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2892 Minitouch Outpatient Endometrial Ablation for Heavy Menstrual Bleeding - The Way Forward!
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Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Patients or Participants: The study population included faculty and residents at two academic hospitals. We identified and surveyed operating room resident and faculty dyads. Interventions: The Wisconsin Surgical Coaching Framework was used to develop a workshop-type presentation, and was delivered to both faculty and residents. Posters and pocket cards were developed to be used as memory aids for the framework. Measurements and Main Results: A total of 28 staff Obstetricians & Gynecologists surveyed reported that time pressure, attitudes towards learners and case difficulty were the most commonly noted barriers to effective surgical coaching. Only 8% of staff physicians report having received formal training in coaching techniques.67% of residents report pre-operative goals were rarely or never set and coaching of non-technical and cognitive skills rarely or never occurs. Post intervention, over 90% of staff physicians and residents report setting goals with an increase in the frequency of teaching of non-technical skills. Conclusion: In Obstetrics & Gynecology, our trainees have noted significant variation in the teaching skills of surgical teachers. A survey of our faculty and residents showed limited exposure to formal surgical coaching concepts. We have established a need and role for a formalized framework and language surrounding operating room teaching.
associated with meaningful savings to payers at a concurrently attractive value proposition to physicians.
Virtual Poster Session 2: Basic Science/Research/Education (1:20 PM − 1:30 PM) 1:20 PM: STATION L 2480 Budget Impact of Changes in Site-Of-Service And Modality of Endometrial Ablation for Severe Menstrual Bleeding for United States Payers and Providers Pietzsch JB,1 Kahan RC,2 Roy KH3,*. 1Wing Tech Inc., Menlo Park, CA; 2 WomanCare PC, Arlington Heights, IL; 3Arizona Gynecology Consultants, Phoenix, AZ *Corresponding author. Study Objective: Heavy menstrual bleeding is a common condition in women that can severely affect quality of life. For patients who fail or refuse medical management, endometrial ablation has emerged as a mainstay treatment alternative. Traditionally, endometrial ablation has been a heat-based procedure, typically performed in a hospital outpatient setting. A newly FDA-approved cryoablation technology now enables physicians to perform a safe, comfortable, and effective endometrial ablation procedure in the lower resource office setting. Our objective was to assess the budget impact of potential site-of-service and device modality changes for payers and physicians. Design: A decision-analytic model was developed to compute differences in annual payer spend and physician revenue for specified current and future site-of-service mixes and device modalities. Per-case reimbursement for the different sites-of-service was determined based on claims data analysis of n=162,943 procedures. Based on expert surveys and interviews, a current site-of-service mix of 90%/10% hospital outpatient vs. office was considered and of 10%/90% for the future scenario. Cost for thermal and cryoablation devices were assumed to be $900 and $1,250, respectively. Physician office margin was computed based on an assumed annual volume of n=72 procedures. Setting: N/A Patients or Participants: N/A Interventions: Endometrial ablation Measurements and Main Results: The shift from 90% hospital outpatient to 10% hospital outpatient was associated with $4,025 of per-case savings for payers, at increased physician revenue of $1,657 per case. This added revenue more than off-set the additional device and procedure-related costs to the physician office, leaving a per-case margin of $1,704, an increase of 30.5% over status-quo. Conclusion: Under current reimbursement, a shift in site-of-service of endometrial ablation procedures from hospital outpatient to the office and a shift in device modality from thermal to cryoablation would be
Virtual Poster Session 2: Basic Science/Research/Education (1:20 PM − 1:30 PM) 1:20 PM: STATION M 2885 Endosee(R) Cystoscopy: An Alternative for Evaluating Ureteral Patency Following Total Laparoscopic Hysterectomy Robinson EF,* Wilson AL. Obstetrics and Gynecology, Wake Forest School Of Medicine, Winston Salem, NC *Corresponding author. Video Objective: To demonstrate an alternative method to evaluate for ureteral patency following benign hysterectomy. Design: This is a retrospective cohort study of ten patients undergoing cystoscopy following benign hysterectomy to assess for ureteral patency. Setting: This study took place at a single academic institution in the inpatient setting. Patients or Participants: Patients were included in the study if they underwent total laparoscopic hysterectomy for benign indications from February 2019 to April 2019. Interventions: Five patients underwent cystoscopy with traditional 70 degree rigid 17 French cystoscope. Five patients underwent cystoscopy with Endosee. Measurements and Main Results: We compared cost, time, diameter size, and amount of bladder