Wellness Wednesday: Utilization of Strategic Duty-free Hours by OB/GYN Residents
Purpose: To detail the specifics of how OB/GYN residents utilize a
monthly duty-free afternoon for wellness activities.
Background: Much attention is paid to burnout and high rates of
depression among physicians. Some speculate these difficulties may start in
medical school but that they become cemented and sometimes problematic in
residency. Studies have made implications that interventions, specifically
promotion of self-care and work-family balance, and work hour restrictions,
early in residency can decrease burnout and depression levels.
Methods: Starting in 2016, all residents of an OB/GYN program
were allowed to have the first Wednesday afternoon of each month free from
clinical duties. Faculty members covered all clinical services from noon to
5pm. Residents were then permitted to use the time for whatever they felt
promoted their well-being. Two years of data were collected through surveys to
determine the specific activities completed by the residents.
Results: The commonly reported activities included health care
visits, financial planning activities, leisure time with family/friends,
community or church group events, every day errands, home chores, and fitness.
Additionally, the residents also used the time away from clinical
responsibilities to study and fulfill administrative requirements.
Discussions: By better understanding what residents choose to do to
promote their own well-being, programs can then tailor structured wellness
activities to those choices. Alternatively, programs can look at an
open-ended wellness day as a possible intervention for fostering excellent
overall health and welfare of their residents. More research is needed to
validate this approach to wellness promotion.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Systems-Based Practice & Improvement, GME, CME, UME, Quality & Safety,
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Wellness on a Budget: Can It Be Done?
Purpose: To quantify resident well-being, assess the most common stressors
and sources of burnout among residents, and develop cost effective strategies
to improve wellness.
Background: In 2017, the ACGME mandated that residency and
fellowship programs had to demonstrate a commitment to the well-being of the
residents, faculty members, students and all members of the health care team.
Methods: Identifying a cost effective assessment tool
(Well-Being Index) which would link to important wellness resources, national
comparative data, and provide comprehensive reporting to our residency
programs. Analysis of this data and use of focus groups to develop a Resident
Results: The Well-Being Index, distributed at the beginning of
the training year, showed 30% of residents who responded had “at risk” scores.
The focus groups then determined the most common stressors at Henry Ford
Hospital, which fell into 4 common categories: work efficiency/support;
workflow/job demands; organizational values/meaning in work; and work-life
balance. These results allowed the Wellness Taskforce to develop strategies,
both personal and institutional, to combat areas of high stress. Cost effective
interventions totaled under $25,000 and included a Wellness Curriculum
and Wellness Rounds. Details will be shared in presentation.
Discussions: Baseline wellness scores and focus groups allowed us to
determine the extent of our residents’ burnout and identify their most common
stressors. This was an important starting point for planning cost effective
interventions and programming geared to improving resident wellness. Future
plans include assessing the Well-Being Index post-intervention to determine the
effect of the taskforce initiatives on resident burnout.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Systems-Based Practice & Improvement, GME, Advocacy,
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Vaginal Hysterectomy Training in Residency: How Many Cases Is Enough?
Purpose: To evaluate the association of number of total vaginal hysterectomies
(TVHs) performed during residency on comfort level and practice habits after
Background: TVH is the preferred route of hysterectomy whenever
feasible. Evidence is limited about the number of cases needed in residency to
produce physicians comfortable with TVH.
Methods: We performed a cross-sectional study of 2007-2017
graduates of the MAHEC OBGYN Residency Program. Using an online survey,
self-reported feedback was collected on number of TVHs performed in residency,
ratings (5-point scales) of adequacy of training and comfort level with the
procedure, and the number of TVHs performed in current practice. Spearman
correlation (coefficient rho) was used to examine the correlation between the
number of TVHs performed in residency and outcomes.
Results: Of the 35 graduates meeting inclusion criteria, 31
(88.6%) completed the survey. The range of TVHs performed by graduation varied
from 10-59. TVHs performed in residency was significantly correlated with:
perceived overall quality of training in TVH (rho=0.565; p=0.001), level of
comfort performing TVH within 12 months of graduation (rho=0.384; p=0.43) ,
level of comfort currently (rho=0.414; p=0.028), and number of TVHs performed
over the last year (rho = 0.448; p=0.042). Graphic representation
of TVHs performed in residency against comfort ratings demonstrated
substantial, favorable increases in ratings from 10-19 to 20-29 and to 30-39
and leveling off from 30-39 and above.
