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Implementing Communications Training for OB/GYN Residents: Disclosure of Adverse Peri-operative Events

Precis: This study investigated the effect of self-evaluation on the improvement of surgical skills by comparing OSATS scores over a 4-month period to determine if the addition of a self-evaluation improved surgical skills more than instructor evaluation alone. 

Purpose: To study the implementation of communications training for OB/GYN residents on the disclosure of adverse peri-operative events

Background: Communication skills are key components of the patient-physician relationship, however, these skills are not routinely taught during OB/GYN residency or fellowship. As OB/GYNs, disclosure of serious news happens routinely in various aspects of patient care.  

Methods: OB/GYN residents at a single institution participated in a 4-hour communication didactics session using VitalTalk methodology.  Participants were surveyed at baseline, immediately following training and 3 months post-training to measure changes in comfort and confidence in the performance of communication skills. A 5 point Likert scale was used to measure comfort/confidence: Novice (1), Advanced Beginner (2), Competent (3), Proficient (4) or Expert (5).  

Results: 27 residents participated in training; 8(29.6%) interns, 7(25.9%) 2nd year, 7(25.9%) 3rd year and 5(18.5) 4th years. 11/27 (40.7%) reported prior communication training. Before training, residents reported the most competence: detecting emotion cues (median: 3.1), detecting patient/family sadness (3.0) and responding empathetically (2.8). Residents felt the least competent: assessing patient/family willingness to discuss perioperative complications (2.0), assessing how much a patient/family wants to know (2.1), confirming understanding of the adverse event (2.3). Baseline comfort and skill performing these conversations was 2.1 and 1.9, respectively. Immediately post-intervention, average comfort and skill level increased to 2.8 and 2.8, respectively. 3 month data is currently being collected.

Discussion: OB/GYN residents self-rate their communication confidence and skills at an advanced beginner level.  Implementation of participatory communication training for OB/GYN residents is feasible and improves both trainee comfort and skills in the disclosure of adverse peri-operative events. Further work is ongoing to understand retention of these skills to inform more longitudinal curricula.  

Topics: General Ob-Gyn, Standardized Patient, Simulation, GME, Interpersonal & Communication Skills, Professionalism, Residency Director, Clerkship Director, Faculty, Resident, Student, 2020, SES,

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Simulation Increases Anticipated Usage of Trigger Point Injections in Treatment of Myofascial Abdominal Pain

PRECIS: Evaluation of a simulation model and didactic training session for the education of ACGME residents in trigger point injections for myofascial abdominal pain in chronic pelvic pain patients.

PURPOSE:  To test a training module for the education of abdominal trigger point injections

BACKGROUND:  For the treatment of chronic abdominal and pelvic pain, training in interventions is lacking among trainees at the residency level.  One very effective and simple intervention is abdominal trigger point injections for the treatment of abdominal myofascial pain syndrome, present in 74% of women in chronic pelvic pain practices.  

METHODS:  This study evaluates an abdominal trigger point teaching model for the training of USMLE OBGYN residency level physicians, containing a multimedia didactic presentation and a gelatin-based abdominal wall injection model.  Participants completed a 10-item knowledge pre- test and an 8-item participant experience questionnaire gauging prior knowledge and experience with myofascial pain syndrome and abdominal trigger point injections.  After 5 minutes of unsupervised time with the gelatin model, a 30-minute scripted didactic session was given, participants interacted post-training with the simulation model, and a post-test was completed.

RESULTS:  Trainees improved from pre-test (48%) to post-test scores (90%) and reported increasing confidence levels on a 5-point Likert scale from 1.67 pre-test to 3.7 post-test.   Ninety percent of participants agreed or strongly agreed that this exercise would result in them using abdominal trigger points in their own practice. 

DISCUSSION:  A simple educational tool containing a short didactic educational module and gelatin simulation model increases knowledge, confidence level and the likelihood of USMLE OBGYN residents to use trigger point injections in the treatment of chronic pelvic pain.

Topics: SES, 2020, Resident, Faculty, Patient Care, Medical Knowledge, Practice-Based Learning & Improvement, GME, CME, Assessment, Simulation, Lecture, Gynecologic Oncology, Pediatric & Adolescent Gynecology, Minimally Invasive Surgery, Reproductive Endocrinology & Infertility, General Ob-Gyn,

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A Needs Assessment for a National Ob/Gyn Residency Education Curriculum

Purpose: We sought to determine Ob/Gyn residents’, program directors’ (PDs), and assistant program directors’ (APDs) perceptions of the need for a national Ob/Gyn residency education curriculum. This study was funded by the CREOG Empower Award.

