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A Needs Assessment for a National Ob/Gyn Residency Education Curriculum

Purpose: We sought to determine Ob/Gyn residents’, program directors’ (PDs), and assistant program directors’ (APDs) perceptions of the need for a national Ob/Gyn residency education curriculum. This study was funded by the CREOG Empower Award.

Background: Several specialties have implemented standardized, national residency education curricula. These curricula allow residents to have equal access to a centrally located, structured, common knowledge base. In Ob/Gyn, although we have outstanding educational resources, they are not integrated into a national curriculum nor are they co-located. Rather, each residency program develops its own didactic curriculum, which requires a significant amount of time and effort and leads to variability in curriculum quality and content.

Methods: A 12-question web-based survey was developed and distributed to residents, program directors, and assistant program directors nationwide using the Ob/Gyn program coordinator’s listserve and program contact information from the ACOG website.

Results: 780 participants (651 residents, 83 PDs, and 46 APDs) completed the survey, with a diverse range of regions, program types, and program sizes represented. Almost all (97.2%) participants agreed or strongly agreed that residents nationwide should have equal access to high quality Ob/Gyn education resources. Further, 91.9% agreed or strongly agreed that core Ob/Gyn educational resources should be centrally located. A majority, 77.8% (residents 78%, PDs 75%, and APDs 78%), agreed or strongly agreed that there is a need for a national Ob/Gyn residency education curriculum.

Discussions: Our results demonstrate a perceived need for a centrally located, structured national Ob/Gyn residency education curriculum.

Topics: General Ob-Gyn, Independent Study, Lecture, GME, Medical Knowledge, Residency Coordinator, Residency Director, Osteopathic Faculty, Clerkship Coordinator, Clerkship Director, Faculty, Resident, Student, 2020, CREOG & APGO Annual Meeting,

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Validation of the Animal Tissue Model for Laparoscopic Salpingectomy Training

Purpose: To gather validity evidence for a laparoscopic salpingectomy model developed for resident training.

Background: Laparoscopic salpingectomy is a milestone procedure for gynecologic trainees and is commonly performed in the management of ectopic pregnancies. Opportunities to practice the use of electrosurgical devices prior to the operating room can be limited. An animal tissue model was developed and previously piloted at our institution for this purpose, and was modified to include a pelvic sidewall and ovaries.

Methods: 25 simulations of laparoscopic salpingectomy were performed by 14 trainees (5 PGY-1, 4 PGY-2, 1 PGY-3, 4 PGY-4).  For analysis purposes the PGY-3 and PGY-4 trainees were combined.  Each trainee received scripted instructions and reviewed a video with proper technique beforehand. These recordings were evaluated by 2 blinded gynecologic surgeons using the Global Operative Assessment of Laparoscopic Skills (GOALS) and Objective Structured Assessment of Laparoscopic Salpingectomy (OSA-LS).

Results: There was good agreement between the graders with intraclass correlation coefficients of 0.63 and 0.79, respectively, for GOALS and OSA-LS.   The mean GOALS score increased with experience (10, 13.2, and 15.5 for PGY-1, PGY-2, and PGY-3/4, respectively) and was significantly different between PGY-1 and PGY-3/4 (two-sample t-test, p=0.004). The mean OSA-LS score increased with experience (8.9, 14.2, and 16.2 for PGY-1, PGY-2, and PGY-3/4) and was significantly different between PGY-1 and PGY-2 (p=0.006) and between PGY-1 and PGY-3/4 (p< 0.001).

Discussions: This training model and rubrics differentiated experienced and novice trainees and could be used to establish a preoperative competency benchmark.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Residency Director, Practice-Based Learning & Improvement, GME, Assessment, Simulation, Minimally Invasive Surgery, General Ob-Gyn,

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Uptake and Efficacy of a Novel Self-Directed Foundational Curriculum for OB-Gyn Interns

Purpose: To evaluate a curriculum for OB-Gyn interns.

Background: To provide incoming interns with a reading plan, residency leadership created a novel, self-directed, online foundational curriculum for interns modeled after the ABOG MOC process.  The curriculum was first offered to interns starting residency in July 2017.
For each core intern clinical experience (Obstetrics, Gynecology, Family Planning, Office) selected readings represented the foundational knowledge expected of an OB-Gyn intern, totaling 42 readings.  For each reading, multiple choice questions highlighting the key information were crafted by attendings to create an online 40-question pretest, self-directed curriculum of 42 modules comprised of a reading and relevant comprehension questions, and 80-question posttest using unique questions not utilized in the pretest or modules.

