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.
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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Use of POEs( Point of EPA Evaluations) Across All Third Year Clerkships for Year Long EPA ( Entrustable Professional Activity) Monitoring
Purpose: To describe the development of a school wide and longitudinal
assessment of the core Entrustable Professional Activity (EPA)s using an easily
Background: Our insitution is part of the EPA pilot study
sponsored by the AAMC to explore the feasibility of teaching and assessing the
core EPAs. This year direct observation and assessment of the EPAs was
implemented across clerkships . Each clerkship was allowed to determine which
EPAs were applicable to their field.
Methods: The OBGYN department determined and assessed that
EPA1( History and Physical) , ] EPA2 ( Differential Dx) , EPA3 ( Dx
and Screening Tests) and EPA6 ( Oral Presentation) were core skills to
the clerkship with the following scale (1=student observed, 2=assessor had to
talk the student through it, 3=assessor had direct them from time to time, and
4=assessor needed to be available just in case.)
OB Other Clerkships p
EPA 1 3.0( 0.5) 3.5 (0.5) <0.0001
EPA 2 3.0 (0.9) 3.4 (0.6) <0.05
EPA3 3.0 (0.9) 3.4 (0.7) n.s
EPA6 3.1( 0.5) 3.4 (0.5) < 0.005
For the first 3 months there
were 2783 EPA assessments. The average score was 3.45. In comparison to other
clerkships, students on OBGYN received lower scores in EPA 1,2,6.( p<.0001,
P< .05 and P< .005) possibly
indicating more stringent grading by faculty or lower performance of
Discussions: In comparison to all other clerkships combines, student on
OBGYN received lower scores in all four EPAs possibly indicating more
stringent grading by faculty or lower performance of medical students. Lower
EPA scores may indicate more stringent grading by faculty or lower
performance of medical students. This could also be related to lower numbers of
overall EPAs reuired by the OB/GYN clerkship. Further research is needed
to determine the significance of these findings.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Practice-Based Learning & Improvement, GME, UME, Assessment,
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Transgender Healthy Care: On-line Survey of Physician Knowledge and Comfort
Purpose: To evaluate OB/Gyn provider knowledge and comfort with
transgender health care
Background: Transgender and gender non-conforming patients (TGNC)
are an underserved population that often encounters inadequate or ‘unsafe’
clinical care. Education regarding TGNC patient care has traditionally been
minimal, contributing to gaps in Ob/Gyn care for many of these individuals,
including transgender men.
Methods: An IRB approved, anonymous online non-validated survey
was emailed to 130 APGO program coordinators to distribute to their Ob/Gyn
faculty and post-graduate learners. Questions addressed included years of
practice, experience with TGNC patients, provider comfort, and TGNC education.
Results: One hundred and sixty four surveys were completed and
an additional ~50 were opened but no information was provided. Of the 164
completed surveys, 76.3% of participants reported less than 5 hours of TGNC
specific healthcare education, despite the fact that 75.7% of responders had
cared for at least one TGNC patient. Overall most respondents felt
comfortable/very comfortable (79.8%) caring for this population. No correlation
was found between years in practice and overall provider comfort caring for
TGNC patients. Major obstacles reported by participants included concern
for patient comfort, appropriate language, and lack of sufficient clinical
education for both providers and support staff
Discussions: These data suggest that enhanced TGNC clinical education for
the entire health care team is warranted.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, GME, Advocacy,
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Training Residents to Place Immediate Postpartum LARC: An Update Among U.S. Residency Programs
Purpose: To survey U.S. Obstetrics and Gynecology (Ob/Gyn) Residency
Programs on immediate postpartum (IP) long-acting reversible contraception
(LARC) training and challenges.
Background: In 2016, the American College of Obstetricians and
Gynecologists (ACOG) released a committee opinion supporting IP LARC. Growing
evidence describes provider/hospital barriers which hinder IP LARC provision.
We hypothesize similar difficulties have prevented programs from implementing
Methods: We distributed an electronic survey addressing IP LARC
training to 273 U.S. Accredited Council for Graduate Medical Education (ACGME)
Ob/Gyn Residency Program Directors from the 2017-2018 Academic Year. Data
analysis was performed with chi-square and Fisher’s exact test.
Results: Of 86 programs that participated, residents were
trained in the immediate postpartum period to place implants in 54 programs
(63%) and to place intrauterine devices (IUDs) in 52 programs (60%).
