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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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Medical Students’ Perceptions of Teaching on the Obstetrics and Gynecology Clerkship

Purpose: Assess medical students’ perceptions of the learning quality in their OBGYN clerkship.

 

Background: OBGYN uniquely synthesizes primary, subspecialty, and surgical care. Accordingly, medical student teaching must reflect the breadth of our field. Many teaching modalities are employed within the clerkship, such as patient interactions in the clinic setting and wards, intraoperative instruction, non-traditional case-based conferences, and written texts. While overall learning and students’ decisions about specialty selection are known to be contingent on effective education, it is not known which modalities students perceive as most efficacious.

 

Methods: An eighteen-item electronic questionnaire was distributed to consenting third year students at the completion of their six-week clerkship at the University of Florida’s two campuses over a twelve-month academic year.

 

Results: Students receive approximately 6 hours of group and individual instruction weekly and felt this was appropriate. Satisfaction was high for resident and attending instruction, opportunities to demonstrate clinical knowledge, and meaningfulness of students’ roles in patient care. The ability to practice procedures and receive feedback were ranked lowest. Among key topics in OBGYN, the highest scores included preeclampsia and abnormal uterine bleeding, with relatively lower scores for pelvic floor dysfunction. Labor and Delivery board rounds was perceived as the most effective mode of instruction. Roles in the outpatient setting were perceived as primarily observational, while perceived responsibilities in the OR varied.

 

Discussions: Potential areas of growth include incorporating more procedural training and providing more effective feedback. Limitations to our study included survey format, single academic year, and limitation to two institutions.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, Lecture,

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Management of Postoperative Issues in Gynecology and Gynecologic Oncology: A New Method for Teaching Residents

Purpose: This project sought to develop and assess a curriculum to improve resident knowledge of and comfort in managing common post operative issues.

 

Background: Junior obstetrics/gynecology residents enter training with varied experience in post-operative management. They are often the first contact for surgical patients with little formal education on post-operative issues. 

 

Methods: Eleven common post-operative issues were identified based on literature review, resident experience and gynecology/gynecologic oncology faculty input. Topic based curriculum included: example case, pathophysiology, differential diagnosis, next steps, and useful resources. It was presented at two educational sessions, involving lectures and small-group simulations. Residents completed a pre and post-assessment questionnaire assessing comfort level in managing (10-point Likert scale) and baseline knowledge about (content-specific questions) the topics.

 

Results: Twenty-three residents participated.Seventeen completed one or both pre-assessment surveys (nine junior residents). Ten completed one or both post-assessment surveys (five junior residents). All post-assessment respondents reported improved knowledge of issues covered. Average self-rated comfort level increased for ten of eleven topics amongst junior residents (average increase 1.6 points (range 0.5 – 3.2; p = 0.02)). Largest increase in score was for hypoxia and low urine output. Average scores maintained or improved for 80% of the content questions (not significant). Residents had no preference for lecture versus small group format.

 

Discussions: As a result of directed teaching, resident knowledge of post-operative issues showed measurable improvement. Resident comfort level in management increased significantly for 90% of topics covered, most noticeably amongst junior residents. A systematic, resident-led curriculum on post-operative management can improve resident knowledge and patient care.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Medical Knowledge, GME, Simulation, Lecture, Problem-Based Learning, Team-Based Learning, Gynecologic Oncology, Minimally Invasive Surgery, Female Pelvic Medicine & Reconstructive Surgery, General Ob-Gyn,

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Lifting the Mask: Exploring Factors That Influence Medical Students\' Perceptions of Resident Teaching on the OB/GYN Clerkship

Purpose: To determine factors that influence medical students\' perceptions of resident teaching on the OB/GYN rotation.

 

Background: The Liaison Committee on Medical Education directs that residents “are prepared for their roles in teaching and assessment.\"  Our goal was to ascertain if medical student year and use of pre-made teaching tools impact views of residents as teachers.

