Use of Video Interviews for Selection of Obstetrics and Gynecology Residents
Purpose: To improve the residency selection process using asynchronous
Background: Residency applications have increased, while data
available for decision making in ERAS has been static. One-way (asynchronous)
video interviews (OWVI) involve the candidate recording answers to pre-selected
Methods: Applicants to an OB/GYN residency program with USMLE
Step 1 ≥ 220, no USMLE failures and at least 3 months of US clinical experience
were scored using five criteria (USMLE 1 score, clinical clerkship grades,
letters of recommendation, research achievements and extracurricular/leadership
activities) scored 1-5, with 5 as the top score. Applicants with scores from 19
to 22 were invited to complete an OWVI. The OWVI consisted of 1 open
ended question and 2 behavioral questions, scored from 1-5. Applicants were
invited for an in person interview based on their video interview scores.
Results: For the 2018 residency application season, 495
applications were received, 272 applications were scored and invited to
complete a video interview, 234 applicants completed OWVI and 97 OWVI were used
for the decision to invite for an in-person interview. Mean OWVI score was 10.4
(range 4-15). For the 2018 season, OWVI scores were weakly correlated with rank
list placement (Pearson coefficient = 0.29), in-person interview scores (0.18)
and application scores (0.33). The mean in-person interview
score increased after implementation of OWVI screening from 59.0 in 2017
to 62.2 in 2018 (P<0.01).
Discussions: Use of OWVI led to higher in-person interview scores,
suggesting that video interviewing is a useful supplemental tool for selecting
competitive residency candidates.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, GME, UME, Assessment,
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Trends in Off-Service Rotations in Ob/Gyn Residencies Before and After Duty Hour Restrictions
Purpose: To establish trends in off-service rotations in OB/GYN residencies
before and after duty hour restrictions.
Background: As co-morbidities in our patient population increases,
the skills required of OB/GYNs are changing, we sought to determine the
characteristics of off service rotations.
Methods: We searched websites of ACGME accredited OB/GYN
residency programs. We collected data on off service rotations: services,
number of rotations, and PGY year of rotations. Surveys were emailed to
programs regarding off service rotations in 2018 and before duty hour changes
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,
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Students Stuck in a Swamp? Scripting Promotes Medical Student Involvement in Obstetric & Gynecologic Care
Purpose: Characterize the effect of staff scripting on medical student
acceptance in outpatient ob-gyn clinic visits.
Background: Direct patient care is a major tributary in the river
of medical education. When patients refuse medical student involvement in their
care, students are stranded in stagnant quagmire. Review of the literature
shows that medical student refusal is a national issue not limited solely to
obstetrics and gynecology (ob-gyn) clerkships (Chang, et al, 2010; Mavis,
et al, 2006; Hartz & Beale, 2000). Written and video messages about medical
student training have been effective in furthering medical student acceptance
in clinical encounters (Buck & Littleton, 2016). Open the floodgates!
Methods: A literature review using search terms “medical
student AND refusal” was conducted to guide script composition. Medical
assistant and nursing staff implemented the script in an outpatient ob-gyn
resident clinic. The script was revised halfway through the clerkship year
based on patient and staff feedback. All ob-gyn medical students were surveyed
regarding their involvement in patient visits prior to and after script
Results: After script implementation, the percent of medical
students refused from at least one patient interaction decreased from 92% to
86%. 66% percent of our students perceived scripting as a supportive measure
for medical students, and 61% percent witnessed staff, residents, and faculty
Discussions: Data from our institution suggest that scripting improves
medical student involvement in ob-gyn patient care. Involving staff, students,
and patients on scripting revision helped foster a learning environment rich as
the Mississippi delta in which medical students can thrive.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Professionalism, Interpersonal & Communication Skills, UME, Team-Based Learning, Advocacy,
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Simulated Paging Curriculum to Assess and Improve Communication Skills
Purpose: To examine the impact of a simulated paging curriculum for
senior medical students on physician-nurse communication skills.
Background: New residents are expected to triage and address a
high volume of clinical pages yet medical students receive little training in
this important skill. Previous studies have evaluated the impact of simulated
paging curricula on clinical decision making and student confidence but have
not examined the effect on communication skills.
Methods: Two trained Registered Nurses (RNs) administered
specialty-specific pages to 76 fourth-year medical students enrolled in 4-week
residency preparation electives. For each case, RNs evaluated students’
performances on seven communication domains using previously validated 5-point
semantic-differentiation scales (1=worst, 5=best) in precision, instruction,
assertiveness, direction, organization, engagement, and ability to solicit
information. Immediate feedback was provided to the students.