Background: Several specialties have implemented standardized, national residency education curricula. These curricula allow residents to have equal access to a centrally located, structured, common knowledge base. In Ob/Gyn, although we have outstanding educational resources, they are not integrated into a national curriculum nor are they co-located. Rather, each residency program develops its own didactic curriculum, which requires a significant amount of time and effort and leads to variability in curriculum quality and content.

Methods: A 12-question web-based survey was developed and distributed to residents, program directors, and assistant program directors nationwide using the Ob/Gyn program coordinator’s listserve and program contact information from the ACOG website.

Results: 780 participants (651 residents, 83 PDs, and 46 APDs) completed the survey, with a diverse range of regions, program types, and program sizes represented. Almost all (97.2%) participants agreed or strongly agreed that residents nationwide should have equal access to high quality Ob/Gyn education resources. Further, 91.9% agreed or strongly agreed that core Ob/Gyn educational resources should be centrally located. A majority, 77.8% (residents 78%, PDs 75%, and APDs 78%), agreed or strongly agreed that there is a need for a national Ob/Gyn residency education curriculum.

Discussions: Our results demonstrate a perceived need for a centrally located, structured national Ob/Gyn residency education curriculum.

Topics: General Ob-Gyn, Independent Study, Lecture, GME, Medical Knowledge, Residency Coordinator, Residency Director, Osteopathic Faculty, Clerkship Coordinator, Clerkship Director, Faculty, Resident, Student, 2020, CREOG & APGO Annual Meeting,

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Validation of the Animal Tissue Model for Laparoscopic Salpingectomy Training

Purpose: To gather validity evidence for a laparoscopic salpingectomy model developed for resident training.

Background: Laparoscopic salpingectomy is a milestone procedure for gynecologic trainees and is commonly performed in the management of ectopic pregnancies. Opportunities to practice the use of electrosurgical devices prior to the operating room can be limited. An animal tissue model was developed and previously piloted at our institution for this purpose, and was modified to include a pelvic sidewall and ovaries.

Methods: 25 simulations of laparoscopic salpingectomy were performed by 14 trainees (5 PGY-1, 4 PGY-2, 1 PGY-3, 4 PGY-4).  For analysis purposes the PGY-3 and PGY-4 trainees were combined.  Each trainee received scripted instructions and reviewed a video with proper technique beforehand. These recordings were evaluated by 2 blinded gynecologic surgeons using the Global Operative Assessment of Laparoscopic Skills (GOALS) and Objective Structured Assessment of Laparoscopic Salpingectomy (OSA-LS).

Results: There was good agreement between the graders with intraclass correlation coefficients of 0.63 and 0.79, respectively, for GOALS and OSA-LS.   The mean GOALS score increased with experience (10, 13.2, and 15.5 for PGY-1, PGY-2, and PGY-3/4, respectively) and was significantly different between PGY-1 and PGY-3/4 (two-sample t-test, p=0.004). The mean OSA-LS score increased with experience (8.9, 14.2, and 16.2 for PGY-1, PGY-2, and PGY-3/4) and was significantly different between PGY-1 and PGY-2 (p=0.006) and between PGY-1 and PGY-3/4 (p< 0.001).

Discussions: This training model and rubrics differentiated experienced and novice trainees and could be used to establish a preoperative competency benchmark.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Residency Director, Practice-Based Learning & Improvement, GME, Assessment, Simulation, Minimally Invasive Surgery, General Ob-Gyn,

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Timing the “Fun” to the Fundamentals of Laparoscopic Surgery (FLS) in an Obstetrics and Gynecology Residency Training Program

Purpose: To determine the time required by Obstetrics/Gynecology (OBGYN) residents to gain proficiency with FLS skills

Background: FLS is a standardized assessment of laparoscopic knowledge and skills and an eligibility requirement of The American Board of Obstetrics and Gynecology (ABOG) Qualifying Exam. There is no published data on expected training time to guide curricula planning or how PGY level, prior surgical experience, or milestone assignment may associate with FLS skill acquisition.

Methods: A prospective cohort study was performed at a community based hospital where PGY2-4 residents were consented to participate in a structured FLS curriculum, which included five skill sessions supervised by gynecologic surgical faculty. Time spent in supervised and self-study sessions was recorded. A baseline and final assessment of FLS skills was administered noting errors and time to complete. Participants reported PGY level, number of prior laparoscopic hysterectomy cases, and their endoscopic technical skill milestone levels, which were analyzed using multivariate regression analysis.

