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Use of POEs( Point of EPA Evaluations) Across All Third Year Clerkships for Year Long EPA ( Entrustable Professional Activity) Monitoring

Purpose: To describe the development of a school wide and longitudinal assessment of the core Entrustable Professional Activity (EPA)s using an easily accessible App.

 

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.)

Results:

 

                       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 medical students.

 

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.

Topics: 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 in 2003.

 

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.

Topics: 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 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: 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.

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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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: 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.

 

Background: Group 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.

 

Methods: An 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.

 

Results: 96/254 (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 care.

Topics: 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 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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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 behavior.

 

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 unintended pregnancy.

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, 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 education conferences.

 

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 meetings (p>0.05).

 

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.

Topics: 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% (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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Navigate Stormy Seas with Effective Simulation Training in Delivering Serious News

 

Purpose: To 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 OB/GYN.

 

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%).

 

Discussions: This 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.

Topics: 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 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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Development of an Effective Comprehensive Curriculum Regarding the Patient and Provider Experience of Stillbirth

Purpose: To 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.

 

Discussions: A 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.

 

Topics: 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

Purpose: Data 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).

 

Discussions: Having 24-hour in-house attending coverage is associated with lower NTSV cesarean rates. Resident involvement may also be a factor in lowering this rate.

 

Topics: 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

Purpose: To 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, 2017). 

 

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 department administrators.

 

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.

 

Discussions: When utilized effectively, medical students are an asset to physician productivity in the outpatient setting.  

Topics: 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

Objective/Background:

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

research.

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

electives.

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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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.

Topics: 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.

Topics: 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

Topics: 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

Topics: 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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