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Shah N, Medairos R, Koduri S, Davis C. An Introduction to Cystoscopy for OB/GYN Residents. MedEdPORTAL 2022; 18:11220. [PMID: 35178470 PMCID: PMC8818811 DOI: 10.15766/mep_2374-8265.11220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/06/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION OB/GYN residents' preparedness to perform cystoscopy after residency may vary as the ACGME requires only 10 cystoscopic cases to be performed during training. Given residents' potentially limited exposure to cystoscopy, supplemental educational activities centered around increasing familiarity with the procedure may be useful. The objective of this workshop was to provide an opportunity for OB/GYN residents to become more comfortable with cystoscopic equipment and performing cystoscopy. METHODS We showed a video of common pathology seen on cystoscopy and then progressed through two hands-on stations. One station focused on equipment familiarity, with learners identifying equipment and then practicing assembling and disassembling the cystoscope. The other station allowed for simulated cystoscopy utilizing a pig bladder. We used a checklist assessment and pre- and postcourse surveys to evaluate familiarity with equipment and anxiety surrounding performing cystoscopy. RESULTS Twenty residents ranging from PGY 1s to PGY 4s who participated in this workshop over the past 2 years completed both pre- and postcourse evaluations. There was statistically significant improvement in ratings of familiarity with equipment and anxiety surrounding the procedure. All participants whom we assessed showed improvement in identifying and assembling equipment as well as in performing the steps of the procedure independently. DISCUSSION This workshop provided OB/GYN residents with an opportunity for hands-on cystoscopic experience. Through direct assessment and evaluation forms, the workshop was shown to be a beneficial activity for improving cystoscopic knowledge.
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Affiliation(s)
- Nayan Shah
- Second-Year Resident, Department of Urology, Medical College of Wisconsin
| | - Robert Medairos
- Fifth-Year Resident, Department of Urology, Medical College of Wisconsin
| | - Sumana Koduri
- Associate Professor, Department of Obstetrics and Gynecology, Medical College of Wisconsin
| | - Carley Davis
- Associate Professor, Department of Urology, Medical College of Wisconsin
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Veneziano D, Ploumidis A, Proietti S, Tokas T, Kamphuis G, Tripepi G, Van Cleynenbreugel B, Gozen A, Breda A, Palou J, Sarica K, Liatsikos E, Ahmed K, Somani BK. Validation of the endoscopic stone treatment step 1 (EST-s1): a novel EAU training and assessment tool for basic endoscopic stone treatment skills-a collaborative work by ESU, ESUT and EULIS. World J Urol 2019; 38:193-205. [PMID: 30919099 DOI: 10.1007/s00345-019-02736-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/18/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The endoscopic stone treatment step 1 (EST s1) protocol has been developed after 2 years of collaborative work between different European Association of Urology (EAU) sections. OBJECTIVES In this study, we added construct validity evidence to the EST s1 curriculum. MATERIALS AND METHODS The EST-s1 curriculum includes four standardized tasks: flexible cystoscopy, rigid cystoscopy, semi-rigid URS and flexible URS. Validation was performed during the annual 2016 EUREP meeting in Prague. 124 participants provided information on their endoscopic logbook and carried out these 4 tasks during a DVD recorded session. Recordings were anonymized and blindly assessed independently by five proctors. Inter-rater reliability was checked on a sample of five videos by the calculation of intra-class correlation coefficient. Task-specific clinical background of participants was correlated with their personal performance on the simulator. Breakpoint analysis was used to define the minimum number of performed cases, to be considered "proficient". "Proficient" and "Non-proficient" groups were compared for construct validity assessment. Likert scale-based questionnaires were used to test content and to comment on when the EST-s1 exams should be undertaken within the residency program. RESULTS 124 participants (105 final-year residents and 19 faculty members) took part in this study. The breakpoint analysis showed a significant change in performance curve at 36, 41, 67 and 206 s, respectively, corresponding to 30, 60, 25 and 120 clinical cases for each of the 4 tasks. EST-s1 was scored as a valid training tool, correctly representing the procedures performed in each task. Experts felt that this curriculum is best used during the third year of residency training. CONCLUSION Our validation study successfully demonstrated correlation between clinical expertise and EST-s1 tasks, adding construct validity evidence to it. Our work also demonstrates the successful collaboration established within various EAU sections.
