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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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Use of Video Interviews for Selection of Obstetrics and Gynecology Residents

Purpose: To improve the residency selection process using asynchronous video interviews

 

Background: Residency applications have increased, while data available for decision making in ERAS has been static. One-way (asynchronous) video interviews (OWVI) involve the candidate recording answers to pre-selected questions.

 

Methods: Applicants to an OB/GYN residency program with USMLE Step 1 ≥ 220, no USMLE failures and at least 3 months of US clinical experience were scored using five criteria (USMLE 1 score, clinical clerkship grades, letters of recommendation, research achievements and extracurricular/leadership activities) scored 1-5, with 5 as the top score. Applicants with scores from 19 to 22 were invited to complete an OWVI.  The OWVI consisted of 1 open ended question and 2 behavioral questions, scored from 1-5. Applicants were invited for an in person interview based on their video interview scores.

 

Results: For the 2018 residency application season, 495 applications were received, 272 applications were scored and invited to complete a video interview, 234 applicants completed OWVI and 97 OWVI were used for the decision to invite for an in-person interview. Mean OWVI score was 10.4 (range 4-15). For the 2018 season, OWVI scores were weakly correlated with rank list placement (Pearson coefficient = 0.29), in-person interview scores (0.18) and application scores (0.33). The mean in-person interview score increased after implementation of OWVI screening from 59.0 in 2017 to 62.2 in 2018 (P<0.01).

 

Discussions: Use of OWVI led to higher in-person interview scores, suggesting that video interviewing is a useful supplemental tool for selecting competitive residency candidates.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, GME, UME, Assessment,

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Use of POEs( Point of EPA Evaluations) Across All Third Year Clerkships for Year Long EPA ( Entrustable Professional Activity) Monitoring

Purpose: To describe the development of a school wide and longitudinal assessment of the core Entrustable Professional Activity (EPA)s using an easily accessible App.

 

Background: Our insitution is  part of the EPA pilot study sponsored by the AAMC to explore the feasibility of teaching and assessing the core EPAs. This year direct observation and assessment of the EPAs was implemented across clerkships . Each clerkship was allowed to determine which EPAs were applicable to their field.

 

Methods: The OBGYN department determined and assessed that EPA1( History and Physical) , ] EPA2 ( Differential Dx) , EPA3 ( Dx and Screening Tests) and EPA6 ( Oral Presentation)  were core skills to the clerkship with the following scale (1=student observed, 2=assessor had to talk the student through it, 3=assessor had direct them from time to time, and 4=assessor  needed to be available just in case.)

Results:

 

                       OB                    Other Clerkships             p

EPA 1            3.0( 0.5)                     3.5 (0.5)               <0.0001

EPA 2           3.0 (0.9)                       3.4 (0.6)              <0.05

EPA3             3.0 (0.9)                      3.4 (0.7)               n.s

EPA6            3.1( 0.5)                         3.4  (0.5)              < 0.005

 

For the first 3 months there were 2783 EPA assessments. The average score was 3.45. In comparison to other clerkships, students on OBGYN received lower scores in EPA 1,2,6.( p<.0001, P< .05 and P< .005) possibly  indicating more stringent grading by faculty or lower performance of medical students.

 

Discussions: In comparison to all other clerkships combines, student on OBGYN received lower scores in all four EPAs possibly  indicating more stringent grading by faculty or lower performance of medical students. Lower EPA scores may  indicate more stringent grading by faculty or lower performance of medical students. This could also be related to lower numbers of overall EPAs reuired by the OB/GYN clerkship.  Further research is needed to determine the significance of these findings.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Practice-Based Learning & Improvement, GME, UME, Assessment,

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Trends in Off-Service Rotations in Ob/Gyn Residencies Before and After Duty Hour Restrictions

Purpose: To establish trends in off-service rotations in OB/GYN residencies before and after duty hour restrictions.

 

Background: As co-morbidities in our patient population increases, the skills required of OB/GYNs are changing, we sought to determine the characteristics of off service rotations.