Methods: The curriculum operated on the online educational platform, SparkLearn.  OB-Gyn interns starting residency at Vanderbilt in July 2017 completed the pretest during orientation.  Rising second-year residents completed the posttest simultaneously at the conclusion of intern year.  The intern class completed modules at their own pace and concluded intern year with the posttest.  Pretest, module, and posttest scoring was cataloged in SparkLearn.  IRB exempt study approval was obtained.

Results: For interns participating in the curriculum (N=6), mean module completion rate was 82.71% (range 26-95%).  Mean participator pretest and posttest scores were 71.04% (SD=7.22) and 82.71%(SD=7.04), respectively (p=0.01).
Participator module completion rate was strongly correlated with posttest scores (pearson coefficient 0.60) and weakly correlated to first year CREOG scores (pearson coefficient 0.12).   
Mean posttest scores at end of intern year were higher among curriculum participators (82.71%) compared to non-participators (75.31%) (p=0.05).  Mean first-year CREOG scores for curriculum participators were also higher (207) compared to non-participators (198) (p=0.24).

Discussions: Our novel online self-directed intern foundational reading curriculum had variable uptake but overall good utilization in its first year of deployment.  Compared to the preceeding intern class, participating interns had higher posttest knowledge scores.  There was a strong positive correlation between module completion rate and posttest performance.
Our study was limited by small sample size (N=6), but we continue to collect additional data with subsequent classes.  Multi-site deployment might permit correlation of curriculum utilization with milestones achievement in medical knowledge.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Medical Knowledge, Practice-Based Learning & Improvement, Independent Study, Problem-Based Learning,

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Pilot Study of Interactive Video-assisted Laparoscopic Teaching for OB/GYN Surgical Residents

Purpose: It is common knowledge that athletes review tapes as part of training. Although differences between a sports game and surgery are obvious, both require technical skill and performing under pressure. Surgeons may benefit from reviewing surgical tapes in training.

Background: Prior studies have explored using surgical videos to increase exposure to operative scenarios or evaluate technical skill. However, no standardized approach exists to incorporate video review into surgical training, particularly in gynecology. This interactive teaching model uses review of laparoscopic videos to enhance surgical knowledge and technique.

Methods: A gynecologic surgeon led participants through review of laparoscopic gynecologic surgery videos. The surgeon highlighted aspects of the video, pausing to enforce teaching points and lead discussion. Participants completed a 25-question multiple-choice survey prior to, immediately after and two months after the session. Individual changes in scores were analyzed before and after aforementioned intervention, stratified by residency year.

Results: Of participants who underwent the intervention, 100% completed the pre-survey, 60% completed the immediate post-survey. Response rate was 40% for the 2-month post-session survey. Of those who underwent intervention and completed the post-session survey, 71% improved their score while 29% had no change. When stratified by year, junior residents showed score improvement, senior residents had no change.

Discussions: Video-assisted teaching can enhance gynecologic surgical training. It seems most beneficial earlier in training as junior residents have yet to develop ways of doing things. While video sessions do not replace OR time, they provide forums for reviewing surgical approach and technique with visual aids to reinforce teaching points.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Team-Based Learning,

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Timing the “Fun” to the Fundamentals of Laparoscopic Surgery (FLS) in an Obstetrics and Gynecology Residency Training Program

Purpose: To determine the time required by Obstetrics/Gynecology (OBGYN) residents to gain proficiency with FLS skills

Background: FLS is a standardized assessment of laparoscopic knowledge and skills and an eligibility requirement of The American Board of Obstetrics and Gynecology (ABOG) Qualifying Exam. There is no published data on expected training time to guide curricula planning or how PGY level, prior surgical experience, or milestone assignment may associate with FLS skill acquisition.

Methods: A prospective cohort study was performed at a community based hospital where PGY2-4 residents were consented to participate in a structured FLS curriculum, which included five skill sessions supervised by gynecologic surgical faculty. Time spent in supervised and self-study sessions was recorded. A baseline and final assessment of FLS skills was administered noting errors and time to complete. Participants reported PGY level, number of prior laparoscopic hysterectomy cases, and their endoscopic technical skill milestone levels, which were analyzed using multivariate regression analysis.

