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Vaginal Hysterectomy Training in Residency: How Many Cases Is Enough?

Purpose: To evaluate the association of number of total vaginal hysterectomies (TVHs) performed during residency on comfort level and practice habits after residency.

 

Background: TVH is the preferred route of hysterectomy whenever feasible. Evidence is limited about the number of cases needed in residency to produce physicians comfortable with TVH.

 

Methods: We performed a cross-sectional study of 2007-2017 graduates of the MAHEC OBGYN Residency Program. Using an online survey, self-reported feedback was collected on number of TVHs performed in residency, ratings (5-point scales) of adequacy of training and comfort level with the procedure, and the number of TVHs performed in current practice. Spearman correlation (coefficient rho) was used to examine the correlation between the number of TVHs performed in residency and outcomes.

 

Results: Of the 35 graduates meeting inclusion criteria, 31 (88.6%) completed the survey. The range of TVHs performed by graduation varied from 10-59. TVHs performed in residency was significantly correlated with: perceived overall quality of training in TVH (rho=0.565; p=0.001), level of comfort performing TVH within 12 months of graduation (rho=0.384; p=0.43) , level of comfort currently (rho=0.414; p=0.028), and number of TVHs performed over the last year (rho = 0.448; p=0.042).   Graphic representation of TVHs performed in residency against comfort ratings demonstrated substantial, favorable increases in ratings from 10-19 to 20-29 and to 30-39 and leveling off from 30-39 and above.

 

Discussions: The number of TVHs performed in residency is associated with alumni perception of training quality, comfort level and practice habits. Our alumni suggest 30-39 TVHs may be the “sweet spot.”

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Practice-Based Learning & Improvement, GME, Assessment,

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

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

 

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

 

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

 

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

 

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

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

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The 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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Simulation Training for Operative Vaginal Delivery Among Obstetrics and Gynecology Residents: A Systematic Review

Purpose: To evaluate the impact of simulation training of operative vaginal delivery (OVD) on learner technique, operator comfort, and patient-centered outcomes.

 

Background: Obstetric simulation affords learners opportunities to acquire and to refine clinical skills in a low-stress environment while potentially improving patient outcomes.  However, the effect of simulation on OVD training is less clear. 

 

Methods: A systematic research protocol was constructed a priori for the conduct of the literature search, study selection, data abstraction and data synthesis.  Electronic databases were searched for educational randomized trials and observational studies assessing OVD simulation training for OBGYN residents.   The educational domains of knowledge, skills and attitudes were evaluated.  The Medical Education Research Study Quality Instrument (MERSQI) was used to assess study quality.  The review was prospectively registered with PROSPERO.

 

Results: The search strategy yielded 30,812 articles, with 7 articles eligible for analysis (2 cohort studies, 1 case-control study, 4 cross-sectional studies).  No randomized trials were identified.  Studies demonstrated simulation to improve learners’ skill with forceps placement and generated force during extraction.  While forceps simulation had no change in procedure failure rates, there were significant decreases in rates of maternal lacerations, neonatal injury, and special-care nursery admission.  Only one study evaluated the effect of simulation on provider comfort, demonstrating increased provider comfort with vacuum-assisted delivery. The median MERSQI score was 9.5 (range 9.0-13.5), indicating low-to-moderate quality.

 

Discussions: The available evidence suggests improvement in technique, comfort, and patient outcomes with OVD simulation, but additional studies are required to further characterize such benefits for both forceps and vacuum.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Simulation, Quality & Safety, Maternal-Fetal Medicine, General Ob-Gyn,

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

 

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

 

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

 

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

 

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

 

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

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

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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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Preparing Obstetrics and Gynecology Residents for the Fundamentals of Laparoscopic Surgery Assessment

Purpose: The purpose of this report is to describe the training curriculum which has been successfully used to prepare Ob/Gyn residents for the Fundamentals of Laparoscopic Surgery (FLS) assessment at the University of Massachusetts Medical School-Baystate campus.

