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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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Wellness on a Budget: Can It Be Done?

 

Purpose: To quantify resident well-being, assess the most common stressors and sources of burnout among residents, and develop cost effective strategies to improve wellness.

 

Background: In 2017, the ACGME mandated that residency and fellowship programs had to demonstrate a commitment to the well-being of the residents, faculty members, students and all members of the health care team.

 

Methods: Identifying a cost effective assessment tool (Well-Being Index) which would link to important wellness resources, national comparative data, and provide comprehensive reporting to our residency programs. Analysis of this data and use of focus groups to develop a Resident Wellness Taskforce.

 

Results: The Well-Being Index, distributed at the beginning of the training year, showed 30% of residents who responded had “at risk” scores. The focus groups then determined the most common stressors at Henry Ford Hospital, which fell into 4 common categories: work efficiency/support; workflow/job demands; organizational values/meaning in work; and work-life balance. These results allowed the Wellness Taskforce to develop strategies, both personal and institutional, to combat areas of high stress. Cost effective interventions totaled under $25,000  and included a Wellness Curriculum and Wellness Rounds. Details will be shared in presentation.

 

Discussions: Baseline wellness scores and focus groups allowed us to determine the extent of our residents’ burnout and identify their most common stressors. This was an important starting point for planning cost effective interventions and programming geared to improving resident wellness. Future plans include assessing the Well-Being Index post-intervention to determine the effect of the taskforce initiatives on resident burnout.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Systems-Based Practice & Improvement, GME, Advocacy,

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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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Trends in Off-Service Rotations in Ob/Gyn Residencies Before and After Duty Hour Restrictions

Purpose: To establish trends in off-service rotations in OB/GYN residencies before and after duty hour restrictions.

 

Background: As co-morbidities in our patient population increases, the skills required of OB/GYNs are changing, we sought to determine the characteristics of off service rotations.

 

Methods: We searched websites of ACGME accredited OB/GYN residency programs. We collected data on off service rotations: services, number of rotations, and PGY year of rotations. Surveys were emailed to programs regarding off service rotations in 2018 and before duty hour changes in 2003.

 

Results: 92% (n=259) of programs had information available on off-service rotations, of these, 24% (n=62) had no off-service rotations, 26% (n=67) had 1, 25% (n=66) had 2, 13% (n=34) had 3, 12% (n=30) had 4 or more. The majority (84%) of rotations were in PGY1. The most common rotations were ER (47%, n=122), SICU (24%, n=62), IM (25%, n=66), MICU (9%, n=23). We received 53 responses to the survey (19% response rate). Of those who responded, the most common rotations for 2018 and before 2003 were ER & SICU. The number of programs with SICU rotations remained stable from 2003 to 2018 (43% vs 47%) compared to 1.4 fold decrease in programs with ER rotations. The number of programs with IM rotations decreased 2.5 fold from before 2003 to 2018.

 

Discussions: Duty hour restrictions have affected off-service rotations. A quarter of all programs have no off-service rotations, with a decrease in ER and IM exposure during residency. This does not reflect the breadth of knowledge required of OB/GYNs today.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Quality & Safety, General Ob-Gyn, CREOG & APGO Annual Meeting, 2019, Student, Resident, Clerkship Director, Residency Director, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Team-Based Learning,

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Training Residents to Place Immediate Postpartum LARC: An Update Among U.S. Residency Programs

Purpose: To survey U.S. Obstetrics and Gynecology (Ob/Gyn) Residency Programs on immediate postpartum (IP) long-acting reversible contraception (LARC) training and challenges.

 

Background: In 2016, the American College of Obstetricians and Gynecologists (ACOG) released a committee opinion supporting IP LARC. Growing evidence describes provider/hospital barriers which hinder IP LARC provision. We hypothesize similar difficulties have prevented programs from implementing training.

 

Methods: We distributed an electronic survey addressing IP LARC training to 273 U.S. Accredited Council for Graduate Medical Education (ACGME) Ob/Gyn Residency Program Directors from the 2017-2018 Academic Year. Data analysis was performed with chi-square and Fisher’s exact test.

