New directions in medical student clerkship evaluations

Purpose: To compare the number of requested medical student evaluations with mean evaluation scores and final clerkship grades. Background: The University of Iowa Obstetrics & Gynecology (OBGYN) clerkship requires six evaluations for each student: two assigned and four requested by the student. Many students request more evaluations than required, contributing to a backlog that slows the grading process. Methods: Medical student evaluations from 2014 to 2016 were analyzed. Three groups were created based on the number of evaluations an individual student received. Group 1 received 3-4 evaluations (73), Group 2 received 5-6 evaluations (240) and Group 3 received 7-16 evaluations (222). A paired T-test compared mean evaluation scores and a chi-square test was used to compare mean shelf exam scores and percentages of pass, near honors, and honors grades. Results: A total of 535 independent students and their evaluations were reviewed for the study. The difference in mean evaluation scores for groups 1 and 2 and groups 2 and 3 were statistically significant (p 0.05). Similarly, the differences in rates of pass, near honors, and honors grades between groups were not statistically significant (p > 0.05). Discussion: Increased number of requested evaluations did not translate to differences in rates of pass, near honors, and honors grades for medical students on their OBGYN clerkship, indicating that decreasing the mandatory evaluations per student would not be detrimental to student outcomes and would potentially expedite the grading process

Prevalence, attitudes and knowledge of misoprostol for self-induction of abortion in women presenting for abortion at Midwestern reproductive health

Expansive restrictions to legal abortion have led to reports of self-induced termination of undesired pregnancies with misoprostol obtained without a prescription or provider. This study seeks to describe the prevalence of women seeking or employing misoprostol for self-induced abortion and how they access information. Women are accessing information regarding misoprostol for self-induction of abortion on the internet and as barriers to legal abortion increase, women may be more likely to self-induce abortion

The effects of obesity with pregnancy termination: a literature review

Obesity has become a major health problem in the United States as well as globally which may affect the safety of pregnancy termination. Thus, a literature review was conducted to determine the available evidence regarding the effects of obesity with pregnancy termination to assist with patient care and counseling. The available evidence is limited by small numbers and descriptive study design. While pregnancy termination upon obese women may impart additional technical challenges, experienced providers complete procedures upon obese women without statistically significant differences in procedure or patient outcomes compared to normal weight women for first trimester gestations. Pharmacological abortion may be a more practical option in some very obese women

A select issue in the postpartum period: contraception

One half of pregnancies in the United States are unintended and associated with adverse pregnancy outcomes. The postpartum period is an important, yet underutilized, time to initiate contraception. The U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 provides evidence-based guidelines for choosing a contraceptive method and an update in 2011 specifically addresses contraceptive method use in the puerperium. The variety of contraceptive methods include hormonal contraception, lactational amenorrhea, barrier contraception, natural family planning, and sterilization. Ideally, counseling about contraceptive choice should begin early in pregnancy care and continue postpartum; it should also include a variety of teaching modalities. Specifically we recommend LARC options such as intrauterine devices and etonorgestrel implants, postpartum tubal sterilization, and progestin-only pills for those desiring an oral method

Planned use of long acting reversible postpartum contraception in low-risk women in CenteringPregnancy® group versus individual physician prenatal care

Introduction: Education on effective contraceptive methods is necessary during the prenatal period to help women achieve optimal birth spacing. This study identified rates of long-acting reversible contraception (LARC) uptake in women who attended CenteringPregnancy® (CP) group prenatal care versus individual physician care (IP). Methods: Charts for low-risk women who participated in group CP or IP prenatal care between March 2012 and May 2016 were reviewed. Charts of IP subjects were randomly selected in each year to achieve a CP:IP ratio of at least 1:3. The primary outcome was rate of LARC use at discharge and within 8 weeks postpartum. Pearson chi-squared test and Wilcoxon rank-sum tests were performed, and a p-value <0.05 was considered significant. Results: 129 women participated in CP care and 412 in IP care. CP women were more likely nulliparous (91, or 70.5% vs 212, or 51.5%, p=0.0001) and more likely to attend at least 15 prenatal visits (54, or 41.9% vs 62, or 15.1%, p<0.0001). LARC use rates at discharge and at the postpartum visit were similar (36, or 27.9% vs 89, or 21.6%, p=0.142; 39, or 32.2% vs 110, or 29.4%, p=0.557). Rates of women using effective contraception (LARC and other hormonal options, including oral contraceptives and Depo Provera) at discharge and at the postpartum visit were similar (59, or 45.7% vs 206, or 50.0%, p=0.177; 72, or 59.5% vs 229, or 61.2%, p=0.157). IUD use was greater than subdermal implant use in both groups (31, or 24.0% vs 5, or 3.9%; 72, or 17.5% vs 17, or 4.1%; p=0.081). Rates of routine postpartum visit attendance at 6-8 weeks postpartum were similar and high in both groups (121, or 93.8% vs 374, or 90.8%; adjusted p-value=0.164). Conclusion: Although CP subjects had more prenatal visits and spent more time with providers, there was no difference on uptake of LARC or effective contraception at discharge or at the postpartum visit when compared to IP subjects

Factors affecting the pre- and post-elective abortion contraception choices in Iowa

To characterize the contraceptive uses and identify contraceptive concerns and preferences among Iowa women seeking abortion

Full thickness epidermal burn from a heating pad on a cesarean incision with silver dressing: a case report

We present a case of a full thickness epidermal burn resulting from an all-natural clay-based heating pad over a cesarean incision silver dressing to bring awareness to the risks associated with nonpharmacologic management of post cesarean pain. There is limited guidance on nonpharmacological management of post cesarean pain. It is important that providers are able to advise their patients about their options, including to be wary of using heating pads on post-cesarean dressings, especially with pain in the early post-partum period

Postpartum LARC use in low-risk women in CenteringPregnancy® versus traditional certified nurse midwife prenatal care

Contraception satisfaction and utilization is linked to pre-use clinical counseling. Group prenatal care may offer increased opportunity for education on postpartum contraception options. This study evaluated postpartum long acting reversible contraception (LARC) rates in women who attend CenteringPregnancy® group prenatal (CP) care versus individual prenatal care with Certified Nurse Midwives (CNM)

Postpartum contraception acceptance and readiness study

Determine the optimal time to discuss and formulate a plan for postpartum contraception. Determine factors associated with uptake of and adherence to chosen postpartum contraception plan