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Wellness Challenges and Burnout Contributors: A Systematic Approach to Issue Identification & Program Development

Purpose: To implement an institutionally-specific process to: A: Identify wellness challenges/burnout contributors. B: Develop a systematic approach to wellness programming prioritized by Maslow need level

 

Background: Addressing wellness challenges/burnout contributors (WC/BC) is critically important to both providers and the patients they treat.

 

Methods: A representative task force was assembled.  Using mind-mapping, members developed a comprehensive list of WC/BC issues and related factors.  These were then mapped by members to Maslow need levels ranging from physiologic (level 1) to transcendence (level 8). PDs were then queried regarding wellness programming in their residencies to generate a “menu” of institutionally-available programming. Gaps were then identified by mapping WC/BC issues to available PD-reported programming.  Highest priority was given to program development for WC/BC issues with lowest Maslow levels for which there was no programming available.

 

Results: From October, 2016-May, 2017, the task forced include 20 representatives from 7 departments and the GME Office and included residency/fellowship PDs, residents, and staff.  Through mind-mapping work, 12 categories of WC/BC issues and 38 related factors were identified. While all GME program directors reported having WC/BC programming in place, the majority (57%) of this was informal support around “healthy lifestyles”.  For 34 of 38 factors (89%) identified, no programming was reported. Notably, when mapping factors to Maslow need level, 30 of 38 (80%) mapped to basic Maslow levels 1-4.  Program development was recommended for WC/BC factors with lowest Maslow levels for which no institutional programming was in place.

 

Discussions: An institutionally-specific approach to identifying WC/BC issues and prioritizing them for resource development by Maslow level was successfully implemented.

Topics: CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, GME, CME, UME, Quality & Safety, Problem-Based Learning, General Ob-Gyn,

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Video Curriculum for Gynecologic Surgery

Purpose: To evaluate the efficacy of a surgical video curriculum versus standard learning throughout the rotation.

 

Background: With decreasing surgical volume, training time restrictions, and more routes to approach individual cases, efficient and effective tools for surgical learning are essential.  We developed several videos teaching pelvic anatomy and steps of common gynecologic procedures.

 

Methods: The video curriculum was presented to alternating groups of students completing their OBGYN clinical rotation compared with standard rotation exposure. Participants knowledge of relevant anatomy and surgical steps was assessed at baseline, the rotation end, and immediately after exposure in the video group. Mean score assessment scores, overall impressions, and learning preferences were evaluated.

 

Results: All 42 participants had similar training, case exposure, and baseline scores.  At the end of the rotation, the mean rotation-end scores were 34% and 46% for control and video groups (p=0.005), and the difference remained significant when corrected for baseline score (p=0.012). The mean post-test score rose to 49% compared to a baseline mean of 25% (p<0.001). Seventy-four percent of participants preferred video over text, 86% reported the series was a useful educational tool, 90% would use the videos for case preparation, and 55% felt more engaged during surgery.

 

Discussions: The video series improved students’ performance on assessment of anatomy and surgical steps. Overall impressions of the video series were positive and most students reported they preferred video to text format.  Moving forward, videos like these can be used and examined as adjunctive tools for acquisition of specific surgical knowledge and skills.

Topics: CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Medical Knowledge, GME, UME, Independent Study, Minimally Invasive Surgery,

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Use of Forum Theater to improve the Clinical Learning Environment

Background: Reports of student mistreatment remain unacceptably high at Duke University School of Medicine. Addressing the learning environment with lectures, anonymous reporting and personal coaches has had little effect. The humanities have been used for building empathy in physicians. In interactive or Forum Theater, spectators have opportunities to express opinions and make decisions while the actors incorporate the suggestions as they re-play a scene over again. The technique of Forum Theater has been used for medical faculty development for improving handling of student multiculturalism with positive results.

 

Methods: After IRB approval, 2 Forum theater sessions were held as OB-Gyn Grand Rounds with scenes depicting interactive challenges.  The learning environment dean led discussion on the scenes before re-enactment with audience input. A brief survey was collected on the Playbill regarding demographics, mistreatment attitudes and opinions on Forum Theater. Replies between students and residents were compared with Fishers Exact analysis.

 

Results: 110 attendees participated in 2 Forum Theater sessions. 41 participants completed surveys-12 medical students, 17 residents, 4 fellows and 8 faculty. Students agreed with statements that medical student mistreatment is prevalent at the school and in the department significantly more often than the residents. (p<.05) There were no differences between responses on the learning environment in the clerkship. 83% of participants reported that Forum theater raised mistreatment awareness and could improve the learning environment.

