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

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Too Many Learners? Do Students Belong in Resident Continuity Clinics?

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


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


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


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


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

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

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

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

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

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


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


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


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


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


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

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

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

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


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


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

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


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

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

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

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

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

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Near-Peer Gynecology and Obstetrics Clerkship M4 Mentorship Program

Purpose: To support and teach high-yield topics to third year medical students on their OB/Gyn clerkship and engage fourth year medical students in mentorship opportunities.


Background: Practicing teaching skills and providing mentorship to third-year students are valuable opportunities for fourth year students to take on leadership roles. A Near-Peer mentorship program was developed to provide orientation and support to students on their OB/Gyn clerkship, and to address high-yield topics that supplement didactic teaching by faculty.


Methods: Three fourth-year medical students each teach an eight-minute lesson on a topic assigned by clerkship directors. Presentations are varied in format, but limited in scope with tangible learning objectives. Third-year medical students complete a satisfaction survey following the presentations.


Results: Nine of seventeen students (52.9%) on the Gynecology and Obstetrics clerkship responded to the survey. Seventy-eight of respondents rated the fourth-year student presentations at 4 or above on a Likert scale of 1 to 5 on effectiveness compared to a traditional lecture. Fifty-six percent of respondents rated presentations at 4 or above on a Likert scale of 1 to 5 on memorability compared to a traditional lecture. Twenty-six percent of respondents reported increasing knowledge from “Don’t know much at all” to “Know the basics” or from “Know to basics” to “Could have taught it” as a result of the presentations.


Discussions: Fourth year medical students are an excellent resource in providing additional teaching and mentorship support to students rotating on the OB/Gyn clerkship.

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

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

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


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


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


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


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

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

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Let\'s Get Jazzy: Career Preparedness in OB/GYN Residents; Assessing the Need, and Developing a Curriculum

Purpose: To assess the need for a formal and structured curriculum focused on OB/Gyn resident career and employment preparedness.


Background: Many residents rely on mentors and resident colleagues to help determine their career paths. Curriculum during residency in obstetrics and gynecology often lacks an emphasis on preparing residents to enter the job field as practicing physicians. Often physicians complete training with significant amount of education debt.  Some employment scenarios may have negative financial implications. Residents need to be formally educated on the impacts changes in research funding, the healthcare system, and insurance market play in their career decisions. It is important to determine how to best prepare residents to choose a career path.


Methods: We administered a career curriculum needs assessment and a validated career readiness survey, which included questions relating to mentorship, job search strategies and opportunities, negotiation, and practice climate to 28 residents. The survey results determined the topics that were needed.


Results: 89% of residents agreed it was important to learn about career paths during residency. 96% of the residents believed that a career-planning curriculum would be helpful.  89% thought it was important to have a career mentor. Overall, 67.9% of respondents do not feel confident about their ability to negotiate a contract. The majority of resident were not familiar with medical practice finance and malpractice insurance.


Discussions: The survey results were used to inform curriculum for the academic year. Topics included career mentoring and individual planning, negotiation, finance, and insurance. Comparison of pre/post curriculum will be performed after 1 year.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Professionalism, GME, CME, Lecture, Independent Study,

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Let the Good Grades Roll: Optimizing Shelf Exam Performance with a Novel Peer-led Comprehensive Review Session

Purpose: To create a comprehensive review for third year medical students at Brody School of Medicine in preparation for the end of clerkship national board shelf examination in OB/GYN.


Background: With the increasing availability of resources in preparation for clinical clerkships, medical students struggle to identify high-yield topics in review for end of clerkship shelf examinations. This dilemma is further exacerbated by having educational objectives published by both the National Board of Medical Examinations (NBME) and the Association of Professors of Gynecology and Obstetrics (APGO). Although though it was proven that the NBME exam appropriately tests students on the information that APGO deemed “essential,” there still isn’t a timely and comprehensive review resource available for students focusing on these specific topics. Due to this, a comprehensive high-yield review was created using the student educational objectives in OB/GYN published by the APGO.


Methods: A two-hour comprehensive review presentation was created for students who were rotating on the OB/GYN clerkship at the Brody School of Medicine using the APGO objectives. The presentation was created in a question and answer format to allow students to use the information presented as both a study tool and as a self-assessment of knowledge. This review was created using the follow resources: U-World, Step-Up to Obstetrics and Gynecology, and Pre-Test OB/GYN.


Results: A post-presentation survey revealed that participants found the review to be educational, high yield, and extremely useful for studying for the NBME shelf examination. An additional survey was also sent to students after taking the NBME shelf examination to assess the quality of the information presented. Overall the students who attended the review session and used the presentation as a study tool reported positive impacts on shelf examination scores and overall understanding of high-yield concepts in OB/GYN.


Discussions: With the positive feedback from students who attended the review session and used the presentation as a study-tool for the NBME shelf examination, we hope that comprehensive reviews such as this will be created for additional clerkships to help students prepare for other NBME examinations.  

