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,
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Gender in OB-GYN Residency: An Analysis of Factors Impacting Program Diversity
Purpose: To investigate if
geographic region, gender mix of previous classes and program leadership impact
the gender composition of residency programs.
comprised only 7.1% of all Obstetrics and Gynecology (OB-GYN) providers in
1970, and held 58.7% of OB-GYN positions in 2017.
Methods: 56 of
the top OB-GYN residencies as ranked by Doximity.com and US News & World
Report were identified and grouped by geographic region. Demographic
information for residents (n = 1732) and program/departmental leadership (n =
112) were compiled. Individuals’ gender was identified using online photos and
biographical descriptors. The male-to-female ratio (MFR) of the 2018 intern
class, of existing residency classes, program directors and departmental chairs
were calculated and compared. Two-way ANOVA and Tukey’s multiple comparison
tests were used (significance = p<0.05).
majority of trainees in OB-GYN programs are women (62.5-94%.) The MFR varied
significantly based on geographic region; southern programs had the highest MFR
(Figure 1). Programs with male chairs compared to those with female chairs
recruited more male interns (14.2% vs. 8.9%, p < 0.001). Programs with >
20% male residents (PGY 2,3,4) had a higher MFR in the incoming intern class
compared to programs with < 20% (15.4% vs. 11.4%, p = 0.020).
Discussions: Men are a minority in
OB-GYN training. Gender composition of residency programs is influenced by the
gender of leadership, geographic region, and of prior classes. Programs
must balance empowerment of women with a culture of inclusion and support of
qualified male candidates to ensure strength gained through diversity.
CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, GME, UME, Advocacy, Sexuality,
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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
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.
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
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
CREOG & APGO Annual Meeting, 2019, Resident, Residency Director, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, Pediatric & Adolescent Gynecology, Sexuality,
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Teaching Lesbian, Gay, Bisexual, Transgendered, and Queer Family Building in a Third Year OBGYN Clerkship
explore third year medical students’ fund of knowledge and attitudes about
LGBTQ family building and third party reproduction.
Background: Medical student knowledge and attitudes about family building for LGBTQ
families and third party reproduction (TPR) varies based on student prior
experience and pre-clinical teaching.
The OBGYN clerkship is a unique opportunity for students to learn
medical knowledge and reflect on attitudes about this subject.
Methods: A quantitative study of knowledge and attitude among third year medical
students done after IRB approval. The intervention consisted of a one hour
lecture on TPR and participating in a group discussion about LGBTQ family
building. Students (231) completed a survey asking about their knowledge and
attitudes prior to starting the rotation and 178 completed the survey following
the intervention. Survey respondents rated items using a Likert scale and
completed a knowledge assessmented. Changes in knowledge scores were investigated
Results: Survey respondents were 51% female, 48% male, 1% gender non-conforming;
heterosexual 93%; and partnered 59%. Comfort with same sex couples was endorsed
by 92%. 56% of students felt that opting out of assisting a patient with family
building was not an option. Fertility knowledge increased from after
intervention significantly (p<0.0001). Some students, 29%, thought that infertility was hard to discuss,
but 67% felt it would be hard to discuss for same sex couples.
students’ fund of knowledge was increased with lecture and small group
discussion about TPR and LGBTQ patients. Students report being comfortable with
TPR and LGBTQ families but have some discomfort with varied pathways to
parenthood. Most feel that opting out of care for LGBTQ families is not an
CREOG & APGO Annual Meeting, 2018, Student, Faculty, Clerkship Director, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, UME, Lecture, Advocacy, Reproductive Endocrinology & Infertility, Sexuality,
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OB/GYN Residency Training in Transgender Healthcare: A Survey of U.S. Program Directors
characterize transgender healthcaretraining during OB/GYN residency.
Background: Professional medical organizations increasingly recognize the importance
of transgender healthcare, but the training currently offered in OB/GYN
residencies is not well understood.
