study of 1014 female Northern California
Kaiser Permanente (KP) members diagnosed with DCIS between 1990-1997
and treated with breast-conserving surgery. Cases were identified using
the KP tumor registry and charts were reviewed to obtain pertinent clinical
information (eg, menopausal status and symptoms, HRT use, BMI). Patients
were followed through July 2002, until a subsequent cancer event developed
(recurrence or other primary), or until termination of KP membership.
The prevalence of HRT use among women who were or became postmenopausal
after diagnosis was calculated.
results: During the median follow-up time of 63.9 months a total
of 769 women were eligible for the study; 694 were postmenopausal at
diagnosis and 75 became postmenopausal after diagnosis. Of the 694 women
who were postmenopausal at diagnosis, 320 (46%) were current users of
HRT. Sixty-six of the 320 continued to use HRT after their diagnosis
and 254 stopped. Of the remaining 374 postmenopausal women with DCIS,
37 (1%) started HRT after diagnosis. Vaginal dryness was the most common
reason for initiating HRT use. Seven (9%) of the 75 women who became
postmenopausal used HRT for some period after their diagnosis. Hot flashes
and vaginal dryness were the most common reason for use in this group.
Overall, the most frequent HRT regimen used was estrogen alone.
discussion: In our population, the diagnosis of DCIS is associated
with discontinued HRT use. These results are consistent with previous
reports. With the recent media attention regarding the increased risk
of breast cancer among HRT users (ie, Women's Health Initiative study)
it will be interesting to examine the reasons patients discontinue therapy.
Given the increase in diagnosis of DCIS, it will be important to continue
to examine use of HRT in this population.
