Training Residents to Place Immediate Postpartum LARC: An Update Among U.S. Residency Programs
Purpose: To survey U.S. Obstetrics and Gynecology (Ob/Gyn) Residency
Programs on immediate postpartum (IP) long-acting reversible contraception
(LARC) training and challenges.
Background: In 2016, the American College of Obstetricians and
Gynecologists (ACOG) released a committee opinion supporting IP LARC. Growing
evidence describes provider/hospital barriers which hinder IP LARC provision.
We hypothesize similar difficulties have prevented programs from implementing
Methods: We distributed an electronic survey addressing IP LARC
training to 273 U.S. Accredited Council for Graduate Medical Education (ACGME)
Ob/Gyn Residency Program Directors from the 2017-2018 Academic Year. Data
analysis was performed with chi-square and Fisher’s exact test.
Results: Of 86 programs that participated, residents were
trained in the immediate postpartum period to place implants in 54 programs
(63%) and to place intrauterine devices (IUDs) in 52 programs (60%).
2015, only 20% of the programs were training their residents to place IP IUDs.
Thirty-one percent of eligible programs initiated training in 2017. The
majority of programs focused training interns (98%). Patient/provider
convenience motivated 46% of programs to offer IP LARC and compliance motivated
The two barriers
most frequently encountered, regardless of program training status, were
problems with billing and compensation for services (61%) and the pharmacy
that reported primarily seeing patients with insurance, either private or
Medicaid, were more likely to have IP IUD training compared to programs seeing
mostly indigent/uninsured populations (p<0.05).
Discussions: IP LARC training has increased since the ACOG Committee
Opinion was published, however many programs are still facing challenges with
implementation, affecting resident training.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Systems-Based Practice & Improvement, GME, Public Health, Advocacy, Contraception or Family Planning,
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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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Remote, Off-site Abortion Training: Experiences of Obstetrics and Gynecology Residents at an Academic Program
Purpose: To describe the experiences of obstetrics and gynecology
residents regarding a local compared to a remote, off-site family planning (FP)
Background: The Accreditation Council for Graduate Medical
Education (ACGME) requires that obstetrics and gynecology residency programs
provide access to abortion training. Residents at our institution
had the option of such training at a local, free-standing abortion clinic until
2013. This training was then replaced by a rotation at a remote,
free-standing abortion clinic three hours away.
Methods: We surveyed graduated obstetrics and gynecology
residents who trained at our institution from 2009-2017. The survey contained
both closed-ended and open-ended questions about graduates’ experiences with FP
training. We asked about respondent’s assessment of the rotation’s
educational value and support of its integration into the residency curriculum.
We assessed predictors of FP rotation participation with Fisher’s exact
Results: Of the 32 eligible graduates surveyed, we received 21
complete responses (67%). Overall, 13 (62%) respondents participated in
the FP rotation. Ten respondents trained when the local rotation was
available and six of them would have been interested in a remote
rotation. Of the 11 respondents who trained when the remote rotation was
available, 8 participated and all 8 described the rotation as having high
educational value. Almost all respondents strongly supported integration
of an FP rotation into the curriculum (19/21). Relationship status,
having children, and current practice type were not associated with FP rotation
Discussions: Trainees in obstetrics and gynecology value access to
abortion training, even if the training is off-site and remote.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Residency Director, Residency Coordinator, Practice-Based Learning & Improvement, GME, Public Health, Advocacy, Contraception or Family Planning,
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Professionalism Training in the Global Setting: Program at Ayder Hospital and Mekele University in Ethiopia
Purpose: Using the current partnership between University of Illinois
in Chicago, Illinois (UIC) and Ayder Hospital/Mekele University in Mekele,
Ethiopia (Ayder), this study evaluated the effectiveness of professionalism
training for medical students and resident trainees at Ayder.
