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Efficacy of Video versus Verbal Feedback in Surgical Training Using Simulated Laparoscopic Vaginal Cuff Closure

Purpose: The purpose of this study is to compare the efficacy of video-based feedback to standard verbal feedback in improving OB/GYN residents’ surgical skills using a validated simulated laparoscopic vaginal cuff closure (SLVCC) model. 

 

Background: Expert feedback on performance is integral to surgical training. Recently, there has been interest in the incorporation of video-based feedback. However, the efficacy of video-based feedback remains unclear.

 

Methods: We designed a prospective, randomized cross-over study utilizing a validated SLVCC model. Eighteen OB/GYN residents participating in the study completed the SLVCC, received feedback on their performance and then repeated the task. Tasks were video-recorded and participants were randomized to receive verbal or video-based feedback. After a washout period of two months, the process was repeated with residents receiving the alternative form of feedback. Surgical performance was assessed by two independent expert surgeons using the validated OSATS model. Additional metrics included time to SLVCC completion and a validated assessment of resident self-efficacy.  The two sided paired t-test was used for statistical analysis using the significance level of 5% with an effect size of 0.6.

 

Results: There was no statistically significant difference between video-based and standard verbal feedback in either study phase with regard to improvement in time to completion of task (p=0.17, 0.18), OSATS scoring (p=0.48, 0.91), or residents’ reported self-efficacy (p=0.73, 0.80). 

 

Discussions: Our finding that video-based feedback is not superior to structured verbal feedback is consistent with prior studies. However, larger studies are needed to further clarify the role of video-based feedback in surgical education.

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

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Decel Defense! Teaching Interns to Tackle Category II Fetal Heart Rate Tracings

Purpose: To teach interns a standardized approach to management of Category II fetal heart rate (FHR) tracings.

 

Background: Many interns feel trepidation when facing Category II FHR tracings.  We designed a workshop to allay initial anxiety interns may feel at the start of training.

 

Methods: During Orientation we conducted a flipped classroom workshop.  Interns practiced applying a novel mnemonic device when managing FHR tracings in a variety of common clinical scenarios.

 

Results: Confidence level managing Category II FHR tracings was assessed pre and post-workshop.  Mean baseline confidence level was 1.83 on a 1-4 scale  of “not confident to very confident”.  Mean confidence level increased to 3 immediately post-workshop.  Evaluations of the workshop were very positive, mean rating 5.0 out of 5.0.  Residents appreciated the opportunity to manage FHR decelerations in a simulated, low-risk setting prior to caring for actual patients. 

A follow up survey one month after the workshop found that 33% of interns used the mnemonic ”sometimes” and 33% reported “often” use when managing Category II FHR tracings in real time.  Mean confidence level rose to 2.83 on the 1-4 scale.  On average, participants recalled 7.67 of 13 elements in the mnemonic tool.  At six months, 66% of interns used the mnemonic ”sometimes” and 33% “often” when managing FHR tracings.  Mean confidence level rose to 3.33 and interns recalled 8.33 of 13 elements.

 

Discussions: Interns found coaching in a small group setting with simulated cases and a mnemonic device to be an effective method for building confidence in managing Category II FHR tracings.

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

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Creating engaging educational tools with limited resources

Round Table Text:
Objective/Background: This discussion will provide participants with information and examples
using video to present topics to medical students in an efficient and engaging manner. While
educational videos are common, poor selection of topics and/or poor execution hinder the
effectiveness of such resources.
Round Table Agenda: In this interactive discussion, we will review benefits of video media and
discuss well suited topics for this platform. Common pitfalls encountered when creating video
media resources for students and strategies to help overcome barriers will be reviewed. Finally,
we will go through examples of videos and discuss aspects that make these effective.