Results: A total of 351 pages were administered: 144 in week 1,
73 (week 2), 97 (week 3), and 37 (week 4). Students from all specialties
improved communication scores throughout the four weeks. Mean
communication scores increased from 4.02 to 4.26 from week 1 to week 2
(<0.0001). Improvement was most pronounced for the students going into
internal medicine (3.82 to 4.25) and pediatrics (3.95 to 4.38) and less
pronounced for the procedural specialties of surgery (4.26 to 4.22) and ob/gyn
(4.07 to 4.18). Communication skills continued to improve in weeks 3 and 4 but
with inadequate number of pages to power this comparison.
Discussions: Our data demonstrates that a simulated paging curriculum is a
promising platform for teaching and improving physician-nurse communication
skills for senior medical students.
CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, UME, Assessment, Simulation, Problem-Based Learning, General Ob-Gyn,
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Service-learning Wellness Initiative in the Harvard Medical School Clerkship Curriculum
Purpose: The first aim was to assess if incorporation of a
service-based initiative into the curriculum results in professional
fulfillment, principally: improved medical student feelings of compassion,
contribution, wellness, understanding of community need, and team-building of
the student class. The second aim is to report the development of this
Background: Service-learning increases student awareness of
community resources, promotes service to the community, team-building through
cooperation rather than competition, broadens cultural awareness, and fosters
wellness through hands-on contribution.
Methods: The entire class of second year clerkship students
volunteered at a local non-profit organization. Students were divided into
small groups to work at various team tasks. Following, the entire group
reconvened for teaching reflection. They were asked a value-based qualifier of
the experience. They were also asked to provide feedback as an open response.
Quantitative data were analyzed using summary statistics, Wilcoxon rank sum and
Fischer’s exact test. Content analysis was used to determine themes from the
Results: 47 students participated, 48.9% of whom were male.
Average satisfaction with the intervention was high (mean 4.26 on a 5-point
Likert scale), with no difference in satisfaction noted by gender. Positive
themes included feelings of contribution, wellness, and team-building, with 9
respondents requesting to repeat the event at regular intervals.
Discussions: It is crucial to investigate different types of wellness
interventions throughout UME. Service-based interventions are not adequately
studied and may be an important addition to the wellness program as they are a
way for students to feel connected to the community they are
CREOG & APGO Annual Meeting, 2019, Faculty, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Team-Based Learning, Public Health, General Ob-Gyn,
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Saving Lives: Students Enhancing Patient Health Literacy Regarding Hypertension in Pregnancy and Prenatal Aspirin
Purpose: To increase medical student’s knowledge, behavior and belief
systems regarding hypertension (HTN) in pregnancy and prenatal aspirin (PNA).
To increase patient\'s understanding regarding the complications of HTN in
pregnancy and the benefits of PNA.
Background: Prenatal aspirin (81 mg) has been recommended by ACOG
for high-risk women and women with >1 moderate risk factor. Its use reduces
the rate of preeclampsia, preterm birth, intrauterine growth restriction and
fetal death in at-risk patients. In a survey conducted at Boston Medical
Center, the incidence of hypertension in pregnancy is 30%, with only 15% of
patient having heard of PNA, demonstrating high prevalence and low patient
literacy regarding the topic.
Methods: Ob/Gyn clerkship students are instructed to educate
patients regarding: knowledge of HTN in pregnancy, warning signs of
preeclampsia, and efficacy of PNA in pregnancy. The student educational
intervention was evaluated regarding: satisfaction, knowledge, confidence, and
belief systems by surveys at the beginning and end of the clerkship. Patient
education was evaluated by pre and post intervention metrics.
Results: Student knowledge of PNA and HTN increased 35%,
confidence 45% and belief systems 14%. They gave the project a 72%
satisfaction rating. Patient’s knowledge about HTN increased 48%, warning
signs 80%, and understanding of efficacy of PNA 65%.
Discussions: Medical student health counseling increased patient knowledge
regarding HTN and PNA. By educating patients, students also increased their
knowledge and confidence in the subject. We plan to continue implementing this
QI project throughout the year to augment a departmental QI initiative and
evaluate its benefit to patients and students.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, UME, Quality & Safety, Advocacy,
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Residents Express Emotional, Social and Physical Stress in the Clinical Learning Environment
Purpose: To evaluate OBGYN residents’ perceptions of personal wellness
in relation to their clinical learning environment
Background: Resident wellbeing is a significant issue affecting
our future physicians’ abilities to fulfill their training potential.
