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Pilot Study of a Condensed Communication Skills Workshop for Gynecologic Oncology Fellows

Purpose: Implement and evaluate the effectiveness of a newly condensed, previously piloted communication workshop in a cohort of gynecologic oncology (GO) fellows.

 

Background: In GO fellowship, devoting sufficient time to learn communication skills can be challenging due to the time and logistics required. A two day workshop was previously piloted at a single institution with GOs and found to be beneficial. We sought to disseminate that curriculum in a condensed form.

 

Methods: We conducted two four-hour sessions with 4 GO fellows over 4 months. Sessions consisted of a didactic in communication skills led by faculty with VitalTalk© training, followed by application with a simulated patient. Cases were developed and previously used in a two-day workshop at another institution. Fellows were surveyed prior to both sessions and after the second session.  Perceived confidence was assessed on a Likert scale (1 to 5). An improvement was defined by an increase of ≥1 in Likert score.

 

Results: All fellows reported that the educational quality of the sessions was “excellent,” that the time in between sessions was “just right,” allowing them to apply skills learned in the first session prior to the second. After both sessions, at least three of the four fellows reported an improvement in confidence in nearly 50% (10/21) of the topics (Table 1).

Table 1**

Name the key steps of delivering serious news

Bring up advance care planning

Elicit a patient’s goals of care from a patient or family member

Lead a family conference

Manage conflict that arises during a family meeting

Describe comfort-focused care

Respond to patients or family members who have not accepted the seriousness of the patient’s illness

Discuss religious or spiritual issues with a patient or family member

Counsel a patient or family member about what to expect in the dying process

Teach and mentor learners about how to facilitate delivering serious news

**Areas in which ≥75% of fellows reported an improvement in confidence (at least ≥1 increase in level of confidence)

 

Discussions: GO fellows perceived improvements in communication skills with condensed half-day training seminars.

Topics: CREOG & APGO Annual Meeting, 2019, Faculty, Medical Knowledge, Interpersonal & Communication Skills, GME, Standardized Patient, Gynecologic Oncology,

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Management of Postoperative Issues in Gynecology and Gynecologic Oncology: A New Method for Teaching Residents

Purpose: This project sought to develop and assess a curriculum to improve resident knowledge of and comfort in managing common post operative issues.

 

Background: Junior obstetrics/gynecology residents enter training with varied experience in post-operative management. They are often the first contact for surgical patients with little formal education on post-operative issues. 

 

Methods: Eleven common post-operative issues were identified based on literature review, resident experience and gynecology/gynecologic oncology faculty input. Topic based curriculum included: example case, pathophysiology, differential diagnosis, next steps, and useful resources. It was presented at two educational sessions, involving lectures and small-group simulations. Residents completed a pre and post-assessment questionnaire assessing comfort level in managing (10-point Likert scale) and baseline knowledge about (content-specific questions) the topics.

 

Results: Twenty-three residents participated.Seventeen completed one or both pre-assessment surveys (nine junior residents). Ten completed one or both post-assessment surveys (five junior residents). All post-assessment respondents reported improved knowledge of issues covered. Average self-rated comfort level increased for ten of eleven topics amongst junior residents (average increase 1.6 points (range 0.5 – 3.2; p = 0.02)). Largest increase in score was for hypoxia and low urine output. Average scores maintained or improved for 80% of the content questions (not significant). Residents had no preference for lecture versus small group format.

 

Discussions: As a result of directed teaching, resident knowledge of post-operative issues showed measurable improvement. Resident comfort level in management increased significantly for 90% of topics covered, most noticeably amongst junior residents. A systematic, resident-led curriculum on post-operative management can improve resident knowledge and patient care.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Medical Knowledge, GME, Simulation, Lecture, Problem-Based Learning, Team-Based Learning, Gynecologic Oncology, Minimally Invasive Surgery, Female Pelvic Medicine & Reconstructive Surgery, General Ob-Gyn,

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Does Participation in Ob-gyn Subspecialties Improve Clerkship Clinical Scores, NBME Exam Scores, or Final Grades?

Purpose: The primary objective is to determine if participation in subspecialty rotations during Ob/Gyn core clerkships improves student performance as measured by National Board of Medical Examiners (NBME) scores, clinical evaluations and final clerkship summative grade when compared to students without focused subspecialty time.

 

Background: There is limited research evaluating the effect of subspecialty rotation experience during Ob/Gyn clerkships on student performance, however similar research in general surgery indicates adequate medical student competency and improvements in medical knowledge.


Results: Complete data was identified for 474 students during this study period. There was no significant difference in NMBE scores or final clerkship summative grade when comparing general track students to the subspecialty track. There was a significant difference in the clinical evaluation scores between general track and sub-specialty track students (p<0.002).  45 of the 474 students pursued an Ob/Gyn residency, 75% of whom participated in a subspecialty track.

