Wellness Wednesday: Utilization of Strategic Duty-free Hours by OB/GYN Residents
Purpose: To detail the specifics of how OB/GYN residents utilize a
monthly duty-free afternoon for wellness activities.
Background: Much attention is paid to burnout and high rates of
depression among physicians. Some speculate these difficulties may start in
medical school but that they become cemented and sometimes problematic in
residency. Studies have made implications that interventions, specifically
promotion of self-care and work-family balance, and work hour restrictions,
early in residency can decrease burnout and depression levels.
Methods: Starting in 2016, all residents of an OB/GYN program
were allowed to have the first Wednesday afternoon of each month free from
clinical duties. Faculty members covered all clinical services from noon to
5pm. Residents were then permitted to use the time for whatever they felt
promoted their well-being. Two years of data were collected through surveys to
determine the specific activities completed by the residents.
Results: The commonly reported activities included health care
visits, financial planning activities, leisure time with family/friends,
community or church group events, every day errands, home chores, and fitness.
Additionally, the residents also used the time away from clinical
responsibilities to study and fulfill administrative requirements.
Discussions: By better understanding what residents choose to do to
promote their own well-being, programs can then tailor structured wellness
activities to those choices. Alternatively, programs can look at an
open-ended wellness day as a possible intervention for fostering excellent
overall health and welfare of their residents. More research is needed to
validate this approach to wellness promotion.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Systems-Based Practice & Improvement, GME, CME, UME, Quality & Safety,
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Trends in Off-Service Rotations in Ob/Gyn Residencies Before and After Duty Hour Restrictions
Purpose: To establish trends in off-service rotations in OB/GYN residencies
before and after duty hour restrictions.
Background: As co-morbidities in our patient population increases,
the skills required of OB/GYNs are changing, we sought to determine the
characteristics of off service rotations.
Methods: We searched websites of ACGME accredited OB/GYN
residency programs. We collected data on off service rotations: services,
number of rotations, and PGY year of rotations. Surveys were emailed to
programs regarding off service rotations in 2018 and before duty hour changes
Results: 92% (n=259) of programs had information available on
off-service rotations, of these, 24% (n=62) had no off-service rotations, 26%
(n=67) had 1, 25% (n=66) had 2, 13% (n=34) had 3, 12% (n=30) had 4 or more. The
majority (84%) of rotations were in PGY1. The most common rotations were ER
(47%, n=122), SICU (24%, n=62), IM (25%, n=66), MICU (9%, n=23). We received 53
responses to the survey (19% response rate). Of those who responded, the most
common rotations for 2018 and before 2003 were ER & SICU. The number of
programs with SICU rotations remained stable from 2003 to 2018 (43% vs 47%)
compared to 1.4 fold decrease in programs with ER rotations. The number of
programs with IM rotations decreased 2.5 fold from before 2003 to 2018.
Discussions: Duty hour restrictions have affected off-service rotations. A
quarter of all programs have no off-service rotations, with a decrease in ER
and IM exposure during residency. This does not reflect the breadth of
knowledge required of OB/GYNs today.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Quality & Safety, General Ob-Gyn, CREOG & APGO Annual Meeting, 2019, Student, Resident, Clerkship Director, Residency Director, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Team-Based Learning,
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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
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,
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Saving Lives: Students Enhancing Patient Health Literacy Regarding Hypertension in Pregnancy and Prenatal Aspirin
Purpose: To increase medical student’s knowledge, behavior and belief
systems regarding hypertension (HTN) in pregnancy and prenatal aspirin (PNA).
To increase patient\'s understanding regarding the complications of HTN in
pregnancy and the benefits of PNA.
Background: Prenatal aspirin (81 mg) has been recommended by ACOG
for high-risk women and women with >1 moderate risk factor. Its use reduces
the rate of preeclampsia, preterm birth, intrauterine growth restriction and
fetal death in at-risk patients. In a survey conducted at Boston Medical
Center, the incidence of hypertension in pregnancy is 30%, with only 15% of
patient having heard of PNA, demonstrating high prevalence and low patient
literacy regarding the topic.
