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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 training.

 

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%).

Prior to 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 27%.

The two barriers most frequently encountered, regardless of program training status, were problems with billing and compensation for services (61%) and the pharmacy (33%).

Programs 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.

Topics: 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 curriculum project.

 

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 open-ended responses.

 

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 serving.  

Topics: 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) rotation.

 

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 tests.

 

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 participation.

 

Discussions: Trainees in obstetrics and gynecology value access to abortion training, even if the training is off-site and remote. 

Topics: 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.

Topics: 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 justice.

 

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

 

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

 

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

 

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

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

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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.

 

Background: The 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.

 

Methods: A 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 analyze results.

 

Results: Five 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%.

Topics: 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 residents. 

 

Background: As 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 practices. 

 

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.

 

Results: The 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 (p=0.11).

 

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 FAVD. 

Topics: 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 residents

 

Background: Immediately 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.

 

Methods: A 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 type. 

 

Results: Sixty-two (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.

Topics: 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.

 

Background: Low 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 described.

 

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 excluded.

 

Results: Eighty 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.  

Topics: 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.

 

Background: Breastfeeding 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.

 

Methods: We 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.

 

Results: We 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.

Topics: 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.

 

Background: The 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 goal.

Methods: Survey 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.

Results: Each 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.

Topics: 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.

 

Background: Opioid 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.

 

Methods: This 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 Theory.

 

Results: Twenty-seven 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.

Topics: 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 residency.

 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. 

Topics: 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 program.

 

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 (p=0.045).

 

Discussions: Residents’ involvement in SMM reviews can determine care improvement opportunities and provide training on safety and quality.

Topics: 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: The 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 follow-up assessment.

 

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.

 

Discussions: Residents effectively administered a reproductive health care curriculum to high school students that was informative, well received and changed attitudes of students, teachers and residents.

Topics: 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

Purpose: To 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 residents.

 

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%, p=.02). 

 

Discussions: One-third 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.

Topics: 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

Objective/Background:

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

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

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

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

culturally relevant care and promoting healthy equity.

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

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

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

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

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

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

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

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

Take Home Product:

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

identify social determinants of health and unconscious bias.

Keywords:

unconscious bias, social determinants of health, health equity

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

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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

participants.

Key Words:

Advocacy, collaboration, multi-institution

Topics: 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.

Topics: 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
• Examples:
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.

Topics: 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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