Methods: We conducted a cross-sectional survey of a regionally representative
random sample of 100 from 236 OB/GYN residency program directors between August
2016 and June 2017. Questions addressed demographics, presence and type of
resident transgender healthcare training. We compared attitudes, barriers and
facilitators between programs that did and did not offer transgender healthcare
training using chi-squared testing.
Results: Among 61 responding program directors, 50.8% (N=31) reported offering
transgender healthcare training, Region of country, program type and size did
not differ between those offering and not offering training. Of those offering clinical training in
transgender healthcare, 41.9% did so in generalist and 22.6% in specialist
OBGYN clinics, 32.3% provided hormone therapy, and 16.1% learned about gender
reassignment surgery techniques.
Programs offering training were more likely to report a transgender
community requesting services (90.3% versus 53.3%, p=0.001), interested faculty
(45.2% versus 20.0%, p=0.03), time allotted for training (29.0% versus 0%,
p=0.001) and resident interest (64.5% versus 36.7%, p=0.03). The most significant barrier to providing
training was lack of interested faculty, reported by 73.3% of programs that did
not versus 38.7% that did offer training (p=0.006).
half of responding residency programs offer transgender healthcare training.
CREOG named transgender healthcare an educational objective in 2013 and should
support this by identifying interested faculty and resident champions who can
lead implementation at all OB/GYN residency programs.
CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, GME, General Ob-Gyn, Sexuality,
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Assessment of a Sexual Health Curriculum for High School Students Delivered by OBGYN Residents
purpose of the project was to build a curriculum for high school studentson
sexual health including reproduction, contraception, pregnancy and sexually
trasmitted infections. This curriculum was delivered to the students by the SIU
OBGYN residents. We evaluated the knowledge and attitudes of students,
knowledge, skills and attitudes of the residents focussing on what their
perceptions of the students.
Background: The teenage pregnancy and sexually transmitted infection rates for teens
in the Sangamon County are higher than nantional averages. The residents expressed an interest in
reaching out to schools. High school
health teachers were contacted and overwhelmingly agreed to have the residents
participate in health classes about reproductive health.
Methods: We built a curriculum based on ACOG materials and best practices for
reproductive health. Needs assessments
to measure knowledge and attidtudes were given to a sample of high school
students on reproductive topics. Another
assessment was given to residents to gage skills in teaching as well as
attitudes towards teen. Assessments of
knowledge after the sessions were given to the students. Teachers were asked to rate the sessions and
provide feedback. Residents completed a
Results: Students have large gaps in reproductive knowledge but have the perception
they knonwlegable. Accurate knowledge improved. Teaches overwhelmingly were
satisfied with the material presented and the format. Residents had high satisfaction rates for
this activity and better perceptions of students.
effectively administered a reproductive health care curriculum to high school
students that was informative, well received and changed attitudes of students,
teachers and residents.
CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, GME, Public Health, Contraception or Family Planning, Pediatric & Adolescent Gynecology, General Ob-Gyn, Sexuality,
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“On-the-Go” Training: Downloadable Modules to Educate Students in Care for Sexual Assault Survivors
innovative approach to train students to provide trauma-informed care for survivors
of sexual assault (SA) through independent learning.
Background: All medical providers encounter patients who have experienced SA, and can
have significant impact on survivors; long-term health. Training medical
students to provide appropriate, trauma-informed care is lacking in most
medical school sexual health curricula. Appealing to the millennial learner, we
developed three downloadable video/podcast-style modules for on-the-go use.
Methods: We worked with interdisciplinary experts in trauma-informed care to
develop modules on interviewing patients with recent and distant history of SA
and acute medical management. The study group was a cohort of interested
medical students. Students completed pre- and post-tests assessing knowledge,
and a paired t-test evaluated overall change in knowledge test scores. Students
responded to a Lichert-style question on self-reported comfort caring for this
population, and responses were analyzed with a chi-square test.
