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Zooming past Traditional Textbooks: Using Audio Podcasts for OBGYN Resident Education

Background: Resident duty hours and increased clinical volume have changed the landscape of modern resident education.  Due to these constraints the typical classroom model for teaching as well as teaching “on the fly” during the clinical duty hours is not sufficient to cover the depth and breadth of resident education.  Little has been studied using podcast learning in OBGYN education.


Methods: After IRB approval, residents were consented to participate in the study.  12 audio podcasts were created and distributed over 6 months in sets of 2 podcasts per month. Prior to their distribution we assessed the residents’ baseline knowledge and experience with podcast learning.  After distribution and use of the audio files we performed another evaluation examining the residents experience with the podcasts and their likelihood to use them in the future.  We offered an incentive for listening to the podcasts for the first half of the episodes but not for the second half.


Results: 24 residents consented to the study but no more than 13 residents listened to each session.  Satisfaction was high among participants and podcast learning was rated second only to self directed learning as a preferred method of education.  Residents cited a lack of time as the main reason they chose not to participate.


Discussions: Our residents were more likely to participate when an incentive was offered.  However, audio podcasts did rank highly as an effective learning tool among those who chose to participate.


Keywords: Ambulatory Education, Distance Learning, Instructional Materials/Methods, Technology, Other

Topics: CREOG & APGO Annual Meeting, 2017, Residency Director, Residency Coordinator, Medical Knowledge, GME, Independent Study,

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X-Ray Vision - Finding Opportunities to Teach Professionalism in the Preclinical Years

Background: Although professionalism constitutes one of eight domains of competence outlined by the AAMC, it remains difficult to teach to medical students (Al-Eraky, 2015). While previous literature emphasizes the value of reflective writing in developing clinical students’ professional identities (Kenny,2003), there has been minimal incorporation into the pre-clinical years.  


Methods: 88 second-year medical students listened to patient stories about reproductive illnesses and completed reflective essays. De-identified essays were coded by three reviewers using directed content analysis to indicate whether students explored the domains of competency (Table 1) in their essays. Reviewers identified additional sub themes, and consensus was achieved after each round of coding. IRB exemption was obtained.  Table1: Professionalism Domains, ACGME 5.1 Demonstrate compassion, integrity and respect for others 5.2 Demonstrate responsiveness to patient needs that supersedes self-interest 5.3 Demonstrate respect for patient privacy and autonomy 5.4 Demonstrate accountability to patient, society, and the profession 5.5 Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities and sexual orientation. 5.6 Demonstrate a commitment to ethical principles pertaining to provision or withholding of care, confidentiality, informed consent, and business practices, including compliance with relevant laws, policies and regulatory bodies  


Results: 96.6% of students addressed at least 1 domain of professionalism, with some addressing up to four. The most common domain identified was Domain 5.1: demonstrates compassion, integrity and respect for others (86.2% of the essays, p < 0.001). Agreement between reviewers ranged from 75-98.9%. Subthemes included 1) complexity of the medical system; 2) psychosocial impact of disease; 3) tiers of medical care; 4) the role of patients as their own advocates; 5) importance of the patient “story”; and 6) importance of communication.


Discussions: This approach may provide an avenue for pre-clinical students to demonstrate their understanding of  professionalism. Feedback to students surrounding professionalism themes could be an avenue to open the dialog about the professional competencies expected of them.


Keywords: Curriculum Development/Evaluation, Instructional Materials/Methods, Professionalism

Topics: CREOG & APGO Annual Meeting, 2017, Student, Clerkship Director, Professionalism, UME,

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Willing and Able: A New Model for Resident Research

Background: OB/GYN programs rely on resident research projects for the ACGME scholarly requirements. Recently, ACGME has shifted to requesting better definitions/additional curriculums. This obligation shift represents a major change for residencies. The Six-Source Model of Influence (SSM) is a well-studied model for change based on Motivation and Ability of three forces: Personal, Social, and Structural. We established a team based resident research program using SSM. We then evaluated the success of our program.


