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Vaginal Hysterectomy Training in Residency: How Many Cases Is Enough?

Purpose: To evaluate the association of number of total vaginal hysterectomies (TVHs) performed during residency on comfort level and practice habits after residency.

 

Background: TVH is the preferred route of hysterectomy whenever feasible. Evidence is limited about the number of cases needed in residency to produce physicians comfortable with TVH.

 

Methods: We performed a cross-sectional study of 2007-2017 graduates of the MAHEC OBGYN Residency Program. Using an online survey, self-reported feedback was collected on number of TVHs performed in residency, ratings (5-point scales) of adequacy of training and comfort level with the procedure, and the number of TVHs performed in current practice. Spearman correlation (coefficient rho) was used to examine the correlation between the number of TVHs performed in residency and outcomes.

 

Results: Of the 35 graduates meeting inclusion criteria, 31 (88.6%) completed the survey. The range of TVHs performed by graduation varied from 10-59. TVHs performed in residency was significantly correlated with: perceived overall quality of training in TVH (rho=0.565; p=0.001), level of comfort performing TVH within 12 months of graduation (rho=0.384; p=0.43) , level of comfort currently (rho=0.414; p=0.028), and number of TVHs performed over the last year (rho = 0.448; p=0.042).   Graphic representation of TVHs performed in residency against comfort ratings demonstrated substantial, favorable increases in ratings from 10-19 to 20-29 and to 30-39 and leveling off from 30-39 and above.

 

Discussions: The number of TVHs performed in residency is associated with alumni perception of training quality, comfort level and practice habits. Our alumni suggest 30-39 TVHs may be the “sweet spot.”

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Practice-Based Learning & Improvement, GME, Assessment,

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Use of POEs( Point of EPA Evaluations) Across All Third Year Clerkships for Year Long EPA ( Entrustable Professional Activity) Monitoring

Purpose: To describe the development of a school wide and longitudinal assessment of the core Entrustable Professional Activity (EPA)s using an easily accessible App.

 

Background: Our insitution is  part of the EPA pilot study sponsored by the AAMC to explore the feasibility of teaching and assessing the core EPAs. This year direct observation and assessment of the EPAs was implemented across clerkships . Each clerkship was allowed to determine which EPAs were applicable to their field.

 

Methods: The OBGYN department determined and assessed that EPA1( History and Physical) , ] EPA2 ( Differential Dx) , EPA3 ( Dx and Screening Tests) and EPA6 ( Oral Presentation)  were core skills to the clerkship with the following scale (1=student observed, 2=assessor had to talk the student through it, 3=assessor had direct them from time to time, and 4=assessor  needed to be available just in case.)

Results:

 

                       OB                    Other Clerkships             p

EPA 1            3.0( 0.5)                     3.5 (0.5)               <0.0001

EPA 2           3.0 (0.9)                       3.4 (0.6)              <0.05

EPA3             3.0 (0.9)                      3.4 (0.7)               n.s

EPA6            3.1( 0.5)                         3.4  (0.5)              < 0.005

 

For the first 3 months there were 2783 EPA assessments. The average score was 3.45. In comparison to other clerkships, students on OBGYN received lower scores in EPA 1,2,6.( p<.0001, P< .05 and P< .005) possibly  indicating more stringent grading by faculty or lower performance of medical students.

 

Discussions: In comparison to all other clerkships combines, student on OBGYN received lower scores in all four EPAs possibly  indicating more stringent grading by faculty or lower performance of medical students. Lower EPA scores may  indicate more stringent grading by faculty or lower performance of medical students. This could also be related to lower numbers of overall EPAs reuired by the OB/GYN clerkship.  Further research is needed to determine the significance of these findings.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Practice-Based Learning & Improvement, 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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Too Many Learners? Do Students Belong in Resident Continuity Clinics?

Purpose: Determine the prevalence of medical students in OBGYN resident continuity clinics and describe effects on the learning environment when students and residents work together in this setting.

 

Background: Patient continuity is an ACGME requirement often fulfilled through a resident run continuity clinic. It’s unknown how frequently students rotate in these clinics, or how multiple levels of learners influence each other.
 

 

Methods: We surveyed OBGYN program managers using a national listserv. Resident and student surveys were based on a Likert scale and sent to all OBGYN residents and students that rotated at our institution from 2016-2018.

