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.
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
Discussions: Updated objectives and modern teaching methods
improved resident impressions of didactics, but did not improve CREOG exam
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
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.
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.
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.
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
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
• 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.
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.
• 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
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.
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
Methods: We surveyed OBGYN program managers using a national
listserv. Resident and student surveys were based on a Likert scale and sent to
all OBGYN residents and students that rotated at our institution from
Results: Program managers responded from 45 programs and 75.6%
scheduled students in resident continuity clinics. Our response rates were
79/116(68.1%) for students and 21/24(87.5%) for residents. A one-sample
Wilcoxon signed rank test was used to test the hypothesis that the typical
response on the five-level Likert scale was \\\"Agree\\\" or \\\"Strongly
Agree.\\\" Of medical students, 88.6% stated that they agreed or strongly
agreed they enjoyed working with residents (p<0.001) and 60.8% stated
they agreed or strongly agreed residents were effective teachers (p<0.001).
Among residents, 52.4% agreed or strongly agreed that they enjoyed working with
students (p<0.001). However, 61.9% said they agreed or strongly agreed they
were too busy to be effective teachers (p<0.001).
Discussions: Many institutions have students rotate in resident continuity
clinics. Residents and students have positive views regarding their
interactions. Although students were satisfied, residents expressed concerns
about their ability to be effective teachers given clinical demands. Our
results highlight the importance of developing resident teaching skills.
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
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
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.
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
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
Discussions: Residents’ laparoscopic simulation time was dismal at our
program in this study. Dedicated mandatory simulation time may increase
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
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.
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
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.
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.
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.
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
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
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
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
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
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%).
(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
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
Background: Practicing teaching skills and providing mentorship to
third-year students are valuable opportunities for fourth year students to take
on leadership roles. A Near-Peer mentorship program was developed to provide
orientation and support to students on their OB/Gyn clerkship, and to address
high-yield topics that supplement didactic teaching by faculty.
Methods: Three fourth-year medical students each teach an
eight-minute lesson on a topic assigned by clerkship directors. Presentations
are varied in format, but limited in scope with tangible learning objectives.
Third-year medical students complete a satisfaction survey following the
Results: Nine of seventeen students (52.9%) on the Gynecology
and Obstetrics clerkship responded to the survey. Seventy-eight of respondents
rated the fourth-year student presentations at 4 or above on a Likert scale of
1 to 5 on effectiveness compared to a traditional lecture. Fifty-six percent of
respondents rated presentations at 4 or above on a Likert scale of 1 to 5 on
memorability compared to a traditional lecture. Twenty-six percent of
respondents reported increasing knowledge from “Don’t know much at all” to
“Know the basics” or from “Know to basics” to “Could have taught it” as a
result of the presentations.
Discussions: Fourth year medical students are an excellent resource in
providing additional teaching and mentorship support to students rotating on
the OB/Gyn clerkship.
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.
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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