Vaginal Hysterectomy Training in Residency: How Many Cases Is Enough?
Purpose: To evaluate the association of number of total vaginal hysterectomies
(TVHs) performed during residency on comfort level and practice habits after
Background: TVH is the preferred route of hysterectomy whenever
feasible. Evidence is limited about the number of cases needed in residency to
produce physicians comfortable with TVH.
Methods: We performed a cross-sectional study of 2007-2017
graduates of the MAHEC OBGYN Residency Program. Using an online survey,
self-reported feedback was collected on number of TVHs performed in residency,
ratings (5-point scales) of adequacy of training and comfort level with the
procedure, and the number of TVHs performed in current practice. Spearman
correlation (coefficient rho) was used to examine the correlation between the
number of TVHs performed in residency and outcomes.
Results: Of the 35 graduates meeting inclusion criteria, 31
(88.6%) completed the survey. The range of TVHs performed by graduation varied
from 10-59. TVHs performed in residency was significantly correlated with:
perceived overall quality of training in TVH (rho=0.565; p=0.001), level of
comfort performing TVH within 12 months of graduation (rho=0.384; p=0.43) ,
level of comfort currently (rho=0.414; p=0.028), and number of TVHs performed
over the last year (rho = 0.448; p=0.042). Graphic representation
of TVHs performed in residency against comfort ratings demonstrated
substantial, favorable increases in ratings from 10-19 to 20-29 and to 30-39
and leveling off from 30-39 and above.
Discussions: The number of TVHs performed in residency is associated with
alumni perception of training quality, comfort level and practice habits. Our
alumni suggest 30-39 TVHs may be the “sweet spot.”
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Practice-Based Learning & Improvement, GME, Assessment,
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Transgender Healthy Care: On-line Survey of Physician Knowledge and Comfort
Purpose: To evaluate OB/Gyn provider knowledge and comfort with
transgender health care
Background: Transgender and gender non-conforming patients (TGNC)
are an underserved population that often encounters inadequate or ‘unsafe’
clinical care. Education regarding TGNC patient care has traditionally been
minimal, contributing to gaps in Ob/Gyn care for many of these individuals,
including transgender men.
Methods: An IRB approved, anonymous online non-validated survey
was emailed to 130 APGO program coordinators to distribute to their Ob/Gyn
faculty and post-graduate learners. Questions addressed included years of
practice, experience with TGNC patients, provider comfort, and TGNC education.
Results: One hundred and sixty four surveys were completed and
an additional ~50 were opened but no information was provided. Of the 164
completed surveys, 76.3% of participants reported less than 5 hours of TGNC
specific healthcare education, despite the fact that 75.7% of responders had
cared for at least one TGNC patient. Overall most respondents felt
comfortable/very comfortable (79.8%) caring for this population. No correlation
was found between years in practice and overall provider comfort caring for
TGNC patients. Major obstacles reported by participants included concern
for patient comfort, appropriate language, and lack of sufficient clinical
education for both providers and support staff
Discussions: These data suggest that enhanced TGNC clinical education for
the entire health care team is warranted.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, GME, Advocacy,
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Training Residents to Place Immediate Postpartum LARC: An Update Among U.S. Residency Programs
Purpose: To survey U.S. Obstetrics and Gynecology (Ob/Gyn) Residency
Programs on immediate postpartum (IP) long-acting reversible contraception
(LARC) training and challenges.
Background: In 2016, the American College of Obstetricians and
Gynecologists (ACOG) released a committee opinion supporting IP LARC. Growing
evidence describes provider/hospital barriers which hinder IP LARC provision.
We hypothesize similar difficulties have prevented programs from implementing
Methods: We distributed an electronic survey addressing IP LARC
training to 273 U.S. Accredited Council for Graduate Medical Education (ACGME)
Ob/Gyn Residency Program Directors from the 2017-2018 Academic Year. Data
analysis was performed with chi-square and Fisher’s exact test.
