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Visualizing Quality Challenges and Using Corrective Refraction to Focus Change

Objective/Background: Quality improvement (QI) initiatives drive change to streamline processes, minimize waste, and improve outcomes. Although QI efforts are commonly applied to medicine, we receive little formal training.  Our workshop will address this knowledge gap by providing attendees with an infrastructure the use educate trainees and other providers about the core components of a QI initiative.

Workshop Agenda: We will provide an overview of QI improvement in industry with application to medicine (15 min).  The remainder of the workshop will be a “hands-on” group effort to address an identified quality issue.  Small group discussions will focus on an “Sticky Note” affinity sort identifying factors/barriers associated with the quality issue (10 min).  The group will share ideas and collaborate to create a cause-effect fishbone diagram and process flow map for the identified quality issue (20 min).  Each small group will then independently identify a proposed process improvement and define core process, outcome, and balancing measures to measure through a plan do study act (PDSA) cycle (15 min).  The workshop will conclude with a discussion of each groups plan and proposed measures (15 min)

Interactive Component:

  1. “Sticky Note” Affinity Sort Brainstorming
  2. Cause-Effect Brainstorming/Creation of Fishbone Diagram
  3. Process Flow Map Brainstorming
  4. Process Improvement Approach/Outcome Assessment Brainstorming
  5. Discussion of Proposed QI Approach and Measures

Take Home Product: Attendees will return to their institutions with a framework and “tool kit” to use to approach QI initiatives and to train medical students and residents. 


Topics: Quality & Safety, UME, GME, Systems-Based Practice & Improvement, Residency Coordinator, Residency Director, Clerkship Director, Faculty, Resident, 2020, Faculty Development Seminar,

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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.

Topics: GME, Practice-Based Learning & Improvement, Residency Director, Faculty, Resident, 2019, CREOG & APGO Annual Meeting,

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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 enhanced folliculogenesis. 

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. 

Topics: Reproductive Endocrinology & Infertility, Team-Based Learning, Problem-Based Learning, CME, GME, Medical Knowledge, Patient Care, Faculty, Resident, Student, 2019, CREOG & APGO Annual Meeting,

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Join the Club: Integration of the CREOG Journal Club Curriculum Improves OBGYN Residents Statistical Literacy

Purpose: To evaluate the impact on resident comprehension of biostatistics and research methodology after restructuring a residency journal club based on the CREOG journal club curriculum. 

Background: Studies reveal dismal resident performance on statistical literacy evaluations. However, little is known regarding OBGYN residents’ ability to interpret research methodology and results and how these abilities are impacted by the integration of evidence-based medicine principles into journal club curricula.

Methods: A pre-/post-intervention study of 22 OBGYN residents at a single institution was conducted to evaluate the impact of integrating the new curriculum (intervention). Participants were administered a survey comprised of 3 sections: a questionnaire in which residents ranked their perceived ability to analyze research literature, a previously validated fifteen question epidemiological/biostatistical knowledge tool, and five questions assessing the curriculum changes. Analysis was performed using Chi-square test, Wilcoxon rank sum test, and paired t-test. 

Results: The overall mean percentage correct on statistical knowledge and interpretation of results pre-intervention was 36.6% versus 67.3% (p<0.0001) post-intervention. Higher pre-intervention scores were associated with prior biostatistics training (45.2% vs 32.9%; p=.001); however, post-intervention, scores were equivalent (66.9% vs 69.4%; p=0.753). Residents (90.9%) preferred the restructured journal club, and 19/22 (86.3%) residents report their desire to continue participating in this journal club format post-training.

Discussions: Significant improvement in residents’ biostatistics knowledge, with resultant increased confidence in their ability to interpret clinical research results, was a demonstrated outcome of the implementation of the CREOG journal club format. Residency programs can provide more effective biostatistics training by incorporating this curriculum.

