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Implementing Communications Training for OB/GYN Residents: Disclosure of Adverse Peri-operative Events

Precis: This study investigated the effect of self-evaluation on the improvement of surgical skills by comparing OSATS scores over a 4-month period to determine if the addition of a self-evaluation improved surgical skills more than instructor evaluation alone. 

Purpose: To study the implementation of communications training for OB/GYN residents on the disclosure of adverse peri-operative events

Background: Communication skills are key components of the patient-physician relationship, however, these skills are not routinely taught during OB/GYN residency or fellowship. As OB/GYNs, disclosure of serious news happens routinely in various aspects of patient care.  

Methods: OB/GYN residents at a single institution participated in a 4-hour communication didactics session using VitalTalk methodology.  Participants were surveyed at baseline, immediately following training and 3 months post-training to measure changes in comfort and confidence in the performance of communication skills. A 5 point Likert scale was used to measure comfort/confidence: Novice (1), Advanced Beginner (2), Competent (3), Proficient (4) or Expert (5).  

Results: 27 residents participated in training; 8(29.6%) interns, 7(25.9%) 2nd year, 7(25.9%) 3rd year and 5(18.5) 4th years. 11/27 (40.7%) reported prior communication training. Before training, residents reported the most competence: detecting emotion cues (median: 3.1), detecting patient/family sadness (3.0) and responding empathetically (2.8). Residents felt the least competent: assessing patient/family willingness to discuss perioperative complications (2.0), assessing how much a patient/family wants to know (2.1), confirming understanding of the adverse event (2.3). Baseline comfort and skill performing these conversations was 2.1 and 1.9, respectively. Immediately post-intervention, average comfort and skill level increased to 2.8 and 2.8, respectively. 3 month data is currently being collected.

Discussion: OB/GYN residents self-rate their communication confidence and skills at an advanced beginner level.  Implementation of participatory communication training for OB/GYN residents is feasible and improves both trainee comfort and skills in the disclosure of adverse peri-operative events. Further work is ongoing to understand retention of these skills to inform more longitudinal curricula.  

Topics: General Ob-Gyn, Standardized Patient, Simulation, GME, Interpersonal & Communication Skills, Professionalism, Residency Director, Clerkship Director, Faculty, Resident, Student, 2020, SES,

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The Magic of Reflection: Facilitating Resident Discussion of Challenging Family Planning Patient Scenarios

Purpose: To describe residents’ experiences of a guided reflection workshop about patient interactions which provoke negative emotions in the physician

Background: In 2016 we trained faculty to facilitate a guided reflection workshop.  The Professionalism in Reproductive Healthcare Workshop (PRHW) guides obstetrics and gynecology (ob-gyn) residents in exploring interactions with challenging patients, particularly those seeking family planning care.

Methods: Faculty volunteered for the training via a community listserv, underwent a half-day training, and then led workshops at 23 different institutions. Institutions were informed about the workshop by listserv emails, and scheduled workshops into their resident didactics. We conducted pre- and post-training surveys and descriptive analyses to assess post-workshop resident satisfaction and changes in attitudes about patient scenarios using Likert scales.

Results: From 2016 to 2019, 27 faculty conducted 28 workshops with 222 residents in the US and Canada. We collected 139 post-workshop surveys (63%), and 72 matched pre- and post-workshop surveys.  Patient scenarios residents most frequently identified as challenging were women who had more than one abortion, and women who did not want to become pregnant but were not using contraception.  In matched surveys, learners demonstrated greater awareness of reasons a patient might not initiate contraception after abortion and greater acceptance of that decision compared with responses before the workshop  (p< 0.01). The majority (91%) rated the workshop as worthwhile.

Discussions: Resident learners exhibited more understanding attitudes towards challenging family planning patient scenarios after participating in the PRHW. Supporting resident reflections about challenging patient scenarios may improve their ability to provide more high-quality, patient-centered family planning care.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, GME, Contraception or Family Planning,

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Spellbound: Impact of a Professionalism Workshop on Abortion Attitudes for Residents at Catholic Programs

Purpose: To determine if a professionalism workshop that explores attitudes about abortion care influences ob-gyn resident attitudes at Catholic residency programs.