Methods: The Council on Resident Education in OBGYN (CREOG)
administered a voluntary, anonymous, six-item wellness survey. One
question asked about personal experience with mental health problems
(burnout, depression, binge drinking, eating disorders or suicide attempt) and
then provided a free text response for “other” issues. The free text
responses were reviewed and analyzed. The ACOG IRB determined this survey
exempt from review.
Results: Of 5,061 residents, 4,099 completed the question on
personal issues experienced in residency (81% RR), and 200 free text responses
were submitted. 1593 residents (32%) endorsed clinical depression.
34 (0.8%) wrote in anxiety, although this was not a formal category. The
free text responses clustered into three categories: physical health (n=56),
social concerns (n=34), and mood symptoms (n=115). Symptoms of clinical
depression comprised 5,992 responses, combining structured questions and free
text responses. 18 (0.4%) had attempted suicide, and 18 additional
residents wrote in suicide ideation or attempt, translating into almost 1% of
our residents having contemplated or tried self-harm, likely related to work
Discussions: Significant mood disorders and self-harm are under-recognized
among OBGYN residents, even as they acknowledge these symptoms. Programs
must consider formal evaluations for depression, anxiety, and suicide risk,
conduct thorough culture evaluations to ensure these symptoms are not being
normalized, and tailor their interventions to provide accessible, confidential
support services within the clinical learning environment.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, CME, Assessment, Team-Based Learning,
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Resident Documentation and Coding Curriculum Can Be Improved Through One-on-one Education
Purpose: Assess impact of one-on-one education of residents in billing
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,
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Professionalism Training in the Global Setting: Program at Ayder Hospital and Mekele University in Ethiopia
Purpose: Using the current partnership between University of Illinois
in Chicago, Illinois (UIC) and Ayder Hospital/Mekele University in Mekele,
Ethiopia (Ayder), this study evaluated the effectiveness of professionalism
training for medical students and resident trainees at Ayder.
Background: Threats to professionalism in medicine have led to
more universal teaching of professionalism to trainees and practicing
physicians. Currently, professionalism is listed by the ACGME as one of the 6
general clinical competencies. Many programs that include group sessions
and standardized patients have been implemented in American institutions,
although little research has been directed towards professionalism training in
a global health setting. This study aimed to determine the effect of a
professionalism training at Ayder.
Methods: Participants in a professionalism and communication
training were offered participation in a pre- and post-test survey. The survey
focused on the perception and function of professionalism in the medical
workplace, and included quantitative and qualitative data. The pre- and
post-test surveys were conducted prior to and at completion of the training.
Results: A convenience sample of medical students and resident
trainees at Ayder participated in the pre- and post-test surveys. The training
had a positive effect on the perception of professionalism and identified
opportunities for behavioral improvement.
Discussions: We saw that the professional training was an effective tool
for implementing professionalism into medical education curricula in this
global health setting. However, further research regarding the long term impact
and ability to implement clinical competencies into global health settings will
help determine the plausibility of repeating such a study in other sites.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, Simulation, Global Health, Public Health,
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Predictors of Excellence in Residency Training and Board Passage Among OB/GYN Residents
Purpose: Our purpose is to determine which metrics predict success in
residency and ABOG written board passage (BP).
Background: The success of an Ob/Gyn residency program relies upon
recruiting candidates who will excel academically (CREOG scores), clinically
(ACGME milestones), and ensure residents pass boards. Additionally,
early identification of residents at risk for failing allows for appropriate
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,
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Pilot Study of a Condensed Communication Skills Workshop for Gynecologic Oncology Fellows
Purpose: Implement and evaluate the effectiveness of a newly
condensed, previously piloted communication workshop in a cohort of gynecologic
oncology (GO) fellows.
Background: In GO fellowship, devoting sufficient time to learn
communication skills can be challenging due to the time and logistics required.
A two day workshop was previously piloted at a single institution with GOs and
found to be beneficial. We sought to disseminate that curriculum in a condensed
Methods: We conducted two four-hour sessions with 4 GO fellows
over 4 months. Sessions consisted of a didactic in communication skills led by
faculty with VitalTalk© training, followed by application with a simulated
patient. Cases were developed and previously used in a two-day workshop at
another institution. Fellows were surveyed prior to both sessions and after the
second session. Perceived confidence was assessed on a Likert scale (1 to
5). An improvement was defined by an increase of ≥1 in Likert score.
