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Pilot Study of a Condensed Communication Skills Workshop for Gynecologic Oncology Fellows

Purpose: Implement and evaluate the effectiveness of a newly condensed, previously piloted communication workshop in a cohort of gynecologic oncology (GO) fellows.

 

Background: In GO fellowship, devoting sufficient time to learn communication skills can be challenging due to the time and logistics required. A two day workshop was previously piloted at a single institution with GOs and found to be beneficial. We sought to disseminate that curriculum in a condensed form.

 

Methods: We conducted two four-hour sessions with 4 GO fellows over 4 months. Sessions consisted of a didactic in communication skills led by faculty with VitalTalk© training, followed by application with a simulated patient. Cases were developed and previously used in a two-day workshop at another institution. Fellows were surveyed prior to both sessions and after the second session.  Perceived confidence was assessed on a Likert scale (1 to 5). An improvement was defined by an increase of ≥1 in Likert score.

 

Results: All fellows reported that the educational quality of the sessions was “excellent,” that the time in between sessions was “just right,” allowing them to apply skills learned in the first session prior to the second. After both sessions, at least three of the four fellows reported an improvement in confidence in nearly 50% (10/21) of the topics (Table 1).

Table 1**

Name the key steps of delivering serious news

Bring up advance care planning

Elicit a patient’s goals of care from a patient or family member

Lead a family conference

Manage conflict that arises during a family meeting

Describe comfort-focused care

Respond to patients or family members who have not accepted the seriousness of the patient’s illness

Discuss religious or spiritual issues with a patient or family member

Counsel a patient or family member about what to expect in the dying process

Teach and mentor learners about how to facilitate delivering serious news

**Areas in which ≥75% of fellows reported an improvement in confidence (at least ≥1 increase in level of confidence)

 

Discussions: GO fellows perceived improvements in communication skills with condensed half-day training seminars.

Topics: CREOG & APGO Annual Meeting, 2019, Faculty, Medical Knowledge, Interpersonal & Communication Skills, GME, Standardized Patient, Gynecologic Oncology,

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Outcomes of a Transgender Care Training Program in Obstetrics and Gynecology Resident Education

Purpose: We sought to evaluate outcomes of an Obstetrics and Gynecology (OB/GYN) resident education program on transgender health.

 

Background: OB/GYNs are often frontline providers for the transgender community, as patients may first present to an OB/GYN with symptoms of gender dysphoria or postoperative care needs and complications. Both the American College of Obstetricians and Gynecologists (ACOG) and the Council on Resident Education in Obstetrics and Gynecology (CREOG) have developed key areas of competency pertaining to the care of transgender patients by OB/GYNS.  To date, standardized educational curriculums on these competency areas are not available.

 

Methods: Residents at our institution completed a 2.5-hour training on transgender health comprised of a standardized patient interaction, debriefing session, and didactic session led by an expert on transgender gynecological care. A 42 item pre- and post-training survey evaluated participant demographics, a validated transphobia questionnaire, medical knowledge of transgender care and preparedness to provide transgender care.

 

Results: Eighteen residents and medical students completed the training. The average pre- and post-training knowledge assessments scores significantly improved from 74.8% to 88.9%, (p<0.001). Specifically, knowledge of transgender health disparities, professional guidelines, and management of abnormal uterine bleeding all significantly improved. Baseline transphobia scores were low and did not significantly change. Residents felt more prepared to collect a transgender focused medical history, provide referrals, and access additional educational resources.

 

Discussions: Our training improved residents’ knowledge and preparedness to provide a variety of aspects of transgender care.  This training was feasible, reproducible and positively received by the resident participants.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, CME, Assessment, Standardized Patient, Advocacy, General Ob-Gyn, Sexuality,

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Oral Milestone Assessment versus Electronic Evaluation (E-Value) Milestone Assessment-Is One Better Than Another?

Purpose: To compare milestones assigned to PGY 1 and 2 Residents via an Oral Milestone Exam versus the traditional retrospective monthly electronic evaluation system to assess how they aligned. 

 

Background: Programs are tasked with implementing assessment tools to evaluate the 28 milestones. Most programs use some form of an electronic evaluation at rotation completion. The Clinical Competency Committee reviews all information for final score assignment each six month period. 

