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

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Use of POEs( Point of EPA Evaluations) Across All Third Year Clerkships for Year Long EPA ( Entrustable Professional Activity) Monitoring

Purpose: To describe the development of a school wide and longitudinal assessment of the core Entrustable Professional Activity (EPA)s using an easily accessible App.

 

Background: Our insitution is  part of the EPA pilot study sponsored by the AAMC to explore the feasibility of teaching and assessing the core EPAs. This year direct observation and assessment of the EPAs was implemented across clerkships . Each clerkship was allowed to determine which EPAs were applicable to their field.

 

Methods: The OBGYN department determined and assessed that EPA1( History and Physical) , ] EPA2 ( Differential Dx) , EPA3 ( Dx and Screening Tests) and EPA6 ( Oral Presentation)  were core skills to the clerkship with the following scale (1=student observed, 2=assessor had to talk the student through it, 3=assessor had direct them from time to time, and 4=assessor  needed to be available just in case.)

Results:

 

                       OB                    Other Clerkships             p

EPA 1            3.0( 0.5)                     3.5 (0.5)               <0.0001

EPA 2           3.0 (0.9)                       3.4 (0.6)              <0.05

EPA3             3.0 (0.9)                      3.4 (0.7)               n.s

EPA6            3.1( 0.5)                         3.4  (0.5)              < 0.005

 

For the first 3 months there were 2783 EPA assessments. The average score was 3.45. In comparison to other clerkships, students on OBGYN received lower scores in EPA 1,2,6.( p<.0001, P< .05 and P< .005) possibly  indicating more stringent grading by faculty or lower performance of medical students.

 

Discussions: In comparison to all other clerkships combines, student on OBGYN received lower scores in all four EPAs possibly  indicating more stringent grading by faculty or lower performance of medical students. Lower EPA scores may  indicate more stringent grading by faculty or lower performance of medical students. This could also be related to lower numbers of overall EPAs reuired by the OB/GYN clerkship.  Further research is needed to determine the significance of these findings.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Practice-Based Learning & Improvement, GME, UME, Assessment,

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Trends in Off-Service Rotations in Ob/Gyn Residencies Before and After Duty Hour Restrictions

Purpose: To establish trends in off-service rotations in OB/GYN residencies before and after duty hour restrictions.

 

Background: As co-morbidities in our patient population increases, the skills required of OB/GYNs are changing, we sought to determine the characteristics of off service rotations.

 

Methods: We searched websites of ACGME accredited OB/GYN residency programs. We collected data on off service rotations: services, number of rotations, and PGY year of rotations. Surveys were emailed to programs regarding off service rotations in 2018 and before duty hour changes in 2003.

 

Results: 92% (n=259) of programs had information available on off-service rotations, of these, 24% (n=62) had no off-service rotations, 26% (n=67) had 1, 25% (n=66) had 2, 13% (n=34) had 3, 12% (n=30) had 4 or more. The majority (84%) of rotations were in PGY1. The most common rotations were ER (47%, n=122), SICU (24%, n=62), IM (25%, n=66), MICU (9%, n=23). We received 53 responses to the survey (19% response rate). Of those who responded, the most common rotations for 2018 and before 2003 were ER & SICU. The number of programs with SICU rotations remained stable from 2003 to 2018 (43% vs 47%) compared to 1.4 fold decrease in programs with ER rotations. The number of programs with IM rotations decreased 2.5 fold from before 2003 to 2018.

 

Discussions: Duty hour restrictions have affected off-service rotations. A quarter of all programs have no off-service rotations, with a decrease in ER and IM exposure during residency. This does not reflect the breadth of knowledge required of OB/GYNs today.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Quality & Safety, General Ob-Gyn, CREOG & APGO Annual Meeting, 2019, Student, Resident, Clerkship Director, Residency Director, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Team-Based Learning,

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Transgender Healthy Care: On-line Survey of Physician Knowledge and Comfort

Purpose: To evaluate OB/Gyn provider knowledge and comfort with transgender health care

 

Background: Transgender and gender non-conforming patients (TGNC) are an underserved population that often encounters inadequate or ‘unsafe’ clinical care. Education regarding TGNC patient care has traditionally been minimal, contributing to gaps in Ob/Gyn care for many of these individuals, including transgender men.

