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
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
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
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
Results: 92% (n=259) of programs had information available on
off-service rotations, of these, 24% (n=62) had no off-service rotations, 26%
(n=67) had 1, 25% (n=66) had 2, 13% (n=34) had 3, 12% (n=30) had 4 or more. The
majority (84%) of rotations were in PGY1. The most common rotations were ER
(47%, n=122), SICU (24%, n=62), IM (25%, n=66), MICU (9%, n=23). We received 53
responses to the survey (19% response rate). Of those who responded, the most
common rotations for 2018 and before 2003 were ER & SICU. The number of
programs with SICU rotations remained stable from 2003 to 2018 (43% vs 47%)
compared to 1.4 fold decrease in programs with ER rotations. The number of
programs with IM rotations decreased 2.5 fold from before 2003 to 2018.
Discussions: Duty hour restrictions have affected off-service rotations. A
quarter of all programs have no off-service rotations, with a decrease in ER
and IM exposure during residency. This does not reflect the breadth of
knowledge required of OB/GYNs today.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Quality & Safety, General Ob-Gyn, CREOG & APGO Annual Meeting, 2019, Student, Resident, Clerkship Director, Residency Director, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Team-Based Learning,
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Transgender Healthy Care: On-line Survey of Physician Knowledge and Comfort
Purpose: To evaluate OB/Gyn provider knowledge and comfort with
transgender health care
Background: Transgender and gender non-conforming patients (TGNC)
are an underserved population that often encounters inadequate or ‘unsafe’
clinical care. Education regarding TGNC patient care has traditionally been
minimal, contributing to gaps in Ob/Gyn care for many of these individuals,
including transgender men.
Methods: An IRB approved, anonymous online non-validated survey
was emailed to 130 APGO program coordinators to distribute to their Ob/Gyn
faculty and post-graduate learners. Questions addressed included years of
practice, experience with TGNC patients, provider comfort, and TGNC education.
Results: One hundred and sixty four surveys were completed and
an additional ~50 were opened but no information was provided. Of the 164
completed surveys, 76.3% of participants reported less than 5 hours of TGNC
specific healthcare education, despite the fact that 75.7% of responders had
cared for at least one TGNC patient. Overall most respondents felt
comfortable/very comfortable (79.8%) caring for this population. No correlation
was found between years in practice and overall provider comfort caring for
TGNC patients. Major obstacles reported by participants included concern
for patient comfort, appropriate language, and lack of sufficient clinical
education for both providers and support staff
Discussions: These data suggest that enhanced TGNC clinical education for
the entire health care team is warranted.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, GME, Advocacy,
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Training Residents to Place Immediate Postpartum LARC: An Update Among U.S. Residency Programs
Purpose: To survey U.S. Obstetrics and Gynecology (Ob/Gyn) Residency
Programs on immediate postpartum (IP) long-acting reversible contraception
(LARC) training and challenges.
Background: In 2016, the American College of Obstetricians and
Gynecologists (ACOG) released a committee opinion supporting IP LARC. Growing
evidence describes provider/hospital barriers which hinder IP LARC provision.
We hypothesize similar difficulties have prevented programs from implementing
Methods: We distributed an electronic survey addressing IP LARC
training to 273 U.S. Accredited Council for Graduate Medical Education (ACGME)
Ob/Gyn Residency Program Directors from the 2017-2018 Academic Year. Data
analysis was performed with chi-square and Fisher’s exact test.
Results: Of 86 programs that participated, residents were
trained in the immediate postpartum period to place implants in 54 programs
(63%) and to place intrauterine devices (IUDs) in 52 programs (60%).
2015, only 20% of the programs were training their residents to place IP IUDs.
Thirty-one percent of eligible programs initiated training in 2017. The
majority of programs focused training interns (98%). Patient/provider
convenience motivated 46% of programs to offer IP LARC and compliance motivated
The two barriers
most frequently encountered, regardless of program training status, were
problems with billing and compensation for services (61%) and the pharmacy
that reported primarily seeing patients with insurance, either private or
Medicaid, were more likely to have IP IUD training compared to programs seeing
mostly indigent/uninsured populations (p<0.05).