 

Methods: We searched websites of ACGME accredited OB/GYN residency programs. We collected data on off service rotations: services, number of rotations, and PGY year of rotations. Surveys were emailed to programs regarding off service rotations in 2018 and before duty hour changes in 2003.

 

Results: 92% (n=259) of programs had information available on off-service rotations, of these, 24% (n=62) had no off-service rotations, 26% (n=67) had 1, 25% (n=66) had 2, 13% (n=34) had 3, 12% (n=30) had 4 or more. The majority (84%) of rotations were in PGY1. The most common rotations were ER (47%, n=122), SICU (24%, n=62), IM (25%, n=66), MICU (9%, n=23). We received 53 responses to the survey (19% response rate). Of those who responded, the most common rotations for 2018 and before 2003 were ER & SICU. The number of programs with SICU rotations remained stable from 2003 to 2018 (43% vs 47%) compared to 1.4 fold decrease in programs with ER rotations. The number of programs with IM rotations decreased 2.5 fold from before 2003 to 2018.

 

Discussions: Duty hour restrictions have affected off-service rotations. A quarter of all programs have no off-service rotations, with a decrease in ER and IM exposure during residency. This does not reflect the breadth of knowledge required of OB/GYNs today.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Quality & Safety, General Ob-Gyn, CREOG & APGO Annual Meeting, 2019, Student, Resident, Clerkship Director, Residency Director, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Team-Based Learning,

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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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Time to Face the Music: Attitudes of Current and Future OB/GYN Residents Regarding the Structure of Residency Training

Purpose: Measure future and current resident perspectives regarding OB/GYN residency training structure and possible future models.

 

Background: Modifications to the current OB/GYN training paradigm are being considered however the perspective of learner stakeholders on substantial changes has not been measured.

 

Methods: Medical students invited for OB/GYN residency interviews and residents (PGY1-4) at the University of Colorado, University of Washington, University of California San Francisco, Loyola University, St. Joseph’s Hospital, and Texas A&M in 2017-2018 received a voluntary, electronic survey regarding possible models for restructuring residency training.  Student and resident responses were compared using a chi-square for categorical and two-sample t-test for continuous items. 

 

Results: Applicants (63%, 280/444) and residents (66%, 101/154) had similar response rates.  Applicants (24%) and residents (29%) reported having concerns about the current structure of residency training.  The ideal residency duration was reported as 4 years by 72% of applicants and 85% of residents.  Lack of gynecologic surgical volume was the most frequently reported concern among applicants (75%) and residents (72%).  Fourth-year tracking (focusing on training aligned with post-graduation career path) was preferred by 90% of applicants and 77% of residents (p=0.002), and 92% among respondents planning fellowship.  Most applicants (68%) and residents (75%) preferred not starting fellowship training after the 3rd year of residency.    

 

Discussions: The majority of learners surveyed support a 4-year training structure, but likewise support individualizing training in the PGY-4 year. It is imperative that OB/GYN leadership consider this and other feedback from learners when considering modifications to the current OB/GYN training paradigm. 

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

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The Effect of a 6-week vs 4-week Clerkship on NBME Shelf Scores in Obstetrics and Gynecology

Purpose: To determine the effect of a 6-week vs 4-week clerkship on NBME shelf scores in Obstetrics and Gynecology

 

Background: A medical school wide curriculum change took place at Penn State College of Medicine during the 2017-2018 academic year to increase longitudinal and integrated learning.  The OB/GYN clerkship was shortened to 4 weeks and placed into a fifteen-week block with other rotations.  OB/GYN students continued to rotate through three clinical sites.  Shelf exams, previously given at clerkship conclusion, were then administered in the final week of the block.  

 

Methods: A retrospective review of NBME shelf scores for our Obstetrics and Gynecology clerkship was performed for academic years 2015-2017 and compared to those from academic year 2017-2018.  Student scores were collected and de-identified.  Mean scores were then obtained for each six-week rotation in 2015-2017 as well as the 4-week rotation school year.  

