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Pilot Study of Interactive Video-assisted Laparoscopic Teaching for OB/GYN Surgical Residents

Purpose: It is common knowledge that athletes review tapes as part of training. Although differences between a sports game and surgery are obvious, both require technical skill and performing under pressure. Surgeons may benefit from reviewing surgical tapes in training.

Background: Prior studies have explored using surgical videos to increase exposure to operative scenarios or evaluate technical skill. However, no standardized approach exists to incorporate video review into surgical training, particularly in gynecology. This interactive teaching model uses review of laparoscopic videos to enhance surgical knowledge and technique.

Methods: A gynecologic surgeon led participants through review of laparoscopic gynecologic surgery videos. The surgeon highlighted aspects of the video, pausing to enforce teaching points and lead discussion. Participants completed a 25-question multiple-choice survey prior to, immediately after and two months after the session. Individual changes in scores were analyzed before and after aforementioned intervention, stratified by residency year.

Results: Of participants who underwent the intervention, 100% completed the pre-survey, 60% completed the immediate post-survey. Response rate was 40% for the 2-month post-session survey. Of those who underwent intervention and completed the post-session survey, 71% improved their score while 29% had no change. When stratified by year, junior residents showed score improvement, senior residents had no change.

Discussions: Video-assisted teaching can enhance gynecologic surgical training. It seems most beneficial earlier in training as junior residents have yet to develop ways of doing things. While video sessions do not replace OR time, they provide forums for reviewing surgical approach and technique with visual aids to reinforce teaching points.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Team-Based Learning,

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Spellbound: Impact of a Professionalism Workshop on Abortion Attitudes for Residents at Catholic Programs

Purpose: To determine if a professionalism workshop that explores attitudes about abortion care influences ob-gyn resident attitudes at Catholic residency programs.

Background: Catholic residency programs face institutional barriers to abortion training.

Methods: Between 2018-2019, we provided professionalism workshops at five Catholic programs that do not provide abortion training. Participants received a pre and post survey related to abortion training and attitudes.  We compared Likert responses using Wilcoxon matched pair test. 

Results: 41 residents (87% of eligible residents) completed both surveys; 29.3% reported Catholic religion, 14.6% reported their personal views on reproductive care are in line with their institution, and 12.2% reported selecting a Catholic program based on its religious affiliation.  With respect to prior abortion experiences, 75.6% provided options counselling, 41.5% provided abortion referral, and 9.8% provided first-trimester abortion for nonmedical reasons.  Views on whether abortion or related circumstances is justifiable did not change for a patient presenting with an undesired pregnancy (p=0.32), but demonstrated increasing acceptance for the following circumstances:  (1) patient presenting for abortion at 19 weeks (p=0.001), (2) patient presenting for second abortion (p=0.01), and (3) patient declining post-abortal contraception (p< 0.001).  Emotional reactions to scenarios were unchanged.  When asked about when abortion is morally acceptable, views became more accepting for patients presenting with financial inability (p< 0.01) and for disruption to career or education (p< 0.01).

Discussions: A professionalism workshop can be a useful tool for residents at Catholic training programs to explore their abortion attitudes and results in more accepting attitudes toward women who choose abortion in certain circumstances.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, Assessment, Public Health, Contraception or Family Planning,

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Proficiency Perception and Relevance of Gynecological Procedures Among Obstetrics and Gynecology Graduates; Evaluating the Residency Surgical Curriculum

Purpose: To determine graduates’ perception of their proficiency in gynecologic operations and the relevance of these procedures to their current practice

Background: Program directors must certify that graduates are competent to practice without supervision after residency. Achieving proficiency in gynecologic surgery after 4 years is challenging. Evaluating the current surgical curriculum is critical

Methods: A survey of 40 graduates from a single academic instituition was conducted. 36 gynecologic procedures were listed. Each procedure corresponded to two four-point scales (strongly agree to strongly disagree). One scale was headed with preparation to independently perform the operation, and the other questioned the relevance of the procedure in their current practice. A third scale reviewed the need for additional training, and the case/volume per year. A subgroup analysis was done to evaluate the preferred route of hysterectomy and the rationale if vaginal hysterectomy was avoided