Results: No residents (n=17) passed the baseline assessment. All participants passed the final assessment after curriculum completion with improvement in time (-12.2  minutes p = 0.0005) and reduction in errors (-2.5, p = 0.0025). The amount of structured time spent with a faculty member was correlated with improvement in assessment time (r=0.5979) with at least 155 minutes demonstrating significant improvement (p = 0.009). PGY level, milestone level, number of laparoscopies, and self-directed practice were not associated with improvement in performance.

Discussions: Deliberate practice was the driving factor for FLS skill acquisition independent of PGY, milestone, surgical experience, or self-directed practice time.

Topics: CREOG & APGO Annual Meeting, 2020, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, GME, Simulation, Minimally Invasive Surgery, General Ob-Gyn,

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Text vs Email for a Question of the Day: Which do Today’s Medical Students Prefer?

Purpose: Compare completion rates and satisfaction of question of the day(QOD) received via text vs email.

Background: Fast, hands on learning e-tools are a popular effective technique with current generation of medical learners.

Methods: Twenty-eight questions of the day(QOD) developed focusing on commonly missed NBME exam concepts. A prospective cohort study of ob/gyn clerkship students conducted. Students self-selected to receive QOD by text or email from 1/19-7/19. Students received QOD nightly on weekdays via text or email, completion was optional. 
Primary outcome was overall response rate(RR). Secondary outcomes include RR/question and average weekly RR. Qualitative feedback regarding satisfaction, time spent, and utility also obtained.

Results: Eighty-one medical students participated, 40 selecting text and 41 email. In sum, 863 texts and 1269 emails sent during study period. Overall text RR was significantly lower than email(55.2%vs78.6%,p< 0.001). For no question was text RR greater than email RR. Average RR did not vary by week(wk1: text 55% vs 83% email, wk6: text 64% vs email 77%).
43/81(53%) students gave qualitative feedback, 28/41 from email cohort, and 15/40 text. 86% found the QOD helpful/very helpful(no difference by mode of receipt). However, email recipients more likely to find it very helpful(54%vs13%,p=0.02). 77% found the level of difficulty to be “just right”,(no difference by mode of receipt). The QOD took all students less than 5 minutes. Nearly all(93%) students found the QOD worthwhile and 98% would recommend to future students.

Discussions: Surprisingly, QOD completion rates were higher with email than text, though satisfaction and perceived utility high in both groups.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Faculty, Clerkship Director, Medical Knowledge, Practice-Based Learning & Improvement, UME, Assessment, Independent Study, General Ob-Gyn,

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Residents as Preceptors: Developing a Teaching Curriculum for Obstetrics and Gynecology Residents

Background: Residents serve a critical role in medical student education as near-peer educators. Positive experiences with residents and perceived quality of teaching have been associated with improved clerkship satisfaction and career choices in that discipline. ACOG and ACGME milestones further emphasize the importance of residents as educators. While the role of residents as preceptors is widely acknowledged, preparation for that role is variable.

Methods: A single arm interventional study with pre and post intervention analyses was used. A four part lecture series was designed and implemented during obstetrics and gynecology resident didactics at the University of Minnesota.  Residents completed blinded and paired online surveys pre and post lecture. 5 point Likert scale responses
were summarized and compared using Wilcoxon Signed Rank and Nominal Symmetry tests.

Results: There was a statistically significant
difference in the distribution of rankings towards the positive between pre and post surveys for questions regarding evaluation and teaching
. There were no statistically significant differences in the distribution of rankings for questions regarding feedback.  Barriers to teaching were also identified qualitatively.

Discussions: Implementation of a teaching curriculum significantly improved residents\' perceived preparedness and understanding of medical student teaching and preceptorship but did not improve attitudes towards and frequency of feedback. Strengths of this study include description of a novel, resident led program. Limitations include a small sample size at a single institution within a single specialty.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, GME, Assessment, Lecture, General Ob-Gyn,

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Resident Surgical Evaluations: Feasibility of Integration into the Electronic Medical Record (EMR)

Purpose: Describe the development and implementation of a surgical evaluation tool within the Epic EMR to facilitate real-time feedback for resident learners.

Background: Evaluation of a resident’s surgical performance is critical to the developing surgeon’s education but challenging for both learners and teachers in a busy clinical environment. This study aims to describe how a surgical evaluation tool can be integrated into the EMR and the acceptability of the tool to both faculty and residents.

