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Connecting OB/GYN Residents with the Local Adolescent Community: An Underutilized Symbiotic Relationship

Purpose: To provide reproductive health education to adolescents in a local underserved community, and encourage OB/GYN residents to better understand the local community to improve clinical practice.

 

Background: Many residents have limited knowledge about the surrounding local community and the socioeconomic context of their patients. Providing structured means for residents to interact with members of the community outside of the clinical environment could be beneficial.

Methods: A survey was sent to all residents in one OB/GYN residency assessing knowledge of the local community and comfort with discussing reproductive health topics. Residents paired with a local community organization and voluntarily led educational sessions for adolescent youth about common reproductive health topics. Residents who participated completed a post-program survey.

Results: Twenty-two residents participated in the pre-program survey. Ten residents participated in the program, seven completed the post-program survey. In the pre-program survey, half of respondents felt either somewhat unconnected to or not at all connected to the local community.

In the post-program survey, 85% of respondents felt more connected to the community after the program. Qualitative responses indicated participating in the program motivated residents to reconsider how to explain medical topics and counsel patients. Overall, residents who participated in the program appreciated the opportunity to connect with local adolescents and were interested in participating in future sessions.

 

Discussions: The relationship between residents and local adolescents through guided classes on reproductive health allowed residents to feel more connected to the local community and change their clinical practice to better consider the social contexts of their patients.

Topics: CREOG & APGO Annual Meeting, 2019, Resident, Residency Director, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, Pediatric & Adolescent Gynecology, Sexuality,

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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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Perceptions Regarding Pediatric and Adolescent Gynecology Training in Obstetrics and Gynecology Residency Programs

Background: Pediatric and adolescent gynecology (PAG) is a required aspect of OB/GYN resident training.  OB/GYN providers are expected to care for this patient population.  In this program, a formal curriculum occurs in the second year and involves didactics, clinic experience, and assigned study materials. 

 

Methods: A survey assessing comfort level and desire for further training was administered to all current residents at a single OB/GYN resident training program.  The residents completed an exam to test knowledge of various aspects of PAG prior to the curriculum start, immediately after curriculum completion and again 1-2 years later. Survey results were evaluated using descriptive statistics and exam scores via paired t-test statistics.

 

Results: The survey revealed that 64% and 56% of current residents did not feel confident or competent when caring for pediatric and adolescent patients, respectively.  However most indicated that they intend to care for pediatric and adolescent patients in their future practice.  Interestingly, their exam scores increased significantly immediately after the curriculum (p=0.002) and remained significantly higher after 1-2 years (p=0.005). 

 

Discussions: PAG is an important and required aspect of OB/GYN resident training. Objectively, there was a significant increase in medical knowledge after curriculum completion that was maintained for almost 2 years.  However, despite significant long-term knowledge retention, residents still expressed subjective concerns regarding poor confidence caring for this patient population.   Despite an effective dedicated curriculum, programs should consider innovative ways to incorporate PAG educational experiences longitudinally throughout residency training.

 

Keywords: Gynecology, residents, pediatric


Topics: Pediatric & Adolescent Gynecology, Lecture, Assessment, GME, Medical Knowledge, Residency Coordinator, Residency Director, Osteopathic Faculty, Faculty, Resident, 2016, CREOG & APGO Annual Meeting,

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Analysis of New Teaching Methods in Pediatric Gynecology

OBJECTIVES: Assess if learning with pelvic model simulations will enhance didactic teaching in Pediatric Gynecology.

STUDY DESIGN: 16 OBGYN residents from two OBGYN programs underwent an interactive teaching session about pediatric vaginal discharge. Residents underwent testing during and 2 months after the session. Survey at the end of the intial teaching session assessed satisfaction and perception of teaching methods. Those who could not make the session were given reading and served as controls.

Data analysis utilized descriptive statistical techniques and inferential statistics.

RESULTS: After the teaching session, there was an 8% improvement in test scores compared to controls. At 2 months there was a 3% improved test score compared to controls. As importantly, surveys for those at the teaching session noted an increased satisfaction of learning and comfortableness with the pediatric gynecology patient.

CONCLUSIONS: Teaching pediatric vaginal discharge using simulation techniques provides a more effective method of teaching, enhances provider comfort with pediatric patients, and promotes retention over traditional didactic teaching alone.

Topics: Pediatric & Adolescent Gynecology, Simulation, Virtual Patient, Assessment, GME, Practice-Based Learning & Improvement, Medical Knowledge, Faculty, 2013,

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Backward Design of a Pediatric-Adolescent Gynecology Curriculum for Residents

Celeste O. Hemingway, MD
Vanderbilt University Medical Center, Nashville, TN

Objective: To develop a formal pediatric-adolescent gynecology curriculum to augment an existing clinical experience for residents.

