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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Service-learning Wellness Initiative in the Harvard Medical School Clerkship Curriculum
Purpose: The first aim was to assess if incorporation of a
service-based initiative into the curriculum results in professional
fulfillment, principally: improved medical student feelings of compassion,
contribution, wellness, understanding of community need, and team-building of
the student class. The second aim is to report the development of this
Background: Service-learning increases student awareness of
community resources, promotes service to the community, team-building through
cooperation rather than competition, broadens cultural awareness, and fosters
wellness through hands-on contribution.
Methods: The entire class of second year clerkship students
volunteered at a local non-profit organization. Students were divided into
small groups to work at various team tasks. Following, the entire group
reconvened for teaching reflection. They were asked a value-based qualifier of
the experience. They were also asked to provide feedback as an open response.
Quantitative data were analyzed using summary statistics, Wilcoxon rank sum and
Fischer’s exact test. Content analysis was used to determine themes from the
Results: 47 students participated, 48.9% of whom were male.
Average satisfaction with the intervention was high (mean 4.26 on a 5-point
Likert scale), with no difference in satisfaction noted by gender. Positive
themes included feelings of contribution, wellness, and team-building, with 9
respondents requesting to repeat the event at regular intervals.
Discussions: It is crucial to investigate different types of wellness
interventions throughout UME. Service-based interventions are not adequately
studied and may be an important addition to the wellness program as they are a
way for students to feel connected to the community they are
CREOG & APGO Annual Meeting, 2019, Faculty, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Team-Based Learning, Public Health, General Ob-Gyn,
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Saving Lives: Students Enhancing Patient Health Literacy Regarding Hypertension in Pregnancy and Prenatal Aspirin
Purpose: To increase medical student’s knowledge, behavior and belief
systems regarding hypertension (HTN) in pregnancy and prenatal aspirin (PNA).
To increase patient\'s understanding regarding the complications of HTN in
pregnancy and the benefits of PNA.
Background: Prenatal aspirin (81 mg) has been recommended by ACOG
for high-risk women and women with >1 moderate risk factor. Its use reduces
the rate of preeclampsia, preterm birth, intrauterine growth restriction and
fetal death in at-risk patients. In a survey conducted at Boston Medical
Center, the incidence of hypertension in pregnancy is 30%, with only 15% of
patient having heard of PNA, demonstrating high prevalence and low patient
literacy regarding the topic.
Methods: Ob/Gyn clerkship students are instructed to educate
patients regarding: knowledge of HTN in pregnancy, warning signs of
preeclampsia, and efficacy of PNA in pregnancy. The student educational
intervention was evaluated regarding: satisfaction, knowledge, confidence, and
belief systems by surveys at the beginning and end of the clerkship. Patient
education was evaluated by pre and post intervention metrics.
Results: Student knowledge of PNA and HTN increased 35%,
confidence 45% and belief systems 14%. They gave the project a 72%
satisfaction rating. Patient’s knowledge about HTN increased 48%, warning
signs 80%, and understanding of efficacy of PNA 65%.
Discussions: Medical student health counseling increased patient knowledge
regarding HTN and PNA. By educating patients, students also increased their
knowledge and confidence in the subject. We plan to continue implementing this
QI project throughout the year to augment a departmental QI initiative and
evaluate its benefit to patients and students.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, UME, Quality & Safety, Advocacy,
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Outcomes of a Transgender Care Training Program in Obstetrics and Gynecology Resident Education
Purpose: We sought to evaluate outcomes of an Obstetrics and
Gynecology (OB/GYN) resident education program on transgender health.
Background: OB/GYNs are often frontline providers for the
transgender community, as patients may first present to an OB/GYN with symptoms
of gender dysphoria or postoperative care needs and complications. Both the
American College of Obstetricians and Gynecologists (ACOG) and the Council on
Resident Education in Obstetrics and Gynecology (CREOG) have developed key
areas of competency pertaining to the care of transgender patients by OB/GYNS.
To date, standardized educational curriculums on these competency areas
are not available.
Methods: Residents at our institution completed a 2.5-hour
training on transgender health comprised of a standardized patient interaction,
debriefing session, and didactic session led by an expert on transgender
gynecological care. A 42 item pre- and post-training survey evaluated
participant demographics, a validated transphobia questionnaire, medical
knowledge of transgender care and preparedness to provide transgender care.