Results: Of 86 programs that participated, residents were
trained in the immediate postpartum period to place implants in 54 programs
(63%) and to place intrauterine devices (IUDs) in 52 programs (60%).
2015, only 20% of the programs were training their residents to place IP IUDs.
Thirty-one percent of eligible programs initiated training in 2017. The
majority of programs focused training interns (98%). Patient/provider
convenience motivated 46% of programs to offer IP LARC and compliance motivated
The two barriers
most frequently encountered, regardless of program training status, were
problems with billing and compensation for services (61%) and the pharmacy
that reported primarily seeing patients with insurance, either private or
Medicaid, were more likely to have IP IUD training compared to programs seeing
mostly indigent/uninsured populations (p<0.05).
Discussions: IP LARC training has increased since the ACOG Committee
Opinion was published, however many programs are still facing challenges with
implementation, affecting resident training.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Systems-Based Practice & Improvement, GME, Public Health, Advocacy, Contraception or Family Planning,
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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
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
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.
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
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
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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Testosterone Supplementation in Women with Diminished Ovarian Reserve
Purpose: To evaluate the efficacy of transdermal testosterone as an
adjuvant to the standard IVF protocol to improve outcomes in women with
diminished ovarian reserve (DOR).
Background: Women with DOR have extremely low pregnancy rates
after IVF cycles, and there are currently few treatment options available.
Testosterone supplementation may improve ovarian response to stimulation via
Methods: This retrospective cohort study analyzed
83 IVF cycles based on inclusion criteria of age < 42 and
diagnosis of DOR (basal FSH > 10, AMH < 1, antral follicle
count < 6, or history of poor response [< 4 follicles]). Cycles in
the control group were carried out using the standard IVF protocol while
cycles in the treatment group involved the addition of transdermal testosterone
prior to ovarian stimulation. Four primary outcomes were evaluated: total
number of oocytes retrieved, number of mature oocytes retrieved, number of
embryos generated, and pregnancy potential of the embryos.
Results: Pretreatment with transdermal testosterone had no
impact on the total number of eggs retrieved after ovarian stimulation.
Testosterone had a negative impact of the number of mature oocytes retrieved,
but had no impact on the number of embryos generated from those oocytes.
Pregnancy rates between the treatment and control groups were no different per
embryo transfer, but were lower per cycle initiation with testosterone therapy.
Discussions: Within this study population, retrospective analysis of
testosterone therapy revealed no improvement in IVF outcomes. A randomized
controlled trial is recommended to further investigate this association.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Medical Knowledge, GME, CME, Problem-Based Learning, Team-Based Learning, Reproductive Endocrinology & Infertility,
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Students Stuck in a Swamp? Scripting Promotes Medical Student Involvement in Obstetric & Gynecologic Care
Purpose: Characterize the effect of staff scripting on medical student
acceptance in outpatient ob-gyn clinic visits.
Background: Direct patient care is a major tributary in the river
of medical education. When patients refuse medical student involvement in their
care, students are stranded in stagnant quagmire. Review of the literature
shows that medical student refusal is a national issue not limited solely to
obstetrics and gynecology (ob-gyn) clerkships (Chang, et al, 2010; Mavis,
et al, 2006; Hartz & Beale, 2000). Written and video messages about medical
student training have been effective in furthering medical student acceptance
in clinical encounters (Buck & Littleton, 2016). Open the floodgates!
Methods: A literature review using search terms “medical
student AND refusal” was conducted to guide script composition. Medical
assistant and nursing staff implemented the script in an outpatient ob-gyn
resident clinic. The script was revised halfway through the clerkship year
based on patient and staff feedback. All ob-gyn medical students were surveyed
regarding their involvement in patient visits prior to and after script
Results: After script implementation, the percent of medical
students refused from at least one patient interaction decreased from 92% to
86%. 66% percent of our students perceived scripting as a supportive measure
for medical students, and 61% percent witnessed staff, residents, and faculty
Discussions: Data from our institution suggest that scripting improves
medical student involvement in ob-gyn patient care. Involving staff, students,
and patients on scripting revision helped foster a learning environment rich as
the Mississippi delta in which medical students can thrive.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Professionalism, Interpersonal & Communication Skills, UME, Team-Based Learning, Advocacy,
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Simulation Training for Operative Vaginal Delivery Among Obstetrics and Gynecology Residents: A Systematic Review
Purpose: To evaluate the impact of simulation training of operative
vaginal delivery (OVD) on learner technique, operator comfort, and
Background: Obstetric simulation affords learners opportunities to
acquire and to refine clinical skills in a low-stress environment while
potentially improving patient outcomes. However, the effect of simulation
on OVD training is less clear.