 

Discussions: Forum Theater holds promise as a tool for addressing learning environment challenges.

Topics: CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Professionalism, Interpersonal & Communication Skills, GME, UME, General Ob-Gyn,

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Ultrasound Training in Obstetrics and Gynecology Residency: A National Portrait

Purpose: To understand current training in obstetric and gynecologic ultrasound.

 

Background: Modern obstetrics and gynecology practice requires the frequent use of ultrasound (US) and therefore US training has become an important part of resident education. We sought to understand how residents are currently being trained in obstetric and gynecologic US by surveying residency program directors.

 

Methods: We developed a 36 item self-administered questionnaire targeted for residency program directors (PD). PD from all 261 accredited programs were invited to participate. We inquired about US curriculums, time spent in US training, types of US taught, learning environments and instructors, feedback regarding resident competence and resident input of the learning experience. IRB approval was obtained prior to study onset.

 

Results: We received 108 completed responses.PD from all geographical US areas and Canada responded. PD self-described their programs as 52% university based, 28% community based, 18% combination of university/community based and 2% military. Over 65% reported US education was built into the curriculum as a distinct rotation. Of the US rotations >50% were described as a one month separate block. 40% stated 1 – 4 hours week devoted to US education. 99% said supervised instruction was the norm with the majority of teachers being MFM physicians/sonographers. A mixture of observational and hands-on ultrasound experience is the norm for most programs. Over 76% PD gave residents US reading assignments and have formal lectures, mostly by MFM and REI faculty. Less than 20% of programs supported any experience with ultrasound simulator training. 90% of PD give formal feedback to the residents about their skills. Only 69% state that their residents can evaluate the learning experience.

 

Discussions: We recount details of the current status of US education in OB/Gyn residency programs as reported by PD across the country. Our questions were designed to understand the amount of time actually committed to ultrasound education. With the inception of widespread US need in the daily life of obstetrics and gynecology the challenge of ensuring adequate resident training exists. More structure and protected learning time may assist in resident training.  Simulator training for US education seems underutilized.

Topics: CREOG & APGO Annual Meeting, 2018, Resident, Faculty, Residency Director, Medical Knowledge, GME, Assessment, Simulation, Lecture, General Ob-Gyn,

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There Is an APP for That: Vaginal Hysterectomy

Purpose: To create an instructional app which includes medical knowledge, procedural steps and assessments based on the ACOG curriculum for vaginal hysterectomy.

 

Background: Vaginal hysterectomy is the evidence based medicine route of choice when feasible.  Significant challenges exist in teaching this procedure due to lack of simulation training, proper assessment of specific techniques and timely instruction prior to performing the procedure.  There is also considerable variation in how cases are tracked and assessments of technique are done.

 

Methods: Key features/contents of the application include:  1) ACOG curriculum for vaginal hysterectomy, 2) a complete step by step live and simulated surgical video tutorial, 3) a procedural step by step assessment (10 steps-- 0-10 score), 4) a global surgical rating scale (7 metrics), and 5) a knowledge based assessment (4 metrics, 0-4 scale). 

 

Results: The data captured on the app can be accessed via IPAD and iPhone mobile devices and is verified by Apple.  The evaluations can be directly emailed to any database.

 

Discussions: A comprehensive instructional surgery app coupled with real time assessment will provide greater learning efficiency and will more effectively improve surgical skills.  This app has the potential to standardize surgical evaluation in the operating room and provide a more efficient method to track surgeon competency using ACOG guidelines.  The assessment is currently employed by the ACOG Simulation Consortium Working group during vaginal hysterectomy simulation and is part of a surgical simulation course which certified by the ABOG for MOC credits.

 

Topics: CREOG & APGO Annual Meeting, 2018, Resident, Faculty, Clerkship Director, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Assessment, Simulation, Lecture, Minimally Invasive Surgery,

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The Impact of a Structured Wellness Curriculum on Burnout Among Obstetrics and Gynecology Residents

Purpose: Our primary aim was to evaluate the effects of a formalized wellness curriculum on the rate of burnout among University of New Mexico (UNM) obstetrics and gynecology (OBGyn) residents.  Our secondary aim was to evaluate the effect of a wellness curriculum on rates of depression, alcohol abuse and suicide risk.

