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The Substantial Rise of Clinician Educators Among Obstetrics and Gynecology Faculty, 1977-2017

Purpose: To determine trends in faculty career development, stratified by gender and under-represented minority (URM) status, for obstetrician-gynecologists (ob-gyn) at all U.S. medical schools.

 

Background: The growing number of faculty and opportunities for career pathways have expanded considerably at U.S. medical schools. This growth differs between clinical specialties. Any dominance of non-tenure faculty has important implications on academic promotion policies and teaching expectations.

 

Methods: In this observational study, we used the Association of American Medical Colleges Faculty Roster to describe trends in career pathways (clinician educator, tenure-track, tenure) of full-time faculty at all U.S. MD-granting medical schools between 1977 and 2017.  Proportions of female and URM faculty on each pathway were compared with that of male and non-URM faculty.

 

Results: Between 1977 and 2017, the number of full-time faculty increased from 1,628 to 6,347, mostly as clinician educators (from 345 to 4,607; 13.4-fold increase) than as being either tenured (from 457 to 587) or on tenure-track (366 to 514). The proportion of clinician educators increased from 21.2% to 69.4%. The availability of tenure positions remained constant (92.7% of all schools); however, the proportions of tenured and tenure-track faculty declined steadily from 28.1% and 22.5%, respectively to 8.2-9.1% for each group.  The proportions of male and female faculty who were tenured or on tenure track declined from 52.9% and 37.1% respectively to 23.3% and 13.6%. The proportion who were tenured or on tenure-track declined similarly for URM (from 55.3% to 13.4%) and non-URM (from 50.2% to 18.0%) faculty.

 

Discussions: The substantial rise in ob-gyn faculty is largely among those who pursued careers as clinician educators. This finding confirms the essential need and protected time for educator development programs at all schools to more effectively teach medical students and resident physicians.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Professionalism, CME, Lecture,

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Medical Students’ Perceptions of Teaching on the Obstetrics and Gynecology Clerkship

Purpose: Assess medical students’ perceptions of the learning quality in their OBGYN clerkship.

 

Background: OBGYN uniquely synthesizes primary, subspecialty, and surgical care. Accordingly, medical student teaching must reflect the breadth of our field. Many teaching modalities are employed within the clerkship, such as patient interactions in the clinic setting and wards, intraoperative instruction, non-traditional case-based conferences, and written texts. While overall learning and students’ decisions about specialty selection are known to be contingent on effective education, it is not known which modalities students perceive as most efficacious.

 

Methods: An eighteen-item electronic questionnaire was distributed to consenting third year students at the completion of their six-week clerkship at the University of Florida’s two campuses over a twelve-month academic year.

 

Results: Students receive approximately 6 hours of group and individual instruction weekly and felt this was appropriate. Satisfaction was high for resident and attending instruction, opportunities to demonstrate clinical knowledge, and meaningfulness of students’ roles in patient care. The ability to practice procedures and receive feedback were ranked lowest. Among key topics in OBGYN, the highest scores included preeclampsia and abnormal uterine bleeding, with relatively lower scores for pelvic floor dysfunction. Labor and Delivery board rounds was perceived as the most effective mode of instruction. Roles in the outpatient setting were perceived as primarily observational, while perceived responsibilities in the OR varied.

 

Discussions: Potential areas of growth include incorporating more procedural training and providing more effective feedback. Limitations to our study included survey format, single academic year, and limitation to two institutions.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, Lecture,

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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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Let\'s Get Jazzy: Career Preparedness in OB/GYN Residents; Assessing the Need, and Developing a Curriculum

Purpose: To assess the need for a formal and structured curriculum focused on OB/Gyn resident career and employment preparedness.

 

Background: Many residents rely on mentors and resident colleagues to help determine their career paths. Curriculum during residency in obstetrics and gynecology often lacks an emphasis on preparing residents to enter the job field as practicing physicians. Often physicians complete training with significant amount of education debt.  Some employment scenarios may have negative financial implications. Residents need to be formally educated on the impacts changes in research funding, the healthcare system, and insurance market play in their career decisions. It is important to determine how to best prepare residents to choose a career path.

