bluuebunny/crossref_metadata_2025 huggingface dataset:
An Assessment of Knowledge and Comfort Surrounding Pessary Use Among US Ob/Gyn Residents
Authors: Kandadai Padma , Sullivan Gina , Larrieux J. , O'Dell Katharine
Published: September 2016

BACKGROUND:

There is limited information regarding residents' attitudes towards and comfort with pessary use.

METHODS:

A 31-item anonymous electronic survey (Qualtrics 2015, Provo, Utah) regarding attitudes towards, education, and comfort with pessaries was distributed to all U.S. Ob/Gyn residents. Surveys completed between March 1 and June 15, 2015 were used. Participants answered questions regarding pessary education and comfort with pessary-use using a 5-point Likert scale. Descriptive statistical analysis was used with P.

RESULTS:

Four hundred seventy-eight completed surveys were returned (response rate 40%). Mean age was 29.5 (±0.12) years. Participants were evenly distributed among PGY levels (PGY1-25%, PGY2-28%, PGY3-25%, PGY4-22%). Eighty-three percent reported having a dedicated urogynecology rotation, and 72% had a urogynecology fellowship in the department. Compared with junior residents (PGY-1/2), senior residents (PGY-3/4) reported significantly more experience in pessary fitting (77% versus 32%), current feelings of adequate preparation (72% versus 47%), and comfort with pessary management now (72% versus 25%) and anticipated after graduation (70% versus 67%). Having a dedicated urogynecology rotation and outpatient urogynecology experience played a significant role in this comfort, as did having formal didactics specific to pessary fitting and management (P<.001). Having a urogynecology fellowship and receiving didactics only on prolapse and incontinence did not impact comfort and preparation.

DISCUSSION:

Formal rotations with outpatient experience specific to urogynecology and pessary-focused didactics may improve resident comfort with incorporating pessary use into their practice.
Development of a Medical Student Online Case Study Curriculum: Cases in Obstetrics and Gynecology (COGs)
Authors: Pierson Rebecca , Schnee D. Mark , Di Corcia Mark , Litwiller Abigail
Published: September 2016

BACKGROUND:

As the size of medical school classes grows, the challenges of standardizing the educational experience also increase, particularly when schools must use multiple educational sites to accommodate large groups of students. Here we describe the development, validation, and implementation of an online system of interactive Ob/Gyn case studies that help address this issue. Other clerkships have successfully used this type of curricula but nothing of this kind is available for Ob/Gyn clerkships.

METHODS:

A series of 25 online, interactive cases were developed that included obstetric and gynecologic topics that were linked to the APGO Medical Student Educational Objectives.

RESULTS:

Comparison of National Board of Medical Examiners (NBME) subject exam scores for the year of implementation to historical data showed no significant difference in mean score by rotation as well as no significant difference in first time pass rate. Subjective data were also captured on student opinions and perceptions regarding contribution to general Ob/Gyn knowledge and usefulness of cases in exam preparation. A majority of students felt that the cases enhanced their clerkship experience and were useful for subject exam preparation (77.5% and 65.3% respectively).

DISCUSSION:

The case series is a useful addition to standard Ob/Gyn clerkship curriculum which increases student exposure to a standardized set of topics and increases positive perception of the Ob/Gyn clerkship.
Evaluation of Ethics Education in Ob-Gyn: A Survey of Resident Physicians
Authors: Byrne John , Derby Katherine , Chor Julie
Published: September 2016

BACKGROUND:

Ob-Gyn residents face a myriad of ethically challenging situations, both specialty-specific and universal to all medical specialties. Ob-Gyn-specific Milestones require programs to assess residents' abilities to implement key ethical principles and behaviors. However, there is limited research evaluating resident preparedness in addressing ethically complex situations.

METHODS:

A cross-sectional, web-based survey was deployed to residents from 9 of 11 ACGME accredited Ob-Gyn residency programs in Chicago. The survey was modified from a prior survey of Ob-Gyn residency program directors and developed in collaboration with a professional survey lab at the University of Chicago. Descriptive statistics were used to analyze data.

RESULTS:

Of 191 eligible ob-gyn residents, 111 (58%) responded to the survey. Most respondents were from university-based programs (n=90, 81%) without religious affiliation (n=81, 73%). Only 23% (n=26) of respondents indicated their program included ethics in its core educational curriculum. Eighty percent (n=89) of respondents stated their program dedicated 0–5 hours per year to ethics. The vast majority of residents (n=90, 81%) would like “more” to “a lot more” ethics education and believed it should be required (n=72, 65%) for residency completion. Forty-two percent (n=47) of respondents stated they felt “somewhat” or “very unprepared” to deal with ethically challenging situations. Residents identified curricular crowding (n=87, 78%) and limited faculty expertise (n=69, 62%) as barriers to receiving formal ethics education.

DISCUSSION:

Although barriers such as time constraints and faculty inexperience exist, Ob-Gyn residents desire greater ethics education in residency training.
Implementation of a Novel iOS Application to Improve Patient Handoffs
Authors: Turner Taylor , Bevis Kerri , Yan Tony , Yeh Jason
Published: September 2016

BACKGROUND:

Shift changes are complex and present opportunities for error. At Duke University, inpatient services have a pager number that must be linked to a specific resident's pager, requiring seven phone calls and 168 keystrokes. A single error can prevent communication between nursing staff and residents. An application for iOS was released January 2015, reducing the total keystrokes to seven.