 

Discussions: Exposure to subspecialty fields is not uniform during core clerkships. Our study indicates that using core clerkship time for early subspecialty exposure does not negatively impact student outcomes, and potentially improves clinical evaluations.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Clerkship Director, Clerkship Coordinator, Medical Knowledge, UME, Team-Based Learning, Gynecologic Oncology, Maternal-Fetal Medicine, General Ob-Gyn,

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Decreasing the incidence of hospital-acquired venous thromboembolism (VTE) through inter-disciplinary educational methods

Purpose: This study explored the knowledge of a venous thromboembolism (VTE) prevention protocol among residents, fellows and nurses and the impact of an educational module in an effort to improve adherence to this protocol and subsequently decrease the incidence of hospital-acquired VTE.

 

Background: VTE significantly contributes to morbidity and mortality in hospitalized patients. Patients with gynecologic cancers are at high risk primarily due to malignancy, increased age, and recent surgery and immobility. Several evidence-based interventions are used to decrease the risk of hospital-acquired VTE commonly leading to institutional policies. The division of Gynecologic Oncology at University Hospitals Cleveland Medical Center  standardized VTE prevention guidelines in 2015.

 

Methods: Participants included OB-GYN residents, Gynecologic Oncology fellows and nurses on the Gynecologic Oncology floor. Participants received a fifteen question pre-test immediately followed by an educational presentation describing the venous thromboembolism prevention guidelines. They then received the same fifteen question post-test. The participants were re-tested in six months to gauge knowledge retention. The scores were compared using an unpaired T test.

 

Results: There were seventy-five eligible participants. The survey response rates were: pretest 68%, post-test 35%, follow up pretest 28% and follow up posttest 21%.Of the participants who identified their role, 62% were nurses, 33% were residents and 5% were fellows. There was a statistically significant difference between the test scores before and after the educational intervention during the initial intervention and the six month follow up (p= 0.0001). During the initial survey, the mean pre-test and post-test scores were 54.5% (95% CI 49.7-59.3) and 80.2% (95% CI 73.4-87.1) respectively. At the six month follow up, the mean pre-test and post-test scores were 62.2% (95% CI 56.5-67.9) and 82.1% (95% CI 75.3-88.9) respectively. There was no significant difference between the post-test scores at zero and six months (p= 0.7).

 

Discussions: These findings suggest that knowledge of the VTE prevention guidelines improved following an educational module. Further studies can elucidate the impact of this knowledge on compliance with the VTE protocol and incidence of hospital-acquired VTE.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, GME, Quality & Safety, Gynecologic Oncology,

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Assessment of Medical Student Knowledge of Lynch Syndrome Cancers, Screening, and Prevention

Purpose: To assess medical students’ knowledge regarding Lynch syndrome (LS)

 

Background: LS accounts for 3% of newly diagnosed endometrial cancers (EMC) and colon cancers (CC). Identifying patients with LS is fundamental to enable proper screening and prevention of at risk malignancies, along with encouraging cascade testing of family members. We aimed to assess medical student knowledge of LS associated cancers, screening and prevention measures to decrease malignancy risk.

 

Methods: An anonymous, voluntary, multiple choice survey was emailed to 14 medical schools throughout the US.

 

Results: We surveyed 328 medical students, 65% were MS3 or MS4s. Ninety-two percent knew that CC is one of two most commonly diagnosed cancers in LS; however only 37% knew EMC was the other most common malignancy. Fifty-eight percent recognized that 2-5% of all newly diagnosed EMC and CC are due to LS. Ninety percent recognized a family history that would indicate screening for LS, but only 48% knew that all patients diagnosed with EMC prior to age 50 should be screened for LS per NCCN guidelines.

 

Discussions: Almost two thirds of medical students did not recognize EMC as a common LS malignancy and less than 50% were aware of when to screen patients with EMC for LS; almost all students recognized CC link with LS.  Curriculum change with targeted education regarding endometrial cancer and LS during medical school ob-gyn clerkship should be implemented. This call to action is critical to improve diagnosis of LS, screening and prevention of cancers in both patients and family members to reduce mortality.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Medical Knowledge, UME, Assessment, Gynecologic Oncology, Genetics,

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Applications of 3D Printing: A Novel Visual Aid to Improve Understanding and Reduce Anxiety During Colposcopy

Purpose: We have created an interactive model of a cervix that shows a variety of possible colposcopy findings to be used for patient and medical student education.

 

Background: Many interventions have been studied as attempts to both improve understanding and reduce anxiety surrounding colposcopy.   There are no reports of 3D-printing used to describe cervical dysplasia.

 

Methods: The model was created by Cassandra Jones, BA.  The model is an enlarged representation of a cervix divided into four quadrants, each representing a different type of cervical abnormality. Patients undergoing colposcopy were randomized into two groups. One group received counseling using the model as a visual aid, and the other received usual counseling.