Background: Threats to professionalism in medicine have led to
more universal teaching of professionalism to trainees and practicing
physicians. Currently, professionalism is listed by the ACGME as one of the 6
general clinical competencies. Many programs that include group sessions
and standardized patients have been implemented in American institutions,
although little research has been directed towards professionalism training in
a global health setting. This study aimed to determine the effect of a
professionalism training at Ayder.
Methods: Participants in a professionalism and communication
training were offered participation in a pre- and post-test survey. The survey
focused on the perception and function of professionalism in the medical
workplace, and included quantitative and qualitative data. The pre- and
post-test surveys were conducted prior to and at completion of the training.
Results: A convenience sample of medical students and resident
trainees at Ayder participated in the pre- and post-test surveys. The training
had a positive effect on the perception of professionalism and identified
opportunities for behavioral improvement.
Discussions: We saw that the professional training was an effective tool
for implementing professionalism into medical education curricula in this
global health setting. However, further research regarding the long term impact
and ability to implement clinical competencies into global health settings will
help determine the plausibility of repeating such a study in other sites.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, Simulation, Global Health, Public Health,
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OB/GYN Resident Education and Experience with Reproductive Justice
Purpose: To understand OB/GYN resident experience with reproductive
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.
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.
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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Improving Tetanus, Diphtheria, Pertussis Vaccination Rates in an Academic Center Through Resident-driven Education
Purpose: To improve rates of
prenatal Tetanus, Diphtheria, Pertussis (Tdap) vaccination for clinic patients
in an academic training center.
United States is experiencing a resurgence of pertussis, which can cause
serious complications for infants, especially within the first six months of
life. To maximize maternal antibody response to Tdap and antibody transfer to
the newborn, vaccination between 27-36 weeks of gestation is recommended.
pre-post survey study design was used to evaluate OBGYN residents at the
University of Tennessee during the 2017-2018 academic year. The primary outcome
was Tdap vaccination rate. Secondary outcomes were resident-reported Tdap
counseling and resident understanding of the appropriate gestational age for
administration. The following educational methods were utilized: resident-lead
lecture, provider handouts, English and Spanish patient education posters
throughout the clinic. Direct comparison of pre and post-surveys was used to
Tdap vaccinations were given in the four months prior to pre-survey
administration (0.33 vaccines/resident). Following the Tdap educational
program, forty-three vaccinations were given in four months (2.86
vaccines/resident). Pre-surveys indicated eleven residents (73%) provided Tdap
counseling, while post-surveys revealed fifteen residents (100%) provided
counseling. On pre-surveys, the majority of residents (33%) incorrectly
answered that Tdap was indicated between 27 weeks gestation until delivery. In
post-surveys, thirteen residents (87%) correctly answered that Tdap was
indicated between 27-36 weeks gestation.
Discussions: Tdap vaccination rate
increased by 767% after implementation of the educational tools. Additionally,
resident-driven counseling about Tdap increased by 36% and resident
understanding of appropriate gestational age for vaccine administration
improved by 225%.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Patient Care, Medical Knowledge, GME, Lecture, Quality & Safety, Public Health, Advocacy,
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Family Planning Training at Catholic and Other Faith-based Obstetrics and Gynecology Programs
Purpose: The objective of this
study was to determine the current paradigm of forceps assisted vaginal
delivery (FAVD) training across the United States (U.S.) amongst OBGYN
national FAVD rates decline and primary cesarean rates continue to be high, we
must be aware of resident interest, training, and skill acquisition in
FAVD. There is a current paucity of literature on FAVD training
Methods: A survey
was created and disseminated on the internet and to OBGYN residency program
directors for distribution to current OBGYN residents from March to June 2018.
Geographic regions were determined using Census Bureau-designated regions.
survey was completed by 434 OBGYN residents (8.5% of 5,061 ACGME residency
positions) with representation from all U.S. regions. Of postgraduate year
(PGY)-4 respondents, 71% participated in ≤10 FAVDs, with only 20.2% with
>20 FAVDs. Of all residents, 40% expressed a desire to learn FAVD, with
54.6% completing FAVD simulation training. While 46% of resident stated that
they would like to perform both FAVD and VAVD once in practice, only 13%
expressed confidence in performing FAVD independently. Residents from the
Midwest are most likely to have completed >20 FAVD at 18%, compared to 0%,
5.7% and 11.3% of residents from the Northeast, West and South, respectively
Discussions: Residents are motivated
to learn FAVD and would like to have the skill to perform them independently.
