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Does Self Evaluation Improve Surgical Skills? A Randomized Control Trial: A Pilot Study

Précis: This study investigated the effect of self-evaluation on the improvement of surgical skills by comparing OSATS scores over a 4-month period to determine if the addition of a self-evaluation improved surgical skills more than instructor evaluation alone. 

Purpose: To determine if self-evaluation improves surgical performance more than instructor evaluation alone.

Background: The OSATS score is a validated rating scale for the evaluation of surgical skills. Self-evaluation using OSATS has been compared to instructor evaluation to determine the correlation of the scores. Self-evaluation in combination with instructor evaluation to improve surgical skills has not been studied.

Methods: A RCT was performed in which learners, PGY 1-4, were randomized into either the control group who only received instructor OSATS evaluations or the experimental group who received instructor evaluations as well as self-evaluations. Everyone received the same instructions and performed the same simulation which was videotaped for review.  The instructor was blinded to each arm and the simulation was repeated after four months. The primary outcome was the change in instructor OSATS score over the study period.

Results: Fifteen residents were enrolled and completed the study. There was no difference in the change in instructor OSATS score (p=0.726). There was a correlation in the learner and instructor score for time and motion (p= 0.02) and instrument handling (p=0.008). All participants reported that self-evaluation was a useful educational tool. Only participants from the experimental group reported practicing on their own time.

Discussion: The current study attempted to demonstrate the utility of self-evaluation on surgical education. The correlation between learner and instructor scores are consistent with the literature. Self-evaluation did not improve overall change in score; however, all participants found it useful and it did increase practice at home. 

Topics: SES, 2020, Resident, Faculty, Clerkship Director, Residency Director, Practice-Based Learning & Improvement, GME, Assessment, Simulation, Independent Study,

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Simulation Increases Anticipated Usage of Trigger Point Injections in Treatment of Myofascial Abdominal Pain

PRECIS: Evaluation of a simulation model and didactic training session for the education of ACGME residents in trigger point injections for myofascial abdominal pain in chronic pelvic pain patients.

PURPOSE:  To test a training module for the education of abdominal trigger point injections

BACKGROUND:  For the treatment of chronic abdominal and pelvic pain, training in interventions is lacking among trainees at the residency level.  One very effective and simple intervention is abdominal trigger point injections for the treatment of abdominal myofascial pain syndrome, present in 74% of women in chronic pelvic pain practices.  

METHODS:  This study evaluates an abdominal trigger point teaching model for the training of USMLE OBGYN residency level physicians, containing a multimedia didactic presentation and a gelatin-based abdominal wall injection model.  Participants completed a 10-item knowledge pre- test and an 8-item participant experience questionnaire gauging prior knowledge and experience with myofascial pain syndrome and abdominal trigger point injections.  After 5 minutes of unsupervised time with the gelatin model, a 30-minute scripted didactic session was given, participants interacted post-training with the simulation model, and a post-test was completed.

RESULTS:  Trainees improved from pre-test (48%) to post-test scores (90%) and reported increasing confidence levels on a 5-point Likert scale from 1.67 pre-test to 3.7 post-test.   Ninety percent of participants agreed or strongly agreed that this exercise would result in them using abdominal trigger points in their own practice. 

DISCUSSION:  A simple educational tool containing a short didactic educational module and gelatin simulation model increases knowledge, confidence level and the likelihood of USMLE OBGYN residents to use trigger point injections in the treatment of chronic pelvic pain.

Topics: SES, 2020, Resident, Faculty, Patient Care, Medical Knowledge, Practice-Based Learning & Improvement, GME, CME, Assessment, Simulation, Lecture, Gynecologic Oncology, Pediatric & Adolescent Gynecology, Minimally Invasive Surgery, Reproductive Endocrinology & Infertility, General Ob-Gyn,

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Validation of the Animal Tissue Model for Laparoscopic Salpingectomy Training

Purpose: To gather validity evidence for a laparoscopic salpingectomy model developed for resident training.

Background: Laparoscopic salpingectomy is a milestone procedure for gynecologic trainees and is commonly performed in the management of ectopic pregnancies. Opportunities to practice the use of electrosurgical devices prior to the operating room can be limited. An animal tissue model was developed and previously piloted at our institution for this purpose, and was modified to include a pelvic sidewall and ovaries.