2015, only 20% of the programs were training their residents to place IP IUDs.
Thirty-one percent of eligible programs initiated training in 2017. The
majority of programs focused training interns (98%). Patient/provider
convenience motivated 46% of programs to offer IP LARC and compliance motivated
The two barriers
most frequently encountered, regardless of program training status, were
problems with billing and compensation for services (61%) and the pharmacy
that reported primarily seeing patients with insurance, either private or
Medicaid, were more likely to have IP IUD training compared to programs seeing
mostly indigent/uninsured populations (p<0.05).
Discussions: IP LARC training has increased since the ACOG Committee
Opinion was published, however many programs are still facing challenges with
implementation, affecting resident training.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Systems-Based Practice & Improvement, GME, Public Health, Advocacy, Contraception or Family Planning,
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Targeted Interventions to Improve Resident Well-being
Purpose: To quantify and compare physician well-being and incidence of
burnout across residency programs at our institution, emphasizing
program-specific and resident-driven interventions
Background: As the national conversation regarding physician
well-being evolves, the importance of addressing physician burnout has come to
the forefront. Our institution identified moderate levels of burnout across all
residency programs, and thus initiated institution-wide efforts. Literature
suggests utilizing organization-wide and targeted interventions together has
the most significant impact on improving well-being and reducing burnout.
Methods: A Modified Maslach Burnout Inventory (MBI) survey is
distributed annually to all residents at our institution. Results from
2015-2018 were analyzed to track changes in burnout scores. All residents
participated in institution-wide interventions. Some departments initiated
additional resident-determined program-specific interventions.
Results: Mean MBI scores qualified for moderate burnout for all
programs across all years. Most programs utilizing institution-wide
interventions demonstrated no change in burnout scores; while some,
specifically OB/GYN, saw a statistically significant increase in burnout scores
(p<0.001). Departments with program-specific interventions demonstrated
decreased scores during the same time period.
Discussions: Residency programs utilizing targeted interventions
demonstrated marked improvement in burnout scores. Amongst those
without targeted interventions, OB/GYN demonstrated the largest increase in
burnout, suggesting differing etiologies of burnout for individual programs,
with OB/GYN being uniquely susceptible. We plan to combat this by utilizing a
guided focus group of OB/GYN residents to identify drivers of burnout and
specific interventions addressing these factors, using the Mayo Well-Being
Index to track anticipated improvement. Continued work in evidence-based
strategies addressing the challenge of burnout will ultimately produce more
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Systems-Based Practice & Improvement, GME,
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Students Stuck in a Swamp? Scripting Promotes Medical Student Involvement in Obstetric & Gynecologic Care
Purpose: Characterize the effect of staff scripting on medical student
acceptance in outpatient ob-gyn clinic visits.
Background: Direct patient care is a major tributary in the river
of medical education. When patients refuse medical student involvement in their
care, students are stranded in stagnant quagmire. Review of the literature
shows that medical student refusal is a national issue not limited solely to
obstetrics and gynecology (ob-gyn) clerkships (Chang, et al, 2010; Mavis,
et al, 2006; Hartz & Beale, 2000). Written and video messages about medical
student training have been effective in furthering medical student acceptance
in clinical encounters (Buck & Littleton, 2016). Open the floodgates!
Methods: A literature review using search terms “medical
student AND refusal” was conducted to guide script composition. Medical
assistant and nursing staff implemented the script in an outpatient ob-gyn
resident clinic. The script was revised halfway through the clerkship year
based on patient and staff feedback. All ob-gyn medical students were surveyed
regarding their involvement in patient visits prior to and after script
Results: After script implementation, the percent of medical
students refused from at least one patient interaction decreased from 92% to
86%. 66% percent of our students perceived scripting as a supportive measure
for medical students, and 61% percent witnessed staff, residents, and faculty
Discussions: Data from our institution suggest that scripting improves
medical student involvement in ob-gyn patient care. Involving staff, students,
and patients on scripting revision helped foster a learning environment rich as
the Mississippi delta in which medical students can thrive.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Professionalism, Interpersonal & Communication Skills, UME, Team-Based Learning, Advocacy,
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Simulation Training for Operative Vaginal Delivery Among Obstetrics and Gynecology Residents: A Systematic Review
Purpose: To evaluate the impact of simulation training of operative
vaginal delivery (OVD) on learner technique, operator comfort, and
Background: Obstetric simulation affords learners opportunities to
acquire and to refine clinical skills in a low-stress environment while
potentially improving patient outcomes. However, the effect of simulation
on OVD training is less clear.
