Training Residents to Place Immediate Postpartum LARC: An Update Among U.S. Residency Programs
Purpose: To survey U.S. Obstetrics and Gynecology (Ob/Gyn) Residency
Programs on immediate postpartum (IP) long-acting reversible contraception
(LARC) training and challenges.
Background: In 2016, the American College of Obstetricians and
Gynecologists (ACOG) released a committee opinion supporting IP LARC. Growing
evidence describes provider/hospital barriers which hinder IP LARC provision.
We hypothesize similar difficulties have prevented programs from implementing
Methods: We distributed an electronic survey addressing IP LARC
training to 273 U.S. Accredited Council for Graduate Medical Education (ACGME)
Ob/Gyn Residency Program Directors from the 2017-2018 Academic Year. Data
analysis was performed with chi-square and Fisher’s exact test.
Results: Of 86 programs that participated, residents were
trained in the immediate postpartum period to place implants in 54 programs
(63%) and to place intrauterine devices (IUDs) in 52 programs (60%).
2015, only 20% of the programs were training their residents to place IP IUDs.
Thirty-one percent of eligible programs initiated training in 2017. The
majority of programs focused training interns (98%). Patient/provider
convenience motivated 46% of programs to offer IP LARC and compliance motivated
The two barriers
most frequently encountered, regardless of program training status, were
problems with billing and compensation for services (61%) and the pharmacy
that reported primarily seeing patients with insurance, either private or
Medicaid, were more likely to have IP IUD training compared to programs seeing
mostly indigent/uninsured populations (p<0.05).
Discussions: IP LARC training has increased since the ACOG Committee
Opinion was published, however many programs are still facing challenges with
implementation, affecting resident training.
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,
Read more »
Remote, Off-site Abortion Training: Experiences of Obstetrics and Gynecology Residents at an Academic Program
Purpose: To describe the experiences of obstetrics and gynecology
residents regarding a local compared to a remote, off-site family planning (FP)
Background: The Accreditation Council for Graduate Medical
Education (ACGME) requires that obstetrics and gynecology residency programs
provide access to abortion training. Residents at our institution
had the option of such training at a local, free-standing abortion clinic until
2013. This training was then replaced by a rotation at a remote,
free-standing abortion clinic three hours away.
Methods: We surveyed graduated obstetrics and gynecology
residents who trained at our institution from 2009-2017. The survey contained
both closed-ended and open-ended questions about graduates’ experiences with FP
training. We asked about respondent’s assessment of the rotation’s
educational value and support of its integration into the residency curriculum.
We assessed predictors of FP rotation participation with Fisher’s exact
Results: Of the 32 eligible graduates surveyed, we received 21
complete responses (67%). Overall, 13 (62%) respondents participated in
the FP rotation. Ten respondents trained when the local rotation was
available and six of them would have been interested in a remote
rotation. Of the 11 respondents who trained when the remote rotation was
available, 8 participated and all 8 described the rotation as having high
educational value. Almost all respondents strongly supported integration
of an FP rotation into the curriculum (19/21). Relationship status,
having children, and current practice type were not associated with FP rotation
Discussions: Trainees in obstetrics and gynecology value access to
abortion training, even if the training is off-site and remote.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Residency Director, Residency Coordinator, Practice-Based Learning & Improvement, GME, Public Health, Advocacy, Contraception or Family Planning,
Read more »
Predictors of Trainees\' Willingness to Provide Family Planning Services: A Survey of Ob-Gyn Residents
Purpose: To determine factors that contribute to a resident’s
willingness to provide abortions post-residency.
Background: The shortage of abortion providers makes accessing
care difficult. Personal and environmentalfactors within the residency training
environment may be modified so that greater numbers ofgraduates opt to become
Methods: A multiple-choice survey was sent to all ACGME
accredited OB/GYN residency programs. Data on demographics,religious and
political views, residency training experience and intent to provide abortions
was collected anonymously (n=396).