 

Methods: We administered a career curriculum needs assessment and a validated career readiness survey, which included questions relating to mentorship, job search strategies and opportunities, negotiation, and practice climate to 28 residents. The survey results determined the topics that were needed.

 

Results: 89% of residents agreed it was important to learn about career paths during residency. 96% of the residents believed that a career-planning curriculum would be helpful.  89% thought it was important to have a career mentor. Overall, 67.9% of respondents do not feel confident about their ability to negotiate a contract. The majority of resident were not familiar with medical practice finance and malpractice insurance.

 

Discussions: The survey results were used to inform curriculum for the academic year. Topics included career mentoring and individual planning, negotiation, finance, and insurance. Comparison of pre/post curriculum will be performed after 1 year.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Professionalism, GME, CME, Lecture, Independent Study,

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Let the Good Grades Roll: Optimizing Shelf Exam Performance with a Novel Peer-led Comprehensive Review Session

Purpose: To create a comprehensive review for third year medical students at Brody School of Medicine in preparation for the end of clerkship national board shelf examination in OB/GYN.

 

Background: With the increasing availability of resources in preparation for clinical clerkships, medical students struggle to identify high-yield topics in review for end of clerkship shelf examinations. This dilemma is further exacerbated by having educational objectives published by both the National Board of Medical Examinations (NBME) and the Association of Professors of Gynecology and Obstetrics (APGO). Although though it was proven that the NBME exam appropriately tests students on the information that APGO deemed “essential,” there still isn’t a timely and comprehensive review resource available for students focusing on these specific topics. Due to this, a comprehensive high-yield review was created using the student educational objectives in OB/GYN published by the APGO.

 

Methods: A two-hour comprehensive review presentation was created for students who were rotating on the OB/GYN clerkship at the Brody School of Medicine using the APGO objectives. The presentation was created in a question and answer format to allow students to use the information presented as both a study tool and as a self-assessment of knowledge. This review was created using the follow resources: U-World, Step-Up to Obstetrics and Gynecology, and Pre-Test OB/GYN.

 

Results: A post-presentation survey revealed that participants found the review to be educational, high yield, and extremely useful for studying for the NBME shelf examination. An additional survey was also sent to students after taking the NBME shelf examination to assess the quality of the information presented. Overall the students who attended the review session and used the presentation as a study tool reported positive impacts on shelf examination scores and overall understanding of high-yield concepts in OB/GYN.

 

Discussions: With the positive feedback from students who attended the review session and used the presentation as a study-tool for the NBME shelf examination, we hope that comprehensive reviews such as this will be created for additional clerkships to help students prepare for other NBME examinations.  

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Medical Knowledge, GME, CME, UME, Lecture, General Ob-Gyn,

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Keeping Residents Well: How Important Are Perceptions of Program Support and Psycholocical Safety to Resident Wellness?

Purpose: We aimed to test whether measures of resident well-being correlated with perceptions of program support and psychological safety.

 

Background: Trainee well-being is a crucial component of developing competent and skilled OB/GYN physicians. While there are several measures of well-being collected at the national-level, there is little insight in the role of individual programs to foster trainee well-being. Perceived organizational and psychological safety are two constructs that can help identify cultural aspects of the clinical learning environment that may relate to trainee well-being.

 

Methods: OBGYN residents in a training program were recruited to complete an IRB-approved survey through paper and electronic methods between May-June 2018. Measures included the Survey of Perceived Organizational Support (POS), Psychological Safety Scale (PS), Perceived Stress Scale (PSS), Wayne State Wellness Scale (RWS) and Physician Well-Being Index (PWBI); all demonstrate validity and reliability evidence to assess factors of well-being and cultural aspects of the training program.

 

Results: 20 OBGYN residents completed our survey. Results indicated a strong relationship between perceived organizational support and wellness  (r= .62, P<.01 for RWS, r=.50, P<.05 for PWB)., suggesting greater perceptions of support relate to better wellness. Similarly, psychological safety also had a strong relationship with wellness (r=.56, p<.05 for RWS;  r= -.72, p<.01 for PWB)

Discussions:  
Our findings suggest that there is a strong relationship between trainee wellness and the cultural measures of support and safety, especially between psypschological safety and negative indicators of well-being (e.g,. feeling burnt out from work, feelings of irritation). Further research should include interventions to improve percpetions of suport and safety.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, Quality & Safety, Advocacy, CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Lecture, Advocacy,

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amming with Podcasting: Make Education Swing for Medical Students!