Methods: A systematic research protocol was constructed a
priori for the conduct of the literature search, study selection, data
abstraction and data synthesis. Electronic databases were searched for
educational randomized trials and observational studies assessing OVD
simulation training for OBGYN residents. The educational domains of
knowledge, skills and attitudes were evaluated. The Medical Education
Research Study Quality Instrument (MERSQI) was used to assess study
quality. The review was prospectively registered with PROSPERO.
Results: The search strategy yielded 30,812 articles, with 7
articles eligible for analysis (2 cohort studies, 1 case-control study, 4
cross-sectional studies). No randomized trials were identified.
Studies demonstrated simulation to improve learners’ skill with forceps
placement and generated force during extraction. While forceps simulation
had no change in procedure failure rates, there were significant decreases in
rates of maternal lacerations, neonatal injury, and special-care nursery
admission. Only one study evaluated the effect of simulation on provider
comfort, demonstrating increased provider comfort with vacuum-assisted
delivery. The median MERSQI score was 9.5 (range 9.0-13.5), indicating
Discussions: The available evidence suggests improvement in technique,
comfort, and patient outcomes with OVD simulation, but additional studies are
required to further characterize such benefits for both forceps and vacuum.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Simulation, Quality & Safety, Maternal-Fetal Medicine, General Ob-Gyn,
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Saving Lives: Students Enhancing Patient Health Literacy Regarding Hypertension in Pregnancy and Prenatal Aspirin
Purpose: To increase medical student’s knowledge, behavior and belief
systems regarding hypertension (HTN) in pregnancy and prenatal aspirin (PNA).
To increase patient\'s understanding regarding the complications of HTN in
pregnancy and the benefits of PNA.
Background: Prenatal aspirin (81 mg) has been recommended by ACOG
for high-risk women and women with >1 moderate risk factor. Its use reduces
the rate of preeclampsia, preterm birth, intrauterine growth restriction and
fetal death in at-risk patients. In a survey conducted at Boston Medical
Center, the incidence of hypertension in pregnancy is 30%, with only 15% of
patient having heard of PNA, demonstrating high prevalence and low patient
literacy regarding the topic.
Methods: Ob/Gyn clerkship students are instructed to educate
patients regarding: knowledge of HTN in pregnancy, warning signs of
preeclampsia, and efficacy of PNA in pregnancy. The student educational
intervention was evaluated regarding: satisfaction, knowledge, confidence, and
belief systems by surveys at the beginning and end of the clerkship. Patient
education was evaluated by pre and post intervention metrics.
Results: Student knowledge of PNA and HTN increased 35%,
confidence 45% and belief systems 14%. They gave the project a 72%
satisfaction rating. Patient’s knowledge about HTN increased 48%, warning
signs 80%, and understanding of efficacy of PNA 65%.
Discussions: Medical student health counseling increased patient knowledge
regarding HTN and PNA. By educating patients, students also increased their
knowledge and confidence in the subject. We plan to continue implementing this
QI project throughout the year to augment a departmental QI initiative and
evaluate its benefit to patients and students.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, UME, Quality & Safety, Advocacy,
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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
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.
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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Professionalism Training in the Global Setting: Program at Ayder Hospital and Mekele University in Ethiopia
Purpose: Using the current partnership between University of Illinois
in Chicago, Illinois (UIC) and Ayder Hospital/Mekele University in Mekele,
Ethiopia (Ayder), this study evaluated the effectiveness of professionalism
training for medical students and resident trainees at Ayder.
Background: Threats to professionalism in medicine have led to
more universal teaching of professionalism to trainees and practicing
physicians. Currently, professionalism is listed by the ACGME as one of the 6
general clinical competencies. Many programs that include group sessions
and standardized patients have been implemented in American institutions,
although little research has been directed towards professionalism training in
a global health setting. This study aimed to determine the effect of a
professionalism training at Ayder.
Methods: Participants in a professionalism and communication
training were offered participation in a pre- and post-test survey. The survey
focused on the perception and function of professionalism in the medical
workplace, and included quantitative and qualitative data. The pre- and
post-test surveys were conducted prior to and at completion of the training.