Results: Sixty-eight percent of residents intended to provide
abortions (n = 269). The sample was 89% female, underage 35 (97%), heterosexual
(91%). In a multivariable logistical regression, the following demographic
factors predicted intent to provide abortion; being female (aOR 2.8; 95% CI
1.2-6.5), identifying as non-Christian (aOR 3.6; 1.9-6.6), and being raised in
the Northeast (vs South) (aOR 3.0; 1.3-6.7) .Modifiable predictors of intention
to provide included programs where 50% of the faculty provided abortions (aOR
3.3;95% CI 1.8-5.8). Additionally, residents who performed greater than 20
cases (uOR 3.3, 95% CI 1.6-6.7) were three times more likely to plan
toprovide.Selection of a residency emphasizing family planning significantly
correlated with intent toprovide (aOR 4.3; 95% CI 2.4-7.8). Those training at
Ryan Programs were twice as likely (uOR2.4; 95% CI 1.6-3.8) to intend to
Discussions: Modifiable factors such as early exposure of medical students
to family planning, faculty selection, robust case volumes and establishment of
a Ryanprogram may enhance the number of graduates offering abortions while in
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,
Read more »
OB/GYN Resident Education and Experience with Reproductive Justice
Purpose: To understand OB/GYN resident experience with reproductive
Background: Reproductive justice (RJ) is defined as: the right to
have a child, the right to not have a child, the right to parent the children
we have, and the right to control our our birthing and contraceptive options.
Despite its relevance to OB/GYN residency milestones, such as patient-centered
care, patient advocacy, and informed consent, there is currently no formalized
RJ education in residency training.
Methods: We distributed a web-based survey to U.S. OB/GYN
residents to 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.
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.
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,
Read more »
Jazzing up Family Planning Education for Students in a Texas Medical School
Purpose: To determine the
effects of resident-led family planning education during the third-year
obstetrics and gynecology clerkship on medical student knowledge and/or
medical school clerkship directors report that formal family planning education
is not offered. Students are more likely to be comfortable referring and
providing reproductive health services when exposed to formal education.
students during their obstetrics and gynecology clerkship at McGovern Medical
School during the 2017-2018 academic year were given a de-identified quiz and
survey at the beginning and end of their rotation. Half of the students
participated in a resident-led one-hour didactic session on family planning
while half did not. Data was analyzed using chi-squared test for categorical
students had low baseline scores on a family planning quiz (48.0% intervention
group (I) vs. 49.0% no intervention (NI) group, p=0.51). A formal educational
initiative significantly improved scores on the quiz (58.2% I vs. 50.7%
NI, p<0.0001).Students’ pre-rotation attitudes about women obtaining a
second trimester abortion under any circumstance showed that 17% disagreed. After
the educational intervention, fewer students agreed with women having access to
second trimester abortion under circumstances such as rape, incest or fetal
anomalies (69.2% I vs 88.4% NI, p=0.0049).
Discussions: Although the
intervention improved knowledge, students were not more likely to report
comfort providing family planning services in their future practice. Students’
attitudinal bias against ACOG-supported access to abortion in the second
trimester paradoxically increased. Further studies are needed to elucidate
barriers to improving knowledge and attitudes about reproductive health.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Residency Director, Medical Knowledge, UME, Contraception or Family Planning,
Read more »
Inter-professional OSCE Based Simulation Collaboration to Teach Obstetrics & Gynecology to Second Year Medical Students and Nursing Students
Purpose: To describe an
inter-professional workshop (IPE) utilizing simulation, OSCE and flipped
classroom to introduce 2nd year medical and nursing students to OBGYN concepts
Background: IPE has been
shown to facilitate improved patient-centered care
November 2017; students studied an online fetal heart rate (FHR) lecture; at
workshop worked in groups on clinical FHR scenarios, and presented findings for
group learning and discussions. Students rotated through three stations each
for 45 minutes as follows: 1) MFM faculty taught students on cervical dilation
using “blinded” and “open” cervical models. Students had hands-on with
obstetrical procedures such as B-Lynch Suture. 2) Students performed a
simulated vaginal delivery supervised by MFM fellow; nursing students
resuscitated newborn and gave SBAR report to medical students. 3) MFM fellow
and gynecologist faculty taught students on contraception methods while a
technician taught students IUD insertion. Students self-assessed and were
assessed by faculty using OSCE; knowledge quizzes were completed for
contraception and cervical examination accuracy.
