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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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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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Gender and Satisfaction with Mentorship In Medical School: A National Study

Purpose: Using the American Association of Medical Colleges (AAMC) Graduation Questionnaire (GQ), we assess if males and females at all U.S. medical schools report differing experiences with satisfaction with faculty mentorship.  Secondarily, we assess the role of men\'s and women\'s scholarly projects and career plans as they relate to satisfaction with mentoring.

Background: Female physicians experience gender-based professional differences, such as lower compensation, slower rates of promotion, and decreased representation in leadership positions as compared to their male colleagues.  The way this gender-based professional inequity affects the experience of medical student mentees has yet to be elucidated in the literature.

Methods: Data were obtained from the AAMC GQ years 2016-2018.  Student satisfaction with faculty mentoring was analyzed by chi-squared and logistic regression.

Results: With an 82% response rate we analyzed data for 47,063 students; 51% were male and 49% female. When asked about satisfaction with faculty mentoring, 81% of males verses 79% of females reported being \"satisfied\" or \"very satisfied\" (p< 0.001). A higher proportion of males reported faculty were helpful to students with academic matters (60% versus 55%; p< 0.001) and with non-academic matters (58% versus 55%; p< 0.001) \"very often\" or \"always.\" Females were less likely to be satisfied with faculty mentoring even after controlling for participation in research with a faculty member and future research plans.

Discussions: This work serves as a needs assessment to encourage individual medical schools to investigate their own gender-based cultures regarding faculty representation and leadership to allow gender-equal mentorship of all students.

Topics: CREOG & APGO Annual Meeting, 2020, Faculty, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, GME, CME, UME, Advocacy,

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Assessing the Effectiveness of Single Session Didactic Teaching in Improving Health Care Professionals’ Knowledge of the LGBTQ Population

Purpose: To examine the impact of a single didactic session on short-term knowledge acquisition and long-term knowledge retention of principles related to LGBTQ healthcare.

Background: Individuals who identify as Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) compose an estimated 1.1-3.8% of the population. Despite significant legal and societal advances, disparities persist in LGBTQ health care education, delivery, and outcomes. Multiple national medical organizations have produced initiatives emphasizing the development of educational resources to address these disparities.

Methods: A prospective observational study was performed. Knowledge acquisition was examined by a written survey, including 5 semantic differential scale and 5 multiple-choice questions. The survey was provided prior to and after a didactic session, then again four weeks later. Participation was voluntary and anonymous. Statistics were analyzed using Graph Pad Prism 8 Software (San Diego, CA).

Results: Comparing summed scores, immediate pre and post results (n=63) showed significant improvement across both semantic differential scale (5.7-7.78; p-value 0.00005) and multiple-choice (71%-91%; p-value 0.0004) questions. The 4-week post results (n=33) showed knowledge degradation, but significant improvement when compared to pre-test (5.7-7.21; p-value 0.01, 71%-86%; p-value 0.0095). The most significant improvements were in knowledge of LGBTQ community resources (3.9-7.6-6.4; p-value < 0.00001) and options for gender affirmation (51%-73%-69%; p-value < 0.00001).

Discussions: As medical curricula continue to evolve to address the needs of the LGBTQ population, this study indicates that a single didactic session may significantly improve provider knowledge about LGBTQ health care. This should result in improvements in awareness and communication, patient satisfaction, and health outcomes.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, CME, Lecture, Public Health, Advocacy, General Ob-Gyn, Sexuality,

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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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Looking into the Future: How to Develop a Medical Education Podcast and Navigate Social Media

Background: Social media and podcasts have become increasingly popular and impactful among learners in medicine through the free open access medical education movement. The aim of our workshop is to share our experience with creating a highly successful educational podcast and promoting it on social media, and to allow others to do the same.

Workshop Agenda: Prior to the workshop, learners will be informed to bring headphones and laptops with necessary programming; Windows users will need to download “Audacity,” while Apple users will already have “Garageband” installed as a standard program. Wifi will not be required. The workshop will begin with introduction of the workshop leaders’ journey in creating a successful medical education podcast, assessment of learner podcast experience, and orientation of podcasting equipment (15 minutes). Learners will divide into pairs, brainstorm podcast topic, and record a five-minute podcast (20 minutes). We will then learn about editing equipment (10 minutes). Learners will then edit their podcast and create a finished product (10 minutes). Finally, we will have a large group discussion about podcast dissemination through podcast hosts, website creation, and social media outlets (15 minutes). We will conclude with questions and closing discussion (5 minutes).