 

Methods: An IRB approved, anonymous online non-validated survey was emailed to 130 APGO program coordinators to distribute to their Ob/Gyn faculty and post-graduate learners. Questions addressed included years of practice, experience with TGNC patients, provider comfort, and TGNC education.

 

Results: One hundred and sixty four surveys were completed and an additional ~50 were opened but no information was provided. Of the 164 completed surveys, 76.3% of participants reported less than 5 hours of TGNC specific healthcare education, despite the fact that 75.7% of responders had cared for at least one TGNC patient. Overall most respondents felt comfortable/very comfortable (79.8%) caring for this population. No correlation was found between years in practice and overall provider comfort caring for TGNC patients.  Major obstacles reported by participants included concern for patient comfort, appropriate language, and lack of sufficient clinical education for both providers and support staff

 

Discussions: These data suggest that enhanced TGNC clinical education for the entire health care team is warranted.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, GME, Advocacy,

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Training Residents to Place Immediate Postpartum LARC: An Update Among U.S. Residency Programs

Purpose: To survey U.S. Obstetrics and Gynecology (Ob/Gyn) Residency Programs on immediate postpartum (IP) long-acting reversible contraception (LARC) training and challenges.

 

Background: In 2016, the American College of Obstetricians and Gynecologists (ACOG) released a committee opinion supporting IP LARC. Growing evidence describes provider/hospital barriers which hinder IP LARC provision. We hypothesize similar difficulties have prevented programs from implementing training.

 

Methods: We distributed an electronic survey addressing IP LARC training to 273 U.S. Accredited Council for Graduate Medical Education (ACGME) Ob/Gyn Residency Program Directors from the 2017-2018 Academic Year. Data analysis was performed with chi-square and Fisher’s exact test.

 

Results: Of 86 programs that participated, residents were trained in the immediate postpartum period to place implants in 54 programs (63%) and to place intrauterine devices (IUDs) in 52 programs (60%).

Prior to 2015, only 20% of the programs were training their residents to place IP IUDs. Thirty-one percent of eligible programs initiated training in 2017. The majority of programs focused training interns (98%). Patient/provider convenience motivated 46% of programs to offer IP LARC and compliance motivated 27%.

The two barriers most frequently encountered, regardless of program training status, were problems with billing and compensation for services (61%) and the pharmacy (33%).

Programs that reported primarily seeing patients with insurance, either private or Medicaid, were more likely to have IP IUD training compared to programs seeing mostly indigent/uninsured populations (p<0.05).

 

Discussions: IP LARC training has increased since the ACOG Committee Opinion was published, however many programs are still facing challenges with implementation, affecting resident training.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Systems-Based Practice & Improvement, GME, Public Health, Advocacy, Contraception or Family Planning,

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Too Many Learners? Do Students Belong in Resident Continuity Clinics?

Purpose: Determine the prevalence of medical students in OBGYN resident continuity clinics and describe effects on the learning environment when students and residents work together in this setting.

 

Background: Patient continuity is an ACGME requirement often fulfilled through a resident run continuity clinic. It’s unknown how frequently students rotate in these clinics, or how multiple levels of learners influence each other.
 

 

Methods: We surveyed OBGYN program managers using a national listserv. Resident and student surveys were based on a Likert scale and sent to all OBGYN residents and students that rotated at our institution from 2016-2018.

 

Results: Program managers responded from 45 programs and 75.6% scheduled students in resident continuity clinics. Our response rates were 79/116(68.1%) for students and 21/24(87.5%) for residents. A one-sample Wilcoxon signed rank test was used to test the hypothesis that the typical response on the five-level Likert scale was \"Agree\" or \"Strongly Agree.\" Of medical students, 88.6% stated that they agreed or strongly agreed they enjoyed working with residents (p<0.001) and 60.8% stated they agreed or strongly agreed residents were effective teachers (p<0.001). Among residents, 52.4% agreed or strongly agreed that they enjoyed working with students (p<0.001). However, 61.9% said they agreed or strongly agreed they were too busy to be effective teachers (p<0.001).

