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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Use of POEs( Point of EPA Evaluations) Across All Third Year Clerkships for Year Long EPA ( Entrustable Professional Activity) Monitoring
Purpose: To describe the development of a school wide and longitudinal
assessment of the core Entrustable Professional Activity (EPA)s using an easily
Background: Our insitution is part of the EPA pilot study
sponsored by the AAMC to explore the feasibility of teaching and assessing the
core EPAs. This year direct observation and assessment of the EPAs was
implemented across clerkships . Each clerkship was allowed to determine which
EPAs were applicable to their field.
Methods: The OBGYN department determined and assessed that
EPA1( History and Physical) , ] EPA2 ( Differential Dx) , EPA3 ( Dx
and Screening Tests) and EPA6 ( Oral Presentation) were core skills to
the clerkship with the following scale (1=student observed, 2=assessor had to
talk the student through it, 3=assessor had direct them from time to time, and
4=assessor needed to be available just in case.)
OB Other Clerkships p
EPA 1 3.0( 0.5) 3.5 (0.5) <0.0001
EPA 2 3.0 (0.9) 3.4 (0.6) <0.05
EPA3 3.0 (0.9) 3.4 (0.7) n.s
EPA6 3.1( 0.5) 3.4 (0.5) < 0.005
For the first 3 months there
were 2783 EPA assessments. The average score was 3.45. In comparison to other
clerkships, students on OBGYN received lower scores in EPA 1,2,6.( p<.0001,
P< .05 and P< .005) possibly
indicating more stringent grading by faculty or lower performance of
Discussions: In comparison to all other clerkships combines, student on
OBGYN received lower scores in all four EPAs possibly indicating more
stringent grading by faculty or lower performance of medical students. Lower
EPA scores may indicate more stringent grading by faculty or lower
performance of medical students. This could also be related to lower numbers of
overall EPAs reuired by the OB/GYN clerkship. Further research is needed
to determine the significance of these findings.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Practice-Based Learning & Improvement, GME, UME, Assessment,
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Trends in Off-Service Rotations in Ob/Gyn Residencies Before and After Duty Hour Restrictions
Purpose: To establish trends in off-service rotations in OB/GYN residencies
before and after duty hour restrictions.
Background: As co-morbidities in our patient population increases,
the skills required of OB/GYNs are changing, we sought to determine the
characteristics of off service rotations.
Methods: We searched websites of ACGME accredited OB/GYN
residency programs. We collected data on off service rotations: services,
number of rotations, and PGY year of rotations. Surveys were emailed to
programs regarding off service rotations in 2018 and before duty hour changes
Results: 92% (n=259) of programs had information available on
off-service rotations, of these, 24% (n=62) had no off-service rotations, 26%
(n=67) had 1, 25% (n=66) had 2, 13% (n=34) had 3, 12% (n=30) had 4 or more. The
majority (84%) of rotations were in PGY1. The most common rotations were ER
(47%, n=122), SICU (24%, n=62), IM (25%, n=66), MICU (9%, n=23). We received 53
responses to the survey (19% response rate). Of those who responded, the most
common rotations for 2018 and before 2003 were ER & SICU. The number of
programs with SICU rotations remained stable from 2003 to 2018 (43% vs 47%)
compared to 1.4 fold decrease in programs with ER rotations. The number of
programs with IM rotations decreased 2.5 fold from before 2003 to 2018.
Discussions: Duty hour restrictions have affected off-service rotations. A
quarter of all programs have no off-service rotations, with a decrease in ER
and IM exposure during residency. This does not reflect the breadth of
knowledge required of OB/GYNs today.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Quality & Safety, General Ob-Gyn, CREOG & APGO Annual Meeting, 2019, Student, Resident, Clerkship Director, Residency Director, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Team-Based Learning,
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Transgender Healthy Care: On-line Survey of Physician Knowledge and Comfort
Purpose: To evaluate OB/Gyn provider knowledge and comfort with
transgender health care
Background: Transgender and gender non-conforming patients (TGNC)
are an underserved population that often encounters inadequate or ‘unsafe’
clinical care. Education regarding TGNC patient care has traditionally been
minimal, contributing to gaps in Ob/Gyn care for many of these individuals,
including transgender men.
