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Using Student Interest Groups to Train Medical Students to Lead

Purpose: Medical student interest groups (SIG) serve as students’ introduction to medical specialties. The student leaders of these groups are driven and demonstrate leadership ability early in their careers. Connecting these student leaders with young physicians can improve specialty matriculation, leadership among new residents, and foster mentorship in the organization.

 

Background: The American College of Obstetrics and Gynecology (ACOG) has leadership positions for residents, however, less for medical students, who are encouraged to participate in meetings rather than engage.  SIG leaders have not been a focus of recruitment for ACOG, however, these students are primed to become leaders in ACOG upon completion of medical school. 

 

Methods: Prior to the 2017 ACOG’s Annual Clinical and Scientific Meeting, we contacted medical students registered for the meeting to identify any SIG leaders. A meeting was arranged for student leaders to meet with several national representatives. The group of 17 students was introduced to the structure and benefits of the organization and given training for optimizing SIG function and efficacy. Through our survey, all students appreciated the information about ACOG, ideas on how to improve their SIG, and resources available through ACOG, rating it as just the right of information or stated they would like to hear more.

 

Results: Sixty four percent were planning on establishing a generic SIG email to improve communication with ACOG while 23% already had one. When asked if they felt prepared to take the information back to their SIGs, all students answered positively. Only three of the 17 students had read a leadership book and all students said they would love to participate in a more formal leadership training. 

 

Discussions: Medical student leadership represents a natural group to become future ACOG leaders. Given the barrier of contacting the SIG leaders, we recommended establishing a generic email address for groups (eg OBGYNSIG@***). All students wanted leadership training and to be involved in ACOG. In conclusion, medical SIG leaders are an enthusiastic and untapped resource who will become our colleagues. Connecting with student leaders at organizational meetings secures future leadership and continued engagement after medical student graduation. 

Topics: CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Clerkship Coordinator, Professionalism, Systems-Based Practice & Improvement, GME, Independent Study,

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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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Time to Face the Music: Attitudes of Current and Future OB/GYN Residents Regarding the Structure of Residency Training

Purpose: Measure future and current resident perspectives regarding OB/GYN residency training structure and possible future models.

 

Background: Modifications to the current OB/GYN training paradigm are being considered however the perspective of learner stakeholders on substantial changes has not been measured.

 

Methods: Medical students invited for OB/GYN residency interviews and residents (PGY1-4) at the University of Colorado, University of Washington, University of California San Francisco, Loyola University, St. Joseph’s Hospital, and Texas A&M in 2017-2018 received a voluntary, electronic survey regarding possible models for restructuring residency training.  Student and resident responses were compared using a chi-square for categorical and two-sample t-test for continuous items. 

 

Results: Applicants (63%, 280/444) and residents (66%, 101/154) had similar response rates.  Applicants (24%) and residents (29%) reported having concerns about the current structure of residency training.  The ideal residency duration was reported as 4 years by 72% of applicants and 85% of residents.  Lack of gynecologic surgical volume was the most frequently reported concern among applicants (75%) and residents (72%).  Fourth-year tracking (focusing on training aligned with post-graduation career path) was preferred by 90% of applicants and 77% of residents (p=0.002), and 92% among respondents planning fellowship.  Most applicants (68%) and residents (75%) preferred not starting fellowship training after the 3rd year of residency.    

 

Discussions: The majority of learners surveyed support a 4-year training structure, but likewise support individualizing training in the PGY-4 year. It is imperative that OB/GYN leadership consider this and other feedback from learners when considering modifications to the current OB/GYN training paradigm. 

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, GME, UME, General Ob-Gyn, CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Patient Care, Practice-Based Learning & Improvement, GME, Simulation,

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The Effect of Dedicated Research Time in an Obstetrics and Gynecology Residency

Purpose: To determine the effect of a second-year research rotation on scholarly output in an academic OB/GYN residency program.

 

Background: Dedicated research time has been shown to have positive impacts on resident outlook and understanding of research, research productivity, and clinical care.  A minority of OB/GYN residencies provide a research rotation due to resource availability and as a result, data on the effect of an OB/GYN specific rotation are sparse.

 

Methods: A retrospective review of resident scholarly activity was performed from academic years 2012-2017, with the rotation implemented 2015-2016.  Data collected from these reports included number of publications, presentations, book chapters, and number of residents who participated in these projects each year. 

 

Results: Following the introduction of research rotation, resident participation in projects doubled to 12/20 (60%).  6 of 19 or 20 residents (31.6% and 30% respectively) had scholarly output each year from 2012-2016, except 2013-2014 when 3/19 residents (15.8%) participated.  Publications nearly doubled and presentations increased by 50% in the first two years of the rotation.  In the second year of implementation alone, there were nearly three times as many publications and more than twice as many presentations than any individual year before the rotation.   

