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Wellness Wednesday: Utilization of Strategic Duty-free Hours by OB/GYN Residents

Purpose: To detail the specifics of how OB/GYN residents utilize a monthly duty-free afternoon for wellness activities. 

 

Background: Much attention is paid to burnout and high rates of depression among physicians. Some speculate these difficulties may start in medical school but that they become cemented and sometimes problematic in residency. Studies have made implications that interventions, specifically promotion of self-care and work-family balance, and work hour restrictions, early in residency can decrease burnout and depression levels.  

 

Methods: Starting in 2016, all residents of an OB/GYN program were allowed to have the first Wednesday afternoon of each month free from clinical duties. Faculty members covered all clinical services from noon to 5pm. Residents were then permitted to use the time for whatever they felt promoted their well-being. Two years of data were collected through surveys to determine the specific activities completed by the residents. 

 

Results: The commonly reported activities included health care visits, financial planning activities, leisure time with family/friends, community or church group events, every day errands, home chores, and fitness. Additionally, the residents also used the time away from clinical responsibilities to study and fulfill administrative requirements. 

 

Discussions: By better understanding what residents choose to do to promote their own well-being, programs can then tailor structured wellness activities to those choices.  Alternatively, programs can look at an open-ended wellness day as a possible intervention for fostering excellent overall health and welfare of their residents. More research is needed to validate this approach to wellness promotion.

 

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Systems-Based Practice & Improvement, GME, CME, UME, Quality & Safety,

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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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Influences of Gynecologic Oncology Education on Health Maintenance Practices of Female OB/GYN Residents

Courtney S. Legum-Wenk, DO
James J. Burke, II, MD
Objective: To investigate the influence of the gynecologic oncology rotation on personal health care practices and views of preventive health among female obstetrics and gynecology residents.
Methods: From February 2010 to July 2010, a questionnaire was distributed to female residents of 244 ACGME accredited OB/GYN residency programs by an anonymous online survey link provided to the program directors and coordinators. The IRB approved questionnaire consisted of 30 questions, querying basic demographic information, personal health practices, personal and family cancer history, views about preventive measures and surveillance for gynecological malignancies. Statistical analysis of responses consisted of Chi-square statistics, with significant associations being a p-value less than 0.05.
Results: While the survey was open, 699 visits (response rate of 18.2%) to the website occurred, resulting in 554 surveys being fully completed. Most respondents were 35 years of age or less (range 25-50 years), with a similar number of respondents from each year of residency. Two thirds of the respondents (66%) came from residency programs considered university based programs. Regardless of whether the residency was university or community based, respondents reported that the gynecologic oncology curriculum consisted of 23 weeks (mean 22.8 weeks) during the four year residency. Fifty-two percent of the residents do not have a primary care physician and 40% did not regularly visit an OB/GYN. Although 64% of the respondents “strongly” believe that annual pap smear testing is important and 73.5% “strongly” believe in the administration of HPV vaccination, 23% of residents in the 25-35 age group do not undergo routine pap smears even though 86.9% did so prior to residency. All respondents would “strongly” consider prophylactic hysterectomy and/or oophorectomy, but less than half (47%) would undergo BRCA testing. As residents experienced more weeks of the GYN/ONC curriculum, their interest in pursing a gynecologic oncology fellowship decreased (p< 0.012). However, those respondents wishing to pursue a gynecologic oncology fellowship were greatest among residents from a combined residency program.
Conclusions: Despite type of residency training, obstetrics and gynecology residents are receiving the same amount of exposure to the gynecology oncology rotation throughout their education. Although this standard exists, our residents are less interested in a future in gynecology oncology, pap smear compliance decreases, and establishment of a primary care provider is lacking during residency. Further analysis of a second distribution of the survey, which is currently in progress, hopes to provide even more insight into OB/GYN residency education and the effects of the gynecology oncology rotation on this education.

Topics: CREOG & APGO Annual Meeting, 2012, Resident, Faculty, Patient Care, Medical Knowledge, GME, Assessment, Quality & Safety, Public Health, Gynecologic Oncology, General Ob-Gyn, Genetics,

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Are Medical Students at an Increased Risk of Developing Vitamin D Deficiency?

Premlatha, Amalraj, MBBS, MPH
Charletta, A, Ayers, MD, MPH, Erin, Murphy, MD
Winner 2012 CREOG & APGO Annual Meeting - Award for Oral Abstract Presentation Part-Time/Volunteer Faculty
Introduction/Background: Approximately 1 billion people are estimated to be affected globally by low serum levels of Vitamin D. Preventing and correcting this deficiency would have a large positive impact on health outcomes and health care costs worldwide. According to National Center for Health Statistics (NCHS), approximately 36% of Americans are Vitamin D deficient. Lack of Vitamin D at a young age is known to affect the skeletal strength at a later age and can lead to osteomalacia, osteopenia and osteoporosis. Young adults who appear to be at great risk for developing Vitamin D deficiency due to limited sunlight exposure are medical students. These learners are mainly indoors during the prime time of sun exposure, i.e. from 10am to 3pm. Objective: We hypothesized (Ha) that majority of medical students tested would have serum Vitamin D levels below values that are considered sufficient. The objectives of this study was to test the study hypothesis by: (i) measuring the level of serum Vitamin D in medical students between 20-30 years of age; (ii) increasing their awareness of Vitamin D benefits as future health care providers; and (iii) educating subjects on Vitamin D deficiency, its consequences and the preventative measures to avoid the sequelae that may result from low levels.
Methods: A cross-sectional study of 20-30 year old medical students (n=40) currently enrolled in UMDNJ/RWJMS, was conducted from March-April 2011. A brief questionnaire collected their demographics, food habits, outside activity and degree of sun exposure. Blood was drawn to assess serum levels of 25 hydroxyvitamin-D levels (25(OH) D). Vitamin D deficiency was defined as serum levels below 20ng/ml, and Vitamin D insufficiency was defined as serum levels between 20-30ng/ml and normal levels beyond 30ng/ml. Each student (n=40) was provided with a fact sheet from National Institute of Health on Vitamin D, it’s importance and ways to prevent Vitamin deficiency.
Results: The sample comprised of 54%females; 43.6% whites. Based on the serum levels of 25(OH)D, one third of this sample was Vitamin D deficient 25(OH)D serum level of <20ng/ml) 25% had adequate Vitamin D levels (>30ng/ml) and the remaining were Vitamin D insufficient (20-30ng/ml).
Conclusion: Seventy five percent of medical students were found to have below sufficient levels of serum Vitamin D. This finding supports our hypothesis that inadequate Vitamin D levels in medical students are a major public health issue. This group of learners may have future bone health problems if wide spread Vitamin D education is not embarked upon and that these students, in turn, educate their future patients about the Vitamin D. Because of the small sample size, these results cannot be statistically verified. Hence more research is warranted to confirm these preliminary findings.

Topics: General Ob-Gyn, Advocacy, Public Health, Assessment, GME, Patient Care, Residency Director, Clerkship Director, Resident, Student, 2012, CREOG & APGO Annual Meeting,

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