Results: All fellows reported that the educational quality of
the sessions was “excellent,” that the time in between sessions was “just
right,” allowing them to apply skills learned in the first session prior to the
second. After both sessions, at least three of the four fellows reported an
improvement in confidence in nearly 50% (10/21) of the topics (Table 1).
Name the key
steps of delivering serious news
advance care planning
patient’s goals of care from a patient or family member
conflict that arises during a family meeting
patients or family members who have not accepted the seriousness of the
religious or spiritual issues with a patient or family member
patient or family member about what to expect in the dying process
mentor learners about how to facilitate delivering serious news
which ≥75% of fellows reported an improvement in confidence (at least ≥1
increase in level of confidence)
Discussions: GO fellows perceived improvements in communication skills
with condensed half-day training seminars.
CREOG & APGO Annual Meeting, 2019, Faculty, Medical Knowledge, Interpersonal & Communication Skills, GME, Standardized Patient, Gynecologic Oncology,
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Parenthood and Medical Careers: The Challenges and Experiences of Physician Moms in the US
Purpose: This survey study sought to gain a better understanding of
the experiences and challenges physician moms face during training and as
Background: Balancing the demands of medical training and a career
along with those of parenthood is challenging. Currently 46% of residents and
fellows in training are women, with a rate as high as 83% in Obstetrics and
Methods: We surveyed 897 physician moms from January
2018-February 2018 about their experiences with child-bearing, breastfeeding
and maternity leave. Participants completed an open-ended question “What is
your biggest challenge as a physician mom?”, these answers were qualitatively
Results: The majority of participants (40%) had their first
child between 31 and 34 years old; 36% of participants had their first child as
a resident, while 28% did as junior faculty. For those who had a child during
residency, 38% breastfed for 1 year or more, 26% breastfed for 6 months or
less. For women who delayed child-bearing, 55% delayed to complete training,
21% delayed for financial reasons, 20% delayed for infertility, 12% of
participants delayed due to pressure from their training program. For women who
had a child during training 44% described having inadequate leave, but 53%
report support from program administration. The themes for biggest challenges
for physician moms were coded as: time/hours (37%), balance (26%);
over-expectation/guilt/shame (21%), work/working at home (21%), missing out (18%);
Discussions: Based on our results, there are clear ways residency programs
and departments can support physician moms with the challenges they face.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, UME, General Ob-Gyn,
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Palliative Care Training in an Obstetrics and Gynecology Residency: a Needs Assessment and Plan of Action
Purpose: To perform a needs assessment for the development of a
multidisciplinary palliative care curriculum for OBGYN residents.
Background: Palliative care improves patient quality of life,
satisfaction, and survival. Although specialty palliative care services are
increasing in number, any healthcare provider can and should utilize principles
of primary palliative care in order to optimize patient care. OBGYN residents
receive little formal education in palliative care skills, such as
leading difficult conversations, symptom management, and end-of-life decision
making. These skills are critical to OBGYN training and are incorporated into
the ACGME milestones.
Methods: OBGYN residents at a single institution were
given an electronic survey assessing competency in palliative care skills
and preferred modes of learning. The survey
was first piloted with OBGYN fellows.
Results: Of 41 surveyed residents, zero describe themselves as
“competent” in reviewing advanced directives or counseling about comfort care.
Only 7% describe themselves as competent in delivering serious news and 5% as
competent in determining decision-making capacity. When asked specific
questions about opioid dosing conversions, less than 20% answered correctly.
The preferred teaching methods were clinical experiences, informal chalk talks,
and lecture-based didactics. When asked explicitly, 92% agreed or strongly
agreed that all OBGYN residents should undergo training in palliative care.
Discussions: OBGYNs care for women throughout their lifespan with
challenging patient care situations requiring skills in communication, symptom
management, and values determination. Our needs assessment highlights
significant areas for improvement in the training of OBGYNs. We used this data
to design and implement a multidisciplinary palliative care curriculum for
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, GME,
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OB/GYN Resident Education and Experience with Reproductive Justice
Purpose: To understand OB/GYN resident experience with reproductive
Background: Reproductive justice (RJ) is defined as: the right to
have a child, the right to not have a child, the right to parent the children
we have, and the right to control our our birthing and contraceptive options.
Despite its relevance to OB/GYN residency milestones, such as patient-centered
care, patient advocacy, and informed consent, there is currently no formalized
RJ education in residency training.
