United States

Background: Although mandated by the ACGME, access to comprehensive abortion training is severely limited, and recent legislative restrictions have further decimated educational opportunities for learners. In states with limited to no abortion access, resident physicians must travel to external programs to gain this necessary training. Simulation-based training has been shown to increase clinical proficiency and improve patient care outcomes. There is a critical need for pre-clinical, comprehensive, simulation-based training to prepare resident physicians for abortion care clinical experiences. 

Methods: Using an iterative design process, we created an innovative, affordable, and modifiable pelvic training model with an associated clinical curriculum under the guidance of two board-certified obstetrics and gynecology (OB/GYN) physicians. The ReproSTART model and curriculum is designed to teach five key surgical techniques necessary for procedural abortion and is modifiable for various clinical situations. OB/GYN physicians and trainees tested each procedural station and component of the model to provide qualitative feedback. Thirty-one resident physicians representing all years of training completed three varying workshops and provided feedback via pre- and post-session evaluations. A website was created to disseminate the ReproSTART model and curriculum to other institutions (https://obgyn.mcw.edu/repro-start/ password:abortion). 

Results: Abortion care experts and resident trainees found the ReproSTART model and associated curriculum to be superior to currently available models and hands-on trainings for abortion procedural techniques. Learners across all levels of training found the simulation to be useful for developing familiarity with procedural techniques, and first-year resident physicians showed a significant improvement in reported confidence with the abortion-related procedural techniques after completing the training. Furthermore, Ob/Gyn Residency Programs have reported success in building the model and implementing the training using only the website as a guide. 



Conclusion: The novel ReproSTART model and curriculum is an innovative simulation-based training to familiarize resident physicians with abortion procedural techniques. The model provides a more accurate, dynamic, and comprehensive pelvic anatomy than previous models, and the simulation allows for increased familiarity with procedural techniques and improved confidence in early learners. The ReproSTART model, curriculum, and website allows for more equitable and accessible abortion procedural training. The simplicity and adaptability of the ReproSTART model provides potential additional wide-reaching benefits for simulation-based training in obstetrics and gynecology.

AMA Research Challenge 2024 

ReproSTART: An Innovative Five-Station Simulation Model to Teach Procedural Abortion Skills

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AMA Research Challenge 2022

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Background: Improving knowledge of common ocular diseases can lead to earlier detection and better health outcomes. However, both student and patient education face significant challenges: medical curricula allocate limited time to ocular diseases and readability of patient education materials frequently exceeds patient comprehension. Videos have been shown to be a more accessible medium of education, and virtual reality (VR) videos specifically offer a novel approach to education by allowing viewers to experience eye diseases from the patient's perspective, rather than merely presenting information. This study aims to examine how virtual reality videos impact patient and student understanding of common ocular diseases, as well as subsequent behaviors and beliefs. 

Methods: Patients and students were analyzed independently in this pilot study. 189 patients were surveyed in 2020 at a blood pressure screening event, while 299 students were surveyed during a virtual eye health teaching session. Both surveys contained virtual reality videos created by the National Institute of Health (NEI) on four common ocular diseases: cataracts, glaucoma, diabetes, and age-related macular degeneration. Wilcoxon signed rank tests analyzed participant responses before and after watching the videos. A stepwise multiple regression analysis assessed the presence of predictor variables. 

Results: The VR videos significantly increased patient understanding of the 4 ocular disorders (Mdn = 4.00 pre-survey vs Mdn = 5.00 post survey, z = -8.93, p<0.001), motivation to receive annual eye exams (45.45%, N=85), and likeliness to recommend having future virtual health visits that include videos like these (80.85%, N=152). Students also significantly increased their comfort with understanding eye pathologies (p<0.001). Despite most students having no prior eye care experience, the majority felt more motivated to learn about ocular diseases (86.96%, N=240) and believed the videos should remain a part of the curriculum (80.36%, N=221). 