Interactive Component: Workshop participants will record a short podcast, edit it, and promote it via Twitter in small groups. Large group discussions will also be held regarding personal experience with these topics.

Take-home Product: Other than their recorded podcast, learners will be given a lecture on podcast creation via vodcast to download

Topics: Faculty Development Seminar, 2020, Resident, Faculty, Clerkship Director, Residency Director, Medical Knowledge, GME, CME, Independent Study,

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Get Laser Focused: Essentialism For The Medical Educator

Background: We cannot be effective advocates of wellness for our learners if we model dysfunctional patterns of work. Meditation, healthy eating, and yoga are great tools for managing our internal environment, but they are easily negated by mismanagement of our external environment. Studies show that avoiding burnout involves identifying purpose and meaning in our work. In this workshop based on Greg McKeown’s Essentialism participants will take a deep dive into the idea that, although we can’t do it all, we can choose what we do and don’t do. We will accept the notion that when we forfeit our right to choose someone else will choose for us, and we will take an essentialist approach to identifying our highest contribution and maintaining the discipline to eliminate work that takes our focus off that purpose.


Objectives: Explore your individual purpose by examining:

What deeply inspires me?

What am I particularly talented at?

What meets a significant need in the world?

Identify tradeoffs and choice associated with each of your current responsibilities.

Practice strategies to gracefully eliminate non-essential work


Agenda:

Introduction to Essentialism (10 minutes)

Self-Inventory Activity (15 minutes)

Guided Interpretation of Self-Inventory Activity (15 minutes)

Small group reflection/discussion (20 minutes)

Large group debrief, wrap up, questions and sharing of resources (15 minutes)


Take Home: Participants will leave with a clearer idea of their highest purpose, a plan for eliminating responsibilities that have distracted them from that purpose, and some techniques for gracefully saying no to new opportunities that are not essential to achieving their professional goals.

Topics: General Ob-Gyn, Lecture, CME, Systems-Based Practice & Improvement, Professionalism, Residency Director, Clerkship Director, Faculty, 2020, Faculty Development Seminar,

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Academic Promotion Strategies for Clinician-Educators: A Hands-on Workshop

Objective/Background: Confusion about the promotions process is a source of stress for faculty, and a deterrent to academic progress. This hands-on interactive session will help educators understand principals of academic promotion, identify specific requirements at their own institutions, and achieve, track, and effectively document activities that “count” towards promotion.  

Agenda:
Principles of academic promotion for educators (15 minutes)
Pearls from the panel: considerations for medical educators who wish to be promoted (10 minutes)
Table exercise: a (poorly prepared) sample CV will be on the table. Each group will be asked to apply sample promotion criteria to decide if the person should be promoted to associate professor on the non-tenure educator track. (15 minutes)
Tables report out their vote and discuss (10 minutes)
A better organized and quantified CV will then be provided. The tables will discuss and vote again. (10 minutes)
Questions and discussion (15 minutes) 
Interactive Component: See agenda, above: half of the session will be hands-on application of specific promotion criteria to an educator’s CV, and table-based discussion.

Take Home Product:
Checklist of activities to track for promotion
CV tip sheet
Annotated version of a poorly-prepared promotion CV
Sample of well-prepared promotion CV 
Recommendation of APGO resource, Career Development: Your Journey to Success 

Topics: Faculty Development, CME, Systems-Based Practice & Improvement, Faculty, 2020, Faculty Development Seminar,

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Wellness Wednesday: Utilization of Strategic Duty-free Hours by OB/GYN Residents

Purpose: To detail the specifics of how OB/GYN residents utilize a monthly duty-free afternoon for wellness activities. 

Background: Much attention is paid to burnout and high rates of depression among physicians. Some speculate these difficulties may start in medical school but that they become cemented and sometimes problematic in residency. Studies have made implications that interventions, specifically promotion of self-care and work-family balance, and work hour restrictions, early in residency can decrease burnout and depression levels.  

Methods: Starting in 2016, all residents of an OB/GYN program were allowed to have the first Wednesday afternoon of each month free from clinical duties. Faculty members covered all clinical services from noon to 5pm. Residents were then permitted to use the time for whatever they felt promoted their well-being. Two years of data were collected through surveys to determine the specific activities completed by the residents. 

Results: The commonly reported activities included health care visits, financial planning activities, leisure time with family/friends, community or church group events, every day errands, home chores, and fitness. Additionally, the residents also used the time away from clinical responsibilities to study and fulfill administrative requirements. 