 

Methods: In 2015, we instituted an Oral Milestone examination to assign the six-month milestones and compared those scores to our retrospective monthly on-line evaluations. We evaluated PGY 1 and 2 residents in a simulated forum on milestones, which included Medical Knowledge, Patient Care, and Interpersonal /Communication Skills Competencies. All residents were given simulated patients, cases, and/or skills while each examiner was given the specific ACGME milestone assessment sheet to score. The residents were provided with immediate feedback.

 

Results: From 2015-2018, 78.4% of PGY 1 and 43% of PGY 2 residents scored higher on the real-time oral milestone exam. Additionally, in 82% of PGY 1 residents and 52% of PGY 2 residents score on the oral exam was at 0.5-1milestone level higher than the retrospective electronic monthly evaluations.

 

Discussions: Clinical Competency Committees are tasked with Milestone assignment to all residents every six months. Evaluation tools that most reflect the actual milestone completion is a mission of all programs. We set out to assess whether our electronic monthly retrospective evaluation system was mirroring the assessment performed on our residents with the real-time oral milestone exams at the end of the six month interval, just prior to submission to the ACGME.


Our data suggests discrepancy in our online retrospective milestone evaluation versus the real-time assessment of an oral exam. Not only did residents score higher in most circumstances in an oral format, but they were higher by a half-whole milestone level in the majority of the cases. It would suggest that our ability as educators to recollect the performance of a resident at an interval later than the performance may be flawed.
Programs may want to consider instituting an oral milestone examination for enhanced milestone assessment.

Topics: Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Professionalism, GME, Assessment, Simulation, Standardized Patient, General Ob-Gyn,

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Navigate Stormy Seas with Effective Simulation Training in Delivering Serious News

 

Purpose: To evaluate the change in obstetrics and gynecology (OB/GYN) resident’s self-confidence in delivering serious news after a communication simulation workshop.

 

Background: Although OB/GYN residents regularly disclose serious news to patients, formal training on best communication practices is lacking. Using the VitalTalk framework, we developed and evaluated a workshop for delivering serious news in OB/GYN.

 

Methods: OB/GYN residents attended a 3-hour small group workshop, with didactic and drills (1 hour) followed by practice delivering serious news with simulated patients (2 hours). Change in self-confidence pre- and post-workshop was measured using a 5-point Likert scale (1 is lowest, 5 is highest) and was compared using Wilcoxon signed rank test (alpha = 0.05).

 

Results: Twenty-five residents completed the training.  Residents agreed that delivering serious news requires a discrete set of skills (89%) and is a procedure all residents should learn (96%). Following the workshop, residents expressed greater confidence explaining medical information (p<0.01), identifying and responding to emotion cues (p<0.01), delivering serious news (p<0.001), and teaching learners about how to facilitate delivering serious news (p<0.001). Residents felt that it taught them skills they plan to use (96%), that simulated practice prepared them better than clinical experience alone (92%), that observing other residents improved their own communication skills (80%) and that they would recommend the workshop (96%).

 

Discussions: This workshop was well received and associated with improvement in self-confidence in delivering serious news. Longer-term observation is needed to see if this confidence persists and translates into improved patient care.

Topics: CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Patient Care, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, CME, UME, Simulation, Standardized Patient, Maternal-Fetal Medicine, General Ob-Gyn,

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Development of an Effective Comprehensive Curriculum Regarding the Patient and Provider Experience of Stillbirth

Purpose: To develop and evaluate a comprehensive curriculum about stillbirth focused on both the patient and the provider experience with this difficult topic.

 

Background: Pilot data from our institution showed that OB/GYN residents felt ill prepared to care for patients with stillbirth, and that training about the patient experience of stillbirth was impactful but emotionally distressing. We sought to develop a comprehensive stillbirth curriculum that included knowledge, communication skills, and emotional domains.

 

Methods: A four-part curriculum was created including: 1.  Medical management, 2. A stillbirth panel discussion with patients/families, 3. Simulation training in delivering serious news, and 4. Workshop on resiliency. OB/GYN residents completed pre- and post-testing for each session. Five-point Likert scales were compared using the Wilcoxon signed rank test (alpha = 0.05).

