bluuebunny/crossref_metadata_2025_split huggingface dataset:
“Guiding Light” to Reduce Incidence of Medical Student Refusal in the Obstetric & Gynecology Clinic
Authors: Bremer Kristin , Thayer Mackenzie , Verhoef Katee , Waldschmidt Noelle , Weaver Corbin , Boevers Emily 
Published: September 2018

PURPOSE:
Characterize and reduce the frequency at which medical students are 'cast off' from patient care in the Ob-Gyn clerkship.

BACKGROUND:
For optimal medical education and patient care, it is imperative to have 'all hands on deck'. Review of the literature shows that medical student refusal is an issue nationally in Ob-Gyn as well as other clerkships (1-3). Review of our Ob-Gyn clerkship data shows that students report that patients refuse their involvement in 14% of patient interactions. Furthermore, in 19% of interactions, students felt refusal was related to their gender.

METHODS:
Beginning in 2017, surveys measuring medical students' perception of refusal were administered upon completion of our Ob-Gyn clerkship. Interventions to reduce refusal of these 'castaways' were implemented with each subsequent clerkship. Faculty mentors: Sarah Shaffer DO & Colleen Stockdale MD, MS.

RESULTS:
Data collection is on-going. To date, 85% reported exclusion from a patient interaction on the Ob-Gyn clerkship due to being a medical student. Twenty-three percent reported greater than five episodes of exclusion from patient care. Forty-three percent perceived that restricted participation was related to their gender with multiple qualitative responses describing patient discomfort with the presence of male 'comrades'.

DISCUSSION:
Data from our institution suggests that exclusion from patient care in the Ob-Gyn clerkship occurs for the majority of medical students queried. Further, gender-based exclusion is likely a related problem. Future exploration includes analysis of trends after the implementation of interventions designed to keep patients and staff 'abreast' of the presence and role of medical students.
Assessment of Postpartum Visits: Creating a Checklist to Improve Comprehensiveness
Authors: Hecker Erin , Wieneke Carrie 
Published: September 2018

PURPOSE:
The aim of this project is to create a template for residents to use to evaluate their documentation during postpartum visits and assess if pertinent issues during the postpartum period are addressed. Thus, allowing residents to self-evaluate and identify areas for improvement while allowing for self-directed learning and outcomes analysis.

BACKGROUND:
The postpartum period typically brings excitement but is also filled with numerous challenges and adaptations to several physical, emotional, and social changes. All women should attend a postpartum visit that addresses these matters and ensures the transition to a primary care provider to begin management of chronic health conditions.

METHODS:
A checklist of 17 key postpartum components was developed from ACOG Committee Opinion 666. A retrospective chart review of postpartum visits from each PGY was performed to assess documentation of these key components prior to template implementation. Post-implementation retrospective chart review was performed by residents after a 6-month time period. Percentage of template items documented adequately (≥90%), mediocrely (21-89%) and deficiently (≤20%) was calculated for both pre and post implementation data.

RESULTS:
Post implementation documentation was statistically significantly improved from pre-implementation documentation. Pre-implementation data revealed only 6 items were adequately addressed while post-implementation data revealed 8 items were adequately addressed, followed by an improvement in moderately addressed items and a decrease in deficiently addressed items.

DISCUSSION:
The postpartum visit is the ideal time to address multiple aspects of maternal health. Our data shows that providing residents with a template of key items to be discussed improves addressing these items and their documentation.
Development of an Effective Comprehensive Curriculum Regarding the Patient and Provider Experience of Stillbirth
Authors: Fay Emily , Amory Josephine , Gravett Michael , Alexander Sarah , Delaney Shani , Stephenson-Famy Alyssa 
Published: September 2018

PURPOSE:
To develop and evaluate a comprehensive curriculum about stillbirth focused on both the patient and the provider experience with this difficult topic.

BACKGROUND:
Pilot data from our institution showed that OB/GYN residents felt ill prepared to care for patients with stillbirth, and that training about the patient experience of stillbirth was impactful but emotionally distressing. We sought to develop a comprehensive stillbirth curriculum that included knowledge, communication skills, and emotional domains.

METHODS:
A four-part curriculum was created including: 1. Medical management, 2. A stillbirth panel discussion with patients/families, 3. Simulation training in delivering serious news, and 4. Workshop on resiliency. OB/GYN residents completed pre- and post-testing for each session. Five-point Likert scales were compared using the Wilcoxon signed rank test (alpha = 0.05).

