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.
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.
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
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
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.
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
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
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
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.
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
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
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
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.
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
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
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.
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
Discussions: Updated objectives and modern teaching methods
improved resident impressions of didactics, but did not improve CREOG exam
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
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.
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)
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
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.
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
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.
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
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
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
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.
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,
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.
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
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.
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
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
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.
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.
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
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.
define cultural humility and discuss best practices in cross cultural
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)
rubric , Resource
guide with annotated bibliography
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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