Methods: The principles of backward design as outlined in "Understanding by Design" by Grant Wiggins and Jay McTighe were used to create a seven-week pediatric-adolescent gynecology curriculum to enhance an existing weekly one-on-one clinical experience with our faculty. Rather than start by crafting the learning experiences themselves, backward design requires first identifying desired outcomes and acceptable evidence for their achievement then modeling learning experiences to facilitate their realization. Our desired results for the pediatric-adolescent gynecology curriculum were outlined as 7 essential questions for the practice of pediatric-adolescent gynecology and 6 core understandings based on the CREOG objectives. For example, an essential question for the curriculum is, “How do health and behavioral trends among the adolescent population impact the care and guidance we offer young women in our care?” while an understanding is, "For the adolescent population, providers should know the most common causes of mortality and morbidity in order to identify patients at risk and provide guidance for risk-reduction." One of the goals of the curriculum is to revisit essential questions and understandings throughout the experience to ensure they are addressed by the resident learners. True to the backward design concept, once desired results were determined and acceptable evidence for their achievement were established, the learning experiences were crafted to address these needs. A case conference series to precede each clinical session was designed around core knowledge and skills. Six clinical topics (the pediatric examination, adolescent sexual history and contraception, menstrual abnormalities, disorders of puberty, special populations, preventive care) and a final mock oral boards session comprise the seven-week series. Residents prepare for these sessions with readings housed on our department’s blackboard website and are assessed on their participation and preparedness in addition to a proposed research question written each week in response to the day’s learning. The mock oral board session encapsulates the range of topics and serves as an additional assessment tool. Each clinic session is supervised by a faculty member who is tasked with observing at least one complete clinical transaction between the resident and a pediatric-adolescent patient every week. In addition to structured evaluations and feedback by the faculty member, patients and/or their family members are asked to evaluate the resident as well. Clinic documentation is reviewed by the faculty member, and the resident submits for review a portfolio of cases completed during the seven-week session. Finally, the resident evaluates his own performance with a self-efficacy questionnaire at the close of the experience.

Results: Residents are currently completing the pediatric-adolescent curriculum as part of their senior clinical experience. They receive faculty feedback from their case conference work, mock oral boards, their observed clinical interactions, and their documentation. They also receive feedback from their patients and/or their family members, depending on age. Lastly, they complete a self-efficacy questionnaire which assesses their perceived preparedness to provide pediatric-adolescent gynecologic care upon completion of training.

Conclusions: Using backward design to create a formal pediatric-adolescent gynecology curriculum for residents is a novel way to design learning experiences that target core knowledge and skills while addressing essential questions and understandings.

Topics: CREOG & APGO Annual Meeting, 2014, Resident, Residency Director, Patient Care, Medical Knowledge, GME, Independent Study, Pediatric & Adolescent Gynecology,

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Teaching Pediatric Gyn via a Web-based Case Series: A Sign of Evolving Education in the 21st Century

Nirupama K. De Silva University of Oklahoma-Tulsa, Tulsa, OK
Jennifer E. Dietrich MD, MSc, Amy E. Young, MD
Study objective: Formal teaching in Pediatric and Adolescent Gynecology (PAG) is important for all medical students and residents. Education on the most basic aspects of normal and abnormal puberty and knowledge of common treatments for gynecologic abnormalities in the pediatric and adolescent population is included in the APGO and CREOG Objectives. The initial version of the PAGWebEd website was launched in April 2013, through funding from an unrestricted educational grant from APGO, with the goal of enhancing and promoting uniform and effective teaching in basic PAG. 20 cases on common topics in pediatric and adolescent gynecology were made available as a learning tool for medical students and residents in OB/GYN departments in the U.S. A survey was included after case review to determine effectiveness and usefulness of this site for the learner. Our objective was to determine if preliminary data confirmed that the PAGWebEd website is both effective and useful to the learner.
Methods: The survey consists of 16 questions assessing the background of the learner, their exposure to PAG in their training, and about their perceptions on the effectiveness of the PAGWebEd website to their learning PAG. 18 surveys have been completed and reviewed since initiation of the PAG website. Data analysis utilized descriptive statistical techniques.
Results: 38.9% of participants were 3rd and 4th year residents, 33.3% were 1st and 2nd year residents, 17.6% were faculty, and 11.1% were medical students. 61.1% of the surveys were completed by female providers. Participating U.S. training programs were located in the South (50%), Midwest (11.1%) and Northeast (38.9%). All participants agreed that the education and formal training in PAG is an important component for OBGYN residents, yet 66.7% noted that they have exposure <10% of the time and 75% of participants noted that they have a short PAG rotation (< 3 weeks) over the 4 years of training. Two-thirds of participants thought that the cases would alter how they handle a PAG case in the future.
Conclusions: Learning basic PAG via the PAGWebEd case-based system has allowed students and residents in training to enhance their knowledge in PAG and has allowed the majority of them to improve their care of pediatric gynecology patients in the future. Tools such as PAGWebEd will enhance education in basic PAG for all learners, especially those without access to formal clinical education in this area. The availability via the web allows for learning opportunities ad hoc, enhancing the accessibility of the learning platform.
Key words: Pediatric and Adolescent Gynecology, Web-based learning, resident education.