Methods: 25 simulations of laparoscopic salpingectomy were performed by 14 trainees (5 PGY-1, 4 PGY-2, 1 PGY-3, 4 PGY-4).  For analysis purposes the PGY-3 and PGY-4 trainees were combined.  Each trainee received scripted instructions and reviewed a video with proper technique beforehand. These recordings were evaluated by 2 blinded gynecologic surgeons using the Global Operative Assessment of Laparoscopic Skills (GOALS) and Objective Structured Assessment of Laparoscopic Salpingectomy (OSA-LS).

Results: There was good agreement between the graders with intraclass correlation coefficients of 0.63 and 0.79, respectively, for GOALS and OSA-LS.   The mean GOALS score increased with experience (10, 13.2, and 15.5 for PGY-1, PGY-2, and PGY-3/4, respectively) and was significantly different between PGY-1 and PGY-3/4 (two-sample t-test, p=0.004). The mean OSA-LS score increased with experience (8.9, 14.2, and 16.2 for PGY-1, PGY-2, and PGY-3/4) and was significantly different between PGY-1 and PGY-2 (p=0.006) and between PGY-1 and PGY-3/4 (p< 0.001).

Discussions: This training model and rubrics differentiated experienced and novice trainees and could be used to establish a preoperative competency benchmark.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Residency Director, Practice-Based Learning & Improvement, GME, Assessment, Simulation, Minimally Invasive Surgery, General Ob-Gyn,

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Uptake and Efficacy of a Novel Self-Directed Foundational Curriculum for OB-Gyn Interns

Purpose: To evaluate a curriculum for OB-Gyn interns.

Background: To provide incoming interns with a reading plan, residency leadership created a novel, self-directed, online foundational curriculum for interns modeled after the ABOG MOC process.  The curriculum was first offered to interns starting residency in July 2017.
For each core intern clinical experience (Obstetrics, Gynecology, Family Planning, Office) selected readings represented the foundational knowledge expected of an OB-Gyn intern, totaling 42 readings.  For each reading, multiple choice questions highlighting the key information were crafted by attendings to create an online 40-question pretest, self-directed curriculum of 42 modules comprised of a reading and relevant comprehension questions, and 80-question posttest using unique questions not utilized in the pretest or modules.

Methods: The curriculum operated on the online educational platform, SparkLearn.  OB-Gyn interns starting residency at Vanderbilt in July 2017 completed the pretest during orientation.  Rising second-year residents completed the posttest simultaneously at the conclusion of intern year.  The intern class completed modules at their own pace and concluded intern year with the posttest.  Pretest, module, and posttest scoring was cataloged in SparkLearn.  IRB exempt study approval was obtained.

Results: For interns participating in the curriculum (N=6), mean module completion rate was 82.71% (range 26-95%).  Mean participator pretest and posttest scores were 71.04% (SD=7.22) and 82.71%(SD=7.04), respectively (p=0.01).
Participator module completion rate was strongly correlated with posttest scores (pearson coefficient 0.60) and weakly correlated to first year CREOG scores (pearson coefficient 0.12).   
Mean posttest scores at end of intern year were higher among curriculum participators (82.71%) compared to non-participators (75.31%) (p=0.05).  Mean first-year CREOG scores for curriculum participators were also higher (207) compared to non-participators (198) (p=0.24).

Discussions: Our novel online self-directed intern foundational reading curriculum had variable uptake but overall good utilization in its first year of deployment.  Compared to the preceeding intern class, participating interns had higher posttest knowledge scores.  There was a strong positive correlation between module completion rate and posttest performance.
Our study was limited by small sample size (N=6), but we continue to collect additional data with subsequent classes.  Multi-site deployment might permit correlation of curriculum utilization with milestones achievement in medical knowledge.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Medical Knowledge, Practice-Based Learning & Improvement, Independent Study, Problem-Based Learning,

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Pilot Study of Interactive Video-assisted Laparoscopic Teaching for OB/GYN Surgical Residents

Purpose: It is common knowledge that athletes review tapes as part of training. Although differences between a sports game and surgery are obvious, both require technical skill and performing under pressure. Surgeons may benefit from reviewing surgical tapes in training.

Background: Prior studies have explored using surgical videos to increase exposure to operative scenarios or evaluate technical skill. However, no standardized approach exists to incorporate video review into surgical training, particularly in gynecology. This interactive teaching model uses review of laparoscopic videos to enhance surgical knowledge and technique.