Topics: Problem-Based Learning, Assessment, CME, GME, Practice-Based Learning & Improvement, Medical Knowledge, Residency Coordinator, Residency Director, Osteopathic Faculty, Faculty, Resident, 2019, CREOG & APGO Annual Meeting,

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A Novel Approach to Improve Resident Research

Purpose: To improve the quality of resident research. 

Background: Over the past decade, scholarly activity has become more defined and outcomes-based. For years, residents have completed research projects that did not always fulfill the ACGME defined categories of publications (with PubMed IDs) or abstracts/presentations/posters (given at international, national, or regional meetings.) After assessing barriers to meaningful research, a formal strategy was developed to tackle obstacles to productive research; perceived lack of support, knowledge and motivation.

Methods: Residents began their research projects in their PGY2 year and received support and guidance from a medical editor and 2 faculty mentors. A formal program consisting of both a didactic curriculum (6 lectures) on research/statistical techniques and scheduled, bimonthly, mandatory meetings to assist with study design, IRB submission and presentations was developed. Throughout the research projects, a clear expectation of submission of the abstracts to selected national/regional meetings was made, and if accepted, residents were rewarded with financial subsidy to attend the conference.

Results: In 2016, 50% of resident research projects (3 of 6 projects) were accepted at national and regional meetings and in 2017, 70% (7 of 10 projects) were accepted. After instituting a comprehensive didactic, support and reward program, the number of research projects that were presented at meetings increased by 133%. 

Discussions: Implementing a scholarly activity approach that addresses issues of support, motivation and knowledge shows promise to improve quality of research. Further study is needed to make scholarly activity a more rewarding and productive part of residency.

Topics: Independent Study, GME, Professionalism, Medical Knowledge, Residency Director, Faculty, Resident, 2019, CREOG & APGO Annual Meeting,

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Spicing up Scholarly Productivity: Impact of a Structured Resident Research Program

Purpose: To evaluate whether implementation of a structured resident research program improved scholarly productivity at an academic obstetrics and gynecology (OB-GYN) program.


Background: The Accreditation Council for Graduate Medical Education requires resident participation in scholarly activity.  Since the 1970s, OB-GYN residents at University of Colorado (CU) have been required to complete a research project.  Starting with the graduating class of 2016, the CU OB-GYN program appointed two Assistant Program Directors of Resident Research who instituted a formalized research program including didactics, timelines, detailed protocol review, an expectation of manuscript submission, and an internal grant funding mechanism.


Methods: We compared scholarly productivity related to the required resident research projects for the graduating classes of 2012-2014 (before program implementation) and 2016-2018 (after implementation).  Two investigators independently searched for abstracts presented at national meetings, grants received, and publications using PubMed and Google search engines.  We also confirmed with the resident or mentor.  We compared the proportion of residents who had an accepted abstract or manuscript for their research projects using Fisher’s exact test.


Results: Fifty-four residents were included; 27 before and 27 after program implementation. The proportion of residents who had oral presentations at a national meeting remained the same (11%), whereas those with an accepted poster presentation increased from 44% to 89% (p=0.001).  The proportion who had manuscript publication increased from 26% to 59% (p=0.03). 


Discussions: A formalized, structured research curriculum resulted in improved scholarly productivity.  Our experience can guide other programs faced with the challenge of improving resident scholarly activity and output. 

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Systems-Based Practice & Improvement, GME, Independent Study,

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A Systematic Review and Meta-analysis of Simulation in Obstetrics Training

Purpose: To summarize the available data on the benefits of the use of simulation in training obstetric providers.


Background: Although simulation is being increasingly used to train obstetric providers, its overall benefit has not been systematically assessed.


Methods: A systematic search of MEDLINE was performed from May 2011 until April 2017 to identify research evaluating simulation in obstetrics. Data regarding provider type, instructional design, outcomes, and research quality, using the medical education research study quality index (MERSQI) and Newcastle-Ottawa Scale for Education (NOS-E), was abstracted. The average weighted Hedges g effect size was calculated.