RESULTS:
All 28 residents participated in parts of the curriculum, with 85% attending two or more sessions. Following the curriculum, we found statistically significant self-reported improvements in multiple aspects of the stillbirth training: general knowledge (P<.01), appropriate tests to order (P<.05), interpretation of placental pathology (P<.01), genetic evaluation (P<.01), comfort conveying sympathy (P<.05), expressing emotion (P<.01), and confidence in delivering serious news (P<.001). In the resiliency workshop, residents shared ideas about how faculty can support them during difficult clinical situations.

DISCUSSION:
A comprehensive stillbirth curriculum which addressed the cognitive, emotional, and skills aspects of this topic was well received and effective. Long-term data is needed to evaluate whether these improvements persist and can enhance resident satisfaction with other challenging topics within OB/GYN.
Do Entering Ob Gyn Interns Understand How to Navigate Today's Complex Health Care Systems?
Authors: Mann Stephanie , McNamara Tristan 
Published: September 2018

PURPOSE:
We sought to determine the baseline QI/PS and population health knowledge for new obgyn interns in comparison to new interns from other specialties.

BACKGROUND:
The ACGME requires residents to be trained in practice-based learning and improvement (PBLI) as well as systems-based practice (SBP). In an effort to establish a formal curriculum for graduate medical education, several residencies at our institution are piloting a novel QI/PS/population health curriculum that will ensure residents are educated in SBP and PBLI.

METHODS:
Baseline knowledge of all new interns was assessed with the Quality Improvement Knowledge Application Tool-Revised (QIKAT-R), a self-assessment questionnaire and a Population Health Knowledge Application tool (POPKAT). Mean score differences for each intern group were measured with ANOVA. Interrater reliability was assessed using Cohen's k.

RESULTS:
Preliminary assessments of incoming obgyn interns compared to all new interns at our institution suggests they are equally familiar with the principles of QI (PBL1, PBL2 level 2) and PS (SBP level 2) but have a slightly higher baseline knowledge of population health (SBP2 level 3). Interrater reliability for total scores and individual categories on the QIKATR and POPKAT was consistent.

DISCUSSION:
Understanding baseline knowledge of new interns can help PDs obtain a baseline assessment of entering residents; SBP and PBLI. After implementation of a QI/PS/population health directed curricula, resident acquisition of knowledge for SBP and PBLI can be quantitated. A quantitative holistic assessment of knowledge utilizing validated knowledge tools will give programs an opportunity to evaluate the impact of their QI/PS/population health focused curricula.
Do Obgyn Residents and the CCC Reach the Same Competency Conclusions? A Comparison of Resident Versus Faculty Milestone Assessments
Authors: Mann Stephanie , Burns Timothy 
Published: September 2018

PURPOSE:
Our objective was to compare resident self-assessments to CCC evaluations within the milestone framework.

BACKGROUND:
Resident progress across 28 milestones are evaluated biannually by a clinical competency committee (CCC). We sought to determine the correlation in milestone assessment between the CCC and individual resident's self-assessment.

METHODS:
Retrospective study that compares resident self-assessment of milestone competency to that of the CCC. Milestone assessment differences were calculated by subtracting the resident score from the faculty score. A negative value indicates that the CCC evaluated residents at a lower level than the resident's self-assessment. Kruskal Wallis test was used to identify differences between self-evaluations and corresponding CCC evaluations for each competency. Dunn's post hoc test was used to determine specific differences. Major disparities were defined as a mean disparity >0.5 in either direction. The association between assessment disparity and PGY year was analyzed using non parametric χ2.

RESULTS:
15 residents participated. Overall, 32% (129/409) of the time residents and CCC were in agreement. The global median assessment difference was significant [−0.20 (−0.5 to 0.5), P<.003] suggesting residents evaluated themselves at a higher level than the CCC did. 19% evaluations had a mean overall assessment difference >−0.5 (residents assessed at a higher level than CCC), whereas 8% had a difference >0.5. Positive self-evaluations were more common for medical knowledge and patient care. There was no association between PGY year and CCC agreement.