Methods: A gynecologic surgeon led participants through review of laparoscopic gynecologic surgery videos. The surgeon highlighted aspects of the video, pausing to enforce teaching points and lead discussion. Participants completed a 25-question multiple-choice survey prior to, immediately after and two months after the session. Individual changes in scores were analyzed before and after aforementioned intervention, stratified by residency year.

Results: Of participants who underwent the intervention, 100% completed the pre-survey, 60% completed the immediate post-survey. Response rate was 40% for the 2-month post-session survey. Of those who underwent intervention and completed the post-session survey, 71% improved their score while 29% had no change. When stratified by year, junior residents showed score improvement, senior residents had no change.

Discussions: Video-assisted teaching can enhance gynecologic surgical training. It seems most beneficial earlier in training as junior residents have yet to develop ways of doing things. While video sessions do not replace OR time, they provide forums for reviewing surgical approach and technique with visual aids to reinforce teaching points.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Team-Based Learning,

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Text vs Email for a Question of the Day: Which do Today’s Medical Students Prefer?

Purpose: Compare completion rates and satisfaction of question of the day(QOD) received via text vs email.

Background: Fast, hands on learning e-tools are a popular effective technique with current generation of medical learners.

Methods: Twenty-eight questions of the day(QOD) developed focusing on commonly missed NBME exam concepts. A prospective cohort study of ob/gyn clerkship students conducted. Students self-selected to receive QOD by text or email from 1/19-7/19. Students received QOD nightly on weekdays via text or email, completion was optional. 
Primary outcome was overall response rate(RR). Secondary outcomes include RR/question and average weekly RR. Qualitative feedback regarding satisfaction, time spent, and utility also obtained.

Results: Eighty-one medical students participated, 40 selecting text and 41 email. In sum, 863 texts and 1269 emails sent during study period. Overall text RR was significantly lower than email(55.2%vs78.6%,p< 0.001). For no question was text RR greater than email RR. Average RR did not vary by week(wk1: text 55% vs 83% email, wk6: text 64% vs email 77%).
43/81(53%) students gave qualitative feedback, 28/41 from email cohort, and 15/40 text. 86% found the QOD helpful/very helpful(no difference by mode of receipt). However, email recipients more likely to find it very helpful(54%vs13%,p=0.02). 77% found the level of difficulty to be “just right”,(no difference by mode of receipt). The QOD took all students less than 5 minutes. Nearly all(93%) students found the QOD worthwhile and 98% would recommend to future students.

Discussions: Surprisingly, QOD completion rates were higher with email than text, though satisfaction and perceived utility high in both groups.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Faculty, Clerkship Director, Medical Knowledge, Practice-Based Learning & Improvement, UME, Assessment, Independent Study, General Ob-Gyn,

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Resident Surgical Evaluations: Feasibility of Integration into the Electronic Medical Record (EMR)

Purpose: Describe the development and implementation of a surgical evaluation tool within the Epic EMR to facilitate real-time feedback for resident learners.

Background: Evaluation of a resident’s surgical performance is critical to the developing surgeon’s education but challenging for both learners and teachers in a busy clinical environment. This study aims to describe how a surgical evaluation tool can be integrated into the EMR and the acceptability of the tool to both faculty and residents.

Methods: A novel tool was developed within the EMR of a single academic hospital that triggers an automated in-basket message to the attending surgeon upon case completion. This message directs the attending surgeon to complete a 4 question evaluation consisting of 2 validated feedback questions and 2 open ended questions. Upon completion, an email is sent providing residents with immediate feedback. At the end of the study period, a survey was sent to attending surgeons and residents to assess the acceptability of the tool.

Results: Between February 2019 and June 2019 719 cases were performed and 553 surgical evaluations were completed (77%). The acceptability survey was completed by 26 of 27 (96%) of residents and 14 of 16 (88%) faculty. Among residents, 96% reported that they received more feedback because of the tool and 85% liked receiving feedback in this way. Among faculty, 21% reported that they felt they gave more feedback because of the tool and 93% found the tool acceptable to use.

Discussions: Implementation of an automated surgical evaluation tool within the EMR is feasible, acceptable to use, and well received by learners.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Assessment, General Ob-Gyn,

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Resident Confidence with Obstetric Ultrasound – Are We Meeting CREOG Objectives and ACGME Milestones?

Purpose: The objective of this study assess resident confidence in obstetric ultrasound as per ACGME milestones and CREOG objectives, and factors associated with confidence performing US independently.

Background: Performing obstetric ultrasound(US) is an ACGME milestone, a CREOG objective, and a CREOG core procedure, though many programs lack formal US curricula.