Results: Thirty-two medical students spanning all years beta-tested the modules and
97% completed the study. Overall, student knowledge scores improved 20% (95%
CI=16%-23%, p<0.0001). After completing the curriculum, students reported a
significantly improved comfort level (p=0.0250). Students enjoyed the learning
format and reported the modules enhanced their education (72-88%) and were
appropriate for their education level (69-97%).
completion of modules, students demonstrated improved knowledge and reported
increased confidence in caring for this patient population. These modules seek
to empower students to step beyond screening in their care for patients with
sexual trauma history. Future directions include publication of existing
modules and expansion of the module library.
CREOG & APGO Annual Meeting, 2018, Student, Clerkship Director, Clerkship Coordinator, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, UME, Lecture, Independent Study, Standardized Patient, Advocacy, General Ob-Gyn, Sexuality,
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Sexual Health Education Challenges- How to handle the hard stuff
Background: Sexual Health Education is lacking in many medical schools and OB/GYN
Residency programs, with many residents feeling like this should be a priority, but most inadequately
prepared for graduation and practice.
Workshop Agenda: This workshop aims to identify opportunities for learners in the most challenging
topics of sexual health education including: transgender health, sex trafficking, and cultural competency
with female genital cutting. Learners will be able to identify and familiarize themselves with the key
information they need and practice the skills that are most essential to prepare them to teach medical
students and residents proficiency in these areas.
Interactive Component: The workshop will utilize a flipped classroom technique to review challenging
issues in transgender health, sex trafficking, and cultural competency including female genital cutting.
We will then proceed to have a small group patient simulation exercise to illustrate difficult scenarios,
and give learners practice with the end goal of proficiency in these areas.
Take home product: Learners will bring back to their home institutions proficiency in the most
challenging areas of Sexual Health Education, with patient cases to run small group exercises to directly
insert lessons learned into their OB/GYN Resident and Medical Student curriculum.
Sexuality, Problem-Based Learning, UME, GME, Medical Knowledge, Patient Care, Residency Director, Clerkship Director, 2018, Faculty Development Seminar,
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Evaluation of a Comprehensive Sex Education Program Developed and Implemented by Medical Students
Background: The number of sexually transmitted infections (STIs)
among young adults in Miami Dade County continues to rise, demonstrating a need
for improved sex education and access to STI screening and treatment.
Methods: A single-session, comprehensive sex education program
was developed by medical students at the University of Miami Miller School of
Medicine and delivered to middle and high school students in Miami over a 30
month period. A ten-question STI knowledge test was conducted pre and
post intervention. Matched pairs t-test was performed to assess the
curriculum’s ability to improve student knowledge, and a Likert-type scale (1
(lowest) to 5 (highest)) was used to rate presentation quality by public school
teachers who witnessed the intervention.
Results: Pre and post-intervention knowledge surveys (n=355)
demonstrated immediate post-intervention knowledge gains by students (p <
0.0001). The mean of the scores improved from 4.56 (SD 2.18) on the pre-test to
8.00 (SD 2.48) on the post-test. On average, classroom teachers (n=13) rated
the quality of intervention content 4.62 and the overall quality of the
Discussions: Teens continue to be infected with STIs at high
rates. This school-based, comprehensive sex education program implemented
by medical students is a high quality intervention that effectively improves
knowledge about STIs and methods to prevent them among teens. Further research
is needed to assess the impact of this intervention on behavior and STI
screening and acquisition.
Keywords: Sex education
CREOG & APGO Annual Meeting, 2016, Student, Resident, Faculty, Medical Knowledge, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, UME, Public Health, Sexuality,
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Patient Sexual Health: Teaching Medical Students\' Comfort and Competency
Background: Given the United States’ poor sexual health status and
the mission of the medical field, medical providers ought to be knowledgeable
and competent caregivers for sexual health problems, yet many medical students
and physicians express discomfort discussing sex with patients and
dissatisfaction in the training opportunities at their schools.
Methods: Based on literature and field evidence, we developed a
training module to improve competency addressing sexuality concerns with
patients. The program covers sexual health, diversity of sexual behaviors and
expressions, and best treatment practices for trauma-informed care. The program
has been implemented in Washington University’s OB/Gyn clerkship program every
6 weeks since July 2014.
Program evaluation was conducted using a pre/post
test and survey design.