Background: Catholic residency programs face institutional barriers to abortion training.

Methods: Between 2018-2019, we provided professionalism workshops at five Catholic programs that do not provide abortion training. Participants received a pre and post survey related to abortion training and attitudes.  We compared Likert responses using Wilcoxon matched pair test. 

Results: 41 residents (87% of eligible residents) completed both surveys; 29.3% reported Catholic religion, 14.6% reported their personal views on reproductive care are in line with their institution, and 12.2% reported selecting a Catholic program based on its religious affiliation.  With respect to prior abortion experiences, 75.6% provided options counselling, 41.5% provided abortion referral, and 9.8% provided first-trimester abortion for nonmedical reasons.  Views on whether abortion or related circumstances is justifiable did not change for a patient presenting with an undesired pregnancy (p=0.32), but demonstrated increasing acceptance for the following circumstances:  (1) patient presenting for abortion at 19 weeks (p=0.001), (2) patient presenting for second abortion (p=0.01), and (3) patient declining post-abortal contraception (p< 0.001).  Emotional reactions to scenarios were unchanged.  When asked about when abortion is morally acceptable, views became more accepting for patients presenting with financial inability (p< 0.01) and for disruption to career or education (p< 0.01).

Discussions: A professionalism workshop can be a useful tool for residents at Catholic training programs to explore their abortion attitudes and results in more accepting attitudes toward women who choose abortion in certain circumstances.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, Assessment, Public Health, Contraception or Family Planning,

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Sexual Harassment in Obstetrics and Gynecology Postgraduate Training

Purpose: To determine the prevalence of sexual harassment(SH) in obstetrics and gynecology(OBGYN) residency and fellowships.

Background: SH is a common problem the U.S. with 1 in 3 women experiencing some form of it in their lifetime. According to the National Academies of Sciences, Engineering, and Medicine (NASEM,) 24-50.4% of female medical students experienced sexual harassment, which is more than their peers in science and engineering, and 220% more than female students in non-science fields.

Methods: We conducted a voluntary, anonymous survey study of all U.S. OBGYN trainees in ACGME-accredited residency and fellowship programs. The survey included the validated Sexual Experience Questionnaire (SEQ) short form, and other questions including demographics. The NASEM definition of SH was used in the study and described to the participants in the survey instructions. Descriptive statistics were utilized.

Results: The survey was distributed to 1473 trainees in the US; 395 responses were received (26.8%response rate: 86%females, 13.5%males). 20.6% of participants (78/378: 21.1%females, 21.7%males) responded yes to having been sexually harassed during their OBGYN training. Based on the SEQ questionnaire, 69.1% OBGYN trainees (253/366) had experienced some form of SH. Sexist hostility was the most common form of SH followed by crude behavior (211/253,83.4%;182/253,71.9% respectively). Males and senior OBGYN attendings (154/208,74.4%;110/395,27.9% respectively) were named the most common perpetrator; the operating room was the number one location for SH followed by Labor and Delivery (97/395,24.6%;83/395, 21.0% respectively).

Discussions: Although OBGYN is a female dominated field, the rate of SH of trainees remains high according to our data.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME,

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Resident Perceptions of Power-Based Violence and Impact of Bystander Intervention Training

Purpose: To evaluate resident perceptions of power-based violence (PBV) and assess initial impact of bystander intervention (BI) training.

Background: Creating a safe, welcoming workplace is important in medical education.  PBV in the form of overt aggression, microaggression, or bullying can threaten the educational community.  BI training offers residents a skill set to intervene to counteract PBV and foster a safer, welcoming clinical environment for their teams.