Our study demonstrates that current trainees are not obtaining adequate
experience, irrespective of geographical region. Current OBGYN residency
training programs should implement simulation and real-time training of
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, GME, Assessment, Public Health, Contraception or Family Planning,
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Evaluating the Rates of Visualized IUD Strings Following Immediate Post-Partum Placement by Ob/Gyn Residents
Purpose: Compare the incidence
of visualized IUD strings at follow up by mode of postpartum IUD placement by
postpartum contraception decreases maternal mortality, low birth weight,
preterm births and infant mortality. Missing strings in the setting of a
well positioned IUD are more common following postpartum placement as compared
to interval placement. This difference may be explained by variation in
residents’ techniques for placement in the postpartum setting.
retrospective chart review of 306 women receiving immediate postpartum IUD insertion
by residents was performed between July 1, 2017-February 15th, 2018.
Variables analyzed included: type of IUD, length of strings prior to placement,
method of insertion (applicator, ring-forceps, manual), and delivery
(20%) women attended postpartum follow-up between four to six weeks after
delivery. Eleven of 14 (79%) post-cesarean section and 39 of 48 (81%)
post-vaginal delivery had strings visualized. Insertion via the IUD
applicator was associated with significantly more IUD strings visualized at the
postpartum visit when compared to manual insertion (p <0.05) and ring
forceps (p <0.05). There was no difference in string visualization between
IUD types or after cutting the string to 10 cm.
Discussions: Mode of placement
affects postpartum IUD string visibility. Future research will include
developing a protocol for best practices for post-placental IUD placement to
improve string visibility at the postpartum visit. Additional research is
needed on the low postpartum follow up rate in this subset of the population.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Quality & Safety, Public Health, Contraception or Family Planning, General Ob-Gyn,
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Evaluating Patient Understanding of the “diagnosis of Pregnancy of Unknown Location”
Purpose: To evaluate health
literacy in an inner city population among a high risk group of
resident-managed patients with a diagnosis of pregnancy of unknown location.
health literacy is associated with poor reproductive health outcomes. Previous
research on patient compliance with methotrexate protocols as treatment for
ectopic pregnancy has shown poor compliance (as low as 10%). Rates of
follow up after diagnosis with pregnancy of unknown location are not well
Methods: A chart
review was performed to identify of all patients seen in an inner city hospital
with the diagnosis of pregnancy of unknown location. Patients meeting inclusion
criteria were contacted by phone to survey understanding of the rationale for
close follow up. Patients who never followed up after initial contact were
seven patients with the diagnosis of pregnancy of unknown location were
identified between January – April 2018. Twenty nine patients met
inclusion criteria and twenty agreed to participate. Only 40% of patients correctly
explained that there was a concern for ectopic pregnancy. The remaining
patients identified their diagnosis as an “abnormal pregnancy” (10%),
“miscarriage” (10%); “I don’t know” (15%), and other (25%).
Discussions: Although the patients
surveyed were compliant with follow up, nearly half of the patients showed poor
comprehension of their clinical condition. It may be that poor understanding is
a major underlying cause for noncompliance for the many patients who never
followed up. This should be evaluated in future research.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, Quality & Safety, Public Health, General Ob-Gyn,
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Enhancing Breastfeeding in Rural Tennessee Through Education
Purpose: To promote
breastfeeding education and increase rate of exclusive postpartum
breast-feeding to 10% in Rural Tennessee.
provides many physical and emotional benefits to both the mother and baby. It
is physiologically normal for mothers and children. Providing education about
breastfeeding during pregnancy can help keep patients informed and increase
breastfeeding rates postpartum.
