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Surviving the Threat of Burnout

Roundtable APGO Fac Dev Seminar
Precis: Like Smokey Bear says\\\"Only you can prevent burnout...\\\"
Workshop Text: The stressors that contribute to professional burnout are everywhere. At the close of
this discussion the involved learner should be able to; 1. describe the causes of professional burnout 2.
list common symptoms associated with professional burnout 3. implement a strategy of body, mind and
spirit to minimize to impact of stress and avoid burnout.

Topics: CME, GME, Interpersonal & Communication Skills, Professionalism, Residency Director, Osteopathic Faculty, Clerkship Director, Faculty, Resident, Student, 2016, Faculty Development Seminar,

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Impact of an Immediate Postpartum Intrauterine Device Insertion Simulation on Resident and Attending Providers

Background: PPIUD use may be reduced if providers feel they have inadequate knowledge and skills. 

 

Methods: From 11/2013-2/2015, obstetrical providers at two teaching hospitals participated in a 30-minute PPIUD simulation workshop. We assessed knowledge of PPIUD indications, technique, and safety, and comfort with knowledge and skills pre-intervention, immediately following, and 6 months post-training.  

 

Results: Training participants (n=84) included 39 residents and 45 attendings (25 certified nurse-midwives and 20 OB/GYNs). Fifty-seven participants (68%) completed the 6-month assessments. Many participants had placed PPIUDs (54% of residents vs 64% of attendings, p=0.32); 52% were comfortable with their knowledge and 45% with their insertion skills defined by self-assessment of ≥7 on a10-point scale.  On the pre-test, 77% answered ≥80% of the knowledge-based questions correctly; this proportion rose to 95% and 97% on the immediate and 6-month assessments respectively, and were similar between residents and attendings. Immediately post-simulation, 94% of participants scored their comfort with PPIUD knowledge at ≥7/10; this fell to 86% by 6 months.  Likewise, 87% and 74% scored their comfort with skills at ≥7/10 immediately and at 6 months respectively. By 6 months, 81% reported placing ≥1 PPIUD (92% of residents and 71% of attendings, p=0.05).

 

Discussions: Residents and attendings demonstrate sustained improvement in knowledge and comfort with PPIUDs 6 months after a standardized simulation workshop.  This may lead to increased provision of PPIUDs to patients.

 

Keywords: evaluation; PPIUD; simulation

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

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Impact of a Resident-as-teachers Objective Structured Teaching Examination (OSTE) on Medical Student Vaginal Delivery Learning Outcomes

Background: One of the most common procedures learned by medical students on the OBGYN clerkship is normal vaginal delivery. Currently, students learn this procedure at the bedside, from residents who have had no formal instruction in optimal teaching methods. 

 

Methods: A quasi-experimental time-sequential static group study. Obstetrics and Gynecology (OBGYN) residents were exposed to a RaT curriculum consisting of a didactic session, an OSTE using a standardized student and NOELLE birthing simulator. Third-year medical students on the 6-week OBGYN clerkship logged all vaginal delivery experiences during academic years preceeding and following the RaT curriculum, recording their level of involvement in each of 16 procedural steps (Likert-type scale: 1=Observed; 2=Assisted; 3=Performed with assistance; 4=Performed without assistance). The level of involvement ratings for each procedural step, were compared pre and post RaT intervention, using the chi-square test . P < .05 was considered statistically significant.

 

Results: A total of 240 and 204 delivery experiences, were recorded by students pre and post the RaT curriculum, respectively. Following the curriculum, a significantly greater proportion of student delivery experiences occurred with chief residents (PGY-4) than prior to the curriculum (19.6% vs. 4.6%, p < .01). Mean student level of involvement scores for setting up the delivery table, patient draping, postpartum hemorrhage preventive measures, and inspection of the cervix/vagina/perinuem were significantly higher post-curriculum, as compared to pre (2.53 vs 2.02, p < .01; 2.15 vs 1.87, p < .01; 2.56 vs 2.36, p=.01; 2.25 vs 2.05, p < .01).

 

Discussions: A residents-as-teachers vaginal delivery OSTE may increase engagement of PGY-4 residents in student teaching and the level of student involvement in certain aspects of actual vaginal delivery experiences.

