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
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.”
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
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.)
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
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.
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
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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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
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
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.
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
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
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.
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
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
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.
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
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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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
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.
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
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)
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
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
Discussions: Trainees in obstetrics and gynecology value access to
abortion training, even if the training is off-site and remote.
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
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.
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
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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Perioperative Complications Curriculum for the OB/GYN Resident: A Pilot Study
Purpose: To develop and implement a perioperative complications
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
pretest mean score was 72% (40-90%, SD = 15).
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.
module completion rates were 50%, 36%, 29%, and 18% for weeks 1-4,
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.
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.
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.
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.
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
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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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
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 )=
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
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
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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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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