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Timing the “Fun” to the Fundamentals of Laparoscopic Surgery (FLS) in an Obstetrics and Gynecology Residency Training Program

Purpose: To determine the time required by Obstetrics/Gynecology (OBGYN) residents to gain proficiency with FLS skills

Background: FLS is a standardized assessment of laparoscopic knowledge and skills and an eligibility requirement of The American Board of Obstetrics and Gynecology (ABOG) Qualifying Exam. There is no published data on expected training time to guide curricula planning or how PGY level, prior surgical experience, or milestone assignment may associate with FLS skill acquisition.  

Methods: A prospective cohort study was performed at a community based hospital where PGY2-4 residents were consented to participate in a structured FLS curriculum, which included five skill sessions supervised by gynecologic surgical faculty. Time spent in supervised and self-study sessions was recorded.  A baseline and final assessment of FLS skills was administered noting errors and time to complete. Participants reported PGY level, number of prior laparoscopic hysterectomy cases, and their endoscopic technical skill milestone levels, which were analyzed using multivariate regression analysis. 

Results: No residents (n=17) passed the baseline assessment. All participants passed the final assessment after curriculum completion with improvement in time (-12.2 minutes p = 0.0005) and reduction in errors (-2.5, p = 0.0025). The amount of structured time spent with a faculty member was correlated with improvement in assessment time (r=0.5979)with at least 155 minutes demonstrating significant improvement (p = 0.009). PGY level, milestone level, number of laparoscopies, and self-directed practice were not associated with improvement in performance. 

Discussion: Deliberate practice was the driving factor for FLS skill acquisition independent of PGY, milestone, surgical experience, or self-directed practice time.

Topics: Minimally Invasive Surgery, Simulation, GME, Medical Knowledge, Residency Director, Faculty, 2020, SES,

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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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A Needs Assessment for a National Ob/Gyn Residency Education Curriculum

Purpose: We sought to determine Ob/Gyn residents’, program directors’ (PDs), and assistant program directors’ (APDs) perceptions of the need for a national Ob/Gyn residency education curriculum. This study was funded by the CREOG Empower Award.

Background: Several specialties have implemented standardized, national residency education curricula. These curricula allow residents to have equal access to a centrally located, structured, common knowledge base. In Ob/Gyn, although we have outstanding educational resources, they are not integrated into a national curriculum nor are they co-located. Rather, each residency program develops its own didactic curriculum, which requires a significant amount of time and effort and leads to variability in curriculum quality and content.

Methods: A 12-question web-based survey was developed and distributed to residents, program directors, and assistant program directors nationwide using the Ob/Gyn program coordinator’s listserve and program contact information from the ACOG website.

Results: 780 participants (651 residents, 83 PDs, and 46 APDs) completed the survey, with a diverse range of regions, program types, and program sizes represented. Almost all (97.2%) participants agreed or strongly agreed that residents nationwide should have equal access to high quality Ob/Gyn education resources. Further, 91.9% agreed or strongly agreed that core Ob/Gyn educational resources should be centrally located. A majority, 77.8% (residents 78%, PDs 75%, and APDs 78%), agreed or strongly agreed that there is a need for a national Ob/Gyn residency education curriculum.

Discussions: Our results demonstrate a perceived need for a centrally located, structured national Ob/Gyn residency education curriculum.

Topics: General Ob-Gyn, Independent Study, Lecture, GME, Medical Knowledge, Residency Coordinator, Residency Director, Osteopathic Faculty, Clerkship Coordinator, Clerkship Director, Faculty, Resident, Student, 2020, CREOG & APGO Annual Meeting,

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Uptake and Efficacy of a Novel Self-Directed Foundational Curriculum for OB-Gyn Interns

Purpose: To evaluate a curriculum for OB-Gyn interns.

Background: To provide incoming interns with a reading plan, residency leadership created a novel, self-directed, online foundational curriculum for interns modeled after the ABOG MOC process.  The curriculum was first offered to interns starting residency in July 2017.
For each core intern clinical experience (Obstetrics, Gynecology, Family Planning, Office) selected readings represented the foundational knowledge expected of an OB-Gyn intern, totaling 42 readings.  For each reading, multiple choice questions highlighting the key information were crafted by attendings to create an online 40-question pretest, self-directed curriculum of 42 modules comprised of a reading and relevant comprehension questions, and 80-question posttest using unique questions not utilized in the pretest or modules.