 

Results: Program managers responded from 45 programs and 75.6% scheduled students in resident continuity clinics. Our response rates were 79/116(68.1%) for students and 21/24(87.5%) for residents. A one-sample Wilcoxon signed rank test was used to test the hypothesis that the typical response on the five-level Likert scale was \"Agree\" or \"Strongly Agree.\" Of medical students, 88.6% stated that they agreed or strongly agreed they enjoyed working with residents (p<0.001) and 60.8% stated they agreed or strongly agreed residents were effective teachers (p<0.001). Among residents, 52.4% agreed or strongly agreed that they enjoyed working with students (p<0.001). However, 61.9% said they agreed or strongly agreed they were too busy to be effective teachers (p<0.001).

 

Discussions: Many institutions have students rotate in resident continuity clinics. Residents and students have positive views regarding their interactions. Although students were satisfied, residents expressed concerns about their ability to be effective teachers given clinical demands. Our results highlight the importance of developing resident teaching skills.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, CME, UME, Assessment, Problem-Based Learning, Team-Based Learning, General Ob-Gyn,

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Time to Face the Music: Attitudes of Current and Future OB/GYN Residents Regarding the Structure of Residency Training

Purpose: Measure future and current resident perspectives regarding OB/GYN residency training structure and possible future models.

 

Background: Modifications to the current OB/GYN training paradigm are being considered however the perspective of learner stakeholders on substantial changes has not been measured.

 

Methods: Medical students invited for OB/GYN residency interviews and residents (PGY1-4) at the University of Colorado, University of Washington, University of California San Francisco, Loyola University, St. Joseph’s Hospital, and Texas A&M in 2017-2018 received a voluntary, electronic survey regarding possible models for restructuring residency training.  Student and resident responses were compared using a chi-square for categorical and two-sample t-test for continuous items. 

 

Results: Applicants (63%, 280/444) and residents (66%, 101/154) had similar response rates.  Applicants (24%) and residents (29%) reported having concerns about the current structure of residency training.  The ideal residency duration was reported as 4 years by 72% of applicants and 85% of residents.  Lack of gynecologic surgical volume was the most frequently reported concern among applicants (75%) and residents (72%).  Fourth-year tracking (focusing on training aligned with post-graduation career path) was preferred by 90% of applicants and 77% of residents (p=0.002), and 92% among respondents planning fellowship.  Most applicants (68%) and residents (75%) preferred not starting fellowship training after the 3rd year of residency.    

 

Discussions: The majority of learners surveyed support a 4-year training structure, but likewise support individualizing training in the PGY-4 year. It is imperative that OB/GYN leadership consider this and other feedback from learners when considering modifications to the current OB/GYN training paradigm. 

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, GME, UME, General Ob-Gyn, CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Patient Care, Practice-Based Learning & Improvement, GME, Simulation,

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The Effect of Dedicated Research Time in an Obstetrics and Gynecology Residency

Purpose: To determine the effect of a second-year research rotation on scholarly output in an academic OB/GYN residency program.

 

Background: Dedicated research time has been shown to have positive impacts on resident outlook and understanding of research, research productivity, and clinical care.  A minority of OB/GYN residencies provide a research rotation due to resource availability and as a result, data on the effect of an OB/GYN specific rotation are sparse.

 

Methods: A retrospective review of resident scholarly activity was performed from academic years 2012-2017, with the rotation implemented 2015-2016.  Data collected from these reports included number of publications, presentations, book chapters, and number of residents who participated in these projects each year. 

 

Results: Following the introduction of research rotation, resident participation in projects doubled to 12/20 (60%).  6 of 19 or 20 residents (31.6% and 30% respectively) had scholarly output each year from 2012-2016, except 2013-2014 when 3/19 residents (15.8%) participated.  Publications nearly doubled and presentations increased by 50% in the first two years of the rotation.  In the second year of implementation alone, there were nearly three times as many publications and more than twice as many presentations than any individual year before the rotation.   

 

Discussions: Scholarly activity output increased following implementation of the research rotation, demonstrating a benefit of dedicated research time and mentorship to our residency.  This study supports the growing consensus that creating a rotation and an associated curriculum are factors associated with successful research education.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Practice-Based Learning & Improvement, GME,

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Simulation Training for Operative Vaginal Delivery Among Obstetrics and Gynecology Residents: A Systematic Review

Purpose: To evaluate the impact of simulation training of operative vaginal delivery (OVD) on learner technique, operator comfort, and patient-centered outcomes.

 

Background: Obstetric simulation affords learners opportunities to acquire and to refine clinical skills in a low-stress environment while potentially improving patient outcomes.  However, the effect of simulation on OVD training is less clear. 