Methods: A systematic research protocol was constructed a
priori for the conduct of the literature search, study selection, data
abstraction and data synthesis. Electronic databases were searched for
educational randomized trials and observational studies assessing OVD
simulation training for OBGYN residents. The educational domains of
knowledge, skills and attitudes were evaluated. The Medical Education
Research Study Quality Instrument (MERSQI) was used to assess study
quality. The review was prospectively registered with PROSPERO.
Results: The search strategy yielded 30,812 articles, with 7
articles eligible for analysis (2 cohort studies, 1 case-control study, 4
cross-sectional studies). No randomized trials were identified.
Studies demonstrated simulation to improve learners’ skill with forceps
placement and generated force during extraction. While forceps simulation
had no change in procedure failure rates, there were significant decreases in
rates of maternal lacerations, neonatal injury, and special-care nursery
admission. Only one study evaluated the effect of simulation on provider
comfort, demonstrating increased provider comfort with vacuum-assisted
delivery. The median MERSQI score was 9.5 (range 9.0-13.5), indicating
Discussions: The available evidence suggests improvement in technique,
comfort, and patient outcomes with OVD simulation, but additional studies are
required to further characterize such benefits for both forceps and vacuum.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Simulation, Quality & Safety, Maternal-Fetal Medicine, General Ob-Gyn,
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Simulated Paging Curriculum to Assess and Improve Communication Skills
Purpose: To examine the impact of a simulated paging curriculum for
senior medical students on physician-nurse communication skills.
Background: New residents are expected to triage and address a
high volume of clinical pages yet medical students receive little training in
this important skill. Previous studies have evaluated the impact of simulated
paging curricula on clinical decision making and student confidence but have
not examined the effect on communication skills.
Methods: Two trained Registered Nurses (RNs) administered
specialty-specific pages to 76 fourth-year medical students enrolled in 4-week
residency preparation electives. For each case, RNs evaluated students’
performances on seven communication domains using previously validated 5-point
semantic-differentiation scales (1=worst, 5=best) in precision, instruction,
assertiveness, direction, organization, engagement, and ability to solicit
information. Immediate feedback was provided to the students.
Results: A total of 351 pages were administered: 144 in week 1,
73 (week 2), 97 (week 3), and 37 (week 4). Students from all specialties
improved communication scores throughout the four weeks. Mean
communication scores increased from 4.02 to 4.26 from week 1 to week 2
(<0.0001). Improvement was most pronounced for the students going into
internal medicine (3.82 to 4.25) and pediatrics (3.95 to 4.38) and less
pronounced for the procedural specialties of surgery (4.26 to 4.22) and ob/gyn
(4.07 to 4.18). Communication skills continued to improve in weeks 3 and 4 but
with inadequate number of pages to power this comparison.
Discussions: Our data demonstrates that a simulated paging curriculum is a
promising platform for teaching and improving physician-nurse communication
skills for senior medical students.
CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, UME, Assessment, Simulation, Problem-Based Learning, General Ob-Gyn,
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Saving Lives: Students Enhancing Patient Health Literacy Regarding Hypertension in Pregnancy and Prenatal Aspirin
Purpose: To increase medical student’s knowledge, behavior and belief
systems regarding hypertension (HTN) in pregnancy and prenatal aspirin (PNA).
To increase patient\'s understanding regarding the complications of HTN in
pregnancy and the benefits of PNA.