Methods: Ob/Gyn clerkship students are instructed to educate
patients regarding: knowledge of HTN in pregnancy, warning signs of
preeclampsia, and efficacy of PNA in pregnancy. The student educational
intervention was evaluated regarding: satisfaction, knowledge, confidence, and
belief systems by surveys at the beginning and end of the clerkship. Patient
education was evaluated by pre and post intervention metrics.
Results: Student knowledge of PNA and HTN increased 35%,
confidence 45% and belief systems 14%. They gave the project a 72%
satisfaction rating. Patient’s knowledge about HTN increased 48%, warning
signs 80%, and understanding of efficacy of PNA 65%.
Discussions: Medical student health counseling increased patient knowledge
regarding HTN and PNA. By educating patients, students also increased their
knowledge and confidence in the subject. We plan to continue implementing this
QI project throughout the year to augment a departmental QI initiative and
evaluate its benefit to patients and students.
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, Interpersonal & Communication Skills, UME, Quality & Safety, Advocacy,
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Perceptions Regarding Medical Students Performing Pelvic Examinations on Anesthetized Female Patients
Purpose: The purpose of this study was to determine perceptions
regarding medical students performingpelvic examinations on anesthetized female
Background: Pelvic exams performed under anesthesia continues to
be a controversial topic, but studies looking at medical staff are lacking.
Methods: An internet based survey was distributed to OB/GYNs,
OR nurses/techs,anesthesiologists/CRNAs, and medical students at multiple
hospitals and medical schools.Demographic data were collected. Non-demographic
answers to questions were recorded on a 5-point scale. Characteristics between
the respondent groups were statistically compared usingChi-squared test for
independence and the Fisher’s Exact Test.
Results: 337surverys were completed. 72% of respondents
believed permission should be obtained from patientsprior to the performance of
EUAs by medical students on anesthetized femalepatients. 30% of respondents
believed prior consent was usually obtained. 50% believed patients would agree
to have the exams performed. 80% thought patients would be upset if an EUA by a
medical student was performed on them without their prior consent. 32% of
nurses believed medical students should be allowed to examine anesthetized
patients. Medical students were less likely to believe it was appropriate
for a student to examine a patient, there was an educational benefit, and that
patients would consent.
Discussions: Despite the perception of all OB/GYN OR team members that
consent should be obtained beforemedical students perform pelvic examinations
on anesthetized female patients, this does notusually occur. Almost 50% of
medical students would not encourage their female relatives toconsent to
medical students performing such pelvic examinations.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Patient Care, Professionalism, GME, Quality & Safety, Advocacy,
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Pain Perception in Cervical Biopsy- Variations by Patient and Provider Characteristics in an Academic Teaching Clinic
Purpose: We aim to identify factors which dependably predict patients’
experience of pain during colposcopy, and to evaluate if providers, stratified
by level of training, are capable of anticipating procedural pain.
Background: Cervical biopsy procedures, including colposcopy and
loop electrosurgical excision procedure (LEEP), are considered non-invasive
office procedures and efforts to codify their use emphasize logistics and
ability to detect disease. A significant gap exists for mitigating
psychological distress and procedural pain. Previous research suggests that
physician assessment of procedural discomfort varies by years of experience.
Methods: Patients presenting to an academic gynecology practice
for colposcopy with cervical biopsy or LEEP completed Pre- and Post-Procedure
surveys (14- and 3-item surveys, respectively), assessing demographics, past
cervical procedures, menstrual pain, and anticipated biopsy pain, among other
metrics. Post-Procedure surveys assessed a numerical level of pain experienced
during the biopsy. The health care provider (HCP) and procedural assistant were
surveyed for perceptions of patient pain. Pain scores were evaluated using a
100mm visual analog scale. Data analysis was performed using Spearman
rank correlation, and coefficients for relevant variables were calculated.