Results: Eighteen residents and medical students completed the
training. The average pre- and post-training knowledge assessments scores
significantly improved from 74.8% to 88.9%, (p<0.001). Specifically,
knowledge of transgender health disparities, professional guidelines, and
management of abnormal uterine bleeding all significantly improved. Baseline
transphobia scores were low and did not significantly change. Residents felt
more prepared to collect a transgender focused medical history, provide
referrals, and access additional educational resources.
Discussions: Our training improved residents’ knowledge and preparedness
to provide a variety of aspects of transgender care. This training was
feasible, reproducible and positively received by the resident participants.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, CME, Assessment, Standardized Patient, Advocacy, General Ob-Gyn, Sexuality,
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OB/GYN Resident Education and Experience with Reproductive Justice
Purpose: To understand OB/GYN resident experience with reproductive
Background: Reproductive justice (RJ) is defined as: the right to
have a child, the right to not have a child, the right to parent the children
we have, and the right to control our our birthing and contraceptive options.
Despite its relevance to OB/GYN residency milestones, such as patient-centered
care, patient advocacy, and informed consent, there is currently no formalized
RJ education in residency training.
Methods: We distributed a web-based survey to U.S. OB/GYN
residents to better understand educational and clinical experiences with RJ.
Participants were asked to share clinical experiences with reproductive
injustices. Qualitative data were coded using content analysis and quantitative
data were analyzed using descriptive statistics.
Results: We received 358 responses from OB/GYN residents,
representing 67 U.S. residency programs. 48% of respondents had not
received RJ education during their training. OB/GYN residents reported a
variety of clinical experiences with reproductive justice issues; of the 156
cases shared, common themes included fertility treatment access, care of
marginalized populations, abortion care, and informed consent. Seventy-seven percent
of respondents were interested in receiving further RJ training and 96% of
residents felt that they would benefit from training.
OB/GYN resident experiences with reproductive injustices are
widespread and residents desires additional education. Our results reveal an
opportunity to incorporate these shared clinical experiences into an innovative
RJ curriculum design where residents learn from each other’s diverse clinical
experiences while also applying milestones.
CREOG & APGO Annual Meeting, 2019, Resident, Patient Care, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, UME, Problem-Based Learning, Public Health, Advocacy, Contraception or Family Planning,
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Medical Students Reflections About Patient Care Affected by Race, Ethnicity or Language During the Obstetrics and Gynecology Clerkship
Purpose: To explore medical students’ reflections about obstetrics and
gynecology (OBGYN) clerkship experiences in which they witnessed patient
mistreatment based on patients’ race, ethnicity and language.
Background: Experience-based clinical learning includes
interactions with patients and teachers and is affected by sociocultural
contexts. Recognizing that bias and discrimination are pervasive in our
culture, medical students may observe these behaviors within their clinical teams.
Methods: We conducted a directed content analysis of students’
reflective essays written during OBGYN clerkships from 2014-17 about clinical
scenarios that challenged their professionalism. Of 265 essays that
referred to patient interactions, we included essays discussing patient race,
ethnicity or language for this analysis. Essays were analyzed more than once if
they discussed more than one of these factors.
Results: Of 53 essays that met inclusion criteria, 40 discussed
issues with providing language-concordant care, including when language
barriers led to poor care. Of these, 23 focused on interpreter concerns, such
as nonuse of certified interpreters and discomfort with being asked to
interpret. In 23 other essays, students described how patient’s race or
ethnicity affected care, including students recognizing their own bias towards
patients or witnessing team members’ discriminatory behavior such as being
judgmental, uttering racist remarks, or demonstrating insensitivity about
Discussions: Medical students witnessed and reflected about clinical team
member’s discriminatory behaviors toward patients. These narratives should
compel educators to reflect on their own biases and to set higher standards for
justice-informed care in the clinical learning environment – both to provide
justice-informed care for patients and to optimize experience-based learning.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, UME, General Ob-Gyn,
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Implementing a Longitudinal Social Determinants of Health Curriculum at an Academic Residency Program
Purpose: To examine feasibility
and reception of a city-specific social determinants of health (SDH) curriculum
at an academic medical program
understanding of health acknowledges that an individual’s social milieu impacts
health as much as genetics. Healthcare providers must consider SDH to provide
just, equitable care to a diverse patient population. However, despite a
growing emphasis on teaching SDH in medical school, these factors are not
formally addressed in traditional residency curriculum.
literature review and consultations with local educators identified best
practices for teaching SDH to medical professionals. Topics were incorporated
into resident teaching activities, including grand rounds, resident retreat,
discussions with content experts and community stakeholders, clinic teaching,
morbidity and mortality conferences, and a city tour conducted by Rochester, NY
natives. Pre- and post-surveys (n=32) were conducted to assess resident knowledge
of city resources/demographics and attitudes towards SDH in patient care.