program trained 116 (73%) medical and 51(22%) nursing students. There were no
significant differences between medical students and nursing students scores
which were respectively: IUD insertion self-assessment = 8.84 vs. 8.43; IUD
insertion faculty-assessment= 9 vs. 8; cervical examination accuracy = 13.1 vs.
12.7; contraception quiz = 9.1 vs. 9.3. Medical students
birth simulation self-assessment vs. faculty-assessment scores were 8.6 vs.
8.9, p <0.001.
Discussions: Medical and nursing
students learned OBGYN skills equally, nursing students had the opportunity to
teach medical students. Medical students were more critical of their
learning than faculty.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Simulation, Team-Based Learning, Contraception or Family Planning, General Ob-Gyn,
Read more »
Immediate Post-placental IUD Insertion: Evaluation of Clinician Knowledge and Views
Purpose: To increase
practitioner knowledge and comfort performing immediate post-placental IUD
insertion with a session including lecture and simulation.
post-placental (within 10 minutes of placental delivery) insertion of an
intrauterine device (IUD) has been shown to be both safe and effective
contraception. Post-placental IUD insertion removes barriers (loss of
insurance, loss to follow up, etc.) in the prevention of unplanned pregnancies.
In order to increase practitioner knowledge and comfort performing immediate
post-placental IUD insertion, this project developed and administered education
and procedural simulation sessions.
session consisted of a 10 minute pretest, 15 minute scripted powerpoint
presentation, 15 minute procedure simulation, and 10 minute post-test. The primary
outcome of knowledge score was calculated as the sum of all knowledge
questions. The change in knowledge score and comfort levels were assessed by
paired T-tests. Participants were asked to rate their comfort level on
performing post-placental IUD insertion on a scale of 1-5 (1=not comfortable at
all; 5=completely comfortable).
obstetrical providers attended the sessions. The average knowledge score
pre-training was 11.4 (95% CI 10.6-12.2) as compared to 15.5 (14.5-16.5)
post-training (p<0.01). Pre-training, participants were less comfortable
with immediate post-placental IUD insertion (mean 2.82; 95% CI 2.4-3.2) as
compared to post-training (mean 3.96; 95% CI 3.7-4.2), (p<0.01).
Discussions: Education and
procedural simulation sessions are an effective method to improving knowledge
and procedural comfort of post-placental IUD insertion. A curriculum dedicated
to improving knowledge and comfort of post-placental IUD insertion should be
integrated into obstetrical training.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Medical Knowledge, Practice-Based Learning & Improvement, GME, Simulation, Lecture, Contraception or Family Planning,
Read more »
Family Planning Training at Catholic and Other Faith-based Obstetrics and Gynecology Programs
Purpose: The objective of this
study was to determine the current paradigm of forceps assisted vaginal
delivery (FAVD) training across the United States (U.S.) amongst OBGYN
national FAVD rates decline and primary cesarean rates continue to be high, we
must be aware of resident interest, training, and skill acquisition in
FAVD. There is a current paucity of literature on FAVD training
Methods: A survey
was created and disseminated on the internet and to OBGYN residency program
directors for distribution to current OBGYN residents from March to June 2018.
