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Wellness Wednesday: Utilization of Strategic Duty-free Hours by OB/GYN Residents

Purpose: To detail the specifics of how OB/GYN residents utilize a monthly duty-free afternoon for wellness activities. 

 

Background: Much attention is paid to burnout and high rates of depression among physicians. Some speculate these difficulties may start in medical school but that they become cemented and sometimes problematic in residency. Studies have made implications that interventions, specifically promotion of self-care and work-family balance, and work hour restrictions, early in residency can decrease burnout and depression levels.  

 

Methods: Starting in 2016, all residents of an OB/GYN program were allowed to have the first Wednesday afternoon of each month free from clinical duties. Faculty members covered all clinical services from noon to 5pm. Residents were then permitted to use the time for whatever they felt promoted their well-being. Two years of data were collected through surveys to determine the specific activities completed by the residents. 

 

Results: The commonly reported activities included health care visits, financial planning activities, leisure time with family/friends, community or church group events, every day errands, home chores, and fitness. Additionally, the residents also used the time away from clinical responsibilities to study and fulfill administrative requirements. 

 

Discussions: By better understanding what residents choose to do to promote their own well-being, programs can then tailor structured wellness activities to those choices.  Alternatively, programs can look at an open-ended wellness day as a possible intervention for fostering excellent overall health and welfare of their residents. More research is needed to validate this approach to wellness promotion.

 

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

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Using Student Interest Groups to Train Medical Students to Lead

Purpose: Medical student interest groups (SIG) serve as students’ introduction to medical specialties. The student leaders of these groups are driven and demonstrate leadership ability early in their careers. Connecting these student leaders with young physicians can improve specialty matriculation, leadership among new residents, and foster mentorship in the organization.

 

Background: The American College of Obstetrics and Gynecology (ACOG) has leadership positions for residents, however, less for medical students, who are encouraged to participate in meetings rather than engage.  SIG leaders have not been a focus of recruitment for ACOG, however, these students are primed to become leaders in ACOG upon completion of medical school. 

 

Methods: Prior to the 2017 ACOG’s Annual Clinical and Scientific Meeting, we contacted medical students registered for the meeting to identify any SIG leaders. A meeting was arranged for student leaders to meet with several national representatives. The group of 17 students was introduced to the structure and benefits of the organization and given training for optimizing SIG function and efficacy. Through our survey, all students appreciated the information about ACOG, ideas on how to improve their SIG, and resources available through ACOG, rating it as just the right of information or stated they would like to hear more.

 

Results: Sixty four percent were planning on establishing a generic SIG email to improve communication with ACOG while 23% already had one. When asked if they felt prepared to take the information back to their SIGs, all students answered positively. Only three of the 17 students had read a leadership book and all students said they would love to participate in a more formal leadership training. 

 

Discussions: Medical student leadership represents a natural group to become future ACOG leaders. Given the barrier of contacting the SIG leaders, we recommended establishing a generic email address for groups (eg OBGYNSIG@***). All students wanted leadership training and to be involved in ACOG. In conclusion, medical SIG leaders are an enthusiastic and untapped resource who will become our colleagues. Connecting with student leaders at organizational meetings secures future leadership and continued engagement after medical student graduation. 

Topics: CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Clerkship Coordinator, Professionalism, Systems-Based Practice & Improvement, GME, Independent Study,

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Use of Video Interviews for Selection of Obstetrics and Gynecology Residents

Purpose: To improve the residency selection process using asynchronous video interviews

 

Background: Residency applications have increased, while data available for decision making in ERAS has been static. One-way (asynchronous) video interviews (OWVI) involve the candidate recording answers to pre-selected questions.

 

Methods: Applicants to an OB/GYN residency program with USMLE Step 1 ≥ 220, no USMLE failures and at least 3 months of US clinical experience were scored using five criteria (USMLE 1 score, clinical clerkship grades, letters of recommendation, research achievements and extracurricular/leadership activities) scored 1-5, with 5 as the top score. Applicants with scores from 19 to 22 were invited to complete an OWVI.  The OWVI consisted of 1 open ended question and 2 behavioral questions, scored from 1-5. Applicants were invited for an in person interview based on their video interview scores.