Methods: CREOG coordinator listserve used to distribute 27-question anonymous e-survey in 3/2018 to OBGYN residents in US and Puerto Rico. Questions included experience performed growth US(gUS) and anatomy US(aUS) as primary sonographer, performing US independently, and for 4th year residents only, comfort performing US post-residency. Bivariate statistics compared residents comfortable performing US independently to those who were not.

Results: 417 residents completed the survey: 88% were female, 75% from academic programs, and nearly 50% were post-graduate year(PGY) 3&4.   While 89.1% had been primary sonographer for gUS, only 63% felt comfortable performing independently. Of chief residents, 14% didn’t feel comfortable performing gUS post-residency. In contrast, 60.9% had been primary sonographer for aUS, only 20.1% felt comfortable performing aUS independently, and 68.8% didn’t feel comfortable performing aUS post-residency.   Residents were more likely to feel comfortable performing gUS independently in PGY3&4 (p< 0.01) and after longer MFM rotations(p=0.02), and less likely when MFM fellows were present (p=0.02). Residents not comfortable performing aUS were twice as likely to have MFM fellows (p< 0.01), and less likely to be PGY3&4(p< 0.01).

Discussions: significant percentage of residents are not comfortable with their ultrasound skills. This data further emphasizes the need for structured US curricula and simulation.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Patient Care, Practice-Based Learning & Improvement, GME, Assessment, Simulation, Maternal-Fetal Medicine, General Ob-Gyn,

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Proficiency Perception and Relevance of Gynecological Procedures Among Obstetrics and Gynecology Graduates; Evaluating the Residency Surgical Curriculum

Purpose: To determine graduates’ perception of their proficiency in gynecologic operations and the relevance of these procedures to their current practice

Background: Program directors must certify that graduates are competent to practice without supervision after residency. Achieving proficiency in gynecologic surgery after 4 years is challenging. Evaluating the current surgical curriculum is critical

Methods: A survey of 40 graduates from a single academic instituition was conducted. 36 gynecologic procedures were listed. Each procedure corresponded to two four-point scales (strongly agree to strongly disagree). One scale was headed with preparation to independently perform the operation, and the other questioned the relevance of the procedure in their current practice. A third scale reviewed the need for additional training, and the case/volume per year. A subgroup analysis was done to evaluate the preferred route of hysterectomy and the rationale if vaginal hysterectomy was avoided

Results: The response rate was 67.5%. All respondents felt prepared to perform 25% (9/36) of procedures. More than 50% did not feel competent performing laparoscopic single site hysterectomy, laparoscopic myomectomy, sling, utero-sacral ligament suspension, vesico-vaginal fistula repair, colpocleisis, and office hysteroscopy. Vaginal hysterectomy was relevant for 78% of graduates, however, 89% performed fewer than 10 cases per year, and 55% would benefit from additional training. More than 50% of graduates would choose a non-vaginal route of hysterectomy, and interestingly, 93% of those based their decision on lack of comfort with the procedure

Discussions: While several gynecologic surgeries are relevant to recent graduates’ practices, some may not feel competent performing these procedures after residency. Vaginal hysterectomy is not commonly performed among graduates, largely due to inexperience with the procedure

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Patient Care, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME,

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Novel Realistic Bladder Model Teaches Anatomy & Builds Resident Confidence in Cystotomy Recognition/Repair

Purpose: To develop and pilot an inexpensive, reusable, water-tight moderate-fidelity bladder model that can be used to teach Ob-Gyn residents cystotomy repair.

Background: Cystotomy repair is a required Ob-Gyn milestone procedure; however, low surgical volume for cystotomy may impact resident ability/confidence to perform the procedure. Available simulation models are either expensive or low-fidelity and not water-tight. Our goal is to create a cost-effective, realistic, functional bladder model (visible ureteral jets, water-tight after repair) for simulation of cystotomy repair.

Methods: Phase 1: Design and creation of the model using molds developed with 3D design software and 3D printing. The silicone model includes ureters, urethra, trigone, ureteral orifices, rugae, muscularis, and mucosa.
Phase 2: Pilot of the model with Ob-Gyn residents as part of their simulation curriculum. Residents were given a pre- and post-test to identify the model’s anatomic landmarks and rate their confidence in 1) identifying cystotomy and 2) performing open cystotomy repair. Residents evaluated the model’s fidelity post-simulation.