Results: An IRB-approved pilot evaluation showed a
significant increase in students’ sense of comfort initiating discussions of
sexual wellness with patients [t(10) = -2.89, p < 0.05] and self-perception
of ability to discuss sexual health effectively [t(10) = -10.00, p <
0.05]. A comprehensive analysis of continuing evaluation [N=50] indicates
improved attitudes and perception of skills, with program effectiveness rated
4.2/5. Surveys indicated a positive reception by students.
Discussions: Program evaluations indicate a positive immediate
effect, while additional measures are needed to assess long-term effectiveness.
Based on literature review, the longitudinal implementation of similar
programming is essential for true program effectiveness.
Keywords: Sexuality, roleplay, diversity
Sexuality, Advocacy, Quality & Safety, UME, Professionalism, Patient Care, Clerkship Coordinator, Clerkship Director, Faculty, Student, 2016, CREOG & APGO Annual Meeting,
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How Well Do Obstetricians and Gynecologists Address Sensitive Subjects?
OBJECTIVE: The objective is to determine the ob/gyn's perspective of well they address sensitive subjects and their comfort level. This was compared with the ob/gyn patient’s view of how well their physician address their sexuality and their own comfort level in discussing sexuality with their physicians.
MATERIALS and METHODS: IRB approved surveys, regarding a physician’s perspective of how well they address sexual health, orientation, and dysfunction with their patients and their comfort level, were distributed to all ob/gyn residents and attendings in the OU program and to other nationwide Ob/Gyn residency programs. Surveys were distributed to all patients, willing to participate, at the OU ob/gyn clinics.
RESULTS: 73% of physicians report they do not feel they have an adequate level of knowledge to address all sexual health topics. 22% of physicians felt uncomfortable addressing sensitive subjects, which varied among level of training. 33% of the patients wish their ob/gyn would address their sexual health and 18% perceived their physician to be uncomfortable with this. The majority of patients reported their ob/gyn has not addressed any sexual health topics with them.
CONCLUSION: Both physicians and patients believe ob/gyns can do a better job of addressing sexual health. This demonstrates the need to improve physician education and comfort in addressing sensitive subjects and will serve as a basis to develop a training program to help ob/gyns improve their knowledge, comfort, and skills in addressing sexual health.
CREOG & APGO Annual Meeting, 2015, Resident, Faculty, Interpersonal & Communication Skills, GME, CME, Sexuality,
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Assessing Residency Program approaches to the Transgender Health CREOG Objective
The transgender population is a small yet distinctive portion of the gynecology patient population, requiring both primary care and specialty services. Recognizing the need for increased education. CREOG developed an objective specific to the care of transgendered patients.
Study Objective: To assess residency Program Directors ’knowledge about the transgender health CREOG objective, describe how the objective is being implemented in U.S. training programs, and identify what types of educational materials would be useful if they were available.
Methods: In May 2014, an 11-item anonymous survey was sent via email to all eligible Program Directors of accredited Obstetrics and Gynecology residency programs. The short questionnaire contained questions about program demographics, approach to training residents with regards to the CREOG objective, and opinions on tools they would like to use to train their residents on the transgender CREOG objective.
Results: There were 86 geographically diverse respondents. Just under half (47%) were from hospital-based programs. The majority reported that the transgender health CREOG objective was important (82%); however, only 70% were familiar with the objective itself. Most respondents (96%) felt that providing an educational activity in their training program would be beneficial for their residents’ education.
Conclusions: Most Program Directors support the CREOG transgender health objective and are in favor of implementing educational tools to meet the objective, suggesting that development of new tools to meet this need would be useful.
