Trends in Off-Service Rotations in Ob/Gyn Residencies Before and After Duty Hour Restrictions
Purpose: To establish trends in off-service rotations in OB/GYN residencies
before and after duty hour restrictions.
Background: As co-morbidities in our patient population increases,
the skills required of OB/GYNs are changing, we sought to determine the
characteristics of off service rotations.
Methods: We searched websites of ACGME accredited OB/GYN
residency programs. We collected data on off service rotations: services,
number of rotations, and PGY year of rotations. Surveys were emailed to
programs regarding off service rotations in 2018 and before duty hour changes
Results: 92% (n=259) of programs had information available on
off-service rotations, of these, 24% (n=62) had no off-service rotations, 26%
(n=67) had 1, 25% (n=66) had 2, 13% (n=34) had 3, 12% (n=30) had 4 or more. The
majority (84%) of rotations were in PGY1. The most common rotations were ER
(47%, n=122), SICU (24%, n=62), IM (25%, n=66), MICU (9%, n=23). We received 53
responses to the survey (19% response rate). Of those who responded, the most
common rotations for 2018 and before 2003 were ER & SICU. The number of
programs with SICU rotations remained stable from 2003 to 2018 (43% vs 47%)
compared to 1.4 fold decrease in programs with ER rotations. The number of
programs with IM rotations decreased 2.5 fold from before 2003 to 2018.
Discussions: Duty hour restrictions have affected off-service rotations. A
quarter of all programs have no off-service rotations, with a decrease in ER
and IM exposure during residency. This does not reflect the breadth of
knowledge required of OB/GYNs today.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Quality & Safety, General Ob-Gyn, CREOG & APGO Annual Meeting, 2019, Student, Resident, Clerkship Director, Residency Director, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Team-Based Learning,
Read more »
Too Many Learners? Do Students Belong in Resident Continuity Clinics?
Purpose: Determine the prevalence of medical students in OBGYN
resident continuity clinics and describe effects on the learning environment
when students and residents work together in this setting.
Background: Patient continuity is an ACGME requirement often
fulfilled through a resident run continuity clinic. It’s unknown how frequently
students rotate in these clinics, or how multiple levels of learners influence
Methods: We surveyed OBGYN program managers using a national
listserv. Resident and student surveys were based on a Likert scale and sent to
all OBGYN residents and students that rotated at our institution from
Results: Program managers responded from 45 programs and 75.6%
scheduled students in resident continuity clinics. Our response rates were
79/116(68.1%) for students and 21/24(87.5%) for residents. A one-sample
Wilcoxon signed rank test was used to test the hypothesis that the typical
response on the five-level Likert scale was \"Agree\" or \"Strongly
Agree.\" Of medical students, 88.6% stated that they agreed or strongly
agreed they enjoyed working with residents (p<0.001) and 60.8% stated
they agreed or strongly agreed residents were effective teachers (p<0.001).
Among residents, 52.4% agreed or strongly agreed that they enjoyed working with
students (p<0.001). However, 61.9% said they agreed or strongly agreed they
were too busy to be effective teachers (p<0.001).
Discussions: Many institutions have students rotate in resident continuity
clinics. Residents and students have positive views regarding their
interactions. Although students were satisfied, residents expressed concerns
about their ability to be effective teachers given clinical demands. Our
results highlight the importance of developing resident teaching skills.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, CME, UME, Assessment, Problem-Based Learning, Team-Based Learning, General Ob-Gyn,
Read more »
Time to Face the Music: Attitudes of Current and Future OB/GYN Residents Regarding the Structure of Residency Training
Purpose: Measure future and current resident perspectives regarding
OB/GYN residency training structure and possible future models.
Background: Modifications to the current OB/GYN training paradigm
are being considered however the perspective of learner stakeholders on
substantial changes has not been measured.
Methods: Medical students invited for OB/GYN residency
interviews and residents (PGY1-4) at the University of Colorado, University of
Washington, University of California San Francisco, Loyola University, St.
Joseph’s Hospital, and Texas A&M in 2017-2018 received a voluntary,
electronic survey regarding possible models for restructuring residency
training. Student and resident responses were compared using a chi-square
for categorical and two-sample t-test for continuous items.