Methods: The curriculum operated on the online educational platform, SparkLearn.  OB-Gyn interns starting residency at Vanderbilt in July 2017 completed the pretest during orientation.  Rising second-year residents completed the posttest simultaneously at the conclusion of intern year.  The intern class completed modules at their own pace and concluded intern year with the posttest.  Pretest, module, and posttest scoring was cataloged in SparkLearn.  IRB exempt study approval was obtained.

Results: For interns participating in the curriculum (N=6), mean module completion rate was 82.71% (range 26-95%).  Mean participator pretest and posttest scores were 71.04% (SD=7.22) and 82.71%(SD=7.04), respectively (p=0.01).
Participator module completion rate was strongly correlated with posttest scores (pearson coefficient 0.60) and weakly correlated to first year CREOG scores (pearson coefficient 0.12).   
Mean posttest scores at end of intern year were higher among curriculum participators (82.71%) compared to non-participators (75.31%) (p=0.05).  Mean first-year CREOG scores for curriculum participators were also higher (207) compared to non-participators (198) (p=0.24).

Discussions: Our novel online self-directed intern foundational reading curriculum had variable uptake but overall good utilization in its first year of deployment.  Compared to the preceeding intern class, participating interns had higher posttest knowledge scores.  There was a strong positive correlation between module completion rate and posttest performance.
Our study was limited by small sample size (N=6), but we continue to collect additional data with subsequent classes.  Multi-site deployment might permit correlation of curriculum utilization with milestones achievement in medical knowledge.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Medical Knowledge, Practice-Based Learning & Improvement, Independent Study, Problem-Based Learning,

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Timing the “Fun” to the Fundamentals of Laparoscopic Surgery (FLS) in an Obstetrics and Gynecology Residency Training Program

Purpose: To determine the time required by Obstetrics/Gynecology (OBGYN) residents to gain proficiency with FLS skills

Background: FLS is a standardized assessment of laparoscopic knowledge and skills and an eligibility requirement of The American Board of Obstetrics and Gynecology (ABOG) Qualifying Exam. There is no published data on expected training time to guide curricula planning or how PGY level, prior surgical experience, or milestone assignment may associate with FLS skill acquisition.

Methods: A prospective cohort study was performed at a community based hospital where PGY2-4 residents were consented to participate in a structured FLS curriculum, which included five skill sessions supervised by gynecologic surgical faculty. Time spent in supervised and self-study sessions was recorded. A baseline and final assessment of FLS skills was administered noting errors and time to complete. Participants reported PGY level, number of prior laparoscopic hysterectomy cases, and their endoscopic technical skill milestone levels, which were analyzed using multivariate regression analysis.

Results: No residents (n=17) passed the baseline assessment. All participants passed the final assessment after curriculum completion with improvement in time (-12.2  minutes p = 0.0005) and reduction in errors (-2.5, p = 0.0025). The amount of structured time spent with a faculty member was correlated with improvement in assessment time (r=0.5979) with at least 155 minutes demonstrating significant improvement (p = 0.009). PGY level, milestone level, number of laparoscopies, and self-directed practice were not associated with improvement in performance.

Discussions: Deliberate practice was the driving factor for FLS skill acquisition independent of PGY, milestone, surgical experience, or self-directed practice time.

Topics: CREOG & APGO Annual Meeting, 2020, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, GME, Simulation, Minimally Invasive Surgery, General Ob-Gyn,

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The Magic of Reflection: Facilitating Resident Discussion of Challenging Family Planning Patient Scenarios

Purpose: To describe residents’ experiences of a guided reflection workshop about patient interactions which provoke negative emotions in the physician

Background: In 2016 we trained faculty to facilitate a guided reflection workshop.  The Professionalism in Reproductive Healthcare Workshop (PRHW) guides obstetrics and gynecology (ob-gyn) residents in exploring interactions with challenging patients, particularly those seeking family planning care.

Methods: Faculty volunteered for the training via a community listserv, underwent a half-day training, and then led workshops at 23 different institutions. Institutions were informed about the workshop by listserv emails, and scheduled workshops into their resident didactics. We conducted pre- and post-training surveys and descriptive analyses to assess post-workshop resident satisfaction and changes in attitudes about patient scenarios using Likert scales.

