bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of the Indicated Delivery Calculator on Obstetric Residents’ Clinical Decision-Making
Authors: Asarch Samantha , Morikawa Erika , Nguyen Tina , Sridhar Aparna 
Published: October 2019

PURPOSE:
Evaluating the utility of an indicated delivery calculator (IDC) in assisting residents’ determination of delivery timeline for complex obstetric scenarios.

BACKGROUND:
The American College of Obstetrics and Gynecologists (ACOG) mobile application includes an IDC to provide decision-making support when considering conditions that may necessitate early delivery. The utility of this IDC has not yet been studied.

METHODS:
After IRB exemption, obstetric residents at our academic center (n=28) were asked to determine delivery timing for fifteen scenarios, with and without use of the IDC. A mixed effects logistic regression model assessed the change in proportion of test items correct. We conducted semi-structured interviews of the residents’ experience utilizing the calculator. Their responses were subjected to content analysis.

RESULTS:
Residents’ ability to identify the gestational age at delivery for the obstetric scenarios significantly improved after use of IDC (47% pre to 86% post; p<0.01). Positive feedback included the calculator being “user-friendly,” “convenient,” and “well-organized.” The ability to enter multiple conditions was thought to be the best feature of the application. Residents expressed desire to incorporate this tool into their practice. Criticism about the calculator included desire for more robust yet streamlined complication list, more evidence-based references and elimination of prompt for estimated due date/gestational age.

DISCUSSION:
ACOG’s IDC was effective in improving accuracy of residents’ clinical decisions regarding delivery timelines for complex obstetric scenarios. Users quickly adapted to the tool and successfully navigated the features. Streamlining the input prompts and complication choice list may improve efficiency and increase use.
Not Quite so Happy Hour: Associations of Alcohol Use With Wellness Problems Among OBGYN Residents
Authors: Winkel Abigail , Woodland Mark , Mahany Erica , Dow Margaret , Palmer James , Morgan Helen 
Published: October 2019

PURPOSE:
To explore associations between residents’ personal habits and problems with wellness.

BACKGROUND:
It will be essential that we develop evidence-based interventions to improve burnout and wellness problems in our resident physicians.

METHODS:
A voluntary, anonymous survey was administered to all US OBGYN residents at the time of the 2017 CREOG examination. Symptoms of burnout and problems with wellness were queried with the question, “during your residency training, have you personally experienced any of the follow issues?” Respondents also reported how often they engaged in activities that they felt helped to maintain wellness in their lives. Associations between reporting wellness problems and participation in common activities were examined using chi-squared tests. Significance was defined as p<.004 using a Bonferroni correction based on the number of comparisons.

RESULTS:
Of the 5855 residents, 4999 completed the survey (85% RR). 3065 (61.3%) residents endorsed problems with wellness, including burnout (51.2%), depression (32.0%), and binge drinking (12.6%). The most common wellness activities reported were social activity (n=4320, 93.2%), watching TV (n=3614, 77.1%), cooking (n=3614, 52.4%), exercise (n=2228, 47.3%), and drinking alcohol (n=2132, 45.6%). Respondents who indicated alcohol as a wellness activity had an increased odds ratio of 2.10 of also having a wellness problem (Χ2(1)=29.6, p<0.001). Respondents who indicated heavy drinking (“Often (4+ times)”/week) had a higher odds ratio of 3.30 (Χ2(1)= 40.3, p<.001.).

DISCUSSION:
Despite social norms, residency programs should use caution when choosing alcohol as the basis for social events or stress release, as our data suggest that it is associated with increased negative outcomes for resident wellness.
Perceptions Regarding Medical Students Performing Pelvic Examinations on Anesthetized Female Patients
Authors: Rice Elizabeth , Chase White , Myers John , Ko Janet , Goldberg Jay , Jaspan David 
Published: October 2019

PURPOSE:
The purpose of this study was to determine perceptions regarding medical students performing pelvic examinations on anesthetized female patients.

BACKGROUND:
Pelvic exams performed under anesthesia continues to be a controversial topic, but studies looking at medical staff are lacking.