Discussions: The number of TVHs performed in residency is associated with
alumni perception of training quality, comfort level and practice habits. Our
alumni suggest 30-39 TVHs may be the “sweet spot.”
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Practice-Based Learning & Improvement, GME, Assessment,
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Using Student Interest Groups to Train Medical Students to Lead
Purpose: Medical student interest groups (SIG) serve as students’
introduction to medical specialties. The student leaders of these groups are
driven and demonstrate leadership ability early in their careers. Connecting
these student leaders with young physicians can improve specialty
matriculation, leadership among new residents, and foster mentorship in the
Background: The American College of Obstetrics and Gynecology
(ACOG) has leadership positions for residents, however, less for medical
students, who are encouraged to participate in meetings rather than
engage. SIG leaders have not been a focus of recruitment for ACOG,
however, these students are primed to become leaders in ACOG upon completion of
Methods: Prior to the 2017 ACOG’s Annual Clinical and
Scientific Meeting, we contacted medical students registered for the meeting to
identify any SIG leaders. A meeting was arranged for student leaders to meet
with several national representatives. The group of 17 students was introduced
to the structure and benefits of the organization and given training for
optimizing SIG function and efficacy. Through our survey, all students
appreciated the information about ACOG, ideas on how to improve their SIG, and
resources available through ACOG, rating it as just the right of information or
stated they would like to hear more.
Results: Sixty four percent were planning on establishing a
generic SIG email to improve communication with ACOG while 23% already had one.
When asked if they felt prepared to take the information back to their SIGs,
all students answered positively. Only three of the 17 students had read a
leadership book and all students said they would love to participate in a more
formal leadership training.
Discussions: Medical student leadership represents a natural group to
become future ACOG leaders. Given the barrier of contacting the SIG leaders, we
recommended establishing a generic email address for groups (eg OBGYNSIG@***).
All students wanted leadership training and to be involved in ACOG. In
conclusion, medical SIG leaders are an enthusiastic and untapped resource who
will become our colleagues. Connecting with student leaders at organizational
meetings secures future leadership and continued engagement after medical
CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Clerkship Coordinator, Professionalism, Systems-Based Practice & Improvement, GME, Independent Study,
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Use of Video Interviews for Selection of Obstetrics and Gynecology Residents
Purpose: To improve the residency selection process using asynchronous
Background: Residency applications have increased, while data
available for decision making in ERAS has been static. One-way (asynchronous)
video interviews (OWVI) involve the candidate recording answers to pre-selected
Methods: Applicants to an OB/GYN residency program with USMLE
Step 1 ≥ 220, no USMLE failures and at least 3 months of US clinical experience
were scored using five criteria (USMLE 1 score, clinical clerkship grades,
letters of recommendation, research achievements and extracurricular/leadership
activities) scored 1-5, with 5 as the top score. Applicants with scores from 19
to 22 were invited to complete an OWVI. The OWVI consisted of 1 open
ended question and 2 behavioral questions, scored from 1-5. Applicants were
invited for an in person interview based on their video interview scores.
Results: For the 2018 residency application season, 495
applications were received, 272 applications were scored and invited to
complete a video interview, 234 applicants completed OWVI and 97 OWVI were used
for the decision to invite for an in-person interview. Mean OWVI score was 10.4
(range 4-15). For the 2018 season, OWVI scores were weakly correlated with rank
list placement (Pearson coefficient = 0.29), in-person interview scores (0.18)
and application scores (0.33). The mean in-person interview
score increased after implementation of OWVI screening from 59.0 in 2017
to 62.2 in 2018 (P<0.01).
