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Implementing Communications Training for OB/GYN Residents: Disclosure of Adverse Peri-operative Events

Precis: This study investigated the effect of self-evaluation on the improvement of surgical skills by comparing OSATS scores over a 4-month period to determine if the addition of a self-evaluation improved surgical skills more than instructor evaluation alone. 

Purpose: To study the implementation of communications training for OB/GYN residents on the disclosure of adverse peri-operative events

Background: Communication skills are key components of the patient-physician relationship, however, these skills are not routinely taught during OB/GYN residency or fellowship. As OB/GYNs, disclosure of serious news happens routinely in various aspects of patient care.  

Methods: OB/GYN residents at a single institution participated in a 4-hour communication didactics session using VitalTalk methodology.  Participants were surveyed at baseline, immediately following training and 3 months post-training to measure changes in comfort and confidence in the performance of communication skills. A 5 point Likert scale was used to measure comfort/confidence: Novice (1), Advanced Beginner (2), Competent (3), Proficient (4) or Expert (5).  

Results: 27 residents participated in training; 8(29.6%) interns, 7(25.9%) 2nd year, 7(25.9%) 3rd year and 5(18.5) 4th years. 11/27 (40.7%) reported prior communication training. Before training, residents reported the most competence: detecting emotion cues (median: 3.1), detecting patient/family sadness (3.0) and responding empathetically (2.8). Residents felt the least competent: assessing patient/family willingness to discuss perioperative complications (2.0), assessing how much a patient/family wants to know (2.1), confirming understanding of the adverse event (2.3). Baseline comfort and skill performing these conversations was 2.1 and 1.9, respectively. Immediately post-intervention, average comfort and skill level increased to 2.8 and 2.8, respectively. 3 month data is currently being collected.

Discussion: OB/GYN residents self-rate their communication confidence and skills at an advanced beginner level.  Implementation of participatory communication training for OB/GYN residents is feasible and improves both trainee comfort and skills in the disclosure of adverse peri-operative events. Further work is ongoing to understand retention of these skills to inform more longitudinal curricula.  

Topics: General Ob-Gyn, Standardized Patient, Simulation, GME, Interpersonal & Communication Skills, Professionalism, Residency Director, Clerkship Director, Faculty, Resident, Student, 2020, SES,

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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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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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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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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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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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Impact of a Pediatric Adolescent Gynecology (PAG) Learning Module: A Multi-Institutional Randomized Controlled Study

Purpose: To determine if an online PAG learning module improves resident knowledge and clinical performance.

Background: CREOG recommends education in PAG, yet resident training is often inadequate secondary to insufficient specialists and clinical exposure.

Methods: We conducted a multi-institutional single-blinded randomized controlled trial across four university programs; three had PAG rotations and two had PAG fellowship-trained faculty.  Our intervention was a previously validated 20-minute electronic module.  We applied block randomization across institutions in a 1:1 ratio.  All residents subsequently completed a PAG-related knowledge assessment (maximum score=5) that queried understanding of pre-pubertal bleeding and an objective structured clinical examination (OSCE, maximum score=16) that assessed history collection and performance of a genital exam, vaginal culture, and vaginoscopy for a pediatric patient.  OSCEs were videotaped and reviewed by two blinded faculty; inter-rater reliability score was 96.5%.  We calculated frequencies and compared composite knowledge assessment and OSCE scores using median tests. 

Results: Amongst 115 invited residents, 97 (83.4%) participated; 45 were randomized to the module with equal representation across training levels.   Majorities were female (90.7%) and reported no prior PAG didactic (77%) or clinical experiences (77%-87.6%); randomization groups were similar.  The intervention group scored significantly higher on both the knowledge assessment (4 versus 2, p < 0.001) and the OSCE (13 versus 7, p < 0.001).  Notably, the intervention group was more likely to appropriately avoid using a speculum in a pediatric patient (95.6% vs. 57.7%, p < 0.001).

Discussions: Our self-study PAG module resulted in improved knowledge and clinical approaches and may be of benefit to other training programs.

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

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Gaining Resident Buy-In: Three Year Follow Up of a Resident-Led Resident as Teacher Program

Purpose: To evaluate teaching culture in an OB/GYN residency three years after the initiation of a Resident-Led Resident as Teacher (RLRT) program.

Background: In October 2016, a RLRT program was created to foster the growth of clinician-educators by providing opportunities for direct instruction of medical students, educational leadership and professional development. Residents completing 25 hours of educational work are recognized as Distinguished Resident Educators at graduation.

Methods: We reviewed end of clerkship evaluations of resident teaching from July 2016 - June 2019.  We also surveyed residents annually regarding teaching skills and views of the RLRT program in October 2016-2018. Chi-square and Kruskal-wallis testing were used for statistical analysis.

