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