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

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

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

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

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

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

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

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OBGYN Trainees Perception of Departmental Climate with Regards to Sexual Harassment

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

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

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

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

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

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

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

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

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

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

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

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

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

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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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Impact of Curriculum Update with New Objectives and Modern Methods on Resident Impression of Didactics

Purpose: To determine impact of curriculum changes on resident impressions of didactics.

Background: Recently, CREOG released the 11th Edition learning objectives. Simultaneously, resident surveys suggested our didactic curriculum needed improvement.  We restructured our curriculum to reflect these changes and incorporate different teaching techniques for millennial learners.

Methods: CREOG learning objectives were reviewed to determine the appropriate length and frequency of topics covered.  Faculty were assigned objectives; the use of ACOG Practice Bulletins and Committee Opinions was encouraged. Faculty were asked to incorporate case discussions, hands-on interactive activity, simulation, flipped classroom, etc.   A resident survey was administered both before and one-year after implementation to assess satisfaction.  Surveys were given immediately after the CREOG exam to analyze score outcomes relative to curricular changes.

Results: Didactics were organized in a 2-year calendar with 3 weekly hours. Residents perceived improved overall quality, organization, and depth/breadth of material (10-20 points on 100 point scale, all p< 0.05). Resident attendance, topic known >1 week in advance, and reading assigned >1 week in advance all improved (p< 0.05). The pre- group had more “not detailed enough” and “not enough variety” responses while the post- group had more “appropriate level” of both depth/breadth and detail (p< 0.05). Overall CREOG scores improved as anticipated 12.9±9.6 points with the additional year of training (p< 0.05); however, “by year” scores were unchanged (Δ5.4 points, p=0.17) suggesting no impact of curriculum changes on performance, only perceived satisfaction.

Discussions: Updated objectives and modern teaching methods improved resident impressions of didactics, but did not improve CREOG exam scores.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, CME, Simulation, Lecture, Standardized Patient,

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

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

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

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

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

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

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

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Does Personal Care Impact Burnout? An Academic Institution’s Exemplar

Purpose: To assess resident compliance with routine health maintenance and risk of burnout at a single midwestern institution

Background: Resident physician burnout is a concern facing medical education. It has been linked to depression, inversely correlates with job satisfaction, and has a cumulative effect as the years of residency progress. Correlations between suspected burnout and reduced resident personal care have been sparsely assessed.     

Methods: Residents in all specialties at the University of Toledo were surveyed in the last academic year through an anonymous 27-item online survey addressing health care compliance and risk of burnout (using a non-validated index). A total of 75 surveys were completed.

Results: Up to 40% of residents had neither seen a primary care provider nor had routine eye exams in >24 months while >30% had no dental care in the previous 12 months. 80% of residents reported clinical duties preceded personal wellness. 50% reported financial concerns as a contributor to decreased wellness. 100% of residents were at risk of burnout with only 25% in the low-risk category. Of those in the severe risk category, 80% addressed their condition by ignoring it and had the least mental health service utilization.

Discussions: Un-aligned resident priorities may result in ignoring oneself and one’s needs. This in turn may result in increased predisposition to burnout. Mental, physical and financial wellness need to be assessed and addressed by institutions regularly. Mitigation modalities, as implemented at our institution following the survey, will need to be in place to enhance personal care, subsequently reducing risk of burnout.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Residency Coordinator, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, Advocacy,

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Developing Committed Resident Leaders: A Survey of the Obstetrics and Gynecology Administrative Chief Resident Experience

Purpose: To define the challenges and experiences of Obstetrics and Gynecology (OBGYN) administrative chief residents (ACRs) and identify support needed to make them successful.

Background: ACRs are integral to OBGYN residency programs, however little research has been done on the experiences, training, and support of ACRs.