Background: Prenatal aspirin (81 mg) has been recommended by ACOG
for high-risk women and women with >1 moderate risk factor. Its use reduces
the rate of preeclampsia, preterm birth, intrauterine growth restriction and
fetal death in at-risk patients. In a survey conducted at Boston Medical
Center, the incidence of hypertension in pregnancy is 30%, with only 15% of
patient having heard of PNA, demonstrating high prevalence and low patient
literacy regarding the topic.
Methods: Ob/Gyn clerkship students are instructed to educate
patients regarding: knowledge of HTN in pregnancy, warning signs of
preeclampsia, and efficacy of PNA in pregnancy. The student educational
intervention was evaluated regarding: satisfaction, knowledge, confidence, and
belief systems by surveys at the beginning and end of the clerkship. Patient
education was evaluated by pre and post intervention metrics.
Results: Student knowledge of PNA and HTN increased 35%,
confidence 45% and belief systems 14%. They gave the project a 72%
satisfaction rating. Patient’s knowledge about HTN increased 48%, warning
signs 80%, and understanding of efficacy of PNA 65%.
Discussions: Medical student health counseling increased patient knowledge
regarding HTN and PNA. By educating patients, students also increased their
knowledge and confidence in the subject. We plan to continue implementing this
QI project throughout the year to augment a departmental QI initiative and
evaluate its benefit to patients and students.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, UME, Quality & Safety, Advocacy,
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Resident Documentation and Coding Curriculum Can Be Improved Through One-on-one Education
Purpose: Assess impact of one-on-one education of residents in billing
Background: As billing and coding education was changed from
generalized education at didactics to more intensive one-on-one education, the
revenue team evaluated the impact for accuracy in billing and monetary impact.
Methods: Three groups of residents were analyzed. Group 1 (n=4)
were fourth year residents at intervention and had a general meeting with other
departments about coding and then one or two one-on-one sessions. Group 2 (n=4)
were third year residents at intervention and had two to three one-on-one
sessions. Group 3 (n=4) were second year residents at intervention and had
three consistent one-on-one sessions every 6 months. A selection of 10 records
per resident were randomly selected for review by a certified coder to identify
documentation and coding opportunities.
Results: The documentation and coding accuracy improved with
increased education. Accuracy Group 1: 55%, Group 2: 76%, Group 3: 89%. Revenue
lift was also analyzed with these encounters and an average lift of ~$40 was
noted between group 1 and group 3.
Discussions: By consistent billing and coding one-on-one education for
residents, the accuracy of coding improved as seen in the differences in
accuracy rate between graduating 4th years (55%) and second year residents
(89%). Residents see 5 patients on average per clinic session in their final 2
years and have approximately 30 clinics per year. This equates to an extra
$12,000 in revenue per resident over their final two years. By investing in
billing and coding education, accuracy and revenue were increased.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, General Ob-Gyn,
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Predictors of Trainees\' Willingness to Provide Family Planning Services: A Survey of Ob-Gyn Residents
Purpose: To determine factors that contribute to a resident’s
willingness to provide abortions post-residency.
Background: The shortage of abortion providers makes accessing
care difficult. Personal and environmentalfactors within the residency training
environment may be modified so that greater numbers ofgraduates opt to become
Methods: A multiple-choice survey was sent to all ACGME
accredited OB/GYN residency programs. Data on demographics,religious and
political views, residency training experience and intent to provide abortions
was collected anonymously (n=396).
