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Wellness Wednesday: Utilization of Strategic Duty-free Hours by OB/GYN Residents

Purpose: To detail the specifics of how OB/GYN residents utilize a monthly duty-free afternoon for wellness activities. 

 

Background: Much attention is paid to burnout and high rates of depression among physicians. Some speculate these difficulties may start in medical school but that they become cemented and sometimes problematic in residency. Studies have made implications that interventions, specifically promotion of self-care and work-family balance, and work hour restrictions, early in residency can decrease burnout and depression levels.  

 

Methods: Starting in 2016, all residents of an OB/GYN program were allowed to have the first Wednesday afternoon of each month free from clinical duties. Faculty members covered all clinical services from noon to 5pm. Residents were then permitted to use the time for whatever they felt promoted their well-being. Two years of data were collected through surveys to determine the specific activities completed by the residents. 

 

Results: The commonly reported activities included health care visits, financial planning activities, leisure time with family/friends, community or church group events, every day errands, home chores, and fitness. Additionally, the residents also used the time away from clinical responsibilities to study and fulfill administrative requirements. 

 

Discussions: By better understanding what residents choose to do to promote their own well-being, programs can then tailor structured wellness activities to those choices.  Alternatively, programs can look at an open-ended wellness day as a possible intervention for fostering excellent overall health and welfare of their residents. More research is needed to validate this approach to wellness promotion.

 

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Systems-Based Practice & Improvement, GME, CME, UME, Quality & Safety,

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Use of Video Interviews for Selection of Obstetrics and Gynecology Residents

Purpose: To improve the residency selection process using asynchronous video interviews

 

Background: Residency applications have increased, while data available for decision making in ERAS has been static. One-way (asynchronous) video interviews (OWVI) involve the candidate recording answers to pre-selected questions.

 

Methods: Applicants to an OB/GYN residency program with USMLE Step 1 ≥ 220, no USMLE failures and at least 3 months of US clinical experience were scored using five criteria (USMLE 1 score, clinical clerkship grades, letters of recommendation, research achievements and extracurricular/leadership activities) scored 1-5, with 5 as the top score. Applicants with scores from 19 to 22 were invited to complete an OWVI.  The OWVI consisted of 1 open ended question and 2 behavioral questions, scored from 1-5. Applicants were invited for an in person interview based on their video interview scores.

 

Results: For the 2018 residency application season, 495 applications were received, 272 applications were scored and invited to complete a video interview, 234 applicants completed OWVI and 97 OWVI were used for the decision to invite for an in-person interview. Mean OWVI score was 10.4 (range 4-15). For the 2018 season, OWVI scores were weakly correlated with rank list placement (Pearson coefficient = 0.29), in-person interview scores (0.18) and application scores (0.33). The mean in-person interview score increased after implementation of OWVI screening from 59.0 in 2017 to 62.2 in 2018 (P<0.01).

 

Discussions: Use of OWVI led to higher in-person interview scores, suggesting that video interviewing is a useful supplemental tool for selecting competitive residency candidates.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, GME, UME, Assessment,

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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.

Topics: 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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Residents Express Emotional, Social and Physical Stress in the Clinical Learning Environment

 

Purpose: To evaluate OBGYN residents’ perceptions of personal wellness in relation to their clinical learning environment

 

Background: Resident wellbeing is a significant issue affecting our future physicians’ abilities to fulfill their training potential.

 

Methods: The Council on Resident Education in OBGYN (CREOG) administered a voluntary, anonymous, six-item wellness survey.  One question asked about personal experience with mental health problems (burnout, depression, binge drinking, eating disorders or suicide attempt) and then provided a free text response for “other” issues.  The free text responses were reviewed and analyzed.  The ACOG IRB determined this survey exempt from review.  

 

Results: Of 5,061 residents, 4,099 completed the question on personal issues experienced in residency (81% RR), and 200 free text responses were submitted.  1593 residents (32%) endorsed clinical depression.  34 (0.8%) wrote in anxiety, although this was not a formal category.  The free text responses clustered into three categories: physical health (n=56), social concerns (n=34), and mood symptoms (n=115).  Symptoms of clinical depression comprised 5,992 responses, combining structured questions and free text responses.  18 (0.4%) had attempted suicide, and 18 additional residents wrote in suicide ideation or attempt, translating into almost 1% of our residents having contemplated or tried self-harm, likely related to work stress.