distending fluid required in patients undergoing traditional cystoscopy versus Endosee cystoscopy. The average cost for traditional cystoscopy was $246 and $165 (not including cost for hand piece) per case for Endosee cystoscopy. The average time for set-up and procedure was 7-12 minutes and 3 minutes for traditional and Endosee cystoscopy, respectively. The diameter of traditional cystoscope was 5.7 mm and 4.8 £ 4.2 mm of Endosee cystoscope. Traditional cystoscope required approximately 200-300 mL distending fluid versus less than 60 mL distending fluid with Endosee. Conclusion: Endosee cystoscopy is an efficient and reliable way to evaluate ureteral patency following benign total laparoscopic hysterectomy. Virtual Poster Session 2: Basic Science/Research/Education (1:20 PM − 1:30 PM) 1:20 PM: STATION N 2892 Minitouch Outpatient Endometrial Ablation for Heavy Menstrual Bleeding - The Way Forward! Thakur N,1,* Sant R,1 Nicholls S,2 McDonald S,2 Thakur V,3 Thakur Y2. 1 University College London, London, United Kingdom; 2Department of Gynaecology, Basildon University Hospital, Basildon, United Kingdom; 3 Department of Gynaecology, Broomfield Hospital, Chelmsford, United Kingdom *Corresponding author. Study Objective: We have been carrying out Minitouch Outpatient ablation at two hospitals since 2015. We share our experience of 179 cases carried out between 2015-2018. Design: Patients with heavy menstrual bleeding are offered Minitouch ablation if they have completed family and if medical management options have failed. Setting: One district general hospital, one community hospital. Patients or Participants: 20% Patients had significant comorbidities, such as body mass index >50, severe pulmonary hypertension and cardiac disease. Interventions: All selected patients are given information leaflets and analgesia, and nurse contact numbers to discuss any queries. We carry out Transvaginal Ultrasound scan on all patients and endometrial biopsy unless already done prior to the procedure. Hysteroscopy is performed on
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
S151
patients with structural abnormalities, such as polyps or fibroids, when detected on pelvic ultrasound scan. Patients are instructed to have pre-procedure analgesia at home (Diclofenac, Ibuprofen, Paracetamol) and Entonox (inhaled nitrous oxide) is offered during the procedure. Patients received standard Minitouch treatment. Energy customization features have been used for optimum patient comfort since 2017. Measurements and Main Results: No complications were reported. Full energy dose was not delivered in three cases due to patient discomfort. Mean pain scores were 6/10 (intra-procedure) and 1/10 (post-procedure). Overall Success rate was 86% (154/179) with amenorrhea rate of 29%. 18 (10%) patients received further treatments − 2 Gonadotropin-releasing hormone analogue, 7 Repeat Minitouch ablation and 9 Hysterectomy. 31 patients treated using energy customization features had increased comfort and an overall success rate of 93.5% (29/31). Conclusion: Minitouch Outpatient ablation without anesthesia, sedation or paracervical block is a safe procedure with high success rates. Customization features enhanced patient comfort without affecting clinical outcomes.
Study Objective: To describe the characteristics of patients with adnexal torsion after previous hysterectomy. Design: Retrospective case-series Setting: Academic tertiary care hospital. Patients or Participants: Patients with a history of hysterectomy, who subsequently presented with confirmed adnexal torsion from 2006-2019. Interventions: Electronic medical records were searched using ICD 9 and ICD 10 codes, to identify patients with a history of adnexal torsion. Charts were manually reviewed for history of hysterectomy, patient and operative characteristics. Measurements and Main Results: A total of 36 surgically confirmed adnexal torsions occurred in 35 patients with a prior surgical history of hysterectomy. This represents 16% of all patients identified with adnexal torsion (219) during the study period. Of those with post-hysterectomy torsion, the most common surgical approach to hysterectomy was laparoscopic (including robotic-assisted laparoscopy). Route of hysterectomy for patients with subsequent torsion included 86% laparoscopic, 9% abdominal and 6% vaginal. Most common indications for hysterectomy were abnormal uterine bleeding (23/35), uterine fibroids (10/35), and chronic pelvic pain/endometriosis (14/35). Median time from hysterectomy to torsion was 2.5 years. Torsion was managed via laparoscopic approach in 35 of the 36 cases. Ipsilateral or bilateral fallopian tubes were present at the time of torsion in 55.6% (20/36) of cases. All of these patients underwent concurrent salpingectomy during surgical management of torsion. Conclusion: Incidence of adnexal torsion after hysterectomy may be higher than previously described. Providers should maintain a suspicion for adnexal torsion in patients with clinical signs and symptoms, even after prior hysterectomy. The majority of adnexal torsions occurred after hysterectomy via laparoscopic approach. Further study may identify patient characteristics and operative factors at time of hysterectomy, which increase the risk of future torsion.