Results: Eight bladder models were constructed for $206. The model was water-tight post-repair and cystoscopy demonstrated bilateral ureteral jets. All residents, n=16, had no prior cystotomy simulation and limited experience with cystotomy repair. The model improved ability to identify bladder anatomy (4.3/6 items pre vs 5.8/6 items post, p=0.04) and confidence in both identifying cystotomy (2.14 vs 3.4 of 5, p= 0.006) and performing cystotomy (1.4 vs 3.3 of 5, p=0.014). Learners strongly agreed the model was realistic, mean 4.6/5.

Discussions: Our novel bladder model is cost-effective, realistic and useful for teaching anatomy and simulation of cystotomy repair.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Practice-Based Learning & Improvement, GME, Simulation, General Ob-Gyn,

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Increasing Resident Education in Pediatric and Adolescent Gynecology

Purpose: The NASPAG short curriculum project was initiated to improve education of gynecology residents in the field of pediatric and adolescent gynecology.

Background: Pediatric and adolescent gynecology is a limited field amongst obstetric and gynecology residency programs. Many programs have no clinical rotations and very limited didactic education in adolescent gynecology. NASPAG has created a ten lecture curriculum to better train residents in this field.

Methods: The NASPAG short curriculum was implemented and residents completed self-assessment surveys and examinations before, immediately after, and three months after the curriculum. Additionally, the mean scores for pediatric and adolescent questions on the CREOG exams were analyzed for the year prior to and immediately after implementation of the curriculum. Paired t-test analysis was used to determine if there was a statistically significant difference for each arm of the study.

Results: There was a statistically significant improvement in all ten areas studied in regards to the resident self-assessment surveys. Objectively, there was a statistically significant difference in six of the ten areas studied immediately after the course and four of the areas three months later. The implementation of the NASPAG curriculum led to an increase in the mean CREOG score on pediatric and adolescent questions from 57% to 62%.

Discussions: The implementation of the NASPAG short curriculum subjectively enhanced resident comfort level when caring for pediatric and adolescent gynecologic patients. The curriculum also led to improved medical knowledge amongst the residents. This curriculum may be a vital tool in preparing for the standardized CREOG exams. 

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Residency Director, Medical Knowledge, Practice-Based Learning & Improvement, GME, Lecture, Problem-Based Learning, Standardized Patient, Team-Based Learning, Pediatric & Adolescent Gynecology,

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Improving the Basic Science Curriculum by Integrating the Clinical Sciences

Purpose: To evaluate medical student perceptions on whether curriculum innovations through the integration of clinical medicine with basic science improves learning in the pre-clinical curriculum.

Background: Medical schools are transitioning to competency-based curricula that emphasize an early introduction to clinical training. Students who learn basic science explanations for clinical correlates have improved retention. By integrating clinical sciences into the pre-clinical curriculum, learning is optimized for students.

Methods: At the end of the Reproduction pre-clinical sequence at the University of Michigan, students were asked to evaluate the overall quality of the course, whether objectives were met, and whether the course was well-organized, with a one-to-five level scale. These parameters were compared for the sequence between 2018 and 2019, after curricula changes were introduced.

Results: For the Reproduction sequence in 2019, course assessment parameters were improved in comparison to 2018 values. Overall, students rated the quality of the course as “very good/excellent” (4.21 ± 0.91), compared to “fair/good” (2.88 ± 1.01). Students “strongly agreed/agreed” that objectives for the course were met (4.44 ± 0.82) versus “agreed” (3.74 ± 0.88), and “agreed” that the course was well-organized (4.21 ± 1.07) compared to “disagreed” (2.66 ± 1.19).

Discussions: The restructuring of the Reproduction sequence allowed for purposeful integration of clinical medicine into the basic science pre-clinical curriculum, resulting in improved quality of learning for students. Recruiting clinical faculty for lectures, and implementing case-based instruction with the APGO videos for supplementation, provided an effective and efficient method of integrating clinical medicine content within the sequence.

Topics: CREOG & APGO Annual Meeting, 2020, Clerkship Director, Medical Knowledge, Practice-Based Learning & Improvement, UME, Lecture, Problem-Based Learning,

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Impact of TrueLearn Question Bank on Resident Performance on the CREOG In-Service Training Exam

Purpose: To determine how implementation of the TrueLearn (TL) question bank and mock in-service training exam (ITE) impacts performance on the CREOG ITE.

Background: The CREOG ITE is an annual exam on which, success has been correlated to success on the American Board of Obstetrics and Gynecology Qualifying Exam. Question banks are quickly becoming a popular study tool, but their utility on improving CREOG ITE performance is unknown.

