From the Department of Obstetrics and Gynecology, Dalhousie University, IWK Health Center, Halifax, Nova Scotia, Canada. Reprints: Alfred Bent, MD, 455 Cottage Ln, PO Box 367, B0N 1C0 Canada. E-mail: [email protected]. The author has declared that there are no conflicts of interest.

From the Department of Obstetrics and Gynecology, Dalhousie University, IWK Health Center, Halifax, Nova Scotia, Canada. Reprints: Alfred Bent, MD, 455 Cottage Ln, PO Box 367, Brookfield, Nova Scotia B0N 1C0 Canada. E-mail: [email protected]. The author has declared that there are no conflicts of interest.

From the Department of Obstetrics and Gynecology, Dalhousie University, IWK Health Center, Halifax, Nova Scotia, Canada. Reprints: Alfred Bent, MD, 455 Cottage Ln, PO Box 367, B0N 1C0 Canada. E-mail: [email protected]. The author has declared that there are no conflicts of interest.

Introduction and hypothesis Little evidence is available concerning the ability of women with urinary incontinence (UI) to properly assess their problem. This study compared women’s assessments of their UI type with physicians’ diagnoses. Methods Women referred to a urogynecology clinic for UI were asked to anonymously answer a short validated Questionnaire for Urinary Incontinence Diagnosis (QUID) before their physician visit. Women completed the QUID and read a brief explanation of its interpretation, after which they were asked to choose their UI type: stress, urge, or mixed. Physicians, blinded to patients’ answers, conducted routine examinations and indicated their diagnoses of incontinence types. Sample size was representative of typical clinic volumes. Levels of agreement among physician diagnoses, QUID scores, and patient self-assessments of UI type were calculated with kappa (κ) statistics. Physician diagnosis was the gold standard. Results We had 497 patients return the questionnaire; 338 met inclusion criteria. Mean age was 53 (±13) years. Levels of agreement among physician diagnoses and patients’ assessments of UI type (κ = 0.411, p < 0.01) and QUID scores (κ = 0.378, p < 0.01) were significant. Significant level of agreement was found among QUID scores and patients’ assessments of UI type (κ = 0.497, p < 0.001). Conclusions With aid of a brief standardized questionnaire, women can accurately assess their UI type. This suggests women could be educated about UI via good-quality Internet health sites and choose appropriate conservative management options.

Please cite this paper as: Geoffrion R, Gebhart J, Dooley Y, Bent A, Dandolu V, Meeks R, Baker K, Tang S, Ross S, Robert M. The minds scalpel in surgical education: a randomised controlled trial of mental imagery. BJOG 2012;119:10401048. Objective To evaluate the role of mental imagery (MI) in resident training for a complex surgical procedure. Design Randomised controlled trial. Setting Eight centres across Canada and the USA. Population Junior gynaecology residents who had performed fewer than five vaginal hysterectomies (VH). Methods After performing a pretest VH, junior gynaecology residents were randomised to standard MI versus textbook reading (No MI) and then performed a test VH. Surgeons blinded to group evaluated resident performance on the pretest and test VH via global rating scales (GRS), procedure-specific scales and intraoperative parameters. Residents evaluated their own performance. Main outcome measure Change in surgeon GRS score from pretest to test VH. The study was powered to detect a 20% difference in score change. Results Fifty residents completed the trial (24 MI, 26 No MI). There was no difference in GRS score change via blinded assessment from pretest to test evaluation between groups (mean change 13% [SD 17] versus 7% [SD 14], P = 0.192). There was no difference in procedure-specific score change. There was a significant difference in self-scored GRS score change between groups (mean change 19% [SD 12] versus 9% [SD 11], P = 0.005). Residents also felt more confident performing a VH (mean change 19% [SD 16] MI versus 11% [SD 10] No MI, P = 0.033). Conclusions No difference was observed in the surgical performance of residents after MI. Improved resident self-confidence may be attributable to MI or the effect of unblinding on trial participants.

Female Pelvic Medicine & Reconstructive Surgery: May 2011 - Volume 17 - Issue 3 - p 109 doi: 10.1097/SPV.0b013e3182203691

Female Pelvic Medicine & Reconstructive Surgery 17(6):p 263, November 2011. | DOI: 10.1097/SPV.0b013e31823b234a

Female Pelvic Medicine & Reconstructive Surgery 17(2):p 59, March 2011. | DOI: 10.1097/SPV.0b013e31820fb930

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TUDY DESIGN: This was a multicenter prospective study involving 5 bstetrics and gynecology residency programs. Surgeons from each ite generated case scenarios based on common gynecologic proceures. Construct validity was evaluated by correlating scores to training evel, in-service examinations, and surgical skill and experience using a lobal Rating Scale of Operative Performance and case volumes.

Female Pelvic Medicine & Reconstructive Surgery 17(5):p 209, September 2011. | DOI: 10.1097/SPV.0b013e31822e0504

OBJECTIVE:We sought to develop a valid, reliable assessment of intraoperative judgment by residents during gynecologic surgery based on Script Concordance Theory.STUDY DESIGN:This was a multicenter prospective study involving 5 obstetrics and gynecology residency programs. Surgeons from each site generated case scenarios based on common gynecologic procedures. Construct validity was evaluated by correlating scores to training level, in-service examinations, and surgical skill and experience using a Global Rating Scale of Operative Performance and case volumes.RESULTS:A final test that included 42 case scenarios was administered to 75 residents. Internal consistency (Cronbach alpha = 0.73) and test-retest reliability (Lin correlation coefficient = 0.76) were good. There were significant differences between test scores and training levels (P = .002) and test scores correlated with in-service examination scores (r = 0.38; P = .001). There was no association between test scores and total number of cases or technical skills.CONCLUSION:The Script Concordance Test appears to be a reliable, valid assessment tool for intraoperative decision-making during gynecologic surgery.

From the Department of Obstetrics and Gynecology, Dalhousie University, IWK Health Center, Halifax, Nova Scotia, Canada.

OBJECTIVES To determine whether Zuidex using a non-cystoscopy mid-urethral injection technique produces as good a result (i.e. was not inferior) as Contigen injected endoscopically at the bladder neck in the treatment of urinary stress incontinence secondary to intrinsic sphincter deficiency in adult women.METHODS A prospective 2:1 randomized trial of mid-urethral injections of Zuidex-Implacer vs proximal urethral cystoscopic injections of Contigen was performed in 344 women with intrinsic sphincter deficiency at 23 North American sites, and followed up for >1 year from last treatment.RESULTS Outcomes at 12 months from last treatment failed to demonstrate that mid-urethral injected Zuidex was equivalent to cystoscopically injected Contigen in primary and secondary outcome variables. The primary outcome, the proportion of women who achieved a 50% reduction in urinary leakage on provocation testing, was achieved in 84% of Contigen-treated women vs 65% of Zuidex-treated women.CONCLUSIONS Confounding Multiple variables inherent in the Study design make a detailed analysis Of Study Outcomes difficult. UROLOGY 74: 771-777, 2009. (C) 2009 Elsevier Inc.