Results: Applicants (63%, 280/444) and residents (66%, 101/154)
had similar response rates. Applicants (24%) and residents (29%) reported
having concerns about the current structure of residency training. The
ideal residency duration was reported as 4 years by 72% of applicants and 85%
of residents. Lack of gynecologic surgical volume was the most frequently
reported concern among applicants (75%) and residents (72%). Fourth-year
tracking (focusing on training aligned with post-graduation career path) was
preferred by 90% of applicants and 77% of residents (p=0.002), and 92% among
respondents planning fellowship. Most applicants (68%) and residents
(75%) preferred not starting fellowship training after the 3rd year of
Discussions: The majority of learners surveyed support a 4-year training
structure, but likewise support individualizing training in the PGY-4 year. It
is imperative that OB/GYN leadership consider this and other feedback from
learners when considering modifications to the current OB/GYN training
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, GME, UME, General Ob-Gyn, CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Residency Coordinator, Patient Care, Practice-Based Learning & Improvement, GME, Simulation,
Read more »
Simulation Training for Operative Vaginal Delivery Among Obstetrics and Gynecology Residents: A Systematic Review
Purpose: To evaluate the impact of simulation training of operative
vaginal delivery (OVD) on learner technique, operator comfort, and
Background: Obstetric simulation affords learners opportunities to
acquire and to refine clinical skills in a low-stress environment while
potentially improving patient outcomes. However, the effect of simulation
on OVD training is less clear.
Methods: A systematic research protocol was constructed a
priori for the conduct of the literature search, study selection, data
abstraction and data synthesis. Electronic databases were searched for
educational randomized trials and observational studies assessing OVD
simulation training for OBGYN residents. The educational domains of
knowledge, skills and attitudes were evaluated. The Medical Education
Research Study Quality Instrument (MERSQI) was used to assess study
quality. The review was prospectively registered with PROSPERO.
Results: The search strategy yielded 30,812 articles, with 7
articles eligible for analysis (2 cohort studies, 1 case-control study, 4
cross-sectional studies). No randomized trials were identified.
Studies demonstrated simulation to improve learners’ skill with forceps
placement and generated force during extraction. While forceps simulation
had no change in procedure failure rates, there were significant decreases in
rates of maternal lacerations, neonatal injury, and special-care nursery
admission. Only one study evaluated the effect of simulation on provider
comfort, demonstrating increased provider comfort with vacuum-assisted
delivery. The median MERSQI score was 9.5 (range 9.0-13.5), indicating
Discussions: The available evidence suggests improvement in technique,
comfort, and patient outcomes with OVD simulation, but additional studies are
required to further characterize such benefits for both forceps and vacuum.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Simulation, Quality & Safety, Maternal-Fetal Medicine, General Ob-Gyn,
Read more »
Simulated Paging Curriculum to Assess and Improve Communication Skills
Purpose: To examine the impact of a simulated paging curriculum for
senior medical students on physician-nurse communication skills.
Background: New residents are expected to triage and address a
high volume of clinical pages yet medical students receive little training in
this important skill. Previous studies have evaluated the impact of simulated
paging curricula on clinical decision making and student confidence but have
not examined the effect on communication skills.
Methods: Two trained Registered Nurses (RNs) administered
specialty-specific pages to 76 fourth-year medical students enrolled in 4-week
residency preparation electives. For each case, RNs evaluated students’
performances on seven communication domains using previously validated 5-point
semantic-differentiation scales (1=worst, 5=best) in precision, instruction,
assertiveness, direction, organization, engagement, and ability to solicit
information. Immediate feedback was provided to the students.
Results: A total of 351 pages were administered: 144 in week 1,
73 (week 2), 97 (week 3), and 37 (week 4). Students from all specialties
improved communication scores throughout the four weeks. Mean
communication scores increased from 4.02 to 4.26 from week 1 to week 2
(<0.0001). Improvement was most pronounced for the students going into
internal medicine (3.82 to 4.25) and pediatrics (3.95 to 4.38) and less
pronounced for the procedural specialties of surgery (4.26 to 4.22) and ob/gyn
(4.07 to 4.18). Communication skills continued to improve in weeks 3 and 4 but
with inadequate number of pages to power this comparison.
Discussions: Our data demonstrates that a simulated paging curriculum is a
promising platform for teaching and improving physician-nurse communication
skills for senior medical students.
CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, UME, Assessment, Simulation, Problem-Based Learning, General Ob-Gyn,
Read more »
Service-learning Wellness Initiative in the Harvard Medical School Clerkship Curriculum
Purpose: The first aim was to assess if incorporation of a
service-based initiative into the curriculum results in professional
fulfillment, principally: improved medical student feelings of compassion,
contribution, wellness, understanding of community need, and team-building of
the student class. The second aim is to report the development of this
Background: Service-learning increases student awareness of
community resources, promotes service to the community, team-building through
cooperation rather than competition, broadens cultural awareness, and fosters
wellness through hands-on contribution.
Methods: The entire class of second year clerkship students
volunteered at a local non-profit organization. Students were divided into
small groups to work at various team tasks. Following, the entire group
reconvened for teaching reflection. They were asked a value-based qualifier of
the experience. They were also asked to provide feedback as an open response.
Quantitative data were analyzed using summary statistics, Wilcoxon rank sum and
Fischer’s exact test. Content analysis was used to determine themes from the
Results: 47 students participated, 48.9% of whom were male.
Average satisfaction with the intervention was high (mean 4.26 on a 5-point
Likert scale), with no difference in satisfaction noted by gender. Positive
themes included feelings of contribution, wellness, and team-building, with 9
respondents requesting to repeat the event at regular intervals.
Discussions: It is crucial to investigate different types of wellness
interventions throughout UME. Service-based interventions are not adequately
studied and may be an important addition to the wellness program as they are a
way for students to feel connected to the community they are
CREOG & APGO Annual Meeting, 2019, Faculty, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Team-Based Learning, Public Health, General Ob-Gyn,
Read more »
Resident Documentation and Coding Curriculum Can Be Improved Through One-on-one Education
Purpose: Assess impact of one-on-one education of residents in billing
Background: As billing and coding education was changed from
generalized education at didactics to more intensive one-on-one education, the
revenue team evaluated the impact for accuracy in billing and monetary impact.
Methods: Three groups of residents were analyzed. Group 1 (n=4)
were fourth year residents at intervention and had a general meeting with other
departments about coding and then one or two one-on-one sessions. Group 2 (n=4)
were third year residents at intervention and had two to three one-on-one
sessions. Group 3 (n=4) were second year residents at intervention and had
three consistent one-on-one sessions every 6 months. A selection of 10 records
per resident were randomly selected for review by a certified coder to identify
documentation and coding opportunities.
Results: The documentation and coding accuracy improved with
increased education. Accuracy Group 1: 55%, Group 2: 76%, Group 3: 89%. Revenue
lift was also analyzed with these encounters and an average lift of ~$40 was
noted between group 1 and group 3.
Discussions: By consistent billing and coding one-on-one education for
residents, the accuracy of coding improved as seen in the differences in
accuracy rate between graduating 4th years (55%) and second year residents
(89%). Residents see 5 patients on average per clinic session in their final 2
years and have approximately 30 clinics per year. This equates to an extra
$12,000 in revenue per resident over their final two years. By investing in
billing and coding education, accuracy and revenue were increased.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, General Ob-Gyn,
Read more »
Perioperative Complications Curriculum for the OB/GYN Resident: A Pilot Study
Purpose: To develop and implement a perioperative complications
Background: ACGME program requirements and milestones include
recognizing and managing perioperative complications.
Methods: Residents, Fellows, and Faculty were sent a needs
assessment survey, addressing satisfaction with baseline perioperative
complications curriculum and preferences for development of new
curricula. Additionally, Residents completed a knowledge pretest.
Over four weeks, Residents received weekly emails through the Qualtrics
software program linking to topic-specific materials, including interactive,
online case-based modules. A post-implementation survey was distributed
to assess Resident satisfaction with programming and to retest knowledge.
Results: With 75% (21/28) of Residents and 47% (40/86)
Fellows/Faculty completing the needs assessment survey, 95% (20/21) of
Residents and 90% (36/40) Fellows/Faculty reported dissatisfaction with
pretest mean score was 72% (40-90%, SD = 15).
online case-based modules were developed for topics including ureteral injury,
bowel injury, vaginal cuff dehiscence, and bladder injury. Curriculum
materials were successfully distributed on a weekly basis to all Resident
learners, as confirmed through the web-based software program.
module completion rates were 50%, 36%, 29%, and 18% for weeks 1-4,
percent of Residents completed the post-implementation survey, with 100%
reporting satisfaction with the online case-based modular curriculum.
Knowledge post-test mean score was 84% (SD = 15).