 

Background: Burnout is a pathological syndrome characterized by depersonalization, emotional exhaustion and a low sense of personal achievement. Burnout is a concern for resident physicians due to their heavy workload and low sense of autonomy.

 

Methods: A structured wellness curriculum was instituted at the start of the 2016 academic year.  A 45-item survey, consisting of the Maslach Burnout Inventory Human Services Survey (MBI-HSS), personal health questionnaire-9 (PHQ9), suicide behaviors questionnaire-revised (SBQr), and the alcohol use disorders identification test (AUDIT), was to be administered at the start, midpoint, and end of the academic year.

 

Results: The study included 23 UNM OBGyn residents. Midpoint and end of curriculum surveys were collected as planned and demonstrated no difference in rate of burnout.  Upon completion of the 2016 academic year 18 (78.2%) residents reported moderate to severe emotional exhaustion; 13 (59.1%) moderate to severe depersonalization; and 5 (21.7%) low personal achievement.  SBQ-R identified 4 (18.2%) residents at high risk for suicide and AUDIT-C identified 15 (68.2%) at high risk for alcohol abuse.

 

Discussions: High rates of burnout, depression, alcohol abuse, and suicide risk did not change between the midpoint and end of a structured wellness curriculum.

 

Topics: CREOG & APGO Annual Meeting, 2018, Resident, Faculty, Residency Director, Interpersonal & Communication Skills, GME, UME,

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The Effect of a Shortened OB/GYN Clerkship on Student Performance and Perception of Quality

Purpose: To examine medical student performance and perception of clerkship quality during the shortened, third-year OB/GYN rotation.

 

Background: As medical school curricula evolve, core clinical clerkships often become shortened to allow more time for career exploration and other professional development. There is conflicting data regarding the impact of duration of clerkships on student performance, and little is known about the impact of shortened clerkships on student satisfaction.

 

Methods: We collected data from NBME subject exam scores and clerkship evaluation scores for third-year clerkships over three academic years.  In years 2014-2015 and 2015-2016, students had traditional clerkship lengths.  In 2016-2017, clerkship durations were shortened by 25%.  Analysis of variance was conducted to examine the effect of academic year on mean NBME scores and student evaluation scores.

 

Results: There was no significant difference in mean OB/GYN NBME scores between students participating in the traditional vs. shortened clerkship (mean score 79.7 ± 8.1 in 2014-2015, 79.7 ± 6.8 in 2015-2016, and 79.8 ± 7.0 in 2016-2017; p= 0.991).  Student perception of quality of the OB/GYN clerkship decreased with the shortened clerkships; however, these differences were not statistically significant (4.0 ± 0.9 in 2014-2015, 4.0 ± 0.9 in 2015-2016, and 3.8 ± 0.9 in 2016-2017; p= 0.074).  By comparison, other clerkships experienced an increase in perception of quality over the same time-period. 

 

Discussions: A shortened OB/GYN student clerkship does not appear to adversely affect objective performance on the rotation; however, medical student perception of quality of the rotation did trend towards lower clerkship scores.

 

Topics: CREOG & APGO Annual Meeting, 2018, Faculty, Clerkship Director, Clerkship Coordinator, Practice-Based Learning & Improvement, UME, Assessment, General Ob-Gyn,

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Teaching Wellness Skills: Effect of a Curriculum Designed to Increase Physician Resilience on Obstetrics and Gynecology Intern Burnout, Mindfulness and Self-compassion

Purpose: To assess whether a curriculum targeting psychological resilience impacts the burnout, mindfulness and self-compassion of obstetrics and gynecology interns.

 

Background: Physician burnout impacts more than half of obstetrician/gynecologists nationwide.  One strategy to reduce burnout is to improve individual physicians’ resiliency through cognitive and behavioral strategies linked to wellness in other populations.

 

Methods: A prospective, longitudinal cohort, mixed-methods evaluation of a 12-hour curriculum taught to a residency class of seven obstetrics and gynecology interns was conducted using paired, de-identified, pre- and post-curriculum assessments of Maslach Burnout Inventory (MBI), Five Facets of Mindfulness Questionnaire (FFMQ) and Self-Compassion Scale for Researchers (SCS) scores.  Data were analyzed descriptively looking primarily at changes in paired scores.  A post-curriculum focus group was conducted to further investigate curriculum acceptance and impact.

 

Results: Burnout exhaustion and depersonalization scores increased following the curriculum (median difference 3 and 3, respectively). FFMQ and SCS scores also increased (median difference 20 and 7, respectively). Focus group findings suggested interns valued the curriculum, but described an acute increase in distress as they were taken out of their prior “just powering through” coping strategy.

