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Trends in Off-Service Rotations in Ob/Gyn Residencies Before and After Duty Hour Restrictions

Purpose: To establish trends in off-service rotations in OB/GYN residencies before and after duty hour restrictions.

 

Background: As co-morbidities in our patient population increases, the skills required of OB/GYNs are changing, we sought to determine the characteristics of off service rotations.

 

Methods: We searched websites of ACGME accredited OB/GYN residency programs. We collected data on off service rotations: services, number of rotations, and PGY year of rotations. Surveys were emailed to programs regarding off service rotations in 2018 and before duty hour changes in 2003.

 

Results: 92% (n=259) of programs had information available on off-service rotations, of these, 24% (n=62) had no off-service rotations, 26% (n=67) had 1, 25% (n=66) had 2, 13% (n=34) had 3, 12% (n=30) had 4 or more. The majority (84%) of rotations were in PGY1. The most common rotations were ER (47%, n=122), SICU (24%, n=62), IM (25%, n=66), MICU (9%, n=23). We received 53 responses to the survey (19% response rate). Of those who responded, the most common rotations for 2018 and before 2003 were ER & SICU. The number of programs with SICU rotations remained stable from 2003 to 2018 (43% vs 47%) compared to 1.4 fold decrease in programs with ER rotations. The number of programs with IM rotations decreased 2.5 fold from before 2003 to 2018.

 

Discussions: Duty hour restrictions have affected off-service rotations. A quarter of all programs have no off-service rotations, with a decrease in ER and IM exposure during residency. This does not reflect the breadth of knowledge required of OB/GYNs today.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Quality & Safety, General Ob-Gyn, CREOG & APGO Annual Meeting, 2019, Student, Resident, Clerkship Director, Residency Director, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Team-Based Learning,

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Transgender Healthy Care: On-line Survey of Physician Knowledge and Comfort

Purpose: To evaluate OB/Gyn provider knowledge and comfort with transgender health care

 

Background: Transgender and gender non-conforming patients (TGNC) are an underserved population that often encounters inadequate or ‘unsafe’ clinical care. Education regarding TGNC patient care has traditionally been minimal, contributing to gaps in Ob/Gyn care for many of these individuals, including transgender men.

 

Methods: An IRB approved, anonymous online non-validated survey was emailed to 130 APGO program coordinators to distribute to their Ob/Gyn faculty and post-graduate learners. Questions addressed included years of practice, experience with TGNC patients, provider comfort, and TGNC education.

 

Results: One hundred and sixty four surveys were completed and an additional ~50 were opened but no information was provided. Of the 164 completed surveys, 76.3% of participants reported less than 5 hours of TGNC specific healthcare education, despite the fact that 75.7% of responders had cared for at least one TGNC patient. Overall most respondents felt comfortable/very comfortable (79.8%) caring for this population. No correlation was found between years in practice and overall provider comfort caring for TGNC patients.  Major obstacles reported by participants included concern for patient comfort, appropriate language, and lack of sufficient clinical education for both providers and support staff

 

Discussions: These data suggest that enhanced TGNC clinical education for the entire health care team is warranted.

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

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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 enhanced folliculogenesis. 

 

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. 

Topics: 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 stress.

 

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

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

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Resident Documentation and Coding Curriculum Can Be Improved Through One-on-one Education

Purpose: Assess impact of one-on-one education of residents in billing and coding. 

 

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.

Topics: 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 patients.

 

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.

Topics: 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 performed.

 

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

 

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

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

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Medical Student 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 female patients.

 

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 anesthetizedfemale patients

Topics: 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.

 

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

 

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

 

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

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

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, Quality & Safety, Advocacy, CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Lecture, Advocacy,

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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 management.

 

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 unit.

 

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.

 

Results: Participants 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.

Topics: 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.

 

Background: Students 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.

 

Methods: A 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.

Results: Survey 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 (p=0.009).

 

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.

Topics: 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 delivery.

 

Background: Residents express discomfort managing menopause. Didactic teaching of this topic can be tailored to learning style, which may influence retention and improve discomfort.

 

Methods: Prospective 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.

 

Results: Thirty-three 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).

 

Discussions: Immediately 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.

Topics: 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.

 

Methods: Resident 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.  

 

Results: There 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 standardized method.

 

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 preferable.

Topics: 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.

 

Background: Quality 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.

 

Methods: Three-day 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.

 

Results: Six (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 biannually.

 

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.

Topics: 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.

 

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

 

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

 

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

 

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

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

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

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

 

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

 

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

 

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

 

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

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

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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.

 

Background: The 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 goal.

Methods: Survey 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.

Results: Each 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.

Topics: 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).

 

Background: The 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.

 

Methods: SNMs 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. 

Topics: 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 approach

 - To provide a clinical application of interprofessional learning

 - To inform continuous quality improvement

 

Background: Dell 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.

 

Methods: Students 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.

Topics: 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 behavior.

 

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 unintended pregnancy.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, GME, CME, Assessment, Lecture, Quality & Safety, Contraception or Family Planning,

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