Results: From 2016 to 2019, 27 faculty conducted 28 workshops with 222 residents in the US and Canada. We collected 139 post-workshop surveys (63%), and 72 matched pre- and post-workshop surveys.  Patient scenarios residents most frequently identified as challenging were women who had more than one abortion, and women who did not want to become pregnant but were not using contraception.  In matched surveys, learners demonstrated greater awareness of reasons a patient might not initiate contraception after abortion and greater acceptance of that decision compared with responses before the workshop  (p< 0.01). The majority (91%) rated the workshop as worthwhile.

Discussions: Resident learners exhibited more understanding attitudes towards challenging family planning patient scenarios after participating in the PRHW. Supporting resident reflections about challenging patient scenarios may improve their ability to provide more high-quality, patient-centered family planning care.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, GME, Contraception or Family Planning,

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Text vs Email for a Question of the Day: Which do Today’s Medical Students Prefer?

Purpose: Compare completion rates and satisfaction of question of the day(QOD) received via text vs email.

Background: Fast, hands on learning e-tools are a popular effective technique with current generation of medical learners.

Methods: Twenty-eight questions of the day(QOD) developed focusing on commonly missed NBME exam concepts. A prospective cohort study of ob/gyn clerkship students conducted. Students self-selected to receive QOD by text or email from 1/19-7/19. Students received QOD nightly on weekdays via text or email, completion was optional. 
Primary outcome was overall response rate(RR). Secondary outcomes include RR/question and average weekly RR. Qualitative feedback regarding satisfaction, time spent, and utility also obtained.

Results: Eighty-one medical students participated, 40 selecting text and 41 email. In sum, 863 texts and 1269 emails sent during study period. Overall text RR was significantly lower than email(55.2%vs78.6%,p< 0.001). For no question was text RR greater than email RR. Average RR did not vary by week(wk1: text 55% vs 83% email, wk6: text 64% vs email 77%).
43/81(53%) students gave qualitative feedback, 28/41 from email cohort, and 15/40 text. 86% found the QOD helpful/very helpful(no difference by mode of receipt). However, email recipients more likely to find it very helpful(54%vs13%,p=0.02). 77% found the level of difficulty to be “just right”,(no difference by mode of receipt). The QOD took all students less than 5 minutes. Nearly all(93%) students found the QOD worthwhile and 98% would recommend to future students.

Discussions: Surprisingly, QOD completion rates were higher with email than text, though satisfaction and perceived utility high in both groups.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Faculty, Clerkship Director, Medical Knowledge, Practice-Based Learning & Improvement, UME, Assessment, Independent Study, General Ob-Gyn,

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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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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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Increasing Resident Education in Pediatric and Adolescent Gynecology

Purpose: The NASPAG short curriculum project was initiated to improve education of gynecology residents in the field of pediatric and adolescent gynecology.

Background: Pediatric and adolescent gynecology is a limited field amongst obstetric and gynecology residency programs. Many programs have no clinical rotations and very limited didactic education in adolescent gynecology. NASPAG has created a ten lecture curriculum to better train residents in this field.

Methods: The NASPAG short curriculum was implemented and residents completed self-assessment surveys and examinations before, immediately after, and three months after the curriculum. Additionally, the mean scores for pediatric and adolescent questions on the CREOG exams were analyzed for the year prior to and immediately after implementation of the curriculum. Paired t-test analysis was used to determine if there was a statistically significant difference for each arm of the study.

Results: There was a statistically significant improvement in all ten areas studied in regards to the resident self-assessment surveys. Objectively, there was a statistically significant difference in six of the ten areas studied immediately after the course and four of the areas three months later. The implementation of the NASPAG curriculum led to an increase in the mean CREOG score on pediatric and adolescent questions from 57% to 62%.

Discussions: The implementation of the NASPAG short curriculum subjectively enhanced resident comfort level when caring for pediatric and adolescent gynecologic patients. The curriculum also led to improved medical knowledge amongst the residents. This curriculum may be a vital tool in preparing for the standardized CREOG exams. 

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

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Improving the Basic Science Curriculum by Integrating the Clinical Sciences

Purpose: To evaluate medical student perceptions on whether curriculum innovations through the integration of clinical medicine with basic science improves learning in the pre-clinical curriculum.