selected patients who never breastfed for this study. After signing the consent
form at their initial obstetric visit, patients received education about
lactation in the form of discussion, brochures, CD-ROMs, and flash drives
during pregnancy, delivery, and during the postpartum period. Patients
completed a survey during their initial obstetric about their prior knowledge
of breastfeeding advantages, as well as their intention to breast feed. During
the postpartum period, patients filled a survey about their satisfaction of the
information they received, and their breastfeeding intention and success.
analyzed 141 antepartum and postpartum patients. Antepartum survey showed 84.5%
wanted to breast feed and 82.5% knew the benefits of breast feeding. Postpartum
survey showed 83.2% and 91% indicated that they received adequate information
about lactation during pregnancy and delivery, respectively. The survey showed
that 64.9% intended to breastfeed within the first 12 months; 35.1% (p value
< 0.001) breastfed up to 6 weeks.
Discussions: In rural Tennessee,
providing breastfeeding knowledge throughout pregnancy, during delivery, and
postpartum for obstetrics patients helped motivate them to breastfeed. This
healthy approach increased from the State of Tennessee goal of 10% to 35.1%
during the postpartum period.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Patient Care, Medical Knowledge, CME, Public Health, Advocacy, General Ob-Gyn,
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Attitudes Regarding the Effect of the New 24 Work Hour Extension During the ObGyn Clerkship
Purpose: To survey 3rd/4th
year medical students, ObGyn residents, and faculty on the perceived effects of
24-hour call expansion to the 3rd year ObGyn Clerkship.
ACGME expanded intern call to 24 continuous work hours to
improve resident education by allowing interns to more fully participate as
healthcare team members. Therefore, this presented an
opportunity for 24-hour call expansion to the ObGyn Clerkship for the same
Monkey anonymously surveyed all ObGyn faculty, residents, and 3rd/4th year
medical students at West Virginia University on five statements using
a six-point Likert scale:
1. Medical student education
will be enhanced by the 24-hour call expansion on the ObGyn Clerkship.
2. 24-hour call will
enhance patient continuity with less missed educational oportunities.
3. 24-hour call
improves medical student\'s ability to be a part of the medical team.
4. 24-hour call better
reflects the ObGyn lifestyle.
5. A more accurate
representation of the ObGyn lifestyle with 24-hour call will allow medical
students to better decide whether to pursue an ObGyn career.
group\'s highest percent response is given for the five statements.
1. Faculty-56% strongly agree,
Residents-45% slightly agree, 3rd year students- 41% moderately agree, 4th
year students-40% strongly disagree.
2. Faculty-56% strongly agree,
Residents-36% slightly agree, 3rd year students-28% moderately agree, 4th year
students-33% strongly disagree.
3. Faculty-56% strongly agree,
Residents-45% slightly agree, 3rd year students-31% moderately agree, 4th year
students-33% strongly disagree.
4. Faculty-56% strongly agree,
Residents-36% strongly agree and 36% moderately agree, 3rd year students-44%
moderately agree, 4th year students-31% slightly agree.
5. 56% of faculty strongly
agree, 36% of residents moderately agree, 34% of 3rd year students moderately
agree, 29% of 4th year students slightly agree.
Discussions: The majority agreed
that 24-hour call would enhance medical student education, allow for increased
patient continuity, and improve the student’s ability to be part of the medical
team. 4th year medical students did not follow this trend with the highest
percentage choosing strongly disgree. All groups agreed that 24-hour call
better reflects the ObGyn lifestyle and would provide a more accurate
representation for students when deciding whether to pursue it as a career.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, GME, UME, Team-Based Learning, Public Health, Advocacy,
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Addressing Patient Fears in Perinatal Substance Use Treatment
Purpose: To inform obstetricians
of potential barriers to engagement in perinatal substance use treatment, as
reported by patients in a comprehensive program.
use disorder in pregnancy diagnoses have rapidly increased, 127% from 1998 to
2011. Comprehensive perinatal substance use treatment including
medication-assisted treatment (MAT) is recommended to reduce risks for the
mother-baby dyad: however, access to this treatment remains limited. While OUD
is a pervasive perinatal health issue, Ob/Gyns may lack awareness of their
patients’ needs and concerns related to it.
