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Simulation Increases Anticipated Usage of Trigger Point Injections in Treatment of Myofascial Abdominal Pain

PRECIS: Evaluation of a simulation model and didactic training session for the education of ACGME residents in trigger point injections for myofascial abdominal pain in chronic pelvic pain patients.

PURPOSE:  To test a training module for the education of abdominal trigger point injections

BACKGROUND:  For the treatment of chronic abdominal and pelvic pain, training in interventions is lacking among trainees at the residency level.  One very effective and simple intervention is abdominal trigger point injections for the treatment of abdominal myofascial pain syndrome, present in 74% of women in chronic pelvic pain practices.  

METHODS:  This study evaluates an abdominal trigger point teaching model for the training of USMLE OBGYN residency level physicians, containing a multimedia didactic presentation and a gelatin-based abdominal wall injection model.  Participants completed a 10-item knowledge pre- test and an 8-item participant experience questionnaire gauging prior knowledge and experience with myofascial pain syndrome and abdominal trigger point injections.  After 5 minutes of unsupervised time with the gelatin model, a 30-minute scripted didactic session was given, participants interacted post-training with the simulation model, and a post-test was completed.

RESULTS:  Trainees improved from pre-test (48%) to post-test scores (90%) and reported increasing confidence levels on a 5-point Likert scale from 1.67 pre-test to 3.7 post-test.   Ninety percent of participants agreed or strongly agreed that this exercise would result in them using abdominal trigger points in their own practice. 

DISCUSSION:  A simple educational tool containing a short didactic educational module and gelatin simulation model increases knowledge, confidence level and the likelihood of USMLE OBGYN residents to use trigger point injections in the treatment of chronic pelvic pain.

Topics: SES, 2020, Resident, Faculty, Patient Care, Medical Knowledge, Practice-Based Learning & Improvement, GME, CME, Assessment, Simulation, Lecture, Gynecologic Oncology, Pediatric & Adolescent Gynecology, Minimally Invasive Surgery, Reproductive Endocrinology & Infertility, 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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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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Resident Confidence with Obstetric Ultrasound – Are We Meeting CREOG Objectives and ACGME Milestones?

Purpose: The objective of this study assess resident confidence in obstetric ultrasound as per ACGME milestones and CREOG objectives, and factors associated with confidence performing US independently.

Background: Performing obstetric ultrasound(US) is an ACGME milestone, a CREOG objective, and a CREOG core procedure, though many programs lack formal US curricula.

Methods: CREOG coordinator listserve used to distribute 27-question anonymous e-survey in 3/2018 to OBGYN residents in US and Puerto Rico. Questions included experience performed growth US(gUS) and anatomy US(aUS) as primary sonographer, performing US independently, and for 4th year residents only, comfort performing US post-residency. Bivariate statistics compared residents comfortable performing US independently to those who were not.

Results: 417 residents completed the survey: 88% were female, 75% from academic programs, and nearly 50% were post-graduate year(PGY) 3&4.   While 89.1% had been primary sonographer for gUS, only 63% felt comfortable performing independently. Of chief residents, 14% didn’t feel comfortable performing gUS post-residency. In contrast, 60.9% had been primary sonographer for aUS, only 20.1% felt comfortable performing aUS independently, and 68.8% didn’t feel comfortable performing aUS post-residency.   Residents were more likely to feel comfortable performing gUS independently in PGY3&4 (p< 0.01) and after longer MFM rotations(p=0.02), and less likely when MFM fellows were present (p=0.02). Residents not comfortable performing aUS were twice as likely to have MFM fellows (p< 0.01), and less likely to be PGY3&4(p< 0.01).

Discussions: significant percentage of residents are not comfortable with their ultrasound skills. This data further emphasizes the need for structured US curricula and simulation.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Patient Care, Practice-Based Learning & Improvement, GME, Assessment, Simulation, Maternal-Fetal Medicine, 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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Novel Realistic Bladder Model Teaches Anatomy & Builds Resident Confidence in Cystotomy Recognition/Repair

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

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

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

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

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

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

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Improving Patient Care and Resident Education Through a Resident-Led Quality Improvement Program

Purpose: To describe an innovative quality improvement skills acquisition curriculum through a resident-led morbidity and mortality (M&M) review and presentation format.

Background: The ACGME requires that residents participate in quality improvement (QI) initiatives as a part of their training.

Methods: The Residents on Quality (ROQ), developed at our institution, consists of 15% of the residents and two faculty advisors who review cases submitted for (M&M).  Submissions include a brief summary, type of error, and areas of potential improvement.  They are reviewed by a resident member and then evaluated by a faculty member for presentation at the departmental M&M/QI conference.

Results: 377 cases were submitted from 5/2018- 4/2019. 178 were gynecologic cases (47%) and 199 were obstetrics cases (53%).   The most common indications for submission were: readmission (19.4%), sepsis (17.5%), and unplanned ICU admissions (11.4%).  Failure to diagnosis and failure to follow established protocol were the most frequently indicated errors at 30.7% and 28.1%, respectively. QI modifications were made in the following areas: mentorship for junior faculty, guideline updates for preeclampsia, protocols for advanced obstetric vaginal repairs, and breech vaginal delivery simulations.