 

Results: 55 surveys were completed.  Demographics did not differ between the two groups.  On paired T-test, both groups showed significant improvement in knowledge after counseling, with average pre-counseling scores of 3.38 +/- 1.8 and post-colposcopy scores of 4.93 +/- 1.6 with model (p = 0.0003); and average pre-counseling scores of 3.85 +/- 1.9 and post-colposcopy scores of 4.96 +/- 1.7 without model (p = 0.0009). Likewise, understanding scores improved significantly in both groups, with average pre-counseling scores of 10.28 +/- 3.7 and post-colposcopy scores of 13.24 +/- 3.2 with model (p = 0.0002); and average pre-counseling scores of 11.12 +/- 3.6 and post-colposcopy scores of 13.62 +/- 3.4 without model (p = < 0.0001). Anxiety significantly decreased with use of the model, with pre-counseling scores of 4644 +/- 14.4 and post-colposcopy scores of 40.12 +/- 15.0 (p = 0.0009). Anxiety scores also decreased after counseling without use of the model from pre-counseling scores of 42.05 +/- 13.9 to post-colposcopy scores of 36.03 +/- 12.5, though this decrease was not statistically significant (p = 0.087).

 

Discussions: Both patients and providers unanimously reported finding the model helpful in explaining and understanding cervical dysplasia. Further directions include use of model to increase compliance with cervical cacner screening and as adjunct for medical student education.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Patient Care, Interpersonal & Communication Skills, UME, Simulation, Advocacy, Gynecologic Oncology, Infectious Disease, General Ob-Gyn,

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Improvement in CREOG Scores Through Focused Review Sessions

Purpose: To determine if focused review sessions lead to improvement in CREOG scores.

 

Background: In 2013, faculty at the University of Kentucky developed a Gynecologic Oncology (GYO) review aimed at improving resident scores.

 

Methods: Each year, residents voluntarily participated in five review sessions on major topics in GYO.  Sessions consisted of a pre-test (approximately 15 questions) followed by a discussion that emphasized the key concepts for that subject. From 2014-2017, GYO scores were compared between residents who attended (A) over 50% of the sessions and those who did not (NA). Scores from 2010-2013 were collected as a control group (C). SAS (9.4) was used to analyze the data via ANOVA with repeated measures and least square difference pairwise comparisons. Significance was defined as p <0.05.

 

Results: Data was collected on 153 tests from 55 residents (80 from 2010-13 and 73 from 2014-17). The mean scores for GYO and overall test increased with each resident year (p<0.0001). Attendance revealed a statistically significant improvement on GYO scores when compared to NA (p=0.0001) and C (p=0.0008).  There was no difference between C and NA (p=0.3875). Those who attended also scored significantly higher on overall test scores compared to NA (p=0.0002). There was no difference between A and C (p=0.1747). For those residents who attended multiple years of review sessions, there was no significant improvement in GYO or overall scores compared to less frequent attendees. 

 

Discussions: Our findings support the hypothesis that focused review sessions improved resident comprehension as reflected by CREOG scores.

Topics: CREOG & APGO Annual Meeting, 2018, Resident, Faculty, Residency Director, Medical Knowledge, GME, Assessment, Lecture, Independent Study, Gynecologic Oncology, General Ob-Gyn, CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Advocacy, General Ob-Gyn,

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Improved Adherence to C. Difficile Isolation Protocols Through Inter-disciplinary Education

Background: CD rates are increasing, causing 14,000 deaths and $1 billion in healthcare spending annually (CDC, May 2015).  This is especially true in the high risk gynecologic oncology population. Appropriate testing and use of contact precautions have proven efficacy.  Staff education may lead to improved adherence to isolation protocols and decrease infection rates.

 

Methods: A CD educational module was administered to all involved nurses and residents. Knowledge of correct protocol was tested utilizing a pre-test/post-test design. All patients on the gynecologic oncology service tested for CD were then prospectively followed for appropriate CD toxin PCR and isolation orders, acceptance of orders, and PCR results. Historical data on the above were collected from January 2012-July 2014 and analyzed using the Fisher\'s exact test.

 

Results: Historically, 138 patients had CD PCR ordered.  Of these, none (0%) had appropriate isolation orders and 19/138 (1.4%) tested positive. Fifty-three nurses and house staff were educated and surveyed, with a pre and post test completion rate of 66%. Average post-test scores were 100% amongst residents and 95% amongst nurses. Twenty-five post intervention CD PCRs were ordered, of which 18/25 (72%) had isolation orders. Zero CD PCR tests were positive. Compliance with precautions ( p < 0.0001) and  CD infection rates (p < 0.05) were significantly improved after undergoing the educational module.

 

Discussions: Use of a multi-disciplinary education module improves adherence to CD isolation precautions and may decrease infection spread.

 

Keywords: C-difficile, gynecologic-oncology, compliance


Topics: CREOG & APGO Annual Meeting, 2016, Resident, Faculty, Patient Care, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, CME, Quality & Safety, Team-Based Learning, Gynecologic Oncology,

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A Novel Approach to Teaching Residents Comprehensive Risk Reduction and Management Strategies

Background: Awareness about genetic predisposition to breast and ovarian cancer has increased dramatically over the last decade, yet working knowledge of how to identify and manage high risk patients is lacking among many physicians. The study goal  was to assess knowledge deficits among residents and determine whether a novel approach will help bridge the perceived knowledge gap.