Results: In the
pre-survey, 73.3% of trainees reported familiarity with SDH. After the
curriculum, 88% of residents reported a better understanding of the effects of
SDH, and 78% felt that the lessons learned from the curriculum affected
interactions with their patients. 97% of residents felt more knowledgeable
about Rochester demographics. Overall, residents recognized the importance of
formal SDH training and felt that social hardships are important to acknowledge
in their clinical interactions. However, some expressed concerns that it took
time away from the traditional didactic curriculum.
Discussions: A comprehensive,
longitudinal, city-specific curriculum on the SDH enriches residents’
understanding of their patient population and available social resources to
address these factors.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Patient Care, Medical Knowledge, Professionalism, GME, Advocacy,
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Evaluating the Rates of Visualized IUD Strings Following Immediate Post-Partum Placement by Ob/Gyn Residents
Purpose: Compare the incidence
of visualized IUD strings at follow up by mode of postpartum IUD placement by
postpartum contraception decreases maternal mortality, low birth weight,
preterm births and infant mortality. Missing strings in the setting of a
well positioned IUD are more common following postpartum placement as compared
to interval placement. This difference may be explained by variation in
residents’ techniques for placement in the postpartum setting.
retrospective chart review of 306 women receiving immediate postpartum IUD insertion
by residents was performed between July 1, 2017-February 15th, 2018.
Variables analyzed included: type of IUD, length of strings prior to placement,
method of insertion (applicator, ring-forceps, manual), and delivery
(20%) women attended postpartum follow-up between four to six weeks after
delivery. Eleven of 14 (79%) post-cesarean section and 39 of 48 (81%)
post-vaginal delivery had strings visualized. Insertion via the IUD
applicator was associated with significantly more IUD strings visualized at the
postpartum visit when compared to manual insertion (p <0.05) and ring
forceps (p <0.05). There was no difference in string visualization between
IUD types or after cutting the string to 10 cm.
Discussions: Mode of placement
affects postpartum IUD string visibility. Future research will include
developing a protocol for best practices for post-placental IUD placement to
improve string visibility at the postpartum visit. Additional research is
needed on the low postpartum follow up rate in this subset of the population.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Quality & Safety, Public Health, Contraception or Family Planning, General Ob-Gyn,
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Evaluating Patient Understanding of the “diagnosis of Pregnancy of Unknown Location”
Purpose: To evaluate health
literacy in an inner city population among a high risk group of
resident-managed patients with a diagnosis of pregnancy of unknown location.
health literacy is associated with poor reproductive health outcomes. Previous
research on patient compliance with methotrexate protocols as treatment for
ectopic pregnancy has shown poor compliance (as low as 10%). Rates of
follow up after diagnosis with pregnancy of unknown location are not well
Methods: A chart
review was performed to identify of all patients seen in an inner city hospital
with the diagnosis of pregnancy of unknown location. Patients meeting inclusion
criteria were contacted by phone to survey understanding of the rationale for
close follow up. Patients who never followed up after initial contact were
seven patients with the diagnosis of pregnancy of unknown location were
identified between January – April 2018. Twenty nine patients met
inclusion criteria and twenty agreed to participate. Only 40% of patients correctly
explained that there was a concern for ectopic pregnancy. The remaining
patients identified their diagnosis as an “abnormal pregnancy” (10%),
“miscarriage” (10%); “I don’t know” (15%), and other (25%).