Methods: An IRB approved, anonymous online non-validated survey
was emailed to 130 APGO program coordinators to distribute to their Ob/Gyn
faculty and post-graduate learners. Questions addressed included years of
practice, experience with TGNC patients, provider comfort, and TGNC education.
Results: One hundred and sixty four surveys were completed and
an additional ~50 were opened but no information was provided. Of the 164
completed surveys, 76.3% of participants reported less than 5 hours of TGNC
specific healthcare education, despite the fact that 75.7% of responders had
cared for at least one TGNC patient. Overall most respondents felt
comfortable/very comfortable (79.8%) caring for this population. No correlation
was found between years in practice and overall provider comfort caring for
TGNC patients. Major obstacles reported by participants included concern
for patient comfort, appropriate language, and lack of sufficient clinical
education for both providers and support staff
Discussions: These data suggest that enhanced TGNC clinical education for
the entire health care team is warranted.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, GME, Advocacy,
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Removing the Shelf Cutoff to Achieve Honors in the Clerkship Does Not Change Test Scores
Purpose: Purpose: To identify students’ performance on the NBME
subject examination changes when a minimum score requirement for Honors is
Background: Background: The NBME subject examination is used in
many obstetrics and gynecology clerkships as an objective measure of knowledge.
The exam score may be included in the calculation of a student’s final grade,
with a requirement to achieve a certain minimum score to be eligible for a
grade of Honors. At our institution, this cutoff was removed from the obstetrics
and gynecology clerkship in 2017.
Methods: Methods: Scores for the Obstetrics and Gynecology
subject examination at the University of Pennsylvania were compared between
2016 (the most recent year in which a cutoff was used) and 2017 (the first year
in which the cutoff was removed). Comparative statistical analyses were
performed, including mean, standard deviation, and Student’s T-test.
Results: Results: In 2016, 161 students took the NBME subject
examination, during which time a minimum score of 81 was required to be
eligible for a final grade of Honors. The mean score was 80.58 (range 61-93,
standard deviation 6.34). In 2017, the minimum cutoff requirement was removed,
and 163 students took the exam. The mean score was 80.42 (range 53-94, standard
deviation 6.38). The T-test result for comparison between the two means was
Discussions: Discussion: At this academic institution, the mean NBME
subject examination score did not change between the two years. Students
continue to study for the final exam when the minimum cutoff is removed.
CREOG & APGO Annual Meeting, 2019, Faculty, Clerkship Director, Medical Knowledge, UME, Assessment, Independent Study,
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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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Perioperative Complications Curriculum for the OB/GYN Resident: A Pilot Study
Purpose: To develop and implement a perioperative complications
Background: ACGME program requirements and milestones include
recognizing and managing perioperative complications.
Methods: Residents, Fellows, and Faculty were sent a needs
assessment survey, addressing satisfaction with baseline perioperative
complications curriculum and preferences for development of new
curricula. Additionally, Residents completed a knowledge pretest.
Over four weeks, Residents received weekly emails through the Qualtrics
software program linking to topic-specific materials, including interactive,
online case-based modules. A post-implementation survey was distributed
to assess Resident satisfaction with programming and to retest knowledge.
Results: With 75% (21/28) of Residents and 47% (40/86)
Fellows/Faculty completing the needs assessment survey, 95% (20/21) of
Residents and 90% (36/40) Fellows/Faculty reported dissatisfaction with
pretest mean score was 72% (40-90%, SD = 15).
online case-based modules were developed for topics including ureteral injury,
bowel injury, vaginal cuff dehiscence, and bladder injury. Curriculum
materials were successfully distributed on a weekly basis to all Resident
learners, as confirmed through the web-based software program.
module completion rates were 50%, 36%, 29%, and 18% for weeks 1-4,
percent of Residents completed the post-implementation survey, with 100%
reporting satisfaction with the online case-based modular curriculum.
Knowledge post-test mean score was 84% (SD = 15).
Discussions: A needs assessment confirmed poor satisfaction with baseline
perioperative complications curriculum. Web-based materials were
developed and distributed weekly to all Residents who successfully accessed the
4 developed modules. While post-survey responses were few, 100% of
responders reported satisfaction with the developed curriculum.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, Practice-Based Learning & Improvement, GME, Assessment, Independent Study, Problem-Based Learning, General Ob-Gyn,
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Pain Perception in Cervical Biopsy- Variations by Patient and Provider Characteristics in an Academic Teaching Clinic
Purpose: We aim to identify factors which dependably predict patients’
experience of pain during colposcopy, and to evaluate if providers, stratified
by level of training, are capable of anticipating procedural pain.