qualitative study combined semi-structured interviews and
participant-observation with patients in a comprehensive perinatal substance
use treatment program, in a largely rural Appalachian region. Sampling was
opportunistic and purposive; all data were analyzed using modified Grounded
MAT patients participated in prenatal and/or postpartum interviews, and were
observed (along with a larger cohort in care during the four-month study
period) in the clinical setting. Participants described the importance of
receiving supportive care in a non-judgmental clinical setting, in contrast
with past experiences of stigmatizing treatment. Many participants reported
concerns about social services involvement with the current pregnancy or
existing children, as a factor influencing their comfort seeking substance use
treatment during pregnancy.
Discussions: Concerns about the
external consequences of substance use treatment shape women’s experience
seeking clinical care. Clinicians addressing patient concerns about social
services involvement and a non-judgmental approach overall facilitate
engagement with care. With the increase of OUD in pregnancy, obstetric faculty
benefit from understanding patient perspectives on barriers to care.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, GME, CME, Public Health, Advocacy, General Ob-Gyn,
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RAD Times in the Big Easy: Race, Access, and Diversity in Abortion Training
Purpose: To explore residents’ interest in doing abortions with a
focus on ethnic diversity.
Background: Abortion training is critical to increase access for
the 39% of US women who live in the 90% of counties with no abortion care.
Racial/ethnic minority physicians are more likely than white physicians to care
for poor and minority patients and practice in underserved
areas.1 We explored racial and ethnic differences in residents’
interest in providing abortions in ob/gyn, the most racially diverse ACGME
1. Marrast LM, Zallman L, Woolhandler S, Bor
DH, McCormick D. JAMA Intern Med 2014;174:289–91.
Methods: Using Ryan Residency Program post-rotation survey data
collected in 2015-2018, we assessed intention to provide abortion and training
participation by resident race/ethnicity.
Results: The majority of residents (658, 79%) completed
surveys. Respondents were: 412(65%) white, 50(8%) black, 27(4%)
Hispanic/Latino, 118(19%) Asian, and 24(4%) other. Overall, 57% intended to
provide abortion for all indications and 82% for pregnancy complications.
The proportions that planned to provide abortions by race/ethnicity were: 70%
of Asian, 63% of Latino, 54% of white and 48% of black. While in bivariate
analysis Asians were more likely than whites to intend provision (p 0.003),
there were no difference by race/ethnicity when controlling for religion and
abortion attitudes, which were both associated with intention (p<0.05).
There was also no difference in training participation by race/ethnicity.
Discussions: The majority of residents overall planned to include abortion
in their practice. Increasing resident diversity may close the abortion access
gap in the US by providing care in underserved areas.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, UME, Public Health, Contraception or Family Planning,
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Multidisciplinary Severe Maternal Morbidity Reviews Can Teach the Clinical Learning Environment Review Focus Areas of Patient Safety and Quality
Purpose: To describe
a resident focused multidisciplinary severe maternal morbidity (SMM) review
Background: The Joint Commission defined SMM as peri-partum blood transfusion of 4
units or admission to ICU and recommends multidisciplinary reviews to determine
opportunities for improvement in care
Methods: An ongoing process detects cases of SMM with root-cause-analysis performed
if case qualifies as a sentinel event. Data is extract and presented quarterly
to, a multidisciplinary committee to determine contributory factors,
opportunities to alter outcome, best practices and recommendations.
Results: Forty-five SMM cases were reviewed from 1/15 to 6/17 by residents 67%,
fellows 9%, nurses 7%, and MFM faculty 17%. Opportunities to alter care were
determined to be strong in 9% and possible in 62%. System/provider could alter outcome in 53% while the patient
could have altered outcome in 33% of cases.