Topics: General Ob-Gyn, Standardized Patient, Problem-Based Learning, Simulation, Virtual Patient, UME, Interpersonal & Communication Skills, Medical Knowledge, Residency Director, Clerkship Director, Faculty, 2018, Faculty Development Seminar,

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Evaluation of a Case-Based, Community-Engaged LGB-TGNC Health Training Module for Trainees in Obstetrics and Gynecology

Background: OB/GYN providers are frontline in providing care to LGB-TGNC people. Limited curricula specific to OB/GYN trainees exist. Deficits in competency limit access and quality of care. The AAMC and APGO/CREOG mandate inclusion of population-specific curricula.  

 

Methods: Curriculum consisted of 2 1-hour modules meeting APGO/CREOG learning objectives, developed in partnership with an LGB-TGNC community health center. Modules integrated role-play, small groups, and cases, focusing on culturally humble vocabulary, disparities, and best practices. We measured learner satisfaction and anticipated behavior change using Likert scales. Knowledge acquisition was assessed using a pre/post survey in a subgroup (n=14). Feedback was elicited using semi-structured questions. Responses were tabulated and de-identified. Statistical analyses was performed in STATA 13.0. Qualitative responses were coded for theme. Learners were residents and 4th year students at 3 institutions.

 

Results: 82% (82/100) participants responded. 81% (67/82) highly agreed that stated objectives were worthwhile; 71% (58/82) strongly agreed that objectives were adequately met. 37% (30/82) strongly agreed that curriculum dispelled myths held. 52% (43/82) strongly agreed and 38% (31/82) agreed that curriculum would impact their work as an OB/GYN. Gradients in pre/post knowledge acquisition were greatest for transgender health-related content.  Participants wanted further training on gender affirming hormone therapy, and legislative context.

 

Discussions: LGB-TGNC health is a priority in medical education. We describe an innovative curriculum with high learner satisfaction and knowledge acquisition. Next steps will address curricular limitations and evaluate impact on observed skills and health outcomes.

 

Keywords: Communication Skills, Community Health, Cultural Diversity/Cultural Competency, Curriculum Development/Evaluation, LGBTQIA, Underserved Communities

Topics: CREOG & APGO Annual Meeting, 2017, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, CME, UME, Assessment, Virtual Patient, Lecture, Problem-Based Learning, Team-Based Learning, Public Health, Advocacy, Faculty Development,

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MedEd Apps That Will Quench Your Thirst

Jan 2017 Workshop
Précis: When presented with an app overload, how does a busy medical educator know which apps will
help educate their students in the OB/GYN clerkship? This workshop will be an interactive
demonstration of expert-recommended apps and a small group breakout session focused on using apps
that engage millennial students.
Workshop Text: With a growing number of mobile applications (apps) related to the medical field, APP
OVERLOAD is much like trying to drink from a fire hose. This session will give participants the tools to
distinguish a mirage from an oasis in this digital medical education landscape. It will highlight available
apps that have been systematically vetted for quality in various educational settings, including
interactive didactics, on-the-fly teaching, exam prep and fingertip resources for medical students and all
lifelong learners.The workshop will begin with an introduction to apps, a discussion of the potential
dangers of inaccurate apps, and an education on choosing apps. During the session, participants will
download expert-recommended apps onto their own hand-held devices. A real-time demonstration
will give attendees an opportunity to familiarize themselves with the apps. Participants will then work
in small groups to brainstorm ways to use these apps in one or more educational settings. The
presenters will then flip the workshop back to the audience, who will have the opportunity to Share
Your Favorite App by syncing their own devices to provide a demo for the entire group. Attendees will
leave with a list of high quality apps to make sure they are never stranded in the digital desert again

Topics: General Ob-Gyn, Team-Based Learning, Problem-Based Learning, Independent Study, Virtual Patient, UME, CME, GME, Practice-Based Learning & Improvement, Interpersonal & Communication Skills, Systems-Based Practice & Improvement, Medical Knowledge, Residency Director, Clerkship Director, Faculty, Resident, 2017, Faculty Development Seminar,

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Making Movie Magic

Jan Meeting Workshop


Précis: Making short films is a fun and creative way to reach out to your learners. After reviewing some tips and tricks on movie making we will script, film and edit up a quick one minute block buster during the workshop.