Discussions: Use of OWVI led to higher in-person interview scores,
suggesting that video interviewing is a useful supplemental tool for selecting
competitive residency candidates.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, GME, UME, Assessment,
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Use of POEs( Point of EPA Evaluations) Across All Third Year Clerkships for Year Long EPA ( Entrustable Professional Activity) Monitoring
Purpose: To describe the development of a school wide and longitudinal
assessment of the core Entrustable Professional Activity (EPA)s using an easily
Background: Our insitution is part of the EPA pilot study
sponsored by the AAMC to explore the feasibility of teaching and assessing the
core EPAs. This year direct observation and assessment of the EPAs was
implemented across clerkships . Each clerkship was allowed to determine which
EPAs were applicable to their field.
Methods: The OBGYN department determined and assessed that
EPA1( History and Physical) , ] EPA2 ( Differential Dx) , EPA3 ( Dx
and Screening Tests) and EPA6 ( Oral Presentation) were core skills to
the clerkship with the following scale (1=student observed, 2=assessor had to
talk the student through it, 3=assessor had direct them from time to time, and
4=assessor needed to be available just in case.)
OB Other Clerkships p
EPA 1 3.0( 0.5) 3.5 (0.5) <0.0001
EPA 2 3.0 (0.9) 3.4 (0.6) <0.05
EPA3 3.0 (0.9) 3.4 (0.7) n.s
EPA6 3.1( 0.5) 3.4 (0.5) < 0.005
For the first 3 months there
were 2783 EPA assessments. The average score was 3.45. In comparison to other
clerkships, students on OBGYN received lower scores in EPA 1,2,6.( p<.0001,
P< .05 and P< .005) possibly
indicating more stringent grading by faculty or lower performance of
Discussions: In comparison to all other clerkships combines, student on
OBGYN received lower scores in all four EPAs possibly indicating more
stringent grading by faculty or lower performance of medical students. Lower
EPA scores may indicate more stringent grading by faculty or lower
performance of medical students. This could also be related to lower numbers of
overall EPAs reuired by the OB/GYN clerkship. Further research is needed
to determine the significance of these findings.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Practice-Based Learning & Improvement, GME, UME, Assessment,
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Trends in Off-Service Rotations in Ob/Gyn Residencies Before and After Duty Hour Restrictions
Purpose: To establish trends in off-service rotations in OB/GYN residencies
before and after duty hour restrictions.
Background: As co-morbidities in our patient population increases,
the skills required of OB/GYNs are changing, we sought to determine the
characteristics of off service rotations.
Methods: We searched websites of ACGME accredited OB/GYN
residency programs. We collected data on off service rotations: services,
number of rotations, and PGY year of rotations. Surveys were emailed to
programs regarding off service rotations in 2018 and before duty hour changes
Results: 92% (n=259) of programs had information available on
off-service rotations, of these, 24% (n=62) had no off-service rotations, 26%
(n=67) had 1, 25% (n=66) had 2, 13% (n=34) had 3, 12% (n=30) had 4 or more. The
majority (84%) of rotations were in PGY1. The most common rotations were ER
(47%, n=122), SICU (24%, n=62), IM (25%, n=66), MICU (9%, n=23). We received 53
responses to the survey (19% response rate). Of those who responded, the most
common rotations for 2018 and before 2003 were ER & SICU. The number of
programs with SICU rotations remained stable from 2003 to 2018 (43% vs 47%)
compared to 1.4 fold decrease in programs with ER rotations. The number of
programs with IM rotations decreased 2.5 fold from before 2003 to 2018.
Discussions: Duty hour restrictions have affected off-service rotations. A
quarter of all programs have no off-service rotations, with a decrease in ER
and IM exposure during residency. This does not reflect the breadth of
knowledge required of OB/GYNs today.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Quality & Safety, General Ob-Gyn, CREOG & APGO Annual Meeting, 2019, Student, Resident, Clerkship Director, Residency Director, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Team-Based Learning,
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Transgender Healthy Care: On-line Survey of Physician Knowledge and Comfort
Purpose: To evaluate OB/Gyn provider knowledge and comfort with
transgender health care
Background: Transgender and gender non-conforming patients (TGNC)
are an underserved population that often encounters inadequate or ‘unsafe’
clinical care. Education regarding TGNC patient care has traditionally been
minimal, contributing to gaps in Ob/Gyn care for many of these individuals,
including transgender men.
Methods: An IRB approved, anonymous online non-validated survey
was emailed to 130 APGO program coordinators to distribute to their Ob/Gyn
faculty and post-graduate learners. Questions addressed included years of
practice, experience with TGNC patients, provider comfort, and TGNC education.
