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Wellness on a Budget: Can It Be Done?

 

Purpose: To quantify resident well-being, assess the most common stressors and sources of burnout among residents, and develop cost effective strategies to improve wellness.

 

Background: In 2017, the ACGME mandated that residency and fellowship programs had to demonstrate a commitment to the well-being of the residents, faculty members, students and all members of the health care team.

 

Methods: Identifying a cost effective assessment tool (Well-Being Index) which would link to important wellness resources, national comparative data, and provide comprehensive reporting to our residency programs. Analysis of this data and use of focus groups to develop a Resident Wellness Taskforce.

 

Results: The Well-Being Index, distributed at the beginning of the training year, showed 30% of residents who responded had “at risk” scores. The focus groups then determined the most common stressors at Henry Ford Hospital, which fell into 4 common categories: work efficiency/support; workflow/job demands; organizational values/meaning in work; and work-life balance. These results allowed the Wellness Taskforce to develop strategies, both personal and institutional, to combat areas of high stress. Cost effective interventions totaled under $25,000  and included a Wellness Curriculum and Wellness Rounds. Details will be shared in presentation.

 

Discussions: Baseline wellness scores and focus groups allowed us to determine the extent of our residents’ burnout and identify their most common stressors. This was an important starting point for planning cost effective interventions and programming geared to improving resident wellness. Future plans include assessing the Well-Being Index post-intervention to determine the effect of the taskforce initiatives on resident burnout.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Systems-Based Practice & Improvement, GME, Advocacy,

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Too Many Learners? Do Students Belong in Resident Continuity Clinics?

Purpose: Determine the prevalence of medical students in OBGYN resident continuity clinics and describe effects on the learning environment when students and residents work together in this setting.

 

Background: Patient continuity is an ACGME requirement often fulfilled through a resident run continuity clinic. It’s unknown how frequently students rotate in these clinics, or how multiple levels of learners influence each other.
 

 

Methods: We surveyed OBGYN program managers using a national listserv. Resident and student surveys were based on a Likert scale and sent to all OBGYN residents and students that rotated at our institution from 2016-2018.

 

Results: Program managers responded from 45 programs and 75.6% scheduled students in resident continuity clinics. Our response rates were 79/116(68.1%) for students and 21/24(87.5%) for residents. A one-sample Wilcoxon signed rank test was used to test the hypothesis that the typical response on the five-level Likert scale was \"Agree\" or \"Strongly Agree.\" Of medical students, 88.6% stated that they agreed or strongly agreed they enjoyed working with residents (p<0.001) and 60.8% stated they agreed or strongly agreed residents were effective teachers (p<0.001). Among residents, 52.4% agreed or strongly agreed that they enjoyed working with students (p<0.001). However, 61.9% said they agreed or strongly agreed they were too busy to be effective teachers (p<0.001).

 

Discussions: Many institutions have students rotate in resident continuity clinics. Residents and students have positive views regarding their interactions. Although students were satisfied, residents expressed concerns about their ability to be effective teachers given clinical demands. Our results highlight the importance of developing resident teaching skills.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, CME, UME, Assessment, Problem-Based Learning, Team-Based Learning, General Ob-Gyn,

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Time to Face the Music: Attitudes of Current and Future OB/GYN Residents Regarding the Structure of Residency Training

Purpose: Measure future and current resident perspectives regarding OB/GYN residency training structure and possible future models.

 

Background: Modifications to the current OB/GYN training paradigm are being considered however the perspective of learner stakeholders on substantial changes has not been measured.

 

Methods: Medical students invited for OB/GYN residency interviews and residents (PGY1-4) at the University of Colorado, University of Washington, University of California San Francisco, Loyola University, St. Joseph’s Hospital, and Texas A&M in 2017-2018 received a voluntary, electronic survey regarding possible models for restructuring residency training.  Student and resident responses were compared using a chi-square for categorical and two-sample t-test for continuous items. 

 

Results: Applicants (63%, 280/444) and residents (66%, 101/154) had similar response rates.  Applicants (24%) and residents (29%) reported having concerns about the current structure of residency training.  The ideal residency duration was reported as 4 years by 72% of applicants and 85% of residents.  Lack of gynecologic surgical volume was the most frequently reported concern among applicants (75%) and residents (72%).  Fourth-year tracking (focusing on training aligned with post-graduation career path) was preferred by 90% of applicants and 77% of residents (p=0.002), and 92% among respondents planning fellowship.  Most applicants (68%) and residents (75%) preferred not starting fellowship training after the 3rd year of residency.    

