bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abortion Practice After Routine Training: A Prospective Cohort Study
Authors: Turk Jema , Koenemann Katheryn , Landy Uta , Steinauer Jody 
Published: September 2018

PURPOSE:
To explore Ryan Program graduates; post-residency practice in abortion care.

BACKGROUND:
The Ryan Program supports residency programs to integrate abortion into training. In 2012 we commenced a prospective cohort study of graduated residents.

METHODS:
Residents complete web-based surveys after the family planning rotation and consent to participate in future studies. In 2016, we surveyed ob-gyns 2+ years after residency about their current practice. Post-rotation and post-residency surveys were matched and then de-identified.

RESULTS:
Sixty percent (394) who consented to participate responded. Nearly all graduates did abortions during residency (median of 31, including medical and procedural techniques). 86% fully participated in training, while 14% opted out for personal or religious reasons. 33% percent overall, and 40% of those who intended to, do abortions in current practice (median of 12 per month). An additional 36% do not do abortions but wish to, and 16% do not nor desire to provide abortion care. Physicians doing abortions are more likely to have fully participated (42% vs. 8%, P=.00) and did more abortions in training than those not doing abortions (median 32 vs. 16, P=.00). Those without an academic affiliation (n=134) are less likely to do abortions (23% vs. 45%, P=.00) and more likely to want to integrate abortion care (56% vs. 44%, P=.02).

DISCUSSION:
One-third of ob-gyns who trained in Ryan programs include abortion care in their practice. An additional third are unable to despite intending to at the time of their training. Further studies are needed to understand the barriers to integrating abortion care into practice.
How Clerkship Students Learn Procedural Skills
Authors: Martir Janel , Everett Elise 
Published: September 2018

PURPOSE:
To assess how clerkship students at the Larner College of Medicine receive instruction in procedural skills during their clerkship in obstetrics and gynecology

BACKGROUND:
Achieving competence in procedural skills is an important but overlooked aspect of formal medical education. The Association of Professors of Gynecology and Obstetrics (APGO) defined nine basic clinical skills to be incorporated into clerkship curriculums in the United States. Clerkship students are expected to gain competency in these skills.

METHODS:
An online 16-question survey was distributed to third and fourth-year medical students. The survey listed the nine basic skills. For each skill, students indicated how they received procedural instruction. Data was collected anonymously. The survey was approved by the medical school IRB committee before distribution.

RESULTS:
We received a response rate of 43%. Per skill, the instructor varied with either residents or attendings as the primary educators. The most preferred method of instruction was a resident-led workshop and the second most preferred was an acting-intern led workshop. More than 65% and 75% of students indicated that their confidence in performing the skill would have increased with more instruction and with more practice respectively.

DISCUSSION:
Results show that clerkship students rely on residents as teachers and suggest the potential role of acting interns as educators. These findings demonstrate the importance of developing, implementing, maintaining and assessing a robust Resident and Medical Student as Teacher curriculums to equip residents and senior medical students with a teaching skills set to facilitate the learning of the acquisition of technical skills for clerkship students.
Creating a Win–Win: Medical Students as Assets in the Ambulatory Clinic
Authors: Zuo Stephanie , Valle Orlando , Salas Rachel , Gamaldo Charlene , Patel Silka 
Published: September 2018

PURPOSE:
To determine whether exemplary OBGYN clinician educators maintain productivity with medical students in the ambulatory setting and if so, to design a clinic workflow to optimize medical student involvement in outpatient clinics.

BACKGROUND:
With the challenges of integrating clinical, documentation, and teaching responsibilities, it is not surprising that 40% of Hopkins OBGYN faculty feel that medical students decrease productivity (68% response). Yet recent research actually reports evidence of increases in physician productivity with medical student involvement in an outpatient Neurology clinic (Tanner et al, 2017).

