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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Testosterone Supplementation in Women with Diminished Ovarian Reserve
Purpose: To evaluate the efficacy of transdermal testosterone as an
adjuvant to the standard IVF protocol to improve outcomes in women with
diminished ovarian reserve (DOR).
Background: Women with DOR have extremely low pregnancy rates
after IVF cycles, and there are currently few treatment options available.
Testosterone supplementation may improve ovarian response to stimulation via
Methods: This retrospective cohort study analyzed
83 IVF cycles based on inclusion criteria of age < 42 and
diagnosis of DOR (basal FSH > 10, AMH < 1, antral follicle
count < 6, or history of poor response [< 4 follicles]). Cycles in
the control group were carried out using the standard IVF protocol while
cycles in the treatment group involved the addition of transdermal testosterone
prior to ovarian stimulation. Four primary outcomes were evaluated: total
number of oocytes retrieved, number of mature oocytes retrieved, number of
embryos generated, and pregnancy potential of the embryos.
Results: Pretreatment with transdermal testosterone had no
impact on the total number of eggs retrieved after ovarian stimulation.
Testosterone had a negative impact of the number of mature oocytes retrieved,
but had no impact on the number of embryos generated from those oocytes.
Pregnancy rates between the treatment and control groups were no different per
embryo transfer, but were lower per cycle initiation with testosterone therapy.
Discussions: Within this study population, retrospective analysis of
testosterone therapy revealed no improvement in IVF outcomes. A randomized
controlled trial is recommended to further investigate this association.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Medical Knowledge, GME, CME, Problem-Based Learning, Team-Based Learning, Reproductive Endocrinology & Infertility,
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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.
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 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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Perceptions Regarding Medical Students Performing Pelvic Examinations on Anesthetized Female Patients
Purpose: The purpose of this study was to determine perceptions
regarding medical students performingpelvic examinations on anesthetized female
Background: Pelvic exams performed under anesthesia continues to
be a controversial topic, but studies looking at medical staff are lacking.
Methods: An internet based survey was distributed to OB/GYNs,
OR nurses/techs,anesthesiologists/CRNAs, and medical students at multiple
hospitals and medical schools.Demographic data were collected. Non-demographic
answers to questions were recorded on a 5-point scale. Characteristics between
the respondent groups were statistically compared usingChi-squared test for
independence and the Fisher’s Exact Test.
Results: 337surverys were completed. 72% of respondents
believed permission should be obtained from patientsprior to the performance of
EUAs by medical students on anesthetized femalepatients. 30% of respondents
believed prior consent was usually obtained. 50% believed patients would agree
to have the exams performed. 80% thought patients would be upset if an EUA by a
medical student was performed on them without their prior consent. 32% of
nurses believed medical students should be allowed to examine anesthetized
patients. Medical students were less likely to believe it was appropriate
for a student to examine a patient, there was an educational benefit, and that
patients would consent.
Discussions: Despite the perception of all OB/GYN OR team members that
consent should be obtained beforemedical students perform pelvic examinations
on anesthetized female patients, this does notusually occur. Almost 50% of
medical students would not encourage their female relatives toconsent to
medical students performing such pelvic examinations.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Patient Care, Professionalism, GME, Quality & Safety, Advocacy,
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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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Medical Student Perceptions Regarding Students Performing Pelvic Examinations on Anesthetized Female Patients
Purpose: The purpose of this study was to determine perceptions of
medical students regarding performing pelvic examinations on anesthetized
Background: Pelvic exams performed on anesthetized women continues
to be an important topic of discussion, however, it is not frequently evaluated
from the medical student\'s perspective.
Methods: An internet based survey was distributed to medical
students at multiple medical schools.Demographic data was collected.
Non-demographic answers to questions were recorded on a 5-point scale.
Characteristics between the respondent groups were statistically compared
usingChi-squared test for independence and the Fisher’s Exact Test.
Results: 220 medical students completed the questionnaire. 77%
of all medical students believed permission should be obtained from
patients prior to the performance of EUAs by medical students on anesthetized
patients. 30% of respondents believed prior consent was usually obtained.
46% believed patients, if asked, would agree to have the exams performed.
85% believed patients would be upset if they were made aware a pelvic
examination by a medical student had been performed without their prior
consent.60% of medical students believed they should be allowed to examine
anesthetized patients, with 87% thinking there is an educational benefit.