 

Discussions: A wellness curriculum targeting improved resident resilience was associated with an acute worsening of burnout, but with short-term improvements in mindfulness and self-compassion, both of which have been associated with improved well-being and resilience in other populations.  Worsened burnout may have been a result of increased awareness of uncomfortable thoughts and feelings.  Extensive further research is needed on how to develop and measure physician resilience, including long-term implications of improved mindfulness and self-compassion.

Topics: CREOG & APGO Annual Meeting, 2018, Resident, Faculty, Osteopathic Faculty, Residency Director, Professionalism, Interpersonal & Communication Skills, GME, General Ob-Gyn,

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Teaching Lesbian, Gay, Bisexual, Transgendered, and Queer Family Building in a Third Year OBGYN Clerkship

Purpose: To explore third year medical students’ fund of knowledge and attitudes about LGBTQ family building and third party reproduction.

 

Background: Medical student knowledge and attitudes about family building for LGBTQ families and third party reproduction (TPR) varies based on student prior experience and pre-clinical teaching.  The OBGYN clerkship is a unique opportunity for students to learn medical knowledge and reflect on attitudes about this subject.

 

Methods: A quantitative study of knowledge and attitude among third year medical students done after IRB approval. The intervention consisted of a one hour lecture on TPR and participating in a group discussion about LGBTQ family building. Students (231) completed a survey asking about their knowledge and attitudes prior to starting the rotation and 178 completed the survey following the intervention. Survey respondents rated items using a Likert scale and completed a knowledge assessmented. Changes in knowledge scores were investigated using t-tests.

 

Results: Survey respondents were 51% female, 48% male, 1% gender non-conforming; heterosexual 93%; and partnered 59%. Comfort with same sex couples was endorsed by 92%. 56% of students felt that opting out of assisting a patient with family building was not an option. Fertility knowledge increased from after intervention significantly (p<0.0001). Some students, 29%,  thought that infertility was hard to discuss, but 67% felt it would be hard to discuss for same sex couples.

 

Discussions: Medical students’ fund of knowledge was increased with lecture and small group discussion about TPR and LGBTQ patients. Students report being comfortable with TPR and LGBTQ families but have some discomfort with varied pathways to parenthood. Most feel that opting out of care for LGBTQ families is not an option. 

Topics: CREOG & APGO Annual Meeting, 2018, Student, Faculty, Clerkship Director, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, UME, Lecture, Advocacy, Reproductive Endocrinology & Infertility, Sexuality,

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Teaching Cystotomy Repair: Low Fidelity Model Provides Effective Simulation at Minimal Cost

Purpose: To develop an inexpensive bladder model that can be used to teach Ob-Gyn Residents open and laparoscopic cystotomy repair.

 

Background: Recognition of cystotomy and repair is a requirement of Ob-Gyn surgical milestones. Simulation products currently exist for cystoscopy but not for cystotomy repair.

 

Methods: Pilot study of a novel low fidelity bladder model that can be used for simulation of both open and laparoscopic cystotomy repair. A cystotomy model was created using the following materials: small whoopee cushion “bladder mucosa”, shelf liner “bladder muscularis” and Press\'n Seal® for “serosa”.  Markings were placed inside the cushion to represent the trigone with ureteral orifices. Residents were asked to identify the model’s anatomic landmarks and rate their confidence in identifying cystotomy and performing both and open and laparoscopic cystotomy repair, pre- and post-simulation.

 

Results: 16 bladder models were constructed for approximately $1.50 per model. The model is reusable and manipulated well with surgical instruments and suture both open and laparoscopically; the model was a bit large for the laparoscopic trainer and lighting became a challenge for suturing. All participating residents correctly identified the anatomic structures post-simulation compared to 12/13 pre-simulation.  Change in mean resident confidence was statistically significant for identifying cystotomy (pre M=3.1/5 vs post M=4.2/5, p=0.009) and performing open cystotomy repair (pre M=2.4/5 vs post M=4/5, p= 0.03) but not for laparoscopic repair (pre M=1.6/5 vs post M 3.1/5, p=0.09).

Discussions: Our bladder model is easily constructed and inexpensive. It performs well for open cystotomy repair but has been decreased in size to better perform laparoscopically.