CREOG & APGO Annual Meeting, 2015, Resident, Residency Director, Systems-Based Practice & Improvement, GME, Advocacy, Sexuality,
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Title: Gynecologic Elective Rotation in Transgender Care
1) To create a syllabus of readings that reflects basic health needs of transgender individuals
2) To educate residents on the psychosocial and physical changes which accompany the transition from male-to-female or female-to-male to allow for culturally competent care; on preventive health care for transgender patients; and on sex hormone supplementation and health ramifications of supplementation
This is a curriculum design project using “learner-centered” education. A syllabus of reading material is in development using input from the transgender multidisciplinary care team at Kaiser Permanente Oakland, the World Professional Association for Transgender Health, and the ACOG. The resident will participate in patient care for one month in the multidisciplinary transgender clinic at Kaiser Permanente Oakland. The resident will develop a practice-based learning project on a transgender topic of choice which will culminate in a presentation to the multidisciplinary clinic faculty. At the end of each rotation, feedback will be garnered from the resident and the multidisciplinary team to facilitate ongoing improvement for trainee education.
Residents will participate in a semi-structured, learner-based curriculum centered on transgender health care. Resident and faculty feedback will be incorporated into the curriculum to allow for an evolving educational experience with this patient population.
Residents will acquire knowledge of psychosocial and physical changes associated with transgender transitions. Residents will be able to provide culturally-competent preventive health care to transgender patients and will have a basic understanding of sex hormone supplementation and its effects.
2014, Resident, Residency Director, Patient Care, GME, Sexuality,
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Improving students’ comfort in taking a female health history
2012 ASL ABSTRACTS
To assess if an interactive curriculum using standardized patients would improve second-year medical students’ comfort in taking a thorough female health history.
One hundred second year students attended a 2 hour session on reproductive health history taking as part of the Preclinical Clerkship and completed a pre- and post-program survey to assess their comfort asking specific questions regarding reproductive health.
Comfort asking about sexual history and asking about domestic violence improved from 33 to 82% (p=0.005) and 23 to 71% (p=<0.001), respectively. Improvement in comfort asking other questions varied from 42-60%.
Implementing a pre-clinical curriculum on female health history taking was followed by short-term improvement in students’ comfort asking patients about sensitive reproductive health issues.
Key words: female health history taking, student comfort
2012, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Interpersonal & Communication Skills, GME, Standardized Patient, General Ob-Gyn, Sexuality,
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Caring for Survivors of Sexual Assault: The Need for Dedicated Training
Sarah B. Krantz
The George Washington University School of Medicine and Health Sciences, Washington, DC
Study Objective: An estimated one in six women experiences sexual assault in her lifetime, with prevalence rates in some groups as high as 34%. Survivors are at increased risk for substance abuse, depression, post-traumatic stress disorder, chronic pelvic pain, and other somatic sequelae. Despite the reproductive health implications, little research exists regarding the role of the obstetrician/gynecologist (OB/GYN) in the survivor’s recovery process. While immediate post-assault care has been examined, there is a dearth of information regarding the long-term role of physicians caring for these women. Formal education on the provision of care to this population is frequently not included in OB/GYN residency curricula. Through a survey of OB/GYN Residency Directors, we examined the current state of residency education regarding reproductive care for survivors of sexual assault.
Methods: Institutional IRB approval was obtained. Residency program websites were used to obtain email addresses for OB/GYN Program Directors (PDs) listed on the ACOG website. A short survey of programs’ practices and curricula regarding the care of survivors of sexual assault was sent to 183 PDs using SurveyMonkey. Four subsequent reminder emails were sent. All results were recorded anonymously and analyzed using the SurveyMonkey tool.
Results: The survey achieved a response rate of 23%, which is consistent with general response trends of non-incentivized online surveys. Seventy percent (n=30) of respondents were Directors of university-based programs with 30% (n=13) from community programs. While ninety-one percent (n=39) of programs train their residents to ask patients about their sexual assault history, twenty-one percent (n=9) of programs do not include information about patients’ experiences as victims of sexual abuse or trauma as a standard part of their medical record. In addition, 54% (n=23) of programs do not have any formal didactic sessions focusing on the provision of reproductive care for survivors of sexual assault.
