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
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
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,
Read more »
Successful Implementation of an OB/GYN Resident FLS Training Curriculum
Purpose: To describe the implementation of an ob/gyn resident
Fundamentals of Laparoscopic Surgery (FLS) training curriculum
Background: Beginning in May 2020, all ob/gyn graduating residents
will be required to successfully complete the FLS program as a prerequisite for
specialty board certification.
Methods: Between January 2017 – April 2018, 36 ob/gyn residents
participated in the BCM FLS curriculum. The curriculum consisted of six
3-hour faculty supervised gynecologic simulation sessions, 24/7 individual
access to the simulation lab, proctored voluntary one-on-one sessions, and a
final mock FLS session. Participants were followed with attendance
sign-in sheets to gauge number and time involved in all sessions.
Residents completed evaluation forms after each simulation session.
Descriptive statistics were utilized to determine the average/range of
the number and time involved in the practices sessions, between PGY levels and
FLS pass rates.
Results: All 36 ob/gyn residents successfully completed FLS
certification on the first attempt. In addition to the mandatory
sessions, residents required an average of 8.64 independent practice sessions
(range 3-22) lasting an average 72 minutes/session. Approximately 688
minutes (range 235 – 1357 minutes) of independent practice were required to
pass the FLS exam. Many residents felt that the curriculum gave them
adequate support to succeed on the exam and stated that one of the most
valuable components of the curriculum were proctored teaching
Discussions: With a dedicated curriculum and proctored teaching, residents
in obstetrics and gynecology can successfully pass the FLS certification exam
with their initial test.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Medical Knowledge, GME, Simulation, Minimally Invasive Surgery,
Read more »
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
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
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.
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,
Read more »
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.
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,
Read more »
Professionalism Training in the Global Setting: Program at Ayder Hospital and Mekele University in Ethiopia
Purpose: Using the current partnership between University of Illinois
in Chicago, Illinois (UIC) and Ayder Hospital/Mekele University in Mekele,
Ethiopia (Ayder), this study evaluated the effectiveness of professionalism
training for medical students and resident trainees at Ayder.
Background: Threats to professionalism in medicine have led to
more universal teaching of professionalism to trainees and practicing
physicians. Currently, professionalism is listed by the ACGME as one of the 6
general clinical competencies. Many programs that include group sessions
and standardized patients have been implemented in American institutions,
although little research has been directed towards professionalism training in
a global health setting. This study aimed to determine the effect of a
professionalism training at Ayder.
Methods: Participants in a professionalism and communication
training were offered participation in a pre- and post-test survey. The survey
focused on the perception and function of professionalism in the medical
workplace, and included quantitative and qualitative data. The pre- and
post-test surveys were conducted prior to and at completion of the training.
Results: A convenience sample of medical students and resident
trainees at Ayder participated in the pre- and post-test surveys. The training
had a positive effect on the perception of professionalism and identified
opportunities for behavioral improvement.
Discussions: We saw that the professional training was an effective tool
for implementing professionalism into medical education curricula in this
global health setting. However, further research regarding the long term impact
and ability to implement clinical competencies into global health settings will
help determine the plausibility of repeating such a study in other sites.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, Simulation, Global Health, Public Health,
Read more »
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
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.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Practice-Based Learning & Improvement, GME, Assessment, Simulation,
Read more »
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
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.
Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Professionalism, GME, Assessment, Simulation, Standardized Patient, General Ob-Gyn,
Read more »
Management of Postoperative Issues in Gynecology and Gynecologic Oncology: A New Method for Teaching Residents
Purpose: This project sought to develop and assess a curriculum to
improve resident knowledge of and comfort in managing common post operative
Background: Junior obstetrics/gynecology residents enter training
with varied experience in post-operative management. They are often the first
contact for surgical patients with little formal education on post-operative
Methods: Eleven common post-operative issues were identified
based on literature review, resident experience and gynecology/gynecologic
oncology faculty input. Topic based curriculum included: example case,
pathophysiology, differential diagnosis, next steps, and useful resources. It
was presented at two educational sessions, involving lectures and small-group
simulations. Residents completed a pre and post-assessment questionnaire
assessing comfort level in managing (10-point Likert scale) and baseline
knowledge about (content-specific questions) the topics.