Topics: CREOG & APGO Annual Meeting, 2014, Resident, Residency Director, Patient Care, Medical Knowledge, GME, Pediatric & Adolescent Gynecology,

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Enhancing Post Graduate Fellowship Training in Pediatric and Adolescent Gynecology

Jennifer E. Dietrich, MD, MSc
Baylor College of Medicine, Houston, TX

Study Objectives: Gynecologic problems in the pediatric population often differ from that of the adult population and thus require specific knowledge as well as surgical and communication skills, in light of the age of the patients. Few OB/GYN residency programs offer exposure to Pediatric and Adolescent Gynecology (PAG). Among 104 programs recently surveyed, 63% reported no formal or dedicated PAG Clinic and 85% reported no outpatient PAG rotation. Fellowship training in PAG has been available since the 1980’s in an apprenticeship model. In the last few years a more formal fellowship structure has arisen, with an increased interest in PAG training programs in North America. Therefore, the need for coordinated curricula for specialized postgraduate training arose. This abstract describes the process of curriculum development for fellowships in PAG.

Methods: Program directors from the existing PAG fellowships met formally in 2010 at the annual meeting of the North American Society of Pediatric and Adolescent Gynecology (NASPAG), the society dedicated to education of healthcare providers about PAG. Several fellowship programs had created their own educational guidelines to comply with their Graduate Medical Education and ACGME requirements for competency evaluation. These existing educational efforts and expertise in the field was shared and compiled by a small working group and modified by all PAG fellowship directors at Cincinnati Children’s Hospital Medical Center, Baylor College of Medicine, Washington University, Kosair Children’s-Louisville, University of Missouri-Kansas City, University of Toronto, University of Michigan, Georgetown University and University of Ottawa. This led to the creation of a common PAG fellowship curriculum, based on the CREOG Educational Guidelines for residency training in PAG, but with a level of complexity specifically designed for the PAG fellow.

Results: A comprehensive educational curriculum that covers all areas of PAG was designed. Keys for documenting developing skills throughout the fellowship and recommended reading materials were added. The second developed tool was a surgical log that covers all the procedures in the PAG arena. With the onset of yearly fellowship director meetings among 9 current programs in North America as well as curriculum development, there has been increased interest in the formation of new PAG training sites given the 1:8 match rate. Finally, the NRMP is now used for the common fellowship match process.

Conclusions: The development of a formal PAG curriculum, approved by all fellowship directors, has increased the visibility of the PAG subspecialty training and has aided with the formation of more PAG fellowships with more consistent training of fellows. Eventually this may allow Pediatric and Adolescent Gynecology to develop into a separate highly specialized field similar to the way in which pediatric urology and pediatric surgery programs have subspecialized in order to better serve children and adolescents.

Key Words: Fellowships, Pediatric and Adolescent Gynecology, curriculum

Topics: Pediatric & Adolescent Gynecology, GME, Practice-Based Learning & Improvement, Medical Knowledge, Patient Care, Resident, 2014, CREOG & APGO Annual Meeting,

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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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The Effect of Student Gender on the Third Year Obstetrics and Gynecology Clinical Clerkship

Poster
Jenifer Briscoe, MD

Pamela Promecene

Background: Studies have evaluated gender discrimination in medical education. Gender discrimination is felt predominately by females; however this is not true for obstetrics and gynecology. In 2004, Emmons et al found that 78% of male students felt their gender negatively impacted their clinical experience, and students who perceived a negative bias performed fewer clinical skills and felt less confident counseling patients. Our study was to determine if medical students at our institution perceived a gender bias during the OB/Gyn clerkship. We also examined if a gender bias exists in student confidence and participation and if there was a gender difference in grade distribution.

Methods: After IRB approval, an anonymous survey was sent to all third year students who had completed their obstetrics and gynecology clerkship in the 2011-2012 year. Students reported their gender and whether they felt their gender had an effect on their OB/Gyn rotation. Students were given a list of clinical problems (vaginitis, urinary tract infection, secondary amenorrhea, preeclampsia), and asked to rate their ability to begin a workup. Students were also asked to rate their comfort level with patient counseling on clinical situations (contraception, pap screening, breast cancer screening, labor precautions). A 5-point Likert scale was used where 1= very uncomfortable and 5= very comfortable. Students were asked to estimate the number of times they performed common clinical tasks (speculum exam, breast exam, participating in a vaginal delivery, or performing a vaginal delivery).