Results: For 2018-2019 academic year, 48% of medical students strongly agreed that residents provided effective teaching compared to 30% in 2016-2017 (p< 0.01).  Of 48 residents, 42 (88%), 34 (71%), and 30 (63%) residents completed the survey in 2016, 2017, and 2018, respectively.  In 2018, 93% of PGY1s and PGY2s intended to be recognized as Distinguished Resident Educators, compared to 56% of PGY3s and PGY4s (p=0.02).  Incoming PGY1s in 2018 rated themselves higher on average in teaching skills than PGY1s in 2016, specifically in making mini-lectures and guiding students to evidenced-based medicine resources (p< 0.01).  All of the PGY1s (100%) in 2018 felt that the RLRT positively influenced their decision to join the residency program.

Discussions: A RLRT program can strengthen the teaching culture by increasing the effectiveness of resident teachers and aiding in recruitment of residents interested in resident teaching. 

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

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Evaluation Disparity and Implicit Bias in Medical Student Grading: Findings from Evaluator Focus Groups

Purpose: To perform a needs assessment of medical student evaluators to uncover reasons for evaluation disparity in order to work towards improving the quality, consistency, and accuracy of OB/GYN clerkship evaluations.

Background: Accurate evaluation of medical student clinical clerkship performance is challenging. Scale-based student ratings often do not correlate to comments provided. Additionally, there can be a wide variance of scores for the same student by different evaluators. Information regarding differing grading systems is available, but there is a lack of guidance around inter-rater reliability and implicit bias.

Methods: From May - July 2019, we performed three resident and faculty focus groups. We began the session discussing evaluation form reliability and current behaviorally anchored rating scales, same student evaluation inconsistencies demonstrated between evaluators, accuracy, and potential evaluator bias. Qualitative analysis utilizing two reviewers was used to identify themes.

Results: Overall, participants expressed a need for more formal student evaluation information and instruction. Other themes were requests for education and information regarding the evaluation forms and student grading, an admission of variation between ‘hard’ and ‘easy’ graders, and implicit bias in student evaluation, particularly regarding perceived specialty choice.

Discussions: Evaluators felt a need to better understand how evaluations contributed to student rotation grades and were interested in improving the quality, consistency, and accuracy of evaluations. Time with students directly influences the accuracy of objective evaluations. Implicit bias around one’s own ‘grading scale’, and around student specialty selection, can influence student evaluations.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Professionalism, Interpersonal & Communication Skills, UME, Assessment,

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Duty Hours and Medical Student Performance: Is There a Correlation?

Purpose: To describe the association between duty hours (DH) and shelf exam score, and between DH and overall grade.

Background: Medical students are required to comply with the same DH regulations as residents. However, variation exists between the total DH worked due to diversity of clinical sites, surgical rotations, and student engagement. The impact of DH on exam scores and clinical grade is poorly understood.

Methods: Retrospective cohort study of students in OB/GYN clerkship at a single academic center from 8/18-6/19. Weekly duty hours tabulated and averages obtained. Students working more than 75%ile for DH weekly (long hours) compared to those working less. Impact of long hours in last two weeks of clerkship also examined. Outcomes of interest were high overall grade ( >95%), high shelf score ( >90%), and low shelf score (< 60%) adjusted for quartile of year. Simple statistics used to analyze data.

Results: The average weekly DH was 43.1hr/wk (SD 7.32hr). This didn’t vary by gender. Students in the latter half of the year worked longer (45.2 hrs/wk vs 41.9 hrs/wk, p=0.03). The 75%ile of weekly DH was 47.1 hrs. Students working long hours were not more likely to have low shelf (21.7% vs 30.4%,p=0.6), high shelf (28.3% vs 28.6%,p >0.99), or high overall grade (25% vs 28.9%,p >0.99). Long hours in the last 2 weeks of the clerkship was not associated with high overall grade (33.3% vs 31.1%,p >0.99) or low shelf (21.7% vs 34.2%,p=0.32). A trend toward high shelf scores was seen (41.3% vs 23.2%,p0.06).

Discussions: Long duty hours, even late in the clerkship, were not associated with high or low shelf scores, nor high overall grade.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Medical Knowledge, UME, Assessment, General Ob-Gyn,

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Curriculum Development in the OBGYN Clerkship: Effect on NBME Scores

Purpose: Investigate whether implementation of APGO Medical Student Educational Objectives into an OBGYN clerkship didactic curriculum results in higher NBME exam scores.

Background: Medical student curriculum reform is at the forefront of OBGYN educational research. Active, adult learning techniques are highly touted; data are promising for student satisfaction, but more studies about effect on objective assessments are needed.

