Browsing by Author "Komanapalli, Sarah"

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    Case-Based Options Counseling Panel to Supplement an Indiana Medical School’s Pre-Clinical Family Planning and Abortion Education Curriculum
    (2022-04-16) McKinzie, Alexandra; Brown, Lucy; Swiezy, Sarah; Komanapalli, Sarah; Bernard, Caitlin
    Background: While 25% of US women will seek an abortion before age 45, targeted laws have led to a decline in abortion clinics, subsequently leaving 96% of Indiana counties and the 70% Hoosier women residing in these counties without access to services they desperately need.1,2 Despite the need for a physician workforce that is educated and able to provide full-spectrum reproductive health care, few medical institutions have a standardized family planning and abortion pre-clinical curriculum. Methods: A Qualtrics survey was disseminated to students from Indiana University School of Medicine (IUSM) to evaluate (1) student interest in curriculum reform, (2) self-assessed preparedness to counsel on contraceptive and pregnancy options, and (3) preferred modality of instruction for family planning and abortion topics. Based on the pre-panel survey feedback, a case-based pregnancy options counseling panel will be implemented in the students’ pre-clinical, didactic course Endocrine, Reproductive, Musculoskeletal, Dermatologic Systems (ERMD) in February 2022. A Qualtrics post-panel survey will be disseminated to evaluate students’ perceived efficacy and quality of the panel, as well as their self-assessed preparedness to counsel on pregnancy options. Results: Participants in the pre-panel survey (n=303) were primarily female (61.72%) and White (74.43%). Across all class levels, many (60.80%) students expected to learn about family planning and abortion in their pre-clinical education. While most (84-88%) participants felt prepared to counsel about common, non-controversial pharmacotherapies (e.g. beta-blockers and diuretics), only 20% of students felt prepared to counsel on abortion options. Overall, 85.67% of students believed that IUSM should enhance its reproductive health coverage in pre-clinical, didactic courses. Traditional lectures, panels, and direct clinical exposure were the most popular instructional modalities. Expected Results: The authors predict that following the panel, students will indicate improved confidence in providing pregnancy options counseling. Additionally, students will provide constructive feedback on the structure and content of the panel for incorporation into future years’ curriculum. Conclusions: IUSM students overwhelmingly expressed interest in expanding their pre-clinical curriculum’s coverage of family planning and abortion topics. To specifically improve students’ self-assessed preparedness to provide pregnancy options counseling and address students’ self-cited learning gaps, a case-based provider panel session will be implemented in response to students’ preferred modality feedback.
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    Curriculum Integration of Pregnancy Termination and Family Planning in Didactic Medical Education
    (2021-04) Brown, Lucy; Swiezy, Sarah; Komanapalli, Sarah; McKinzie, Alexandra; Bernard, Caitlin
    Background: Given that one in four women will seek an abortion before age 45, there is an urgent need to demystify abortion-related topics and expand providers’ foundational knowledge about pregnancy termination and family planning. An effective way of addressing gaps in women’s reproductive healthcare is integration of the public health importance, legal factors, and counseling surrounding family planning and pregnancy termination into medical school curricula in accordance with Association of Professors of Gynecology and Obstetrics (APGO) guidelines. Objective: Determine whether Indiana University School of Medicine’s (IUSM’s) current pregnancy termination and family planning curricula follow proposed APGO educational guidelines. Evaluate medical student preparedness and interest surrounding family planning and pregnancy termination. Methods: To assess the alignment between IUSM and APGO educational guidelines, session learning objectives (SLOs) from the didactic course Endocrine, Reproductive, Musculoskeletal, Dermatologic Systems (ERMD) syllabus were compared to the relevant APGO objectives. Data was collected through a survey via Qualtrics disseminated to all IUSM students which was intended to assess students’ feelings of preparedness providing accurate medical information regarding reproductive health topics, including contraception, abortion, ethical and legal implications of pregnancy termination, personal values clarification, and others, as well as interest in integrating those topics into IUSM curriculum. Results: Participants (n=303) were primarily female (61.72%) and White (74.43%) and included students who had completed the Reproductive Block of the Endocrine, Reproductive, Musculoskeletal, and Dermatologic Systems (ERMD) Course and the OB/GYN Clerkship (35.64%), only the ERMD Course (25.08%), or neither (39.27%). Across all levels of undergraduate medical education, the majority (60.80%) of students expected to learn about family planning and contraception in preclinical or clinical years of medical school. Overall, 85.67% of students believed that IUSM should enhance its reproductive and sexual health coverage in the current curriculum, including expanding family planning and contraception didactic training.
