Wellness Challenges and Burnout Contributors: A Systematic Approach to Issue Identification & Program Development
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
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.
institutionally-specific approach to identifying WC/BC issues and prioritizing
them for resource development by Maslow level was successfully implemented.
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
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
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.
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
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
Theater holds promise as a tool for addressing learning environment challenges.
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
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
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.
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
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
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
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.
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
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
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
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
rates of burnout, depression, alcohol abuse, and suicide risk did not change
between the midpoint and end of a structured wellness curriculum.
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
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.
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
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
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
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
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
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.
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
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
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
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-
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
bladder model is easily constructed and inexpensive. It performs well for open
cystotomy repair but has been decreased in size to better perform
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
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
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
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
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
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
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
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).
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.
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
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
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
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
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.
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.
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
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).
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.
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
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
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%).
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.
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
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
involvement in SMM reviews can determine care improvement opportunities and
provide training on safety and quality.
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
evaluate medical student mistreatment in obstetrics and gynecology rotations as
perceived by physicians and medical students using standardized video-taped
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
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.
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
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
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.
findings support the hypothesis that focused review sessions improved resident
comprehension as reflected by CREOG scores.
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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