 

Results: All 28 residents participated in parts of the curriculum, with 85% attending two or more sessions.  Following the curriculum, we found statistically significant self-reported improvements in multiple aspects of the stillbirth training: general knowledge (p<0.01), appropriate tests to order (p<0.05), interpretation of placental pathology (p<0.01), genetic evaluation (p<0.01), comfort conveying sympathy (p<0.05), expressing emotion (p<0.01), and confidence in delivering serious news (p<0.001).  In the resiliency workshop, residents shared ideas about how faculty can support them during difficult clinical situations.

 

Discussions: A comprehensive stillbirth curriculum which addressed the cognitive, emotional, and skills aspects of this topic was well received and effective. Long-term data is needed to evaluate whether these improvements persist and can enhance resident satisfaction with other challenging topics within OB/GYN.

 

Topics: CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, CME, UME, Simulation, Lecture, Standardized Patient, Maternal-Fetal Medicine, General Ob-Gyn,

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“On-the-Go” Training: Downloadable Modules to Educate Students in Care for Sexual Assault Survivors

Purpose: An innovative approach to train students to provide trauma-informed care for survivors of sexual assault (SA) through independent learning.

 

Background: All medical providers encounter patients who have experienced SA, and can have significant impact on survivors; long-term health. Training medical students to provide appropriate, trauma-informed care is lacking in most medical school sexual health curricula. Appealing to the millennial learner, we developed three downloadable video/podcast-style modules for on-the-go use.

 

Methods: We worked with interdisciplinary experts in trauma-informed care to develop modules on interviewing patients with recent and distant history of SA and acute medical management. The study group was a cohort of interested medical students. Students completed pre- and post-tests assessing knowledge, and a paired t-test evaluated overall change in knowledge test scores. Students responded to a Lichert-style question on self-reported comfort caring for this population, and responses were analyzed with a chi-square test.

 

Results: Thirty-two medical students spanning all years beta-tested the modules and 97% completed the study. Overall, student knowledge scores improved 20% (95% CI=16%-23%, p<0.0001). After completing the curriculum, students reported a significantly improved comfort level (p=0.0250). Students enjoyed the learning format and reported the modules enhanced their education (72-88%) and were appropriate for their education level (69-97%). 

 

Discussions: Following completion of modules, students demonstrated improved knowledge and reported increased confidence in caring for this patient population. These modules seek to empower students to step beyond screening in their care for patients with sexual trauma history. Future directions include publication of existing modules and expansion of the module library.

Topics: CREOG & APGO Annual Meeting, 2018, Student, Clerkship Director, Clerkship Coordinator, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, UME, Lecture, Independent Study, Standardized Patient, Advocacy, General Ob-Gyn, Sexuality,

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CAST: Cultural Awareness Simulation Training: A Novel Way to Train Learners in Cultural Competency

Objective/Background: Cultural competency is the ability of providers to provide

health care in the context of the patient’s cultural, social, and linguistic needs. It is a skill that all medical

students, residents, and attending physicians must have to provide their patients with high quality care.

But how can you teach such an important and abstract concept? We introduce CAST as a novel way of

training your learners in cultural competency. With CAST your learners will become more effective

communicators with patients of diverse cultural backgrounds, making them better physicians.

Workshop agenda: The workshop will begin with a brief presentation on “CAST” and the process

involved including the creation of supplementary materials such as a communication evaluation

checklist and pre-/post-simulation surveys. An abbreviated role-play of the simulation with Haitian

Creole patients will be presented. In small groups, participants will create their own simulation and

brainstorm how this method can be applied at their parent institution. Participants will also practice

using our supplementary materials. Large group discussion will follow to highlight the strategies that

were identified in small group.

Interactive Component: Small group collaboration to create cultural competency simulation pertinent to

participants’ parent institute.

Take home product: Communication evaluation form, pre/post-simulation surveys, and methods for

creating a cultural competence simulation at participants’ parent institution.

Key words: Cultural Competency, Simulation, Faculty Development

Topics: General Ob-Gyn, Standardized Patient, Simulation, Assessment, UME, Interpersonal & Communication Skills, Systems-Based Practice & Improvement, Professionalism, Patient Care, Clerkship Coordinator, Clerkship Director, Faculty, 2019, Faculty Development Seminar,

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Creating engaging educational tools with limited resources

Round Table Text:
Objective/Background: This discussion will provide participants with information and examples
using video to present topics to medical students in an efficient and engaging manner. While
educational videos are common, poor selection of topics and/or poor execution hinder the
effectiveness of such resources.
Round Table Agenda: In this interactive discussion, we will review benefits of video media and
discuss well suited topics for this platform. Common pitfalls encountered when creating video
media resources for students and strategies to help overcome barriers will be reviewed. Finally,
we will go through examples of videos and discuss aspects that make these effective.