Methods: A novel tool was developed within the EMR of a single academic hospital that triggers an automated in-basket message to the attending surgeon upon case completion. This message directs the attending surgeon to complete a 4 question evaluation consisting of 2 validated feedback questions and 2 open ended questions. Upon completion, an email is sent providing residents with immediate feedback. At the end of the study period, a survey was sent to attending surgeons and residents to assess the acceptability of the tool.

Results: Between February 2019 and June 2019 719 cases were performed and 553 surgical evaluations were completed (77%). The acceptability survey was completed by 26 of 27 (96%) of residents and 14 of 16 (88%) faculty. Among residents, 96% reported that they received more feedback because of the tool and 85% liked receiving feedback in this way. Among faculty, 21% reported that they felt they gave more feedback because of the tool and 93% found the tool acceptable to use.

Discussions: Implementation of an automated surgical evaluation tool within the EMR is feasible, acceptable to use, and well received by learners.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Assessment, General Ob-Gyn,

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Resident Confidence with Obstetric Ultrasound – Are We Meeting CREOG Objectives and ACGME Milestones?

Purpose: The objective of this study assess resident confidence in obstetric ultrasound as per ACGME milestones and CREOG objectives, and factors associated with confidence performing US independently.

Background: Performing obstetric ultrasound(US) is an ACGME milestone, a CREOG objective, and a CREOG core procedure, though many programs lack formal US curricula.

Methods: CREOG coordinator listserve used to distribute 27-question anonymous e-survey in 3/2018 to OBGYN residents in US and Puerto Rico. Questions included experience performed growth US(gUS) and anatomy US(aUS) as primary sonographer, performing US independently, and for 4th year residents only, comfort performing US post-residency. Bivariate statistics compared residents comfortable performing US independently to those who were not.

Results: 417 residents completed the survey: 88% were female, 75% from academic programs, and nearly 50% were post-graduate year(PGY) 3&4.   While 89.1% had been primary sonographer for gUS, only 63% felt comfortable performing independently. Of chief residents, 14% didn’t feel comfortable performing gUS post-residency. In contrast, 60.9% had been primary sonographer for aUS, only 20.1% felt comfortable performing aUS independently, and 68.8% didn’t feel comfortable performing aUS post-residency.   Residents were more likely to feel comfortable performing gUS independently in PGY3&4 (p< 0.01) and after longer MFM rotations(p=0.02), and less likely when MFM fellows were present (p=0.02). Residents not comfortable performing aUS were twice as likely to have MFM fellows (p< 0.01), and less likely to be PGY3&4(p< 0.01).

Discussions: significant percentage of residents are not comfortable with their ultrasound skills. This data further emphasizes the need for structured US curricula and simulation.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Patient Care, Practice-Based Learning & Improvement, GME, Assessment, Simulation, Maternal-Fetal Medicine, General Ob-Gyn,

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Novel Realistic Bladder Model Teaches Anatomy & Builds Resident Confidence in Cystotomy Recognition/Repair

Purpose: To develop and pilot an inexpensive, reusable, water-tight moderate-fidelity bladder model that can be used to teach Ob-Gyn residents cystotomy repair.

Background: Cystotomy repair is a required Ob-Gyn milestone procedure; however, low surgical volume for cystotomy may impact resident ability/confidence to perform the procedure. Available simulation models are either expensive or low-fidelity and not water-tight. Our goal is to create a cost-effective, realistic, functional bladder model (visible ureteral jets, water-tight after repair) for simulation of cystotomy repair.

Methods: Phase 1: Design and creation of the model using molds developed with 3D design software and 3D printing. The silicone model includes ureters, urethra, trigone, ureteral orifices, rugae, muscularis, and mucosa.
Phase 2: Pilot of the model with Ob-Gyn residents as part of their simulation curriculum. Residents were given a pre- and post-test to identify the model’s anatomic landmarks and rate their confidence in 1) identifying cystotomy and 2) performing open cystotomy repair. Residents evaluated the model’s fidelity post-simulation.

Results: Eight bladder models were constructed for $206. The model was water-tight post-repair and cystoscopy demonstrated bilateral ureteral jets. All residents, n=16, had no prior cystotomy simulation and limited experience with cystotomy repair. The model improved ability to identify bladder anatomy (4.3/6 items pre vs 5.8/6 items post, p=0.04) and confidence in both identifying cystotomy (2.14 vs 3.4 of 5, p= 0.006) and performing cystotomy (1.4 vs 3.3 of 5, p=0.014). Learners strongly agreed the model was realistic, mean 4.6/5.