Purpose: Take five to explore the podcast format as a smooth way to teach medical students intimate partner violence (IPV) screening and history-taking.

 

Background: The USPSTF recommends IPV screening as routine health maintenance.2 Research has found that perceived preparedness and comfort level are barriers to screening and intervention.1,3 There were only crickets regarding IPV screening in our own curriculum. As a result we sought to harmonize the instruction of students with an accessible and memorable educational format.

 

Methods: We laid down a brief introductory lecture about IPV followed by a 22 minute podcast about screening and addressing IPV disclosures for first-year medical students. They completed pre- and post- surveys assessing general knowledge and perceived confidence.

 

Results: The pre-survey “opener” showed 52% of respondents had no prior experience nor training in IPV screening.  Initially, 64% of respondents hit a sour note feeling either “somewhat not confident” or “not confident at all.” In a smooth turn-around, the post-survey showed that listening to the smokin’ podcast increased students’ confidence. When asked about addressing a positive disclosure of IPV, the post-survey again showed an increase in confidence.  The objective section of the post-survey demo’ed an increase in correct answers for every knowledge question.

 

Discussions: This curricular intervention employs a hot form of information sharing.  Initial data suggested that a majority of students did not feel confident screening for IPV nor addressing a positive disclosure.  After a paired lecture/podcast on this topic, students demonstrated increased general knowledge about IPV as well as a measureable crescendo of confidence.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, UME, Lecture,

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Improving Tetanus, Diphtheria, Pertussis Vaccination Rates in an Academic Center Through Resident-driven Education

Purpose: To improve rates of prenatal Tetanus, Diphtheria, Pertussis (Tdap) vaccination for clinic patients in an academic training center.

 

Background: The United States is experiencing a resurgence of pertussis, which can cause serious complications for infants, especially within the first six months of life. To maximize maternal antibody response to Tdap and antibody transfer to the newborn, vaccination between 27-36 weeks of gestation is recommended.

 

Methods: A pre-post survey study design was used to evaluate OBGYN residents at the University of Tennessee during the 2017-2018 academic year. The primary outcome was Tdap vaccination rate. Secondary outcomes were resident-reported Tdap counseling and resident understanding of the appropriate gestational age for administration. The following educational methods were utilized: resident-lead lecture, provider handouts, English and Spanish patient education posters throughout the clinic. Direct comparison of pre and post-surveys was used to analyze results.

 

Results: Five Tdap vaccinations were given in the four months prior to pre-survey administration (0.33 vaccines/resident). Following the Tdap educational program, forty-three vaccinations were given in four months (2.86 vaccines/resident). Pre-surveys indicated eleven residents (73%) provided Tdap counseling, while post-surveys revealed fifteen residents (100%) provided counseling. On pre-surveys, the majority of residents (33%) incorrectly answered that Tdap was indicated between 27 weeks gestation until delivery. In post-surveys, thirteen residents (87%) correctly answered that Tdap was indicated between 27-36 weeks gestation.

 

Discussions: Tdap vaccination rate increased by 767% after implementation of the educational tools. Additionally, resident-driven counseling about Tdap increased by 36% and resident understanding of appropriate gestational age for vaccine administration improved by 225%.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Patient Care, Medical Knowledge, GME, Lecture, Quality & Safety, Public Health, Advocacy,

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Impact of Resident Led Didactics on OBGYN Clerkship Shelf Scores and Student Satisfaction

Purpose: Compare NBME shelf scores prior to and after implementation of the Wednesday lecture series.Compare satisfaction scores of students prior to and post implementation of Wednesday lecture series. Scores would be obtained from the Aesculapian Society who evaluates students’ overall perceptions of clerkships

 

Background:

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

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

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

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

·       Lectures designed to complement Team-Based Learning sessions

Methods:

·       Shelf exam scores from 2011-2017 were reviewed and compared across the training sites.