Conclusion: The findings of this pilot study demonstrate that virtual reality videos may help improve comfort in understanding common ocular pathologies among both patients and medical students. Current literature already explores the role of virtual modalities in improving patient comprehension and student surgical training, but our study is unique in that it implements virtual reality videos that simulate the patient’s experience of an ocular disorder. This added awareness may be more beneficial to patient and student knowledge and empathy. Moving forward, future research should explore long-term effects of these videos and sample more locations. Through improving medical education, we can strive towards higher quality patient care and improved patient outcomes.

Addressing Gaps in Ophthalmology Education Through Virtual Reality Videos: A Pilot Study of Patients and Students

Background
Simulation training is becoming increasingly recognized as a powerful learning tool in medical education, as it offers a unique advantage to practice surgical skills in a low-risk environment. The Ophthalmology Interest Group at the Long School of Medicine, in partnership with the UT Health Ophthalmology Department, created an Eye Suture Workshop for medical students. The aim of this workshop was to provide students with hands-on experience and exposure to the field of ophthalmology, as well as to assess knowledge gained in a prospective cohort study. 
Methods
Twelve first year medical students participated in an eye suture workshop. The students were divided into six groups of two and given cow eyes for suturing under the supervision of an ophthalmology faculty member and residents. Pre- and post-workshop surveys using 1-10 Likert scale questions were administered to participants to assess the degree of agreement with questions on surgical and ophthalmology interest, comfort with microscope use, and confidence in suturing skills. Suture technique knowledge and ocular anatomy were also assessed through multiple choice and matching quizzes. Results were analyzed in STATA using a Student’s T-Test and Wilcoxon Signed Rank Test (p <0.05 indicating significance). 
Results
Self-reported interest in both a surgical specialty (p-value = 0.0455) and in ophthalmology (p-value = 0.0462) increased significantly following the workshop, as well as student confidence in suture skills (p-value = 0.002) and microscope comfort (p-value = 0.0016). Basic suturing technique skills (p-value = 0.0001) and ocular anatomy (p-value = 0.0462) similarly improved following the workshop. On additional post-test Likert questions that assessed agreement with statements about their perception of the workshop, students rated that receiving hands-on demonstrations of eye suturing skills was helpful (mean: 9.83 (SD: 0.39)) and that they would recommend this workshop to other preclinical students (mean: 9.83 (SD: 0.39)). 
Conclusion
This workshop proved to be a highly effective educational intervention by improving student confidence in suturing techniques and increasing knowledge of suture skills and ocular anatomy, as well as increasing interest in ophthalmology and in surgical specialties. Limitations to this study include a lack of distant outcome measurements to assess persistence of the knowledge gained. Furthermore, the small sample size due to capacity limits in the lab reduces the power of this study.

Precision in Practice: Teaching Ophthalmology Suturing Skills to Medical Students

Background: Total hip and knee arthroplasty (THA and TKA) are two of the most common joint arthroplasties performed in the United States, with the prevalence of these procedures anticipated to continue increasing with the aging population. Therefore, medical education programs must expose students to the pathology, mechanisms of surgical intervention, and variance in implant materials for THA and TKA. One of the purposes of the WMed Skeletal Teaching and Research (STaR) Series is to target this educational goal, however, considering whether the collection is representative of the surrounding population is imperative when training medical providers to care for local communities. As few formal skeletal collections exist within the United States, research pertaining to representation of orthopedic surgeries is arguably nonexistent. The WMed STaR Series aims to target this gap in research, comparing representation of THA and TKA from the series to community statistics.

Methods: Donors from the WMed STaR Series were thoroughly evaluated for the presence of THAs and TKAs, as well as associated musculoskeletal pathology. The type and material of implant, laterality of intervention, donor medical history, and donor demographics were documented. Preliminary data collected from the series was evaluated in comparison to national statistics, and will plan to be compared to analogous data from orthopedic patients seen at the WMed Health clinic.