Discussions: A needs assessment confirmed poor satisfaction with baseline
perioperative complications curriculum. Web-based materials were
developed and distributed weekly to all Residents who successfully accessed the
4 developed modules. While post-survey responses were few, 100% of
responders reported satisfaction with the developed curriculum.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, Practice-Based Learning & Improvement, GME, Assessment, Independent Study, Problem-Based Learning, General Ob-Gyn,
Read more »
Parenthood and Medical Careers: The Challenges and Experiences of Physician Moms in the US
Purpose: This survey study sought to gain a better understanding of
the experiences and challenges physician moms face during training and as
Background: Balancing the demands of medical training and a career
along with those of parenthood is challenging. Currently 46% of residents and
fellows in training are women, with a rate as high as 83% in Obstetrics and
Methods: We surveyed 897 physician moms from January
2018-February 2018 about their experiences with child-bearing, breastfeeding
and maternity leave. Participants completed an open-ended question “What is
your biggest challenge as a physician mom?”, these answers were qualitatively
Results: The majority of participants (40%) had their first
child between 31 and 34 years old; 36% of participants had their first child as
a resident, while 28% did as junior faculty. For those who had a child during
residency, 38% breastfed for 1 year or more, 26% breastfed for 6 months or
less. For women who delayed child-bearing, 55% delayed to complete training,
21% delayed for financial reasons, 20% delayed for infertility, 12% of
participants delayed due to pressure from their training program. For women who
had a child during training 44% described having inadequate leave, but 53%
report support from program administration. The themes for biggest challenges
for physician moms were coded as: time/hours (37%), balance (26%);
over-expectation/guilt/shame (21%), work/working at home (21%), missing out (18%);
Discussions: Based on our results, there are clear ways residency programs
and departments can support physician moms with the challenges they face.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, UME, General Ob-Gyn,
Read more »
Pain Perception in Cervical Biopsy- Variations by Patient and Provider Characteristics in an Academic Teaching Clinic
Purpose: We aim to identify factors which dependably predict patients’
experience of pain during colposcopy, and to evaluate if providers, stratified
by level of training, are capable of anticipating procedural pain.
Background: Cervical biopsy procedures, including colposcopy and
loop electrosurgical excision procedure (LEEP), are considered non-invasive
office procedures and efforts to codify their use emphasize logistics and
ability to detect disease. A significant gap exists for mitigating
psychological distress and procedural pain. Previous research suggests that
physician assessment of procedural discomfort varies by years of experience.
Methods: Patients presenting to an academic gynecology practice
for colposcopy with cervical biopsy or LEEP completed Pre- and Post-Procedure
surveys (14- and 3-item surveys, respectively), assessing demographics, past
cervical procedures, menstrual pain, and anticipated biopsy pain, among other
metrics. Post-Procedure surveys assessed a numerical level of pain experienced
during the biopsy. The health care provider (HCP) and procedural assistant were
surveyed for perceptions of patient pain. Pain scores were evaluated using a
100mm visual analog scale. Data analysis was performed using Spearman
rank correlation, and coefficients for relevant variables were calculated.
Results: 80 patients were enrolled and 62 underwent cervical
biopsy. Patients with higher anticipated pain gave higher ratings for
post-procedure pain (p=0.024). Women reporting more intense periods predicted
and experienced more procedural pain (p<0.001, p=0.058). From the provider
perspective, HCPs correctly estimated patients’ pain when compared with the
patients’ perceptions (p=0.066). However, only PGY3 and PGY4 OB/GYN residents
did so with statistical significance (p=0.014) and PGY1 and PGY2 residents
rated lower pain scores (p=0.039). Male assistants rated pain lower than
female assistants (p=0.037).
Discussions: Providers accurately estimated patients’ pain with variation
by years of training. Patient characteristics of age, anxiety, and dysmenorrhea
were reliable predictors of pain levels. Our findings suggest that
pre-procedure screening of patients may be helpful in directing pain reduction
interventions. Additionally, years of experience may provide enhanced pain
perception, suggesting future research into pain management training for junior
resident physicians and medical students.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Practice-Based Learning & Improvement, GME, CME, Quality & Safety, General Ob-Gyn,
Read more »
P&S Partners in Pregnancy: A Longitudinal, Patient-Centered Program for Preclinical Students
Purpose: To develop a longitudinal clinical program pairing first-year
medical students with prenatal patients.
Background: Students who participate in early clinical,
longitudinal experiences report greater confidence in communication, comfort in
clinical settings, and self-esteem during transition to clerkship year.