Results: 1423 articles were identified, of which 63 met inclusion criteria.  39 were excluded because they were 1 group pretest-posttest studies (which nearly always show positive effects), and 5 were excluded because they did not contain sufficient information to calculate effect size, leaving 19 articles in the meta-analysis.  Of the selected articles 15 were randomized, 3 were nonrandomized, and 1 was a cross-over study.  Provider satisfaction was assessed in 2 studies, knowledge in 1, simulated skills in 11, clinical behaviors in 4, and patient effects in 1.  The average MERSQI and NOS-E quality scores were 13.3±23 (out of 18) and 5±0.8 (out of 6), respectively.  The weighted average effect size for the 19 studies was 0.71 (95% CI, 0.58-0.83).


Discussions: Simulation training in obstetrics is associated with moderate effects in provider satisfaction, knowledge, skills, behaviors, and impact on patients. The effects sizes described here were slightly smaller and methodological quality slightly higher compared to previous meta-analyses in Anesthesiology and Emergency Medicine    

Topics: CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, GME, CME, UME, Simulation, General Ob-Gyn,

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Abortion Practice After Routine Training: A Prospective Cohort Study

Purpose: To explore Ryan Program graduates; post-residency practice in abortion care.


Background: The Ryan Program supports residency programs to integrate abortion into training. In 2012 we commenced a prospective cohort study of graduated residents.


Methods: Residents complete web-based surveys after the family planning rotation and consent to participate in future studies. In 2016, we surveyed ob-gyns 2+ years after residency about their current practice. Post-rotation and post-residency surveys were matched and then de-identified.


Results: Sixty percent (394) who consented to participate responded. Nearly all graduates did abortions during residency (median of 31, including medical and procedural techniques).  86% fully participated in training, while 14% opted out for personal or religious reasons.  33% percent overall, and 40% of those who intended to, do abortions in current practice (median of 12 per month).  An additional 36% do not do abortions but wish to, and 16% do not nor desire to provide abortion care.  Physicians doing abortions are more likely to have fully participated (42% vs. 8%, p=.00) and did more abortions in training than those not doing abortions (median 32 vs. 16, p=.00). Those without an academic affiliation (n=134) are less likely to do abortions (23% v. 45%, p=.00) and more likely to want to integrate abortion care (56% v. 44%, p=.02). 


Discussions: One-third of ob-gyns who trained in Ryan programs include abortion care in their practice. An additional third are unable to despite intending to at the time of their training. Further studies are needed to understand the barriers to integrating abortion care into practice.

Topics: CREOG & APGO Annual Meeting, 2018, Resident, Faculty, Residency Director, Patient Care, Professionalism, GME, CME, Assessment, Public Health, Contraception or Family Planning,

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Becoming the Big Kahuna for a Student Research Experience


Evidence of academic productivity through research is increasingly important for students

seeking an OB/GYN residency. Our workshop will provide participants with concrete ways to

implement effective medical student research experiences at their institutions.

Workshop Agenda, Including Interactive Component:

Introduction (5min): Recent trends of student research participation from the NRMP Charting

Outcomes for the Match will be presented and importance of medical student research in

preparation for residency and applications will be highlighted.

Interactive Session (5min): Small-group discussions will focus on “How to create a research

environment for students and make mentors accessible?” to encourage student participation in


Recap (10min): Group discussion concerning approaches to create a robust research

environment for students.

Interactive Session (10min): Small-group discussions will focus on “How to create an effective

research elective?” to elucidate critical elements of a rotation.

Recap (10min): Group discussion/presenters supplement with personal and institutional

examples to include rotation core components and student resources to conduct research.

Interactive Session (10min): Small-group discussions will focus on “How to evaluate the

students on research rotations?” to define evaluation metrics for students engaged in research


Conclusion (15min): Group discussion of proposed performance metrics. Summative approach

to an effective research elective will be generated and provided to participants to use at their

home institution.

Take Home Product:

Participants will return home with an outline/toolkit (inclusive of examples rotational

templates, core components, performance metrics, and student resources for conduct of

research) developed during this interactive session to establish a formal student research

experience in OB/GYN.