METHODS:

An anonymous survey was sent to all residents who had the application available to them. Phone records were reviewed for handoff errors before and after implementation of the application. Each transition of care was evaluated for timely re-assignment of pagers.

RESULTS:

Twenty-five of 38 residents (66%) responded to the survey. Ninety percent of respondents had an iOS compatible device and 40% installed the application. Eighty percent of those with it installed used the application, and 100% of users felt it reduced errors. Two hundred total handoff events were evaluated. Pre-implementation there was a 29.9% error rate, with the application available the error rate was 31.6%.

DISCUSSION:

A mobile application to improve patient care handoffs was not widely used despite high levels of software compatibility. There was no improvement in error rates of pager assignments in our preliminary evaluation, however residents using the application felt it reduced errors. This study demonstrates the difficulty in implementing technology-based tools to reduce errors in handoffs, in both utilization rates and predicting efficacy. Future development efforts should consider these issues.
Network Analysis of Mentoring: A Tool for the Assessment and Management of Mentoring
Authors: Smith Roger , Learman Lee
Published: September 2016

BACKGROUND:

Mentoring works only when the goals of both the mentor and mentee are well aligned. The most effective mentoring relationships must include feedback, which is possible only in acknowledged, bilateral, relationships. Social network analysis tools lend themselves well to evaluating these aspects of mentoring.

METHODS:

Network analysis tools were used to create network maps and descriptive quantification of mentoring relationships. Data were obtained over a 2-year period using a standardized tool, which provided definitions of mentoring and asked faculty to list their mentors and mentees and perceived strength of each relationship.

RESULTS:

Thirty faculty (93.8% of possible responders) participated in 2013 and 33 (94.3%) participated in 2014. Network analysis in the first year showed a robust, but clustered, network of mentoring consisting of 4 communities, which became more diverse (6 communities) in the second year. The number of faculty without an identified departmental mentor declined by half, from 6 (20.0%) in 2013, to 3 (9.1%) in 2014 (P=.22). The number of faculty who reported no mentees declined steeply from 22 (73.3%) to 9 (27.3%) (P<.01). The mentor acknowledged one or more relationships in 75.0% of cases in 2013 and 70.4% of cases in 2014 (P=.54).

DISCUSSION:

Network analysis is a promising tool to assess mentoring in an academic department, identify gaps and track changes over time.
Ob Gyn Intern Boot Camp: Educational Outcomes-Council for Residency Education in Obstetrics and Gynecology Examinations and Preparedness for Clinical Care
Authors: Haver Mary , Rauth Virginia , Borahay Mostafa , Jain Sangeeta , Bastien Sherry , Wen Tony
Published: September 2016

BACKGROUND:

Traditional resident education were weekly lectures, M&M and surgical training involving “see one; do one and teach one.” In more recent time, clinical training in both medical school and residency has been significantly impacted by national educational policies, a focus on patient safety and a decrease financial support for indigent health care.

METHODS:

IBC 3-days curriculum was composed of reading materials and lectures on prenatal care, labor, contraception, surgical techniques, abortion (Ab) and ectopic pregnancy, ward emergencies, postpartum hemorrhage (PPH), postoperative fever and postpartum care, fluid/electrolytes and pain management. The simulation trainings included pap/bimanual exam, vaginal and cesarean delivery, knot and suturing, IUD insertion, episiotomy repair, Ob ultrasound, and ward emergency, postop infection and pulmonary emboli (PE) management. Data on medical school graduates, gender, USMLE step 1 and 2 exams were compared. A 17-questions survey on their clinical skill preparedness in various Ob Gyn clinical settings scored on a 7-likert scale with score of 1–3 for not well-prepared and score of 5–7 for well-prepared for patient evaluation/management and Ob Gyn procedures.

RESULTS:

The IBC and NBC groups were similar in gender, medical school attended and step 1. The IBC group did score significantly higher on step 2. There was a trend for higher CREOG and higher portion of residents scored above the national mean of 200. The IBC group felt better prepared to manage in Ob triage (4.27), clinic (4.47), postop fever (4.80), PE (4.13), Ab (4.47), and ectopic (4.40). However, IBC group felt less prepared to perform procedures: suturing (4.47), SVD (4.47), CS (3.33), D&C (3.93), Colpo (4.80), and IUD insertion (4.47) and to manage ward call (3.93) and PPH (3.87).

DISCUSSION:

Residents who received IBC training felt better prepared to manage Ob triage, clinic, postop fever, PE, ab, and ectopic, but less prepared to manage labor, PPH and to perform Ob Gyn procedures. Despite scoring higher in CREOG, they still felt less prepared.
Obstetric Hemorrhage: Improving Readiness and Response in a Community Hospital
Authors: Gupta Ankita , Daniels Kelli
Published: September 2016

BACKGROUND:

The rates of PPH in the US have steadily increased over the years up to almost 3% in 2006. In order to improve the safety of patient care and decrease the rates of morbidity from PPH, a QI project was designed.