Methods: We performed a quasi-experimental retrospective review of the CREOG ITE score reports from 2017 to 2019 at our institution. Starting in 2018, TL was made available and a mock ITE was administered for the first time. A two-sided paired t-test compared average annual improvement in CREOG ITE scores before and after TL implementation. Correlation coefficients between TL usage and improvement on the 2019 ITE were calculated using Pearson correlation testing and a linear regression was used to determine their association.

Results: After providing TL, mean improvement in percentage points on the CREOG ITE was 6.6, 9.33 and 6.75 as residents matriculated from PGY1-2, PGY2-3 and PGY3-4 respectively. This was a significant improvement compared to the previous year.  As a program there was a moderate correlation with TL usage and percentage point improvement on the CREOG ITE; r=0.38, p= 0.038.

Discussions: After providing universal access to TL question bank and administering a mock ITE, a statistically significant improvement on the CREOG ITE was seen. TL’s question bank and mock ITE are valuable resources for improving CREOG ITE performance.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Independent Study, Problem-Based Learning, General Ob-Gyn,

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Impact of Curriculum Update with New Objectives and Modern Methods on Resident Impression of Didactics

Purpose: To determine impact of curriculum changes on resident impressions of didactics.

Background: Recently, CREOG released the 11th Edition learning objectives. Simultaneously, resident surveys suggested our didactic curriculum needed improvement.  We restructured our curriculum to reflect these changes and incorporate different teaching techniques for millennial learners.

Methods: CREOG learning objectives were reviewed to determine the appropriate length and frequency of topics covered.  Faculty were assigned objectives; the use of ACOG Practice Bulletins and Committee Opinions was encouraged. Faculty were asked to incorporate case discussions, hands-on interactive activity, simulation, flipped classroom, etc.   A resident survey was administered both before and one-year after implementation to assess satisfaction.  Surveys were given immediately after the CREOG exam to analyze score outcomes relative to curricular changes.

Results: Didactics were organized in a 2-year calendar with 3 weekly hours. Residents perceived improved overall quality, organization, and depth/breadth of material (10-20 points on 100 point scale, all p< 0.05). Resident attendance, topic known >1 week in advance, and reading assigned >1 week in advance all improved (p< 0.05). The pre- group had more “not detailed enough” and “not enough variety” responses while the post- group had more “appropriate level” of both depth/breadth and detail (p< 0.05). Overall CREOG scores improved as anticipated 12.9±9.6 points with the additional year of training (p< 0.05); however, “by year” scores were unchanged (Δ5.4 points, p=0.17) suggesting no impact of curriculum changes on performance, only perceived satisfaction.

Discussions: Updated objectives and modern teaching methods improved resident impressions of didactics, but did not improve CREOG exam scores.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, CME, Simulation, Lecture, Standardized Patient,

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Impact of a Pediatric Adolescent Gynecology (PAG) Learning Module: A Multi-Institutional Randomized Controlled Study

Purpose: To determine if an online PAG learning module improves resident knowledge and clinical performance.

Background: CREOG recommends education in PAG, yet resident training is often inadequate secondary to insufficient specialists and clinical exposure.

Methods: We conducted a multi-institutional single-blinded randomized controlled trial across four university programs; three had PAG rotations and two had PAG fellowship-trained faculty.  Our intervention was a previously validated 20-minute electronic module.  We applied block randomization across institutions in a 1:1 ratio.  All residents subsequently completed a PAG-related knowledge assessment (maximum score=5) that queried understanding of pre-pubertal bleeding and an objective structured clinical examination (OSCE, maximum score=16) that assessed history collection and performance of a genital exam, vaginal culture, and vaginoscopy for a pediatric patient.  OSCEs were videotaped and reviewed by two blinded faculty; inter-rater reliability score was 96.5%.  We calculated frequencies and compared composite knowledge assessment and OSCE scores using median tests. 

Results: Amongst 115 invited residents, 97 (83.4%) participated; 45 were randomized to the module with equal representation across training levels.   Majorities were female (90.7%) and reported no prior PAG didactic (77%) or clinical experiences (77%-87.6%); randomization groups were similar.  The intervention group scored significantly higher on both the knowledge assessment (4 versus 2, p < 0.001) and the OSCE (13 versus 7, p < 0.001).  Notably, the intervention group was more likely to appropriately avoid using a speculum in a pediatric patient (95.6% vs. 57.7%, p < 0.001).