 

Discussions: The majority of learners surveyed support a 4-year training structure, but likewise support individualizing training in the PGY-4 year. It is imperative that OB/GYN leadership consider this and other feedback from learners when considering modifications to the current OB/GYN training paradigm. 

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, GME, UME, General Ob-Gyn, CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Patient Care, Practice-Based Learning & Improvement, GME, Simulation,

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Targeted Interventions to Improve Resident Well-being

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

 

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

 

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

 

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

 

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

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

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Service-learning Wellness Initiative in the Harvard Medical School Clerkship Curriculum

Purpose: The first aim was to assess if incorporation of a service-based initiative into the curriculum results in professional fulfillment, principally: improved medical student feelings of compassion, contribution, wellness, understanding of community need, and team-building of the student class. The second aim is to report the development of this curriculum project.

 

Background: Service-learning increases student awareness of community resources, promotes service to the community, team-building through cooperation rather than competition, broadens cultural awareness, and fosters wellness through hands-on contribution.

 

Methods: The entire class of second year clerkship students volunteered at a local non-profit organization. Students were divided into small groups to work at various team tasks.  Following, the entire group reconvened for teaching reflection. They were asked a value-based qualifier of the experience. They were also asked to provide feedback as an open response. Quantitative data were analyzed using summary statistics, Wilcoxon rank sum and Fischer’s exact test. Content analysis was used to determine themes from the open-ended responses.

 

Results: 47 students participated, 48.9% of whom were male. Average satisfaction with the intervention was high (mean 4.26 on a 5-point Likert scale), with no difference in satisfaction noted by gender. Positive themes included feelings of contribution, wellness, and team-building, with 9 respondents requesting to repeat the event at regular intervals.

 

Discussions: It is crucial to investigate different types of wellness interventions throughout UME. Service-based interventions are not adequately studied and may be an important addition to the wellness program as they are a way for students to feel connected to the community they are serving.  

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

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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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Predictors of Trainees\' Willingness to Provide Family Planning Services: A Survey of Ob-Gyn Residents

Purpose: To determine factors that contribute to a resident’s willingness to provide abortions post-residency.

 

Background: The shortage of abortion providers makes accessing care difficult. Personal and environmentalfactors within the residency training environment may be modified so that greater numbers ofgraduates opt to become abortion providers.

 

Methods: A multiple-choice survey was sent to all ACGME accredited OB/GYN residency programs. Data on demographics,religious and political views, residency training experience and intent to provide abortions was collected anonymously (n=396).

 

Results: Sixty-eight percent of residents intended to provide abortions (n = 269). The sample was 89% female, underage 35 (97%), heterosexual (91%). In a multivariable logistical regression, the following demographic factors predicted intent to provide abortion; being female (aOR 2.8; 95% CI 1.2-6.5), identifying as non-Christian (aOR 3.6; 1.9-6.6), and being raised in the Northeast (vs South) (aOR 3.0; 1.3-6.7) .Modifiable predictors of intention to provide included programs where 50% of the faculty provided abortions (aOR 3.3;95% CI 1.8-5.8). Additionally, residents who performed greater than 20 cases (uOR 3.3, 95% CI 1.6-6.7) were three times more likely to plan toprovide.Selection of a residency emphasizing family planning significantly correlated with intent toprovide (aOR 4.3; 95% CI 2.4-7.8). Those training at Ryan Programs were twice as likely (uOR2.4; 95% CI 1.6-3.8) to intend to provide.

 

Discussions: Modifiable factors such as early exposure of medical students to family planning, faculty selection, robust case volumes and establishment of a Ryanprogram may enhance the number of graduates offering abortions while in practice.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Osteopathic Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, GME, UME, Advocacy, Contraception or Family Planning,

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Parenthood and Medical Careers: The Challenges and Experiences of Physician Moms in the US

Purpose: This survey study sought to gain a better understanding of the experiences and challenges physician moms face during training and as junior faculty.

 

Background: Balancing the demands of medical training and a career along with those of parenthood is challenging. Currently 46% of residents and fellows in training are women, with a rate as high as 83% in Obstetrics and Gynecology.

 

Methods: We surveyed 897 physician moms from January 2018-February 2018 about their experiences with child-bearing, breastfeeding and maternity leave. Participants completed an open-ended question “What is your biggest challenge as a physician mom?”, these answers were qualitatively coded.