·       Control Group: Baton Rouge and Lafayette based students who do not receive the same lectures.

·       Aesculapian Society Evaluations.Scores before and after implementation were examined

Results:

·       Positive correlation in resident teaching and satisfaction scores

·       Positive correlation in NBME scores and satisfaction scores

 

Discussions:

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

·       No standardized resident-lectures amongst all locations

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

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

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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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Evaluation of Knowledge Retention 3 Months After Completion of a Resident Menopause Curriculum

Purpose: Evaluate residents’ retention of menopause-based knowledge 3 months after completion of self-administered modules that varied by menopause-related topic and format of delivery.

 

Background: Residents express discomfort managing menopause. Didactic teaching of this topic can be tailored to learning style, which may influence retention and improve discomfort.

 

Methods: Prospective cross-over study of Obstetrics and Gynecology and Family Medicine residents at one institution over the 2017-2018 academic year. Residents were randomized to a series of 3 PowerPoints, each < 30 slides, administered during protected learning time. Each series contained 3 different subjects (Menopause Basics (MB), Hormone Replacement Therapy (HRT), Genitourinary Syndrome of Menopause (GSM)) delivered through 3 different presentation styles (typical presentation (typical), pictures and a narration (pictures), and interactive to reveal information (interactive)). Knowledge and comfort were assessed through baseline, immediate post-exposure, and 3-month follow-up surveys containing 24 knowledge questions (multiple choice) and 10 comfort and satisfaction questions (5-point Likert scale and multiple choice). Statistical tests were applied with a p< 0.05 considered significant.

 

Results: Thirty-three residents completed 3-month follow-up. Immediately post-exposure, knowledge and comfort increased from baseline for all topics (p< 0.05).  On 3-month follow-up, the HRT topic demonstrated a sustained increase in knowledge (p=0.047). The typical format of the GSM topic had significantly better retention than the picture format (p=0.027). All formats were associated with a significant increase in comfort (all p< 0.01).

 

Discussions: Immediately post-exposure knowledge and comfort were universally improved by topic, however, on 3-month follow-up retention varied by format and topic. Comfort in managing menopause remained increased on follow-up.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Medical Knowledge, GME, Assessment, Lecture, Independent Study, General Ob-Gyn,

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Development of a Novel Method for OBGYN Resident Recruitment

Purpose: We aimed to improve our resident recruitment method to promote individualized, holistic admissions and decrease applicant stress.

 

Background: The AAMC is promoting processes that utilize holistic, individualized resident applicant criteria and methods that reduce candidate stress.

 

Methods: Resident applicants were divided among six experienced faculty who selected candidates based on objective scoring of academic records. Selected applicants were emailed to rank interview date preferences within 72-hours, and then received an email with interview placement. Following interviews, applicants were surveyed about the process.

 Three ranks lists were generated and compared: a behavioral-based composite rank list (BBC); a BBC with pre-interview scores included; and a traditional list. In the BBC method, faculty were blinded to pre-interview scores, and applicants were evaluated on professionalism, leadership, trainability, and fit. The traditional rank list was generated via open discussion with interviewers. The three rank lists were compared to determine concordance between methods.  

 

Results: There were 78 applicants interviewed. There was 62.8% concordance between the BBC and traditional rank list, which dropped to 32.1% concordance when pre-interview scores were combined with BBC scores. Applicant post-invitation survey response rate was 67%; with 93.3% reporting the interview invitation process was more equitable, less stressful (82.7%), and better than other institutions (86.6%). All faculty involved in the candidate prescreen preferred the new standardized method.

 

Discussions: There was concordance between the BBC and standard rank lists, but not when pre-interview scores was combined with the BBC.  Candidates were satisfied with the new method of invitation and faculty found the standardized pre-interview scoring method preferable.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, CME, Assessment, Lecture,

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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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Bringing Basic Science to the Ob/Gyn Clerkship: Perspective from Our Learners

Purpose: To evaluate medical student perceptions on whether basic science concepts were taught during patient care delivery in an Obstetrics-Gynecology clinical clerkship.