Results: 80 patients were enrolled and 62 underwent cervical
biopsy. Patients with higher anticipated pain gave higher ratings for
post-procedure pain (p=0.024). Women reporting more intense periods predicted
and experienced more procedural pain (p<0.001, p=0.058). From the provider
perspective, HCPs correctly estimated patients’ pain when compared with the
patients’ perceptions (p=0.066). However, only PGY3 and PGY4 OB/GYN residents
did so with statistical significance (p=0.014) and PGY1 and PGY2 residents
rated lower pain scores (p=0.039). Male assistants rated pain lower than
female assistants (p=0.037).
Discussions: Providers accurately estimated patients’ pain with variation
by years of training. Patient characteristics of age, anxiety, and dysmenorrhea
were reliable predictors of pain levels. Our findings suggest that
pre-procedure screening of patients may be helpful in directing pain reduction
interventions. Additionally, years of experience may provide enhanced pain
perception, suggesting future research into pain management training for junior
resident physicians and medical students.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Practice-Based Learning & Improvement, GME, CME, Quality & Safety, 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.
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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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.
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.
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
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.
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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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.
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.
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
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%.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Patient Care, Medical Knowledge, GME, Lecture, Quality & Safety, Public Health, Advocacy,
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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.
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,
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Evaluating the Rates of Visualized IUD Strings Following Immediate Post-Partum Placement by Ob/Gyn Residents
Purpose: Compare the incidence
of visualized IUD strings at follow up by mode of postpartum IUD placement by
postpartum contraception decreases maternal mortality, low birth weight,
preterm births and infant mortality. Missing strings in the setting of a
well positioned IUD are more common following postpartum placement as compared
to interval placement. This difference may be explained by variation in
residents’ techniques for placement in the postpartum setting.
retrospective chart review of 306 women receiving immediate postpartum IUD insertion
by residents was performed between July 1, 2017-February 15th, 2018.
Variables analyzed included: type of IUD, length of strings prior to placement,
method of insertion (applicator, ring-forceps, manual), and delivery
(20%) women attended postpartum follow-up between four to six weeks after
delivery. Eleven of 14 (79%) post-cesarean section and 39 of 48 (81%)
post-vaginal delivery had strings visualized. Insertion via the IUD
applicator was associated with significantly more IUD strings visualized at the
postpartum visit when compared to manual insertion (p <0.05) and ring
forceps (p <0.05). There was no difference in string visualization between
IUD types or after cutting the string to 10 cm.
Discussions: Mode of placement
affects postpartum IUD string visibility. Future research will include
developing a protocol for best practices for post-placental IUD placement to
improve string visibility at the postpartum visit. Additional research is
needed on the low postpartum follow up rate in this subset of the population.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Quality & Safety, Public Health, Contraception or Family Planning, General Ob-Gyn,
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Evaluating Patient Understanding of the “diagnosis of Pregnancy of Unknown Location”
Purpose: To evaluate health
literacy in an inner city population among a high risk group of
resident-managed patients with a diagnosis of pregnancy of unknown location.
health literacy is associated with poor reproductive health outcomes. Previous
research on patient compliance with methotrexate protocols as treatment for
ectopic pregnancy has shown poor compliance (as low as 10%). Rates of
follow up after diagnosis with pregnancy of unknown location are not well
Methods: A chart
review was performed to identify of all patients seen in an inner city hospital
with the diagnosis of pregnancy of unknown location. Patients meeting inclusion
criteria were contacted by phone to survey understanding of the rationale for
close follow up. Patients who never followed up after initial contact were
seven patients with the diagnosis of pregnancy of unknown location were
identified between January – April 2018. Twenty nine patients met
inclusion criteria and twenty agreed to participate. Only 40% of patients correctly
explained that there was a concern for ectopic pregnancy. The remaining
patients identified their diagnosis as an “abnormal pregnancy” (10%),
“miscarriage” (10%); “I don’t know” (15%), and other (25%).
Discussions: Although the patients
surveyed were compliant with follow up, nearly half of the patients showed poor
comprehension of their clinical condition. It may be that poor understanding is
a major underlying cause for noncompliance for the many patients who never
followed up. This should be evaluated in future research.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, Quality & Safety, Public Health, General Ob-Gyn,
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Developing a Culture of Continual Process Improvement: A Pilot Kaizen Event in an OB/GYN Resident Clinic
Purpose: To apply Lean Six Sigma
concepts and foster a culture of continual process improvement.
improvement is an ACGME Obstetrics and Gynecology Milestones
sub-competency. However, the 2016 CLER National Report demonstrated that most
residents have little working knowledge of basic quality improvement concepts.
