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Resident Perceptions of Power-Based Violence and Impact of Bystander Intervention Training

Purpose: To evaluate resident perceptions of power-based violence (PBV) and assess initial impact of bystander intervention (BI) training.

Background: Creating a safe, welcoming workplace is important in medical education.  PBV in the form of overt aggression, microaggression, or bullying can threaten the educational community.  BI training offers residents a skill set to intervene to counteract PBV and foster a safer, welcoming clinical environment for their teams.

Methods: Pre-training and post-training surveys were completed by OB-Gyn residents at Vanderbilt prior to formal Green Dots BI training.  The survey assessed frequency of experienced or witnessed PBV, sexism, and racism.  Residents self-assessed their ability to recognize overt versus subtle PBV, and whether they would intervene in instances of PBV based on the role of the perpetrator.  Residents completing BI training were re-surveyed with the same instrument 3 months later.  Exempt IRB approval was obtained.

Results: 22 active residents were surveyed pre-training. 19 residents completed BI training and the post-training survey.  Active residents reported at least sometimes being the target of PBV (22.7%), sexism (45.5%), or racism (9.0%).  Even more residents reported at least sometimes witnessing PBV (50.0%), sexism (59.1%), or racism (45.5%).  Residents’ willingness to intervene varied by perpetrator: fellow resident (59.0%), attending (18.2%), nursing staff (40.9%).  100% of active residents felt obligated to foster a safe work environment free of PBV.  
Among residents completing BI training, the percentage reporting recognition of overt PBV increased after training from 84.2% to 94.7% (p=0.29), and the percentage reporting recognition of subtle PBV increased after training from 78.9% to 89.5% (p=0.37).  There was a modest increase after training in the percentage reporting they would intervene for PBV perpetrated by a resident (52.6% to 57.9%, p=0.74) or nursing staff (31.6% to 36.8%, p=0.73), but no change for faculty-perpetrated PBV.

Discussions: PBV is experienced and/or witnessed by residents not infrequently.  While residents are more likely to intervene for PBV perpetrated by a fellow resident, they are less likely to intervene when perpetrated by attendings or nursing staff.  BI training appears to offer modest improvements in recognition of PBV and willingness to intervene, but its effect in this study was limited by sample size.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Residency Director, Professionalism, GME, UME, Team-Based Learning, Advocacy,

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Gender and Satisfaction with Mentorship In Medical School: A National Study

Purpose: Using the American Association of Medical Colleges (AAMC) Graduation Questionnaire (GQ), we assess if males and females at all U.S. medical schools report differing experiences with satisfaction with faculty mentorship.  Secondarily, we assess the role of men\'s and women\'s scholarly projects and career plans as they relate to satisfaction with mentoring.

Background: Female physicians experience gender-based professional differences, such as lower compensation, slower rates of promotion, and decreased representation in leadership positions as compared to their male colleagues.  The way this gender-based professional inequity affects the experience of medical student mentees has yet to be elucidated in the literature.

Methods: Data were obtained from the AAMC GQ years 2016-2018.  Student satisfaction with faculty mentoring was analyzed by chi-squared and logistic regression.

Results: With an 82% response rate we analyzed data for 47,063 students; 51% were male and 49% female. When asked about satisfaction with faculty mentoring, 81% of males verses 79% of females reported being \"satisfied\" or \"very satisfied\" (p< 0.001). A higher proportion of males reported faculty were helpful to students with academic matters (60% versus 55%; p< 0.001) and with non-academic matters (58% versus 55%; p< 0.001) \"very often\" or \"always.\" Females were less likely to be satisfied with faculty mentoring even after controlling for participation in research with a faculty member and future research plans.

Discussions: This work serves as a needs assessment to encourage individual medical schools to investigate their own gender-based cultures regarding faculty representation and leadership to allow gender-equal mentorship of all students.

Topics: CREOG & APGO Annual Meeting, 2020, Faculty, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, GME, CME, UME, Advocacy,

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Does Personal Care Impact Burnout? An Academic Institution’s Exemplar

Purpose: To assess resident compliance with routine health maintenance and risk of burnout at a single midwestern institution

Background: Resident physician burnout is a concern facing medical education. It has been linked to depression, inversely correlates with job satisfaction, and has a cumulative effect as the years of residency progress. Correlations between suspected burnout and reduced resident personal care have been sparsely assessed.     