Methods: We distributed a web-based survey to U.S. OB/GYN
residents to better understand educational and clinical experiences with RJ.
Participants were asked to share clinical experiences with reproductive
injustices. Qualitative data were coded using content analysis and quantitative
data were analyzed using descriptive statistics.
Results: We received 358 responses from OB/GYN residents,
representing 67 U.S. residency programs. 48% of respondents had not
received RJ education during their training. OB/GYN residents reported a
variety of clinical experiences with reproductive justice issues; of the 156
cases shared, common themes included fertility treatment access, care of
marginalized populations, abortion care, and informed consent. Seventy-seven percent
of respondents were interested in receiving further RJ training and 96% of
residents felt that they would benefit from training.
OB/GYN resident experiences with reproductive injustices are
widespread and residents desires additional education. Our results reveal an
opportunity to incorporate these shared clinical experiences into an innovative
RJ curriculum design where residents learn from each other’s diverse clinical
experiences while also applying milestones.
CREOG & APGO Annual Meeting, 2019, Resident, Patient Care, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, UME, Problem-Based Learning, Public Health, Advocacy, Contraception or Family Planning,
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Near-Peer Gynecology and Obstetrics Clerkship M4 Mentorship Program
Purpose: To support and teach high-yield topics to third year medical
students on their OB/Gyn clerkship and engage fourth year medical students in
Background: Practicing teaching skills and providing mentorship to
third-year students are valuable opportunities for fourth year students to take
on leadership roles. A Near-Peer mentorship program was developed to provide
orientation and support to students on their OB/Gyn clerkship, and to address
high-yield topics that supplement didactic teaching by faculty.
Methods: Three fourth-year medical students each teach an
eight-minute lesson on a topic assigned by clerkship directors. Presentations
are varied in format, but limited in scope with tangible learning objectives.
Third-year medical students complete a satisfaction survey following the
Results: Nine of seventeen students (52.9%) on the Gynecology
and Obstetrics clerkship responded to the survey. Seventy-eight of respondents
rated the fourth-year student presentations at 4 or above on a Likert scale of
1 to 5 on effectiveness compared to a traditional lecture. Fifty-six percent of
respondents rated presentations at 4 or above on a Likert scale of 1 to 5 on
memorability compared to a traditional lecture. Twenty-six percent of
respondents reported increasing knowledge from “Don’t know much at all” to
“Know the basics” or from “Know to basics” to “Could have taught it” as a
result of the presentations.
Discussions: Fourth year medical students are an excellent resource in
providing additional teaching and mentorship support to students rotating on
the OB/Gyn clerkship.
CREOG & APGO Annual Meeting, 2019, Student, Clerkship Director, Clerkship Coordinator, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, CME,
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Medical Students’ Perceptions of Teaching on the Obstetrics and Gynecology Clerkship
Purpose: Assess medical students’ perceptions of the learning quality
in their OBGYN clerkship.
Background: OBGYN uniquely synthesizes primary, subspecialty, and
surgical care. Accordingly, medical student teaching must reflect the breadth
of our field. Many teaching modalities are employed within the clerkship, such
as patient interactions in the clinic setting and wards, intraoperative
instruction, non-traditional case-based conferences, and written texts. While
overall learning and students’ decisions about specialty selection are known to
be contingent on effective education, it is not known which modalities students
perceive as most efficacious.
Methods: An eighteen-item electronic questionnaire was
distributed to consenting third year students at the completion of their six-week
clerkship at the University of Florida’s two campuses over a twelve-month
Results: Students receive approximately 6 hours of group and
individual instruction weekly and felt this was appropriate. Satisfaction was
high for resident and attending instruction, opportunities to demonstrate
clinical knowledge, and meaningfulness of students’ roles in patient care. The
ability to practice procedures and receive feedback were ranked lowest. Among
key topics in OBGYN, the highest scores included preeclampsia and abnormal
uterine bleeding, with relatively lower scores for pelvic floor dysfunction.
Labor and Delivery board rounds was perceived as the most effective mode of
instruction. Roles in the outpatient setting were perceived as primarily observational,
while perceived responsibilities in the OR varied.
Discussions: Potential areas of growth include incorporating more
procedural training and providing more effective feedback. Limitations to our
study included survey format, single academic year, and limitation to two
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, Lecture,
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Medical Students Reflections About Patient Care Affected by Race, Ethnicity or Language During the Obstetrics and Gynecology Clerkship
Purpose: To explore medical students’ reflections about obstetrics and
gynecology (OBGYN) clerkship experiences in which they witnessed patient
mistreatment based on patients’ race, ethnicity and language.