 

Methods: A cross-sectional survey based on the Baker Clinical Educator Self-Assessment using a 1-5 Likert scale was given to 37 medical students who participated in end-of-OB/GYN clerkship focus groups from October 2017-June 2018.  The survey consisted of 13 questions regarding resident teaching skills along with 2 questions regarding resident use of pre-made teaching tools and medical student year.   Unpaired t-test and one-way ANOVA was used for analysis.

 

Results: Eighteen second year, eleven third year, and eight fourth year medical students completed the survey.  There was significant difference amongst the medical student levels (p<0.01), with third year medical students rating resident teaching skills the highest (3.55), second year medical students in the middle (2.98) and fourth year medical students rating teaching skills the lowest (2.55).  The 12 students that had residents use pre-made teaching tools rated resident teaching skills significantly higher than the 25 students who did not have residents use pre-made teaching tools (3.39 vs 2.90, p < 0.01).

 

Discussions: Medical student year affects perception of resident teaching.  This may be due to interest in the rotation or that teaching needs to be individualized to year of training.  Resident preparedness to teach positively influences student views of teaching skills.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Clerkship Director, Residency Director, Practice-Based Learning & Improvement, GME, UME, Team-Based Learning,

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Jazzing up Family Planning Education for Students in a Texas Medical School

Purpose: To determine the effects of resident-led family planning education during the third-year obstetrics and gynecology clerkship on medical student knowledge and/or attitudes.

 

Background: Many medical school clerkship directors report that formal family planning education is not offered. Students are more likely to be comfortable referring and providing reproductive health services when exposed to formal education.

 

Methods: Medical students during their obstetrics and gynecology clerkship at McGovern Medical School during the 2017-2018 academic year were given a de-identified quiz and survey at the beginning and end of their rotation. Half of the students participated in a resident-led one-hour didactic session on family planning while half did not. Data was analyzed using chi-squared test for categorical variables.

 

Results: Pre-rotation, students had low baseline scores on a family planning quiz (48.0% intervention group (I) vs. 49.0% no intervention (NI) group, p=0.51). A formal educational initiative significantly improved scores on the quiz (58.2% I vs. 50.7% NI, p<0.0001).Students’ pre-rotation attitudes about women obtaining a second trimester abortion under any circumstance showed that 17% disagreed. After the educational intervention, fewer students agreed with women having access to second trimester abortion under circumstances such as rape, incest or fetal anomalies (69.2% I vs 88.4% NI, p=0.0049). 

 

Discussions: Although the intervention improved knowledge, students were not more likely to report comfort providing family planning services in their future practice. Students’ attitudinal bias against ACOG-supported access to abortion in the second trimester paradoxically increased. Further studies are needed to elucidate barriers to improving knowledge and attitudes about reproductive health.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Residency Director, Medical Knowledge, UME, Contraception or Family Planning,

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Improving Tetanus, Diphtheria, Pertussis Vaccination Rates in an Academic Center Through Resident-driven Education

Purpose: To improve rates of prenatal Tetanus, Diphtheria, Pertussis (Tdap) vaccination for clinic patients in an academic training center.

 

Background: The United States is experiencing a resurgence of pertussis, which can cause serious complications for infants, especially within the first six months of life. To maximize maternal antibody response to Tdap and antibody transfer to the newborn, vaccination between 27-36 weeks of gestation is recommended.

 

Methods: A pre-post survey study design was used to evaluate OBGYN residents at the University of Tennessee during the 2017-2018 academic year. The primary outcome was Tdap vaccination rate. Secondary outcomes were resident-reported Tdap counseling and resident understanding of the appropriate gestational age for administration. The following educational methods were utilized: resident-lead lecture, provider handouts, English and Spanish patient education posters throughout the clinic. Direct comparison of pre and post-surveys was used to analyze results.

 

Results: Five Tdap vaccinations were given in the four months prior to pre-survey administration (0.33 vaccines/resident). Following the Tdap educational program, forty-three vaccinations were given in four months (2.86 vaccines/resident). Pre-surveys indicated eleven residents (73%) provided Tdap counseling, while post-surveys revealed fifteen residents (100%) provided counseling. On pre-surveys, the majority of residents (33%) incorrectly answered that Tdap was indicated between 27 weeks gestation until delivery. In post-surveys, thirteen residents (87%) correctly answered that Tdap was indicated between 27-36 weeks gestation.

