Vaginal Hysterectomy Training in Residency: How Many Cases Is Enough?
Purpose: To evaluate the association of number of total vaginal hysterectomies
(TVHs) performed during residency on comfort level and practice habits after
Background: TVH is the preferred route of hysterectomy whenever
feasible. Evidence is limited about the number of cases needed in residency to
produce physicians comfortable with TVH.
Methods: We performed a cross-sectional study of 2007-2017
graduates of the MAHEC OBGYN Residency Program. Using an online survey,
self-reported feedback was collected on number of TVHs performed in residency,
ratings (5-point scales) of adequacy of training and comfort level with the
procedure, and the number of TVHs performed in current practice. Spearman
correlation (coefficient rho) was used to examine the correlation between the
number of TVHs performed in residency and outcomes.
Results: Of the 35 graduates meeting inclusion criteria, 31
(88.6%) completed the survey. The range of TVHs performed by graduation varied
from 10-59. TVHs performed in residency was significantly correlated with:
perceived overall quality of training in TVH (rho=0.565; p=0.001), level of
comfort performing TVH within 12 months of graduation (rho=0.384; p=0.43) ,
level of comfort currently (rho=0.414; p=0.028), and number of TVHs performed
over the last year (rho = 0.448; p=0.042). Graphic representation
of TVHs performed in residency against comfort ratings demonstrated
substantial, favorable increases in ratings from 10-19 to 20-29 and to 30-39
and leveling off from 30-39 and above.
Discussions: The number of TVHs performed in residency is associated with
alumni perception of training quality, comfort level and practice habits. Our
alumni suggest 30-39 TVHs may be the “sweet spot.”
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Practice-Based Learning & Improvement, GME, 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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Too Many Learners? Do Students Belong in Resident Continuity Clinics?
Purpose: Determine the prevalence of medical students in OBGYN
resident continuity clinics and describe effects on the learning environment
when students and residents work together in this setting.
Background: Patient continuity is an ACGME requirement often
fulfilled through a resident run continuity clinic. It’s unknown how frequently
students rotate in these clinics, or how multiple levels of learners influence
Methods: We surveyed OBGYN program managers using a national
listserv. Resident and student surveys were based on a Likert scale and sent to
all OBGYN residents and students that rotated at our institution from
Results: Program managers responded from 45 programs and 75.6%
scheduled students in resident continuity clinics. Our response rates were
79/116(68.1%) for students and 21/24(87.5%) for residents. A one-sample
Wilcoxon signed rank test was used to test the hypothesis that the typical
response on the five-level Likert scale was \"Agree\" or \"Strongly
Agree.\" Of medical students, 88.6% stated that they agreed or strongly
agreed they enjoyed working with residents (p<0.001) and 60.8% stated
they agreed or strongly agreed residents were effective teachers (p<0.001).
Among residents, 52.4% agreed or strongly agreed that they enjoyed working with
students (p<0.001). However, 61.9% said they agreed or strongly agreed they
were too busy to be effective teachers (p<0.001).
Discussions: Many institutions have students rotate in resident continuity
clinics. Residents and students have positive views regarding their
interactions. Although students were satisfied, residents expressed concerns
about their ability to be effective teachers given clinical demands. Our
results highlight the importance of developing resident teaching skills.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, CME, UME, Assessment, Problem-Based Learning, Team-Based Learning, General Ob-Gyn,
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The Substantial Rise of Clinician Educators Among Obstetrics and Gynecology Faculty, 1977-2017
Purpose: To determine trends in faculty career development, stratified
by gender and under-represented minority (URM) status, for
obstetrician-gynecologists (ob-gyn) at all U.S. medical schools.