Results: The response rate was 67.5%. All respondents felt prepared to perform 25% (9/36) of procedures. More than 50% did not feel competent performing laparoscopic single site hysterectomy, laparoscopic myomectomy, sling, utero-sacral ligament suspension, vesico-vaginal fistula repair, colpocleisis, and office hysteroscopy. Vaginal hysterectomy was relevant for 78% of graduates, however, 89% performed fewer than 10 cases per year, and 55% would benefit from additional training. More than 50% of graduates would choose a non-vaginal route of hysterectomy, and interestingly, 93% of those based their decision on lack of comfort with the procedure

Discussions: While several gynecologic surgeries are relevant to recent graduates’ practices, some may not feel competent performing these procedures after residency. Vaginal hysterectomy is not commonly performed among graduates, largely due to inexperience with the procedure

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Patient Care, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME,

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OBGYN Trainees Perception of Departmental Climate with Regards to Sexual Harassment

Purpose: To assess Obstetrics and Gynecology(OBGYN) trainees’ perception of departmental-cultural-climate(DCC) regarding sexual harassment(SH).

Background: Positive DCC results in better psychological health and workplace environment. Climates perceived to be permissive of SH by the employees has lower overall work satisfaction.

Methods: Using REDCap data collection tool, we conducted an anonymous survey of OBGYN trainees in ACGME-accredited residency/fellowship programs in the U.S. The survey included demographics; the validated Sexual Experience Questionnaire(SEQ) short form; and assessment of DCC via questions regarding institutional reporting systems and trainees’ perceptions of how complaints would be handled. Descriptive statistics were utilized.

Results: The survey was distributed to 1,473 residents/fellows in the U.S. with 26.8%(395/1,473) response rate. The prevalence of SH was 69.1%(253/366). 90.3%(331/366) of trainees felt safe in their institution, while only 3.0%(11/366) felt unsafe. 72.7%(8/11) of trainees who felt unsafe had experienced SH. 88.5%(337/381) believed their SH report would be taken seriously. 75.1%(286/381) believed privacy would be maintained. 80.3%(305/380) thought their department would support them, and 76.7%(289/377) that the report would be handled fairly. 15.6%(59/379) thought they would be labeled as a troublemaker, and 10%(38/379) thought they would be punished.  Only 3.3%(4/121) made an official report. 67.4%(149/221) did not tell anyone; and 39.4%(95/241) did not know of a reporting system. No action was taken for 47.5%(29/61) of the reports; the perpetrator was spoken to about their behavior[14.8%(9/61)]; concerns were taken seriously[8.2%(5/61)]; and, concerns were found to be unsubstantiated[1.6%(1/61)].

Discussions: OBGYN trainees are often reluctant to report SH, and OBGYN departments may to need improvement in DCC based on our results.

Topics: GME, Systems-Based Practice & Improvement, Professionalism, Residency Coordinator, Residency Director, Osteopathic Faculty, Clerkship Director, Faculty, Resident, Student, 2020, CREOG & APGO Annual Meeting,

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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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Does Personal Care Impact Burnout? An Academic Institution’s Exemplar

Purpose: To assess resident compliance with routine health maintenance and risk of burnout at a single midwestern institution

Background: Resident physician burnout is a concern facing medical education. It has been linked to depression, inversely correlates with job satisfaction, and has a cumulative effect as the years of residency progress. Correlations between suspected burnout and reduced resident personal care have been sparsely assessed.     

Methods: Residents in all specialties at the University of Toledo were surveyed in the last academic year through an anonymous 27-item online survey addressing health care compliance and risk of burnout (using a non-validated index). A total of 75 surveys were completed.

Results: Up to 40% of residents had neither seen a primary care provider nor had routine eye exams in >24 months while >30% had no dental care in the previous 12 months. 80% of residents reported clinical duties preceded personal wellness. 50% reported financial concerns as a contributor to decreased wellness. 100% of residents were at risk of burnout with only 25% in the low-risk category. Of those in the severe risk category, 80% addressed their condition by ignoring it and had the least mental health service utilization.