Results: A convenience sample of medical students and resident
trainees at Ayder participated in the pre- and post-test surveys. The training
had a positive effect on the perception of professionalism and identified
opportunities for behavioral improvement.
Discussions: We saw that the professional training was an effective tool
for implementing professionalism into medical education curricula in this
global health setting. However, further research regarding the long term impact
and ability to implement clinical competencies into global health settings will
help determine the plausibility of repeating such a study in other sites.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, Simulation, Global Health, Public Health,
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Predictors of Trainees\' Willingness to Provide Family Planning Services: A Survey of Ob-Gyn Residents
Purpose: To determine factors that contribute to a resident’s
willingness to provide abortions post-residency.
Background: The shortage of abortion providers makes accessing
care difficult. Personal and environmentalfactors within the residency training
environment may be modified so that greater numbers ofgraduates opt to become
Methods: A multiple-choice survey was sent to all ACGME
accredited OB/GYN residency programs. Data on demographics,religious and
political views, residency training experience and intent to provide abortions
was collected anonymously (n=396).
Results: Sixty-eight percent of residents intended to provide
abortions (n = 269). The sample was 89% female, underage 35 (97%), heterosexual
(91%). In a multivariable logistical regression, the following demographic
factors predicted intent to provide abortion; being female (aOR 2.8; 95% CI
1.2-6.5), identifying as non-Christian (aOR 3.6; 1.9-6.6), and being raised in
the Northeast (vs South) (aOR 3.0; 1.3-6.7) .Modifiable predictors of intention
to provide included programs where 50% of the faculty provided abortions (aOR
3.3;95% CI 1.8-5.8). Additionally, residents who performed greater than 20
cases (uOR 3.3, 95% CI 1.6-6.7) were three times more likely to plan
toprovide.Selection of a residency emphasizing family planning significantly
correlated with intent toprovide (aOR 4.3; 95% CI 2.4-7.8). Those training at
Ryan Programs were twice as likely (uOR2.4; 95% CI 1.6-3.8) to intend to
Discussions: Modifiable factors such as early exposure of medical students
to family planning, faculty selection, robust case volumes and establishment of
a Ryanprogram may enhance the number of graduates offering abortions while in
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Osteopathic Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, GME, UME, Advocacy, Contraception or Family Planning,
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Perceptions Regarding Medical Students Performing Pelvic Examinations on Anesthetized Female Patients
Purpose: The purpose of this study was to determine perceptions
regarding medical students performingpelvic examinations on anesthetized female
Background: Pelvic exams performed under anesthesia continues to
be a controversial topic, but studies looking at medical staff are lacking.
Methods: An internet based survey was distributed to OB/GYNs,
OR nurses/techs,anesthesiologists/CRNAs, and medical students at multiple
hospitals and medical schools.Demographic data were collected. Non-demographic
answers to questions were recorded on a 5-point scale. Characteristics between
the respondent groups were statistically compared usingChi-squared test for
independence and the Fisher’s Exact Test.
Results: 337surverys were completed. 72% of respondents
believed permission should be obtained from patientsprior to the performance of
EUAs by medical students on anesthetized femalepatients. 30% of respondents
believed prior consent was usually obtained. 50% believed patients would agree
to have the exams performed. 80% thought patients would be upset if an EUA by a
medical student was performed on them without their prior consent. 32% of
nurses believed medical students should be allowed to examine anesthetized
patients. Medical students were less likely to believe it was appropriate
for a student to examine a patient, there was an educational benefit, and that
patients would consent.
Discussions: Despite the perception of all OB/GYN OR team members that
consent should be obtained beforemedical students perform pelvic examinations
on anesthetized female patients, this does notusually occur. Almost 50% of
medical students would not encourage their female relatives toconsent to
medical students performing such pelvic examinations.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Patient Care, Professionalism, GME, Quality & Safety, Advocacy,
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Oral Milestone Assessment versus Electronic Evaluation (E-Value) Milestone Assessment-Is One Better Than Another?
Purpose: To compare milestones assigned to PGY 1 and 2 Residents via
an Oral Milestone Exam versus the traditional retrospective monthly electronic
evaluation system to assess how they aligned.
Background: Programs are tasked with implementing assessment tools
to evaluate the 28 milestones. Most programs use some form of an electronic
evaluation at rotation completion. The Clinical Competency Committee
reviews all information for final score assignment each six month period.