Workshop Text: Off in the distance you can see a floating image, a flickering light, perhaps a figure
moving. Is it a mirage on the landscape, or something you have conjured up? No, its a movie silly! And if you sit back and enjoyed it for a little while, you just might learn something.This workshop is designed for those who are interested in making great short films. Whether your goal is to jazz up one of your lecture presentations or to create a knock out video to submit to the next CREOG-APGO Film Festival, this conference will have something for everyone who has a little movie director in their heart. We will be begin with a quick introduction to basic scripting, filming and editing techniques, and quickly turn to the audience to work on a short one minute movie script. Using cell phone cameras we will film up some footage and create a short film in real time with the audience working as editors. We will then use the same footage to highlight other important video editing tips and tricks to spice up short films like sound effects, transitions, slow-motion and more.All conference attendees will leave with a link to our video on how to make great short films and a list of videos and resources on how to turn the movie making mirage into reality.

Topics: Team-Based Learning, Independent Study, Lecture, Virtual Patient, Assessment, UME, CME, GME, Practice-Based Learning & Improvement, Interpersonal & Communication Skills, Systems-Based Practice & Improvement, Medical Knowledge, Patient Care, Residency Coordinator, Residency Director, Osteopathic Faculty, Clerkship Coordinator, Clerkship Director, Faculty, Resident, Student, 2017, Faculty Development Seminar,

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Creating Wells in Deserts of Opportunity: Developing Simulation Modules to Enhance the Student Experience

Workshop APGO Fac Dev Seminar
Précis: Participants will collaborate with others in small-group settings to create a simulation module by
defining goals and objectives, building a tangible model or video for simulation, and creating an
assessment tool aimed at improving medical student clinical skills.
Workshop Text: Objective: To deliver a workshop that provides participants with the ideas, the skills,
and the resources to develop a simulation curriculum to enhance the clinical training of third year
medical students. Background: In the ever-evolving landscape of medical education, the medical-legal
presence continues to expand, subsequently leaving medical students with fewer opportunities for
direct patient care. Students are being marginalized to clinical observers. To prevent legally imposed
limitations from compromising student learning, medical schools can provide simulated methods of
education to supplement direct patient interaction. Agenda: The workshop will start with a 10 minute
introduction by facilitators outlining the development of simulation modules and curricula from idea to
implementation. This will be followed by a 10 minute large group discussion, where participants will
discuss opportunities for simulated learning and successful and unsuccessful experiences with
simulation. The majority of the workshop will be a 45 minute, small group, interactive activity, and
conclude with a 10 minute debrief.Interactive component: During the 45 minute small group,
participants will create a simulation model or instructional video (from a random collection of household
items on their table, i.e. balloons, Playdoh, etc.) that represents a common clinical scenario encountered
in Ob/Gyn. Each group will identify key curriculum components including goals, objectives, the
simulated activity, and an assessment tool such as a checklist. Product: Participants will leave with
ideas, skills, and a toolkit with links to curricula, instructions, and videos on how to establish a successful
student simulation curriculum.

Topics: Faculty Development Seminar, 2017, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, UME, Virtual Patient, Simulation, Problem-Based Learning, Standardized Patient, Team-Based Learning, General Ob-Gyn,

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Its not a mirage! Simulation without a budget! Sub Topic:

Précis: Participants in this roundtable discussion will learn about a novel simulation exercise that can
be done at no cost and yet covers all of the ACGME Competencies.
Round Table Text: Objective To demonstrate how simulation is conducted at SUNY Downstate
Medical Center without a budget. Additionally the simulation covers all of the ACGME
Competencies which many medical schools have recently adopted for their students. The
participants will participate in the simulation to be done at the roundtable. Major Discussion
Points: 1. To discuss why the simulation is valuable to their students 2. How to incorporate the
simulation into their own clerkships for free.

