Acceleration of fetal maturation with intra-amniotic administration of thyroxine was employed in eight patients in whom preterm delivery was necessary because of malignant disease of the mother. Thyroxine (200 mcg to 500 mcg) was given at weekly intervals starting at the 27th to 32nd week of gestation until the L-S ratio exceeded 2.0. The fetuses were delivered between the 29.4 and 34.0 week. None of the newborns suffered from respiratory distress syndrome, and three newborns were cared for in the regular nursery. Thyroxine-induced acceleration of fetal maturation and pre-term delivery permits earlier initiation of antineoplastic and radiation therapy without exposing the fetus to the hazards of maternal therapy and those of prematurity.

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Faculty Advisor: John Fischer, MD PURPOSE: To develop a low fidelity model for retroperitoneal dissection and identification of the ureter to improve resident's confidence and competency in the operating room. BACKGROUND: Work hour restrictions and few open laparotomies have created barriers to confident resident performance of retroperitoneal dissections. While simulation training models have been developed for laparoscopy, few have been created and validated for open laparotomies. METHODS: OB/GYN residents were divided into case (PGY3) and control (PGY4). A pretest questionnaire assessed operative experience. Both groups performed a videotaped low fidelity simulated retroperitoneal dissection that included identifying the course of the ureter. An instructional video was introduced and repeat simulation was performed by PGY3 trainees only. Three expert gynecologists independently scored performances using a checklist and global rating scale of operative performance (OSAT). PGY3 pretest/posttest scores were compared to PGY4 scores using the Wilcoxon rank sum test. Paired t-test was used for comparison of cases. P<.05. RESULTS: Median pretest checklist score for PGY4 was significantly increased compared to PGY3 (7.3 vs. 6.3, P=.0314) however the median pretest OSAT score was not. A statistically significant increase in average PGY3 scores between pre vs. post final checklist scores and final OSAT scores was noted. A statistically significant increase in the median scores between PGY4 pretest (control) vs. PGY3 posttest (case) final checklist scores and final global scores (7.3 vs. 9.2, P=.0052) and (24.2 vs. 28.2, P=.0042) was noted. DISCUSSION: The development of a low fidelity model for retroperitoneal dissection and use of an instructional video may complement traditional learning for this core competency.

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