METHODS:

The planning phase of our PDSA cycle assessed current deficits including lack of provider skill with procedures like Bakri balloon and B lynch suture placement and systems errors like a lack of a specific PPH reporting form. An intervention was designed including lectures, on site simulation drills and skills workshops to address these deficiencies. A severe maternal morbidity reporting form has been proposed. A mobile based app was developed as a quick reference tool for providers to aid in the management of PPH. The results of this intervention were studied using paired t tests for analysis of pre and posttest questionnaires judging knowledge and provider comfort with procedures.

RESULTS:

A statistically significant difference was noted between provider comfort in diagnosing PPH, calculating estimated blood loss, placing a Bakri balloon, placing a B-lynch suture and requesting blood products for management of PPH with P<.05.

DISCUSSION:

A simple, low-cost intervention including simulation drills, skills workshops and a free mobile app, can improve provider knowledge and comfort with management of PPH, impacting patient safety.
Peer-to-Peer Interactive Breast Health Training With Simulation: Effect on Medical Student Anxiety and Exam Scores
Authors: Steen Claire , Hou Melody
Published: September 2016

BACKGROUND:

Changes in national screening guidelines have decreased student clinical experience with breast health, which may be ameliorated using a case-based simulation model in the curriculum.

METHODS:

A case-based interactive peer-to-peer didactic using a breast simulation model was introduced to the OB/GYN clerkship curriculum at the University of California, Davis School of Medicine during AY2013-2014. Students who underwent the didactic completed pre- and post-didactic surveys assessing anxiety regarding breast health. The post-didactic survey was compared to a survey of students from AY2012-2013 who did not experience this didactic, as were each group's OB/GYN shelf exam performance on breast health questions.

RESULTS:

Fifty of 96 students (52%) from AY2012-13 and 63 of 97 students (65%) from AY2013-14 completed the survey. Among AY2013-14 students, there was no significant difference in anxiety before and after the didactic (P=.12), nor when compared with AY2012-13 students (P=.25). However, 26 of 63 (41%) of students from AY2013-14 reported anxiety about differentiating malignant versus benign disease, compared with 35 of 50 (70%) students from AY2012-13 (P=.002). On the OB/GYN shelf exam, AY2013-14 students collectively performed 13% higher than national average on breast health questions, while AY2012-13 students performed 3% higher than national average.

DISCUSSION:

A case-based simulation model did not improve anxiety regarding breast health. However, students who experienced this didactic session had improved confidence in benign versus malignant differentiation and improved exam performance compared to students who did not.
Surgical Case Logging Habits and Attitudes: A Multi-Specialty Survey of Residents
Authors: Cadish Lauren , Fung Vicki , Lane Felicia , Campbell Eric
Published: September 2016

BACKGROUND:

The Accreditation Council for Graduate Medical Education measures surgical residents' experience by mandating that residents log each procedure in which they have participated. This system is the primary mechanism by which breadth and depth of surgical training are documented.

METHODS:

Investigators developed and administered a voluntary, 45-item survey to all general surgery, obstetrics and gynecology, orthopedics, urology, neurosurgery, otolaryngology, and plastic surgery residents at a large academic medical center. Resident demographic data, program details, logging behaviors, and attitudes were examined using descriptive statistics. Authors used multivariate logistic regression to assess characteristics associated with logging habits.

RESULTS:

Eighty-two of 126 surgical residents participated, yielding a response rate of 65%. Overall, 7.5% considered the system highly inaccurate, 28.8% somewhat inaccurate, 52.5% somewhat accurate, and 11.3% highly accurate. Nearly half (48.1%) use an incorrect metric to log their role as surgeon or assistant. Half logged monthly or less frequently. The longest time residents reported falling behind ranged from less than a week to more than a year, with about half (51.4%) reporting backlogs of 3 months or longer. Approximately two-thirds considered the system difficult to navigate (64.2%) and burdensome (68.8%).

DISCUSSION:

Inconsistency of logging habits and perceived lack of accuracy raise concerns about use of the system for assessing surgical preparedness or accrediting training programs.
Training Costs in a Surgical Subspecialty
Authors: Buys Elizabeth , Galvin Shelley
Published: September 2016

BACKGROUND:

Resident training is expensive, ∼$80,000/resident/year. As the healthcare system evolves, residencies must evolve to produce physicians competent to meet future needs and challenges. Yet additional GME dollars haven't accompanied IOM calls for a larger, high-quality physician workforce. Current funding may already be insufficient. We wanted more clarity about the real costs of training in a surgical subspecialty.

METHODS:

The minimum thresholds for surgeries performed by generalist OBGYNs are: Cesarean=145; TAH=35; TVH=15; TLH=20; Incontinence=25; Cystoscopy=10; Laparoscopy=60; Hysteroscopy=40; Total=350. We assigned each PGY a proportional threshold and OR time based on historical reports—longer durations to novice-advanced beginners and shorter durations to competent-proficient surgeons. We estimated hours of surgery-related clinical activities (CA). Faculty: surgery conference (1-h/wk); outpatient pre-op and post-op appointments and checkouts (4-h/wk and 2-h/wk); inpatient pre-op (5 min/procedure); rounding-morning (1-h/shift×5-days×4-residents); rounding-evening (1-h/shift×5-days); case preparation (30-min/procedure); case logs (5 min/procedure) evaluation (5 min/procedure); and simulation (16-h/year×4-faculty). Residents: surgery conference (1-hr/wk); outpatient pre-op and post-op appointments and checkouts (4-h/wk and 4-h/wk, respectively); inpatient pre-op (5 min/procedure); inpatient supervision (1-h/shift×5-days); case preparation (15-min/procedure); evaluation (5 min/procedure); and simulation (16-h/resident). We calculated the mean generalist hourly wage (salary+benefits/40 hours/52 weeks; no call) and the mean hourly wage by PGY (salaries+benefits/80 hours/52 weeks).