Topics: General Ob-Gyn, Standardized Patient, Problem-Based Learning, Simulation, Virtual Patient, UME, Interpersonal & Communication Skills, Medical Knowledge, Residency Director, Clerkship Director, Faculty, 2018, Faculty Development Seminar,

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Revitalizing ‘Pore’ Assessment Practices – Valid and Reliable Assessment Tools in Medical Education

George Miller gave educational framework a face lift in 1990 when he published his
pyramid for assessment of clinical competence, which helps to frame the difference between cognition
and behavior. Beyond this, medical educators must consider how the method of assessment may
change with varying levels of clinical competence. Objective, reliable and valid tools are needed, and
expected, to adequately assess the contemporary medical student – no matter their level of
competence. Educators may be asked to purify or create multiple-choice quizzes, written or oral
examinations, standardized patient exams or clinical performance checklists. How do we know what
constitutes a reliable multiple-choice exam? How do we write pertinent standardized patient scenarios?
How do we test a rubric for reliability and validity? Basic standards for these types of assessments will
be presented to equip participants to scour & refresh an existing assessment or to clarify & refine a
completely new tool. Join us for a cleanse & purge approach to valid, reliable, understandable and
useful assessment tools!
After a brief overview & history of assessment in medical education, the format will alternate between
presentation of best practices for creating common assessment tools and active participation.
There will be creation, critique, guided use as well as small group practice using examples of several
common assessment tools.
Participants will leave with training as well as a basic understanding of assessment tools and how to
create them. References and resources will be supplied these skills can be refined at home institutions.

Topics: Standardized Patient, Simulation, Assessment, UME, GME, Medical Knowledge, Patient Care, Residency Director, Osteopathic Faculty, Clerkship Director, Faculty, 2018, Faculty Development Seminar,

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Mirror, Mirror on the Wall: the Effect of a Longitudinal Simulation Curriculum on Student Clerkship Satisfaction

Background: Third-year clerkship evaluations at our institution indicate dissatisfaction with hands-on experience and faculty continuity.  We developed a longitudinal simulation curriculum where faculty members were paired with small student groups.

 

Methods: For the 2015-2016 academic year, our three-part simulation curriculum incorporated GTA (Gynecologic Teaching Associate) exams, suturing with BOSS-platforms, and vaginal delivery with the Noelle™ Birth Simulator.  The same preceptor facilitated each session.

 

Results: Students (n=144) used a 5-point Likert scale to score the sessions’ usefulness for their learning.   GTA and vaginal delivery sessions received mean scores of 4.00±0.8 and 2.86±1.08.  Comments conveyed dissatisfaction with the “reality” of Noelle™. Suturing mean scores were similar; however, comments indicated that these were particularly valued sessions.  While the majority of students (>60%) found each simulation exercise to be “mostly useful” to “essential;” this increased to over 70% for suturing. Twenty-five percent (36/144) reported that their longitudinal preceptor was helpful outside of the scheduled sessions.  Overall faculty involvement scores remained similar to the previous year. Twenty-one percent of students reported that they only shadowed in the clinical setting, which was similar to the previous year.

 

Discussions: The majority of students found this simulation curriculum useful.  However, having a longitudinal program did not translate into improved clerkship evaluations of overall attending involvement in teaching and student involvement in active patient care.   Students desire authentic clinical experiences and meaningful faculty interaction.  Simulation and structured faculty interactions alone cannot satisfy this need.  

 

Keywords: Curriculum Development/Evaluation, Instructional Materials/Methods, Simulation, Teaching Skills

Topics: CREOG & APGO Annual Meeting, 2017, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Interpersonal & Communication Skills, UME, Simulation, Standardized Patient,

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Effectiveness of Simulation Learning for Management of Breech Presentation

Background: In order to reduce the high rate of primary Cesarean sections in the United States, the American Congress of Obstetrics and Gynecology has suggested multiple measures physicians may utilize in the management of labor.  One of these recommendations is to increase the use of external cephalic version for managing breech presentations at term, and another suggests that vaginal breech delivery is a reasonable option for carefully selected patients. As these deliveries are rare, a simulation-based curriculum was designed for physicians to learn and practice skills in managing breech deliveries. 

