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Timing the “Fun” to the Fundamentals of Laparoscopic Surgery (FLS) in an Obstetrics and Gynecology Residency Training Program

Purpose: To determine the time required by Obstetrics/Gynecology (OBGYN) residents to gain proficiency with FLS skills

Background: FLS is a standardized assessment of laparoscopic knowledge and skills and an eligibility requirement of The American Board of Obstetrics and Gynecology (ABOG) Qualifying Exam. There is no published data on expected training time to guide curricula planning or how PGY level, prior surgical experience, or milestone assignment may associate with FLS skill acquisition.  

Methods: A prospective cohort study was performed at a community based hospital where PGY2-4 residents were consented to participate in a structured FLS curriculum, which included five skill sessions supervised by gynecologic surgical faculty. Time spent in supervised and self-study sessions was recorded.  A baseline and final assessment of FLS skills was administered noting errors and time to complete. Participants reported PGY level, number of prior laparoscopic hysterectomy cases, and their endoscopic technical skill milestone levels, which were analyzed using multivariate regression analysis. 

Results: No residents (n=17) passed the baseline assessment. All participants passed the final assessment after curriculum completion with improvement in time (-12.2 minutes p = 0.0005) and reduction in errors (-2.5, p = 0.0025). The amount of structured time spent with a faculty member was correlated with improvement in assessment time (r=0.5979)with at least 155 minutes demonstrating significant improvement (p = 0.009). PGY level, milestone level, number of laparoscopies, and self-directed practice were not associated with improvement in performance. 

Discussion: Deliberate practice was the driving factor for FLS skill acquisition independent of PGY, milestone, surgical experience, or self-directed practice time.

Topics: Minimally Invasive Surgery, Simulation, GME, Medical Knowledge, Residency Director, Faculty, 2020, SES,

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Learner-Initiated Feedback Framework Trial (LIFFT): a Formal Framework for Perioperative Feedback

Purpose: To evaluate the effect of a learner-initiated framework for perioperative feedback on the frequency and satisfaction of resident feedback.

Background:  Procedural feedback is an important aspect of resident education and surgical performance improvement.  Satisfaction with feedback has been low in our program (64% reported somewhat, very or extremely satisfied) compared to the ACGME national average (72%).

Methods: This is a prospective cohort study of OBGYN residents at Los Angeles County+USC Medical Center.  A learner-initiated framework was implemented for 3 months of gynecologic cases. After a pre-survey was performed the framework was introduced via didactic.  Residents completed immediate postoperative surveys following each case.  Residents and faculty completed a post-intervention survey.  Primary outcome was proportion of cases in which feedback was given.  To detect a 25% difference in feedback frequency, a total of 99 cases were required with 80% power.
  
Results: Before intervention, residents reported feedback in 25 of 42 cases (59.5%), compared to 82 of 122 cases (67.2%) during the study period (NS). Resident satisfaction (reported sometimes, very, or extremely satisfied) with feedback increased from 67.9% to 90.3% (p=0.003).  Residents also reported both more frequent review of case goals (p<0.01) and receipt of feedback (p=0.007).  

Discussion: Learner-initiated framework objectively raised frequency of feedback received from faculty, albeit non-significantly.  Subjectively, residents indicated they received more frequent feedback and were more satisfied with that feedback.  This trial demonstrated that a formal framework for perioperative feedback significantly improved resident satisfaction with feedback and should be considered for routine use at USC.  

Topics: Assessment, GME, Interpersonal & Communication Skills, Residency Director, Faculty, Resident, 2020, SES,

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Does Self Evaluation Improve Surgical Skills? A Randomized Control Trial: A Pilot Study

Précis: This study investigated the effect of self-evaluation on the improvement of surgical skills by comparing OSATS scores over a 4-month period to determine if the addition of a self-evaluation improved surgical skills more than instructor evaluation alone. 

Purpose: To determine if self-evaluation improves surgical performance more than instructor evaluation alone.

Background: The OSATS score is a validated rating scale for the evaluation of surgical skills. Self-evaluation using OSATS has been compared to instructor evaluation to determine the correlation of the scores. Self-evaluation in combination with instructor evaluation to improve surgical skills has not been studied.

Methods: A RCT was performed in which learners, PGY 1-4, were randomized into either the control group who only received instructor OSATS evaluations or the experimental group who received instructor evaluations as well as self-evaluations. Everyone received the same instructions and performed the same simulation which was videotaped for review.  The instructor was blinded to each arm and the simulation was repeated after four months. The primary outcome was the change in instructor OSATS score over the study period.

Results: Fifteen residents were enrolled and completed the study. There was no difference in the change in instructor OSATS score (p=0.726). There was a correlation in the learner and instructor score for time and motion (p= 0.02) and instrument handling (p=0.008). All participants reported that self-evaluation was a useful educational tool. Only participants from the experimental group reported practicing on their own time.