Discussions: By better understanding what residents choose to do to promote their own well-being, programs can then tailor structured wellness activities to those choices.  Alternatively, programs can look at an open-ended wellness day as a possible intervention for fostering excellent overall health and welfare of their residents. More research is needed to validate this approach to wellness promotion.

Topics: Quality & Safety, UME, CME, GME, Systems-Based Practice & Improvement, Professionalism, Residency Coordinator, Residency Director, Osteopathic Faculty, Clerkship Coordinator, Clerkship Director, Faculty, Resident, Student, 2019, CREOG & APGO Annual Meeting,

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

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The Substantial Rise of Clinician Educators Among Obstetrics and Gynecology Faculty, 1977-2017

Purpose: To determine trends in faculty career development, stratified by gender and under-represented minority (URM) status, for obstetrician-gynecologists (ob-gyn) at all U.S. medical schools.

Background: The growing number of faculty and opportunities for career pathways have expanded considerably at U.S. medical schools. This growth differs between clinical specialties. Any dominance of non-tenure faculty has important implications on academic promotion policies and teaching expectations.

Methods: In this observational study, we used the Association of American Medical Colleges Faculty Roster to describe trends in career pathways (clinician educator, tenure-track, tenure) of full-time faculty at all U.S. MD-granting medical schools between 1977 and 2017.  Proportions of female and URM faculty on each pathway were compared with that of male and non-URM faculty.

Results: Between 1977 and 2017, the number of full-time faculty increased from 1,628 to 6,347, mostly as clinician educators (from 345 to 4,607; 13.4-fold increase) than as being either tenured (from 457 to 587) or on tenure-track (366 to 514). The proportion of clinician educators increased from 21.2% to 69.4%. The availability of tenure positions remained constant (92.7% of all schools); however, the proportions of tenured and tenure-track faculty declined steadily from 28.1% and 22.5%, respectively to 8.2-9.1% for each group.  The proportions of male and female faculty who were tenured or on tenure track declined from 52.9% and 37.1% respectively to 23.3% and 13.6%. The proportion who were tenured or on tenure-track declined similarly for URM (from 55.3% to 13.4%) and non-URM (from 50.2% to 18.0%) faculty.

Discussions: The substantial rise in ob-gyn faculty is largely among those who pursued careers as clinician educators. This finding confirms the essential need and protected time for educator development programs at all schools to more effectively teach medical students and resident physicians.

Topics: Lecture, CME, Professionalism, Faculty, Resident, Student, 2019, CREOG & APGO Annual Meeting,

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The Residency Buddy System: A Better Way to Encourage Laparoscopy Simulation Training?

Purpose: To determine if a “buddy-system” compared to independent training increases laparoscopic simulation time amongst residents.

Background: Based on prior research, laparoscopic box-trainers improve proficiency on surgical skills, however voluntary simulation time by residents is traditionally low. We propose that a buddy system approach to simulation will increase laparoscopic training time, and further improve skills.

Methods: Thirty-two residents at a single obstetric and gynecology residency program were consented for the study.  Each buddy pair was composed of a junior and senior resident. During the first half of the 20-week study, 12 residents were randomly assigned a buddy while 20 remained solo.  During the second half, solo-trainers were assigned buddies and conversely buddies were made solo. Residents recorded check-in and -out times electronically. (Assignments were provided via email at the beginning and mid-way points; no other contact was made.) At the conclusion of the study period a survey link was distributed.

Results: Six of the 32 residents (18.8%) attended simulation in the 20-weeks, with an average time of 2 hours 14 minutes. In the solo-trainer group, 1 resident checked in 3 times and 2 residents once. In the buddy group, 1 pair checked in together and 1 person checked in alone.  Fifteen residents (46.9%) completed the survey.  Thirteen (86.7%) agreed they accurately reported times; 1 was neutral and 1 never attended. All communicated with their buddy monthly or less frequently, while 10 of them never communicated.

Discussions: Residents’ laparoscopic simulation time was dismal at our program in this study. Dedicated mandatory simulation time may increase participation.

Topics: Minimally Invasive Surgery, Independent Study, CME, Medical Knowledge, Residency Director, Faculty, 2019, CREOG & APGO Annual Meeting,

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Testosterone Supplementation in Women with Diminished Ovarian Reserve

Purpose: To evaluate the efficacy of transdermal testosterone as an adjuvant to the standard IVF protocol to improve outcomes in women with diminished ovarian reserve (DOR). 