 

Keywords: OSTE, Simulation, Obstetrics


Topics: CREOG & APGO Annual Meeting, 2016, Resident, Faculty, Clerkship Director, Osteopathic Faculty, Residency Director, Patient Care, GME, UME, Simulation, Standardized Patient, Faculty Development,

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How Effective Are New Milestones Evaluations at Demonstrating Resident Growth: 1 Year of Data

Background: A novel post-graduate year (PGY) and venue-specific evaluation tool incorporating ACGME Milestones was initiated during academic year 2014-15. The tool was used to evaluate residents along multiple dimensions, including medical knowledge, technical skills, professionalism, etc., in the operating room and labor and delivery (L&D) venues.

 

Methods: Resident development along the above dimensions was captured over time. To account for different rotation schedules, the year was divided into thirds and compared using two-tailed Fisher’s exact and Student’s t-tests (significance: p < 0.05).

 

Results: A total of 822 evaluations were completed from 9/1/14-6/1/15. Over time, a significant shift toward evaluation scores of “with minimal supervision” and “independent” was seen among PGY1s (p=0.03) for ‘managing normal labor.’ For all parameters, “independent” L&D scores increased monotonically across the starts of all years: 8.4% for PGY1s, 60.3% for PGY2s, 73.7% for PGY3s, and 87.5% for PGY4s. For all surgery types combined, PGY3s demonstrated a notable increase in “able to be primary surgeon,” from 36% in the first two-thirds of the year, to 62.3% in the last third (p < 0.01).

 

Discussions: ACGME Milestone evaluations capture the growth of residents over time and are able to demonstrate quantifiable differences in achievements between PGY classes. These tools will allow for targeted teaching opportunities for individual residents and the program overall.

 

Keywords: Milestones; Evaluation tools


Topics: CREOG & APGO Annual Meeting, 2016, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Assessment,

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How Does the First Clerkship Affect Medical Students’ Views of the Relationship Between Physicians and Nurses?

Background: Preparing future physicians to work collaboratively with nurses is a must for today’s educators. Effective physician-nurse collaboration improves patient care and health outcomes. Medical students’ views of the physician-nurse relationship and how these views may evolve during their clerkships have not been well examined.  

 

Methods: Medical students on their first clinical clerkship completed the Jefferson Survey of Attitudes Towards Physician-Nurse Collaboration on the first and last day of their six-week obstetrics and gynecology clerkship.  This 20-question instrument addresses areas of responsibility and collaboration between physicians and nurses and has construct validity and reliability.  All questions used a 4-point Likert scale (1=strongly disagree, 4=strongly agree).  Pre- and post-clerkship scores were compared using paired t-tests.

 

Results: 25 students completed the pre- and post-surveys with a 100% response rate.  Students overall had positive views of the physician-nurse relationship.  At the completion of the clerkship, medical students felt more strongly that “during their education; medical and nursing students should be involved in teamwork in order to understand their respective roles” (pre: 3.82, post: 3.95, p=0.042), and that “there are many overlapping areas of responsibility between physicians and nurses” (pre: 3.26, post: 3.57, p=0.008). 

 

Discussions: Our work reveals promising data that medical students begin their clinical clerkships with positive views of the physician-nurse relationship.  Furthermore after the completion of their first clerkship, the students had significantly higher views of the importance of collaboration and shared responsibility.

 

Keywords: Interprofessional education


Topics: CREOG & APGO Annual Meeting, 2016, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, UME, Assessment, Faculty Development,

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How Does OBGYN Resident Training at Restrictive Faith-based Institutions Impact Subsequent Provision of Reproductive Healthcare for Women? A Qualitative Analysis

Background: OBGYN residency prepares trainees to become experts in women’s healthcare.  Trainees at faith-based hospitals may not receive adequate training in family planning services.

 

Methods: Semi-structured individual interviews were conducted with recent graduates from seven faith-based hospitals. All are generalists at secular institutions.  Participants were asked about their experiences, perceived deficiencies, and current provision of family planning services.  Three researchers independently coded the transcripts using grounded theory; codes were organized into overarching themes and discrepancies were resolved.

 

Results: We reached thematic saturation after 15 interviews.  None of the participants cited a preference to match at their program based on restrictive family planning policies.  All participants reported reproductive healthcare training deficiencies that were partially attenuated by didactic educational activities, variations in on-site restrictions, and off-site training.  Participants expressed frustration about inadequate on-site training in postpartum tubal ligations; upon graduation they either avoided provision or required mentorship from partners to become competent.  A few participants who sought off-site training now provide outpatient D&Cs and/or inpatient D&Es for abnormal or unintended pregnancies.  All participants proposed that faith-based programs improve family planning training by providing routine, opt-out opportunities.

