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

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

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

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

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

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

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

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

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

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Keeping Residents Well: How Important Are Perceptions of Program Support and Psycholocical Safety to Resident Wellness?

Purpose: We aimed to test whether measures of resident well-being correlated with perceptions of program support and psychological safety.

 

Background: Trainee well-being is a crucial component of developing competent and skilled OB/GYN physicians. While there are several measures of well-being collected at the national-level, there is little insight in the role of individual programs to foster trainee well-being. Perceived organizational and psychological safety are two constructs that can help identify cultural aspects of the clinical learning environment that may relate to trainee well-being.

 

Methods: OBGYN residents in a training program were recruited to complete an IRB-approved survey through paper and electronic methods between May-June 2018. Measures included the Survey of Perceived Organizational Support (POS), Psychological Safety Scale (PS), Perceived Stress Scale (PSS), Wayne State Wellness Scale (RWS) and Physician Well-Being Index (PWBI); all demonstrate validity and reliability evidence to assess factors of well-being and cultural aspects of the training program.

 

Results: 20 OBGYN residents completed our survey. Results indicated a strong relationship between perceived organizational support and wellness  (r= .62, P<.01 for RWS, r=.50, P<.05 for PWB)., suggesting greater perceptions of support relate to better wellness. Similarly, psychological safety also had a strong relationship with wellness (r=.56, p<.05 for RWS;  r= -.72, p<.01 for PWB)

Discussions:  
Our findings suggest that there is a strong relationship between trainee wellness and the cultural measures of support and safety, especially between psypschological safety and negative indicators of well-being (e.g,. feeling burnt out from work, feelings of irritation). Further research should include interventions to improve percpetions of suport and safety.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, Quality & Safety, Advocacy, CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Lecture, Advocacy,

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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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Implementing a Longitudinal Social Determinants of Health Curriculum at an Academic Residency Program

Purpose: To examine feasibility and reception of a city-specific social determinants of health (SDH) curriculum at an academic medical program

 

Background: Our understanding of health acknowledges that an individual’s social milieu impacts health as much as genetics. Healthcare providers must consider SDH to provide just, equitable care to a diverse patient population. However, despite a growing emphasis on teaching SDH in medical school, these factors are not formally addressed in traditional residency curriculum.  

 

Methods: A literature review and consultations with local educators identified best practices for teaching SDH to medical professionals. Topics were incorporated into resident teaching activities, including grand rounds, resident retreat, discussions with content experts and community stakeholders, clinic teaching, morbidity and mortality conferences, and a city tour conducted by Rochester, NY natives. Pre- and post-surveys (n=32) were conducted to assess resident knowledge of city resources/demographics and attitudes towards SDH in patient care.

 

Results: In the pre-survey, 73.3% of trainees reported familiarity with SDH. After the curriculum, 88% of residents reported a better understanding of the effects of SDH, and 78% felt that the lessons learned from the curriculum affected interactions with their patients. 97% of residents felt more knowledgeable about Rochester demographics. Overall, residents recognized the importance of formal SDH training and felt that social hardships are important to acknowledge in their clinical interactions. However, some expressed concerns that it took time away from the traditional didactic curriculum.

 

Discussions: A comprehensive, longitudinal, city-specific curriculum on the SDH enriches residents’ understanding of their patient population and available social resources to address these factors.

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

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Impact of Electronic Health Records on Resident Physicians’ Off-Duty Time: A Multi-specialty Resident Survey at a Large ACGME Accredited Institution

 

Purpose: The purpose of this study is to evaluate off-duty electronic health records (EHR) use among residents at a large multispecialty institution.

 

Background: Studies have shown that EHRs have greatly impacted the amount of time allocated to documentation of patient care. Little research has been done to investigate the extent to which residents access EHRs remotely while off-duty to complete daily clinical activities.

 

Methods: A voluntary survey was administered to LSUHSC residents to subjectively quantify EHR use in their various settings while on and off duty. Spearman’s correlation analysis was performed to assess associations between ordinal variables while the Kruskal-Wallis test was used to compare residents’ perceptions about EHR access among the top 4 largest specialties and all “other” specialties combined.