 

Discussions: Tdap vaccination rate increased by 767% after implementation of the educational tools. Additionally, resident-driven counseling about Tdap increased by 36% and resident understanding of appropriate gestational age for vaccine administration improved by 225%.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Patient Care, Medical Knowledge, GME, Lecture, Quality & Safety, Public Health, Advocacy,

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Impact of Resident Led Didactics on OBGYN Clerkship Shelf Scores and Student Satisfaction

Purpose: Compare NBME shelf scores prior to and after implementation of the Wednesday lecture series.Compare satisfaction scores of students prior to and post implementation of Wednesday lecture series. Scores would be obtained from the Aesculapian Society who evaluates students’ overall perceptions of clerkships

 

Background:

·       The ACGME and LCME has designated teaching as an accreditation standard with numerous competencies. Residents serve as clinical teachers for medical students with studies indicating that residents spend up to 20% of their time teaching medical students.

·       In a national survey 60% of students reported that they received their teaching from residents and fellows during their obstetrics and gynecology clerkships.

·       In 2015-2016, the department of Obstetrics & Gynecology at Louisiana State University School of Medicine-New Orleans implemented a new lecture series for 3rd year medical students.

·       Wednesday Lectures: High yield OB/GYN topics delivered by chief resident.

·       Lectures designed to complement Team-Based Learning sessions

Methods:

·       Shelf exam scores from 2011-2017 were reviewed and compared across the training sites.

·       Control Group: Baton Rouge and Lafayette based students who do not receive the same lectures.

·       Aesculapian Society Evaluations.Scores before and after implementation were examined

Results:

·       Positive correlation in resident teaching and satisfaction scores

·       Positive correlation in NBME scores and satisfaction scores

 

Discussions:

·       Student experience and satisfaction  may vary by location based on clinical exposure and opportunity

·       No standardized resident-lectures amongst all locations

·       Future Implications: Standardized implementation of resident led didactics. Our goal is to Implement ACGME recommended ‘Resident-as-teachers program as already established in other institutions and improve shelf scores over the next 5 years.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, CME, Assessment, Lecture, Team-Based Learning, CREOG & APGO Annual Meeting, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Medical Knowledge, Professionalism, UME, Assessment, General Ob-Gyn,

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Effect of Simulation Exercises on Medical Student Satisfaction and Performance in the Ob/Gyn Clerkship

Purpose: To evaluate the use of structured resident-led simulation exercises in improving medical student interest in Ob/Gyn as a specialty, satisfaction with their rotation experience, and improvement on NBME exam sores at the end of the rotation.

 

Background: Medical students persistently rank their obstetrics and gynecology (Ob/Gyn) clerkship experience below that of other surgical specialties, in addition to also raking the clerkship lowest for the ability of residents to provide effective teaching. Current research shows that clinical simulation during the Ob/Gyn clerkship leads to increased confidence and has been shown to increase medical students\' end of rotation oral and written examination scores.

 

Methods: Prospective cohort study from July 2016-June 2017 involving medical students enrolled at the McGovern Medical School- Memorial Hermann Hospital campus for their Ob/Gyn clerkship.  Rotations were randomized by alternating intervention with non-intervention,  the intervention consisted of weekly resident-led simulation exercises.  All students were given anonymous pre-rotation and post-rotation surveys that used a Liekart scale to analyze their opinions of their clerkship experience.  The surveys and NBME grades were then analyzed between the two groups.

 

Results: Overall population was 71, with 38 students in the control group and 33 in the intervention group with survey response rates of 94% and 97% respectively.  The responses of the pre and post-rotation surveys were then analyzed using the Wilcoxon ranked sum test comparing the median response.  Overall, the intervention group had a higher median score regarding preparedness in the clerkship (p .052) and scored better on the NBME (P .2679).  The intervention group had a lower median response to questions regarding importance of residents’ involvement in their clerkship, which was statistically significant (p .008). 