Topics: Faculty Development Seminar, 2017, Faculty, Clerkship Director, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, UME, Virtual Patient, Simulation, Problem-Based Learning, General Ob-Gyn,

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Development of a Medical Student Online Case Study Curriculum: Cases in Obstetrics and Gynecology (COGs)​

Background: As the size of medical school classes grows, the challenges of standardizing the educational experience also increase, particularly when schools must use multiple educational sites to accommodate large groups of students. Here we describe the development, validation, and implementation of an online system of interactive Ob/Gyn case studies that help address this issue. Other clerkships have successfully used this type of curricula but nothing of this kind is available for Ob/Gyn clerkships.

 

Methods: A series of 25 online, interactive cases were developed that included obstetric and gynecologic topics that were linked to the APGO Medical Student Educational Objectives.

 

Results: Comparison of National Board of Medical Examiners (NBME) subject exam scores for the year of implementation to historical data showed no significant difference in mean score by rotation as well as no significant difference in first time pass rate. Subjective data was also captured on student opinions and perceptions regarding contribution to general Ob/Gyn knowledge and usefulness of cases in exam preparation. A majority of students felt that the cases enhanced their clerkship experience and were useful for subject exam preparation (77.5% and 65.3% respectively).

 

Discussions: The case series is a useful addition to standard Ob/Gyn clerkship curriculum which increases student exposure to a standardized set of topics and increases positive perception of the Ob/Gyn clerkship.

 

Keywords: education, online learning


Topics: CREOG & APGO Annual Meeting, 2016, Faculty, Clerkship Director, Clerkship Coordinator, Medical Knowledge, UME, Virtual Patient, Independent Study, Problem-Based Learning,

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A Pilot Study of Breech Extraction Simulation to Develop Confidence in Practice

Background: The ACOG Simulations Consortium seeks to provide a simulation based adjunct  to education to help improve residency performance in certain skills, such as postpartum hemorrhage or eclampsia.  Breech extraction of a second twin has not been part of this curriculum.  As breech extraction remains an important skill in managing twin pregnancies, we propose a simulation based curriculum to help provide training and confidence in performing this procedure.

 

Methods: We developed a curriculum regarding intrapartum management of a twin pregnancy and breech extraction technique. A breech extraction simulation model was prepared. Following a lecture, the residents and faculty were first assessed regarding their clinical experience and comfort performing breech extractions.  They then participated in the simulation performing a breech extraction.  Following the exercise, they were reassessed regarding the an assessment of the model and confidence performing the procedure. 

 

Results: A total of 11 providers participated in the exercise and completed surveys, including 3 interns, 5 PGY-2s, a PGY-3, a PGY-4, and an OB/GYN generalist. 7/11 participants (63%), felt their confidence in performing breech extractions improved after the simulation.  All participants (11/11) felt the activity was a useful addition to residency education.

 

Discussions: Breech extraction is an important skill for obstetric providers in the management of twin gestation pregnancies.  Simulation may play a potential role in developing confidence and skill in the procedure, and may become a useful addition to the Simulations Consortium.

 

Keywords: simulation, breech extraction


Topics: CREOG & APGO Annual Meeting, 2016, Resident, Faculty, Patient Care, Medical Knowledge, GME, Assessment, Virtual Patient, Simulation, Maternal-Fetal Medicine, General Ob-Gyn,

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A Perceptual Adaptive Learning Module Results in Improved Fetal Heart Rate Categorization

Background: No published studies have evaluated the best method of teaching FHR interpretation. The PALM has been shown to improve learning in skills which require pattern recognition.

 

Methods: All subjects underwent a pretest and received a basic FHR physiology lecture. The subjects were then either exposed to the PALM or to additional lecture time reviewing the details of FHR categorization. All subjects then took a posttest, delayed test six weeks later, and survey.

