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Learner-Initiated Feedback Framework Trial (LIFFT): a Formal Framework for Perioperative Feedback

Purpose: To evaluate the effect of a learner-initiated framework for perioperative feedback on the frequency and satisfaction of resident feedback.

Background:  Procedural feedback is an important aspect of resident education and surgical performance improvement.  Satisfaction with feedback has been low in our program (64% reported somewhat, very or extremely satisfied) compared to the ACGME national average (72%).

Methods: This is a prospective cohort study of OBGYN residents at Los Angeles County+USC Medical Center.  A learner-initiated framework was implemented for 3 months of gynecologic cases. After a pre-survey was performed the framework was introduced via didactic.  Residents completed immediate postoperative surveys following each case.  Residents and faculty completed a post-intervention survey.  Primary outcome was proportion of cases in which feedback was given.  To detect a 25% difference in feedback frequency, a total of 99 cases were required with 80% power.
  
Results: Before intervention, residents reported feedback in 25 of 42 cases (59.5%), compared to 82 of 122 cases (67.2%) during the study period (NS). Resident satisfaction (reported sometimes, very, or extremely satisfied) with feedback increased from 67.9% to 90.3% (p=0.003).  Residents also reported both more frequent review of case goals (p<0.01) and receipt of feedback (p=0.007).  

Discussion: Learner-initiated framework objectively raised frequency of feedback received from faculty, albeit non-significantly.  Subjectively, residents indicated they received more frequent feedback and were more satisfied with that feedback.  This trial demonstrated that a formal framework for perioperative feedback significantly improved resident satisfaction with feedback and should be considered for routine use at USC.  

Topics: Assessment, GME, Interpersonal & Communication Skills, Residency Director, Faculty, Resident, 2020, SES,

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Implementing Communications Training for OB/GYN Residents: Disclosure of Adverse Peri-operative Events

Precis: This study investigated the effect of self-evaluation on the improvement of surgical skills by comparing OSATS scores over a 4-month period to determine if the addition of a self-evaluation improved surgical skills more than instructor evaluation alone. 

Purpose: To study the implementation of communications training for OB/GYN residents on the disclosure of adverse peri-operative events

Background: Communication skills are key components of the patient-physician relationship, however, these skills are not routinely taught during OB/GYN residency or fellowship. As OB/GYNs, disclosure of serious news happens routinely in various aspects of patient care.  

Methods: OB/GYN residents at a single institution participated in a 4-hour communication didactics session using VitalTalk methodology.  Participants were surveyed at baseline, immediately following training and 3 months post-training to measure changes in comfort and confidence in the performance of communication skills. A 5 point Likert scale was used to measure comfort/confidence: Novice (1), Advanced Beginner (2), Competent (3), Proficient (4) or Expert (5).  

Results: 27 residents participated in training; 8(29.6%) interns, 7(25.9%) 2nd year, 7(25.9%) 3rd year and 5(18.5) 4th years. 11/27 (40.7%) reported prior communication training. Before training, residents reported the most competence: detecting emotion cues (median: 3.1), detecting patient/family sadness (3.0) and responding empathetically (2.8). Residents felt the least competent: assessing patient/family willingness to discuss perioperative complications (2.0), assessing how much a patient/family wants to know (2.1), confirming understanding of the adverse event (2.3). Baseline comfort and skill performing these conversations was 2.1 and 1.9, respectively. Immediately post-intervention, average comfort and skill level increased to 2.8 and 2.8, respectively. 3 month data is currently being collected.

Discussion: OB/GYN residents self-rate their communication confidence and skills at an advanced beginner level.  Implementation of participatory communication training for OB/GYN residents is feasible and improves both trainee comfort and skills in the disclosure of adverse peri-operative events. Further work is ongoing to understand retention of these skills to inform more longitudinal curricula.  

Topics: General Ob-Gyn, Standardized Patient, Simulation, GME, Interpersonal & Communication Skills, Professionalism, Residency Director, Clerkship Director, Faculty, Resident, Student, 2020, SES,

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

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

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

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

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

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

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

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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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Sexual Harassment in Obstetrics and Gynecology Postgraduate Training

Purpose: To determine the prevalence of sexual harassment(SH) in obstetrics and gynecology(OBGYN) residency and fellowships.

Background: SH is a common problem the U.S. with 1 in 3 women experiencing some form of it in their lifetime. According to the National Academies of Sciences, Engineering, and Medicine (NASEM,) 24-50.4% of female medical students experienced sexual harassment, which is more than their peers in science and engineering, and 220% more than female students in non-science fields.