Results were evaluated using Student’s T test. Student grades from the rotation were broken
down by rotation evaluations, NBME shelf exam grades and overall grades. Each category was evaluated with student’s T tests. Results: 171 students, 98 responded (57.3% response rate; 62% male, 38% female). Nearly half of all students felt that their clerkship was gender-neutral (Table 1). There was no difference in clinical mastery of problems (Table 2) or with comfort in counseling (Table 3). Table 1: Perceived gender bias? male 27 (44%) female 19 (51%) Table 2: Clinical problems Male Female P Vaginitis 4.3 4.51 NS UTI 4.18 4.40 NS Secondary amenorrhea 3.78 4.05 NS Preeclampsia 4.07 3.97 NS Table 3: Counseling Male Female P Contraception 4.47 4.36 NS Pap screening 4.03 4.36 NS Breast cancer screening 4.00 3.84 NS Labor precautions 4.5 4.61 NS Females performed more speculum exams (P<0.01). There was no difference in other tasks. There was no difference in evaluations, NBME grades and final grades.

Discussion: With the decrease in men choosing obstetrics and gynecology, and the decrease in interest in the field overall, it is important to encourage interested medical students while on the OB/Gyn clerkship regardless of their gender.

Topics: CREOG & APGO Annual Meeting, 2013, Student, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Patient Care, Professionalism, Systems-Based Practice & Improvement, UME, Contraception or Family Planning, Pediatric & Adolescent Gynecology, Maternal-Fetal Medicine, General Ob-Gyn, Sexuality,

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Development of a Women.s Health Fellowship Curriculum Based in an OB-GYN Department

Poster
Carrie Bell, MD
Margaret Punch, Timothy Johnson

Background: The University of Michigan received recognition as a National Center of Excellence in Women’s Health in 1997. A comprehensive program of women-centered services and resources have been developed and maintained. With the goal of excellent clinical training in Women’s Health (WH), coupled with an academic focus, a fellowship in WH was created. Physicians trained in Obstetrics and Gynecology, Family Medicine, Internal Medicine, Pediatrics or Psychiatry were considered eligible applicants.

Objective: Develop an interdisciplinary, flexible, women-centered curriculum for physicians
committed to a career in Women’s Health.

Methods: As the WH Program forms a cornerstone in the department of OB-GYN, the responsibility for the fellowship was assumed by the department of OB-GYN. A Fellowship advisory committee was formed; including members from ob-gyn, family medicine, internal medicine, and psychiatry. Over the last five years, fellows trained in the program have been added to the committee. The advisory committee steers the fellowship, accesses resources throughout the university, and choses the fellows. University faculty members were identified with a strong commitment to women’s health as well as willingness to train fellows. These persons participate in the clinical and research electives for fellows as teachers and mentors. Mandatory electives include clinics focusing on hysterectomy alternatives, pediatric and adolescent gynecology, pelvic pain, vulvar conditions, breast, urogynecology and reproductive endocrinology and infertility. The clinical, interdisciplinary panel of electives include the following: Women’s Health, Obstetrics (high risk pregnancy and repair for 3rd/ 4th degree lacerations), Gynecology (outpatient procedures and medical gynecology), Endocrinology and Metabolism, Eating Disorders, Women’s Cardiology, Gastroenterology, Pulmonary and Mental Health, Sexual Health, Geriatrics, Complementary/Alternative medicine and WH research. Fellows may opt out of obstetrics. The IM electives may be substituted based on areas of interest or required additional training. Fellows have regular meetings with the fellowship director for mentoring, goal setting, research development and support and feedback on clinical experiences. Fellows have access to the research support in the department of OB-GYN and FM. Additional years of support may be considered for an MPH, a Masters’ of Science (Clinical Design and Statistical Analysis) or faculty development course in medical education. A formal evaluation process is being developed.

Result: Five fellows have been trained to date using this broad-based curriculum. Fellows craft an individual training program with personalized goals, taking advantage of the extensive resources available. Location in OB-GYN provides access to training in outpatient procedures and high risk obstetrics not found as readily in other departments.

Conclusion: The women health fellowship based in OB-GYN offers unique clinical experiences and advances women’s health care. . A fellowship advisory committee is an invaluable resource for a multidisciplinary approach to women focused graduate education.

Topics: CREOG & APGO Annual Meeting, 2012, Resident, Faculty, Osteopathic Faculty, Residency Director, Systems-Based Practice & Improvement, GME, Quality & Safety, Global Health, Public Health, Advocacy, Contraception or Family Planning, Pediatric & Adolescent Gynecology, Infectious Disease, General Ob-Gyn, Sexuality,

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