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Medical Knowledge, GME, CME, UME, Lecture, General Ob-Gyn,

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Join the Club: Integration of the CREOG Journal Club Curriculum Improves OBGYN Residents Statistical Literacy


Purpose: To evaluate the impact on resident comprehension of biostatistics and research methodology after restructuring a residency journal club based on the CREOG journal club curriculum.


Background: Studies reveal dismal resident performance on statistical literacy evaluations. However, little is known regarding OBGYN residents’ ability to interpret research methodology and results and how these abilities are impacted by the integration of evidence-based medicine principles into journal club curricula.


Methods: A pre-/post-intervention study of 22 OBGYN residents at a single institution was conducted to evaluate the impact of integrating the new curriculum (intervention). Participants were administered a survey comprised of 3 sections: a questionnaire in which residents ranked their perceived ability to analyze research literature, a previously validated fifteen question epidemiological/biostatistical knowledge tool, and five questions assessing the curriculum changes. Analysis was performed using Chi-square test, Wilcoxon rank sum test, and paired t-test.


Results: The overall mean percentage correct on statistical knowledge and interpretation of results pre-intervention was 36.6% versus 67.3% (p<0.0001) post-intervention. Higher pre-intervention scores were associated with prior biostatistics training (45.2% vs 32.9%; p=.001); however, post-intervention, scores were equivalent (66.9% vs 69.4%; p=0.753). Residents (90.9%) preferred the restructured journal club, and 19/22 (86.3%) residents report their desire to continue participating in this journal club format post-training.


Discussions: Significant improvement in residents’ biostatistics knowledge, with resultant increased confidence in their ability to interpret clinical research results, was a demonstrated outcome of the implementation of the CREOG journal club format. Residency programs can provide more effective biostatistics training by incorporating this curriculum.

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

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Impact of Resident Led Didactics on OBGYN Clerkship Shelf Scores and Student Satisfaction

Purpose: Compare NBME shelf scores prior to and after implementation of the Wednesday lecture series.Compare satisfaction scores of students prior to and post implementation of Wednesday lecture series. Scores would be obtained from the Aesculapian Society who evaluates students’ overall perceptions of clerkships



·       The ACGME and LCME has designated teaching as an accreditation standard with numerous competencies. Residents serve as clinical teachers for medical students with studies indicating that residents spend up to 20% of their time teaching medical students.

·       In a national survey 60% of students reported that they received their teaching from residents and fellows during their obstetrics and gynecology clerkships.

·       In 2015-2016, the department of Obstetrics & Gynecology at Louisiana State University School of Medicine-New Orleans implemented a new lecture series for 3rd year medical students.

·       Wednesday Lectures: High yield OB/GYN topics delivered by chief resident.

·       Lectures designed to complement Team-Based Learning sessions


·       Shelf exam scores from 2011-2017 were reviewed and compared across the training sites.

·       Control Group: Baton Rouge and Lafayette based students who do not receive the same lectures.

·       Aesculapian Society Evaluations.Scores before and after implementation were examined


·       Positive correlation in resident teaching and satisfaction scores

·       Positive correlation in NBME scores and satisfaction scores



·       Student experience and satisfaction  may vary by location based on clinical exposure and opportunity

·       No standardized resident-lectures amongst all locations

·       Future Implications: Standardized implementation of resident led didactics. Our goal is to Implement ACGME recommended ‘Resident-as-teachers program as already established in other institutions and improve shelf scores over the next 5 years.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, CME, Assessment, Lecture, Team-Based Learning, CREOG & APGO Annual Meeting, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Medical Knowledge, Professionalism, UME, Assessment, General Ob-Gyn,

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Enhancing Breastfeeding in Rural Tennessee Through Education

Purpose: To promote breastfeeding education and increase rate of exclusive postpartum breast-feeding to 10% in Rural Tennessee.


Background: Breastfeeding provides many physical and emotional benefits to both the mother and baby. It is physiologically normal for mothers and children. Providing education about breastfeeding during pregnancy can help keep patients informed and increase breastfeeding rates postpartum.


Methods: We selected patients who never breastfed for this study. After signing the consent form at their initial obstetric visit, patients received education about lactation in the form of discussion, brochures, CD-ROMs, and flash drives during pregnancy, delivery, and during the postpartum period. Patients completed a survey during their initial obstetric about their prior knowledge of breastfeeding advantages, as well as their intention to breast feed. During the postpartum period, patients filled a survey about their satisfaction of the information they received, and their breastfeeding intention and success.


Results: We analyzed 141 antepartum and postpartum patients. Antepartum survey showed 84.5% wanted to breast feed and 82.5% knew the benefits of breast feeding. Postpartum survey showed 83.2% and 91% indicated that they received adequate information about lactation during pregnancy and delivery, respectively. The survey showed that 64.9% intended to breastfeed within the first 12 months; 35.1% (p value < 0.001) breastfed up to 6 weeks.  


