United States

Background
The pelvic exam is used in the evaluation of many gynecologic complaints. Providers across all specialties should be able to perform this exam with an emphasis on consent, patient comfort, and accuracy. The OB/GYN clerkship is an important time for medical students to develop the technique and interpersonal skills necessary to perform pelvic exams on patients assigned female at birth. Graduating students should be able to independently perform these examinations accurately and sensitively; however, students report limited exposure in the clinical setting.
Methods
This was a prospective, mixed-methods study of medical students and OB/GYN preceptors at a large academic center in NYC between June 2024 and March 2025. The authors developed surveys using a modified Delphi process and refined them through cognitive interviews. Students logged the number of pelvic exams they performed and completed a survey at the end of the 5-week clerkship. Preceptors were surveyed via email. Quantitative analysis included descriptive statistics and nonparametric tests. Qualitative data from open-ended survey responses were analyzed inductively to identify key themes.
Results
Among 93 student respondents (91.2% response rate), the average number of exams performed per student was 4.25 speculum and 2.17 bimanual exams. Students at the academic center performed significantly fewer exams than those at the community hospital. Over half of students (51.6%) did not perform any bimanual exams. Cisgender male students performed fewer speculum exams than cisgender female students. Students reported increased confidence and reduced anxiety with pelvic exams after the clerkship. Simulation and gynecologic teaching associate sessions were rated as helpful, but students emphasized the need for real clinical opportunities. Among 89 preceptor respondents (52.0% response rate), barriers to student participation included patient preference, exam complexity, time constraints, and institutional climate. Preceptors at the academic center cited time constraints and institutional climate as barriers more often than those at the community hospital.
Conclusion
Despite improved confidence by the end of the OB/GYN clerkship, many students perform few pelvic exams in the clinical setting. Preceptor behavior, institutional policies, and clinical environment significantly impact student opportunity. To ensure all students meet pelvic exam learning objectives, institutions should supplement clinical training with simulation, improve preceptor engagement, and clearly communicate policies around student participation and patient consent.

AMA Research Challenge 2025 

Educational Experience &amp; Ethical Tensions in Pelvic Exam Training: A Mixed-Methods Study

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Educational Experience & Ethical Tensions in Pelvic Exam Training: A Mixed-Methods Study

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Hemodynamic responses to combined ice-cold water intake, leg raising, and the diving response in young healthy subjects – A potential intervention to convert paroxysmal atrial fibrillation.