Discussions: Despite the perception that consent should be obtained before
medical students performpelvic examinations on anesthetized female patients,
this does not usually occur. 50% ofmedical students would not encourage
their female relatives to consent to medical studentsperforming pelvic
examinations. There was no statistical difference between male andfemale
medical students regarding perceptions of student pelvic examinations on
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Professionalism, GME, Advocacy,
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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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Improved Team Climate and Increased Student Involvement with Interprofessional Learning on Labor and Delivery
Purpose: To evaluate the impact
of an obstetrical interprofessional learning experience for medical students on
team climate and medical student clinical involvement.
often express difficulty integrating into the obstetrical team and a desire
more clinical involvement on the unit. We hypothesized that an
obstetrical nurse-shadowing experience for students could increase student
understanding of the team’s function and that nurses who worked with students
would be more willing to advocate for student involvement in deliveries. We
planned to use the Team Climate Inventory to assess students’ inclusion in the
team, and to use the percentage of students playing a hands-on role in a
vaginal delivery to assess student clinical involvement.
baseline Team Climate Inventory was administered to students in 2015. The
nurse-shadowing day was introduced in 2016-2017 and these students also
completed the Team Climate Inventory; student T test used for analysis.
The percentages of students assisting in a vaginal delivery before and after
the intervention were compared using Fisher’s Exact Test.
response rates were 38% for control group and 42% for intervention group.
Significant improvement (p<0.05) was noted on all axes assessed by the
Team Climate Inventory following the intervention with the largest change in
Participative Safety. 64.25% of control group students assisted in a vaginal
delivery; this increased significantly to 84.65% in the intervention group
Discussions: The introduction of an
interprofessional learning exercise on Labor and Delivery was associated with
improvement in medical student assessment of team climate and with increased
involvement of students in vaginal deliveries.
CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Professionalism, Systems-Based Practice & Improvement, UME, Team-Based Learning, General Ob-Gyn,
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Evaluation of Knowledge Retention 3 Months After Completion of a Resident Menopause Curriculum
Purpose: Evaluate residents’
retention of menopause-based knowledge 3 months after completion of
self-administered modules that varied by menopause-related topic and format of
express discomfort managing menopause. Didactic teaching of this topic can be
tailored to learning style, which may influence retention and improve
cross-over study of Obstetrics and Gynecology and Family Medicine residents at
one institution over the 2017-2018 academic year. Residents were randomized to
a series of 3 PowerPoints, each < 30 slides, administered during protected
learning time. Each series contained 3 different subjects (Menopause Basics
(MB), Hormone Replacement Therapy (HRT), Genitourinary Syndrome of Menopause
(GSM)) delivered through 3 different presentation styles (typical presentation
(typical), pictures and a narration (pictures), and interactive to reveal
information (interactive)). Knowledge and comfort were assessed through
baseline, immediate post-exposure, and 3-month follow-up surveys containing 24
knowledge questions (multiple choice) and 10 comfort and satisfaction questions
(5-point Likert scale and multiple choice). Statistical tests were applied with
a p< 0.05 considered significant.
residents completed 3-month follow-up. Immediately post-exposure, knowledge and
comfort increased from baseline for all topics (p< 0.05). On 3-month
follow-up, the HRT topic demonstrated a sustained increase in knowledge
(p=0.047). The typical format of the GSM topic had significantly better retention
than the picture format (p=0.027). All formats were associated with a
significant increase in comfort (all p< 0.01).
post-exposure knowledge and comfort were universally improved by topic,
however, on 3-month follow-up retention varied by format and topic. Comfort in
managing menopause remained increased on follow-up.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Medical Knowledge, GME, Assessment, Lecture, Independent Study, General Ob-Gyn,
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Development of a Novel Method for OBGYN Resident Recruitment
Purpose: We aimed to improve our
resident recruitment method to promote individualized, holistic admissions and
decrease applicant stress.
Background: The AAMC
is promoting processes that utilize holistic, individualized resident applicant
criteria and methods that reduce candidate stress.
applicants were divided among six experienced faculty who selected candidates
based on objective scoring of academic records. Selected applicants were
emailed to rank interview date preferences within 72-hours, and then received
an email with interview placement. Following interviews, applicants were
surveyed about the process.
Three ranks lists were generated and compared:
a behavioral-based composite rank list (BBC); a BBC with pre-interview scores
included; and a traditional list. In the BBC method, faculty were blinded to
pre-interview scores, and applicants were evaluated on professionalism,
leadership, trainability, and fit. The traditional rank list was generated via
open discussion with interviewers. The three rank lists were compared to
determine concordance between methods.
were 78 applicants interviewed. There was 62.8% concordance between the BBC and
traditional rank list, which dropped to 32.1% concordance when pre-interview
scores were combined with BBC scores. Applicant post-invitation survey response
rate was 67%; with 93.3% reporting the interview invitation process was more
equitable, less stressful (82.7%), and better than other institutions (86.6%).