Results: One hundred and sixty four surveys were completed and
an additional ~50 were opened but no information was provided. Of the 164
completed surveys, 76.3% of participants reported less than 5 hours of TGNC
specific healthcare education, despite the fact that 75.7% of responders had
cared for at least one TGNC patient. Overall most respondents felt
comfortable/very comfortable (79.8%) caring for this population. No correlation
was found between years in practice and overall provider comfort caring for
TGNC patients. Major obstacles reported by participants included concern
for patient comfort, appropriate language, and lack of sufficient clinical
education for both providers and support staff
Discussions: These data suggest that enhanced TGNC clinical education for
the entire health care team is warranted.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, GME, Advocacy,
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Training Residents to Place Immediate Postpartum LARC: An Update Among U.S. Residency Programs
Purpose: To survey U.S. Obstetrics and Gynecology (Ob/Gyn) Residency
Programs on immediate postpartum (IP) long-acting reversible contraception
(LARC) training and challenges.
Background: In 2016, the American College of Obstetricians and
Gynecologists (ACOG) released a committee opinion supporting IP LARC. Growing
evidence describes provider/hospital barriers which hinder IP LARC provision.
We hypothesize similar difficulties have prevented programs from implementing
Methods: We distributed an electronic survey addressing IP LARC
training to 273 U.S. Accredited Council for Graduate Medical Education (ACGME)
Ob/Gyn Residency Program Directors from the 2017-2018 Academic Year. Data
analysis was performed with chi-square and Fisher’s exact test.
Results: Of 86 programs that participated, residents were
trained in the immediate postpartum period to place implants in 54 programs
(63%) and to place intrauterine devices (IUDs) in 52 programs (60%).
2015, only 20% of the programs were training their residents to place IP IUDs.
Thirty-one percent of eligible programs initiated training in 2017. The
majority of programs focused training interns (98%). Patient/provider
convenience motivated 46% of programs to offer IP LARC and compliance motivated
The two barriers
most frequently encountered, regardless of program training status, were
problems with billing and compensation for services (61%) and the pharmacy
that reported primarily seeing patients with insurance, either private or
Medicaid, were more likely to have IP IUD training compared to programs seeing
mostly indigent/uninsured populations (p<0.05).
Discussions: IP LARC training has increased since the ACOG Committee
Opinion was published, however many programs are still facing challenges with
implementation, affecting resident training.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Systems-Based Practice & Improvement, GME, Public Health, Advocacy, Contraception or Family Planning,
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Too Many Learners? Do Students Belong in Resident Continuity Clinics?
Purpose: Determine the prevalence of medical students in OBGYN
resident continuity clinics and describe effects on the learning environment
when students and residents work together in this setting.
Background: Patient continuity is an ACGME requirement often
fulfilled through a resident run continuity clinic. It’s unknown how frequently
students rotate in these clinics, or how multiple levels of learners influence
Methods: We surveyed OBGYN program managers using a national
listserv. Resident and student surveys were based on a Likert scale and sent to
all OBGYN residents and students that rotated at our institution from
Results: Program managers responded from 45 programs and 75.6%
scheduled students in resident continuity clinics. Our response rates were
79/116(68.1%) for students and 21/24(87.5%) for residents. A one-sample
Wilcoxon signed rank test was used to test the hypothesis that the typical
response on the five-level Likert scale was \"Agree\" or \"Strongly
Agree.\" Of medical students, 88.6% stated that they agreed or strongly
agreed they enjoyed working with residents (p<0.001) and 60.8% stated
they agreed or strongly agreed residents were effective teachers (p<0.001).
Among residents, 52.4% agreed or strongly agreed that they enjoyed working with
students (p<0.001). However, 61.9% said they agreed or strongly agreed they
were too busy to be effective teachers (p<0.001).
Discussions: Many institutions have students rotate in resident continuity
clinics. Residents and students have positive views regarding their
interactions. Although students were satisfied, residents expressed concerns
about their ability to be effective teachers given clinical demands. Our
results highlight the importance of developing resident teaching skills.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, CME, UME, Assessment, Problem-Based Learning, Team-Based Learning, General Ob-Gyn,
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Time to Face the Music: Attitudes of Current and Future OB/GYN Residents Regarding the Structure of Residency Training
Purpose: Measure future and current resident perspectives regarding
OB/GYN residency training structure and possible future models.