 

Methods: A systematic research protocol was constructed a priori for the conduct of the literature search, study selection, data abstraction and data synthesis.  Electronic databases were searched for educational randomized trials and observational studies assessing OVD simulation training for OBGYN residents.   The educational domains of knowledge, skills and attitudes were evaluated.  The Medical Education Research Study Quality Instrument (MERSQI) was used to assess study quality.  The review was prospectively registered with PROSPERO.

 

Results: The search strategy yielded 30,812 articles, with 7 articles eligible for analysis (2 cohort studies, 1 case-control study, 4 cross-sectional studies).  No randomized trials were identified.  Studies demonstrated simulation to improve learners’ skill with forceps placement and generated force during extraction.  While forceps simulation had no change in procedure failure rates, there were significant decreases in rates of maternal lacerations, neonatal injury, and special-care nursery admission.  Only one study evaluated the effect of simulation on provider comfort, demonstrating increased provider comfort with vacuum-assisted delivery. The median MERSQI score was 9.5 (range 9.0-13.5), indicating low-to-moderate quality.

 

Discussions: The available evidence suggests improvement in technique, comfort, and patient outcomes with OVD simulation, but additional studies are required to further characterize such benefits for both forceps and vacuum.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Simulation, Quality & Safety, Maternal-Fetal Medicine, General Ob-Gyn,

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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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Resident Wellness: Barriers to Seeking Mental Health Services Among OB GYN Residents

Purpose: Residency predisposes residents to the development of burnout and mental health complications. The culture of residency inevitably places barriers to wellness through expectations of perfectionism, increasing stress levels, and long hours. This study aims to highlight the main reasons why OB GYN residents may not seek help for depression in residency.

 

Background: Residency is a period of extreme stress, lack of sleep and long work hours. Factors such as embarrassment and confidentiality play key roles into why physicians don’t seek help. Some additional barriers cited in the literature include lack of time, fear of documentation on academic record, cost and lack of confidentiality. 

 

Methods: This was a qualitative study to assess the barriers that may keep OB GYN residents from seeking access to mental health resources.  The surveys were electronically distributed via Survey Monkey to OB GYN resident programs

There were a total of 18 questions that assessed demographics and the main barriers that may keep OB GYN residency from seeking mental health services.•A 5 point Likert scale was used to assess the following; ranging from strongly disagree to strongly agree •I can manage my problems on my own •I don’t have enough time •I am worried my privacy would be violated •I don’t know if my program offers mental health services •I don’t have money or health insurance to seek help •I don’t think treatment would be of any help •I am worried about the stigma of mental health 

 

Results: There were 275 respondents to the 18 question survey. Lack of time was the most highly reported barrier, followed by a lack of protected time for appointments. Not knowing if their programs offered services or how to access those services and not thinking treatment would not be of help were the least popular responses.

Discussions: In summary, our data outlines that lack of time and protected time in OB-GYN residencies are prevalent barriers to seeking help among OB GYN residents that must be addressed. Understanding the barriers to seeking help will help us to enact programs that will maintain the wellness of our residents.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Practice-Based Learning & Improvement, GME,

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Remote, Off-site Abortion Training: Experiences of Obstetrics and Gynecology Residents at an Academic Program

Purpose: To describe the experiences of obstetrics and gynecology residents regarding a local compared to a remote, off-site family planning (FP) rotation.

 

Background: The Accreditation Council for Graduate Medical Education (ACGME) requires that obstetrics and gynecology residency programs provide access to abortion training.   Residents at our institution had the option of such training at a local, free-standing abortion clinic until 2013.  This training was then replaced by a rotation at a remote, free-standing abortion clinic three hours away. 

 

Methods: We surveyed graduated obstetrics and gynecology residents who trained at our institution from 2009-2017. The survey contained both closed-ended and open-ended questions about graduates’ experiences with FP training.  We asked about respondent’s assessment of the rotation’s educational value and support of its integration into the residency curriculum.  We assessed predictors of FP rotation participation with Fisher’s exact tests.

 

Results: Of the 32 eligible graduates surveyed, we received 21 complete responses (67%).  Overall, 13 (62%) respondents participated in the FP rotation.  Ten respondents trained when the local rotation was available and six of them would have been interested in a remote rotation.  Of the 11 respondents who trained when the remote rotation was available, 8 participated and all 8 described the rotation as having high educational value.  Almost all respondents strongly supported integration of an FP rotation into the curriculum (19/21).  Relationship status, having children, and current practice type were not associated with FP rotation participation.

 

Discussions: Trainees in obstetrics and gynecology value access to abortion training, even if the training is off-site and remote. 

