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Too Many Learners? Do Students Belong in Resident Continuity Clinics?

Purpose: Determine the prevalence of medical students in OBGYN resident continuity clinics and describe effects on the learning environment when students and residents work together in this setting.

 

Background: Patient continuity is an ACGME requirement often fulfilled through a resident run continuity clinic. It’s unknown how frequently students rotate in these clinics, or how multiple levels of learners influence each other.
 

 

Methods: We surveyed OBGYN program managers using a national listserv. Resident and student surveys were based on a Likert scale and sent to all OBGYN residents and students that rotated at our institution from 2016-2018.

 

Results: Program managers responded from 45 programs and 75.6% scheduled students in resident continuity clinics. Our response rates were 79/116(68.1%) for students and 21/24(87.5%) for residents. A one-sample Wilcoxon signed rank test was used to test the hypothesis that the typical response on the five-level Likert scale was \"Agree\" or \"Strongly Agree.\" Of medical students, 88.6% stated that they agreed or strongly agreed they enjoyed working with residents (p<0.001) and 60.8% stated they agreed or strongly agreed residents were effective teachers (p<0.001). Among residents, 52.4% agreed or strongly agreed that they enjoyed working with students (p<0.001). However, 61.9% said they agreed or strongly agreed they were too busy to be effective teachers (p<0.001).

 

Discussions: Many institutions have students rotate in resident continuity clinics. Residents and students have positive views regarding their interactions. Although students were satisfied, residents expressed concerns about their ability to be effective teachers given clinical demands. Our results highlight the importance of developing resident teaching skills.

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

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Testosterone Supplementation in Women with Diminished Ovarian Reserve

Purpose: To evaluate the efficacy of transdermal testosterone as an adjuvant to the standard IVF protocol to improve outcomes in women with diminished ovarian reserve (DOR). 

 

Background: Women with DOR have extremely low pregnancy rates after IVF cycles, and there are currently few treatment options available. Testosterone supplementation may improve ovarian response to stimulation via enhanced folliculogenesis. 

 

Methods: This retrospective cohort study analyzed 83 IVF cycles based on inclusion criteria of age < 42 and diagnosis of DOR (basal FSH > 10, AMH < 1, antral follicle count < 6, or history of poor response [< 4 follicles]). Cycles in the control group were carried out using the standard IVF protocol while cycles in the treatment group involved the addition of transdermal testosterone prior to ovarian stimulation. Four primary outcomes were evaluated: total number of oocytes retrieved, number of mature oocytes retrieved, number of embryos generated, and pregnancy potential of the embryos.  

 

Results: Pretreatment with transdermal testosterone had no impact on the total number of eggs retrieved after ovarian stimulation. Testosterone had a negative impact of the number of mature oocytes retrieved, but had no impact on the number of embryos generated from those oocytes. Pregnancy rates between the treatment and control groups were no different per embryo transfer, but were lower per cycle initiation with testosterone therapy.

 

Discussions: Within this study population, retrospective analysis of testosterone therapy revealed no improvement in IVF outcomes. A randomized controlled trial is recommended to further investigate this association. 

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Medical Knowledge, GME, CME, Problem-Based Learning, Team-Based Learning, Reproductive Endocrinology & Infertility,

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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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Perioperative Complications Curriculum for the OB/GYN Resident: A Pilot Study

Purpose: To develop and implement a perioperative complications curriculum.

 

Background: ACGME program requirements and milestones include recognizing and managing perioperative complications.

 

Methods: Residents, Fellows, and Faculty were sent a needs assessment survey, addressing satisfaction with baseline perioperative complications curriculum and preferences for development of new curricula.  Additionally, Residents completed a knowledge pretest.  Over four weeks, Residents received weekly emails through the Qualtrics software program linking to topic-specific materials, including interactive, online case-based modules.  A post-implementation survey was distributed to assess Resident satisfaction with programming and to retest knowledge. 

 

Results: With 75% (21/28) of Residents and 47% (40/86) Fellows/Faculty completing the needs assessment survey, 95% (20/21) of Residents and 90% (36/40) Fellows/Faculty reported dissatisfaction with baseline curriculum.

The Resident pretest mean score was 72% (40-90%, SD = 15).

 

Interactive, online case-based modules were developed for topics including ureteral injury, bowel injury, vaginal cuff dehiscence, and bladder injury.  Curriculum materials were successfully distributed on a weekly basis to all Resident learners, as confirmed through the web-based software program.

Resident module completion rates were 50%, 36%, 29%, and 18% for weeks 1-4, respectively.