Background: Medical schools are transitioning to competency-based curricula that emphasize an early introduction to clinical training. Students who learn basic science explanations for clinical correlates have improved retention. By integrating clinical sciences into the pre-clinical curriculum, learning is optimized for students.

Methods: At the end of the Reproduction pre-clinical sequence at the University of Michigan, students were asked to evaluate the overall quality of the course, whether objectives were met, and whether the course was well-organized, with a one-to-five level scale. These parameters were compared for the sequence between 2018 and 2019, after curricula changes were introduced.

Results: For the Reproduction sequence in 2019, course assessment parameters were improved in comparison to 2018 values. Overall, students rated the quality of the course as “very good/excellent” (4.21 ± 0.91), compared to “fair/good” (2.88 ± 1.01). Students “strongly agreed/agreed” that objectives for the course were met (4.44 ± 0.82) versus “agreed” (3.74 ± 0.88), and “agreed” that the course was well-organized (4.21 ± 1.07) compared to “disagreed” (2.66 ± 1.19).

Discussions: The restructuring of the Reproduction sequence allowed for purposeful integration of clinical medicine into the basic science pre-clinical curriculum, resulting in improved quality of learning for students. Recruiting clinical faculty for lectures, and implementing case-based instruction with the APGO videos for supplementation, provided an effective and efficient method of integrating clinical medicine content within the sequence.

Topics: CREOG & APGO Annual Meeting, 2020, Clerkship Director, Medical Knowledge, Practice-Based Learning & Improvement, UME, Lecture, Problem-Based Learning,

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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 TrueLearn Question Bank on Resident Performance on the CREOG In-Service Training Exam

Purpose: To determine how implementation of the TrueLearn (TL) question bank and mock in-service training exam (ITE) impacts performance on the CREOG ITE.

Background: The CREOG ITE is an annual exam on which, success has been correlated to success on the American Board of Obstetrics and Gynecology Qualifying Exam. Question banks are quickly becoming a popular study tool, but their utility on improving CREOG ITE performance is unknown.

Methods: We performed a quasi-experimental retrospective review of the CREOG ITE score reports from 2017 to 2019 at our institution. Starting in 2018, TL was made available and a mock ITE was administered for the first time. A two-sided paired t-test compared average annual improvement in CREOG ITE scores before and after TL implementation. Correlation coefficients between TL usage and improvement on the 2019 ITE were calculated using Pearson correlation testing and a linear regression was used to determine their association.

Results: After providing TL, mean improvement in percentage points on the CREOG ITE was 6.6, 9.33 and 6.75 as residents matriculated from PGY1-2, PGY2-3 and PGY3-4 respectively. This was a significant improvement compared to the previous year.  As a program there was a moderate correlation with TL usage and percentage point improvement on the CREOG ITE; r=0.38, p= 0.038.

Discussions: After providing universal access to TL question bank and administering a mock ITE, a statistically significant improvement on the CREOG ITE was seen. TL’s question bank and mock ITE are valuable resources for improving CREOG ITE performance.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Independent Study, Problem-Based Learning, General Ob-Gyn,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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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Duty Hours and Medical Student Performance: Is There a Correlation?

Purpose: To describe the association between duty hours (DH) and shelf exam score, and between DH and overall grade.

Background: Medical students are required to comply with the same DH regulations as residents. However, variation exists between the total DH worked due to diversity of clinical sites, surgical rotations, and student engagement. The impact of DH on exam scores and clinical grade is poorly understood.

Methods: Retrospective cohort study of students in OB/GYN clerkship at a single academic center from 8/18-6/19. Weekly duty hours tabulated and averages obtained. Students working more than 75%ile for DH weekly (long hours) compared to those working less. Impact of long hours in last two weeks of clerkship also examined. Outcomes of interest were high overall grade ( >95%), high shelf score ( >90%), and low shelf score (< 60%) adjusted for quartile of year. Simple statistics used to analyze data.

Results: The average weekly DH was 43.1hr/wk (SD 7.32hr). This didn’t vary by gender. Students in the latter half of the year worked longer (45.2 hrs/wk vs 41.9 hrs/wk, p=0.03). The 75%ile of weekly DH was 47.1 hrs. Students working long hours were not more likely to have low shelf (21.7% vs 30.4%,p=0.6), high shelf (28.3% vs 28.6%,p >0.99), or high overall grade (25% vs 28.9%,p >0.99). Long hours in the last 2 weeks of the clerkship was not associated with high overall grade (33.3% vs 31.1%,p >0.99) or low shelf (21.7% vs 34.2%,p=0.32). A trend toward high shelf scores was seen (41.3% vs 23.2%,p0.06).