Discussions: In rural Tennessee, providing breastfeeding knowledge throughout pregnancy, during delivery, and postpartum for obstetrics patients helped motivate them to breastfeed. This healthy approach increased from the State of Tennessee goal of 10% to 35.1% during the postpartum period.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Patient Care, Medical Knowledge, CME, Public Health, Advocacy, General Ob-Gyn,

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Development of a Novel Method for OBGYN Resident Recruitment

Purpose: We aimed to improve our resident recruitment method to promote individualized, holistic admissions and decrease applicant stress.


Background: The AAMC is promoting processes that utilize holistic, individualized resident applicant criteria and methods that reduce candidate stress.


Methods: Resident applicants were divided among six experienced faculty who selected candidates based on objective scoring of academic records. Selected applicants were emailed to rank interview date preferences within 72-hours, and then received an email with interview placement. Following interviews, applicants were surveyed about the process.

 Three ranks lists were generated and compared: a behavioral-based composite rank list (BBC); a BBC with pre-interview scores included; and a traditional list. In the BBC method, faculty were blinded to pre-interview scores, and applicants were evaluated on professionalism, leadership, trainability, and fit. The traditional rank list was generated via open discussion with interviewers. The three rank lists were compared to determine concordance between methods.  


Results: There were 78 applicants interviewed. There was 62.8% concordance between the BBC and traditional rank list, which dropped to 32.1% concordance when pre-interview scores were combined with BBC scores. Applicant post-invitation survey response rate was 67%; with 93.3% reporting the interview invitation process was more equitable, less stressful (82.7%), and better than other institutions (86.6%). All faculty involved in the candidate prescreen preferred the new standardized method.


Discussions: There was concordance between the BBC and standard rank lists, but not when pre-interview scores was combined with the BBC.  Candidates were satisfied with the new method of invitation and faculty found the standardized pre-interview scoring method preferable.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, CME, Assessment, Lecture,

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Burnt out and yet Engaged: Are We Asking the Right Questions in Faculty Wellness Research?

Purpose: To examines rates of work engagement and work empowerment in ob-gyn faculty, together with their perceptions on connection at work, in correlation with burnout.


Background: Burnout appears to be an accelerating phenomenon, threatening the health and well-being of providers and patients. There is concern, however, that the term is becoming overused and that the measures may not capture the full picture, with an assumption that the end-goal is the absence of burnout rather than the promotion of wellness.


Methods: Cross-sectional study of 25 ob-gyn faculty at a large academic medical center in the United States. Outcome measures: Utrecht Work Engagement Scale, Work Empowerment Scale, 2-item Maslach Burnout Inventory, and perceptions of connection in the department.


Results: Fifty-six percent of faculty met criteria for emotional exhaustion, 19% for depersonalization, and 19% for high burnout. There was no difference in years of practice and the presence of burnout (P=.74), and no association between burnout and work engagement or work empowerment (P=.33 and P=.25, respectively). Ninety-two percent feel a sense of connection and community at work and 92% trust their colleagues and feel safe discussing concerns with them.


Discussions: Emotional exhaustion, sometimes capitulated to be a sign of pathological burnout, may be an appropriate and normal response to daily activities which does not impact engagement at work. Shifting the focus away from burnout to positive psychology measures and building community may be the key to nourishing joy in practice and transforming the workplace to one that promotes wellness in the face of adversity and challenge.

Topics: CREOG & APGO Annual Meeting, 2019, Faculty, Professionalism, Systems-Based Practice & Improvement, CME, General Ob-Gyn,

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Assessment of Knowledge Gain and Retention with Multidisciplinary Simulation of Maternal Cardiac Arrest

Purpose: Our objective was to assess the improvement and retention of learner knowledge in managing cardiac arrest in the pregnant patient using multidisciplinary simulation training.


Background: Simulation can address challenges facing education, including patient safety, work hours, and decreased patient volume. Simulation is invaluable for rehearsing rare emergencies. There is data showing that simulation improves knowledge; however, there is limited data on the retention of this knowledge, especially for rare events unlikely to be encountered in practice.


Methods: We developed a simulation curriculum for the resuscitation of a pregnant patient who experiences cardiac arrest.  We created a 10-question test that emphasized the points of the didactics. Participants, including residents and nurses, took the test before and after the training and received electronic notification 3 months after their training to take the test again.


Results: Over 9 months in 16 sessions, we trained 90 learners: 31 OB/GYN residents, 5 anesthesiology residents, and 54 labor and delivery nurses. For the OB/GYN residents, the mean scores (out of 10) were 5.4 for the pre-test, 8.8 for the post-test, and 7.9 for the 3-month test. Post-test scores were significantly increased from the baseline (p < 0.0001). The decrease by < 1 point at 3 months was significant (p = 0.006) but still a passing score.


Discussions: We demonstrated a significant knowledge improvement for managing maternal cardiac arrest among OB/GYN residents using simulation. The knowledge was largely maintained 3 months later. Future research including longer intervals for reassessment will aid educators in optimizing training intervals for similar uncommon emergencies.

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

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