Biola Eniola, Sukla Mohajan, Esmeralda Ponce, Gilda Tchao

Background: Patients with paroxysmal atrial fibrillation undergo electro-conversion approximately twice yearly, each requiring general anesthesia. In an attempt to reduce the number of required conversions, patients utilize self-management strategies including leg raising, autonomic maneuvers, and fluid/electrolyte intake. The effectiveness of such strategies is unknown. We explored the hemodynamic responses to these strategies in healthy participants.
Methods: The study was approved by the Institutional Review Board of Burrell College and all young healthy volunteers (n=15, 3♂) provided written informed consent. Exclusion criteria: Pregnancy/nursing; chronic or acute conditions; use of prescription medications except contraceptives. Some subjects participated in multiple sessions separated by at least two days. A 30-minute baseline recording (supine position) was followed by 10 minutes with legs raised by 20 cm (group 1); three inspiratory breath holds while wearing an ice-cold face mask (diving response, group 2); 30 minutes of recording following 500 mL ice-cold water imbibement (group 3); or a combination of these interventions (group 4). Stroke volume was obtained by impedance cardiography, heart rate was derived from the ECG, blood pressure was recorded by finger plethysmography. Data are presented as means±standard error of the mean. Statistics were calculated by one-way analysis of variance. 
Results: Systolic blood pressure increased with leg raising (121.9±4.0 mmHg at baseline vs. 139.4±7.2 mmHg, n=8, P=0.06), the diving response (121.9±3.0 mmHg at baseline vs. 136.1±5.0 mmHg, n=8, P=0.01), and ice-cold water imbibement (123.4±3.8 mmHg at baseline vs. 137.2±6.5 mmHg, n=8, P=0.03), but not for the combination of the three interventions (122.1±5.4mmHg at baseline vs.116.9±4.9mmHg, n=8, P= 0.16). Heart rate decreased in response to all interventions, with the most pronounced bradycardic response observed with the combination of the three interventions (68.8±3.5bmp at baseline vs 61.1±3.4bmp, n=8, P=0.01). The diving response increased stroke volume (68.6±6.6 mL at baseline vs. 94.4±10.2 mL, n=8, P=0.06) and cardiac output (4.2±0.4 L at baseline vs. 5.4±0.6 L, n=8, P=0.11). Likewise, the combination of all three interventions (group 4) increased stroke volume (59.1±6.8mL at baseline vs. 84.3±9.8 mL, n=8, P=0.01) and cardiac output (4.1±0.6 L at baseline vs. 5.2±0.7 L, n=8, P=0.03).
Conclusion: The combined application of ice-cold water imbibement, leg raising, and diving response elicited stronger hemodynamic responses than the individual interventions. The hemodynamic responses to the combined interventions are consistent with increased atrial stretch and cardiac autonomic modulation through baroreceptor and cardiopulmonary reflex responses. Whether these mechanisms can convert paroxysmal atrial fibrillation to sinus rhythm remains to be determined.

Hemodynamic Responses to Combined Ice-cold Water Intake, Leg Raising, and the Diving Response in Young Healthy Subjects – A Potential Intervention to Convert Paroxysmal Atrial Fibrillation.

Abstract Title: Impact of the Renin-Angiotensin System on Left Ventricular Hypertrophy in Polycystic Ovary Syndrome

Background: Polycystic Ovary Syndrome (PCOS) is characterized by androgen excess and ovulatory dysfunction, affecting 5 to 26% of reproductive-aged women. Recent studies suggest that women with PCOS may be at an increased risk for diastolic dysfunction. However, it remains unclear whether the activation of the renin-angiotensin system (RAS) contributes to left ventricle (LV) hypertrophy in PCOS. Using a well-characterized hyperandrogenemic female (HAF) rat model, we aim to test the hypothesis that RAS activation plays a role in the development of left ventricular hypertrophy in HAF rats.

Methods: Twenty Sprague Dawley female rats were randomly assigned to receive either silastic tubes containing dihydrotestosterone (DHT; 8 mg/90 days) or empty silastic tubes (control) via subcutaneous implantation. The LV was weighed and corrected by tibia length (TL). For histopathological examination, Masson Trichome staining was used to assess the myocardial fibrosis. Digital polymerase chain reaction (dPCR) was performed to measure mRNA expression of angiotensinogen (AGT), angiotensin-converting enzyme (ACE), angiotensin-converting enzyme 2 (ACE2), angiotensin type-1 receptor (AT1R) and androgen receptor (AR). Protein expression of AGT, ACE, and AR was analyzed by Western blotting. Data were analyzed using Student’s t-test. A p-value of <0.05 was considered statistically significant. GraphPad Prism was used for analyses.

Results: The HAF rat model exhibited an increase in LV/TL weight compared to controls (19.5 vs. 15.5 mg/mm). Quantification of fibrosis in the LV revealed significantly higher levels in DHT rats than in controls (34.2 vs. 16.2 μm³). dPCR analysis showed upregulation of AGT, ACE, and AT1R mRNA expression in DHT rats, whereas ACE2 and AR mRNA expression was reduced. Consistently, Western blotting demonstrated increased AGT and ACE protein levels and decreased AR protein levels in DHT rats compared to controls.