 

Discussions: Results indicate that resident-led simulation exercises may increase NBME scores and help students to feel more prepared within the clerkship.  However, this increase in performance and preparedness does not correlate with student satisfaction or in the student’s choice of obstetrics and gynecology as their future specialty of choice.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Medical Knowledge, Practice-Based Learning & Improvement, GME, Simulation, Team-Based Learning,

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An Intervention to Improve CREOG Scores

Purpose: To examine the effect of an educational intervention on OB/GYN CREOG in-training exam (ITE) scores

 

Background: Recent reports have correlated performance on the ITE to passing the qualifying board exam (QBE). Residents at risk for failing may benefit from an educational intervention to increase their chance of successfully passing their QBE.

 

Methods: A retrospective pretest/posttest paired subject intervention study was conducted. Residents selected for inclusion were those with an ITE score of < 200 on their most recent attempt. The educational intervention was a four hour test taking strategy workshop completed two months prior to the ITE. Validation of proper implementation of the method was verified with follow up performance reports. Following completion of the intervention, the next ITE score was obtained and recorded. The statistical analysis was completed for non-parametric matched pairs with Wilcoxon Signed Rank testing with alpha set at 0.05.

 

Results: 21 PGY-3 and 4 residents met inclusion criteria for enrollment. The mean ITE baseline score was 192.4. Following the educational intervention, the mean ITE score was 212.4. The mean difference between groups was 19.9 points + 2.29 (p<0.001). All but one resident demonstrated improvement in all subjects. All of the residents subsequently passed their QBE. 

 

Discussions: Our findings suggest that this particular test taking strategy augments CREOG ITE scores by 20 points in residents who score below 200. This pilot study demonstrates that a concentrated two month effort can lead to significant improvements for residents at risk of failing their qualifying board exam in OB/GYN.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Systems-Based Practice & Improvement, CME, Assessment, Problem-Based Learning,

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Resident Self-Entrustment and Expectations of Autonomy: OB > GYN?

Purpose: The goal of this study was to identify the definition and expectations of autonomy from residents’ perspective, as well as the self-entrustment of their surgical competencies in obstetrics (OB) and gynecologic (GYN) procedures.  

 

Background: Entrustment in the operating room (OR) is a two-way street. Resident self-entrustment of their surgical competencies closely associates with their OR training experience and granted autonomy. Some recent studies have investigated how attending surgeons determined and entrusted OB/GYN residents in the OR. There is little to no data, however, in examining these issues from the resident perspective.

 

Methods: We conducted three focus group interviews with 20 OB/GYN residents across four post-graduate year (PGY) levels.  Audio recordings of each interview were transcribed, iteratively analyzed, and emergent themes identified, using a framework method. 

 

Results: A total of 123 minutes of interviews were recorded. Eight junior residents (PGY1-2) and twelve senior residents (PGY3-4) participated.  Our data illustrated that 1) the definition of autonomy shifted significantly throughout residency training; 2) residents demonstrated higher expectations and self-entrustment for OB surgical procedures than for GYN surgical procedures upon graduation; 3) case volume, modalities of OR teaching (e.g. teaching style, attending experience, rotation site) and mutual communication are three factors influencing resident self-entrustment of their surgical competencies.

 

Discussions: Residents showed disparities in their self-entrustment and expectations of autonomy between OB and GYN surgical procedures. Better understanding these differences and the three influencing factors could help programs develop a potential solution for improvement in resident entrustment and autonomy upon graduation.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Assessment, Quality & Safety,

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The “Clerkship Passport” Increases Student Participation in the Third-year Medical Student Obstetrics Clerkship

Purpose: To develop and implement a clinical activity checklist to improve third-year medical student participation, satisfaction, and resident satisfaction on the Obstetrics Clerkship.

 

Background: The “Clerkship Passport” is a checklist of core clinical experiences that students should master.  We hypothesized that its implementation would increase student participation and overall Obstetric Clerkship satisfaction.