Discussions: Our novel bladder model is cost-effective, realistic and useful for teaching anatomy and simulation of cystotomy repair.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Practice-Based Learning & Improvement, GME, Simulation, General Ob-Gyn,

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Impact of TrueLearn Question Bank on Resident Performance on the CREOG In-Service Training Exam

Purpose: To determine how implementation of the TrueLearn (TL) question bank and mock in-service training exam (ITE) impacts performance on the CREOG ITE.

Background: The CREOG ITE is an annual exam on which, success has been correlated to success on the American Board of Obstetrics and Gynecology Qualifying Exam. Question banks are quickly becoming a popular study tool, but their utility on improving CREOG ITE performance is unknown.

Methods: We performed a quasi-experimental retrospective review of the CREOG ITE score reports from 2017 to 2019 at our institution. Starting in 2018, TL was made available and a mock ITE was administered for the first time. A two-sided paired t-test compared average annual improvement in CREOG ITE scores before and after TL implementation. Correlation coefficients between TL usage and improvement on the 2019 ITE were calculated using Pearson correlation testing and a linear regression was used to determine their association.

Results: After providing TL, mean improvement in percentage points on the CREOG ITE was 6.6, 9.33 and 6.75 as residents matriculated from PGY1-2, PGY2-3 and PGY3-4 respectively. This was a significant improvement compared to the previous year.  As a program there was a moderate correlation with TL usage and percentage point improvement on the CREOG ITE; r=0.38, p= 0.038.

Discussions: After providing universal access to TL question bank and administering a mock ITE, a statistically significant improvement on the CREOG ITE was seen. TL’s question bank and mock ITE are valuable resources for improving CREOG ITE performance.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Independent Study, Problem-Based Learning, General Ob-Gyn,

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Duty Hours and Medical Student Performance: Is There a Correlation?

Purpose: To describe the association between duty hours (DH) and shelf exam score, and between DH and overall grade.

Background: Medical students are required to comply with the same DH regulations as residents. However, variation exists between the total DH worked due to diversity of clinical sites, surgical rotations, and student engagement. The impact of DH on exam scores and clinical grade is poorly understood.

Methods: Retrospective cohort study of students in OB/GYN clerkship at a single academic center from 8/18-6/19. Weekly duty hours tabulated and averages obtained. Students working more than 75%ile for DH weekly (long hours) compared to those working less. Impact of long hours in last two weeks of clerkship also examined. Outcomes of interest were high overall grade ( >95%), high shelf score ( >90%), and low shelf score (< 60%) adjusted for quartile of year. Simple statistics used to analyze data.

Results: The average weekly DH was 43.1hr/wk (SD 7.32hr). This didn’t vary by gender. Students in the latter half of the year worked longer (45.2 hrs/wk vs 41.9 hrs/wk, p=0.03). The 75%ile of weekly DH was 47.1 hrs. Students working long hours were not more likely to have low shelf (21.7% vs 30.4%,p=0.6), high shelf (28.3% vs 28.6%,p >0.99), or high overall grade (25% vs 28.9%,p >0.99). Long hours in the last 2 weeks of the clerkship was not associated with high overall grade (33.3% vs 31.1%,p >0.99) or low shelf (21.7% vs 34.2%,p=0.32). A trend toward high shelf scores was seen (41.3% vs 23.2%,p0.06).

Discussions: Long duty hours, even late in the clerkship, were not associated with high or low shelf scores, nor high overall grade.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Medical Knowledge, UME, Assessment, General Ob-Gyn,

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Curriculum Development in the OBGYN Clerkship: Effect on NBME Scores

Purpose: Investigate whether implementation of APGO Medical Student Educational Objectives into an OBGYN clerkship didactic curriculum results in higher NBME exam scores.

Background: Medical student curriculum reform is at the forefront of OBGYN educational research. Active, adult learning techniques are highly touted; data are promising for student satisfaction, but more studies about effect on objective assessments are needed.

Methods: We implemented 21 of 58 APGO Medical Student Educational Objectives into the OBGYN Clerkship didactic curriculum during academic year (AY) 2018-2019. Students were assigned pre-reading material and completed weekly, graded individual readiness assessment tests, followed by team readiness assessments, before each didactic session. NBME scores were compared pre- and post-intervention (AY 2017-2018 to AY 2018-2019, respectively) by yearly cumulative, as well as by individual cohort within each year. Analysis was completed with independent samples t-test with two-sided P < 0.05 statistically significant.