 

Methods: A novel learning module was developed to assess risk level and apply standard recommendations for screening and risk reduction. This approach is unique, as most academic lectures focus on management of high risk patients, but not on risk stratification and risk reduction in all comers. Surveys were completed by residents assessing perceived knowledge before and after the presentation.

 

Results: 833 primary care residents were surveyed after participating in the lecture and case based learning module. 670 (86.5%) stated the information presented was new to them. 768 (94.6%) stated the training increased their knowledge regarding options for risk reduction and early detection. 802 (97.4%) stated after attending training, they understood how to identify patients at increased risk for developing breast and ovarian cancer to refer for genetic counseling and testing. 764 (96.1%) indicated they would incorporate material in the training into their everyday practice.

 

Discussions: Surveys confirmed a knowledge gap in breast and ovarian cancer risk assessment and management. While professional organizations have created guidelines for patient management, most trainees are either unaware of recommendations, or feel information is not presented in a way allowing them to use it practically in patient management. The workshop increased perceived knowledge among residents, allowed them to correctly identify high risk patients, and increased knowledge of risk reduction strategies among all patients. Recent studies have demonstrated poor coordination of care for the majority of high risk patients not opting for risk reducing surgery within the first few months after diagnosis of a gene mutation. Need for comprehensive education among residents in this area is clear. A practical risk stratification approach to identify and manage high risk patients is successful in bridging the knowledge gap among residents in primary care specialties.

 

Keywords: resident education multidisciplinary


Topics: CREOG & APGO Annual Meeting, 2016, Resident, Faculty, Residency Director, Patient Care, Medical Knowledge, Practice-Based Learning & Improvement, GME, Lecture, Problem-Based Learning, Public Health, Gynecologic Oncology, Genetics,

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Using Gynecological Oncology to Facilitate Longitudinal Patient Care in a Basic Sciences Curriculum

Background: The limited exposure to clinical medicine during the first two years of school, in addition to the rapid rotations within clinical clerkships, does not allow for students to form a true patient-doctor relationship until at least residency.  Exposure to this relationship early will better prepare students for their careers as physicians.

 

Methods: We have created a self-guided, student-centered program in which students are able follow a gynecological oncology patient over the course of their surgeries, clinic visits, and radiation or chemotherapy treatments.  Students were given a pre and post program questionnaire to assess their development and attitudes towards longitudinal patient care and were also required to document their visits and personal observations for each time they saw their patient.

 

Results: By the end of the program students became familiar with gynecological oncology but also gained valuable personal insight. They saw firsthand what their patients were experiencing not only from a medical education standpoint, but also from an interpersonal one.  Students were also able to assess outside factors in cancer treatment such as family support, patient adherence, and empathy within a medical setting.   

 

Discussions: Should a greater emphasis be placed on patient care within the first two years of medical school?  Could this be instituted within the existing basic science curriculum?  Students who participated in this program said that they believe they are better prepared for clerkships due to the unique experiences gained without this program.  

 

Keywords: Oncology,  Longitudinal, Relationships


Topics: CREOG & APGO Annual Meeting, 2016, Student, Faculty, Clerkship Director, Osteopathic Faculty, Patient Care, Medical Knowledge, Professionalism, UME, Independent Study, Public Health, Advocacy, Gynecologic Oncology,

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Improving Outpatient LEEP in a Residency Program through Incorporation of a LEEP Simulator

Study Objectives: 1. To incorporate a LEEP simulator into an electrosurgery and LEEP education session for PGY1 residents 2. To improve the office LEEP performance of the PGY2 residents through incorporation of the LEEP simulator

Methods: At the University of Oklahoma, PGY1 Residents spend one afternoon near the end of the academic year in an educational session focused on electrosurgery and LEEP. Traditionally, this session has involved a lecture reviewing the technology, equipment, and technique for performing a LEEP procedure. In 2014 a LEEP simulator was created by the director of the Dysplasia clinic and incorporated into the half day teaching session. Residents were asked to demonstrate the correct way to set up the equipment, use the correct settings on the electrosurgical unit, and demonstrate a LEEP procedure on a bratwurst.

Results: Each of the PGY1 residents was able to demonstrate the appropriate safety procedures, including a time-out and apply the appropriate settings on the electrosurgical machine. Additionally, each resident was able to successfully perform a LEEP procedure on the simulated materials. Since the education, the PGY2 residents have improved their performance in the LEEP clinic as evaluated by the clinic faculty.

Conclusions: A low fidelity simulator is a valuable tool in the education of entry-level residents to be able to perform a safe procedure with an adequate specimen for pathologic interpretation. Our institution plans to continue to use the simulator and incorporate a pre-test and post-test and a more formal evaluation system.