Eighteen percent of Residents completed the post-implementation survey, with 100% reporting satisfaction with the online case-based modular curriculum.  Knowledge post-test mean score was 84% (SD = 15).

 

Discussions: A needs assessment confirmed poor satisfaction with baseline perioperative complications curriculum.  Web-based materials were developed and distributed weekly to all Residents who successfully accessed the 4 developed modules.  While post-survey responses were few, 100% of responders reported satisfaction with the developed curriculum.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, Practice-Based Learning & Improvement, GME, Assessment, Independent Study, Problem-Based Learning, General Ob-Gyn,

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OB/GYN Resident Education and Experience with Reproductive Justice

 

Purpose: To understand OB/GYN resident experience with reproductive justice.

 

Background: Reproductive justice (RJ) is defined as: the right to have a child, the right to not have a child, the right to parent the children we have, and the right to control our our birthing and contraceptive options. Despite its relevance to OB/GYN residency milestones, such as patient-centered care, patient advocacy, and informed consent, there is currently no formalized RJ education in residency training.

 

Methods: We distributed a web-based survey to U.S. OB/GYN residents to better understand educational and clinical experiences with RJ. Participants were asked to share clinical experiences with reproductive injustices. Qualitative data were coded using content analysis and quantitative data were analyzed using descriptive statistics.

 

Results: We received 358 responses from OB/GYN residents, representing 67 U.S. residency programs.  48% of respondents had not received RJ education during their training. OB/GYN residents reported a variety of clinical experiences with reproductive justice issues; of the 156 cases shared, common themes included fertility treatment access, care of marginalized populations, abortion care, and informed consent. Seventy-seven percent of respondents were interested in receiving further RJ training and 96% of residents felt that they would benefit from training.

 

Discussions: OB/GYN resident experiences with reproductive injustices are widespread and residents desires additional education. Our results reveal an opportunity to incorporate these shared clinical experiences into an innovative RJ curriculum design where residents learn from each other’s diverse clinical experiences while also applying milestones.      

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Patient Care, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, UME, Problem-Based Learning, Public Health, Advocacy, Contraception or Family Planning,

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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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Join the Club: Integration of the CREOG Journal Club Curriculum Improves OBGYN Residents Statistical Literacy

 

Purpose: To evaluate the impact on resident comprehension of biostatistics and research methodology after restructuring a residency journal club based on the CREOG journal club curriculum.

 

Background: Studies reveal dismal resident performance on statistical literacy evaluations. However, little is known regarding OBGYN residents’ ability to interpret research methodology and results and how these abilities are impacted by the integration of evidence-based medicine principles into journal club curricula.

 

Methods: A pre-/post-intervention study of 22 OBGYN residents at a single institution was conducted to evaluate the impact of integrating the new curriculum (intervention). Participants were administered a survey comprised of 3 sections: a questionnaire in which residents ranked their perceived ability to analyze research literature, a previously validated fifteen question epidemiological/biostatistical knowledge tool, and five questions assessing the curriculum changes. Analysis was performed using Chi-square test, Wilcoxon rank sum test, and paired t-test.

 

Results: The overall mean percentage correct on statistical knowledge and interpretation of results pre-intervention was 36.6% versus 67.3% (p<0.0001) post-intervention. Higher pre-intervention scores were associated with prior biostatistics training (45.2% vs 32.9%; p=.001); however, post-intervention, scores were equivalent (66.9% vs 69.4%; p=0.753). Residents (90.9%) preferred the restructured journal club, and 19/22 (86.3%) residents report their desire to continue participating in this journal club format post-training.

 

Discussions: Significant improvement in residents’ biostatistics knowledge, with resultant increased confidence in their ability to interpret clinical research results, was a demonstrated outcome of the implementation of the CREOG journal club format. Residency programs can provide more effective biostatistics training by incorporating this curriculum.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Practice-Based Learning & Improvement, GME, CME, Assessment, Problem-Based Learning,

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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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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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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 Intervention to Improve CREOG Scores

Purpose: To examine the effect of an educational intervention on OB/GYN CREOG in-training exam (ITE) scores

 

Background: Recent reports have correlated performance on the ITE to passing the qualifying board exam (QBE). Residents at risk for failing may benefit from an educational intervention to increase their chance of successfully passing their QBE.

 

Methods: A retrospective pretest/posttest paired subject intervention study was conducted. Residents selected for inclusion were those with an ITE score of < 200 on their most recent attempt. The educational intervention was a four hour test taking strategy workshop completed two months prior to the ITE. Validation of proper implementation of the method was verified with follow up performance reports. Following completion of the intervention, the next ITE score was obtained and recorded. The statistical analysis was completed for non-parametric matched pairs with Wilcoxon Signed Rank testing with alpha set at 0.05.