METHODS:
Through a novel exemplary clinician educator program known as the “Osler Attending Preceptor in OBGYN,” six attendings were chosen based on student surveys and interviewed. Qualitative analysis was performed on interview data. Physician productivity data from the 2016-2017 academic year was obtained from department administrators.

RESULTS:
The six Osler Attendings (OAs) were generalists, and three are actively involved in the medical student clerkship. OAs at one suburban clinic billed on average 18-32% more work-adjusted RVUs when a student was present in clinic. Data analysis for OAs at two hospital-based clinics will be completed in the next month. Additionally, OA productivity with and without a medical student will be compared to non-OA designated faculty controls. Using an iterative feedback process, we designed ideal workflow models for OBGYN clinic and procedure-only visits, with a plan to pilot these workflows in the next year to determine efficacy.

DISCUSSION:
When utilized effectively, medical students are an asset to physician productivity in the outpatient setting.
Assessment of a Sexual Health Curriculum for High School Students Delivered by OBGYN Residents
Authors: Kendall Kristen , Nelson Erica 
Published: September 2018

PURPOSE:
The purpose of the project was to build a curriculum for high school students on sexual health including reproduction, contraception, pregnancy and sexually transmitted infections. This curriculum was delivered to the students by the SIU OBGYN residents. We evaluated the knowledge and attitudes of students, knowledge, skills and attitudes of the residents focussing on what their perceptions of the students.

BACKGROUND:
The teenage pregnancy and sexually transmitted infection rates for teens in the Sangamon County are higher than national averages. The residents expressed an interest in reaching out to schools. High school health teachers were contacted and overwhelmingly agreed to have the residents participate in health classes about reproductive health.

METHODS:
We built a curriculum based on ACOG materials and best practices for reproductive health. Needs assessments to measure knowledge and attitudes were given to a sample of high school students on reproductive topics. Another assessment was given to residents to gage skills in teaching as well as attitudes towards teen. Assessments of knowledge after the sessions were given to the students. Teachers were asked to rate the sessions and provide feedback. Residents completed a follow-up assessment.

RESULTS:
Students have large gaps in reproductive knowledge but have the perception they are knowledgeable. Accurate knowledge improved. Teaches overwhelmingly were satisfied with the material presented and the format. Residents had high satisfaction rates for this activity and better perceptions of students.

DISCUSSION:
Residents effectively administered a reproductive health care curriculum to high school students that was informative, well received and changed attitudes of students, teachers and residents.
Identifying and Addressing Medical Student Mistreatment in the OB/GYN Clerkship
Authors: Kappy Michelle , Holman Beth , Santen Sally , Skinner Bethany , Kempner Samantha , Hammoud Maya 
Published: September 2018

PURPOSE:
To describe the University of Michigan's approach to collecting and addressing medical student mistreatment data in the OB/GYN clerkship.

BACKGROUND:
The learning environment of medical students has become an important topic of discussion within professional organizations such as the AAMC and LCME. Medical schools have been charged with mitigating medical student mistreatment and enacting steps to promote a positive learning environment.

METHODS:
We collected the data on student mistreatment from end-of-rotation evaluations, teaching evaluations, and an online reporting system available to medical students. This data was then reported in a stepwise approach to faculty and residents.

RESULTS:
In response to the question, “Students are treated in a professional/respectful manner in this clerkship,” as rated by a 5-point scale (strongly disagree to strongly agree), OB/GYN received scores of 3.55 and 3.61 in 2016 and 2017 academic years respectively (range 3.49-3.83 on all the other clerkships). A total of 32 narrative comments were submitted by 340 students related to mistreatment or unprofessional behavior. Frequent themes included students being treated as ‘stupid’ or discouraged from asking questions (8 comments), being treated in an unprofessional manner by staff (7 comments), feeling ignored or marginalized by faculty (4 comments), and faculty unprofessional behavior towards others (4 comments).

