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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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
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
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.
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
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.
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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Students Stuck in a Swamp? Scripting Promotes Medical Student Involvement in Obstetric & Gynecologic Care
Purpose: Characterize the effect of staff scripting on medical student
acceptance in outpatient ob-gyn clinic visits.
Background: Direct patient care is a major tributary in the river
of medical education. When patients refuse medical student involvement in their
care, students are stranded in stagnant quagmire. Review of the literature
shows that medical student refusal is a national issue not limited solely to
obstetrics and gynecology (ob-gyn) clerkships (Chang, et al, 2010; Mavis,
et al, 2006; Hartz & Beale, 2000). Written and video messages about medical
student training have been effective in furthering medical student acceptance
in clinical encounters (Buck & Littleton, 2016). Open the floodgates!
Methods: A literature review using search terms “medical
student AND refusal” was conducted to guide script composition. Medical
assistant and nursing staff implemented the script in an outpatient ob-gyn
resident clinic. The script was revised halfway through the clerkship year
based on patient and staff feedback. All ob-gyn medical students were surveyed
regarding their involvement in patient visits prior to and after script
Results: After script implementation, the percent of medical
students refused from at least one patient interaction decreased from 92% to
86%. 66% percent of our students perceived scripting as a supportive measure
for medical students, and 61% percent witnessed staff, residents, and faculty
Discussions: Data from our institution suggest that scripting improves
medical student involvement in ob-gyn patient care. Involving staff, students,
and patients on scripting revision helped foster a learning environment rich as
the Mississippi delta in which medical students can thrive.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Professionalism, Interpersonal & Communication Skills, UME, Team-Based Learning, Advocacy,
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Service-learning Wellness Initiative in the Harvard Medical School Clerkship Curriculum
Purpose: The first aim was to assess if incorporation of a
service-based initiative into the curriculum results in professional
fulfillment, principally: improved medical student feelings of compassion,
contribution, wellness, understanding of community need, and team-building of
the student class. The second aim is to report the development of this
Background: Service-learning increases student awareness of
community resources, promotes service to the community, team-building through
cooperation rather than competition, broadens cultural awareness, and fosters
wellness through hands-on contribution.
Methods: The entire class of second year clerkship students
volunteered at a local non-profit organization. Students were divided into
small groups to work at various team tasks. Following, the entire group
reconvened for teaching reflection. They were asked a value-based qualifier of
the experience. They were also asked to provide feedback as an open response.
Quantitative data were analyzed using summary statistics, Wilcoxon rank sum and
Fischer’s exact test. Content analysis was used to determine themes from the
Results: 47 students participated, 48.9% of whom were male.
Average satisfaction with the intervention was high (mean 4.26 on a 5-point
Likert scale), with no difference in satisfaction noted by gender. Positive
themes included feelings of contribution, wellness, and team-building, with 9
respondents requesting to repeat the event at regular intervals.
Discussions: It is crucial to investigate different types of wellness
interventions throughout UME. Service-based interventions are not adequately
studied and may be an important addition to the wellness program as they are a
way for students to feel connected to the community they are
CREOG & APGO Annual Meeting, 2019, Faculty, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Team-Based Learning, Public Health, General Ob-Gyn,
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Residents Express Emotional, Social and Physical Stress in the Clinical Learning Environment
Purpose: To evaluate OBGYN residents’ perceptions of personal wellness
in relation to their clinical learning environment
Background: Resident wellbeing is a significant issue affecting
our future physicians’ abilities to fulfill their training potential.
Methods: The Council on Resident Education in OBGYN (CREOG)
administered a voluntary, anonymous, six-item wellness survey. One
question asked about personal experience with mental health problems
(burnout, depression, binge drinking, eating disorders or suicide attempt) and
then provided a free text response for “other” issues. The free text
responses were reviewed and analyzed. The ACOG IRB determined this survey
exempt from review.
Results: Of 5,061 residents, 4,099 completed the question on
personal issues experienced in residency (81% RR), and 200 free text responses
were submitted. 1593 residents (32%) endorsed clinical depression.