 

Results: A comparison of 4-week versus 6-week shelf scores at each site showed a significant decrease of 2.16 in the shelf scores at Hershey during the 4-week rotation (P=0.03).  Harrisburg Hospital scores decreased by 0.31 (P=0.83) while York scores increased by 2.23 (P=0.21) during 4-week rotations.  However, a decrease in overall mean shelf score in 4-week scores compared to 6-week scores across all sites by 0.08 was not significant (P=0.93).

 

Discussions: Analysis of the shelf scores across all of the 4-week rotations following curriculum change revealed no significant difference in mean scores when compared to the 6-week rotations.  However, there was a site-specific significant decrease in mean scores at our main hospital.  

Topics: CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Clerkship Coordinator, Medical Knowledge, UME, Assessment,

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Students Stuck in a Swamp? Scripting Promotes Medical Student Involvement in Obstetric & Gynecologic Care

Purpose: Characterize the effect of staff scripting on medical student acceptance in outpatient ob-gyn clinic visits.

 

Background: Direct patient care is a major tributary in the river of medical education. When patients refuse medical student involvement in their care, students are stranded in stagnant quagmire. Review of the literature shows that medical student refusal is a national issue not limited solely to obstetrics and gynecology (ob-gyn) clerkships (Chang, et al, 2010; Mavis, et al, 2006; Hartz & Beale, 2000). Written and video messages about medical student training have been effective in furthering medical student acceptance in clinical encounters (Buck & Littleton, 2016). Open the floodgates!

 

Methods: A literature review using search terms “medical student AND refusal” was conducted to guide script composition. Medical assistant and nursing staff implemented the script in an outpatient ob-gyn resident clinic. The script was revised halfway through the clerkship year based on patient and staff feedback. All ob-gyn medical students were surveyed regarding their involvement in patient visits prior to and after script implementation.

 

Results: After script implementation, the percent of medical students refused from at least one patient interaction decreased from 92% to 86%. 66% percent of our students perceived scripting as a supportive measure for medical students, and 61% percent witnessed staff, residents, and faculty utilizing scripting.

 

Discussions: Data from our institution suggest that scripting improves medical student involvement in ob-gyn patient care. Involving staff, students, and patients on scripting revision helped foster a learning environment rich as the Mississippi delta in which medical students can thrive.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Professionalism, Interpersonal & Communication Skills, UME, Team-Based Learning, Advocacy,

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Simulated Paging Curriculum to Assess and Improve Communication Skills

Purpose: To examine the impact of a simulated paging curriculum for senior medical students on physician-nurse communication skills.

 

Background: New residents are expected to triage and address a high volume of clinical pages yet medical students receive little training in this important skill. Previous studies have evaluated the impact of simulated paging curricula on clinical decision making and student confidence but have not examined the effect on communication skills.

 

Methods: Two trained Registered Nurses (RNs) administered specialty-specific pages to 76 fourth-year medical students enrolled in 4-week residency preparation electives.  For each case, RNs evaluated students’ performances on seven communication domains using previously validated 5-point semantic-differentiation scales (1=worst, 5=best) in precision, instruction, assertiveness, direction, organization, engagement, and ability to solicit information. Immediate feedback was provided to the students.

 

Results: A total of 351 pages were administered: 144 in week 1, 73 (week 2), 97 (week 3), and 37 (week 4). Students from all specialties improved communication scores throughout the four weeks. Mean communication scores increased from 4.02 to 4.26 from week 1 to week 2 (<0.0001).  Improvement was most pronounced for the students going into internal medicine (3.82 to 4.25) and pediatrics (3.95 to 4.38) and less pronounced for the procedural specialties of surgery (4.26 to 4.22) and ob/gyn (4.07 to 4.18). Communication skills continued to improve in weeks 3 and 4 but with inadequate number of pages to power this comparison.

 

Discussions: Our data demonstrates that a simulated paging curriculum is a promising platform for teaching and improving physician-nurse communication skills for senior medical students.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, UME, Assessment, Simulation, Problem-Based Learning, General Ob-Gyn,

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Service-learning Wellness Initiative in the Harvard Medical School Clerkship Curriculum

Purpose: The first aim was to assess if incorporation of a service-based initiative into the curriculum results in professional fulfillment, principally: improved medical student feelings of compassion, contribution, wellness, understanding of community need, and team-building of the student class. The second aim is to report the development of this curriculum project.