Geographic regions were determined using Census Bureau-designated regions.
survey was completed by 434 OBGYN residents (8.5% of 5,061 ACGME residency
positions) with representation from all U.S. regions. Of postgraduate year
(PGY)-4 respondents, 71% participated in ≤10 FAVDs, with only 20.2% with
>20 FAVDs. Of all residents, 40% expressed a desire to learn FAVD, with
54.6% completing FAVD simulation training. While 46% of resident stated that
they would like to perform both FAVD and VAVD once in practice, only 13%
expressed confidence in performing FAVD independently. Residents from the
Midwest are most likely to have completed >20 FAVD at 18%, compared to 0%,
5.7% and 11.3% of residents from the Northeast, West and South, respectively
Discussions: Residents are motivated
to learn FAVD and would like to have the skill to perform them independently.
Our study demonstrates that current trainees are not obtaining adequate
experience, irrespective of geographical region. Current OBGYN residency
training programs should implement simulation and real-time training of
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, GME, Assessment, Public Health, Contraception or Family Planning,
Read more »
Evaluating the Rates of Visualized IUD Strings Following Immediate Post-Partum Placement by Ob/Gyn Residents
Purpose: Compare the incidence
of visualized IUD strings at follow up by mode of postpartum IUD placement by
postpartum contraception decreases maternal mortality, low birth weight,
preterm births and infant mortality. Missing strings in the setting of a
well positioned IUD are more common following postpartum placement as compared
to interval placement. This difference may be explained by variation in
residents’ techniques for placement in the postpartum setting.
retrospective chart review of 306 women receiving immediate postpartum IUD insertion
by residents was performed between July 1, 2017-February 15th, 2018.
Variables analyzed included: type of IUD, length of strings prior to placement,
method of insertion (applicator, ring-forceps, manual), and delivery
(20%) women attended postpartum follow-up between four to six weeks after
delivery. Eleven of 14 (79%) post-cesarean section and 39 of 48 (81%)
post-vaginal delivery had strings visualized. Insertion via the IUD
applicator was associated with significantly more IUD strings visualized at the
postpartum visit when compared to manual insertion (p <0.05) and ring
forceps (p <0.05). There was no difference in string visualization between
IUD types or after cutting the string to 10 cm.
Discussions: Mode of placement
affects postpartum IUD string visibility. Future research will include
developing a protocol for best practices for post-placental IUD placement to
improve string visibility at the postpartum visit. Additional research is
needed on the low postpartum follow up rate in this subset of the population.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Quality & Safety, Public Health, Contraception or Family Planning, General Ob-Gyn,
Read more »
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.
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
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%.
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.
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,
Read more »
RAD Times in the Big Easy: Race, Access, and Diversity in Abortion Training
Purpose: To explore residents’ interest in doing abortions with a
focus on ethnic diversity.
Background: Abortion training is critical to increase access for
the 39% of US women who live in the 90% of counties with no abortion care.
Racial/ethnic minority physicians are more likely than white physicians to care
for poor and minority patients and practice in underserved
areas.1 We explored racial and ethnic differences in residents’
interest in providing abortions in ob/gyn, the most racially diverse ACGME
1. Marrast LM, Zallman L, Woolhandler S, Bor
DH, McCormick D. JAMA Intern Med 2014;174:289–91.
Methods: Using Ryan Residency Program post-rotation survey data
collected in 2015-2018, we assessed intention to provide abortion and training
participation by resident race/ethnicity.
Results: The majority of residents (658, 79%) completed
surveys. Respondents were: 412(65%) white, 50(8%) black, 27(4%)
Hispanic/Latino, 118(19%) Asian, and 24(4%) other. Overall, 57% intended to
provide abortion for all indications and 82% for pregnancy complications.
The proportions that planned to provide abortions by race/ethnicity were: 70%
of Asian, 63% of Latino, 54% of white and 48% of black. While in bivariate
analysis Asians were more likely than whites to intend provision (p 0.003),
there were no difference by race/ethnicity when controlling for religion and
abortion attitudes, which were both associated with intention (p<0.05).
There was also no difference in training participation by race/ethnicity.