Methods: We developed a resident research program over a seven year period in a OB/GYN resident program on probation in part due to lack of scholarly activities. Using SSM we identified personal motivation/ability, social motivation/ability, and structural motivation/ability factors for intervention. Personal motivation - research required for graduation. Personal ability- supported by monthly learning sessions. Learning topics included types of research studies, statistics, research design, and abstract/manuscript writing. Social Motivation and Social Ability were obtained by using a team research approach. Each team was comprised of a PGY1, 2, 3, and 4. Roles were delegated by year with team interaction and support. Structural Motivation - monetary rewards for project presentation and free trips if abstracts were accepted. Structural ability - designated research program director and support staff for statistics/project completion. Monthly sessions were built into academic schedule for group research. A designated resident research office was created.


Results: All 28 residents completed their projects on schedule. 8/28 residents went on to fellowship programs. 8/28 obtained positions in academic departments. 8 residents presented posters at national OB/GYN meetings including APGO, ACOG, CAOG, and SMFM. 4/28 residents gave oral presentations at one of these meetings. One resident was awarded the national ACOG prize for best resident research project.


Discussions: Resident research requirements are changing. Accepting that people do things for two reasons: motivation - because they want to, and ability - because they can, provides the basis for SSM. By applying these two reasons to the three forces of personal, social, and structural; a sound resident research model can be constructed. Our research presentations support SSM can produce positive, productive, and sustainable change.


Keywords: Curriculum Development/Evaluation, Instructional Materials/Methods, Research Methods

Topics: CREOG & APGO Annual Meeting, 2017, Residency Director, Systems-Based Practice & Improvement, GME, Assessment, Team-Based Learning,

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West Virginia University\'s Department of OB/GYN Resident Resiliency Curriculum: A Focus on Well-Being

Background: Stress and burnout impact physicians at all stages of training and practice, but resident physicians are particularly at risk. Resiliency skills may protect physicians from the dangers of stress and burnout and may provide improved coping skills.


Methods: The Department of Obstetrics and Gynecology conducted monthly meetings with the Residents to discuss resiliency topics in an off-site, private setting without judgment, evaluation consequences, or attending participation.


Results: During the 2015-2016 Academic Year, 12 sessions were conducted focusing on Communication Styles, Conflict Resolution, Leadership Skills, Difficult Patient Encounters, Physician Wellness, Resiliency, and Stress/Burnout Management. After completion, residents were anonymously surveyed and sessions were evaluated for effectiveness, based on a Likert scale of 1-5.  11/12 sessions returned a 4 or 5 rating corresponding with a moderately or strongly agree from 100% of the residents. Only one session revealed 1 resident with a neutral response or 3.


Discussions: Sessions explored difficult patient encounters, sentinel events, and interpersonal and professional conflicts. Positive mindfulness-based resilience interventions were discussed. Resident communication about perceived failures and stressors  promoted positive discussion and insight. Sessions were almost all uniformly positively scored, with the highest ratings in communication styles, leadership/team-building, and conflict resolution. Resiliency is a key coping skill for physicians to maintain well-being. A residency resiliency curriculum has shown to be well-received in our institution and should be considered as integral in curricula as medical knowledge concepts.


Keywords: Communication Skills, Counseling (Personal or Academic), Curriculum Development/Evaluation, Mentoring, Personal Characteristics/Attitudes

Topics: CREOG & APGO Annual Meeting, 2017, Residency Director, Residency Coordinator, Professionalism, Systems-Based Practice & Improvement, GME,

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Waking from Enchanted Sleep: Increasing Safety Event Reporting by Obstetrics and Gynecology Residents

Background: AHRQ culture of safety survey and ACGME CLER visit both evaluate resident participation in event reporting to enhance quality of care and promote a safe environment for patients and providers. At our institution, there were only 33 safety events reported amongst 770 trainees in 2014. Reporting by residents has been hindered by fear of retaliation, inconvenience, uncertainty about which events merit reporting, and lack of follow-up.


Methods: All residents were instructed on three available mechanisms for reporting: a desktop icon, voicemail hotline, and online reporting. Staff and residents were coached about types of events that merit reporting. A financial incentive program was initiated by the institutional GME office to encourage residents to meet a goal.  Outcomes of reports were reviewed at a feedback session.


Results: Among Ob/GYN trainees, there were 65 events reported during a 9-month period in 2015-2016, an increase from a mean of 0 to 7 events per month.  Most events were submitted through the voicemail hotline; residents confirm that the ease of use promoted reporting.  Our trainees met reporting goals and received the financial incentive.  The majority of incidents involved communication errors and equipment shortages, prompting further investigations and action to avoid recurrent events.


