Use of POEs( Point of EPA Evaluations) Across All Third Year Clerkships for Year Long EPA ( Entrustable Professional Activity) Monitoring
Purpose: To describe the development of a school wide and longitudinal
assessment of the core Entrustable Professional Activity (EPA)s using an easily
Background: Our insitution is part of the EPA pilot study
sponsored by the AAMC to explore the feasibility of teaching and assessing the
core EPAs. This year direct observation and assessment of the EPAs was
implemented across clerkships . Each clerkship was allowed to determine which
EPAs were applicable to their field.
Methods: The OBGYN department determined and assessed that
EPA1( History and Physical) , ] EPA2 ( Differential Dx) , EPA3 ( Dx
and Screening Tests) and EPA6 ( Oral Presentation) were core skills to
the clerkship with the following scale (1=student observed, 2=assessor had to
talk the student through it, 3=assessor had direct them from time to time, and
4=assessor needed to be available just in case.)
OB Other Clerkships p
EPA 1 3.0( 0.5) 3.5 (0.5) <0.0001
EPA 2 3.0 (0.9) 3.4 (0.6) <0.05
EPA3 3.0 (0.9) 3.4 (0.7) n.s
EPA6 3.1( 0.5) 3.4 (0.5) < 0.005
For the first 3 months there
were 2783 EPA assessments. The average score was 3.45. In comparison to other
clerkships, students on OBGYN received lower scores in EPA 1,2,6.( p<.0001,
P< .05 and P< .005) possibly
indicating more stringent grading by faculty or lower performance of
Discussions: In comparison to all other clerkships combines, student on
OBGYN received lower scores in all four EPAs possibly indicating more
stringent grading by faculty or lower performance of medical students. Lower
EPA scores may indicate more stringent grading by faculty or lower
performance of medical students. This could also be related to lower numbers of
overall EPAs reuired by the OB/GYN clerkship. Further research is needed
to determine the significance of these findings.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Practice-Based Learning & Improvement, GME, UME, Assessment,
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Trends in Off-Service Rotations in Ob/Gyn Residencies Before and After Duty Hour Restrictions
Purpose: To establish trends in off-service rotations in OB/GYN residencies
before and after duty hour restrictions.
Background: As co-morbidities in our patient population increases,
the skills required of OB/GYNs are changing, we sought to determine the
characteristics of off service rotations.
Methods: We searched websites of ACGME accredited OB/GYN
residency programs. We collected data on off service rotations: services,
number of rotations, and PGY year of rotations. Surveys were emailed to
programs regarding off service rotations in 2018 and before duty hour changes
Results: 92% (n=259) of programs had information available on
off-service rotations, of these, 24% (n=62) had no off-service rotations, 26%
(n=67) had 1, 25% (n=66) had 2, 13% (n=34) had 3, 12% (n=30) had 4 or more. The
majority (84%) of rotations were in PGY1. The most common rotations were ER
(47%, n=122), SICU (24%, n=62), IM (25%, n=66), MICU (9%, n=23). We received 53
responses to the survey (19% response rate). Of those who responded, the most
common rotations for 2018 and before 2003 were ER & SICU. The number of
programs with SICU rotations remained stable from 2003 to 2018 (43% vs 47%)
compared to 1.4 fold decrease in programs with ER rotations. The number of
programs with IM rotations decreased 2.5 fold from before 2003 to 2018.
Discussions: Duty hour restrictions have affected off-service rotations. A
quarter of all programs have no off-service rotations, with a decrease in ER
and IM exposure during residency. This does not reflect the breadth of
knowledge required of OB/GYNs today.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Quality & Safety, General Ob-Gyn, CREOG & APGO Annual Meeting, 2019, Student, Resident, Clerkship Director, Residency Director, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Team-Based Learning,
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Testosterone Supplementation in Women with Diminished Ovarian Reserve
Purpose: To evaluate the efficacy of transdermal testosterone as an
adjuvant to the standard IVF protocol to improve outcomes in women with
diminished ovarian reserve (DOR).