Topics: CREOG & APGO Annual Meeting, 2015, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, GME, Assessment, Simulation, Gynecologic Oncology, Minimally Invasive Surgery, General Ob-Gyn,

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The Implementation of a Flipped Classroom Model in the Obstetrics and Gynecology Medical

Objective: In order to limit the amount of time medical students were excused from patient care opportunities, and to increase student satisfaction with didactic sessions, a flipped classroom curriculum was implemented for the gynecologic oncology topics of an obstetrics and gynecology clerkship.

Study Design: Four short online videos on the topics of endometrial hyperplasia, cervical dysplasia, evaluation of an adnexal mass, and ovarian cancer were developed, and students were instructed to view them prior to a class-time active learning session. The Learning Activity Management System (LAMS) was utilized to create a class-time activity that consisted of faculty coached discussions of cases. Student satisfaction with the flipped curriculum was assessed. In addition, lecture assessment for the gynecologic oncology topics, and aggregate student performance on the gynecological oncology questions of the National Board of Medical Examiners (NBME) Obstetrics and Gynecology Subject Examination, were compared before and after implementation of the curriculum.

Results: Of the 89 students, 71 (84%) viewed the videos prior the class session and 84 (94%) attended the session. High student satisfaction was indicated for both flipped curriculum components, with particularly strong support for the expansion of the LAMS case discussions. There was no significant statistical difference in aggregate student performance on the gynecologic oncology questions of the NBME Subject Examination.

Conclusion: This pilot implementation of the flipped classroom curriculum for gynecologic oncology topics successfully demonstrates a promising platform for making more efficient use of medical students’ time, and for the creation of dynamic, interactive active learning in the classroom.

Topics: 2014, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Medical Knowledge, UME, Independent Study, Problem-Based Learning, Team-Based Learning, Gynecologic Oncology,

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The Implementation of a Flipped Classroom Model in the Obstetrics and Gynecology Medical Student Clerkship: Results of a Pilot Study

Objective: In order to limit the amount of time medical students were excused from patient care opportunities, and to increase student satisfaction with didactic sessions, a flipped classroom curriculum was implemented for the gynecologic oncology topics of an obstetrics and gynecology clerkship.

Study Design: Four short online videos on the topics of endometrial hyperplasia, cervical dysplasia, evaluation of an adnexal mass, and ovarian cancer were developed, and students were instructed to view them prior to a class-time active learning session. The Learning Activity Management System (LAMS) was utilized to create a class-time activity that consisted of faculty coached discussions of cases. Student satisfaction with the flipped curriculum was assessed. In addition, lecture assessment for the gynecologic oncology topics, and aggregate student performance on the gynecological oncology questions of the National Board of Medical Examiners (NBME) Obstetrics and Gynecology Subject Examination, were compared before and after implementation of the curriculum.

Results: Of the 89 students, 71 (84%) viewed the videos prior the class session and 84 (94%) attended the session. High student satisfaction was indicated for both flipped curriculum components, with particularly strong support for the expansion of the LAMS case discussions. There was no significant statistical difference in aggregate student performance on the gynecologic oncology questions of the NBME Subject Examination.

Conclusion: This pilot implementation of the flipped classroom curriculum for gynecologic oncology topics successfully demonstrates a promising platform for making more efficient use of medical students’ time, and for the creation of dynamic, interactive active learning in the classroom.

Topics: 2014, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Medical Knowledge, UME, Independent Study, Problem-Based Learning, Team-Based Learning, Gynecologic Oncology,

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The Development of a Peer Observation of Teaching Tool for use in OB/GYN Clerkship Didactics

Katharyn Meredith Atkins, MD
Beth Israel Deaconess Medical Center, Boston, MA
Study Objective: Peer Observation of Teaching (POT) is important in the development of educators. For POT to be effective it should be criterion based and utilize reliable instruments. In the September 2011 Clerkship Review of the Harvard Medical School (HMS) OB/GYN Clerkship, the Course and Clerkship Review and Evaluation Committee recommended incorporating a POT program to improve faculty development. While members of the Clerkship Committee were in favor of pursuing such a program, we felt an instrument appropriate for use in the student didactic teaching seminars did not yet exist. The goal of this project was to develop a peer observation of teaching instrument for use in the HMS OB/GYN Clerkship Didactic Seminars.

Methods: This project utilized a modified Delphi process. The Delphi process is an iterative, multistage group facilitation technique, designed to establish group consensus. The HMS OB/GYN Clerkship Directors at all four HMS teaching sites as well as key educators served as the experts in this process. Key educators were previous Clerkship Directors at HMS sites with extensive knowledge of the clerkship.