Topics: CREOG & APGO Annual Meeting, 2018, Resident, Faculty, Residency Director, Medical Knowledge, Practice-Based Learning & Improvement, GME, Simulation, Minimally Invasive Surgery, General Ob-Gyn,

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Setting New Directions for Medical Student Clerkship Evaluations

Purpose: Compare the number of medical student evaluations with mean evaluation scores, shelf exam scores, and final clerkship grades.

 

Background: The University of Iowa OBGYN clerkship requires 6 evaluations for each student: 2 assigned and 4 requested by student. Many students request more evaluations than required, contributing to a delay in the grading process.

 

Methods: Medical student evaluations from 2014 to 2016 were analyzed. 3 groups were created based on the number of evaluations an individual student received. Group 1 received 3-4 evaluations (n=73), Group 2 received 5-6 evaluations (n=240) and Group 3 received 7-16 evaluations (n=222). Paired T-test was used to compare mean evaluation scores and chi-square test was used to compare mean shelf exam scores and percentages of pass, near honors, and honors grades.

 

Results: 535 students completed the OBGYN clerkship. While mean evaluation scores were similar (86.8-89.1) for each group, compared to group 1, groups 2 and 3 means were statistically greater (p<0.01, and 0.02, respectively). Shelf grade percentages for honors, near honors, and honors were similar for each group; with no difference in group means (p>0.05). Likewise, rates of pass, near honors, and honors grades between groups were similar for each group (p>0.05).

 

Discussions: Increased number of requested evaluations did not translate to differences in rates of pass, near honors, and honors grades for medical students on their OBGYN clerkship, indicating that decreasing the mandatory evaluations per student would not be detrimental to student outcomes and would potentially expedite the grading process.

Topics: CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Systems-Based Practice & Improvement, UME, Assessment, General Ob-Gyn,

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RWJBarnabas Health System: System-wide Obstetrics Collaborative. the Clinical, Research and Teaching Implications and Benefits

Purpose: The eight perinatal hospitals in the RWJBarnabas health care system, with ~25,000 deliveries annually, utilize bi-monthly interdisciplinary meetings to update all sites on quality outcomes, evidence-based best practice, research initiatives and education. This model trains Ob/Gyn residents, as well as the entire health care team on an overall approach to maternity care.

 

Background: In 2015, the perinatal practices at each of the hospitals were functioning  independently, which resulted in variation in clinical practice and outcomes, scant research and different approaches to patient care models for resident education. The RWJBarnabas Health leadership recognized the benefit of a systematic approach to optimize this service and to best utilize the strengths and experience of all its health care obstetrical providers. This would also translate into a stronger model to enhance resident education. This approach was promoted by Dr. Asch who stated in the September 23, 2009 JAMA that the best function Ob-Gyn attendings in NY and FL came from residency programs that emphasized the best-practice of evidence-based medicine in a culture of patient safety. Thus, creating a win-win scenario for quality patient care and resident education.

 

Methods: Supported by corporate leadership the RWJBarnabas Health Ob Collaborative was initiated. The obstetrical department chairs and the Ob nursing administrators from each site met bi-monthly to review pooled data, develop clinical bundles and institute standards of practice at each medical site based on a common EMR. From the pooled data, clinical practice changes and research ideas were also introduced that the health care team and the learners could initiate/participate in.

 

Results: This model has been very effective in improving patient satisfaction, quality and patient safety. This is especially notable in Pain Management, the reduction of SSI and C/Section rates and increased TOLAC/VBAC rates. In addition, medical education for residents includes utilization of standardized evidenced based practices developed by the collaborative across all the sites. The specifics of the data collection will be discussed.

 

Discussions: Not only have there been benefits in the core missions of clinical care, teaching and research, but this model has inspired a joint effort by others within the health care system to further improve outcomes through collaborative educational venues.

 

Topics: CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Systems-Based Practice & Improvement, GME, CME, Quality & Safety, General Ob-Gyn,

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Resident Self Perception of Milestone Level as Compared to the Clinical Competency Committee

Purpose: To assess resident perception of Milestone level as compared to the Clinical Competency Committee (CCC).

 

Background: The Milestone Project was a joint initiative of ACGME, ABOG and ACOG and implemented in July of 2014.  The Milestones serve as a descriptive blueprint to guide curriculum development and assessment practices. They allow programs to more accurately evaluate the outcomes of residency education and allow programs to track resident development over time.