Methods: In 2015, we instituted an Oral Milestone examination
to assign the six-month milestones and compared those scores to our
retrospective monthly on-line evaluations. We evaluated PGY 1 and 2 residents
in a simulated forum on milestones, which included Medical Knowledge, Patient
Care, and Interpersonal /Communication Skills Competencies. All residents were
given simulated patients, cases, and/or skills while each examiner was given
the specific ACGME milestone assessment sheet to score. The residents were
provided with immediate feedback.
Results: From 2015-2018, 78.4% of PGY 1 and 43% of PGY 2 residents
scored higher on the real-time oral milestone exam. Additionally, in 82% of PGY
1 residents and 52% of PGY 2 residents score on the oral exam was at
0.5-1milestone level higher than the retrospective electronic monthly
Discussions: Clinical Competency Committees are tasked with Milestone
assignment to all residents every six months. Evaluation tools that most
reflect the actual milestone completion is a mission of all programs. We set
out to assess whether our electronic monthly retrospective evaluation system
was mirroring the assessment performed on our residents with the real-time oral
milestone exams at the end of the six month interval, just prior to submission
to the ACGME.
Our data suggests discrepancy in our online retrospective milestone evaluation
versus the real-time assessment of an oral exam. Not only did residents score
higher in most circumstances in an oral format, but they were higher by a
half-whole milestone level in the majority of the cases. It would suggest that
our ability as educators to recollect the performance of a resident at an
interval later than the performance may be flawed.
Programs may want to consider instituting an oral milestone examination for
enhanced milestone assessment.
Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Professionalism, GME, Assessment, Simulation, Standardized Patient, General Ob-Gyn,
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Ob/Gyn Residents’ Perspectives on Preparedness for Difficult Conversations
Purpose: To characterize obstetrics and gynecology (ob/gyn) resident
experience in conducting difficult conversations during various patient-care
Background: Effective and compassionate communication is an
essential part of the physician-patient relationship. Leading family meetings
to discuss end-of-life care, fetal loss, infertility, or poor maternal outcomes
can be a difficult and anxiety-provoking experience. However, there is often
limited formal guidance for ob/gyn residents on how to conduct these difficult
Methods: A 16-question survey was sent to all ob/gyn residents
in the state of Michigan. Participants answered questions regarding previous
training, self-perceived preparedness, and confidence conducting difficult
Results: Of 314 ob/gyn residents identified in the state of
Michigan, 75 (24%) responded and the survey is still ongoing. Nineteen (27%) of
respondents said that formal training about difficult conversations was part of
their residency curriculum. Prior training included online modules/coursework 9
(12%), conferences/lectures 18 (25%), and rotation with palliative care 5 (7%).
(57%) believed post-grad training in difficult conversations was either
completely inadequate or could be improved. Moreover, 61 (81%) of respondents
believed formal training for residents on conducting difficult conversations
would either probably or definitely improve the quality of patient care. Nearly
half the respondent felt a lack of confidence as the biggest barrier in
satisfactorily conducting these discussions with the families.
Discussions: Efforts to improve residency training in conducting difficult
conversations should be urgently undertaken. In this survey, ob/gyn residents
overwhelming felt that the current training in leading difficult conversations
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Patient Care, GME, CME, UME,
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Medical Student Self-initiated Form Improves Compliance of Documenting Formal Mid-clerkship Feedback
Purpose: A medical student self-initiated feedback form is a simple,
yet innovative way to meet LCME requirement to document mid-rotation feedback
during the busy clerkship.
Background: Mid-rotation feedback during the clerkship is crucial
in helping trainees learn their strengths/weakness in order to improve clinical
performance and develop clinical competency. The LCME has
established a standard for clerkship directors (CD) to document formal
mid-rotation feedback for medical students during clinical clerkships but due
to competing demands, this standard has been challenging to meet. This
educational quality improvement project examined the effect of instituting a
self-initiated feedback form on documentation of formal mid-rotation feedback.
Methods: Beginning January 2018, we instituted a mandatory
self-initiated feedback form to be completed prior to meeting with the
CD. The 4-item feedback form includes prompts for students to
self-reflect on strengths/weaknesses and space for comments to discuss with the
CD. Completed forms are uploaded to an electronic assessment system.