Discussions: Increasing resident involvement in quality and safety improvement enhances patient care. Providing an incentive and a convenient way to report patient safety events successfully increased the frequency reporting by Ob/GYN trainees.  Discussing incident follow-up was considered valuable in identifying areas for future quality improvement projects.  


Keywords: Curriculum Development/Evaluation, Healthcare Systems, Interprofessional, Patient Safety/Medical Errors

Topics: CREOG & APGO Annual Meeting, 2017, Resident, Residency Director, Systems-Based Practice & Improvement, GME, Quality & Safety,

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Using Inter-professional OSCE Based Simulation Collaboration to Teach Obstetrics to Second Year Medical Students

Background: We have shown that it is possible to introduce an obstetrical simulation program to pre-clinical second year medical students. In the second year of our obstetrics simulation curriculum for 2nd year medical students, we introduced OSCE assessment in collaboration with the nursing school educator with the program occurring in the nursing school simulation center in November 2015. 


Methods: Students rotated through three stations: 1) simulated vaginal delivery demonstrated by nurse educator and OBGYN resident 2) MFM faculty gave interactive presentation on fetal heart rate (FHR), a student nurse then role played with students and they were assessed by OSCE format, 3) OBGYN resident and faculty taught and assessed students on cervical dilation using cervical models. Students completed surveys on attitude, knowledge before, after and 7 months post curriculum.


Results: Of 95 students , mean scores for the FHR OSCE were: identifies FHR baseline = 0.97, identifies FHR variability= 0.92, provides accurate identification of periodic pattern= 0.73, identifies FHR category= 0.67 and orders appropriate medical interventions=0.93.For the cervical station OSCE, the mean score on cervical examination skills after training was 75%.,   For the knowledge questions on obstetrics and fetal heart rate monitoring, students obtained a mean pre-score of 2.57

+ 0.09,  post-simulation the mean score increased to 3.24 + 0.11  (p+ 0.12 .


Pre-simulation; students scored their comfort level with obstetrical procedures as 12.2

+ 0.63, after simulation the mean score increased to 28 +-.63(p+1 (p=0.001). 


Discussions: We have demonstrated the feasibility of an OSCE based inter-professional educational curriculum utilizing nursing, physician and resident faculty instructing medical students and nursing students jointly.  For FHR teaching, the concept of FHR category was the most challenging for the students to grasp. The course improved students’ short-term knowledge but had dropped back to baseline by 7 months. Students’ comfort level increased immediately post training and decreased but was still higher than baseline at 7 months. Further curriculum development is undergoing on increasing long term knowledge gain.


Keywords: Assessment, Curriculum Development/Evaluation, Interprofessional

Topics: CREOG & APGO Annual Meeting, 2017, Clerkship Director, Clerkship Coordinator, Patient Care, Interpersonal & Communication Skills, UME, Assessment, Simulation,

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Training Medical Students as Reproductive Health Patient Advocates

Background: Studies have examined the effects of reproductive health (RH) training on medical students but little is known about the impact of hands-on, interactive counseling of patients.


Methods: We developed a training curriculum inclusive of the medical, social and legal aspects of contraception and abortion. First and second year medical students applied and were selected as RHAs. They participated in mentored patient counseling sessions and were present during clinical encounters. We assessed pre- and post- training knowledge and attitudes via surveys and compared this to third year medical students completing the standard OB/GYN clinical rotation.



Among RHAs, significant differences between pre and post tests knowledge assessment were noted on misidentification of LARC and emergency contraception. When comparing students in the OB/GYN rotation to RHAs, RHA students had increased significantly increased knowledge regarding abortion rates and identification of emergency contraception. Based on Likert scale assessment, RHAs experienced a significant change from baseline on their belief that abortions are safe.  The importance of patient decision making autonomy and access to abortion was also rated higher.


Discussions: Our program resulted in increased knowledge of contraceptive options and greater awareness of the psychosocial context of abortion care.  Meaningful benefits were derived from direct patient interactions resulting in evolving perceptions of family planning policies. Expansion of our model into general medical curricula would improve student training.


Keywords: Communication Skills, Counseling (Personal or Academic), Curriculum Development/Evaluation, Leadership Organizational Development, Mentoring

Topics: CREOG & APGO Annual Meeting, 2017, Clerkship Director, Clerkship Coordinator, Medical Knowledge, UME, Simulation, Advocacy,

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Training and Knowledge of Transgender Health Among Obstetric and Gynecology Residents

Background: Transgender individuals experience significant health disparities, including stigma and lack of provider knowledge. The Council on Resident Education in Obstetrics and Gynecology (CREOG) has specific educational objectives regarding care for transgender individuals; however, the extent to which OB/GYN residents meet these objectives is not known. 


