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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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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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The Residency Buddy System\': A Better Way to Encourage Laparoscopy Simulation Training?

 

Purpose: To determine if a “buddy-system” compared to independent training increases laparoscopic simulation time amongst residents.

 

Background: Based on prior research, laparoscopic box-trainers improve proficiency on surgical skills, however voluntary simulation time by residents is traditionally low. We propose that a buddy system approach to simulation will increase laparoscopic training time, and further improve skills.

 

Methods: Thirty-two residents at a single obstetric and gynecology residency program were consented for the study.  Each buddy pair was composed of a junior and senior resident. During the first half of the 20-week study, 12 residents were randomly assigned a buddy while 20 remained solo.  During the second half, solo-trainers were assigned buddies and conversely buddies were made solo. Residents recorded check-in and -out times electronically. (Assignments were provided via email at the beginning and mid-way points; no other contact was made.) At the conclusion of the study period a survey link was distributed.

 

Results: Six of the 32 residents (18.8%) attended simulation in the 20-weeks, with an average time of 2 hours 14 minutes. In the solo-trainer group, 1 resident checked in 3 times and 2 residents once. In the buddy group, 1 pair checked in together and 1 person checked in alone.  Fifteen residents (46.9%) completed the survey.  Thirteen (86.7%) agreed they accurately reported times; 1 was neutral and 1 never attended. All communicated with their buddy monthly or less frequently, while 10 of them never communicated.

 

Discussions: Residents’ laparoscopic simulation time was dismal at our program in this study. Dedicated mandatory simulation time may increase participation.

Topics: CREOG & APGO Annual Meeting, 2019, Faculty, Residency Director, Medical Knowledge, CME, Independent Study, Minimally Invasive Surgery,

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The Effect of a 6-week vs 4-week Clerkship on NBME Shelf Scores in Obstetrics and Gynecology

Purpose: To determine the effect of a 6-week vs 4-week clerkship on NBME shelf scores in Obstetrics and Gynecology

 

Background: A medical school wide curriculum change took place at Penn State College of Medicine during the 2017-2018 academic year to increase longitudinal and integrated learning.  The OB/GYN clerkship was shortened to 4 weeks and placed into a fifteen-week block with other rotations.  OB/GYN students continued to rotate through three clinical sites.  Shelf exams, previously given at clerkship conclusion, were then administered in the final week of the block.  

 

Methods: A retrospective review of NBME shelf scores for our Obstetrics and Gynecology clerkship was performed for academic years 2015-2017 and compared to those from academic year 2017-2018.  Student scores were collected and de-identified.  Mean scores were then obtained for each six-week rotation in 2015-2017 as well as the 4-week rotation school year.  

 

Results: A comparison of 4-week versus 6-week shelf scores at each site showed a significant decrease of 2.16 in the shelf scores at Hershey during the 4-week rotation (P=0.03).  Harrisburg Hospital scores decreased by 0.31 (P=0.83) while York scores increased by 2.23 (P=0.21) during 4-week rotations.  However, a decrease in overall mean shelf score in 4-week scores compared to 6-week scores across all sites by 0.08 was not significant (P=0.93).

 

Discussions: Analysis of the shelf scores across all of the 4-week rotations following curriculum change revealed no significant difference in mean scores when compared to the 6-week rotations.  However, there was a site-specific significant decrease in mean scores at our main hospital.  

Topics: CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Clerkship Coordinator, Medical Knowledge, UME, Assessment,

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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 enhanced folliculogenesis. 

 

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. 

Topics: 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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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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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 patient-centered outcomes.

 

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 low-to-moderate quality.

 

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.

Topics: 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.

Topics: 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.

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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Removing the Shelf Cutoff to Achieve Honors in the Clerkship Does Not Change Test Scores

Purpose: Purpose: To identify students’ performance on the NBME subject examination changes when a minimum score requirement for Honors is removed.

 

Background: Background: The NBME subject examination is used in many obstetrics and gynecology clerkships as an objective measure of knowledge. The exam score may be included in the calculation of a student’s final grade, with a requirement to achieve a certain minimum score to be eligible for a grade of Honors. At our institution, this cutoff was removed from the obstetrics and gynecology clerkship in 2017.

 

Methods: Methods: Scores for the Obstetrics and Gynecology subject examination at the University of Pennsylvania were compared between 2016 (the most recent year in which a cutoff was used) and 2017 (the first year in which the cutoff was removed). Comparative statistical analyses were performed, including mean, standard deviation, and Student’s T-test.