Discussions: Un-aligned resident priorities may result in ignoring oneself and one’s needs. This in turn may result in increased predisposition to burnout. Mental, physical and financial wellness need to be assessed and addressed by institutions regularly. Mitigation modalities, as implemented at our institution following the survey, will need to be in place to enhance personal care, subsequently reducing risk of burnout.

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

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

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

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

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

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

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

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

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Context Impacts Ob Gyn Resident Performance and Attitude After Participation in a Quality Improvement Curriculum

Purpose: To explore how contextual factors influence ob/gyn residents’ ability to apply acquired knowledge and their self-confidence and attitudes towards QI endeavors after exposure to a QI curriculum.

Background: In order for QI to be embraced and perceived as a core value similar to that of any other aspect of training, there must be a deeper understanding of what aspects of the individual learner, the learning environment, and the interaction between the learner and his/her environment are necessary for ensuring that the practice of QI is a part of and not separate from providing excellent, high quality patient care.

Methods: The authors used an explanatory sequential mixed methods design.  The study was deemed exempt by the IRB. First and second year residents from Ob Gyn, Family Medicine, Pediatrics and Anesthesia were exposed to a didactic and experiential 11-month QI curriculum.  Pre/post curriculum assessments included QI knowledge application (QIKAT-R, range 0-9) and a questionnaire measuring confidence and attitudes about QI (range 6-50).  Quantitative data were analyzed using a two-way mixed design ANOVA (P< .05 was significant). After completion of the assessments, participants engaged in semi-structured interviews to facilitate understanding of how contextual factors affected their attitudes, self-confidence and/or ability to apply their QI knowledge.

Results: 37 residents participated in the curriculum. Although there was no significant change in mean pre/post overall QIKAT-R score (4
+1 vs. 4
+1) for the cohort of ob gyn residents (n=6) in comparison to the overall group (n=31), ob gyn residents showed a significant increase in composite self-efficacy score (32.5+0.7 vs. 36.6+0.8, p< .0001, η2 = .55) after participating in the curriculum.  Semi-structured interviews revealed that prior QI exposure, perceived value of QI, engagement of the departmental faculty preceptor, and time allotted for the curriculum were associated with a change in QI knowledge and overall attitude about QI practice.

Discussions: This study demonstrates that exposure to a targeted QI curriculum will result in increased resident confidence in applying this QI knowledge and suggests that QI knowledge acquisition does not correlate with changes in attitude and confidence.  Individual and departmental contextual factors are important to consider when designing and implementing a QI curriculum.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Quality & Safety,

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

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

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

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

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

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

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

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Assessment of Chief Resident Laparoscopic Hysterectomy Performance Using Global Operative Assessment of Laparoscopic Skills (GOALS)

Purpose: To implement a validated, standardized tool to assess resident performance during laparoscopic hysterectomy.

Background: Surgical feedback  is critical to resident education, but it is often subjective and sporadically given. GOALS is a validated tool consisting of a 10-item checklist, 5-item global rating score, and an overall satisfaction score that is widely used in general surgery to assess resident skills during laparoscopic cholycystectomy and appendectomy.

Methods: Chief residents and one attending performing laparoscopic hysterectomies together filled out blinded evaluations after each case. The checklist was constructed by identifying 10 critical steps in completing the operation independently. Five laparoscopic domains (depth perception, bimanual dexterity, efficiency, tissue handling, and autonomy) and an assessment of case difficulty were scored on a 5-point scale. Overall satisfaction with the resident performance was rated on a 10-point scale. Paired t-tests were used to compare resident and attending scores. A regression analysis demonstrated an association between case difficulty and resident step completion.

Results: 56 hysterectomies were performed during the study interval with a mean step completion resident score of 6.9 (attending score 6.8; P = 0.56). Residents rated themselves lower in laparoscopic skills than the attending (3.25 vs 3.6; P = 0.0001), even though estimation of case difficulty was similar (2.81 vs 3.13; P = 0.03).