DISCUSSION:
The students on the OB/GYN clerkship report a high rate of mistreatment. Efforts are being made to intentionally communicate those results to educators in order to improve the learning environment for medical students.
Improved Strategies for Teaching Surgical Skills to Medical Students: Simulation and Beyond
Authors: Welch Eva , Jordan Sali , McLeod Francine , Marko Emily , Sheridan Michael 
Published: September 2018

PURPOSE:
Develop a curriculum to optimize surgical skills and to increase operating room (OR) opportunities for medical students.

BACKGROUND:
Simulation-based strategies for teaching surgical skills are evolving. Using an innovative task trainer, we compared one-on-one deliberate practice to video-based self-guidance in the performance of two-handed knot tying and subcuticular suturing during the OBGYN clerkship.

METHODS:
A randomized prospective trial compared two groups of third year medical students in the same clerkship rotations. Group A received one-on-one deliberate practice undergoing three sessions with an instructor and Group B received unlimited access to video-based self-guided practice over six weeks. At the end of the clerkship, surgical performance was assessed using the validated checklist. Self-reported data regarding OR experience was collected using a specifically designed phone application.

RESULTS:
Fifty-nine students participated in the study. Group A demonstrated a statistically significant improvement in two-handed knot tying and subcuticular suturing in pre-post assessments (knot-tying +4.34, P<.001; suturing +19.4, P<.001). Group B demonstrated a statistically significant improvement (knot-tying +6.03, P<.001; suturing +22.3, P<.001). No significant differences were found between groups in overall knot-tying (P=.13), suturing (P=.14), hours practiced (P=.90), or number of OR cases (P=.49).

DISCUSSION:
The use of simulation significantly improved surgical skills for all students from baseline. No differences were found between one-on-one deliberate practice and video-based self-guided practice. Both instructional strategies provided equal efficacy in teaching surgical skills and optimizing surgical performance for students during the OBGYN clerkship.
Improvement in CREOG Scores Through Focused Review Sessions
Authors: Cook Ian , Marcum Miriam , Xu Yan , Qi Ya , McQuerry Kristen , DeSimone Christopher 
Published: September 2018

PURPOSE:
To determine if focused review sessions lead to improvement in CREOG scores.

BACKGROUND:
In 2013, faculty at the University of Kentucky developed a Gynecologic Oncology (GYO) review aimed at improving resident scores.

METHODS:
Each year, residents voluntarily participated in five review sessions on major topics in GYO. Sessions consisted of a pre-test (approximately 15 questions) followed by a discussion that emphasized the key concepts for that subject. From 2014-2017, GYO scores were compared between residents who attended (A) over 50% of the sessions and those who did not (NA). Scores from 2010-2013 were collected as a control group (C). SAS (9.4) was used to analyze the data via ANOVA with repeated measures and least square difference pairwise comparisons. Significance was defined as P<.05.

RESULTS:
Data was collected on 153 tests from 55 residents (80 from 2010-13 and 73 from 2014-17). The mean scores for GYO and overall test increased with each resident year (P<.0001). Attendance revealed a statistically significant improvement on GYO scores when compared to NA (P=.0001) and C (P=.0008). There was no difference between C and NA (P=.3875). Those who attended also scored significantly higher on overall test scores compared to NA (P=.0002). There was no difference between A and C (P=.1747). For those residents who attended multiple years of review sessions, there was no significant improvement in GYO or overall scores compared to less frequent attendees.

DISCUSSION:
Our findings support the hypothesis that focused review sessions improved resident comprehension as reflected by CREOG scores.
Piloting a Resident-Oriented Leadership Training Program Using the Leadership Observation and Feedback Tool (LOFT)
Authors: Santoro Nanette , Jones Kelsey , Allshouse Amanda , Alston Meredith , Landry Elaine , Aagaard Eva 
Published: September 2018

PURPOSE:
To pilot a leadership training program for residents designed to develop interprofessional and team management skills.

BACKGROUND:
Leadership in medicine is increasingly important, however many residency programs lack curricula on how to effectively lead and work on a team of healthcare professionals.