 

Background: Medical school curriculums are moving towards competency-based curricula, with an emphasis on early introduction to clinical training. These changes condense the traditional basic science curriculum, yet basic science remains critical to clinical medicine. Students who learn basic science explanations for clinical correlates have improved retention. The goal is to embed basic sciences within the clerkship.

 

Methods: At the end of each required clinical clerkship at the University of Michigan, students on their rotations were asked to evaluate their overall clerkship experiences from December 2017 to July 2018. The survey included the statement “Basic science concepts were taught during patient care delivery” with a too-little to too-much five level scale, with a score of three being “just right”. Descriptive statistics were used to analyze the results.  

 

Results: For the OB/gyn clerkship, 102 students completed the survey. The mean score was 2.37 with a standard deviation of 0.7. Other clerkships were blinded. The same statement in other clerkships resulted in a score of 2.39 (0.69), 2.73 (0.68), 2.88 (0.56), 2.68 (0.64), 2.65 (0.63), 2.45 (0.73), and 2.66 (0.59).

 

Discussions: While basic science concepts are taught in the OB/gyn clerkship, there is significant room for improvement. All clerkships fell below what students considered optimal basic science teaching. Teaching scripts, basic science videos, and didactics with purposeful integration of basic science principles could be an effective, efficient method of integrating basic science content within the clerkship. 

Topics: CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Medical Knowledge, Practice-Based Learning & Improvement, Lecture, Problem-Based Learning, General Ob-Gyn,

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An Effective Vaginal Delivery Simulation and Lecture Combination for the Medical Student Learner

Purpose: To evaluate the effectiveness of a normal spontaneous vaginal delivery (NSVD) simulation and lecture combination on medical student education.

 

Background: In obstetrical training, simulation significantly improves learner knowledge and confidence. However, time and space constraints may hinder routine integration of simulation into medical student education. Findings regarding effectiveness of a concise and easy-to-implement medical student education program consisting of an NSVD simulation and lecture are presented.

 

Methods: An on-campus outpatient space was used for an educational program aimed at third year medical students. This program occurred at the start of the obstetrics and gynecology clerkship and consisted of: (1) lecture on NSVD of fetus and placenta, stages of labor and identification of lacerations and fetal presentation, station and position and (2) simulation of an NSVD on a portable birthing mannequin. No more than 9 students participated during the 45-minute program. 15 to 20 minutes were used for lecture; 25 to 30 minutes for simulation. Medical students completed questionnaires before and after the program regarding confidence (based on a 1-5 Likert scale, 5 being very confident) and knowledge on NSVD and associated aspects (total possible score of 16).

 

Results: Total of 33 medical students participated. Mean confidence and knowledge scores significantly increased from 1.9 to 3.9 (p < 0.001) and from 8.8 to 14.3 (p < 0.001) before and after the program, respectively.

 

Discussions: A concise and easy-to-implement educational program consisting of an NSVD simulation and lecture significantly improves medical student confidence and knowledge.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Medical Knowledge, UME, Simulation, Lecture, General Ob-Gyn,

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Increasing Access to Emergency Contraception, Non-emergent Contraception, and LARC Referrals in the Emergency Room: A Resident-based Educational Intervention

 

Purpose: The aim of this study is to determine whether an educational intervention improves emergency medicine residents\' knowledge of and personal comfort with prescribing EC, offering non-emergent contraception, and referring patients for LARCs.

 

Background: Approximately 50% of pregnancies in the United States are unintended. Increasing access to emergency contraception (EC), non-emergent contraception, and long-acting reversible contraception methods (LARCs) is one way of decreasing unintended pregnancies. Emergency rooms enable physicians to assess a woman\'s risk of unintended pregnancy and afford an opportunity to intervene, if appropriate. Previous studies have found that emergency medicine physicians do not always offer EC, even in cases of sexual assault. Barriers to prescribing EC have been identified and include time constraints, lack of clinical resources, concern about discouraging regular birth control, and concern about birth defects.