However, few longitudinal experiences exist for preclinical students at
Columbia University Vagelos College of Physicians and Surgeons.
Methods: A retrospective needs assessment evaluating interest,
motivating factors, and perceived barriers to participation was distributed to
second-year students. In response, we developed a program pairing ten
first-year students with pregnant patients. Students partake in lectures and
accompany patients to prenatal visits. Initial perceptions about the
patient-physician relationship were assessed in both groups using the
Patient-Practitioner Orientation Scale (PPOS), with 1 indicating
“doctor-/disease-centered,” and 6 indicating “patient-centered.”
Results: 49% of students completed the needs assessment. 90%
reported that they would be at least “somewhat interested” in a longitudinal
prenatal pairing program. Motivating factors included desiring longitudinal
experience (87%), early clinical exposure (82%), and patient advocacy/community
engagement (78%). Our program was designed accordingly. All first-year students
were invited to apply; ten were accepted. At recruitment, mean student PPOS
score was 4.64 compared to 3.95 for patients.
Discussions: Students in early medical education are enthusiastic about
longitudinal patient experiences and demonstrate patient-centered mindsets.
Programs such as ours may help maintain and cultivate patient-centeredness,
with the potential to improve patient satisfaction(1) and create positive
attitudes towards medical student involvement.
E et al. Patient orientations of physicians and patients: the effect of
doctor-patient congruence of satisfaction. Patient Educ Couns 2000;
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Medical Knowledge, Professionalism, UME, Independent Study, Team-Based Learning, Advocacy, General Ob-Gyn,
Read more »
Outcomes of a Transgender Care Training Program in Obstetrics and Gynecology Resident Education
Purpose: We sought to evaluate outcomes of an Obstetrics and
Gynecology (OB/GYN) resident education program on transgender health.
Background: OB/GYNs are often frontline providers for the
transgender community, as patients may first present to an OB/GYN with symptoms
of gender dysphoria or postoperative care needs and complications. Both the
American College of Obstetricians and Gynecologists (ACOG) and the Council on
Resident Education in Obstetrics and Gynecology (CREOG) have developed key
areas of competency pertaining to the care of transgender patients by OB/GYNS.
To date, standardized educational curriculums on these competency areas
are not available.
Methods: Residents at our institution completed a 2.5-hour
training on transgender health comprised of a standardized patient interaction,
debriefing session, and didactic session led by an expert on transgender
gynecological care. A 42 item pre- and post-training survey evaluated
participant demographics, a validated transphobia questionnaire, medical
knowledge of transgender care and preparedness to provide transgender care.
Results: Eighteen residents and medical students completed the
training. The average pre- and post-training knowledge assessments scores
significantly improved from 74.8% to 88.9%, (p<0.001). Specifically,
knowledge of transgender health disparities, professional guidelines, and
management of abnormal uterine bleeding all significantly improved. Baseline
transphobia scores were low and did not significantly change. Residents felt
more prepared to collect a transgender focused medical history, provide
referrals, and access additional educational resources.
Discussions: Our training improved residents’ knowledge and preparedness
to provide a variety of aspects of transgender care. This training was
feasible, reproducible and positively received by the resident participants.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, CME, Assessment, Standardized Patient, Advocacy, General Ob-Gyn, Sexuality,
Read more »
Oral Milestone Assessment versus Electronic Evaluation (E-Value) Milestone Assessment-Is One Better Than Another?
Purpose: To compare milestones assigned to PGY 1 and 2 Residents via
an Oral Milestone Exam versus the traditional retrospective monthly electronic
evaluation system to assess how they aligned.
Background: Programs are tasked with implementing assessment tools
to evaluate the 28 milestones. Most programs use some form of an electronic
evaluation at rotation completion. The Clinical Competency Committee
reviews all information for final score assignment each six month period.
Methods: In 2015, we instituted an Oral Milestone examination
to assign the six-month milestones and compared those scores to our
retrospective monthly on-line evaluations. We evaluated PGY 1 and 2 residents
in a simulated forum on milestones, which included Medical Knowledge, Patient
Care, and Interpersonal /Communication Skills Competencies. All residents were
given simulated patients, cases, and/or skills while each examiner was given
the specific ACGME milestone assessment sheet to score. The residents were
provided with immediate feedback.