Background: Modifications to the current OB/GYN training paradigm
are being considered however the perspective of learner stakeholders on
substantial changes has not been measured.
Methods: Medical students invited for OB/GYN residency
interviews and residents (PGY1-4) at the University of Colorado, University of
Washington, University of California San Francisco, Loyola University, St.
Joseph’s Hospital, and Texas A&M in 2017-2018 received a voluntary,
electronic survey regarding possible models for restructuring residency
training. Student and resident responses were compared using a chi-square
for categorical and two-sample t-test for continuous items.
Results: Applicants (63%, 280/444) and residents (66%, 101/154)
had similar response rates. Applicants (24%) and residents (29%) reported
having concerns about the current structure of residency training. The
ideal residency duration was reported as 4 years by 72% of applicants and 85%
of residents. Lack of gynecologic surgical volume was the most frequently
reported concern among applicants (75%) and residents (72%). Fourth-year
tracking (focusing on training aligned with post-graduation career path) was
preferred by 90% of applicants and 77% of residents (p=0.002), and 92% among
respondents planning fellowship. Most applicants (68%) and residents
(75%) preferred not starting fellowship training after the 3rd year of
Discussions: The majority of learners surveyed support a 4-year training
structure, but likewise support individualizing training in the PGY-4 year. It
is imperative that OB/GYN leadership consider this and other feedback from
learners when considering modifications to the current OB/GYN training
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, GME, UME, General Ob-Gyn, CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Patient Care, Practice-Based Learning & Improvement, GME, Simulation,
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The Substantial Rise of Clinician Educators Among Obstetrics and Gynecology Faculty, 1977-2017
Purpose: To determine trends in faculty career development, stratified
by gender and under-represented minority (URM) status, for
obstetrician-gynecologists (ob-gyn) at all U.S. medical schools.
Background: The growing number of faculty and opportunities for
career pathways have expanded considerably at U.S. medical schools. This growth
differs between clinical specialties. Any dominance of non-tenure faculty has
important implications on academic promotion policies and teaching
Methods: In this observational study, we used the Association
of American Medical Colleges Faculty Roster to describe trends in career
pathways (clinician educator, tenure-track, tenure) of full-time faculty at all
U.S. MD-granting medical schools between 1977 and 2017. Proportions of
female and URM faculty on each pathway were compared with that of male and
Results: Between 1977 and 2017, the number of full-time faculty
increased from 1,628 to 6,347, mostly as clinician educators (from 345 to
4,607; 13.4-fold increase) than as being either tenured (from 457 to 587) or on
tenure-track (366 to 514). The proportion of clinician educators increased from
21.2% to 69.4%. The availability of tenure positions remained constant (92.7%
of all schools); however, the proportions of tenured and tenure-track faculty
declined steadily from 28.1% and 22.5%, respectively to 8.2-9.1% for each
group. The proportions of male and female faculty who were tenured or on
tenure track declined from 52.9% and 37.1% respectively to 23.3% and 13.6%. The
proportion who were tenured or on tenure-track declined similarly for URM (from
55.3% to 13.4%) and non-URM (from 50.2% to 18.0%) faculty.
Discussions: The substantial rise in ob-gyn faculty is largely among those
who pursued careers as clinician educators. This finding confirms the essential
need and protected time for educator development programs at all schools to
more effectively teach medical students and resident physicians.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Professionalism, CME, Lecture,
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The Residency Buddy System\': A Better Way to Encourage Laparoscopy Simulation Training?
Purpose: To determine if a “buddy-system” compared to independent
training increases laparoscopic simulation time amongst residents.