Methods: We invited all current US OB/GYN residents to complete an electronic, anonymous 42-item survey including questions regarding transgender health training, experiences caring for transgender patients, and comfort meeting the CREOG educational objectives. 


Results: Of programs that had at least one respondent, 313 of 2276 eligible trainees completed the survey for a corrected response rate of 13.8%. The majority (76%) of respondents had received at least some form of training on transgender health topics. 42% of respondents had cared for a transgender individual as a resident. While most residents (80%) felt comfortable with basic trans-sensitivity protocols, only 22% of respondents felt competent to provide trans-relevant services. Over 90% of respondents felt this was an important topic for OB/GYN residents to learn and desired to receive more training. 


Discussions: While many respondents felt comfortable with basic topics regarding terminology and sensitivity protocols, a minority of respondents reported feeling prepared to provide care for transgender individuals independently. Given the high desire among respondents for more training, creation of high-quality educational materials for OB/GYN residents should be a priority for residency programs and national organizations, such as CREOG.


Keywords: Curriculum Development/Evaluation, Instructional Materials/Methods, LGBTQIA, Underserved Communities

Topics: CREOG & APGO Annual Meeting, 2017, Resident, Patient Care, Medical Knowledge, GME, Advocacy,

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Toward an Understanding of the Student Experience During the Ob-Gyn Clerkship

Background: Medical school graduates rank the Obstetrics and Gynecology (Ob-Gyn) clerkship as one of the lowest clerkships in medical school. Studies further exploring such experiences and attitudes are limited.


Methods: Third year medical students in their Ob-Gyn clerkship at a Harvard-affiliated institution were invited to participate in a focus group and complete a survey about their clerkship experiences. Discussion topics included the transition from pre-clinical to clinical medicine, general Ob-Gyn clerkship experiences, and relationships with patients, faculty, and house staff. Focus groups were conducted by individuals unaffiliated with the clerkship. Anonymized transcripts were coded by consensus by four study members to identify common themes.


Results: All students (n=13) from two consecutive Ob-Gyn clerkship blocks were invited to participate. Eleven (84.6%) participated in a total of two focus groups and eight (69.2%) completed the survey. Only 44% of survey respondents indicated that they were looking forward to the clerkship before it began. Two-thirds of students reported that the clerkship exceeded their expectations, reporting positive experiences particularly with house staff and patients. Major focus group themes included the need to advocate for educational opportunities, the desire for coaching in interactions with nurses and residents, and a lack of continuity or meaningful relationships with patients.


Discussions: Clerkship improvement projects that encourage self-advocacy, provide coaching in interpersonal and interdisciplinary relationships, and promote continuity of care are likely to positively impact student experiences in the Ob-Gyn clerkship.


Keywords: Curriculum Development/Evaluation, Personal Characteristics/Attitudes, Student Affairs

Topics: CREOG & APGO Annual Meeting, 2017, Clerkship Director, Clerkship Coordinator, Professionalism, Interpersonal & Communication Skills, UME,

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To Review Student Data Regarding Clerkship Experience with Change in Curriculum Design

Background: The Ob/Gyn clerkship transitioned from a 6 week discipline specific clinical experience to an integrated 15 week surgery and reproduction curriculum. Student perception of clerkship quality across the curriculum is assessed at the end of the 3rd year and in the graduation questionnaire.


Methods: Year-end curriculum surveys, NBME Ob/Gyn shelf exam scores and AAMC graduation questionnaire results for students graduating 2012-2016 were examined.  End of year NBME Ob/Gyn shelf scores were compared by year of graduation. Analysis of variance was used to compare scores in the traditional design (students graduated 2012-15) and Integrated design (students graduated 2016).


Results: End of year clinical curriculum survey response rates ranged between 43.7%-86.3%.  There was a significant increase in response rates in the 2016 class (86.3%). During this period, 211, 209, 217, 242 and 180 students completed NBME Ob/Gyn shelf exam.  The mean clerkship rating increased significantly from 2012 to 2015 (p < 0.05). There was a declined in the clerkship rating in 2016 (3.85) but it remained higher than in 2012 (3.74). GQ survey results remained above the national mean for the same duration.  There was no difference in the mean NBME subject score during this period (p=0.525).