 

Discussions: OB-GYNs trained at faith-based institutions feel that religion-based policies negatively impact training experiences and the range of health services they subsequently can provide.  Forming collaborations with off-site facilities, particularly for tubal ligation and outpatient uterine evacuation procedures, may improve the reproductive care these physicians provide to women.

 

Keywords: faith-based, family planning


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

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GoPros in the OR: Using Surgical Videos to Improve Resident Education, Debrief, and Nurture Operative Teaching Skills

Background: New compact, high-definition cameras allow us to preserve footage from a surgeon’s perspective.  Various cameras have been used successfully in neurosurgery and plastic surgery proof-of-concept studies; surgeons and learners preferred the surgeon point-of-view to traditional light-mounted or hand-held views.  This technology is not commonly used in OB/GYN. There are no structured tools for using these videos for feedback.

 

Methods: Video was made with headmounted GoPro Hero4s. Filmed patients were consented and signed releases. Footage was edited into case-based videos.  Residents were surveyed about interest in filming and for feedback on a pilot instructional video. A feedback tool for residents and attendings was created for postoperative film debriefing to facilitate resident self-reflection and provide feedback about surgical technique, operative management, and teaching skills. Senior residents were asked to provide video of an abdominal or vaginal hysterectomy and use the feedback tool with identified faculty. 

 

Results: GoPro Hero3 cameras made high-quality videos without obstructing the surgeon’s view or movement.  100% of residents would use the pilot and similar videos for operative preparation and would find it useful to review video of themselves operating to receive feedback.  Six senior residents who participated in GoPro filming and debriefing found the process helpful for developing surgical skills and improving confidence in teaching surgery.

 

Discussions: Surgeon’s point-of-view videos are an exciting frontier in surgical education. Creating GoPro surgical videos was feasible and embraced by residents. 

 

Keywords: surgery, technology, education


Topics: CREOG & APGO Annual Meeting, 2016, Student, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Assessment,

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Getting Residents to Drink the Medical Knowledge: What Flavor Sells?

Background: Residents have increasing difficulty in attaining competent medical knowledge. To develop a more collaborative structured educational program, we designed a survey.

 

Methods: A 19-item anonymous online survey was sent to OB/GYN residents at our institution to query for perceptions of best learning methods, motivating factors, and barriers. Responses were compared by postgraduate year and self-reported previous year’s CREOG score.

 

Results: Of a total of 48 residents, 95.8% participated in the survey, with approximately equal distributions of upper level and lower level residents.  Sixty five percent scored below 200 on last year\'s exam.The majority of residents (65.2 %) reported studying under 3 hours/week, with time listed as the common barrier, and 67% preferred practice bulletins and committee opinions over textbooks and journal articles.  The most effective motivator for doing well on the CREOG was a day off work.  Compared to senior residents, junior residents prefer learning by hands-on experience (76.0% vs 42.9%, p=0.02) and studying at home (58.3% vs 28.6%, p=0.04).  There was no correlation between reported study time and CREOG score performance, and near unanimous support for weekly quizzes with remediation for poor performance.  In addition, higher performers (>200) desired a mandatory reading program more than low scorers ( < 200), but this was not statistically significant (p=0.81).

 

Discussions: Surveying residents’ perceptions and preferences for learning can assist a residency program to develop a more effective structured curriculum.

 

Keywords: Perceptions, Learning


Topics: CREOG & APGO Annual Meeting, 2016, Resident, Faculty, Residency Director, Residency Coordinator, Practice-Based Learning & Improvement, GME, Independent Study, Problem-Based Learning,

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Gender Differences in Medical Student Performance of Simulated Vaginal Deliveries and Cervical Exams

Background: Studies have demonstrated that female student perform better on the OB/GYN clerkship, possibly due to women not wanting male trainees to participate in their care.  Simulation may circumvent this problem as males and females can participate equally.  We investigated the effects of gender and simulation training on student performance during an objective structured clinical examination (OSCE) to determine if a gender difference exists and whether simulation training mitigates this difference.

 

Methods: During the 3rd year OB/GYN clerkship students were assigned 1:1 to receive vaginal delivery or cervical exam training with each group serving as the simulation naïve control group for the other skill.  Their performance was assessed during an end of clerkship OSCE.  The number of real-life vaginal deliveries and cervical exams performed during the clerkship were also recorded.  The effects of gender and its interactions with training were assessed using a 2-way ANOVA.