Keywords: Research, Medical Student, Rotation

Topics: Faculty Development Seminar, 2019, Faculty, Medical Knowledge, UME, Team-Based Learning, Faculty Development Seminar, 2019, Faculty, Clerkship Director, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, Team-Based Learning,

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Let Sunshine in Your Learning Environment: A Novel Method Engaging Students in Difficult Conversations and Planning

Objective/Background: Engaging students to candidly share learning environment

experiences is essential to understand existing problems. Traditional information gathering methods,

including surveys, do not create a conversational space for student affirmation and empowerment.

Other informal conversations create buzz while not necessarily contributing to actionable intervention


The Group Level Assessment (GLA) is a recently described, participatory group method generating data

that participants themselves analyze and discuss. Published applications of the GLA include diverse participants, including Fortune 500 teams, and academic/community research groups. We have

conducted learning environment GLAs with medical students and residents to illuminate diverse

perspectives and plan to share this methodology by conducting a mock GLA with meeting participants.

Workshop Agenda: A 10-minute didactic session will introduce the benefits and format of the GLA. We

will then conduct a mock GLA and conclude with idea sharing and reflections on the process.

Participants will discuss potential applications of the GLA at their home institutions.

Interactive Component: We will conduct an abbreviated mock Group Level Assessment with

participants. During the GLA, participants respond to prompts or open-ended questions, addressing

group concerns and future directions. Prompts fostering participant imagination are included to raise

group energy level. GLA participants share prompt responses anonymously on Post-it Notes® placed on

wall charts. The responses are analyzed by small participant groups. Finally, the larger group discusses

the analysis and devises a strategic action plan.

Take-home Product: Participants will participate in a Group Level Assessment and leave with resources

to conduct a session at their home institution.

Key Words: Learning Environment, Methods

Topics: Faculty Development Seminar, 2019, Student, Resident, Faculty, Clerkship Director, Residency Director, Systems-Based Practice & Improvement, GME, UME,

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Willing and Able: A New Model for Resident Research

Background: OB/GYN programs rely on resident research projects for the ACGME scholarly requirements. Recently, ACGME has shifted to requesting better definitions/additional curriculums. This obligation shift represents a major change for residencies. The Six-Source Model of Influence (SSM) is a well-studied model for change based on Motivation and Ability of three forces: Personal, Social, and Structural. We established a team based resident research program using SSM. We then evaluated the success of our program.


Methods: We developed a resident research program over a seven year period in a OB/GYN resident program on probation in part due to lack of scholarly activities. Using SSM we identified personal motivation/ability, social motivation/ability, and structural motivation/ability factors for intervention. Personal motivation - research required for graduation. Personal ability- supported by monthly learning sessions. Learning topics included types of research studies, statistics, research design, and abstract/manuscript writing. Social Motivation and Social Ability were obtained by using a team research approach. Each team was comprised of a PGY1, 2, 3, and 4. Roles were delegated by year with team interaction and support. Structural Motivation - monetary rewards for project presentation and free trips if abstracts were accepted. Structural ability - designated research program director and support staff for statistics/project completion. Monthly sessions were built into academic schedule for group research. A designated resident research office was created.


Results: All 28 residents completed their projects on schedule. 8/28 residents went on to fellowship programs. 8/28 obtained positions in academic departments. 8 residents presented posters at national OB/GYN meetings including APGO, ACOG, CAOG, and SMFM. 4/28 residents gave oral presentations at one of these meetings. One resident was awarded the national ACOG prize for best resident research project.


Discussions: Resident research requirements are changing. Accepting that people do things for two reasons: motivation - because they want to, and ability - because they can, provides the basis for SSM. By applying these two reasons to the three forces of personal, social, and structural; a sound resident research model can be constructed. Our research presentations support SSM can produce positive, productive, and sustainable change.