Results: At our institution, compliance with documenting Ob/Gyn
mid-rotation feedback improved substantially to 98% in 2017-18 as compared to
77% in 2016-17 and 71% in 2015-16. Similar trends occurred in other
clerkships, particularly in pediatrics and general surgery, thereby
demonstrating generalizability of intervention.
A medical student self-initiated feedback form improved
compliance of documenting formal mid-rotation feedback while decreasing CD
workload. This intervention also made feedback meetings more engaging,
robust and meaningful. This innovation places ownership of
initiating feedback on the medical student, and less on the CD. This form
can be incorporated at other undergraduate medical institutions.
CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Osteopathic Faculty, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, UME, Assessment,
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Medical Student Perceptions Regarding Students Performing Pelvic Examinations on Anesthetized Female Patients
Purpose: The purpose of this study was to determine perceptions of
medical students regarding performing pelvic examinations on anesthetized
Background: Pelvic exams performed on anesthetized women continues
to be an important topic of discussion, however, it is not frequently evaluated
from the medical student\'s perspective.
Methods: An internet based survey was distributed to medical
students at multiple medical schools.Demographic data was collected.
Non-demographic answers to questions were recorded on a 5-point scale.
Characteristics between the respondent groups were statistically compared
usingChi-squared test for independence and the Fisher’s Exact Test.
Results: 220 medical students completed the questionnaire. 77%
of all medical students believed permission should be obtained from
patients prior to the performance of EUAs by medical students on anesthetized
patients. 30% of respondents believed prior consent was usually obtained.
46% believed patients, if asked, would agree to have the exams performed.
85% believed patients would be upset if they were made aware a pelvic
examination by a medical student had been performed without their prior
consent.60% of medical students believed they should be allowed to examine
anesthetized patients, with 87% thinking there is an educational benefit.
Discussions: Despite the perception that consent should be obtained before
medical students performpelvic examinations on anesthetized female patients,
this does not usually occur. 50% ofmedical students would not encourage
their female relatives to consent to medical studentsperforming pelvic
examinations. There was no statistical difference between male andfemale
medical students regarding perceptions of student pelvic examinations on
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Professionalism, GME, Advocacy,
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Join the Club: Integration of the CREOG Journal Club Curriculum Improves OBGYN Residents Statistical Literacy
Purpose: To evaluate the impact
on resident comprehension of biostatistics and research methodology after
restructuring a residency journal club based on the CREOG journal club
reveal dismal resident performance on statistical literacy evaluations.
However, little is known regarding OBGYN residents’ ability to interpret
research methodology and results and how these abilities are impacted by the
integration of evidence-based medicine principles into journal club curricula.
pre-/post-intervention study of 22 OBGYN residents at a single institution was
conducted to evaluate the impact of integrating the new curriculum
(intervention). Participants were administered a survey comprised of 3
sections: a questionnaire in which residents ranked their perceived ability to
analyze research literature, a previously validated fifteen question
epidemiological/biostatistical knowledge tool, and five questions assessing the
curriculum changes. Analysis was performed using Chi-square test, Wilcoxon rank
sum test, and paired t-test.
overall mean percentage correct on statistical knowledge and interpretation of
results pre-intervention was 36.6% versus 67.3% (p<0.0001)
post-intervention. Higher pre-intervention scores were associated with prior
biostatistics training (45.2% vs 32.9%; p=.001); however, post-intervention,
scores were equivalent (66.9% vs 69.4%; p=0.753). Residents (90.9%) preferred
the restructured journal club, and 19/22 (86.3%) residents report their desire
to continue participating in this journal club format post-training.
Discussions: Significant improvement
in residents’ biostatistics knowledge, with resultant increased confidence in
their ability to interpret clinical research results, was a demonstrated
outcome of the implementation of the CREOG journal club format. Residency
programs can provide more effective biostatistics training by incorporating
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Practice-Based Learning & Improvement, GME, CME, Assessment, Problem-Based Learning,
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Jazzy Tracking Curriculum Provides Music to the Ears of Innovative Educators in OB/GYN
Purpose: Share outcomes from an
innovative curricular approach to improving the training and skill of OB/GYN physicians
in an environment of decreased training hours
programs across the US are searching for ways to improve surgical experiences
in OB/GYN residencies with decreased training hours. In response, we developed
the first OB/GYN program to offer an innovative, flexible curriculum referred
to as “tracking.”
modified-Delphi method was initially used to develop the program and gain
faculty consensus for innovative curriculum change. Evaluation of the outcomes
of our 15 graduates between 2016-2018 includes job/fellowship placement,
subjective data and achievement of minimum requirements based on procedure
is consistently noted as a reason that candidates interview at our program. Our
residents have consistently exceeded minimal surgical requirements. Examples
are 2018 graduates had an average of 395 of 200 required SDEL (331-461,) 272 of
145 required CDEL (211-333,) and 61 of 20 required LHYST (41-100.) 2019
class had only AHYST and ISPF yet left to achieve at the beginning of year 4.