In 2017, Lean Six Sigma certification was incorporated into Summa Health’s
resident education. To apply these concepts, a resident-designed pilot Kaizen
event was executed in the resident clinic.
Lean Six Sigma training began in 2017; the pilot Kaizen event was planned for
June 2018. Preparation included a brainstorming session and the creation of
interprofessional teams and project area assignments. During the half-day
event, house staff (residents and attendings) and office staff identified
workplace process inefficiencies and implemented solutions within five assigned
project areas: scheduling, patient flow, room setup, patient consent and
instrument stocking. Teams then presented their improvements to the
larger group and 22 participants completed a post-event survey.
(46%) house staff completed Yellow Belt certification prior to the event and
all rated the training “very helpful” in identifying and improving processes
during the event. Eight (72%) house and 6 (75%) office staff reported the
improvements “very positively” impacted the clinic. Seven (54%) house and 8
(100%) office staff responded that the event should be repeated at least
Discussions: Residents found Yellow
Belt training and the Kaizen event to be beneficial and have a positive
impact on daily workflow. These activities will be repeated in the future
to foster a culture of continual process improvement.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Osteopathic Faculty, Residency Director, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, Quality & Safety,
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Decreasing the incidence of hospital-acquired venous thromboembolism (VTE) through inter-disciplinary educational methods
Purpose: This study explored the
knowledge of a venous thromboembolism (VTE) prevention protocol among
residents, fellows and nurses and the impact of an educational module in an
effort to improve adherence to this protocol and subsequently decrease the
incidence of hospital-acquired VTE.
significantly contributes to morbidity and mortality in hospitalized patients.
Patients with gynecologic cancers are at high risk primarily due to malignancy,
increased age, and recent surgery and immobility. Several evidence-based
interventions are used to decrease the risk of hospital-acquired VTE commonly
leading to institutional policies. The division of Gynecologic Oncology at
University Hospitals Cleveland Medical Center standardized VTE prevention
guidelines in 2015.
included OB-GYN residents, Gynecologic Oncology fellows and nurses on the
Gynecologic Oncology floor. Participants received a fifteen question pre-test
immediately followed by an educational presentation describing the venous
thromboembolism prevention guidelines. They then received the same fifteen
question post-test. The participants were re-tested in six months to gauge
knowledge retention. The scores were compared using an unpaired T test.
were seventy-five eligible participants. The survey response rates were:
pretest 68%, post-test 35%, follow up pretest 28% and follow up posttest 21%.Of
the participants who identified their role, 62% were nurses, 33% were residents
and 5% were fellows. There was a statistically significant difference between
the test scores before and after the educational intervention during the
initial intervention and the six month follow up (p= 0.0001). During the
initial survey, the mean pre-test and post-test scores were 54.5% (95% CI
49.7-59.3) and 80.2% (95% CI 73.4-87.1) respectively. At the six month follow
up, the mean pre-test and post-test scores were 62.2% (95% CI 56.5-67.9) and
82.1% (95% CI 75.3-88.9) respectively. There was no significant difference between
the post-test scores at zero and six months (p= 0.7).
Discussions: These findings suggest
that knowledge of the VTE prevention guidelines improved following an
educational module. Further studies can elucidate the impact of this knowledge
on compliance with the VTE protocol and incidence of hospital-acquired VTE.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, GME, Quality & Safety, Gynecologic Oncology,
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Bring Back the Tubal: An Intervention to Provide Postpartum Bilateral Tubal Ligation in the Underserved Population
Purpose: Improve educational
awareness and receptiveness to the PPBTL procedure.