Results: To compile the initial list of criteria for the teaching instrument, all HMS Peer Observation of Teaching Instruments were reviewed. In addition, previously published instruments were reviewed. 32 criteria were generated from this list. Participants were asked to rate the criteria using a scale of 1 to 4 with 1 being very important and 4 indicating the criteria should be eliminated. Measures of central tendency, mean and standard deviation (SD) were used to determine the level of group consensus. For the initial round, 10 participants rated 32 criteria. A mean of less than or equal to 2.0 and SD less than 0.99 were used to determine inclusion in the instrument. In the second round 9 participants rated 19 criteria and a mean of less than or equal to 1.56 was used to determine criteria for inclusion in the instrument. All SD were less than 0.99 in this round. In the final round 10 participants rated 15 criteria. In this round there were two criteria with means great than 1.4 and SD greater than 0.5, and these items were discarded. Additionally, two criteria were combined, leaving 12 criteria in the final instrument.

Conclusions: A modified Delphi process resulted in a strong consensus on criteria to be used in a peer observation of teaching instrument for use in the didactic teaching seminars in the HMS OB/GYN Clerkship. The next step in this project is to perform a pilot study of the instrument to evaluate internal consistency and inter-rater agreement. Ultimately we hope to establish a formative POT program in the OB/GYN Clerkships at HMS.

Key Words: Peer Observation, Teaching

Topics: CREOG & APGO Annual Meeting, 2014, Clerkship Director, Residency Director, Patient Care, Medical Knowledge, Practice-Based Learning & Improvement, GME, Assessment, Team-Based Learning, Gynecologic Oncology, General Ob-Gyn,

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Interdisciplinary colposcopy conference: an educational forum for medical students and residents

Britt K. Erickson, MD
University of Alabama at Birmingham, Birmingham, AL
Objective: As screening guidelines and management recommendations for pre-invasive cervical disease evolve in complexity, teaching medical students and OBGYN residents these concepts has become more challenging. As such, we created a protected educational forum for residents and medical students to review pre-invasive cervical disease in a multidisciplinary forum incorporating cytology, cervical imaging, histology, and updated screening and management guidelines.

Methods: Monthly colposcopy conferences were planned through the joint efforts of the surgical pathology, cytopathology, and gynecologic oncology fellows. Each month, 5-8 patients were selected for presentation at the conference from our University-based colposcopy clinic which is attended weekly by medical students, residents, and gynecologic oncology fellows. During the conference, patient demographics were presented including age, parity, referral cytology, and medical and social history. Next, the cytology specimen was reviewed through the multi-headed teaching microscope and notable findings were discussed. Images captured directly from the colposcopy exam (both before and after application of acetic acid and/or Lugol’s solution) were also displayed. Residents were asked to describe the images, render a diagnostic impression, and discuss optimal locations for biopsy. After reviewing the cervical images and the biopsy sites, the histopathology of the biopsy specimen was reviewed using the teaching microscope. The pathology fellow emphasized the cyto-histologic features used to differentiate normal from both low and high-grade squamous intraepithelial lesions. Once a final diagnosis was made, medical students and residents were asked about subsequent management and follow-up according to the most recent American Society for Colposcopy and Cervical Pathology (ASCCP) screening and management guidelines. When available, loop excisional specimens were also reviewed and correlated with previous biopsy results.

Results: A total of ten monthly conferences were held between August 2012 and May 2013. Three OBGYN residents had protected time to attend the conference each month (1 PGY-2, and 2 PGY-1). In addition, 2-5 medical students from the rotation, 3-4 fellows (oncology, cytopathology, and surgical pathology), and 1-4 pathology and/or oncology staff attended each conference. Feedback in the form of an anonymous survey was obtained regarding the utility of the conference at the completion of the academic year. The survey consisted of 10 questions, 6 of which were part of standardized departmental conference evaluations. Residents had four answer options, including: “Not Applicable”, “No”, “Yes/Somewhat”, “Yes/Definitely”. All fifteen members of the 2012-2013 first and second year resident classes submitted evaluations. Fourteen residents attended at least one conference (range 0-5, median 2). Of these 14 residents, 93% indicated that the conference “Yes/Definitely” provided a unique opportunity for inter-professional collaboration, increased their medical knowledge, and introduced them to new concepts. Nine residents attended two or more colposcopy conferences. Of these residents, 100% indicated that conferences “Yes/Definitely” improved their ability to recognize cervical pathology and decide where to best perform directed biopsies, as well as improve their understanding of the ASCCP screening and management guidelines.

Conclusions: The comprehensive evaluation of pre-invasive cervical disease is a complex topic for medical students and OBGYN residents. Through an interdisciplinary approach involving gynecologic oncology, surgical pathology, and cytopathology, we were able to successfully create a forum for medical students and residents to review and learn this important subject.

Key Words: colposcopy, multidisciplinary education

Topics: CREOG & APGO Annual Meeting, 2014, Clerkship Director, Residency Director, Patient Care, Medical Knowledge, Practice-Based Learning & Improvement, GME, Assessment, Team-Based Learning, Gynecologic Oncology, General Ob-Gyn,

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Effect of a Scheduled Curriculum with Electronic Reminders on Ob/Gyn Resident CREOG Scores in GYNONC

Renata R. Urban
University of Washington, Seattle, WA

Study Objectives: Regulation of resident work hours have affected the time available for dedicated education. To address this issue, the education director in the Gynecologic Oncology (Gyn Onc) division at the University of Washington created and implemented a new Gyn Onc curriculum for residents. Our objective was to assess the effect of this new curriculum by assessing resident scores on the Gyn Onc section of the CREOG annual in-service exam.