34 (0.8%) wrote in anxiety, although this was not a formal category. The
free text responses clustered into three categories: physical health (n=56),
social concerns (n=34), and mood symptoms (n=115). Symptoms of clinical
depression comprised 5,992 responses, combining structured questions and free
text responses. 18 (0.4%) had attempted suicide, and 18 additional
residents wrote in suicide ideation or attempt, translating into almost 1% of
our residents having contemplated or tried self-harm, likely related to work
Discussions: Significant mood disorders and self-harm are under-recognized
among OBGYN residents, even as they acknowledge these symptoms. Programs
must consider formal evaluations for depression, anxiety, and suicide risk,
conduct thorough culture evaluations to ensure these symptoms are not being
normalized, and tailor their interventions to provide accessible, confidential
support services within the clinical learning environment.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, CME, Assessment, Team-Based Learning,
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P&S Partners in Pregnancy: A Longitudinal, Patient-Centered Program for Preclinical Students
Purpose: To develop a longitudinal clinical program pairing first-year
medical students with prenatal patients.
Background: Students who participate in early clinical,
longitudinal experiences report greater confidence in communication, comfort in
clinical settings, and self-esteem during transition to clerkship year.
However, few longitudinal experiences exist for preclinical students at
Columbia University Vagelos College of Physicians and Surgeons.
Methods: A retrospective needs assessment evaluating interest,
motivating factors, and perceived barriers to participation was distributed to
second-year students. In response, we developed a program pairing ten
first-year students with pregnant patients. Students partake in lectures and
accompany patients to prenatal visits. Initial perceptions about the
patient-physician relationship were assessed in both groups using the
Patient-Practitioner Orientation Scale (PPOS), with 1 indicating
“doctor-/disease-centered,” and 6 indicating “patient-centered.”
Results: 49% of students completed the needs assessment. 90%
reported that they would be at least “somewhat interested” in a longitudinal
prenatal pairing program. Motivating factors included desiring longitudinal
experience (87%), early clinical exposure (82%), and patient advocacy/community
engagement (78%). Our program was designed accordingly. All first-year students
were invited to apply; ten were accepted. At recruitment, mean student PPOS
score was 4.64 compared to 3.95 for patients.
Discussions: Students in early medical education are enthusiastic about
longitudinal patient experiences and demonstrate patient-centered mindsets.
Programs such as ours may help maintain and cultivate patient-centeredness,
with the potential to improve patient satisfaction(1) and create positive
attitudes towards medical student involvement.
E et al. Patient orientations of physicians and patients: the effect of
doctor-patient congruence of satisfaction. Patient Educ Couns 2000;
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Medical Knowledge, Professionalism, UME, Independent Study, Team-Based Learning, Advocacy, General Ob-Gyn,
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One Size Doesn’t Fit All for Wellness: Residents’ Perception of Wellness Programming
Purpose: To investigate which wellness interventions have the most meaning
for a modern cohort of OB/GYN residents.
Background: The 2017 CREOG Resident Survey found significant
associations between the learning environment and wellness. The primary
analysis indicated that PGY-1’s prioritized wellness, and that a sense of
wellness decreased with each PGY level. In order to explore whether
developmental stage influenced how wellness initiatives were perceived, we
performed a secondary analysis of the survey to determine how residents at
different PGY levels perceived wellness interventions.
Methods: A six-item survey on wellness was administered before
the 2017 CREOG exam. IRB exemption was obtained. Participation was
voluntary and anonymous, linked only to PGY level. A mixed-methods
analysis of the data was performed. Descriptive statistics were analyzed with
Microsoft Excel 2010. Mann-Whitney U tests were used to explore
differences between PGY-levels. Thematic analysis of text responses was
Results: Among the 5855 residents, 4,753 answered questions
regarding wellness programming (81% RR). Significant differences existed
between year of training and perceived effectiveness for several initiatives.
PGY1 residents valued peer mentorship (p=0.003) and strategic napping
(p<0.001) more than senior residents, while PGY3 residents emphasized
faculty mentoring (p=.005). Regardless of training level, residents
prioritized the same three activities: wellness days to address personal needs,
team-building retreats, and facilitated exercise programs.