Results: Twenty-three residents participated.Seventeen
completed one or both pre-assessment surveys (nine junior residents). Ten
completed one or both post-assessment surveys (five junior residents). All
post-assessment respondents reported improved knowledge of issues covered.
Average self-rated comfort level increased for ten of eleven topics amongst
junior residents (average increase 1.6 points (range 0.5 – 3.2; p = 0.02)).
Largest increase in score was for hypoxia and low urine output. Average scores
maintained or improved for 80% of the content questions (not significant).
Residents had no preference for lecture versus small group format.
Discussions: As a result of directed teaching, resident knowledge of
post-operative issues showed measurable improvement. Resident comfort level in
management increased significantly for 90% of topics covered, most noticeably
amongst junior residents. A systematic, resident-led curriculum on
post-operative management can improve resident knowledge and patient care.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Medical Knowledge, GME, Simulation, Lecture, Problem-Based Learning, Team-Based Learning, Gynecologic Oncology, Minimally Invasive Surgery, Female Pelvic Medicine & Reconstructive Surgery, General Ob-Gyn,
Read more »
Magnesium Toxicity and Medical Errors: A Multidisciplinary Simulation for Debriefing an Obstetric Emergency
Purpose: To create a simulation that improves communication during
obstetric emergency and promotes a safe learning environment to debrief and
evaluate medical errors.
Background: Simulation is known to improve communication and
comfort in obstetric emergency. Little data exist regarding simulation for
enhancing expertise in debriefing and evaluating system errors.
Methods: The simulation highlights an unresponsive patient
shortly following a preterm delivery at 30 weeks gestation. The team discovers
an accidental bolus of intravenous magnesium was given instead of postpartum
oxytocin. Following conclusion of the simulation, participants were asked to
lead a debrief session. Surveys were performed to assess participant comfort
with magnesium toxicity, debriefing, evaluating a medical error, and
communication during an emergency.
Results: Participants felt the simulation was (1) a realistic
scenario that allowed practice debriefing a medical error within a large
multidisciplinary team, (2) a place to practice high acuity care and
communication, and (3) a safe place to receive and provide feedback. On
average, residents reported an increase in comfort with management of magnesium
toxicity from little comfort(2/5) tomoderate comfort(4/5). In general,
participants (90%; N=10) felt like they learned advanced management of acute
magnesium toxicity. All participants (100%; N=10) reported they would recommend
this simulation to others in their profession.
Discussions: We have designed a simple model that highlights the
importance of (1) communication during an obstetric emergency and (2)
debriefing and evaluating errors from systems perspective. This model increased
participant knowledge and comfort with magnesium toxicity and promoted a safe
culture to discuss medical errors and practice debriefing.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, CME, Simulation, Quality & Safety, Team-Based Learning,
Read more »
Inter-professional OSCE Based Simulation Collaboration to Teach Obstetrics & Gynecology to Second Year Medical Students and Nursing Students
Purpose: To describe an
inter-professional workshop (IPE) utilizing simulation, OSCE and flipped
classroom to introduce 2nd year medical and nursing students to OBGYN concepts
Background: IPE has been
shown to facilitate improved patient-centered care
November 2017; students studied an online fetal heart rate (FHR) lecture; at
workshop worked in groups on clinical FHR scenarios, and presented findings for
group learning and discussions. Students rotated through three stations each
for 45 minutes as follows: 1) MFM faculty taught students on cervical dilation
using “blinded” and “open” cervical models. Students had hands-on with
obstetrical procedures such as B-Lynch Suture. 2) Students performed a
simulated vaginal delivery supervised by MFM fellow; nursing students
resuscitated newborn and gave SBAR report to medical students. 3) MFM fellow
and gynecologist faculty taught students on contraception methods while a
technician taught students IUD insertion. Students self-assessed and were
assessed by faculty using OSCE; knowledge quizzes were completed for
contraception and cervical examination accuracy.
program trained 116 (73%) medical and 51(22%) nursing students. There were no
significant differences between medical students and nursing students scores
which were respectively: IUD insertion self-assessment = 8.84 vs. 8.43; IUD
insertion faculty-assessment= 9 vs. 8; cervical examination accuracy = 13.1 vs.