Discussions: Our self-study PAG module resulted in improved knowledge and clinical approaches and may be of benefit to other training programs.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Problem-Based Learning, Standardized Patient, Pediatric & Adolescent Gynecology,

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Context Impacts Ob Gyn Resident Performance and Attitude After Participation in a Quality Improvement Curriculum

Purpose: To explore how contextual factors influence ob/gyn residents’ ability to apply acquired knowledge and their self-confidence and attitudes towards QI endeavors after exposure to a QI curriculum.

Background: In order for QI to be embraced and perceived as a core value similar to that of any other aspect of training, there must be a deeper understanding of what aspects of the individual learner, the learning environment, and the interaction between the learner and his/her environment are necessary for ensuring that the practice of QI is a part of and not separate from providing excellent, high quality patient care.

Methods: The authors used an explanatory sequential mixed methods design.  The study was deemed exempt by the IRB. First and second year residents from Ob Gyn, Family Medicine, Pediatrics and Anesthesia were exposed to a didactic and experiential 11-month QI curriculum.  Pre/post curriculum assessments included QI knowledge application (QIKAT-R, range 0-9) and a questionnaire measuring confidence and attitudes about QI (range 6-50).  Quantitative data were analyzed using a two-way mixed design ANOVA (P< .05 was significant). After completion of the assessments, participants engaged in semi-structured interviews to facilitate understanding of how contextual factors affected their attitudes, self-confidence and/or ability to apply their QI knowledge.

Results: 37 residents participated in the curriculum. Although there was no significant change in mean pre/post overall QIKAT-R score (4
+1 vs. 4
+1) for the cohort of ob gyn residents (n=6) in comparison to the overall group (n=31), ob gyn residents showed a significant increase in composite self-efficacy score (32.5+0.7 vs. 36.6+0.8, p< .0001, η2 = .55) after participating in the curriculum.  Semi-structured interviews revealed that prior QI exposure, perceived value of QI, engagement of the departmental faculty preceptor, and time allotted for the curriculum were associated with a change in QI knowledge and overall attitude about QI practice.

Discussions: This study demonstrates that exposure to a targeted QI curriculum will result in increased resident confidence in applying this QI knowledge and suggests that QI knowledge acquisition does not correlate with changes in attitude and confidence.  Individual and departmental contextual factors are important to consider when designing and implementing a QI curriculum.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Quality & Safety,

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Assessment of Chief Resident Laparoscopic Hysterectomy Performance Using Global Operative Assessment of Laparoscopic Skills (GOALS)

Purpose: To implement a validated, standardized tool to assess resident performance during laparoscopic hysterectomy.

Background: Surgical feedback  is critical to resident education, but it is often subjective and sporadically given. GOALS is a validated tool consisting of a 10-item checklist, 5-item global rating score, and an overall satisfaction score that is widely used in general surgery to assess resident skills during laparoscopic cholycystectomy and appendectomy.

Methods: Chief residents and one attending performing laparoscopic hysterectomies together filled out blinded evaluations after each case. The checklist was constructed by identifying 10 critical steps in completing the operation independently. Five laparoscopic domains (depth perception, bimanual dexterity, efficiency, tissue handling, and autonomy) and an assessment of case difficulty were scored on a 5-point scale. Overall satisfaction with the resident performance was rated on a 10-point scale. Paired t-tests were used to compare resident and attending scores. A regression analysis demonstrated an association between case difficulty and resident step completion.

Results: 56 hysterectomies were performed during the study interval with a mean step completion resident score of 6.9 (attending score 6.8; P = 0.56). Residents rated themselves lower in laparoscopic skills than the attending (3.25 vs 3.6; P = 0.0001), even though estimation of case difficulty was similar (2.81 vs 3.13; P = 0.03).

Discussions: We describe here a method for standardizing feedback and evaluation in the performance of laparoscopic hysterectomies. Residents consistently perform about 7 of the 10 steps required to independently perform laparoscopic hysterectomy. Trainees were more critical than the attending in assessing their own performance.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Gynecologic Oncology, Minimally Invasive Surgery, General Ob-Gyn,

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APGO Academic Scholars and Leaders Program: 20-Year Outcomes

Purpose: We report the twenty-year experience of the Academic Scholars and Leaders (ASL) Program founded in 1998, a national, longitudinal program of the Association of Professors of Obstetrics and Gynecology

Background: The medical education community recognizes a need for faculty development for clinician educators. Faculty development programs include a variety of content and teaching methods, are often longitudinal, and many include a scholarly project.  While faculty rate these programs highly in the short term, long-term outcomes are rarely reported.