 

Methods: The Passport was based on milestones 1 from the Ob/Gyn Milestones Project.  Two student cohorts were studied before and after implementation (2/2017 – 3/2018).  Overall participation was the primary outcome, secondary measures included task-specific participation and student and resident satisfaction.  Chi-square, ANOVA, linear regression and qualitative coding were used for analysis.

 

Results: 79 of 84 (94%) third-year medical students participated.  Overall participation rates increased from 68% to 87% on nine pre-determined tasks (p < 0.001).  Participation rates were higher on the Passport (96%) than on anonymous survey (p < 0.001).  Academic quarter and interest were associated with participation (p=0.011 and 0.002).  After controlling for both, the passport still increased participation aOR 1.7 [1.1, 2.3].  Lactation counseling, knot tying and performing sterile speculum exams increased the most.  Despite increased participation, satisfaction with “amount of hands-on experience” decreased (p = 0.03).  The remainder of clerkship satisfaction scores were unchanged.  Residents reported the Passport defined expectations, increased teaching, encouraged feedback and was not burdensome.

 

Discussions: This study supports the use of a clinical activity checklist, which improves student participation.  Overall clerkship satisfaction is not improved, but students report satisfaction with the Passport itself. Residents also support the use of this checklist. 

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Practice-Based Learning & Improvement, UME, Assessment,

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Piloting a Resident-Oriented Leadership Training Program Using the Leadership Observation and Feedback Tool (LOFT)

Purpose: To pilot a leadership training program for residents designed to develop interprofessional and team management skills.

 

Background: Leadership in medicine is increasingly important, however many residency programs lack curricula on how to effectively lead and work on a team of healthcare professionals.

 

Methods: Myers-Briggs Personality Inventory and debriefing were performed prior to intervention for all participants as a prepartory step. Pilot curriculum consisted of 360-feedback, and four 30-minute, interactive, didactic sessions addressing topics in leadership. Residents were randomized to: 1) feedback-only, 2) didactic sessions-only, 3) both, and 4) neither (controls). 360 feedback was obtained using the LOFT, a 29-item questionnaire designed to assess resident leadership behaviors. Evaluations were completed before and after a rotation by 2 to 5 raters (supervisors, peers, and subordinates blinded to randomization status). Trained human resource professionals conveyed 360 feedback. Faculty gave didactics in groups of 1-6 residents. We compared change in LOFT score, adjusted for baseline, between randomization groups in a linear mixed-effects model.

 

Results: Twenty-nine residents completed the pilot and 5-10 per group were available for analysis. Total LOFT score improved (mean change 4.9 points; p<0.001), however, improvement did not significantly differ among any treatment group or controls. Similarly, improvement in each LOFT domain (coaching:1.62, p=0.002, project management:1.81, p<0.001, and self-control: 1.41, p<0.001), was significant but not different by randomization group. Among residents with the lowest quartile of average baseline LOFT, feedback was associated with significantly more improvement than no feedback (3.61, p=0.001). Didactic sessions were not associated with significant improvement overall or by domain.

 

Discussions: Performance feedback has the potential to improve resident leadership behavior as assessed by 360 evaluation. In this pilot study, significant improvement was only observed amongst those with the most room for improvement.

 

Topics: CREOG & APGO Annual Meeting, 2018, Resident, Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, Assessment, General Ob-Gyn,

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Improved Strategies for Teaching Surgical Skills to Medical Students: Simulation and Beyond

Purpose: Develop a curriculum to optimize surgical skills and to increase operating room (OR) opportunities for medical students.

 

Background: Simulation-based strategies for teaching surgical skills are evolving. Using an innovative task trainer, we compared one-on-one deliberate practice to video-based self-guidance in the performance of two-handed knot tying and subcuticular suturing during the OBGYN clerkship.

 

Methods: A randomized prospective trial compared two groups of third year medical students in the same clerkship rotations. Group A received one-on-one deliberate practice undergoing three sessions with an instructor and Group B received unlimited access to video-based self-guided practice over six weeks. At the end of the clerkship, surgical performance was assessed using the validated checklist. Self-reported data regarding OR experience was collected using a specifically designed phone application.