 

Results: The majority of participants (40%) had their first child between 31 and 34 years old; 36% of participants had their first child as a resident, while 28% did as junior faculty. For those who had a child during residency, 38% breastfed for 1 year or more, 26% breastfed for 6 months or less. For women who delayed child-bearing, 55% delayed to complete training, 21% delayed for financial reasons, 20% delayed for infertility, 12% of participants delayed due to pressure from their training program. For women who had a child during training 44% described having inadequate leave, but 53% report support from program administration. The themes for biggest challenges for physician moms were coded as: time/hours (37%), balance (26%); over-expectation/guilt/shame (21%), work/working at home (21%), missing out (18%); logistics/child-care (11%).

 

Discussions: Based on our results, there are clear ways residency programs and departments can support physician moms with the challenges they face.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, UME, General Ob-Gyn,

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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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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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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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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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RWJBarnabas Health System: System-wide Obstetrics Collaborative. the Clinical, Research and Teaching Implications and Benefits

Purpose: The eight perinatal hospitals in the RWJBarnabas health care system, with ~25,000 deliveries annually, utilize bi-monthly interdisciplinary meetings to update all sites on quality outcomes, evidence-based best practice, research initiatives and education. This model trains Ob/Gyn residents, as well as the entire health care team on an overall approach to maternity care.

 

Background: In 2015, the perinatal practices at each of the hospitals were functioning  independently, which resulted in variation in clinical practice and outcomes, scant research and different approaches to patient care models for resident education. The RWJBarnabas Health leadership recognized the benefit of a systematic approach to optimize this service and to best utilize the strengths and experience of all its health care obstetrical providers. This would also translate into a stronger model to enhance resident education. This approach was promoted by Dr. Asch who stated in the September 23, 2009 JAMA that the best function Ob-Gyn attendings in NY and FL came from residency programs that emphasized the best-practice of evidence-based medicine in a culture of patient safety. Thus, creating a win-win scenario for quality patient care and resident education.

 

Methods: Supported by corporate leadership the RWJBarnabas Health Ob Collaborative was initiated. The obstetrical department chairs and the Ob nursing administrators from each site met bi-monthly to review pooled data, develop clinical bundles and institute standards of practice at each medical site based on a common EMR. From the pooled data, clinical practice changes and research ideas were also introduced that the health care team and the learners could initiate/participate in.

 

Results: This model has been very effective in improving patient satisfaction, quality and patient safety. This is especially notable in Pain Management, the reduction of SSI and C/Section rates and increased TOLAC/VBAC rates. In addition, medical education for residents includes utilization of standardized evidenced based practices developed by the collaborative across all the sites. The specifics of the data collection will be discussed.

 

Discussions: Not only have there been benefits in the core missions of clinical care, teaching and research, but this model has inspired a joint effort by others within the health care system to further improve outcomes through collaborative educational venues.

 

Topics: CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Systems-Based Practice & Improvement, GME, CME, Quality & Safety, General Ob-Gyn,

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An Analysis of the Nulliparous, Term, Singleton, Vertex Cesarean Birth Rate Among Practice Groups in a High-Volume Community Teaching Hospital

Purpose: Data regarding factors that influence the nulliparous, term, singleton, vertex (NTSV) cesarean birth rate is limited. This study’s purpose was to compare the NTSV cesarean rate across practice groups at Virginia Hospital Center (VHC).

 

Background: VHC is a high-volume community teaching hospital in Arlington, Virginia. Labor and Delivery is managed by different practice groups: hospitalists with resident coverage, hospitalists without resident coverage, and private attendings. Hospitalists are attending physicians who provide 24-hour in-house management of laboring patients, whereas private attendings are only expected to be in-house for patients in active labor.

 

Methods: This was a retrospective cohort study of all NTSV pregnant women who delivered at VHC from 2014 to 2016. Chi-square tests were used to determine whether NTSV cesarean rates were significantly different over time and across different practice groups.

 

Results: There were 2,339, 2,090, and 1,673 NTSV pregnancies in 2014, 2015, and 2016, respectively. The NTSV cesarean rate decreased significantly by 30.8% (31.8% in 2014, 27.7% in 2015, and 22.0% in 2016,  0.01). The NTSV cesarean rate was significantly lower with hospitalists, with the lowest rate in the hospitalists with resident coverage (NTSV rate of 19.8% for hospitalists plus residents, 25.7% for hospitalists without residents, 30.3% for private attendings,  0.01). All groups decreased their NTSV cesarean birth rate over time, with significant decreases in the hospitalists without residents and private attending groups ( 0.01).

 

Discussions: Having 24-hour in-house attending coverage is associated with lower NTSV cesarean rates. Resident involvement may also be a factor in lowering this rate.