Discussions: IP LARC training has increased since the ACOG Committee
Opinion was published, however many programs are still facing challenges with
implementation, affecting resident training.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Systems-Based Practice & Improvement, GME, Public Health, Advocacy, Contraception or Family Planning,
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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
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.
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Resident Documentation and Coding Curriculum Can Be Improved Through One-on-one Education
Purpose: Assess impact of one-on-one education of residents in billing
Background: As billing and coding education was changed from
generalized education at didactics to more intensive one-on-one education, the
revenue team evaluated the impact for accuracy in billing and monetary impact.
Methods: Three groups of residents were analyzed. Group 1 (n=4)
were fourth year residents at intervention and had a general meeting with other
departments about coding and then one or two one-on-one sessions. Group 2 (n=4)
were third year residents at intervention and had two to three one-on-one
sessions. Group 3 (n=4) were second year residents at intervention and had
three consistent one-on-one sessions every 6 months. A selection of 10 records
per resident were randomly selected for review by a certified coder to identify
documentation and coding opportunities.
Results: The documentation and coding accuracy improved with
increased education. Accuracy Group 1: 55%, Group 2: 76%, Group 3: 89%. Revenue
lift was also analyzed with these encounters and an average lift of ~$40 was
noted between group 1 and group 3.
Discussions: By consistent billing and coding one-on-one education for
residents, the accuracy of coding improved as seen in the differences in
accuracy rate between graduating 4th years (55%) and second year residents
(89%). Residents see 5 patients on average per clinic session in their final 2
years and have approximately 30 clinics per year. This equates to an extra
$12,000 in revenue per resident over their final two years. By investing in
billing and coding education, accuracy and revenue were increased.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, General Ob-Gyn,
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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.
E et al. Patient orientations of physicians and patients: the effect of
doctor-patient congruence of satisfaction. Patient Educ Couns 2000;
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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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
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
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Professionalism, GME, CME, Team-Based Learning,
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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.
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.
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
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.
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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Incorporating a Resident-Driven Quality Improvement Process Change Through a Lean Transformation of Post-Partum Hemorrhage (PPH) Care
Purpose: To investigate a
resident-driven quality improvement lean event to improve satisfaction in PPH
Background: Interdisciplinary PPH
response strategies are recommended as standard of care. OBGYN resident
perceptions regarding PPH management prompted an interprofessional quality
improvement lean event to create a systems process change on the post-partum
Methods: This was
a pre-/post-intervention study evaluating the impact of a lean event that
created new hemorrhage protocols (intervention) on postpartum units including:
medication safety bundle, assigned/clarified roles for providers, and a
streamlined communication process. The survey queried respondents regarding
team communication, access to uterotonics and analgesia, and perception of
overall patient safety during PPH. It was administered to resident physicians
and post-partum nurses prior to the system changes and at 6 and 12-month
intervals. These results were compared using nonparametric analyses.
included 15 residents and 16 nurses. Pre-intervention, there was a significant
difference in the overall perception of safety when comparing resident and
nurse response (p=0.0495) with residents perceiving a less safe environment.
Post-intervention, overall satisfaction among the 2 groups was improved at the
6 & 12 month intervals (p<0.05) without discrepancy between the
groups. Nurse results demonstrated significantly increased satisfaction
with team communication and IV access protocols (p<0.05).
Discussions: Resident led quality
improvement events can result in improved satisfaction of interprofessional
team members in PPH care with improvements maintained over 12 months. Reaching
a shared perception and mental model between nursing and residents in the care
of PPH can further be studied from the patient’s perspective.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, GME, General Ob-Gyn,
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Gender in OB-GYN Residency: An Analysis of Factors Impacting Program Diversity
Purpose: To investigate if
geographic region, gender mix of previous classes and program leadership impact
the gender composition of residency programs.
comprised only 7.1% of all Obstetrics and Gynecology (OB-GYN) providers in
1970, and held 58.7% of OB-GYN positions in 2017.