 

Methods: A curriculum was designed using standardized patient consultations and skills workshops for 3 obstetrical skills modules. In the first module, learners counseled a standardized patient and performed an external cephalic version on a task-trainer. In the second module, learners counseled a patient for vaginal breech delivery who refuses Cesarean section.  In the third module, learners practiced a vaginal breech delivery and the use of Piper Forceps on a birthing manikin.   Thirteen obstetrics and gynecology residents from two academic institutions participated. Outcome measures were pre/post-knowledge tests, confidence-rating surveys and validated performance assessments. Scores were compared using statistical analysis. 

 

Results: All residents achieved competency by the end of the program based on performance assessments. Knowledge test score improvements were approaching significance (+9.03%, p=0.09). On a 5-point Likert scale, resident confidence levels showed significant improvement for each module with the greatest improvements in their confidence to use Piper’s forceps (+2.27, p=0.0001), perform a vaginal breech delivery (+1.78, p=0.0001), counsel a patient on her options for vaginal breech delivery (+1.5, p=0.0001), consent a patient for an external cephalic version (+0.64, p=0.0001) and perform an external cephalic version (+1.25, p=0.0018). 

 

Discussions: This simulation-based curriculum for the management of breech deliveries was effective at improving the knowledge, skills and attitudes of Obstetrics and Gynecology residents. This program offers tools for reducing the incidence of Cesarean sections due to breech presentation.

 

Keywords: Assessment, Curriculum Development/Evaluation, Evaluation of Clinical Performance, Instructional Materials/Methods, Simulation

Topics: CREOG & APGO Annual Meeting, 2017, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, CME, Assessment, Simulation, Standardized Patient,

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Educating Medical Students to Deliver Bad News in Obstetrics: Is There a Role for Didactic Lecture?

Background: Breaking bad news (BBN) is a necessary, disturbing and not uncommon duty for practicing physicians.  Yet physicians report inadequate training in the skill and educators have little evidence-based guidance for developing a BBN curriculum.

                         

Methods: In 2011-2012 a prospective randomized trial was performed to assess the impact of didactic lecture on student competence and comfort in BBN in a simulated obstetric setting.  After informed consent, 51 medical students were randomized to either receive or not receive didactic instruction prior to simulating disclosure of fetal death.  Student performance was assessed from multiple perspectives: student surveys, simulated patients assessment, and independent video review by three blinded professionals.

 

Results: While no improvement in student comfort was demonstrated after a didactic lecture, there was a significant improvement in knowledge (p=0.009).  Correspondingly, the simulated patients’ evaluations demonstrated a small to medium effect size in the students ability to impart knowledge and information to the patient (-0.37) and to provide an appropriate summary and follow up (-0.43).  Video review indicated a significant improvement in student ability to assess the patient perception of their clinical situation and to obtain an invitation prior to giving bad news in the lecture group, compared to the control (p=.002). Video assessment score showed a medium effect size overall in delivery of bad news (-0.52)

 

Discussions: Didactic lecture is effective in improving students’ knowledge and competence in delivering bad news in a complex environment like obstetrics.  

 

Keywords: Communication Skills, Curriculum Development/Evaluation, Instructional Materials/Methods, Professionalism

Topics: CREOG & APGO Annual Meeting, 2017, Faculty, Clerkship Director, Patient Care, Professionalism, Interpersonal & Communication Skills, UME, Lecture, Standardized Patient,

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Cesarean Section Surgical Competency Operating Room Evaluation (CS-SCORE) Use as Assessment Tool Has a Learning Curve

Background: We had faculty all agree to a standarad procedure of performing a cesarean delivery (CD)  based on latest literature review. A CD was then video taped and recorded. Also, we adopted the Cesarean section surgical competency operating room evaluation (CS-SCORE) from the O-SCORE described in literature. The control group was those interns who learnt theCD procedure by traditional methods which included memorizing the steps & using simulation models. The video group watched a video of CD being performed along with the traditional methods. Our objective was to determine whether using a video of CD as an alternative teaching method and the CS-SCORE as an evaluation tool will help intern performance.