 

Topics: CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Quality & Safety, Team-Based Learning, General Ob-Gyn,

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Abortion Practice After Routine Training: A Prospective Cohort Study

Purpose: To explore Ryan Program graduates; post-residency practice in abortion care.

 

Background: The Ryan Program supports residency programs to integrate abortion into training. In 2012 we commenced a prospective cohort study of graduated residents.

 

Methods: Residents complete web-based surveys after the family planning rotation and consent to participate in future studies. In 2016, we surveyed ob-gyns 2+ years after residency about their current practice. Post-rotation and post-residency surveys were matched and then de-identified.

 

Results: Sixty percent (394) who consented to participate responded. Nearly all graduates did abortions during residency (median of 31, including medical and procedural techniques).  86% fully participated in training, while 14% opted out for personal or religious reasons.  33% percent overall, and 40% of those who intended to, do abortions in current practice (median of 12 per month).  An additional 36% do not do abortions but wish to, and 16% do not nor desire to provide abortion care.  Physicians doing abortions are more likely to have fully participated (42% vs. 8%, p=.00) and did more abortions in training than those not doing abortions (median 32 vs. 16, p=.00). Those without an academic affiliation (n=134) are less likely to do abortions (23% v. 45%, p=.00) and more likely to want to integrate abortion care (56% v. 44%, p=.02). 

 

Discussions: One-third of ob-gyns who trained in Ryan programs include abortion care in their practice. An additional third are unable to despite intending to at the time of their training. Further studies are needed to understand the barriers to integrating abortion care into practice.

Topics: CREOG & APGO Annual Meeting, 2018, Resident, Faculty, Residency Director, Patient Care, Professionalism, GME, CME, Assessment, Public Health, Contraception or Family Planning,

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Bringing Students and Nurses Together

Do your students evaluate their clerkship poorly due to mistreatment (at

worst) or barely being tolerated (at best)? Do you wish your nursing colleagues enjoyed

working with students as you do? Do you want to share with students an appreciation for the

important role nurses play in patient care, and eventually, see the improvements in safety and

quality that happen when we work as an interdisciplinary team? In this round table,

participants will hear about the MMC-TUSM model, and together create a list of activities to

bring back to your own institutions.

Topics: Faculty Development Seminar, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Professionalism, Interpersonal & Communication Skills, UME, Quality & Safety, Team-Based Learning,

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\"Interprofessional Education: The how-to of implementing IPE to invigorate your educational teams and learning environment\"

Interprofessional Education is an important area in medical education. It is

vital that we, as medical educators, start implementing a collaborative interprofessional

approach; yet, many of us struggle as to how to do this in our institutions. This roundtable is

designed to discuss what IPE is and why it matters, identify obstacles to implementing IPE,

share ideas for IPE implementation and to provide a toolkit of resources to faculty and resident

educators to help facilitate that discussion and tools to facilitate the implementation of IPE.

Topics: General Ob-Gyn, Team-Based Learning, Quality & Safety, UME, GME, Interpersonal & Communication Skills, Systems-Based Practice & Improvement, Professionalism, Patient Care, Clerkship Director, Faculty, Resident, 2019, Faculty Development Seminar,

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A Nurse for a Day: The First Step towards Interprofessional Paradise

Background/Objective:

Research has shown that interactions between third year medical students and nurses is generally rated

as poor. Evidence suggests that residents generally do not have a high opinion of nurses

cooperativeness and competence. This in turn affects communication and interdisciplinary team work,

which may extend beyond post graduate education.

Interprofessional training has been identified as helping to address bias, improve understanding of

scope of practice of team members and promote good communication. It has also been shown to

improve quality of patient care and outcomes. A nurse shadowing program attempts to address this by

inverting the traditional medical hierarchy, putting the nurses in a role as teachers and experts in their

field.

Workshop Agenda

We will start with a review of the literature as it pertains to interprofessional training and medical

students (15 mins)

Then participants will work in small groups to outline the objectives, rules of engagement, logistics and

assessment of a medical student nurse shadowing program in one of four areas: Labor and Delivery, the

operating room, clinics and wards. (35 mins)

The groups will share their results thus creating a framework for a nurse shadowing program in many

clinical arenas. The facilitators will compare and contrast the results of the group with the experience

from their own institutions’ implementation of a nurse shadowing program on Labor and Delivery. (25

mins)

Take Home Product:

Participants will return to their institutions with an framework of a functioning and potential nurse

shadowing program

Topics: Faculty Development Seminar, 2019, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, UME, Quality & Safety, Team-Based Learning,

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