Results: The American College of Rheumatology cites about 1.2 million TKA and THA procedures in the U.S. annually with approximately 36.3% being THA and 63.7% being TKA. Upon evaluation of the STaR series, there were six THA (83% with a metal femoral head and a polymer socket, and the remaining 17% with a ceramic femoral head and a polymer socket) and seven TKA (all with metal tibial and femoral components and plastic spacers). This results in a relative frequency of 46.2% THA and 53.8% TKA in the WMed STaR Series, showing that while WMed has a similar proportion of THA and TKA to the national statistic, the STaR Series shows slightly higher prevalence of THA. 

Conclusion: The development of the WMed STaR Series will provide educators with a reference for orthopedic implants available for medical education, and will offer a unique perspective for further understanding of musculoskeletal pathology and mechanism for surgical intervention. Medical education resources that reflect the surrounding populations, such as the WMed STaR series, are imperative to prepare medical trainees to deliver comprehensive care to their communities. 


An Examination of Orthopedic Implants in the WMed Skeletal Teaching and Research Series: Presenting a Resource for Medical Education and Research

Introduction
The Journal of the American Academy of Orthopaedic Surgeons (JAAOS) is a high-impact journal that publishes crucial research to inform surgeons’ clinical decision-making. Recent studies examining orthopaedic surgery journals have found a median time to acceptance of 119 days and have found little evidence of nonscientific factors affecting time to publication. The purpose of this study was to determine the median time from submission to acceptance for articles published by the JAAOS and to evaluate factors which may influence time to acceptance.

Methods
All studies published in JAAOS from 2020-2022 were obtained. Abstracts were screened for submission and acceptance dates, and time to acceptance was calculated. Studies were excluded if dates were unavailable. Data extracted included article type, main topic, and sex of the first author. Univariate and multivariate analyses were used to assess time to acceptance. Simple linear regression, analysis of variance (ANOVA), and independent samples t-test were utilized for univariate analysis. For multivariate analyses, a standard least squares regression was applied. 

Results
We analyzed 754 articles. Over the past 3 years, time to acceptance has not significantly changed (p = 0.894). Regarding article type, letters had the shortest time to acceptance (median 5 days, IQR 2-10, p<0.0001), followed by guidelines (median 63.5 days, IQR 20.75-178.25). Interventional studies had the longest time to acceptance (median 171.5 days, IQR 106-309.5), followed by review articles (median 147.5 days, IQR 91.25-214) and observational articles (median 127 days, IQR 87.5-191.5). Articles pertaining to COVID-19 (median 62 days, IQR 2-121), diversity (median 90 days, IQR 24-156), and training (median 92 days, IQR 63.5-150) had the shortest times to acceptance. Articles pertaining to radiology (median 189.5 days, IQR 100-309.5), trauma (median 183 days, IQR 126.5-269.5), and sports (median 157.5 days, IQR 100-269.5) had the longest times to acceptance (p<.0008). Time to acceptance was not significantly different between male and female first authors. 

Conclusion
This study provides a tool for authors to estimate their mean time from submission to acceptance based on the characteristics of their study. With literature submissions constantly increasing each year with unknown times to acceptance, authors may make a more informed decision with journal selection based on the qualities of their study.