 

Discussions: Significant mood disorders and self-harm are under-recognized among OBGYN residents, even as they acknowledge these symptoms.  Programs must consider formal evaluations for depression, anxiety, and suicide risk, conduct thorough culture evaluations to ensure these symptoms are not being normalized, and tailor their interventions to provide accessible, confidential support services within the clinical learning environment.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, CME, Assessment, Team-Based Learning,

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Resident Wellness: Barriers to Seeking Mental Health Services Among OB GYN Residents

Purpose: Residency predisposes residents to the development of burnout and mental health complications. The culture of residency inevitably places barriers to wellness through expectations of perfectionism, increasing stress levels, and long hours. This study aims to highlight the main reasons why OB GYN residents may not seek help for depression in residency.

 

Background: Residency is a period of extreme stress, lack of sleep and long work hours. Factors such as embarrassment and confidentiality play key roles into why physicians don’t seek help. Some additional barriers cited in the literature include lack of time, fear of documentation on academic record, cost and lack of confidentiality. 

 

Methods: This was a qualitative study to assess the barriers that may keep OB GYN residents from seeking access to mental health resources.  The surveys were electronically distributed via Survey Monkey to OB GYN resident programs

There were a total of 18 questions that assessed demographics and the main barriers that may keep OB GYN residency from seeking mental health services.•A 5 point Likert scale was used to assess the following; ranging from strongly disagree to strongly agree •I can manage my problems on my own •I don’t have enough time •I am worried my privacy would be violated •I don’t know if my program offers mental health services •I don’t have money or health insurance to seek help •I don’t think treatment would be of any help •I am worried about the stigma of mental health 

 

Results: There were 275 respondents to the 18 question survey. Lack of time was the most highly reported barrier, followed by a lack of protected time for appointments. Not knowing if their programs offered services or how to access those services and not thinking treatment would not be of help were the least popular responses.

Discussions: In summary, our data outlines that lack of time and protected time in OB-GYN residencies are prevalent barriers to seeking help among OB GYN residents that must be addressed. Understanding the barriers to seeking help will help us to enact programs that will maintain the wellness of our residents.

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

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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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P&S Partners in Pregnancy: A Longitudinal, Patient-Centered Program for Preclinical Students

Purpose: To develop a longitudinal clinical program pairing first-year medical students with prenatal patients. 

 

Background: Students who participate in early clinical, longitudinal experiences report greater confidence in communication, comfort in clinical settings, and self-esteem during transition to clerkship year. However, few longitudinal experiences exist for preclinical students at Columbia University Vagelos College of Physicians and Surgeons.

 

Methods: A retrospective needs assessment evaluating interest, motivating factors, and perceived barriers to participation was distributed to second-year students. In response, we developed a program pairing ten first-year students with pregnant patients. Students partake in lectures and accompany patients to prenatal visits. Initial perceptions about the patient-physician relationship were assessed in both groups using the Patient-Practitioner Orientation Scale (PPOS), with 1 indicating “doctor-/disease-centered,” and 6 indicating “patient-centered.”

 

Results: 49% of students completed the needs assessment. 90% reported that they would be at least “somewhat interested” in a longitudinal prenatal pairing program. Motivating factors included desiring longitudinal experience (87%), early clinical exposure (82%), and patient advocacy/community engagement (78%). Our program was designed accordingly. All first-year students were invited to apply; ten were accepted. At recruitment, mean student PPOS score was 4.64 compared to 3.95 for patients.

 

Discussions: Students in early medical education are enthusiastic about longitudinal patient experiences and demonstrate patient-centered mindsets. Programs such as ours may help maintain and cultivate patient-centeredness, with the potential to improve patient satisfaction(1) and create positive attitudes towards medical student involvement.

 

1 Krupat E et al. Patient orientations of physicians and patients: the effect of doctor-patient congruence of satisfaction. Patient Educ Couns 2000; 39:49-59.  

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Medical Knowledge, Professionalism, UME, Independent Study, Team-Based Learning, Advocacy, 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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One Size Doesn’t Fit All for Wellness: Residents’ Perception of Wellness Programming

Purpose: To investigate which wellness interventions have the most meaning for a modern cohort of OB/GYN residents.

 

Background: The 2017 CREOG Resident Survey found significant associations between the learning environment and wellness. The primary analysis indicated that PGY-1’s prioritized wellness, and that a sense of wellness decreased with each PGY level. In order to explore whether developmental stage influenced how wellness initiatives were perceived, we performed a secondary analysis of the survey to determine how residents at different PGY levels perceived wellness interventions.

 

Methods: A six-item survey on wellness was administered before the 2017 CREOG exam.  IRB exemption was obtained.  Participation was voluntary and anonymous, linked only to PGY level.  A mixed-methods analysis of the data was performed. Descriptive statistics were analyzed with Microsoft Excel 2010.  Mann-Whitney U tests were used to explore differences between PGY-levels. Thematic analysis of text responses was performed.