Background: Based on prior research, laparoscopic box-trainers
improve proficiency on surgical skills, however voluntary simulation time by
residents is traditionally low. We propose that a buddy system approach to
simulation will increase laparoscopic training time, and further improve
Methods: Thirty-two residents at a single obstetric and
gynecology residency program were consented for the study. Each
buddy pair was composed of a junior and senior resident. During the first half
of the 20-week study, 12 residents were randomly assigned a buddy while 20
remained solo. During the second half, solo-trainers were assigned
buddies and conversely buddies were made solo. Residents recorded check-in and -out
times electronically. (Assignments were provided via email at the beginning and
mid-way points; no other contact was made.) At the conclusion of the study
period a survey link was distributed.
Results: Six of the 32 residents (18.8%) attended simulation in
the 20-weeks, with an average time of 2 hours 14 minutes. In the solo-trainer
group, 1 resident checked in 3 times and 2 residents once. In the buddy group,
1 pair checked in together and 1 person checked in alone. Fifteen
residents (46.9%) completed the survey. Thirteen (86.7%) agreed they
accurately reported times; 1 was neutral and 1 never attended. All communicated
with their buddy monthly or less frequently, while 10 of them never
Discussions: Residents’ laparoscopic simulation time was dismal at our
program in this study. Dedicated mandatory simulation time may increase
CREOG & APGO Annual Meeting, 2019, Faculty, Residency Director, Medical Knowledge, CME, Independent Study, Minimally Invasive Surgery,
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The Effect of Dedicated Research Time in an Obstetrics and Gynecology Residency
Purpose: To determine the effect of a second-year research rotation on
scholarly output in an academic OB/GYN residency program.
Background: Dedicated research time has been shown to have
positive impacts on resident outlook and understanding of research, research
productivity, and clinical care. A minority of OB/GYN residencies
provide a research rotation due to resource availability and as a result, data
on the effect of an OB/GYN specific rotation are sparse.
Methods: A retrospective review of resident scholarly activity
was performed from academic years 2012-2017, with the rotation implemented
2015-2016. Data collected from these reports included number of
publications, presentations, book chapters, and number of residents who
participated in these projects each year.
Results: Following the introduction of research rotation,
resident participation in projects doubled to 12/20 (60%). 6 of 19
or 20 residents (31.6% and 30% respectively) had scholarly output each year
from 2012-2016, except 2013-2014 when 3/19 residents (15.8%) participated.
Publications nearly doubled and presentations increased by 50% in the
first two years of the rotation. In the second year of
implementation alone, there were nearly three times as many publications and
more than twice as many presentations than any individual year before the rotation.
Discussions: Scholarly activity output increased following implementation
of the research rotation, demonstrating a benefit of dedicated research time
and mentorship to our residency. This study supports the growing
consensus that creating a rotation and an associated curriculum are factors
associated with successful research education.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Practice-Based Learning & Improvement, GME,
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The Effect of a 6-week vs 4-week Clerkship on NBME Shelf Scores in Obstetrics and Gynecology
Purpose: To determine the effect of a 6-week vs 4-week clerkship on
NBME shelf scores in Obstetrics and Gynecology
Background: A medical school wide curriculum change took place at
Penn State College of Medicine during the 2017-2018 academic year to increase
longitudinal and integrated learning. The OB/GYN clerkship was
shortened to 4 weeks and placed into a fifteen-week block with other
rotations. OB/GYN students continued to rotate through three
clinical sites. Shelf exams, previously given at clerkship
conclusion, were then administered in the final week of the block.
Methods: A retrospective review of NBME shelf scores for our
Obstetrics and Gynecology clerkship was performed for academic years 2015-2017
and compared to those from academic year 2017-2018. Student scores
were collected and de-identified. Mean scores were then obtained for
each six-week rotation in 2015-2017 as well as the 4-week rotation school
Results: A comparison of 4-week versus 6-week shelf scores at
each site showed a significant decrease of 2.16 in the shelf scores at Hershey
during the 4-week rotation (P=0.03). Harrisburg Hospital scores
decreased by 0.31 (P=0.83) while York scores increased by 2.23 (P=0.21) during
4-week rotations. However, a decrease in overall mean shelf score in
4-week scores compared to 6-week scores across all sites by 0.08 was not
Discussions: Analysis of the shelf scores across all of the 4-week
rotations following curriculum change revealed no significant difference in
mean scores when compared to the 6-week rotations. However, there
was a site-specific significant decrease in mean scores at our main
CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Clerkship Coordinator, Medical Knowledge, UME, Assessment,
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Testosterone Supplementation in Women with Diminished Ovarian Reserve
Purpose: To evaluate the efficacy of transdermal testosterone as an
adjuvant to the standard IVF protocol to improve outcomes in women with
diminished ovarian reserve (DOR).