 

Discussions: Many institutions have students rotate in resident continuity clinics. Residents and students have positive views regarding their interactions. Although students were satisfied, residents expressed concerns about their ability to be effective teachers given clinical demands. Our results highlight the importance of developing resident teaching skills.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, CME, UME, Assessment, Problem-Based Learning, Team-Based Learning, General Ob-Gyn,

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Time to Face the Music: Attitudes of Current and Future OB/GYN Residents Regarding the Structure of Residency Training

Purpose: Measure future and current resident perspectives regarding OB/GYN residency training structure and possible future models.

 

Background: Modifications to the current OB/GYN training paradigm are being considered however the perspective of learner stakeholders on substantial changes has not been measured.

 

Methods: Medical students invited for OB/GYN residency interviews and residents (PGY1-4) at the University of Colorado, University of Washington, University of California San Francisco, Loyola University, St. Joseph’s Hospital, and Texas A&M in 2017-2018 received a voluntary, electronic survey regarding possible models for restructuring residency training.  Student and resident responses were compared using a chi-square for categorical and two-sample t-test for continuous items. 

 

Results: Applicants (63%, 280/444) and residents (66%, 101/154) had similar response rates.  Applicants (24%) and residents (29%) reported having concerns about the current structure of residency training.  The ideal residency duration was reported as 4 years by 72% of applicants and 85% of residents.  Lack of gynecologic surgical volume was the most frequently reported concern among applicants (75%) and residents (72%).  Fourth-year tracking (focusing on training aligned with post-graduation career path) was preferred by 90% of applicants and 77% of residents (p=0.002), and 92% among respondents planning fellowship.  Most applicants (68%) and residents (75%) preferred not starting fellowship training after the 3rd year of residency.    

 

Discussions: The majority of learners surveyed support a 4-year training structure, but likewise support individualizing training in the PGY-4 year. It is imperative that OB/GYN leadership consider this and other feedback from learners when considering modifications to the current OB/GYN training paradigm. 

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, GME, UME, General Ob-Gyn, CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Patient Care, Practice-Based Learning & Improvement, GME, Simulation,

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Targeted Interventions to Improve Resident Well-being

Purpose: To quantify and compare physician well-being and incidence of burnout across residency programs at our institution, emphasizing program-specific and resident-driven interventions

 

Background: As the national conversation regarding physician well-being evolves, the importance of addressing physician burnout has come to the forefront. Our institution identified moderate levels of burnout across all residency programs, and thus initiated institution-wide efforts. Literature suggests utilizing organization-wide and targeted interventions together has the most significant impact on improving well-being and reducing burnout.

 

Methods: A Modified Maslach Burnout Inventory (MBI) survey is distributed annually to all residents at our institution. Results from 2015-2018 were analyzed to track changes in burnout scores. All residents participated in institution-wide interventions. Some departments initiated additional resident-determined program-specific interventions.

 

Results: Mean MBI scores qualified for moderate burnout for all programs across all years. Most programs utilizing institution-wide interventions demonstrated no change in burnout scores; while some, specifically OB/GYN, saw a statistically significant increase in burnout scores (p<0.001). Departments with program-specific interventions demonstrated decreased scores during the same time period.

 

Discussions: Residency programs utilizing targeted interventions demonstrated marked improvement in burnout scores.  Amongst those without targeted interventions, OB/GYN demonstrated the largest increase in burnout, suggesting differing etiologies of burnout for individual programs, with OB/GYN being uniquely susceptible. We plan to combat this by utilizing a guided focus group of OB/GYN residents to identify drivers of burnout and specific interventions addressing these factors, using the Mayo Well-Being Index to track anticipated improvement. Continued work in evidence-based strategies addressing the challenge of burnout will ultimately produce more engaged physicians.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Systems-Based Practice & Improvement, GME,

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Successful Implementation of an OB/GYN Resident FLS Training Curriculum

Purpose: To describe the implementation of an ob/gyn resident Fundamentals of Laparoscopic Surgery (FLS) training curriculum

 

Background: Beginning in May 2020, all ob/gyn graduating residents will be required to successfully complete the FLS program as a prerequisite for specialty board certification.  