Background: The growing number of faculty and opportunities for
career pathways have expanded considerably at U.S. medical schools. This growth
differs between clinical specialties. Any dominance of non-tenure faculty has
important implications on academic promotion policies and teaching
Methods: In this observational study, we used the Association
of American Medical Colleges Faculty Roster to describe trends in career
pathways (clinician educator, tenure-track, tenure) of full-time faculty at all
U.S. MD-granting medical schools between 1977 and 2017. Proportions of
female and URM faculty on each pathway were compared with that of male and
Results: Between 1977 and 2017, the number of full-time faculty
increased from 1,628 to 6,347, mostly as clinician educators (from 345 to
4,607; 13.4-fold increase) than as being either tenured (from 457 to 587) or on
tenure-track (366 to 514). The proportion of clinician educators increased from
21.2% to 69.4%. The availability of tenure positions remained constant (92.7%
of all schools); however, the proportions of tenured and tenure-track faculty
declined steadily from 28.1% and 22.5%, respectively to 8.2-9.1% for each
group. The proportions of male and female faculty who were tenured or on
tenure track declined from 52.9% and 37.1% respectively to 23.3% and 13.6%. The
proportion who were tenured or on tenure-track declined similarly for URM (from
55.3% to 13.4%) and non-URM (from 50.2% to 18.0%) faculty.
Discussions: The substantial rise in ob-gyn faculty is largely among those
who pursued careers as clinician educators. This finding confirms the essential
need and protected time for educator development programs at all schools to
more effectively teach medical students and resident physicians.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Professionalism, CME, Lecture,
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The Residency Buddy System\': A Better Way to Encourage Laparoscopy Simulation Training?
Purpose: To determine if a “buddy-system” compared to independent
training increases laparoscopic simulation time amongst residents.
Background: Based on prior research, laparoscopic box-trainers
improve proficiency on surgical skills, however voluntary simulation time by
residents is traditionally low. We propose that a buddy system approach to
simulation will increase laparoscopic training time, and further improve
Methods: Thirty-two residents at a single obstetric and
gynecology residency program were consented for the study. Each
buddy pair was composed of a junior and senior resident. During the first half
of the 20-week study, 12 residents were randomly assigned a buddy while 20
remained solo. During the second half, solo-trainers were assigned
buddies and conversely buddies were made solo. Residents recorded check-in and -out
times electronically. (Assignments were provided via email at the beginning and
mid-way points; no other contact was made.) At the conclusion of the study
period a survey link was distributed.
Results: Six of the 32 residents (18.8%) attended simulation in
the 20-weeks, with an average time of 2 hours 14 minutes. In the solo-trainer
group, 1 resident checked in 3 times and 2 residents once. In the buddy group,
1 pair checked in together and 1 person checked in alone. Fifteen
residents (46.9%) completed the survey. Thirteen (86.7%) agreed they
accurately reported times; 1 was neutral and 1 never attended. All communicated
with their buddy monthly or less frequently, while 10 of them never
Discussions: Residents’ laparoscopic simulation time was dismal at our
program in this study. Dedicated mandatory simulation time may increase
CREOG & APGO Annual Meeting, 2019, Faculty, Residency Director, Medical Knowledge, CME, Independent Study, Minimally Invasive Surgery,
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The Effect of a 6-week vs 4-week Clerkship on NBME Shelf Scores in Obstetrics and Gynecology
Purpose: To determine the effect of a 6-week vs 4-week clerkship on
NBME shelf scores in Obstetrics and Gynecology
Background: A medical school wide curriculum change took place at
Penn State College of Medicine during the 2017-2018 academic year to increase
longitudinal and integrated learning. The OB/GYN clerkship was
shortened to 4 weeks and placed into a fifteen-week block with other
rotations. OB/GYN students continued to rotate through three
clinical sites. Shelf exams, previously given at clerkship
conclusion, were then administered in the final week of the block.