Results: Overall, AY 2018-2019 had higher average NBME scores than AY 2017-2018, although not statistically significant (79.5 vs 78.6, P=0.29). Cohorts 4 and 6 showed significantly higher scores in AY 2018-2019 relative to AY 2017-2018, 80.0 vs 75.4 and 82.1 vs 77.7 respectively, (P< 0.05). Cohorts 3 and 5 scores were slightly higher on average and cohorts 1 and 2 scores were lower on average in AY 2018-2019 relative to AY 2017-2018, but these differences were not found to be statistically significant.

Discussions: Implementation of the APGO Medical Student Education Objectives into our OBGYN didactic curriculum showed a trend toward higher NBME scores, suggesting benefit, however this difference was not statistically significant.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Faculty, Clerkship Director, Clerkship Coordinator, Medical Knowledge, GME, Assessment, Lecture, Team-Based Learning, General Ob-Gyn,

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Clerkship Directors’ Reports and Attitudes on Pelvic Exams Performed by Medical Students

Purpose: To examine current practices of obtaining consent for pelvic exams performed by medical students as reported by OBGYN Clerkship Directors (CDs).

Background: Recently, ethical concerns regarding student involvement in pelvic exams performed while a woman is under anesthesia have been raised in the scientific, professional, and popular literature.

Methods: An online survey about the educational pelvic exam was administered to OBGYN CDs as part of the APGO annual clerkship directors’ survey. CDs were asked if their institution had policies on the performance of pelvic exams by students, if explicit consent was obtained, and if patients, students, and providers were educated on the policy. These were evaluated by descriptive statistics of self-reported policies. We also compared the median values of the perceived importance of telling a patient about the involvement of a medical student across seven different procedures.

Results: The survey was sent to 230 clerkship directors, 140 responses were returned, with a response rate of 61%. 57 CDs reported they follow all 4 recommendations (40.7%) as published by APGO’s statement on pelvic exams under anesthesia. 9 CDs did not believe the exam had to be related to the procedure performed. Consent for pelvic exam was seen equivalent to consent for rectal exam, intubation, and making the incision. Consent was perceived less important to watch the procedure, suture the incision, and retract.

Discussions: While many CDs report institutional policies on students performing pelvic exams, it is clear that education is still needed to ensure proper consent is obtained.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, UME, Quality & Safety, General Ob-Gyn,

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Care Across the Life Cycle: Results of an Integrated Pediatric, Obstetrics and Gynecology, and Geriatric Medical Student Clerkship

Purpose: The authors explore medical knowledge attainment and course evaluation data in Pediatrics and Obstetrics and Gynecology after the implementation of a novel, three-phase undergraduate medical school education curriculum called ForWard. In ForWard, the two clerkships were shortened from six to four weeks and combined with geriatrics to form an integrated 12-week clinical block.

Background: The traditional structure for clinical clerkships are specialty specific rotations. Due to evolving needs of both patients and learners, there has been interest in integrating the clinical fields during delivery of undergraduate medical education. With any curricular change, it is important to evaluate the learning outcomes.

Methods: Pediatric and Obstetrics and Gynecology NBME subject exam scores were compared prior to (n=180) and after (n=162) the implementation of the ForWard curriculum using an analysis of variance with covariate (ANCOVA).  Student satisfaction with the traditional and ForWard curriculum were determined based on post-clerkship evaluation forms and compared using unpaired t-tests.

Results: The unadjusted mean NBME Pediatrics and Obstetrics and Gynecology subject examination scores were 77.1 and 80.0 in the traditional curriculum and 76.9 and 79.3 in the ForWard curriculum (p=0.83) and (p=0.37). The mean Pediatric and Obstetrics and Gynecology clerkship evaluation scores in the traditional curriculum were 77.1 (SD 7.6) and 80.0 (SD 6.9) compared to 76.9 (SD 7.9) (95%CI -1.84-1.47) and 79.3 (SD 7.7) (95%CI -2.26-0.85) in the ForWard curriculum.

Discussions: Despite shortened Pediatric and Obstetrics and Gynecology clerkship experiences, performance on the NBME subject examinations in both subjects was unchanged and student satisfaction was maintained.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Medical Knowledge, UME, Assessment, General Ob-Gyn,

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Attitudes of Obstetrics and Gynecology Residents Regarding Current Requirements for Gynecologic Surgical Training

Purpose: Understanding perspectives of residents in Obstetrics and Gynecology (OB/GYN) regarding gynecologic surgical training requirements including the Fundamentals of Laparoscopic Surgery (FLS) and the Accreditation Council for Graduate Medical Education (ACGME) case minimums.