METHODS:
An internet based survey was distributed to OB/GYNs, OR nurses/techs, anesthesiologists/CRNAs, and medical students at multiple hospitals and medical schools. Demographic data were collected. Non-demographic answers to questions were recorded on a 5-point scale. Characteristics between the respondent groups were statistically compared using Chi-squared test for independence and the Fisher’s Exact Test.

RESULTS:
337 surveys were completed. 72% of respondents believed permission should be obtained from patients prior to the performance of EUAs by medical students on anesthetized female patients. 30% of respondents believed prior consent was usually obtained. 50% believed patients would agree to have the exams performed. 80% thought patients would be upset if an EUA by a medical student was performed on them without their prior consent. 32% of nurses believed medical students should be allowed to examine anesthetized patients. Medical students were less likely to believe it was appropriate for a student to examine a patient, there was an educational benefit, and that patients would consent.

DISCUSSION:
Despite the perception of all OB/GYN OR team members that consent should be obtained before medical students perform pelvic examinations on anesthetized female patients, this does not usually occur. Almost 50% of medical students would not encourage their female relatives to consent to medical students performing such pelvic examinations.
Simulated Paging Curriculum to Assess and Improve Communication Skills
Authors: Kempner Samantha , Heidemann Lauren , Blaszczak Julie , Malone Anita , Bell Carrie , Morgan Helen 
Published: October 2019

PURPOSE:
To examine the impact of a simulated paging curriculum for senior medical students on physician-nurse communication skills.

BACKGROUND:
New residents are expected to triage and address a high volume of clinical pages yet medical students receive little training in this important skill. Previous studies have evaluated the impact of simulated paging curricula on clinical decision making and student confidence but have not examined the effect on communication skills.

METHODS:
Two trained Registered Nurses (RNs) administered specialty-specific pages to 76 fourth-year medical students enrolled in 4-week residency preparation electives. For each case, RNs evaluated students’ performances on seven communication domains using previously validated 5-point semantic-differentiation scales (1=worst, 5=best) in precision, instruction, assertiveness, direction, organization, engagement, and ability to solicit information. Immediate feedback was provided to the students.

RESULTS:
A total of 351 pages were administered: 144 in week 1, 73 (week 2), 97 (week 3), and 37 (week 4). Students from all specialties improved communication scores throughout the four weeks. Mean communication scores increased from 4.02 to 4.26 from week 1 to week 2 (<0.0001). Improvement was most pronounced for the students going into internal medicine (3.82 to 4.25) and pediatrics (3.95 to 4.38) and less pronounced for the procedural specialties of surgery (4.26 to 4.22) and ob/gyn (4.07 to 4.18). Communication skills continued to improve in weeks 3 and 4 but with inadequate number of pages to power this comparison.

DISCUSSION:
Our data demonstrates that a simulated paging curriculum is a promising platform for teaching and improving physician-nurse communication skills for senior medical students.
Mind Over Bricks: Facilitation of Decision-Making With LEGO® Elements
Authors: Banh David 
Published: October 2019

OBJECTIVE:
To examine the feasibility of implementing LEGO® SERIOUS PLAY® (LSP) workshops to improve participant satisfaction with group decision-making in two residency programs as represented by decisional uncertainty.

METHODS:
We used a prospective single-group pre-post study and O’Connor’s validated scale to measure decisional conflict before and after the LSP workshop. Resident physicians at the Texas Tech University Health Sciences Center at the Permian Basin voluntarily attended an LSP workshop, discussing leadership identity based on the participants’ values, to address a contentious decision, i.e., the election of their administrative chief resident. We used the Wilcoxon rank-sum test to evaluate the pre-post change in decisional uncertainty and a two-tailed P value < 0.05 to define a statistically significant change.

RESULTS:
Family Medicine (n=15) and OBGYN (n=9) residents participated in their respective LSP workshops, but only 9 Family Medicine and 6 OBGYN residents responded to the voluntary post-LSP survey. The average decisional conflict scale (DCS) scores at pre- and post-LSP did not show any significant change (n=15, Pre: 37.9 [24.9–51] vs. Post: 37.8 [24.2–51.4]). Regarding the evaluated decision of their chosen administrative chief, 9 (60%) residents persisted in the same decision after attending the LSP workshop, while 6 (40%) residents chose another person.