Conclusions: Over half of all OB/GYN residency programs fail to address the ongoing reproductive care of survivors of sexual assault through dedicated curricula. Several programs described educational content limited to lectures addressing post-assault care and forensic nursing. Since many of these sessions omit ongoing care of survivors, the number of programs adequately addressing this issue is likely lower than the 46% found in this study. Over fifteen percent of women are survivors of sexual assault. More research is needed to examine the long-term reproductive health needs of this underserved population, along with the role of the OB/GYN in providing compassionate and sensitive care. We are developing a didactic curriculum to facilitate resident education in this area. Our approach, utilizing traditional didactics as well as case discussion and standardized patients, will incorporate lessons learned from survivors and surveys of PDs, residents and students. We plan to pilot and assess this curriculum at GWU.
Keywords: Assault, rape, residency education
CREOG & APGO Annual Meeting, 2014, Resident, Residency Director, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, GME, Assessment, Advocacy, General Ob-Gyn, Sexuality,
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Sexual Assault as a Resident Competency: Evaluating a new obstetrics and gynecology curriculum
Shannon L. Bell, M
Boston Medical Center, Boston, MA Jessica T. Ristau, Olivera Vragovic,
Study Objectives: Most patients reporting sexual assault are identified and treated in emergency departments by sexual assault nurse examiners (SANEs). However, SANE programs across the US often do not have the budget or manpower to extend services to patients identified after they are admitted to the hospital. Local hospital policies state that obstetrics and gynecology teams are responsible for evaluating non-ICU inpatients who disclose an assault. OB-GYN residents and attendings have not traditionally received training around care of these patients or evidence collection. Objectives of this pilot study were: 1) To meet a minimum standard of education for health care personnel who are asked to conduct the sexual assault exam; and 2) To assess the impact of a novel resident curriculum covering an ACGME competency area for OB-GYN.
Methods: Investigators organized a four hour training program initiated in fall, 2012 focusing on psychological aftercare and the SANE evaluation (taught by representatives from the local rape crisis center and SANE nurses, respectively). Investigators administered identical pre and post-tests to the eleven OB-GYN residents who participated in the full training program. The test included a combination of multiple choice and fill-in questions assessing knowledge of important material. Participants also answered questions regarding prior exposure to the topic and confidence in key skills before and after the training. A delayed six-month post-test was then administered in June, 2013 to reassess resident confidence and knowledge with a test identical to the immediate post-test.
Results: Four of the 11 (36%) residents had prior personal experience with sexual assault (SA), and 9 of 11 (82%) had a friend or family member who experienced SA. Three of 11 (27%) had administered a rape kit, but only 1 participant had been previously trained. Residents’ self-reported confidence in eight elements of providing effective care to sexual assault survivors showed a statistically significant increase, or shift towards “agree” or “strongly agree” on a Likert scale (p≤0.05) following the training. There was no difference when the same questions were asked at six months post-training (p=0.86), with approximately two-thirds (63%) of the group with this high level of confidence at both time points. Residents showed improved scores on knowledge-based questions with average scores of 54% (range 40-76%) on the pretest versus 72% (range 48-96%) on the post-test. This difference was statistically significant (p=0.006). The six-month post-test indicated that the residents retained the knowledge, although at the lower average score of 65% (range 52-80%). The difference was still statistically significant (p=0.04).
Conclusions: Results support continued training of new OB-GYN residents and sustained efforts to foster a culture within the department that sexual assault survivor care falls under the purview of obstetrician-gynecologists.
Key Word: sexual assault education
CREOG & APGO Annual Meeting, 2014, Resident, Residency Director, Patient Care, Medical Knowledge, GME, Assessment, Lecture, General Ob-Gyn, Sexuality,
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Committee on Fellowship Training in Obstetrics and Gynecology: A needs assessment
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.
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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Resident Abortion Providers Support (RAPS) Group: Reaching out to Novice Providers
Rachel Shepherd, MD
Objective: To describe our experience developing and implementing a support group for resident abortion providers which we named RAPS (Resident Abortion Provider Support) group. In late 2010, a resident, after performing a late 2nd trimester abortion was called into a C-section. She found the experience emotionally difficult and sought out support from a faculty member, known to be supportive of abortion-training. From this conversation, the RAPS group was conceived and has evolved from spontaneous support to formal gatherings with curriculum.