Background: The specialty of OB/GYN has changed substantially over the past several decades, including a reduction in overall surgical volume and more focused practice patterns. The American Board of Obstetrics and Gynecology (ABOG) and ACGME have instituted surgical training requirements . This study assesses the alignment of resident preferences with these requirements.

Methods: Current residents and newly matched first year residents within OB/GYN residency programs during the 2018-2019 academic year at the University of Colorado, University of Washington, University of California San Francisco, Loyola University, St. Joseph’s Hospital, University of Utah and Texas A&M (n=225) were invited to participate in a 13-item electronic survey regarding the FLS requirement and case minimums.

Results: One hundred fifty six respondents completed the survey for a response rate of 69%. PGY 2-4 residents were less likely to indicate that the FLS requirement strengthens surgical training (71% v. 43%, p< .001) or makes them more confident with laparoscopy (79% v. 26%, p< .001). PGY2-4 trainees found the current abdominal hysterectomy requirement too low (66% v. 43%, p< .001).

Discussions: PGY2-4 OB/GYN residents report that FLS will not enhance their surgical training, and that the current ACGME case minimum number for abdominal hysterectomy is insufficient. New requirements for gynecologic surgical training are discordant with resident perspectives. Involving trainees as stakeholders in specialty training reform is critical.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, GME, Assessment, Simulation, Minimally Invasive Surgery, General Ob-Gyn,

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Assessment of Chief Resident Laparoscopic Hysterectomy Performance Using Global Operative Assessment of Laparoscopic Skills (GOALS)

Purpose: To implement a validated, standardized tool to assess resident performance during laparoscopic hysterectomy.

Background: Surgical feedback  is critical to resident education, but it is often subjective and sporadically given. GOALS is a validated tool consisting of a 10-item checklist, 5-item global rating score, and an overall satisfaction score that is widely used in general surgery to assess resident skills during laparoscopic cholycystectomy and appendectomy.

Methods: Chief residents and one attending performing laparoscopic hysterectomies together filled out blinded evaluations after each case. The checklist was constructed by identifying 10 critical steps in completing the operation independently. Five laparoscopic domains (depth perception, bimanual dexterity, efficiency, tissue handling, and autonomy) and an assessment of case difficulty were scored on a 5-point scale. Overall satisfaction with the resident performance was rated on a 10-point scale. Paired t-tests were used to compare resident and attending scores. A regression analysis demonstrated an association between case difficulty and resident step completion.

Results: 56 hysterectomies were performed during the study interval with a mean step completion resident score of 6.9 (attending score 6.8; P = 0.56). Residents rated themselves lower in laparoscopic skills than the attending (3.25 vs 3.6; P = 0.0001), even though estimation of case difficulty was similar (2.81 vs 3.13; P = 0.03).

Discussions: We describe here a method for standardizing feedback and evaluation in the performance of laparoscopic hysterectomies. Residents consistently perform about 7 of the 10 steps required to independently perform laparoscopic hysterectomy. Trainees were more critical than the attending in assessing their own performance.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Gynecologic Oncology, Minimally Invasive Surgery, General Ob-Gyn,

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Assessing the Effectiveness of Single Session Didactic Teaching in Improving Health Care Professionals’ Knowledge of the LGBTQ Population

Purpose: To examine the impact of a single didactic session on short-term knowledge acquisition and long-term knowledge retention of principles related to LGBTQ healthcare.

Background: Individuals who identify as Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) compose an estimated 1.1-3.8% of the population. Despite significant legal and societal advances, disparities persist in LGBTQ health care education, delivery, and outcomes. Multiple national medical organizations have produced initiatives emphasizing the development of educational resources to address these disparities.

Methods: A prospective observational study was performed. Knowledge acquisition was examined by a written survey, including 5 semantic differential scale and 5 multiple-choice questions. The survey was provided prior to and after a didactic session, then again four weeks later. Participation was voluntary and anonymous. Statistics were analyzed using Graph Pad Prism 8 Software (San Diego, CA).