Virtual Poster Session 2: Basic Science/Research/Education (1:20 PM − 1:30 PM) 1:20 PM: STATION O 1966 Structured Teaching to Enhance Laparoscopy Learning Galhotra S,1,* Lizon C,2 Weyenberg L,3 Clear E,3 Tam MT1. 1Rush University Medical Center, Chicago, IL; 2Loyola University, Chicago, IL; 3 St. Francis Hospital, Chicago, IL *Corresponding author. Study Objective: To measure the impact of a standardized laparoscopic curriculum on knowledge and simulation skills assessment in Ob/Gyn residents Design: Non-Randomized Control Trial Setting: Three residency programs in Chicago, IL Patients or Participants: Twenty-four residents Interventions: A standardized laparoscopic curriculum was developed in accordance with Fundamentals of Laparoscopic Surgery (FLS) training guidelines. The educational program consisted of a didactic lecture with a written pre and post test and laparoscopic simulation training. Residents were trained in peg transfer and precision pattern cutting skills. A skills assessment was administered pre and post simulation training. This skills assessment measured time to completion of peg transfer and time to completion of precision cutting. Data points were assessed using a repeated measures analysis of variance. Measurements and Main Results: The residents were evaluated with a significant improvement in knowledge score from 66.7% to 84.4% (p<0.001). Time to complete peg transfer improved from 363 to 207 seconds (p=0.004). Time to complete precision pattern cutting improved from 426 to 219 seconds (p=0.006). Conclusion: Implementing a standardized curriculum improved resident knowledge and simulation skills in laparoscopic techniques. The program demonstrated an improvement in residency learning and could be applied to improve resident training in laparoscopy and FLS training. Virtual Poster Session 2: Basic Science/Research/Education (1:20 PM − 1:30 PM) 1:20 PM: STATION P 2689 Exploring Patient Characteristics in Adnexal Torsion after Hysterectomy Valentine LN,1,* Birchall C,2 Harkins GJ3. 1OB/GYN MIGS, Penn State Hershey Medical Center, Hershey, PA; 2OB/GYN, Penn State Hershey Medical Center, Hershey, PA; 3Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA *Corresponding author.
Virtual Poster Session 2: Basic Science/Research/Education (1:20 PM − 1:30 PM) 1:20 PM: STATION Q 1686 The Effect of 24-hour Call on Laparoscopic Skills of ObGyn Residents Mazzone E*. ObGyn, Indiana University, Indianapolis, IN *Corresponding author. Study Objective: To assess the effect of 24-hour call on the simulated laparoscopic skills of Ob/Gyn residents from a large, tertiary-care hospital in a metropolitan city. Design: A standard peg transfer drill module on the Laparoscopy VR Trainer (CAE Healthcare) was used as a surrogate for surgical skills. Participants performed the simulation module three times at the start of their call and later at the completion of call. Participants also completed a short survey of basic demographics, caffeine intake and sleep over the call shift, and prior experience on the simulator. All sessions on the simulator were logged and data, including total time, average right and left path lengths, and number of dropped pegs, was extracted. Setting: n/a Patients or Participants: Residents of a university-based Ob/Gyn program Interventions: n/a Measurements and Main Results: 22 residents were recruited for the study. A total of 35 trials were performed. Participants showed improvement in all outcomes over their call shift with a significant decrease in total time required to complete the task, a significant decrease in left and right path lengths, and significantly less pegs dropped from pre to post call sessions (p < .0001 for all outcomes). Covariates were not found to be significant (p > .05) for any of the outcomes. Conclusion: Data revealed a statistically significant improvement in post call performances across all measured variables. This was true regardless
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Patients or Participants: The study population included faculty and residents at two academic hospitals. We identified and surveyed operating room resident and faculty dyads. Interventions: The Wisconsin Surgical Coaching Framework was used to develop a workshop-type presentation, and was delivered to both faculty and residents. Posters and pocket cards were developed to be used as memory aids for the framework. Measurements and Main Results: A total of 28 staff Obstetricians & Gynecologists surveyed reported that time pressure, attitudes towards learners and case difficulty were the most commonly noted barriers to effective surgical coaching. Only 8% of staff physicians report having received formal training in coaching techniques.67% of residents report pre-operative goals were rarely or never set and coaching of non-technical and cognitive skills rarely or never occurs. Post intervention, over 90% of staff physicians and residents report setting goals with an increase in the frequency of teaching of non-technical skills. Conclusion: In Obstetrics & Gynecology, our trainees have noted significant variation in the teaching skills of surgical teachers. A survey of our faculty and residents showed limited exposure to formal surgical coaching concepts. We have established a need and role for a formalized framework and language surrounding operating room teaching.