Methods: A Qualtrics survey was emailed to program coordinators at all 292 ACGME OBGYN residency programs. Response styles included MCQs, yes/no, likert scales, and short answer. Question topics included demographics, chief duties, support, and experiences. Study participants were defined as current / past ACRs (2019-2020, 2018-2019) and program directors (PDs).

Results: Ninety two ACRs and 24 PDs received the survey, as confirmed by program coordinators. Forty five surveys were completed (response rate 39%), including 38 (84%) ACRs and 7 (16%) PDs. 
The majority (67%) were from academic programs with a median of six residents and two ACRs per year. Forty-nine percent of respondents reported ACRs spend 4-7 hours per week on administrative duties.  Eighty seven percent reported no protected time. On a 10-point likert scale, mean perceived support from faculty, PD, administration, and other residents was 6.8, 8.6, 7.1, and 7.5 respectively; however, mean stress level was 7.1. 
Common challenges reported by ACR’s are conflict resolution and workload management. Many ACRs felt they would benefit from formal leadership training and protected time.

Discussions: These results summarize the experience of ACRs. Best practices and formal training in identified challenge areas should be added to residency curriculum and used to develop toolkits to support ACRs nationwide.

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

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Attitudes of Obstetrics and Gynecology Residents Regarding Current Requirements for Gynecologic Surgical Training

Purpose: Understanding perspectives of residents in Obstetrics and Gynecology (OB/GYN) regarding gynecologic surgical training requirements including the Fundamentals of Laparoscopic Surgery (FLS) and the Accreditation Council for Graduate Medical Education (ACGME) case minimums.

Background: The specialty of OB/GYN has changed substantially over the past several decades, including a reduction in overall surgical volume and more focused practice patterns. The American Board of Obstetrics and Gynecology (ABOG) and ACGME have instituted surgical training requirements . This study assesses the alignment of resident preferences with these requirements.

Methods: Current residents and newly matched first year residents within OB/GYN residency programs during the 2018-2019 academic year at the University of Colorado, University of Washington, University of California San Francisco, Loyola University, St. Joseph’s Hospital, University of Utah and Texas A&M (n=225) were invited to participate in a 13-item electronic survey regarding the FLS requirement and case minimums.

Results: One hundred fifty six respondents completed the survey for a response rate of 69%. PGY 2-4 residents were less likely to indicate that the FLS requirement strengthens surgical training (71% v. 43%, p< .001) or makes them more confident with laparoscopy (79% v. 26%, p< .001). PGY2-4 trainees found the current abdominal hysterectomy requirement too low (66% v. 43%, p< .001).

Discussions: PGY2-4 OB/GYN residents report that FLS will not enhance their surgical training, and that the current ACGME case minimum number for abdominal hysterectomy is insufficient. New requirements for gynecologic surgical training are discordant with resident perspectives. Involving trainees as stakeholders in specialty training reform is critical.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, GME, Assessment, Simulation, Minimally Invasive Surgery, 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 Multicenter Study Of The Impact Of An Online Question Bank On OB/GYN Resident In-Service Examination Performance

Purpose: The objective was to assess the effect of implementing an online test bank on CREOG exam performance.

Background: Several vendors produce online question banks for self-assessment. Little data is available assessing the impact of use of these banks on inservice test performance.

Methods: 10 programs using the TrueLearn OB/GYN test bank (QB) participated. Each site provided de-identified CREOG exam results paired with QB usage for 2016 and 2017. Program mean CREOG scores were compared before and after the first year of TrueLearn use. Using resident-level data, we compared PGY-level and overall CREOG scores between users and persistent non-users of the QB.

Results: No significant difference was seen in the mean CREOG score per program before versus after implementation (mean increase 1.01, p=0.58). There was no significant difference in mean CREOG scores between resident users and non-users prior to the 2016 CREOG or prior to the 2017 exam. Among residents who did not use the QB prior to the 2016 CREOG, residents that switched to users of the QB (n=22) improved an average of 7.2 points between 2016 and 2017, compared to 4.8 points for persistent non-users (n=16), a non-significant difference (p=0.54).The percent of questions answered correctly on the QB practice tests positively correlated with CREOG scores in both 2016 and 2017.