Methods: Residents in all specialties at the University of Toledo were surveyed in the last academic year through an anonymous 27-item online survey addressing health care compliance and risk of burnout (using a non-validated index). A total of 75 surveys were completed.

Results: Up to 40% of residents had neither seen a primary care provider nor had routine eye exams in >24 months while >30% had no dental care in the previous 12 months. 80% of residents reported clinical duties preceded personal wellness. 50% reported financial concerns as a contributor to decreased wellness. 100% of residents were at risk of burnout with only 25% in the low-risk category. Of those in the severe risk category, 80% addressed their condition by ignoring it and had the least mental health service utilization.

Discussions: Un-aligned resident priorities may result in ignoring oneself and one’s needs. This in turn may result in increased predisposition to burnout. Mental, physical and financial wellness need to be assessed and addressed by institutions regularly. Mitigation modalities, as implemented at our institution following the survey, will need to be in place to enhance personal care, subsequently reducing risk of burnout.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Residency Coordinator, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, Advocacy,

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Assessing the Effectiveness of Single Session Didactic Teaching in Improving Health Care Professionals’ Knowledge of the LGBTQ Population

Purpose: To examine the impact of a single didactic session on short-term knowledge acquisition and long-term knowledge retention of principles related to LGBTQ healthcare.

Background: Individuals who identify as Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) compose an estimated 1.1-3.8% of the population. Despite significant legal and societal advances, disparities persist in LGBTQ health care education, delivery, and outcomes. Multiple national medical organizations have produced initiatives emphasizing the development of educational resources to address these disparities.

Methods: A prospective observational study was performed. Knowledge acquisition was examined by a written survey, including 5 semantic differential scale and 5 multiple-choice questions. The survey was provided prior to and after a didactic session, then again four weeks later. Participation was voluntary and anonymous. Statistics were analyzed using Graph Pad Prism 8 Software (San Diego, CA).

Results: Comparing summed scores, immediate pre and post results (n=63) showed significant improvement across both semantic differential scale (5.7-7.78; p-value 0.00005) and multiple-choice (71%-91%; p-value 0.0004) questions. The 4-week post results (n=33) showed knowledge degradation, but significant improvement when compared to pre-test (5.7-7.21; p-value 0.01, 71%-86%; p-value 0.0095). The most significant improvements were in knowledge of LGBTQ community resources (3.9-7.6-6.4; p-value < 0.00001) and options for gender affirmation (51%-73%-69%; p-value < 0.00001).

Discussions: As medical curricula continue to evolve to address the needs of the LGBTQ population, this study indicates that a single didactic session may significantly improve provider knowledge about LGBTQ health care. This should result in improvements in awareness and communication, patient satisfaction, and health outcomes.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, CME, Lecture, Public Health, Advocacy, General Ob-Gyn, Sexuality,

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A Design Thinking Approach Will Engage Obstetrics and Gynecology Residents in Quality Improvement Education

Purpose: To incorporate design thinking methods in quality improvement curricula to generate impactful patient interventions and enhance resident satisfaction.

Background: Incorporating a meaningful quality improvement (QI) experience into an already overloaded residency training program is challenging. We applied the principles of design thinking to a QI curriculum to inspire residents (“users”) to develop patient-centered QI projects.

Methods: Starting in 2017, residents at an academic medical center were introduced to QI grounded in the Model for Improvement. The experiential component was implemented using a five phase Design Thinking process (Empathy, Define, Ideate, Prototype, Test). Data were obtained from ACGME surveys and patient outcomes. Chi square was used to compare yearly trends in resident satisfaction; patient outcomes were analyzed using an independent t test. P< 0.05 was significant.