CONCLUSION:
In our study assessing the feasibility of LSP workshop implementation in two residency programs, the workshop was not associated with an improvement in participants’ satisfaction with the group decision-making process. Limitations of the study include its small size, use of one-decision scenario, and high non-response rate.
Tomorrow’s Women’s Healthcare Leaders: A Needs Assessment for the Development of an OBGYN Resident and Fellow Leadership Curriculum
Authors: Ellington David R. , Bevis Kerri , Boitano Teresa 
Published: October 2019

OBJECTIVE:
To conduct a needs assessment of Obstetrics and Gynecology (OBGYN) faculty, fellows, and residents in preparation for the development of a leadership curriculum.

HYPOTHESIS:
Resident and fellow learners recognize the need for a formal leadership curriculum to improve their effectiveness as physician leaders. Faculty perceive a need for and benefit from a formal leadership curriculum.

METHODS:
We conducted a needs assessment of faculty, fellow, and resident learners. The needs assessment was based on previously published data and a Likert-type scale was implemented to assess responses. Descriptive statistics were calculated using frequency for categorical variables and averages for scale variables. The needs assessment was administered via Survey Monkey, Inc. (www.surveymonkey.com).

RESULTS:
Seventy-three percent (66/90) of surveyed faculty, fellows, and residents responded. The majority (64%) of faculty responders agreed that learners needed a moderate to extreme amount of leadership training. Despite 95% of responders self-evaluating their leadership skills as moderately to extremely effective, only 45% were satisfied with their current leadership skills. Perception of a need for leadership training for faculty (77%) and trainees (88%) was similar. The most desired skills for a leadership program were conflict resolution, team building, mentorship, team motivation, and effective evaluation and feedback.

CONCLUSION:
Faculty, fellows, and residents are overall satisfied with their leadership skills; however, faculty and trainees alike perceive the need for more skill acquisition and training. The preferred learning format was case studies and small group exercises with availability of faculty and trainees noted as the most significant barrier to implementation.
Development of a Flipped Classroom Case-Based Curriculum on the Screening and Management of Women With Opiate Dependence in Pregnancy
Authors: Garrison Etoi , Grimm Barry , Foxx Alexandra , Young Jessica , Rodriguez Michelle , Baksh Lindsey , Dewey Charlene 
Published: October 2019

PROBLEM:
Opioid use in pregnancy is rising and parallels the national opioid epidemic observed in the United States. Residency programs however, have limited opportunities to offer structured training in the screening and management of women with opiate dependence.

INTERVENTION:
The APGO/CREOG Empower award was used to develop a flipped classroom (FC) case-based curriculum to improve resident knowledge regarding the screening, counseling, and interdisciplinary management of women with opiate use in pregnancy.

CONTEXT:
The Kellogg logic model and curriculum design model by Oliva were used to create three 90- minute case-based teaching modules: 1) Substance use disorder (SUD) screening and medical management, 2) Use of the state-controlled substance monitoring database (CSMD), and 3) Inpatient management and neonatal abstinence syndrome (NAS). A survey was used to measure pre and post module knowledge acquisition, anticipated behavior change, and satisfaction/compliance with the FC case-based format.

OUTCOME/LESSONS LEARNED:
Fourteen residents participated in 2 of 3 teaching modules. Pre and post module knowledge scores improved for SUD screening, NAS, and medical management (p<0.01). Residents agreed or strongly agreed (90%) that the curriculum improved confidence with SUD screening and patient counseling (p<0.01). Residents preferred the flipped format compared to traditional lecture (95%) however only 50% pre-read the primary reference and 35% pre-read the secondary reference. This workshop was well received and associated with improved knowledge and skill regarding SUD/opiate dependence in pregnancy. Next steps will include residents from other residency programs, evaluation of the CSMD curriculum, and longer-term impact on knowledge retention and patient care.
Medical Student Empathy: Any Correlation to Abortion Attitudes?
Authors: Gorelik Kristin , Amdur Richard 
Published: October 2019

OBJECTIVE:
Physician and medical student empathy have been well studied, but little empirical research exists relating empathy to abortion care. Abortion is common; all physicians will interact with patients who have had, or considered, abortion. We seek a correlation between students' empathy and their attitudes about abortion. With better understanding of this association, interventions to augment medical trainee empathy can be undertaken.