 

Results: Of 86 programs that participated, residents were trained in the immediate postpartum period to place implants in 54 programs (63%) and to place intrauterine devices (IUDs) in 52 programs (60%).

Prior to 2015, only 20% of the programs were training their residents to place IP IUDs. Thirty-one percent of eligible programs initiated training in 2017. The majority of programs focused training interns (98%). Patient/provider convenience motivated 46% of programs to offer IP LARC and compliance motivated 27%.

The two barriers most frequently encountered, regardless of program training status, were problems with billing and compensation for services (61%) and the pharmacy (33%).

Programs that reported primarily seeing patients with insurance, either private or Medicaid, were more likely to have IP IUD training compared to programs seeing mostly indigent/uninsured populations (p<0.05).

 

Discussions: IP LARC training has increased since the ACOG Committee Opinion was published, however many programs are still facing challenges with implementation, affecting resident training.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Systems-Based Practice & Improvement, GME, Public Health, Advocacy, Contraception or Family Planning,

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Too Many Learners? Do Students Belong in Resident Continuity Clinics?

Purpose: Determine the prevalence of medical students in OBGYN resident continuity clinics and describe effects on the learning environment when students and residents work together in this setting.

 

Background: Patient continuity is an ACGME requirement often fulfilled through a resident run continuity clinic. It’s unknown how frequently students rotate in these clinics, or how multiple levels of learners influence each other.
 

 

Methods: We surveyed OBGYN program managers using a national listserv. Resident and student surveys were based on a Likert scale and sent to all OBGYN residents and students that rotated at our institution from 2016-2018.

 

Results: Program managers responded from 45 programs and 75.6% scheduled students in resident continuity clinics. Our response rates were 79/116(68.1%) for students and 21/24(87.5%) for residents. A one-sample Wilcoxon signed rank test was used to test the hypothesis that the typical response on the five-level Likert scale was \"Agree\" or \"Strongly Agree.\" Of medical students, 88.6% stated that they agreed or strongly agreed they enjoyed working with residents (p<0.001) and 60.8% stated they agreed or strongly agreed residents were effective teachers (p<0.001). Among residents, 52.4% agreed or strongly agreed that they enjoyed working with students (p<0.001). However, 61.9% said they agreed or strongly agreed they were too busy to be effective teachers (p<0.001).

 

Discussions: Many institutions have students rotate in resident continuity clinics. Residents and students have positive views regarding their interactions. Although students were satisfied, residents expressed concerns about their ability to be effective teachers given clinical demands. Our results highlight the importance of developing resident teaching skills.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, CME, UME, Assessment, Problem-Based Learning, Team-Based Learning, General Ob-Gyn,

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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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Simulation Training for Operative Vaginal Delivery Among Obstetrics and Gynecology Residents: A Systematic Review

Purpose: To evaluate the impact of simulation training of operative vaginal delivery (OVD) on learner technique, operator comfort, and patient-centered outcomes.

 

Background: Obstetric simulation affords learners opportunities to acquire and to refine clinical skills in a low-stress environment while potentially improving patient outcomes.  However, the effect of simulation on OVD training is less clear. 

 

Methods: A systematic research protocol was constructed a priori for the conduct of the literature search, study selection, data abstraction and data synthesis.  Electronic databases were searched for educational randomized trials and observational studies assessing OVD simulation training for OBGYN residents.   The educational domains of knowledge, skills and attitudes were evaluated.  The Medical Education Research Study Quality Instrument (MERSQI) was used to assess study quality.  The review was prospectively registered with PROSPERO.

 

Results: The search strategy yielded 30,812 articles, with 7 articles eligible for analysis (2 cohort studies, 1 case-control study, 4 cross-sectional studies).  No randomized trials were identified.  Studies demonstrated simulation to improve learners’ skill with forceps placement and generated force during extraction.  While forceps simulation had no change in procedure failure rates, there were significant decreases in rates of maternal lacerations, neonatal injury, and special-care nursery admission.  Only one study evaluated the effect of simulation on provider comfort, demonstrating increased provider comfort with vacuum-assisted delivery. The median MERSQI score was 9.5 (range 9.0-13.5), indicating low-to-moderate quality.