12.7; contraception quiz = 9.1 vs. 9.3. Medical students
birth simulation self-assessment vs. faculty-assessment scores were 8.6 vs.
8.9, p <0.001.
Discussions: Medical and nursing
students learned OBGYN skills equally, nursing students had the opportunity to
teach medical students. Medical students were more critical of their
learning than faculty.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Simulation, Team-Based Learning, Contraception or Family Planning, General Ob-Gyn,
Read more »
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).
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.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Patient Care, GME, Assessment, Simulation, Maternal-Fetal Medicine,
Read more »
Implementation of Laparoscopic Simulation Curriculum in Obstetrics and Gynecology Residency: A Pilot Study
Purpose: A pilot study to
implement a laparoscopic curriculum for our residency program.
studies have shown the effectiveness of laparoscopic simulators in training
residents technical skills needed to gain proficiency in the operating room.
Unfortunately, many programs struggle to incorporate this routinely in their
approval was obtained. A survey was sent to different residency programs to
assess other implemented laparoscopic curriculums. UF OB/GYN residents were
enrolled in the curriculum (N=11), which included a pre/post-curriculum survey
and baseline FLS scores. A cost-effective, portable laparoscopic trainer was
designed and given to each resident. They were required to record 10-minute
videos weekly for evaluation and individual feedback were given through text
showed that on average, there was a slight improvement in perceived proficiency
by the residents after implementation of the curriculum. There is improvement
in average time to completion of all three tasks, but it was not statistically
significant. Initially, 3 out of 11 residents could perform intracorporeal
knot-tying; all 11 residents could complete this task after the curriculum
(p=0.0019). Secondary outcomes showed that individual practice outside of
the mandatory practice is positively correlated with improvement in 2 out of 3
Discussions: This is a good stepping
stone to help our program develop a laparoscopic curriculum especially with the
new ABOG requirement of passing the FLS exam prior to taking the written board
exam. Mandatory deliberate practice ensured that residents practiced
laparoscopic skills weekly. This was made even more accessible by giving
residents a home laparoscopic trainer.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Residency Director, Practice-Based Learning & Improvement, GME, Simulation, Minimally Invasive Surgery,
Read more »
Immediate Post-placental IUD Insertion: Evaluation of Clinician Knowledge and Views
Purpose: To increase
practitioner knowledge and comfort performing immediate post-placental IUD
insertion with a session including lecture and simulation.
post-placental (within 10 minutes of placental delivery) insertion of an
intrauterine device (IUD) has been shown to be both safe and effective
contraception. Post-placental IUD insertion removes barriers (loss of
insurance, loss to follow up, etc.) in the prevention of unplanned pregnancies.
In order to increase practitioner knowledge and comfort performing immediate
post-placental IUD insertion, this project developed and administered education
and procedural simulation sessions.
session consisted of a 10 minute pretest, 15 minute scripted powerpoint
presentation, 15 minute procedure simulation, and 10 minute post-test. The primary
outcome of knowledge score was calculated as the sum of all knowledge
questions. The change in knowledge score and comfort levels were assessed by
paired T-tests. Participants were asked to rate their comfort level on
performing post-placental IUD insertion on a scale of 1-5 (1=not comfortable at
all; 5=completely comfortable).
obstetrical providers attended the sessions. The average knowledge score
pre-training was 11.4 (95% CI 10.6-12.2) as compared to 15.5 (14.5-16.5)
post-training (p<0.01). Pre-training, participants were less comfortable
with immediate post-placental IUD insertion (mean 2.82; 95% CI 2.4-3.2) as
compared to post-training (mean 3.96; 95% CI 3.7-4.2), (p<0.01).
Discussions: Education and
procedural simulation sessions are an effective method to improving knowledge
and procedural comfort of post-placental IUD insertion. A curriculum dedicated
to improving knowledge and comfort of post-placental IUD insertion should be
integrated into obstetrical training.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Medical Knowledge, Practice-Based Learning & Improvement, GME, Simulation, Lecture, Contraception or Family Planning,
Read more »
Fundamentals of Gynecologic & Minimally Invasive Surgery for the Fourth Year Medical Student
Purpose: Development of a
four-week elective rotation in minimally invasive gynecology designed for
fourth year medical students to meet the gynecology knowledge and skill
milestone objectives for students entering an obstetrics and gynecology
curriculum is modeled on the milestone-based approach implemented by the
Council on Resident Education in Obstetrics and Gynecology. Proficient
psychomotor skills are developed, allowing a more prepared learner in the
students follow a four-week structured curriculum. The time is divided equally
between clinical observation, skills training, and independent study.