Methods: Pre-training and post-training surveys were completed by OB-Gyn residents at Vanderbilt prior to formal Green Dots BI training.  The survey assessed frequency of experienced or witnessed PBV, sexism, and racism.  Residents self-assessed their ability to recognize overt versus subtle PBV, and whether they would intervene in instances of PBV based on the role of the perpetrator.  Residents completing BI training were re-surveyed with the same instrument 3 months later.  Exempt IRB approval was obtained.

Results: 22 active residents were surveyed pre-training. 19 residents completed BI training and the post-training survey.  Active residents reported at least sometimes being the target of PBV (22.7%), sexism (45.5%), or racism (9.0%).  Even more residents reported at least sometimes witnessing PBV (50.0%), sexism (59.1%), or racism (45.5%).  Residents’ willingness to intervene varied by perpetrator: fellow resident (59.0%), attending (18.2%), nursing staff (40.9%).  100% of active residents felt obligated to foster a safe work environment free of PBV.  
Among residents completing BI training, the percentage reporting recognition of overt PBV increased after training from 84.2% to 94.7% (p=0.29), and the percentage reporting recognition of subtle PBV increased after training from 78.9% to 89.5% (p=0.37).  There was a modest increase after training in the percentage reporting they would intervene for PBV perpetrated by a resident (52.6% to 57.9%, p=0.74) or nursing staff (31.6% to 36.8%, p=0.73), but no change for faculty-perpetrated PBV.

Discussions: PBV is experienced and/or witnessed by residents not infrequently.  While residents are more likely to intervene for PBV perpetrated by a fellow resident, they are less likely to intervene when perpetrated by attendings or nursing staff.  BI training appears to offer modest improvements in recognition of PBV and willingness to intervene, but its effect in this study was limited by sample size.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Residency Director, Professionalism, GME, UME, Team-Based Learning, Advocacy,

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Gender and Satisfaction with Mentorship In Medical School: A National Study

Purpose: Using the American Association of Medical Colleges (AAMC) Graduation Questionnaire (GQ), we assess if males and females at all U.S. medical schools report differing experiences with satisfaction with faculty mentorship.  Secondarily, we assess the role of men\'s and women\'s scholarly projects and career plans as they relate to satisfaction with mentoring.

Background: Female physicians experience gender-based professional differences, such as lower compensation, slower rates of promotion, and decreased representation in leadership positions as compared to their male colleagues.  The way this gender-based professional inequity affects the experience of medical student mentees has yet to be elucidated in the literature.

Methods: Data were obtained from the AAMC GQ years 2016-2018.  Student satisfaction with faculty mentoring was analyzed by chi-squared and logistic regression.

Results: With an 82% response rate we analyzed data for 47,063 students; 51% were male and 49% female. When asked about satisfaction with faculty mentoring, 81% of males verses 79% of females reported being \"satisfied\" or \"very satisfied\" (p< 0.001). A higher proportion of males reported faculty were helpful to students with academic matters (60% versus 55%; p< 0.001) and with non-academic matters (58% versus 55%; p< 0.001) \"very often\" or \"always.\" Females were less likely to be satisfied with faculty mentoring even after controlling for participation in research with a faculty member and future research plans.

Discussions: This work serves as a needs assessment to encourage individual medical schools to investigate their own gender-based cultures regarding faculty representation and leadership to allow gender-equal mentorship of all students.

Topics: CREOG & APGO Annual Meeting, 2020, Faculty, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, GME, CME, UME, Advocacy,

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Developing Committed Resident Leaders: A Survey of the Obstetrics and Gynecology Administrative Chief Resident Experience

Purpose: To define the challenges and experiences of Obstetrics and Gynecology (OBGYN) administrative chief residents (ACRs) and identify support needed to make them successful.

Background: ACRs are integral to OBGYN residency programs, however little research has been done on the experiences, training, and support of ACRs.

Methods: A Qualtrics survey was emailed to program coordinators at all 292 ACGME OBGYN residency programs. Response styles included MCQs, yes/no, likert scales, and short answer. Question topics included demographics, chief duties, support, and experiences. Study participants were defined as current / past ACRs (2019-2020, 2018-2019) and program directors (PDs).

