Development and implementation of guided, self-directed learning modules in graduate medical education

This study sought to investigate the use of interactive iBook learning modules as a guided, self-directed learning resource for trainees within an obstetrics and gynecology residency program. The implementation of an iBook learning module as a supplement to lecture was studied in comparison to teaching sessions with lecture only

Obstetric care among refugee populations: reinforcing cultural humility in residency training—preliminary report

The burden of increasing obstetric morbidity and mortality in the United States disproportionately impacts certain populations more than others, one such group being refugees. Poor obstetric outcomes among refugee communities historically have been attributed to delayed initiation of prenatal care, failure to detect co-morbidities, as well as higher rates of Cesarean sections (C-sections), stillbirths, pre-term births, and low birth weight infants in comparison to host-country mothers. Therefore, understanding the contextual nuances that play a role in these poor outcomes among refugee populations is very important

Simulation training in forceps assisted vaginal birth: trainee competence, clinical behavior and procedural competence

To determine whether simulation training in forceps assisted vaginal delivery affected: · The confidence of the trainee in offering and performing forceps assisted vaginal delivery before and after the intervention · The frequency with which forceps assisted vaginal delivery is offered to the parturient compared to vacuum assisted vaginal delivery

COVID-19 expands food insecurity disparities among rural, high-risk obstetrics patients

Objective: To compare rural and urban food insecurity in a high-risk obstetrics population prior to and during the COVID-19 pandemic. Methods: Utilizing convenience sampling of high-risk obstetrics patients, validated survey questions assessed self-reported food insecurity from March - October 2019 (pre-COVID-19) and March - October 2020 (COVID-19). Chi-squared analysis compared food insecurity between these two periods and among patients living in rural vs. urban counties.Results: A total of 1089 (pre-COVID-19) and 1246 (COVID-19) screenings were completed. Compared to 2019, the prevalence of food insecurity in 2020 was significantly higher from March-June only (7.8% pre-COVID-19 vs. 11.4 % COVID-19, p=0.04). Despite pre-COVID-19 similarity, rural patients reported significantly higher food insecurity prevalence during COVID-19 than urban counterparts (12.9% rural vs. 8.2% urban, p<0.01). Conclusions: The COVID-19 pandemic was associated with a disproportionate effect on food insecurity among rural patients with high-risk pregnancies. Rural health systems and agencies should explore proactive screening and intervention efforts to mitigate the adverse, downstream health effects of food insecurity

Upstream oncology: identifying social determinants of health in a gynecologic oncology population

Introduction: Social determinants of health (SDoH) are the factors that affect a patient’s health quality and outcomes and contribute to health disparities. Evidence suggests that clinical care contributes only 20% to patients’ health outcomes, while the remainder is under the influence of upstream factors. The upstream approach to healthcare aims to address SDoH before they contribute to less ideal outcomes downstream. Several SDoH may contribute to outcomes for cancer patients. This Upstream Gynecologic Oncology Initiative seeks to identify which SDoH affect a population of patients with gynecologic malignancies. Hypothesis: This study hypothesizes that women receiving care for gynecologic malignancies are affected by specific SDoH among the categories of housing, food, transportation, finances, health literacy and social support. This study aims to identify the frequency of these six social factors among the outpatient gynecologic oncology population at the University of Iowa. Methods: This needs assessment is the first phase in a quality improvement project assessing the SDoH affecting women with gynecologic cancers. Two hundred twenty-two patients receiving outpatient care for gynecologic malignancies completed an anonymous needs assessment survey. Validated survey questions regarding housing, food, transportation, finances, health literacy and social support were used to identify needs. Responses were considered positive if any degree of need was reported. Results: Responses demonstrated the most substantial need in the categories of social support (32%), health literacy (28%) and financial stability (24%). Less need was reported in the categories of food (11%), transportation (5%) and housing (4%). Fifty-seven percent of women reported at least one social need among the six categories screened. Conclusion: Upstream SDoH, most notably social support, health literacy and financial stability are identified to be present and likely contributing to health quality, outcomes, and disparities within this gynecologic oncology patient population. Overall, these findings support the idea that SDoH should be assessed for each unique patient population - and for each patient receiving care for gynecologic cancer. While social support was the most frequently reported SDoH, many patients already received adequate help at home; suggesting that meaningful efforts should next be directed at improving health literacy in the population. Appreciation and assessment of SDoH potential to impact care and management should be used to design a routine screening tool for the study population and organize resources to address or mitigate the identified needs

A pilot evaluation of social needs among gynecologic oncology patients in inpatient versus outpatient settings

The WHO defines social determinants of health (SDoH) as the conditions in which we are born, grow, work, and live as well as other large systems that positively or negatively affect our health. Many healthcare systems currently lack the resources and strategies required to accurately assess and address SDoH. Action must be taken because studies have found that chronic diseases, including cancer, are affected by SDoH. The aim of this study is to identify the incidence of social needs in an inpatient gynecologic oncology population and its relation to patient demographics and clinical diagnostic data to guide and inform future intervention. Patients agreeing to participate in the study completed a needs assessment survey during their inpatient stay at the hospital between November 2020 to March 2021. The survey contained seven questions, six of which were questions screening for social needs including food and housing security, transportation means, financial stability, health literacy, and social support. Responses were considered positive if any degree of need was reported. Demographic and cancer diagnosis data were then collected and included zip code, race, cancer stage and age at diagnosis, treatment history, and number of hospital admissions and length of stay over the past 12 months. The most substantial reported needs across all gynecologic malignancies were social support (65%), health literacy (37%), and financial need (22%). Less need was reported in the categories of food (11%), housing (7%), and transportation (4%). SDoH have been studied in the outpatient gynecologic population and the needs seen in this study are similar to the needs of that population. However, there are likely different challenges and frequencies of unmet need in the different types of gynecologic cancers that may affect the stage at which their cancer is diagnosed as well as the number of hospital admissions related to their cancer care