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

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

 

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

 

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

 

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

 

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

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

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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 sessions.  

 

Discussions: With a dedicated curriculum and proctored teaching, residents in obstetrics and gynecology can successfully pass the FLS certification exam with their initial test. 

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Medical Knowledge, GME, Simulation, Minimally Invasive Surgery,

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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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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.

Topics: 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,

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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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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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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 issues.

 

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 issues. 

 

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.

Topics: 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,

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Magnesium Toxicity and Medical Errors: A Multidisciplinary Simulation for Debriefing an Obstetric Emergency

Purpose: To create a simulation that improves communication during obstetric emergency and promotes a safe learning environment to debrief and evaluate medical errors.

 

Background: Simulation is known to improve communication and comfort in obstetric emergency. Little data exist regarding simulation for enhancing expertise in debriefing and evaluating system errors.

 

Methods: The simulation highlights an unresponsive patient shortly following a preterm delivery at 30 weeks gestation. The team discovers an accidental bolus of intravenous magnesium was given instead of postpartum oxytocin. Following conclusion of the simulation, participants were asked to lead a debrief session. Surveys were performed to assess participant comfort with magnesium toxicity, debriefing, evaluating a medical error, and communication during an emergency. 

 

Results: Participants felt the simulation was (1) a realistic scenario that allowed practice debriefing a medical error within a large multidisciplinary team, (2) a place to practice high acuity care and communication, and (3) a safe place to receive and provide feedback. On average, residents reported an increase in comfort with management of magnesium toxicity from little comfort(2/5) tomoderate comfort(4/5). In general, participants (90%; N=10) felt like they learned advanced management of acute magnesium toxicity. All participants (100%; N=10) reported they would recommend this simulation to others in their profession. 

 

Discussions: We have designed a simple model that highlights the importance of (1) communication during an obstetric emergency and (2) debriefing and evaluating errors from systems perspective. This model increased participant knowledge and comfort with magnesium toxicity and promoted a safe culture to discuss medical errors and practice debriefing.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, CME, Simulation, Quality & Safety, Team-Based Learning,

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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

 

Methods: In 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.

 

Results: The 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.

Topics: 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,

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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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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.

 

Background: Multiple 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 curriculum.

 

Methods: IRB 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 message.

 

Results: This 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 tasks.

 

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.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Residency Director, Practice-Based Learning & Improvement, GME, Simulation, Minimally Invasive Surgery,

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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.

 

Background: Immediate 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.

 

Methods: A 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).

 

Results: 62 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.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Medical Knowledge, Practice-Based Learning & Improvement, GME, Simulation, Lecture, Contraception or Family Planning,

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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 residency program.

 

Background: The 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 operating room.

 

Methods: 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.

 

Results: The 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 courses. 

Topics: 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,

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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.   

 

Background: NRP 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. 

Topics: 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,

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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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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.

 

Background: Medical 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.

 

Methods: Prospective 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.

 

Results: Overall 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 choice.

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

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Defining the Learning Curve for the Labor Cervical Examination

Purpose: To define the learning curve of the labor cervical exam in a simulated setting.

 

Background: Accurate cervical assessments are crucial in labor management.  Little information is available regarding the amount of practice needed to obtain competence. 

 

Methods: Medical 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.

 

Results: 27 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 training.

 

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.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Clerkship Director, Residency Director, Patient Care, GME, UME, Assessment, 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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Can I Get a Suggestion? Improv Training to Teach Empathy in Ob/Gyn Residents

Purpose: To examine improvisation training on Ob/Gyn resident empathy

 

Background: Physician 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 over time.
 

 

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.

 

Results: 22 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.   

Topics: 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,

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