Discussions: Although the patients
surveyed were compliant with follow up, nearly half of the patients showed poor
comprehension of their clinical condition. It may be that poor understanding is
a major underlying cause for noncompliance for the many patients who never
followed up. This should be evaluated in future research.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, Quality & Safety, Public Health, General Ob-Gyn,
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Enhancing Breastfeeding in Rural Tennessee Through Education
Purpose: To promote
breastfeeding education and increase rate of exclusive postpartum
breast-feeding to 10% in Rural Tennessee.
provides many physical and emotional benefits to both the mother and baby. It
is physiologically normal for mothers and children. Providing education about
breastfeeding during pregnancy can help keep patients informed and increase
breastfeeding rates postpartum.
selected patients who never breastfed for this study. After signing the consent
form at their initial obstetric visit, patients received education about
lactation in the form of discussion, brochures, CD-ROMs, and flash drives
during pregnancy, delivery, and during the postpartum period. Patients
completed a survey during their initial obstetric about their prior knowledge
of breastfeeding advantages, as well as their intention to breast feed. During
the postpartum period, patients filled a survey about their satisfaction of the
information they received, and their breastfeeding intention and success.
analyzed 141 antepartum and postpartum patients. Antepartum survey showed 84.5%
wanted to breast feed and 82.5% knew the benefits of breast feeding. Postpartum
survey showed 83.2% and 91% indicated that they received adequate information
about lactation during pregnancy and delivery, respectively. The survey showed
that 64.9% intended to breastfeed within the first 12 months; 35.1% (p value
< 0.001) breastfed up to 6 weeks.
Discussions: In rural Tennessee,
providing breastfeeding knowledge throughout pregnancy, during delivery, and
postpartum for obstetrics patients helped motivate them to breastfeed. This
healthy approach increased from the State of Tennessee goal of 10% to 35.1%
during the postpartum period.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Patient Care, Medical Knowledge, CME, Public Health, Advocacy, General Ob-Gyn,
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Connecting OB/GYN Residents with the Local Adolescent Community: An Underutilized Symbiotic Relationship
Purpose: To provide reproductive
health education to adolescents in a local underserved community, and encourage
OB/GYN residents to better understand the local community to improve clinical
residents have limited knowledge about the surrounding local community and the
socioeconomic context of their patients. Providing structured means for
residents to interact with members of the community outside of the clinical
environment could be beneficial.
Methods: A survey
was sent to all residents in one OB/GYN residency assessing knowledge
of the local community and comfort with discussing reproductive health topics.
Residents paired with a local community organization and voluntarily led
educational sessions for adolescent youth about common reproductive health
topics. Residents who participated completed a post-program survey.
residents participated in the pre-program survey. Ten residents participated in
the program, seven completed the post-program survey. In the pre-program
survey, half of respondents felt either somewhat unconnected to or not at all
connected to the local community.
In the post-program survey, 85%
of respondents felt more connected to the community after the program.
Qualitative responses indicated participating in the program motivated
residents to reconsider how to explain medical topics and counsel patients.
Overall, residents who participated in the program appreciated the opportunity
to connect with local adolescents and were interested in participating in future
Discussions: The relationship
between residents and local adolescents through guided classes on reproductive
health allowed residents to feel more connected to the local community and
change their clinical practice to better consider the social contexts of their
CREOG & APGO Annual Meeting, 2019, Resident, Residency Director, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, Pediatric & Adolescent Gynecology, Sexuality,
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Bring Back the Tubal: An Intervention to Provide Postpartum Bilateral Tubal Ligation in the Underserved Population
Purpose: Improve educational
awareness and receptiveness to the PPBTL procedure.
Background: 50% of
women requesting a PPBTL undergo the procedure. Barriers exist to obtain the
PPBTL, including lack of available operating rooms and concern for patient
regret. Half of pregnancies in the U.S. are unintended, occurring
disproportionately higher in low-income and minority populations. Children
resulting from unintended pregnancies are at risk for poor health outcomes
including low birth weight and developmental delay. Additionally, the U.S.
financial burden of unintended pregnancy accounted for approximately 21 billion
dollars in 2010.