Discussions: No significant changes were seen in mean CREOG scores on a program-level before versus after QB usage or between users and non-users on a per-resident level. Performance on the QB did correlate with CREOG performance, suggesting predictive validity of an online QB, and supporting utility in examination preparation.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Residency Coordinator, Medical Knowledge, GME, Assessment, Independent Study,

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Visualizing Quality Challenges and Using Corrective Refraction to Focus Change

Objective/Background: Quality improvement (QI) initiatives drive change to streamline processes, minimize waste, and improve outcomes. Although QI efforts are commonly applied to medicine, we receive little formal training.  Our workshop will address this knowledge gap by providing attendees with an infrastructure the use educate trainees and other providers about the core components of a QI initiative.

Workshop Agenda: We will provide an overview of QI improvement in industry with application to medicine (15 min).  The remainder of the workshop will be a “hands-on” group effort to address an identified quality issue.  Small group discussions will focus on an “Sticky Note” affinity sort identifying factors/barriers associated with the quality issue (10 min).  The group will share ideas and collaborate to create a cause-effect fishbone diagram and process flow map for the identified quality issue (20 min).  Each small group will then independently identify a proposed process improvement and define core process, outcome, and balancing measures to measure through a plan do study act (PDSA) cycle (15 min).  The workshop will conclude with a discussion of each groups plan and proposed measures (15 min)

Interactive Component:

  1. “Sticky Note” Affinity Sort Brainstorming
  2. Cause-Effect Brainstorming/Creation of Fishbone Diagram
  3. Process Flow Map Brainstorming
  4. Process Improvement Approach/Outcome Assessment Brainstorming
  5. Discussion of Proposed QI Approach and Measures


Take Home Product: Attendees will return to their institutions with a framework and “tool kit” to use to approach QI initiatives and to train medical students and residents. 


 

Topics: Quality & Safety, UME, GME, Systems-Based Practice & Improvement, Residency Coordinator, Residency Director, Clerkship Director, Faculty, Resident, 2020, Faculty Development Seminar,

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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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Focus On Youterus: Using Art To Improve Teamwork, Communication and Professional Identity Formation

Background: Teamwork and communication among health professionals leads to improved patient outcomes, reduction in errors, improved patient satisfaction.  Too often time is not provided within individual training programs to develop the knowledge, skills and behaviors associated with high performing teams.  Development of a strong professional identity can lead to strong team leaders and team members.  Over the course of this workshop, we will present a low cost simulation using art that can be used to achieve above mentioned goals

Objectives: Our objectives for this session are to: 
Discuss the increasing importance of teams and communication in medicine
Discuss the role of professional identity in professional growth
Perform a simulated team exercise using art
Detail the numerous ways art can be used in medical education

Agenda/Interactive Component: The 75-minute workshop will include:
Introduction to teamwork, communication, and professional identity and directions for the art simulation (Large group, 15 minutes) 
The large group will break into teams of 5-10 participants and each group will go through 1 of the following 3  group exercises (30 minutes):
     o Team #1:  Teamwork
     o Team #2:  Communication
     o Team #3:  Professional Identity
Small groups will share their experience with the large group. (10 minutes)
Large group will brainstorm other applications of this exercise. (10 minutes)
Wrap-Up and questions (Large group, 10 minutes

Take-home Product:  Participants will leave with one example of a fun, low-cost art simulation that can be adapted to many different situations that involve teamwork, communication, and identity formation. 

Topics: Team-Based Learning, Simulation, UME, GME, Practice-Based Learning & Improvement, Interpersonal & Communication Skills, Professionalism, Residency Coordinator, Residency Director, Clerkship Director, Faculty, Resident, Student, 2020, Faculty Development Seminar,

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