Keywords: Curriculum Development/Evaluation, Instructional Materials/Methods, Research Methods

Topics: CREOG & APGO Annual Meeting, 2017, Residency Director, Systems-Based Practice & Improvement, GME, Assessment, Team-Based Learning,

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The Impact of Fifty-Years of Resident and Fellow Research in an Academic Gynecology and Obstetrics Department

Background: Research has been a core component of the department’s graduate medical education programs since 1967. On the occasion of the 50th resident and fellow research day, we quantified published papers as well as regional and national conference presentations. We were intersted to know the impact of the program and whether changes to the program format were assoicated with quantifiable changes in scholarly products.


Methods: We identified regional and national presentations and publications through a review of electronic sources including Pubmed and Web of Science, as well as the Department’s historical archives, and more recently the department’s academic scorecard. For manuscripts we determined the citation number and index score for papers using Web of Science and Incites. We then looked at the number of publications and presentations before (1997-2006) and after (2007-2016) changes to the program format.


Results: Our search yielded 157 manuscripts and 114 presentations at regional, national, or international meetings. We identified 20 papers that exceeded the citation index relative to their category by at least two.  There were 10 publications that were cited at least 50 times.  The number of original projects per trainee decreased by about 20% after program changes.  The proportion of projects resulting in publications was similar before (24%) compared to after (26%) the changes.  There was a 9% increase in proportion of projects presented at regional and national/international conferences after program revisions.


Discussions: The longevity of the department’s resident and fellow research program reflects the importance of inquiry and scholarship as core elements of training. This analysis documents the impact of our approach to resident and fellow research and provides data to quantify the return on investments committed by the department in terms of faculty mentorship and trainee effort, staffing, and financial resources to support resident and fellow initiated research and scholarship.


Keywords: Curriculum Development/Evaluation, Publication, Research Methods

Topics: CREOG & APGO Annual Meeting, 2017, Resident, Faculty, Professionalism, Practice-Based Learning & Improvement, GME, Problem-Based Learning,

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Mentoring Residents to Be Manuscript Referees


The quality of peer reviewers is extremely important to the quality and academic credibility of a journal. Peer reviewers or manuscript referees act as intellectual gatekeepers to the journal as they provide an objective assessment of a submitted manuscript and determine its value for publication. There is no formal process in which trainees learn about the peer review process and how to act as manuscript referees. 


Methods: Residents were offered the opportunity to individually review a submitted journal manuscript as part of the peer review process. First, the residents and attending discussed how the peer review process works. Residents then independently reviewed a submitted manuscript. They then discussed their findings and jointly formatted recommendations to the journal editor with the attending. Residents who had participated in the program were then surveyed via a Google Form regarding their experience learning about the peer review process and how to serve as a manuscript referee. Simple descriptive statistical analysis was performed.



12 residents were surveyed via Google Forms who had participated in the manuscript referee exercise. On average, it took residents 2.8 hours to review and discuss a manuscript. 92% felt that this exercise was very valuable for their medical education. 100% reported gaining more insight into / knowledge regarding the peer review process. 100% would be willing to serve as a manuscript referee again in the future. 100% would recommend participation to a fellow resident.


Discussions: A mentoring program to expose residents to the peer review process as manuscript referees was felt to be valuable and provide insight into the peer review process. A manuscript referee mentoring program would be easy to implement into any residency with faculty who regularly contribute to the peer review process.


Keywords: Curriculum Development/Evaluation, Evidence Based Practice, Faculty Development, Mentoring, Publication, Research Methods

Topics: CREOG & APGO Annual Meeting, 2017, Resident, Faculty, Residency Director, Medical Knowledge, Practice-Based Learning & Improvement, GME,

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Bringing Basic Science to the Women\'s Health Bedside: A Proof of Concept

Background: The University of Michigan’s new curriculum emphasizes an early introduction to clinical training. This presents a challenge as it condenses two years of traditional classroom basic sciences into just one. Therefore, an elective was developed to integrate reproductive sciences into clinical training.