METHODS:
Myers-Briggs Personality Inventory and debriefing were performed prior to intervention for all participants as a preparatory step. Pilot curriculum consisted of 360-feedback, and four 30-minute, interactive, didactic sessions addressing topics in leadership. Residents were randomized to: 1) feedback-only, 2) didactic sessions-only, 3) both, and 4) neither (controls). 360 feedback was obtained using the LOFT, a 29-item questionnaire designed to assess resident leadership behaviors. Evaluations were completed before and after a rotation by 2 to 5 raters (supervisors, peers, and subordinates blinded to randomization status). Trained human resource professionals conveyed 360 feedback. Faculty gave didactics in groups of 1-6 residents. We compared change in LOFT score, adjusted for baseline, between randomization groups in a linear mixed-effects model.

RESULTS:
Twenty-nine residents completed the pilot and 5-10 per group were available for analysis. Total LOFT score improved (mean change 4.9 points; P<.001), however, improvement did not significantly differ among any treatment group or controls. Similarly, improvement in each LOFT domain (coaching:1.62, P=.002, project management:1.81, P<.001, and self-control: 1.41, P<.001), was significant but not different by randomization group. Among residents with the lowest quartile of average baseline LOFT, feedback was associated with significantly more improvement than no feedback (3.61, P=.001). Didactic sessions were not associated with significant improvement overall or by domain.

DISCUSSION:
Performance feedback has the potential to improve resident leadership behavior as assessed by 360 evaluation. In this pilot study, significant improvement was only observed amongst those with the most room for improvement.
Use of Forum Theater to Improve the Clinical Learning Environment
Authors: Harris Benjamin , Arnold Jade , Knudsen Nancy , Muasher Lisa 
Published: September 2018

PURPOSE:
To practice difficult conversations between teachers and learners utilizing Forum Theater techniques exploring differences in perceptions of mistreatment.

BACKGROUND:
Reports of student mistreatment remain unacceptably high at Duke University School of Medicine. Addressing the learning environment with lectures, anonymous reporting and personal coaches has had little effect. The humanities have been used for building empathy in physicians. In interactive or Forum Theater, spectators have opportunities to express opinions and make decisions while the actors incorporate the suggestions as they re-play a scene over again. The technique of Forum Theater has been used for medical faculty development for improving handling of student multiculturalism with positive results.

METHODS:
After IRB approval, 2 Forum theater sessions were held as OB-Gyn Grand Rounds with scenes depicting interactive challenges. The learning environment dean led discussion on the scenes before re-enactment with audience input. A brief survey was collected on the Playbill regarding demographics, mistreatment attitudes and opinions on Forum Theater. Replies between students and residents were compared with Fishers Exact analysis.

RESULTS:
110 attendees participated in 2 Forum Theater sessions. 41 participants completed surveys-12 medical students, 17 residents, 4 fellows and 8 faculty. Students agreed with statements that medical student mistreatment is prevalent at the school and in the department significantly more often than the residents. (P<.05) There were no differences between responses on the learning environment in the clerkship. 83% of participants reported that Forum theater raised mistreatment awareness and could improve the learning environment.

DISCUSSION:
Forum Theater holds promise as a tool for addressing learning environment challenges.
Development of a Comprehensive Clerkship Assessment Tool
Authors: Bodine Andrea M. 
Published: September 2018

Local Mentor:

Michael Plevyak, MD

APGO Advisor:

Lee A. Learman, MD, PhD

PROBLEM:
The medical school curriculum, core competencies, learning objectives, and assessment tool should align with the 14 Entrustable Professional Activities (EPAs) required for medical licensure in 2020.