 

Results: Fifty-nine students participated in the study. Group A demonstrated a statistically significant improvement in two-handed knot tying and subcuticular suturing in pre-post assessments (knot-tying +4.34, p<0.001; suturing +19.4, p<0.001). Group B demonstrated a statistically significant improvement (knot-tying +6.03, p<0.001; suturing +22.3, p<0.001). No significant differences were found between groups in overall knot-tying (p=0.13), suturing (p=0.14), hours practiced (p=0.90), or number of OR cases (p=0.49).

 

Discussions: The use of simulation significantly improved surgical skills for all students from baseline. No differences were found between one-on-one deliberate practice and video-based self-guided practice. Both instructional strategies provided equal efficacy in teaching surgical skills and optimizing surgical performance for students during the OBGYN clerkship.

 

Topics: CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Patient Care, GME, Simulation, Independent Study, General Ob-Gyn,

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Assessment of a Sexual Health Curriculum for High School Students Delivered by OBGYN Residents

Purpose: The purpose of the project was to build a curriculum for high school studentson sexual health including reproduction, contraception, pregnancy and sexually trasmitted infections. This curriculum was delivered to the students by the SIU OBGYN residents. We evaluated the knowledge and attitudes of students, knowledge, skills and attitudes of the residents focussing on what their perceptions of the students.

 

Background: The teenage pregnancy and sexually transmitted infection rates for teens in the Sangamon County are higher than nantional averages.  The residents expressed an interest in reaching out to schools.  High school health teachers were contacted and overwhelmingly agreed to have the residents participate in health classes about reproductive health.

 

Methods: We built a curriculum based on ACOG materials and best practices for reproductive health.  Needs assessments to measure knowledge and attidtudes were given to a sample of high school students on reproductive topics.  Another assessment was given to residents to gage skills in teaching as well as attitudes towards teen.  Assessments of knowledge after the sessions were given to the students.  Teachers were asked to rate the sessions and provide feedback.  Residents completed a follow-up assessment.

 

Results: Students have large gaps in reproductive knowledge but have the perception they knonwlegable. Accurate knowledge improved. Teaches overwhelmingly were satisfied with the material presented and the format.  Residents had high satisfaction rates for this activity and better perceptions of students.

 

Discussions: Residents effectively administered a reproductive health care curriculum to high school students that was informative, well received and changed attitudes of students, teachers and residents.

Topics: CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, GME, Public Health, Contraception or Family Planning, Pediatric & Adolescent Gynecology, General Ob-Gyn, Sexuality,

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\'Guiding Light\' to Reduce Incidence of Medical Student Refusal in the Obstetric & Gynecology Clinic

 

Purpose: Characterize and reduce the frequency at which medical students are \'cast off\' from patient care in the Ob-Gyn clerkship.

 

Background: For optimal medical education and patient care, it is imperitive to have \'all hands on deck\'. Review of the literature shows that medical student refusal is an issue nationally in Ob-Gyn as well as other clerskships (1-3). Review of our Ob-Gyn clerkship data shows that students report that patients refuse their involvement in 14% of patient interactions. Furthermore, in 19% of interactions, students felt refusal was related to their gender.

 

Methods: Beginning in 2017, surveys measuring medical students\' perception of refusal were administered upon completion of our Ob-Gyn clerkship. Interventions to reduce refusal of these \'castaways\' were implemented with each subsequent clerkship. Faculty mentors: Sarah Shaffer DO & Colleen Stockdale MD, MS

 

Results: Data collection is on-going. To date, 85% reported exclusion from a patient interaction on the Ob-Gyn clerkship due to being a medical student. Twenty-three percent reported greater than five episodes of exclusion from patient care. Forty-three percent perceived that restricted participation was related to their gender with multiple qualitative responses describing patient discomfort with the presence of male \'comrades\'.

 

Discussions: Data from our institution suggests that exclusion from patient care in the Ob-Gyn clerkship occurs for the majority of medical students queried. Further, gender-based exclusion is likely a related problem. Future exploration includes analysis of trends after the implementation of interventions designed to keep patients and staff \'abreast\' of the presence and role of medical students.

