Liposomal Bupivacaine Infiltration and Transversus Abdominis Plane Block Versus Standard of Care for Post Caesarean Pain Control: A Retrospective Chart Review

Transversus abdominis plane (TAP) block and wound infiltration with local anesthetics are shown to reduce opiate use and pain scores when compared to controls who received narcotic pain medications. With the current opiate epidemic, finding different ways to control pain without opiates is important,-to prevent unnecessary use of these drugs and reduce the potential for addiction in patients having a Cesarean delivery who often times receive opiate medications on schedule regardless of their reported pain

Integrating an Evidence Based Medicine Module Presentation into the Ob-Gyn Clerkship

Introduction: During the preclinical curriculum, students are introduced to EBM principles, however structured application to clinical medicine varies throughout clinical experiences. Application of EBM in a clinical educational environment affords students opportunities to practice required skills. Methods: Students selected a patient case and formulated a question related to diagnosis ortreatment using the PICO framework. Students selected research publications related to the patient case, critically appraised their validity and generalization, and developed a comprehensive presentation involving a case summary and related EBM topics, which were evaluated by a faculty member using a rubric developed for the project. To assess the effectiveness of the curriculum addition, students were administered a survey to rate their knowledge of EBM before and after completing the EBM project. Results: One full academic year of clerkship cohorts (n=103) were surveyed. Regardless of EBM knowledge before the project, comparison of self-reported knowledge increased to above-average level of understanding as a result of the project (mean=4.0, SD=1.07, CI=3.75-4.19). Furthermore, student presentation percentage scores using the rubric showed an above average understanding of EBM (mean=96, SD=4.40). Conclusion: It is important for students to integrate EBM into their practice early in their training. This curriculum addition was effective and could be utilized in other clerkships

Obstetrics Emergency Labor and Delivery Case Simulations with Normal Vaginal Delivery Demonstration: A Hands-on Simulation for Clerkship Students

Introduction: Simulation is rarely used for medical student education in the field of obstetrics. This method is an effective model of learning for topics that are encountered in clinical situations and for topics that pose significant risk to patients when an untrained individual is involved. Methods: A 2-hour obstetric delivery simulation session was developed and incorporated into the third-year obstetrics and gynecology clerkship rotation at Wright State University Boonshoft School of Medicine. Medical students completed self-guided content reviews with resources provided prior to the session. During the session, each medical student conducted a normal vaginal delivery and one of the emergent cases (umbilical cord prolapse, pre-eclampsia/eclampsia, shoulder dystocia, and postpartum hemorrhage). During each case the Resident facilitator followed a script which included asking questions using gamification strategies to promote a low-stress learning environment. Critical action checklists were used to ensure students gained a strong understanding of topics. Simulation sessions were conducted both remotely and in-person. The simulation experience was evaluated using surveys and quizzes completed prior to and after participating in the simulation session. Results: Students reported that the simulation experience increased their comfort with emergent obstetric situations, increased their medical knowledge, and was beneficial to their education. Discussion: Simulation is an untapped learning method in obstetrics. We developed simulations for obstetric events to provide medical students with hands-on exposure to important obstetric experiences. This simulation session provides the framework for other medical schools to incorporate these obstetric simulations into their clerkship curriculum