 

Methods: The 24 residents of the Saint Louis University Ob/Gyn program were asked to rate themselves on each of the 28 Milestones based on their perception of where they felt they were in their training.  This was done independent of the CCC.  The CCC met for its semi-annual meeting and completed the Milestone report for each resident in standard fashion.  The CCC was not aware that the residents were also rating themselves on each Milestone. Resident and CCC ratings were compared, with differences defined as a discrepancy ≥1 point.

 

Results: Overall, there was a close approximation of what the CCC and residents determined to be their Milestone level.  Milestone agreement varied slightly by post graduate year, with the greatest agreement observed in PGY-4 (90%) and the least agreement in PGY-3 (79%). When analyzed by Milestone group, the greatest agreement was observed in Interpersonal Communication and Medical Knowledge (90% and 89%, respectively).

 

Discussions: Resident self-perception of Milestone level is comparable to the CCC in our program.  There tends to be slightly more variation among the PGY-2 and 3 levels across all Milestones. 

Topics: CREOG & APGO Annual Meeting, 2018, Resident, Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Assessment, General Ob-Gyn,

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Reliable Assessment of Medical Student Performance on the Obstetrics and Gynecology Clerkship

Purpose: To determine the number of assessors needed to reliably assess medical students’ overall clinical performance during the OB/GYN clerkship.

 

Background: Reliable assessment of students’ clinical performance during clerkships provides important information for decisions regarding grades and advancement.  However, the assessment ratings students receive can vary based on many factors, and there are no clear data regarding the number of assessors needed to obtain a reliable assessment of students’ clinical performance on the OB/GYN clerkship.

 

Methods: During the 2015-2016 OB/GYN clerkship, faculty and residents completed one assessment per student.  Using the overall performance score for each student, we performed generalizability analysis to determine the number of assessors needed to achieve an acceptable threshold of reliability (G=0.7).

 

Results: Students’ mean overall performance score was 6.38+/-1.21 (scale of 1-10).  90.1% of variance in scores was attributed to assessors and 9.9% was attributed to students.  The generalizability estimate for eight assessors was G=0.469.  For other clerkships, G coefficients for eight assessors ranged from 0.000-0.795.  Decision studies suggest that 17 assessors were needed to achieve G=0.7 for the OB/GYN clerkship, compared to 4-12 assessors for other clerkships.

 

Discussions: Much of the variation in students’ overall performance scores can be attributed to assessors rather than students.  We suggest clerkships with high variability among assessment scores find alternative ways to interpret these scores.  For example, we currently use each assessor’s Z score to determine the number of standard deviations each student’s assessment lies from the assessor’s mean student evaluation score to adjust for assessor stringency or leniency. 

Topics: CREOG & APGO Annual Meeting, 2018, Student, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, UME, Assessment, General Ob-Gyn,

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Piloting a Resident-Oriented Leadership Training Program Using the Leadership Observation and Feedback Tool (LOFT)

Purpose: To pilot a leadership training program for residents designed to develop interprofessional and team management skills.

 

Background: Leadership in medicine is increasingly important, however many residency programs lack curricula on how to effectively lead and work on a team of healthcare professionals.

 

Methods: Myers-Briggs Personality Inventory and debriefing were performed prior to intervention for all participants as a prepartory step. Pilot curriculum consisted of 360-feedback, and four 30-minute, interactive, didactic sessions addressing topics in leadership. Residents were randomized to: 1) feedback-only, 2) didactic sessions-only, 3) both, and 4) neither (controls). 360 feedback was obtained using the LOFT, a 29-item questionnaire designed to assess resident leadership behaviors. Evaluations were completed before and after a rotation by 2 to 5 raters (supervisors, peers, and subordinates blinded to randomization status). Trained human resource professionals conveyed 360 feedback. Faculty gave didactics in groups of 1-6 residents. We compared change in LOFT score, adjusted for baseline, between randomization groups in a linear mixed-effects model.

 

Results: Twenty-nine residents completed the pilot and 5-10 per group were available for analysis. Total LOFT score improved (mean change 4.9 points; p<0.001), however, improvement did not significantly differ among any treatment group or controls. Similarly, improvement in each LOFT domain (coaching:1.62, p=0.002, project management:1.81, p<0.001, and self-control: 1.41, p<0.001), was significant but not different by randomization group. Among residents with the lowest quartile of average baseline LOFT, feedback was associated with significantly more improvement than no feedback (3.61, p=0.001). Didactic sessions were not associated with significant improvement overall or by domain.