 

Discussions: The available evidence suggests improvement in technique, comfort, and patient outcomes with OVD simulation, but additional studies are required to further characterize such benefits for both forceps and vacuum.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Simulation, Quality & Safety, Maternal-Fetal Medicine, General Ob-Gyn,

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Saving Lives: Students Enhancing Patient Health Literacy Regarding Hypertension in Pregnancy and Prenatal Aspirin

Purpose: To increase medical student’s knowledge, behavior and belief systems regarding hypertension (HTN) in pregnancy and prenatal aspirin (PNA). To increase patient\'s understanding regarding the complications of HTN in pregnancy and the benefits of PNA.

 

Background: Prenatal aspirin (81 mg) has been recommended by ACOG for high-risk women and women with >1 moderate risk factor. Its use reduces the rate of preeclampsia, preterm birth, intrauterine growth restriction and fetal death in at-risk patients. In a survey conducted at Boston Medical Center, the incidence of hypertension in pregnancy is 30%, with only 15% of patient having heard of PNA, demonstrating high prevalence and low patient literacy regarding the topic.

 

Methods: Ob/Gyn clerkship students are instructed to educate patients regarding: knowledge of HTN in pregnancy, warning signs of preeclampsia, and efficacy of PNA in pregnancy. The student educational intervention was evaluated regarding: satisfaction, knowledge, confidence, and belief systems by surveys at the beginning and end of the clerkship. Patient education was evaluated by pre and post intervention metrics.

 

Results: Student knowledge of PNA and HTN increased 35%, confidence 45% and belief systems 14%. They gave the project a 72% satisfaction rating. Patient’s knowledge about HTN increased 48%, warning signs 80%, and understanding of efficacy of PNA 65%.

 

Discussions: Medical student health counseling increased patient knowledge regarding HTN and PNA. By educating patients, students also increased their knowledge and confidence in the subject. We plan to continue implementing this QI project throughout the year to augment a departmental QI initiative and evaluate its benefit to patients and students.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, UME, Quality & Safety, Advocacy,

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Resident Documentation and Coding Curriculum Can Be Improved Through One-on-one Education

Purpose: Assess impact of one-on-one education of residents in billing and coding. 

 

Background: As billing and coding education was changed from generalized education at didactics to more intensive one-on-one education, the revenue team evaluated the impact for accuracy in billing and monetary impact.

 

Methods: Three groups of residents were analyzed. Group 1 (n=4) were fourth year residents at intervention and had a general meeting with other departments about coding and then one or two one-on-one sessions. Group 2 (n=4) were third year residents at intervention and had two to three one-on-one sessions. Group 3 (n=4) were second year residents at intervention and had three consistent one-on-one sessions every 6 months. A selection of 10 records per resident were randomly selected for review by a certified coder to identify documentation and coding opportunities. 

 

Results: The documentation and coding accuracy improved with increased education. Accuracy Group 1: 55%, Group 2: 76%, Group 3: 89%. Revenue lift was also analyzed with these encounters and an average lift of ~$40 was noted between group 1 and group 3. 

 

Discussions: By consistent billing and coding one-on-one education for residents, the accuracy of coding improved as seen in the differences in accuracy rate between graduating 4th years (55%) and second year residents (89%). Residents see 5 patients on average per clinic session in their final 2 years and have approximately 30 clinics per year. This equates to an extra $12,000 in revenue per resident over their final two years. By investing in billing and coding education, accuracy and revenue were increased.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, General Ob-Gyn,

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Predictors of Trainees\' Willingness to Provide Family Planning Services: A Survey of Ob-Gyn Residents

Purpose: To determine factors that contribute to a resident’s willingness to provide abortions post-residency.

 

Background: The shortage of abortion providers makes accessing care difficult. Personal and environmentalfactors within the residency training environment may be modified so that greater numbers ofgraduates opt to become abortion providers.

 

Methods: A multiple-choice survey was sent to all ACGME accredited OB/GYN residency programs. Data on demographics,religious and political views, residency training experience and intent to provide abortions was collected anonymously (n=396).