Conclusion: Despite downregulation of androgen receptor expression, chronic hyperandrogenemia in the HAF rat model led to LV hypertrophy and increased myocardial fibrosis. These changes were associated with upregulation of key RAS components, including AGT, ACE, and AT1R. This suggests that hyperandrogenemia may indirectly activate the RAS, contributing to cardiac remodeling independently of direct AR signaling.

Impact of the Renin-Angiotensin System on Left Ventricular Hypertrophy in Polycystic Ovary Syndrome

Traumatic injuries are the leading cause of death for individuals under the age of 46, with 30% to 40% of these deaths resulting from blood loss. In order to minimize the delay between presentation to the hospital and administration of blood products, Artificial Intelligence (AI) techniques were used to predict the need of transfusions in trauma patients. The Trauma Quality Improvement Program (TQIP) was used in an 80-20 train-test split for several different Machine Learning (ML) models. XGBoost was the best performing model with an AUROC of 0.845. Shapley values were then calculated, showing the 5 most important features for the model were ISS, SBP, Highest Activation, and Pulse Rate. This work showed that XGBoost was able to effectively predict transfusion requirements while Shapley values provided interpretability and trustworthiness. Future work includes comparing with additional AI models such as neural networks, as well as deploying the model for use in a clinical environment.

Prediction of Transfusions Using Machine Learning

Background
Quantitative analysis of nerve histomorphology is essential for nerve regeneration research. Manual quantification of axon numbers, diameters, and myelin thickness is time-consuming and labor-intensive. . Semi-automated processes have improved this process, but newer computational technologies may offer further opportunities for enhanced efficiency. Recently developed open access deep learning software, AxonDeepSeg, does offer many advantages for certain imaging analysis but is less proficient at analyzing brightfield microscopy images. We believed that this software could be further optimized for this application.

Methods
A modified UNet++ architecture was used to develop “DeepAxon”, an fully automated segmentation tool for nerve toluidine blue image analysis. Images were pre-processed into patches, segmented using the UNet++ model, and restitched using a Hann window algorithm. Morphometric analysis was automatically performed on segmented images to extract key parameters. Improved “DeepAxon” efficiency and proficiency was validated in comparison to alternative analysis techniques

Results
DeepAxon demonstrated comparable accuracy to manual segmentation in measuring g-ratio and axon diameter but reduced analysis time by 99.9% compared to manual segmentation and 96.2% compared to AxonDeepSeg.

Conclusions
DeepAxon is a novel automated segmentation tool for nerve immunohistochemistry images. It significantly reduces analysis time and provides accurate morphometric measurements. By addressing limitations of existing methods, DeepAxon offers a valuable tool for researchers in the field of nerve regeneration. Future improvements, such as a user-friendly interface and enhanced model training, will further expand its utility

DeepAxon: Automatic Morphometric Analysis of Axon Brightfield Microscopy

Abstract Title: Lung Lesion CT Imaging Features Associated with Sufficient Tissue Sampling by Monarch Platform Bronchoscopy 

Background 

Monarch Platform is a robot-assisted bronchoscopy (RAB) used to biopsy pulmonary lesions suspicious of lung cancer. Multiple studies have evaluated the safety and diagnostic yield of RAB, but the criteria used to calculate the diagnostic yield have varied leading to inconsistent results. This study aims to assist by identifying CT imaging features of lung lesions, such as diameter, associated with sufficient tissue sampling to calculate diagnostic yield. 

Methods 

Data was retrospectively collected of patients who underwent a Monarch Platform bronchoscopy at Penn State Hershey Medical Center for the past two years. Patients with a previous chest CT scan in which a diameter of the lesion was reported by a radiologist were included as well as the Monarch planning CT examination. Pathology results of the biopsy collected via RAB were determined. Biopsies relying on analysis of lymph node biopsy or cytology brushing were excluded. Diagnostic yield was calculated as the proportion of biopsies with a diagnostic result using the Conservative Criteria introduced by Vachani et al. Malignant and specific-benign diagnoses were diagnostic while all other results were non-diagnostic. 

