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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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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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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 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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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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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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Forceps Simulation Training Improves Knowledge, Skills and Attitudes of OB/GYN Residents in an Academic Medical Center

Purpose: To improve resident “readiness” for clinical training opportunities in forceps delivery.

Background: Exposure to forceps-assisted delivery is declining nationwide. In the clinical learning environment, forceps training opportunities are often acute/emergent. Simulation training may help residents feel more prepared for such opportunities.

Methods: Eleven residents (PGY1-4) underwent 8 hours training on forceps delivery over 6 months. The curriculum included a 2-hour didactic session (covering case selection, clinical evaluation, safety checks and global second stage awareness) followed by three 2-hour simulation training sessions utilizing “Lucy and Lucy’s Mum” (MODEL-med, Australia) at 3-monthly intervals. Knowledge/confidence scores (10-point VAS) were assessed at baseline and 3/6 months later. A 20-point skills checklist was used to objectively score residents’ procedural competency before each simulation session as well as 2 weeks after the first.

Results: Knowledge scores increased from 53±5.4% pre-training to 64±5.3% at 3 months and 77±6.8% at 6 months (p=0.007). Confidence scores increased from 22±8.3% pre-training to 33±9.2% at 3 months and 49±9.6% at 6 months (p=0.046). Skills assessment scores were 47±7.2% at baseline and increased to 76±5.0% two weeks after the first simulation (p< 0.01). Scores remained higher at 3 months (79±2.3%, p< 0.001) and 6 months (93±0.9%, p< 0.001). Pre-training there was an effect of seniority (p=0.002) with lowest scores for PGY1 (12±0.9%) and highest for PGY4 (59±9.3%). Post-training scores were independent of PGY level (p=0.605).

Discussions: Structured simulation training increases residence knowledge, skills and confidence levels with respect to forceps delivery and may help supplement clinical learning opportunities to protect against loss of this valuable skill.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, GME, Assessment, Simulation, Quality & Safety,

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Empathy Training Using Improvisational Comedy: Impact on Multidisciplinary Education among Health Professions Students

Purpose: Determine the impact of improvisation training on self-reported and observed measures of empathy among a multidisciplinary group of health professions students

Background: Provider empathy improves patient outcomes. The most effective technique for promoting empathy remains unknown. Improvisation training may improve cognitive and affective empathy by enhancing one’s ability to react to the observed experience of others. Improvisation workshops have been shown to improve empathy in OB/GYN residents. We aimed to evaluate the impact this training on self-reported and observed measures of empathy within a multidisciplinary group of health professions students.

Methods: This is a prospective cohort study of health professions students who participated in a mixed-methods empathy training activity (improvisation exercises and case-based scenarios administered by standardized patient actors before, during, and after the educational component). Students completed pre- and post-intervention self-reported empathy questionnaires. Trained patient actors observed student interactions and completed validated empathy questionnaires following each case-based interaction. Paired t-tests were used for within-person comparisons over time and ANOVA was used to compare changes across groups.

Results: Twenty-eight students participated (4 medical; 8 social work; 11 nursing; 5 physical therapy). Self-reported empathy scores improved significantly from pre- to post-intervention (34.3 vs 38.2, p< 0.0001) although observed empathy scores did not change (43.6 vs 42.9, p=0.65). When comparing across disciplines, there was no difference in observed empathy scores (p=0.75).

Discussions: Improvisation training improves self-reported but not observed empathy among a multidisciplinary group of health professions students. There was no difference in the efficacy of the training workshop between disciplines.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Interpersonal & Communication Skills, GME, Assessment, Simulation, Team-Based Learning,

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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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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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A National Wellness Curriculum for OBGYN Residents: Impact of the CREOG Wellness Curriculum

Purpose: A national study explored the impact of a wellness curriculum for residents.

Background: The CREOG/APGO Physician Wellness Taskforce developed a national curriculum for physician wellness for obstetrics and gynecology residents. A multi-institutional study explored the impact of this curriculum on professional fulfillment and burnout of residents across the United States.

Methods: Twenty-five residency programs from all CREOG regions participated in the study. Residents in these programs participated in 6 interactive workshops on physician wellness over 1 year. Before and after the curriculum, residents completed the Professional Fulfillment Index (PFI) a 16-item survey tool measuring professional fulfillment (PF), and burnout composite (BC) (measures of work exhaustion and disengagement). T-tests analyzed changes in scores, comparing groups with higher attendance and lower attendance at the wellness curriculum sessions.