Results: Ninety two ACRs and 24 PDs received the survey, as confirmed by program coordinators. Forty five surveys were completed (response rate 39%), including 38 (84%) ACRs and 7 (16%) PDs. 
The majority (67%) were from academic programs with a median of six residents and two ACRs per year. Forty-nine percent of respondents reported ACRs spend 4-7 hours per week on administrative duties.  Eighty seven percent reported no protected time. On a 10-point likert scale, mean perceived support from faculty, PD, administration, and other residents was 6.8, 8.6, 7.1, and 7.5 respectively; however, mean stress level was 7.1. 
Common challenges reported by ACR’s are conflict resolution and workload management. Many ACRs felt they would benefit from formal leadership training and protected time.

Discussions: These results summarize the experience of ACRs. Best practices and formal training in identified challenge areas should be added to residency curriculum and used to develop toolkits to support ACRs nationwide.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, Assessment, Team-Based Learning,

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Teaching Cultural Humility To Medical Students By Building Cross-Cultural Patient Education Tools

Workshop Text: Cultural humility and cross cultural communication are essential skills for medical students who will be called upon to translate medically complex concepts and treatment plans to patients from diverse backgrounds.  This skill set, however, is not often taught effectively during medical school.

This workshop will demonstrate a method for teaching cultural humility to medical students.  Through the process of designing and testing a cross cultural patient education model, the student explores essential features and pitfalls of cross cultural education. Workshop participants will design an abbreviated patient education tool based on a case based scenario and engage in group discussion about the challenges involved. Presenters will share a project that was used in three languages from sub-Saharan Africa and another in Vermont and will discuss challenges from their field work. An evaluation rubric will be provided. 

Introduction (5mins) define cultural humility and discuss best practices in cross cultural communication. 

Group Activity (10 mins) Using 1-2-4-all format, discuss pitfalls of cross cultural communication demonstrated in an excerpt from The Spirit Catches You and You Fall Down.

Breakout Activity/ Interactive component (30 mins) Small groups of participants will design a patient education tool for a specific patient population based on a real life scenario. 

Group Activity (15 mins) Discuss the process of designing a cross-cultural patient education tool with respect to cultural humility.

Wrap up (5 mins)

Take home products: Grading rubric , Resource guide with annotated bibliography

 

Topics: Faculty Development Seminar, 2020, Faculty, Clerkship Director, Patient Care, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Global Health, Advocacy,

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SERIOUS PLAY® Intermediate Level: Collaborative Play Using LEGO® Elements to Build a Dynamic Team

Objective/Background: LEGO® SERIOUS PLAY® (LSP) methodology deepens the reflection process. This tool encourages the culture of participation by flattening the hierarchy through narrative play. By creating the shared identity of a team through cooperative play, involved participants have a shared understanding of their team dynamics. Intermediate level of facilitation techniques will build upon last year’s and this year’s introductory concepts with new techniques that involve creating a shared team identity and role play in a landscape format using an individual’s narrative in a collaborative play environment.

Workshop Agenda: The workshop will re-introduce the concept of LSP, as needed. Simultaneously, the participants will have hands-on experience with the process itself. This workshop will expand upon the basic concepts of LSP by using the LEGO building challenges to create the team identity. Nota bene: Attendance of the SERIOUS PLAY® Introductory Level is not required but recommended. Certain basic concepts will be reviewed but its absence will not take away from this expanded experience.

Interactive Component: Participants will partake in the actual process of LSP, learning and experiencing first-hand how cooperative play encourages teambuilding and leadership development.

Take Home Product: Participants will receive a toolkit that will include an open-source manual to the LSP methodology via a hyperlink, an illustrated example of a teambuilding workshop design, and a handout with additional resources.   