Discussions: OBGYN residents perceive some wellness activities as valuable
throughout training, while the importance of others may vary based on resident
year. Most programs do not yet provide the wellness programs (retreats,
facilitated exercise, personal time) that OBGYN residents identify as most
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Professionalism, GME, CME, Team-Based Learning,
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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
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
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.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Medical Knowledge, GME, Simulation, Lecture, Problem-Based Learning, Team-Based Learning, Gynecologic Oncology, Minimally Invasive Surgery, Female Pelvic Medicine & Reconstructive Surgery, General Ob-Gyn,
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Magnesium Toxicity and Medical Errors: A Multidisciplinary Simulation for Debriefing an Obstetric Emergency
Purpose: To create a simulation that improves communication during
obstetric emergency and promotes a safe learning environment to debrief and
evaluate medical errors.
Background: Simulation is known to improve communication and
comfort in obstetric emergency. Little data exist regarding simulation for
enhancing expertise in debriefing and evaluating system errors.
Methods: The simulation highlights an unresponsive patient
shortly following a preterm delivery at 30 weeks gestation. The team discovers
an accidental bolus of intravenous magnesium was given instead of postpartum
oxytocin. Following conclusion of the simulation, participants were asked to
lead a debrief session. Surveys were performed to assess participant comfort
with magnesium toxicity, debriefing, evaluating a medical error, and
communication during an emergency.
Results: Participants felt the simulation was (1) a realistic
scenario that allowed practice debriefing a medical error within a large
multidisciplinary team, (2) a place to practice high acuity care and
communication, and (3) a safe place to receive and provide feedback. On
average, residents reported an increase in comfort with management of magnesium
toxicity from little comfort(2/5) tomoderate comfort(4/5). In general,
participants (90%; N=10) felt like they learned advanced management of acute
magnesium toxicity. All participants (100%; N=10) reported they would recommend
this simulation to others in their profession.
Discussions: We have designed a simple model that highlights the
importance of (1) communication during an obstetric emergency and (2)
debriefing and evaluating errors from systems perspective. This model increased
participant knowledge and comfort with magnesium toxicity and promoted a safe
culture to discuss medical errors and practice debriefing.
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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Lifting the Mask: Exploring Factors That Influence Medical Students\' Perceptions of Resident Teaching on the OB/GYN Clerkship
Purpose: To determine factors that influence medical students\'
perceptions of resident teaching on the OB/GYN rotation.
Background: The Liaison Committee on Medical Education directs
that residents “are prepared for their roles in teaching and
assessment.\" Our goal was to ascertain if medical student year and
use of pre-made teaching tools impact views of residents as teachers.
Methods: A cross-sectional survey based on the Baker Clinical
Educator Self-Assessment using a 1-5 Likert scale was given to 37 medical
students who participated in end-of-OB/GYN clerkship focus groups from October
2017-June 2018. The survey consisted of 13 questions regarding resident
teaching skills along with 2 questions regarding resident use of pre-made
teaching tools and medical student year. Unpaired t-test and
one-way ANOVA was used for analysis.
second year, eleven third year, and eight fourth year medical students completed
the survey. There was significant difference amongst the medical student
levels (p<0.01), with third year medical students rating resident teaching
skills the highest (3.55), second year medical students in the middle (2.98)
and fourth year medical students rating teaching skills the lowest
(2.55). The 12 students that had residents use pre-made teaching tools
rated resident teaching skills significantly higher than the 25 students who
did not have residents use pre-made teaching tools (3.39 vs 2.90, p < 0.01).
Discussions: Medical student year affects perception of resident
teaching. This may be due to interest in the rotation or that teaching
needs to be individualized to year of training. Resident preparedness to
teach positively influences student views of teaching skills.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Clerkship Director, Residency Director, Practice-Based Learning & Improvement, GME, UME, Team-Based Learning,
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Inter-professional OSCE Based Simulation Collaboration to Teach Obstetrics & Gynecology to Second Year Medical Students and Nursing Students
Purpose: To describe an
inter-professional workshop (IPE) utilizing simulation, OSCE and flipped
classroom to introduce 2nd year medical and nursing students to OBGYN concepts
Background: IPE has been
shown to facilitate improved patient-centered care
November 2017; students studied an online fetal heart rate (FHR) lecture; at
workshop worked in groups on clinical FHR scenarios, and presented findings for
group learning and discussions. Students rotated through three stations each
for 45 minutes as follows: 1) MFM faculty taught students on cervical dilation
using “blinded” and “open” cervical models. Students had hands-on with
obstetrical procedures such as B-Lynch Suture. 2) Students performed a
simulated vaginal delivery supervised by MFM fellow; nursing students
resuscitated newborn and gave SBAR report to medical students. 3) MFM fellow
and gynecologist faculty taught students on contraception methods while a
technician taught students IUD insertion. Students self-assessed and were
assessed by faculty using OSCE; knowledge quizzes were completed for
contraception and cervical examination accuracy.