Background: Women with DOR have extremely low pregnancy rates
after IVF cycles, and there are currently few treatment options available.
Testosterone supplementation may improve ovarian response to stimulation via
Methods: This retrospective cohort study analyzed
83 IVF cycles based on inclusion criteria of age < 42 and
diagnosis of DOR (basal FSH > 10, AMH < 1, antral follicle
count < 6, or history of poor response [< 4 follicles]). Cycles in
the control group were carried out using the standard IVF protocol while
cycles in the treatment group involved the addition of transdermal testosterone
prior to ovarian stimulation. Four primary outcomes were evaluated: total
number of oocytes retrieved, number of mature oocytes retrieved, number of
embryos generated, and pregnancy potential of the embryos.
Results: Pretreatment with transdermal testosterone had no
impact on the total number of eggs retrieved after ovarian stimulation.
Testosterone had a negative impact of the number of mature oocytes retrieved,
but had no impact on the number of embryos generated from those oocytes.
Pregnancy rates between the treatment and control groups were no different per
embryo transfer, but were lower per cycle initiation with testosterone therapy.
Discussions: Within this study population, retrospective analysis of
testosterone therapy revealed no improvement in IVF outcomes. A randomized
controlled trial is recommended to further investigate this association.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Medical Knowledge, GME, CME, Problem-Based Learning, Team-Based Learning, Reproductive Endocrinology & Infertility,
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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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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
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.
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.
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
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Practice-Based Learning & Improvement, GME, CME, Assessment, Problem-Based Learning,
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Group Prenatal Care in OB/GYN Residencies
Purpose: To assess exposure to
group prenatal care (GPNC) in Obstetrics and Gynecology (OB/GYN) residencies,
and resident and program director (PD) perceptions of GPNC.
prenatal care is a model of prenatal care that has been growing in popularity
for several decades, especially among midwives. However, the state of GPNC in
OB/GYN residencies nationally is unknown.
electronic survey was sent to all OB/GYN PDs; subsequent similar surveys were
sent to OB/GYN residents through responding PDs as well as program
coordinators. The authors also encouraged PDs to complete the online survey in
person during the APGO/CREOG 2018 meeting. Descriptive statistics and logistic
regression were used for data analysis.
(38%) of OB/GYN PDs responded with a geographically balanced response rate.
Most had a positive perception of GPNC (71%), 82% believe that
residencies should include GPNC training, but only 44% had been exposed
themselves previously. 467/4956 (9%) of all OB/GYN residents nationwide
responded. Again, most residents had a positive perception of GPNC (70%),
while 87% said they would like to learn more during residency but only 33% reported
exposure during residency. No demographic factor was associated with a
positive perception of GPNC.
Discussions: Most OB/GYN PD
and resident respondents have positive perceptions of GPNC ,are interested in
learning more and including training in GPNC in the residency curriculum,
yet very few are exposed to GPNC. GPNC is not commonly included in OB/GYN
residency training despite a widespread interest in this model of prenatal
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Patient Care, Practice-Based Learning & Improvement, GME, Assessment, Team-Based Learning, General Ob-Gyn,
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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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Increasing Access to Emergency Contraception, Non-emergent Contraception, and LARC Referrals in the Emergency Room: A Resident-based Educational Intervention
Purpose: The aim of this study is to determine whether an educational
intervention improves emergency medicine residents\' knowledge of and personal
comfort with prescribing EC, offering non-emergent contraception, and referring
patients for LARCs.
Background: Approximately 50% of pregnancies in the United States
are unintended. Increasing access to emergency contraception (EC), non-emergent
contraception, and long-acting reversible contraception methods (LARCs) is one
way of decreasing unintended pregnancies. Emergency rooms enable physicians to
assess a woman\'s risk of unintended pregnancy and afford an opportunity to
intervene, if appropriate. Previous studies have found that emergency medicine
physicians do not always offer EC, even in cases of sexual assault. Barriers to
prescribing EC have been identified and include time constraints, lack of
clinical resources, concern about discouraging regular birth control, and
concern about birth defects.