Results: Since introduction of the QI curriculum, we have had 100% resident involvement (increase from 83%, P< .05 ) and collaboratively generated QI interventions that improved patient outcomes and enhanced resident engagement. One initiative increased postpartum visit adherence in a high-risk population from 21% to 63% (P< .01). An initiative addressing prenatal tobacco use in resident clinics produced a state-funded $53,000 grant to screen and treat pregnant smokers. Overall satisfaction with the residency increased by 64% between 2017-2019 (P< .05)

Discussions: Design thinking can be integrated into graduate medical education. Although this curriculum was initially implemented to meet ACGME QI project requirements, we found that a design thinking approach empowers residents with the knowledge, creativity and problem-solving skills to design impactful QI initiatives while simultaneously enhancing resident wellbeing.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Quality & Safety, Public Health, Advocacy, General Ob-Gyn,

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Teaching Cultural Humility To Medical Students By Building Cross-Cultural Patient Education Tools

Workshop Text: Cultural humility and cross cultural communication are essential skills for medical students who will be called upon to translate medically complex concepts and treatment plans to patients from diverse backgrounds.  This skill set, however, is not often taught effectively during medical school.

This workshop will demonstrate a method for teaching cultural humility to medical students.  Through the process of designing and testing a cross cultural patient education model, the student explores essential features and pitfalls of cross cultural education. Workshop participants will design an abbreviated patient education tool based on a case based scenario and engage in group discussion about the challenges involved. Presenters will share a project that was used in three languages from sub-Saharan Africa and another in Vermont and will discuss challenges from their field work. An evaluation rubric will be provided. 

Introduction (5mins) define cultural humility and discuss best practices in cross cultural communication. 

Group Activity (10 mins) Using 1-2-4-all format, discuss pitfalls of cross cultural communication demonstrated in an excerpt from The Spirit Catches You and You Fall Down.

Breakout Activity/ Interactive component (30 mins) Small groups of participants will design a patient education tool for a specific patient population based on a real life scenario. 

Group Activity (15 mins) Discuss the process of designing a cross-cultural patient education tool with respect to cultural humility.

Wrap up (5 mins)

Take home products: Grading rubric , Resource guide with annotated bibliography

 

Topics: Faculty Development Seminar, 2020, Faculty, Clerkship Director, Patient Care, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Global Health, Advocacy,

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Helping Medical Students Recognize the Effects of Their Biases on Patient Care

Learning or Performance Objectives: Participants will identify implicit biases and prejudices that impact clinicians’ interaction with patients. They will discover tools to assist educators and learners to identify bias, to engage in constructive discussions about implicit bias, and to thereby improve healthcare quality.

Background:  Emerging data points to implicit racial bias as a cause of disparity in maternal health outcomes between women of color and white women. The perceptions, and biases healthcare providers formulate, based upon patients’ skin color, impact the way we render care. Oftentime, we are unaware of the effects of our biases on the clinical decisions we make. As multi-disciplinary teams work to eradicate these disparities, we need to train healthcare providers to identify the effects of their biases. Workshop agenda: This workshop will review recent findings of implicit bias in healthcare, teach participants a mechanism for identifying their own biases, and empower participants to train learners and faculty to identify bias.

Participants will engage in interactive clinical scenarios, assigning patients to categories. They will identify what implicit biases affect their choices. They will learn facilitative language for clarifying biases, discover available resources for identifying biases and updating attitudes and behaviors, and will receive a take-home tool-kit.

Interactive component:  Interactive media usage during large group presentation. Categorization of patients. Small group breakouts reviewing clinical scenarios and discussing challenges of identifying biases.

Take-home product: (1) Checklist of key components for implicit bias identification, (2) Model for bias clarification activities for faculty and learners, (3) Clinical scenarios.

Topics: Faculty Development Seminar, 2020, Student, Resident, Faculty, Clerkship Director, Osteopathic Faculty, Residency Director, Patient Care, Professionalism, Interpersonal & Communication Skills, GME, UME, Problem-Based Learning, Team-Based Learning, Public Health, Advocacy,

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Creating Gender Inclusivity: A Primer On Transgender And Gender Non-Binary Health Care

Workshop Text: Care of transgender and gender non-binary patients affects all medical specialties, but most physicians, medical students and clinic staff do not have specific training in gender inclusive healthcare.  
Through games and interactive discussion, participants will learn context and skills helpful in care of a gender diverse population.   These exercises are an excerpt of a longer, three part series, the outline of which will be provided to participants.   