Discussions: A resident-run QI program teaches trainees to critically evaluate patient care.  ROQ  identified delays in diagnosis, failure to follow protocols, and technical errors as the most common QI needs.  By involving residents in M&M case identification, review, selection, and presentation, residents receive practical training in QI processes and develop the ability for continual improvement.  Department presentation of these cases fosters an environment of learning and allows for tangible changes to improve patient care.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, Lecture, Quality & Safety, Problem-Based Learning,

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

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

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

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

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

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

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

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Development and Validation of a Vaginal Anterior Colporrhaphy Simulation Model for Surgical Training

Purpose: To design and validate a surgical model for anterior colporrhaphy.

Background: Simulation-Based learning is beneficial. To date no simulation model exist for anterior colporrhaphy.

Methods: The model was constructed with nylon tights, PVC tube, polyester battening, and densified polyester padding, costing $43.92. Participants were divided into two groups: “trainees” and “experts”. “Trainees” were Ob/Gyn residents, subdivided into two groups by experience. The “Experts” group comprised Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellows and faculty.  Performance of the procedure was recorded then evaluated by a blinded reviewer using the Objective Structured Assessment of Technical Skills (OSATS) (total 35) and a procedure-specific assessment, which was based on the American Board of Obstetrics and Gynecology recommendations for resident milestone evaluation (ARPA) (total 25). ANOVA was used to compare scores between the groups.

Results: The study included 13 novice 18 advanced trainees and 6 experts.  The “Experts” group scored significantly higher than the “Trainees”. The mean (±SD) OSATS score for “Experts” was 32.30 (±6.06), versus novice and advanced “Trainees”: 17.15 (±5.84) and 21.11 (±5.61), respectively (p=0.001). The mean “Experts’” score for the ARPA was 23.00 (±3.95), versus 10.62 (±4.70) and 14.33 (±4.73) for the novice and advanced “Trainees”, respectively (p< 0.001). Ninety-four percent of trainees reported the model to be “useful” or “very useful” in learning this procedure.

Discussions: This model is low cost, easily constructed, and reusable. Higher scores by experts demonstrates construct validity of this model. This valuable simulation tool allows trainees to practice and improve their technique in a risk-free environment prior to surgery.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Patient Care, GME, Simulation, Female Pelvic Medicine & Reconstructive Surgery,

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Developing Four Year Surgical Skill Learning Curves: Modeling a Process in OB/GYN Residency Using myTIPreport

Purpose: To develop a process for procedural learning curve construction in a national cohort of OB/GYN residents from PGY1 through PGY4

Background: Descriptions of resident surgical proficiency have been limited by subjective experience and surrogates such as operative time or numbers of completed cases. Objective data describing number of procedures required to achieve proficiency for OB/GYN procedures are limited.

Methods: This descriptive study was a secondary analysis of the myTIPreport database from July, 2015 – June, 2019 for the graduating PGY-class of 2019. Feedback included in this database was characterized by residents receiving procedure-specific surgical proficiency scores, rated 1-5. Surgical proficiency was defined as Level 4 (“Supervision Only”). Using database time stamps, chronologic case numbers were generated. Fitted Linear Modeling generated an approximate number of cases to achieve proficiency. To reduce type I error, specific procedures were examined only when 100 or more feedback encounters were reported. Procedures were subsequently excluded when the model-predicted number of cases needed to achieve proficiency was not achieved or when a negative modeling slope was noted.

Results: Of the 3599 feedback encounters reported, 5 procedures met inclusion criteria. Using the above modeling for these 5 procedures, the number of cases needed to achieve proficiency, a Level 4 rating, was: D&C -9, operative hysteroscopy-11, diagnostic laparoscopy-9, laparoscopic BSO-11, and SVD-11.

Discussions: These data demonstrate a process using myTIPreport to begin the innovative work of procedural learning curve construction. Such a process could ultimately be used to build program-specific learning curves and potentially help identify at-risk learners.

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

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CREOGs Over Coffee—A Feasibility Study on Medical Education Podcast Creation and Social Media Outreach

Purpose: To describe the development and implementation of a medical education podcast series for obstetrics and gynecology (Ob/Gyn) resident learning and demonstrate feasibility, sustainability, and acceptance of this series.

Background: Podcasts and other digital resources have become popular among medical learners. Demand by learners for these types of resources compared to traditional methods of learning may increase as we move further into the digital age. Medical educators may wish to incorporate podcast learning into their curriculum and disseminate their work to a larger audience.

Methods: Council on Resident Education in Obstetrics and Gynecology (CREOG) educational guidelines were used to create a study podcast for Ob/Gyn residents over 9 months. Feasibility markers include production of weekly episodes and ability to offset costs. Sustainability markers included download markers over time. Acceptance was measured by number of reviews on Apple iTunes and followers on Twitter.