Outcomes could have been altered by contraception/sterilization in 13%,
patient compliance 11%, early prenatal care 20%, referral/consultations 9%,
improved documentation 7%, early recognition 33%, team communication 4% and
management 31%. Good practices recognized included multidisciplinary
teamwork/communication 60%, evidence-based response 36%, timely recognition
24%, documentation 20%, quality obstetric care 22%, timely referral 13%, expertise
care 9%, and patient-centered-care 7%. Strong opportunity to alter outcome was
present with hypertensive crisis (p=0.026). Significant opportunities to alter
outcomes were: preterm SMM cases by contraception/sterilization (p=0.036);
patient compliance in Medicaid insured (p=0.01) and younger women (p=0.04).
Transfusions were recognized for the good practice of timely recognition
involvement in SMM reviews can determine care improvement opportunities and
provide training on safety and quality.
CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Quality & Safety, Public Health, Maternal-Fetal Medicine,
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Assessment of a Sexual Health Curriculum for High School Students Delivered by OBGYN Residents
purpose of the project was to build a curriculum for high school studentson
sexual health including reproduction, contraception, pregnancy and sexually
trasmitted infections. This curriculum was delivered to the students by the SIU
OBGYN residents. We evaluated the knowledge and attitudes of students,
knowledge, skills and attitudes of the residents focussing on what their
perceptions of the students.
Background: The teenage pregnancy and sexually transmitted infection rates for teens
in the Sangamon County are higher than nantional averages. The residents expressed an interest in
reaching out to schools. High school
health teachers were contacted and overwhelmingly agreed to have the residents
participate in health classes about reproductive health.
Methods: We built a curriculum based on ACOG materials and best practices for
reproductive health. Needs assessments
to measure knowledge and attidtudes were given to a sample of high school
students on reproductive topics. Another
assessment was given to residents to gage skills in teaching as well as
attitudes towards teen. Assessments of
knowledge after the sessions were given to the students. Teachers were asked to rate the sessions and
provide feedback. Residents completed a
Results: Students have large gaps in reproductive knowledge but have the perception
they knonwlegable. Accurate knowledge improved. Teaches overwhelmingly were
satisfied with the material presented and the format. Residents had high satisfaction rates for
this activity and better perceptions of students.
effectively administered a reproductive health care curriculum to high school
students that was informative, well received and changed attitudes of students,
teachers and residents.
CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, GME, Public Health, Contraception or Family Planning, Pediatric & Adolescent Gynecology, General Ob-Gyn, Sexuality,
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Abortion Practice After Routine Training: A Prospective Cohort Study
explore Ryan Program graduates; post-residency practice in abortion care.
Background: The Ryan Program supports residency programs to integrate abortion into
training. In 2012 we commenced a prospective cohort study of graduated
Methods: Residents complete web-based surveys after the family planning rotation
and consent to participate in future studies. In 2016, we surveyed ob-gyns 2+
years after residency about their current practice. Post-rotation and
post-residency surveys were matched and then de-identified.
Results: Sixty percent (394) who consented to participate responded. Nearly all
graduates did abortions during residency (median of 31, including medical and
procedural techniques). 86% fully
participated in training, while 14% opted out for personal or religious
reasons. 33% percent overall, and 40% of
those who intended to, do abortions in current practice (median of 12 per
month). An additional 36% do not do
abortions but wish to, and 16% do not nor desire to provide abortion care. Physicians doing abortions are more likely to
have fully participated (42% vs. 8%, p=.00) and did more abortions in training
than those not doing abortions (median 32 vs. 16, p=.00). Those without an
academic affiliation (n=134) are less likely to do abortions (23% v. 45%,
p=.00) and more likely to want to integrate abortion care (56% v. 44%,
of ob-gyns who trained in Ryan programs include abortion care in their
practice. An additional third are unable to despite intending to at the time of
their training. Further studies are needed to understand the barriers to
integrating abortion care into practice.