 

Results: Thirty male and 28 female students received cervical exam training.  Thirty five male and 19 female students received vaginal delivery training.  There was no effect of gender or an interaction with training and gender save for the number of real-life vaginal deliveries performed.  Female vaginal delivery students performed significantly more real-life deliveries than male vaginal delivery students.

 

Discussions: Although prior retrospective studies demonstrated that female students perform better on several aspects of the OB/GYN clerkship, our prospective study of OSCE performance did not show any gender differences in performance.

 

Keywords: Student GenderSimulation


Topics: CREOG & APGO Annual Meeting, 2016, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Interpersonal & Communication Skills, GME, UME, Assessment, Simulation, Standardized Patient, General Ob-Gyn,

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Furthering the Validity of a Tool to Assess Non‐Directive Pregnancy Options Counseling Skills

Background: The Association of Professors of Obstetrics and Gynecology has designated a non-directive pregnancy options counseling as one of the few skills in women’s reproductive health at a “does” level of competency, creating the need for a validated assessment tool.  

 

Methods:   A previously developed rating tool was distributed nationally for enhancement of content validity. A pilot, using an OSCE that also had been previously developed, was implemented in a family medicine clerkship with third year medical students. Response process data directed improved clarity and organization of the tool. Three raters trained through review of training videos and a think-aloud process then used previously taped videos of 46 performances to yield the data for internal structure and correlation with other variables.

 

Results:   The content validity of the original tool was affirmed. Internal structure data included a Cronbach’s alpha of 0.704. Overall communication skills and the global rating for patient-centered communication generated moderate to substantial agreement. All but one item unique to the clinical situation of pregnancy options counseling generated substantial to near-perfect agreement. Relations to other variables within the checklist were strong, while relations to variables assessed outside of this OSCE, including clerkship communication grades, was poor.

 

Discussions:   This tool for assessing pregnancy options counseling skills has excellent content and strong internal structure validity. Further work to improve the validity of the global and overall communication skills scales may be necessary for summative use.

 

Keywords: OSCE asssessment pregnancy-options


Topics: CREOG & APGO Annual Meeting, 2016, Faculty, Clerkship Director, Osteopathic Faculty, Residency Director, Patient Care, Professionalism, Interpersonal & Communication Skills, GME, UME, Assessment, Standardized Patient, Public Health, Contraception or Family Planning,

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Formalized Teaching of Electronic Fetal Monitoring Improves Resident Knowledge and Judgment

Background: We recently implemented a yearly structured program for teaching EFM, in line with the CREOG learning objectives and OBGYN milestones.

 

Methods: Using an assessment-driven e-learning platform (GNOSIS, Advanced Practice Strategies), residents complete an electronic assessment of EFM knowledge and judgment which determines an individualized learning plan based on pre-test competence. We evaluated pre-test scores for 3 resident classes over 2 years (PGY1/2, PGY2/3 and PGY3/4) and compared results in knowledge and judgment from Year 1 to Year 2. Year 1 and Year 2 scores were also compared to the APS national OB attendings.

 

Results: Year 1 assessment results showed 2/3 classes ranking in the bottom 50th percentile in judgment, relative to the OB attendings. Year 2 assessment results showed significant improvement in judgment scores in all 3 classes compared to Year 1, with all 3 classes scoring in the top quartile, relative to OB attendings. Overall, from Year 1 to Year 2 there was improvement in both knowledge and judgment.

 

Discussions: A structured, personalized EFM program contributed to an improvement our residents’ knowledge and judgment after 2 years. We are encouraged by interval improvement in judgment, which represents critical thinking, an area difficult to assess in medical education.  Future studies will need to examine the impact of such a curriculum on patient-centered outcomes.

 

Keywords: Standardized Resident Education


Topics: CREOG & APGO Annual Meeting, 2016, Student, Resident, Faculty, Residency Director, Medical Knowledge, Systems-Based Practice & Improvement, GME, CME, Assessment, Independent Study, Problem-Based Learning,

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Flipping an Obstetrics Clerkship Session to Replace a Lecture with Active Learning

Background: The flipped classroom is an innovative approach that has not been reported during medical student clerkships.