 

Discussions: Performance feedback has the potential to improve resident leadership behavior as assessed by 360 evaluation. In this pilot study, significant improvement was only observed amongst those with the most room for improvement.

 

Topics: CREOG & APGO Annual Meeting, 2018, Resident, Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, Assessment, General Ob-Gyn,

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OB/GYN Residency Training in Transgender Healthcare: A Survey of U.S. Program Directors

Purpose: To characterize transgender healthcaretraining during OB/GYN residency.

 

Background: Professional medical organizations increasingly recognize the importance of transgender healthcare, but the training currently offered in OB/GYN residencies is not well understood.

 

Methods: We conducted a cross-sectional survey of a regionally representative random sample of 100 from 236 OB/GYN residency program directors between August 2016 and June 2017. Questions addressed demographics, presence and type of resident transgender healthcare training. We compared attitudes, barriers and facilitators between programs that did and did not offer transgender healthcare training using chi-squared testing.

 

Results: Among 61 responding program directors, 50.8% (N=31) reported offering transgender healthcare training, Region of country, program type and size did not differ between those offering and not offering training.  Of those offering clinical training in transgender healthcare, 41.9% did so in generalist and 22.6% in specialist OBGYN clinics, 32.3% provided hormone therapy, and 16.1% learned about gender reassignment surgery techniques.  Programs offering training were more likely to report a transgender community requesting services (90.3% versus 53.3%, p=0.001), interested faculty (45.2% versus 20.0%, p=0.03), time allotted for training (29.0% versus 0%, p=0.001) and resident interest (64.5% versus 36.7%, p=0.03).  The most significant barrier to providing training was lack of interested faculty, reported by 73.3% of programs that did not versus 38.7% that did offer training (p=0.006).

 

Discussions: Only half of responding residency programs offer transgender healthcare training. CREOG named transgender healthcare an educational objective in 2013 and should support this by identifying interested faculty and resident champions who can lead implementation at all OB/GYN residency programs.

Topics: CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, GME, General Ob-Gyn, Sexuality,

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Navigate Stormy Seas with Effective Simulation Training in Delivering Serious News

 

Purpose: To evaluate the change in obstetrics and gynecology (OB/GYN) resident’s self-confidence in delivering serious news after a communication simulation workshop.

 

Background: Although OB/GYN residents regularly disclose serious news to patients, formal training on best communication practices is lacking. Using the VitalTalk framework, we developed and evaluated a workshop for delivering serious news in OB/GYN.

 

Methods: OB/GYN residents attended a 3-hour small group workshop, with didactic and drills (1 hour) followed by practice delivering serious news with simulated patients (2 hours). Change in self-confidence pre- and post-workshop was measured using a 5-point Likert scale (1 is lowest, 5 is highest) and was compared using Wilcoxon signed rank test (alpha = 0.05).

 

Results: Twenty-five residents completed the training.  Residents agreed that delivering serious news requires a discrete set of skills (89%) and is a procedure all residents should learn (96%). Following the workshop, residents expressed greater confidence explaining medical information (p<0.01), identifying and responding to emotion cues (p<0.01), delivering serious news (p<0.001), and teaching learners about how to facilitate delivering serious news (p<0.001). Residents felt that it taught them skills they plan to use (96%), that simulated practice prepared them better than clinical experience alone (92%), that observing other residents improved their own communication skills (80%) and that they would recommend the workshop (96%).

 

Discussions: This workshop was well received and associated with improvement in self-confidence in delivering serious news. Longer-term observation is needed to see if this confidence persists and translates into improved patient care.

Topics: CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Patient Care, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, CME, UME, Simulation, Standardized Patient, Maternal-Fetal Medicine, General Ob-Gyn,

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Multidisciplinary Severe Maternal Morbidity Reviews Can Teach the Clinical Learning Environment Review Focus Areas of Patient Safety and Quality

Purpose: To describe a resident focused multidisciplinary severe maternal morbidity (SMM) review program.

 

Background: The Joint Commission defined SMM as peri-partum blood transfusion of 4 units or admission to ICU and recommends multidisciplinary reviews to determine opportunities for improvement in care

 

Methods: An ongoing process detects cases of SMM with root-cause-analysis performed if case qualifies as a sentinel event. Data is extract and presented quarterly to, a multidisciplinary committee to determine contributory factors, opportunities to alter outcome, best practices and recommendations.