Topics: Quality & Safety, UME, GME, Interpersonal & Communication Skills, Professionalism, Residency Director, Clerkship Director, Faculty, Resident, Student, 2020, Faculty Development Seminar,

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On The Lookout: Use Of Debriefing With Clerkship Students To Aid In Wellness And Resiliency

Objective/Background: The Obstetrics and Gynecology rotation may expose students to their first experiences with serious medical conditions and traumatic events. These events shape students’ perspectives, and if left unaddressed, could potentially contribute to the development of burnout over time. Debriefing serves as a tool to allow students to discuss shared experiences and build resiliency, especially with topics often considered routine amongst practicing physicians. 

Workshop Agenda:
The workshop will begin with large group discussion of clinical issues that place students at risk for developing emotional fatigue (10 min). 
Workshop facilitators will then introduce debriefing concepts and tools. Facilitators will model the method of debriefing employed at their institution, and shared experiences and development of coping skills will be discussed by participants (20 min). 
Participants will be given examples of clinical scenarios that may require debriefing, divide into small groups, and will practice the debriefing model using the tools (20 min).
Participants will share their experiences with each scenario as a large group (10 min).
Finally, the group will brainstorm, discussing innovative ways to integrate debriefing into their clerkships (15 min).  

Interactive Component: Participants will be given clinical scenarios that allow them to practice debriefing from the facilitator and student perspectives.  

Take Home Product: Participants will be provided a toolkit for implementing debriefing at their home institutions. It will include a detailed description of common methods of debriefing, a guide for implementation in the clerkship, and literary resources.  Group brainstorming ideas will also be documented and shared. 

Topics: Team-Based Learning, Problem-Based Learning, Independent Study, Assessment, UME, GME, Practice-Based Learning & Improvement, Interpersonal & Communication Skills, Professionalism, Residency Coordinator, Residency Director, Osteopathic Faculty, Clerkship Coordinator, Clerkship Director, Faculty, Resident, 2020, Faculty Development Seminar,

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Helping Medical Students Recognize the Effects of Their Biases on Patient Care

Learning or Performance Objectives: Participants will identify implicit biases and prejudices that impact clinicians’ interaction with patients. They will discover tools to assist educators and learners to identify bias, to engage in constructive discussions about implicit bias, and to thereby improve healthcare quality.

Background:  Emerging data points to implicit racial bias as a cause of disparity in maternal health outcomes between women of color and white women. The perceptions, and biases healthcare providers formulate, based upon patients’ skin color, impact the way we render care. Oftentime, we are unaware of the effects of our biases on the clinical decisions we make. As multi-disciplinary teams work to eradicate these disparities, we need to train healthcare providers to identify the effects of their biases. Workshop agenda: This workshop will review recent findings of implicit bias in healthcare, teach participants a mechanism for identifying their own biases, and empower participants to train learners and faculty to identify bias.

Participants will engage in interactive clinical scenarios, assigning patients to categories. They will identify what implicit biases affect their choices. They will learn facilitative language for clarifying biases, discover available resources for identifying biases and updating attitudes and behaviors, and will receive a take-home tool-kit.

Interactive component:  Interactive media usage during large group presentation. Categorization of patients. Small group breakouts reviewing clinical scenarios and discussing challenges of identifying biases.

Take-home product: (1) Checklist of key components for implicit bias identification, (2) Model for bias clarification activities for faculty and learners, (3) Clinical scenarios.

Topics: Faculty Development Seminar, 2020, Student, Resident, Faculty, Clerkship Director, Osteopathic Faculty, Residency Director, Patient Care, Professionalism, Interpersonal & Communication Skills, GME, UME, Problem-Based Learning, Team-Based Learning, Public Health, Advocacy,

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Get Laser Focused: Essentialism For The Medical Educator

Background: We cannot be effective advocates of wellness for our learners if we model dysfunctional patterns of work. Meditation, healthy eating, and yoga are great tools for managing our internal environment, but they are easily negated by mismanagement of our external environment. Studies show that avoiding burnout involves identifying purpose and meaning in our work. In this workshop based on Greg McKeown’s Essentialism participants will take a deep dive into the idea that, although we can’t do it all, we can choose what we do and don’t do. We will accept the notion that when we forfeit our right to choose someone else will choose for us, and we will take an essentialist approach to identifying our highest contribution and maintaining the discipline to eliminate work that takes our focus off that purpose.