Background: Cervical biopsy procedures, including colposcopy and
loop electrosurgical excision procedure (LEEP), are considered non-invasive
office procedures and efforts to codify their use emphasize logistics and
ability to detect disease. A significant gap exists for mitigating
psychological distress and procedural pain. Previous research suggests that
physician assessment of procedural discomfort varies by years of experience.
Methods: Patients presenting to an academic gynecology practice
for colposcopy with cervical biopsy or LEEP completed Pre- and Post-Procedure
surveys (14- and 3-item surveys, respectively), assessing demographics, past
cervical procedures, menstrual pain, and anticipated biopsy pain, among other
metrics. Post-Procedure surveys assessed a numerical level of pain experienced
during the biopsy. The health care provider (HCP) and procedural assistant were
surveyed for perceptions of patient pain. Pain scores were evaluated using a
100mm visual analog scale. Data analysis was performed using Spearman
rank correlation, and coefficients for relevant variables were calculated.
Results: 80 patients were enrolled and 62 underwent cervical
biopsy. Patients with higher anticipated pain gave higher ratings for
post-procedure pain (p=0.024). Women reporting more intense periods predicted
and experienced more procedural pain (p<0.001, p=0.058). From the provider
perspective, HCPs correctly estimated patients’ pain when compared with the
patients’ perceptions (p=0.066). However, only PGY3 and PGY4 OB/GYN residents
did so with statistical significance (p=0.014) and PGY1 and PGY2 residents
rated lower pain scores (p=0.039). Male assistants rated pain lower than
female assistants (p=0.037).
Discussions: Providers accurately estimated patients’ pain with variation
by years of training. Patient characteristics of age, anxiety, and dysmenorrhea
were reliable predictors of pain levels. Our findings suggest that
pre-procedure screening of patients may be helpful in directing pain reduction
interventions. Additionally, years of experience may provide enhanced pain
perception, suggesting future research into pain management training for junior
resident physicians and medical students.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Practice-Based Learning & Improvement, GME, CME, Quality & Safety, General Ob-Gyn,
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Outcomes of a Transgender Care Training Program in Obstetrics and Gynecology Resident Education
Purpose: We sought to evaluate outcomes of an Obstetrics and
Gynecology (OB/GYN) resident education program on transgender health.
Background: OB/GYNs are often frontline providers for the
transgender community, as patients may first present to an OB/GYN with symptoms
of gender dysphoria or postoperative care needs and complications. Both the
American College of Obstetricians and Gynecologists (ACOG) and the Council on
Resident Education in Obstetrics and Gynecology (CREOG) have developed key
areas of competency pertaining to the care of transgender patients by OB/GYNS.
To date, standardized educational curriculums on these competency areas
are not available.
Methods: Residents at our institution completed a 2.5-hour
training on transgender health comprised of a standardized patient interaction,
debriefing session, and didactic session led by an expert on transgender
gynecological care. A 42 item pre- and post-training survey evaluated
participant demographics, a validated transphobia questionnaire, medical
knowledge of transgender care and preparedness to provide transgender care.
Results: Eighteen residents and medical students completed the
training. The average pre- and post-training knowledge assessments scores
significantly improved from 74.8% to 88.9%, (p<0.001). Specifically,
knowledge of transgender health disparities, professional guidelines, and
management of abnormal uterine bleeding all significantly improved. Baseline
transphobia scores were low and did not significantly change. Residents felt
more prepared to collect a transgender focused medical history, provide
referrals, and access additional educational resources.
Discussions: Our training improved residents’ knowledge and preparedness
to provide a variety of aspects of transgender care. This training was
feasible, reproducible and positively received by the resident participants.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, CME, Assessment, Standardized Patient, Advocacy, General Ob-Gyn, Sexuality,
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Oral Milestone Assessment versus Electronic Evaluation (E-Value) Milestone Assessment-Is One Better Than Another?