 

Results: Sixty-eight percent of residents intended to provide abortions (n = 269). The sample was 89% female, underage 35 (97%), heterosexual (91%). In a multivariable logistical regression, the following demographic factors predicted intent to provide abortion; being female (aOR 2.8; 95% CI 1.2-6.5), identifying as non-Christian (aOR 3.6; 1.9-6.6), and being raised in the Northeast (vs South) (aOR 3.0; 1.3-6.7) .Modifiable predictors of intention to provide included programs where 50% of the faculty provided abortions (aOR 3.3;95% CI 1.8-5.8). Additionally, residents who performed greater than 20 cases (uOR 3.3, 95% CI 1.6-6.7) were three times more likely to plan toprovide.Selection of a residency emphasizing family planning significantly correlated with intent toprovide (aOR 4.3; 95% CI 2.4-7.8). Those training at Ryan Programs were twice as likely (uOR2.4; 95% CI 1.6-3.8) to intend to provide.

 

Discussions: Modifiable factors such as early exposure of medical students to family planning, faculty selection, robust case volumes and establishment of a Ryanprogram may enhance the number of graduates offering abortions while in practice.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Osteopathic Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, GME, UME, Advocacy, Contraception or Family Planning,

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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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Obstetrical Resident Improved Education and Teaching (ORIEnT)

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

 

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

 

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

 

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

 

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

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

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Not Quite so Happy Hour: Associations of Alcohol Use with Wellness Problems Among OBGYN Residents

Purpose: To explore associations between residents’ personal habits and problems with wellness.

 

Background: It will be essential that we develop evidence-based interventions to improve burnout and wellness problems in our resident physicians.

 

Methods: A voluntary, anonymous survey was administered to all US OBGYN residents at the time of the 2017 CREOG examination. Symptoms of burnout and problems with wellness were queried with the question, “during your residency training, have you personally experienced any of the follow issues?” Respondents also reported how often they engaged in activities that they felt helped to maintain wellness in their lives. Associations between reporting wellness problems and participation in common activities were examined using chi-squared tests. Significance was defined as p<.004 using a Bonferroni correction based on the number of comparisons.

 

Results: Of the 5855 residents, 4999 completed the survey (85% RR).  3065 (61.3%) residents endorsed problems with wellness, including burnout (51.2%), depression (32.0%), and binge drinking (12.6%). The most common wellness activities reported were social activity (n=4320, 93.2%), watching TV (n=3614, 77.1%), cooking (n=3614, 52.4%), exercise (n=2228, 47.3%), and drinking alcohol (n= 2132, 45.6%). Respondents who indicated alcohol as a wellness activity had an increased odds ratio of 2.10 of also having a wellness problem (Χ2(1 )=29.6, p< 0.001).  Respondents who indicated heavy drinking (“Often (4+ times)”/week) had a higher odds ratio of 3.30 (Χ2(1 )= 40.3, p<.001.)

 

Discussions: Despite social norms, residency programs should use caution when choosing alcohol as the basis for social events or stress release, as our data suggest that it is associated with increased negative outcomes for resident wellness.

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

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Medical Students Reflections About Patient Care Affected by Race, Ethnicity or Language During the Obstetrics and Gynecology Clerkship

Purpose: To explore medical students’ reflections about obstetrics and gynecology (OBGYN) clerkship experiences in which they witnessed patient mistreatment based on patients’ race, ethnicity and language.

 

Background: Experience-based clinical learning includes interactions with patients and teachers and is affected by sociocultural contexts. Recognizing that bias and discrimination are pervasive in our culture, medical students may observe these behaviors within their clinical teams. 

 

Methods: We conducted a directed content analysis of students’ reflective essays written during OBGYN clerkships from 2014-17 about clinical scenarios that challenged their professionalism.  Of 265 essays that referred to patient interactions, we included essays discussing patient race, ethnicity or language for this analysis. Essays were analyzed more than once if they discussed more than one of these factors.

 

Results: Of 53 essays that met inclusion criteria, 40 discussed issues with providing language-concordant care, including when language barriers led to poor care. Of these, 23 focused on interpreter concerns, such as nonuse of certified interpreters and discomfort with being asked to interpret. In 23 other essays, students described how patient’s race or ethnicity affected care, including students recognizing their own bias towards patients or witnessing team members’ discriminatory behavior such as being judgmental, uttering racist remarks, or demonstrating insensitivity about cultural differences.