 

Methods: Between January 2017 – April 2018, 36 ob/gyn residents participated in the BCM FLS curriculum.  The curriculum consisted of six 3-hour faculty supervised gynecologic simulation sessions, 24/7 individual access to the simulation lab, proctored voluntary one-on-one sessions, and a final mock FLS session.  Participants were followed with attendance sign-in sheets to gauge number and time involved in all sessions.   Residents completed evaluation forms after each simulation session.  Descriptive statistics were utilized to determine the average/range of the number and time involved in the practices sessions, between PGY levels and FLS pass rates.   

 

Results: All 36 ob/gyn residents successfully completed FLS certification on the first attempt.  In addition to the mandatory sessions, residents required an average of 8.64 independent practice sessions (range 3-22) lasting an average 72 minutes/session.  Approximately 688 minutes (range 235 – 1357 minutes) of independent practice were required to pass the FLS exam.  Many residents felt that the curriculum gave them adequate support to succeed on the exam and stated that one of the most valuable components of the curriculum were proctored teaching sessions.  

 

Discussions: With a dedicated curriculum and proctored teaching, residents in obstetrics and gynecology can successfully pass the FLS certification exam with their initial test. 

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Medical Knowledge, GME, Simulation, Minimally Invasive Surgery,

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Students Stuck in a Swamp? Scripting Promotes Medical Student Involvement in Obstetric & Gynecologic Care

Purpose: Characterize the effect of staff scripting on medical student acceptance in outpatient ob-gyn clinic visits.

 

Background: Direct patient care is a major tributary in the river of medical education. When patients refuse medical student involvement in their care, students are stranded in stagnant quagmire. Review of the literature shows that medical student refusal is a national issue not limited solely to obstetrics and gynecology (ob-gyn) clerkships (Chang, et al, 2010; Mavis, et al, 2006; Hartz & Beale, 2000). Written and video messages about medical student training have been effective in furthering medical student acceptance in clinical encounters (Buck & Littleton, 2016). Open the floodgates!

 

Methods: A literature review using search terms “medical student AND refusal” was conducted to guide script composition. Medical assistant and nursing staff implemented the script in an outpatient ob-gyn resident clinic. The script was revised halfway through the clerkship year based on patient and staff feedback. All ob-gyn medical students were surveyed regarding their involvement in patient visits prior to and after script implementation.

 

Results: After script implementation, the percent of medical students refused from at least one patient interaction decreased from 92% to 86%. 66% percent of our students perceived scripting as a supportive measure for medical students, and 61% percent witnessed staff, residents, and faculty utilizing scripting.

 

Discussions: Data from our institution suggest that scripting improves medical student involvement in ob-gyn patient care. Involving staff, students, and patients on scripting revision helped foster a learning environment rich as the Mississippi delta in which medical students can thrive.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Professionalism, Interpersonal & Communication Skills, UME, Team-Based Learning, Advocacy,

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Saving Lives: Students Enhancing Patient Health Literacy Regarding Hypertension in Pregnancy and Prenatal Aspirin

Purpose: To increase medical student’s knowledge, behavior and belief systems regarding hypertension (HTN) in pregnancy and prenatal aspirin (PNA). To increase patient\'s understanding regarding the complications of HTN in pregnancy and the benefits of PNA.

 

Background: Prenatal aspirin (81 mg) has been recommended by ACOG for high-risk women and women with >1 moderate risk factor. Its use reduces the rate of preeclampsia, preterm birth, intrauterine growth restriction and fetal death in at-risk patients. In a survey conducted at Boston Medical Center, the incidence of hypertension in pregnancy is 30%, with only 15% of patient having heard of PNA, demonstrating high prevalence and low patient literacy regarding the topic.