Factors for Predicting Time to Acceptance in the JAAOS

Background
Historically, women are underrepresented in the field of orthopedic surgery. To evaluate progress in this area, it is important to assess not only representation but also activity at high profile orthopedic conferences in the field.
Methods
Poster presentations from the 2023 and 2024 AAOS annual meetings were identified via the AAOS ePoster archive. First, second and last authors were recorded for each poster that met inclusion criteria. For each author included in the data, gender was determined and recorded. In addition gender, degree title (as listed on the AAOS website) was recorded, including authors’ AAOS membership status if listed. The Elsevier database, Scopus, was used to determine each authors’ academic influence at the time of data collection. H-indexes, an author specific metric that evaluates scientific output based on publications and citations, were recorded for each author.
Results
Chi-squared analysis for independence revealed a statistically significant difference in distribution of authorship positions by sex (P=0.03). Using a student's T-test, H-index for male first authors (M = 9, SD = 8) were found to be significantly higher than that for female first authors (M = 5, SD = 6), P < .001. Similar trends were observed for second authors (male: M = 10, SD = 8; female: M = 8, SD = 7), P < .001, and senior authors (male: M = 27, SD = 19; female: M = 17, SD = 18), P < .001. There was also a statistically significant difference in the proportion of male and female authors between the two years (P=0.03). Finally, there was an increase in the proportion of female authors from 14.3% in 2023 to 16.3% in 2024.
Conclusion
In our analysis of the two most recent AAOS summit authorship data, male authors dominate all authorship positions—first author, second author, and senior author. This disparity is most pronounced in the senior author role, where only 9.6% of senior authors are female. These findings further underscore a persistent gender imbalance in authorship positions at the AAOS annual meeting. Additionally, male authors generally have higher citation impacts than their female counterparts across all author positions. An increase in the proportion of female authors from 14.3% in 2023 to 16.3% in 2024 indicates a positive trend toward greater female representation in orthopedic presentations at the AAOS annual meeting. This significant increase suggests ongoing efforts to promote gender diversity in the field, which remains predominantly male.

Representation of Female Authorship to Evaluate Gender Diversity in Orthopedics

Background
Lumbar fusion has long been the gold standard operation for degenerative disc disease; however, lumbar disc replacement has recently gained popularity due to its motion-sparing benefits and increasing patient demand influenced by social media. The social media platform X (formerly Twitter) is widely used in healthcare for sharing patient experiences, and sentiment analysis can assess the emotional tone of these tweets to gauge public perception of medical procedures. The aim of this study was to analyze tweets referencing lumbar fusion and lumbar disc replacement to evaluate the tone of the content and to assess the trend of patient preference for disc replacement over fusion.

Methods
All tweets containing keywords most frequently adopted in discussions related to lumbar fusion and disc replacement were collected from January 2013 through August 2023. These phrases included: lumbar fusion, lumbar arthrodesis, lumbar interbody fusion, lumbar disc replacement, lumbar disk replacement, total disc replacement, total disk replacement, lumbar disc arthroplasty, lumbar disk arthroplasty, total disc arthroplasty, and total disc arthroplasty. Sentiment analysis was then performed using TweetNLP, a cutting-edge natural language processing library, and sentiment analysis time series plots were created. ANOVA was used for combined sentiment analysis, and the Wilcoxon Rank-Sum test for time series plots.

Results
There were 7377 and 1572 tweets mentioning lumbar fusion and lumbar disc replacement, respectively. Sentiment analysis demonstrated 1254 positive, 1389 negative, and 4734 neutral lumbar fusion related tweets (p < 0.001). For lumbar disc replacement, there were 248 positive, 113 negative, and 1211 neutral tweets (p < 0.001). The percentage of positive tweets each month was slightly higher for lumbar fusion (16.16% ± 7.28%) compared to disc replacement (15.20% ± 14.41%), while negative sentiment was 2.6 times higher for lumbar fusion (17.79% ± 8.42%) than disc replacement (6.77% ± 7.89%) (p < 0.001), with a continued rise over the past 5 years.

Conclusion
Over the past decade, patients have increasingly used X to share opinions on lumbar fusion vs. disc replacement. Though the number of tweets discussing lumbar fusion outnumber those of disc replacement, there has been considerably more negative sentiment across tweets discussing lumbar fusion. This trend may reflect the growing preference for disc replacement among patients, and spine surgeons should recognize the influence of social media on patient perceptions and its potential impact on their practice.