Methods: We implemented 21 of 58 APGO Medical Student Educational Objectives into the OBGYN Clerkship didactic curriculum during academic year (AY) 2018-2019. Students were assigned pre-reading material and completed weekly, graded individual readiness assessment tests, followed by team readiness assessments, before each didactic session. NBME scores were compared pre- and post-intervention (AY 2017-2018 to AY 2018-2019, respectively) by yearly cumulative, as well as by individual cohort within each year. Analysis was completed with independent samples t-test with two-sided P < 0.05 statistically significant.

Results: Overall, AY 2018-2019 had higher average NBME scores than AY 2017-2018, although not statistically significant (79.5 vs 78.6, P=0.29). Cohorts 4 and 6 showed significantly higher scores in AY 2018-2019 relative to AY 2017-2018, 80.0 vs 75.4 and 82.1 vs 77.7 respectively, (P< 0.05). Cohorts 3 and 5 scores were slightly higher on average and cohorts 1 and 2 scores were lower on average in AY 2018-2019 relative to AY 2017-2018, but these differences were not found to be statistically significant.

Discussions: Implementation of the APGO Medical Student Education Objectives into our OBGYN didactic curriculum showed a trend toward higher NBME scores, suggesting benefit, however this difference was not statistically significant.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Faculty, Clerkship Director, Clerkship Coordinator, Medical Knowledge, GME, Assessment, Lecture, Team-Based Learning, General Ob-Gyn,

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CREOGs Over Coffee—A Feasibility Study on Medical Education Podcast Creation and Social Media Outreach

Purpose: To describe the development and implementation of a medical education podcast series for obstetrics and gynecology (Ob/Gyn) resident learning and demonstrate feasibility, sustainability, and acceptance of this series.

Background: Podcasts and other digital resources have become popular among medical learners. Demand by learners for these types of resources compared to traditional methods of learning may increase as we move further into the digital age. Medical educators may wish to incorporate podcast learning into their curriculum and disseminate their work to a larger audience.

Methods: Council on Resident Education in Obstetrics and Gynecology (CREOG) educational guidelines were used to create a study podcast for Ob/Gyn residents over 9 months. Feasibility markers include production of weekly episodes and ability to offset costs. Sustainability markers included download markers over time. Acceptance was measured by number of reviews on Apple iTunes and followers on Twitter.

Results: 42 episodes were released from September 30, 2018-June 30, 2019 (39 weeks). Initial costs included $3150 startup and $29 monthly. Online donations through Patreon amounted to $200/month, which covered 50% of startup costs at 6 months and are projected to cover full costs by 1.5 years. The podcast had 137,500 downloads as recorded through Podbean (39/month 9/2018, increased to 25,000/month 6/2019). It obtained 609 followers on Twitter and 131 ratings on Apple iTunes, with an average of 5.0 stars.

Discussions: Medical education podcasts are a feasible way of disseminating educational materials to learners. We also demonstrate sustainability and acceptance of this platform. 

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Medical Knowledge, GME, UME, Lecture, Independent Study,

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Clerkship Directors’ Reports and Attitudes on Pelvic Exams Performed by Medical Students

Purpose: To examine current practices of obtaining consent for pelvic exams performed by medical students as reported by OBGYN Clerkship Directors (CDs).

Background: Recently, ethical concerns regarding student involvement in pelvic exams performed while a woman is under anesthesia have been raised in the scientific, professional, and popular literature.

Methods: An online survey about the educational pelvic exam was administered to OBGYN CDs as part of the APGO annual clerkship directors’ survey. CDs were asked if their institution had policies on the performance of pelvic exams by students, if explicit consent was obtained, and if patients, students, and providers were educated on the policy. These were evaluated by descriptive statistics of self-reported policies. We also compared the median values of the perceived importance of telling a patient about the involvement of a medical student across seven different procedures.

Results: The survey was sent to 230 clerkship directors, 140 responses were returned, with a response rate of 61%. 57 CDs reported they follow all 4 recommendations (40.7%) as published by APGO’s statement on pelvic exams under anesthesia. 9 CDs did not believe the exam had to be related to the procedure performed. Consent for pelvic exam was seen equivalent to consent for rectal exam, intubation, and making the incision. Consent was perceived less important to watch the procedure, suture the incision, and retract.

Discussions: While many CDs report institutional policies on students performing pelvic exams, it is clear that education is still needed to ensure proper consent is obtained.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, UME, Quality & Safety, General Ob-Gyn,

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Care Across the Life Cycle: Results of an Integrated Pediatric, Obstetrics and Gynecology, and Geriatric Medical Student Clerkship

Purpose: The authors explore medical knowledge attainment and course evaluation data in Pediatrics and Obstetrics and Gynecology after the implementation of a novel, three-phase undergraduate medical school education curriculum called ForWard. In ForWard, the two clerkships were shortened from six to four weeks and combined with geriatrics to form an integrated 12-week clinical block.