 

Results: Results: In 2016, 161 students took the NBME subject examination, during which time a minimum score of 81 was required to be eligible for a final grade of Honors. The mean score was 80.58 (range 61-93, standard deviation 6.34). In 2017, the minimum cutoff requirement was removed, and 163 students took the exam. The mean score was 80.42 (range 53-94, standard deviation 6.38). The T-test result for comparison between the two means was 0.41.

 

Discussions: Discussion: At this academic institution, the mean NBME subject examination score did not change between the two years. Students continue to study for the final exam when the minimum cutoff is removed.

Topics: CREOG & APGO Annual Meeting, 2019, Faculty, Clerkship Director, Medical Knowledge, UME, Assessment, Independent Study,

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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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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 remediation plans.  

 

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 regression. 

  

 

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 residents.

Topics: 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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Pilot Study of a Condensed Communication Skills Workshop for Gynecologic Oncology Fellows

Purpose: Implement and evaluate the effectiveness of a newly condensed, previously piloted communication workshop in a cohort of gynecologic oncology (GO) fellows.

 

Background: In GO fellowship, devoting sufficient time to learn communication skills can be challenging due to the time and logistics required. A two day workshop was previously piloted at a single institution with GOs and found to be beneficial. We sought to disseminate that curriculum in a condensed form.

 

Methods: We conducted two four-hour sessions with 4 GO fellows over 4 months. Sessions consisted of a didactic in communication skills led by faculty with VitalTalk© training, followed by application with a simulated patient. Cases were developed and previously used in a two-day workshop at another institution. Fellows were surveyed prior to both sessions and after the second session.  Perceived confidence was assessed on a Likert scale (1 to 5). An improvement was defined by an increase of ≥1 in Likert score.

 

Results: All fellows reported that the educational quality of the sessions was “excellent,” that the time in between sessions was “just right,” allowing them to apply skills learned in the first session prior to the second. After both sessions, at least three of the four fellows reported an improvement in confidence in nearly 50% (10/21) of the topics (Table 1).

Table 1**

Name the key steps of delivering serious news

Bring up advance care planning

Elicit a patient’s goals of care from a patient or family member

Lead a family conference

Manage conflict that arises during a family meeting

Describe comfort-focused care

Respond to patients or family members who have not accepted the seriousness of the patient’s illness

Discuss religious or spiritual issues with a patient or family member

Counsel a patient or family member about what to expect in the dying process

Teach and mentor learners about how to facilitate delivering serious news

**Areas in which ≥75% of fellows reported an improvement in confidence (at least ≥1 increase in level of confidence)

 

Discussions: GO fellows perceived improvements in communication skills with condensed half-day training seminars.

Topics: CREOG & APGO Annual Meeting, 2019, Faculty, Medical Knowledge, Interpersonal & Communication Skills, GME, Standardized Patient, Gynecologic Oncology,

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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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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 OBGYN residents.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, GME,

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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.

 

1 Krupat E et al. Patient orientations of physicians and patients: the effect of doctor-patient congruence of satisfaction. Patient Educ Couns 2000; 39:49-59.  

Topics: 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.

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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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 evaluations.

 

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.

Topics: Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Professionalism, GME, Assessment, Simulation, Standardized Patient, General Ob-Gyn,

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Obstetrical Resident Improved Education and Teaching (ORIEnT)

Purpose: To implement a new obstetric education curriculum for the L&D rotation. It is based on the flipped classroom model, including self-directed learning with podcasts and assigned readings; as well as, group based learning with case discussions

 

Background: Duty hours and workload make the labor and delivery unit a difficult environment to achieve a structured learning curriculum. It has been identified as an area where resident education is lacking and provides an opportunity for implementing a formal education component.

 

Methods: The curriculum was implemented at the University of Colorado and University of Oklahoma. It consisted of 6 modules covering the following topics: multiple gestation, PPH, PPROM, PTL, short cervix/cerclage, and IUFD. All modules could be accessed through Dropbox, which included a link to podcasts, reading materials and case discussions. Case discussions were led each week on L&D with a faculty member or MFM fellow. Outcomes measured included resident and faculty satisfaction and resident knowledge acquisition.

 

Results: Pre and post surveys of residents and faculty showed an overall positive response to the new curriculum. Resident surveys indicated that they acquired new knowledge through the curriculum. Faculty surveys demonstrated a positive response for enhancing L&D education and improving access to learning materials.

 

Discussions: The new curriculum was received well among residents and faculty as a way to implement structured teaching on L&D. Challenges included participation, resident schedules and inability to assess knowledge acquisition. While there were challenges, this curriculum provided multiple formats to learn and improved access to learning materials.    

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, General Ob-Gyn,

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