Of our 15 graduates, 9 (60%) have entered fellowship. All 6 of our PGY-4 class
are interviewing for fellowship.
Discussions: Flexible curricula,
such as tracking, offer an innovative approach to a changing climate of medicine.
The ability to offer flexible, focused training will produce graduates who
excel in all areas of OB/GYN while sharpening skills specific to their areas of
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, GME, Assessment, Independent Study,
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amming with Podcasting: Make Education Swing for Medical Students!
Purpose: Take five to explore
the podcast format as a smooth way to teach medical students intimate
partner violence (IPV) screening and history-taking.
USPSTF recommends IPV screening as routine health maintenance.2 Research has
found that perceived preparedness and comfort level are barriers to screening
and intervention.1,3 There were only crickets regarding IPV screening in our
own curriculum. As a result we sought to harmonize the instruction of students
with an accessible and memorable educational format.
Methods: We laid
down a brief introductory lecture about IPV followed by a 22 minute podcast
about screening and addressing IPV disclosures for first-year medical students.
They completed pre- and post- surveys assessing general knowledge and perceived
pre-survey “opener” showed 52% of respondents had no prior experience nor
training in IPV screening. Initially, 64% of respondents hit a sour
note feeling either “somewhat not confident” or “not confident at all.” In a
smooth turn-around, the post-survey showed that listening to the smokin’
podcast increased students’ confidence. When asked about addressing a positive
disclosure of IPV, the post-survey again showed an increase in confidence.
The objective section of the post-survey demo’ed an increase in correct
answers for every knowledge question.
Discussions: This curricular
intervention employs a hot form of information sharing. Initial data
suggested that a majority of students did not feel confident screening for IPV
nor addressing a positive disclosure. After a paired lecture/podcast on
this topic, students demonstrated increased general knowledge about IPV as well
as a measureable crescendo of confidence.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, UME, Lecture,
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Inter-professional OSCE Based Simulation Collaboration to Teach Obstetrics & Gynecology to Second Year Medical Students and Nursing Students
Purpose: To describe an
inter-professional workshop (IPE) utilizing simulation, OSCE and flipped
classroom to introduce 2nd year medical and nursing students to OBGYN concepts
Background: IPE has been
shown to facilitate improved patient-centered care
November 2017; students studied an online fetal heart rate (FHR) lecture; at
workshop worked in groups on clinical FHR scenarios, and presented findings for
group learning and discussions. Students rotated through three stations each
for 45 minutes as follows: 1) MFM faculty taught students on cervical dilation
using “blinded” and “open” cervical models. Students had hands-on with
obstetrical procedures such as B-Lynch Suture. 2) Students performed a
simulated vaginal delivery supervised by MFM fellow; nursing students
resuscitated newborn and gave SBAR report to medical students. 3) MFM fellow
and gynecologist faculty taught students on contraception methods while a
technician taught students IUD insertion. Students self-assessed and were
assessed by faculty using OSCE; knowledge quizzes were completed for
contraception and cervical examination accuracy.
program trained 116 (73%) medical and 51(22%) nursing students. There were no
significant differences between medical students and nursing students scores
which were respectively: IUD insertion self-assessment = 8.84 vs. 8.43; IUD
insertion faculty-assessment= 9 vs. 8; cervical examination accuracy = 13.1 vs.
12.7; contraception quiz = 9.1 vs. 9.3. Medical students
birth simulation self-assessment vs. faculty-assessment scores were 8.6 vs.
8.9, p <0.001.
Discussions: Medical and nursing
students learned OBGYN skills equally, nursing students had the opportunity to
teach medical students. Medical students were more critical of their
learning than faculty.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Simulation, Team-Based Learning, Contraception or Family Planning, General Ob-Gyn,
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