Results: Among 592 participating residents, 424(72%) completed the pretest and 385(65%) the posttest. Residents participated in 3.96 sessions on average. Overall,PF increased slightly with 23.8% meeting the threshold for robust PF pretest to 25.2% meeting the same thre posttest. BC scores improved slightly with 46.8% meeting criteria for burnout pretest to 43.9% posttest. The 246 residents attending 4-6 sessions in the wellness curriculum (High Attendance) had improved scores compared to the 139 residents attending 0-3 (Low Attendance): PF-high attendance (28.05%) vs. PF-Low Attendance (20.14%), p< .001, and BC-High Attendance (39.8%) vs. BC-Low Attendance (51.1%), p=0.03.

Discussions: A longitudinal wellness curriculum is feasible within an OBGYN residency training program. While burnout has been shown to increase throughout the academic year, this may be mitigated by participation in the curriculum, with residents who were more engaged demonstrating greater improvement in professional fulfillment and less burnout over 1 year.

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

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A Design Thinking Approach Will Engage Obstetrics and Gynecology Residents in Quality Improvement Education

Purpose: To incorporate design thinking methods in quality improvement curricula to generate impactful patient interventions and enhance resident satisfaction.

Background: Incorporating a meaningful quality improvement (QI) experience into an already overloaded residency training program is challenging. We applied the principles of design thinking to a QI curriculum to inspire residents (“users”) to develop patient-centered QI projects.

Methods: Starting in 2017, residents at an academic medical center were introduced to QI grounded in the Model for Improvement. The experiential component was implemented using a five phase Design Thinking process (Empathy, Define, Ideate, Prototype, Test). Data were obtained from ACGME surveys and patient outcomes. Chi square was used to compare yearly trends in resident satisfaction; patient outcomes were analyzed using an independent t test. P< 0.05 was significant.

Results: Since introduction of the QI curriculum, we have had 100% resident involvement (increase from 83%, P< .05 ) and collaboratively generated QI interventions that improved patient outcomes and enhanced resident engagement. One initiative increased postpartum visit adherence in a high-risk population from 21% to 63% (P< .01). An initiative addressing prenatal tobacco use in resident clinics produced a state-funded $53,000 grant to screen and treat pregnant smokers. Overall satisfaction with the residency increased by 64% between 2017-2019 (P< .05)

Discussions: Design thinking can be integrated into graduate medical education. Although this curriculum was initially implemented to meet ACGME QI project requirements, we found that a design thinking approach empowers residents with the knowledge, creativity and problem-solving skills to design impactful QI initiatives while simultaneously enhancing resident wellbeing.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Quality & Safety, Public Health, Advocacy, General Ob-Gyn,

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On The Lookout: Use Of Debriefing With Clerkship Students To Aid In Wellness And Resiliency

Objective/Background: The Obstetrics and Gynecology rotation may expose students to their first experiences with serious medical conditions and traumatic events. These events shape students’ perspectives, and if left unaddressed, could potentially contribute to the development of burnout over time. Debriefing serves as a tool to allow students to discuss shared experiences and build resiliency, especially with topics often considered routine amongst practicing physicians. 

Workshop Agenda:
The workshop will begin with large group discussion of clinical issues that place students at risk for developing emotional fatigue (10 min). 
Workshop facilitators will then introduce debriefing concepts and tools. Facilitators will model the method of debriefing employed at their institution, and shared experiences and development of coping skills will be discussed by participants (20 min). 
Participants will be given examples of clinical scenarios that may require debriefing, divide into small groups, and will practice the debriefing model using the tools (20 min).
Participants will share their experiences with each scenario as a large group (10 min).
Finally, the group will brainstorm, discussing innovative ways to integrate debriefing into their clerkships (15 min).  

Interactive Component: Participants will be given clinical scenarios that allow them to practice debriefing from the facilitator and student perspectives.  

Take Home Product: Participants will be provided a toolkit for implementing debriefing at their home institutions. It will include a detailed description of common methods of debriefing, a guide for implementation in the clerkship, and literary resources.  Group brainstorming ideas will also be documented and shared. 

Topics: Team-Based Learning, Problem-Based Learning, Independent Study, Assessment, UME, GME, Practice-Based Learning & Improvement, Interpersonal & Communication Skills, Professionalism, Residency Coordinator, Residency Director, Osteopathic Faculty, Clerkship Coordinator, Clerkship Director, Faculty, Resident, 2020, Faculty Development Seminar,

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Helping Medical Students Recognize the Effects of Their Biases on Patient Care

Learning or Performance Objectives: Participants will identify implicit biases and prejudices that impact clinicians’ interaction with patients. They will discover tools to assist educators and learners to identify bias, to engage in constructive discussions about implicit bias, and to thereby improve healthcare quality.