Background: 50% of
women requesting a PPBTL undergo the procedure. Barriers exist to obtain the
PPBTL, including lack of available operating rooms and concern for patient
regret. Half of pregnancies in the U.S. are unintended, occurring
disproportionately higher in low-income and minority populations. Children
resulting from unintended pregnancies are at risk for poor health outcomes
including low birth weight and developmental delay. Additionally, the U.S.
financial burden of unintended pregnancy accounted for approximately 21 billion
dollars in 2010.
retrospective chart review was conducted from 2015-2016 to document the
baseline prevalence of PPBTLs performed at IFMC. Educational sessions with pre-
and post-session questionnaires were conducted for departments of OB/GYN, Anesthesia,
and Nursing. Data was collected from April 2017 - April 2018 regarding patients
desiring the procedure, those completing the procedure, and reasons for
unsuccessful procedure completion. A pre-post comparison was performed to
assess the impact of the educational sessions and the overall prevalence of
multidisciplinary staff members at IFMC participated in the educational
sessions. All departments showed significant improvement in knowledge of the
PPBTL (OB/GYN p=0.0117, Anesthesia p=0.0002, Nursing p=0.0001). A baseline
prevalence of three PPBTLs were performed from 2015-2016, which increased to
fifty-six from 2017-2018. Comparing pre-post intervention, the percentage of
PPBTLs requested and ultimately performed increased from 39% to 60%.
multidisciplinary educational sessions were effective in identifying barriers
and increasing educational awareness. Overall, this resulted in increased
access to and performance of sterilization in the underserved population.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Patient Care, Professionalism, Interpersonal & Communication Skills, GME, Quality & Safety, Team-Based Learning, Advocacy, Contraception or Family Planning,
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An Interprofessional Fais Do-Do: Medical Student Field Notes on a New Integrated Practice Unit
Purpose: - To gauge medical
students’ perspectives on integrated care using an experiential learning
- To provide a clinical application of
- To inform continuous quality improvement
Medical School students attain the Basic Certificate in Quality & Safety
through the IHI Open School online course in year two of our interprofessional
integration curriculum. Recently, our institution opened a Complex Gynecology
Integrated Practice Unit (CGIPU), which also serves as an interprofessional
clinical site for students on the Women’s Health (OB/GYN) clerkship.
followed CGIPU team members and composed field notes on the provision of
high-quality, patient-centric care. They used a truncated list of the IOM
Six Aims for Healthcare on which to base their notes: Timeliness, Efficiency,
Equity, and Patient-centeredness. At the end of each clerkship block,
they submitted a group report based on individual experiences. Reports
were qualitatively analyzed to identify key questions and recommendations
emerging from their observations.
Results: 100% of
students completed individual field notes (N=50). Six group reports were
evaluated. Results revealed positive Patient-centered observations,
specifically the desire to attain patients’ goals, time allotted for visits,
and interprofessional coordination of care. Under Equity, psychosocial
determinants of health and access to care were routinely addressed.
Appointments were lengthy due to the delivery of personalized care.
Recommendations included a better balance of time (Timeliness). Efficiency
focused on technical operations including improved integration of the EHR and
facilitation of online language interpretation.
Discussions: Reports were submitted
to leadership to consider recommendations for quality improvement. The
assignment achieved its purposes.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, UME, Assessment, Quality & Safety, Problem-Based Learning,
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A Triple Aim Curriculum That Addresses Health Care Inequity: A Resident Driven Patient Centered QI Project That Improves Postpartum Care Utilization for a High Risk Population
Purpose: To describe the design
and implementation of a resident driven QI initiative which addresses the low
percentage of patients returning for a 6-week postpartum visit in a resident
postpartum period or the “fourth trimester of pregnancy” is a critical period
for women’s health and well-being. At our resident clinic (2014-2016),
only 21% of patients presented to their 6-week postpartum visits compared to
80-93% in other practices. As part of a new, mentored experiential
approach to QI education, our residents completed a QI project based on an
identified clinically relevant patient care issue.