Purpose: To compare milestones assigned to PGY 1 and 2 Residents via
an Oral Milestone Exam versus the traditional retrospective monthly electronic
evaluation system to assess how they aligned.
Background: Programs are tasked with implementing assessment tools
to evaluate the 28 milestones. Most programs use some form of an electronic
evaluation at rotation completion. The Clinical Competency Committee
reviews all information for final score assignment each six month period.
Methods: In 2015, we instituted an Oral Milestone examination
to assign the six-month milestones and compared those scores to our
retrospective monthly on-line evaluations. We evaluated PGY 1 and 2 residents
in a simulated forum on milestones, which included Medical Knowledge, Patient
Care, and Interpersonal /Communication Skills Competencies. All residents were
given simulated patients, cases, and/or skills while each examiner was given
the specific ACGME milestone assessment sheet to score. The residents were
provided with immediate feedback.
Results: From 2015-2018, 78.4% of PGY 1 and 43% of PGY 2 residents
scored higher on the real-time oral milestone exam. Additionally, in 82% of PGY
1 residents and 52% of PGY 2 residents score on the oral exam was at
0.5-1milestone level higher than the retrospective electronic monthly
Discussions: Clinical Competency Committees are tasked with Milestone
assignment to all residents every six months. Evaluation tools that most
reflect the actual milestone completion is a mission of all programs. We set
out to assess whether our electronic monthly retrospective evaluation system
was mirroring the assessment performed on our residents with the real-time oral
milestone exams at the end of the six month interval, just prior to submission
to the ACGME.
Our data suggests discrepancy in our online retrospective milestone evaluation
versus the real-time assessment of an oral exam. Not only did residents score
higher in most circumstances in an oral format, but they were higher by a
half-whole milestone level in the majority of the cases. It would suggest that
our ability as educators to recollect the performance of a resident at an
interval later than the performance may be flawed.
Programs may want to consider instituting an oral milestone examination for
enhanced milestone assessment.
Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Professionalism, GME, Assessment, Simulation, Standardized Patient, General Ob-Gyn,
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Medical Student Self-initiated Form Improves Compliance of Documenting Formal Mid-clerkship Feedback
Purpose: A medical student self-initiated feedback form is a simple,
yet innovative way to meet LCME requirement to document mid-rotation feedback
during the busy clerkship.
Background: Mid-rotation feedback during the clerkship is crucial
in helping trainees learn their strengths/weakness in order to improve clinical
performance and develop clinical competency. The LCME has
established a standard for clerkship directors (CD) to document formal
mid-rotation feedback for medical students during clinical clerkships but due
to competing demands, this standard has been challenging to meet. This
educational quality improvement project examined the effect of instituting a
self-initiated feedback form on documentation of formal mid-rotation feedback.
Methods: Beginning January 2018, we instituted a mandatory
self-initiated feedback form to be completed prior to meeting with the
CD. The 4-item feedback form includes prompts for students to
self-reflect on strengths/weaknesses and space for comments to discuss with the
CD. Completed forms are uploaded to an electronic assessment system.
Results: At our institution, compliance with documenting Ob/Gyn
mid-rotation feedback improved substantially to 98% in 2017-18 as compared to
77% in 2016-17 and 71% in 2015-16. Similar trends occurred in other
clerkships, particularly in pediatrics and general surgery, thereby
demonstrating generalizability of intervention.
A medical student self-initiated feedback form improved
compliance of documenting formal mid-rotation feedback while decreasing CD
workload. This intervention also made feedback meetings more engaging,
robust and meaningful. This innovation places ownership of
initiating feedback on the medical student, and less on the CD. This form
can be incorporated at other undergraduate medical institutions.
CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Osteopathic Faculty, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, UME, Assessment,
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Magnesium Toxicity and Medical Errors: A Multidisciplinary Simulation for Debriefing an Obstetric Emergency
Purpose: To create a simulation that improves communication during
obstetric emergency and promotes a safe learning environment to debrief and
evaluate medical errors.
Background: Simulation is known to improve communication and
comfort in obstetric emergency. Little data exist regarding simulation for
enhancing expertise in debriefing and evaluating system errors.