Agenda:
Introduction:  Why is this important? Brief presentation on trans health care disparities (5 mins)
Interactive Group Activity:  Is this the right word?  Brainstorming and then defining terminology related to gender (10 mins)
Breakout Activity:  Celebrity game!  “Players” vs “Monitors” – have your team guess the celebrity you are describing using only gender neutral pronouns.  If a monitor catches you using a gendered pronoun, your turn is over. (15 mins)
Debrief (5mins)
Breakout activity:  using “1-2-4-all,” groups evaluate clinical scenarios on each table (15 mins)
Interactive Group Activity:  How can I make my clinic more inclusive?  Discuss elements of a gender inclusive clinic. (20 mins)
Questions (5 mins)

Take home products:
Syllabus for three part series
Pre and post-test evaluation for series
Annotated resource list

Topics: Sexuality, Advocacy, UME, GME, Practice-Based Learning & Improvement, Interpersonal & Communication Skills, Systems-Based Practice & Improvement, Professionalism, Patient Care, Faculty, 2020, Faculty Development Seminar,

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Wellness on a Budget: Can It Be Done?

Purpose: To quantify resident well-being, assess the most common stressors and sources of burnout among residents, and develop cost effective strategies to improve wellness.

Background: In 2017, the ACGME mandated that residency and fellowship programs had to demonstrate a commitment to the well-being of the residents, faculty members, students and all members of the health care team.

Methods: Identifying a cost effective assessment tool (Well-Being Index) which would link to important wellness resources, national comparative data, and provide comprehensive reporting to our residency programs. Analysis of this data and use of focus groups to develop a Resident Wellness Taskforce.

Results: The Well-Being Index, distributed at the beginning of the training year, showed 30% of residents who responded had “at risk” scores. The focus groups then determined the most common stressors at Henry Ford Hospital, which fell into 4 common categories: work efficiency/support; workflow/job demands; organizational values/meaning in work; and work-life balance. These results allowed the Wellness Taskforce to develop strategies, both personal and institutional, to combat areas of high stress. Cost effective interventions totaled under $25,000  and included a Wellness Curriculum and Wellness Rounds. Details will be shared in presentation.

Discussions: Baseline wellness scores and focus groups allowed us to determine the extent of our residents’ burnout and identify their most common stressors. This was an important starting point for planning cost effective interventions and programming geared to improving resident wellness. Future plans include assessing the Well-Being Index post-intervention to determine the effect of the taskforce initiatives on resident burnout.

Topics: Advocacy, GME, Systems-Based Practice & Improvement, Faculty, Resident, Student, 2019, CREOG & APGO Annual Meeting,

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Transgender Healthy Care: On-line Survey of Physician Knowledge and Comfort

Purpose: To evaluate OB/Gyn provider knowledge and comfort with transgender health care

Background: Transgender and gender non-conforming patients (TGNC) are an underserved population that often encounters inadequate or ‘unsafe’ clinical care. Education regarding TGNC patient care has traditionally been minimal, contributing to gaps in Ob/Gyn care for many of these individuals, including transgender men.

Methods: An IRB approved, anonymous online non-validated survey was emailed to 130 APGO program coordinators to distribute to their Ob/Gyn faculty and post-graduate learners. Questions addressed included years of practice, experience with TGNC patients, provider comfort, and TGNC education.

Results: One hundred and sixty four surveys were completed and an additional ~50 were opened but no information was provided. Of the 164 completed surveys, 76.3% of participants reported less than 5 hours of TGNC specific healthcare education, despite the fact that 75.7% of responders had cared for at least one TGNC patient. Overall most respondents felt comfortable/very comfortable (79.8%) caring for this population. No correlation was found between years in practice and overall provider comfort caring for TGNC patients.  Major obstacles reported by participants included concern for patient comfort, appropriate language, and lack of sufficient clinical education for both providers and support staff

Discussions: These data suggest that enhanced TGNC clinical education for the entire health care team is warranted.

Topics: Advocacy, GME, Professionalism, Medical Knowledge, Patient Care, Residency Coordinator, Residency Director, Osteopathic Faculty, Clerkship Coordinator, Clerkship Director, Faculty, Resident, Student, 2019, CREOG & APGO Annual Meeting,

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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: Contraception or Family Planning, Advocacy, Public Health, GME, Systems-Based Practice & Improvement, Patient Care, Residency Coordinator, Residency Director, Osteopathic Faculty, Clerkship Coordinator, Clerkship Director, Faculty, Resident, Student, 2019, CREOG & APGO Annual Meeting,

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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 implementation.