Results: No residents (n=17) passed the baseline assessment. All participants passed the final assessment after curriculum completion with improvement in time (-12.2  minutes p = 0.0005) and reduction in errors (-2.5, p = 0.0025). The amount of structured time spent with a faculty member was correlated with improvement in assessment time (r=0.5979) with at least 155 minutes demonstrating significant improvement (p = 0.009). PGY level, milestone level, number of laparoscopies, and self-directed practice were not associated with improvement in performance.

Discussions: Deliberate practice was the driving factor for FLS skill acquisition independent of PGY, milestone, surgical experience, or self-directed practice time.

Topics: CREOG & APGO Annual Meeting, 2020, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, GME, Simulation, Minimally Invasive Surgery, General Ob-Gyn,

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The Magic of Reflection: Facilitating Resident Discussion of Challenging Family Planning Patient Scenarios

Purpose: To describe residents’ experiences of a guided reflection workshop about patient interactions which provoke negative emotions in the physician

Background: In 2016 we trained faculty to facilitate a guided reflection workshop.  The Professionalism in Reproductive Healthcare Workshop (PRHW) guides obstetrics and gynecology (ob-gyn) residents in exploring interactions with challenging patients, particularly those seeking family planning care.

Methods: Faculty volunteered for the training via a community listserv, underwent a half-day training, and then led workshops at 23 different institutions. Institutions were informed about the workshop by listserv emails, and scheduled workshops into their resident didactics. We conducted pre- and post-training surveys and descriptive analyses to assess post-workshop resident satisfaction and changes in attitudes about patient scenarios using Likert scales.

Results: From 2016 to 2019, 27 faculty conducted 28 workshops with 222 residents in the US and Canada. We collected 139 post-workshop surveys (63%), and 72 matched pre- and post-workshop surveys.  Patient scenarios residents most frequently identified as challenging were women who had more than one abortion, and women who did not want to become pregnant but were not using contraception.  In matched surveys, learners demonstrated greater awareness of reasons a patient might not initiate contraception after abortion and greater acceptance of that decision compared with responses before the workshop  (p< 0.01). The majority (91%) rated the workshop as worthwhile.

Discussions: Resident learners exhibited more understanding attitudes towards challenging family planning patient scenarios after participating in the PRHW. Supporting resident reflections about challenging patient scenarios may improve their ability to provide more high-quality, patient-centered family planning care.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, GME, Contraception or Family Planning,

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Text vs Email for a Question of the Day: Which do Today’s Medical Students Prefer?

Purpose: Compare completion rates and satisfaction of question of the day(QOD) received via text vs email.

Background: Fast, hands on learning e-tools are a popular effective technique with current generation of medical learners.

Methods: Twenty-eight questions of the day(QOD) developed focusing on commonly missed NBME exam concepts. A prospective cohort study of ob/gyn clerkship students conducted. Students self-selected to receive QOD by text or email from 1/19-7/19. Students received QOD nightly on weekdays via text or email, completion was optional. 
Primary outcome was overall response rate(RR). Secondary outcomes include RR/question and average weekly RR. Qualitative feedback regarding satisfaction, time spent, and utility also obtained.

Results: Eighty-one medical students participated, 40 selecting text and 41 email. In sum, 863 texts and 1269 emails sent during study period. Overall text RR was significantly lower than email(55.2%vs78.6%,p< 0.001). For no question was text RR greater than email RR. Average RR did not vary by week(wk1: text 55% vs 83% email, wk6: text 64% vs email 77%).
43/81(53%) students gave qualitative feedback, 28/41 from email cohort, and 15/40 text. 86% found the QOD helpful/very helpful(no difference by mode of receipt). However, email recipients more likely to find it very helpful(54%vs13%,p=0.02). 77% found the level of difficulty to be “just right”,(no difference by mode of receipt). The QOD took all students less than 5 minutes. Nearly all(93%) students found the QOD worthwhile and 98% would recommend to future students.

Discussions: Surprisingly, QOD completion rates were higher with email than text, though satisfaction and perceived utility high in both groups.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Faculty, Clerkship Director, Medical Knowledge, Practice-Based Learning & Improvement, UME, Assessment, Independent Study, General Ob-Gyn,

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Spellbound: Impact of a Professionalism Workshop on Abortion Attitudes for Residents at Catholic Programs

Purpose: To determine if a professionalism workshop that explores attitudes about abortion care influences ob-gyn resident attitudes at Catholic residency programs.

Background: Catholic residency programs face institutional barriers to abortion training.

Methods: Between 2018-2019, we provided professionalism workshops at five Catholic programs that do not provide abortion training. Participants received a pre and post survey related to abortion training and attitudes.  We compared Likert responses using Wilcoxon matched pair test. 