 

Results: 16 subjects completed the PALM module and 19 were assigned to additional lecture. Only the PALM showed significant improvement in accuracy and fluency from the pretest to posttest (accuracy 35% vs 71%, p < 0.05; fluency 27% vs 65%, p < 0.05). Both interventions showed significant improvement in accuracy and fluency on the delayed test reflecting learning throughout the rotation. However, the PALM showed a significantly greater improvement as compared to the lecture group in both the posttest (accuracy 71% vs 47%, p < 0.05; fluency 65% vs 31%, p < 0.05) and the delayed test (fluency 58% vs 41%, p=0.05).

              

Discussions: The PALM resulted in more accurate and fluent categorization of FHR tracings compared to traditional lecture methods, and the effect persisted on delayed testing.

 

Keywords: Simulation, Students, Obstetrics


Topics: CREOG & APGO Annual Meeting, 2016, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Medical Knowledge, GME, UME, Virtual Patient, Simulation, Independent Study, Maternal-Fetal Medicine, General Ob-Gyn,

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Chart a New Course: Tips, Tricks and Tools to Incorporate Web-Based Technologies into your Clerkship

Workshop Text: Objective/Background: Now that you have decided to flip the classroom and move to a webbased clerkship curriculum, the hard work begins. Although there are many resources available on the Internet, which ones should you use? How should they be incorporated? Other medical educators have individually created one or two really great webbased curriculum components. Do you want to network and share electronic resources and ideas? Of course, it would be great to avoid reinventing the wheel and avoid common pitfalls! Workshop Agenda: Sharing best practices and evaluating outcomes are the first steps to creating an educational resource bank and national standards for webbased technologies in an OB/GYN clerkship. This workshop will begin with sharing some of the webbased technologies that have been working with our students, including interactive video clinical scenarios, multisite educational Podcasts, social media for student communications and electronic evaluation of medical knowledge and clinical performance. Interactive Component: We strongly encourage participants to bring digital resources that are working (and perhaps not working!) to share for discussion. Break out groups will discuss where we should focus our attention to best create and utilize webbased technologies for the educational curriculum of the future. Take home Product: We hope to create a collaborative of medical educators interested in standardizing content and structure for digital educational materials, as well as develop a catalog of content currently available content and what needs to be created.

Topics: Faculty Development Seminar, 2016, Resident, Clerkship Director, Clerkship Coordinator, Medical Knowledge, Practice-Based Learning & Improvement, GME, Assessment, Virtual Patient,

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Move your OSCE from Pass/Fail to graded, objectively!

Round Table Text: Move your OSCE from Pass/Fail to graded, objectively!Author: Sabrina Holmquist MD, MPHObjective: Participants will learn how to employ a modified Anghoff method to move their Objective Structured Clinical Exam (OSCE) from a pass/fail to an objectively graded experience with three assessors and a series of checklists.Discussion points: oAdd a robust objective measure to your students final gradesoCreate a defensible assessment structure for your clerkshipoGet the most out of the practical exam you how put so much into developing!

Topics: Faculty Development Seminar, 2016, Clerkship Director, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, UME, Assessment, Virtual Patient, Simulation, Standardized Patient, Faculty Development,

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Test of Integrated Professional Skills (TIPS): an OSCE/Simulation Hybrid Exam for Residents

Objective: Design and implementation of a tool for resident evaluation that assesses integration of patient care, communication and technical skills using simulation and bench skills testing in an OSCE format.

Study Design: The Test of Integrated Professional Skills (TIPS) includes five stations with standardized patients (SPs) and complex scenarios involving ultrasound, procedural skills and evidence-based medicine. All were directly observed by faculty. SPs are trained as raters using behaviorally-anchored checklists, and faculty rated technical skills. Performance data from TIPS was analyzed and compared to standard faculty clinical evaluations utilizing Spearman’s rho.