 

Background: Service-learning increases student awareness of community resources, promotes service to the community, team-building through cooperation rather than competition, broadens cultural awareness, and fosters wellness through hands-on contribution.

 

Methods: The entire class of second year clerkship students volunteered at a local non-profit organization. Students were divided into small groups to work at various team tasks.  Following, the entire group reconvened for teaching reflection. They were asked a value-based qualifier of the experience. They were also asked to provide feedback as an open response. Quantitative data were analyzed using summary statistics, Wilcoxon rank sum and Fischer’s exact test. Content analysis was used to determine themes from the open-ended responses.

 

Results: 47 students participated, 48.9% of whom were male. Average satisfaction with the intervention was high (mean 4.26 on a 5-point Likert scale), with no difference in satisfaction noted by gender. Positive themes included feelings of contribution, wellness, and team-building, with 9 respondents requesting to repeat the event at regular intervals.

 

Discussions: It is crucial to investigate different types of wellness interventions throughout UME. Service-based interventions are not adequately studied and may be an important addition to the wellness program as they are a way for students to feel connected to the community they are serving.  

Topics: CREOG & APGO Annual Meeting, 2019, Faculty, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Team-Based Learning, Public Health, General Ob-Gyn,

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Saving Lives: Students Enhancing Patient Health Literacy Regarding Hypertension in Pregnancy and Prenatal Aspirin

Purpose: To increase medical student’s knowledge, behavior and belief systems regarding hypertension (HTN) in pregnancy and prenatal aspirin (PNA). To increase patient\'s understanding regarding the complications of HTN in pregnancy and the benefits of PNA.

 

Background: Prenatal aspirin (81 mg) has been recommended by ACOG for high-risk women and women with >1 moderate risk factor. Its use reduces the rate of preeclampsia, preterm birth, intrauterine growth restriction and fetal death in at-risk patients. In a survey conducted at Boston Medical Center, the incidence of hypertension in pregnancy is 30%, with only 15% of patient having heard of PNA, demonstrating high prevalence and low patient literacy regarding the topic.

 

Methods: Ob/Gyn clerkship students are instructed to educate patients regarding: knowledge of HTN in pregnancy, warning signs of preeclampsia, and efficacy of PNA in pregnancy. The student educational intervention was evaluated regarding: satisfaction, knowledge, confidence, and belief systems by surveys at the beginning and end of the clerkship. Patient education was evaluated by pre and post intervention metrics.

 

Results: Student knowledge of PNA and HTN increased 35%, confidence 45% and belief systems 14%. They gave the project a 72% satisfaction rating. Patient’s knowledge about HTN increased 48%, warning signs 80%, and understanding of efficacy of PNA 65%.

 

Discussions: Medical student health counseling increased patient knowledge regarding HTN and PNA. By educating patients, students also increased their knowledge and confidence in the subject. We plan to continue implementing this QI project throughout the year to augment a departmental QI initiative and evaluate its benefit to patients and students.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, UME, Quality & Safety, Advocacy,

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Removing the Shelf Cutoff to Achieve Honors in the Clerkship Does Not Change Test Scores

Purpose: Purpose: To identify students’ performance on the NBME subject examination changes when a minimum score requirement for Honors is removed.

 

Background: Background: The NBME subject examination is used in many obstetrics and gynecology clerkships as an objective measure of knowledge. The exam score may be included in the calculation of a student’s final grade, with a requirement to achieve a certain minimum score to be eligible for a grade of Honors. At our institution, this cutoff was removed from the obstetrics and gynecology clerkship in 2017.

 

Methods: Methods: Scores for the Obstetrics and Gynecology subject examination at the University of Pennsylvania were compared between 2016 (the most recent year in which a cutoff was used) and 2017 (the first year in which the cutoff was removed). Comparative statistical analyses were performed, including mean, standard deviation, and Student’s T-test.