retrospective chart review was conducted from 2015-2016 to document the
baseline prevalence of PPBTLs performed at IFMC. Educational sessions with pre-
and post-session questionnaires were conducted for departments of OB/GYN, Anesthesia,
and Nursing. Data was collected from April 2017 - April 2018 regarding patients
desiring the procedure, those completing the procedure, and reasons for
unsuccessful procedure completion. A pre-post comparison was performed to
assess the impact of the educational sessions and the overall prevalence of
multidisciplinary staff members at IFMC participated in the educational
sessions. All departments showed significant improvement in knowledge of the
PPBTL (OB/GYN p=0.0117, Anesthesia p=0.0002, Nursing p=0.0001). A baseline
prevalence of three PPBTLs were performed from 2015-2016, which increased to
fifty-six from 2017-2018. Comparing pre-post intervention, the percentage of
PPBTLs requested and ultimately performed increased from 39% to 60%.
multidisciplinary educational sessions were effective in identifying barriers
and increasing educational awareness. Overall, this resulted in increased
access to and performance of sterilization in the underserved population.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Patient Care, Professionalism, Interpersonal & Communication Skills, GME, Quality & Safety, Team-Based Learning, Advocacy, Contraception or Family Planning,
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RAD Times in the Big Easy: Race, Access, and Diversity in Abortion Training
Purpose: To explore residents’ interest in doing abortions with a
focus on ethnic diversity.
Background: Abortion training is critical to increase access for
the 39% of US women who live in the 90% of counties with no abortion care.
Racial/ethnic minority physicians are more likely than white physicians to care
for poor and minority patients and practice in underserved
areas.1 We explored racial and ethnic differences in residents’
interest in providing abortions in ob/gyn, the most racially diverse ACGME
1. Marrast LM, Zallman L, Woolhandler S, Bor
DH, McCormick D. JAMA Intern Med 2014;174:289–91.
Methods: Using Ryan Residency Program post-rotation survey data
collected in 2015-2018, we assessed intention to provide abortion and training
participation by resident race/ethnicity.
Results: The majority of residents (658, 79%) completed
surveys. Respondents were: 412(65%) white, 50(8%) black, 27(4%)
Hispanic/Latino, 118(19%) Asian, and 24(4%) other. Overall, 57% intended to
provide abortion for all indications and 82% for pregnancy complications.
The proportions that planned to provide abortions by race/ethnicity were: 70%
of Asian, 63% of Latino, 54% of white and 48% of black. While in bivariate
analysis Asians were more likely than whites to intend provision (p 0.003),
there were no difference by race/ethnicity when controlling for religion and
abortion attitudes, which were both associated with intention (p<0.05).
There was also no difference in training participation by race/ethnicity.
Discussions: The majority of residents overall planned to include abortion
in their practice. Increasing resident diversity may close the abortion access
gap in the US by providing care in underserved areas.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, UME, Public Health, Contraception or Family Planning,
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Teaching Lesbian, Gay, Bisexual, Transgendered, and Queer Family Building in a Third Year OBGYN Clerkship
explore third year medical students’ fund of knowledge and attitudes about
LGBTQ family building and third party reproduction.
Background: Medical student knowledge and attitudes about family building for LGBTQ
families and third party reproduction (TPR) varies based on student prior
experience and pre-clinical teaching.
The OBGYN clerkship is a unique opportunity for students to learn
medical knowledge and reflect on attitudes about this subject.
Methods: A quantitative study of knowledge and attitude among third year medical
students done after IRB approval. The intervention consisted of a one hour
lecture on TPR and participating in a group discussion about LGBTQ family
building. Students (231) completed a survey asking about their knowledge and
attitudes prior to starting the rotation and 178 completed the survey following
the intervention. Survey respondents rated items using a Likert scale and
completed a knowledge assessmented. Changes in knowledge scores were investigated
Results: Survey respondents were 51% female, 48% male, 1% gender non-conforming;
heterosexual 93%; and partnered 59%. Comfort with same sex couples was endorsed
by 92%. 56% of students felt that opting out of assisting a patient with family
building was not an option. Fertility knowledge increased from after
intervention significantly (p<0.0001). Some students, 29%, thought that infertility was hard to discuss,
but 67% felt it would be hard to discuss for same sex couples.
students’ fund of knowledge was increased with lecture and small group
discussion about TPR and LGBTQ patients. Students report being comfortable with
TPR and LGBTQ families but have some discomfort with varied pathways to
parenthood. Most feel that opting out of care for LGBTQ families is not an
CREOG & APGO Annual Meeting, 2018, Student, Faculty, Clerkship Director, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, UME, Lecture, Advocacy, Reproductive Endocrinology & Infertility, Sexuality,
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OB/GYN Residency Training in Transgender Healthcare: A Survey of U.S. Program Directors
characterize transgender healthcaretraining during OB/GYN residency.