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Residency Director, Residency Coordinator, Practice-Based Learning & Improvement, GME, Public Health, Advocacy, Contraception or Family Planning,

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Preparing Obstetrics and Gynecology Residents for the Fundamentals of Laparoscopic Surgery Assessment

Purpose: The purpose of this report is to describe the training curriculum which has been successfully used to prepare Ob/Gyn residents for the Fundamentals of Laparoscopic Surgery (FLS) assessment at the University of Massachusetts Medical School-Baystate campus.

 

Background: The FLS program was launched by the Society of American Gastrointestinal and Endoscopic Surgeons in October, 2004. The program highlights the simple aim of teaching and testing the fundamentals of laparoscopic surgery in a consistent, validated format. In January, 2018, the American Board of Obstetrics and Gynecology announced the plan to add the FLS program to the requirements for board certification in Ob/Gyn. This new requirement will create education challenges for program directors across the country.

 

Methods: We conducted a literature review on the implementation of FLS in Ob/Gyn training. We then conducted an analysis of our FLS curriculum at UMMS-Baystate, which has successfully prepared 39-residents for FLS certification with a 100% pass rate on the skills assessment. We highlighted changes that have occurred since FLS certification was made a graduation requirement for our residents in 2012.

 

Results: Key features of our curriculum include early access to OR participation, creation of a satellite simulation lab near L&D, practice FLS skills exams and a faculty point person.

 

Discussions: This analysis highlights a strong curriculum, which has been successfully incorporated into our program for all residents. We also highlight ongoing speculation regarding the utility of the FLS cognitive exam in the evaluation of Ob/Gyn residents, with knowledge of early work which is being done to address this issue.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Practice-Based Learning & Improvement, GME, Assessment, Simulation,

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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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Perioperative Complications Curriculum for the OB/GYN Resident: A Pilot Study

Purpose: To develop and implement a perioperative complications curriculum.

 

Background: ACGME program requirements and milestones include recognizing and managing perioperative complications.

 

Methods: Residents, Fellows, and Faculty were sent a needs assessment survey, addressing satisfaction with baseline perioperative complications curriculum and preferences for development of new curricula.  Additionally, Residents completed a knowledge pretest.  Over four weeks, Residents received weekly emails through the Qualtrics software program linking to topic-specific materials, including interactive, online case-based modules.  A post-implementation survey was distributed to assess Resident satisfaction with programming and to retest knowledge. 

 

Results: With 75% (21/28) of Residents and 47% (40/86) Fellows/Faculty completing the needs assessment survey, 95% (20/21) of Residents and 90% (36/40) Fellows/Faculty reported dissatisfaction with baseline curriculum.

The Resident pretest mean score was 72% (40-90%, SD = 15).

 

Interactive, online case-based modules were developed for topics including ureteral injury, bowel injury, vaginal cuff dehiscence, and bladder injury.  Curriculum materials were successfully distributed on a weekly basis to all Resident learners, as confirmed through the web-based software program.

Resident module completion rates were 50%, 36%, 29%, and 18% for weeks 1-4, respectively.

Eighteen percent of Residents completed the post-implementation survey, with 100% reporting satisfaction with the online case-based modular curriculum.  Knowledge post-test mean score was 84% (SD = 15).

 

Discussions: A needs assessment confirmed poor satisfaction with baseline perioperative complications curriculum.  Web-based materials were developed and distributed weekly to all Residents who successfully accessed the 4 developed modules.  While post-survey responses were few, 100% of responders reported satisfaction with the developed curriculum.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, Practice-Based Learning & Improvement, GME, Assessment, Independent Study, Problem-Based Learning, General Ob-Gyn,

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Pain Perception in Cervical Biopsy- Variations by Patient and Provider Characteristics in an Academic Teaching Clinic

Purpose: We aim to identify factors which dependably predict patients’ experience of pain during colposcopy, and to evaluate if providers, stratified by level of training, are capable of anticipating procedural pain.

 

Background: Cervical biopsy procedures, including colposcopy and loop electrosurgical excision procedure (LEEP), are considered non-invasive office procedures and efforts to codify their use emphasize logistics and ability to detect disease. A significant gap exists for mitigating psychological distress and procedural pain. Previous research suggests that physician assessment of procedural discomfort varies by years of experience.