 

Discussions: Scholarly activity output increased following implementation of the research rotation, demonstrating a benefit of dedicated research time and mentorship to our residency.  This study supports the growing consensus that creating a rotation and an associated curriculum are factors associated with successful research education.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Practice-Based Learning & Improvement, GME,

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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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Successful Implementation of an OB/GYN Resident FLS Training Curriculum

Purpose: To describe the implementation of an ob/gyn resident Fundamentals of Laparoscopic Surgery (FLS) training curriculum

 

Background: Beginning in May 2020, all ob/gyn graduating residents will be required to successfully complete the FLS program as a prerequisite for specialty board certification.  

 

Methods: Between January 2017 – April 2018, 36 ob/gyn residents participated in the BCM FLS curriculum.  The curriculum consisted of six 3-hour faculty supervised gynecologic simulation sessions, 24/7 individual access to the simulation lab, proctored voluntary one-on-one sessions, and a final mock FLS session.  Participants were followed with attendance sign-in sheets to gauge number and time involved in all sessions.   Residents completed evaluation forms after each simulation session.  Descriptive statistics were utilized to determine the average/range of the number and time involved in the practices sessions, between PGY levels and FLS pass rates.   

 

Results: All 36 ob/gyn residents successfully completed FLS certification on the first attempt.  In addition to the mandatory sessions, residents required an average of 8.64 independent practice sessions (range 3-22) lasting an average 72 minutes/session.  Approximately 688 minutes (range 235 – 1357 minutes) of independent practice were required to pass the FLS exam.  Many residents felt that the curriculum gave them adequate support to succeed on the exam and stated that one of the most valuable components of the curriculum were proctored teaching sessions.  

 

Discussions: With a dedicated curriculum and proctored teaching, residents in obstetrics and gynecology can successfully pass the FLS certification exam with their initial test. 

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Medical Knowledge, GME, Simulation, Minimally Invasive Surgery,

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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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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 removed.

 

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 0.41.

 

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.

Topics: CREOG & APGO Annual Meeting, 2019, Faculty, Clerkship Director, Medical Knowledge, UME, Assessment, Independent Study,

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Preparing Obstetrics and Gynecology Residents for the Fundamentals of Laparoscopic Surgery Assessment

Purpose: The purpose of this report is to describe the training curriculum which has been successfully used to prepare Ob/Gyn residents for the Fundamentals of Laparoscopic Surgery (FLS) assessment at the University of Massachusetts Medical School-Baystate campus.

 

Background: The FLS program was launched by the Society of American Gastrointestinal and Endoscopic Surgeons in October, 2004. The program highlights the simple aim of teaching and testing the fundamentals of laparoscopic surgery in a consistent, validated format. In January, 2018, the American Board of Obstetrics and Gynecology announced the plan to add the FLS program to the requirements for board certification in Ob/Gyn. This new requirement will create education challenges for program directors across the country.

 

Methods: We conducted a literature review on the implementation of FLS in Ob/Gyn training. We then conducted an analysis of our FLS curriculum at UMMS-Baystate, which has successfully prepared 39-residents for FLS certification with a 100% pass rate on the skills assessment. We highlighted changes that have occurred since FLS certification was made a graduation requirement for our residents in 2012.

 

Results: Key features of our curriculum include early access to OR participation, creation of a satellite simulation lab near L&D, practice FLS skills exams and a faculty point person.

 

Discussions: This analysis highlights a strong curriculum, which has been successfully incorporated into our program for all residents. We also highlight ongoing speculation regarding the utility of the FLS cognitive exam in the evaluation of Ob/Gyn residents, with knowledge of early work which is being done to address this issue.

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

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Perioperative Complications Curriculum for the OB/GYN Resident: A Pilot Study

Purpose: To develop and implement a perioperative complications curriculum.

 

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 baseline curriculum.

The Resident pretest mean score was 72% (40-90%, SD = 15).

 

Interactive, 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.

Resident module completion rates were 50%, 36%, 29%, and 18% for weeks 1-4, respectively.

Eighteen 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.

Topics: 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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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.

Topics: 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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Ob/Gyn Residents’ Perspectives on Preparedness for Difficult Conversations

Purpose: To characterize obstetrics and gynecology (ob/gyn) resident experience in conducting difficult conversations during various patient-care scenarios.

 

Background: Effective and compassionate communication is an essential part of the physician-patient relationship. Leading family meetings to discuss end-of-life care, fetal loss, infertility, or poor maternal outcomes can be a difficult and anxiety-provoking experience. However, there is often limited formal guidance for ob/gyn residents on how to conduct these difficult conversations.

 

Methods: A 16-question survey was sent to all ob/gyn residents in the state of Michigan. Participants answered questions regarding previous training, self-perceived preparedness, and confidence conducting difficult conversations.

 

Results: Of 314 ob/gyn residents identified in the state of Michigan, 75 (24%) responded and the survey is still ongoing. Nineteen (27%) of respondents said that formal training about difficult conversations was part of their residency curriculum. Prior training included online modules/coursework 9 (12%), conferences/lectures 18 (25%), and rotation with palliative care 5 (7%).

Overall, 43 (57%) believed post-grad training in difficult conversations was either completely inadequate or could be improved. Moreover, 61 (81%) of respondents believed formal training for residents on conducting difficult conversations would either probably or definitely improve the quality of patient care. Nearly half the respondent felt a lack of confidence as the biggest barrier in satisfactorily conducting these discussions with the families.