Methods: A retrospective review of NBME shelf scores for our
Obstetrics and Gynecology clerkship was performed for academic years 2015-2017
and compared to those from academic year 2017-2018. Student scores
were collected and de-identified. Mean scores were then obtained for
each six-week rotation in 2015-2017 as well as the 4-week rotation school
Results: A comparison of 4-week versus 6-week shelf scores at
each site showed a significant decrease of 2.16 in the shelf scores at Hershey
during the 4-week rotation (P=0.03). Harrisburg Hospital scores
decreased by 0.31 (P=0.83) while York scores increased by 2.23 (P=0.21) during
4-week rotations. However, a decrease in overall mean shelf score in
4-week scores compared to 6-week scores across all sites by 0.08 was not
Discussions: Analysis of the shelf scores across all of the 4-week
rotations following curriculum change revealed no significant difference in
mean scores when compared to the 6-week rotations. However, there
was a site-specific significant decrease in mean scores at our main
CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Clerkship Coordinator, Medical Knowledge, UME, Assessment,
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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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Resident Documentation and Coding Curriculum Can Be Improved Through One-on-one Education
Purpose: Assess impact of one-on-one education of residents in billing
Background: As billing and coding education was changed from
generalized education at didactics to more intensive one-on-one education, the
revenue team evaluated the impact for accuracy in billing and monetary impact.
Methods: Three groups of residents were analyzed. Group 1 (n=4)
were fourth year residents at intervention and had a general meeting with other
departments about coding and then one or two one-on-one sessions. Group 2 (n=4)
were third year residents at intervention and had two to three one-on-one
sessions. Group 3 (n=4) were second year residents at intervention and had
three consistent one-on-one sessions every 6 months. A selection of 10 records
per resident were randomly selected for review by a certified coder to identify
documentation and coding opportunities.
Results: The documentation and coding accuracy improved with
increased education. Accuracy Group 1: 55%, Group 2: 76%, Group 3: 89%. Revenue
lift was also analyzed with these encounters and an average lift of ~$40 was
noted between group 1 and group 3.
Discussions: By consistent billing and coding one-on-one education for
residents, the accuracy of coding improved as seen in the differences in
accuracy rate between graduating 4th years (55%) and second year residents
(89%). Residents see 5 patients on average per clinic session in their final 2
years and have approximately 30 clinics per year. This equates to an extra
$12,000 in revenue per resident over their final two years. By investing in
billing and coding education, accuracy and revenue were increased.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, General Ob-Gyn,
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Professionalism Training in the Global Setting: Program at Ayder Hospital and Mekele University in Ethiopia
Purpose: Using the current partnership between University of Illinois
in Chicago, Illinois (UIC) and Ayder Hospital/Mekele University in Mekele,
Ethiopia (Ayder), this study evaluated the effectiveness of professionalism
training for medical students and resident trainees at Ayder.
Background: Threats to professionalism in medicine have led to
more universal teaching of professionalism to trainees and practicing
physicians. Currently, professionalism is listed by the ACGME as one of the 6
general clinical competencies. Many programs that include group sessions
and standardized patients have been implemented in American institutions,
although little research has been directed towards professionalism training in
a global health setting. This study aimed to determine the effect of a
professionalism training at Ayder.
Methods: Participants in a professionalism and communication
training were offered participation in a pre- and post-test survey. The survey
focused on the perception and function of professionalism in the medical
workplace, and included quantitative and qualitative data. The pre- and
post-test surveys were conducted prior to and at completion of the training.
Results: A convenience sample of medical students and resident
trainees at Ayder participated in the pre- and post-test surveys. The training
had a positive effect on the perception of professionalism and identified
opportunities for behavioral improvement.
Discussions: We saw that the professional training was an effective tool
for implementing professionalism into medical education curricula in this
global health setting. However, further research regarding the long term impact
and ability to implement clinical competencies into global health settings will
help determine the plausibility of repeating such a study in other sites.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, Simulation, Global Health, Public Health,
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Predictors of Trainees\' Willingness to Provide Family Planning Services: A Survey of Ob-Gyn Residents
Purpose: To determine factors that contribute to a resident’s
willingness to provide abortions post-residency.