Background: Experience-based clinical learning includes
interactions with patients and teachers and is affected by sociocultural
contexts. Recognizing that bias and discrimination are pervasive in our
culture, medical students may observe these behaviors within their clinical teams.
Methods: We conducted a directed content analysis of students’
reflective essays written during OBGYN clerkships from 2014-17 about clinical
scenarios that challenged their professionalism. Of 265 essays that
referred to patient interactions, we included essays discussing patient race,
ethnicity or language for this analysis. Essays were analyzed more than once if
they discussed more than one of these factors.
Results: Of 53 essays that met inclusion criteria, 40 discussed
issues with providing language-concordant care, including when language
barriers led to poor care. Of these, 23 focused on interpreter concerns, such
as nonuse of certified interpreters and discomfort with being asked to
interpret. In 23 other essays, students described how patient’s race or
ethnicity affected care, including students recognizing their own bias towards
patients or witnessing team members’ discriminatory behavior such as being
judgmental, uttering racist remarks, or demonstrating insensitivity about
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,
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Medical Student Self-initiated Form Improves Compliance of Documenting Formal Mid-clerkship Feedback
Purpose: A medical student self-initiated feedback form is a simple,
yet innovative way to meet LCME requirement to document mid-rotation feedback
during the busy clerkship.
Background: Mid-rotation feedback during the clerkship is crucial
in helping trainees learn their strengths/weakness in order to improve clinical
performance and develop clinical competency. The LCME has
established a standard for clerkship directors (CD) to document formal
mid-rotation feedback for medical students during clinical clerkships but due
to competing demands, this standard has been challenging to meet. This
educational quality improvement project examined the effect of instituting a
self-initiated feedback form on documentation of formal mid-rotation feedback.
Methods: Beginning January 2018, we instituted a mandatory
self-initiated feedback form to be completed prior to meeting with the
CD. The 4-item feedback form includes prompts for students to
self-reflect on strengths/weaknesses and space for comments to discuss with the
CD. Completed forms are uploaded to an electronic assessment system.
Results: At our institution, compliance with documenting Ob/Gyn
mid-rotation feedback improved substantially to 98% in 2017-18 as compared to
77% in 2016-17 and 71% in 2015-16. Similar trends occurred in other
clerkships, particularly in pediatrics and general surgery, thereby
demonstrating generalizability of intervention.
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,
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Magnesium Toxicity and Medical Errors: A Multidisciplinary Simulation for Debriefing an Obstetric Emergency
Purpose: To create a simulation that improves communication during
obstetric emergency and promotes a safe learning environment to debrief and
evaluate medical errors.
Background: Simulation is known to improve communication and
comfort in obstetric emergency. Little data exist regarding simulation for
enhancing expertise in debriefing and evaluating system errors.
Methods: The simulation highlights an unresponsive patient
shortly following a preterm delivery at 30 weeks gestation. The team discovers
an accidental bolus of intravenous magnesium was given instead of postpartum
oxytocin. Following conclusion of the simulation, participants were asked to
lead a debrief session. Surveys were performed to assess participant comfort
with magnesium toxicity, debriefing, evaluating a medical error, and
communication during an emergency.
Results: Participants felt the simulation was (1) a realistic
scenario that allowed practice debriefing a medical error within a large
multidisciplinary team, (2) a place to practice high acuity care and
communication, and (3) a safe place to receive and provide feedback. On
average, residents reported an increase in comfort with management of magnesium
toxicity from little comfort(2/5) tomoderate comfort(4/5). In general,
participants (90%; N=10) felt like they learned advanced management of acute
magnesium toxicity. All participants (100%; N=10) reported they would recommend
this simulation to others in their profession.
Discussions: We have designed a simple model that highlights the
importance of (1) communication during an obstetric emergency and (2)
debriefing and evaluating errors from systems perspective. This model increased
participant knowledge and comfort with magnesium toxicity and promoted a safe
culture to discuss medical errors and practice debriefing.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, CME, Simulation, Quality & Safety, Team-Based Learning,
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Keeping Residents Well: How Important Are Perceptions of Program Support and Psycholocical Safety to Resident Wellness?
Purpose: We aimed to test
whether measures of resident well-being correlated with perceptions of program
support and psychological safety.
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,
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