Results: From 2015-2018, 78.4% of PGY 1 and 43% of PGY 2 residents
scored higher on the real-time oral milestone exam. Additionally, in 82% of PGY
1 residents and 52% of PGY 2 residents score on the oral exam was at
0.5-1milestone level higher than the retrospective electronic monthly
Discussions: Clinical Competency Committees are tasked with Milestone
assignment to all residents every six months. Evaluation tools that most
reflect the actual milestone completion is a mission of all programs. We set
out to assess whether our electronic monthly retrospective evaluation system
was mirroring the assessment performed on our residents with the real-time oral
milestone exams at the end of the six month interval, just prior to submission
to the ACGME.
Our data suggests discrepancy in our online retrospective milestone evaluation
versus the real-time assessment of an oral exam. Not only did residents score
higher in most circumstances in an oral format, but they were higher by a
half-whole milestone level in the majority of the cases. It would suggest that
our ability as educators to recollect the performance of a resident at an
interval later than the performance may be flawed.
Programs may want to consider instituting an oral milestone examination for
enhanced milestone assessment.
Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Professionalism, GME, Assessment, Simulation, Standardized Patient, General Ob-Gyn,
Read more »
Obstetrical Resident Improved Education and Teaching (ORIEnT)
Purpose: To implement a new obstetric education curriculum for the
L&D rotation. It is based on the flipped classroom model, including self-directed
learning with podcasts and assigned readings; as well as, group based learning
with case discussions
Background: Duty hours and workload make the labor and delivery
unit a difficult environment to achieve a structured learning curriculum. It
has been identified as an area where resident education is lacking and provides
an opportunity for implementing a formal education component.
Methods: The curriculum was implemented at the University of
Colorado and University of Oklahoma. It consisted of 6 modules covering the
following topics: multiple gestation, PPH, PPROM, PTL, short cervix/cerclage,
and IUFD. All modules could be accessed through Dropbox, which included a link
to podcasts, reading materials and case discussions. Case discussions were led
each week on L&D with a faculty member or MFM fellow. Outcomes measured
included resident and faculty satisfaction and resident knowledge acquisition.
Results: Pre and post surveys of residents and faculty showed
an overall positive response to the new curriculum. Resident surveys indicated
that they acquired new knowledge through the curriculum. Faculty surveys
demonstrated a positive response for enhancing L&D education and improving
access to learning materials.
The new curriculum was received well among residents and
faculty as a way to implement structured teaching on L&D. Challenges
included participation, resident schedules and inability to assess knowledge
acquisition. While there were challenges, this curriculum provided multiple
formats to learn and improved access to learning materials.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, General Ob-Gyn,
Read more »
Medical Students Reflections About Patient Care Affected by Race, Ethnicity or Language During the Obstetrics and Gynecology Clerkship
Purpose: To explore medical students’ reflections about obstetrics and
gynecology (OBGYN) clerkship experiences in which they witnessed patient
mistreatment based on patients’ race, ethnicity and language.
Background: Experience-based clinical learning includes
interactions with patients and teachers and is affected by sociocultural
contexts. Recognizing that bias and discrimination are pervasive in our
culture, medical students may observe these behaviors within their clinical teams.
Methods: We conducted a directed content analysis of students’
reflective essays written during OBGYN clerkships from 2014-17 about clinical
scenarios that challenged their professionalism. Of 265 essays that
referred to patient interactions, we included essays discussing patient race,
ethnicity or language for this analysis. Essays were analyzed more than once if
they discussed more than one of these factors.
Results: Of 53 essays that met inclusion criteria, 40 discussed
issues with providing language-concordant care, including when language
barriers led to poor care. Of these, 23 focused on interpreter concerns, such
as nonuse of certified interpreters and discomfort with being asked to
interpret. In 23 other essays, students described how patient’s race or
ethnicity affected care, including students recognizing their own bias towards
patients or witnessing team members’ discriminatory behavior such as being
judgmental, uttering racist remarks, or demonstrating insensitivity about
Discussions: Medical students witnessed and reflected about clinical team
member’s discriminatory behaviors toward patients. These narratives should
compel educators to reflect on their own biases and to set higher standards for
justice-informed care in the clinical learning environment – both to provide
justice-informed care for patients and to optimize experience-based learning.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, UME, General Ob-Gyn,
Read more »
Management of Postoperative Issues in Gynecology and Gynecologic Oncology: A New Method for Teaching Residents
Purpose: This project sought to develop and assess a curriculum to
improve resident knowledge of and comfort in managing common post operative
Background: Junior obstetrics/gynecology residents enter training
with varied experience in post-operative management. They are often the first
contact for surgical patients with little formal education on post-operative
Methods: Eleven common post-operative issues were identified
based on literature review, resident experience and gynecology/gynecologic
oncology faculty input. Topic based curriculum included: example case,
pathophysiology, differential diagnosis, next steps, and useful resources. It
was presented at two educational sessions, involving lectures and small-group
simulations. Residents completed a pre and post-assessment questionnaire
assessing comfort level in managing (10-point Likert scale) and baseline
knowledge about (content-specific questions) the topics.
