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Soffer MD, Shook LL, James K, Sawyer MR, Ciaranello A, Mahrouk R, Bernstein SN, Boatin AA, Edlow AG, York-Best C, Kaimal AJ, Goldfarb IT. Protocol-Driven Intensive Outpatient Management of Pregnant Patients With Symptomatic Coronavirus Disease 2019. Open Forum Infect Dis 2020; 7:ofaa524. [PMID: 33241071 PMCID: PMC7665663 DOI: 10.1093/ofid/ofaa524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023] Open
Abstract
Background Reports of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have focused on pregnant women hospitalized due to moderate to severe coronavirus disease 2019 (COVID-19) or asymptomatic women diagnosed through universal screening at the time of obstetric admission. Many pregnant women who have symptomatic SARS-CoV-2 infection may not meet criteria for hospitalization; however, whether and how these women can be managed safely in outpatient setting is not well described. Methods We sought to describe the time to symptom and viral clearance and to identify predictors of hospitalization to better understand the safety of monitoring pregnant patients with symptomatic COVID-19 in the outpatient setting. We performed a retrospective cohort study of pregnant patients with symptomatic, confirmed COVID-19 illness at a large, academic medical center. Patients had systematic telehealth follow up by a clinician team to assess for symptoms, provide virtual prenatal care, and arrange in-person visits when appropriate in a dedicated outpatient center. Data were collected via chart abstraction. Results Of 180 pregnant patients presenting with symptoms and undergoing reverse-transcription polymerase chain reaction (RT-PCR) testing, 67 patients with confirmed COVID-19 infection were identified during the study period. Nineteen (28%) required acute care given worsening of COVID-19 symptoms, and 95% of these were directed to this acute care setting due to symptom severity telehealth evaluation. Nine women (13%) were admitted to the hospital given worsening symptoms, 3 required intensive care unit care, 2 required ventilatory support, and 2 required delivery. Women with the presenting symptoms of fever, cough, shortness of breath, chest pain, or nausea and vomiting were more likely to require admission. The median duration from initial positive test to RT-PCR viral clearance was 26 days. Disease progression, time to viral clearance, and duration of symptoms did not vary significantly by trimester of infection. Conclusions Management of the majority of pregnant women with symptomatic COVID-19 illness can be accomplished in the outpatient setting with intensive and protocol-driven monitoring for symptom progression.
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Affiliation(s)
- M D Soffer
- Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Maternal Fetal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - L L Shook
- Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Maternal Fetal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - K James
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - M R Sawyer
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - A Ciaranello
- Department of Internal Medicine, Division of Infectious Disease, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - R Mahrouk
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - S N Bernstein
- Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Maternal Fetal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - A A Boatin
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - A G Edlow
- Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Maternal Fetal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - C York-Best
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - A J Kaimal
- Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Maternal Fetal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - I T Goldfarb
- Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Maternal Fetal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Johnson N, Khachadoorian-Elia H, Royce C, York-Best C, Atkins K, Chen XP, Pelletier A. Faculty perspectives on the use of standardized versus non-standardized oral examinations to assess medical students. Int J Med Educ 2018; 9:255-261. [PMID: 30278431 PMCID: PMC6387762 DOI: 10.5116/ijme.5b96.17ca] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 07/18/2017] [Accepted: 09/10/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To determine if faculty perceive standardized oral examinations to be more objective and useful than the non-standardized format in assessing third-year medical students' learning on the obstetrics and gynecology rotation. METHODS Obstetrics and gynecology faculty at three teaching hospitals were sampled to complete a survey retrospectively comparing the standardized oral examination (SOE) and non-standardized or traditional oral examinations (TOE). A Likert scale (0-5) was used to assess satisfaction, objectivity, and usefulness of SOE and TOE. Wilcoxon signed rank test was performed to compare median Likert scale scores for each survey item. A Spearman's correlation coefficient was used to investigate the relationship between the perceived level of objectivity and SOE characteristics. For qualitative measures, content analysis was applied. RESULTS Sixty-six percent (n=25) of eligible faculty completed the survey. Faculty perceived the standardized oral examination as significantly more objective compared with the non-standardized (z=-3.15, p=0.002). Faculty also found SOE to be more useful in assessing overall clerkship performance (z=-2.0, p<0.05). All of the survey participants were willing to administer the standardized examination again. Faculty reported strengths of the SOE to be uniformity, fairness, and ease of use. Major weaknesses reported included inflexibility and decreased ability to assess students' higher order reasoning skills. CONCLUSIONS Faculty found standardized oral examinations to be more objective in assessing third-year medical students' clinical competency when compared with a non-standardized approach. This finding can be meaningfully applied to medical education programs internationally.