 

Results: For the 2018 residency application season, 495 applications were received, 272 applications were scored and invited to complete a video interview, 234 applicants completed OWVI and 97 OWVI were used for the decision to invite for an in-person interview. Mean OWVI score was 10.4 (range 4-15). For the 2018 season, OWVI scores were weakly correlated with rank list placement (Pearson coefficient = 0.29), in-person interview scores (0.18) and application scores (0.33). The mean in-person interview score increased after implementation of OWVI screening from 59.0 in 2017 to 62.2 in 2018 (P<0.01).

 

Discussions: Use of OWVI led to higher in-person interview scores, suggesting that video interviewing is a useful supplemental tool for selecting competitive residency candidates.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, GME, UME, Assessment,

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

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

 

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

 

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

 

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

 

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

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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The Substantial Rise of Clinician Educators Among Obstetrics and Gynecology Faculty, 1977-2017

Purpose: To determine trends in faculty career development, stratified by gender and under-represented minority (URM) status, for obstetrician-gynecologists (ob-gyn) at all U.S. medical schools.

 

Background: The growing number of faculty and opportunities for career pathways have expanded considerably at U.S. medical schools. This growth differs between clinical specialties. Any dominance of non-tenure faculty has important implications on academic promotion policies and teaching expectations.

 

Methods: In this observational study, we used the Association of American Medical Colleges Faculty Roster to describe trends in career pathways (clinician educator, tenure-track, tenure) of full-time faculty at all U.S. MD-granting medical schools between 1977 and 2017.  Proportions of female and URM faculty on each pathway were compared with that of male and non-URM faculty.

 

Results: Between 1977 and 2017, the number of full-time faculty increased from 1,628 to 6,347, mostly as clinician educators (from 345 to 4,607; 13.4-fold increase) than as being either tenured (from 457 to 587) or on tenure-track (366 to 514). The proportion of clinician educators increased from 21.2% to 69.4%. The availability of tenure positions remained constant (92.7% of all schools); however, the proportions of tenured and tenure-track faculty declined steadily from 28.1% and 22.5%, respectively to 8.2-9.1% for each group.  The proportions of male and female faculty who were tenured or on tenure track declined from 52.9% and 37.1% respectively to 23.3% and 13.6%. The proportion who were tenured or on tenure-track declined similarly for URM (from 55.3% to 13.4%) and non-URM (from 50.2% to 18.0%) faculty.

 

Discussions: The substantial rise in ob-gyn faculty is largely among those who pursued careers as clinician educators. This finding confirms the essential need and protected time for educator development programs at all schools to more effectively teach medical students and resident physicians.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Professionalism, CME, Lecture,

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Targeted Interventions to Improve Resident Well-being

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

 

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

 

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

 

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

 

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

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

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

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

 

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

 

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

 

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

 

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

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

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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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Service-learning Wellness Initiative in the Harvard Medical School Clerkship Curriculum

Purpose: The first aim was to assess if incorporation of a service-based initiative into the curriculum results in professional fulfillment, principally: improved medical student feelings of compassion, contribution, wellness, understanding of community need, and team-building of the student class. The second aim is to report the development of this curriculum project.

 

Background: Service-learning increases student awareness of community resources, promotes service to the community, team-building through cooperation rather than competition, broadens cultural awareness, and fosters wellness through hands-on contribution.

 

Methods: The entire class of second year clerkship students volunteered at a local non-profit organization. Students were divided into small groups to work at various team tasks.  Following, the entire group reconvened for teaching reflection. They were asked a value-based qualifier of the experience. They were also asked to provide feedback as an open response. Quantitative data were analyzed using summary statistics, Wilcoxon rank sum and Fischer’s exact test. Content analysis was used to determine themes from the open-ended responses.

