Faculty Bibliography

Objectives: There is general consensus in the surgical community that task and virtual reality trainers, as well as surgical skills labs should be utilized before trainees embark on live surgery (1-4). The objective skills assessment test (OSAT) for assessing resident skills is used as a modality to objectively assess residents' performance, and more recently has been used as a way to troubleshoot skill deficits.[5-9]While a vaginal hysterectomymodel has been developed by Greer and colleagues (10), validation for construct validity using OSATs has not yet been established. Our primary aim was to use OSATs and GRS checklists to assess the construct validity of the vaginal hysterectomy task trainer as a teaching tool. We sought to assess learners of all levels to comprehensively analyze the validity of the task trainer. Methods: All 3rd and 4th year medical students, OB/GYN residents, Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellows, FPMRS attendings and OB/GYN attendings at our institution received an email invitation to participate in the study. Subjects first took a non-validated pre-test assessing overall general knowledge of performing vaginal hysterectomy. They were then oriented to the model and watched a video demonstrating how to complete a vaginal hysterectomy on the task trainer before performing the task. This assessment was videotaped and a blinded grader graded each subject using OSATS and GRS checklists. Total time to accomplish the task was also recorded. The primary outcome of our study was GRS/OSAT scores for each participant. We also looked at surgical performance time and pre-test scores as secondary outcomes. Results: We recruited 14 medical students, 15 residents, 3 FPMRS fellows, 11 generalist gynecology attendings and 3 FPMRS attendings. Mean GRS and OSAT scores did significantly improve with surgeon level (p<0.001) (Table 1). When comparing students versus residents versus all others the scores improved significantly according to surgical experience (p<0.001) (Table 1). In general, mean time to completion was not significantly different between the groups, however when comparing students and residents versus all others there was a significant improvement in mean time to complete the task (33.7 versus 27.5 minutes respectively) (Table 1). Lastly, mean pre-test scores did improve with level of experience (p=0.05). Conclusions: The vaginal hysterectomymodel can be validated across surgeon level using both general (GRS) and surgery specific (OSAT skills) assessment tools. Using this low cost task trainer as an educational intervention should be considered by training programs for teaching vaginal hysterectomy

Stress urinary incontinence (SUI) is said to effect up to 80 % of all women who complain of some type of urinary leakage. As education about the diagnosis and treatment of SUI becomes more widespread, there is a need for understanding the efficacy and potential complications of the therapies used to treat this condition. It is widely accepted that the gold standard for treatment of SUI is mid-urethral sling (MUS). One significant complication of the MUS procedure is subsequent bladder outlet obstruction (BOO). We review the incidence and etiology of BOO following MUS and hope this document can be used as a guide for identifying patients who may be affected by postsurgical BOO. Additionally, we discuss modalities for achieving a timely and accurate diagnosis and highlight recent evidence regarding the various applications of urodynamic studies, when concerned for BOO. Lastly, various managements of this complication are discussed. This chapter serves as a comprehensive overview of BOO after incontinence procedures, highlighting the recent research contributions, which have enhanced our understanding of this potential complication when treating SUI

BACKGROUND: Patients with breast cancer must choose among a variety of treatment options when first diagnosed. Patient age, independent of extent of disease, is also related to quality of life. This study examined the impact of patient age on treatment selected, factors influencing this selection, and perceived quality of life. METHODS: A 62-question survey evaluating breast cancer treatment and quality of life was mailed to breast cancer survivors. Responses were stratified by age (<50, 50-65, >65 years) and extent of disease. RESULTS: Of the 1,131 surveys mailed, 402 were included for analysis. There were 104, 179, and 119 women aged <50, 50-65, and >65 years, respectively. The median patient age was 58 years, and the average interval from diagnosis to survey participation was 31.5 months. CONCLUSIONS: Young women were more likely to have undergone aggressive therapies and had better physical functioning than old women. Old patients reported good quality of life and body image. Clinicians should consider patient age when discussing breast cancer treatment options.

Objective: Risk-reducing BSO (RRBSO), or prophylactic removal of the adnexae in women at increased genetic risk of ovarian cancer, diminishes ovarian cancer risk. While many general gynecologists (GG) perform these procedures, some argue that they should be performed exclusively by gynecologic oncologists (GO). Crucial aspects of the procedure include attention to removing all adnexal tissue, systematic methods and processing to detect occult disease, and communication between surgeon and pathologist. After compiling a "best practices" protocol for performing RRBSO, we sought to identify how often these practices were followed and whether surgeons' training affected implementation. Methods: All cases of RRBSO from 2006 to 2010 at a single institution were identified.We abstracted data from the medical record, including type of surgeon and year of procedure. We reviewed operative reports to determine if pelvic washings were obtained; whether the upper abdomen, and peritoneal surfaces were inspected; and whether a retroperitoneal approach was used to skeletonize the infundibulopelvic (IP) ligament and maximize length of this pedicle. The pathology report was used to determine if the applicable preoperative diagnosis was noted and whether the entirety of the fallopian tubes and ovaries was sectioned or if only representative sections were reviewed. Fisher's exact test and chi-square were used as appropriate to compare differences between groups (InStat, LaJolla, CA). Results: Among 290 RRBSOs, 26 were performed by GGs and 264 by GOs. When performed by GOs, the ovaries and fallopian tubes were more likely to be completely sectioned compared with GG cases: 231/264 (88%) vs. 17/26 (65%) (P =0.003). GOs were more likely to perform pelvic washings 228/264 (86%) when compared to GGs 13/ 26 (50%) (P < 0.0001). GOs were more likely to use a retroperitoneal approach to skeletonize the IP ligaments 172/264 (65%) when compared to GGs 6/26 (23%) (P < 0.0001). GOs were more likely to include a description of t!