Results: 41 residents (87% of eligible residents) completed both surveys; 29.3% reported Catholic religion, 14.6% reported their personal views on reproductive care are in line with their institution, and 12.2% reported selecting a Catholic program based on its religious affiliation.  With respect to prior abortion experiences, 75.6% provided options counselling, 41.5% provided abortion referral, and 9.8% provided first-trimester abortion for nonmedical reasons.  Views on whether abortion or related circumstances is justifiable did not change for a patient presenting with an undesired pregnancy (p=0.32), but demonstrated increasing acceptance for the following circumstances:  (1) patient presenting for abortion at 19 weeks (p=0.001), (2) patient presenting for second abortion (p=0.01), and (3) patient declining post-abortal contraception (p< 0.001).  Emotional reactions to scenarios were unchanged.  When asked about when abortion is morally acceptable, views became more accepting for patients presenting with financial inability (p< 0.01) and for disruption to career or education (p< 0.01).

Discussions: A professionalism workshop can be a useful tool for residents at Catholic training programs to explore their abortion attitudes and results in more accepting attitudes toward women who choose abortion in certain circumstances.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, Assessment, Public Health, Contraception or Family Planning,

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Sexual Harassment in Obstetrics and Gynecology Postgraduate Training

Purpose: To determine the prevalence of sexual harassment(SH) in obstetrics and gynecology(OBGYN) residency and fellowships.

Background: SH is a common problem the U.S. with 1 in 3 women experiencing some form of it in their lifetime. According to the National Academies of Sciences, Engineering, and Medicine (NASEM,) 24-50.4% of female medical students experienced sexual harassment, which is more than their peers in science and engineering, and 220% more than female students in non-science fields.

Methods: We conducted a voluntary, anonymous survey study of all U.S. OBGYN trainees in ACGME-accredited residency and fellowship programs. The survey included the validated Sexual Experience Questionnaire (SEQ) short form, and other questions including demographics. The NASEM definition of SH was used in the study and described to the participants in the survey instructions. Descriptive statistics were utilized.

Results: The survey was distributed to 1473 trainees in the US; 395 responses were received (26.8%response rate: 86%females, 13.5%males). 20.6% of participants (78/378: 21.1%females, 21.7%males) responded yes to having been sexually harassed during their OBGYN training. Based on the SEQ questionnaire, 69.1% OBGYN trainees (253/366) had experienced some form of SH. Sexist hostility was the most common form of SH followed by crude behavior (211/253,83.4%;182/253,71.9% respectively). Males and senior OBGYN attendings (154/208,74.4%;110/395,27.9% respectively) were named the most common perpetrator; the operating room was the number one location for SH followed by Labor and Delivery (97/395,24.6%;83/395, 21.0% respectively).

Discussions: Although OBGYN is a female dominated field, the rate of SH of trainees remains high according to our data.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME,

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Residents as Preceptors: Developing a Teaching Curriculum for Obstetrics and Gynecology Residents

Background: Residents serve a critical role in medical student education as near-peer educators. Positive experiences with residents and perceived quality of teaching have been associated with improved clerkship satisfaction and career choices in that discipline. ACOG and ACGME milestones further emphasize the importance of residents as educators. While the role of residents as preceptors is widely acknowledged, preparation for that role is variable.

Methods: A single arm interventional study with pre and post intervention analyses was used. A four part lecture series was designed and implemented during obstetrics and gynecology resident didactics at the University of Minnesota.  Residents completed blinded and paired online surveys pre and post lecture. 5 point Likert scale responses
were summarized and compared using Wilcoxon Signed Rank and Nominal Symmetry tests.

Results: There was a statistically significant
difference in the distribution of rankings towards the positive between pre and post surveys for questions regarding evaluation and teaching
. There were no statistically significant differences in the distribution of rankings for questions regarding feedback.  Barriers to teaching were also identified qualitatively.

Discussions: Implementation of a teaching curriculum significantly improved residents\' perceived preparedness and understanding of medical student teaching and preceptorship but did not improve attitudes towards and frequency of feedback. Strengths of this study include description of a novel, resident led program. Limitations include a small sample size at a single institution within a single specialty.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, GME, Assessment, Lecture, General Ob-Gyn,

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Resident Surgical Evaluations: Feasibility of Integration into the Electronic Medical Record (EMR)

Purpose: Describe the development and implementation of a surgical evaluation tool within the Epic EMR to facilitate real-time feedback for resident learners.