Background: The shortage of abortion providers makes accessing
care difficult. Personal and environmentalfactors within the residency training
environment may be modified so that greater numbers ofgraduates opt to become
Methods: A multiple-choice survey was sent to all ACGME
accredited OB/GYN residency programs. Data on demographics,religious and
political views, residency training experience and intent to provide abortions
was collected anonymously (n=396).
Results: Sixty-eight percent of residents intended to provide
abortions (n = 269). The sample was 89% female, underage 35 (97%), heterosexual
(91%). In a multivariable logistical regression, the following demographic
factors predicted intent to provide abortion; being female (aOR 2.8; 95% CI
1.2-6.5), identifying as non-Christian (aOR 3.6; 1.9-6.6), and being raised in
the Northeast (vs South) (aOR 3.0; 1.3-6.7) .Modifiable predictors of intention
to provide included programs where 50% of the faculty provided abortions (aOR
3.3;95% CI 1.8-5.8). Additionally, residents who performed greater than 20
cases (uOR 3.3, 95% CI 1.6-6.7) were three times more likely to plan
toprovide.Selection of a residency emphasizing family planning significantly
correlated with intent toprovide (aOR 4.3; 95% CI 2.4-7.8). Those training at
Ryan Programs were twice as likely (uOR2.4; 95% CI 1.6-3.8) to intend to
Discussions: Modifiable factors such as early exposure of medical students
to family planning, faculty selection, robust case volumes and establishment of
a Ryanprogram may enhance the number of graduates offering abortions while in
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Osteopathic Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, GME, UME, Advocacy, Contraception or Family Planning,
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Near-Peer Gynecology and Obstetrics Clerkship M4 Mentorship Program
Purpose: To support and teach high-yield topics to third year medical
students on their OB/Gyn clerkship and engage fourth year medical students in
Background: Practicing teaching skills and providing mentorship to
third-year students are valuable opportunities for fourth year students to take
on leadership roles. A Near-Peer mentorship program was developed to provide
orientation and support to students on their OB/Gyn clerkship, and to address
high-yield topics that supplement didactic teaching by faculty.
Methods: Three fourth-year medical students each teach an
eight-minute lesson on a topic assigned by clerkship directors. Presentations
are varied in format, but limited in scope with tangible learning objectives.
Third-year medical students complete a satisfaction survey following the
Results: Nine of seventeen students (52.9%) on the Gynecology
and Obstetrics clerkship responded to the survey. Seventy-eight of respondents
rated the fourth-year student presentations at 4 or above on a Likert scale of
1 to 5 on effectiveness compared to a traditional lecture. Fifty-six percent of
respondents rated presentations at 4 or above on a Likert scale of 1 to 5 on
memorability compared to a traditional lecture. Twenty-six percent of
respondents reported increasing knowledge from “Don’t know much at all” to
“Know the basics” or from “Know to basics” to “Could have taught it” as a
result of the presentations.
Discussions: Fourth year medical students are an excellent resource in
providing additional teaching and mentorship support to students rotating on
the OB/Gyn clerkship.
CREOG & APGO Annual Meeting, 2019, Student, Clerkship Director, Clerkship Coordinator, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, CME,
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Medical Students’ Perceptions of Teaching on the Obstetrics and Gynecology Clerkship
Purpose: Assess medical students’ perceptions of the learning quality
in their OBGYN clerkship.
Background: OBGYN uniquely synthesizes primary, subspecialty, and
surgical care. Accordingly, medical student teaching must reflect the breadth
of our field. Many teaching modalities are employed within the clerkship, such
as patient interactions in the clinic setting and wards, intraoperative
instruction, non-traditional case-based conferences, and written texts. While
overall learning and students’ decisions about specialty selection are known to
be contingent on effective education, it is not known which modalities students
perceive as most efficacious.