                                                                                   

Methods: An evidenced based video of a primary CD was made. The 2013-14 interns comprised the controls. The interns starting July, 2014 and then July, 2015, were shown the CD video along with the traditional methods (video group). The CS-SCORE was completed by the faculty present at surgery. The video group was compared to the control. The CS-SCORE included preop preparation of patient, each step of the surgery and immediate post op care. Each of these was compared using Man Whitney test and student t test. P value

 

Results: Eight interns from UTMB and 6 from UCSD were included each year. 112 CS-SCORE were completed for control group and 167 for video group.  Intern survey indicated that video improved understanding and learning in a low stress environment. Comparing CS-SCORE forms revealed better performance of the controls for most of the CD steps than the video group in 2014-15 group, but equally good performance in 2015-16 video group.

 

Discussions: Introducing CS-SCORE form may be a useful tool for feedback provided discussion of the completed form is done with resident .• There may be a learning curve to use of CS-SCORE forms for those providing the assessment. Video of CD may be a useful tool for teaching CD to resident interns

 

Keywords: Assessment, Communication Skills, Evaluation of Clinical Performance, Evidence Based Practice, Faculty Development, Feedback Evaluation, Milestones, Teaching Skills, Video Creation

Topics: CREOG & APGO Annual Meeting, 2017, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, CME, Assessment, Simulation, Quality & Safety, Standardized Patient, Faculty Development, Maternal-Fetal Medicine, General Ob-Gyn,

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Assessment of Resident Milestone Competency and Competency Domain Achievement with an Observed Structured Clinical Exam

Background: Competency-based, evaluation tools in many of the ACGME milestone areas for OB/GYN are lacking, so we proposed administering an OSCE to supplement existing evaluation tools. Four ACGME milestones (pelvic mass, surgical skills, stress urinary incontinence, and preconception care) were selected for evaluation based on 1) the paucity of existing data on our resident learners on which to base milestone achievement or progression in these areas, and 2) perceived difficulty in obtaining consistent and robust individual assessment of these milestones during routine clinical care.

 

Methods:

Content experts developed OSCE scenarios and assessment tools locally. Each assessment tool evaluated multiple clinical skills for a milestone, and these skills were assigned a milestone domain corresponding to the ACGME milestone descriptors. The scenarios and assessment tools were internally and externally validated using the Delphi technique. Learners achieved competency for the OSCE and each individual scenario if they demonstrated knowledge of 70% or greater of the skills for that scenario. Additionally, learners passed milestone domains if they performed greater than - 2 standard deviations of the mean for their peer group. Data was analyzed using descriptive statistics.

 

Results: 36 residents performed the OSCE in the spring of 2016, comprised of 4 separate clinical scenarios. Two independent faculty evaluated each resident on each scenario. Overall, 72.2% of residents were able to achieve competency of all 4 scenarios, the majority being senior residents, compared with junior level residents (77.8% versus 66.7%, respectively). On average, junior learners failed to pass more milestone domains than senior learners (3.6 versus 2.2).

 

Discussions: Evaluation of OB/GYN ACGME milestone competencies and competency domains can be performed successfully through an OSCE. Individual learners can be compared to their group peers to highlight competency domains that require attention, and overall competency can be assessed and used to supplement existing evaluation tools in assigning milestone progression.

 

Keywords: Assessment, Communication Skills, Evaluation of Clinical Performance, Feedback Evaluation, Instructional Materials/Methods, Professionalism

Topics: CREOG & APGO Annual Meeting, 2017, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Assessment, Standardized Patient,

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Creating Wells in Deserts of Opportunity: Developing Simulation Modules to Enhance the Student Experience