Discussions: The majority of residents overall planned to include abortion
in their practice. Increasing resident diversity may close the abortion access
gap in the US by providing care in underserved areas.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, UME, Public Health, Contraception or Family Planning,
Read more »
Increasing Access to Emergency Contraception, Non-emergent Contraception, and LARC Referrals in the Emergency Room: A Resident-based Educational Intervention
Purpose: The aim of this study is to determine whether an educational
intervention improves emergency medicine residents\' knowledge of and personal
comfort with prescribing EC, offering non-emergent contraception, and referring
patients for LARCs.
Background: Approximately 50% of pregnancies in the United States
are unintended. Increasing access to emergency contraception (EC), non-emergent
contraception, and long-acting reversible contraception methods (LARCs) is one
way of decreasing unintended pregnancies. Emergency rooms enable physicians to
assess a woman\'s risk of unintended pregnancy and afford an opportunity to
intervene, if appropriate. Previous studies have found that emergency medicine
physicians do not always offer EC, even in cases of sexual assault. Barriers to
prescribing EC have been identified and include time constraints, lack of
clinical resources, concern about discouraging regular birth control, and
concern about birth defects.
Methods: Emergency medicine residents were given an interactive
lecture on contraception with emphasis on EC. They were also given a pocketbook
on contraception to keep. Pre- and post-lecture surveys were given in person,
along with another 6 months later. The surveys assessed knowledge, comfort
level, and prescribing/referring practices with both quantitative data and
qualitative data. Data will also be extracted from the electronic medical
record to assess if there was an increase in prescriptions for contraception
and/or referrals to family planning.
Results: The preliminary data analysis is currently being
conducted. Twenty-three emergency medicine residents completed the pre- and
post-test surveys. Additional information from prescriptions and referrals will
provide objective data to assess whether the educational intervention changed
Discussions: There are two hypotheses for this study. First, it is
hypothesized that an educational intervention will increase emergency medicine
residents\' knowledge of and comfort with EC, non-emergent contraception, and
LARCs. Second, there will be a significant increase in prescriptions for EC,
non-emergent contraception, and referrals for LARCs one year after the
educational intervention takes place. If the hypotheses are correct, residency
programs and hospitals should consider developing educational strategies and
policies to improve access to contraception in the emergency room and prevent
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, GME, CME, Assessment, Lecture, Quality & Safety, Contraception or Family Planning,
Read more »
Family Planning Training at Catholic and Other Faith-based Obstetrics and Gynecology Programs
Purpose: To evaluate family
planning training at obstetrics and gynecology (OB-GYN) residency programs that
primarily train at restrictive religious hospitals.
and other religious hospitals face institutional family planning care
restrictions, which are in conflict with the training requirements set forth by
the Accreditation Council for Graduate Medical Education (ACGME).
identified 30 ACGME accredited OB-GYN residency programs in which at least 70%
of resident time is in restrictive, faith-based hospitals. We
queried program representatives about training using an online survey and
follow-up telephone interview.
Results: We had
an 80% survey response rate. The majorities were program directors (83%),
represented Catholic hospitals (75%), and completed telephone interviews (71%).
Programs often relied on other sites to accomplish contraceptive (33%),
sterilization (71%), and abortion (88%) training. All programs reported
adequate training in reversible contraception. 58% reported inadequate
sterilization training, most commonly in postpartum and hysteroscopic
sterilizations. 67% reported inadequate abortion training, most commonly
in D&E. Approximately half (54%) offered ‘routine’ and 13% did not
offer any abortion training. Eight programs (33%) received a total of ten
Residency Review Committee citations due to insufficient family planning
training, and most of these programs (71%) reported using these citations to
gain institutional support for off-site training.
Discussions: While Catholic and
other faith-based OB-GYN residency training programs have developed strategies
in response to institutional restrictions, many report ongoing deficiencies and
half remain noncompliant with abortion training requirements. Residency Review
Committee citations, however, provided an opportunity for programs to leverage
support for comprehensive training.