CREOG & APGO Annual Meeting, 2018, Resident, Faculty, Residency Director, Patient Care, Professionalism, GME, CME, Assessment, Public Health, Contraception or Family Planning,
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Health Equity: A Toolkit for Medical Educators
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.
unconscious bias, social determinants of health, health equity
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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Catching waves like a local: A statewide approach to advocacy builds meaningful, lasting contributions in healthcare
In our current legislative environment, it is important for future health care providers
to have the skills to advocate for issues that affect patients and healthcare delivery. Physicians need to
be able to partner with various stakeholders in order to effect positive change. This workshop will share
the experience of a single state - including faculty and students from 5 medical schools and residents
from 3 programs- as an example of collaborative success in complementary curricular development.
The session will provide tools for other states to collaborate in training effective advocates.
Workshop Agenda and Interactive Component:
Participants will be introduced to the variety of advocacy opportunities - from hospital or institutional
policies to local, state, or national legislative issues - and how partnering with neighboring institutions,
ACOG and state medical associations can avoid duplication of efforts.
Utilizing audience response systems and small group discussion, participants will identify advocacy
opportunities to engage learners in their home state and community. This will form the scaffolding for
one’s own approach to integrating advocacy curriculum in their home and neighboring institutions.
Take Home Product:
In addition to great ideas from an engaging discussion, an electronic tool kit containing sample syllabi,
independent learning modules, and slide sets that can be adopted or modified, will be provided to
Advocacy, collaboration, multi-institution
Advocacy, Public Health, Quality & Safety, UME, CME, GME, Systems-Based Practice & Improvement, Residency Director, Osteopathic Faculty, Clerkship Director, Resident, Student, 2019, Faculty Development Seminar,
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Today’s Public Health Crisis: Managing Opioid Substance Use Disorder in Women’s Health Curriculum
Round Table Text:
Opioid substance use disorder is a major public health crisis today affecting our OBGYN
patients. The LCME encourages teaching this longitudinal theme. We’ve created curriculum
for students to explore issues related to substance abuse in the special populations of women,
pregnancy, and neonates. We teach using multi-disciplinary faculty (MFM, Neonatology,
Psychiatry, Addiction Medicine). Students learn to evaluate and identify: risks and screening
methods for substance abuse disorders in women and pregnancy, treatment options and their
risks/ benefits, options for acute pain management for patients during labor and delivery, and
signs of withdrawal and overdose and management in pregnancy.
Public Health, UME, Systems-Based Practice & Improvement, Medical Knowledge, Patient Care, Faculty, 2018, Faculty Development Seminar,
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Partnering at the intersections: Incorporate Reproductive Justice into your curriculum!
Objective/Background: Reproductive justice (RJ) highlights the need to advocate for a
woman’s right to have a child, not have a child, and parent the children they have, and provides a
conceptual framework for understanding the inequalities that exist in reproductive healthcare. In this
workshop, we will introduce the concept of reproductive justice and discuss how it can fulfill EPA’s and
milestones related to diversity and health care disparities, augment learner understanding of social
determinants of health and provide an outlet for student advocacy. Participants will have the
opportunity to reflect on how RJ is relevant in their health care setting, brainstorm ways to involve
learners in identifying RJ issues, and evidence-based strategies for forming partnerships to develop and
deliver an RJ curriculum.
Workshop Agenda; Interactive components in italics:
• Introduction to RJ: 10m
• Brainstorm: Where are opportunities to incorporate RJ in your curriculum? 5m
o RJ on L&D: birth justice: 5m
o RJ for residents: developing curricula: 5m
o RJ for medical students: longitudinal curriculum across clerkships: 5m
• Small group activity: applying vignettes to diverse teaching settings: 15m
• Large group: debrief of above activity: 15m
• Take-home points: 5m
Product: Participants will come away with a working understanding of RJ, tools for incorporating RJ
concepts into their curriculum, and strategies for building community partnerships to strengthen and
validate the curriculum.
Advocacy, Public Health, UME, CME, Interpersonal & Communication Skills, Systems-Based Practice & Improvement, Patient Care, Residency Director, Clerkship Director, Faculty, Resident, 2018, Faculty Development Seminar,
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