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
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
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
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
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
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.
Development/Evaluation, Instructional Materials/Methods, Research Methods
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
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
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
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
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
post-simulation the mean score increased to 3.24 + 0.11 (p+ 0.12 .
students scored their comfort level with obstetrical procedures as 12.2
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
Keywords: Assessment, Curriculum Development/Evaluation,
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.
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
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.
Development/Evaluation, Instructional Materials/Methods, LGBTQIA, Underserved
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
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
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
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.
Development/Evaluation, Evaluation of Clinical Performance, Instructional
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
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
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.
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.
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
Skills, Instructional Materials/Methods, Residents As Teachers, Teaching Skills
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
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
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%
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
Keywords: Patient Safety/Medical Errors
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
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,
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
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,
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
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
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
Diversity/Cultural Competency, Distance Learning, Instructional
Materials/Methods, Video Creation
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
Keywords: Curriculum Development/Evaluation, Instructional
Materials/Methods, Residents As Teachers, Teaching Skills, Technology
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
Keywords: Communication Skills, Cultural Diversity/Cultural
Competency, Curriculum Development/Evaluation, Global Health, Professionalism
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.
Skills, Healthcare Workforce, Interprofessional, Personal
CREOG & APGO Annual Meeting, 2017, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, GME, Team-Based Learning,
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