 

Background: The FLS program was launched by the Society of American Gastrointestinal and Endoscopic Surgeons in October, 2004. The program highlights the simple aim of teaching and testing the fundamentals of laparoscopic surgery in a consistent, validated format. In January, 2018, the American Board of Obstetrics and Gynecology announced the plan to add the FLS program to the requirements for board certification in Ob/Gyn. This new requirement will create education challenges for program directors across the country.

 

Methods: We conducted a literature review on the implementation of FLS in Ob/Gyn training. We then conducted an analysis of our FLS curriculum at UMMS-Baystate, which has successfully prepared 39-residents for FLS certification with a 100% pass rate on the skills assessment. We highlighted changes that have occurred since FLS certification was made a graduation requirement for our residents in 2012.

 

Results: Key features of our curriculum include early access to OR participation, creation of a satellite simulation lab near L&D, practice FLS skills exams and a faculty point person.

 

Discussions: This analysis highlights a strong curriculum, which has been successfully incorporated into our program for all residents. We also highlight ongoing speculation regarding the utility of the FLS cognitive exam in the evaluation of Ob/Gyn residents, with knowledge of early work which is being done to address this issue.

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

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Perioperative Complications Curriculum for the OB/GYN Resident: A Pilot Study

Purpose: To develop and implement a perioperative complications curriculum.

 

Background: ACGME program requirements and milestones include recognizing and managing perioperative complications.

 

Methods: Residents, Fellows, and Faculty were sent a needs assessment survey, addressing satisfaction with baseline perioperative complications curriculum and preferences for development of new curricula.  Additionally, Residents completed a knowledge pretest.  Over four weeks, Residents received weekly emails through the Qualtrics software program linking to topic-specific materials, including interactive, online case-based modules.  A post-implementation survey was distributed to assess Resident satisfaction with programming and to retest knowledge. 

 

Results: With 75% (21/28) of Residents and 47% (40/86) Fellows/Faculty completing the needs assessment survey, 95% (20/21) of Residents and 90% (36/40) Fellows/Faculty reported dissatisfaction with baseline curriculum.

The Resident pretest mean score was 72% (40-90%, SD = 15).

 

Interactive, online case-based modules were developed for topics including ureteral injury, bowel injury, vaginal cuff dehiscence, and bladder injury.  Curriculum materials were successfully distributed on a weekly basis to all Resident learners, as confirmed through the web-based software program.

Resident module completion rates were 50%, 36%, 29%, and 18% for weeks 1-4, respectively.

Eighteen percent of Residents completed the post-implementation survey, with 100% reporting satisfaction with the online case-based modular curriculum.  Knowledge post-test mean score was 84% (SD = 15).

 

Discussions: A needs assessment confirmed poor satisfaction with baseline perioperative complications curriculum.  Web-based materials were developed and distributed weekly to all Residents who successfully accessed the 4 developed modules.  While post-survey responses were few, 100% of responders reported satisfaction with the developed curriculum.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, Practice-Based Learning & Improvement, GME, Assessment, Independent Study, Problem-Based Learning, General Ob-Gyn,

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

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

 

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

 

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

 

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

 

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

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

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Oral Milestone Assessment versus Electronic Evaluation (E-Value) Milestone Assessment-Is One Better Than Another?

Purpose: To compare milestones assigned to PGY 1 and 2 Residents via an Oral Milestone Exam versus the traditional retrospective monthly electronic evaluation system to assess how they aligned. 

 

Background: Programs are tasked with implementing assessment tools to evaluate the 28 milestones. Most programs use some form of an electronic evaluation at rotation completion. The Clinical Competency Committee reviews all information for final score assignment each six month period. 

 

Methods: In 2015, we instituted an Oral Milestone examination to assign the six-month milestones and compared those scores to our retrospective monthly on-line evaluations. We evaluated PGY 1 and 2 residents in a simulated forum on milestones, which included Medical Knowledge, Patient Care, and Interpersonal /Communication Skills Competencies. All residents were given simulated patients, cases, and/or skills while each examiner was given the specific ACGME milestone assessment sheet to score. The residents were provided with immediate feedback.