Objectives: Explore your individual purpose by examining:

What deeply inspires me?

What am I particularly talented at?

What meets a significant need in the world?

Identify tradeoffs and choice associated with each of your current responsibilities.

Practice strategies to gracefully eliminate non-essential work


Agenda:

Introduction to Essentialism (10 minutes)

Self-Inventory Activity (15 minutes)

Guided Interpretation of Self-Inventory Activity (15 minutes)

Small group reflection/discussion (20 minutes)

Large group debrief, wrap up, questions and sharing of resources (15 minutes)


Take Home: Participants will leave with a clearer idea of their highest purpose, a plan for eliminating responsibilities that have distracted them from that purpose, and some techniques for gracefully saying no to new opportunities that are not essential to achieving their professional goals.

Topics: General Ob-Gyn, Lecture, CME, Systems-Based Practice & Improvement, Professionalism, Residency Director, Clerkship Director, Faculty, 2020, Faculty Development Seminar,

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Focus On Youterus: Using Art To Improve Teamwork, Communication and Professional Identity Formation

Background: Teamwork and communication among health professionals leads to improved patient outcomes, reduction in errors, improved patient satisfaction.  Too often time is not provided within individual training programs to develop the knowledge, skills and behaviors associated with high performing teams.  Development of a strong professional identity can lead to strong team leaders and team members.  Over the course of this workshop, we will present a low cost simulation using art that can be used to achieve above mentioned goals

Objectives: Our objectives for this session are to: 
Discuss the increasing importance of teams and communication in medicine
Discuss the role of professional identity in professional growth
Perform a simulated team exercise using art
Detail the numerous ways art can be used in medical education

Agenda/Interactive Component: The 75-minute workshop will include:
Introduction to teamwork, communication, and professional identity and directions for the art simulation (Large group, 15 minutes) 
The large group will break into teams of 5-10 participants and each group will go through 1 of the following 3  group exercises (30 minutes):
     o Team #1:  Teamwork
     o Team #2:  Communication
     o Team #3:  Professional Identity
Small groups will share their experience with the large group. (10 minutes)
Large group will brainstorm other applications of this exercise. (10 minutes)
Wrap-Up and questions (Large group, 10 minutes

Take-home Product:  Participants will leave with one example of a fun, low-cost art simulation that can be adapted to many different situations that involve teamwork, communication, and identity formation. 

Topics: Team-Based Learning, Simulation, UME, GME, Practice-Based Learning & Improvement, Interpersonal & Communication Skills, Professionalism, Residency Coordinator, Residency Director, Clerkship Director, Faculty, Resident, Student, 2020, Faculty Development Seminar,

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Eliminate Remediation Blind Spots and Define a Clear Path to Success for Medical Learners

Objective/Background: Medical students and residents are expected to progress in their medical education using Milestones and other benchmarks to guide learning. However, within medical education, there is no standard pathway or framework for students or residents who require remediation to address professionalism or academic concerns. 

Workshop Agenda: The workshop will be an interactive mix of didactic and case-based learning.  We will define terms such as andragogy, professionalism, and academic failure.  We will suggest methods to establish interrater reliability amongst the faculty to identify the struggling learner including the use of a residency Clinical Competency Committee and a medical student grading committee.  Once we have characterized the struggling learner, we will explain methods used at our institutions to deploy individualized learning plans, including curriculum mapping, for professionalism and academic failure.  

Interactive Component: Case vignettes will be used to create remediation plans for both professionalism and academic failure.  Participants will complete curriculum maps based on the scenarios, develop appropriate learning objectives, and use existing evaluation tools to measure their plans

Take home Product: Handouts will be available to provide a format for implementation including a remediation framework, curriculum maps, and evaluation tools.  A modifiable presentation will be supplied to participants in order to return to their home institutions to use for faculty development.