METHODS:
A literature review identified existing abortion attitude and empathy assessment tools. A cross-sectional survey was sent to GWU undergraduate medical students, comprised of the Jefferson Scale of Physician Empathy (JSPE-S),1 a modified Abortion Attitude Assessment (AAA), and a modified Feelings Thermometer (WARM). Higher numbers correlate with more empathy (JSPE-S) and more favorable abortion attitudes (AAA, WARM). Religiosity was analyzed.

RESULTS:
Two emails were sent, with 20 first- (10.5%), 3 second- (1.7%), 26 third- (15.7%), and 19 fourth-year (13.3%) respondents. 64% were female, 35% male, and 1.4% transgender. 42% identified as not religious, 44% moderately/somewhat, and 10% very religious. Positive correlations were identified between empathy and warmth (r=0.36), empathy and abortion (r=0.31), and between warmth and abortion attitudes (r=0.57). A negative correlation was identified between religiosity and abortion attitudes (r=-0.42).

CONCLUSION:
We found a correlation between the JSPE and abortion attitudes in this small, single-institution study. As expected, religious individuals had more negative abortion attitudes, and a surprising trend toward lower levels of empathy overall. Our main limitation was a low response rate, and student recruitment is ongoing. Future studies should include more students with greater demographic diversity.
Preparing Medical Students for Transition Into OB/Gyn Residency
Authors: Kim Christine 
Published: October 2019

PROBLEM:
There is increased focus on supporting medical students’ transitions to internships to improve basic knowledge, efficiency and quality of care. Providing pre-residency education may help improve knowledge, clinical skills, and confidence.

INTERVENTION:
A 2-day preparatory course for OB/Gyn-matched MS4s reviewed topics in the OB/Gyn ACGME Milestone 1 curriculum. The course used lectures, videos, and “hands-on” skills workshops.

CONTEXT:
OB/Gyn-matched MS4s were invited to attend. Students took the APGO Prep for Res knowledge test (scored as percent correct) and completed a survey assessing confidence in Milestone 1 topics (Likert scale, 1=strongly disagree, 5=strongly agree) before and after the course. Students were sent a follow-up survey two months into internship assessing how the course impacted skills and inviting feedback.

OUTCOME/LESSONS LEARNED:
Nine students attended. All 9 completed the pre-test, 7 the post-test, and 8 completed both surveys. The average test score before the course was 73%, and after 79% (p=0.24). No student had lower knowledge score after the course. Average confidence skills were 3.03 before and 4.47 after (p<0.05). Confidence improved most for these skills: applying fetal scalp electrode, repairing a perineal laceration, c-section steps. The least improvement noted for knot tying/suturing, and managing common outpatient gynecologic problems. Post-course confidence was highest for interpreting FHR, managing postpartum hemorrhage and repairing perineal lacerations, and lowest for biopsy skills and labor management. Interns reported the course to be “very helpful” to their transition. Suggestions for the future include: induction of labor, pre-eclampsia, hysteroscopy, contraceptive implant certification, and including students entering family medicine.
Bartholin Gland Cyst Educational Simulation Improves Knowledge and Confidence
Authors: Johnson Kathryn P. , Shelton Sarah , Deisher Heather 
Published: October 2019

PROBLEM:
Our institution had an increasing number of ER consults for recurrent Bartholin gland cysts/abscesses between May of 2015 and June of 2016. The majority had incorrect placement of the incision and drainage site or limited or improper Word catheter use. Ob/Gyn, Family Medicine, and ER departments did not have specific training available for this diagnosis and treatment.