A Case of Ruptured Cornual Pregnancy with Delivery of a Viable Pre-Term Infant

Interstitial and cornual ectopic pregnancies are rare forms of ectopic with high mortality rate. As such, they pose significant challenges in diagnosis, treatment, and follow up. This patient was a 42 y/o female G2P1001 at 25+3 weeks gestational age who presented from an outside hospital after an episode of sudden onset abdominal pain with syncope. She was noted to have hypotension, tachycardia, lactic acidosis, and peritoneal free fluid. Physical exam was significant for peritoneal signs with abdominal guarding and rebound. Her pregnancy was complicated by advanced maternal age, THC use, and late presentation for prenatal care in the second trimester. While she had no obstetrical complaints on admission, bedside ultrasound was done and showed viable infant in breech position with anhydramnios and free fluid in the abdomen. Fetal heart tones were category 2 with periods of minimal variability and intermittent variable and late decelerations. Given her clinical picture, she was consented for exploratory laparotomy and possible cesarean section and was taken to the OR by both Obstetrics and Trauma Surgery with NICU on standby. Upon entry to the abdomen, 2 liters of hemoperitoneum was evacuated, and visualization of the uterus revealed active bleeding from a right cornual rupture which extended into the isthmus of the right fallopian tube. The infant was delivered breech via classical cesarean section and handed off to NICU staff. The hysterotomy and cornual rupture were then repaired, including removal of the right fallopian tube, with good hemostasis noted. Trauma Surgery then explored the abdomen, with no further pathology or sources of bleeding noted. The patient’s post-operative course was complicated by post-op ileus, which resolved after 24 hours, and gestational hypertension. She was discharged home on post op day 4 in good condition. The infant’s NICU course was complicated by intraventricular hemorrhage, GERD, chronic lung disease with mild pulmonary hypertension, and retinopathy of prematurity. She was eventually transferred to another facility on day of life 130 due to worsening respiratory status and concern for ventilator acquired pneumonia. Interstitial and cornual ectopic pregnancies are extremely difficult to diagnose and this difficulty only increases as the pregnancy progresses. When these ectopics evade detection into the second or third trimester, rupture can lead to life threatening hemorrhage due to the highly vascularized state of the uterus. This case highlights the importance of early and thorough dating ultrasounds

Evaluating the Effectiveness of Early Exposure: Obstetrics and Gynecology Two-Week Virtual Elective

Clinical clerkships are an integral part of undergraduate medical education. Until now, clerkships have either been offered through simulation labs, didactics or in the healthcare setting dependent upon the pedagogical approach of each institutions’ curricula. Subsequent to coronavirus-2019, medical students had decreased accessibility to the aforementioned educational settings. This has provided an innovative opportunity for clerkship directors to provide the same clinical experience to students in a novel way –virtually. Recently, the Larner College of Medicine at the University of Vermont created a two-week virtual simulated clerkship electiveencompassing the curricula taught throughout the OB/GYN clerkship. Until now, this virtual elective had yet to be evaluated on its effectiveness in increasing student success in the traditional OB/GYN clerkship. Based on a study conducted by Surmon et al (2016), four main themes corelate with students’ perception of preparedness – positive influences, learning to adapt, and potentially modifiable influences, which encompasses positive and negative influences. Our systematic review of self-perceived preparedness focused on the modifiable f actors of positive and negative influences -competence, curriculum, and learning

The Role of Art in Teaching Virtual Anatomy During the COVID-19 Pandemic

The purpose of this study is to determine whether drawing anatomical structures and teaching it virtually to others improves student confidence in remembering anatomy and improves student perceptions of OB/GYN anatomy in the obstetrics and gynecology core clerkship. Active recall is a superior method of learning and memory retention because it practices information retrieval. If one draws an anatomic region of the human body after visualization and then teaches it, the learner would be exercising retrieval thus promotion retention of the material. The specific act of writing things down on paper promotes memory retention. This study sets a precedence of online teaching and learning during the COVID-19 pandemic as students across the United States were required to move their education on a virtual platform. Students were given a 15-minute lecture on improved visualization and attention to detail. Students were then randomly assigned one of eight areas of OB/GYN anatomy. Students were given 20 minutes to draw their assigned diagram on paper. At the end of the 20-minute exercise, students described and explained their drawing to the rest of the groups on the virtual WebEx platform. At the end of class, a survey instrument was distributed to all students. The majority of students agreed or strongly agreed that the act of drawing the anatomy and then teaching it improved their confidence in remembering the anatomy. Student perspectives on this method of learning were also favorable, with over 50% being in the agree to strongly agree range and 0-13% being in the disagree to strongly disagree range. This preliminary research study indicates that practicing active recall through drawing not only solidifies one’s remembrance of the anatomy, but also has favorable student perspectives in virtual learning

Local Wound Infiltration With Liposomal Bupivacaine Decreases Post-Cesarean Pain Scores

Surgical patients are routinely prescribed opioid analgesics that are strongly associated with drug overdose deaths. Liposomal bupivacaine is a long-acting local anesthetic that received FDA approval in 2011 for local surgical site infiltration to promote post-operative analgesia. This anesthetic has demonstrated an improvement in post-operative pain control in various surgical realms, indicating a decreased need for opiates and subsequently decreased risks. However, few studies have investigated its use at the time of cesarean delivery

Evaluating the Effectiveness of Early Exposure: Obstetrics and Gynecology Two-Week Virtual Elective