Results: Sixty-eight percent of residents intended to provide
abortions (n = 269). The sample was 89% female, underage 35 (97%), heterosexual
(91%). In a multivariable logistical regression, the following demographic
factors predicted intent to provide abortion; being female (aOR 2.8; 95% CI
1.2-6.5), identifying as non-Christian (aOR 3.6; 1.9-6.6), and being raised in
the Northeast (vs South) (aOR 3.0; 1.3-6.7) .Modifiable predictors of intention
to provide included programs where 50% of the faculty provided abortions (aOR
3.3;95% CI 1.8-5.8). Additionally, residents who performed greater than 20
cases (uOR 3.3, 95% CI 1.6-6.7) were three times more likely to plan
toprovide.Selection of a residency emphasizing family planning significantly
correlated with intent toprovide (aOR 4.3; 95% CI 2.4-7.8). Those training at
Ryan Programs were twice as likely (uOR2.4; 95% CI 1.6-3.8) to intend to
Discussions: Modifiable factors such as early exposure of medical students
to family planning, faculty selection, robust case volumes and establishment of
a Ryanprogram may enhance the number of graduates offering abortions while in
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Osteopathic Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, GME, UME, Advocacy, Contraception or Family Planning,
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Predictors of Excellence in Residency Training and Board Passage Among OB/GYN Residents
Purpose: Our purpose is to determine which metrics predict success in
residency and ABOG written board passage (BP).
Background: The success of an Ob/Gyn residency program relies upon
recruiting candidates who will excel academically (CREOG scores), clinically
(ACGME milestones), and ensure residents pass boards. Additionally,
early identification of residents at risk for failing allows for appropriate
Methods: Medical school ranking, OBGYN clerkship grade, letters
of recommendation (LOR), USMLE Step scores were collected from 2013-2018 for
the Wayne State OBGYN residency program (n=59) and related to their CREOG
scores, ACGME milestones and to board passage using mixed effects logistical
Results: Students honoring ObGyn and those with Step 1 scores
>200 were more likely to become successful residents (milestones >3
“Excellent or Outstanding”). While, milestones were not predictive of board
passage, higher milestones, specifically in problem based learning (PBL) were
associated with higher scores on all CREOGs which are associated with board
passage. Additionally, wording in the MSPE was positively associated with
honors, CREOG3 & CREOG 4 scores, and board passage. Residents in danger of
failing Boards had CREOG3 (or 3.8 95%CI 1.7-8.6) or CREOG4 (or 3.7 95%CI
1.7-8.2) scores were unrelated to board passage.
Discussions: This study suggests selecting applicants with high clerkship
grades, USMLE1, and high class rank and discounts the value of LOR. Milestones
appear to be of limited value for board passage and in identifying at-risk
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME,
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Perioperative Complications Curriculum for the OB/GYN Resident: A Pilot Study
Purpose: To develop and implement a perioperative complications
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
pretest mean score was 72% (40-90%, SD = 15).
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.
module completion rates were 50%, 36%, 29%, and 18% for weeks 1-4,
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.
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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Perceptions Regarding Medical Students Performing Pelvic Examinations on Anesthetized Female Patients
Purpose: The purpose of this study was to determine perceptions
regarding medical students performingpelvic examinations on anesthetized female
Background: Pelvic exams performed under anesthesia continues to
be a controversial topic, but studies looking at medical staff are lacking.
Methods: An internet based survey was distributed to OB/GYNs,
OR nurses/techs,anesthesiologists/CRNAs, and medical students at multiple
hospitals and medical schools.Demographic data were collected. Non-demographic
answers to questions were recorded on a 5-point scale. Characteristics between
the respondent groups were statistically compared usingChi-squared test for
independence and the Fisher’s Exact Test.
Results: 337surverys were completed. 72% of respondents
believed permission should be obtained from patientsprior to the performance of
EUAs by medical students on anesthetized femalepatients. 30% of respondents
believed prior consent was usually obtained. 50% believed patients would agree
to have the exams performed. 80% thought patients would be upset if an EUA by a
medical student was performed on them without their prior consent. 32% of
nurses believed medical students should be allowed to examine anesthetized
patients. Medical students were less likely to believe it was appropriate
for a student to examine a patient, there was an educational benefit, and that
patients would consent.
Discussions: Despite the perception of all OB/GYN OR team members that
consent should be obtained beforemedical students perform pelvic examinations
on anesthetized female patients, this does notusually occur. Almost 50% of
medical students would not encourage their female relatives toconsent to
medical students performing such pelvic examinations.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Patient Care, Professionalism, GME, Quality & Safety, Advocacy,
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Palliative Care Training in an Obstetrics and Gynecology Residency: a Needs Assessment and Plan of Action
Purpose: To perform a needs assessment for the development of a
multidisciplinary palliative care curriculum for OBGYN residents.