Workshop APGO Fac Dev Seminar
Précis: Participants will collaborate with others in small-group settings to create a simulation module by
defining goals and objectives, building a tangible model or video for simulation, and creating an
assessment tool aimed at improving medical student clinical skills.
Workshop Text: Objective: To deliver a workshop that provides participants with the ideas, the skills,
and the resources to develop a simulation curriculum to enhance the clinical training of third year
medical students. Background: In the ever-evolving landscape of medical education, the medical-legal
presence continues to expand, subsequently leaving medical students with fewer opportunities for
direct patient care. Students are being marginalized to clinical observers. To prevent legally imposed
limitations from compromising student learning, medical schools can provide simulated methods of
education to supplement direct patient interaction. Agenda: The workshop will start with a 10 minute
introduction by facilitators outlining the development of simulation modules and curricula from idea to
implementation. This will be followed by a 10 minute large group discussion, where participants will
discuss opportunities for simulated learning and successful and unsuccessful experiences with
simulation. The majority of the workshop will be a 45 minute, small group, interactive activity, and
conclude with a 10 minute debrief.Interactive component: During the 45 minute small group,
participants will create a simulation model or instructional video (from a random collection of household
items on their table, i.e. balloons, Playdoh, etc.) that represents a common clinical scenario encountered
in Ob/Gyn. Each group will identify key curriculum components including goals, objectives, the
simulated activity, and an assessment tool such as a checklist. Product: Participants will leave with
ideas, skills, and a toolkit with links to curricula, instructions, and videos on how to establish a successful
student simulation curriculum.

Topics: Faculty Development Seminar, 2017, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, UME, Virtual Patient, Simulation, Problem-Based Learning, Standardized Patient, Team-Based Learning, General Ob-Gyn,

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Charting the Course: Designing a 4th Year OBGYN Curriculum using Entrustable Professional Activities

Workshop APGO Fac Dev Seminar
Précis: In this highly interactive workshop, attendees will develop fourth year electives in womens
health and map them to specific Entrustable Professional Activities. Participants will leave this workshop
with a ready-to-use course outline and tools for successful implementation.
Workshop Text: Objective/Background: With the national move toward competency-based medical
education outlined by the ACGME Milestones and the AAMC Core Entrustable Professional Activities
(EPAs), medical schools and residency programs are developing curricula to meet these needs. Fourth
year bootcamps in Obstetrics/Gynecology can serve as an excellent opportunity to ensure that students
are meeting competency-based educational goals prior to residency. We will demonstrate how to map
bootcamp topics to the professional goals of the EPAs.Workshop Agenda: In this highly interactive
workshop, we will present an overview of the EPA framework, and review the current state of
preparation-for-residency courses within the fourth year curriculum. Working in small groups, attendees
will develop a fourth year OBGYN elective curriculum appropriate for their home institutions that
incorporates specific EPAs. Participants will be tasked with creating appropriate assessment tools
demonstrating achievement of these EPAs. Participants will discuss their curriculum maps and
assessment tools with the larger group. We will conclude with a review of best practices, including the
highly successful OBGYN Bootcamp at Harvard Medical School.Interactive Component: Participants will
have multiple opportunities for engagement with the presenters and fellow attendees including
discussing the merits of the EPA framework and how the fourth year curriculum can be further
enhanced. The small group activity will give attendees a hands-on opportunity to map a fourth year
OBGYN clinical elective to the EPAs.Take home Product: A ready-to-implement course outline with
associated EPAs and assessment tools that can be applied as well as a toolbox of examples of successful
courses.

Topics: Faculty Development Seminar, 2017, Clerkship Director, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, UME, Assessment, Standardized Patient,

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Water in the Desert: An Elective Course to Improve Medical Student Competency in Intimate Partner Violence

Roundtable APGO Fac Dev Seminar
Précis: This interactive roundtable discussion will propose structure for an Ob/Gyn elective on
intimate partner violence. This elective will empower students to provide more empathetic,
comprehensive, and safe care for patients experiencing violence at home.
Round Table Text: Competency in the care of patients experiencing intimate partner violence
(IPV) is an indispensable part of any medical education, particularly so for those pursuing
Obstetrics and Gynecology. This interactive roundtable discussion will outline a fourth year
elective course for students interested in expanding their knowledge of IPV. This proposed
elective will center on teaching students to function independently, with increased awareness
of available resources and techniques to foster a safe environment for those patients struggling
with violence and abuse at home.

Topics: Faculty Development Seminar, 2017, Faculty, Clerkship Director, Patient Care, Professionalism, Practice-Based Learning & Improvement, UME, Standardized Patient, Public Health, Advocacy,

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Teaching Humanistic Care for Women with Limited English Proficiency Using Standardized Patients

Roundtable: APGO Fac Dev Seminar 2017
Précis: Explore the factors and barriers at play in how students learn to care for patients with limited
English proficiency (LEP). Learn how to develop and integrate a curriculum for humanistic care of
patients with LEP using role play and standardized patients.
Round Table Text: Women with limited English proficiency (LEP) frequently receive suboptimal
medical care placing them at added risk for adverse events. Medical students often have little
formal training on this topic since it is thought that much of this learning happens in the clinical
setting from their preceptors. The literature shows that students experience a hidden
curriculum that does not support humanistic care of LEP patients. Educators must emphasize
the importance of humanistic care of women with LEP and integrate it into the formal
curriculum. This can be done effectively by using standardized patients in the OSCE.