Discussions: Transition from a traditional 6 week Ob/Gyn curriculum to an integrated longitudinal curriculum with surgery resulted improving student evaluation scores and similar NBME performance.


Keywords: Curriculum Development/Evaluation, Evaluation of Clinical Performance, Instructional Materials/Methods

Topics: CREOG & APGO Annual Meeting, 2017, Clerkship Director, Clerkship Coordinator, Systems-Based Practice & Improvement, UME, Assessment,

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Tiny Talks - Practice Bulletin in 5 Minutes


A majority of an educational learning occurs through direct patient care, augmented with review of literature, sometimes difficult in busy clinical environments. \"Tiny Talks\" was a project initiated by residents at Albert Einstein/Montefiore creating a succinct, “on-the-fly” teaching and self-learning tool, and supporting residents teaching each other as well as medical student.  



Residents selected topics from ACOG Practice Bulletins and condensed them into 8-12 slide PowerPoint presentations, and made available through a shared folder. Residents and medical students were surveyed regarding topics reviewed, usefulness as teaching and self-learning tool, time spent, and how often they anticipate they would use the slides per week.



There were 14 total respondents to this on-going survey, with responses from medical students and all four years of residency. 85% of respondents stated the review took from 5-10 minutes. 71% strongly agreed that they were effective teaching and self-learning tools. 92% strongly agreed or agreed that they were an acceptable alternative to Practice Bulletins for \"on-the-fly\" teaching. 92% strongly agreed or agreed that they were not burdensome to use. The majority of respondents (43%) stated they would use Tiny Talks approximately once a week.



The benefits of Tiny Talks were: residents learn and report retaining information during the creation of the Tiny Talks, and residents and students maximize available time in their work day reviewing a topic within 5-10 minutes 


Keywords: Communication Skills, Instructional Materials/Methods, Residents As Teachers, Teaching Skills

Topics: CREOG & APGO Annual Meeting, 2017, Resident, Residency Director, Medical Knowledge, GME, Lecture,

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Time for Integration of a Formal Robotic-assisted Surgical Training Program into Obstetrics/Gynecology Residency Curricula

Background: With the rapid adoption of robotic approaches in gynecologic surgery, there is increased interest in developing standardized robotic surgery training programs.There are currently no recommendations for formal robotics training in OB/Gyn residency programs.


Methods: A 31-item survey was developed and distributed residents in ACGME-accredited OB/Gyn residency programs via email. Data collected included demographics and information about robotics exposure, training modalities, and resident perception of their trianing.


Results: There were 178 participants included with 98.9% of respondents reported access to a surgical robot. A majority of respondents were females (82.6%) in university residency program (57.3%) located in the Midwest (33.1%) and Northeast (38.8%). In total, 65% of participants reported a robotic training program at their institution. The most commonly used training modality was online modules (79.7%). Over 74% of participants identified a barrier to completion of robotics training. Approximately 78% of respondents reported a desire for formal robotics training, and this was positively correlated with the belief that robotics training is an important part of residency (r=.510).


Discussions: This study illustrates that a majority of residents are completing formal robotics training programs and these programs utilize a wide variety of training modalities. Residents desire such training and feel that this is an important part of residency. Therefore, the ACGME should consider recommending the incorporation of standardized robotics training as part of the OB/Gyn residency curriculum.


Keywords: Curriculum Development/Evaluation, Instructional Materials/Methods, Simulation, Technology

Topics: CREOG & APGO Annual Meeting, 2017, Residency Director, Medical Knowledge, GME, Simulation,

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The Surgical Checklist: Educating Medical Students Today for a Safer Tomorrow

Background: The World Health Organization (WHO) developed the surgical safety checklist as the key component of the Second Global Patient Safety Challenge. We sought to increase the exposure and familiarity of third year medical students to this tool through educational modules and reflective evaluation of their experiences. 


Methods: The students completed a five-question pretest assessing their comfort and familiarity with surgical safety checklists.  Students completed the Institute for Healthcare Improvement Open School Modules PS100, PS101, and PS102.  At the end of the clerkship, the students completed a posttest assessing comfort and familiarity with the checklist.  Students also debriefed their checklist experiences with the clerkship director.