CREOG & APGO Annual Meeting, 2019, Resident, Residency Director, Patient Care, Systems-Based Practice & Improvement, GME, Contraception or Family Planning,
Read more »
Basic Knowledge of Contraception and Emergency Contraception Is Low Among Recent Medical School Graduates
evaluate the knowledge of recent medical school graduates regarding
contraception and emergency contraception
Background: The Association of Professors of Gynecology and Obstetrics (APGO) medical
student educational objectives includes contraception and emergency
contraception among expected competancies, but little information exists on
whether these objectives are being met.
Methods: A 28-question survey of basic contraception knowledge was created,
including questions about LARC methods (12 questions), Tier 2 methods (10
questions) and emergency contraception (4 questions). Two consecutive intern classes were evaluated
during hospital orientation.
Results: 157 interns completed the survey, representing 73 medical schools. The
overall correct score was 51.8%. Subscores were 56.7% for LARC methods, 62% for
tier 2 methods, and 22.2% for emergency contraception. Men scored lower than
women overall, 50% vs 60.4%, p= < 0.001, and on all subscores. Men were
also less comfortable with contraceptive knowledge than women, 5.8 vs 6.7 on a
10-point Likert scale, p= 0.006. Osteopathic physicians scored lower than
allopathic physicians on overall score, 49.6% vs 54.6%, p= 0.04, and emergency
contraception, 12.5% vs 25%, p=0.01, but not on LARC, tier 2 methods or
self-reported comfort. Those with high self-reported comfort levels scored
higher on overall score, LARC and tier 2 methods, but not on emergency contraception.
There was no difference in overall score when evaluated by amount of training
received during medical school.
ubiquitous prescribing, medical school graduates have only rudimentary
knowledge of contraception, particularly emergency contraception. Individual
medical schools should evaluate their programs to determine how to improve
knowledge of these important topics.
CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, GME, UME, Assessment, Contraception or Family Planning,
Read more »
Assessment of Low-cost, Intrauterine Contraception Simulation Training for Preclinical Students
assess whether a low-cost didactic workshop on intrauterine devices (IUDs)
improves preclinical medical students’ knowledge and comfort with counseling
patients on IUDs.
Background: Medical school reproductive health curricula often lack teaching regarding
IUDs. Preclinical medical students have insufficient knowledge and training to
counsel patients about IUDs.
Methods: Preclinical medical students completed a survey before and after a
voluntary IUD didactic workshop at the University of Washington. The session
consisted of a 45-minute lecture and 45-minute hands-on simulation of IUD
insertion. The primary outcome was comfort level with IUD counseling.
Results: Ninety-eight students completed both pre- and post-workshop surveys. Most
students planned to enter primary care specialties. . More than half of
students had seen at least one IUD inserted and almost all students (91%) had
an IUD themselves or knew someone personally who had one. The proportion of
students scoring 75% or higher on the IUD knowledge questions increased from
55% prior to the workshop to 91% after completing the workshop (p < 0.001).
The proportion of students who felt comfortable counseling patients on IUDs increased
from 31% to 90% (p < 0.001).
simple, low-cost workshop increases medical students’ knowledge and comfort
with IUDs. This workshop could serve as a framework for medical schools to
ensure students receive appropriate education and hands-on learning related to
IUDs prior to entering their clinical rotations and for their future careers.
CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Patient Care, Medical Knowledge, Practice-Based Learning & Improvement, UME, Simulation, Lecture, Contraception or Family Planning, General Ob-Gyn,
Read more »
Assessment of a Sexual Health Curriculum for High School Students Delivered by OBGYN Residents
purpose of the project was to build a curriculum for high school studentson
sexual health including reproduction, contraception, pregnancy and sexually
trasmitted infections. This curriculum was delivered to the students by the SIU
OBGYN residents. We evaluated the knowledge and attitudes of students,
knowledge, skills and attitudes of the residents focussing on what their
perceptions of the students.
Background: The teenage pregnancy and sexually transmitted infection rates for teens
in the Sangamon County are higher than nantional averages. The residents expressed an interest in
reaching out to schools. High school
health teachers were contacted and overwhelmingly agreed to have the residents
participate in health classes about reproductive health.