 

Discussions: Efforts to improve residency training in conducting difficult conversations should be urgently undertaken. In this survey, ob/gyn residents overwhelming felt that the current training in leading difficult conversations was inadequate.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Patient Care, GME, CME, UME,

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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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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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Jazzing up Family Planning Education for Students in a Texas Medical School

Purpose: To determine the effects of resident-led family planning education during the third-year obstetrics and gynecology clerkship on medical student knowledge and/or attitudes.

 

Background: Many medical school clerkship directors report that formal family planning education is not offered. Students are more likely to be comfortable referring and providing reproductive health services when exposed to formal education.

 

Methods: Medical students during their obstetrics and gynecology clerkship at McGovern Medical School during the 2017-2018 academic year were given a de-identified quiz and survey at the beginning and end of their rotation. Half of the students participated in a resident-led one-hour didactic session on family planning while half did not. Data was analyzed using chi-squared test for categorical variables.

 

Results: Pre-rotation, students had low baseline scores on a family planning quiz (48.0% intervention group (I) vs. 49.0% no intervention (NI) group, p=0.51). A formal educational initiative significantly improved scores on the quiz (58.2% I vs. 50.7% NI, p<0.0001).Students’ pre-rotation attitudes about women obtaining a second trimester abortion under any circumstance showed that 17% disagreed. After the educational intervention, fewer students agreed with women having access to second trimester abortion under circumstances such as rape, incest or fetal anomalies (69.2% I vs 88.4% NI, p=0.0049). 

 

Discussions: Although the intervention improved knowledge, students were not more likely to report comfort providing family planning services in their future practice. Students’ attitudinal bias against ACOG-supported access to abortion in the second trimester paradoxically increased. Further studies are needed to elucidate barriers to improving knowledge and attitudes about reproductive health.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Residency Director, Medical Knowledge, UME, Contraception or Family Planning,

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amming with Podcasting: Make Education Swing for Medical Students!

Purpose: Take five to explore the podcast format as a smooth way to teach medical students intimate partner violence (IPV) screening and history-taking.

 

Background: The USPSTF recommends IPV screening as routine health maintenance.2 Research has found that perceived preparedness and comfort level are barriers to screening and intervention.1,3 There were only crickets regarding IPV screening in our own curriculum. As a result we sought to harmonize the instruction of students with an accessible and memorable educational format.

 

Methods: We laid down a brief introductory lecture about IPV followed by a 22 minute podcast about screening and addressing IPV disclosures for first-year medical students. They completed pre- and post- surveys assessing general knowledge and perceived confidence.

 

Results: The pre-survey “opener” showed 52% of respondents had no prior experience nor training in IPV screening.  Initially, 64% of respondents hit a sour note feeling either “somewhat not confident” or “not confident at all.” In a smooth turn-around, the post-survey showed that listening to the smokin’ podcast increased students’ confidence. When asked about addressing a positive disclosure of IPV, the post-survey again showed an increase in confidence.  The objective section of the post-survey demo’ed an increase in correct answers for every knowledge question.

 

Discussions: This curricular intervention employs a hot form of information sharing.  Initial data suggested that a majority of students did not feel confident screening for IPV nor addressing a positive disclosure.  After a paired lecture/podcast on this topic, students demonstrated increased general knowledge about IPV as well as a measureable crescendo of confidence.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, UME, Lecture,

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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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Implementing a Longitudinal Social Determinants of Health Curriculum at an Academic Residency Program

Purpose: To examine feasibility and reception of a city-specific social determinants of health (SDH) curriculum at an academic medical program

 

Background: Our understanding of health acknowledges that an individual’s social milieu impacts health as much as genetics. Healthcare providers must consider SDH to provide just, equitable care to a diverse patient population. However, despite a growing emphasis on teaching SDH in medical school, these factors are not formally addressed in traditional residency curriculum.  

 

Methods: A literature review and consultations with local educators identified best practices for teaching SDH to medical professionals. Topics were incorporated into resident teaching activities, including grand rounds, resident retreat, discussions with content experts and community stakeholders, clinic teaching, morbidity and mortality conferences, and a city tour conducted by Rochester, NY natives. Pre- and post-surveys (n=32) were conducted to assess resident knowledge of city resources/demographics and attitudes towards SDH in patient care.

 

Results: In the pre-survey, 73.3% of trainees reported familiarity with SDH. After the curriculum, 88% of residents reported a better understanding of the effects of SDH, and 78% felt that the lessons learned from the curriculum affected interactions with their patients. 97% of residents felt more knowledgeable about Rochester demographics. Overall, residents recognized the importance of formal SDH training and felt that social hardships are important to acknowledge in their clinical interactions. However, some expressed concerns that it took time away from the traditional didactic curriculum.

 

Discussions: A comprehensive, longitudinal, city-specific curriculum on the SDH enriches residents’ understanding of their patient population and available social resources to address these factors.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Patient Care, Medical Knowledge, Professionalism, GME, 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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