Methods: The elective was developed by OBGYN departmental medical education experts and faculty from the pathology department. The goal was for students to engage in patient care, and relate these experiences to underlying pathophysiology. The topic of placental pathology was chosen as a pilot, and faculty from MFM, pathology and the basic sciences were recruited.


Results: The pilot course was designed so students initially review normal placental histopathology and placental abnormalities. After following patients with interesting clinical findings, students examine specific patients’ placental histopathology with the expertise of pathologists. The latter half of the course focused on a literature search of a basic sciences topic of interest, which was presented to the department.


Discussions: We were successful in developing and offering an elective that revisits basic science education in the context of clinical activities. We identified areas for improvement, including narrowing a topic of interest earlier to allow students to expand their scientific inquiry, and realize the vast amount of resources required to optimize learning. We envision that this pilot can be broadened to include concepts such as fetal malformations, genito-urinary dysplasia, and gynecological cancers.


Keywords: Curriculum Development/Evaluation, Interdisciplinary, Research Methods, Other

Topics: CREOG & APGO Annual Meeting, 2017, Student, Faculty, Clerkship Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, UME, Independent Study, Maternal-Fetal Medicine,

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Are We on the Same Page? A Multi-Institutional Evaluation of Faculty and Resident Training Needs

Background: Resident and faculty needs are important in guiding the educational agenda; studies demonstrate that these groups do not always agree on needs. A previously piloted 50-item needs assessment evaluating content areas of feedback, the 15 Ob-Gyn milestone procedures, and simulation was used to assess and compare faculty and resident needs.


Methods: The needs assessment was administered electronically to two academic Ob-Gyn residency programs (located in South Carolina and Texas) in June 2016; all items were ranked on a 5-point agreement scale. Equivalent versions were written to capture resident and faculty perceptions of the training program; results were anonymous and participation was voluntary.


Results: 42 surgical faculty (52.5%) and 47 residents (62.5%) completed the needs assessment; t-tests compared resident/faculty group differences. Both groups agreed on the adequacy of surgical content, however, faculty consistently self-reported delivering feedback at a significantly higher level than residents’ perceived receiving it (p < 0.05) for 8/16 feedback items.  Overall, both groups were least satisfied with training in breech vaginal delivery, 3rd/4th-degree laceration repair and operative vaginal delivery; residents were most satisfied with training in cesarean section while faculty were most satisfied with laparoscopy. Both groups agreed simulation can improve procedure performance; no significant differences existed. These findings were consistent between institutions although each institution’s levels of agreement differed for individual items.


Discussions: Although residents and faculty agree on areas of strengths and weaknesses, significant differences exist in perception of feedback delivery and reception.


Keywords: Assessment, Communication Skills, Curriculum Development/Evaluation, Milestones, Research Methods

Topics: CREOG & APGO Annual Meeting, 2017, Resident, Faculty, Residency Director, Interpersonal & Communication Skills, GME, Assessment,

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All alone at the front of the caravan? Straggling Behind? Lead your team toward the oasis with a QI simulation

Workshop: APGO Fac Dev Seminar 2017
Healthcare educators are asked to develop proficiency in QI knowledge and skills but bothbecoming trained and training others are daunting prospects. This workshop takes teams through an adaptable rapid cycle QI simulation project.
Workshop Text: Continuous quality improvement (QI) is the goal of all of our endeavors and yet not one
we can achieve without our teams. Currently the AAMC, ACGME and ABOG all have expectations of QI
competency for students, residents and faculty. Despite availability of resources for training, many are
too intimidated or time constrained to begin to learn QI. In this workshop a QI simulation demonstrates
how the steps of a rapid cycle QI project engages learners in experiential QI application. This simulation
has been used with interprofessional groups along the educational continuum, here adapted for a
Womens health audience. You will participate in a simulated QI project acting on an adverse event
report. Teams will develop an aim statement, then choose from a menu of resources to learn about
relevant local and national data. Cause and effect diagrams and process mapping will be developed to
understand patient flow and where problems occur. Selected interventions will lead to outcome data for
your accelerated run chart (fast forwarding results). Plan Do Study Act cycles will revise interventions
with new data results. Prior to the workshop QI novices are encouraged to complete the (free) Institute
for Healthcare Improvement modules QI101 and 102. QI leaders will leave with a model QI simulation
adaptable for interprofessional learners of all backgrounds, modifiable to your clinical and educational
environments. QI novices will leave having participated in a rapid cycle QI simulation preparing you to
embark upon your own educational or clinical QI projects having utilized the tools of QI.