Methods: We conducted a voluntary, anonymous survey study of all U.S. OBGYN trainees in ACGME-accredited residency and fellowship programs. The survey included the validated Sexual Experience Questionnaire (SEQ) short form, and other questions including demographics. The NASEM definition of SH was used in the study and described to the participants in the survey instructions. Descriptive statistics were utilized.

Results: The survey was distributed to 1473 trainees in the US; 395 responses were received (26.8%response rate: 86%females, 13.5%males). 20.6% of participants (78/378: 21.1%females, 21.7%males) responded yes to having been sexually harassed during their OBGYN training. Based on the SEQ questionnaire, 69.1% OBGYN trainees (253/366) had experienced some form of SH. Sexist hostility was the most common form of SH followed by crude behavior (211/253,83.4%;182/253,71.9% respectively). Males and senior OBGYN attendings (154/208,74.4%;110/395,27.9% respectively) were named the most common perpetrator; the operating room was the number one location for SH followed by Labor and Delivery (97/395,24.6%;83/395, 21.0% respectively).

Discussions: Although OBGYN is a female dominated field, the rate of SH of trainees remains high according to our data.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME,

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Residents as Preceptors: Developing a Teaching Curriculum for Obstetrics and Gynecology Residents

Background: Residents serve a critical role in medical student education as near-peer educators. Positive experiences with residents and perceived quality of teaching have been associated with improved clerkship satisfaction and career choices in that discipline. ACOG and ACGME milestones further emphasize the importance of residents as educators. While the role of residents as preceptors is widely acknowledged, preparation for that role is variable.

Methods: A single arm interventional study with pre and post intervention analyses was used. A four part lecture series was designed and implemented during obstetrics and gynecology resident didactics at the University of Minnesota.  Residents completed blinded and paired online surveys pre and post lecture. 5 point Likert scale responses
were summarized and compared using Wilcoxon Signed Rank and Nominal Symmetry tests.

Results: There was a statistically significant
difference in the distribution of rankings towards the positive between pre and post surveys for questions regarding evaluation and teaching
. There were no statistically significant differences in the distribution of rankings for questions regarding feedback.  Barriers to teaching were also identified qualitatively.

Discussions: Implementation of a teaching curriculum significantly improved residents\' perceived preparedness and understanding of medical student teaching and preceptorship but did not improve attitudes towards and frequency of feedback. Strengths of this study include description of a novel, resident led program. Limitations include a small sample size at a single institution within a single specialty.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, GME, Assessment, Lecture, General Ob-Gyn,

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Resident Surgical Evaluations: Feasibility of Integration into the Electronic Medical Record (EMR)

Purpose: Describe the development and implementation of a surgical evaluation tool within the Epic EMR to facilitate real-time feedback for resident learners.

Background: Evaluation of a resident’s surgical performance is critical to the developing surgeon’s education but challenging for both learners and teachers in a busy clinical environment. This study aims to describe how a surgical evaluation tool can be integrated into the EMR and the acceptability of the tool to both faculty and residents.

Methods: A novel tool was developed within the EMR of a single academic hospital that triggers an automated in-basket message to the attending surgeon upon case completion. This message directs the attending surgeon to complete a 4 question evaluation consisting of 2 validated feedback questions and 2 open ended questions. Upon completion, an email is sent providing residents with immediate feedback. At the end of the study period, a survey was sent to attending surgeons and residents to assess the acceptability of the tool.

Results: Between February 2019 and June 2019 719 cases were performed and 553 surgical evaluations were completed (77%). The acceptability survey was completed by 26 of 27 (96%) of residents and 14 of 16 (88%) faculty. Among residents, 96% reported that they received more feedback because of the tool and 85% liked receiving feedback in this way. Among faculty, 21% reported that they felt they gave more feedback because of the tool and 93% found the tool acceptable to use.

Discussions: Implementation of an automated surgical evaluation tool within the EMR is feasible, acceptable to use, and well received by learners.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Assessment, General Ob-Gyn,

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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 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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Gender and Satisfaction with Mentorship In Medical School: A National Study

Purpose: Using the American Association of Medical Colleges (AAMC) Graduation Questionnaire (GQ), we assess if males and females at all U.S. medical schools report differing experiences with satisfaction with faculty mentorship.  Secondarily, we assess the role of men\'s and women\'s scholarly projects and career plans as they relate to satisfaction with mentoring.

Background: Female physicians experience gender-based professional differences, such as lower compensation, slower rates of promotion, and decreased representation in leadership positions as compared to their male colleagues.  The way this gender-based professional inequity affects the experience of medical student mentees has yet to be elucidated in the literature.