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Affiliation(s)
- Domenico Veneziano
- Department of Urology and Kidney Transplant, GOM, Reggio Calabria, Italy.
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.
- ICVS/3B'S, PT Government Associate Laboratory, Braga, Portugal.
- Department of Urology, Hofstra University School of Medicine, New York, NY, USA.
| | | | - Silvia Proietti
- Department of Urology, San Raffaele Hospital, Ville Turro Division, Milan, Italy
| | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall in Tirol, Innsbruck, Austria
| | | | - Giovanni Tripepi
- Centro Nazionale Ricerca IFC, U.O. of Nephrology, Reggio Calabria, Italy
| | - Ben Van Cleynenbreugel
- Department of Urology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ali Gozen
- Department of Urology, Klinikum Heilbronn, Heilbronn, Germany
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Kemal Sarica
- Department of Urology, Dr. Lütfi Kǵrdar Kartal Research and Training Hospital, Istanbul, Turkey
| | | | - Kamran Ahmed
- Department of Urology, Guy's Hospital, London, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Dagnaes-Hansen J, Mahmood O, Bube S, Bjerrum F, Subhi Y, Rohrsted M, Konge L. Direct Observation vs. Video-Based Assessment in Flexible Cystoscopy. J Surg Educ 2018; 75:671-677. [PMID: 29102559 DOI: 10.1016/j.jsurg.2017.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/11/2017] [Accepted: 10/11/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Direct observation in assessment of clinical skills is prone to bias, demands the observer to be present at a certain location at a specific time, and is time-consuming. Video-based assessment could remove the risk of bias, increase flexibility, and reduce the time spent on assessment. This study investigated if video-based assessment was a reliable tool for cystoscopy and if direct observers were prone to bias compared with video-raters. DESIGN This study was a blinded observational trial. Twenty medical students and 9 urologists were recorded during 2 cystoscopies and rated by a direct observer and subsequently by 2 blinded video-raters on a global rating scale (GRS) for cystoscopy. Both intrarater and interrater reliability were explored. Furthermore, direct observer bias was explored by a paired samples t-test. RESULTS Intrarater reliability calculated by Pearson's r was 0.86. Interrater reliability was 0.74 for single measure and 0.85 for average measures. A hawk-dove effect was seen between the 2 raters. Direct observer bias was detected when comparing direct observer scores to the assessment by an independent video-rater (p < 0.001). CONCLUSION This study found that video-based assessment was a reliable tool for cystoscopy with 2 video-raters. There was a significant bias when comparing direct observation with blinded video-based assessment.