Methods: Emergency medicine residents were given an interactive
lecture on contraception with emphasis on EC. They were also given a pocketbook
on contraception to keep. Pre- and post-lecture surveys were given in person,
along with another 6 months later. The surveys assessed knowledge, comfort
level, and prescribing/referring practices with both quantitative data and
qualitative data. Data will also be extracted from the electronic medical
record to assess if there was an increase in prescriptions for contraception
and/or referrals to family planning.
Results: The preliminary data analysis is currently being
conducted. Twenty-three emergency medicine residents completed the pre- and
post-test surveys. Additional information from prescriptions and referrals will
provide objective data to assess whether the educational intervention changed
Discussions: There are two hypotheses for this study. First, it is
hypothesized that an educational intervention will increase emergency medicine
residents\' knowledge of and comfort with EC, non-emergent contraception, and
LARCs. Second, there will be a significant increase in prescriptions for EC,
non-emergent contraception, and referrals for LARCs one year after the
educational intervention takes place. If the hypotheses are correct, residency
programs and hospitals should consider developing educational strategies and
policies to improve access to contraception in the emergency room and prevent
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, GME, CME, Assessment, Lecture, Quality & Safety, Contraception or Family Planning,
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Publication Rate of Abstracts Presented at the Annual APGO/CREOG Meeting
Purpose: To determine the publication rate of abstracts presented at
the Annual APGO/CREOG Meetings and compare it to rates from other medical
Background: Abstract presentations at conferences represent an
important means of disseminating scholarly activity. Failure to publish
educational research in peer-reviewed journals leads to unnecessary duplication
and publication bias.
Methods: The following characteristics were recorded from the
2014-2015 APGO/CREOG meeting abstracts: format (oral/poster), award status,
type of scholarship (research/educational innovation), methods
(quantitative/qualitative), and number of centers involved. Medline and
Google Scholar were searched using the names of the first and last author, and
key-words from the title and abstract. Chi-square and Fisher’s exact
tests were performed to determine which characteristics were associated with
publication. The previously reported publication rates from the 2005-2006
Research in Medical Education (RIME) and the Canadian Conference on Medical
Education (CCME) conferences were compared to the APGO/CREOG abstracts.
Results: 314 abstracts were reviewed, and 29 (9%) were
published. Award winning and oral abstracts, but none of the other
characteristics, were associated with higher publication rates. Of the
445 abstracts reviewed from the RIME and CCME conferences 141 (31%) were
published, which is a significantly higher rate than those from the APGO/CREOG
Discussions: Award winning and oral abstracts were more likely to be
published. The rate of publication for abstract presented at APGO/CREOG
meetings is notably lower than other conferences. APGO/CREOG should
consider ways to increase the publication rate which would potentially enhance
the reputation of both the presenters and the Annual Meeting.
CREOG & APGO Annual Meeting, 2019, Faculty, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, CME, UME,
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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%
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.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Systems-Based Practice & Improvement, GME, Independent Study,
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Navigate Stormy Seas with Effective Simulation Training in Delivering Serious News
evaluate the change in obstetrics and gynecology (OB/GYN) resident’s self-confidence
in delivering serious news after a communication simulation workshop.
Background: Although OB/GYN residents regularly disclose serious news to patients,
formal training on best communication practices is lacking. Using the VitalTalk
framework, we developed and evaluated a workshop for delivering serious news in
Methods: OB/GYN residents attended a 3-hour small group workshop, with didactic and
drills (1 hour) followed by practice delivering serious news with simulated
patients (2 hours). Change in self-confidence pre- and post-workshop was
measured using a 5-point Likert scale (1 is lowest, 5 is highest) and was
compared using Wilcoxon signed rank test (alpha = 0.05).