Understanding Public Perception Through Natural Language Processing: Lumbar Fusion vs. Disc Replacement

Strong physician communication skills are an essential component to physician training that help strengthen patient satisfaction and health outcomes. Our study will analyze how implementation of a communication training program into standard medical education conferences will improve physician-patient communication skills and overall patient satisfaction. Our study has three goals: to improve physician-patient relations through a strong communication curriculum focused on relationship centered care and empathy, to build a strong foundation in physician-patient communication skills using communication tools, and to assess resident comfort level before and after interventions with education on physician communication skills. Our QI project followed a group of pediatric residents and attendings through a 10-month, block-based curriculum with each month catered towards a specific communication goal. Participants completed monthly surveys throughout the intervention to assess for efficacy and a post-intervention survey was administered to assess for changes in resident comfort in utilizing communication techniques. Through the mid-intervention survey’s, an increased number of individuals began utilizing these techniques and subjective level of comfort with these phrases was widely noted. Our study reinforces the importance of integrating hands-on, cumulative communication education and emphasizes how helpful techniques can create stronger doctor-patient relationships and more confident, empathetic physicians.

Pediatric Implementation of a Standardized Physician Communication
Curriculum

Background: Positional plagiocephaly, characterized by cranial asymmetry, has increased significantly following the implementation of the Back-to-Sleep campaign. While this initiative successfully reduced the incidence of Sudden Infant Death Syndrome, it inadvertently led to a 5-fold increase in plagiocephaly cases. This condition can result in aesthetic concerns, psychosocial issues, and functional challenges, including difficulties with headgear fitting. Despite its prevalence, many parents and caregivers remain unaware of plagiocephaly and its prevention strategies. This study aims to assess the impact of targeted parental education on plagiocephaly prevention and to provide evidence-based recommendations for clinical practice.

Methods: Our prospective, randomized control trial included full-term newborns (≤14 days old) without congenital craniofacial anomalies. Subjects were randomly assigned to intervention (n=75) or control (n=75) groups using a computer-generated randomization sequence. The intervention group received a comprehensive educational package consisting of an informative pamphlet and a 3-minute video on plagiocephaly awareness, risk factors, and prevention strategies. The control group received standard care without additional educational materials.

Cephalic index, calculated from head circumference, biparietal diameter, and anteroposterior diameter, was assessed at enrollment and subsequent 2, 4, and 6-month well-child visits. The primary outcome measure was the difference in cephalic index between groups at the 6-month follow-up. 

Results: Our institution's previous pilot study (n=39) demonstrated a statistically significant difference in cephalic index between intervention and control groups. The intervention group showed a smaller average cephalic index, indicating reduced plagiocephaly incidence. The interim findings are limited by gaps in the 2, 4, and 6-month follow-up data. Our goal is to complete data collection for all 150 patients by year-end, which will reinforce the statistical significance of the study and allow for more robust conclusions. Currently, forty new subjects have been enrolled (n=79) and 18 two-month follow-ups have been completed. While preliminary analysis of this additional data is ongoing, it is premature to draw definitive conclusions about its statistical impact on the overall study results.

Conclusion: Our interim findings indicate that targeted parental education may effectively reduce plagiocephaly incidence and improve long-term cranial development outcomes. This study underscores the importance of preventive education in pediatric care and its potential to mitigate an avoidable condition with long-term implications. The educational intervention appears to enhance parental knowledge and promote adherence to preventive measures.


Impact of Parental Education on Positional Plagiocephaly Prevention: A Randomized Controlled Trial

Background
Annually, close to 290,000 adult patients experience in-hospital cardiac arrest in the United States. Internal medicine residents in our program felt the need for code blue training and simulation sessions to run in-hospital cardiac arrest. We conducted a quality improvement project to enhance residents’ knowledge, readiness, and confidence in leading code blue.