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    Development and Implementation of Pregnancy Options Counseling Curriculum in Preclinical Medical Education
    (2022-04-28) Komanapalli, Sarah; Brown, Lucy; Swiezy, Sarah; McKinzie, Alexandra; Stout, Julianne
    INTRODUCTION: Pre-clinical education during medical school is an opportunity to lay a strong foundation for clinical skill development. Options counseling for pregnancy is one such topic that is essential for students to learn early in their education. The most recent estimates from the CDC report that 102.1 per 1,000 women aged 15–44 will be pregnant. Teaching medical students the skills for pregnancy options counseling centers patient goals and prevents significant adverse outcomes, particularly those that come from being denied appropriate abortion counseling. In a previous assessment of student preparedness and interest, we found that Indiana University School of Medicine (IUSM) adequately covers family planning topics, but has gaps in abortion counseling during preclinical education. Our survey definitively showed that IUSM medical students are interested in learning about options counseling and feel unprepared to counsel about abortion; additionally, abortion counseling preparedness did not improve in our sample even after completing the OBGYN clerkship. Based on these findings, we sought to implement curriculum change in the form of a panel-based discussion that would improve student education and comfort with this crucial healthcare topic. STUDY OBJECTIVE: 1) Introduce options counseling education into IUSM preclinical reproductive education and 2) evaluate changes in student preparedness and 3) satisfaction with the panel discussion METHODS: We used data from prior surveys that demonstrated high student interest and poor preparedness regarding complete options counseling to approach faculty regarding adding options counseling to preclinical curriculum. We subsequently collaborated with pre clinical education course faculty to design and implement a panel discussion about options counseling for the preclinical reproductive coure. We then developed a survey in Qualtrics to distribute to students following the panel. The survey has 17 questions including 3 free response prompts. The survey evaluates whether students feel prepared to provide options counseling after the panel, how well topics were covered, and satisfaction overall. RESULTS: The panel will take place on February 7, 2022 and the survey will be open for weeks after the panel, at which point we will analyze student responses. We expect that our post-panel survey will demonstrate increased preparedness to counsel patients about options during pregnancy. CONCLUSIONS/IMPLICATIONS: Future panels and additional course development will fill gaps in preclinical education regarding options counseling, while expanding the skills of medical students. In addition, being prepared to offer patient centered care could better prepare students for clerkships and clinical experiences. This is a promising start to enhance preclinical education regarding women’s health.
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    Evaluation of family planning and abortion education in preclinical curriculum at a large midwestern medical school
    (Elsevier, 2022) Brown, Lucy; Swiezy, Sarah; McKinzie, Alexandra; Komanapalli, Sarah; Bernard, Caitlin
    OBJECTIVE: Evaluate a Midwestern medical school's current pregnancy termination and family planning undergraduate medical curriculum (UMC) in accordance with Association of Professors of Gynecology and Obstetrics (APGO) guidelines. Assess 1) student interest 2) preparedness to counsel patients, and 3) preferred modality of instruction. STUDY DESIGN: A survey assessed students about UMC. Course syllabus learning objectives and APGO educational guidelines were compared. RESULTS: There were 309 responses total; six did not complete all survey questions and were excluded. Participants (n = 303) were primarily female (62%) and White (74%). Across all class levels, many (61%) students expected to learn about family planning and contraception in UMC. While most (84-88%) participants who completed the preclinical course with or without the clerkship felt prepared to counsel about common, non-controversial pharmacotherapies, only 20% of students felt prepared to counsel on abortion options, and 75% of students who had completed both the preclinical and OBGYN clerkship felt unprepared for abortion counseling Overall, 86% of all students surveyed believed that the medical school should enhance its reproductive health coverage in UMC. Traditional lectures, panels, and direct clinical exposure were the most popular instructional modalities. CONCLUSION: We identified potential gaps in UMC where students expressed high level of interest with low level of preparedness regarding abortion options counseling, even among senior students. Considering the high percentage of students expecting to learn about pregnancy termination and family planning in their UMC, this expectation is not being met. Students were open to a variety of modalities of instruction, indicating that several possible options exist for curricular integration. IMPLICATIONS: Despite evidence of need for training in family planning and abortion, few medical institutions have a standardized curriculum. Little available literature exists on curricula covering pregnancy options and contraception counseling, signifying a gap of knowledge and an opportunity to study how to integrate these important topics into UMC.