Results: There were 81 participants.  After the clerkship, 87% were familiar with the surgical safety checklist compared to 21% in the pretest group.  Only 51% of students had seen the checklist prevent harm or improve readiness compared to 97% after the supplement.  84% of students felt comfortable performing a timeout compared to 34% pretest.  97% felt they understood human factors in patient safety compared to 61% pretest.


Discussions: Following exposure to this curriculum supplement, our students report being more comfortable using a surgical checklist.  We anticipate they will have more familiarity with patient safety concepts during residency.


Keywords: Patient Safety/Medical Errors

Topics: CREOG & APGO Annual Meeting, 2017, Student, Clerkship Director, Patient Care, Interpersonal & Communication Skills, UME, Quality & Safety,

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The Rate of Medical Student Mistreatment in Clinical Clerkships: The Impact of Increasing Awareness

Background: Mistreatment is a topic of increasing study and importance, as rates of medical student-reported mistreatment have escalated in recent years. Historically, Ob/Gyn is known to have high rates of mistreatment, second only to General Surgery. Our goal was to determine how an intervention to increase awareness would impact the rates of reported mistreatment, and more specifically address institution-specific shortcomings.


Methods: Presentations about mistreatment were given by the Associate Dean for Student Affairs and Curriculum to students beginning clinical clerkships, and also to the Department of Ob/Gyn starting January 2016. Required electronic post-clerkship evaluations given to every student following clinical clerkships before and after this presentation were eligible for analysis (2011-2016). Rates and classification of student-reported mistreatment were analyzed. 


Results: Of the completed surveys,148 of 7332 (2.0%) students reported mistreatment before the presentation was given versus 45 of 1583 (2.76%) students reporting mistreatment after the presentation, p < 0.046. Thirteen total incidents of mistreatment in the Ob/Gyn department were reported. The majority (56%) of reported mistreatment was classified as “public belittlement or humiliation”


Discussions: It appears the dean increased awareness with students, resulting in a significantly increased rate of reported mistreatment. There were too few incidents in the department of Ob/Gyn to note whether the presentation to the members of the department had a positive or negative impact on the rate of mistreatment. 


Keywords: Communication Skills, Faculty Development, Student Mistreatment

Topics: CREOG & APGO Annual Meeting, 2017, Clerkship Director, Professionalism, UME, Faculty Development,

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The Innovative Use of a Paging Simulation to Assess Professionalism and Communication Competencies

Background: Communication and professionalism competencies present assessment challenges for medical educators at the undergraduate and graduate medical education levels.  A simulated paging curriculum could provide an opportunity to assess and supply feedback on the level one milestone Professionalism and Communication competencies for medical students matching into OBGYN residencies. 


Methods: Fourth year medical students enrolled in a four-week residency preparation course participated in a paging simulation curriculum consisting of six cases. A Certified Nurse Midwife (CNM) simulated the role of floor nurse and recorded the time from the page to a response time. After each case, the CNM assessed level one communication competencies for each student using a 100 mm visual analogue scale.  The CNM assessed global effectiveness in communication using a 1-10 scale.


Results: A response time within five minutes occurred for 83% of the 171 pages sent.  60% of pages were returned in under 3 minutes.  The mean score for ‘respectful when communicating’ and ‘cooperative when communicating’ was 87 and 86% respectively. Assessment of ‘structured when communicating’ had a mean of 77% and ‘able to gather and share information’ 75%. The overall mean score for global effectiveness of communication during the scenario was 9.


Discussions: The paging simulation offered a unique platform for the assessment of Professionalism and Communication level one competencies. While students were effective when communicating, structured conversation and the ability to gather and share information might be improved. This curriculum provided an opportunity for informed feedback to individual students on these necessary skills in an OBGYN residency.


Keywords: Communication Skills, Feedback Evaluation, Milestones, Professionalism, Simulation

Topics: CREOG & APGO Annual Meeting, 2017, Student, Residency Director, Professionalism, Interpersonal & Communication Skills, GME, UME, Assessment, Simulation,

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The Impact of Fifty-Years of Resident and Fellow Research in an Academic Gynecology and Obstetrics Department

Background: Research has been a core component of the department’s graduate medical education programs since 1967. On the occasion of the 50th resident and fellow research day, we quantified published papers as well as regional and national conference presentations. We were intersted to know the impact of the program and whether changes to the program format were assoicated with quantifiable changes in scholarly products.