Results: Twenty-four residents participated in the TIPS. Performance followed developmental trends, although there was a wide variation of performance, and outliers were identified. Internal consistency of ratings Cronbach’s alpha .69-.82. Standard faculty evaluations varied little internally, and did not correlate with TIPS performance.

Conclusions: A simulation-based OSCE facilitates observation of resident skill integration, and may differentiate resident performance more effectively than standard evaluation processes.

Topics: 2013, Resident, Residency Director, Patient Care, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Assessment, Virtual Patient, Simulation, General Ob-Gyn,

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Impact of a Forceps-Assisted Vaginal Delivery Professional Development Session for Junior Faculty

Objectives: To determine the impact of a Forceps-Assisted Vaginal Delivery (FAVD) professional development session on junior faculty comfort with the procedure.

Study Design: A faculty development session on FAVD including an Objective Structured Clinical Examination (OSCE) was conducted for fellows in training at the University of Louisville. Subjects completed a pre-test, post-test and 5-month follow-up post-test to assess their FAVD training in residency, comfort with procedural steps, and reflections on the experience. Volume of FAVD precepted by these fellows on Labor and Delivery was compared with that of fellows in the prior year who had not participated in the session.

Results: 6 fellows participated. All reported improved comfort with some of the procedural steps on the immediate post-test. In the following 5-months, fellows supervised 0 FAVD, in comparison with 3 during the same interval in 2011. On the 5-month remote post-test, 2 fellows reported that the session increased their awareness of the limitations of their skills, 2 reported that self-perception of skills had not changed after the session, and 2 reported that they perceived an improvement in skills after the session.

Conclusions: New fellows may not feel competent to perform and teach all steps of FAVD. One training session did not result in an increase in the number of FAVD cases supervised by the fellows.

Topics: Maternal-Fetal Medicine, Simulation, Virtual Patient, CME, GME, Medical Knowledge, Patient Care, Residency Director, Faculty, 2013,

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Frequency of Forceps Training: Difference in Comfort Levels and Likelihood of Use

Objectives: To determine if residency comfort with forceps improves with repeated drills on the NOELLE simulator. To determine if there is a plateau effect after 3 drills or there is continued improvement.

Study Design: Prospective cohort study. A small group of 16 residents from a single program of obstetrics and gynecology, including all PGY-1 through PGY-4 residents will participate in a didactic lecture about forceps and complete two drills on the NOELLE simulator, spaced 2 months apart. Prior to any lecture or drill, residents will complete a survey with a Likert scale, measuring the residents’ perceived comfort and likelihood of use. They will complete the same survey after each drill session. The survey results will be analyzed by linear regression to predict the comfort scores.

Results: The outcome of the study should be a comfort scale, indicating residents’ comfort with forceps evolving over time. There will be both a summation score and individual scores for each session.

Conclusion: Depending on the results of the study, there will likely either be a plateau effect with the residents’ comfort scale after the first or second session, or there will be a steady increase with each drill session. If there is a plateau, there is likely less benefit to repeating the drill after that session. If there is continued increase, there is likely to more benefit in scheduling repetitive drills into the curriculum.

Topics: 2013, Resident, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, GME, Virtual Patient, Simulation, Maternal-Fetal Medicine,

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Analysis of New Teaching Methods in Pediatric Gynecology

OBJECTIVES: Assess if learning with pelvic model simulations will enhance didactic teaching in Pediatric Gynecology.

STUDY DESIGN: 16 OBGYN residents from two OBGYN programs underwent an interactive teaching session about pediatric vaginal discharge. Residents underwent testing during and 2 months after the session. Survey at the end of the intial teaching session assessed satisfaction and perception of teaching methods. Those who could not make the session were given reading and served as controls.

Data analysis utilized descriptive statistical techniques and inferential statistics.