Results: Comparing summed scores, immediate pre and post results (n=63) showed significant improvement across both semantic differential scale (5.7-7.78; p-value 0.00005) and multiple-choice (71%-91%; p-value 0.0004) questions. The 4-week post results (n=33) showed knowledge degradation, but significant improvement when compared to pre-test (5.7-7.21; p-value 0.01, 71%-86%; p-value 0.0095). The most significant improvements were in knowledge of LGBTQ community resources (3.9-7.6-6.4; p-value < 0.00001) and options for gender affirmation (51%-73%-69%; p-value < 0.00001).

Discussions: As medical curricula continue to evolve to address the needs of the LGBTQ population, this study indicates that a single didactic session may significantly improve provider knowledge about LGBTQ health care. This should result in improvements in awareness and communication, patient satisfaction, and health outcomes.

Topics: CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, CME, Lecture, Public Health, Advocacy, General Ob-Gyn, Sexuality,

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A National Wellness Curriculum for OBGYN Residents: Impact of the CREOG Wellness Curriculum

Purpose: A national study explored the impact of a wellness curriculum for residents.

Background: The CREOG/APGO Physician Wellness Taskforce developed a national curriculum for physician wellness for obstetrics and gynecology residents. A multi-institutional study explored the impact of this curriculum on professional fulfillment and burnout of residents across the United States.

Methods: Twenty-five residency programs from all CREOG regions participated in the study. Residents in these programs participated in 6 interactive workshops on physician wellness over 1 year. Before and after the curriculum, residents completed the Professional Fulfillment Index (PFI) a 16-item survey tool measuring professional fulfillment (PF), and burnout composite (BC) (measures of work exhaustion and disengagement). T-tests analyzed changes in scores, comparing groups with higher attendance and lower attendance at the wellness curriculum sessions.

Results: Among 592 participating residents, 424(72%) completed the pretest and 385(65%) the posttest. Residents participated in 3.96 sessions on average. Overall,PF increased slightly with 23.8% meeting the threshold for robust PF pretest to 25.2% meeting the same thre posttest. BC scores improved slightly with 46.8% meeting criteria for burnout pretest to 43.9% posttest. The 246 residents attending 4-6 sessions in the wellness curriculum (High Attendance) had improved scores compared to the 139 residents attending 0-3 (Low Attendance): PF-high attendance (28.05%) vs. PF-Low Attendance (20.14%), p< .001, and BC-High Attendance (39.8%) vs. BC-Low Attendance (51.1%), p=0.03.

Discussions: A longitudinal wellness curriculum is feasible within an OBGYN residency training program. While burnout has been shown to increase throughout the academic year, this may be mitigated by participation in the curriculum, with residents who were more engaged demonstrating greater improvement in professional fulfillment and less burnout over 1 year.

Topics: CREOG & APGO Annual Meeting, 2020, Faculty, Residency Director, Residency Coordinator, Professionalism, GME, CREOG & APGO Annual Meeting, 2020, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, GME, Lecture, Independent Study, General Ob-Gyn,

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A Design Thinking Approach Will Engage Obstetrics and Gynecology Residents in Quality Improvement Education

Purpose: To incorporate design thinking methods in quality improvement curricula to generate impactful patient interventions and enhance resident satisfaction.

Background: Incorporating a meaningful quality improvement (QI) experience into an already overloaded residency training program is challenging. We applied the principles of design thinking to a QI curriculum to inspire residents (“users”) to develop patient-centered QI projects.

Methods: Starting in 2017, residents at an academic medical center were introduced to QI grounded in the Model for Improvement. The experiential component was implemented using a five phase Design Thinking process (Empathy, Define, Ideate, Prototype, Test). Data were obtained from ACGME surveys and patient outcomes. Chi square was used to compare yearly trends in resident satisfaction; patient outcomes were analyzed using an independent t test. P< 0.05 was significant.

Results: Since introduction of the QI curriculum, we have had 100% resident involvement (increase from 83%, P< .05 ) and collaboratively generated QI interventions that improved patient outcomes and enhanced resident engagement. One initiative increased postpartum visit adherence in a high-risk population from 21% to 63% (P< .01). An initiative addressing prenatal tobacco use in resident clinics produced a state-funded $53,000 grant to screen and treat pregnant smokers. Overall satisfaction with the residency increased by 64% between 2017-2019 (P< .05)

Discussions: Design thinking can be integrated into graduate medical education. Although this curriculum was initially implemented to meet ACGME QI project requirements, we found that a design thinking approach empowers residents with the knowledge, creativity and problem-solving skills to design impactful QI initiatives while simultaneously enhancing resident wellbeing.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Quality & Safety, Public Health, Advocacy, General Ob-Gyn,

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