Methods: In January of 2009, we instituted a new Gyn Onc curriculum of weekly topics based on the Gyn Onc educational objectives of the CREOG. Every week, the residents on the Gyn Onc service, as well as all faculty members, received an e-mail reminder of the upcoming topic to be discussed. Residents were asked to prepare for the week by reading pertinent chapters from Berek & Hacker’s Gynecologic Oncology. The series of topics was repeated during each eight week resident rotation. To evaluate the effect of the new curriculum on resident Gyn Onc knowledge, we performed a retrospective analysis comparing CREOG scores from all graduated residents from 1999-2009 to those from 2010-2011.

Results: Ninety residents were included in this analysis, including 73 females and 17 males. This yielded a total of 295 scores for analysis. The mean percentage correct on the Gyn Onc section of the CREOGs increased significantly by 6.5 percentage points (95% CI 3.5-9.6), from 66.9 in 1999-2009 to 73.6 in 2010-2011. During this time period, the overall CREOG scores did not significantly change (0.2 percentage points, 95% CI -1.7 to 2.1).

Conclusions: This simple tool of scheduled reminders to residents and faculty of weekly curriculum topics improved Gyn Onc CREOG scores. This may be due to expected and intentional review of educational content by attendings.

Key Words: CREOG, gynecologic oncology, curriculum, residents

Topics: CREOG & APGO Annual Meeting, 2014, Resident, Residency Director, Residency Coordinator, Medical Knowledge, GME, Assessment, Gynecologic Oncology,

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Model Ovarian Tumors

Sheela M. Barhan, MD
Wright State University Boonshoft School of Medicine, Dayton, OH
Objective: To provide an experiential and energetic learning format to educate residents on the details of different classes of ovarian neoplasms.

Methods: Residents are given a pretest on ovarian tumors. Then residents are divided into groups. Each group is given a different handout of data on an ovarian neoplasm class; for example germ cell tumors. Handout contains an overview of the specific types of ovarian tumors within that class, plus corresponding clinical data, and photos of histological features. Each person within a group is then asked to pick a specific tumor within that class and create model of it out of props available from a selection of craft items. Props include modeling clay, and labeled bowls of items such as coffee beans, clear glass marbles, signet rings, teeth and hair. Some props allow the resident to demonstrate behavior of the tumor, such as tampons for granulosa cell tumors, mustaches for sertoli-leydig tumors, and labels for child, adolescent or adult. At the end of the modeling session, each group has made 3 different models of ovarian tumors demonstrating features of different classes. A spokesperson from each group then shares the details of the tumors that they created with the group; why they chose certain props to create their model and how it exemplifies the characteristics of certain classes of ovarian tumors or the specific type they chose to make. Lastly, the group is given a post-test on ovarian tumor knowledge and each resident compares their results to the pretest. Finally models are left on display in the resident clinic with name labels of tumor type and sculptor.

Results: Residents participate in a new method of instruction that is experiential and interactive to learn a standard concept. The pre and post test shows improvement in personal knowledge.

Conclusion: The classic organization of ovarian tumors is taught by lecture but often the details are difficult to remember. By virtue of this being an interactive and experiential learning session, it can provide a more memorable impression of the ovarian tumor details.

Key Word: interactive, ovarian tumor

Topics: CREOG & APGO Annual Meeting, 2014, Resident, Faculty, Residency Director, Medical Knowledge, GME, Assessment, Simulation, Advocacy, Gynecologic Oncology,

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Committee on Fellowship Training in Obstetrics and Gynecology: A needs assessment

Poster
Carrie L. Bell, MD

R Kevin Reynolds, MD, Peggy Engel , Timothy RB Johnson, MD

Background: APGO serves educators focused on women’s health by providing resources and support. Faculty in Obstetrics and Gynecology rely on APGO for this vital role. Currently, no unifying organization or committee exists for fellowships in Obstetrics and Gynecology. In 2010, a group of educators committed to the training of fellows formed a Committee on Fellowship Training in Obstetrics and Gynecology (COFTOG). The group determined that a needs assessment survey would best outline and direct the goals and objectives of the new group.

Objective: Survey the fellowship directors of OB/GYN based fellowships as a basis for the new Committee on Fellowship Training in Obstetrics and Gynecology.

Methods: A survey was designed; 5 demographic questions and 15 survey questions. The survey was entered into Survey Monkey. Contacts were identified gynecology oncology, maternal fetal medicine, reproductive endocrinology and infertility, female pelvic medicine and reproductive surgery, family planning, minimally invasive surgery, breast, pediatric and adolescent gynecology, genetics, and women’s health. The survey was sent to the contact lists. For specific fellowships, the national organization requested the survey for approval and subsequently, the organization sent it out to fellowship directors. The results were collected anonymously by Survey Monkey. The results were compiled and analyzed. The project was determined to be IRB exempt.