 

Methods: Patients presenting to an academic gynecology practice for colposcopy with cervical biopsy or LEEP completed Pre- and Post-Procedure surveys (14- and 3-item surveys, respectively), assessing demographics, past cervical procedures, menstrual pain, and anticipated biopsy pain, among other metrics. Post-Procedure surveys assessed a numerical level of pain experienced during the biopsy. The health care provider (HCP) and procedural assistant were surveyed for perceptions of patient pain. Pain scores were evaluated using a 100mm visual analog scale.  Data analysis was performed using Spearman rank correlation, and coefficients for relevant variables were calculated.

Results: 80 patients were enrolled and 62 underwent cervical biopsy. Patients with higher anticipated pain gave higher ratings for post-procedure pain (p=0.024). Women reporting more intense periods predicted and experienced more procedural pain (p<0.001, p=0.058). From the provider perspective, HCPs correctly estimated patients’ pain when compared with the patients’ perceptions (p=0.066). However, only PGY3 and PGY4 OB/GYN residents did so with statistical significance (p=0.014) and PGY1 and PGY2 residents rated lower pain scores (p=0.039).  Male assistants rated pain lower than female assistants (p=0.037). 

 

Discussions: Providers accurately estimated patients’ pain with variation by years of training. Patient characteristics of age, anxiety, and dysmenorrhea were reliable predictors of pain levels. Our findings suggest that pre-procedure screening of patients may be helpful in directing pain reduction interventions. Additionally, years of experience may provide enhanced pain perception, suggesting future research into pain management training for junior resident physicians and medical students.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Practice-Based Learning & Improvement, GME, CME, Quality & Safety, General Ob-Gyn,

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Obstetrical Resident Improved Education and Teaching (ORIEnT)

Purpose: To implement a new obstetric education curriculum for the L&D rotation. It is based on the flipped classroom model, including self-directed learning with podcasts and assigned readings; as well as, group based learning with case discussions

 

Background: Duty hours and workload make the labor and delivery unit a difficult environment to achieve a structured learning curriculum. It has been identified as an area where resident education is lacking and provides an opportunity for implementing a formal education component.

 

Methods: The curriculum was implemented at the University of Colorado and University of Oklahoma. It consisted of 6 modules covering the following topics: multiple gestation, PPH, PPROM, PTL, short cervix/cerclage, and IUFD. All modules could be accessed through Dropbox, which included a link to podcasts, reading materials and case discussions. Case discussions were led each week on L&D with a faculty member or MFM fellow. Outcomes measured included resident and faculty satisfaction and resident knowledge acquisition.

 

Results: Pre and post surveys of residents and faculty showed an overall positive response to the new curriculum. Resident surveys indicated that they acquired new knowledge through the curriculum. Faculty surveys demonstrated a positive response for enhancing L&D education and improving access to learning materials.

 

Discussions: The new curriculum was received well among residents and faculty as a way to implement structured teaching on L&D. Challenges included participation, resident schedules and inability to assess knowledge acquisition. While there were challenges, this curriculum provided multiple formats to learn and improved access to learning materials.    

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, General Ob-Gyn,

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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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Not Quite so Happy Hour: Associations of Alcohol Use with Wellness Problems Among OBGYN Residents

Purpose: To explore associations between residents’ personal habits and problems with wellness.

 

Background: It will be essential that we develop evidence-based interventions to improve burnout and wellness problems in our resident physicians.

 

Methods: A voluntary, anonymous survey was administered to all US OBGYN residents at the time of the 2017 CREOG examination. Symptoms of burnout and problems with wellness were queried with the question, “during your residency training, have you personally experienced any of the follow issues?” Respondents also reported how often they engaged in activities that they felt helped to maintain wellness in their lives. Associations between reporting wellness problems and participation in common activities were examined using chi-squared tests. Significance was defined as p<.004 using a Bonferroni correction based on the number of comparisons.

 

Results: Of the 5855 residents, 4999 completed the survey (85% RR).  3065 (61.3%) residents endorsed problems with wellness, including burnout (51.2%), depression (32.0%), and binge drinking (12.6%). The most common wellness activities reported were social activity (n=4320, 93.2%), watching TV (n=3614, 77.1%), cooking (n=3614, 52.4%), exercise (n=2228, 47.3%), and drinking alcohol (n= 2132, 45.6%). Respondents who indicated alcohol as a wellness activity had an increased odds ratio of 2.10 of also having a wellness problem (Χ2(1 )=29.6, p< 0.001).  Respondents who indicated heavy drinking (“Often (4+ times)”/week) had a higher odds ratio of 3.30 (Χ2(1 )= 40.3, p<.001.)

 

Discussions: Despite social norms, residency programs should use caution when choosing alcohol as the basis for social events or stress release, as our data suggest that it is associated with increased negative outcomes for resident wellness.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME,

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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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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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