 

Results: From 2015-2018, 78.4% of PGY 1 and 43% of PGY 2 residents scored higher on the real-time oral milestone exam. Additionally, in 82% of PGY 1 residents and 52% of PGY 2 residents score on the oral exam was at 0.5-1milestone level higher than the retrospective electronic monthly evaluations.

 

Discussions: Clinical Competency Committees are tasked with Milestone assignment to all residents every six months. Evaluation tools that most reflect the actual milestone completion is a mission of all programs. We set out to assess whether our electronic monthly retrospective evaluation system was mirroring the assessment performed on our residents with the real-time oral milestone exams at the end of the six month interval, just prior to submission to the ACGME.


Our data suggests discrepancy in our online retrospective milestone evaluation versus the real-time assessment of an oral exam. Not only did residents score higher in most circumstances in an oral format, but they were higher by a half-whole milestone level in the majority of the cases. It would suggest that our ability as educators to recollect the performance of a resident at an interval later than the performance may be flawed.
Programs may want to consider instituting an oral milestone examination for enhanced milestone assessment.

Topics: Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Professionalism, GME, Assessment, Simulation, Standardized Patient, General Ob-Gyn,

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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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Let’s All Have Big Fun on the Bayou: Exploring Gender Differences in Year-end Faculty Evaluations

Purpose: Evaluate how female and male faculty score themselves on self-evaluations compared to each other and the Chairperson.

 

Background: For decades, women have been proportionately represented among ob/gyn residency graduates. However, male ob/gyn faculty are disproportionately represented among leadership positions and rank of professor and male salaries remain higher. Advancement and salaries are often based on evaluations.

 

Methods: We analyzed de-identified departmental data from 2015-2018, comparing the mean self-evaluation score (range 1-5) for female and male faculty and the difference between self and Chair rating for patient care, education and research. Continuous variables were analyzed using student t-tests.

 

Results: The mean number of female and male faculty during the study period was 16 and 15 respectively. The rank of female and male faculty were 69% and 47% assistant, 31% and 20% associate and 0% and 33% professors, respectively. Self-ratings for women and men were 4.1 vs. 4.5 (p=0.04) for patient care, 3.8 vs. 4.3 (p <0.001) for education, and 3.6 vs 3.8 (p=NS) for research. Compared to the Chair rating, the mean difference for female and male self-evaluation was similar in patient care (0.72 vs. 0.53, p= NS) and research (0.22 vs. 0.25 p=NS) but differed in education (0.9 vs. 0.5 p<0.01)

 

Discussions: Faculty self-evaluation differed between women and men; women consistently rated themselves lower, with significant discrepancies in patient care and education. Chair ratings were comparable, but were higher for females in education. The cause and impact of this gender difference in faculty evaluation merits further study.

 

Topics: CREOG & APGO Annual Meeting, 2019, Faculty, Professionalism, GME, Assessment,

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

 

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

 

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

 

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

 

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

 

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

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

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Jazzy Tracking Curriculum Provides Music to the Ears of Innovative Educators in OB/GYN

 

Purpose: Share outcomes from an innovative curricular approach to improving the training and skill of OB/GYN physicians in an environment of decreased training hours

 

Background: Residency programs across the US are searching for ways to improve surgical experiences in OB/GYN residencies with decreased training hours. In response, we developed the first OB/GYN program to offer an innovative, flexible curriculum referred to as “tracking.”   

 

Methods: A modified-Delphi method was initially used to develop the program and gain faculty consensus for innovative curriculum change. Evaluation of the outcomes of our 15 graduates between 2016-2018 includes job/fellowship placement, subjective data and achievement of minimum requirements based on procedure logs.

 

Results: Tracking is consistently noted as a reason that candidates interview at our program. Our residents have consistently exceeded minimal surgical requirements. Examples are 2018 graduates had an average of 395 of 200 required SDEL (331-461,) 272 of 145 required CDEL (211-333,) and 61 of 20 required LHYST (41-100.)  2019 class had only AHYST and ISPF yet left to achieve at the beginning of year 4. Of our 15 graduates, 9 (60%) have entered fellowship. All 6 of our PGY-4 class are interviewing for fellowship.