Topics: CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Professionalism, Interpersonal & Communication Skills, GME, UME, Team-Based Learning,

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How Clerkship Students Learn Procedural Skills

Purpose: To assess how clerkship students at the Larner College of Medicine receive instruction in procedural skills during their clerkship in obstetrics and gynecology

 

Background: Achieving competence in procedural skills is an important but overlooked aspect of formal medical education. The Association of Professors of Gynecology and Obstetrics (APGO) defined nine basic clinical skills to be incorporated into clerkship curriculums in the United States. Clerkship students are expected to gain competency in these skills.

 

Methods: An online 16-question survey was distributed to third and fourth-year medical students. The survey listed the nine basic skills. For each skill, students indicated how they received procedural instruction. Data was collected anonymously. The survey was approved by the medical school IRB committee before distribution.

 

Results: We received a response rate of 43%. Per skill, the instructor varied with either residents or attendings as the primary educators. The most preferred method of instruction was a resident-led workshop and the second most preferred was an acting-intern led workshop. More than 65% and 75% of students indicated that their confidence in performing the skill would have increased with more instruction and with more practice respectively.

 

Discussions: Results show that clerkship students rely on residents as teachers and suggest the potential role of acting interns as educators. These findings demonstrate the importance of developing, implementing, maintaining and assessing a robust Resident and Medical Student as Teacher curriculums to equip residents and senior medical students with a teaching skills set to facilitate the learning of the acquisition of technical skills for clerkship students.

Topics: CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Medical Knowledge, Systems-Based Practice & Improvement, GME, UME, Assessment, General Ob-Gyn,

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Finding Tomorrow’s Sunshine: Developing the next generation of medical educators

Objective/Background

Near-peer teaching (NPT) is commonly used in medical education for pre-clinical didactics, large

and small group sessions and clinical skills. Junior learners consistently report NPT contributes

to a supportive learning environment, better quality feedback and mentoring. Traditional NPT

programs assume natural teaching ability, and limit tutor involvement to direct teaching roles

with little instruction as educators via formal instruction in educational theory, teaching

techniques, or other aspects of pedagogy. Teaching experiences are usually short-term and may

not contribute to students’ development as educators.

Providing students with a longitudinal course in medical education may help to develop future

medical educators. Additionally, observed teaching experiences with a longitudinal preceptor

may help students to hone their teaching skills.

Workshop Agenda

Participants will engage in exercises to develop longitudinal near-peer teaching programs for

their home institutions. We will explore opportunities and challenges from the perspective of

junior learners, near-peer tutors, and faculty. Participants will be able to identify and discuss

the needs of NPT’s for pedagogical development.

Icebreaker (5 min)

Introductions

Share Best/Worst Peer teaching experiences

Review of Literature (7 min)

Activity 1: Design a NPT experience (12 min)

Participants will design a NPT for one of several types of learning scenarios: procedures, case based learning, ambulatory and clinical learning

Report out (7 min)

Activity 2: Curricula for NPT (12 min)

Participants will discuss what elements of education theory, curriculum development and other

aspects of medical education are most valuable to NPTs

Report out (5 min)

Activity 3: Pitfalls (12 min)

Participants will troubleshoot potential difficulties inexperienced teachers face and how to

prepare new teachers for difficult situations.

Report out (7 min)

Discussion of Toolbox Resources (10 min)

Interactive Component

Small group discussions of challenges and opportunities of NPT.

Take home Product

Participants will receive a curriculum outline for a longitudinal medical education course

for their home institution.

Keywords: Near-peer teaching; longitudinal medical education; curriculum development;

mentoring

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

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Empowering Faculty and Residents to Engage OB/GYN Clerkship Students: Tools to Improve Learner–Focused Procedural Teaching

Objective/background: The fast-paced clinical environments of the Operating Room

and Labor & Delivery units provide a potentially challenging environment for both teaching and learning.

Faculty and residents need to feel empowered with tools they can utilized to engage students at any

level of learning. Engaged and empowered teachers help students feel welcome and supported in the

learning environment.