Methods: We identified regional and national presentations and publications through a review of electronic sources including Pubmed and Web of Science, as well as the Department’s historical archives, and more recently the department’s academic scorecard. For manuscripts we determined the citation number and index score for papers using Web of Science and Incites. We then looked at the number of publications and presentations before (1997-2006) and after (2007-2016) changes to the program format.


Results: Our search yielded 157 manuscripts and 114 presentations at regional, national, or international meetings. We identified 20 papers that exceeded the citation index relative to their category by at least two.  There were 10 publications that were cited at least 50 times.  The number of original projects per trainee decreased by about 20% after program changes.  The proportion of projects resulting in publications was similar before (24%) compared to after (26%) the changes.  There was a 9% increase in proportion of projects presented at regional and national/international conferences after program revisions.


Discussions: The longevity of the department’s resident and fellow research program reflects the importance of inquiry and scholarship as core elements of training. This analysis documents the impact of our approach to resident and fellow research and provides data to quantify the return on investments committed by the department in terms of faculty mentorship and trainee effort, staffing, and financial resources to support resident and fellow initiated research and scholarship.


Keywords: Curriculum Development/Evaluation, Publication, Research Methods

Topics: CREOG & APGO Annual Meeting, 2017, Resident, Faculty, Professionalism, Practice-Based Learning & Improvement, GME, Problem-Based Learning,

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The Impact of a Postpartum Rounding Video Module on Medical Student Learning During the Obstetrics and Gynecology Core Clerkship

Background: The 4C-ID model has been adapted for medical education to help students manage significant cognitive loads while developing strategies for improvement. To date, no 4C-ID intervention exists for the wards or postpartum rounding.


Methods: Third year medical students on the OB-GYN core clerkship who agreed to participate were randomized by clerkship block to receive the 20-minute postpartum rounding video module, or standard education. Knowledge and clinical reasoning were assessed during orientation and clerkship conclusion using a clinical scenario (32 points) and the Diagnostic Thinking Inventory (246 points). Satisfaction was assessed  using Likert scale questions (0-5, 5= very satisfied/strongly agree).


Results: 78/79 eligible students participated. The only significant baseline difference between groups was greater knowledge of physical exam skills in the intervention group (4.8/7, 4.1/7 p=0.049). Students in the intervention group demonstrated higher post-intervention improvement in knowledge  (8.9, 4.5 p=0.0011). Both groups increased clinical reasoning, however there was no significant difference between groups pre- or post- intervention (160.1, 160.5 p=0.92 165.0, 168.8 p=0.34). Students in the control group reported a better clerkship experience (3.9,3.5 p=0.04). Students who received the video would recommend the video to their peers (3.7).


Discussions: A postpartum video based in the 4C-ID model of education increased student knowledge in the third year medical student OB-GYN core clerkship. Video learning is acceptable to medical students, and can be easily incorporated into specialty rounds at any institution.


Keywords: Cultural Diversity/Cultural Competency, Distance Learning, Instructional Materials/Methods, Video Creation

Topics: CREOG & APGO Annual Meeting, 2017, Resident, Clerkship Director, Patient Care, Medical Knowledge, GME, Simulation, Independent Study,

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The FLAME Initiative: \"Five-minute Lectures Accelerating Medical Education\" Empowering Resident Teaching

Background: The ever-increasing volume of medical knowledge and time available to acquire it are inversely proportional, creating a conundrum for resident-educators of medical students during clerkships. As learners themselves, resident teaching opportunities can be stifled by self-confidence, time, and accessibility of resources. The FLAME initiative seeks to increase the frequency and quality of teachable encounters while catalyzing resident learning through teaching.


Methods: FLAME seeks to create a short presentation for each APGO medical student learning objective. These can be readily accessed on www.flame.rocks and through an iphone application. Our primary hypothesis, assessed by confidential survey before and after FLAME implementation, is that residents will be better able to meet their own teaching goals with FLAME as a resource. Secondary hypotheses include: residents will be more comfortable teaching, residents will teach medical students more frequently, students will be more satisfied with resident teaching, and student Shelf scores will improve.


Results: Of 28 residents surveyed pre-FLAME, 92% find medical student teaching important, and 88% wished they taught more. Major barriers impeding teaching are: time/clinical duties (100%), comfort with teaching (23%) and accessibility of resources (18%). The survey will be repeated in January 2017 and compared to the pre-FLAME baseline. Medical student post-clerkship survey scores and Shelf scores for 12 months following FLAME introduction will be compared to the 12 months prior. 