Topics: Faculty Development Seminar, 2017, Systems-Based Practice & Improvement, GME, CME,

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Furthering the Validity of a Tool to Assess Non‐Directive Pregnancy Options Counseling Skills

Background: The Association of Professors of Obstetrics and Gynecology has designated a non-directive pregnancy options counseling as one of the few skills in women’s reproductive health at a “does” level of competency, creating the need for a validated assessment tool.  


Methods:   A previously developed rating tool was distributed nationally for enhancement of content validity. A pilot, using an OSCE that also had been previously developed, was implemented in a family medicine clerkship with third year medical students. Response process data directed improved clarity and organization of the tool. Three raters trained through review of training videos and a think-aloud process then used previously taped videos of 46 performances to yield the data for internal structure and correlation with other variables.


Results:   The content validity of the original tool was affirmed. Internal structure data included a Cronbach’s alpha of 0.704. Overall communication skills and the global rating for patient-centered communication generated moderate to substantial agreement. All but one item unique to the clinical situation of pregnancy options counseling generated substantial to near-perfect agreement. Relations to other variables within the checklist were strong, while relations to variables assessed outside of this OSCE, including clerkship communication grades, was poor.


Discussions:   This tool for assessing pregnancy options counseling skills has excellent content and strong internal structure validity. Further work to improve the validity of the global and overall communication skills scales may be necessary for summative use.


Keywords: OSCE asssessment pregnancy-options

Topics: CREOG & APGO Annual Meeting, 2016, Faculty, Clerkship Director, Osteopathic Faculty, Residency Director, Patient Care, Professionalism, Interpersonal & Communication Skills, GME, UME, Assessment, Standardized Patient, Public Health, Contraception or Family Planning,

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Appraising Medical Literature: the Effect of a Structured Journal Club Curriculum Using the Lancet Handbook of Essential Concepts in Clinical Research© on Resident Self-Assessment and Knowledge in Milestone-Based Competencies

Background: Competency in the appraisal, interpretation, and application of medical literature is imperative to quality, evidence-based medical care and lifelong learning.  These competencies are included in milestone-based evaluation of obstetrics and gynecology residents and journal clubs are a common forum for teaching them. However, evidence suggests the education and understanding in research design, interpretation, and physician numeracy is lacking amongst trainees.


Methods: We developed a year-long journal club curriculum that paired a chapter from The Lancet Handbook of Essential Concepts in Clinical Research with a research article relevant to the chapter subject matter. Prior to implementing the year-long curriculum, 16 Ob/Gyn residents were asked to complete a voluntary electronic survey that included 6 self-assessment and 29 objective knowledge questions pertaining to milestone-based competencies in self-directed learning and critical appraisal of medical literature. The same survey was re-administered after the curriculum was completed.


Results: There was no significant difference in answers to the self-assessment questions before and after the curriculum change.  The average percent of correct categorizations for the 29 objective questions increased from 69.7 (±17.9) before the curriculum change to 76.2 (±19.6) after the curriculum change (p=0.45).  More residents correctly categorized at least 80% of the objective knowledge questions correctly after the curriculum implementation (80.0%) as compared to before the implementation (20.0%), although the difference was not statistically significant (p=0.07; OR 0.18,, 95% CI 0.02-1.31).