 

Results: Among the 5855 residents, 4,753 answered questions regarding wellness programming (81% RR). Significant differences existed between year of training and perceived effectiveness for several initiatives. PGY1 residents valued peer mentorship (p=0.003) and strategic napping (p<0.001) more than senior residents, while PGY3 residents emphasized faculty mentoring (p=.005).  Regardless of training level, residents prioritized the same three activities: wellness days to address personal needs, team-building retreats, and facilitated exercise programs.  

 

Discussions: OBGYN residents perceive some wellness activities as valuable throughout training, while the importance of others may vary based on resident year.  Most programs do not yet provide the wellness programs (retreats, facilitated exercise, personal time) that OBGYN residents identify as most effective.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Professionalism, GME, CME, Team-Based Learning,

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Medical Student Wellness

Purpose: The purpose of this study was to evaluate medical student wellness at our institution. We distributed a survey intended to identify sources of stress as well as coping mechanisms. 

 

Background: Psychological distress is higher in medical students than in age-matched peers2. Studies have shown that both the mental and general health of medical students decline within the first year.3 Fifty percent of medical students experience burnout3, and ten percent experience suicidal ideations4. Only fifteen percent seek psychiatric care.

 

Methods: A survey was electronically distributed to all medical students with a 43% response rate. Statistical analysis was performed using Students t-test and Fisher Exact test.

 

Results: Students identified the amount of pressure placed on themselves and pressure others placed on them as a prime source of stress. Female students were more likely to identify volume needed to learn as a source of stress. Female students were also more likely to identify a support system as a coping mechanism, utilize counseling, and feel more anxiety. Students who took a gap year were more likely to own a pet that provided stress relief. Financial concerns were not found to be a significant source of stress.

 

Discussions: Stress, burnout, and mental health issues are issues that must be identified and managed in order to promote wellness. Male and female students may have different perceptions about sources of stress and coping mechanisms. Age and life experience appears to impact coping mechanisms. This data may help schools develop resources to assist students, and may help target the development of wellness programs.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Professionalism, UME,

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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\'s Get Jazzy: Career Preparedness in OB/GYN Residents; Assessing the Need, and Developing a Curriculum

Purpose: To assess the need for a formal and structured curriculum focused on OB/Gyn resident career and employment preparedness.

 

Background: Many residents rely on mentors and resident colleagues to help determine their career paths. Curriculum during residency in obstetrics and gynecology often lacks an emphasis on preparing residents to enter the job field as practicing physicians. Often physicians complete training with significant amount of education debt.  Some employment scenarios may have negative financial implications. Residents need to be formally educated on the impacts changes in research funding, the healthcare system, and insurance market play in their career decisions. It is important to determine how to best prepare residents to choose a career path.

 

Methods: We administered a career curriculum needs assessment and a validated career readiness survey, which included questions relating to mentorship, job search strategies and opportunities, negotiation, and practice climate to 28 residents. The survey results determined the topics that were needed.

 

Results: 89% of residents agreed it was important to learn about career paths during residency. 96% of the residents believed that a career-planning curriculum would be helpful.  89% thought it was important to have a career mentor. Overall, 67.9% of respondents do not feel confident about their ability to negotiate a contract. The majority of resident were not familiar with medical practice finance and malpractice insurance.

 

Discussions: The survey results were used to inform curriculum for the academic year. Topics included career mentoring and individual planning, negotiation, finance, and insurance. Comparison of pre/post curriculum will be performed after 1 year.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Professionalism, GME, CME, Lecture, Independent Study,

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Keeping Residents Well: How Important Are Perceptions of Program Support and Psycholocical Safety to Resident Wellness?

Purpose: We aimed to test whether measures of resident well-being correlated with perceptions of program support and psychological safety.

 

Background: Trainee well-being is a crucial component of developing competent and skilled OB/GYN physicians. While there are several measures of well-being collected at the national-level, there is little insight in the role of individual programs to foster trainee well-being. Perceived organizational and psychological safety are two constructs that can help identify cultural aspects of the clinical learning environment that may relate to trainee well-being.

 

Methods: OBGYN residents in a training program were recruited to complete an IRB-approved survey through paper and electronic methods between May-June 2018. Measures included the Survey of Perceived Organizational Support (POS), Psychological Safety Scale (PS), Perceived Stress Scale (PSS), Wayne State Wellness Scale (RWS) and Physician Well-Being Index (PWBI); all demonstrate validity and reliability evidence to assess factors of well-being and cultural aspects of the training program.