Background: The traditional structure for clinical clerkships are specialty specific rotations. Due to evolving needs of both patients and learners, there has been interest in integrating the clinical fields during delivery of undergraduate medical education. With any curricular change, it is important to evaluate the learning outcomes.

Methods: Pediatric and Obstetrics and Gynecology NBME subject exam scores were compared prior to (n=180) and after (n=162) the implementation of the ForWard curriculum using an analysis of variance with covariate (ANCOVA).  Student satisfaction with the traditional and ForWard curriculum were determined based on post-clerkship evaluation forms and compared using unpaired t-tests.

Results: The unadjusted mean NBME Pediatrics and Obstetrics and Gynecology subject examination scores were 77.1 and 80.0 in the traditional curriculum and 76.9 and 79.3 in the ForWard curriculum (p=0.83) and (p=0.37). The mean Pediatric and Obstetrics and Gynecology clerkship evaluation scores in the traditional curriculum were 77.1 (SD 7.6) and 80.0 (SD 6.9) compared to 76.9 (SD 7.9) (95%CI -1.84-1.47) and 79.3 (SD 7.7) (95%CI -2.26-0.85) in the ForWard curriculum.

Discussions: Despite shortened Pediatric and Obstetrics and Gynecology clerkship experiences, performance on the NBME subject examinations in both subjects was unchanged and student satisfaction was maintained.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Medical Knowledge, UME, Assessment, General Ob-Gyn,

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Can Less Be More in the OBG Clerkship?

Purpose: Determine how new “shift scheduling” for OBG clerkship would affect student clinical experience and learning.

Background: Increasing numbers of learners and shortage of clinical sites require innovative strategies to address demand. A potential approach would be to assign students specific shifts with varied assignments that cover the breadth of OBGYN over the course of a clerkship. Potential barriers would be decreased ability for the student to meet required encounters, decreased satisfaction, lack of engagement with the team and less clinical exposure.

Methods: A 32 -question survey adapted from the validated Dundee Ready Education Environment Measure (DREEM) was piloted and distributed to 365 third- year medical students (classes of 2019 and 2020). Topics included workload, opportunities to interact with patients, ability to complete required clinical encounters, perception of belonging and being meaningful participants in the clinical team, learning environment, study time, NBME exam preparation and performance.

Results: 180 surveys were completed (response rate 49.3%). 50.8 % were male and 49.2% were female. 93 (42.27%) were from the class of 2019 and 92 (63.4%) were from the class of 2020. Statistically significant improvement was noted in NBME score, perception of workload and time to study.  All participants were satisfied with the quality of the clerkship, the learning environment, were able to meet required encounters, and reported a good clinical experience. Students perceived higher levels of engagement and belonging with the shift schedule, though these did not reach statistical significance.

Discussions: Shift schedule allows accommodation of more students in the clinical environment while maintaining clerkship quality and clinical experiences.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Faculty, Clerkship Director, Medical Knowledge, UME,

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Assessing the Effectiveness of Single Session Didactic Teaching in Improving Health Care Professionals’ Knowledge of the LGBTQ Population

Purpose: To examine the impact of a single didactic session on short-term knowledge acquisition and long-term knowledge retention of principles related to LGBTQ healthcare.

Background: Individuals who identify as Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) compose an estimated 1.1-3.8% of the population. Despite significant legal and societal advances, disparities persist in LGBTQ health care education, delivery, and outcomes. Multiple national medical organizations have produced initiatives emphasizing the development of educational resources to address these disparities.

Methods: A prospective observational study was performed. Knowledge acquisition was examined by a written survey, including 5 semantic differential scale and 5 multiple-choice questions. The survey was provided prior to and after a didactic session, then again four weeks later. Participation was voluntary and anonymous. Statistics were analyzed using Graph Pad Prism 8 Software (San Diego, CA).

Results: Comparing summed scores, immediate pre and post results (n=63) showed significant improvement across both semantic differential scale (5.7-7.78; p-value 0.00005) and multiple-choice (71%-91%; p-value 0.0004) questions. The 4-week post results (n=33) showed knowledge degradation, but significant improvement when compared to pre-test (5.7-7.21; p-value 0.01, 71%-86%; p-value 0.0095). The most significant improvements were in knowledge of LGBTQ community resources (3.9-7.6-6.4; p-value < 0.00001) and options for gender affirmation (51%-73%-69%; p-value < 0.00001).

Discussions: As medical curricula continue to evolve to address the needs of the LGBTQ population, this study indicates that a single didactic session may significantly improve provider knowledge about LGBTQ health care. This should result in improvements in awareness and communication, patient satisfaction, and health outcomes.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, CME, Lecture, Public Health, Advocacy, General Ob-Gyn, Sexuality,

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