Background: Women with DOR have extremely low pregnancy rates after IVF cycles, and there are currently few treatment options available. Testosterone supplementation may improve ovarian response to stimulation via enhanced folliculogenesis. 

Methods: This retrospective cohort study analyzed 83 IVF cycles based on inclusion criteria of age < 42 and diagnosis of DOR (basal FSH > 10, AMH < 1, antral follicle count < 6, or history of poor response [< 4 follicles]). Cycles in the control group were carried out using the standard IVF protocol while cycles in the treatment group involved the addition of transdermal testosterone prior to ovarian stimulation. Four primary outcomes were evaluated: total number of oocytes retrieved, number of mature oocytes retrieved, number of embryos generated, and pregnancy potential of the embryos.  

Results: Pretreatment with transdermal testosterone had no impact on the total number of eggs retrieved after ovarian stimulation. Testosterone had a negative impact of the number of mature oocytes retrieved, but had no impact on the number of embryos generated from those oocytes. Pregnancy rates between the treatment and control groups were no different per embryo transfer, but were lower per cycle initiation with testosterone therapy.

Discussions: Within this study population, retrospective analysis of testosterone therapy revealed no improvement in IVF outcomes. A randomized controlled trial is recommended to further investigate this association. 

Topics: Reproductive Endocrinology & Infertility, Team-Based Learning, Problem-Based Learning, CME, GME, Medical Knowledge, Patient Care, Faculty, Resident, Student, 2019, CREOG & APGO Annual Meeting,

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Residents Express Emotional, Social and Physical Stress in the Clinical Learning Environment

 Purpose: To evaluate OBGYN residents’ perceptions of personal wellness in relation to their clinical learning environment

Background: Resident wellbeing is a significant issue affecting our future physicians’ abilities to fulfill their training potential.

Methods: The Council on Resident Education in OBGYN (CREOG) administered a voluntary, anonymous, six-item wellness survey.  One question asked about personal experience with mental health problems (burnout, depression, binge drinking, eating disorders or suicide attempt) and then provided a free text response for “other” issues.  The free text responses were reviewed and analyzed.  The ACOG IRB determined this survey exempt from review.  

Results: Of 5,061 residents, 4,099 completed the question on personal issues experienced in residency (81% RR), and 200 free text responses were submitted.  1593 residents (32%) endorsed clinical depression.  34 (0.8%) wrote in anxiety, although this was not a formal category.  The free text responses clustered into three categories: physical health (n=56), social concerns (n=34), and mood symptoms (n=115).  Symptoms of clinical depression comprised 5,992 responses, combining structured questions and free text responses.  18 (0.4%) had attempted suicide, and 18 additional residents wrote in suicide ideation or attempt, translating into almost 1% of our residents having contemplated or tried self-harm, likely related to work stress.

Discussions: Significant mood disorders and self-harm are under-recognized among OBGYN residents, even as they acknowledge these symptoms.  Programs must consider formal evaluations for depression, anxiety, and suicide risk, conduct thorough culture evaluations to ensure these symptoms are not being normalized, and tailor their interventions to provide accessible, confidential support services within the clinical learning environment.

Topics: Team-Based Learning, Assessment, CME, GME, Interpersonal & Communication Skills, Professionalism, Residency Coordinator, Residency Director, Osteopathic Faculty, Faculty, Resident, Student, 2019, CREOG & APGO Annual Meeting,

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

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Outcomes of a Transgender Care Training Program in Obstetrics and Gynecology Resident Education

Purpose: We sought to evaluate outcomes of an Obstetrics and Gynecology (OB/GYN) resident education program on transgender health.

Background: OB/GYNs are often frontline providers for the transgender community, as patients may first present to an OB/GYN with symptoms of gender dysphoria or postoperative care needs and complications. Both the American College of Obstetricians and Gynecologists (ACOG) and the Council on Resident Education in Obstetrics and Gynecology (CREOG) have developed key areas of competency pertaining to the care of transgender patients by OB/GYNS.  To date, standardized educational curriculums on these competency areas are not available.

Methods: Residents at our institution completed a 2.5-hour training on transgender health comprised of a standardized patient interaction, debriefing session, and didactic session led by an expert on transgender gynecological care. A 42 item pre- and post-training survey evaluated participant demographics, a validated transphobia questionnaire, medical knowledge of transgender care and preparedness to provide transgender care.