Methods: We conducted a cross-sectional survey of ASL program graduates from 1999 to 2017. Descriptive data were analyzed using STATA. Open-ended comments were categorized using content analysis. Publications of all ASL graduates were confirmed using PubMed and Google Scholar.

Results: 64% (260) of ASL graduates responded.  Graduates have held many educational leadership roles, including residency program (63%) and clerkship (47%) leadership, vice chair in education (21%,) and dean’s office positions (13%). Seventy-one percent have been promoted since graduation. Seventy-six percent (197) listed meaningful ASL program impacts on skills: curriculum development (48%), direct teaching (38%), leadership (33%) and educational scholarship (27%).  For all graduates (including non-responders), literature search confirmed that 17% published the ASL project and 44% published additional education papers.

Discussions: In our twenty-year experience, the APGO ASL program has trained an impressive group of faculty leaders and scholars. Graduates have experienced a remarkable degree of success, as measured by promotion, scholarship, and leadership.

Topics: CME, Practice-Based Learning & Improvement, Faculty, 2020, ASL, CREOG & APGO Annual Meeting, Faculty Development,

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A Design Thinking Approach Will Engage Obstetrics and Gynecology Residents in Quality Improvement Education

Purpose: To incorporate design thinking methods in quality improvement curricula to generate impactful patient interventions and enhance resident satisfaction.

Background: Incorporating a meaningful quality improvement (QI) experience into an already overloaded residency training program is challenging. We applied the principles of design thinking to a QI curriculum to inspire residents (“users”) to develop patient-centered QI projects.

Methods: Starting in 2017, residents at an academic medical center were introduced to QI grounded in the Model for Improvement. The experiential component was implemented using a five phase Design Thinking process (Empathy, Define, Ideate, Prototype, Test). Data were obtained from ACGME surveys and patient outcomes. Chi square was used to compare yearly trends in resident satisfaction; patient outcomes were analyzed using an independent t test. P< 0.05 was significant.

Results: Since introduction of the QI curriculum, we have had 100% resident involvement (increase from 83%, P< .05 ) and collaboratively generated QI interventions that improved patient outcomes and enhanced resident engagement. One initiative increased postpartum visit adherence in a high-risk population from 21% to 63% (P< .01). An initiative addressing prenatal tobacco use in resident clinics produced a state-funded $53,000 grant to screen and treat pregnant smokers. Overall satisfaction with the residency increased by 64% between 2017-2019 (P< .05)

Discussions: Design thinking can be integrated into graduate medical education. Although this curriculum was initially implemented to meet ACGME QI project requirements, we found that a design thinking approach empowers residents with the knowledge, creativity and problem-solving skills to design impactful QI initiatives while simultaneously enhancing resident wellbeing.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Quality & Safety, Public Health, Advocacy, General Ob-Gyn,

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Teaching Cultural Humility To Medical Students By Building Cross-Cultural Patient Education Tools

Workshop Text: Cultural humility and cross cultural communication are essential skills for medical students who will be called upon to translate medically complex concepts and treatment plans to patients from diverse backgrounds.  This skill set, however, is not often taught effectively during medical school.

This workshop will demonstrate a method for teaching cultural humility to medical students.  Through the process of designing and testing a cross cultural patient education model, the student explores essential features and pitfalls of cross cultural education. Workshop participants will design an abbreviated patient education tool based on a case based scenario and engage in group discussion about the challenges involved. Presenters will share a project that was used in three languages from sub-Saharan Africa and another in Vermont and will discuss challenges from their field work. An evaluation rubric will be provided. 

Introduction (5mins) define cultural humility and discuss best practices in cross cultural communication. 

Group Activity (10 mins) Using 1-2-4-all format, discuss pitfalls of cross cultural communication demonstrated in an excerpt from The Spirit Catches You and You Fall Down.

Breakout Activity/ Interactive component (30 mins) Small groups of participants will design a patient education tool for a specific patient population based on a real life scenario. 

Group Activity (15 mins) Discuss the process of designing a cross-cultural patient education tool with respect to cultural humility.

Wrap up (5 mins)

Take home products: Grading rubric , Resource guide with annotated bibliography


Topics: Faculty Development Seminar, 2020, Faculty, Clerkship Director, Patient Care, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Global Health, Advocacy,

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