 

Results: 21 PGY-3 and 4 residents met inclusion criteria for enrollment. The mean ITE baseline score was 192.4. Following the educational intervention, the mean ITE score was 212.4. The mean difference between groups was 19.9 points + 2.29 (p<0.001). All but one resident demonstrated improvement in all subjects. All of the residents subsequently passed their QBE. 

 

Discussions: Our findings suggest that this particular test taking strategy augments CREOG ITE scores by 20 points in residents who score below 200. This pilot study demonstrates that a concentrated two month effort can lead to significant improvements for residents at risk of failing their qualifying board exam in OB/GYN.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Systems-Based Practice & Improvement, CME, Assessment, Problem-Based Learning,

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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 approach

 - To provide a clinical application of interprofessional learning

 - To inform continuous quality improvement

 

Background: Dell 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.

 

Methods: Students 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.

Topics: 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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ADAPT: A Novel On-line Simulation Game That Promotes Knowledge of Maternal and Fetal Physiology Among Medical Students

Purpose: To evaluate participation, satisfaction and knowledge acquisition with ADAPT, a novel on-line simulation game designed to teach maternal and fetal physiology to medical students.

 

Background: Gaming is a useful tool for engaging learners in subjects that prove time intensive, contain unique concepts, terminology, or are difficult to recall, such as anatomy and physiology. Gaming in medical education is in its infancy and data regarding its effectiveness are lacking.

Results: A total of 27 (28%) 2nd year medical students participated and completed pre/post-game surveys.  Average knowledge score significantly increased after game play (pre 76% +/- 13%; post 87% +/- 9%; p=0.001).  Students also subjectively felt their knowledge improved with 70% reporting improved knowledge and 33% improved ability to manage pre-eclampsia.  The majority (82%) would recommend this method of learning to a colleague.

 

Discussions: The addition of ADAPT to traditional lecture both objectively and subjectively improved knowledge of pregnancy physiology.  Although the majority felt it improved knowledge and learning, the low levels of voluntary participation suggest that this format may be less familiar or immediately appealing to students. 

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Residency Director, GME, Independent Study, Problem-Based Learning, General Ob-Gyn,

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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 obstetrics clinic.

 

Background: The 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.

 

Methods: 12 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, P<0.05

 

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.  

Topics: 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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Wellness Challenges and Burnout Contributors: A Systematic Approach to Issue Identification & Program Development

Purpose: To 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 programming available.

 

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.

 

Discussions: An institutionally-specific approach to identifying WC/BC issues and prioritizing them for resource development by Maslow level was successfully implemented.

Topics: 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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Do Obgyn Residents and the CCC Reach the Same Competency Conclusions? A Comparison of Resident versus Faculty Milestone Assessments

Purpose: Our objective was to compare resident self-assessments to CCC evaluations within the milestone framework.

 

Background: Resident progress across 28 milestones are evaluated biannually by a clinical competency committee (CCC).  We sought to determine the correlation in milestone assessment between the CCC and individual resident’s self assessment.

 

Methods: Retrospective study that compares resident self assessment of milestone competency to that of the CCC.  Milestone assessment differences were calculated by subtracting the resident score from the faculty score.  A negative value indicates that the CCC evaluated residents at a lower level than the resident’s self assessment.  Kruskal Wallis test was used to identify differences between self-evaluations and corresponding CCC evaluations for each competency.  Dunn’s post hoc test was used to determine specific differences.  Major disparities were defined as a mean disparity > 0.5 in either direction.  The association between assessment disparity and PGY year was analyzed using non parametric chisquare. P

 

Results: 15 residents participated.  Overall, 32%(129/409) of the time residents and CCC were in agreement.  The global median assessment difference was significant [-0.20(-0.5-0.5), P<0.003] suggesting residents evaluated themselves at a higher level than the CCC did. 19% evaluations had a mean overall assessment difference > -0.5 (residents assessed at a higher level than CCC), whereas 8% had a difference >0.5.  Positive self-evaluations were more common for medical knowledge and patient care.  There was no association between PGY year and CCC agreement.

 

Discussions: Ob/Gyn residents within our program trended toward perceiving a greater level of patient care and medical knowledge and underestimated their competency in PBLI, SBP and ICS.  Understanding these differences will help PDs at their biannual progress meetings with residents.