Results: Twenty-five residents completed the training. Residents agreed that delivering serious news
requires a discrete set of skills (89%) and is a procedure all residents should
learn (96%). Following the workshop, residents expressed greater confidence
explaining medical information (p<0.01), identifying and responding to
emotion cues (p<0.01), delivering serious news (p<0.001), and teaching
learners about how to facilitate delivering serious news (p<0.001).
Residents felt that it taught them skills they plan to use (96%), that
simulated practice prepared them better than clinical experience alone (92%),
that observing other residents improved their own communication skills (80%)
and that they would recommend the workshop (96%).
workshop was well received and associated with improvement in self-confidence
in delivering serious news. Longer-term observation is needed to see if this
confidence persists and translates into improved patient care.
CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Patient Care, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, CME, UME, Simulation, Standardized Patient, Maternal-Fetal Medicine, General Ob-Gyn,
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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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Development of an Effective Comprehensive Curriculum Regarding the Patient and Provider Experience of Stillbirth
develop and evaluate a comprehensive curriculum about stillbirth focused on
both the patient and the provider experience with this difficult topic.
Background: Pilot data from our institution showed that OB/GYN residents felt ill
prepared to care for patients with stillbirth, and that training about the
patient experience of stillbirth was impactful but emotionally distressing. We
sought to develop a comprehensive stillbirth curriculum that included
knowledge, communication skills, and emotional domains.
Methods: A four-part curriculum was created including: 1. Medical management, 2. A stillbirth panel
discussion with patients/families, 3. Simulation training in delivering serious
news, and 4. Workshop on resiliency. OB/GYN residents completed pre- and
post-testing for each session. Five-point Likert scales were compared using the
Wilcoxon signed rank test (alpha = 0.05).
Results: All 28 residents participated in parts of the curriculum, with 85%
attending two or more sessions.
Following the curriculum, we found statistically significant
self-reported improvements in multiple aspects of the stillbirth training:
general knowledge (p<0.01), appropriate tests to order (p<0.05),
interpretation of placental pathology (p<0.01), genetic evaluation
(p<0.01), comfort conveying sympathy (p<0.05), expressing emotion
(p<0.01), and confidence in delivering serious news (p<0.001). In the resiliency workshop, residents shared
ideas about how faculty can support them during difficult clinical situations.
comprehensive stillbirth curriculum which addressed the cognitive, emotional,
and skills aspects of this topic was well received and effective. Long-term
data is needed to evaluate whether these improvements persist and can enhance
resident satisfaction with other challenging topics within OB/GYN.
CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, CME, UME, Simulation, Lecture, Standardized Patient, Maternal-Fetal Medicine, General Ob-Gyn,
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An Analysis of the Nulliparous, Term, Singleton, Vertex Cesarean Birth Rate Among Practice Groups in a High-Volume Community Teaching Hospital
regarding factors that influence the nulliparous, term, singleton, vertex
(NTSV) cesarean birth rate is limited. This study’s purpose was to compare the
NTSV cesarean rate across practice groups at Virginia Hospital Center (VHC).
Background: VHC is a high-volume community teaching hospital in Arlington, Virginia.
Labor and Delivery is managed by different practice groups: hospitalists with
resident coverage, hospitalists without resident coverage, and private
attendings. Hospitalists are attending physicians who provide 24-hour in-house
management of laboring patients, whereas private attendings are only expected
to be in-house for patients in active labor.
Methods: This was a retrospective cohort study of all NTSV pregnant women who
delivered at VHC from 2014 to 2016. Chi-square tests were used to determine
whether NTSV cesarean rates were significantly different over time and across
different practice groups.
Results: There were 2,339, 2,090, and 1,673 NTSV pregnancies in 2014, 2015, and
2016, respectively. The NTSV cesarean rate decreased significantly by 30.8%
(31.8% in 2014, 27.7% in 2015, and 22.0% in 2016, 0.01). The NTSV cesarean rate was significantly
lower with hospitalists, with the lowest rate in the hospitalists with resident
coverage (NTSV rate of 19.8% for hospitalists plus residents, 25.7% for
hospitalists without residents, 30.3% for private attendings, 0.01). All groups decreased their NTSV
cesarean birth rate over time, with significant decreases in the hospitalists
without residents and private attending groups ( 0.01).