METHODS:
A new “EPA Assessment Tool” was developed to address the 9 EPAs to be achieved during the third-year clerkship. Tool development was guided by a literature search to identify publications and existing evaluation tools pertinent to EPAs, competencies, medical education curriculum, osteopathic curriculum, APGO medical student objectives, ACGME milestones, NBME requirements, and institutional clerkship objectives. The EPA Assessment Tool includes 20 qualitative items representing six competency domains with responses that are classified using a rubric to one of four levels (from unsatisfactory to high honors). Reliability and validity will be assessed by comparing the EPA Assessment Tool scores with traditional evaluation scores from the same evaluators, a global assessment question, and Comprehensive Osteopathic Medical Achievement Test scores for the first three clerkship rotations. Feasibility will be assessed by evaluator ratings and evaluation completeness. IRB approval/exemption was obtained for the participating sites.

CONTEXT:
The tool was pilot-tested at Berkshire Medical Center for eight students in all disciplines, and at Eastern CT Health Network for two Ob/Gyn students.

OUTCOME/LESSONS LEARNED:
Preliminary data suggest no difference between forms. Evaluators express concern regarding decreased ease of use. Continued use of the tool and knowledge of the milestones will increase evaluator's familiarity and comfort. The pilot study will continue for the remainder of the 2017-18 academic year to gain further data for reliability and validity analysis.
Implementation and Evaluation of a Structured Program to Promote Resident Scholarly Activity
Authors: Chaudhry Taimur 
Published: September 2018

Local Mentor:

Mark B. Woodland, MS, MD

APGO Advisor:

Kimberly Kenton, MD

PROBLEM:
The annual Accreditation Council for Graduate Medical Education (ACGME) Resident Surveys for our independent academic medical center (IAMC) indicated that our OB/GYN residents were not satisfied with opportunities for scholarly activity.

INTERVENTION:
After financial and programmatic support was secured from the department chair, the faculty made a commitment to attend bimonthly 2-hour research/QI meetings with the residents during their protected didactic time. Also, the department employed an experienced clinical researcher to facilitate access to statistical support for the residents.

CONTEXT:
The ACGME Common Program Requirements mandate that residents should participate in scholarly activity. Our ACGME Resident Surveys indicated that the residents were not satisfied with opportunities for scholarly activity. As a result, our Program Evaluation Committee decided that this was an opportunity to improve the educational experience of the residents.

OUTCOME/LESSONS LEARNED:
Within 8 months of implementation of this program, the ACGME Resident Surveys demonstrated improved resident satisfaction with opportunities for scholarly activity from 25% in 2016 to 73% in 2017. There was also increased resident participation in QI projects and residents were getting involved earlier in their training.
Match Preparation: Optimizing Success and Satisfaction
Authors: Duncan Karen M. , Winkel Abigail Ford 
Published: September 2018

Local Mentor:

Abigail Ford Winkel

APGO Advisor:

Hope Ricciotti, MD

PROBLEM:
There is a lack of structured advising for 4th year medical students applying for Ob/Gyn residency. Given the increasing need for Ob/Gyns, it is critical to support top applicants and ensure success. This advising program offers standardized guidance to improve student satisfaction with the match process and outcome.

INTERVENTION:
A specialty-specific program was designed for structured advising and preparation to optimize match results, preparedness for residency interviews, and satisfaction with the match process and outcome. The program consists of 3 group advising meetings for Fourth Year Schedule Planning, Application Strategy and Preparation, and Interview Preparation. Students are assigned to faculty advisors to further assist with applications and participated in mock interviews. Outcomes measured include unmatched rate relative to national rate, percentage of students matching at their top 3 programs, percentage of students participating in the advising program, and satisfaction with the advising process and match outcome measured by survey.

CONTEXT:
This program was implemented during students' third year of medical school and extended through residency match.

OUTCOME/LESSONS LEARNED:
All students applying for Ob/Gyn residency participated in the advising program. All students felt at least somewhat prepared for interviews. Most students felt well prepared. Some students reported the timing of one group advising session was not optimal for the focus topic. All 12 students who participated in the advising program matched into categorical Ob/Gyn residencies, compared to 70% for US graduates. Of the respondents, 72.7% matched into one of their top 3 programs. The majority of students were satisfied with the match process and match results.