 

Methods: Ob/Gyn clerkship students are instructed to educate patients regarding: knowledge of HTN in pregnancy, warning signs of preeclampsia, and efficacy of PNA in pregnancy. The student educational intervention was evaluated regarding: satisfaction, knowledge, confidence, and belief systems by surveys at the beginning and end of the clerkship. Patient education was evaluated by pre and post intervention metrics.

 

Results: Student knowledge of PNA and HTN increased 35%, confidence 45% and belief systems 14%. They gave the project a 72% satisfaction rating. Patient’s knowledge about HTN increased 48%, warning signs 80%, and understanding of efficacy of PNA 65%.

 

Discussions: Medical student health counseling increased patient knowledge regarding HTN and PNA. By educating patients, students also increased their knowledge and confidence in the subject. We plan to continue implementing this QI project throughout the year to augment a departmental QI initiative and evaluate its benefit to patients and students.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, UME, Quality & Safety, Advocacy,

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Residents Express Emotional, Social and Physical Stress in the Clinical Learning Environment

 

Purpose: To evaluate OBGYN residents’ perceptions of personal wellness in relation to their clinical learning environment

 

Background: Resident wellbeing is a significant issue affecting our future physicians’ abilities to fulfill their training potential.

 

Methods: The Council on Resident Education in OBGYN (CREOG) administered a voluntary, anonymous, six-item wellness survey.  One question asked about personal experience with mental health problems (burnout, depression, binge drinking, eating disorders or suicide attempt) and then provided a free text response for “other” issues.  The free text responses were reviewed and analyzed.  The ACOG IRB determined this survey exempt from review.  

 

Results: Of 5,061 residents, 4,099 completed the question on personal issues experienced in residency (81% RR), and 200 free text responses were submitted.  1593 residents (32%) endorsed clinical depression.  34 (0.8%) wrote in anxiety, although this was not a formal category.  The free text responses clustered into three categories: physical health (n=56), social concerns (n=34), and mood symptoms (n=115).  Symptoms of clinical depression comprised 5,992 responses, combining structured questions and free text responses.  18 (0.4%) had attempted suicide, and 18 additional residents wrote in suicide ideation or attempt, translating into almost 1% of our residents having contemplated or tried self-harm, likely related to work stress.

 

Discussions: Significant mood disorders and self-harm are under-recognized among OBGYN residents, even as they acknowledge these symptoms.  Programs must consider formal evaluations for depression, anxiety, and suicide risk, conduct thorough culture evaluations to ensure these symptoms are not being normalized, and tailor their interventions to provide accessible, confidential support services within the clinical learning environment.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, CME, Assessment, Team-Based Learning,

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Resident Wellness: Barriers to Seeking Mental Health Services Among OB GYN Residents

Purpose: Residency predisposes residents to the development of burnout and mental health complications. The culture of residency inevitably places barriers to wellness through expectations of perfectionism, increasing stress levels, and long hours. This study aims to highlight the main reasons why OB GYN residents may not seek help for depression in residency.

 

Background: Residency is a period of extreme stress, lack of sleep and long work hours. Factors such as embarrassment and confidentiality play key roles into why physicians don’t seek help. Some additional barriers cited in the literature include lack of time, fear of documentation on academic record, cost and lack of confidentiality. 

 

Methods: This was a qualitative study to assess the barriers that may keep OB GYN residents from seeking access to mental health resources.  The surveys were electronically distributed via Survey Monkey to OB GYN resident programs

There were a total of 18 questions that assessed demographics and the main barriers that may keep OB GYN residency from seeking mental health services.•A 5 point Likert scale was used to assess the following; ranging from strongly disagree to strongly agree •I can manage my problems on my own •I don’t have enough time •I am worried my privacy would be violated •I don’t know if my program offers mental health services •I don’t have money or health insurance to seek help •I don’t think treatment would be of any help •I am worried about the stigma of mental health 

 

Results: There were 275 respondents to the 18 question survey. Lack of time was the most highly reported barrier, followed by a lack of protected time for appointments. Not knowing if their programs offered services or how to access those services and not thinking treatment would not be of help were the least popular responses.