All faculty involved in the candidate prescreen preferred the new
Discussions: There was concordance
between the BBC and standard rank lists, but not when pre-interview scores was
combined with the BBC. Candidates were satisfied with the new method
of invitation and faculty found the standardized pre-interview scoring method
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, CME, Assessment, Lecture,
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Developing a Culture of Continual Process Improvement: A Pilot Kaizen Event in an OB/GYN Resident Clinic
Purpose: To apply Lean Six Sigma
concepts and foster a culture of continual process improvement.
improvement is an ACGME Obstetrics and Gynecology Milestones
sub-competency. However, the 2016 CLER National Report demonstrated that most
residents have little working knowledge of basic quality improvement concepts.
In 2017, Lean Six Sigma certification was incorporated into Summa Health’s
resident education. To apply these concepts, a resident-designed pilot Kaizen
event was executed in the resident clinic.
Lean Six Sigma training began in 2017; the pilot Kaizen event was planned for
June 2018. Preparation included a brainstorming session and the creation of
interprofessional teams and project area assignments. During the half-day
event, house staff (residents and attendings) and office staff identified
workplace process inefficiencies and implemented solutions within five assigned
project areas: scheduling, patient flow, room setup, patient consent and
instrument stocking. Teams then presented their improvements to the
larger group and 22 participants completed a post-event survey.
(46%) house staff completed Yellow Belt certification prior to the event and
all rated the training “very helpful” in identifying and improving processes
during the event. Eight (72%) house and 6 (75%) office staff reported the
improvements “very positively” impacted the clinic. Seven (54%) house and 8
(100%) office staff responded that the event should be repeated at least
Discussions: Residents found Yellow
Belt training and the Kaizen event to be beneficial and have a positive
impact on daily workflow. These activities will be repeated in the future
to foster a culture of continual process improvement.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Osteopathic Faculty, Residency Director, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, Quality & Safety,
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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.
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.
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
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.
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.
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
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%.
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.
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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Attitudes Regarding the Effect of the New 24 Work Hour Extension During the ObGyn Clerkship
Purpose: To survey 3rd/4th
year medical students, ObGyn residents, and faculty on the perceived effects of
24-hour call expansion to the 3rd year ObGyn Clerkship.
ACGME expanded intern call to 24 continuous work hours to
improve resident education by allowing interns to more fully participate as
healthcare team members. Therefore, this presented an
opportunity for 24-hour call expansion to the ObGyn Clerkship for the same
Monkey anonymously surveyed all ObGyn faculty, residents, and 3rd/4th year
medical students at West Virginia University on five statements using
a six-point Likert scale:
1. Medical student education
will be enhanced by the 24-hour call expansion on the ObGyn Clerkship.
2. 24-hour call will
enhance patient continuity with less missed educational oportunities.
3. 24-hour call
improves medical student\'s ability to be a part of the medical team.
4. 24-hour call better
reflects the ObGyn lifestyle.
5. A more accurate
representation of the ObGyn lifestyle with 24-hour call will allow medical
students to better decide whether to pursue an ObGyn career.
group\'s highest percent response is given for the five statements.
1. Faculty-56% strongly agree,
Residents-45% slightly agree, 3rd year students- 41% moderately agree, 4th
year students-40% strongly disagree.
2. Faculty-56% strongly agree,
Residents-36% slightly agree, 3rd year students-28% moderately agree, 4th year
students-33% strongly disagree.
3. Faculty-56% strongly agree,
Residents-45% slightly agree, 3rd year students-31% moderately agree, 4th year
students-33% strongly disagree.
4. Faculty-56% strongly agree,
Residents-36% strongly agree and 36% moderately agree, 3rd year students-44%
moderately agree, 4th year students-31% slightly agree.
5. 56% of faculty strongly
agree, 36% of residents moderately agree, 34% of 3rd year students moderately
agree, 29% of 4th year students slightly agree.
Discussions: The majority agreed
that 24-hour call would enhance medical student education, allow for increased
patient continuity, and improve the student’s ability to be part of the medical
team. 4th year medical students did not follow this trend with the highest
percentage choosing strongly disgree. All groups agreed that 24-hour call
better reflects the ObGyn lifestyle and would provide a more accurate
representation for students when deciding whether to pursue it as a career.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, GME, UME, Team-Based Learning, Public Health, Advocacy,
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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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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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