RESULTS: After the teaching session, there was an 8% improvement in test scores compared to controls. At 2 months there was a 3% improved test score compared to controls. As importantly, surveys for those at the teaching session noted an increased satisfaction of learning and comfortableness with the pediatric gynecology patient.

CONCLUSIONS: Teaching pediatric vaginal discharge using simulation techniques provides a more effective method of teaching, enhances provider comfort with pediatric patients, and promotes retention over traditional didactic teaching alone.

Topics: Pediatric & Adolescent Gynecology, Simulation, Virtual Patient, Assessment, GME, Practice-Based Learning & Improvement, Medical Knowledge, Faculty, 2013,

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ATTITUDES, BARRIERS, AND TOOLS FOR RESIDENT EDUCATION IN REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY

Objective(s): A required component of resident Obstetrics & Gynecology (Ob/Gyn) training is Reproductive Endocrinology and Infertility (REI). The delivery of this subspecialty information in an already crowded curriculum is challenging. We sought to identify residents’ perceived barriers to REI education and assess the value of the American Society of Reproductive Medicine’s (ASRM) eLearn modules.

Study Design: All residents of one academic Ob/Gyn residency program were surveyed regarding perceived barriers to REI education. The REI curriculum was modified to include the ASRM eLearn modules. Residents were asked to rate the educational value of these modules. Descriptive analyses were performed.

Results: The survey was completed by 33 of 34 residents (97%). The majority of residents (78%) reported exposure to REI prior to residency. Although over 60% of respondents had had at least one REI rotation, 74% reported their REI knowledge as “Fair” or “Poor.” Barriers to learning included: limited time on rotation, lack of patient ownership, insufficient didactics, and patients not welcoming of trainee involvement. Residents found the ASRM eLearn modules easy to use and would recommend them to their peers as a learning tool. Following completion of the rotation 78% of residents rated their REI knowledge as “Good” or “Very Good.”

Conclusions(s): REI is a difficult area to incorporate into Ob/Gyn resident education. Knowledge of the perceived barriers to learning will help guide rotation restructuring and improve REI education. The ASRM eLearn modules are a valuable resource that can help target didactic deficiencies due to the limited rotation time.

Topics: 2014, Resident, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, GME, Virtual Patient, Simulation, Independent Study, Reproductive Endocrinology & Infertility,

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Measuring the Most Functional Operating Position for Gynecologic Laparoscopy Procedures

Donald E. Kirton, MD
Baystate Medical Center, Springfield, MA
Study Objectives: This study proposes to test the functional activity of several port site locations commonly used in gynecologic laparoscopy. The objectives are: to compare scores (time and errors) at these various port sites on the same task to determine which is the most efficient, and to have study participants rate the various port site locations for ease and comfort. Our Null Hypotheses were that the peg transfer scores for situation A, B, C, and D will not be significantly different; and comfort levels for subjects will be similar for all situations A, B, C, and D.

Methods: The peg transfer task been validated to correlate with surgical performance in the operating room, and whose completion correlates with the training level of the surgeons completing the tasks. The peg transfer task includes a 12-posted peg board with 6 rubber beads. Each bead must be lifted from its peg with one instrument, transferred to the instrument in the opposite hand, and replaced on a different peg. After moving 6 pegs in this manner, they must be again lifted off the new peg with the opposite hand, transferred to a new hand, and replaced on a new peg Participants did a warm up of the task with the traditional straight-on positional setup, a form of which is required by the American Board of Surgery in the United States to qualify for the ABS Board examination. For the study, four different functional positions were tested – A= LLQ and RLQ ports, B= LLQ and LUQ ports, C= LLQ and suprapubic ports, and D= LLQ and RLQ with use of advanced assistant. In all cases the simulation assumed the camera at the umbilicus. Subjects (n=19 to date with a goal of n=50) were recruited from Baystate Medical Center and asked to complete the peg transfer task for four situations A,B, C and D. Situation A,B, C or D corresponded to four different port placement and subjects were randomized to a particular order of these four situations. Each task was completed twice (i.e. CC, DD, AA, BB) and the best score recorded. Primary outcome was evaluating for transfer times associated with each different peg transfer task. A generalized linear model was used to assess the relationship between peg transfer task times and each of the four port situations. Standard t-tests were used to compare differences in times between each task position compared to position B (LLQ and RLQ port site).