 

Methods: Emergency medicine residents were given an interactive lecture on contraception with emphasis on EC. They were also given a pocketbook on contraception to keep. Pre- and post-lecture surveys were given in person, along with another 6 months later. The surveys assessed knowledge, comfort level, and prescribing/referring practices with both quantitative data and qualitative data. Data will also be extracted from the electronic medical record to assess if there was an increase in prescriptions for contraception and/or referrals to family planning.

 

Results: The preliminary data analysis is currently being conducted. Twenty-three emergency medicine residents completed the pre- and post-test surveys. Additional information from prescriptions and referrals will provide objective data to assess whether the educational intervention changed behavior.

 

Discussions: There are two hypotheses for this study. First, it is hypothesized that an educational intervention will increase emergency medicine residents\' knowledge of and comfort with EC, non-emergent contraception, and LARCs. Second, there will be a significant increase in prescriptions for EC, non-emergent contraception, and referrals for LARCs one year after the educational intervention takes place. If the hypotheses are correct, residency programs and hospitals should consider developing educational strategies and policies to improve access to contraception in the emergency room and prevent unintended pregnancy.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, GME, CME, Assessment, Lecture, Quality & Safety, Contraception or Family Planning,

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Ultrasound Training in Obstetrics and Gynecology Residency: A National Portrait

Purpose: To understand current training in obstetric and gynecologic ultrasound.

 

Background: Modern obstetrics and gynecology practice requires the frequent use of ultrasound (US) and therefore US training has become an important part of resident education. We sought to understand how residents are currently being trained in obstetric and gynecologic US by surveying residency program directors.

 

Methods: We developed a 36 item self-administered questionnaire targeted for residency program directors (PD). PD from all 261 accredited programs were invited to participate. We inquired about US curriculums, time spent in US training, types of US taught, learning environments and instructors, feedback regarding resident competence and resident input of the learning experience. IRB approval was obtained prior to study onset.

 

Results: We received 108 completed responses.PD from all geographical US areas and Canada responded. PD self-described their programs as 52% university based, 28% community based, 18% combination of university/community based and 2% military. Over 65% reported US education was built into the curriculum as a distinct rotation. Of the US rotations >50% were described as a one month separate block. 40% stated 1 – 4 hours week devoted to US education. 99% said supervised instruction was the norm with the majority of teachers being MFM physicians/sonographers. A mixture of observational and hands-on ultrasound experience is the norm for most programs. Over 76% PD gave residents US reading assignments and have formal lectures, mostly by MFM and REI faculty. Less than 20% of programs supported any experience with ultrasound simulator training. 90% of PD give formal feedback to the residents about their skills. Only 69% state that their residents can evaluate the learning experience.

 

Discussions: We recount details of the current status of US education in OB/Gyn residency programs as reported by PD across the country. Our questions were designed to understand the amount of time actually committed to ultrasound education. With the inception of widespread US need in the daily life of obstetrics and gynecology the challenge of ensuring adequate resident training exists. More structure and protected learning time may assist in resident training.  Simulator training for US education seems underutilized.

Topics: CREOG & APGO Annual Meeting, 2018, Resident, Faculty, Residency Director, Medical Knowledge, GME, Assessment, Simulation, Lecture, General Ob-Gyn,

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There Is an APP for That: Vaginal Hysterectomy

Purpose: To create an instructional app which includes medical knowledge, procedural steps and assessments based on the ACOG curriculum for vaginal hysterectomy.

 

Background: Vaginal hysterectomy is the evidence based medicine route of choice when feasible.  Significant challenges exist in teaching this procedure due to lack of simulation training, proper assessment of specific techniques and timely instruction prior to performing the procedure.  There is also considerable variation in how cases are tracked and assessments of technique are done.

 

Methods: Key features/contents of the application include:  1) ACOG curriculum for vaginal hysterectomy, 2) a complete step by step live and simulated surgical video tutorial, 3) a procedural step by step assessment (10 steps-- 0-10 score), 4) a global surgical rating scale (7 metrics), and 5) a knowledge based assessment (4 metrics, 0-4 scale). 

 

Results: The data captured on the app can be accessed via IPAD and iPhone mobile devices and is verified by Apple.  The evaluations can be directly emailed to any database.