Topics: Assessment, UME, GME, Practice-Based Learning & Improvement, Interpersonal & Communication Skills, Systems-Based Practice & Improvement, Professionalism, Residency Coordinator, Residency Director, Clerkship Coordinator, Clerkship Director, Faculty, 2020, Faculty Development Seminar,

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Creating Gender Inclusivity: A Primer On Transgender And Gender Non-Binary Health Care

Workshop Text: Care of transgender and gender non-binary patients affects all medical specialties, but most physicians, medical students and clinic staff do not have specific training in gender inclusive healthcare.  
Through games and interactive discussion, participants will learn context and skills helpful in care of a gender diverse population.   These exercises are an excerpt of a longer, three part series, the outline of which will be provided to participants.   

Agenda:
Introduction:  Why is this important? Brief presentation on trans health care disparities (5 mins)
Interactive Group Activity:  Is this the right word?  Brainstorming and then defining terminology related to gender (10 mins)
Breakout Activity:  Celebrity game!  “Players” vs “Monitors” – have your team guess the celebrity you are describing using only gender neutral pronouns.  If a monitor catches you using a gendered pronoun, your turn is over. (15 mins)
Debrief (5mins)
Breakout activity:  using “1-2-4-all,” groups evaluate clinical scenarios on each table (15 mins)
Interactive Group Activity:  How can I make my clinic more inclusive?  Discuss elements of a gender inclusive clinic. (20 mins)
Questions (5 mins)

Take home products:
Syllabus for three part series
Pre and post-test evaluation for series
Annotated resource list

Topics: Sexuality, Advocacy, UME, GME, Practice-Based Learning & Improvement, Interpersonal & Communication Skills, Systems-Based Practice & Improvement, Professionalism, Patient Care, Faculty, 2020, Faculty Development Seminar,

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Clerkship M&M: Looking Forward through the Rear View

Objective/Background: Clerkship faculty often face unforeseen circumstances that lack the straight-forward solutions typically addressed in the clerkship handbook.  In addition, programs where students rotate at different sites may struggle to deliver a uniform clinical experience.  The objective of this workshop is to empower participants to approach complex scenarios by reviewing actual cases encountered by clerkship directors. Using an interactive approach, participants will reflect on past experiences to devise solutions and create a group-generated compendium of possible resolutions.   

Workshop Agenda: In this workshop we will review unique clerkship situations and devise possible solutions using a framework to approach these issues.  Examples include: leave requests to attend various functions (conferences, weddings, etc), student with depression; toxic resident environment, missed feedback, and sexual harassment. The workshop will start with 1-2 sample cases of real-life scenarios to review as a group.  In small groups, participants will list challenging situations they have encountered and discuss best practices for management using a suggested framework approach.

Interactive Component: Participants will generate a list of unique/challenging concerns they have faced at their institution and discuss strategies on how to best handle each scenario.  In large group, one interesting case from each small group will be reviewed.
 
Take-home product: Participants will leave with a framework of approaching complex scenarios as well as a group generated compendium of possible resolutions.   

Topics: Team-Based Learning, Problem-Based Learning, UME, Systems-Based Practice & Improvement, Professionalism, Clerkship Coordinator, Clerkship Director, Faculty, 2020, Faculty Development Seminar,

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Blind, Or Sight Without Vision? Building A Professional Learning Environment With 20/20 Vision

Background: We can often concur on the most glaring examples of non-professional behavior.  However, a widely accepted definition of professionalism in Ob/Gyn is a blind spot; as such it poses a challenge to assess how well it has been taught to learners.