 

Results: Forty-five SMM cases were reviewed from 1/15 to 6/17 by residents 67%, fellows 9%, nurses 7%, and MFM faculty 17%. Opportunities to alter care were determined to be strong in 9% and possible in 62%. System/provider   could alter outcome in 53% while the patient could have altered outcome in 33% of cases.  Outcomes could have been altered by contraception/sterilization in 13%, patient compliance 11%, early prenatal care 20%, referral/consultations 9%, improved documentation 7%, early recognition 33%, team communication 4% and management 31%. Good practices recognized included multidisciplinary teamwork/communication 60%, evidence-based response 36%, timely recognition 24%, documentation 20%, quality obstetric care 22%, timely referral 13%, expertise care 9%, and patient-centered-care 7%. Strong opportunity to alter outcome was present with hypertensive crisis (p=0.026). Significant opportunities to alter outcomes were: preterm SMM cases by contraception/sterilization (p=0.036); patient compliance in Medicaid insured (p=0.01) and younger women (p=0.04). Transfusions were recognized for the good practice of timely recognition (p=0.045).

 

Discussions: Residents’ involvement in SMM reviews can determine care improvement opportunities and provide training on safety and quality.

Topics: CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Quality & Safety, Public Health, Maternal-Fetal Medicine,

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Medical Student Abuse – an Obstetrics and Gynecology Perspective

Purpose: To evaluate medical student mistreatment in obstetrics and gynecology rotations as perceived by physicians and medical students using standardized video-taped vignettes.

 

Background: Medical student mistreatment is pervasive and typically occurs during the third year of medical school.  While most events are minor, the ramifications for the mistreated medical student are real and include increased risk of anxiety, depression, substance use, suicidal ideation, burnout, avoidance of the specialty where the mistreatment occurred and leaving medicine entirely.

 

Methods: Three video vignettes were filmed portraying possible medical student abuse in obstetrics/gynecology clinical settings.  Attending physicians, resident physicians and rotating medical students were asked about their personal experience with mistreatment and then asked to view the three videos.  After each video, participants were asked if they believed the vignette represented medical student mistreatment and to rate the level of severity.

 

Results: Eight attending physicians, ten resident physicians and ten medical students participated in this study.  Fourteen participants (50%) reported previous mistreatment as a student, all of which occurred during third year of medical school.  Neither previously mistreated participants, women participants nor ethnic minority participants were not more likely to view the scenarios as abuse or rate the scenarios as more severe.  Medical students were not more likely to view the vignettes as mistreatment or more severe as compared to resident and attending physicians.

 

Discussions: In our small pilot study, medical students, resident physicians and attending physicians generally agreed which video vignettes represented medical student mistreatment and the level of severity of the abuse.  

 

Topics: CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, UME, Assessment, Team-Based Learning, General Ob-Gyn,

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Improvement in CREOG Scores Through Focused Review Sessions

Purpose: To determine if focused review sessions lead to improvement in CREOG scores.

 

Background: In 2013, faculty at the University of Kentucky developed a Gynecologic Oncology (GYO) review aimed at improving resident scores.

 

Methods: Each year, residents voluntarily participated in five review sessions on major topics in GYO.  Sessions consisted of a pre-test (approximately 15 questions) followed by a discussion that emphasized the key concepts for that subject. From 2014-2017, GYO scores were compared between residents who attended (A) over 50% of the sessions and those who did not (NA). Scores from 2010-2013 were collected as a control group (C). SAS (9.4) was used to analyze the data via ANOVA with repeated measures and least square difference pairwise comparisons. Significance was defined as p <0.05.

 

Results: Data was collected on 153 tests from 55 residents (80 from 2010-13 and 73 from 2014-17). The mean scores for GYO and overall test increased with each resident year (p<0.0001). Attendance revealed a statistically significant improvement on GYO scores when compared to NA (p=0.0001) and C (p=0.0008).  There was no difference between C and NA (p=0.3875). Those who attended also scored significantly higher on overall test scores compared to NA (p=0.0002). There was no difference between A and C (p=0.1747). For those residents who attended multiple years of review sessions, there was no significant improvement in GYO or overall scores compared to less frequent attendees. 

 

Discussions: Our findings support the hypothesis that focused review sessions improved resident comprehension as reflected by CREOG scores.

Topics: CREOG & APGO Annual Meeting, 2018, Resident, Faculty, Residency Director, Medical Knowledge, GME, Assessment, Lecture, Independent Study, Gynecologic Oncology, General Ob-Gyn, CREOG & APGO Annual Meeting, 2018, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Advocacy, General Ob-Gyn,

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