RESULTS:

Total costs=$323,389: Faculty=$194,462 (OR=$70,836; CA=$123,626); Residents=$128,927 (OR=$9,281; CA=$119,646).

DISCUSSION:

Meeting minimum surgical thresholds exceeds the ∼$320,000/resident/4 years. To include training costs of L&D, ambulatory care, cancer procedures and other experiences of robust physician education, funding streams, (direct and indirect dollars) must evolve also.
A Quality Improvement Curriculum in Ambulatory Obstetrics and Gynecology: Development and Implementation With OBGYN Residents
Authors: Habak Patricia , Manriquez Maria , Ayutyanont Napatkamon
Published: September 2016

Local Mentor: Maria Manriquez, MD

APGO Advisor: Lee A. Learman, MD, PhD

PURPOSE:

To develop a quality improvement (QI) curriculum for Obstetrics and Gynecology (OBGYN) residents using on-line modules from the Institute for Healthcare Improvement's Open School.

BACKGROUND:

OBGYN residents need to acquire knowledge and skills in quality improvement to be prepared to participate in this process in ambulatory practice.

METHODS:

We designed a QI curriculum for residents using on-line modules from the Institute for Healthcare Improvement's Open School. The curriculum comprised three introductory modules supplemented with small group sessions during which ambulatory based QI projects were developed. Completion of the curriculum was a required component of residency training.

EVALUATION PLAN:

Residents completed a pre and post-curriculum survey. The survey included an eleven-question test of knowledge and a nine-question assessment of attitudes and confidence. Knowledge questions were drawn directly from the modules and graded on number of items correct; attitude and confidence questions were scored on a 5-point, Likert-type scale with 5 representing greatest confidence and perceived value surrounding QI issues. Mean knowledge scores increased from 7.25 to 8.72 following completion of the curriculum (P<.001). Similarly, mean attitude scores increased from 3.51 to 3.98 (P<.001). Ninety-seven percent of residents completed the modules and all small groups were successful in development of proposed ambulatory-based quality improvement projects.

DISSEMINATION:

Planned submission to the AAMC Med-Ed PORTAL.

REFLECTIVE CRITIQUE:

Residents showed gains in knowledge and confidence. Residents' development of quality improvement projects would have benefited from addition of a Quality Analyst. Our intent is to continue to develop and carry out the projects identified.
Assessing Qualitative and Quantitative Competence of Resident Knowledge in Communication of Procedure-Specific Risk for Suction Dilatation and Curettage and Vaginal Hysterectomy
Authors: White Amanda B.
Published: September 2016

Local Mentors: John Gianopoulos, MD, and Amy Young, MD

APGO Advisor: Nancy Hueppchen, MD, MSc

PURPOSE:

Perform a knowledge assessment of OBGYN residents' communication of procedure-specific risk for two common gynecologic procedures.

BACKGROUND:

Informed consent is integral to patient autonomy. For surgical patients, satisfaction improves with understanding of the procedure performed. Standardized curriculum for the informed consent process has not been utilized to date. An assessment of resident knowledge in the communication of accurate and adequate information is essential to ensuring adequate disclosure.

METHODS:

Two medical students, 19 residents and 22 faculty were surveyed on understanding of informed consent process and knowledge source on the topic. Respondents identified procedure specific risks for dilation and curettage and vaginal hysterectomy as required by the Texas Medical Disclosure Panel. Statistical analysis was performed to determine knowledge adequacy (unsatisfactory, satisfactory, superior). Interest in formal curriculum was assessed.

RESULTS:

Overall response rate was 74%. Learners were predominantly female (89%) aged 25–29, and evenly distributed across training year. Interval from last surgical rotation was <1 month at all levels. R4/Faculty identified textbooks and American College of Obstetricians and Gynecologists bulletins as their source of knowledge more frequently than other learners (P<.05). Qualitative competence improved with training year (P=.04). Quantitative competence was unsatisfactory at all levels for suction D&C with no difference by PG year (P=.94). Quantitative competence was satisfactory at all levels for vaginal hysterectomy, with no difference by PG year (P=.762). Learners identified formal teaching and direct observation as desired instructional methods.

DISCUSSION:

Though qualitative competence improves with PG training year, the communication of adequate and accurate information remains a challenge at all levels, specifically for suction dilation and curettage. Standardized curriculum should be implemented to achieve competency.
Development of a High Value Care Educational Module for Obstetrics and Gynecology Residents
Authors: Reddy Madhuri , Cantrell Leigh A.
Published: September 2016

Local Mentors: Carrie Wieneke, MD, and Michael Moxley, MD

APGO Advisors: Alice R. Goepfert, MD, and Lee A. Learman, MD, PhD

PURPOSE:

To develop an educational module introducing high value care concepts to obstetrics and gynecology residents.