Methods: An eighteen-item electronic questionnaire was
distributed to consenting third year students at the completion of their six-week
clerkship at the University of Florida’s two campuses over a twelve-month
Results: Students receive approximately 6 hours of group and
individual instruction weekly and felt this was appropriate. Satisfaction was
high for resident and attending instruction, opportunities to demonstrate
clinical knowledge, and meaningfulness of students’ roles in patient care. The
ability to practice procedures and receive feedback were ranked lowest. Among
key topics in OBGYN, the highest scores included preeclampsia and abnormal
uterine bleeding, with relatively lower scores for pelvic floor dysfunction.
Labor and Delivery board rounds was perceived as the most effective mode of
instruction. Roles in the outpatient setting were perceived as primarily observational,
while perceived responsibilities in the OR varied.
Discussions: Potential areas of growth include incorporating more
procedural training and providing more effective feedback. Limitations to our
study included survey format, single academic year, and limitation to two
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, Lecture,
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Management of Postoperative Issues in Gynecology and Gynecologic Oncology: A New Method for Teaching Residents
Purpose: This project sought to develop and assess a curriculum to
improve resident knowledge of and comfort in managing common post operative
Background: Junior obstetrics/gynecology residents enter training
with varied experience in post-operative management. They are often the first
contact for surgical patients with little formal education on post-operative
Methods: Eleven common post-operative issues were identified
based on literature review, resident experience and gynecology/gynecologic
oncology faculty input. Topic based curriculum included: example case,
pathophysiology, differential diagnosis, next steps, and useful resources. It
was presented at two educational sessions, involving lectures and small-group
simulations. Residents completed a pre and post-assessment questionnaire
assessing comfort level in managing (10-point Likert scale) and baseline
knowledge about (content-specific questions) the topics.
Results: Twenty-three residents participated.Seventeen
completed one or both pre-assessment surveys (nine junior residents). Ten
completed one or both post-assessment surveys (five junior residents). All
post-assessment respondents reported improved knowledge of issues covered.
Average self-rated comfort level increased for ten of eleven topics amongst
junior residents (average increase 1.6 points (range 0.5 – 3.2; p = 0.02)).
Largest increase in score was for hypoxia and low urine output. Average scores
maintained or improved for 80% of the content questions (not significant).
Residents had no preference for lecture versus small group format.
Discussions: As a result of directed teaching, resident knowledge of
post-operative issues showed measurable improvement. Resident comfort level in
management increased significantly for 90% of topics covered, most noticeably
amongst junior residents. A systematic, resident-led curriculum on
post-operative management can improve resident knowledge and patient care.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Medical Knowledge, GME, Simulation, Lecture, Problem-Based Learning, Team-Based Learning, Gynecologic Oncology, Minimally Invasive Surgery, Female Pelvic Medicine & Reconstructive Surgery, General Ob-Gyn,
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Lifting the Mask: Exploring Factors That Influence Medical Students\' Perceptions of Resident Teaching on the OB/GYN Clerkship
Purpose: To determine factors that influence medical students\'
perceptions of resident teaching on the OB/GYN rotation.
Background: The Liaison Committee on Medical Education directs
that residents “are prepared for their roles in teaching and
assessment.\" Our goal was to ascertain if medical student year and
use of pre-made teaching tools impact views of residents as teachers.
Methods: A cross-sectional survey based on the Baker Clinical
Educator Self-Assessment using a 1-5 Likert scale was given to 37 medical
students who participated in end-of-OB/GYN clerkship focus groups from October
2017-June 2018. The survey consisted of 13 questions regarding resident
teaching skills along with 2 questions regarding resident use of pre-made
teaching tools and medical student year. Unpaired t-test and
one-way ANOVA was used for analysis.
second year, eleven third year, and eight fourth year medical students completed
the survey. There was significant difference amongst the medical student
levels (p<0.01), with third year medical students rating resident teaching
skills the highest (3.55), second year medical students in the middle (2.98)
and fourth year medical students rating teaching skills the lowest
(2.55). The 12 students that had residents use pre-made teaching tools
rated resident teaching skills significantly higher than the 25 students who
did not have residents use pre-made teaching tools (3.39 vs 2.90, p < 0.01).