program trained 116 (73%) medical and 51(22%) nursing students. There were no
significant differences between medical students and nursing students scores
which were respectively: IUD insertion self-assessment = 8.84 vs. 8.43; IUD
insertion faculty-assessment= 9 vs. 8; cervical examination accuracy = 13.1 vs.
12.7; contraception quiz = 9.1 vs. 9.3. Medical students
birth simulation self-assessment vs. faculty-assessment scores were 8.6 vs.
8.9, p <0.001.
Discussions: Medical and nursing
students learned OBGYN skills equally, nursing students had the opportunity to
teach medical students. Medical students were more critical of their
learning than faculty.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Simulation, Team-Based Learning, Contraception or Family Planning, General Ob-Gyn,
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Improved Team Climate and Increased Student Involvement with Interprofessional Learning on Labor and Delivery
Purpose: To evaluate the impact
of an obstetrical interprofessional learning experience for medical students on
team climate and medical student clinical involvement.
often express difficulty integrating into the obstetrical team and a desire
more clinical involvement on the unit. We hypothesized that an
obstetrical nurse-shadowing experience for students could increase student
understanding of the team’s function and that nurses who worked with students
would be more willing to advocate for student involvement in deliveries. We
planned to use the Team Climate Inventory to assess students’ inclusion in the
team, and to use the percentage of students playing a hands-on role in a
vaginal delivery to assess student clinical involvement.
baseline Team Climate Inventory was administered to students in 2015. The
nurse-shadowing day was introduced in 2016-2017 and these students also
completed the Team Climate Inventory; student T test used for analysis.
The percentages of students assisting in a vaginal delivery before and after
the intervention were compared using Fisher’s Exact Test.
response rates were 38% for control group and 42% for intervention group.
Significant improvement (p<0.05) was noted on all axes assessed by the
Team Climate Inventory following the intervention with the largest change in
Participative Safety. 64.25% of control group students assisted in a vaginal
delivery; this increased significantly to 84.65% in the intervention group
Discussions: The introduction of an
interprofessional learning exercise on Labor and Delivery was associated with
improvement in medical student assessment of team climate and with increased
involvement of students in vaginal deliveries.
CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Professionalism, Systems-Based Practice & Improvement, UME, Team-Based Learning, General Ob-Gyn,
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Impact of Resident Led Didactics on OBGYN Clerkship Shelf Scores and Student Satisfaction
Purpose: Compare NBME shelf
scores prior to and after implementation of the Wednesday lecture
series.Compare satisfaction scores of students prior to and post implementation
of Wednesday lecture series. Scores would be obtained from the Aesculapian
Society who evaluates students’ overall perceptions of clerkships
· The ACGME and LCME has designated teaching as an
accreditation standard with numerous competencies. Residents serve as clinical
teachers for medical students with studies indicating that residents spend up
to 20% of their time teaching medical students.
· In a national survey 60% of students reported that
they received their teaching from residents and fellows during their obstetrics
and gynecology clerkships.
· In 2015-2016, the department of Obstetrics &
Gynecology at Louisiana State University School of Medicine-New Orleans
implemented a new lecture series for 3rd year medical students.
· Wednesday Lectures: High yield OB/GYN topics
delivered by chief resident.
· Lectures designed to complement Team-Based Learning
· Shelf exam scores from 2011-2017 were reviewed and
compared across the training sites.
· Control Group: Baton Rouge and Lafayette based
students who do not receive the same lectures.