 

Methods: All third-year students rotating on our clerkship attended a flipped classroom between July 2014 and June 2015.  Central to the change was replacement of a traditional lecture (“prolonged pregnancy”) with interactive learning at eight stations by student pairs (one each on obstetrics and gynecology services).  The stations featured manipulative models, instruments, data, and images involving late prenatal care, fetal growth and testing, and labor-delivery decision-making.  A list of terms was provided to highlight each station’s case scenario. Before class, students received a handout describing learning objectives, background to the subject, and the stations.  Students evaluated the session via surveys immediately after the session and four weeks later. Before 2014, this topic was presented by the same faculty member as a traditional lecture.

 

Results: The median score given by students increased from 4.0 (previous 4 years) to 4.6 (on a 5-point scale). Compared with traditional lectures by other clerkship faculty, the flipped classroom was judged by students to be easier for learning and more interactive. Students perceived being more responsible for learning with improved retention, better recall, and more application to practice.

 

Discussions: The flipped classroom model was easily executed and effective in educating medical students during their clerkship.  Favorable responses indicated that this interactive learning environment warrants broader application and long-term assessment.

 

Keywords: flipped, learner-centered, lecture


Topics: CREOG & APGO Annual Meeting, 2016, Student, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, UME, Assessment, Simulation, Lecture, Team-Based Learning, Faculty Development,

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First Year Resident Applicants in Obstetrics and Gynecology by Medical School Background, 1992-2015

Background: Physician workforce shortage led to 30% increased enrollment at U.S. allopathic schools, doubling at U.S. osteopathy schools since 2003.

 

Methods: This descriptive study examined National Residency Match Program (NRMP) data when it became available in 1992 until 2015.  Undergraduate medical education was characterized as coming from U.S. medical allopathic or osteopathic schools, or international schools.  The likelihood of matching into an ACGME-accredited ob-gyn residency program was examined according to the medical school background during each year.

 

Results: The total number of applicants who used the NRMP for first-year ob-gyn positions declined from 1,853 in 1993 to 1,366 in 2003.  This number increased thereafter, (1,823 in 2015), especially among U.S. medical school graduates (USMG).  The number of USMG applicants was less than the total number of first-year ob-gyn positions beginning in 1998 (1,052 for 1,075 positions) through 2015 (1,173 for 1,255 positions).  The highest probability of matching was among USMGs (from 76% in 1993 to 85% in 2015).  Applicants from osteopathy schools remained constant, which resulted in the greatest increase in probability of matching (from 26% in 1994 to 61% in 2015).  Applicants from international medical schools increased gradually.  While remaining low, match rates remained higher for U.S-born rather than foreign national IMGs (34% versus 23% in 2015).

 

Discussions: Increased numbers of applicants for first-year ob-gyn residency positions lowered concerns about insufficient matching.  Competition for these positions may increase.

 

Keywords: applicants, background, match-rate


Topics: CREOG & APGO Annual Meeting, 2016, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, UME, Assessment,

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Factors Affecting Resident Participation in Surgical Cases

Background: The Accreditation Council for Graduate Medical Education (ACGME) has established minimum number standards for select surgical procedures for graduating residents in surgical training programs, including Obstetrics and Gynecology.  These numbers reflect the lowest acceptable clinical volume of procedures performed as primary surgeon per graduating resident for program accreditation.  The primary surgeon must perform >50% of the surgical case. Many OB/GYN residency programs are concerned about their ability to meet the minimum numbers standards.  Due to increased emphasis on and availability of conservative treatment options for abnormal uterine bleeding, the volume of hysterectomies performed each year is decreasing. There is also a trend toward minimally invasive routes of hysterectomy including vaginal, laparoscopic, and robotic, but residents are expected to achieve competence in all.

 

Methods: A 41-question survey on Survey Monkey was sent to 123 OB/GYNs in Omaha via email.  The survey assessed the type of setting (academic or private) in which the surgeon practices, how often surgeries are performed typical for an obstetrician and gynecologist, and factors that influence whether or not they allow a resident to perform as a primary on the case.

 

Results: 45 (37 percent) OB/GYNs responded to the survey.  Of those who responded, 59 percent practice in a private setting and 41 percent in an academic setting.  53 percent said that previous experience with the resident very strongly influenced whether they let a resident primary their case.  Factors that were not associated with whether a physician let a resident be the primary surgeon included knowledge of previous simulation experience, the surgeon’s comfort with his own skills, and suspected difficulty of the case.  When the number of cases a surgeon performs were compared with how often a resident gets to primary a case, only robotic assisted total laparoscopic hysterectomies was statistically significant.