Discussion: The current study attempted to demonstrate the utility of self-evaluation on surgical education. The correlation between learner and instructor scores are consistent with the literature. Self-evaluation did not improve overall change in score; however, all participants found it useful and it did increase practice at home. 


Topics: SES, 2020, Resident, Faculty, Clerkship Director, Residency Director, Practice-Based Learning & Improvement, GME, Assessment, Simulation, Independent Study,

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Implementing Communications Training for OB/GYN Residents: Disclosure of Adverse Peri-operative Events

Precis: This study investigated the effect of self-evaluation on the improvement of surgical skills by comparing OSATS scores over a 4-month period to determine if the addition of a self-evaluation improved surgical skills more than instructor evaluation alone. 

Purpose: To study the implementation of communications training for OB/GYN residents on the disclosure of adverse peri-operative events

Background: Communication skills are key components of the patient-physician relationship, however, these skills are not routinely taught during OB/GYN residency or fellowship. As OB/GYNs, disclosure of serious news happens routinely in various aspects of patient care.  

Methods: OB/GYN residents at a single institution participated in a 4-hour communication didactics session using VitalTalk methodology.  Participants were surveyed at baseline, immediately following training and 3 months post-training to measure changes in comfort and confidence in the performance of communication skills. A 5 point Likert scale was used to measure comfort/confidence: Novice (1), Advanced Beginner (2), Competent (3), Proficient (4) or Expert (5).  

Results: 27 residents participated in training; 8(29.6%) interns, 7(25.9%) 2nd year, 7(25.9%) 3rd year and 5(18.5) 4th years. 11/27 (40.7%) reported prior communication training. Before training, residents reported the most competence: detecting emotion cues (median: 3.1), detecting patient/family sadness (3.0) and responding empathetically (2.8). Residents felt the least competent: assessing patient/family willingness to discuss perioperative complications (2.0), assessing how much a patient/family wants to know (2.1), confirming understanding of the adverse event (2.3). Baseline comfort and skill performing these conversations was 2.1 and 1.9, respectively. Immediately post-intervention, average comfort and skill level increased to 2.8 and 2.8, respectively. 3 month data is currently being collected.

Discussion: OB/GYN residents self-rate their communication confidence and skills at an advanced beginner level.  Implementation of participatory communication training for OB/GYN residents is feasible and improves both trainee comfort and skills in the disclosure of adverse peri-operative events. Further work is ongoing to understand retention of these skills to inform more longitudinal curricula.  

Topics: General Ob-Gyn, Standardized Patient, Simulation, GME, Interpersonal & Communication Skills, Professionalism, Residency Director, Clerkship Director, Faculty, Resident, Student, 2020, SES,

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Simulation Increases Anticipated Usage of Trigger Point Injections in Treatment of Myofascial Abdominal Pain

PRECIS: Evaluation of a simulation model and didactic training session for the education of ACGME residents in trigger point injections for myofascial abdominal pain in chronic pelvic pain patients.

PURPOSE:  To test a training module for the education of abdominal trigger point injections

BACKGROUND:  For the treatment of chronic abdominal and pelvic pain, training in interventions is lacking among trainees at the residency level.  One very effective and simple intervention is abdominal trigger point injections for the treatment of abdominal myofascial pain syndrome, present in 74% of women in chronic pelvic pain practices.  

METHODS:  This study evaluates an abdominal trigger point teaching model for the training of USMLE OBGYN residency level physicians, containing a multimedia didactic presentation and a gelatin-based abdominal wall injection model.  Participants completed a 10-item knowledge pre- test and an 8-item participant experience questionnaire gauging prior knowledge and experience with myofascial pain syndrome and abdominal trigger point injections.  After 5 minutes of unsupervised time with the gelatin model, a 30-minute scripted didactic session was given, participants interacted post-training with the simulation model, and a post-test was completed.

RESULTS:  Trainees improved from pre-test (48%) to post-test scores (90%) and reported increasing confidence levels on a 5-point Likert scale from 1.67 pre-test to 3.7 post-test.   Ninety percent of participants agreed or strongly agreed that this exercise would result in them using abdominal trigger points in their own practice. 

DISCUSSION:  A simple educational tool containing a short didactic educational module and gelatin simulation model increases knowledge, confidence level and the likelihood of USMLE OBGYN residents to use trigger point injections in the treatment of chronic pelvic pain.

Topics: SES, 2020, Resident, Faculty, Patient Care, Medical Knowledge, Practice-Based Learning & Improvement, GME, CME, Assessment, Simulation, Lecture, Gynecologic Oncology, Pediatric & Adolescent Gynecology, Minimally Invasive Surgery, Reproductive Endocrinology & Infertility, General Ob-Gyn,

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