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Affiliation(s)
- Natasha Johnson
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, USA
| | | | - Celeste Royce
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, USA
| | - Carey York-Best
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, USA
| | - Katharyn Atkins
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, USA
| | - Xiaodong P. Chen
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, USA
| | - Andrea Pelletier
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, USA
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Berkowitz LR, James K, Petrusa E, York-Best C, Kaimal AJ. New Challenges for a Core Procedure: Development of a Faculty Workshop for Skills Maintenance for Abdominal Hysterectomy. J Surg Educ 2018; 75:942-946. [PMID: 29422404 DOI: 10.1016/j.jsurg.2017.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 10/20/2017] [Revised: 11/30/2017] [Accepted: 12/06/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To describe the development of a low-cost educational module for OB/GYN faculty skills maintenance for total abdominal hysterectomy (TAH), a low frequency core procedure in obstetrics and gynecology. DESIGN After review of existing educational tools and utilization of a modified Delphi method to establish consensus regarding key procedural components for skills maintenance, a 2-hour workshop was developed to review knowledge and participate in a simulation focused on the critical steps in performing TAH. An expert in TAH delivered a lecture highlighting important surgical considerations. Participants then rotated through simulation stations for critical steps in TAH: dissecting the bladder, identifying the ureter, and closing the cuff. Knowledge gains were assessed with a written pre- and posttest. Consecutive focus groups were conducted with participants on effectiveness of the workshop, and suggestions for improvement. Ideas identified in the first focus group were incorporated into the second workshop. SETTING Massachusetts General Hospital, an academic tertiary care facility with a single Obstetrics and Gynecology faculty group, located in Boston, Massachusetts. PARTICIPANTS Eligible participants were recruited via email from full time specialists in General Obstetrics and Gynecology at Massachusetts General Hospital. Of the 25 eligible gynecology faculty subjects, 22 participated (88%). RESULTS On pre or post-test comparison, 70% of participants scored higher on the posttest, demonstrating an increase in knowledge of critical TAH surgical steps. Focus group analyses identified the need for increased review and training demonstrations of TAH, and recommended continued offering of the workshop. CONCLUSIONS Based on focus group responses and pre or posttest comparisons, the workshop was deemed feasible and enhanced short-term learning. Future directions include utilizing more challenging anatomic models and simulation scenarios and optimizing integration of expert demonstration and individualized coaching, as well as identifying regionally tailored surgical workshop programming.
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Affiliation(s)
- Lori R Berkowitz
- Massachusetts General Hospital, Vincent Obstetrics and Gynecology, Boston, Massachusetts.
| | - Kaitlyn James
- Massachusetts General Hospital, Deborah Kelly Center for Outcomes Research, Vincent Obstetrics and Gynecology, Boston, Massachusetts
| | - Emil Petrusa
- Massachusetts General Hospital, Department of Surgery, Boston, Massachusetts
| | - Carey York-Best
- Massachusetts General Hospital, Vincent Obstetrics and Gynecology, Boston, Massachusetts
| | - Anjali J Kaimal
- Massachusetts General Hospital, Vincent Obstetrics and Gynecology, Boston, Massachusetts
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