 

Results: A total of 200 residents (30%) completed the survey. Most residents on their inpatient rotation (60%) reported working 61-80 hours per week and nearly half of the residents accessed EHR outside of work less than 5 hours per week (49%). Among the top 4 specialties and all “other” specialties combined there were significant differences (p=0.027) in the extent of agreement regarding whether “having to access EHRs in your off-duty time negatively impacts your quality of life,” with Ob/Gyn residents having the highest agreement.

 

Discussions:  Some residents perceive that having off-duty access to EHR negatively impacts their quality of life and this perception varies significantly across specialties. Further understanding of the impact of EHR access as a factor that affects educational and wellness implications is essential.

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

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Gender in OB-GYN Residency: An Analysis of Factors Impacting Program Diversity

Purpose: To investigate if geographic region, gender mix of previous classes and program leadership impact the gender composition of residency programs.

 

Background: Women comprised only 7.1% of all Obstetrics and Gynecology (OB-GYN) providers in 1970, and held 58.7% of OB-GYN positions in 2017.

 

Methods: 56 of the top OB-GYN residencies as ranked by Doximity.com and US News & World Report were identified and grouped by geographic region. Demographic information for residents (n = 1732) and program/departmental leadership (n = 112) were compiled. Individuals’ gender was identified using online photos and biographical descriptors. The male-to-female ratio (MFR) of the 2018 intern class, of existing residency classes, program directors and departmental chairs were calculated and compared. Two-way ANOVA and Tukey’s multiple comparison tests were used (significance = p<0.05).

 

Results: A majority of trainees in OB-GYN programs are women (62.5-94%.) The MFR varied significantly based on geographic region; southern programs had the highest MFR (Figure 1). Programs with male chairs compared to those with female chairs recruited more male interns (14.2% vs. 8.9%, p < 0.001). Programs with > 20% male residents (PGY 2,3,4) had a higher MFR in the incoming intern class compared to programs with < 20% (15.4% vs. 11.4%, p = 0.020).

 

Discussions: Men are a minority in OB-GYN training. Gender composition of residency programs is influenced by the gender of leadership, geographic region, and of prior classes.  Programs must balance empowerment of women with a culture of inclusion and support of qualified male candidates to ensure strength gained through diversity.

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

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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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Bring Back the Tubal: An Intervention to Provide Postpartum Bilateral Tubal Ligation in the Underserved Population

Purpose: Improve educational awareness and receptiveness to the PPBTL procedure.

 

Background: 50% of women requesting a PPBTL undergo the procedure. Barriers exist to obtain the PPBTL, including lack of available operating rooms and concern for patient regret. Half of pregnancies in the U.S. are unintended, occurring disproportionately higher in low-income and minority populations. Children resulting from unintended pregnancies are at risk for poor health outcomes including low birth weight and developmental delay. Additionally, the U.S. financial burden of unintended pregnancy accounted for approximately 21 billion dollars in 2010.

 

Methods: A retrospective chart review was conducted from 2015-2016 to document the baseline prevalence of PPBTLs performed at IFMC. Educational sessions with pre- and post-session questionnaires were conducted for departments of OB/GYN, Anesthesia, and Nursing. Data was collected from April 2017 - April 2018 regarding patients desiring the procedure, those completing the procedure, and reasons for unsuccessful procedure completion. A pre-post comparison was performed to assess the impact of the educational sessions and the overall prevalence of PPBTLs.

 

Results: Fifty-one multidisciplinary staff members at IFMC participated in the educational sessions. All departments showed significant improvement in knowledge of the PPBTL (OB/GYN p=0.0117, Anesthesia p=0.0002, Nursing p=0.0001). A baseline prevalence of three PPBTLs were performed from 2015-2016, which increased to fifty-six from 2017-2018. Comparing pre-post intervention, the percentage of PPBTLs requested and ultimately performed increased from 39% to 60%.

 

Discussions: Targeted multidisciplinary educational sessions were effective in identifying barriers and increasing educational awareness. Overall, this resulted in increased access to and performance of sterilization in the underserved population.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Patient Care, Professionalism, Interpersonal & Communication Skills, GME, Quality & Safety, Team-Based Learning, Advocacy, Contraception or Family Planning,

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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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