Discussions: FLAME’s philosophy is simple: empower residents to teach by making relevant, efficient, and reliable teaching resources immediately accessible. 


Keywords: Curriculum Development/Evaluation, Instructional Materials/Methods, Residents As Teachers, Teaching Skills, Technology

Topics: CREOG & APGO Annual Meeting, 2017, Resident, Residency Director, Patient Care, Medical Knowledge, GME, Lecture, Team-Based Learning,

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The Ethics Experiences and Preparation of Medical Trainees Participating in Short-Term, International Educational Programs: A Systematic Review of the Literature

Background: Responding to demand from medical trainees, educators have developed a spate of short-term, global learning opportunities. However, it is uncertain how well the literature has reported and analyzed the ethical challenges for medical trainees participating in these new programs. This knowledge is important for those designing and reforming global health programs. Therefore, we conducted a systematic review to evaluate the literature addressing ethics preparation and experiences of medical trainees who pursue short-term global health trips.


Methods: We devised a set of inclusion and exclusion criteria. Inclusion criteria were four main components: (1) global health, (2) ethics, (3) medical trainees, and (4) short term trips. Articles were excluded if (1) they described or analyzed programs or experiences not supported by a USMLE or ACGME accredited program or (2) were written in a language other than English.   Search strategies were developed in consultation with a librarian for five databases: Pubmed, Embase, Education Source, Academic Search Complete, and Web of Science (Core Collection). A single author analyzed the search results based on the inclusion and exclusion criteria and a team of authors conducted a qualitative content analysis of the resulting papers.


Results: The search protocol returned 530 unique papers, of which 56 were qualified based on the inclusion and exclusion criteria. Identified papers fit into three broad categories: (1) Case reports (n=14). These narratives described curriculum or program development, and addressed curricular ethics content aimed at preparation for short-term trips. (2) Non-empirical papers (n=26). Often drawing on personal experience from program development or participation, these essays contained reflective analysis and narratives. (3) Research papers (n=16) that used research methodology to describe the ethical challenges faced by medical trainees on short-term trips.


Discussions: Our preliminary results show a nascent literature on ethics for medical trainees embarking on short term, international trips. The case studies and essays are helpful for exchanging program ideas; however, more systematic, empirical studies would be useful to evaluate and guide curricular development.


Keywords: Communication Skills, Cultural Diversity/Cultural Competency, Curriculum Development/Evaluation, Global Health, Professionalism

Topics: CREOG & APGO Annual Meeting, 2017, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, GME, UME, Global Health,

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The Decline in Attitudes Towards Physician-nurse Collaboration from Medical School to Residency

Background: Interprofessional education is often part of early medical school curricula; however, as learners progress through their training, there is often less instruction in this important area.  Little is known of the impact of clinical exposure on medical students’ and residents’ attitudes towards physician-nurse collaboration.


Methods: Third year medical students and residents completed the validated Jefferson Survey of Attitudes Towards Physician Nurse Collaboration. This instrument has 20 questions in which trainees indicate their level of agreement with statements regarding physician-nurse collaboration.  All items were scored on a 4-point Likert scale (1= strongly disagree to 4= strongly agree).  Student and resident scores were compared using Student’s t-tests.


Results: The survey was completed by 129 medical students and 260 residents.  The response rate for medical students was 75% and for residents was 16.5%. Resident respondents agreed more strongly with the notion of physician as dominant authority, “the primary function of the nurse is to carry out the physician’s orders” (students: 2.02 ± 0.72 v. residents: 2.45 ± 0.82; p=0.0001) and “doctors should be the dominant authority in all health care matters” (students: 2.36 ± 0.84 v. residents: 2.67 ± 0.89; p=0.0011).


Discussions: Resident physicians’ perceptions of the nurse-physician relationship are significantly less favorable than the views of third year medical students, particularly in the area of authority.  There may be some aspects of the hidden curriculum which contribute to the development of these interprofessional attitudes.


Keywords: Communication Skills, Healthcare Workforce, Interprofessional, Personal Characteristics/Attitudes, Professionalism

Topics: CREOG & APGO Annual Meeting, 2017, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, GME, Team-Based Learning,

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