Workshop agenda: 15-20 minutes review of models and tools for procedural teaching, including the \\\"BID method,\\\" the use of procedural didactic scripts, and milestone-based learner checklists for common

surgical cases. Three 5-10 minute breakouts and subsequent 5 minutes of group sharing of findings for

three of methods covered. 5-10 minutes for final review and questions.

Interactive component: Small group breakouts utilizing specific methods to address sample learner

scenarios, or scenarios from participants\\\' own experiences.

Take-home product: Pocket cards for: (1) BID model cards, (2) procedure didactic script cards, and (3)

milestone-based learner checklist cards.

Key words: Procedural teaching, clerkship learning environment, faculty development

Topics: Problem-Based Learning, UME, GME, Practice-Based Learning & Improvement, Interpersonal & Communication Skills, Systems-Based Practice & Improvement, Residency Director, Clerkship Director, Faculty, Resident, 2019, Faculty Development Seminar, Team-Based Learning,

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It Takes a Village: A Residents as Leaders Make-Over!

Objective/Background:
The Liaison Committee on Medical Education (LCME) expects medical schools to monitor the clinical
learning environment to enhance the positive behaviors of its’ resident teachers (Element 3.5). In
addition, schools should provide resources to promote residents’ teaching and assessment skills
(Element 9.1). Institutions must balance clerkship director (CD) expectations, program director (PD)
needs and medical school/graduate medical education support.
This interactive workshop will explore opportunities for clerkship directors to utilize residents as
teachers both inside and outside the clinical learning environment during the clerkship. Specific
examples of ways residents can influence medical students before, during and after the clerkship will be
presented. Our “village” of CD, PD and medical dean will demonstrate our own personal make-over
solutions.
Take Home Product: Participants will leave with a better understanding of how residents can influence
the learning environment, and new ideas on how they can be incorporated both within and outside the
clinical learning environment.
Learning Objectives:
1. Identify ways CDs can incorporate residents into the teaching curriculum
2. Compare CD and PD perspectives of resident utilization
3. Identify ways the medical school can support the residents’ professional development

Topics: Team-Based Learning, UME, CME, GME, Practice-Based Learning & Improvement, Systems-Based Practice & Improvement, Professionalism, Residency Director, Clerkship Director, Faculty, Resident, 2018, Faculty Development Seminar,

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Games, Groups and Kahoots: A tool-kit for capturing teachable moments in interprofessional learning teams

Objective/Background: Modern academic centers must meet the demands of providing
education to multiple learners of differing levels, in the setting of a busy clinical schedule. Traditional
lectures often fall short of these goals given their lack of individualization, feedback, flexibility, and
interest. Interactive teaching can address learners\\\' individual needs, enhance engagement, and
facilitate teamwork.
Workshop Agenda: Presenters will open this interactive workshop with a review of the theoretical basis
for adult learning theory, the changing needs of \\\"Millennial Learners\\\" and the evidence for multimodal
teaching methods (10 minutes). Large group session will focus on how to apply interactive learning in
everyday practice, helping participants to build a flexible, fun teaching tool kit through participation in
games, groups and kahoots, (40 minutes). Participants will break into small groups to apply knowledge
through use of the tool kit (25 minutes).
Interactive Component: Participants will be provided with a toolkit for clinical educators and break into
small groups to explore. Each group will have an opportunity to explore a variety of technologies,
games and clinical exercises including: Factual learning games (“kahoots”), Case based clinical reasoning
tools (“jeopardy”), Critical thinking tools (“monitor rounds”; “stump the expert”), Interprofessional roles
and perspective (“the interprofessional OSCE”) and Group Feedback (“keeping it constructive and fun”).
Take Home Product: Participants will leave with an educational toolkit of multimodal, interactive
teaching resources that will promote medical education while fostering inter-professional development
and clinical skills.

Topics: Team-Based Learning, Problem-Based Learning, UME, GME, Practice-Based Learning & Improvement, Interpersonal & Communication Skills, Medical Knowledge, Patient Care, Residency Director, Osteopathic Faculty, Clerkship Director, Faculty, Resident, 2018, Faculty Development Seminar,

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