Proficient knowledge of pelvic anatomy, surgical instrumentation, surgical
energy, and dissection are obtained. The student completes a skills training
program with two hours of dedicated practice time per day, gaining proficiency
in laparoscopic tissue manipulation and laparoscopic suturing. Clinical
activities include observation in the operating room and outpatient gynecology
clinics. Weekly written and oral testing and mentor feedback of surgical skill
progression is emphasized.
course has been well received at the two institutions it was implemented at
over the last four years. Learners have felt prepared to assist and participate
in laparoscopic surgeries upon entering their residency program.
Discussions: Implementation of
skills curriculum is paramount given the new American Board of Obstetrics and
Gynecology requirement of Fundamentals of Laparoscopic Surgery certification.
This course allows the learner to enter residency proficient in laparoscopic
psychomotor skills and having a fundamental base of knowledge for gynecology
and minimally invasive procedures. Future collection of subjective and
objective evaluation data could validate the further development of similar
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Medical Knowledge, Professionalism, GME, Assessment, Simulation, Problem-Based Learning, Minimally Invasive Surgery,
Read more »
Evaluation of Neonatal Resuscitation Program (NRP) Knowledge Among OB/GYN Residents
Purpose: To determine OB/GYN
resident retention of neonatal resuscitation program (NRP) knowledge following
their intern NICU rotation and NRP course.
training has been utilized to teach birth attendees evidence-based approaches
to care for the newborn at birth. OB/GYN trainees undergo NRP training
and rotate in the NICU as interns. It is unclear how much NRP knowledge
is retained as OB/GYN residents advance in training.
Methods: A survey
was distributed amongst the 41 OB/GYN residents at Indiana University during
the 2017-2018 academic year. The survey was completed anonymously and
included the resident’s year in training (PGY1-4) and date of their NRP course
and NICU rotation. A 10-question abbreviated NRP quiz was
administered to participants. Correlation analysis was performed to test
for associations between quiz scores and elapsed time (months) between quiz and
the intern NRP course and NICU rotation.
Results: 37 of 41
residents completed the survey. The average test score was 76%.
There was no significant difference between abbreviated NRP quiz score and PGY
level (p=0.30). There was also no difference between time since NRP
course (p=0.21) or time since NICU rotation (p=0.50). Greater time since
NICU rotation correlated with lower quiz scores in the PGY2 class
(p<0.05). No significant correlation was seen in other classes.
Discussions: Overall, there was no
significance between test scores based on training year. With this
information, OB/GYN residents may be able to do an accelerated certification
course while in a training setting instead of the traditional course completion
every 2 years.
CREOG & APGO Annual Meeting, 2019, Residency Director, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Simulation, Quality & Safety, General Ob-Gyn,
Read more »
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.
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.
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.
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.
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,
Read more »
Effect of Simulation Exercises on Medical Student Satisfaction and Performance in the Ob/Gyn Clerkship
Purpose: To evaluate the use of
structured resident-led simulation exercises in improving medical student
interest in Ob/Gyn as a specialty, satisfaction with their rotation experience,
and improvement on NBME exam sores at the end of the rotation.
students persistently rank their obstetrics and gynecology (Ob/Gyn) clerkship
experience below that of other surgical specialties, in addition to also raking
the clerkship lowest for the ability of residents to provide effective
teaching. Current research shows that clinical simulation during the Ob/Gyn
clerkship leads to increased confidence and has been shown to increase medical
students\' end of rotation oral and written examination scores.
cohort study from July 2016-June 2017 involving medical students enrolled at
the McGovern Medical School- Memorial Hermann Hospital campus for their Ob/Gyn
clerkship. Rotations were randomized by alternating intervention with
non-intervention, the intervention consisted of weekly resident-led
simulation exercises. All students were given anonymous pre-rotation and
post-rotation surveys that used a Liekart scale to analyze their opinions of
their clerkship experience. The surveys and NBME grades were then analyzed
between the two groups.