Methods: Shortly after identifying the need among residents receiving abortion training for support in addition to their didactic training, a core group of supportive faculty and motivated residents met to discuss forming the RAPS group. Initial needs were identified and goals were set. The overriding goal was to offer a forum for providing emotional support and sharing experiences. Additional goals included: help for interns in exploring values prior to committing to or opting out of abortion training; resident and faculty support to residents during their family planning rotation; gatherings where experiences could be shared in a confidential safe space; problem-solving for navigating challenging interactions with non-providers and challenging patients; and increasing awareness of resources available in the community.
Results: With the support of the residency director, all residents were invited to be part of the group. A faculty member met with each resident during their family planning rotation to reflect on the resident’s personal experience. Senior residents also reached out to each of those residents. Several events were scheduled including: movie night, values clarification discussions, article discussion, a meeting with a prochoice lobbyist, and a lecture from an experienced provider in the community.
Conclusion: The RAPS group has had lively discussions where residents have felt free to share their personal struggles with providing abortion. Residents have appreciated the support the group provides and have expressed that the discussions have confirmed their beliefs and decisions to be abortion providers. They have felt more emotionally prepared for the services they provide. The group has also opened productive discussions between providers and non-providers within the residency
CREOG & APGO Annual Meeting, 2013, Resident, Residency Director, Patient Care, Professionalism, GME, Advocacy, General Ob-Gyn, Sexuality,
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The Effect of Student Gender on the Third Year Obstetrics and Gynecology Clinical Clerkship
Jenifer Briscoe, MD
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.
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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Teen Pregnancy Prevention in Colorado: A Student Community Advocacy Project Completed with Funding from an APGO MEF Grant
Gail L. Stanley, MPH
Sonya S. Erickson, MD
Objective: LEADS is a longitudinal track at the University of Colorado Medical School designed to promote awareness of social influences on health and disparities, address barriers to health, and teaches advocacy skills. LEADS engages students in advocacy projects by pairing them with a community based project mentor. My objective was to explore physician leadership and advocacy in government. I therefore worked with State Senator Aguilar, a new senator but an experienced community advocate and a MD. During the previous congressional session, a review of teen pregnancy prevention programs demonstrated that overall teen birth rates had declined in Colorado, but continued to be disproportionally elevated in rural counties with large minority and/or low income populations. Our project investigated potential causes of this distribution, determining barriers for rural counties.
Methods: I completed the required LEADS electives during my first year of medical school. There, we learned about the social and cultural determinations of health, with an emphasis on local health disparities. We learned about media interviewing, building collaborative partnerships, and writing op-eds. During the following summer, we conducted our individual community projects, meeting weekly in student run classes designed to broaden our leadership and advocacy skills, and to develop our personal advocacy goals. My summer project was designed to gather background information that would inform the legislative process. I performed a systematic review of teenage pregnancy prevention programs in Colorado with a focus on health behavior models, community programs, and health education. Outcomes measured were participation, community support, teen sexual behaviors, contraception use, and pregnancy rates.
Results: We found that social cognitive theory and the theories of reasoned action and planned behavior were utilized most often. Successful programs targeted urban and minority youths. Infrastructure for reproductive services was adequate in most counties. Health education in schools was not standardized. In rural communities barriers include: community support for science-based health education and integrating youth-friendly services and clinics into existing services.
Conclusions: Community-wide initiatives focusing on teen pregnancy prevention may be responsible for the decline in Latina birth rates. These programs should be expanded into rural counties. Barriers to implementation included: limited community awareness, limited rural infrastructure for reproductive health services, and lack of standardized health education in schools. Physicians and medical students can effect change by increasing awareness of the problem, troubleshooting barriers, and referring patients to the successful programs. Government officials were responsive to our advocacy efforts, and a well crafted e-mail or factsheet can help shape the support for funding.
CREOG & APGO Annual Meeting, 2013, Student, Resident, Osteopathic Faculty, Professionalism, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, CME, UME, Public Health, Advocacy, Contraception or Family Planning, General Ob-Gyn, Sexuality,
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