· Aesculapian Society Evaluations.Scores before and
after implementation were examined
· Positive correlation in resident teaching and
· Positive correlation in NBME scores and satisfaction
· Student experience and satisfaction may vary by
location based on clinical exposure and opportunity
· No standardized resident-lectures amongst all
· Future Implications: Standardized implementation
of resident led didactics. Our goal is to Implement ACGME recommended
‘Resident-as-teachers program as already established in other institutions and
improve shelf scores over the next 5 years.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, CME, Assessment, Lecture, Team-Based Learning, CREOG & APGO Annual Meeting, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Medical Knowledge, Professionalism, UME, Assessment, General Ob-Gyn,
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Group Prenatal Care in OB/GYN Residencies
Purpose: To assess exposure to
group prenatal care (GPNC) in Obstetrics and Gynecology (OB/GYN) residencies,
and resident and program director (PD) perceptions of GPNC.
prenatal care is a model of prenatal care that has been growing in popularity
for several decades, especially among midwives. However, the state of GPNC in
OB/GYN residencies nationally is unknown.
electronic survey was sent to all OB/GYN PDs; subsequent similar surveys were
sent to OB/GYN residents through responding PDs as well as program
coordinators. The authors also encouraged PDs to complete the online survey in
person during the APGO/CREOG 2018 meeting. Descriptive statistics and logistic
regression were used for data analysis.
(38%) of OB/GYN PDs responded with a geographically balanced response rate.
Most had a positive perception of GPNC (71%), 82% believe that
residencies should include GPNC training, but only 44% had been exposed
themselves previously. 467/4956 (9%) of all OB/GYN residents nationwide
responded. Again, most residents had a positive perception of GPNC (70%),
while 87% said they would like to learn more during residency but only 33% reported
exposure during residency. No demographic factor was associated with a
positive perception of GPNC.
Discussions: Most OB/GYN PD
and resident respondents have positive perceptions of GPNC ,are interested in
learning more and including training in GPNC in the residency curriculum,
yet very few are exposed to GPNC. GPNC is not commonly included in OB/GYN
residency training despite a widespread interest in this model of prenatal
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Patient Care, Practice-Based Learning & Improvement, GME, Assessment, Team-Based Learning, General Ob-Gyn,
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Faculty Perceptions of Team Based Learning
Purpose: Team Based Learning
(TBL) is an active learning strategy which replaced most of the traditional
didactic lectures in the Ob/Gyn Clerkship at the University of Kansas Medical
Center (KUMC) in 2015. Our aim of this study was to survey Ob/Gyn faculty about
their perceptions surrounding their experience. We hypothesized faculty prefer
facilitating TBL over other didactic lectures and perceive students as more
engaged during active learning activities.
recently concluded an evaluation of our TBL experience with student test
scores, knowledge retention, and learner satisfaction. We received multiple
queries regarding faculty perceptions and satisfaction. The current research on
TBL focuses on student experience, little has been published on observations of
faculty. This survey sought to characterize and clarify the faculty experience.
cross-sectional, anonymous survey about faculty experiences and satisfaction
with TBL sessions versus traditional lectures was completed by 13 Ob/Gyn
prefer teaching TBL sessions over traditional lectures (8.4 vs 7.3, on scale of
1-10, p=<0.05), TBL sessions require less preparation time (115 vs 26
minutes, p=<0.001). Faculty either strongly agreed or agreed to noticing
increased learner engagement, with one respondent stating “I think they are
excellent for education and being present (not online or on phone) during
Discussions: Faculty consider TBL a
viable and valuable learning strategy and responded they wish more teaching
sessions were in this format. Continued implementation of TBL is likely to
improve learner engagement and performance in addition to increasing faculty
satisfaction and engagement in medical student education.
CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Clerkship Coordinator, Medical Knowledge, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Team-Based Learning,
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Effect of Simulation Exercises on Medical Student Satisfaction and Performance in the Ob/Gyn Clerkship
Purpose: To evaluate the use of
structured resident-led simulation exercises in improving medical student
interest in Ob/Gyn as a specialty, satisfaction with their rotation experience,
and improvement on NBME exam sores at the end of the rotation.
students persistently rank their obstetrics and gynecology (Ob/Gyn) clerkship
experience below that of other surgical specialties, in addition to also raking
the clerkship lowest for the ability of residents to provide effective
teaching. Current research shows that clinical simulation during the Ob/Gyn
clerkship leads to increased confidence and has been shown to increase medical
students\' end of rotation oral and written examination scores.
