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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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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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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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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 attitudes.

 

Background: Many 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.

 

Methods: Medical 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 variables.

 

Results: Pre-rotation, 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.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Residency Director, Medical Knowledge, UME, Contraception or Family Planning,

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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

 

Methods: In 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.

 

Results: The 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.

Topics: 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,

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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.

 

Background: Immediate 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.

 

Methods: A 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).

 

Results: 62 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.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Medical Knowledge, Practice-Based Learning & Improvement, GME, Simulation, Lecture, Contraception or Family Planning,

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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 residents. 

 

Background: As 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 practices. 

 

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.

 

Results: The 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 (p=0.11).

 

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 FAVD. 

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, GME, Assessment, Public Health, Contraception or Family Planning,

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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 residents

 

Background: Immediately 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.

 

Methods: A 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 type. 

 

Results: Sixty-two (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.

Topics: 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,

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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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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 residency.

 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. 

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, UME, Public Health, Contraception or Family Planning,

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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 behavior.

 

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 unintended pregnancy.

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, GME, CME, Assessment, Lecture, Quality & Safety, Contraception or Family Planning,

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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.

 

Background: Catholic 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).

 

Methods: We 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. 

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

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Basic Knowledge of Contraception and Emergency Contraception Is Low Among Recent Medical School Graduates

Purpose: To 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= &lt; 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.

 

Discussions: Despite 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.

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,

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Assessment of Low-cost, Intrauterine Contraception Simulation Training for Preclinical Students

Purpose: To 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).

 

Discussions: A 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. 

Topics: 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,

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Assessment of a Sexual Health Curriculum for High School Students Delivered by OBGYN Residents

Purpose: The 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 follow-up assessment.

 

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.

 

Discussions: Residents effectively administered a reproductive health care curriculum to high school students that was informative, well received and changed attitudes of students, teachers and residents.

Topics: 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,

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Abortion Practice After Routine Training: A Prospective Cohort Study

Purpose: To 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 residents.

 

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%, p=.02). 

 

Discussions: One-third 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.

Topics: CREOG & APGO Annual Meeting, 2018, Resident, Faculty, Residency Director, Patient Care, Professionalism, GME, CME, Assessment, Public Health, Contraception or Family Planning,

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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

Topics: General Ob-Gyn, Contraception or Family Planning, Advocacy, Public Health, UME, GME, Medical Knowledge, Patient Care, Faculty, Resident, Student, 2017, CREOG & APGO Annual Meeting,

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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 post-training.  

 

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 patients.

 

Keywords: evaluation; PPIUD; simulation

Topics: CREOG & APGO Annual Meeting, 2016, Resident, Faculty, Residency Director, Patient Care, Medical Knowledge, GME, CME, Assessment, Simulation, Contraception or Family Planning,

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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 were resolved.

 

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 opportunities.

 

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


Topics: CREOG & APGO Annual Meeting, 2016, Student, Resident, Faculty, Residency Director, Patient Care, Medical Knowledge, GME, Public Health, Contraception or Family Planning,

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