Workshop Agenda:
Who had the vision regarding professionalism?  Learning from our past visionaries. (15 minutes)
     o Poll-everywhere of how people define professionalism
     o Review of sentinel literature from Maxine Papadakis 
What is our current vision of professionalism?  Seeing the issue from all sides. (35 minutes)
     o Review of factors that affect learning environment
     o Three case scenarios of actual mistreatment complaints from our institution
     o Tables will be assigned as student, resident, and faculty perspective and switched for different scenarios.  Debate on the views of professionalism from all sides. 
How do we reach our vision of professionalism? Creating a vision for the future. (25 minutes)
     o Tips for creating a professional environment from our institution
     o Poll everywhere of how other institutions create a professional environment
     o Create a plan for instituting a professionalism curriculum through a worksheet

Interactive Component: Small group discussion, poll-everywhere, large group discussion 

Take Home Product:
Pocket guide for keeping feedback professional
Worksheet: Barriers, Breakthroughs, and Blueprint for teaching professionalism. 

Topics: UME, Interpersonal & Communication Skills, Professionalism, Residency Director, Clerkship Coordinator, Faculty, Resident, Student, 2020, Faculty Development Seminar,

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Aloe on the Burn; Using Grade Appeals to help Learners Improve

Objective/Background: Assigning a clinical grade is one very challenging aspect of medical education.  Students get up early, work hard all day, try to be helpful, and in the end often feel undervalued or worse, unfairly assessed. Once grades are assigned students are frequently disappointed with their grades and approach faculty for more information at the least or a different grade at the most. This process is stressful for students and faculty alike.

Workshop Agenda: In this interactive workshop we will review the literature on grade appeals in medical education and provide examples from our own experience. We will discuss best practices to reduce their frequency. We will review examples of rubrics for grade appeals and have workshop participants develop rubrics for their own institutions. We will do a practical exercise role playing student grade appeals, practicing from a checklist of “tough conversations” geared toward commonly disputed aspects of the grade. 

Interactive Component: Participants will 
1) work on a rubric for grade appeals at their institution, 
2) role play a grade dispute conversation,
3) use large group discussion to identify structures and methods to reduce stress and improve meaning during grade disputes 

Take Home Products: 
1) rubric, 
2) tough conversation checklist 

Topics: Assessment, UME, Interpersonal & Communication Skills, Systems-Based Practice & Improvement, Professionalism, Faculty, Resident, Student, 2020, Faculty Development Seminar,

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

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Targeted Interventions to Improve Resident Well-being

Purpose: To quantify and compare physician well-being and incidence of burnout across residency programs at our institution, emphasizing program-specific and resident-driven interventions

Background: As the national conversation regarding physician well-being evolves, the importance of addressing physician burnout has come to the forefront. Our institution identified moderate levels of burnout across all residency programs, and thus initiated institution-wide efforts. Literature suggests utilizing organization-wide and targeted interventions together has the most significant impact on improving well-being and reducing burnout.

Methods: A Modified Maslach Burnout Inventory (MBI) survey is distributed annually to all residents at our institution. Results from 2015-2018 were analyzed to track changes in burnout scores. All residents participated in institution-wide interventions. Some departments initiated additional resident-determined program-specific interventions.

Results: Mean MBI scores qualified for moderate burnout for all programs across all years. Most programs utilizing institution-wide interventions demonstrated no change in burnout scores; while some, specifically OB/GYN, saw a statistically significant increase in burnout scores (p<0.001). Departments with program-specific interventions demonstrated decreased scores during the same time period.

Discussions: Residency programs utilizing targeted interventions demonstrated marked improvement in burnout scores.  Amongst those without targeted interventions, OB/GYN demonstrated the largest increase in burnout, suggesting differing etiologies of burnout for individual programs, with OB/GYN being uniquely susceptible. We plan to combat this by utilizing a guided focus group of OB/GYN residents to identify drivers of burnout and specific interventions addressing these factors, using the Mayo Well-Being Index to track anticipated improvement. Continued work in evidence-based strategies addressing the challenge of burnout will ultimately produce more engaged physicians.

Topics: GME, Systems-Based Practice & Improvement, Professionalism, Residency Coordinator, Residency Director, Osteopathic Faculty, Faculty, Resident, 2019, CREOG & APGO Annual Meeting,

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