Discussions: We describe here a method for standardizing feedback and evaluation in the performance of laparoscopic hysterectomies. Residents consistently perform about 7 of the 10 steps required to independently perform laparoscopic hysterectomy. Trainees were more critical than the attending in assessing their own performance.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Gynecologic Oncology, Minimally Invasive Surgery, General Ob-Gyn,

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Assessing the Effectiveness of Single Session Didactic Teaching in Improving Health Care Professionals’ Knowledge of the LGBTQ Population

Purpose: To examine the impact of a single didactic session on short-term knowledge acquisition and long-term knowledge retention of principles related to LGBTQ healthcare.

Background: Individuals who identify as Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) compose an estimated 1.1-3.8% of the population. Despite significant legal and societal advances, disparities persist in LGBTQ health care education, delivery, and outcomes. Multiple national medical organizations have produced initiatives emphasizing the development of educational resources to address these disparities.

Methods: A prospective observational study was performed. Knowledge acquisition was examined by a written survey, including 5 semantic differential scale and 5 multiple-choice questions. The survey was provided prior to and after a didactic session, then again four weeks later. Participation was voluntary and anonymous. Statistics were analyzed using Graph Pad Prism 8 Software (San Diego, CA).

Results: Comparing summed scores, immediate pre and post results (n=63) showed significant improvement across both semantic differential scale (5.7-7.78; p-value 0.00005) and multiple-choice (71%-91%; p-value 0.0004) questions. The 4-week post results (n=33) showed knowledge degradation, but significant improvement when compared to pre-test (5.7-7.21; p-value 0.01, 71%-86%; p-value 0.0095). The most significant improvements were in knowledge of LGBTQ community resources (3.9-7.6-6.4; p-value < 0.00001) and options for gender affirmation (51%-73%-69%; p-value < 0.00001).

Discussions: As medical curricula continue to evolve to address the needs of the LGBTQ population, this study indicates that a single didactic session may significantly improve provider knowledge about LGBTQ health care. This should result in improvements in awareness and communication, patient satisfaction, and health outcomes.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, CME, Lecture, Public Health, Advocacy, General Ob-Gyn, Sexuality,

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

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

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

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

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

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

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

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Visualizing Quality Challenges and Using Corrective Refraction to Focus Change

Objective/Background: Quality improvement (QI) initiatives drive change to streamline processes, minimize waste, and improve outcomes. Although QI efforts are commonly applied to medicine, we receive little formal training.  Our workshop will address this knowledge gap by providing attendees with an infrastructure the use educate trainees and other providers about the core components of a QI initiative.

Workshop Agenda: We will provide an overview of QI improvement in industry with application to medicine (15 min).  The remainder of the workshop will be a “hands-on” group effort to address an identified quality issue.  Small group discussions will focus on an “Sticky Note” affinity sort identifying factors/barriers associated with the quality issue (10 min).  The group will share ideas and collaborate to create a cause-effect fishbone diagram and process flow map for the identified quality issue (20 min).  Each small group will then independently identify a proposed process improvement and define core process, outcome, and balancing measures to measure through a plan do study act (PDSA) cycle (15 min).  The workshop will conclude with a discussion of each groups plan and proposed measures (15 min)

Interactive Component:

  1. “Sticky Note” Affinity Sort Brainstorming
  2. Cause-Effect Brainstorming/Creation of Fishbone Diagram
  3. Process Flow Map Brainstorming
  4. Process Improvement Approach/Outcome Assessment Brainstorming
  5. Discussion of Proposed QI Approach and Measures


Take Home Product: Attendees will return to their institutions with a framework and “tool kit” to use to approach QI initiatives and to train medical students and residents. 


 

Topics: Quality & Safety, UME, GME, Systems-Based Practice & Improvement, Residency Coordinator, Residency Director, Clerkship Director, Faculty, Resident, 2020, Faculty Development Seminar,

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Turning The Lens Inward: Using Strengths Identification To Improve Team Work, Performance, And Patient Care

Objective:  Strengths work is a positive psychology approach that turns the notion of problem-based living upside down, using identification of what is going RIGHT to improve individual and team performance, as well as career longevity and job retention. 