 

Results: Results: In 2016, 161 students took the NBME subject examination, during which time a minimum score of 81 was required to be eligible for a final grade of Honors. The mean score was 80.58 (range 61-93, standard deviation 6.34). In 2017, the minimum cutoff requirement was removed, and 163 students took the exam. The mean score was 80.42 (range 53-94, standard deviation 6.38). The T-test result for comparison between the two means was 0.41.

 

Discussions: Discussion: At this academic institution, the mean NBME subject examination score did not change between the two years. Students continue to study for the final exam when the minimum cutoff is removed.

Topics: CREOG & APGO Annual Meeting, 2019, Faculty, Clerkship Director, Medical Knowledge, UME, Assessment, Independent Study,

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Predictors of Trainees\' Willingness to Provide Family Planning Services: A Survey of Ob-Gyn Residents

Purpose: To determine factors that contribute to a resident’s willingness to provide abortions post-residency.

 

Background: The shortage of abortion providers makes accessing care difficult. Personal and environmentalfactors within the residency training environment may be modified so that greater numbers ofgraduates opt to become abortion providers.

 

Methods: A multiple-choice survey was sent to all ACGME accredited OB/GYN residency programs. Data on demographics,religious and political views, residency training experience and intent to provide abortions was collected anonymously (n=396).

 

Results: Sixty-eight percent of residents intended to provide abortions (n = 269). The sample was 89% female, underage 35 (97%), heterosexual (91%). In a multivariable logistical regression, the following demographic factors predicted intent to provide abortion; being female (aOR 2.8; 95% CI 1.2-6.5), identifying as non-Christian (aOR 3.6; 1.9-6.6), and being raised in the Northeast (vs South) (aOR 3.0; 1.3-6.7) .Modifiable predictors of intention to provide included programs where 50% of the faculty provided abortions (aOR 3.3;95% CI 1.8-5.8). Additionally, residents who performed greater than 20 cases (uOR 3.3, 95% CI 1.6-6.7) were three times more likely to plan toprovide.Selection of a residency emphasizing family planning significantly correlated with intent toprovide (aOR 4.3; 95% CI 2.4-7.8). Those training at Ryan Programs were twice as likely (uOR2.4; 95% CI 1.6-3.8) to intend to provide.

 

Discussions: Modifiable factors such as early exposure of medical students to family planning, faculty selection, robust case volumes and establishment of a Ryanprogram may enhance the number of graduates offering abortions while in practice.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Osteopathic Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, GME, UME, Advocacy, Contraception or Family Planning,

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Parenthood and Medical Careers: The Challenges and Experiences of Physician Moms in the US

Purpose: This survey study sought to gain a better understanding of the experiences and challenges physician moms face during training and as junior faculty.

 

Background: Balancing the demands of medical training and a career along with those of parenthood is challenging. Currently 46% of residents and fellows in training are women, with a rate as high as 83% in Obstetrics and Gynecology.

 

Methods: We surveyed 897 physician moms from January 2018-February 2018 about their experiences with child-bearing, breastfeeding and maternity leave. Participants completed an open-ended question “What is your biggest challenge as a physician mom?”, these answers were qualitatively coded.

 

Results: The majority of participants (40%) had their first child between 31 and 34 years old; 36% of participants had their first child as a resident, while 28% did as junior faculty. For those who had a child during residency, 38% breastfed for 1 year or more, 26% breastfed for 6 months or less. For women who delayed child-bearing, 55% delayed to complete training, 21% delayed for financial reasons, 20% delayed for infertility, 12% of participants delayed due to pressure from their training program. For women who had a child during training 44% described having inadequate leave, but 53% report support from program administration. The themes for biggest challenges for physician moms were coded as: time/hours (37%), balance (26%); over-expectation/guilt/shame (21%), work/working at home (21%), missing out (18%); logistics/child-care (11%).

