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.
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
Methods: We surveyed OBGYN program managers using a national
listserv. Resident and student surveys were based on a Likert scale and sent to
all OBGYN residents and students that rotated at our institution from
Results: Program managers responded from 45 programs and 75.6%
scheduled students in resident continuity clinics. Our response rates were
79/116(68.1%) for students and 21/24(87.5%) for residents. A one-sample
Wilcoxon signed rank test was used to test the hypothesis that the typical
response on the five-level Likert scale was \"Agree\" or \"Strongly
Agree.\" Of medical students, 88.6% stated that they agreed or strongly
agreed they enjoyed working with residents (p<0.001) and 60.8% stated
they agreed or strongly agreed residents were effective teachers (p<0.001).
Among residents, 52.4% agreed or strongly agreed that they enjoyed working with
students (p<0.001). However, 61.9% said they agreed or strongly agreed they
were too busy to be effective teachers (p<0.001).
Discussions: Many institutions have students rotate in resident continuity
clinics. Residents and students have positive views regarding their
interactions. Although students were satisfied, residents expressed concerns
about their ability to be effective teachers given clinical demands. Our
results highlight the importance of developing resident teaching skills.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, CME, UME, Assessment, Problem-Based Learning, Team-Based Learning, General Ob-Gyn,
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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.
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
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
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
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.
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
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.
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.
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.
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
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
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
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
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
Background: Practicing teaching skills and providing mentorship to
third-year students are valuable opportunities for fourth year students to take
on leadership roles. A Near-Peer mentorship program was developed to provide
orientation and support to students on their OB/Gyn clerkship, and to address
high-yield topics that supplement didactic teaching by faculty.
Methods: Three fourth-year medical students each teach an
eight-minute lesson on a topic assigned by clerkship directors. Presentations
are varied in format, but limited in scope with tangible learning objectives.
Third-year medical students complete a satisfaction survey following the
Results: Nine of seventeen students (52.9%) on the Gynecology
and Obstetrics clerkship responded to the survey. Seventy-eight of respondents
rated the fourth-year student presentations at 4 or above on a Likert scale of
1 to 5 on effectiveness compared to a traditional lecture. Fifty-six percent of
respondents rated presentations at 4 or above on a Likert scale of 1 to 5 on
memorability compared to a traditional lecture. Twenty-six percent of
respondents reported increasing knowledge from “Don’t know much at all” to
“Know the basics” or from “Know to basics” to “Could have taught it” as a
result of the presentations.
Discussions: Fourth year medical students are an excellent resource in
providing additional teaching and mentorship support to students rotating on
the OB/Gyn clerkship.
CREOG & APGO Annual Meeting, 2019, Student, Clerkship Director, Clerkship Coordinator, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, CME,
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Magnesium Toxicity and Medical Errors: A Multidisciplinary Simulation for Debriefing an Obstetric Emergency
Purpose: To create a simulation that improves communication during
obstetric emergency and promotes a safe learning environment to debrief and
evaluate medical errors.
Background: Simulation is known to improve communication and
comfort in obstetric emergency. Little data exist regarding simulation for
enhancing expertise in debriefing and evaluating system errors.
Methods: The simulation highlights an unresponsive patient
shortly following a preterm delivery at 30 weeks gestation. The team discovers
an accidental bolus of intravenous magnesium was given instead of postpartum
oxytocin. Following conclusion of the simulation, participants were asked to
lead a debrief session. Surveys were performed to assess participant comfort
with magnesium toxicity, debriefing, evaluating a medical error, and
communication during an emergency.
Results: Participants felt the simulation was (1) a realistic
scenario that allowed practice debriefing a medical error within a large
multidisciplinary team, (2) a place to practice high acuity care and
communication, and (3) a safe place to receive and provide feedback. On
average, residents reported an increase in comfort with management of magnesium
toxicity from little comfort(2/5) tomoderate comfort(4/5). In general,
participants (90%; N=10) felt like they learned advanced management of acute
magnesium toxicity. All participants (100%; N=10) reported they would recommend
this simulation to others in their profession.
Discussions: We have designed a simple model that highlights the
importance of (1) communication during an obstetric emergency and (2)
debriefing and evaluating errors from systems perspective. This model increased
participant knowledge and comfort with magnesium toxicity and promoted a safe
culture to discuss medical errors and practice debriefing.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, CME, Simulation, Quality & Safety, Team-Based Learning,
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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
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.
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
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.
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
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.
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.
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.
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
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.
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.
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
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
· 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
· Positive correlation in NBME scores and satisfaction
· Student experience and satisfaction may vary by
location based on clinical exposure and opportunity
· No standardized resident-lectures amongst all
· 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.
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.
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.
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.
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.
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.
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.
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
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
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.
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.
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
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.
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.
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.
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
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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