Methods: We built a curriculum based on ACOG materials and best practices for
reproductive health. Needs assessments
to measure knowledge and attidtudes were given to a sample of high school
students on reproductive topics. Another
assessment was given to residents to gage skills in teaching as well as
attitudes towards teen. Assessments of
knowledge after the sessions were given to the students. Teachers were asked to rate the sessions and
provide feedback. Residents completed a
Results: Students have large gaps in reproductive knowledge but have the perception
they knonwlegable. Accurate knowledge improved. Teaches overwhelmingly were
satisfied with the material presented and the format. Residents had high satisfaction rates for
this activity and better perceptions of students.
effectively administered a reproductive health care curriculum to high school
students that was informative, well received and changed attitudes of students,
teachers and residents.
CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, GME, Public Health, Contraception or Family Planning, Pediatric & Adolescent Gynecology, General Ob-Gyn, Sexuality,
Read more »
Abortion Practice After Routine Training: A Prospective Cohort Study
explore Ryan Program graduates; post-residency practice in abortion care.
Background: The Ryan Program supports residency programs to integrate abortion into
training. In 2012 we commenced a prospective cohort study of graduated
Methods: Residents complete web-based surveys after the family planning rotation
and consent to participate in future studies. In 2016, we surveyed ob-gyns 2+
years after residency about their current practice. Post-rotation and
post-residency surveys were matched and then de-identified.
Results: Sixty percent (394) who consented to participate responded. Nearly all
graduates did abortions during residency (median of 31, including medical and
procedural techniques). 86% fully
participated in training, while 14% opted out for personal or religious
reasons. 33% percent overall, and 40% of
those who intended to, do abortions in current practice (median of 12 per
month). An additional 36% do not do
abortions but wish to, and 16% do not nor desire to provide abortion care. Physicians doing abortions are more likely to
have fully participated (42% vs. 8%, p=.00) and did more abortions in training
than those not doing abortions (median 32 vs. 16, p=.00). Those without an
academic affiliation (n=134) are less likely to do abortions (23% v. 45%,
p=.00) and more likely to want to integrate abortion care (56% v. 44%,
of ob-gyns who trained in Ryan programs include abortion care in their
practice. An additional third are unable to despite intending to at the time of
their training. Further studies are needed to understand the barriers to
integrating abortion care into practice.
CREOG & APGO Annual Meeting, 2018, Resident, Faculty, Residency Director, Patient Care, Professionalism, GME, CME, Assessment, Public Health, Contraception or Family Planning,
Read more »
Beyond Moonstones and Rose Quartz: Patient Interest in Fertility Awareness-Based Methods
Background: FABMs can be used to educate women to achieve or avoid
pregnancy and monitor heath. Previous studies indicate that up to 40% of women
are interested in using FABMs for family planning; however, no studies were
found to assess whether women are interested in FABMs to increase
self-awareness or monitor health.
Methods: A cross-sectional survey was administered to women
presenting for reproductive care at the Lowe Foundation Center for Women’s
Preventative Health Care and UT Southwestern’s Maple Clinic, a private and
public clinic respectively (N=664). 444 participants anonymously completed the
questionnaire for a response rate of 67%. Data was analyzed.
Results: Of the survey respondents, 45% (n=199) were from Maple
Clinic and 55% (n=245) were from the private clinic. 62% of the women surveyed
(n=275) indicated an interest in learning more about an FABM. Of those
interested, 34% specified a desire to learn more about their body, 31%
preferred to learn in order to avoid pregnancy, 28% for monitoring health, and
22% for achieving pregnancy. 50% of those interested (n=138) would prefer
asynchronous educational methods such as online lessons.
Discussions: This study suggests that women in both public and private
clinics are interested in learning about FABMs for more than just family
planning. Online resources may be a reasonable approach to begin educating patients.