Results 

The total number of patients analyzed in this retrospective study was 142. The average age was 69 with 56% being female (n=80). The median diameter of all lesions biopsied was 22 mm. The calculated diagnostic yield was 57%, with 81 patients having a diagnostic biopsy and 61 patients having a non-diagnostic biopsy. 

The median size of diagnostic lesions was 29 mm while the median size of non-diagnostic lesions was 17 mm (p=0.001). The total number of lesions with a diameter ≥15 mm was 114, and the total number of lesions with a diameter ≥30 was 50. The diagnostic yield of lesions ≥15 mm was 61%, while the diagnostic yield of lesions ≥30 mm was 80% (p=0.02). 

Conclusion 

Monarch Platform RAB is a valuable tool in diagnosing lung lesions. This study found that as the diameter of the lung nodule increased, the diagnostic yield also significantly improved, with an increased diagnostic yield from 61% to 80% between 15 mm and 30 mm. The size of the lesion identified on CT scan and its associated likely diagnostic yield could prove helpful to radiologists in determining if RAB is recommended.

Lung Lesion CT Imaging Features Associated with Sufficient Tissue Sampling by Monarch Platform Bronchoscopy


Background
Frequent monitoring of lung function with spirometry in chronic pulmonary disease can help detect early disease progression. The CMI Health SpiroLink device ($79.99) and the Sonmol Digital Spirometer ($29.99) are home spirometers that are commercially available and may help patient monitor their pulmonary status between formal testing. These two devices, however, are not FDA-approved, and pulmonologists may be reluctant to place credence in their measurements. This study aims to assess whether these non-FDA-approved devices provide similar trends to the FDA-approved Jaeger/Vyaire Vyntus Spiro (>$5,000).

Methods
A retrospective review was conducted utilizing spirometric forced expiratory volume in one second (FEV1) data collected by a physician-patient with chronic hypersensitivity pneumonitis. FEV1 values were tracked in parallel on three different spirometers (Sonomol, SpiroLink, and Vyntus) for a year, and a comparative analysis, using Vyntus as a reference standard, was done to assess the variability in measurements. FEV1 trends were visualized using logically estimated scatterplot smoothing (LOESS) across the study time, and data were modeled using nonlinear sinusoidal regression for each device. Regression models were used to obtain 95% confidence intervals of model estimates to compare trend capture across each device.

Results
Despite differences in absolute numerical values, all three devices, upon visual assessment, exhibited consistent trends for FEV1 that reflected the patient’s lung function. LOESS smooth curving of FEV1 data showed a sinusoidal, or wave-like pattern, throughout the year. 95% confidence intervals of these models’ estimates (Amplitude and Frequency) show a high amount of overlap, indicating that each of the three devices captured similar trends of FEV1 over time. However, the confidence interval for displacement (Vertical Shift) didn’t overlap, indicating that the FEV1 measurements of each device were different on average.

Conclusion
The non-FDA-approved Spirolink and Sonmol devices could be used by patients to provide accurate tracking of lung function trends over time, based on the similar variation in FEV1 values over the study period. This can potentially inform pulmonary care by allowing patients to identify changes in their function trends at home earlier than periodically scheduled measurements in a clinic. Future directions include analysis of other spirometry measures, increasing sample size, and increasing study timeframe.