associated with meaningful savings to payers at a concurrently attractive value proposition to physicians.
Virtual Poster Session 2: Basic Science/Research/Education (1:20 PM − 1:30 PM) 1:20 PM: STATION L 2480 Budget Impact of Changes in Site-Of-Service And Modality of Endometrial Ablation for Severe Menstrual Bleeding for United States Payers and Providers Pietzsch JB,1 Kahan RC,2 Roy KH3,*. 1Wing Tech Inc., Menlo Park, CA; 2 WomanCare PC, Arlington Heights, IL; 3Arizona Gynecology Consultants, Phoenix, AZ *Corresponding author. Study Objective: Heavy menstrual bleeding is a common condition in women that can severely affect quality of life. For patients who fail or refuse medical management, endometrial ablation has emerged as a mainstay treatment alternative. Traditionally, endometrial ablation has been a heat-based procedure, typically performed in a hospital outpatient setting. A newly FDA-approved cryoablation technology now enables physicians to perform a safe, comfortable, and effective endometrial ablation procedure in the lower resource office setting. Our objective was to assess the budget impact of potential site-of-service and device modality changes for payers and physicians. Design: A decision-analytic model was developed to compute differences in annual payer spend and physician revenue for specified current and future site-of-service mixes and device modalities. Per-case reimbursement for the different sites-of-service was determined based on claims data analysis of n=162,943 procedures. Based on expert surveys and interviews, a current site-of-service mix of 90%/10% hospital outpatient vs. office was considered and of 10%/90% for the future scenario. Cost for thermal and cryoablation devices were assumed to be $900 and $1,250, respectively. Physician office margin was computed based on an assumed annual volume of n=72 procedures. Setting: N/A Patients or Participants: N/A Interventions: Endometrial ablation Measurements and Main Results: The shift from 90% hospital outpatient to 10% hospital outpatient was associated with $4,025 of per-case savings for payers, at increased physician revenue of $1,657 per case. This added revenue more than off-set the additional device and procedure-related costs to the physician office, leaving a per-case margin of $1,704, an increase of 30.5% over status-quo. Conclusion: Under current reimbursement, a shift in site-of-service of endometrial ablation procedures from hospital outpatient to the office and a shift in device modality from thermal to cryoablation would be
Virtual Poster Session 2: Basic Science/Research/Education (1:20 PM − 1:30 PM) 1:20 PM: STATION M 2885 Endosee(R) Cystoscopy: An Alternative for Evaluating Ureteral Patency Following Total Laparoscopic Hysterectomy Robinson EF,* Wilson AL. Obstetrics and Gynecology, Wake Forest School Of Medicine, Winston Salem, NC *Corresponding author. Video Objective: To demonstrate an alternative method to evaluate for ureteral patency following benign hysterectomy. Design: This is a retrospective cohort study of ten patients undergoing cystoscopy following benign hysterectomy to assess for ureteral patency. Setting: This study took place at a single academic institution in the inpatient setting. Patients or Participants: Patients were included in the study if they underwent total laparoscopic hysterectomy for benign indications from February 2019 to April 2019. Interventions: Five patients underwent cystoscopy with traditional 70 degree rigid 17 French cystoscope. Five patients underwent cystoscopy with Endosee. Measurements and Main Results: We compared cost, time, diameter size, and amount of bladder distending fluid required in patients undergoing traditional cystoscopy versus Endosee cystoscopy. The average cost for traditional cystoscopy was $246 and $165 (not including cost for hand piece) per case for Endosee cystoscopy. The average time for set-up and procedure was 7-12 minutes and 3 minutes for traditional and Endosee cystoscopy, respectively. The diameter of traditional cystoscope was 5.7 mm and 4.8 £ 4.2 mm of Endosee cystoscope. Traditional cystoscope required approximately 200-300 mL distending fluid versus less than 60 mL distending fluid with Endosee. Conclusion: Endosee cystoscopy is an efficient and reliable way to evaluate ureteral patency following benign total laparoscopic hysterectomy. Virtual Poster Session 2: Basic Science/Research/Education (1:20 PM − 1:30 PM) 1:20 PM: STATION N 2892 Minitouch Outpatient Endometrial Ablation for Heavy Menstrual Bleeding - The Way Forward! Thakur N,1,* Sant R,1 Nicholls S,2 McDonald S,2 Thakur V,3 Thakur Y2. 