Background: Professional medical organizations increasingly recognize the importance
of transgender healthcare, but the training currently offered in OB/GYN
residencies is not well understood.
Methods: We conducted a cross-sectional survey of a regionally representative
random sample of 100 from 236 OB/GYN residency program directors between August
2016 and June 2017. Questions addressed demographics, presence and type of
resident transgender healthcare training. We compared attitudes, barriers and
facilitators between programs that did and did not offer transgender healthcare
training using chi-squared testing.
Results: Among 61 responding program directors, 50.8% (N=31) reported offering
transgender healthcare training, Region of country, program type and size did
not differ between those offering and not offering training. Of those offering clinical training in
transgender healthcare, 41.9% did so in generalist and 22.6% in specialist
OBGYN clinics, 32.3% provided hormone therapy, and 16.1% learned about gender
reassignment surgery techniques.
Programs offering training were more likely to report a transgender
community requesting services (90.3% versus 53.3%, p=0.001), interested faculty
(45.2% versus 20.0%, p=0.03), time allotted for training (29.0% versus 0%,
p=0.001) and resident interest (64.5% versus 36.7%, p=0.03). The most significant barrier to providing
training was lack of interested faculty, reported by 73.3% of programs that did
not versus 38.7% that did offer training (p=0.006).
half of responding residency programs offer transgender healthcare training.
CREOG named transgender healthcare an educational objective in 2013 and should
support this by identifying interested faculty and resident champions who can
lead implementation at all OB/GYN residency programs.
CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, GME, General Ob-Gyn, Sexuality,
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Multidisciplinary Severe Maternal Morbidity Reviews Can Teach the Clinical Learning Environment Review Focus Areas of Patient Safety and Quality
Purpose: To describe
a resident focused multidisciplinary severe maternal morbidity (SMM) review
Background: The Joint Commission defined SMM as peri-partum blood transfusion of 4
units or admission to ICU and recommends multidisciplinary reviews to determine
opportunities for improvement in care
Methods: An ongoing process detects cases of SMM with root-cause-analysis performed
if case qualifies as a sentinel event. Data is extract and presented quarterly
to, a multidisciplinary committee to determine contributory factors,
opportunities to alter outcome, best practices and recommendations.
Results: Forty-five SMM cases were reviewed from 1/15 to 6/17 by residents 67%,
fellows 9%, nurses 7%, and MFM faculty 17%. Opportunities to alter care were
determined to be strong in 9% and possible in 62%. System/provider could alter outcome in 53% while the patient
could have altered outcome in 33% of cases.
Outcomes could have been altered by contraception/sterilization in 13%,
patient compliance 11%, early prenatal care 20%, referral/consultations 9%,
improved documentation 7%, early recognition 33%, team communication 4% and
management 31%. Good practices recognized included multidisciplinary
teamwork/communication 60%, evidence-based response 36%, timely recognition
24%, documentation 20%, quality obstetric care 22%, timely referral 13%, expertise
care 9%, and patient-centered-care 7%. Strong opportunity to alter outcome was
present with hypertensive crisis (p=0.026). Significant opportunities to alter
outcomes were: preterm SMM cases by contraception/sterilization (p=0.036);
patient compliance in Medicaid insured (p=0.01) and younger women (p=0.04).
Transfusions were recognized for the good practice of timely recognition
involvement in SMM reviews can determine care improvement opportunities and
provide training on safety and quality.
CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Quality & Safety, Public Health, Maternal-Fetal Medicine,
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Current Trends in Psychiatry Education Among Obstetrics & Gynecology Residency Programs: A Cross-sectional Survey of Program Directors
Purpose: To assess
the status of psychiatry education in Ob/Gyn residencies, focusing on perceived
barriers in education.
Background: One-third of women in the U.S. receive primary care exclusively from
Obstetrician/Gynecologists. Recent literature reveals gaps in recognition of
common psychiatric issues by Ob/Gyns.
Methods: Program directors (PDs) of all 249 accredited Ob/Gyn residency programs
received a 17-item anonymous questionnaire. Analysis of responses included
descriptive statistics, Student;s t-tests, and logistic regression.
Results: 111 programs responded to the survey (44.5%); 20 responses were partial.