Topics: Standardized Patient, Assessment, UME, Interpersonal & Communication Skills, Systems-Based Practice & Improvement, Professionalism, Faculty, 2017, Faculty Development Seminar,

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Impact of a Resident-as-teachers Objective Structured Teaching Examination (OSTE) on Medical Student Vaginal Delivery Learning Outcomes

Background: One of the most common procedures learned by medical students on the OBGYN clerkship is normal vaginal delivery. Currently, students learn this procedure at the bedside, from residents who have had no formal instruction in optimal teaching methods. 

 

Methods: A quasi-experimental time-sequential static group study. Obstetrics and Gynecology (OBGYN) residents were exposed to a RaT curriculum consisting of a didactic session, an OSTE using a standardized student and NOELLE birthing simulator. Third-year medical students on the 6-week OBGYN clerkship logged all vaginal delivery experiences during academic years preceeding and following the RaT curriculum, recording their level of involvement in each of 16 procedural steps (Likert-type scale: 1=Observed; 2=Assisted; 3=Performed with assistance; 4=Performed without assistance). The level of involvement ratings for each procedural step, were compared pre and post RaT intervention, using the chi-square test . P < .05 was considered statistically significant.

 

Results: A total of 240 and 204 delivery experiences, were recorded by students pre and post the RaT curriculum, respectively. Following the curriculum, a significantly greater proportion of student delivery experiences occurred with chief residents (PGY-4) than prior to the curriculum (19.6% vs. 4.6%, p < .01). Mean student level of involvement scores for setting up the delivery table, patient draping, postpartum hemorrhage preventive measures, and inspection of the cervix/vagina/perinuem were significantly higher post-curriculum, as compared to pre (2.53 vs 2.02, p < .01; 2.15 vs 1.87, p < .01; 2.56 vs 2.36, p=.01; 2.25 vs 2.05, p < .01).

 

Discussions: A residents-as-teachers vaginal delivery OSTE may increase engagement of PGY-4 residents in student teaching and the level of student involvement in certain aspects of actual vaginal delivery experiences.

 

Keywords: OSTE, Simulation, Obstetrics


Topics: CREOG & APGO Annual Meeting, 2016, Resident, Faculty, Clerkship Director, Osteopathic Faculty, Residency Director, Patient Care, GME, UME, Simulation, Standardized Patient, Faculty Development,

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Gender Differences in Medical Student Performance of Simulated Vaginal Deliveries and Cervical Exams

Background: Studies have demonstrated that female student perform better on the OB/GYN clerkship, possibly due to women not wanting male trainees to participate in their care.  Simulation may circumvent this problem as males and females can participate equally.  We investigated the effects of gender and simulation training on student performance during an objective structured clinical examination (OSCE) to determine if a gender difference exists and whether simulation training mitigates this difference.

 

Methods: During the 3rd year OB/GYN clerkship students were assigned 1:1 to receive vaginal delivery or cervical exam training with each group serving as the simulation naïve control group for the other skill.  Their performance was assessed during an end of clerkship OSCE.  The number of real-life vaginal deliveries and cervical exams performed during the clerkship were also recorded.  The effects of gender and its interactions with training were assessed using a 2-way ANOVA.

 

Results: Thirty male and 28 female students received cervical exam training.  Thirty five male and 19 female students received vaginal delivery training.  There was no effect of gender or an interaction with training and gender save for the number of real-life vaginal deliveries performed.  Female vaginal delivery students performed significantly more real-life deliveries than male vaginal delivery students.

 

Discussions: Although prior retrospective studies demonstrated that female students perform better on several aspects of the OB/GYN clerkship, our prospective study of OSCE performance did not show any gender differences in performance.

 

Keywords: Student GenderSimulation


Topics: CREOG & APGO Annual Meeting, 2016, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Interpersonal & Communication Skills, GME, UME, Assessment, Simulation, Standardized Patient, General Ob-Gyn,

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