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 utilizing scripting.

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.

Topics: Advocacy, Team-Based Learning, UME, Interpersonal & Communication Skills, Professionalism, Patient Care, Residency Coordinator, Residency Director, Osteopathic Faculty, Clerkship Coordinator, Clerkship Director, Faculty, Resident, Student, 2019, CREOG & APGO Annual Meeting,

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Saving Lives: Students Enhancing Patient Health Literacy Regarding Hypertension in Pregnancy and Prenatal Aspirin

Purpose: To increase medical student’s knowledge, behavior and belief systems regarding hypertension (HTN) in pregnancy and prenatal aspirin (PNA). To increase patient\\\'s understanding regarding the complications of HTN in pregnancy and the benefits of PNA.

 Background: Prenatal aspirin (81 mg) has been recommended by ACOG for high-risk women and women with >1 moderate risk factor. Its use reduces the rate of preeclampsia, preterm birth, intrauterine growth restriction and fetal death in at-risk patients. In a survey conducted at Boston Medical Center, the incidence of hypertension in pregnancy is 30%, with only 15% of patient having heard of PNA, demonstrating high prevalence and low patient literacy regarding the topic.

Methods: Ob/Gyn clerkship students are instructed to educate patients regarding: knowledge of HTN in pregnancy, warning signs of preeclampsia, and efficacy of PNA in pregnancy. The student educational intervention was evaluated regarding: satisfaction, knowledge, confidence, and belief systems by surveys at the beginning and end of the clerkship. Patient education was evaluated by pre and post intervention metrics.

Results: Student knowledge of PNA and HTN increased 35%, confidence 45% and belief systems 14%. They gave the project a 72% satisfaction rating. Patient’s knowledge about HTN increased 48%, warning signs 80%, and understanding of efficacy of PNA 65%.

Discussions: Medical student health counseling increased patient knowledge regarding HTN and PNA. By educating patients, students also increased their knowledge and confidence in the subject. We plan to continue implementing this QI project throughout the year to augment a departmental QI initiative and evaluate its benefit to patients and students.

Topics: Advocacy, Quality & Safety, UME, Interpersonal & Communication Skills, Systems-Based Practice & Improvement, Medical Knowledge, Patient Care, Residency Coordinator, Residency Director, Osteopathic Faculty, Clerkship Coordinator, Clerkship Director, Faculty, Resident, Student, 2019, CREOG & APGO Annual Meeting,

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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: Contraception or Family Planning, Advocacy, Public Health, GME, Practice-Based Learning & Improvement, Residency Coordinator, Residency Director, Resident, Student, 2019, CREOG & APGO Annual Meeting,

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Predictors of Trainees: Willingness to Provide Family Planning Services: A Survey of Ob-Gyn Residents

Purpose: To determine factors that contribute to a resident’s willingness to provide abortions post-residency.

Background: The shortage of abortion providers makes accessing care difficult. Personal and environmentalfactors within the residency training environment may be modified so that greater numbers ofgraduates opt to become abortion providers.

Methods: A multiple-choice survey was sent to all ACGME accredited OB/GYN residency programs. Data on demographics,religious and political views, residency training experience and intent to provide abortions was collected anonymously (n=396).

Results: Sixty-eight percent of residents intended to provide abortions (n = 269). The sample was 89% female, underage 35 (97%), heterosexual (91%). In a multivariable logistical regression, the following demographic factors predicted intent to provide abortion; being female (aOR 2.8; 95% CI 1.2-6.5), identifying as non-Christian (aOR 3.6; 1.9-6.6), and being raised in the Northeast (vs South) (aOR 3.0; 1.3-6.7) .Modifiable predictors of intention to provide included programs where 50% of the faculty provided abortions (aOR 3.3;95% CI 1.8-5.8). Additionally, residents who performed greater than 20 cases (uOR 3.3, 95% CI 1.6-6.7) were three times more likely to plan toprovide.Selection of a residency emphasizing family planning significantly correlated with intent toprovide (aOR 4.3; 95% CI 2.4-7.8). Those training at Ryan Programs were twice as likely (uOR2.4; 95% CI 1.6-3.8) to intend to provide.

Discussions: Modifiable factors such as early exposure of medical students to family planning, faculty selection, robust case volumes and establishment of a Ryanprogram may enhance the number of graduates offering abortions while in practice.