Topics: CREOG & APGO Annual Meeting, 2018, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Assessment, Problem-Based Learning, General Ob-Gyn,

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Surfing into intern year, and the patient care calls

During this round table participants will acquire necessary skills and tools to

implement a straightforward workshop that uses small groups to guide fourth year students

through discussion of commonly encountered scenarios of intern year. Using case-based

scenarios faculty or resident facilitators can lead a small group of fourth year students through

management of common complications encountered on call. Participants will leave with

example cases and ideas for their own scenarios.

Topics: Faculty Development Seminar, 2019, Clerkship Director, Residency Director, Patient Care, Medical Knowledge, Practice-Based Learning & Improvement, UME, Problem-Based Learning,

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Health Equity: A Toolkit for Medical Educators

Objective/Background:

In 2003, the Institute of Medicine (IOM) published Unequal Treatment: Confronting Racial and Ethnic

Disparities in Health Care, which provided evidence that racial and ethnic minorities receive lower

quality healthcare. Two associated factors were social determinants of health and unconscious bias. The

LCME and ACGME have mandated educational curricula that educate future physicians in providing

culturally relevant care and promoting healthy equity.

Workshop Agenda: In this interactive workshop, the learners will identify social determinants of health

through case-base learning. They willl take an implicit aptitude test (IAT) to understand unconscious

bias. They will be given tools so they can adapt the workshop in their own institution.

Interactive Component: Participants will: 1. Be introduced to the diversity toolkit for medical educators

(10 min). 2. Separate into small groups to review cases and identify examples of social determinants of

health and unconscious bias in the cases (20 min). 3. Report back findings to group and create list of

social determinants of health and biases (15 min). 4. Participate in an IAT (10 min). 5. Discuss results (10

min). 6. Review applications and lessons learned. (10 min).

Take Home Product:

Participants will take home a facilitators guide on how to run the case-based workshop to help learners

identify social determinants of health and unconscious bias.

Keywords:

unconscious bias, social determinants of health, health equity

Topics: Faculty Development Seminar, 2019, Faculty, Clerkship Director, Residency Director, Patient Care, Professionalism, Interpersonal & Communication Skills, GME, UME, Lecture, Problem-Based Learning, Public Health, Advocacy, General Ob-Gyn,

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Empowering Faculty and Residents to Engage OB/GYN Clerkship Students: Tools to Improve Learner–Focused Procedural Teaching

Objective/background: The fast-paced clinical environments of the Operating Room

and Labor & Delivery units provide a potentially challenging environment for both teaching and learning.

Faculty and residents need to feel empowered with tools they can utilized to engage students at any

level of learning. Engaged and empowered teachers help students feel welcome and supported in the

learning environment.

Workshop agenda: 15-20 minutes review of models and tools for procedural teaching, including the \\\"BID method,\\\" the use of procedural didactic scripts, and milestone-based learner checklists for common

surgical cases. Three 5-10 minute breakouts and subsequent 5 minutes of group sharing of findings for

three of methods covered. 5-10 minutes for final review and questions.

Interactive component: Small group breakouts utilizing specific methods to address sample learner

scenarios, or scenarios from participants\\\' own experiences.

Take-home product: Pocket cards for: (1) BID model cards, (2) procedure didactic script cards, and (3)

milestone-based learner checklist cards.

Key words: Procedural teaching, clerkship learning environment, faculty development

Topics: Problem-Based Learning, UME, GME, Practice-Based Learning & Improvement, Interpersonal & Communication Skills, Systems-Based Practice & Improvement, Residency Director, Clerkship Director, Faculty, Resident, 2019, Faculty Development Seminar, Team-Based Learning,

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Hacking Health Education: An Open Source Makeover for the Healthcare Curriculum

As medical educators seek out innovative ways to engage learners, there are increasing
electronic resources available – videos, podcasts, presentation slide sets, and journal articles. As one
busy educator creates new content, another may be inadvertently doing the same thing at a different
institution. Such duplicated effort can be both frustrating and limiting.
Leveraging lessons learned in other industries, we can encourage educational collaboration across
institutional and regional boundaries. In this workshop, we will apply open-source principles in medical
education using readily available web-based tools. Participants will convert their own slide set
presentation into an online module complete with references, attachments, and optional audio and
video that can be accessed anywhere.

Topics: Team-Based Learning, Problem-Based Learning, Independent Study, UME, CME, GME, Interpersonal & Communication Skills, Systems-Based Practice & Improvement, Residency Director, Osteopathic Faculty, Clerkship Director, Faculty, 2018, Faculty Development Seminar,

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