Methods: The simulation highlights an unresponsive patient
shortly following a preterm delivery at 30 weeks gestation. The team discovers
an accidental bolus of intravenous magnesium was given instead of postpartum
oxytocin. Following conclusion of the simulation, participants were asked to
lead a debrief session. Surveys were performed to assess participant comfort
with magnesium toxicity, debriefing, evaluating a medical error, and
communication during an emergency.
Results: Participants felt the simulation was (1) a realistic
scenario that allowed practice debriefing a medical error within a large
multidisciplinary team, (2) a place to practice high acuity care and
communication, and (3) a safe place to receive and provide feedback. On
average, residents reported an increase in comfort with management of magnesium
toxicity from little comfort(2/5) tomoderate comfort(4/5). In general,
participants (90%; N=10) felt like they learned advanced management of acute
magnesium toxicity. All participants (100%; N=10) reported they would recommend
this simulation to others in their profession.
Discussions: We have designed a simple model that highlights the
importance of (1) communication during an obstetric emergency and (2)
debriefing and evaluating errors from systems perspective. This model increased
participant knowledge and comfort with magnesium toxicity and promoted a safe
culture to discuss medical errors and practice debriefing.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, CME, Simulation, Quality & Safety, Team-Based Learning,
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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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Improving Medical Student Feedback by Identifying Barriers in Obtaining Evaluations
Purpose: The goal of this study
is to identify barriers encountered by residents and faculty in providing
electronic feedback to medical students regarding their clinical performance.
is an integral part of learning and professional development and needs to be
both specific and corrective to be effective, however, the amount and quality
of feedback received by medical students varies greatly. The response rate for
medical student evaluations at our institution is 33.2%. We performed a
survey-based study to determine barriers to the completion of online medical
with quantitative and qualitative questions were sent to residents, fellows,
and faculty at three teaching institutions in Cleveland, OH.
Results: Of the
71 respondents, 56.5% were attendings and 39.1% residents with an overall
response rate of 40.8%. Time spent with student and time to fill out
evaluations appear to be the most contributory factors cited as barriers to
evaluation completion at 76.1% and 64.8% respectively.
Discussions: Developing systems to
obtain feedback without significant time constraints may increase response
rates. Relying on the evaluations of a few physicians with whom students spend
more time may also improve the quality of feedback.
2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Systems-Based Practice & Improvement, UME,
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Impact of Student and Evaluator Gender on Clinical Performance Evaluations in an OB/GYN Clerkship
Purpose: Determine if student
and evaluator gender are associated with a difference in student clinical
performance evaluations (CPEs) of third year OB/GYN clerkship students at the
University of Kansas School of Medicine (KU SOM).
Background: CPEs are
innately subjective measures of evaluation but account for a large percentage
of clerkship grades. This study evaluates the objective measures (NBME subject
examination and in-house subject test) and CPEs of third year OB/GYN clerkship
students. Objective and subjective data will be compared to assess for
differences based on gender of the student. Further analysis of evaluator
gender on CPEs provided for both male and female students will be evaluated. By
collecting objective and subjective student data, and taking evaluator gender
into account, this study intends to fill in the gaps of previous gender bias
research which has not assessed all factors in combination.
analysis of 1,407 CPEs by 50 evaluators for 249 third year medical students
completing the OB/GYN clerkship at KUSOM from May 2016 through May 2018.
Student/evaluator gender, length of observation, overall clinical performance
and objective examination scores were recorded. T-tests were used to
compare continuous variables and statistical significance was determined by a
and subjective measures of student performance demonstrated no difference
between male (n=126) and female (n=122) students. Female (n=43) and male
(n=7) evaluators scored female students slightly higher, but differences were
not statistically significant.
Discussions: This retrospective
study did not find any difference in clinical performance evaluations of male
or female students in their OB/GYN clerkship.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Professionalism, UME, Assessment,
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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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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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Family Planning Training at Catholic and Other Faith-based Obstetrics and Gynecology Programs
Purpose: The objective of this
study was to determine the current paradigm of forceps assisted vaginal
delivery (FAVD) training across the United States (U.S.) amongst OBGYN
national FAVD rates decline and primary cesarean rates continue to be high, we
must be aware of resident interest, training, and skill acquisition in
FAVD. There is a current paucity of literature on FAVD training
Methods: A survey
was created and disseminated on the internet and to OBGYN residency program
directors for distribution to current OBGYN residents from March to June 2018.