Results: Eighteen residents and medical students completed the training. The average pre- and post-training knowledge assessments scores significantly improved from 74.8% to 88.9%, (p<0.001). Specifically, knowledge of transgender health disparities, professional guidelines, and management of abnormal uterine bleeding all significantly improved. Baseline transphobia scores were low and did not significantly change. Residents felt more prepared to collect a transgender focused medical history, provide referrals, and access additional educational resources.

Discussions: Our training improved residents’ knowledge and preparedness to provide a variety of aspects of transgender care.  This training was feasible, reproducible and positively received by the resident participants.

Topics: Sexuality, General Ob-Gyn, Advocacy, Standardized Patient, Assessment, CME, Professionalism, Medical Knowledge, Patient Care, Residency Coordinator, Residency Director, Faculty, Resident, Student, 2019, CREOG & APGO Annual Meeting,

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One Size Doesn’t Fit All for Wellness: Residents’ Perception of Wellness Programming

Purpose: To investigate which wellness interventions have the most meaning for a modern cohort of OB/GYN residents.

Background: The 2017 CREOG Resident Survey found significant associations between the learning environment and wellness. The primary analysis indicated that PGY-1’s prioritized wellness, and that a sense of wellness decreased with each PGY level. In order to explore whether developmental stage influenced how wellness initiatives were perceived, we performed a secondary analysis of the survey to determine how residents at different PGY levels perceived wellness interventions.

Methods: A six-item survey on wellness was administered before the 2017 CREOG exam.  IRB exemption was obtained.  Participation was voluntary and anonymous, linked only to PGY level.  A mixed-methods analysis of the data was performed. Descriptive statistics were analyzed with Microsoft Excel 2010.  Mann-Whitney U tests were used to explore differences between PGY-levels. Thematic analysis of text responses was performed.

Results: Among the 5855 residents, 4,753 answered questions regarding wellness programming (81% RR). Significant differences existed between year of training and perceived effectiveness for several initiatives. PGY1 residents valued peer mentorship (p=0.003) and strategic napping (p<0.001) more than senior residents, while PGY3 residents emphasized faculty mentoring (p=.005).  Regardless of training level, residents prioritized the same three activities: wellness days to address personal needs, team-building retreats, and facilitated exercise programs.  

Discussions: OBGYN residents perceive some wellness activities as valuable throughout training, while the importance of others may vary based on resident year.  Most programs do not yet provide the wellness programs (retreats, facilitated exercise, personal time) that OBGYN residents identify as most effective.

Topics: Team-Based Learning, CME, GME, Professionalism, Patient Care, Residency Coordinator, Residency Director, Faculty, Resident, 2019, CREOG & APGO Annual Meeting,

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Ob/Gyn Residents’ Perspectives on Preparedness for Difficult Conversations

Purpose: To characterize obstetrics and gynecology (ob/gyn) resident experience in conducting difficult conversations during various patient-care scenarios. 

Background: Effective and compassionate communication is an essential part of the physician-patient relationship. Leading family meetings to discuss end-of-life care, fetal loss, infertility, or poor maternal outcomes can be a difficult and anxiety-provoking experience. However, there is often limited formal guidance for ob/gyn residents on how to conduct these difficult conversations.

Methods: A 16-question survey was sent to all ob/gyn residents in the state of Michigan. Participants answered questions regarding previous training, self-perceived preparedness, and confidence conducting difficult conversations. 

Results: Of 314 ob/gyn residents identified in the state of Michigan, 75 (24%) responded and the survey is still ongoing. Nineteen (27%) of respondents said that formal training about difficult conversations was part of their residency curriculum. Prior training included online modules/coursework 9 (12%), conferences/lectures 18 (25%), and rotation with palliative care 5 (7%).

Overall, 43 (57%) believed post-grad training in difficult conversations was either completely inadequate or could be improved. Moreover, 61 (81%) of respondents believed formal training for residents on conducting difficult conversations would either probably or definitely improve the quality of patient care. Nearly half the respondent felt a lack of confidence as the biggest barrier in satisfactorily conducting these discussions with the families.

Discussions: Efforts to improve residency training in conducting difficult conversations should be urgently undertaken. In this survey, ob/gyn residents overwhelming felt that the current training in leading difficult conversations was inadequate.

Topics: UME, CME, GME, Patient Care, Residency Director, Osteopathic Faculty, Clerkship Coordinator, Clerkship Director, Faculty, Resident, Student, 2019, CREOG & APGO Annual Meeting,

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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: CME, Practice-Based Learning & Improvement, Interpersonal & Communication Skills, Professionalism, Clerkship Coordinator, Clerkship Director, Student, 2019, CREOG & APGO Annual Meeting,

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

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