Background: Evaluation of a resident’s surgical performance is critical to the developing surgeon’s education but challenging for both learners and teachers in a busy clinical environment. This study aims to describe how a surgical evaluation tool can be integrated into the EMR and the acceptability of the tool to both faculty and residents.

Methods: A novel tool was developed within the EMR of a single academic hospital that triggers an automated in-basket message to the attending surgeon upon case completion. This message directs the attending surgeon to complete a 4 question evaluation consisting of 2 validated feedback questions and 2 open ended questions. Upon completion, an email is sent providing residents with immediate feedback. At the end of the study period, a survey was sent to attending surgeons and residents to assess the acceptability of the tool.

Results: Between February 2019 and June 2019 719 cases were performed and 553 surgical evaluations were completed (77%). The acceptability survey was completed by 26 of 27 (96%) of residents and 14 of 16 (88%) faculty. Among residents, 96% reported that they received more feedback because of the tool and 85% liked receiving feedback in this way. Among faculty, 21% reported that they felt they gave more feedback because of the tool and 93% found the tool acceptable to use.

Discussions: Implementation of an automated surgical evaluation tool within the EMR is feasible, acceptable to use, and well received by learners.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Assessment, General Ob-Gyn,

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Resident Perceptions of Power-Based Violence and Impact of Bystander Intervention Training

Purpose: To evaluate resident perceptions of power-based violence (PBV) and assess initial impact of bystander intervention (BI) training.

Background: Creating a safe, welcoming workplace is important in medical education.  PBV in the form of overt aggression, microaggression, or bullying can threaten the educational community.  BI training offers residents a skill set to intervene to counteract PBV and foster a safer, welcoming clinical environment for their teams.

Methods: Pre-training and post-training surveys were completed by OB-Gyn residents at Vanderbilt prior to formal Green Dots BI training.  The survey assessed frequency of experienced or witnessed PBV, sexism, and racism.  Residents self-assessed their ability to recognize overt versus subtle PBV, and whether they would intervene in instances of PBV based on the role of the perpetrator.  Residents completing BI training were re-surveyed with the same instrument 3 months later.  Exempt IRB approval was obtained.

Results: 22 active residents were surveyed pre-training. 19 residents completed BI training and the post-training survey.  Active residents reported at least sometimes being the target of PBV (22.7%), sexism (45.5%), or racism (9.0%).  Even more residents reported at least sometimes witnessing PBV (50.0%), sexism (59.1%), or racism (45.5%).  Residents’ willingness to intervene varied by perpetrator: fellow resident (59.0%), attending (18.2%), nursing staff (40.9%).  100% of active residents felt obligated to foster a safe work environment free of PBV.  
Among residents completing BI training, the percentage reporting recognition of overt PBV increased after training from 84.2% to 94.7% (p=0.29), and the percentage reporting recognition of subtle PBV increased after training from 78.9% to 89.5% (p=0.37).  There was a modest increase after training in the percentage reporting they would intervene for PBV perpetrated by a resident (52.6% to 57.9%, p=0.74) or nursing staff (31.6% to 36.8%, p=0.73), but no change for faculty-perpetrated PBV.

Discussions: PBV is experienced and/or witnessed by residents not infrequently.  While residents are more likely to intervene for PBV perpetrated by a fellow resident, they are less likely to intervene when perpetrated by attendings or nursing staff.  BI training appears to offer modest improvements in recognition of PBV and willingness to intervene, but its effect in this study was limited by sample size.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Residency Director, Professionalism, GME, UME, Team-Based Learning, Advocacy,

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Resident Confidence with Obstetric Ultrasound – Are We Meeting CREOG Objectives and ACGME Milestones?

Purpose: The objective of this study assess resident confidence in obstetric ultrasound as per ACGME milestones and CREOG objectives, and factors associated with confidence performing US independently.

Background: Performing obstetric ultrasound(US) is an ACGME milestone, a CREOG objective, and a CREOG core procedure, though many programs lack formal US curricula.

Methods: CREOG coordinator listserve used to distribute 27-question anonymous e-survey in 3/2018 to OBGYN residents in US and Puerto Rico. Questions included experience performed growth US(gUS) and anatomy US(aUS) as primary sonographer, performing US independently, and for 4th year residents only, comfort performing US post-residency. Bivariate statistics compared residents comfortable performing US independently to those who were not.