 

Results: 47 students participated, 48.9% of whom were male. Average satisfaction with the intervention was high (mean 4.26 on a 5-point Likert scale), with no difference in satisfaction noted by gender. Positive themes included feelings of contribution, wellness, and team-building, with 9 respondents requesting to repeat the event at regular intervals.

 

Discussions: It is crucial to investigate different types of wellness interventions throughout UME. Service-based interventions are not adequately studied and may be an important addition to the wellness program as they are a way for students to feel connected to the community they are serving.  

Topics: CREOG & APGO Annual Meeting, 2019, Faculty, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Team-Based Learning, Public Health, General Ob-Gyn,

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

 

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

 

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

 

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

 

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

 

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

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

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

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

 

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

 

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

 

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

 

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

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

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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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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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Perceptions Regarding Medical Students Performing Pelvic Examinations on Anesthetized Female Patients

Purpose: The purpose of this study was to determine perceptions regarding medical students performingpelvic examinations on anesthetized female patients.

 

Background: Pelvic exams performed under anesthesia continues to be a controversial topic, but studies looking at medical staff are lacking.

 

Methods: An internet based survey was distributed to OB/GYNs, OR nurses/techs,anesthesiologists/CRNAs, and medical students at multiple hospitals and medical schools.Demographic data were collected. Non-demographic answers to questions were recorded on a 5-point scale. Characteristics between the respondent groups were statistically compared usingChi-squared test for independence and the Fisher’s Exact Test.

 

Results: 337surverys were completed. 72% of respondents believed permission should be obtained from patientsprior to the performance of EUAs by medical students on anesthetized femalepatients. 30% of respondents believed prior consent was usually obtained. 50% believed patients would agree to have the exams performed. 80% thought patients would be upset if an EUA by a medical student was performed on them  without their prior consent. 32% of nurses believed medical students should be allowed to examine anesthetized patients.  Medical students were less likely to believe it was appropriate for a student to examine a patient, there was an educational benefit, and that patients would consent. 

 

Discussions: Despite the perception of all OB/GYN OR team members that consent should be obtained beforemedical students perform pelvic examinations on anesthetized female patients, this does notusually occur. Almost 50% of medical students would not encourage their female relatives toconsent to medical students performing such pelvic examinations.

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

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

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

 

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

 

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

 

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

 

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

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

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

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

 

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

 

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

 

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

 

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

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

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OB/GYN Resident Education and Experience with Reproductive Justice

 

Purpose: To understand OB/GYN resident experience with reproductive justice.

 

Background: Reproductive justice (RJ) is defined as: the right to have a child, the right to not have a child, the right to parent the children we have, and the right to control our our birthing and contraceptive options. Despite its relevance to OB/GYN residency milestones, such as patient-centered care, patient advocacy, and informed consent, there is currently no formalized RJ education in residency training.

 

Methods: We distributed a web-based survey to U.S. OB/GYN residents to better understand educational and clinical experiences with RJ. Participants were asked to share clinical experiences with reproductive injustices. Qualitative data were coded using content analysis and quantitative data were analyzed using descriptive statistics.

 

Results: We received 358 responses from OB/GYN residents, representing 67 U.S. residency programs.  48% of respondents had not received RJ education during their training. OB/GYN residents reported a variety of clinical experiences with reproductive justice issues; of the 156 cases shared, common themes included fertility treatment access, care of marginalized populations, abortion care, and informed consent. Seventy-seven percent of respondents were interested in receiving further RJ training and 96% of residents felt that they would benefit from training.

 

Discussions: OB/GYN resident experiences with reproductive injustices are widespread and residents desires additional education. Our results reveal an opportunity to incorporate these shared clinical experiences into an innovative RJ curriculum design where residents learn from each other’s diverse clinical experiences while also applying milestones.      

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Patient Care, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, UME, Problem-Based Learning, Public Health, Advocacy, Contraception or Family Planning,

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