DISCUSSION:
Ob/Gyn residents within our program trended toward perceiving a greater level of patient care and medical knowledge and underestimated their competency in PBLI, SBP and ICS. Understanding these differences will help PDs at their biannual progress meetings with residents.
OB/GYN Residency Training in Transgender Healthcare: A Survey of U.S. Program Directors
Authors: Rush Shannon , Vinekar Kavita , Chiang Seine , Schiff Melissa 
Published: September 2018

PURPOSE:
To characterize transgender healthcare training 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=.001), interested faculty (45.2% versus 20.0%, P=.03), time allotted for training (29.0% versus 0%, P=.001) and resident interest (64.5% versus 36.7%, P=.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=.006).

DISCUSSION:
Only half of responding residency programs offer transgender healthcare training. CREOG named transgender healthcare an educational objective in 2013 and should support this by identifying interested faculty and resident champions who can lead implementation at all OB/GYN residency programs.
RWJBarnabas Health System: System-wide Obstetrics Collaborative. The Clinical, Research and Teaching Implications and Benefits
Authors: Bachmann Gloria , Graebe Robert , Bonamo John , Holecek Nancy , Spernal Suzanne 
Published: September 2018

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

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

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

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

DISCUSSION:
Not only have there been benefits in the core missions of clinical care, teaching and research, but this model has inspired a joint effort by others within the health care system to further improve outcomes through collaborative educational venues.
Setting New Directions for Medical Student Clerkship Evaluations
Authors: Whitis Avery , Waldschmidt Noelle , Hardy-Fairbanks Abbey , Stockdale Colleen 
Published: September 2018

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

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

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

RESULTS:
535 students completed the OBGYN clerkship. While mean evaluation scores were similar (86.8-89.1) for each group, compared to group 1, groups 2 and 3 means were statistically greater (P<.01, and .02, respectively). Shelf grade percentages for honors, near honors, and honors were similar for each group; with no difference in group means (P>.05). Likewise, rates of pass, near honors, and honors grades between groups were similar for each group (P>.05).

DISCUSSION:
Increased number of requested evaluations did not translate to differences in rates of pass, near honors, and honors grades for medical students on their OBGYN clerkship, indicating that decreasing the mandatory evaluations per student would not be detrimental to student outcomes and would potentially expedite the grading process.
Teaching Cystotomy Repair: Low Fidelity Model Provides Effective Simulation at Minimal Cost
Authors: Braun Kelli , Ray Chadburn , Stager Robert , Rungruang Bunja 
Published: September 2018

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

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

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

RESULTS:
16 bladder models were constructed for approximately $1.50 per model. The model is reusable and manipulated well with surgical instruments and suture both open and laparoscopically; the model was a bit large for the laparoscopic trainer and lighting became a challenge for suturing. All participating residents correctly identified the anatomic structures post-simulation compared to 12/13 pre-simulation. Change in mean resident confidence was statistically significant for identifying cystotomy (pre M=3.1/5 vs. post M=4.2/5, P=.009) and performing open cystotomy repair (pre M=2.4/5 vs. post M=4/5, P=.03) but not for laparoscopic repair (pre M=1.6/5 vs. post M 3.1/5, P=.09).

DISCUSSION:
Our bladder model is easily constructed and inexpensive. It performs well for open cystotomy repair but has been decreased in size to better perform laparoscopically.
Teaching Lesbian, Gay, Bisexual, Transgendered, and Queer Family Building in a Third Year OBGYN Clerkship
Authors: Lackritz Katherine , Braverman Andrea , Leubner Emily , Wolf Abigail 
Published: September 2018

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

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

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

RESULTS:
Survey respondents were 51% female, 48% male, 1% gender non-conforming; heterosexual 93%; and partnered 59%. Comfort with same sex couples was endorsed by 92%. 56% of students felt that opting out of assisting a patient with family building was not an option. Fertility knowledge increased from after intervention significantly (P<.0001). Some students, 29%, thought that infertility was hard to discuss, but 67% felt it would be hard to discuss for same sex couples.

DISCUSSION:
Medical students' fund of knowledge was increased with lecture and small group discussion about TPR and LGBTQ patients. Students report being comfortable with TPR and LGBTQ families but have some discomfort with varied pathways to parenthood. Most feel that opting out of care for LGBTQ families is not an option.
Wellness Challenges and Burnout Contributors: A Systematic Approach to Issue Identification & Program Development
Authors: Connolly AnnaMarie 
Published: September 2018

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

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

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

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

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