24-hour in-house attending coverage is associated with lower NTSV cesarean
rates. Resident involvement may also be a factor in lowering this rate.
CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Quality & Safety, Team-Based Learning, General Ob-Gyn,
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Creating a Win-Win: Medical Students as Assets in the Ambulatory Clinic
determine whether exemplary OBGYN clinician educators maintain productivity
with medical students in the ambulatory setting and if so, to design a clinic
workflow to optimize medical student involvement in outpatient clinics.
Background: With the challenges of integrating clinical, documentation, and teaching
responsibilities, it is not surprising that 40% of Hopkins OBGYN faculty feel
that medical students decrease productivity (68% response). Yet recent research
actually reports evidence of increases in physician productivity with medical
student involvement in an outpatient Neurology clinic (Tanner et al,
Methods: Through a novel exemplary clinician educator program known as the “Osler
Attending Preceptor in OBGYN,” six attendings were chosen based on student
surveys and interviewed. Qualitative analysis was performed on interview data.
Physician productivity data from the 2016-2017 academic year was obtained from
Results: The six Osler Attendings (OAs) were generalists, and three are actively
involved in the medical student clerkship. OAs at one suburban clinic billed on
average 18-32% more work-adjusted RVUs when a student was present in
clinic. Data analysis for OAs at two hospital-based clinics will be
completed in the next month. Additionally, OA productivity with and without a
medical student will be compared to non-OA designated faculty controls.
Using an iterative feedback process, we designed ideal workflow models for
OBGYN clinic and procedure-only visits, with a plan to pilot these workflows in
the next year to determine efficacy.
utilized effectively, medical students are an asset to physician productivity
in the outpatient setting.
CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Systems-Based Practice & Improvement, UME, Quality & Safety, General Ob-Gyn,
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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
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
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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Surfing into intern year, and the patient care calls
During this round table participants will acquire necessary skills and tools to
implement a straightforward workshop that uses small groups to guide fourth year students
through discussion of commonly encountered scenarios of intern year. Using case-based
scenarios faculty or resident facilitators can lead a small group of fourth year students through
management of common complications encountered on call. Participants will leave with
example cases and ideas for their own scenarios.
Faculty Development Seminar, 2019, Clerkship Director, Residency Director, Patient Care, Medical Knowledge, Practice-Based Learning & Improvement, UME, Problem-Based Learning,
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There’s More Than One Way to Teach Someone How to Skin A Cat: Evidence Based Strategies for Teaching To and By Residents
Background: K-12 educators have benefited recently from adopting medicine’s tradition
of evidence-based practice. Medicine, meanwhile, lags in its adoption some of the education field’s
longstanding best practices. Lectures are still the primary delivery method of information in many
hospitals, and residents receive little training in how to effectively educate med students and junior
residents. At NYU, we partnered with education experts to design a series of didactics for residents to
become more effective teachers and bridge the gap between our fields.
Workshop Agenda: The workshop will begin with an overview of adult learning and coaching theory,
followed by a description of the principles of effective professional development. Participants will
participate in a sample lesson (teaching clinical microskills), modeled by the presenters, to see the
principles in action, followed by a whole-group debrief of the demonstration. Participants will then
practice what they have learned; they will revise a resident as teacher lesson (teaching in the OR) to
incorporate the principles, receiving feedback from both peers and the presenters. Finally, participants
will have the opportunity to outline a workshop tailored for their specific context.