 

Discussions: A comprehensive instructional surgery app coupled with real time assessment will provide greater learning efficiency and will more effectively improve surgical skills.  This app has the potential to standardize surgical evaluation in the operating room and provide a more efficient method to track surgeon competency using ACOG guidelines.  The assessment is currently employed by the ACOG Simulation Consortium Working group during vaginal hysterectomy simulation and is part of a surgical simulation course which certified by the ABOG for MOC credits.

 

Topics: CREOG & APGO Annual Meeting, 2018, Resident, Faculty, Clerkship Director, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Simulation, Lecture, Minimally Invasive Surgery,

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Teaching Lesbian, Gay, Bisexual, Transgendered, and Queer Family Building in a Third Year OBGYN Clerkship

Purpose: To explore third year medical students’ fund of knowledge and attitudes about LGBTQ family building and third party reproduction.

 

Background: Medical student knowledge and attitudes about family building for LGBTQ families and third party reproduction (TPR) varies based on student prior experience and pre-clinical teaching.  The OBGYN clerkship is a unique opportunity for students to learn medical knowledge and reflect on attitudes about this subject.

 

Methods: A quantitative study of knowledge and attitude among third year medical students done after IRB approval. The intervention consisted of a one hour lecture on TPR and participating in a group discussion about LGBTQ family building. Students (231) completed a survey asking about their knowledge and attitudes prior to starting the rotation and 178 completed the survey following the intervention. Survey respondents rated items using a Likert scale and completed a knowledge assessmented. Changes in knowledge scores were investigated using t-tests.

 

Results: Survey respondents were 51% female, 48% male, 1% gender non-conforming; heterosexual 93%; and partnered 59%. Comfort with same sex couples was endorsed by 92%. 56% of students felt that opting out of assisting a patient with family building was not an option. Fertility knowledge increased from after intervention significantly (p<0.0001). Some students, 29%,  thought that infertility was hard to discuss, but 67% felt it would be hard to discuss for same sex couples.

 

Discussions: Medical students’ fund of knowledge was increased with lecture and small group discussion about TPR and LGBTQ patients. Students report being comfortable with TPR and LGBTQ families but have some discomfort with varied pathways to parenthood. Most feel that opting out of care for LGBTQ families is not an option. 

Topics: CREOG & APGO Annual Meeting, 2018, Student, Faculty, Clerkship Director, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, UME, Lecture, Advocacy, Reproductive Endocrinology & Infertility, Sexuality,

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Improvement in CREOG Scores Through Focused Review Sessions

Purpose: To determine if focused review sessions lead to improvement in CREOG scores.

 

Background: In 2013, faculty at the University of Kentucky developed a Gynecologic Oncology (GYO) review aimed at improving resident scores.

 

Methods: Each year, residents voluntarily participated in five review sessions on major topics in GYO.  Sessions consisted of a pre-test (approximately 15 questions) followed by a discussion that emphasized the key concepts for that subject. From 2014-2017, GYO scores were compared between residents who attended (A) over 50% of the sessions and those who did not (NA). Scores from 2010-2013 were collected as a control group (C). SAS (9.4) was used to analyze the data via ANOVA with repeated measures and least square difference pairwise comparisons. Significance was defined as p <0.05.

 

Results: Data was collected on 153 tests from 55 residents (80 from 2010-13 and 73 from 2014-17). The mean scores for GYO and overall test increased with each resident year (p<0.0001). Attendance revealed a statistically significant improvement on GYO scores when compared to NA (p=0.0001) and C (p=0.0008).  There was no difference between C and NA (p=0.3875). Those who attended also scored significantly higher on overall test scores compared to NA (p=0.0002). There was no difference between A and C (p=0.1747). For those residents who attended multiple years of review sessions, there was no significant improvement in GYO or overall scores compared to less frequent attendees. 

 

Discussions: Our findings support the hypothesis that focused review sessions improved resident comprehension as reflected by CREOG scores.

Topics: CREOG & APGO Annual Meeting, 2018, Resident, Faculty, Residency Director, Medical Knowledge, GME, Assessment, Lecture, Independent Study, Gynecologic Oncology, General Ob-Gyn, CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Advocacy, General Ob-Gyn,

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