 

Discussions: Flexible curricula, such as tracking, offer an innovative approach to a changing climate of medicine. The ability to offer flexible, focused training will produce graduates who excel in all areas of OB/GYN while sharpening skills specific to their areas of interest.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, GME, Assessment, Independent Study,

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Improved Procedure Performance with Practice of Ultrasound Guidance Targeting Tasks

Purpose: To determine if repetitive practice of ultrasound guidance targeting tasks improves procedural skill in a simulated setting

 

Background: Due to a decrease in ultrasound guided invasive procedures other training methods are required to insure all MFM fellows graduate with sufficient skill to independently perform these procedures.

 

Methods: 1st year medical students either practiced the targeting tasks during 4 weekly one hour sessions (training group) or had no training (controls).  Afterward all performed a simulated amniocentesis (AC) and chorionic villus sampling (CVS).  Procedures were timed and the presence of the following recorded: 1) proper angle of entry, 2) excessive (>0.5 cm) needle movement during aspiration, and 3) critical errors (touching the fetus during AC, touching the opposite uterine wall or amniotic cavity during CVS).

 

Results: There were 22 in the training group and 15 controls.  AC completion time was 140±28 seconds (sec) vs. 211±62 sec in the training and control groups, respectively (p(0.0%) vs. 1/15 (6.7%), 3/22 (13.6%) vs. 7/15 (46.7%), and 6/22 27.3%) and 8/15 (53.3%) had improper angles, excessive needle movement (p(9.1%) vs. 10/15 (66.7%), 1/22 (4.5%) vs. 8/15 (53.3%), and 3/22 (13.6%) vs. 9/15 (60.0%)had improper angles, excessive needle movement, and critical errors, respectively (all p<0.05).

 

Discussions: Repetitive practice of the targeting tasks improved student performance in simulated AC and CVS.  There appeared to be greater benefit for CVS performance.  Regular practice of the targeting tasks will likely benefit MFM fellow training.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Patient Care, GME, Assessment, Simulation, Maternal-Fetal Medicine,

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Impact of Student and Evaluator Gender on Clinical Performance Evaluations in an OB/GYN Clerkship

Purpose: Determine if student and evaluator gender are associated with a difference in student clinical performance evaluations (CPEs) of third year OB/GYN clerkship students at the University of Kansas School of Medicine (KU SOM).

 

Background: CPEs are innately subjective measures of evaluation but account for a large percentage of clerkship grades. This study evaluates the objective measures (NBME subject examination and in-house subject test) and CPEs of third year OB/GYN clerkship students.  Objective and subjective data will be compared to assess for differences based on gender of the student.  Further analysis of evaluator gender on CPEs provided for both male and female students will be evaluated. By collecting objective and subjective student data, and taking evaluator gender into account, this study intends to fill in the gaps of previous gender bias research which has not assessed all factors in combination.

 

Methods: Retrospective analysis of 1,407 CPEs by 50 evaluators for 249 third year medical students completing the OB/GYN clerkship at KUSOM from May 2016 through May 2018.  Student/evaluator gender, length of observation, overall clinical performance and objective examination scores were recorded.  T-tests were used to compare continuous variables and statistical significance was determined by a p-value <0.05.

 

Results: Objective and subjective measures of student performance demonstrated no difference between male (n=126) and female (n=122) students.  Female (n=43) and male (n=7) evaluators scored female students slightly higher, but differences were not statistically significant.

 

Discussions: This retrospective study did not find any difference in clinical performance evaluations of male or female students in their OB/GYN clerkship.

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

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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

 

Background:

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

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

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

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

·       Lectures designed to complement Team-Based Learning sessions

Methods:

·       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

Results:

·       Positive correlation in resident teaching and satisfaction scores

·       Positive correlation in NBME scores and satisfaction scores

 

Discussions:

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

·       No standardized resident-lectures amongst all locations

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

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

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