 

Results: 20 OBGYN residents completed our survey. Results indicated a strong relationship between perceived organizational support and wellness  (r= .62, P<.01 for RWS, r=.50, P<.05 for PWB)., suggesting greater perceptions of support relate to better wellness. Similarly, psychological safety also had a strong relationship with wellness (r=.56, p<.05 for RWS;  r= -.72, p<.01 for PWB)

Discussions:  
Our findings suggest that there is a strong relationship between trainee wellness and the cultural measures of support and safety, especially between psypschological safety and negative indicators of well-being (e.g,. feeling burnt out from work, feelings of irritation). Further research should include interventions to improve percpetions of suport and safety.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, Quality & Safety, Advocacy, CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Lecture, 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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Differences in Male and Female Medical Student Perceptions of the Gender Gap in Obstetrics and Gynecology

Purpose: Describe medical student opinions about the gender gap in the OB-GYN workforce and how student gender influences perceptions of an OB-GYN career.

 

Background: OB-GYN has significantly more women in training and in practice. Previous research cites  this gender imbalance as a reason for decreased student interest among men. No study has elaborated on the reasons why gender influences interest in this specialty.

 

Methods: We performed a mixed methods analysis on survey data from MS3/MS4 students to determine how gender influences perceptions of an OB-GYN career choice.

 

Results: A 51% (90/176) response rate was achieved (45% male, 54% female, 1% other). Both men and women considered the current gender gap undesireable (95% vs 89%, p = .68). Among men, negative themes included stigma from providers and patients, perceptions of limited career opportunities, and perceived difficulty relating to patients. Among women responses included female empowerment and ease of connecting with patients despite preference for a more gender-balanced specialty. Male students not pursuing OB-GYN more often decided before medical school (p = .03), while women more often determined this after their third-year clerkship (p = .04).

 

Discussions: Our study suggests that the gender gap negatively influences opinions of OB-GYN for all students. Men believed their gender negatively impacts career opportunities and patient relationships. Women viewed the gender gap negatively and desired equal gender representation, but they also perceived it to be an example of women empowering other women. Career counseling to increase male interest may benefit from targeted responses to these insights.

Topics: CREOG & APGO Annual Meeting, 2019, Faculty, Clerkship Director, Residency Director, Professionalism, Practice-Based Learning & Improvement, GME, UME, General Ob-Gyn,

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Clinical Vignettes: A Novel Residency Group Interview Technique

Purpose: To compare residency applicants experience with a novel group interview technique to a traditional individual interview.

 

Background: A unique group interview has been used by George Washington University’s OBGYN Residency for many years. The group interview involves reading and discussion of several short literary vignettes.  There are no studies looking at this type of interview.  We wanted to ensure that the diversity of our program is not limited by making minority applicants uncomfortable in the group setting. 

 

Methods: A brief questionnaire about the group and faculty interview was sent to all applicants following the completion of the match using a 5 point Likert scale. The responses were analyzed using paired/non-paired t-tests.

 

Results: 38/85 (45%) of interviewed applicants completed the survey. Applicants did not feel as comfortable with the group interview when compared to the individual interview (Mean 3.32 and 4.39, p value 0.0001). The applicants felt the group format did not allow for interviewers to get an accurate impression of them when compared to the individual interview (Mean 3.11 and 4.34, p value 0.0001).   Minority candidates (Men, non-Caucasians, and non-native English speakers) felt more comfortable with the group interview than their peers (Mean 3.37 and 2.8, p value 0.02).

 

Discussions: Applicants felt less comfortable with our novel group interview when compared to the traditional individual interview. Interestingly, minority candidates felt more comfortable in the group setting than their female, Caucasian, native English-speaking counterparts.  This study demonstrates that our group interview does not discourage minority applicants and may improve the diversity of our residency program.

Topics: CREOG & APGO Annual Meeting, 2019, Residency Director, Interpersonal & Communication Skills, GME, Assessment,

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Burnt out and yet Engaged: Are We Asking the Right Questions in Faculty Wellness Research?

Purpose: To examines rates of work engagement and work empowerment in ob-gyn faculty, together with their perceptions on connection at work, in correlation with burnout.

 

Background: Burnout appears to be an accelerating phenomenon, threatening the health and well-being of providers and patients. There is concern, however, that the term is becoming overused and that the measures may not capture the full picture, with an assumption that the end-goal is the absence of burnout rather than the promotion of wellness.

 

Methods: Cross-sectional study of 25 ob-gyn faculty at a large academic medical center in the United States. Outcome measures: Utrecht Work Engagement Scale, Work Empowerment Scale, 2-item Maslach Burnout Inventory, and perceptions of connection in the department.