Methods: 56 of
the top OB-GYN residencies as ranked by Doximity.com and US News & World
Report were identified and grouped by geographic region. Demographic
information for residents (n = 1732) and program/departmental leadership (n =
112) were compiled. Individuals’ gender was identified using online photos and
biographical descriptors. The male-to-female ratio (MFR) of the 2018 intern
class, of existing residency classes, program directors and departmental chairs
were calculated and compared. Two-way ANOVA and Tukey’s multiple comparison
tests were used (significance = p<0.05).
majority of trainees in OB-GYN programs are women (62.5-94%.) The MFR varied
significantly based on geographic region; southern programs had the highest MFR
(Figure 1). Programs with male chairs compared to those with female chairs
recruited more male interns (14.2% vs. 8.9%, p < 0.001). Programs with >
20% male residents (PGY 2,3,4) had a higher MFR in the incoming intern class
compared to programs with < 20% (15.4% vs. 11.4%, p = 0.020).
Discussions: Men are a minority in
OB-GYN training. Gender composition of residency programs is influenced by the
gender of leadership, geographic region, and of prior classes. Programs
must balance empowerment of women with a culture of inclusion and support of
qualified male candidates to ensure strength gained through diversity.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, GME, UME, Advocacy, Sexuality,
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Family Planning Training at Catholic and Other Faith-based Obstetrics and Gynecology Programs
Purpose: The objective of this
study was to determine the current paradigm of forceps assisted vaginal
delivery (FAVD) training across the United States (U.S.) amongst OBGYN
national FAVD rates decline and primary cesarean rates continue to be high, we
must be aware of resident interest, training, and skill acquisition in
FAVD. There is a current paucity of literature on FAVD training
Methods: A survey
was created and disseminated on the internet and to OBGYN residency program
directors for distribution to current OBGYN residents from March to June 2018.
Geographic regions were determined using Census Bureau-designated regions.
survey was completed by 434 OBGYN residents (8.5% of 5,061 ACGME residency
positions) with representation from all U.S. regions. Of postgraduate year
(PGY)-4 respondents, 71% participated in ≤10 FAVDs, with only 20.2% with
>20 FAVDs. Of all residents, 40% expressed a desire to learn FAVD, with
54.6% completing FAVD simulation training. While 46% of resident stated that
they would like to perform both FAVD and VAVD once in practice, only 13%
expressed confidence in performing FAVD independently. Residents from the
Midwest are most likely to have completed >20 FAVD at 18%, compared to 0%,
5.7% and 11.3% of residents from the Northeast, West and South, respectively
Discussions: Residents are motivated
to learn FAVD and would like to have the skill to perform them independently.
Our study demonstrates that current trainees are not obtaining adequate
experience, irrespective of geographical region. Current OBGYN residency
training programs should implement simulation and real-time training of
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, GME, Assessment, Public Health, Contraception or Family Planning,
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Evaluating Patient Understanding of the “diagnosis of Pregnancy of Unknown Location”
Purpose: To evaluate health
literacy in an inner city population among a high risk group of
resident-managed patients with a diagnosis of pregnancy of unknown location.
health literacy is associated with poor reproductive health outcomes. Previous
research on patient compliance with methotrexate protocols as treatment for
ectopic pregnancy has shown poor compliance (as low as 10%). Rates of
follow up after diagnosis with pregnancy of unknown location are not well
Methods: A chart
review was performed to identify of all patients seen in an inner city hospital
with the diagnosis of pregnancy of unknown location. Patients meeting inclusion
criteria were contacted by phone to survey understanding of the rationale for
close follow up. Patients who never followed up after initial contact were
seven patients with the diagnosis of pregnancy of unknown location were
identified between January – April 2018. Twenty nine patients met
inclusion criteria and twenty agreed to participate. Only 40% of patients correctly
explained that there was a concern for ectopic pregnancy. The remaining
patients identified their diagnosis as an “abnormal pregnancy” (10%),
“miscarriage” (10%); “I don’t know” (15%), and other (25%).
Discussions: Although the patients
surveyed were compliant with follow up, nearly half of the patients showed poor
comprehension of their clinical condition. It may be that poor understanding is
a major underlying cause for noncompliance for the many patients who never
followed up. This should be evaluated in future research.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, Quality & Safety, Public Health, General Ob-Gyn,
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Ethical Issues Identified by Third Year OB-GYN Medical Students Vary According to Rotational Site
Purpose: To categorize ethical
concerns identified by OB-GYN medical students and compare across rotational
recognizes that students should understand the basis of ethical issues in
OB-GYN in order to promote quality patient care and patient safety.