 

Discussions: Based on our results, there are clear ways residency programs and departments can support physician moms with the challenges they face.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, UME, General Ob-Gyn,

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P&S Partners in Pregnancy: A Longitudinal, Patient-Centered Program for Preclinical Students

Purpose: To develop a longitudinal clinical program pairing first-year medical students with prenatal patients. 

 

Background: Students who participate in early clinical, longitudinal experiences report greater confidence in communication, comfort in clinical settings, and self-esteem during transition to clerkship year. However, few longitudinal experiences exist for preclinical students at Columbia University Vagelos College of Physicians and Surgeons.

 

Methods: A retrospective needs assessment evaluating interest, motivating factors, and perceived barriers to participation was distributed to second-year students. In response, we developed a program pairing ten first-year students with pregnant patients. Students partake in lectures and accompany patients to prenatal visits. Initial perceptions about the patient-physician relationship were assessed in both groups using the Patient-Practitioner Orientation Scale (PPOS), with 1 indicating “doctor-/disease-centered,” and 6 indicating “patient-centered.”

 

Results: 49% of students completed the needs assessment. 90% reported that they would be at least “somewhat interested” in a longitudinal prenatal pairing program. Motivating factors included desiring longitudinal experience (87%), early clinical exposure (82%), and patient advocacy/community engagement (78%). Our program was designed accordingly. All first-year students were invited to apply; ten were accepted. At recruitment, mean student PPOS score was 4.64 compared to 3.95 for patients.

 

Discussions: Students in early medical education are enthusiastic about longitudinal patient experiences and demonstrate patient-centered mindsets. Programs such as ours may help maintain and cultivate patient-centeredness, with the potential to improve patient satisfaction(1) and create positive attitudes towards medical student involvement.

 

1 Krupat E et al. Patient orientations of physicians and patients: the effect of doctor-patient congruence of satisfaction. Patient Educ Couns 2000; 39:49-59.  

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Medical Knowledge, Professionalism, UME, Independent Study, Team-Based Learning, Advocacy, General Ob-Gyn,

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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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OB/GYN Resident Education and Experience with Reproductive Justice

 

Purpose: To understand OB/GYN resident experience with reproductive justice.

 

Background: Reproductive justice (RJ) is defined as: the right to have a child, the right to not have a child, the right to parent the children we have, and the right to control our our birthing and contraceptive options. Despite its relevance to OB/GYN residency milestones, such as patient-centered care, patient advocacy, and informed consent, there is currently no formalized RJ education in residency training.

 

Methods: We distributed a web-based survey to U.S. OB/GYN residents to better understand educational and clinical experiences with RJ. Participants were asked to share clinical experiences with reproductive injustices. Qualitative data were coded using content analysis and quantitative data were analyzed using descriptive statistics.

 

Results: We received 358 responses from OB/GYN residents, representing 67 U.S. residency programs.  48% of respondents had not received RJ education during their training. OB/GYN residents reported a variety of clinical experiences with reproductive justice issues; of the 156 cases shared, common themes included fertility treatment access, care of marginalized populations, abortion care, and informed consent. Seventy-seven percent of respondents were interested in receiving further RJ training and 96% of residents felt that they would benefit from training.

 

Discussions: OB/GYN resident experiences with reproductive injustices are widespread and residents desires additional education. Our results reveal an opportunity to incorporate these shared clinical experiences into an innovative RJ curriculum design where residents learn from each other’s diverse clinical experiences while also applying milestones.      

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Patient Care, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, UME, Problem-Based Learning, Public Health, Advocacy, Contraception or Family Planning,

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Medical Students Reflections About Patient Care Affected by Race, Ethnicity or Language During the Obstetrics and Gynecology Clerkship

Purpose: To explore medical students’ reflections about obstetrics and gynecology (OBGYN) clerkship experiences in which they witnessed patient mistreatment based on patients’ race, ethnicity and language.

 

Background: Experience-based clinical learning includes interactions with patients and teachers and is affected by sociocultural contexts. Recognizing that bias and discrimination are pervasive in our culture, medical students may observe these behaviors within their clinical teams. 