Results: 417 residents completed the survey: 88% were female, 75% from academic programs, and nearly 50% were post-graduate year(PGY) 3&4.   While 89.1% had been primary sonographer for gUS, only 63% felt comfortable performing independently. Of chief residents, 14% didn’t feel comfortable performing gUS post-residency. In contrast, 60.9% had been primary sonographer for aUS, only 20.1% felt comfortable performing aUS independently, and 68.8% didn’t feel comfortable performing aUS post-residency.   Residents were more likely to feel comfortable performing gUS independently in PGY3&4 (p< 0.01) and after longer MFM rotations(p=0.02), and less likely when MFM fellows were present (p=0.02). Residents not comfortable performing aUS were twice as likely to have MFM fellows (p< 0.01), and less likely to be PGY3&4(p< 0.01).

Discussions: significant percentage of residents are not comfortable with their ultrasound skills. This data further emphasizes the need for structured US curricula and simulation.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Patient Care, Practice-Based Learning & Improvement, GME, Assessment, Simulation, Maternal-Fetal Medicine, General Ob-Gyn,

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Proficiency Perception and Relevance of Gynecological Procedures Among Obstetrics and Gynecology Graduates; Evaluating the Residency Surgical Curriculum

Purpose: To determine graduates’ perception of their proficiency in gynecologic operations and the relevance of these procedures to their current practice

Background: Program directors must certify that graduates are competent to practice without supervision after residency. Achieving proficiency in gynecologic surgery after 4 years is challenging. Evaluating the current surgical curriculum is critical

Methods: A survey of 40 graduates from a single academic instituition was conducted. 36 gynecologic procedures were listed. Each procedure corresponded to two four-point scales (strongly agree to strongly disagree). One scale was headed with preparation to independently perform the operation, and the other questioned the relevance of the procedure in their current practice. A third scale reviewed the need for additional training, and the case/volume per year. A subgroup analysis was done to evaluate the preferred route of hysterectomy and the rationale if vaginal hysterectomy was avoided

Results: The response rate was 67.5%. All respondents felt prepared to perform 25% (9/36) of procedures. More than 50% did not feel competent performing laparoscopic single site hysterectomy, laparoscopic myomectomy, sling, utero-sacral ligament suspension, vesico-vaginal fistula repair, colpocleisis, and office hysteroscopy. Vaginal hysterectomy was relevant for 78% of graduates, however, 89% performed fewer than 10 cases per year, and 55% would benefit from additional training. More than 50% of graduates would choose a non-vaginal route of hysterectomy, and interestingly, 93% of those based their decision on lack of comfort with the procedure

Discussions: While several gynecologic surgeries are relevant to recent graduates’ practices, some may not feel competent performing these procedures after residency. Vaginal hysterectomy is not commonly performed among graduates, largely due to inexperience with the procedure

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Patient Care, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME,

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OBGYN Trainees Perception of Departmental Climate with Regards to Sexual Harassment

Purpose: To assess Obstetrics and Gynecology(OBGYN) trainees’ perception of departmental-cultural-climate(DCC) regarding sexual harassment(SH).

Background: Positive DCC results in better psychological health and workplace environment. Climates perceived to be permissive of SH by the employees has lower overall work satisfaction.

Methods: Using REDCap data collection tool, we conducted an anonymous survey of OBGYN trainees in ACGME-accredited residency/fellowship programs in the U.S. The survey included demographics; the validated Sexual Experience Questionnaire(SEQ) short form; and assessment of DCC via questions regarding institutional reporting systems and trainees’ perceptions of how complaints would be handled. Descriptive statistics were utilized.

Results: The survey was distributed to 1,473 residents/fellows in the U.S. with 26.8%(395/1,473) response rate. The prevalence of SH was 69.1%(253/366). 90.3%(331/366) of trainees felt safe in their institution, while only 3.0%(11/366) felt unsafe. 72.7%(8/11) of trainees who felt unsafe had experienced SH. 88.5%(337/381) believed their SH report would be taken seriously. 75.1%(286/381) believed privacy would be maintained. 80.3%(305/380) thought their department would support them, and 76.7%(289/377) that the report would be handled fairly. 15.6%(59/379) thought they would be labeled as a troublemaker, and 10%(38/379) thought they would be punished.  Only 3.3%(4/121) made an official report. 67.4%(149/221) did not tell anyone; and 39.4%(95/241) did not know of a reporting system. No action was taken for 47.5%(29/61) of the reports; the perpetrator was spoken to about their behavior[14.8%(9/61)]; concerns were taken seriously[8.2%(5/61)]; and, concerns were found to be unsubstantiated[1.6%(1/61)].