BACKGROUND:

Cost effective care is one of the 28 ACGME milestones to be achieved during residency training. It is imperative that physicians are aware of the components of the cost of medical care and how to maintain quality while containing cost.

METHODS:

Needs assessment was performed by surveying graduating seniors and junior faculty. Knowledge gaps were identified and an introductory educational module was designed. This module provides basic information defining high value care and how it can be achieved in clinical settings using a few simple tools; it was presented as an interactive small group discussion with activities illustrating cost-effective care using real life examples.

EVALUATION PLAN:

Participants of the study were OB/GYN residents (n=26) at two academic institutions. The introductory module started with a pretest. Evaluation of knowledge gained and decay was performed by an immediate post-test and a retention test 3 months later. The testing results are reported elsewhere.

DISSEMINATION:

In addition to submission to CREOG-APGO Annual Meeting, the module can be disseminated through AAMC MedEdPORTAL.

REFLECTIVE CRITIQUE:

Traditionally, the attitude of American medical care has been to use all available resources. A shift to taking care of patents using only the appropriate resources is a culture shift for both learners and teachers. Creating a module that is informative and interesting while achieving the goal of changing practice styles was challenging. Development of a robust national curriculum for ob/gyns should be undertaken.
Does an Advocacy Curriculum Focused on Healthcare Disparities Improve Residents' Knowledge and Utilization of Community Resources?
Authors: Hamm Jennifer , Conklin Kendra , Gaskins Jeremy
Published: September 2016

Local Mentor: Sara Petruska, MD

APGO Advisor: Lee A. Learman, MD, PhD

BACKGROUND:

Knowledge regarding health care disparities and local resources available to combat them is an important objective of resident education.

OBJECTIVE:

To evaluate resident knowledge of healthcare disparities and reported utilization rates of related community services before and after participation in a newly developed advocacy curriculum.

METHODS:

This was a prospective, cohort study of University of Louisville Ob-Gyn residents. Knowledge of health care disparities and local resources, as well as utilization rates were assessed via online survey before, immediately following, and 3-month after participating in a healthcare advocacy workshop. Nonparticipating residents completed the pre-course and 3-month follow-up surveys. A 3-point scale was used to assess disparity and resource knowledge (very, somewhat, not at all) and resource utilization rates (frequent, occasional, never).

RESULTS:

The 16 workshop participants had response rates for the pre-course, post-course, and 3-month follow up surveys of 100%, 75%, and 50%, respectively. The 4 non-participants had response rates of 100% pre-course and at 3-month. Baseline disparity knowledge (1.98, 1.55), local resource knowledge (1.44, 1.40) and resource utilization (1.77, 1.57) scores were similar for both groups. Immediately post-workshop, participants demonstrated a global increase in disparity knowledge (2.38) and local resource knowledge (2.29). Three-month disparity knowledge (2.45, 2.22), local resource knowledge (2.27, 2.10) and resource utilization rates (2.21, 2.10) were similar in participants and non-participants.

CONCLUSION:

Resident participation in a health care advocacy curriculum was followed by an immediate increase in reported knowledge of healthcare disparities and local resources. However, similar gains were seen among non-participants at 3-months post-course.
Impact of Faculty Development on Feedback of OBGYN Resident Performance
Authors: Brooks Alison
Published: September 2016

Local Mentor: John Gianopoulos, MD

APGO Advisor: Lee A. Learman, MD, PhD

PURPOSE:

To improve the quantity and quality of faculty feedback on OBGYN resident performance.

BACKGROUND:

Resident performance feedback is a faculty expectation and an ACGME requirement. In 2015 our residency program received a score of 68% compliance for resident satisfaction with feedback after assignments, and identified a need for improvement.

METHODS:

A 30-minute didactic educational intervention on meaningful feedback was administered to the 19 residents and 19 faculty in our program. Immediately before and 3 months after the intervention, all OBGYN residents and faculty completed a questionnaire regarding quantity and quality of oral and written feedback after surgical and non-surgical encounters. Paired t test was performed comparing pre- and post-intervention data.

RESULTS:

Eighty-nine percent of residents and 95% of faculty participated in the intervention, and 100% in each group completed the pre- and post-intervention questionnaires. The percent of residents reporting “some” or “a lot” of oral feedback increased from 58% to 79% (P=.05). The percent of faculty reporting they provided “some” or “a lot” of oral feedback increased slightly from 83% to 95% (P=.19). The quantity of written feedback reported by residents did not improve (43% pre and post) and by faculty improved slightly from 48% to 61% (P=.28). The perceived quality of oral and written feedback did not improve.

DISCUSSION:

A short educational intervention was associated with marked improvement in the quantity of oral feedback but was not associated with improvements in written feedback nor the perceived quality of feedback from faculty to residents.
Is Direct Interaction With Preceptors Linked to Clerkship Satisfaction and Medical Knowledge Gain?
Authors: Schnee D. Mark , Pierson Rebecca C. , Stewart J. Ryan , Learman Lee A.
Published: September 2016

Local Mentor: Lee A. Learman, MD, PhD

APGO Advisor: Alice R. Goepfert, MD

PURPOSE:

To evaluate the correlation between direct-interaction time of OBGYN students with preceptors and their clerkship satisfaction and medical knowledge acquisition.