Discussions: In summary, our data outlines that lack of time and protected time in OB-GYN residencies are prevalent barriers to seeking help among OB GYN residents that must be addressed. Understanding the barriers to seeking help will help us to enact programs that will maintain the wellness of our residents.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Practice-Based Learning & Improvement, GME,

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Remote, Off-site Abortion Training: Experiences of Obstetrics and Gynecology Residents at an Academic Program

Purpose: To describe the experiences of obstetrics and gynecology residents regarding a local compared to a remote, off-site family planning (FP) rotation.

 

Background: The Accreditation Council for Graduate Medical Education (ACGME) requires that obstetrics and gynecology residency programs provide access to abortion training.   Residents at our institution had the option of such training at a local, free-standing abortion clinic until 2013.  This training was then replaced by a rotation at a remote, free-standing abortion clinic three hours away. 

 

Methods: We surveyed graduated obstetrics and gynecology residents who trained at our institution from 2009-2017. The survey contained both closed-ended and open-ended questions about graduates’ experiences with FP training.  We asked about respondent’s assessment of the rotation’s educational value and support of its integration into the residency curriculum.  We assessed predictors of FP rotation participation with Fisher’s exact tests.

 

Results: Of the 32 eligible graduates surveyed, we received 21 complete responses (67%).  Overall, 13 (62%) respondents participated in the FP rotation.  Ten respondents trained when the local rotation was available and six of them would have been interested in a remote rotation.  Of the 11 respondents who trained when the remote rotation was available, 8 participated and all 8 described the rotation as having high educational value.  Almost all respondents strongly supported integration of an FP rotation into the curriculum (19/21).  Relationship status, having children, and current practice type were not associated with FP rotation participation.

 

Discussions: Trainees in obstetrics and gynecology value access to abortion training, even if the training is off-site and remote. 

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Residency Director, Residency Coordinator, Practice-Based Learning & Improvement, GME, Public Health, Advocacy, Contraception or Family Planning,

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Professionalism Training in the Global Setting: Program at Ayder Hospital and Mekele University in Ethiopia

Purpose: Using the current partnership between University of Illinois in Chicago, Illinois (UIC) and Ayder Hospital/Mekele University in Mekele, Ethiopia (Ayder), this study evaluated the effectiveness of professionalism training for medical students and resident trainees at Ayder.

 

Background: Threats to professionalism in medicine have led to more universal teaching of professionalism to trainees and practicing physicians. Currently, professionalism is listed by the ACGME as one of the 6 general clinical competencies. Many programs that include  group sessions and standardized patients have been implemented in American institutions, although little research has been directed towards professionalism training in a global health setting. This study aimed to determine the effect of a professionalism training at Ayder.

 

Methods: Participants in a professionalism and communication training were offered participation in a pre- and post-test survey. The survey focused on the perception and function of professionalism in the medical workplace, and included quantitative and qualitative data. The pre- and post-test surveys were conducted prior to and at completion of the training.

 

Results: A convenience sample of medical students and resident trainees at Ayder participated in the pre- and post-test surveys. The training had a positive effect on the perception of professionalism and identified opportunities for behavioral improvement.

 

Discussions: We saw that the professional training was an effective tool for implementing professionalism into medical education curricula in this global health setting. However, further research regarding the long term impact and ability to implement clinical competencies into global health settings will help determine the plausibility of repeating such a study in other sites.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, Simulation, Global Health, Public Health,

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Preparing Obstetrics and Gynecology Residents for the Fundamentals of Laparoscopic Surgery Assessment

Purpose: The purpose of this report is to describe the training curriculum which has been successfully used to prepare Ob/Gyn residents for the Fundamentals of Laparoscopic Surgery (FLS) assessment at the University of Massachusetts Medical School-Baystate campus.

