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.
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,
Read more »
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
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.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Systems-Based Practice & Improvement, GME, Advocacy,
Read more »
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
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
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
CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Clerkship Coordinator, Professionalism, Systems-Based Practice & Improvement, GME, Independent Study,
Read more »
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
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.
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,
Read more »
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
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%).
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
The two barriers
most frequently encountered, regardless of program training status, were
problems with billing and compensation for services (61%) and the pharmacy
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.
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,
Read more »
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
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
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.
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,
Read more »
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
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Systems-Based Practice & Improvement, GME,
Read more »
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
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
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.
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,
Read more »
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.
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,
Read more »
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
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.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, General Ob-Gyn,
Read more »
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
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
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
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,
Read more »
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
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
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
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,
Read more »
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.
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.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, General Ob-Gyn,
Read more »
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
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 )=
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
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME,
Read more »
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
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.
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,
Read more »
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.
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.
CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Osteopathic Faculty, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, UME, Assessment,
Read more »
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.
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,
Read more »
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.
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.
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
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.
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,
Read more »
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
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
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.
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.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, GME, General Ob-Gyn,
Read more »
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.
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
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.
2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Systems-Based Practice & Improvement, UME,
Read more »