Home-Based Spirometry for Chronic Hypersensitivity Pneumonitis: A Year-Long Comparative Study of Consumer and Medical-Grade Devices

Background:
Undescended testis (UDT), or cryptorchidism, is a common congenital anomaly in male infants, affecting
approximately 3% of full-term and up to 30% of preterm males. Untreated UDT increases the risk of infertility
and malignancy. Orchidopexy is recommended between 6 and 18 months of age, but delays in diagnosis and
treatment remain common in low-resource settings. This study evaluates the clinical presentation and
surgical outcomes of UDT in children at a tertiary care center in Mizoram, India.
Case Presentation:
This cross-sectional observational study was conducted from November 2020 to April 2022 at Civil Hospital,
Aizawl. Twenty male patients under 15 years with unilateral or bilateral UDT were included, excluding
retractile testes and patients above 15 years. Clinical examination and ultrasonography were used to assess
preoperative testicular position, volume, and viability. All patients underwent open inguinal orchidopexy under
general anesthesia. Postoperative follow-ups were done at 2 weeks, 3 weeks, and 6 months, with
ultrasonographic evaluation of testicular volume and viability. Statistical analysis used paired t-tests to
compare pre- and postoperative volumes, with significance set at p<0.05.
Discussion:
The mean age at presentation was 1.93 ± 0.23 years, with 90% presenting before 2.5 years. Low birth weight
was noted in 80% of cases. Most testes (95%) were palpable and 75% were right-sided. The most common
testicular locations were the right superficial inguinal pouch (30%), deep inguinal ring (25%), and inguinal
canal (20%). A significant increase in mean testicular volume was observed postoperatively (from 0.62 ± 0.15
mL to 0.76 ± 0.12 mL; p<0.01). At 6 months, 95% of testes remained viable and properly positioned. One
patient developed testicular atrophy and one had a surgical site infection.
Timely diagnosis and surgical intervention lead to favorable outcomes in children with UDT. This study
demonstrated significant postoperative improvement in testicular volume and high viability rates, supporting
the benefits of early orchidopexy. The minimal complication rate further emphasizes the safety of this
approach. However, delays in presentation highlight the need for increased awareness among caregivers
and primary care providers. Larger-scale studies with extended follow-up are necessary to assess long-term
fertility outcomes and refine care strategies for better population-level impact.

Clinical and Surgical Outcomes in Pediatric Undescended Testis: Experience 
from Mizoram, India

Background
Minority populations remain underrepresented in clinical trials due to multifactorial barriers, including restrictive eligibility criteria, systemic inequities, and patient-related factors. Although, culturally tailored, video-based educational interventions may help address these barriers, they remain understudied in thoracic oncology.
Methods
We developed 3 brief (<5 min), culturally tailored educational videos on clinical trials in thoracic oncology for Black (in English) and Hispanic/Latino patients (in English and Spanish). Eligible patients were adults (≥18 years) diagnosed with stage I–IV lung cancer, ECOG performance status of 0–2, self-identified as Black or Hispanic/Latino, proficient in English or Spanish, and had access to an electronic device. Patients completed pre-, immediate post-, and 6-month post-video surveys assessing knowledge, attitudes, and willingness to participate in clinical trials. Feasibility metrics included recruitment and survey completion rates, as well as video acceptability based on self-reported satisfaction. An exploratory aim was to assess clinical trial enrollment rates within 1 year of viewing the videos.
Results
Between April and September 2024, 54 patients were approached; 30 (56%) enrolled, 4 were deemed ineligible, and 20 declined participation. All enrolled participants completed both the pre- and immediate post-video surveys. Over 90% reported high satisfaction with the videos. Total knowledge scores increased significantly (p < .001), with specific gains in understanding pre-clinical studies (p = .012), placebo use (p = .001), and clinical trial registration (p = .012). Over 90% agreed that clinical trials are essential for drug development and improving lung cancer outcomes. However, 50% still reported potential barriers, including concerns about informed consent, randomization, cost, and provider communication. Willingness to participate in clinical trials increased significantly after viewing the videos (p = .04). At 6-month follow-up, 22 (73.3%) completed the survey; 2 (6.66%) participants had died. As part of our exploratory aim, within 1 year of the intervention, 8 patients (27%) enrolled in a therapeutic clinical trial (5 Black/African American; 3 Hispanic/Latino).
Conclusion
Our culturally tailored, patient-centered educational videos were feasible, well-received, and may have contributed to increased enrollment of minority patients in clinical trials. Broader implementation of these videos may enhance generalizability of findings and support more inclusive, evidence-based care as well as addressing disparities linked to the social construct of race.
Disclosures
Preliminary data presented at 2025 ASCO Annual Meeting as a poster (Abstract #1590); updated data presented here.