cohort study from July 2016-June 2017 involving medical students enrolled at
the McGovern Medical School- Memorial Hermann Hospital campus for their Ob/Gyn
clerkship. Rotations were randomized by alternating intervention with
non-intervention, the intervention consisted of weekly resident-led
simulation exercises. All students were given anonymous pre-rotation and
post-rotation surveys that used a Liekart scale to analyze their opinions of
their clerkship experience. The surveys and NBME grades were then analyzed
between the two groups.
population was 71, with 38 students in the control group and 33 in the
intervention group with survey response rates of 94% and 97%
respectively. The responses of the pre and post-rotation surveys were
then analyzed using the Wilcoxon ranked sum test comparing the median
response. Overall, the intervention group had a higher median score
regarding preparedness in the clerkship (p .052) and scored better on the NBME
(P .2679). The intervention group had a lower median response to
questions regarding importance of residents’ involvement in their clerkship,
which was statistically significant (p .008).
Discussions: Results indicate that
resident-led simulation exercises may increase NBME scores and help students to
feel more prepared within the clerkship. However, this increase in
performance and preparedness does not correlate with student satisfaction or in
the student’s choice of obstetrics and gynecology as their future specialty of
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Medical Knowledge, Practice-Based Learning & Improvement, GME, Simulation, Team-Based Learning,
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Does Participation in Ob-gyn Subspecialties Improve Clerkship Clinical Scores, NBME Exam Scores, or Final Grades?
Purpose: The primary objective
is to determine if participation in subspecialty rotations during Ob/Gyn core
clerkships improves student performance as measured by National Board of
Medical Examiners (NBME) scores, clinical evaluations and final clerkship
summative grade when compared to students without focused subspecialty time.
Background: There is
limited research evaluating the effect of subspecialty rotation experience
during Ob/Gyn clerkships on student performance, however similar research in
general surgery indicates adequate medical student competency and improvements
in medical knowledge.
data was identified for 474 students during this study period. There was no
significant difference in NMBE scores or final clerkship summative grade when
comparing general track students to the subspecialty track. There was a
significant difference in the clinical evaluation scores between general track
and sub-specialty track students (p<0.002). 45 of the 474 students
pursued an Ob/Gyn residency, 75% of whom participated in a subspecialty track.
Discussions: Exposure to
subspecialty fields is not uniform during core clerkships. Our study indicates
that using core clerkship time for early subspecialty exposure does not
negatively impact student outcomes, and potentially improves clinical
CREOG & APGO Annual Meeting, 2019, Student, Clerkship Director, Clerkship Coordinator, Medical Knowledge, UME, Team-Based Learning, Gynecologic Oncology, Maternal-Fetal Medicine, General Ob-Gyn,
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Can I Get a Suggestion? Improv Training to Teach Empathy in Ob/Gyn Residents
Purpose: To examine
improvisation training on Ob/Gyn resident empathy
empathy is associated with improved patient outcomes. Empathy training is
effective in physicians, and many models exist. However, no studies have
examined whether the improvements are sustained over time. Our primary aim is
to determine whether an improv workshop is an effective tool to deliver empathy
training. Our secondary aim is to determine whether that effect is sustained
Methods: This is
a prospective study of Ob/Gyn residents. Validated empathy surveys were
administered 1 week prior to empathy training, immediately after training and 1
month later. Improv games were used in conjunction with empathy training during
the intervention. Paired t-tests and McNemar’s were used to compare statistical
differences at each post-intervention assessment compared to pre-intervention.
residents participated. Empathy scores increased immediately after training
(mean=113 vs 120, p=0.03), but were not sustained 1 month later (mean=113
vs 117, p=0.11). Residents reported that the workshop positively impacted
their delivery of care both immediately (mean=3.5 vs 4.6, p <0.001) and 1
month later (mean=3.5 vs 4.1, p=0.04).
Discussions: Using improv comedy to
delivery empathy training is associated with improved empathy scores in Ob/Gyn
residents, but this improvement gravitates back to baseline over time.
Residents report that the improv workshop was effective at improving empathy,
even up to one month later.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Interpersonal & Communication Skills, GME, Simulation, Team-Based Learning, CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Lecture, Maternal-Fetal Medicine, General Ob-Gyn,
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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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