 

Discussions: Medical students witnessed and reflected about clinical team member’s discriminatory behaviors toward patients. These narratives should compel educators to reflect on their own biases and to set higher standards for justice-informed care in the clinical learning environment – both to provide justice-informed care for patients and to optimize experience-based learning.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, UME, General Ob-Gyn,

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Medical Student Self-initiated Form Improves Compliance of Documenting Formal Mid-clerkship Feedback

Purpose: A medical student self-initiated feedback form is a simple, yet innovative way to meet LCME requirement to document mid-rotation feedback during the busy clerkship.

 

Background: Mid-rotation feedback during the clerkship is crucial in helping trainees learn their strengths/weakness in order to improve clinical performance and develop clinical competency.  The LCME has established a standard for clerkship directors (CD) to document formal mid-rotation feedback for medical students during clinical clerkships but due to competing demands, this standard has been challenging to meet. This educational quality improvement project examined the effect of instituting a self-initiated feedback form on documentation of formal mid-rotation feedback.  

 

Methods: Beginning January 2018, we instituted a mandatory self-initiated feedback form to be completed prior to meeting with the CD.  The 4-item feedback form includes prompts for students to self-reflect on strengths/weaknesses and space for comments to discuss with the CD.  Completed forms are uploaded to an electronic assessment system.

 

Results: At our institution, compliance with documenting Ob/Gyn mid-rotation feedback improved substantially to 98% in 2017-18 as compared to 77% in 2016-17 and 71% in 2015-16.  Similar trends occurred in other clerkships, particularly in pediatrics and general surgery, thereby demonstrating generalizability of intervention.

Discussions: A medical student self-initiated feedback form improved compliance of documenting formal mid-rotation feedback while decreasing CD workload.  This intervention also made feedback meetings more engaging, robust and meaningful.  This innovation places ownership of initiating feedback on the medical student, and less on the CD.  This form can be incorporated at other undergraduate medical institutions.      

Topics: CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Osteopathic Faculty, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, UME, Assessment,

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Magnesium Toxicity and Medical Errors: A Multidisciplinary Simulation for Debriefing an Obstetric Emergency

Purpose: To create a simulation that improves communication during obstetric emergency and promotes a safe learning environment to debrief and evaluate medical errors.

 

Background: Simulation is known to improve communication and comfort in obstetric emergency. Little data exist regarding simulation for enhancing expertise in debriefing and evaluating system errors.

 

Methods: The simulation highlights an unresponsive patient shortly following a preterm delivery at 30 weeks gestation. The team discovers an accidental bolus of intravenous magnesium was given instead of postpartum oxytocin. Following conclusion of the simulation, participants were asked to lead a debrief session. Surveys were performed to assess participant comfort with magnesium toxicity, debriefing, evaluating a medical error, and communication during an emergency. 

 

Results: Participants felt the simulation was (1) a realistic scenario that allowed practice debriefing a medical error within a large multidisciplinary team, (2) a place to practice high acuity care and communication, and (3) a safe place to receive and provide feedback. On average, residents reported an increase in comfort with management of magnesium toxicity from little comfort(2/5) tomoderate comfort(4/5). In general, participants (90%; N=10) felt like they learned advanced management of acute magnesium toxicity. All participants (100%; N=10) reported they would recommend this simulation to others in their profession. 

 

Discussions: We have designed a simple model that highlights the importance of (1) communication during an obstetric emergency and (2) debriefing and evaluating errors from systems perspective. This model increased participant knowledge and comfort with magnesium toxicity and promoted a safe culture to discuss medical errors and practice debriefing.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, CME, Simulation, Quality & Safety, Team-Based Learning,

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Keeping Residents Well: How Important Are Perceptions of Program Support and Psycholocical Safety to Resident Wellness?

Purpose: We aimed to test whether measures of resident well-being correlated with perceptions of program support and psychological safety.