85% offer didactic instruction in psychiatric topics, of which 82% are taught
by Ob/Gyn faculty. Academic institutions were more likely to offer didactics in
psychiatry than community institutions (OR=3.2, p=0.04). Only 20% of programs
offered an elective rotation in mental health. 20% of programs formally
evaluate residents on their management of psychiatric disorders.81% of PDs do
not agree that their residents are fully equipped to identify patients;
psychiatric needs; however, only 23% believe that mental healthcare should be
included as an ACGME milestone. Community programs were more likely to agree
with adding a milestone (p=0.002).The most common barriers to providing
additional psychiatric training were lack of sufficient integration between
Ob/Gyn and psychiatry (44%), ACGME surgical requirements (41%), and lack of
sufficiently knowledgeable instructors (36%).In addition, valuable qualitative
comments were received from respondents.
most programs deliver didactic training in psychiatric topics, most PDs
perceive that residents are not fully equipped to identify psychiatric needs.
The most common barrier to providing additional training was lack of
integration between Ob/Gyn and psychiatry.
CREOG & APGO Annual Meeting, 2018, Student, Resident, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, GME, Assessment, Lecture, General Ob-Gyn,
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Assessment of a Sexual Health Curriculum for High School Students Delivered by OBGYN Residents
purpose of the project was to build a curriculum for high school studentson
sexual health including reproduction, contraception, pregnancy and sexually
trasmitted infections. This curriculum was delivered to the students by the SIU
OBGYN residents. We evaluated the knowledge and attitudes of students,
knowledge, skills and attitudes of the residents focussing on what their
perceptions of the students.
Background: The teenage pregnancy and sexually transmitted infection rates for teens
in the Sangamon County are higher than nantional averages. The residents expressed an interest in
reaching out to schools. High school
health teachers were contacted and overwhelmingly agreed to have the residents
participate in health classes about reproductive health.
Methods: We built a curriculum based on ACOG materials and best practices for
reproductive health. Needs assessments
to measure knowledge and attidtudes were given to a sample of high school
students on reproductive topics. Another
assessment was given to residents to gage skills in teaching as well as
attitudes towards teen. Assessments of
knowledge after the sessions were given to the students. Teachers were asked to rate the sessions and
provide feedback. Residents completed a
Results: Students have large gaps in reproductive knowledge but have the perception
they knonwlegable. Accurate knowledge improved. Teaches overwhelmingly were
satisfied with the material presented and the format. Residents had high satisfaction rates for
this activity and better perceptions of students.
effectively administered a reproductive health care curriculum to high school
students that was informative, well received and changed attitudes of students,
teachers and residents.
CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, GME, Public Health, Contraception or Family Planning, Pediatric & Adolescent Gynecology, General Ob-Gyn, Sexuality,
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Health Equity: A Toolkit for Medical Educators
In 2003, the Institute of Medicine (IOM) published Unequal Treatment: Confronting Racial and Ethnic
Disparities in Health Care, which provided evidence that racial and ethnic minorities receive lower
quality healthcare. Two associated factors were social determinants of health and unconscious bias. The
LCME and ACGME have mandated educational curricula that educate future physicians in providing
culturally relevant care and promoting healthy equity.
Workshop Agenda: In this interactive workshop, the learners will identify social determinants of health
through case-base learning. They willl take an implicit aptitude test (IAT) to understand unconscious
bias. They will be given tools so they can adapt the workshop in their own institution.
Interactive Component: Participants will: 1. Be introduced to the diversity toolkit for medical educators
(10 min). 2. Separate into small groups to review cases and identify examples of social determinants of
health and unconscious bias in the cases (20 min). 3. Report back findings to group and create list of
social determinants of health and biases (15 min). 4. Participate in an IAT (10 min). 5. Discuss results (10
min). 6. Review applications and lessons learned. (10 min).
Take Home Product:
Participants will take home a facilitators guide on how to run the case-based workshop to help learners
identify social determinants of health and unconscious bias.
unconscious bias, social determinants of health, health equity
Faculty Development Seminar, 2019, Faculty, Clerkship Director, Residency Director, Patient Care, Professionalism, Interpersonal & Communication Skills, GME, UME, Lecture, Problem-Based Learning, Public Health, Advocacy, General Ob-Gyn,
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