Discussions: Medical student year affects perception of resident
teaching. This may be due to interest in the rotation or that teaching
needs to be individualized to year of training. Resident preparedness to
teach positively influences student views of teaching skills.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Clerkship Director, Residency Director, Practice-Based Learning & Improvement, GME, UME, Team-Based Learning,
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Let the Good Grades Roll: Optimizing Shelf Exam Performance with a Novel Peer-led Comprehensive Review Session
Purpose: To create a
comprehensive review for third year medical students at Brody School of Medicine
in preparation for the end of clerkship national board shelf examination in
Background: With the
increasing availability of resources in preparation for clinical clerkships,
medical students struggle to identify high-yield topics in review for end of
clerkship shelf examinations. This dilemma is further exacerbated by having
educational objectives published by both the National Board of Medical
Examinations (NBME) and the Association of Professors of Gynecology and
Obstetrics (APGO). Although though it was proven that the NBME exam
appropriately tests students on the information that APGO deemed “essential,”
there still isn’t a timely and comprehensive review resource available for
students focusing on these specific topics. Due to this, a comprehensive
high-yield review was created using the student educational objectives in
OB/GYN published by the APGO.
two-hour comprehensive review presentation was created for students who were
rotating on the OB/GYN clerkship at the Brody School of Medicine using the APGO
objectives. The presentation was created in a question and answer format to
allow students to use the information presented as both a study tool and as a
self-assessment of knowledge. This review was created using the follow
resources: U-World, Step-Up to Obstetrics and Gynecology, and Pre-Test OB/GYN.
post-presentation survey revealed that participants found the review to be
educational, high yield, and extremely useful for studying for the NBME shelf
examination. An additional survey was also sent to students after taking the
NBME shelf examination to assess the quality of the information presented.
Overall the students who attended the review session and used the presentation
as a study tool reported positive impacts on shelf examination scores and
overall understanding of high-yield concepts in OB/GYN.
Discussions: With the positive
feedback from students who attended the review session and used the
presentation as a study-tool for the NBME shelf examination, we hope that
comprehensive reviews such as this will be created for additional clerkships to
help students prepare for other NBME examinations.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Medical Knowledge, GME, CME, UME, Lecture, General Ob-Gyn,
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Improving Tetanus, Diphtheria, Pertussis Vaccination Rates in an Academic Center Through Resident-driven Education
Purpose: To improve rates of
prenatal Tetanus, Diphtheria, Pertussis (Tdap) vaccination for clinic patients
in an academic training center.
United States is experiencing a resurgence of pertussis, which can cause
serious complications for infants, especially within the first six months of
life. To maximize maternal antibody response to Tdap and antibody transfer to
the newborn, vaccination between 27-36 weeks of gestation is recommended.
pre-post survey study design was used to evaluate OBGYN residents at the
University of Tennessee during the 2017-2018 academic year. The primary outcome
was Tdap vaccination rate. Secondary outcomes were resident-reported Tdap
counseling and resident understanding of the appropriate gestational age for
administration. The following educational methods were utilized: resident-lead
lecture, provider handouts, English and Spanish patient education posters
throughout the clinic. Direct comparison of pre and post-surveys was used to
Tdap vaccinations were given in the four months prior to pre-survey
administration (0.33 vaccines/resident). Following the Tdap educational
program, forty-three vaccinations were given in four months (2.86
vaccines/resident). Pre-surveys indicated eleven residents (73%) provided Tdap
counseling, while post-surveys revealed fifteen residents (100%) provided
counseling. On pre-surveys, the majority of residents (33%) incorrectly
answered that Tdap was indicated between 27 weeks gestation until delivery. In
post-surveys, thirteen residents (87%) correctly answered that Tdap was
indicated between 27-36 weeks gestation.
