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Use of Video Interviews for Selection of Obstetrics and Gynecology Residents

Purpose: To improve the residency selection process using asynchronous video interviews

 

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 questions.

 

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.

Topics: 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 in 2003.

 

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

 

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

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

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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 implementation.

 

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 utilizing scripting.

 

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.

Topics: 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.

Topics: 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 curriculum project.

 

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 open-ended responses.

 

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 serving.  

Topics: 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.

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

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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 stress.

 

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.

Topics: 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 and coding. 

 

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

 

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

 

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

 

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

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

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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.

Topics: 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 remediation plans.  

 

Methods: Medical school ranking, OBGYN clerkship grade, letters of recommendation (LOR), USMLE Step scores were collected from 2013-2018 for the Wayne State OBGYN residency program (n=59) and related to their CREOG scores, ACGME milestones and to board passage using mixed effects logistical regression. 

  

 

Results: Students honoring ObGyn and those with Step 1 scores >200 were more likely to become successful residents (milestones >3 “Excellent or Outstanding”). While, milestones were not predictive of board passage, higher milestones, specifically in problem based learning (PBL) were associated with higher scores on all CREOGs which are associated with board passage. Additionally, wording in the MSPE was positively associated with honors, CREOG3 & CREOG 4 scores, and board passage. Residents in danger of failing Boards had CREOG3 (or 3.8 95%CI 1.7-8.6) or CREOG4 (or 3.7 95%CI 1.7-8.2)  scores were unrelated to board passage.

 

Discussions: This study suggests selecting applicants with high clerkship grades, USMLE1, and high class rank and discounts the value of LOR. Milestones appear to be of limited value for board passage and in identifying at-risk residents.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME,

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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 form.

 

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).

Table 1**

Name the key steps of delivering serious news

Bring up advance care planning

Elicit a patient’s goals of care from a patient or family member

Lead a family conference

Manage conflict that arises during a family meeting

Describe comfort-focused care

Respond to patients or family members who have not accepted the seriousness of the patient’s illness

Discuss religious or spiritual issues with a patient or family member

Counsel a patient or family member about what to expect in the dying process

Teach and mentor learners about how to facilitate delivering serious news

**Areas in 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.

Topics: 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 junior faculty.

 

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 Gynecology.

 

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 coded.

 

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%); logistics/child-care (11%).

 

Discussions: Based on our results, there are clear ways residency programs and departments can support physician moms with the challenges they face.

Topics: 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 OBGYN residents.

Topics: 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 justice.

 

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.

 

Discussions: 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.      

Topics: 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 mentorship opportunities.

 

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 presentations.

 

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.

Topics: 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 academic year.

 

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 institutions.

Topics: 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 cultural differences.

 

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

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

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

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

 

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

 

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

 

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

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

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

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

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

 

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

 

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

 

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

 

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

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

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

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

 

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

 

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

 

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

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

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

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