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)
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
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.
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
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.
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
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.
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.
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
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.
define cultural humility and discuss best practices in cross cultural
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)
rubric , Resource
guide with annotated bibliography
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
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
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
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
Interactive component: Interactive
media usage during large group presentation. Categorization of patients. Small
group breakouts reviewing clinical scenarios and discussing challenges of
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.
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.
• 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
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
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.
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.
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
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.
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
Results: After script implementation, the percent of medical
students refused from at least one patient interaction decreased from 92% to
86%. 66% percent of our students perceived scripting as a supportive measure
for medical students, and 61% percent witnessed staff, residents, and faculty
Discussions: Data from our institution suggest that scripting improves
medical student involvement in ob-gyn patient care. Involving staff, students,
and patients on scripting revision helped foster a learning environment rich as
the Mississippi delta in which medical students can thrive.
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.
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)
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.
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
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
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
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
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.
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.
E et al. Patient orientations of physicians and patients: the effect of
doctor-patient congruence of satisfaction. Patient Educ Couns 2000;
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.
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
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.
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.
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
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
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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