Little, however, is known about how OB-GYN medical students experience ethical
issues and if rotational site plays a role. At the University of Colorado
School of Medicine, third year OB-GYN students complete an ethics assignment
based on their experience rotating at either a university hospital (UH), a
safety-net hospital (SH), or a Catholic hospital (CH).
ethics assignments completed during the 2016-2018 academic years were
deidentified of student names and rotational sites. Two investigators
independently performed thematic analysis using a previously published OB-GYN
ethics framework to categorize assignments and reached consensus. We
performed descriptive frequencies and compared ethical categorizations across
sites using Pearson’s chi-square.
assignments were analyzed (46.0% UH, 29.8% SH, 24.2% CH). The most common
ethical category identified was treatment decisions (80.2%). UH students were
more likely to encounter code status (p=0.03), surrogate decision-maker
(p=0.03), and fetal viability (p=0.03) issues. SH students were more
likely to encounter disagreement in treatment plans between patients and
providers (p=0.03) and consent issues (p=0.02). CH students were more likely to
encounter issues of institutional policy restricting care (p<0.001) and
competing responsibilities of mother versus fetus (p= 0.02).
Discussions: OB-GYN medical students
encounter ethical concerns that vary by rotation site. Our findings can inform
site-specific educational interventions to address ethical concerns encountered
during OB-GYN rotations.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Patient Care, Professionalism, GME, UME,
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Decreasing the incidence of hospital-acquired venous thromboembolism (VTE) through inter-disciplinary educational methods
Purpose: This study explored the
knowledge of a venous thromboembolism (VTE) prevention protocol among
residents, fellows and nurses and the impact of an educational module in an
effort to improve adherence to this protocol and subsequently decrease the
incidence of hospital-acquired VTE.
significantly contributes to morbidity and mortality in hospitalized patients.
Patients with gynecologic cancers are at high risk primarily due to malignancy,
increased age, and recent surgery and immobility. Several evidence-based
interventions are used to decrease the risk of hospital-acquired VTE commonly
leading to institutional policies. The division of Gynecologic Oncology at
University Hospitals Cleveland Medical Center standardized VTE prevention
guidelines in 2015.
included OB-GYN residents, Gynecologic Oncology fellows and nurses on the
Gynecologic Oncology floor. Participants received a fifteen question pre-test
immediately followed by an educational presentation describing the venous
thromboembolism prevention guidelines. They then received the same fifteen
question post-test. The participants were re-tested in six months to gauge
knowledge retention. The scores were compared using an unpaired T test.
were seventy-five eligible participants. The survey response rates were:
pretest 68%, post-test 35%, follow up pretest 28% and follow up posttest 21%.Of
the participants who identified their role, 62% were nurses, 33% were residents
and 5% were fellows. There was a statistically significant difference between
the test scores before and after the educational intervention during the
initial intervention and the six month follow up (p= 0.0001). During the
initial survey, the mean pre-test and post-test scores were 54.5% (95% CI
49.7-59.3) and 80.2% (95% CI 73.4-87.1) respectively. At the six month follow
up, the mean pre-test and post-test scores were 62.2% (95% CI 56.5-67.9) and
82.1% (95% CI 75.3-88.9) respectively. There was no significant difference between
the post-test scores at zero and six months (p= 0.7).
Discussions: These findings suggest
that knowledge of the VTE prevention guidelines improved following an
educational module. Further studies can elucidate the impact of this knowledge
on compliance with the VTE protocol and incidence of hospital-acquired VTE.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, GME, Quality & Safety, Gynecologic Oncology,
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Attitudes Around Interprofessional Team-Based Learning on L&D
Purpose: To investigate the
impact of integrating student nurse-midwives (SNMs) into an academic center’s
labor and delivery (L&D).
American College of Obstetricians and Gynecologists (ACOG) and the American
College of Nurse Midwives (ACNM) encourage team-based maternity care. CNM and
OB-GYN resident learners rarely work together clinically.
were integrated into the obstetric team at University of California, San
Francisco. Pre- and post-integration, a validated interprofessional
survey was administered.