Discussions: Tdap vaccination rate
increased by 767% after implementation of the educational tools. Additionally,
resident-driven counseling about Tdap increased by 36% and resident
understanding of appropriate gestational age for vaccine administration
improved by 225%.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Patient Care, Medical Knowledge, GME, Lecture, Quality & Safety, Public Health, Advocacy,
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Impact of Resident Led Didactics on OBGYN Clerkship Shelf Scores and Student Satisfaction
Purpose: Compare NBME shelf
scores prior to and after implementation of the Wednesday lecture
series.Compare satisfaction scores of students prior to and post implementation
of Wednesday lecture series. Scores would be obtained from the Aesculapian
Society who evaluates students’ overall perceptions of clerkships
· The ACGME and LCME has designated teaching as an
accreditation standard with numerous competencies. Residents serve as clinical
teachers for medical students with studies indicating that residents spend up
to 20% of their time teaching medical students.
· In a national survey 60% of students reported that
they received their teaching from residents and fellows during their obstetrics
and gynecology clerkships.
· In 2015-2016, the department of Obstetrics &
Gynecology at Louisiana State University School of Medicine-New Orleans
implemented a new lecture series for 3rd year medical students.
· Wednesday Lectures: High yield OB/GYN topics
delivered by chief resident.
· Lectures designed to complement Team-Based Learning
· Shelf exam scores from 2011-2017 were reviewed and
compared across the training sites.
· Control Group: Baton Rouge and Lafayette based
students who do not receive the same lectures.
· Aesculapian Society Evaluations.Scores before and
after implementation were examined
· Positive correlation in resident teaching and
· Positive correlation in NBME scores and satisfaction
· Student experience and satisfaction may vary by
location based on clinical exposure and opportunity
· No standardized resident-lectures amongst all
· Future Implications: Standardized implementation
of resident led didactics. Our goal is to Implement ACGME recommended
‘Resident-as-teachers program as already established in other institutions and
improve shelf scores over the next 5 years.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, CME, Assessment, Lecture, Team-Based Learning, CREOG & APGO Annual Meeting, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Medical Knowledge, Professionalism, UME, Assessment, General Ob-Gyn,
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Immediate Post-placental IUD Insertion: Evaluation of Clinician Knowledge and Views
Purpose: To increase
practitioner knowledge and comfort performing immediate post-placental IUD
insertion with a session including lecture and simulation.
post-placental (within 10 minutes of placental delivery) insertion of an
intrauterine device (IUD) has been shown to be both safe and effective
contraception. Post-placental IUD insertion removes barriers (loss of
insurance, loss to follow up, etc.) in the prevention of unplanned pregnancies.
In order to increase practitioner knowledge and comfort performing immediate
post-placental IUD insertion, this project developed and administered education
and procedural simulation sessions.
session consisted of a 10 minute pretest, 15 minute scripted powerpoint
presentation, 15 minute procedure simulation, and 10 minute post-test. The primary
outcome of knowledge score was calculated as the sum of all knowledge
questions. The change in knowledge score and comfort levels were assessed by
paired T-tests. Participants were asked to rate their comfort level on
performing post-placental IUD insertion on a scale of 1-5 (1=not comfortable at
all; 5=completely comfortable).
obstetrical providers attended the sessions. The average knowledge score
pre-training was 11.4 (95% CI 10.6-12.2) as compared to 15.5 (14.5-16.5)
post-training (p<0.01). Pre-training, participants were less comfortable
with immediate post-placental IUD insertion (mean 2.82; 95% CI 2.4-3.2) as
compared to post-training (mean 3.96; 95% CI 3.7-4.2), (p<0.01).