Keywords: Community Health, Cultural Diversity/Cultural
Competency, Teaching Skills, Underserved Communities, Other
General Ob-Gyn, Contraception or Family Planning, Advocacy, Public Health, UME, GME, Medical Knowledge, Patient Care, Faculty, Resident, Student, 2017, CREOG & APGO Annual Meeting,
Read more »
Impact of an Immediate Postpartum Intrauterine Device Insertion Simulation on Resident and Attending Providers
Background: PPIUD use may be reduced if providers feel they have
inadequate knowledge and skills.
Methods: From 11/2013-2/2015, obstetrical providers at two
teaching hospitals participated in a 30-minute PPIUD simulation workshop. We
assessed knowledge of PPIUD indications, technique, and safety, and comfort
with knowledge and skills pre-intervention, immediately following, and 6 months
Results: Training participants (n=84) included 39 residents and
45 attendings (25 certified nurse-midwives and 20 OB/GYNs). Fifty-seven
participants (68%) completed the 6-month assessments. Many participants had
placed PPIUDs (54% of residents vs 64% of attendings, p=0.32); 52% were
comfortable with their knowledge and 45% with their insertion skills defined by
self-assessment of ≥7 on a10-point scale. On the pre-test, 77% answered
≥80% of the knowledge-based questions correctly; this proportion rose to 95%
and 97% on the immediate and 6-month assessments respectively, and were similar
between residents and attendings. Immediately post-simulation, 94% of
participants scored their comfort with PPIUD knowledge at ≥7/10; this fell to
86% by 6 months. Likewise, 87% and 74% scored their comfort with skills
at ≥7/10 immediately and at 6 months respectively. By 6 months, 81% reported
placing ≥1 PPIUD (92% of residents and 71% of attendings, p=0.05).
Discussions: Residents and attendings demonstrate sustained
improvement in knowledge and comfort with PPIUDs 6 months after a standardized
simulation workshop. This may lead to increased provision of PPIUDs to
Keywords: evaluation; PPIUD; simulation
CREOG & APGO Annual Meeting, 2016, Resident, Faculty, Residency Director, Patient Care, Medical Knowledge, GME, CME, Assessment, Simulation, Contraception or Family Planning,
Read more »
How Does OBGYN Resident Training at Restrictive Faith-based Institutions Impact Subsequent Provision of Reproductive Healthcare for Women? A Qualitative Analysis
Background: OBGYN residency prepares trainees to become experts in
women’s healthcare. Trainees at faith-based hospitals may not receive
adequate training in family planning services.
Methods: Semi-structured individual interviews were conducted
with recent graduates from seven faith-based hospitals. All are generalists at
secular institutions. Participants were asked about their experiences,
perceived deficiencies, and current provision of family planning
services. Three researchers independently coded the transcripts using
grounded theory; codes were organized into overarching themes and discrepancies
Results: We reached thematic saturation after 15
interviews. None of the participants cited a preference to match at their
program based on restrictive family planning policies. All participants
reported reproductive healthcare training deficiencies that were partially
attenuated by didactic educational activities, variations in on-site
restrictions, and off-site training. Participants expressed frustration
about inadequate on-site training in postpartum tubal ligations; upon
graduation they either avoided provision or required mentorship from partners
to become competent. A few participants who sought off-site training now
provide outpatient D&Cs and/or inpatient D&Es for abnormal or
unintended pregnancies. All participants proposed that faith-based
programs improve family planning training by providing routine, opt-out
Discussions: OB-GYNs trained at faith-based institutions feel that
religion-based policies negatively impact training experiences and the range of
health services they subsequently can provide. Forming collaborations
with off-site facilities, particularly for tubal ligation and outpatient
uterine evacuation procedures, may improve the reproductive care these
physicians provide to women.
Keywords: faith-based, family planning
CREOG & APGO Annual Meeting, 2016, Student, Resident, Faculty, Residency Director, Patient Care, Medical Knowledge, GME, Public Health, Contraception or Family Planning,
Read more »