BACKGROUND:

Historically, physician-teaching ratings by students have predicted NBME subject exam scores and level of interest in the preceptor's specialty. Finding that direct-interaction time is also important could justify increased faculty support for teaching.

METHOD:

MS3 students (n=176) enrolled in the OBGYN clerkship were eligible for this IRB-approved study. Students received the study overview and instructions during clerkship orientation. Participating students texted logged minutes daily to a designated phone number linked to a secured database. The NBME score, clerkship satisfaction survey and logged interaction time were merged into a de-identified database for analysis. Spearman correlation coefficients were calculated to estimate associations of participation in minutes logged, NBME scores and clerkship satisfaction.

RESULTS:

26.7% (n=47) of eligible students reported their direct interaction time. The median direct interaction time was 633 minutes. Associations between numbers of minutes reported with NBME scores, clerkship satisfaction, and level of interest in OBGYN before and after rotation were small and not statistically significant. No difference in clerkship satisfaction was found between students reporting minutes versus no minutes.

DISCUSSION:

The low participation rate increases the likelihood of reporting bias in which motivated students were more likely to participate. Documentation of the precise number of minutes daily was also subject to student motivation. In this small study, no statistical association was found between the number of minutes reported with test scores or clerkship satisfaction.
Knowledge of Cost Consciousness in Obstetrics and Gynecology Residents
Authors: Cantrell Leigh A. , Reddy Madhuri
Published: September 2016

Local Mentors: Michael Moxley, MD, and Carrie Wieneke, MD

APGO Advisors: Lee A. Learman, MD, PhD, and Alice R. Goepfert, MD

PURPOSE:

To evaluate the short and long-term retention of knowledge of cost effective care gained by residents after a pilot intervention.

BACKGROUND:

Increasingly, physicians are expected to practice cost conscious medicine. Resident education must include a basic understanding of cost for their future practice patterns and to fulfill an ACGME milestone.

METHODS:

A high value care module was developed and implemented at 2 academic Obstetrics and Gynecology residency programs comprising 32 residents. Module development is described in a separate report. A survey assessing knowledge was developed, pre-tested, refined and conducted before and after the intervention to determine immediate knowledge change and then at 3 months post intervention to determine knowledge decay.

RESULTS:

Of the 26 residents participating in the intervention, 62% reported no prior education regarding cost-effective care and as the remainder reported their prior education as “on the fly with an Attending.” The percent reporting somewhat to very little knowledge of cost effective care principles fell from 85% to 65% immediately after the intervention (t=1.61; P=.06) and to 63% after 3 months. Residents' tested knowledge improved from 31% correct to 69% immediately post intervention (t=2.95; P=.002) and decayed to 46% at 3 months (t=1.13; .13).

DISCUSSION:

A module addressing the cost-effective care milestone for Obstetrics and Gynecology residents improved low baseline knowledge with moderate decay after 3 months. Next steps will include a larger study of multidisciplinary residents with ongoing study of methods to reinforce knowledge long-term.
Resident Feedback to Improve Bootcamp Effectiveness
Authors: Mendez Melissa D. , Khamsi Naima , Rondeau Nancy U.
Published: September 2016

Local Mentor: Veronica T. Mallett, MD, and J. Christopher Carey, MD

APGO Advisor: John L. Dalrymple, MD

PURPOSE:

To incorporate resident feedback into a boot camp course and assess resident learner satisfaction.

BACKGROUND:

APGO/CREOG Milestone One outlines the knowledge and skills an Ob/Gyn intern should have upon starting residency. Some institutions conduct an intern boot camp; an intense, short course designed to meet Milestone One. Our first boot camp was conducted July 2014 and our second July 2015 and included 19 topics and 5 skills stations.

METHODS:

IRB approval was obtained. After each boot camp, incoming and returning residents were surveyed to assess perceptions of the interns' performance, satisfaction with preparation for internship, and suggestions for additional boot camp topics. A 5-point Likert scale was used to determine topic relevance.

RESULTS:

Five interns (100%) and ten residents (82%) were included in the study. Topics scoring the highest number of “somewhat” and “very” important were given priority for inclusion in the second boot camp. Laparoscopic skills, sutures and hypertension in pregnancy were added into the second boot camp. After the first boot camp, 60% (6/10) of the residents and 60% of the interns (3/5) interns felt that the boot camp was helpful to the interns. After the second boot camp, 100% (6/6) of the residents and 80% of the interns (4/5) felt the boot camp was helpful to the interns.

DISCUSSION:

Our results indicate that resident input and feedback on bootcamp development and effectiveness resulted in high satisfaction rates and readiness perception by both interns and residents. We plan to continually expand and improve our curriculum each year.
Impact of Video-Based Coaching on Gynecologic Resident Laparoscopic Suturing
Authors: Donnellan Nicole , Rindos Noah , Biglan Minhnoi Wroble
Published: September 2016

BACKGROUND:

Laparoscopic surgery affords patients superior outcomes to traditional open surgery. Despite this ubiquitous data, barriers to implementation stem from current resident training, including work hour restrictions and increased procedural oversight, thus necessitating greater emphasis on simulation curriculums. Coaching enhances performance by identifying, focusing on, and achieving specifics goals. Historically attributed to athletics, performance coaching has become a professional development tool in business, education and medicine. Thus, we aimed to evaluate the addition of video-based coaching to an established laparoscopic simulation curriculum on suturing performance.