 

Background: Trainee well-being is a crucial component of developing competent and skilled OB/GYN physicians. While there are several measures of well-being collected at the national-level, there is little insight in the role of individual programs to foster trainee well-being. Perceived organizational and psychological safety are two constructs that can help identify cultural aspects of the clinical learning environment that may relate to trainee well-being.

 

Methods: OBGYN residents in a training program were recruited to complete an IRB-approved survey through paper and electronic methods between May-June 2018. Measures included the Survey of Perceived Organizational Support (POS), Psychological Safety Scale (PS), Perceived Stress Scale (PSS), Wayne State Wellness Scale (RWS) and Physician Well-Being Index (PWBI); all demonstrate validity and reliability evidence to assess factors of well-being and cultural aspects of the training program.

 

Results: 20 OBGYN residents completed our survey. Results indicated a strong relationship between perceived organizational support and wellness  (r= .62, P<.01 for RWS, r=.50, P<.05 for PWB)., suggesting greater perceptions of support relate to better wellness. Similarly, psychological safety also had a strong relationship with wellness (r=.56, p<.05 for RWS;  r= -.72, p<.01 for PWB)

Discussions:  
Our findings suggest that there is a strong relationship between trainee wellness and the cultural measures of support and safety, especially between psypschological safety and negative indicators of well-being (e.g,. feeling burnt out from work, feelings of irritation). Further research should include interventions to improve percpetions of suport and safety.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, Quality & Safety, Advocacy, CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Lecture, Advocacy,

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Incorporating a Resident-Driven Quality Improvement Process Change Through a Lean Transformation of Post-Partum Hemorrhage (PPH) Care

Purpose: To investigate a resident-driven quality improvement lean event to improve satisfaction in PPH management.

 

Background: Interdisciplinary PPH response strategies are recommended as standard of care. OBGYN resident perceptions regarding PPH management prompted an interprofessional quality improvement lean event to create a systems process change on the post-partum unit.

 

Methods: This was a pre-/post-intervention study evaluating the impact of a lean event that created new hemorrhage protocols (intervention) on postpartum units including: medication safety bundle, assigned/clarified roles for providers, and a streamlined communication process. The survey queried respondents regarding team communication, access to uterotonics and analgesia, and perception of overall patient safety during PPH. It was administered to resident physicians and post-partum nurses prior to the system changes and at 6 and 12-month intervals. These results were compared using nonparametric analyses.

 

Results: Participants included 15 residents and 16 nurses. Pre-intervention, there was a significant difference in the overall perception of safety when comparing resident and nurse response (p=0.0495) with residents perceiving a less safe environment. Post-intervention, overall satisfaction among the 2 groups was improved at the 6 & 12 month intervals (p<0.05) without discrepancy between the groups.  Nurse results demonstrated significantly increased satisfaction with team communication and IV access protocols (p<0.05).

 

Discussions: Resident led quality improvement events can result in improved satisfaction of interprofessional team members in PPH care with improvements maintained over 12 months. Reaching a shared perception and mental model between nursing and residents in the care of PPH can further be studied from the patient’s perspective.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, GME, General Ob-Gyn,

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Improving Medical Student Feedback by Identifying Barriers in Obtaining Evaluations

Purpose: The goal of this study is to identify barriers encountered by residents and faculty in providing electronic feedback to medical students regarding their clinical performance.

 

Background: Feedback is an integral part of learning and professional development and needs to be both specific and corrective to be effective, however, the amount and quality of feedback received by medical students varies greatly. The response rate for medical student evaluations at our institution is 33.2%. We performed a survey-based study to determine barriers to the completion of online medical student evaluations.

 

Methods: Surveys with quantitative and qualitative questions were sent to residents, fellows, and faculty at three teaching institutions in Cleveland, OH.

 

Results: Of the 71 respondents, 56.5% were attendings and 39.1% residents with an overall response rate of 40.8%. Time spent with student and time to fill out evaluations appear to be the most contributory factors cited as barriers to evaluation completion at 76.1% and 64.8% respectively.

 

Discussions: Developing systems to obtain feedback without significant time constraints may increase response rates. Relying on the evaluations of a few physicians with whom students spend more time may also improve the quality of feedback.

Topics: 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Systems-Based Practice & Improvement, UME,

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