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Affiliation(s)
- Julia Dagnaes-Hansen
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Capital Region, Denmark; Faculty of Health and Medical Sciences, Faculty of Medicine, University of Copenhagen, Capital Region, Denmark; Department of Urology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
| | - Oria Mahmood
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Capital Region, Denmark; Faculty of Health and Medical Sciences, Faculty of Medicine, University of Copenhagen, Capital Region, Denmark
| | - Sarah Bube
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Capital Region, Denmark; Department of Urology, Zealand University Hospital, Roskilde, Denmark
| | - Flemming Bjerrum
- Department of Surgery, Herlev Gentofte Hospital, University Hospital of Copenhagen, Herlev, Denmark
| | - Yousif Subhi
- Faculty of Health and Medical Sciences, Faculty of Medicine, University of Copenhagen, Capital Region, Denmark; Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
| | - Malene Rohrsted
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Capital Region, Denmark; Department of Urology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Capital Region, Denmark; Faculty of Health and Medical Sciences, Faculty of Medicine, University of Copenhagen, Capital Region, Denmark
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Mahmood O, Dagnæs J, Bube S, Rohrsted M, Konge L. Nonspecialist Raters Can Provide Reliable Assessments of Procedural Skills. J Surg Educ 2018; 75:370-376. [PMID: 28716383 DOI: 10.1016/j.jsurg.2017.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/26/2017] [Accepted: 07/01/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Competency-based learning has become a crucial component in medical education. Despite the advantages of competency-based learning, there are still challenges that need to be addressed. Currently, the common perception is that specialist assessment is needed for evaluating procedural skills which is difficult owing to the limited availability of faculty time. The aim of this study was to explore the validity of assessments of video recorded procedures performed by nonspecialist raters. METHODS This study was a blinded observational trial. Twenty-three novices (senior medical students) and 9 experienced doctors were video recorded while each performing 2 flexible cystoscopies on patients. The recordings were anonymized and placed in random order and then rated by 2 experienced cystoscopists (specialist raters) and 2 medical students (nonspecialist raters). Flexible cystoscopy was chosen as it is a simple procedural skill that is crucial to master in a resident urology program. RESULTS The internal consistency of assessments was high, Cronbach's α = 0.93 and 0.95 for nonspecialist and specialist raters, respectively (p < 0.001 for both correlations). The interrater reliability was significant (p < 0.001) with a Pearson's correlation of 0.77 for the nonspecialists and 0.75 for the specialists. The test-retest reliability showed the biggest difference between the 2 groups, 0.59 and 0.38 for the nonspecialist raters and the specialist raters, respectively (p < 0.001). CONCLUSION Our study suggests that nonspecialist raters can provide reliable and valid assessments of video recorded cystoscopies. This could make mastery learning and competency-based education more feasible.
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Affiliation(s)
- Oria Mahmood
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Capital Region, Denmark; University of Copenhagen, Copenhagen, Denmark.
| | - Julia Dagnæs
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Capital Region, Denmark; University of Copenhagen, Copenhagen, Denmark; Department of Urology, Rigshospitalet, Copenhagen, Denmark
| | - Sarah Bube
- University of Copenhagen, Copenhagen, Denmark; Department of Urology, University Hospital Zealand, Roskilde, Denmark
| | | | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Capital Region, Denmark; University of Copenhagen, Copenhagen, Denmark
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Affiliation(s)
- Petar Bajic
- Department of Urology, Loyola University Medical Center, United States
| | - Derek Matoka
- Department of Urology, Loyola University Medical Center, United States
| | - Max Maizels
- Department of Urology, Lurie Children's Hospital, Northwestern University, United States.
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Safir IJ, Shrewsberry AB, Issa IM, Ogan K, Ritenour CWM, Sullivan J, Issa MM. Impact of remote monitoring and supervision on resident training using new ACGME milestone criteria. Can J Urol 2015; 22:7959-7964. [PMID: 26432965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The study objective was to determine the impact of remote monitoring and supervision (RMS) in integrated endourology suites (IES) on residents achieving endoscopic training milestones. MATERIALS AND METHODS Twenty-one urology residents evaluated RMS in IES using a 25-question survey. IES provided audio-visual communication for faculty to supervise residents remotely. Questionnaire used a linear visual scale of 1-10 to assess acceptability (8 questions), impact on training (10 questions), supervision level (1 question), and pre- and post-training milestone self-assessments (6 questions). Improvements in Patient Care Milestone #7 (upper/lower tract endoscopic procedures) and Patient Care Milestone #9 (office-based procedures) were analyzed. RESULTS Twenty-one urology residents (out of potential 23) evaluated RMS in IES using a 25-question survey (91.3% response rate). Overall RMS acceptability and satisfaction was high (mean score = 9.1/10) with a majority (95.2%) feeling comfortable being alone with the patient. Residents reported positively on the following parameters: autonomy without compromising safety (8.7), supervision level (8.6), achieving independence (8.4), education quality (8.3), learning rate (8.1), clinical decision-making (8.0), and reducing case numbers to achieve proficiency (7.6). Residents perceived no issues with under- or over-supervision, and a majority (76.2%) expressed that RMS should be standard of training in residency programs. Residents reported mean level increases of 2.5 and 2.8 (out of 5) in Patient Care Milestones for endoscopic procedures and office-based procedures, respectively (p < 0.0001). CONCLUSIONS RMS in integrated endourology suites may enhance resident education and endoscopic training. The study demonstrated an increase in competency levels reported by residents trained using RMS.