Methods: Data were obtained from the AAMC GQ years 2016-2018.  Student satisfaction with faculty mentoring was analyzed by chi-squared and logistic regression.

Results: With an 82% response rate we analyzed data for 47,063 students; 51% were male and 49% female. When asked about satisfaction with faculty mentoring, 81% of males verses 79% of females reported being \"satisfied\" or \"very satisfied\" (p< 0.001). A higher proportion of males reported faculty were helpful to students with academic matters (60% versus 55%; p< 0.001) and with non-academic matters (58% versus 55%; p< 0.001) \"very often\" or \"always.\" Females were less likely to be satisfied with faculty mentoring even after controlling for participation in research with a faculty member and future research plans.

Discussions: This work serves as a needs assessment to encourage individual medical schools to investigate their own gender-based cultures regarding faculty representation and leadership to allow gender-equal mentorship of all students.

Topics: CREOG & APGO Annual Meeting, 2020, Faculty, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, GME, CME, UME, Advocacy,

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Gaining Resident Buy-In: Three Year Follow Up of a Resident-Led Resident as Teacher Program

Purpose: To evaluate teaching culture in an OB/GYN residency three years after the initiation of a Resident-Led Resident as Teacher (RLRT) program.

Background: In October 2016, a RLRT program was created to foster the growth of clinician-educators by providing opportunities for direct instruction of medical students, educational leadership and professional development. Residents completing 25 hours of educational work are recognized as Distinguished Resident Educators at graduation.

Methods: We reviewed end of clerkship evaluations of resident teaching from July 2016 - June 2019.  We also surveyed residents annually regarding teaching skills and views of the RLRT program in October 2016-2018. Chi-square and Kruskal-wallis testing were used for statistical analysis.

Results: For 2018-2019 academic year, 48% of medical students strongly agreed that residents provided effective teaching compared to 30% in 2016-2017 (p< 0.01).  Of 48 residents, 42 (88%), 34 (71%), and 30 (63%) residents completed the survey in 2016, 2017, and 2018, respectively.  In 2018, 93% of PGY1s and PGY2s intended to be recognized as Distinguished Resident Educators, compared to 56% of PGY3s and PGY4s (p=0.02).  Incoming PGY1s in 2018 rated themselves higher on average in teaching skills than PGY1s in 2016, specifically in making mini-lectures and guiding students to evidenced-based medicine resources (p< 0.01).  All of the PGY1s (100%) in 2018 felt that the RLRT positively influenced their decision to join the residency program.

Discussions: A RLRT program can strengthen the teaching culture by increasing the effectiveness of resident teachers and aiding in recruitment of residents interested in resident teaching. 

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, GME, UME, Team-Based Learning,

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Evaluation Disparity and Implicit Bias in Medical Student Grading: Findings from Evaluator Focus Groups

Purpose: To perform a needs assessment of medical student evaluators to uncover reasons for evaluation disparity in order to work towards improving the quality, consistency, and accuracy of OB/GYN clerkship evaluations.

Background: Accurate evaluation of medical student clinical clerkship performance is challenging. Scale-based student ratings often do not correlate to comments provided. Additionally, there can be a wide variance of scores for the same student by different evaluators. Information regarding differing grading systems is available, but there is a lack of guidance around inter-rater reliability and implicit bias.

Methods: From May - July 2019, we performed three resident and faculty focus groups. We began the session discussing evaluation form reliability and current behaviorally anchored rating scales, same student evaluation inconsistencies demonstrated between evaluators, accuracy, and potential evaluator bias. Qualitative analysis utilizing two reviewers was used to identify themes.

Results: Overall, participants expressed a need for more formal student evaluation information and instruction. Other themes were requests for education and information regarding the evaluation forms and student grading, an admission of variation between ‘hard’ and ‘easy’ graders, and implicit bias in student evaluation, particularly regarding perceived specialty choice.

Discussions: Evaluators felt a need to better understand how evaluations contributed to student rotation grades and were interested in improving the quality, consistency, and accuracy of evaluations. Time with students directly influences the accuracy of objective evaluations. Implicit bias around one’s own ‘grading scale’, and around student specialty selection, can influence student evaluations.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Professionalism, Interpersonal & Communication Skills, UME, Assessment,

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Empathy Training Using Improvisational Comedy: Impact on Multidisciplinary Education among Health Professions Students

Purpose: Determine the impact of improvisation training on self-reported and observed measures of empathy among a multidisciplinary group of health professions students

Background: Provider empathy improves patient outcomes. The most effective technique for promoting empathy remains unknown. Improvisation training may improve cognitive and affective empathy by enhancing one’s ability to react to the observed experience of others. Improvisation workshops have been shown to improve empathy in OB/GYN residents. We aimed to evaluate the impact this training on self-reported and observed measures of empathy within a multidisciplinary group of health professions students.