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    Outcomes of octogenarians undergoing holmium laser enucleation of prostate
    (Springer, 2022-07) Heiman, Joshua; Agarwal, Deepak; Komanapalli, Sarah; Nottingham, Charles; Large, Tim; Krambeck, Amy; Rivera, Marcelino; Urology, School of Medicine
    Purpose Holmium laser enucleation of prostate (HoLEP) is an effective surgical procedure in men with BPH. Due to the increase in the use of medical therapy for BPH related lower urinary symptoms more octogenarians are presenting in a delayed fashion with significant symptoms and urinary retention. We evaluate the feasibility and safety of octogenarians undergoing HoLEP. Methods We performed a retrospective review of HoLEPs at our institution from July 2018 to December 2019. Patients were stratified into two groups based on age: < 80 and ≥ 80. Results A total of 458 patients were identified, with 74 (16.2%) ≥ 80. In patients ≥ 80, prostate volume was higher (p < 0.0005), there was a higher rate of antiplatelet/anticoagulation (p = 0.029) use, and a lower rate of alpha-blocker use (p = 0.0016). As expected, ASA scores which correlate with increasing number of concomitant diseases were greater in the ≥ 80 cohort (p = 0.016). There was no significant difference in intraoperative complications (p = 0.14), 90 day complication (p = 0.34), readmission rates (p = 0.425) or emergency room visits between groups (p = 0.15). Conclusions Despite higher medical comorbidities and increased rates of anticoagulation in octogenarians, there is no increase in operative or postoperative complication rates. Age alone should not be used as exclusion criteria for HoLEP.
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    Student-Perceived Preparedness in Contraceptive and Abortion Counseling
    (2021-03) Swiezy, Sarah; Brown, Lucy; Komanapalli, Sarah; McKinzie, Alexandra; Bernard, Caitlin
    Project Background: Upwards of 25% of women will seek an abortion by age 45; however, 17% of accredited American medical schools lack any formal abortion-related curriculum, and only 50% offer a clinical elective exposing students to abortion counseling and procedures. The gap between the large number of women seeking this care and the small amount of curriculum designed to prepare students to effectively counsel and provide this care is stark, and it represents an urgent area of study and curriculum re-design. Methods: We performed a cross-sectional survey of students at all levels of medical training to assess student-perceived level of preparedness to provide non-directive counseling on reproductive health topics, such as contraception and abortion. Preparedness was measured on a 6-point preparedness scale (1=very unprepared and 6=very prepared). Mean scores were analyzed as a whole and stratified by training level. We also performed a comparative analysis of the Association of Professors of Gynecology and Obstetrics (APGO) abortion-related learning objectives (LOs) and the corresponding LOs in our didactic reproductive health course curriculum at our institution. Results: Our preliminary survey population (n=57) included majority female (66.7%) and underclassmen (MS1 = 42.1%, MS2 = 31.6%), and varied in intended specialty. Mean preparedness to provide contraception and abortion counseling score was 2.26±0.55. When stratified to include only students in their clinical years (MS3/4, dual degree), mean preparedness score only slightly increased to 2.97±0.75. Our curriculum analysis revealed that LOs from our didactic reproductive health course covered all 5 APGO LOs on Family Planning, but did not cover 2 of the 4 APGO LOs on Pregnancy Termination. Conclusions: We identified gaps in our institution’s Pregnancy Termination curriculum, as defined by the nationally recognized APGO LOs. We also identified that current didactic and clinical training at our institution inadequately prepares medical students to provide comprehensive reproductive health counseling to women, based on mean self-reported preparedness scores. The next step is to disseminate a more in-depth survey from Feb-Mar 2021 to the same student population to further evaluate student perceptions about preparedness for reproductive health counseling compared to preparedness to counsel about hypertension management to determine whether student preparedness in family planning significantly lags preparedness in other areas of medicine. Our ultimate goal is to positively influence curriculum enhancement in comprehensive reproductive health care at our institution.