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Affiliation(s)
- Ilan J Safir
- Department of Urology, Veterans Affairs Medical Center, Atlanta, Georgia, USA
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Hu WG, Feng JY, Wang J, Song YJ, Xu XT, Zhou H, Huang CB. Ureteroscopy and cystoscopy training: comparison between transparent and non-transparent simulators. BMC Med Educ 2015; 15:93. [PMID: 26032174 PMCID: PMC4457046 DOI: 10.1186/s12909-015-0380-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 05/18/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Simulators have been widely used to train operational skills in urology, how to improve its effectiveness deserves further investigation. In this paper, we evaluated training using a novel transparent anatomic simulator, an opaque model or no simulator training, with regard to post-training ureteroscopy and cystoscopy proficiency. METHODS Anatomically correct transparent and non-transparent endourological simulators were fabricated. Ten experienced urologists provided a preliminary evaluation of the models as teaching tools. 36 first-year medical students underwent identical theoretical training and a 50-point examination of theoretical knowledge. The students were randomly assigned to receive training with the transparent simulator (Group 1), the non-transparent simulator (Group 2) or detailed verbal instruction only (Group 3). 12 days after the training session, the trainees' skills at ureteral stent insertion and removal were evaluated using the Uro-Scopic Trainer and rated on an Objective Structured Assessment of Technical Skills (OSATS) scale. RESULTS The new simulators were successfully fabricated in accordance with the design parameters. Of the ten urologists invited to evaluate the devices, 100% rated the devices as anatomically accurate, 90% thought both models were easy to use and 80% thought they were good ureteroscopy and cystoscopy training tools. The scores on the theoretical knowledge test were comparable among the training groups, and all students were able to perform ureteral stent insertion and removal. The mean OSATS scores of groups 1, 2 and 3 were 21.83 ± 3.64, 18.50 ± 4.03 and 15.58 ± 2.23 points, respectively, (p = 0.001). CONCLUSIONS Simulator training allowed students to achieve higher ureteroscopic and cystoscopic proficiency, and transparent simulators were more effective than non-transparent simulators.
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Affiliation(s)
- Wen-Gang Hu
- Department of Urology, Second Affiliated Hospital, Third Military Medical University, XinQiao Street, ShaPingBa, Chongqing, 400037, People's Republic of China.
| | - Jia-Yu Feng
- Department of Urology, Second Affiliated Hospital, Third Military Medical University, XinQiao Street, ShaPingBa, Chongqing, 400037, People's Republic of China.
| | - Jin Wang
- Department of Urology, Second Affiliated Hospital, Third Military Medical University, XinQiao Street, ShaPingBa, Chongqing, 400037, People's Republic of China.
| | - Ya-Jun Song
- Department of Urology, Second Affiliated Hospital, Third Military Medical University, XinQiao Street, ShaPingBa, Chongqing, 400037, People's Republic of China.
| | - Xiao-Ting Xu
- Department of Urology, Second Affiliated Hospital, Third Military Medical University, XinQiao Street, ShaPingBa, Chongqing, 400037, People's Republic of China.
| | - Hong Zhou
- Department of Urology, Second Affiliated Hospital, Third Military Medical University, XinQiao Street, ShaPingBa, Chongqing, 400037, People's Republic of China.
| | - Chi-Bing Huang
- Department of Urology, Second Affiliated Hospital, Third Military Medical University, XinQiao Street, ShaPingBa, Chongqing, 400037, People's Republic of China.