METHODS:

Twenty OB/GYN residents (7-R1s, 7-R2s, 5-R3s and 1-R4) undergoing a 5-week laparoscopic simulation curriculum were video-recorded weekly performing a suturing task. Residents were randomized to receive standard curriculum or standard curriculum plus weekly video review/coaching meetings with a single expert laparoscopic surgeon. Two different expert laparoscopic surgeons independently graded videos. Primary outcome measure was comparison of weekly GOALS score of the suturing task.

RESULTS:

R3s started with significantly higher GOALS scores than R1 and R2s (P<.001), with no difference in GOALS scores across groups (P=.406). All residents showed significant improvement in suturing over the 5-week period (P=.005), with R1s showing greater improvement than R3s (P=.001). There were significantly improved GOALS average scores following the initial video intervention in R1/R2s compared to the control R1/R2s (3.14 versus 3.79, P<.043) with more gradual improvement seen in both groups in subsequent weeks.

DISCUSSION:

Video-based coaching during simulation training has its greatest impact early on novice learners skill acquisition, providing another tool to supplement simulation training.
Interventions to Maximize Medical Student Learning of Cystoscopy
Authors: Brincat Cynthia , Taege Susanne , Shah Arpeet
Published: September 2016

BACKGROUND:

We have sought to involve medical students in our cases by having them perform the cystourethroscopy portion of the case. This typically takes place at the end of the case, and is a low risk procedure where a camera is placed through the urethra into the bladder to assess bladder and ureteral integrity. Presently it is a see one, do one teaching technique.

METHODS:

After IRB exemption, we sought to assess medical student skills at cystourethroscopy after varying teaching interventions and correlate if student satisfaction correlated with skill level. An investigator blinded to the intervention assessed medical students doing cystourethroscopy with the OSATs checklist in each of three groups: 1-students rotating on urogynecology will experience the routine teaching of see one, do one. Two-students rotating on urogynecology will view a slideshow lecture in orientation and then have the routine standard teaching of see one, do one. Three-students rotating on urogynecology will have the opportunity to practice cystoscopy on a low cost simulation model, as well as view a slideshow lecture in orientation.

RESULTS:

Data are still being collected. We will assess 1) skill level, 2) satisfaction with the clerkship, and 3) assess if there is any correlation between the two, or their intervention group.

DISCUSSION:

We hypothesize that skill level does not correlate with intervention, however the more involved intervention will correlate with improved clerkship satisfaction.
Laparoscopic Salpingectomy: A Simulation-Based Resident as Surgical Teacher (RAST) Program
Authors: York-Best Carey , Bengtson Joan , Stagg Amy
Published: September 2016

BACKGROUND:

The ACGME considers resident teaching skills to be a core competency. Simulation is a time efficient way to teach laparoscopic surgical skills.

METHODS:

An OSTE (Objective Structured Teaching Examination) was devised to evaluate senior resident teaching skills and an OSATS (Objective Structured Assessment of Technical Skills) was devised to evaluate junior resident laparoscopic skills. Resident teacher/learner dyads performed a simulated laparoscopic salpingectomy and were evaluated by a faculty observer. The resident pair also evaluated each other. After didactic teaching the pairs were re-evaluated. Residents were surveyed pre and post the program on their attitudes around surgical teaching.

RESULTS:

Most residents initially felt comfortable/neutral in their ability to teach surgery and felt neutral that they had received instruction on surgical teaching. Post-workshop residents showed increased confidence in teaching and acknowledged they had received instruction on teaching surgery. Faculty observers noted a 1.3 point increase in the OSTE scores of the senior residents (P=.006). Junior residents noted a 0.43 point increase in teaching scores (P=.004). Faculty noted a 0.73 point increase in OSATS score of the junior residents (P=.004), compared with a 0.35 point increase noted by senior residents (P=.10).

DISCUSSION:

The Laparoscopic Salpingectomy Simulation-Based RAST Program provides a time efficient, reproducible means for residents to learn and practice surgical teaching. Residents felt it supplemented previous teaching. Faculty observers noted significant improvement in OSTE scores of senior residents. The smaller improvement noted by the junior residents was largely because they ranked their senior residents highly even on the initial simulation.
The Educational Value and Feasibility of a Video-Capture System in the Surgical Training of OBGYN Residents
Authors: Pellini Timothy , Martino Martin , Patruno Joseph
Published: September 2016

BACKGROUND:

Many professions utilize video-capture technology for training and skill improvement. This study explores the utility, sustainability, and effectiveness of this technology as part of a resident surgical evaluation process. In order to optimize surgical training we utilized video-capture technology (SimCapture) as residents performed surgical procedures. Point-of care feedback using standard evaluation tools and video-review, using the same evaluation tools was also conducted.

METHODS:

We recorded a group of OBGYN residents performing one of four surgeries over 8 weeks. This project was considered IRB exempt. An ACGME milestone evaluation and OPRS (operative performance rating system) specific to the procedure was used to evaluate performance. The video was then evaluated by another faculty member, blinded to the resident's level of training, using the milestone and OPRS forms. Data were collected and analyzed regarding the value of the process as a tool to optimize surgical teaching.