Principles of Effective Professional Development
1. Use a skill-based lesson design: introduction of context and content, demonstration, guided
practice, and independent or group practice
2. Use realistic scenarios and roleplay
3. Tailor didactics to the specific educational contexts of your residents
4. Give feedback and offer coaching during the session
Take-home product: Sample Resident as Teacher lessons, designed for Ob/Gyn residents at NYU, that
incorporate the principles of effective professional development.
Problem-Based Learning, Assessment, CME, GME, Practice-Based Learning & Improvement, Interpersonal & Communication Skills, Professionalism, Residency Director, Faculty, Resident, 2018, Faculty Development Seminar,
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Ryan Residency Programs and New York City Medical Student Education on Abortion; A Survey of Exposure, Knowledge and Attitudes
Background: Opt-out training increases resident exposure
to and participation in abortion care. Medical students on
their OB/GYN clerkships train with residents. In programs with opt-out
resident training, medical students may receive more exposure to abortion,
possibly influencing knowledge and attitudes.
Methods: We created a survey of medical student exposure to,
knowledge of, and attitudes towards abortion. APGO educational objectives were
used to develop knowledge questions. Clerkships directors distributed survey
links to participants at the completion of their OB/GYN clerkships.
Results: Five of the six M.D. schools in New York City
participated. 168 surveys were collected. Students rotated at 17
sites; 9 have Ryan programs. No statistically significant differences were
noted between Ryan and non-Ryan Programs when evaluating for knowledge,
attitudes and exposure. Overall, only 43.2% of students reported routinely
scheduled exposure to abortion during the clerkship. Less than half
(48.7%) scored >60% on the knowledge exam. Most (87.8%) felt
education about abortion is an important part of the medical school curriculum.
Discussions: Although medical students feel abortion is an important
part of medical school curriculum, overall knowledge and exposure to abortion
during training through the OB/GYN clerkships is low in New York City.
More accessibility to abortion services, perhaps through a medical school
opt-out learning structure may be considered to bridge the gap
between student learning expectations and realities surrounding abortion.
Keywords: Assessment, Community Health, Curriculum Development/Evaluation,
Evidence Based Practice, Residents As Teachers, Other
CREOG & APGO Annual Meeting, 2017, Faculty, Clerkship Director, Clerkship Coordinator, Medical Knowledge, Professionalism, UME,
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Resident Training in Hysterectomy and Patient Morbidity: Interrogating the Association
Background: Concern regarding resident inexperience as a
contributing factor towards unfavorable surgical outcomes is often claimed but
has been inadequately explored.
Methods: Data were abstracted from American College of Surgeons
National Surgical Quality Improvement Program (ACS NSQIP) on 33,278 benign
hysterectomies performed from January 2005-December 2012. Associations
between resident participation and morbidity were examined using
multivariate-adjusted regression, adjusting for age, BMI, race, ethnicity, year
of surgery, smoking, diabetes, hypertension, steroid use, ASA physical
classification, uterine size, and postoperative diagnosis. Cases without
resident involvement (63.4%) were used as the referent.
Results: Resident involvement was associated with significantly
longer operative times regardless of surgical approach and year of training
(all P < 0.0001). Odds of blood transfusion were increased with
resident participation in abdominal (OR 1.74; 95%CI 1.40-2.17) and laparoscopic
hysterectomy (OR 1.87; 95%CI 1.33-2.64), while odds of sepsis were increased in
abdominal (OR 2.29; 95%CI 1.37-3.83) and vaginal hysterectomy (OR 2.49; 95%CI
1.24-5.00). Odds of urinary tract infections were uniformly higher with
resident participation (all P < 0.001). When stratified by level of
training, these associations only remained significant in hysterectomies
involving senior residents. All associations were significantly
attenuated or absent when operative time was included in the model.
Discussions: Resident involvement is associated with modest increases in
the odds of blood transfusion and infectious morbidity after
hysterectomy. These associations are likely driven by prolonged operative
times with resident participation.
Keywords: Patient Safety/Medical Errors, Teaching Skills, Other
CREOG & APGO Annual Meeting, 2017, Resident, Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Quality & Safety, Public Health,
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