Topics: Contraception or Family Planning, Advocacy, UME, GME, Systems-Based Practice & Improvement, Patient Care, Residency Director, Osteopathic Faculty, Clerkship Director, Faculty, Resident, 2019, CREOG & APGO Annual Meeting,

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Perceptions Regarding Medical Students Performing Pelvic Examinations on Anesthetized Female Patients

Purpose: The purpose of this study was to determine perceptions regarding medical students performingpelvic examinations on anesthetized female patients.

Background: Pelvic exams performed under anesthesia continues to be a controversial topic, but studies looking at medical staff are lacking.

Methods: An internet based survey was distributed to OB/GYNs, OR nurses/techs,anesthesiologists/CRNAs, and medical students at multiple hospitals and medical schools.Demographic data were collected. Non-demographic answers to questions were recorded on a 5-point scale. Characteristics between the respondent groups were statistically compared usingChi-squared test for independence and the Fisher’s Exact Test.

Results: 337surverys were completed. 72% of respondents believed permission should be obtained from patientsprior to the performance of EUAs by medical students on anesthetized femalepatients. 30% of respondents believed prior consent was usually obtained. 50% believed patients would agree to have the exams performed. 80% thought patients would be upset if an EUA by a medical student was performed on them  without their prior consent. 32% of nurses believed medical students should be allowed to examine anesthetized patients.  Medical students were less likely to believe it was appropriate for a student to examine a patient, there was an educational benefit, and that patients would consent. 

Discussions: Despite the perception of all OB/GYN OR team members that consent should be obtained beforemedical students perform pelvic examinations on anesthetized female patients, this does notusually occur. Almost 50% of medical students would not encourage their female relatives toconsent to medical students performing such pelvic examinations.

Topics: Advocacy, Quality & Safety, GME, Professionalism, Patient Care, Residency Director, Osteopathic Faculty, Clerkship Coordinator, Clerkship Director, Faculty, Resident, Student, 2019, CREOG & APGO Annual Meeting,

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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.

 

1 Krupat E et al. Patient orientations of physicians and patients: the effect of doctor-patient congruence of satisfaction. Patient Educ Couns 2000; 39:49-59.  

Topics: General Ob-Gyn, Advocacy, Team-Based Learning, Independent Study, UME, Professionalism, Medical Knowledge, Patient Care, Clerkship Coordinator, Clerkship Director, Faculty, Resident, Student, 2019, CREOG & APGO Annual Meeting,

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

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

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

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

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

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

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

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

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Medical Student Perceptions Regarding Students Performing Pelvic Examinations on Anesthetized Female Patients

Purpose: The purpose of this study was to determine perceptions of medical students regarding performing pelvic examinations on anesthetized female patients. 

Background: Pelvic exams performed on anesthetized women continues to be an important topic of discussion, however, it is not frequently evaluated from the medical student\\\'s perspective.

Methods: An internet based survey was distributed to medical students at multiple medical schools.Demographic data was collected. Non-demographic answers to questions were recorded on a 5-point scale. Characteristics between the respondent groups were statistically compared usingChi-squared test for independence and the Fisher’s Exact Test. 

Results: 220 medical students completed the questionnaire. 77% of all medical students believed  permission should be obtained from patients prior to the performance of EUAs by medical students on anesthetized patients. 30%  of respondents believed prior consent was usually obtained. 46% believed  patients, if asked, would agree to have the exams performed. 85% believed  patients would be upset if they were made aware a pelvic examination by a medical student had been performed without their prior consent.60% of medical students believed they should be allowed to examine anesthetized patients, with 87% thinking there is an educational benefit.

Discussions: Despite the perception that consent should be obtained before medical students performpelvic examinations on anesthetized female patients, this does not usually occur.  50% ofmedical students would not encourage their female relatives to consent to medical studentsperforming pelvic examinations. There was no statistical difference between male andfemale medical students regarding perceptions of student pelvic examinations on anesthetizedfemale patients

Topics: Advocacy, GME, Professionalism, Patient Care, Residency Coordinator, Residency Director, Osteopathic Faculty, Clerkship Coordinator, Clerkship Director, Faculty, Resident, Student, 2019, CREOG & APGO Annual Meeting,

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