RESULTS:

We hoped to assess approximately 25% of cases for our pilot project. Surgical evaluation and survey data regarding the educational value of the experience was collected. Data were assessed and compared using Spearman's Rho correlation statistical assessment using SPSS 16.0.

DISCUSSION:

Our pilot study offers benefit in other areas including surgical training, measuring surgical competence, and optimizing patient care. We hope to provide a video portfolio of resident surgical performance which can be used to display technical skills when pursuing future professional opportunities. This technology may also serve a role in the credentialing and remediation process.
Dual Console Technology Robotic Platform Intraoperative Handoffs: “Near Miss” Prevention and Patient Safety Enhancement
Authors: Breen Michael
Published: September 2016

BACKGROUND:

Dual Console Robotic training has been used in resident training and assessment as well as faculty development. A trans cockpit authority gradient coupled with poor communication skills during robotic arm handoffs contributed in several “near misses” over 6 years of dual console instruction and curriculum development and assessment. These events prompted development of an intraoperative handoff with verbal declaration followed by verbal confirmation. This mirrors current aviation cockpit safety models. Pre and post study Lickert questionnaires utilizing Lickert scale evaluated factors such as comfort levels of teacher and learner, arm assignment confusion, and apprehension. Near misses were tracked. Percentage of complete handoffs were tracked. This study outlines a safe, easily adopted communication and teaching skill that enhances patient safety and reduces near misses.

METHODS:

Analytic Observational Cohort Study. Lickert Pre and Post intervention. Setting: University Teaching Hospital. Patient Population: All from faculty practice associated with Medical School. All agreed to resident participation in their care.

RESULTS:

No interventions were required. No near misses in the study. No adverse events occurred during intraoperative handoffs. No confusion over control of robotic arms. There were incomplete surgical handoffs identified.

DISCUSSION:

Dual console robotic technology provides an unique teaching opportunity for surgical education. Aviation cockpit verbal handoffs are well documented to enhance aviation safety. The robotic intraoperative handoff can mimic this and is an easily adopted and useful teaching method to minimize confusion in co surgeons and minimize risks to patients in dual console robotic surgical procedures.
Quality of Quality Measurement
Authors: Glance Laurent G. , Li Yue , Dick Andrew W.
Published: September 2016

Background

The validity of basing healthcare reimbursement policy on pay-for-performance is grounded in the accuracy of performance measurement.

Methods

Monte Carlo simulation was used to examine the accuracy of performance profiling as a function of statistical methodology, case volume, and the extent to which hospital or physician performance deviates from the average.

Results

There is extensive variation in the true-positive rate and false discovery rate as a function of model specification, hospital quality, and hospital case volume. Hierarchical and nonhierarchical modeling are both highly accurate at very high case volumes for very low-quality hospitals. At equivalent case volumes and hospital effect sizes, the true-positive rate is higher for nonhierarchical modeling than for hierarchical modeling, but the false discovery rate is generally much lower for hierarchical modeling than for nonhierarchical modeling. At low hospital case volumes (200) that are typical for many procedures, and for hospitals with twice the rate of death or major complications for patients undergoing isolated coronary artery bypass graft surgery at the average hospital, hierarchical modeling missed 90.6% of low-quality hospitals, whereas nonhierarchical modeling missed 65.3%. However, at low case volumes, 38.9% of hospitals classified as low-quality outliers using nonhierarchical modeling were actually average quality, compared to 5.3% using hierarchical modeling.

Conclusions

Nonhierarchical modeling frequently misclassified average-quality hospitals as low quality. Hierarchical modeling commonly misclassified low-quality hospitals as average. Assuming that the consequences of misclassifying an average-quality hospital as low quality outweigh the consequences of misclassifying a low-quality hospital as average, hierarchical modeling may be the better choice for quality measurement.
Electronic Learning–Spaced Education to Facilitate Resident Knowledge and Guide Program Didactics
Authors: Gandhi Manisha , Beasley Anitra , Vinas Emily , Sangi-Haghpeykar Haleh , Ramin Susan M. , Kilpatrick Charlie C.
Published: September 2016

OBJECTIVE:

To evaluate the use of mobile technology to facilitate resident learning, assess clinical knowledge, and guide curricular development in a busy clinical environment.

METHODS:

This was a cross-sectional study conducted in a large (N=48) urban obstetrics and gynecology residency program. Question sets were created in the following areas: office gynecology, general obstetrics, gynecologic surgery and urogynecology, maternal–fetal medicine and ultrasonography, reproductive endocrinology and pediatric gynecology, and gynecologic oncology. Using an educational mobile application (app), questions were sent monthly to resident smartphones with immediate feedback on answer accuracy along with answer explanation and references. Outcomes included app use, which was determined by how quickly participants answered questions (very active–active indicates questions answered within 7 days) and proficiency (mean percentage correct) calculated for individuals, resident class level, and by content area.

RESULTS:

All 48 residents participated and 77.4% were very active or active app users. On average, participants answered correctly 61.0% on the first attempt and improved to 78.3% on repeat attempt (P<.001). Proficiency was lowest for gynecologic surgery and highest for general obstetrics.

CONCLUSION:

A mobile app to support e-learning was successfully implemented in our program; its use was associated with knowledge retention and identification of low-proficiency topics to guide curriculum development.