population was 71, with 38 students in the control group and 33 in the
intervention group with survey response rates of 94% and 97%
respectively. The responses of the pre and post-rotation surveys were
then analyzed using the Wilcoxon ranked sum test comparing the median
response. Overall, the intervention group had a higher median score
regarding preparedness in the clerkship (p .052) and scored better on the NBME
(P .2679). The intervention group had a lower median response to
questions regarding importance of residents’ involvement in their clerkship,
which was statistically significant (p .008).
Discussions: Results indicate that
resident-led simulation exercises may increase NBME scores and help students to
feel more prepared within the clerkship. However, this increase in
performance and preparedness does not correlate with student satisfaction or in
the student’s choice of obstetrics and gynecology as their future specialty of
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Medical Knowledge, Practice-Based Learning & Improvement, GME, Simulation, Team-Based Learning,
Read more »
Defining the Learning Curve for the Labor Cervical Examination
Purpose: To define the learning
curve of the labor cervical exam in a simulated setting.
cervical assessments are crucial in labor management. Little information
is available regarding the amount of practice needed to obtain
and nursing students completed 200 simulated cervical exams. Longitudinal
learning curves were constructed and cumulative summation analyses were
performed as a proxy for achieving competence. In medical students
accuracy was assessed at 1, 3, and 6 months after training.
medical students and 33 nursing students participated. After 200
repetitions the median and interquartile range of cumulative accuracy in the
medical students was 69% (65, 78) for dilation and 80% (76, 91) for effacement.
In nursing students the corresponding values were 50% (39, 60) and
63% (53, 72). All medical students achieved competence during the
study. 34% of the nursing students achieved competence for dilation and
69% for effacement. The average and standard deviation of
repetitions needed for medical students to achieve competence was 89±46 (range
25-195) for dilation and 48±38 (range 11-174) for effacement. Accuracy of
the medical students was maintained at 1 month, but not 3 or 6 months after
Discussions: For motivated
individuals at least 200 repetitions are needed if all trainees are to achieve
initial competence. The varied morphology of the learning curves and very
large range of repetitions needed to achieve competence indicates that a “one
size fits all” approach is inefficient and a more competence-based approach to
cervical exam training is warranted.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Clerkship Director, Residency Director, Patient Care, GME, UME, Assessment, Simulation, General Ob-Gyn,
Read more »
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)
interns feel trepidation when facing Category II FHR tracings. We
designed a workshop to allay initial anxiety interns may feel at the start of
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.
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.
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,
Read more »
Can I Get a Suggestion? Improv Training to Teach Empathy in Ob/Gyn Residents
Purpose: To examine
improvisation training on Ob/Gyn resident empathy
empathy is associated with improved patient outcomes. Empathy training is
effective in physicians, and many models exist. However, no studies have
examined whether the improvements are sustained over time. Our primary aim is
to determine whether an improv workshop is an effective tool to deliver empathy
training. Our secondary aim is to determine whether that effect is sustained
Methods: This is
a prospective study of Ob/Gyn residents. Validated empathy surveys were
administered 1 week prior to empathy training, immediately after training and 1
month later. Improv games were used in conjunction with empathy training during
the intervention. Paired t-tests and McNemar’s were used to compare statistical
differences at each post-intervention assessment compared to pre-intervention.
residents participated. Empathy scores increased immediately after training
(mean=113 vs 120, p=0.03), but were not sustained 1 month later (mean=113
vs 117, p=0.11). Residents reported that the workshop positively impacted
their delivery of care both immediately (mean=3.5 vs 4.6, p <0.001) and 1
month later (mean=3.5 vs 4.1, p=0.04).
Discussions: Using improv comedy to
delivery empathy training is associated with improved empathy scores in Ob/Gyn
residents, but this improvement gravitates back to baseline over time.
Residents report that the improv workshop was effective at improving empathy,
even up to one month later.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Interpersonal & Communication Skills, GME, Simulation, Team-Based Learning, CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Lecture, Maternal-Fetal Medicine, General Ob-Gyn,
Read more »