Discussions: OBGYN trainees are often reluctant to report SH, and OBGYN departments may to need improvement in DCC based on our results.

Topics: GME, Systems-Based Practice & Improvement, Professionalism, Residency Coordinator, Residency Director, Osteopathic Faculty, Clerkship Director, Faculty, Resident, Student, 2020, CREOG & APGO Annual Meeting,

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Novel Realistic Bladder Model Teaches Anatomy & Builds Resident Confidence in Cystotomy Recognition/Repair

Purpose: To develop and pilot an inexpensive, reusable, water-tight moderate-fidelity bladder model that can be used to teach Ob-Gyn residents cystotomy repair.

Background: Cystotomy repair is a required Ob-Gyn milestone procedure; however, low surgical volume for cystotomy may impact resident ability/confidence to perform the procedure. Available simulation models are either expensive or low-fidelity and not water-tight. Our goal is to create a cost-effective, realistic, functional bladder model (visible ureteral jets, water-tight after repair) for simulation of cystotomy repair.

Methods: Phase 1: Design and creation of the model using molds developed with 3D design software and 3D printing. The silicone model includes ureters, urethra, trigone, ureteral orifices, rugae, muscularis, and mucosa.
Phase 2: Pilot of the model with Ob-Gyn residents as part of their simulation curriculum. Residents were given a pre- and post-test to identify the model’s anatomic landmarks and rate their confidence in 1) identifying cystotomy and 2) performing open cystotomy repair. Residents evaluated the model’s fidelity post-simulation.

Results: Eight bladder models were constructed for $206. The model was water-tight post-repair and cystoscopy demonstrated bilateral ureteral jets. All residents, n=16, had no prior cystotomy simulation and limited experience with cystotomy repair. The model improved ability to identify bladder anatomy (4.3/6 items pre vs 5.8/6 items post, p=0.04) and confidence in both identifying cystotomy (2.14 vs 3.4 of 5, p= 0.006) and performing cystotomy (1.4 vs 3.3 of 5, p=0.014). Learners strongly agreed the model was realistic, mean 4.6/5.

Discussions: Our novel bladder model is cost-effective, realistic and useful for teaching anatomy and simulation of cystotomy repair.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Practice-Based Learning & Improvement, GME, Simulation, General Ob-Gyn,

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Increasing Resident Education in Pediatric and Adolescent Gynecology

Purpose: The NASPAG short curriculum project was initiated to improve education of gynecology residents in the field of pediatric and adolescent gynecology.

Background: Pediatric and adolescent gynecology is a limited field amongst obstetric and gynecology residency programs. Many programs have no clinical rotations and very limited didactic education in adolescent gynecology. NASPAG has created a ten lecture curriculum to better train residents in this field.

Methods: The NASPAG short curriculum was implemented and residents completed self-assessment surveys and examinations before, immediately after, and three months after the curriculum. Additionally, the mean scores for pediatric and adolescent questions on the CREOG exams were analyzed for the year prior to and immediately after implementation of the curriculum. Paired t-test analysis was used to determine if there was a statistically significant difference for each arm of the study.

Results: There was a statistically significant improvement in all ten areas studied in regards to the resident self-assessment surveys. Objectively, there was a statistically significant difference in six of the ten areas studied immediately after the course and four of the areas three months later. The implementation of the NASPAG curriculum led to an increase in the mean CREOG score on pediatric and adolescent questions from 57% to 62%.

Discussions: The implementation of the NASPAG short curriculum subjectively enhanced resident comfort level when caring for pediatric and adolescent gynecologic patients. The curriculum also led to improved medical knowledge amongst the residents. This curriculum may be a vital tool in preparing for the standardized CREOG exams. 

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Residency Director, Medical Knowledge, Practice-Based Learning & Improvement, GME, Lecture, Problem-Based Learning, Standardized Patient, Team-Based Learning, Pediatric & Adolescent Gynecology,

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Improving the Basic Science Curriculum by Integrating the Clinical Sciences

Purpose: To evaluate medical student perceptions on whether curriculum innovations through the integration of clinical medicine with basic science improves learning in the pre-clinical curriculum.

Background: Medical schools are transitioning to competency-based curricula that emphasize an early introduction to clinical training. Students who learn basic science explanations for clinical correlates have improved retention. By integrating clinical sciences into the pre-clinical curriculum, learning is optimized for students.