Discussions: Long duty hours, even late in the clerkship, were not associated with high or low shelf scores, nor high overall grade.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Medical Knowledge, UME, Assessment, General Ob-Gyn,

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Curriculum Development in the OBGYN Clerkship: Effect on NBME Scores

Purpose: Investigate whether implementation of APGO Medical Student Educational Objectives into an OBGYN clerkship didactic curriculum results in higher NBME exam scores.

Background: Medical student curriculum reform is at the forefront of OBGYN educational research. Active, adult learning techniques are highly touted; data are promising for student satisfaction, but more studies about effect on objective assessments are needed.

Methods: We implemented 21 of 58 APGO Medical Student Educational Objectives into the OBGYN Clerkship didactic curriculum during academic year (AY) 2018-2019. Students were assigned pre-reading material and completed weekly, graded individual readiness assessment tests, followed by team readiness assessments, before each didactic session. NBME scores were compared pre- and post-intervention (AY 2017-2018 to AY 2018-2019, respectively) by yearly cumulative, as well as by individual cohort within each year. Analysis was completed with independent samples t-test with two-sided P < 0.05 statistically significant.

Results: Overall, AY 2018-2019 had higher average NBME scores than AY 2017-2018, although not statistically significant (79.5 vs 78.6, P=0.29). Cohorts 4 and 6 showed significantly higher scores in AY 2018-2019 relative to AY 2017-2018, 80.0 vs 75.4 and 82.1 vs 77.7 respectively, (P< 0.05). Cohorts 3 and 5 scores were slightly higher on average and cohorts 1 and 2 scores were lower on average in AY 2018-2019 relative to AY 2017-2018, but these differences were not found to be statistically significant.

Discussions: Implementation of the APGO Medical Student Education Objectives into our OBGYN didactic curriculum showed a trend toward higher NBME scores, suggesting benefit, however this difference was not statistically significant.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Faculty, Clerkship Director, Clerkship Coordinator, Medical Knowledge, GME, Assessment, Lecture, Team-Based Learning, General Ob-Gyn,

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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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Care Across the Life Cycle: Results of an Integrated Pediatric, Obstetrics and Gynecology, and Geriatric Medical Student Clerkship

Purpose: The authors explore medical knowledge attainment and course evaluation data in Pediatrics and Obstetrics and Gynecology after the implementation of a novel, three-phase undergraduate medical school education curriculum called ForWard. In ForWard, the two clerkships were shortened from six to four weeks and combined with geriatrics to form an integrated 12-week clinical block.

Background: The traditional structure for clinical clerkships are specialty specific rotations. Due to evolving needs of both patients and learners, there has been interest in integrating the clinical fields during delivery of undergraduate medical education. With any curricular change, it is important to evaluate the learning outcomes.

Methods: Pediatric and Obstetrics and Gynecology NBME subject exam scores were compared prior to (n=180) and after (n=162) the implementation of the ForWard curriculum using an analysis of variance with covariate (ANCOVA).  Student satisfaction with the traditional and ForWard curriculum were determined based on post-clerkship evaluation forms and compared using unpaired t-tests.

Results: The unadjusted mean NBME Pediatrics and Obstetrics and Gynecology subject examination scores were 77.1 and 80.0 in the traditional curriculum and 76.9 and 79.3 in the ForWard curriculum (p=0.83) and (p=0.37). The mean Pediatric and Obstetrics and Gynecology clerkship evaluation scores in the traditional curriculum were 77.1 (SD 7.6) and 80.0 (SD 6.9) compared to 76.9 (SD 7.9) (95%CI -1.84-1.47) and 79.3 (SD 7.7) (95%CI -2.26-0.85) in the ForWard curriculum.

Discussions: Despite shortened Pediatric and Obstetrics and Gynecology clerkship experiences, performance on the NBME subject examinations in both subjects was unchanged and student satisfaction was maintained.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Medical Knowledge, UME, Assessment, General Ob-Gyn,

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