 

Methods: We conducted a directed content analysis of students’ reflective essays written during OBGYN clerkships from 2014-17 about clinical scenarios that challenged their professionalism.  Of 265 essays that referred to patient interactions, we included essays discussing patient race, ethnicity or language for this analysis. Essays were analyzed more than once if they discussed more than one of these factors.

 

Results: Of 53 essays that met inclusion criteria, 40 discussed issues with providing language-concordant care, including when language barriers led to poor care. Of these, 23 focused on interpreter concerns, such as nonuse of certified interpreters and discomfort with being asked to interpret. In 23 other essays, students described how patient’s race or ethnicity affected care, including students recognizing their own bias towards patients or witnessing team members’ discriminatory behavior such as being judgmental, uttering racist remarks, or demonstrating insensitivity about cultural differences.

 

Discussions: Medical students witnessed and reflected about clinical team member’s discriminatory behaviors toward patients. These narratives should compel educators to reflect on their own biases and to set higher standards for justice-informed care in the clinical learning environment – both to provide justice-informed care for patients and to optimize experience-based learning.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, UME, General Ob-Gyn,

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Medical Student Wellness

Purpose: The purpose of this study was to evaluate medical student wellness at our institution. We distributed a survey intended to identify sources of stress as well as coping mechanisms. 

 

Background: Psychological distress is higher in medical students than in age-matched peers2. Studies have shown that both the mental and general health of medical students decline within the first year.3 Fifty percent of medical students experience burnout3, and ten percent experience suicidal ideations4. Only fifteen percent seek psychiatric care.

 

Methods: A survey was electronically distributed to all medical students with a 43% response rate. Statistical analysis was performed using Students t-test and Fisher Exact test.

 

Results: Students identified the amount of pressure placed on themselves and pressure others placed on them as a prime source of stress. Female students were more likely to identify volume needed to learn as a source of stress. Female students were also more likely to identify a support system as a coping mechanism, utilize counseling, and feel more anxiety. Students who took a gap year were more likely to own a pet that provided stress relief. Financial concerns were not found to be a significant source of stress.

 

Discussions: Stress, burnout, and mental health issues are issues that must be identified and managed in order to promote wellness. Male and female students may have different perceptions about sources of stress and coping mechanisms. Age and life experience appears to impact coping mechanisms. This data may help schools develop resources to assist students, and may help target the development of wellness programs.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Professionalism, UME,

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Medical Student Self-initiated Form Improves Compliance of Documenting Formal Mid-clerkship Feedback

Purpose: A medical student self-initiated feedback form is a simple, yet innovative way to meet LCME requirement to document mid-rotation feedback during the busy clerkship.

 

Background: Mid-rotation feedback during the clerkship is crucial in helping trainees learn their strengths/weakness in order to improve clinical performance and develop clinical competency.  The LCME has established a standard for clerkship directors (CD) to document formal mid-rotation feedback for medical students during clinical clerkships but due to competing demands, this standard has been challenging to meet. This educational quality improvement project examined the effect of instituting a self-initiated feedback form on documentation of formal mid-rotation feedback.  

 

Methods: Beginning January 2018, we instituted a mandatory self-initiated feedback form to be completed prior to meeting with the CD.  The 4-item feedback form includes prompts for students to self-reflect on strengths/weaknesses and space for comments to discuss with the CD.  Completed forms are uploaded to an electronic assessment system.

 

Results: At our institution, compliance with documenting Ob/Gyn mid-rotation feedback improved substantially to 98% in 2017-18 as compared to 77% in 2016-17 and 71% in 2015-16.  Similar trends occurred in other clerkships, particularly in pediatrics and general surgery, thereby demonstrating generalizability of intervention.

Discussions: A medical student self-initiated feedback form improved compliance of documenting formal mid-rotation feedback while decreasing CD workload.  This intervention also made feedback meetings more engaging, robust and meaningful.  This innovation places ownership of initiating feedback on the medical student, and less on the CD.  This form can be incorporated at other undergraduate medical institutions.      

Topics: CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Osteopathic Faculty, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, UME, Assessment,

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