Background: Palliative care improves patient quality of life,
satisfaction, and survival. Although specialty palliative care services are
increasing in number, any healthcare provider can and should utilize principles
of primary palliative care in order to optimize patient care. OBGYN residents
receive little formal education in palliative care skills, such as
leading difficult conversations, symptom management, and end-of-life decision
making. These skills are critical to OBGYN training and are incorporated into
the ACGME milestones.
Methods: OBGYN residents at a single institution were
given an electronic survey assessing competency in palliative care skills
and preferred modes of learning. The survey
was first piloted with OBGYN fellows.
Results: Of 41 surveyed residents, zero describe themselves as
“competent” in reviewing advanced directives or counseling about comfort care.
Only 7% describe themselves as competent in delivering serious news and 5% as
competent in determining decision-making capacity. When asked specific
questions about opioid dosing conversions, less than 20% answered correctly.
The preferred teaching methods were clinical experiences, informal chalk talks,
and lecture-based didactics. When asked explicitly, 92% agreed or strongly
agreed that all OBGYN residents should undergo training in palliative care.
Discussions: OBGYNs care for women throughout their lifespan with
challenging patient care situations requiring skills in communication, symptom
management, and values determination. Our needs assessment highlights
significant areas for improvement in the training of OBGYNs. We used this data
to design and implement a multidisciplinary palliative care curriculum for
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, GME,
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Pain Perception in Cervical Biopsy- Variations by Patient and Provider Characteristics in an Academic Teaching Clinic
Purpose: We aim to identify factors which dependably predict patients’
experience of pain during colposcopy, and to evaluate if providers, stratified
by level of training, are capable of anticipating procedural pain.
Background: Cervical biopsy procedures, including colposcopy and
loop electrosurgical excision procedure (LEEP), are considered non-invasive
office procedures and efforts to codify their use emphasize logistics and
ability to detect disease. A significant gap exists for mitigating
psychological distress and procedural pain. Previous research suggests that
physician assessment of procedural discomfort varies by years of experience.
Methods: Patients presenting to an academic gynecology practice
for colposcopy with cervical biopsy or LEEP completed Pre- and Post-Procedure
surveys (14- and 3-item surveys, respectively), assessing demographics, past
cervical procedures, menstrual pain, and anticipated biopsy pain, among other
metrics. Post-Procedure surveys assessed a numerical level of pain experienced
during the biopsy. The health care provider (HCP) and procedural assistant were
surveyed for perceptions of patient pain. Pain scores were evaluated using a
100mm visual analog scale. Data analysis was performed using Spearman
rank correlation, and coefficients for relevant variables were calculated.
Results: 80 patients were enrolled and 62 underwent cervical
biopsy. Patients with higher anticipated pain gave higher ratings for
post-procedure pain (p=0.024). Women reporting more intense periods predicted
and experienced more procedural pain (p<0.001, p=0.058). From the provider
perspective, HCPs correctly estimated patients’ pain when compared with the
patients’ perceptions (p=0.066). However, only PGY3 and PGY4 OB/GYN residents
did so with statistical significance (p=0.014) and PGY1 and PGY2 residents
rated lower pain scores (p=0.039). Male assistants rated pain lower than
female assistants (p=0.037).
Discussions: Providers accurately estimated patients’ pain with variation
by years of training. Patient characteristics of age, anxiety, and dysmenorrhea
were reliable predictors of pain levels. Our findings suggest that
pre-procedure screening of patients may be helpful in directing pain reduction
interventions. Additionally, years of experience may provide enhanced pain
perception, suggesting future research into pain management training for junior
resident physicians and medical students.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Practice-Based Learning & Improvement, GME, CME, Quality & Safety, General Ob-Gyn,
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P&S Partners in Pregnancy: A Longitudinal, Patient-Centered Program for Preclinical Students
Purpose: To develop a longitudinal clinical program pairing first-year
medical students with prenatal patients.