Results: Twenty-three residents participated.Seventeen
completed one or both pre-assessment surveys (nine junior residents). Ten
completed one or both post-assessment surveys (five junior residents). All
post-assessment respondents reported improved knowledge of issues covered.
Average self-rated comfort level increased for ten of eleven topics amongst
junior residents (average increase 1.6 points (range 0.5 – 3.2; p = 0.02)).
Largest increase in score was for hypoxia and low urine output. Average scores
maintained or improved for 80% of the content questions (not significant).
Residents had no preference for lecture versus small group format.
Discussions: As a result of directed teaching, resident knowledge of
post-operative issues showed measurable improvement. Resident comfort level in
management increased significantly for 90% of topics covered, most noticeably
amongst junior residents. A systematic, resident-led curriculum on
post-operative management can improve resident knowledge and patient care.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Residency Director, Patient Care, Medical Knowledge, GME, Simulation, Lecture, Problem-Based Learning, Team-Based Learning, Gynecologic Oncology, Minimally Invasive Surgery, Female Pelvic Medicine & Reconstructive Surgery, General Ob-Gyn,
Read more »
Let the Good Grades Roll: Optimizing Shelf Exam Performance with a Novel Peer-led Comprehensive Review Session
Purpose: To create a
comprehensive review for third year medical students at Brody School of Medicine
in preparation for the end of clerkship national board shelf examination in
Background: With the
increasing availability of resources in preparation for clinical clerkships,
medical students struggle to identify high-yield topics in review for end of
clerkship shelf examinations. This dilemma is further exacerbated by having
educational objectives published by both the National Board of Medical
Examinations (NBME) and the Association of Professors of Gynecology and
Obstetrics (APGO). Although though it was proven that the NBME exam
appropriately tests students on the information that APGO deemed “essential,”
there still isn’t a timely and comprehensive review resource available for
students focusing on these specific topics. Due to this, a comprehensive
high-yield review was created using the student educational objectives in
OB/GYN published by the APGO.
two-hour comprehensive review presentation was created for students who were
rotating on the OB/GYN clerkship at the Brody School of Medicine using the APGO
objectives. The presentation was created in a question and answer format to
allow students to use the information presented as both a study tool and as a
self-assessment of knowledge. This review was created using the follow
resources: U-World, Step-Up to Obstetrics and Gynecology, and Pre-Test OB/GYN.
post-presentation survey revealed that participants found the review to be
educational, high yield, and extremely useful for studying for the NBME shelf
examination. An additional survey was also sent to students after taking the
NBME shelf examination to assess the quality of the information presented.
Overall the students who attended the review session and used the presentation
as a study tool reported positive impacts on shelf examination scores and
overall understanding of high-yield concepts in OB/GYN.
Discussions: With the positive
feedback from students who attended the review session and used the
presentation as a study-tool for the NBME shelf examination, we hope that
comprehensive reviews such as this will be created for additional clerkships to
help students prepare for other NBME examinations.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Medical Knowledge, GME, CME, UME, Lecture, General Ob-Gyn,
Read more »
Inter-professional OSCE Based Simulation Collaboration to Teach Obstetrics & Gynecology to Second Year Medical Students and Nursing Students
Purpose: To describe an
inter-professional workshop (IPE) utilizing simulation, OSCE and flipped
classroom to introduce 2nd year medical and nursing students to OBGYN concepts
Background: IPE has been
shown to facilitate improved patient-centered care
November 2017; students studied an online fetal heart rate (FHR) lecture; at
workshop worked in groups on clinical FHR scenarios, and presented findings for
group learning and discussions. Students rotated through three stations each
for 45 minutes as follows: 1) MFM faculty taught students on cervical dilation
using “blinded” and “open” cervical models. Students had hands-on with
obstetrical procedures such as B-Lynch Suture. 2) Students performed a
simulated vaginal delivery supervised by MFM fellow; nursing students
resuscitated newborn and gave SBAR report to medical students. 3) MFM fellow
and gynecologist faculty taught students on contraception methods while a
technician taught students IUD insertion. Students self-assessed and were
assessed by faculty using OSCE; knowledge quizzes were completed for
contraception and cervical examination accuracy.