Methods: This is a prospective cohort study of health professions students who participated in a mixed-methods empathy training activity (improvisation exercises and case-based scenarios administered by standardized patient actors before, during, and after the educational component). Students completed pre- and post-intervention self-reported empathy questionnaires. Trained patient actors observed student interactions and completed validated empathy questionnaires following each case-based interaction. Paired t-tests were used for within-person comparisons over time and ANOVA was used to compare changes across groups.

Results: Twenty-eight students participated (4 medical; 8 social work; 11 nursing; 5 physical therapy). Self-reported empathy scores improved significantly from pre- to post-intervention (34.3 vs 38.2, p< 0.0001) although observed empathy scores did not change (43.6 vs 42.9, p=0.65). When comparing across disciplines, there was no difference in observed empathy scores (p=0.75).

Discussions: Improvisation training improves self-reported but not observed empathy among a multidisciplinary group of health professions students. There was no difference in the efficacy of the training workshop between disciplines.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Interpersonal & Communication Skills, GME, Assessment, Simulation, Team-Based Learning,

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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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Developing Committed Resident Leaders: A Survey of the Obstetrics and Gynecology Administrative Chief Resident Experience

Purpose: To define the challenges and experiences of Obstetrics and Gynecology (OBGYN) administrative chief residents (ACRs) and identify support needed to make them successful.

Background: ACRs are integral to OBGYN residency programs, however little research has been done on the experiences, training, and support of ACRs.

Methods: A Qualtrics survey was emailed to program coordinators at all 292 ACGME OBGYN residency programs. Response styles included MCQs, yes/no, likert scales, and short answer. Question topics included demographics, chief duties, support, and experiences. Study participants were defined as current / past ACRs (2019-2020, 2018-2019) and program directors (PDs).

Results: Ninety two ACRs and 24 PDs received the survey, as confirmed by program coordinators. Forty five surveys were completed (response rate 39%), including 38 (84%) ACRs and 7 (16%) PDs. 
The majority (67%) were from academic programs with a median of six residents and two ACRs per year. Forty-nine percent of respondents reported ACRs spend 4-7 hours per week on administrative duties.  Eighty seven percent reported no protected time. On a 10-point likert scale, mean perceived support from faculty, PD, administration, and other residents was 6.8, 8.6, 7.1, and 7.5 respectively; however, mean stress level was 7.1. 
Common challenges reported by ACR’s are conflict resolution and workload management. Many ACRs felt they would benefit from formal leadership training and protected time.

Discussions: These results summarize the experience of ACRs. Best practices and formal training in identified challenge areas should be added to residency curriculum and used to develop toolkits to support ACRs nationwide.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, Assessment, Team-Based Learning,

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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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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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Teaching Cultural Humility To Medical Students By Building Cross-Cultural Patient Education Tools

Workshop Text: Cultural humility and cross cultural communication are essential skills for medical students who will be called upon to translate medically complex concepts and treatment plans to patients from diverse backgrounds.  This skill set, however, is not often taught effectively during medical school.

This workshop will demonstrate a method for teaching cultural humility to medical students.  Through the process of designing and testing a cross cultural patient education model, the student explores essential features and pitfalls of cross cultural education. Workshop participants will design an abbreviated patient education tool based on a case based scenario and engage in group discussion about the challenges involved. Presenters will share a project that was used in three languages from sub-Saharan Africa and another in Vermont and will discuss challenges from their field work. An evaluation rubric will be provided. 

Introduction (5mins) define cultural humility and discuss best practices in cross cultural communication. 

Group Activity (10 mins) Using 1-2-4-all format, discuss pitfalls of cross cultural communication demonstrated in an excerpt from The Spirit Catches You and You Fall Down.

Breakout Activity/ Interactive component (30 mins) Small groups of participants will design a patient education tool for a specific patient population based on a real life scenario. 

Group Activity (15 mins) Discuss the process of designing a cross-cultural patient education tool with respect to cultural humility.

Wrap up (5 mins)

Take home products: Grading rubric , Resource guide with annotated bibliography

 

Topics: Faculty Development Seminar, 2020, Faculty, Clerkship Director, Patient Care, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Global Health, Advocacy,

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