Background: Students who participate in early clinical,
longitudinal experiences report greater confidence in communication, comfort in
clinical settings, and self-esteem during transition to clerkship year.
However, few longitudinal experiences exist for preclinical students at
Columbia University Vagelos College of Physicians and Surgeons.
Methods: A retrospective needs assessment evaluating interest,
motivating factors, and perceived barriers to participation was distributed to
second-year students. In response, we developed a program pairing ten
first-year students with pregnant patients. Students partake in lectures and
accompany patients to prenatal visits. Initial perceptions about the
patient-physician relationship were assessed in both groups using the
Patient-Practitioner Orientation Scale (PPOS), with 1 indicating
“doctor-/disease-centered,” and 6 indicating “patient-centered.”
Results: 49% of students completed the needs assessment. 90%
reported that they would be at least “somewhat interested” in a longitudinal
prenatal pairing program. Motivating factors included desiring longitudinal
experience (87%), early clinical exposure (82%), and patient advocacy/community
engagement (78%). Our program was designed accordingly. All first-year students
were invited to apply; ten were accepted. At recruitment, mean student PPOS
score was 4.64 compared to 3.95 for patients.
Discussions: Students in early medical education are enthusiastic about
longitudinal patient experiences and demonstrate patient-centered mindsets.
Programs such as ours may help maintain and cultivate patient-centeredness,
with the potential to improve patient satisfaction(1) and create positive
attitudes towards medical student involvement.
E et al. Patient orientations of physicians and patients: the effect of
doctor-patient congruence of satisfaction. Patient Educ Couns 2000;
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Medical Knowledge, Professionalism, UME, Independent Study, Team-Based Learning, Advocacy, 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.
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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Oral Milestone Assessment versus Electronic Evaluation (E-Value) Milestone Assessment-Is One Better Than Another?
Purpose: To compare milestones assigned to PGY 1 and 2 Residents via
an Oral Milestone Exam versus the traditional retrospective monthly electronic
evaluation system to assess how they aligned.
Background: Programs are tasked with implementing assessment tools
to evaluate the 28 milestones. Most programs use some form of an electronic
evaluation at rotation completion. The Clinical Competency Committee
reviews all information for final score assignment each six month period.
Methods: In 2015, we instituted an Oral Milestone examination
to assign the six-month milestones and compared those scores to our
retrospective monthly on-line evaluations. We evaluated PGY 1 and 2 residents
in a simulated forum on milestones, which included Medical Knowledge, Patient
Care, and Interpersonal /Communication Skills Competencies. All residents were
given simulated patients, cases, and/or skills while each examiner was given
the specific ACGME milestone assessment sheet to score. The residents were
provided with immediate feedback.
Results: From 2015-2018, 78.4% of PGY 1 and 43% of PGY 2 residents
scored higher on the real-time oral milestone exam. Additionally, in 82% of PGY
1 residents and 52% of PGY 2 residents score on the oral exam was at
0.5-1milestone level higher than the retrospective electronic monthly
Discussions: Clinical Competency Committees are tasked with Milestone
assignment to all residents every six months. Evaluation tools that most
reflect the actual milestone completion is a mission of all programs. We set
out to assess whether our electronic monthly retrospective evaluation system
was mirroring the assessment performed on our residents with the real-time oral
milestone exams at the end of the six month interval, just prior to submission
to the ACGME.
Our data suggests discrepancy in our online retrospective milestone evaluation
versus the real-time assessment of an oral exam. Not only did residents score
higher in most circumstances in an oral format, but they were higher by a
half-whole milestone level in the majority of the cases. It would suggest that
our ability as educators to recollect the performance of a resident at an
interval later than the performance may be flawed.
Programs may want to consider instituting an oral milestone examination for
enhanced milestone assessment.
Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Professionalism, GME, Assessment, Simulation, Standardized Patient, General Ob-Gyn,
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