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Background: Heart failure (HF) requires a comprehensive nutrition assessment. Biochemical markers, including serum albumin, are particularly inadequate in this population due to confounding by fluid status and other factors. We assessed whether there is congruence between serum albumin levels and malnutrition assessed using the six indicators of malnutrition, in adult patients with end-stage HF who were hospitalized in the HF unit at University Hospitals Cleveland Medical Center.

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OBJECTIVES: Hysteroscopy is routinely used to diagnose and treat various gynecologic issues, necessitating a reliable method to train residents. Commercially available hysteroscopy models can be expensive for budget strapped programs e rendering them cost prohibitive in the training setting. A reusable, easily reproducible uterine model was created for simulation of camera navigation skills when identifying uterine landmarks. This study establishes construct and face validity of a new curriculum using a low cost hysteroscopy model. MATERIALS AND METHODS: The uterine model was constructed using an empty, clear 12-ounce Gatorade bottle. The cervix was fashioned from a hard Styrofoam ball with a continuous hole representing the cervical canal for hysteroscope placement. Six letters and symbols were placed on the bottle representing uterine landmarks. For task completion, the bottle was secured on a board using Velcro. An IRB exempt study at an urban academic center was conducted to evaluate the uterine model for construct and face validity. All first-year obstetrics and gynecology residents were included in the study. Participants were given a survey to obtain basic demographic information, previous hysteroscopy experience and comfort with performing the procedure. Participants then viewed an instructional video of the procedure utilizing the model. A hysteroscopy specific OSATS tool was developed by five experts to assess the steps of the procedure and included the categories: entry into cervix, identifying anatomical uterine landmarks, instrument handling, instrument safety, and knowledge of procedure. OSATS tool scores were compared between four experts (surgeons with 3 to 36 years of post-training experience) and the novice trainees. At study conclusion, participants completed a survey to assess model realism, comfort and preparedness for diagnostic hysteroscopy. RESULTS: All 18 first-year OB/GYN residents completed the study. Experts scored significantly higher than the residents overall on the OSATS tool (p < 0.001) and within each category with the exception of the identifying anatomical landmarks category (p ¼ 0.902). Of the 25 point maximum score, the mean overall OSATS tool score for the experts was 24.9 (SD AE .05), while the mean overall score for the residents was 13.8 (SD AE 1.83). Calculated median of repetitions for novice proficiency was 5.5 (SD AE 2.5). 77.8% of trainees and 100% of experts believed the model simulated the technical skills needed for diagnostic hysteroscopy skill realistically. 94.4% of trainees felt more comfortable and prepared performing a diagnostic hysteroscopy procedure as a result of training utilizing this uterine model. CONCLUSION: Construct and face validity was demonstrated for this curriculum. The data collected determined that the curriculum discriminates skill level. Both experts and novices were pleased with the ability of the uterine model to simulate diagnostic hysteroscopy. Further studies will be conducted for translation of skill to the clinical setting and impl...

INTRODUCTION: Hysteroscopy is a cornerstone operative skill for gynecologists. As with other technical skills, simulation training may improve performance in the OR. Cavitary foods (e.g. bell pepper) have been used as models but these have the limitation of being inflexible and short lived. We have developed a low-fidelity, reusable and reproducible training model using a clear plastic bottle for hysteroscopic simulation. This purpose of this study is to test the face and construct validity of that model. METHODS: This is a prospective observational study. In 2017 and 2018 first year residents in Obstetrics and Gynecology at UT Southwestern completed the curriculum, including instructional videos, pre-test and post-test surveys and a the simulation task. Expert faculty administered an objective structured assembly of technical skills (OSATS) and recorded times required to assemble the hysteroscope and perform the simulation. Residents were given 6 weeks for independent practice with the model after which the OSATS and performance times were collected again. RESULTS: 36 first year residents and 4 faculty experts completed the simulation. Following independent practice, resident OSAT scores improved by 11 points (SD ± 8, out of 39 potential total points) on assembly of hysteroscope and 9 points (SD ± 3.5, out of 15 potential points) on simulation tasks. Resident OSATS scores improved significantly (p<0.005) between pre-test and post-test. Experts scored significantly higher than the residents on the OSATS overall (p < .001). CONCLUSION: Our study supports the use of our reusable hysteroscopic training model as a way to improve resident performance in a simulation environment.