Background: Women with DOR have extremely low pregnancy rates
after IVF cycles, and there are currently few treatment options available.
Testosterone supplementation may improve ovarian response to stimulation via
Methods: This retrospective cohort study analyzed
83 IVF cycles based on inclusion criteria of age < 42 and
diagnosis of DOR (basal FSH > 10, AMH < 1, antral follicle
count < 6, or history of poor response [< 4 follicles]). Cycles in
the control group were carried out using the standard IVF protocol while
cycles in the treatment group involved the addition of transdermal testosterone
prior to ovarian stimulation. Four primary outcomes were evaluated: total
number of oocytes retrieved, number of mature oocytes retrieved, number of
embryos generated, and pregnancy potential of the embryos.
Results: Pretreatment with transdermal testosterone had no
impact on the total number of eggs retrieved after ovarian stimulation.
Testosterone had a negative impact of the number of mature oocytes retrieved,
but had no impact on the number of embryos generated from those oocytes.
Pregnancy rates between the treatment and control groups were no different per
embryo transfer, but were lower per cycle initiation with testosterone therapy.
Discussions: Within this study population, retrospective analysis of
testosterone therapy revealed no improvement in IVF outcomes. A randomized
controlled trial is recommended to further investigate this association.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Medical Knowledge, GME, CME, Problem-Based Learning, Team-Based Learning, Reproductive Endocrinology & Infertility,
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Targeted Interventions to Improve Resident Well-being
Purpose: To quantify and compare physician well-being and incidence of
burnout across residency programs at our institution, emphasizing
program-specific and resident-driven interventions
Background: As the national conversation regarding physician
well-being evolves, the importance of addressing physician burnout has come to
the forefront. Our institution identified moderate levels of burnout across all
residency programs, and thus initiated institution-wide efforts. Literature
suggests utilizing organization-wide and targeted interventions together has
the most significant impact on improving well-being and reducing burnout.
Methods: A Modified Maslach Burnout Inventory (MBI) survey is
distributed annually to all residents at our institution. Results from
2015-2018 were analyzed to track changes in burnout scores. All residents
participated in institution-wide interventions. Some departments initiated
additional resident-determined program-specific interventions.
Results: Mean MBI scores qualified for moderate burnout for all
programs across all years. Most programs utilizing institution-wide
interventions demonstrated no change in burnout scores; while some,
specifically OB/GYN, saw a statistically significant increase in burnout scores
(p<0.001). Departments with program-specific interventions demonstrated
decreased scores during the same time period.
Discussions: Residency programs utilizing targeted interventions
demonstrated marked improvement in burnout scores. Amongst those
without targeted interventions, OB/GYN demonstrated the largest increase in
burnout, suggesting differing etiologies of burnout for individual programs,
with OB/GYN being uniquely susceptible. We plan to combat this by utilizing a
guided focus group of OB/GYN residents to identify drivers of burnout and
specific interventions addressing these factors, using the Mayo Well-Being
Index to track anticipated improvement. Continued work in evidence-based
strategies addressing the challenge of burnout will ultimately produce more
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Systems-Based Practice & Improvement, GME,
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Successful Implementation of an OB/GYN Resident FLS Training Curriculum
Purpose: To describe the implementation of an ob/gyn resident
Fundamentals of Laparoscopic Surgery (FLS) training curriculum
Background: Beginning in May 2020, all ob/gyn graduating residents
will be required to successfully complete the FLS program as a prerequisite for
specialty board certification.
Methods: Between January 2017 – April 2018, 36 ob/gyn residents
participated in the BCM FLS curriculum. The curriculum consisted of six
3-hour faculty supervised gynecologic simulation sessions, 24/7 individual
access to the simulation lab, proctored voluntary one-on-one sessions, and a
final mock FLS session. Participants were followed with attendance
sign-in sheets to gauge number and time involved in all sessions.
Residents completed evaluation forms after each simulation session.