program trained 116 (73%) medical and 51(22%) nursing students. There were no
significant differences between medical students and nursing students scores
which were respectively: IUD insertion self-assessment = 8.84 vs. 8.43; IUD
insertion faculty-assessment= 9 vs. 8; cervical examination accuracy = 13.1 vs.
12.7; contraception quiz = 9.1 vs. 9.3. Medical students
birth simulation self-assessment vs. faculty-assessment scores were 8.6 vs.
8.9, p <0.001.
Discussions: Medical and nursing
students learned OBGYN skills equally, nursing students had the opportunity to
teach medical students. Medical students were more critical of their
learning than faculty.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, UME, Simulation, Team-Based Learning, Contraception or Family Planning, General Ob-Gyn,
Read more »
Incorporating a Resident-Driven Quality Improvement Process Change Through a Lean Transformation of Post-Partum Hemorrhage (PPH) Care
Purpose: To investigate a
resident-driven quality improvement lean event to improve satisfaction in PPH
Background: Interdisciplinary PPH
response strategies are recommended as standard of care. OBGYN resident
perceptions regarding PPH management prompted an interprofessional quality
improvement lean event to create a systems process change on the post-partum
Methods: This was
a pre-/post-intervention study evaluating the impact of a lean event that
created new hemorrhage protocols (intervention) on postpartum units including:
medication safety bundle, assigned/clarified roles for providers, and a
streamlined communication process. The survey queried respondents regarding
team communication, access to uterotonics and analgesia, and perception of
overall patient safety during PPH. It was administered to resident physicians
and post-partum nurses prior to the system changes and at 6 and 12-month
intervals. These results were compared using nonparametric analyses.
included 15 residents and 16 nurses. Pre-intervention, there was a significant
difference in the overall perception of safety when comparing resident and
nurse response (p=0.0495) with residents perceiving a less safe environment.
Post-intervention, overall satisfaction among the 2 groups was improved at the
6 & 12 month intervals (p<0.05) without discrepancy between the
groups. Nurse results demonstrated significantly increased satisfaction
with team communication and IV access protocols (p<0.05).
Discussions: Resident led quality
improvement events can result in improved satisfaction of interprofessional
team members in PPH care with improvements maintained over 12 months. Reaching
a shared perception and mental model between nursing and residents in the care
of PPH can further be studied from the patient’s perspective.
CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, GME, General Ob-Gyn,
Read more »
Improved Team Climate and Increased Student Involvement with Interprofessional Learning on Labor and Delivery
Purpose: To evaluate the impact
of an obstetrical interprofessional learning experience for medical students on
team climate and medical student clinical involvement.
often express difficulty integrating into the obstetrical team and a desire
more clinical involvement on the unit. We hypothesized that an
obstetrical nurse-shadowing experience for students could increase student
understanding of the team’s function and that nurses who worked with students
would be more willing to advocate for student involvement in deliveries. We
planned to use the Team Climate Inventory to assess students’ inclusion in the
team, and to use the percentage of students playing a hands-on role in a
vaginal delivery to assess student clinical involvement.
baseline Team Climate Inventory was administered to students in 2015. The
nurse-shadowing day was introduced in 2016-2017 and these students also
completed the Team Climate Inventory; student T test used for analysis.
The percentages of students assisting in a vaginal delivery before and after
the intervention were compared using Fisher’s Exact Test.
response rates were 38% for control group and 42% for intervention group.
Significant improvement (p<0.05) was noted on all axes assessed by the
Team Climate Inventory following the intervention with the largest change in
Participative Safety. 64.25% of control group students assisted in a vaginal
delivery; this increased significantly to 84.65% in the intervention group
Discussions: The introduction of an
interprofessional learning exercise on Labor and Delivery was associated with
improvement in medical student assessment of team climate and with increased
involvement of students in vaginal deliveries.
CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Professionalism, Systems-Based Practice & Improvement, UME, Team-Based Learning, General Ob-Gyn,
Read more »