Methods: At the end of the Reproduction pre-clinical sequence at the University of Michigan, students were asked to evaluate the overall quality of the course, whether objectives were met, and whether the course was well-organized, with a one-to-five level scale. These parameters were compared for the sequence between 2018 and 2019, after curricula changes were introduced.

Results: For the Reproduction sequence in 2019, course assessment parameters were improved in comparison to 2018 values. Overall, students rated the quality of the course as “very good/excellent” (4.21 ± 0.91), compared to “fair/good” (2.88 ± 1.01). Students “strongly agreed/agreed” that objectives for the course were met (4.44 ± 0.82) versus “agreed” (3.74 ± 0.88), and “agreed” that the course was well-organized (4.21 ± 1.07) compared to “disagreed” (2.66 ± 1.19).

Discussions: The restructuring of the Reproduction sequence allowed for purposeful integration of clinical medicine into the basic science pre-clinical curriculum, resulting in improved quality of learning for students. Recruiting clinical faculty for lectures, and implementing case-based instruction with the APGO videos for supplementation, provided an effective and efficient method of integrating clinical medicine content within the sequence.

Topics: CREOG & APGO Annual Meeting, 2020, Clerkship Director, Medical Knowledge, Practice-Based Learning & Improvement, UME, Lecture, Problem-Based Learning,

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Improving Patient Care and Resident Education Through a Resident-Led Quality Improvement Program

Purpose: To describe an innovative quality improvement skills acquisition curriculum through a resident-led morbidity and mortality (M&M) review and presentation format.

Background: The ACGME requires that residents participate in quality improvement (QI) initiatives as a part of their training.

Methods: The Residents on Quality (ROQ), developed at our institution, consists of 15% of the residents and two faculty advisors who review cases submitted for (M&M).  Submissions include a brief summary, type of error, and areas of potential improvement.  They are reviewed by a resident member and then evaluated by a faculty member for presentation at the departmental M&M/QI conference.

Results: 377 cases were submitted from 5/2018- 4/2019. 178 were gynecologic cases (47%) and 199 were obstetrics cases (53%).   The most common indications for submission were: readmission (19.4%), sepsis (17.5%), and unplanned ICU admissions (11.4%).  Failure to diagnosis and failure to follow established protocol were the most frequently indicated errors at 30.7% and 28.1%, respectively. QI modifications were made in the following areas: mentorship for junior faculty, guideline updates for preeclampsia, protocols for advanced obstetric vaginal repairs, and breech vaginal delivery simulations.

Discussions: A resident-run QI program teaches trainees to critically evaluate patient care.  ROQ  identified delays in diagnosis, failure to follow protocols, and technical errors as the most common QI needs.  By involving residents in M&M case identification, review, selection, and presentation, residents receive practical training in QI processes and develop the ability for continual improvement.  Department presentation of these cases fosters an environment of learning and allows for tangible changes to improve patient care.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, Lecture, Quality & Safety, Problem-Based Learning,

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Impact of TrueLearn Question Bank on Resident Performance on the CREOG In-Service Training Exam

Purpose: To determine how implementation of the TrueLearn (TL) question bank and mock in-service training exam (ITE) impacts performance on the CREOG ITE.

Background: The CREOG ITE is an annual exam on which, success has been correlated to success on the American Board of Obstetrics and Gynecology Qualifying Exam. Question banks are quickly becoming a popular study tool, but their utility on improving CREOG ITE performance is unknown.

Methods: We performed a quasi-experimental retrospective review of the CREOG ITE score reports from 2017 to 2019 at our institution. Starting in 2018, TL was made available and a mock ITE was administered for the first time. A two-sided paired t-test compared average annual improvement in CREOG ITE scores before and after TL implementation. Correlation coefficients between TL usage and improvement on the 2019 ITE were calculated using Pearson correlation testing and a linear regression was used to determine their association.

Results: After providing TL, mean improvement in percentage points on the CREOG ITE was 6.6, 9.33 and 6.75 as residents matriculated from PGY1-2, PGY2-3 and PGY3-4 respectively. This was a significant improvement compared to the previous year.  As a program there was a moderate correlation with TL usage and percentage point improvement on the CREOG ITE; r=0.38, p= 0.038.

Discussions: After providing universal access to TL question bank and administering a mock ITE, a statistically significant improvement on the CREOG ITE was seen. TL’s question bank and mock ITE are valuable resources for improving CREOG ITE performance.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Independent Study, Problem-Based Learning, General Ob-Gyn,

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