 

Background: The FLS program was launched by the Society of American Gastrointestinal and Endoscopic Surgeons in October, 2004. The program highlights the simple aim of teaching and testing the fundamentals of laparoscopic surgery in a consistent, validated format. In January, 2018, the American Board of Obstetrics and Gynecology announced the plan to add the FLS program to the requirements for board certification in Ob/Gyn. This new requirement will create education challenges for program directors across the country.

 

Methods: We conducted a literature review on the implementation of FLS in Ob/Gyn training. We then conducted an analysis of our FLS curriculum at UMMS-Baystate, which has successfully prepared 39-residents for FLS certification with a 100% pass rate on the skills assessment. We highlighted changes that have occurred since FLS certification was made a graduation requirement for our residents in 2012.

 

Results: Key features of our curriculum include early access to OR participation, creation of a satellite simulation lab near L&D, practice FLS skills exams and a faculty point person.

 

Discussions: This analysis highlights a strong curriculum, which has been successfully incorporated into our program for all residents. We also highlight ongoing speculation regarding the utility of the FLS cognitive exam in the evaluation of Ob/Gyn residents, with knowledge of early work which is being done to address this issue.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Practice-Based Learning & Improvement, GME, Assessment, Simulation,

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Perioperative Complications Curriculum for the OB/GYN Resident: A Pilot Study

Purpose: To develop and implement a perioperative complications curriculum.

 

Background: ACGME program requirements and milestones include recognizing and managing perioperative complications.

 

Methods: Residents, Fellows, and Faculty were sent a needs assessment survey, addressing satisfaction with baseline perioperative complications curriculum and preferences for development of new curricula.  Additionally, Residents completed a knowledge pretest.  Over four weeks, Residents received weekly emails through the Qualtrics software program linking to topic-specific materials, including interactive, online case-based modules.  A post-implementation survey was distributed to assess Resident satisfaction with programming and to retest knowledge. 

 

Results: With 75% (21/28) of Residents and 47% (40/86) Fellows/Faculty completing the needs assessment survey, 95% (20/21) of Residents and 90% (36/40) Fellows/Faculty reported dissatisfaction with baseline curriculum.

The Resident pretest mean score was 72% (40-90%, SD = 15).

 

Interactive, online case-based modules were developed for topics including ureteral injury, bowel injury, vaginal cuff dehiscence, and bladder injury.  Curriculum materials were successfully distributed on a weekly basis to all Resident learners, as confirmed through the web-based software program.

Resident module completion rates were 50%, 36%, 29%, and 18% for weeks 1-4, respectively.

Eighteen percent of Residents completed the post-implementation survey, with 100% reporting satisfaction with the online case-based modular curriculum.  Knowledge post-test mean score was 84% (SD = 15).

 

Discussions: A needs assessment confirmed poor satisfaction with baseline perioperative complications curriculum.  Web-based materials were developed and distributed weekly to all Residents who successfully accessed the 4 developed modules.  While post-survey responses were few, 100% of responders reported satisfaction with the developed curriculum.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, Practice-Based Learning & Improvement, GME, Assessment, Independent Study, Problem-Based Learning, General Ob-Gyn,

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Parenthood and Medical Careers: The Challenges and Experiences of Physician Moms in the US

Purpose: This survey study sought to gain a better understanding of the experiences and challenges physician moms face during training and as junior faculty.

 

Background: Balancing the demands of medical training and a career along with those of parenthood is challenging. Currently 46% of residents and fellows in training are women, with a rate as high as 83% in Obstetrics and Gynecology.

 

Methods: We surveyed 897 physician moms from January 2018-February 2018 about their experiences with child-bearing, breastfeeding and maternity leave. Participants completed an open-ended question “What is your biggest challenge as a physician mom?”, these answers were qualitatively coded.