Results: Prior to
integration, all stakeholders were positive about the new team composition.
Residents were more comfortable initiating care discussions and assuming
different roles including leadership. Residents and CNM faculty were concerned
about an increase in workload and MD faculty were concerned about decreasing
resident experience and decreased teaching of residents by CNMs. After
integration, SNMs level of comfort with assuming different roles increased. All
learners and CNM faculty thought that hierarchy was a problem and SNMs were
more likely to comment on a power dynamic. All respondents thought that
midwives provide more holistic care and that residents had more competing
demands. Post integration, MD faculty were less concerned about a diminution of
resident experience and CNM faculty and residents were more mixed about the
impact on their workload.
Discussions: Integration of
midwifery students into a L&D team is feasible and acceptable. CMS
regulations on SNM charting impact resident and CNM workload. While all
respondents reflected positively on the integration and noted more holistic
care provided by midwives, there is still a marked difference in perception of
hierarchy by both midwifery students and faculty.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME,
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An Interprofessional Fais Do-Do: Medical Student Field Notes on a New Integrated Practice Unit
Purpose: - To gauge medical
students’ perspectives on integrated care using an experiential learning
- To provide a clinical application of
- To inform continuous quality improvement
Medical School students attain the Basic Certificate in Quality & Safety
through the IHI Open School online course in year two of our interprofessional
integration curriculum. Recently, our institution opened a Complex Gynecology
Integrated Practice Unit (CGIPU), which also serves as an interprofessional
clinical site for students on the Women’s Health (OB/GYN) clerkship.
followed CGIPU team members and composed field notes on the provision of
high-quality, patient-centric care. They used a truncated list of the IOM
Six Aims for Healthcare on which to base their notes: Timeliness, Efficiency,
Equity, and Patient-centeredness. At the end of each clerkship block,
they submitted a group report based on individual experiences. Reports
were qualitatively analyzed to identify key questions and recommendations
emerging from their observations.
Results: 100% of
students completed individual field notes (N=50). Six group reports were
evaluated. Results revealed positive Patient-centered observations,
specifically the desire to attain patients’ goals, time allotted for visits,
and interprofessional coordination of care. Under Equity, psychosocial
determinants of health and access to care were routinely addressed.
Appointments were lengthy due to the delivery of personalized care.
Recommendations included a better balance of time (Timeliness). Efficiency
focused on technical operations including improved integration of the EHR and
facilitation of online language interpretation.
Discussions: Reports were submitted
to leadership to consider recommendations for quality improvement. The
assignment achieved its purposes.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, UME, Assessment, Quality & Safety, Problem-Based Learning,
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A Triple Aim Curriculum That Addresses Health Care Inequity: A Resident Driven Patient Centered QI Project That Improves Postpartum Care Utilization for a High Risk Population
Purpose: To describe the design
and implementation of a resident driven QI initiative which addresses the low
percentage of patients returning for a 6-week postpartum visit in a resident
postpartum period or the “fourth trimester of pregnancy” is a critical period
for women’s health and well-being. At our resident clinic (2014-2016),
only 21% of patients presented to their 6-week postpartum visits compared to
80-93% in other practices. As part of a new, mentored experiential
approach to QI education, our residents completed a QI project based on an
identified clinically relevant patient care issue.
Ob/Gyn residents (single institution) completed the IHI QI Online modules as
part of a GME supported Health Systems Science initiative focused on operationalizing
a Triple Aim targeted curriculum. Applying the Model for Improvement, the
residents designed and implemented a QI project with the aim of 100% of
postpartum patients discharged from the resident service during a 6-month
period to receive a 2-week post-discharge check-in call. The % of
discharged patients attending their 6-week postpartum visit was calculated and
compared to the % attendance 2014-16. Data analysis: independent t test,
Results: 6 months
after implementation, 97%(37/38) of patients received a 2-week check-in
call. Of those contacted, there was a 45% increase in patients who
returned for a 6-week postpartum visit (p<0.01).