Background:  Emerging data points to implicit racial bias as a cause of disparity in maternal health outcomes between women of color and white women. The perceptions, and biases healthcare providers formulate, based upon patients’ skin color, impact the way we render care. Oftentime, we are unaware of the effects of our biases on the clinical decisions we make. As multi-disciplinary teams work to eradicate these disparities, we need to train healthcare providers to identify the effects of their biases. Workshop agenda: This workshop will review recent findings of implicit bias in healthcare, teach participants a mechanism for identifying their own biases, and empower participants to train learners and faculty to identify bias.

Participants will engage in interactive clinical scenarios, assigning patients to categories. They will identify what implicit biases affect their choices. They will learn facilitative language for clarifying biases, discover available resources for identifying biases and updating attitudes and behaviors, and will receive a take-home tool-kit.

Interactive component:  Interactive media usage during large group presentation. Categorization of patients. Small group breakouts reviewing clinical scenarios and discussing challenges of identifying biases.

Take-home product: (1) Checklist of key components for implicit bias identification, (2) Model for bias clarification activities for faculty and learners, (3) Clinical scenarios.

Topics: Faculty Development Seminar, 2020, Student, Resident, Faculty, Clerkship Director, Osteopathic Faculty, Residency Director, Patient Care, Professionalism, Interpersonal & Communication Skills, GME, UME, Problem-Based Learning, Team-Based Learning, Public Health, Advocacy,

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Bring the Details into Focus: Incorporate a \"Case of the Week” in Your Curriculum

Workshop Text: During the 2017-2018 academic year, educational leadership ‘donned some spectacles’ to review the ObGyn clerkship curriculum in reference to APGO’s Medical Student Objectives.  Topics not ‘seen with naked eye’ were ‘brought into focus’ by adding weekly, online, case-based learning activities. Six topics were ‘eye’-dentified.  Efforts were aimed at providing opportunities for active learning using principles of case-based learning (CBL).  Each week of the 6-week ObGyn clerkship there is a new ‘focal point’ presented as a “Case of the Week”.  Included are a clinical case, as well as the ‘progressive lenses’ of a foundational science question and a clinical science question, followed by an educational handout detailing the principle learning points of each topic. 
Brief presentation to ‘focus’ on the principles of adult learning theory and how our “Case of the Week” is the right ‘prescription’ to meet the educational needs of mature learners
The ‘examination’ – discuss curriculum review and/or needs assessment 
Participants work with table-mates to write their own ‘prescription’ – practice case composition and writing foundational/clinical science questions
Small groups work through a “Case of the Week” and associated foundational/clinical science prompts.
Choose one “uncommon/difficult topic”, then develop an outline of a “Case of the Week” summarizing the learning objectives, \\\'framing\\\' the case, and \\\'focusing\\\' on foundational/clinical science topics to incorporate into questions.   A draft \\\"Case of the Week\\\"!!    Student, curriculum, question

Topics: Problem-Based Learning, Independent Study, Assessment, UME, Practice-Based Learning & Improvement, Medical Knowledge, Osteopathic Faculty, Clerkship Coordinator, Clerkship Director, 2020, Faculty Development Seminar,

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A Simple, Low-Cost Pelvic Model: A Vision For Effective Anatomy Education In Any Setting

Objective/Background: A solid understanding of female pelvic anatomy is fundamental to any women’s health curriculum and key to recognizing and treating many obstetric and gynecologic conditions.  Anatomy has been traditionally taught through formal lecture, as well as anatomic dissection. In resource-limited settings this is particularly challenging, as both cadaveric study and animal dissection are expensive and often unavailable.

Simulation affords students and clinicians the opportunity to learn, practice, and improve clinical skills in a controlled setting without incurring risks to patient safety. However, many simulation models are costly. We created a simple, low-cost and reusable pelvic model that can be used to teach learners in a group setting or individually with the assistance of a guide. 

Agenda:  In this workshop, we will share highlights of our experience developing this pelvic model.  We will describe our experience using it with residents and students at our own institution, as well as in the low resource setting of Addis Ababa University in Ethiopia. 

Interactive component: Participants will work in small groups to construct the pelvic model.  They will create a clinical-based, bite-sized teaching session using the model to illustrate the main points.  Groups will reconvene and demonstrate the session they developed.

Take home product: Pelvic model materials and instruction manual. 

Topics: Osteopathic Faculty, Clerkship Coordinator, Clerkship Director, Resident, 2020, Faculty Development Seminar, Global Health, Simulation, UME, GME, Medical Knowledge, Patient Care, Residency Coordinator, Residency Director,

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

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

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

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

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

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

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

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