Workshop agenda
Introduction to strengths work and literature supporting its use (5 minutes)
Individual completion of an established strengths assessment (15 minutes)
Group discussion and formation of large screen matrix of different strengths and how they contribute to our professional roles (15 minutes)
Dyad analysis of individual strengths as they support current roles and responsibilities (10 minutes)
Overview of free access, commercial and educational resources to bring strengths analysis to learners and colleagues (5 minutes)
Table discussion of specific methods of bringing strengths work to home institutions (10 minutes)
Large group compilation of ideas for take-home work (10 minutes)
Wrap up (5 minutes)

Interactive component:  Attendees will work individually, as dyads, as tables, and as large groups to identify and analyze their individual strengths, determine effective means of applying their strengths to their current roles, and determine realistic ways to bring strengths work to their own environs.

Take-home product: Participants will leave with a formal assessment of personal strengths, new means of applying strengths to daily work, and a specific plan to introduce strengths work at home institutions. 

Topics: UME, Systems-Based Practice & Improvement, Clerkship Coordinator, Clerkship Director, Faculty, 2020, Faculty Development Seminar,

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No Blurry Lines: Creating A Clear Vision For LCME Accreditation Visits

Objective: The LCME accreditation process can be overwhelming.  Early, thorough preparation is the key to a successful outcome.  This workshop will describe tools and strategies for preparing your clerkship and avoiding common pitfalls.  We will specifically discuss methods of improving communication and ensuring equivalent experiences in multi-site programs. 

Workshop agenda:  
Review of LCME preparation guidelines (5 min)
Overview of identified LCME standard-related vulnerabilities (5 min)
Individual identification of vulnerabilities using our checklist (15 min)
Table discussion of vulnerabilities and shared experiences (15 min)
Large group discussion of approaches to meet identified needs (20 min)
Behavioral strategies to manage the visit (5 min)
Suggestions for high yield talking points (5 min)
Wrap up (5 min)

Interactive component: Using our checklist, small groups will identify potential vulnerabilities as they relate to pertinent LCME Standards.  Participants will then share ideas and generate common themes in gap analysis.  Individuals will have an opportunity to test their own knowledge of LCME standards and answer sample questions.  

Take-home product: An outline of LCME accreditation visit needs and potential solutions will be provided and augmented by participants.  Participants will also receive a summary high yield LCME talking points document from a recent successful visit. 

Topics: UME, Systems-Based Practice & Improvement, Clerkship Coordinator, Clerkship Director, 2020, Faculty Development Seminar,

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Get Laser Focused: Essentialism For The Medical Educator

Background: We cannot be effective advocates of wellness for our learners if we model dysfunctional patterns of work. Meditation, healthy eating, and yoga are great tools for managing our internal environment, but they are easily negated by mismanagement of our external environment. Studies show that avoiding burnout involves identifying purpose and meaning in our work. In this workshop based on Greg McKeown’s Essentialism participants will take a deep dive into the idea that, although we can’t do it all, we can choose what we do and don’t do. We will accept the notion that when we forfeit our right to choose someone else will choose for us, and we will take an essentialist approach to identifying our highest contribution and maintaining the discipline to eliminate work that takes our focus off that purpose.


Objectives: Explore your individual purpose by examining:

What deeply inspires me?

What am I particularly talented at?

What meets a significant need in the world?

Identify tradeoffs and choice associated with each of your current responsibilities.

Practice strategies to gracefully eliminate non-essential work


Agenda:

Introduction to Essentialism (10 minutes)

Self-Inventory Activity (15 minutes)

Guided Interpretation of Self-Inventory Activity (15 minutes)

Small group reflection/discussion (20 minutes)

Large group debrief, wrap up, questions and sharing of resources (15 minutes)


Take Home: Participants will leave with a clearer idea of their highest purpose, a plan for eliminating responsibilities that have distracted them from that purpose, and some techniques for gracefully saying no to new opportunities that are not essential to achieving their professional goals.

Topics: General Ob-Gyn, Lecture, CME, Systems-Based Practice & Improvement, Professionalism, Residency Director, Clerkship Director, Faculty, 2020, Faculty Development Seminar,

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

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

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

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

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

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