Ob/Gyn residents (single institution) completed the IHI QI Online modules as
part of a GME supported Health Systems Science initiative focused on operationalizing
a Triple Aim targeted curriculum. Applying the Model for Improvement, the
residents designed and implemented a QI project with the aim of 100% of
postpartum patients discharged from the resident service during a 6-month
period to receive a 2-week post-discharge check-in call. The % of
discharged patients attending their 6-week postpartum visit was calculated and
compared to the % attendance 2014-16. Data analysis: independent t test,
Results: 6 months
after implementation, 97%(37/38) of patients received a 2-week check-in
call. Of those contacted, there was a 45% increase in patients who
returned for a 6-week postpartum visit (p<0.01).
Discussions: An educational
intervention can directly improve patient care. An experiential approach
to QI can facilitate knowledge application and result in improved postpartum
care utilization for high risk patients.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Systems-Based Practice & Improvement, GME, CME, UME, Quality & Safety, Problem-Based Learning,
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Resident Self-Entrustment and Expectations of Autonomy: OB > GYN?
Purpose: The goal of this study was to identify the definition and
expectations of autonomy from residents’ perspective, as well as the
self-entrustment of their surgical competencies in obstetrics (OB) and
gynecologic (GYN) procedures.
Background: Entrustment in the operating room (OR) is a two-way
street. Resident self-entrustment of their surgical competencies closely
associates with their OR training experience and granted autonomy. Some recent
studies have investigated how attending surgeons determined and entrusted
OB/GYN residents in the OR. There is little to no data, however, in examining
these issues from the resident perspective.
Methods: We conducted three focus group interviews with 20
OB/GYN residents across four post-graduate year (PGY) levels. Audio
recordings of each interview were transcribed, iteratively analyzed, and
emergent themes identified, using a framework method.
Results: A total of 123 minutes of interviews were recorded.
Eight junior residents (PGY1-2) and twelve senior residents (PGY3-4)
participated. Our data illustrated that 1) the definition of
autonomy shifted significantly throughout residency training; 2) residents demonstrated
higher expectations and self-entrustment for OB surgical procedures than for
GYN surgical procedures upon graduation; 3) case volume, modalities of OR
teaching (e.g. teaching style, attending experience, rotation site) and mutual
communication are three factors influencing resident self-entrustment of their
Discussions: Residents showed disparities in their self-entrustment and
expectations of autonomy between OB and GYN surgical procedures. Better
understanding these differences and the three influencing factors could help
programs develop a potential solution for improvement in resident entrustment
and autonomy upon graduation.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Assessment, Quality & Safety,
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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
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
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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Wellness Challenges and Burnout Contributors: A Systematic Approach to Issue Identification & Program Development
implement an institutionally-specific process to: A: Identify wellness
challenges/burnout contributors. B: Develop a systematic approach to wellness
programming prioritized by Maslow need level
Background: Addressing wellness challenges/burnout contributors (WC/BC) is critically
important to both providers and the patients they treat.
Methods: A representative task force was assembled.
Using mind-mapping, members developed a comprehensive list of WC/BC
issues and related factors. These were
then mapped by members to Maslow need levels ranging from physiologic (level 1)
to transcendence (level 8). PDs were then queried regarding wellness
programming in their residencies to generate a “menu” of
institutionally-available programming. Gaps were then identified by mapping
WC/BC issues to available PD-reported programming. Highest priority was given to program
development for WC/BC issues with lowest Maslow levels for which there was no
Results: From October, 2016-May, 2017, the task forced include 20 representatives
from 7 departments and the GME Office and included residency/fellowship PDs,
residents, and staff. Through mind-mapping work, 12 categories of WC/BC
issues and 38 related factors were identified. While all GME program directors
reported having WC/BC programming in place, the majority (57%) of this was
informal support around “healthy lifestyles”. For 34 of 38 factors (89%)
identified, no programming was reported. Notably, when mapping factors to
Maslow need level, 30 of 38 (80%) mapped to basic Maslow levels 1-4.
Program development was recommended for WC/BC factors with lowest Maslow levels
for which no institutional programming was in place.
institutionally-specific approach to identifying WC/BC issues and prioritizing
them for resource development by Maslow level was successfully implemented.
CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, GME, CME, UME, Quality & Safety, Problem-Based Learning, General Ob-Gyn,
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