Discussions: An educational
intervention can directly improve patient care. An experiential approach
to QI can facilitate knowledge application and result in improved postpartum
care utilization for high risk patients.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Systems-Based Practice & Improvement, GME, CME, UME, Quality & Safety, Problem-Based Learning,
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Increasing Access to Emergency Contraception, Non-emergent Contraception, and LARC Referrals in the Emergency Room: A Resident-based Educational Intervention
Purpose: The aim of this study is to determine whether an educational
intervention improves emergency medicine residents\' knowledge of and personal
comfort with prescribing EC, offering non-emergent contraception, and referring
patients for LARCs.
Background: Approximately 50% of pregnancies in the United States
are unintended. Increasing access to emergency contraception (EC), non-emergent
contraception, and long-acting reversible contraception methods (LARCs) is one
way of decreasing unintended pregnancies. Emergency rooms enable physicians to
assess a woman\'s risk of unintended pregnancy and afford an opportunity to
intervene, if appropriate. Previous studies have found that emergency medicine
physicians do not always offer EC, even in cases of sexual assault. Barriers to
prescribing EC have been identified and include time constraints, lack of
clinical resources, concern about discouraging regular birth control, and
concern about birth defects.
Methods: Emergency medicine residents were given an interactive
lecture on contraception with emphasis on EC. They were also given a pocketbook
on contraception to keep. Pre- and post-lecture surveys were given in person,
along with another 6 months later. The surveys assessed knowledge, comfort
level, and prescribing/referring practices with both quantitative data and
qualitative data. Data will also be extracted from the electronic medical
record to assess if there was an increase in prescriptions for contraception
and/or referrals to family planning.
Results: The preliminary data analysis is currently being
conducted. Twenty-three emergency medicine residents completed the pre- and
post-test surveys. Additional information from prescriptions and referrals will
provide objective data to assess whether the educational intervention changed
Discussions: There are two hypotheses for this study. First, it is
hypothesized that an educational intervention will increase emergency medicine
residents\' knowledge of and comfort with EC, non-emergent contraception, and
LARCs. Second, there will be a significant increase in prescriptions for EC,
non-emergent contraception, and referrals for LARCs one year after the
educational intervention takes place. If the hypotheses are correct, residency
programs and hospitals should consider developing educational strategies and
policies to improve access to contraception in the emergency room and prevent
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, GME, CME, Assessment, Lecture, Quality & Safety, Contraception or Family Planning,
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Family Planning Training at Catholic and Other Faith-based Obstetrics and Gynecology Programs
Purpose: To evaluate family
planning training at obstetrics and gynecology (OB-GYN) residency programs that
primarily train at restrictive religious hospitals.
and other religious hospitals face institutional family planning care
restrictions, which are in conflict with the training requirements set forth by
the Accreditation Council for Graduate Medical Education (ACGME).
identified 30 ACGME accredited OB-GYN residency programs in which at least 70%
of resident time is in restrictive, faith-based hospitals. We
queried program representatives about training using an online survey and
follow-up telephone interview.
Results: We had
an 80% survey response rate. The majorities were program directors (83%),
represented Catholic hospitals (75%), and completed telephone interviews (71%).
Programs often relied on other sites to accomplish contraceptive (33%),
sterilization (71%), and abortion (88%) training. All programs reported
adequate training in reversible contraception. 58% reported inadequate
sterilization training, most commonly in postpartum and hysteroscopic
sterilizations. 67% reported inadequate abortion training, most commonly
in D&E. Approximately half (54%) offered ‘routine’ and 13% did not
offer any abortion training. Eight programs (33%) received a total of ten
Residency Review Committee citations due to insufficient family planning
training, and most of these programs (71%) reported using these citations to
gain institutional support for off-site training.
Discussions: While Catholic and
other faith-based OB-GYN residency training programs have developed strategies
in response to institutional restrictions, many report ongoing deficiencies and
half remain noncompliant with abortion training requirements. Residency Review
Committee citations, however, provided an opportunity for programs to leverage
support for comprehensive training.
CREOG & APGO Annual Meeting, 2019, Resident, Residency Director, Patient Care, Systems-Based Practice & Improvement, GME, Contraception or Family Planning,
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