Discussions: While limited by a small sample size, our assessment indicates there may be some benefit to incorporating a basic and concise text reference such as The Lancet Handbook of Essential Concepts in Clinical Research© to a journal club curriculum in order to improve objectively demonstrated knowledge in self-directed learning and critical appraisal of medical literature.


Keywords: evidence-based medicine; knowledge translation; faculty development

Topics: CREOG & APGO Annual Meeting, 2016, Resident, Faculty, Osteopathic Faculty, Residency Director, Medical Knowledge, Practice-Based Learning & Improvement, GME, CME, Problem-Based Learning, Team-Based Learning, Faculty Development,

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A Systematic Review of Randomized Controlled Trials in Obstetrics and Gynecology Medical Education

Background: The volume of  Ob-Gyn MedEd research is steadily increasing. Systematic reviews of Ob-Gyn MedEd research are limited and no comprehensive systematic review of RCTs has been completed.


Methods: A literature search encompassing Ob-Gyn MedEd RCTs published between January 2000 and July 2015 was performed. MEDLINE database and author references were searched. Inclusion criteria included: obstetrics and gynecology and related subspecialties, and undergraduate and graduate medical education. Abstracts were coded based on topics, study subjects, data collection method, method of randomization, journal type and statistical methodology. Each manuscript was independently assessed by 2 reviewers.   PRISMA guidelines were followed for the planning, conduct and reporting of the review.   


Results: 51 abstracts meeting inclusion criteria were evaluated. The most common RCT topics studied were simulation (57%), educator approach (12%), and teaching the clinical sciences (8%). Methods of data collection include use of performance scoring and global rating scales (51%),and surveys, questionnaires, and written testing (33%). Groups studied included residents (59%), medical students (39%), and both (2%). Studies were published in obstetrics and/or gynecology journals (71%), followed by surgery (10%) and medical education (8%).


Discussions: There are few studies with sufficient commonalities to perform meta-analyses on Ob-Gyn MedEd topics.  The data provide a road map for future studies.


Keywords: MedEd Research, Ob-Gyn, Trials

Topics: CREOG & APGO Annual Meeting, 2016, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Systems-Based Practice & Improvement, GME, UME,

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A Biweekly Research Workgroup Increases Resident Research Productivity

Background: Almost all residency programs require a resident research project, yet teaching and mentoring of the required skills are often lacking. Nationally, residents report a suboptimal environment for promoting research and do not feel comfortable in their research skills at the completion of residency. In August 2013, a biweekly Gynecologic Oncology Research Workgroup was initiated for OBGYN faculty, fellows and residents. An informal, discussion style format was adopted as a forum for brainstorming research ideas, formulating study protocols and collaborating on IRB submissions. Additional aims included editorial feedback on abstracts/manuscripts as well as oral presentation rehearsal/review.


Methods: The Gynecologic Oncology division\'s academic productivity was queried for the 24 months before and after workgroup initiation, specifically assessing resident involvement in IRB submission, abstract presentation and manuscript preparation.


Results: In the 24 months prior to the initiation of the Gynecologic Oncology Research Workgroup, resident involvement in Gynecologic Oncology IRB submissions and manuscript/abstract preparation was limited. Two of five IRBs submitted pre-workgroup involved resident collaborators, compared to three of six IRBs submitted post-workgroup, all three of which had a resident primary contributor. Five papers/abstracts were published pre-workgroup, none with resident participation. Post-workgroup, nine papers/abstracts were prepared, all nine of which involved resident contribution as first or second author.


Discussions: Engaging OBGYN residents in meaningful, productive research in Gynecologic Oncology can be challenging given resident and faculty clinical time constraints as well as the inherent demands of the research process. Establishment of a dedicated, biweekly Gynecologic Oncology Research Workgroup improved resident contribution in both the initiation of research at the IRB level and considerable resident involvement in abstract/manuscript publication.


Keywords: research, education, productivity

Topics: CREOG & APGO Annual Meeting, 2016, Resident, Faculty, Residency Director, Medical Knowledge, GME, Team-Based Learning,

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