 

Results: Fifty-six percent of faculty met criteria for emotional exhaustion, 19% for depersonalization, and 19% for high burnout. There was no difference in years of practice and the presence of burnout (P=.74), and no association between burnout and work engagement or work empowerment (P=.33 and P=.25, respectively). Ninety-two percent feel a sense of connection and community at work and 92% trust their colleagues and feel safe discussing concerns with them.

 

Discussions: Emotional exhaustion, sometimes capitulated to be a sign of pathological burnout, may be an appropriate and normal response to daily activities which does not impact engagement at work. Shifting the focus away from burnout to positive psychology measures and building community may be the key to nourishing joy in practice and transforming the workplace to one that promotes wellness in the face of adversity and challenge.

Topics: CREOG & APGO Annual Meeting, 2019, Faculty, Professionalism, Systems-Based Practice & Improvement, CME, General Ob-Gyn,

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Bring Back the Tubal: An Intervention to Provide Postpartum Bilateral Tubal Ligation in the Underserved Population

Purpose: Improve educational awareness and receptiveness to the PPBTL procedure.

 

Background: 50% of women requesting a PPBTL undergo the procedure. Barriers exist to obtain the PPBTL, including lack of available operating rooms and concern for patient regret. Half of pregnancies in the U.S. are unintended, occurring disproportionately higher in low-income and minority populations. Children resulting from unintended pregnancies are at risk for poor health outcomes including low birth weight and developmental delay. Additionally, the U.S. financial burden of unintended pregnancy accounted for approximately 21 billion dollars in 2010.

 

Methods: A retrospective chart review was conducted from 2015-2016 to document the baseline prevalence of PPBTLs performed at IFMC. Educational sessions with pre- and post-session questionnaires were conducted for departments of OB/GYN, Anesthesia, and Nursing. Data was collected from April 2017 - April 2018 regarding patients desiring the procedure, those completing the procedure, and reasons for unsuccessful procedure completion. A pre-post comparison was performed to assess the impact of the educational sessions and the overall prevalence of PPBTLs.

 

Results: Fifty-one multidisciplinary staff members at IFMC participated in the educational sessions. All departments showed significant improvement in knowledge of the PPBTL (OB/GYN p=0.0117, Anesthesia p=0.0002, Nursing p=0.0001). A baseline prevalence of three PPBTLs were performed from 2015-2016, which increased to fifty-six from 2017-2018. Comparing pre-post intervention, the percentage of PPBTLs requested and ultimately performed increased from 39% to 60%.

 

Discussions: Targeted multidisciplinary educational sessions were effective in identifying barriers and increasing educational awareness. Overall, this resulted in increased access to and performance of sterilization in the underserved population.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Patient Care, Professionalism, Interpersonal & Communication Skills, GME, Quality & Safety, Team-Based Learning, Advocacy, Contraception or Family Planning,

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The Impact of a Structured Wellness Curriculum on Burnout Among Obstetrics and Gynecology Residents

Purpose: Our primary aim was to evaluate the effects of a formalized wellness curriculum on the rate of burnout among University of New Mexico (UNM) obstetrics and gynecology (OBGyn) residents.  Our secondary aim was to evaluate the effect of a wellness curriculum on rates of depression, alcohol abuse and suicide risk.

 

Background: Burnout is a pathological syndrome characterized by depersonalization, emotional exhaustion and a low sense of personal achievement. Burnout is a concern for resident physicians due to their heavy workload and low sense of autonomy.

 

Methods: A structured wellness curriculum was instituted at the start of the 2016 academic year.  A 45-item survey, consisting of the Maslach Burnout Inventory Human Services Survey (MBI-HSS), personal health questionnaire-9 (PHQ9), suicide behaviors questionnaire-revised (SBQr), and the alcohol use disorders identification test (AUDIT), was to be administered at the start, midpoint, and end of the academic year.

 

Results: The study included 23 UNM OBGyn residents. Midpoint and end of curriculum surveys were collected as planned and demonstrated no difference in rate of burnout.  Upon completion of the 2016 academic year 18 (78.2%) residents reported moderate to severe emotional exhaustion; 13 (59.1%) moderate to severe depersonalization; and 5 (21.7%) low personal achievement.  SBQ-R identified 4 (18.2%) residents at high risk for suicide and AUDIT-C identified 15 (68.2%) at high risk for alcohol abuse.

 

Discussions: High rates of burnout, depression, alcohol abuse, and suicide risk did not change between the midpoint and end of a structured wellness curriculum.

 

Topics: CREOG & APGO Annual Meeting, 2018, Resident, Faculty, Residency Director, Interpersonal & Communication Skills, GME, UME,

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