Geographic regions were determined using Census Bureau-designated regions.
survey was completed by 434 OBGYN residents (8.5% of 5,061 ACGME residency
positions) with representation from all U.S. regions. Of postgraduate year
(PGY)-4 respondents, 71% participated in ≤10 FAVDs, with only 20.2% with
>20 FAVDs. Of all residents, 40% expressed a desire to learn FAVD, with
54.6% completing FAVD simulation training. While 46% of resident stated that
they would like to perform both FAVD and VAVD once in practice, only 13%
expressed confidence in performing FAVD independently. Residents from the
Midwest are most likely to have completed >20 FAVD at 18%, compared to 0%,
5.7% and 11.3% of residents from the Northeast, West and South, respectively
Discussions: Residents are motivated
to learn FAVD and would like to have the skill to perform them independently.
Our study demonstrates that current trainees are not obtaining adequate
experience, irrespective of geographical region. Current OBGYN residency
training programs should implement simulation and real-time training of
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, GME, Assessment, Public Health, Contraception or Family Planning,
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Evaluation of Neonatal Resuscitation Program (NRP) Knowledge Among OB/GYN Residents
Purpose: To determine OB/GYN
resident retention of neonatal resuscitation program (NRP) knowledge following
their intern NICU rotation and NRP course.
training has been utilized to teach birth attendees evidence-based approaches
to care for the newborn at birth. OB/GYN trainees undergo NRP training
and rotate in the NICU as interns. It is unclear how much NRP knowledge
is retained as OB/GYN residents advance in training.
Methods: A survey
was distributed amongst the 41 OB/GYN residents at Indiana University during
the 2017-2018 academic year. The survey was completed anonymously and
included the resident’s year in training (PGY1-4) and date of their NRP course
and NICU rotation. A 10-question abbreviated NRP quiz was
administered to participants. Correlation analysis was performed to test
for associations between quiz scores and elapsed time (months) between quiz and
the intern NRP course and NICU rotation.
Results: 37 of 41
residents completed the survey. The average test score was 76%.
There was no significant difference between abbreviated NRP quiz score and PGY
level (p=0.30). There was also no difference between time since NRP
course (p=0.21) or time since NICU rotation (p=0.50). Greater time since
NICU rotation correlated with lower quiz scores in the PGY2 class
(p<0.05). No significant correlation was seen in other classes.
Discussions: Overall, there was no
significance between test scores based on training year. With this
information, OB/GYN residents may be able to do an accelerated certification
course while in a training setting instead of the traditional course completion
every 2 years.
CREOG & APGO Annual Meeting, 2019, Residency Director, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Simulation, Quality & Safety, General Ob-Gyn,
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Evaluating the Rates of Visualized IUD Strings Following Immediate Post-Partum Placement by Ob/Gyn Residents
Purpose: Compare the incidence
of visualized IUD strings at follow up by mode of postpartum IUD placement by
postpartum contraception decreases maternal mortality, low birth weight,
preterm births and infant mortality. Missing strings in the setting of a
well positioned IUD are more common following postpartum placement as compared
to interval placement. This difference may be explained by variation in
residents’ techniques for placement in the postpartum setting.
retrospective chart review of 306 women receiving immediate postpartum IUD insertion
by residents was performed between July 1, 2017-February 15th, 2018.
Variables analyzed included: type of IUD, length of strings prior to placement,
method of insertion (applicator, ring-forceps, manual), and delivery
(20%) women attended postpartum follow-up between four to six weeks after
delivery. Eleven of 14 (79%) post-cesarean section and 39 of 48 (81%)
post-vaginal delivery had strings visualized. Insertion via the IUD
applicator was associated with significantly more IUD strings visualized at the
postpartum visit when compared to manual insertion (p <0.05) and ring
forceps (p <0.05). There was no difference in string visualization between
IUD types or after cutting the string to 10 cm.
Discussions: Mode of placement
affects postpartum IUD string visibility. Future research will include
developing a protocol for best practices for post-placental IUD placement to
improve string visibility at the postpartum visit. Additional research is
needed on the low postpartum follow up rate in this subset of the population.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Quality & Safety, Public Health, Contraception or Family Planning, General Ob-Gyn,
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