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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 residency.

 

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.”

Topics: 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 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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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 each other.
 

 

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 2016-2018.

 

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.

Topics: 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 expectations.

 

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 non-URM faculty.

 

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.

Topics: 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 skills.

 

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 communicated.

 

Discussions: Residents’ laparoscopic simulation time was dismal at our program in this study. Dedicated mandatory simulation time may increase participation.

Topics: 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 year.  

 

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 significant (P=0.93).

 

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 hospital.  

Topics: 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.

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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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 and coding. 

 

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.

Topics: 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.

Topics: 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 abortion providers.

 

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 provide.

 

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 practice.

Topics: 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 mentorship opportunities.

 

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 presentations.

 

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.

Topics: 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 academic year.

 

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 institutions.

Topics: 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 issues.

 

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 issues. 

 

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.

Topics: 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.

 

Results: Eighteen 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.

Topics: 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 OB/GYN.

 

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.

 

Methods: A 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.

 

Results: A 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.  

Topics: 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.

 

Background: The 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.

 

Methods: A 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 analyze results.

 

Results: Five 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%.

Topics: 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

 

Background:

·       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 sessions

Methods:

·       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

Results:

·       Positive correlation in resident teaching and satisfaction scores

·       Positive correlation in NBME scores and satisfaction scores

 

Discussions:

·       Student experience and satisfaction  may vary by location based on clinical exposure and opportunity

·       No standardized resident-lectures amongst all locations

·       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.

Topics: 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.

 

Background: Immediate 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.

 

Methods: A 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).

 

Results: 62 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.

Topics: 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 residency program.

 

Background: The 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 operating room.

 

Methods: 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.

 

Results: The 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 courses. 

Topics: 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.

 

Background: Medical 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.

 

Methods: Prospective 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.

 

Results: Overall 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 choice.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Medical Knowledge, Practice-Based Learning & Improvement, GME, Simulation, Team-Based Learning,

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