Methods
Residents had mock code simulation sessions every three months over 9 months (July/2023-April/2024) at Northwestern Medicine Huntley Hospital's simulation lab. In each session, residents were divided into two teams. These sessions aimed to be interactive, one team performed a scenario during each session while the other team observed, followed by a debriefing session to discuss what went well and what could be improved. The simulations focused on the roles of code blue leaders, rhythm recognition, and ACLS protocols. Pre-mock code session surveys were emailed to residents to assess their overall knowledge of ACLS protocol (medications, doses, ability to do other tasks like chest compressions, recording...) and confidence in leading code blue. Surveys included questions with a rating scale from (1-5). Following the mock code sessions, we sent post-session surveys that mirrored the initial ones, to reevaluate residents’ knowledge after the intervention.
We used McNemar’s test to determine the significance of change between the 2 surveys before and after intervention. 

Results
Of the 39 residents in our internal medicine residency program, 86.8% felt that code blue simulations significantly helped them. A significant increase was observed in residents' knowledge of code blue leader roles with 42.1% feeling "Very knowledgeable" compared to 3% before (p = 0.05). Confidence in leading code blue also rose significantly with 44.7% feeling "Confident" compared to 18.1% before the intervention (p = 0.008). Knowledge of the ACLS algorithm improved significantly with 44.7% feeling "Very Knowledgeable" compared to 18.1% before (p = 0.025). Knowledge of ACLS medications and doses also increased significantly with 29% feeling "Very Knowledgeable" compared to none before (p = 0.011). While there was no significant change in interpreting rhythm strips during a code blue, more residents reported running code more frequently post-intervention (42% vs 30.3%).

Conclusion
Most residents believed that code blue simulation sessions helped them run code blue confidently. Residents' confidence in leading code blue and knowledge of the ACLS algorithm increased after mock code simulation sessions. We anticipate that this project will positively impact patients’ outcomes following in-hospital cardiac arrest. Therefore, we plan to continue conducting these sessions annually for incoming interns.

Optimizing Internal Medicine Residents Response to In-Hospital Cardiac
Arrest: A Quality Improvement Project

Appropriate use of radiological studies is of utmost importance in medical practice, guiding care and reimbursement. The American College of Radiology Appropriateness Criteria (ACR-AC) is a free, online evidence-based resource dedicated to supporting practitioners with radiology decision-making. However, this resource has historically been underutilized by physicians and medical students, with those groups often opting to use alternative resources such as UpToDate
(UTD). Increasing awareness and user-friendliness of the ACR-AC within medical education is necessary to integrate regular use of this resource in practice. This study seeks to investigate medical student performance with and perception of the ACR-AC and UpToDate when presented with radiology decision-making cases.

Methods
First-year osteopathic medical students were presented with a clinical case and utilized either UpToDate or ACR to assist in determining the most appropriate imaging modality for the case. Following the case, students were surveyed to assess their familiarity with each resource, its effectiveness in establishing a differential diagnosis, ease of selecting the appropriate imaging, perceived usefulness, impact on confidence in imaging selection, and likelihood of future utilization. The accuracy of their decisions was also evaluated based on which resource they used. 

Results
Our survey had 82 respondents for the UTD group, and 83 respondents for the ACR group. The results showed that more students have used UTD over ACR coming into the study (20% vs 8%, p=0.01). The students also more strongly agreed that UTD was more helpful in establishing a differential diagnosis for the cases (56.1% vs 49.4%, p= 0.04). However, students found that ACR was easier to use as a resource for determining the appropriate imaging modality (3.9 vs 4.2, p=0.02). The accuracy of the tests showed a trent towards significance with case one showing 92.1% correct vs 82.6% with UTD (p=0.06) and 84.9% vs 75.6% on case two (p=0.13). 

Conclusion
The awareness of imagining resources among first year medical students is generally low. Following a case presentation, students more strongly agreed that UTD is a more helpful resource in establishing a differential diagnosis. However, students found that ACR was easier to use to determine the appropriate imaging modality. The results also showed a trend towards significance with students making more accurate decisions utilizing ACR over UTD.

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