Results: 42 episodes were released from September 30, 2018-June 30, 2019 (39 weeks). Initial costs included $3150 startup and $29 monthly. Online donations through Patreon amounted to $200/month, which covered 50% of startup costs at 6 months and are projected to cover full costs by 1.5 years. The podcast had 137,500 downloads as recorded through Podbean (39/month 9/2018, increased to 25,000/month 6/2019). It obtained 609 followers on Twitter and 131 ratings on Apple iTunes, with an average of 5.0 stars.

Discussions: Medical education podcasts are a feasible way of disseminating educational materials to learners. We also demonstrate sustainability and acceptance of this platform. 

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Medical Knowledge, GME, UME, Lecture, Independent Study,

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Clerkship Directors’ Reports and Attitudes on Pelvic Exams Performed by Medical Students

Purpose: To examine current practices of obtaining consent for pelvic exams performed by medical students as reported by OBGYN Clerkship Directors (CDs).

Background: Recently, ethical concerns regarding student involvement in pelvic exams performed while a woman is under anesthesia have been raised in the scientific, professional, and popular literature.

Methods: An online survey about the educational pelvic exam was administered to OBGYN CDs as part of the APGO annual clerkship directors’ survey. CDs were asked if their institution had policies on the performance of pelvic exams by students, if explicit consent was obtained, and if patients, students, and providers were educated on the policy. These were evaluated by descriptive statistics of self-reported policies. We also compared the median values of the perceived importance of telling a patient about the involvement of a medical student across seven different procedures.

Results: The survey was sent to 230 clerkship directors, 140 responses were returned, with a response rate of 61%. 57 CDs reported they follow all 4 recommendations (40.7%) as published by APGO’s statement on pelvic exams under anesthesia. 9 CDs did not believe the exam had to be related to the procedure performed. Consent for pelvic exam was seen equivalent to consent for rectal exam, intubation, and making the incision. Consent was perceived less important to watch the procedure, suture the incision, and retract.

Discussions: While many CDs report institutional policies on students performing pelvic exams, it is clear that education is still needed to ensure proper consent is obtained.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, UME, Quality & Safety, General Ob-Gyn,

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

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

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

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

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

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

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

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Teaching Cultural Humility To Medical Students By Building Cross-Cultural Patient Education Tools

Workshop Text: Cultural humility and cross cultural communication are essential skills for medical students who will be called upon to translate medically complex concepts and treatment plans to patients from diverse backgrounds.  This skill set, however, is not often taught effectively during medical school.

This workshop will demonstrate a method for teaching cultural humility to medical students.  Through the process of designing and testing a cross cultural patient education model, the student explores essential features and pitfalls of cross cultural education. Workshop participants will design an abbreviated patient education tool based on a case based scenario and engage in group discussion about the challenges involved. Presenters will share a project that was used in three languages from sub-Saharan Africa and another in Vermont and will discuss challenges from their field work. An evaluation rubric will be provided. 

Introduction (5mins) define cultural humility and discuss best practices in cross cultural communication. 

Group Activity (10 mins) Using 1-2-4-all format, discuss pitfalls of cross cultural communication demonstrated in an excerpt from The Spirit Catches You and You Fall Down.

Breakout Activity/ Interactive component (30 mins) Small groups of participants will design a patient education tool for a specific patient population based on a real life scenario. 

Group Activity (15 mins) Discuss the process of designing a cross-cultural patient education tool with respect to cultural humility.

Wrap up (5 mins)

Take home products: Grading rubric , Resource guide with annotated bibliography

 

Topics: Faculty Development Seminar, 2020, Faculty, Clerkship Director, Patient Care, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Global Health, Advocacy,

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

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

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

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

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

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

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

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Eyes on the Prize: Teaching Students to Manage Obstetric Emergencies and Improve Patient Safety

Objective/Background: Provide participants with the skills to implement a low-cost, interactive workshop that uses obstetric emergencies to teach students about patient safety.  Our session is part of the core curriculum in our Ob-Gyn Clerkship.  Small groups of 3-5 students are assigned different Ob Emergencies, and they work quickly with a small white board to list what actions need to be performed for their assigned case.  Groups then present their plan to the class, and we discuss relevant safety initiatives that have been developed to decrease maternal morbidity and mortality.

Agenda & Interactive Component:  
15 minutes:  Review the increasing demand for active learning in medical education, and the background that led to the creation of this session.
5 minutes:  Distribute vignettes to small groups in the workshop and give the same instructions we give to our students
5 minutes:  Small groups work through their vignettes
10 minutes:  Small groups report back to the large group, and facilitators present examples of safety measures for each scenario (i.e., mass transfusion protocols)
5 minutes:  explain how this format can be used to teach other topics
10 minutes:  Groups create new cases and give them to other tables
5 minutes:  Small groups work on new cases
15 minutes:  Small groups report back to the large group and share feedback 
5 minutes: review feedback from our students

Take-Home Product: We will share our Obstetric Emergencies PPT, and participants can apply this teaching method to other topics in their own curriculums.   

Topics: Team-Based Learning, Quality & Safety, UME, Systems-Based Practice & Improvement, Patient Care, Clerkship Director, Faculty, 2020, Faculty Development Seminar,

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