Results: Using preliminary data with an N=19 different subjects trained in laparoscopy, the mean time to complete the task was fairly similar for all positions except D, with mean times of A 128s, B 139s, C 137s, D 84s. The mean difference in transfer time when comparing positions to B was 10.25 seconds for A, 1 second for C, and 54 seconds for D. T-tests of the paired differences were done, and show statistically significant decrease in time for position D vs. B (p<0.001). 84% participants felt that position D was a comfortable position, while 58% felt position B was comfortable, and only 37% felt A or C were comfortable operating positions.

Conclusions: These results show a statistically significant decrease in time to complete task for position D compared to position B. The advanced surgeon standing across from the study participant is able to improve the scoring of the tests, which may translate to better efficiency in the operating room. Furthermore, this position was overall assessed as the most comfortable by the study participants Results of this study are preliminary and we aim to have an N=50 and complete data by the conference date.

Key Words: laparoscopy, peg transfer, port site.

Topics: CREOG & APGO Annual Meeting, 2014, Resident, Faculty, Residency Director, Patient Care, GME, Virtual Patient, Simulation,

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Breast and Pelvic Exam Skill Curricula in the United States: A Survey of Ob/Gyn Clerkship Directors

Lorraine Dugoff
University of Pennsylvania, Philadelphia, PA
Objective: There is no national standard regarding the optimal approach or timing for teaching and assessment of breast and pelvic examination skills. The primary objective of this study was to ascertain information regarding how and when breast and pelvic examination skills are taught and assessed in LCME accredited allopathic United States (U.S.) medical schools.

Methods: This is a cross-sectional on-line survey study. Obstetrics and Gynecology (Ob/Gyn) clerkship directors from 135 medical schools were invited to complete an anonymous 14-item web-based questionnaire. Two invitations to participate in the study were e-mailed at a two week interval in July, 2013. This study received an exemption from the University of Pennsylvania Institutional Review Board.

Results: 89/135 Ob/Gyn clerkship directors participated in the study for a 66% response rate. Breast and pelvic examinations were most commonly taught during the second preclinical and core clerkship years. Breast examinations were taught on the Ob/Gyn, family medicine , surgery and internal medicine clerkships while pelvic examinations were primarily taught on the Ob/Gyn and family medicine clerkships. Data including the timing in the curriculum when breast and pelvic examination skills are taught, the teaching and assessment methods used, the clerkship director's rating of the examination skills training at their institution and the number of breast and pelvic examinations required on the Ob/Gyn clerkship is provided in the table.

Conclusions: We present data regarding the timing and approach to teaching and evaluating the breast and pelvic examinations in a cohort of U.S. medical schools. Breast and pelvic examinations are most commonly taught during the Ob/Gyn clerkship. Gynecologic teaching associates (GTAs), simulation trainers and actual patients are most commonly used to teach the examinations. Most assessment methods involve direct observation of only, on the average, 3 breast and pelvic exams. Clerkship directors do not seem highly satisfied with the existing status of breast and pelvic exam skill training. This information may prove useful in helping to formulate best practice recommendations regarding innovative and cost-efficient breast and pelvic exam curricula as well as to identify curricular strengths and opportunities for improvement. Although the clerkship directors provided subjective feedback regarding the effectiveness of the current curricula, it may be helpful to assess this using validated objective criteria.

Topics: General Ob-Gyn, Advocacy, Public Health, Simulation, Virtual Patient, Assessment, Systems-Based Practice & Improvement, Patient Care, Clerkship Director, 2014, CREOG & APGO Annual Meeting,

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