INTERVENTION:
We developed a simulation-based curriculum including a didactic presentation on Bartholin gland cyst/abscess diagnosis and treatment options, an instructional video demonstrating the steps of Bartholin gland cyst/abscess drainage with Word catheter placement, and supervised practice on an established Bartholin gland cyst model with feedback. Learner knowledge and confidence were assessed before and after the curriculum, and satisfaction with the simulation model for both I&D and Word catheter placement were assessed after the curriculum.

CONTEXT:
UTMCK has residencies for Ob/Gyn and Family Medicine with protected education time. There is an ER fellowship but most ER providers are ER physicians and PA’s with limited time for group learning.

OUTCOME/LESSONS LEARNED:
Implementation with 26 Ob/Gyn residents and 5 medical students showed increases in learner confidence and some aspects of knowledge. Participants were highly satisfied with the simulation model. Curriculum delivery will need to be tailored to the different specialties. Family Medicine residents are scheduled to complete the group training in January 2019 but the ER providers have requested to complete the training as self-study modules due to shift restrictions.
Identifying the Troubled Test Taker for Early Intervention
Authors: Scott Nicole 
Published: October 2019

OBJECTIVES:
To investigate correlations between obstetrics and gynecology residents’ USMLE Step 1 and 2, APGO Prep for Residency Exam, and in-service CREOG training exam scores. To investigate TrueLearn question bank as a tool to improve CREOG performance.

METHODS:
Residents’ examination scores from one obstetrics and gynecology training program were collected. These included their scores for USMLE Step 1 and 2 examinations taken during medical school, APGO Prep for Residency (APP) exam taken when starting residency, and CREOG examination taken during each year of residency. Correlation coefficients between each of the first 3 scores and the CREOG scores were calculated using Pearson correlation testing with STATA. In 2018, TrueLearn question bank was available for resident use in test preparation. Residents’ use of the question bank and percentage of correct questions were collected. Correlation coefficients between each group and the improvement CREOG scores were calculated using Pearson correlation testing with STATA.

RESULTS:
The APP scores positively correlated with the first CREOG exam scores (R=.6506). Similarly Step 1 and Step 2 scores were positively correlated with performance on CREOG (R=.62, R=.66, respectively). Number of practice questions performed significantly correlated with improvement in CREOG performance when separated by postgraduate year of training. (PGY2 R=.68, PGY 3 R=.3, PGY 4 R=.5). The positive correlation diminished with advancing postgraduate year.

CONCLUSION:
USMLE and Prep for Residency Exams are strongly correlated with performance on CREOG exam. Early identification of learners with poor test taking can lead to early intervention. TrueLearn question bank use can improve performance on CREOG in-service exam.
Knowing Is Seeing: Biography Cards Facilitate Students Seeing Patients in Obstetrics and Gynecology
Authors: Singh Tara A. , Seitchik Allison , Harney Kathleen , Dalrymple John , Hirsh David A. 
Published: October 2019

OBJECTIVE:
We explored whether patients’ pre-visit receipt of student’s biography cards facilitated patients’ accepting students in their obstetrics and gynecology (OBGYN) care.

METHODS:
Before visits, all patients in our ambulatory OBGYN clinics received student “biography cards” (photo, hobbies, “thank you” statement) for two months. We administered questionnaires to patients who accepted or declined student participation. We asked patient demographics and impact of the card. We surveyed students’ perception of the card’s impact. We used logistic regression models to correlate survey responses and acceptance rates.

RESULTS:
Seeing the card (Wald χ2 = 18.85, p < .001) and having seen a student before (Wald χ2 = 5.49, p = .019) significantly predicted acceptance of the student. Patients who saw a student before were 9.20 times (95% CI: 1.44, 58.93) more likely to include a student. Age, ethnicity, and being a new patient did not predict patient acceptance of students. Patients reported they were happy to have student participation, valued participation, believed students improved the quality of their care and experience. Patients expressed a desire to have a student participate in their care on another day. Eleven of 13 students responded to the survey. Students reported increased patient acceptance after patients read their card, using the card made them feel more involved in patient care, and patients were more likely to involve them when patients knew more about them.

CONCLUSION:
In OBGYN clinics, student biography cards and seeing students previously facilitated patients accepting students—an important affordance for students’ OBGYN learning and experience.