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Zhang Y, Liu JS, Wang G, Yu CF, Zhu H, Na YQ. Effectiveness of the UroMentor virtual reality simulator in the skill acquisition of flexible cystoscopy. Chin Med J (Engl) 2013; 126:2079-2082. [PMID: 23769561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Virtual reality (VR) has been recognized as a useful modality in the training of surgical skills. With respect to basic endoscopic skill training of urology, we sought to investigate the effectiveness of the UroMentor(TM) virtual reality simulator (VRS) in the skill acquisition of flexible cystoscopy. METHODS Urologists familiar with rigid cystoscopy procedures were selected to take part in a virtual training course of flexible cystoscopy. Changes in total operating time, frequency of injury, number of digital markers inside the bladder, and the global rating scale (GRS) scores were assessed following eight repeated training sessions on the UroMentor(TM). RESULTS Eighteen urologists voluntarily took part in the study. Total operating time was significantly lower after eight sessions of training by comparison ((111 ± 10) seconds and (511 ± 67) seconds, respectively; P < 0.001). Additionally, the frequency of injury decreased with training from (12 ± 2) times to (5 ± 1) times (P < 0.001), while the number of digital markers observed increased from 9 ± 0 to 10 ± 1 (P = 0.005). Finally, training with the UroMentor(TM) resulted in a GRS increase from (1.3 ± 0.2) points to (3.9 ± 0.2) points (P < 0.001). CONCLUSION the VRS UroMentor(TM) can improve urologists' ability to perform flexible cystoscopy and could be used as an effective training tool for trainees.
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Affiliation(s)
- Yi Zhang
- Wu Jieping Urology Center, Peking University Shougang Hospital, Beijing, China
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Cystoscopy. Clin Privil White Pap 2012;:1-11. [PMID: 22953368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Chesson RR. Cystoscopy should be a routine procedure in the performance of hysterectomy. J Reprod Med 2011; 56:371-372. [PMID: 22010517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Nosti PA, Isaacson MA, Iglesia CB. Current cystoscopy practice of recent graduates of obstetrics and gynecology residency: a survey study. J Reprod Med 2011; 56:373-375. [PMID: 22010518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To provide data regarding the training, credentialing and use of cystoscopy among recent obstetrics and gynecology (Ob/Gyn) residents. STUDY DESIGN A total of 98 surveys were sent to recent graduates of Ob/Gyn residency programs in the District of Columbia (DC). Questions concerning cystoscopy in residency training, current cystoscopy privileges and utilization of this technique were asked. RESULTS Of the 98 surveys sent, 34 (35%) were completed. Of the survey respondents 88% reported rotating through a urogynecology or female urology service during residency, and the majority of residents spent at least 2 months on service. A total of 68% of survey respondents reported currently having cystoscopy privileges. Only 12% of those surveyed reported performing routine cystoscopy after hysterectomy. When asked why, most participants reported performing cystoscopy only if urinary tract injury is suspected. CONCLUSION The majority of recent graduates of Ob/Gyn residency training programs surveyed in DC are exposed to and receive privileges for cystoscopy. However, few choose to use it after routine hysterectomy. Given the fact that 75% of urinary tract injuries occur during gynecologic surgery and that these injuries are more likely to occur at the hands of newly minted surgeons, a change in this practice may be warranted.
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Affiliation(s)
- Patrick A Nosti
- Department of Female Pelvic Medicine and Reconstructive Surgery, Georgetown University Hospital/Washington Hospital Center, 106 Irving Street NW, Suite 2100, Washington, DC 20010, USA.
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