Clinical clerkships are an integral part of undergraduate medical education. Until now, clerkships have either been offered through simulation labs, didactics or in the healthcare setting dependent upon the pedagogical approach of each institutions’ curricula. Subsequent to coronavirus-2019, medical students had decreased accessibility to the aforementioned educational settings. This has provided an innovative opportunity for clerkship directors to provide the same clinical experience to students in a novel way –virtually. Recently, the Larner College of Medicine at the University of Vermont created a two-week virtual simulated clerkship electiveencompassing the curricula taught throughout the OB/GYN clerkship. Until now, this virtual elective had yet to be evaluated on its effectiveness in increasing student success in the traditional OB/GYN clerkship. Based on a study conducted by Surmon et al (2016), four main themes corelate with students’ perception of preparedness – positive influences, learning to adapt, and potentially modifiable influences, which encompasses positive and negative influences. Our systematic review of self-perceived preparedness focused on the modifiable f actors of positive and negative influences -competence, curriculum, and learning

A Case of Ruptured Cornual Pregnancy with Delivery of a Viable Pre-Term Infant

Interstitial and cornual ectopic pregnancies are rare forms of ectopic with high mortality rate. As such, they pose significant challenges in diagnosis, treatment, and follow up. This patient was a 42 y/o female G2P1001 at 25+3 weeks gestational age who presented from an outside hospital after an episode of sudden onset abdominal pain with syncope. She was noted to have hypotension, tachycardia, lactic acidosis, and peritoneal free fluid. Physical exam was significant for peritoneal signs with abdominal guarding and rebound. Her pregnancy was complicated by advanced maternal age, THC use, and late presentation for prenatal care in the second trimester. While she had no obstetrical complaints on admission, bedside ultrasound was done and showed viable infant in breech position with anhydramnios and free fluid in the abdomen. Fetal heart tones were category 2 with periods of minimal variability and intermittent variable and late decelerations. Given her clinical picture, she was consented for exploratory laparotomy and possible cesarean section and was taken to the OR by both Obstetrics and Trauma Surgery with NICU on standby. Upon entry to the abdomen, 2 liters of hemoperitoneum was evacuated, and visualization of the uterus revealed active bleeding from a right cornual rupture which extended into the isthmus of the right fallopian tube. The infant was delivered breech via classical cesarean section and handed off to NICU staff. The hysterotomy and cornual rupture were then repaired, including removal of the right fallopian tube, with good hemostasis noted. Trauma Surgery then explored the abdomen, with no further pathology or sources of bleeding noted. The patient’s post-operative course was complicated by post-op ileus, which resolved after 24 hours, and gestational hypertension. She was discharged home on post op day 4 in good condition. The infant’s NICU course was complicated by intraventricular hemorrhage, GERD, chronic lung disease with mild pulmonary hypertension, and retinopathy of prematurity. She was eventually transferred to another facility on day of life 130 due to worsening respiratory status and concern for ventilator acquired pneumonia. Interstitial and cornual ectopic pregnancies are extremely difficult to diagnose and this difficulty only increases as the pregnancy progresses. When these ectopics evade detection into the second or third trimester, rupture can lead to life threatening hemorrhage due to the highly vascularized state of the uterus. This case highlights the importance of early and thorough dating ultrasounds

Evaluating the Effectiveness of Early Exposure: Obstetrics and Gynecology Two-Week Virtual Elective

Clinical clerkships are an integral part of undergraduate medical education. Until now, clerkships have either been offered through simulation labs, didactics or in the healthcare setting dependent upon the pedagogical approach of each institutions’ curricula. Subsequent to coronavirus-2019, medical students had decreased accessibility to the aforementioned educational settings. This has provided an innovative opportunity for clerkship directors to provide the same clinical experience to students in a novel way –virtually. Recently, the Larner College of Medicine at the University of Vermont created a two-week virtual simulated clerkship electiveencompassing the curricula taught throughout the OB/GYN clerkship. Until now, this virtual elective had yet to be evaluated on its effectiveness in increasing student success in the traditional OB/GYN clerkship. Based on a study conducted by Surmon et al (2016), four main themes corelate with students’ perception of preparedness – positive influences, learning to adapt, and potentially modifiable influences, which encompasses positive and negative influences. Our systematic review of self-perceived preparedness focused on the modifiable f actors of positive and negative influences -competence, curriculum, and learning