1 University College London, London, United Kingdom; 2Department of Gynaecology, Basildon University Hospital, Basildon, United Kingdom; 3 Department of Gynaecology, Broomfield Hospital, Chelmsford, United Kingdom *Corresponding author. Study Objective: We have been carrying out Minitouch Outpatient ablation at two hospitals since 2015. We share our experience of 179 cases carried out between 2015-2018. Design: Patients with heavy menstrual bleeding are offered Minitouch ablation if they have completed family and if medical management options have failed. Setting: One district general hospital, one community hospital. Patients or Participants: 20% Patients had significant comorbidities, such as body mass index >50, severe pulmonary hypertension and cardiac disease. Interventions: All selected patients are given information leaflets and analgesia, and nurse contact numbers to discuss any queries. We carry out Transvaginal Ultrasound scan on all patients and endometrial biopsy unless already done prior to the procedure. Hysteroscopy is performed on
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
S151
patients with structural abnormalities, such as polyps or fibroids, when detected on pelvic ultrasound scan. Patients are instructed to have pre-procedure analgesia at home (Diclofenac, Ibuprofen, Paracetamol) and Entonox (inhaled nitrous oxide) is offered during the procedure. Patients received standard Minitouch treatment. Energy customization features have been used for optimum patient comfort since 2017. Measurements and Main Results: No complications were reported. Full energy dose was not delivered in three cases due to patient discomfort. Mean pain scores were 6/10 (intra-procedure) and 1/10 (post-procedure). Overall Success rate was 86% (154/179) with amenorrhea rate of 29%. 18 (10%) patients received further treatments − 2 Gonadotropin-releasing hormone analogue, 7 Repeat Minitouch ablation and 9 Hysterectomy. 31 patients treated using energy customization features had increased comfort and an overall success rate of 93.5% (29/31). Conclusion: Minitouch Outpatient ablation without anesthesia, sedation or paracervical block is a safe procedure with high success rates. Customization features enhanced patient comfort without affecting clinical outcomes.
Study Objective: To describe the characteristics of patients with adnexal torsion after previous hysterectomy. Design: Retrospective case-series Setting: Academic tertiary care hospital. Patients or Participants: Patients with a history of hysterectomy, who subsequently presented with confirmed adnexal torsion from 2006-2019. Interventions: Electronic medical records were searched using ICD 9 and ICD 10 codes, to identify patients with a history of adnexal torsion. Charts were manually reviewed for history of hysterectomy, patient and operative characteristics. Measurements and Main Results: A total of 36 surgically confirmed adnexal torsions occurred in 35 patients with a prior surgical history of hysterectomy. This represents 16% of all patients identified with adnexal torsion (219) during the study period. Of those with post-hysterectomy torsion, the most common surgical approach to hysterectomy was laparoscopic (including robotic-assisted laparoscopy). Route of hysterectomy for patients with subsequent torsion included 86% laparoscopic, 9% abdominal and 6% vaginal. Most common indications for hysterectomy were abnormal uterine bleeding (23/35), uterine fibroids (10/35), and chronic pelvic pain/endometriosis (14/35). Median time from hysterectomy to torsion was 2.5 years. Torsion was managed via laparoscopic approach in 35 of the 36 cases. Ipsilateral or bilateral fallopian tubes were present at the time of torsion in 55.6% (20/36) of cases. All of these patients underwent concurrent salpingectomy during surgical management of torsion. Conclusion: Incidence of adnexal torsion after hysterectomy may be higher than previously described. Providers should maintain a suspicion for adnexal torsion in patients with clinical signs and symptoms, even after prior hysterectomy. The majority of adnexal torsions occurred after hysterectomy via laparoscopic approach. Further study may identify patient characteristics and operative factors at time of hysterectomy, which increase the risk of future torsion.