Descriptive statistics were utilized to determine the average/range of
the number and time involved in the practices sessions, between PGY levels and
FLS pass rates.
Results: All 36 ob/gyn residents successfully completed FLS
certification on the first attempt. In addition to the mandatory
sessions, residents required an average of 8.64 independent practice sessions
(range 3-22) lasting an average 72 minutes/session. Approximately 688
minutes (range 235 – 1357 minutes) of independent practice were required to
pass the FLS exam. Many residents felt that the curriculum gave them
adequate support to succeed on the exam and stated that one of the most
valuable components of the curriculum were proctored teaching
Discussions: With a dedicated curriculum and proctored teaching, residents
in obstetrics and gynecology can successfully pass the FLS certification exam
with their initial test.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Medical Knowledge, GME, Simulation, Minimally Invasive Surgery,
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Students Stuck in a Swamp? Scripting Promotes Medical Student Involvement in Obstetric & Gynecologic Care
Purpose: Characterize the effect of staff scripting on medical student
acceptance in outpatient ob-gyn clinic visits.
Background: Direct patient care is a major tributary in the river
of medical education. When patients refuse medical student involvement in their
care, students are stranded in stagnant quagmire. Review of the literature
shows that medical student refusal is a national issue not limited solely to
obstetrics and gynecology (ob-gyn) clerkships (Chang, et al, 2010; Mavis,
et al, 2006; Hartz & Beale, 2000). Written and video messages about medical
student training have been effective in furthering medical student acceptance
in clinical encounters (Buck & Littleton, 2016). Open the floodgates!
Methods: A literature review using search terms “medical
student AND refusal” was conducted to guide script composition. Medical
assistant and nursing staff implemented the script in an outpatient ob-gyn
resident clinic. The script was revised halfway through the clerkship year
based on patient and staff feedback. All ob-gyn medical students were surveyed
regarding their involvement in patient visits prior to and after script
Results: After script implementation, the percent of medical
students refused from at least one patient interaction decreased from 92% to
86%. 66% percent of our students perceived scripting as a supportive measure
for medical students, and 61% percent witnessed staff, residents, and faculty
Discussions: Data from our institution suggest that scripting improves
medical student involvement in ob-gyn patient care. Involving staff, students,
and patients on scripting revision helped foster a learning environment rich as
the Mississippi delta in which medical students can thrive.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Professionalism, Interpersonal & Communication Skills, UME, Team-Based Learning, Advocacy,
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Simulation Training for Operative Vaginal Delivery Among Obstetrics and Gynecology Residents: A Systematic Review
Purpose: To evaluate the impact of simulation training of operative
vaginal delivery (OVD) on learner technique, operator comfort, and
Background: Obstetric simulation affords learners opportunities to
acquire and to refine clinical skills in a low-stress environment while
potentially improving patient outcomes. However, the effect of simulation
on OVD training is less clear.
Methods: A systematic research protocol was constructed a
priori for the conduct of the literature search, study selection, data
abstraction and data synthesis. Electronic databases were searched for
educational randomized trials and observational studies assessing OVD
simulation training for OBGYN residents. The educational domains of
knowledge, skills and attitudes were evaluated. The Medical Education
Research Study Quality Instrument (MERSQI) was used to assess study
quality. The review was prospectively registered with PROSPERO.
Results: The search strategy yielded 30,812 articles, with 7
articles eligible for analysis (2 cohort studies, 1 case-control study, 4
cross-sectional studies). No randomized trials were identified.
Studies demonstrated simulation to improve learners’ skill with forceps
placement and generated force during extraction. While forceps simulation
had no change in procedure failure rates, there were significant decreases in
rates of maternal lacerations, neonatal injury, and special-care nursery
admission. Only one study evaluated the effect of simulation on provider
comfort, demonstrating increased provider comfort with vacuum-assisted
delivery. The median MERSQI score was 9.5 (range 9.0-13.5), indicating
Discussions: The available evidence suggests improvement in technique,
comfort, and patient outcomes with OVD simulation, but additional studies are
required to further characterize such benefits for both forceps and vacuum.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Simulation, Quality & Safety, Maternal-Fetal Medicine, General Ob-Gyn,
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