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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.

Topics: 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 training.

 

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%).

Prior to 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 27%.

The two barriers most frequently encountered, regardless of program training status, were problems with billing and compensation for services (61%) and the pharmacy (33%).

Programs 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.

Topics: 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 curriculum project.

 

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 open-ended responses.

 

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 serving.  

Topics: 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.

Topics: 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.

Topics: 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 justice.

 

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.

 

Discussions: 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.      

Topics: 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 cultural differences.

 

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.

Topics: 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

 

Background: Our 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.  

 

Methods: A 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.

Topics: 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 residents

 

Background: Immediately 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.

 

Methods: A 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 type. 

 

Results: Sixty-two (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.

Topics: 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.

 

Background: Low 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 described.

 

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 excluded.

 

Results: Eighty 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.  

Topics: 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.

 

Background: Breastfeeding 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.

 

Methods: We 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.

 

Results: We 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.

Topics: 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 practice.

 

Background: Many 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.

Results: Twenty-two 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 sessions.

 

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 patients.

Topics: 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.

 

Methods: A 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 PPBTLs.

 

Results: Fifty-one 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%.

 

Discussions: Targeted 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.

Topics: 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 residency.

 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. 

Topics: 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

Purpose: To 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 using t-tests.

 

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.

 

Discussions: Medical 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 option. 

Topics: 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

Purpose: To 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).

 

Discussions: Only 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.

Topics: 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 program.

 

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 (p=0.045).

 

Discussions: Residents’ involvement in SMM reviews can determine care improvement opportunities and provide training on safety and quality.

Topics: 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.

 

Discussions: While 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.

 

Topics: 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: The 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 follow-up assessment.

 

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.

 

Discussions: Residents effectively administered a reproductive health care curriculum to high school students that was informative, well received and changed attitudes of students, teachers and residents.

Topics: 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

Objective/Background:

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.

Keywords:

unconscious bias, social determinants of health, health equity

Topics: 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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