 

Discussions: We hope to use this information to modify residency rotations and program structure to optimize resident participation in surgical cases by better understanding the needs and concerns of supervising physicians.

 

Keywords: Resident Education


Topics: CREOG & APGO Annual Meeting, 2016, Resident, Faculty, Residency Director, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, CME, Assessment, Faculty Development, General Ob-Gyn,

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Evaluation of Resident Preference for a Team-Based or Block-Based Learning System at the University of Miami Miller School of Medicine, Department of Obstetrics and Gynecology

Background: Obstetrics and Gynecology residency programs nationwide are continuously modifying their programs in order to provide residents the best training. At the University of Miami Miller School of Medicine, a transition occurred one year ago from a team-based learning system to a block-based learning system.

 

Methods: An internet-based survey was created with SurveyMonkey.com and was distributed to PGY-2, PGY-3, and PGY-4 residents. Fisher’s exact testing was used to analyze associations between learning system type and level of satisfaction.

 

Results: The survey was distributed to 27 residents and was completed by 23 (85% completion rate). After one year of working in a block-based learning system, the residents were more satisfied than they were with the previous team-based system (p < 0.001). A greater percentage of residents agreed that the block-based system allowed them adequate time to prepare for patient encounters (87%); adequate time to manage patients (83%); and opportunities to resolve interpersonal conflicts (78%). A smaller percentage of residents agreed that the team-based system allowed for these factors, respectively 35%, 41%, and 30%. Overall, 87% of participants preferred the block-based to the team-based system.

 

Discussions: Obstetric and Gynecology residents at our institution prefer a block-based learning system approach to a team-based learning system approach. More research is needed to evaluate longitudinal preferences and overall improvements in clinical evaluation and CREOG scores.

 

Keywords: residency,  block-based system


Topics: CREOG & APGO Annual Meeting, 2016, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME,

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Evaluation of Ethics Education in Ob-Gyn: A Survey of Resident Physicians

Background: Ob-Gyn residents face a myriad of ethically challenging situations, both specialty-specific and universal to all medical specialties. Ob-Gyn-specific Milestones require programs to assess residents’ abilities to implement key ethical principles and behaviors. However, there is limited research evaluating resident preparedness in addressing ethically complex situations.

 

Methods: A cross-sectional, web-based survey was deployed to residents from 9 of 11 ACGME accredited Ob-Gyn residency programs in Chicago. The survey was modified from a prior survey of Ob-Gyn residency program directors and developed in collaboration with a professional survey lab at the University of Chicago. Descriptive statistics were used to analyze data.

 

Results: Of 191 eligible Ob-Gyn residents, 112 (59%) responded to the survey. Most respondents were from university-based programs (n=90, 81%) without religious affiliation (n=81, 73%). Only 23% (n=26) of respondents indicated their program included ethics in its core educational curriculum.  87% (n=89) of respondents stated their program dedicated 0-5 hours per year to ethics. The vast majority of residents (n=90, 82%) would like \"more\" to \"a lot more\" ethics education and believed it should be required (n=72, 66%) for residency completion. 42% (n=47) of respondents stated they felt “somewhat” or “very unprepared” to deal with ethically challenging situations.  Residents identified curricular crowding (n=87, 80%) and limited faculty expertise (n=69, 64%) as barriers to receiving formal ethics education.

 

Discussions: Although barriers such as time constraints and faculty inexperience exist, Ob-Gyn residents desire greater ethics education in residency training.

 

Keywords: Ethics, Education, Residency


Topics: CREOG & APGO Annual Meeting, 2016, Resident, Faculty, Residency Director, Medical Knowledge, Professionalism, GME, Lecture,

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Evaluation of Challenger® as an OB/GYN Residency Self-learning Tool

Background: Challenger® is a commercially available on-line educational package, which offers focused readings on a variety of OB/GYN topics with self-assessments tests. It was utilized during the night float block to comply with duty hour restrictions, while still providing educational enrichment. Each resident completed 2-3 modules weekly, including a pre-test, educational content, and a post-test. The Challenger®program allows supervision and monitoring of resident progress. The total cost of Challenger®was approximately $6,000.

 

Methods: After one year of usage of Challenger®, residents completed a quality assessment questionnaire which evaluated the reading assignments, test questions, and their perception of its usefulness as a learning tool. 