Discussions: Education and
procedural simulation sessions are an effective method to improving knowledge
and procedural comfort of post-placental IUD insertion. A curriculum dedicated
to improving knowledge and comfort of post-placental IUD insertion should be
integrated into obstetrical training.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Medical Knowledge, Practice-Based Learning & Improvement, GME, Simulation, Lecture, Contraception or Family Planning,
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Fundamentals of Gynecologic & Minimally Invasive Surgery for the Fourth Year Medical Student
Purpose: Development of a
four-week elective rotation in minimally invasive gynecology designed for
fourth year medical students to meet the gynecology knowledge and skill
milestone objectives for students entering an obstetrics and gynecology
curriculum is modeled on the milestone-based approach implemented by the
Council on Resident Education in Obstetrics and Gynecology. Proficient
psychomotor skills are developed, allowing a more prepared learner in the
students follow a four-week structured curriculum. The time is divided equally
between clinical observation, skills training, and independent study.
Proficient knowledge of pelvic anatomy, surgical instrumentation, surgical
energy, and dissection are obtained. The student completes a skills training
program with two hours of dedicated practice time per day, gaining proficiency
in laparoscopic tissue manipulation and laparoscopic suturing. Clinical
activities include observation in the operating room and outpatient gynecology
clinics. Weekly written and oral testing and mentor feedback of surgical skill
progression is emphasized.
course has been well received at the two institutions it was implemented at
over the last four years. Learners have felt prepared to assist and participate
in laparoscopic surgeries upon entering their residency program.
Discussions: Implementation of
skills curriculum is paramount given the new American Board of Obstetrics and
Gynecology requirement of Fundamentals of Laparoscopic Surgery certification.
This course allows the learner to enter residency proficient in laparoscopic
psychomotor skills and having a fundamental base of knowledge for gynecology
and minimally invasive procedures. Future collection of subjective and
objective evaluation data could validate the further development of similar
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Medical Knowledge, Professionalism, GME, Assessment, Simulation, Problem-Based Learning, Minimally Invasive Surgery,
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Effect of Simulation Exercises on Medical Student Satisfaction and Performance in the Ob/Gyn Clerkship
Purpose: To evaluate the use of
structured resident-led simulation exercises in improving medical student
interest in Ob/Gyn as a specialty, satisfaction with their rotation experience,
and improvement on NBME exam sores at the end of the rotation.
students persistently rank their obstetrics and gynecology (Ob/Gyn) clerkship
experience below that of other surgical specialties, in addition to also raking
the clerkship lowest for the ability of residents to provide effective
teaching. Current research shows that clinical simulation during the Ob/Gyn
clerkship leads to increased confidence and has been shown to increase medical
students\' end of rotation oral and written examination scores.
cohort study from July 2016-June 2017 involving medical students enrolled at
the McGovern Medical School- Memorial Hermann Hospital campus for their Ob/Gyn
clerkship. Rotations were randomized by alternating intervention with
non-intervention, the intervention consisted of weekly resident-led
simulation exercises. All students were given anonymous pre-rotation and
post-rotation surveys that used a Liekart scale to analyze their opinions of
their clerkship experience. The surveys and NBME grades were then analyzed
between the two groups.
population was 71, with 38 students in the control group and 33 in the
intervention group with survey response rates of 94% and 97%
respectively. The responses of the pre and post-rotation surveys were
then analyzed using the Wilcoxon ranked sum test comparing the median
response. Overall, the intervention group had a higher median score
regarding preparedness in the clerkship (p .052) and scored better on the NBME
(P .2679). The intervention group had a lower median response to
questions regarding importance of residents’ involvement in their clerkship,
which was statistically significant (p .008).
Discussions: Results indicate that
resident-led simulation exercises may increase NBME scores and help students to
feel more prepared within the clerkship. However, this increase in
performance and preparedness does not correlate with student satisfaction or in
the student’s choice of obstetrics and gynecology as their future specialty of
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Medical Knowledge, Practice-Based Learning & Improvement, GME, Simulation, Team-Based Learning,
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