 

Results: The majority of participants (40%) had their first child between 31 and 34 years old; 36% of participants had their first child as a resident, while 28% did as junior faculty. For those who had a child during residency, 38% breastfed for 1 year or more, 26% breastfed for 6 months or less. For women who delayed child-bearing, 55% delayed to complete training, 21% delayed for financial reasons, 20% delayed for infertility, 12% of participants delayed due to pressure from their training program. For women who had a child during training 44% described having inadequate leave, but 53% report support from program administration. The themes for biggest challenges for physician moms were coded as: time/hours (37%), balance (26%); over-expectation/guilt/shame (21%), work/working at home (21%), missing out (18%); logistics/child-care (11%).

 

Discussions: Based on our results, there are clear ways residency programs and departments can support physician moms with the challenges they face.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, UME, General Ob-Gyn,

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Outcomes of a Transgender Care Training Program in Obstetrics and Gynecology Resident Education

Purpose: We sought to evaluate outcomes of an Obstetrics and Gynecology (OB/GYN) resident education program on transgender health.

 

Background: OB/GYNs are often frontline providers for the transgender community, as patients may first present to an OB/GYN with symptoms of gender dysphoria or postoperative care needs and complications. Both the American College of Obstetricians and Gynecologists (ACOG) and the Council on Resident Education in Obstetrics and Gynecology (CREOG) have developed key areas of competency pertaining to the care of transgender patients by OB/GYNS.  To date, standardized educational curriculums on these competency areas are not available.

 

Methods: Residents at our institution completed a 2.5-hour training on transgender health comprised of a standardized patient interaction, debriefing session, and didactic session led by an expert on transgender gynecological care. A 42 item pre- and post-training survey evaluated participant demographics, a validated transphobia questionnaire, medical knowledge of transgender care and preparedness to provide transgender care.

 

Results: Eighteen residents and medical students completed the training. The average pre- and post-training knowledge assessments scores significantly improved from 74.8% to 88.9%, (p<0.001). Specifically, knowledge of transgender health disparities, professional guidelines, and management of abnormal uterine bleeding all significantly improved. Baseline transphobia scores were low and did not significantly change. Residents felt more prepared to collect a transgender focused medical history, provide referrals, and access additional educational resources.

 

Discussions: Our training improved residents’ knowledge and preparedness to provide a variety of aspects of transgender care.  This training was feasible, reproducible and positively received by the resident participants.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, CME, Assessment, Standardized Patient, Advocacy, General Ob-Gyn, Sexuality,

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One Size Doesn’t Fit All for Wellness: Residents’ Perception of Wellness Programming

Purpose: To investigate which wellness interventions have the most meaning for a modern cohort of OB/GYN residents.

 

Background: The 2017 CREOG Resident Survey found significant associations between the learning environment and wellness. The primary analysis indicated that PGY-1’s prioritized wellness, and that a sense of wellness decreased with each PGY level. In order to explore whether developmental stage influenced how wellness initiatives were perceived, we performed a secondary analysis of the survey to determine how residents at different PGY levels perceived wellness interventions.

 

Methods: A six-item survey on wellness was administered before the 2017 CREOG exam.  IRB exemption was obtained.  Participation was voluntary and anonymous, linked only to PGY level.  A mixed-methods analysis of the data was performed. Descriptive statistics were analyzed with Microsoft Excel 2010.  Mann-Whitney U tests were used to explore differences between PGY-levels. Thematic analysis of text responses was performed.

 

Results: Among the 5855 residents, 4,753 answered questions regarding wellness programming (81% RR). Significant differences existed between year of training and perceived effectiveness for several initiatives. PGY1 residents valued peer mentorship (p=0.003) and strategic napping (p<0.001) more than senior residents, while PGY3 residents emphasized faculty mentoring (p=.005).  Regardless of training level, residents prioritized the same three activities: wellness days to address personal needs, team-building retreats, and facilitated exercise programs.  

 

Discussions: OBGYN residents perceive some wellness activities as valuable throughout training, while the importance of others may vary based on resident year.  Most programs do not yet provide the wellness programs (retreats, facilitated exercise, personal time) that OBGYN residents identify as most effective.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Professionalism, GME, CME, Team-Based Learning,

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