Updated Results from a Culturally Tailored Education Initiative to Enhance Clinical Trial Awareness in Thoracic Oncology

Assessing Patient Motivation for Requesting Safer Sex Kits in the Emergency Department: A Pilot Survey Study

Background
Condoms are an important public health resource to prevent sexually transmitted infections (STIs) and unwanted pregnancies. However, many barriers exist to access. Condom distribution programs (CDPs) are structural-level solutions that increase accessibility and availability of condoms in various settings. CDPs have increased condom use behaviors in diverse populations, including adolescents, sex workers, adults, and populations with high STI rates.

CDPs have been studied in outpatient and community settings, but there is limited data on their use in emergency departments (EDs). With increasing national rates of STI-related ED visits and increasing use of EDs for primary care, evaluation of safer sex resources in the ED is necessary. This pilot condom distribution survey study serves to close this gap in the research.

Our primary aim is to assess which patients are requesting safer sex kits and the relationship between sexual health risk factors and utilization. The secondary aim is to evaluate the University of Maryland ED as a potential condom distribution site for the Baltimore community.

Methods
ED staff provided safer sex kits consisting of condoms, STI education, and local resources by patient request from informational flyers. Each kit included the QR code to a brief anonymous survey. This questionnaire collected characteristics of patients who requested or received a kit in the ED. Participation was not a requirement for receiving the kits. 

Results
Ongoing distribution of the kits began on April 15, 2025. 31 responses to the survey have been received as of October 5, 2025. 43% were aged 18-25, 43% aged 26-35, and 13% aged 36-45. 57% identified as male and 3% non-binary/gender nonconforming. The most common reason reported for the ED visit was for STI/HIV testing (43%), 40% reported another reason, and 17% declined to answer. 30% of respondents reported using condoms approximately half the time when engaging in vaginal or anal sex. Barriers to condom use included decreased pleasure (30%), partner’s preference (27%), fit (10%), and other (17%). No respondents reported HIV, but 17% reported an STI diagnosed within the last year. Two respondents (7%) reported ever having sex in exchange for a place to stay, money, food, or other items

Conclusion
Preliminary findings suggest that safer sex kits in the ED can target young, sexually active individuals of all genders regardless of prior STI history. Although limited by sample size, initial results provide data on who is likely to access safer sex kits through the ED and suggest utility in considering the ED as another community CDP. Further research would need to be conducted to study this feasibility and impact as well as the pediatric ED as a CDP.

Assessing Patient Motivation for Requesting Safer Sex Kits in the Emergency Department: A Pilot Survey Study

Out-of-hospital cardiac arrest (OHCA) is a leading cause of preventable death, yet fewer than 40% of victims receive bystander CPR, with underserved communities facing the greatest barriers to access. Beat to Breathe CPR, a student-led nonprofit, implemented a mobile, outreach-based CPR program across New Jersey to improve community preparedness through free, one-hour training sessions tailored to specific audiences. In a pilot study of 15 youth camp counselors, average CPR confidence increased by 124% (p<0.001) and knowledge by 82% (p<0.001), with all participants reporting greater readiness to act during emergencies. These findings suggest that community-delivered, low-barrier CPR training can significantly improve layperson competence and confidence while reducing structural barriers such as cost and transportation. This model demonstrates a scalable approach to increasing CPR accessibility and preparedness among populations historically underrepresented in traditional CPR education.

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Hemodynamic Responses to Combined Ice-cold Water Intake, Leg Raising, and the Diving Response in Young Healthy Subjects – A Potential Intervention to Convert Paroxysmal Atrial Fibrillation.

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