Virtual Poster Session 2: Basic Science/Research/Education (1:20 PM − 1:30 PM) 1:20 PM: STATION O 1966 Structured Teaching to Enhance Laparoscopy Learning Galhotra S,1,* Lizon C,2 Weyenberg L,3 Clear E,3 Tam MT1. 1Rush University Medical Center, Chicago, IL; 2Loyola University, Chicago, IL; 3 St. Francis Hospital, Chicago, IL *Corresponding author. Study Objective: To measure the impact of a standardized laparoscopic curriculum on knowledge and simulation skills assessment in Ob/Gyn residents Design: Non-Randomized Control Trial Setting: Three residency programs in Chicago, IL Patients or Participants: Twenty-four residents Interventions: A standardized laparoscopic curriculum was developed in accordance with Fundamentals of Laparoscopic Surgery (FLS) training guidelines. The educational program consisted of a didactic lecture with a written pre and post test and laparoscopic simulation training. Residents were trained in peg transfer and precision pattern cutting skills. A skills assessment was administered pre and post simulation training. This skills assessment measured time to completion of peg transfer and time to completion of precision cutting. Data points were assessed using a repeated measures analysis of variance. Measurements and Main Results: The residents were evaluated with a significant improvement in knowledge score from 66.7% to 84.4% (p<0.001). Time to complete peg transfer improved from 363 to 207 seconds (p=0.004). Time to complete precision pattern cutting improved from 426 to 219 seconds (p=0.006). Conclusion: Implementing a standardized curriculum improved resident knowledge and simulation skills in laparoscopic techniques. The program demonstrated an improvement in residency learning and could be applied to improve resident training in laparoscopy and FLS training. Virtual Poster Session 2: Basic Science/Research/Education (1:20 PM − 1:30 PM) 1:20 PM: STATION P 2689 Exploring Patient Characteristics in Adnexal Torsion after Hysterectomy Valentine LN,1,* Birchall C,2 Harkins GJ3. 1OB/GYN MIGS, Penn State Hershey Medical Center, Hershey, PA; 2OB/GYN, Penn State Hershey Medical Center, Hershey, PA; 3Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA *Corresponding author.
Virtual Poster Session 2: Basic Science/Research/Education (1:20 PM − 1:30 PM) 1:20 PM: STATION Q 1686 The Effect of 24-hour Call on Laparoscopic Skills of ObGyn Residents Mazzone E*. ObGyn, Indiana University, Indianapolis, IN *Corresponding author. Study Objective: To assess the effect of 24-hour call on the simulated laparoscopic skills of Ob/Gyn residents from a large, tertiary-care hospital in a metropolitan city. Design: A standard peg transfer drill module on the Laparoscopy VR Trainer (CAE Healthcare) was used as a surrogate for surgical skills. Participants performed the simulation module three times at the start of their call and later at the completion of call. Participants also completed a short survey of basic demographics, caffeine intake and sleep over the call shift, and prior experience on the simulator. All sessions on the simulator were logged and data, including total time, average right and left path lengths, and number of dropped pegs, was extracted. Setting: n/a Patients or Participants: Residents of a university-based Ob/Gyn program Interventions: n/a Measurements and Main Results: 22 residents were recruited for the study. A total of 35 trials were performed. Participants showed improvement in all outcomes over their call shift with a significant decrease in total time required to complete the task, a significant decrease in left and right path lengths, and significantly less pegs dropped from pre to post call sessions (p < .0001 for all outcomes). Covariates were not found to be significant (p > .05) for any of the outcomes. Conclusion: Data revealed a statistically significant improvement in post call performances across all measured variables. This was true regardless