Results: There were 85 completed surveys from an estimated 250 possible responses; 34% response rate.. Thirty nine percent were MFM directors and 10-17% of surveys completed by family practice, FPMRS, REI and Gyn Onc. A national committee focused on fellowships was desired by 66% of respondents. 11% had formal training to be a fellowship director with twenty percent having served as a clerkship or residency program directors previously. 37% had participated in a faculty development course to help in their role as fellowship director. Sixty four percent thought a fellowship director school would be helpful. When asked about a central repository for evaluation, curricula, policies and organization, 68-70% responded in the affirmative. Specifically, directors asked for a national group to help with requirements from and reporting for national organizations (ABOG and ACGME), resolution of common problems, mental health, evaluation, training objectives and competencies. Two respondents wrote: "Have been looking to APGO for a long time to pick up the mantel. Have attended these meetings to pick up whatever points I could". "An APGO based organization may be able to provide some benchmarks to judge your program by, such as didactic schedules, curriculum, faculty supervision, etc."

Conclusion: Fellowship directors welcome APGO’s involvement and support in the form of COFTOG to provide support through faculty development and consolidation of resources for general use to improve the education of fellows.

Topics: CREOG & APGO Annual Meeting, 2013, Resident, Faculty, Residency Director, Systems-Based Practice & Improvement, GME, Assessment, Gynecologic Oncology, Contraception or Family Planning, Pediatric & Adolescent Gynecology, Minimally Invasive Surgery, Reproductive Endocrinology & Infertility, Female Pelvic Medicine & Reconstructive Surgery, Maternal-Fetal Medicine, Sexuality, Genetics,

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Simulation Model for Carbon Dioxide Laser Training for Ob/Gyn Residency

Poster
Saifuddin T. Mama, MD, MPH

Objectives: Provide an account of a dedicated simulation program for Carbon Dioxide (CO2) laser training for ob/gyn residents focused on safety and skill acquisition in completing laser cones. Given that overall use of lasers in gynecologic surgery has decreased, a simulation program to enhance understanding of the precise ability of CO2 laser in cutting, coagulating and vaporizing tissue was conducted.

Methods: Ob/Gyn residents comprising all four years of training underwent a pretest to assess the baseline knowledge of CO2 laser safety and mechanics. A model of a vagina and cervix was created to simulate the environment in order to perform the exact steps for a laser cone. This utilized material bought from handicraft and hardware stores and a supermarket. Education as to laser safety and the functioning of the CO2 laser was conducted. In the operating room, residents then practiced doing a laser cone to a depth of 7 mm. A post-test was administered.

Results: The average score on pre-test ranged from 20-40% correct. The post-test scores ranged from 90-100% correct. All residents successfully completed a simulated laser cone of the cervix.

Conclusion: Residents were successfully able to complete a program utilizing CO2 laser for cervical cone.

Topics: CREOG & APGO Annual Meeting, 2013, Resident, Patient Care, Medical Knowledge, GME, Assessment, Simulation, Gynecologic Oncology, General Ob-Gyn,

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Simulation Training in Robotic Surgery for Ob/Gyn Residency: A 5-Year Experience

Poster
Saifuddin T. Mama, MD MPH

Objectives: Description of an ongoing 5-year ob/gyn residency training program in robotic surgery since 2007.

Methods: Ob/Gyn residents comprising all four years of training undergo a systematic training process, starting with completion of the Da Vinci surgical system online training module, a hands-on 4 hour tutorial incorporating didactics, the set up and preparation for a robotic surgery and a demonstration of the use of the console in completing a series of simulations of varying difficulty designed to maximize utilization of all three robotic arms along with the camera. This introduction is followed by a dedicated two-day weekend program with two hours of robotic console time per resident, each completing the same series of pre-established tasks. These include: 1) pegboard with removal and re-placement of bands, 2) dissection of a vessel embedded in gel, 3) dissection of a marked area of skin on a chicken wing, 4) dissection of a marked area on a latex surface under tension, 5) utilizing all three arms in space to cut along a prescribed area on telfa, and 6) suturing --both running and interrupted subcuticular sutures. In the fourth year of this training, all residents were timed against each other in completing the tasks. Average times with standard deviations were calculated and a comparison made between participants by residency year.

Results: In all tasks, the time difference required for completion was not significant between residency year, except for the pegboard module where the time needed for completion decreased by year in residency. There was also a difference between the chief residents and the remaining residents in the latex surface dissection. The range and standard deviation for all five modules were wide.

Conclusion: While robotic residency training programs do provide an orientation and familiarity with the robot, the fact that the time taken in completing the modules did not vary by residency year despite the training implies the need for more frequent formalized robotic training, likely via the use of a simulator.

Topics: CREOG & APGO Annual Meeting, 2013, Resident, Patient Care, Medical Knowledge, GME, Assessment, Simulation, Gynecologic Oncology, General Ob-Gyn,

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