 

Results: 16 residents completed the quality assessment questionnaire on Challenger®. 100% of residents found the reading assignments were easy to understand. 75% of residents learned “sometimes/rarely” from the modules. 81% of residents rated the question quality as “poor/fair”. 75% of residents believed it to not be worthwhile.  81% did not believe that it helped to prepare for boards exams. 88% were unlikely to endorse continuation or recommend Challenger® to other residency programs.

 

Discussions: Challenger® was not a useful learning tool for OB/GYN resident education. Some readings were outdated. Some questions were of poor quality in assessing knowledge base.  As pre- and post-test questions were the same, and residents often finished an entire module’s reading section plus the pre- and post-tests within 30 minutes, it is uncertain whether the readings were actually completed.

 

Keywords: Challenger, education


Topics: CREOG & APGO Annual Meeting, 2016, Resident, Faculty, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Independent Study, Problem-Based Learning,

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Evaluation of a Simulation-based Curriculum to Improve Resident Performance in Medical Emergencies in the Outpatient Setting

Background: Emergency response skills are essential to manage procedural complications in the outpatient setting, and simulation-based training may optimize skills.

 

Methods: OB-GYN and Family Medicine trainees enrolled in simulation-based, outpatient emergency training. The curriculum consisted of 2 components:  an online emergency preparedness module and two faculty-led hands-on Basic Life Support and advanced airway sessions. Participants completed pre- and post-training self-efficacy questionnaires and 3 video-recorded simulated scenarios:  seizure, over-sedation and hemorrhage. Scenarios were evaluated with a graded rubric covering five domains (patient care, medical knowledge, interpersonal skills and communication, professionalism and systems-based practice). Self-efficacy data were analyzed using McNemar’s test and Student’s t-tests and objective performance was analyzed using t-tests to determine if the curriculum improved management of simulated outpatient emergencies.

 

Results: Thirty residents completed hands-on training as well as pre- and post- evaluations.  Perceived self-efficacy in emergency management improved. Video performance scores improved in all five domains (p < .05) in all scenarios. When stratified by level of training, subjects in their first two years of training demonstrated significantly greater improvement in interpersonal skills, communication and professionalism in the seizure scenario compared to upper level residents. When stratified by prior outpatient simulation experience, global performance scores did not differ.

 

Discussions: Simulation-based training improves self-efficacy and global performance in management of outpatient medical emergencies.  Simulation training should be incorporated into OB/Gyn and Family Medicine residency training.

 

Keywords: Resident, Simulation, Curriculum    


Topics: CREOG & APGO Annual Meeting, 2016, Student, Resident, Faculty, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, CME, Assessment, Simulation, General Ob-Gyn,

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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 presentation 4.85. 

 

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


Topics: 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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Empowering Students for Improved Patient Outcome: Prevention of Venous Thrombotic Events in Pregnant Patients

Background: Pregnancy significantly increases the risk of VTEs in women. In the US, pregnancy-related mortality has been increasing with deaths due to VTEs representing a leading cause. To address this issue, a quality improvement study was designed to increase rates of VTE risk assessment and appropriate prophylaxis. By engaging medical students, they gain exposure to quality improvement processes in the healthcare setting and improve their clinical skills by counseling patients.

 

Methods: This study is part of a curriculum-wide integration of all third-year medical students into departmental quality improvement projects across the required clerkships. In the obstetrics and gynecology clerkship, students calculated obstetric patients\' risk of VTEs. Students worked with their teams to put in place appropriate prophylactic measures and then provided patient counseling regarding the recommended interventions. Medical students completed pre- and post-tests about their VTE knowledge and a survey regarding their experience with the study.

 

Results: 94% of third-year medical students who had completed their obstetrics and gynecology clerkship participated in this study. 76% of these students responded to a survey about their participation. Of these respondents, 92% reported participation had improved their understanding of obstetric VTE prophylaxis, 77% reported they had gained confidence counseling patients, and 69% reported having a better understanding of quality improvement in the healthcare setting.

 

Discussions: This study demonstrates that medical students can be engaged in a large-scale quality improvement initiative with the goal of improving patient outcomes. In addition to advancing the success of a departmental patient safety initiative, students reported increased medical knowledge and clinical skills.

 

Keywords: QI student engagement


Topics: CREOG & APGO Annual Meeting, 2016, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Patient Care, Medical Knowledge, GME, Quality & Safety, Maternal-Fetal Medicine, General Ob-Gyn,

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