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.
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
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
Keywords: evaluation; PPIUD; simulation
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
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
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
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,
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
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
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
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
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
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
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
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
Keywords: Perceptions, Learning
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
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
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
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
Keywords: Standardized Resident Education
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
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
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
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
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
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
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
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
Discussions: Although barriers such as time constraints and faculty
inexperience exist, Ob-Gyn residents desire greater ethics education in
Keywords: Ethics, Education, Residency
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
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
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
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
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
Keywords: Resident, Simulation,
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
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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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
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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