bluuebunny/crossref_metadata_2025_split huggingface dataset:
Video Curriculum for Gynecologic Surgery
Authors: Johnson Christina , Stroup Caroline , Gujral Harneet , Wright Kelly , Baecher-Lind Laura 
Published: September 2018

PURPOSE:
To evaluate the efficacy of a surgical video curriculum versus standard learning throughout the rotation.

BACKGROUND:
With decreasing surgical volume, training time restrictions, and more routes to approach individual cases, efficient and effective tools for surgical learning are essential. We developed several videos teaching pelvic anatomy and steps of common gynecologic procedures.

METHODS:
The video curriculum was presented to alternating groups of students completing their OBGYN clinical rotation compared with standard rotation exposure. Participants knowledge of relevant anatomy and surgical steps was assessed at baseline, the rotation end, and immediately after exposure in the video group. Mean score assessment scores, overall impressions, and learning preferences were evaluated.

RESULTS:
All 42 participants had similar training, case exposure, and baseline scores. At the end of the rotation, the mean rotation-end scores were 34% and 46% for control and video groups (P=.005), and the difference remained significant when corrected for baseline score (P=.012). The mean post-test score rose to 49% compared to a baseline mean of 25% (P<.001). Seventy-four percent of participants preferred video over text, 86% reported the series was a useful educational tool, 90% would use the videos for case preparation, and 55% felt more engaged during surgery.

DISCUSSION:
The video series improved students' performance on assessment of anatomy and surgical steps. Overall impressions of the video series were positive and most students reported they preferred video to text format. Moving forward, videos like these can be used and examined as adjunctive tools for acquisition of specific surgical knowledge and skills.
Recent Ob/Gyn Residency Graduates' Experience With Hysterectomy
Authors: Cadish Lauren A. , Muffly Tyler M. 
Published: September 2018

Local Mentor:

Carol Major, MD

APGO Advisor:

Jody Steinauer, MD

OBJECTIVE:
To estimate the average hysterectomy volume performed by Obstetrician-Gynecologists in their first five years following residency graduation

METHODS:
This is a retrospective cohort study of recent residency graduates. Provider-identified, patient-deidentified case mix data from 2004-2014 were obtained from the Massachusetts Center for Health Information Analysis statewide database. Data were crosslinked to demographics, year of residency graduation, and fellowship training. Data were narrowed to simple hysterectomies by Ob/Gyn specialists within five years of graduation. Mean hysterectomy numbers performed in each of the first five full calendar years following residency were determined by descriptive statistics and stratified by modality. A veteran cohort of physicians completing residency training 20 or more years earlier but younger than 65 served as a comparison group.

RESULTS:
Case mix data revealed 89,026 hysterectomies performed by 1,909 physicians from January 1, 2004 to December 31, 2013. Of these 1,359 were simple hysterectomies performed by 85 recent residency graduates practicing as Ob/Gyn specialists. For this cohort, the mean number of hysterectomies performed annually was 4.7, 4.6, 4.7, 4.3, and 4.1 in each of the first five full calendar years respectively following training. Recent graduates most commonly chose the abdominal route (41.6%), with laparoscopic (32.4%), laparoscopically assisted vaginal (11.1%) and vaginal (14.7%) chosen less commonly. Hysterectomy volume did not change significantly over the first five years. Procedures performed in 2014, and comparison to the veteran cohort will be included in the final analysis (see poster presentation).

CONCLUSION:
Recent graduates perform an average of 4 hysterectomies annually, most often abdominally.
Simulation in the Obstetrics and Gynecology Clerkship: A Systematic Review of the Literature
Authors: Hunt Rebecca , Hostage Jean 
Published: September 2018

Local Mentor:

Robert Trowbridge, MD

APGO Advisor:

Kimberly Kenton, MD

CONTEXT:
Simulation is increasingly being used in medical education at all levels - to teach, train, and practice. Since time, effort, and resources are budgeted toward that training, it would be helpful to know if simulation is useful in obstetrics and gynecology clerkship, and if so, to what degree.

OBJECTIVE:
The purpose of this systematic review of the literature is to present what is known about the use of simulation in the Obstetrics and Gynecology clerkship. The review outlines the core surgical and procedural skills that are addressed by simulation, what simulations exist, and what has been found to be satisfactory, cost conscious, and effective. By identifying gaps, we shall be able to develop new simulations in the future that will be useful to medical students and their teachers.

DATA SOURCE:
A search was made in the databases of MEDLINE, Cochrane, MedEd Portal, BioMed Central and ScienceDirect, 1996 to present.

STUDY SELECTION:
Articles in English describing or evaluating simulation in obstetrics and gynecology clerkships. Search terms included: obstetrics, gynecology, simulation, clerkship, reproductive system, undergraduate medical education, high-fidelity sim training, patient simulation.

EXCLUDED:
Focus on 4th years or non-medical students, general surgery, virtual patients requiring only standard computer equipment, human patient actors.

DATA EXTRACTION:
Review of the articles is pending.

PLANNED MATRIX:
Training level, clinical topic, location (Sim center or clinical), study design, number of students exposed, method of group assignment, outcomes, methodological quality, (using MERSQI), IRB, and whether applies to a Milestone or APGO Objective.

CONCLUSION:
Pending review and data abstraction.
Effects of a Stress Management Workshop on Medical Students' Knowledge and Self-Awareness of Coping With Stress
Authors: Johnson Natasha R. , Chen Justin , Meyer Fremonta , Chen Xiaodong (Phoenix) 
Published: September 2018

Local Mentor:

John Dalrymple, MD

APGO Advisor:

Nancy Hueppchen, MD

OBJECTIVE:
To investigate the effects of a stress management workshop on medical students' knowledge and self-awareness of stress and potential coping strategies.

METHODS:
A two-hour workshop was given to medical students before starting their clerkships consisting of a one hour didactic followed by a panel discussion and small group breakouts. Topics included stress in clinical medicine, learning challenges, competition with colleagues, self-care, handling stressful events, and recognizing burnout symptoms. A longitudinal survey design was utilized to measure pre-, post-, and long-term (3-month) post-workshop students' reported changes in 4 domains: knowledge (impact of stress on their own health, learning, and patient care), confidence, perceived skills, and attitude (towards utilizing adaptive coping strategies to prevent burnout). Surveys were distributed to all students (N=135) participating in the workshop. Paired t-test and multivariate analyses were performed to assess the differences between survey responses on a 5-point Likert scale. IRB approval was obtained.

RESULTS:
The survey response rate was 79.5% (pre- 90.4%, post-77%, long-term post- 71.1%). Compared to the pre-workshop, students reported significant improvement in all 4 domains immediately after the workshop: knowledge (4.4 vs. 4.7, P<.05), confidence (3.6 vs. 3.9, P<.05), perceived skills (3.3 vs. 3.7, P<.05), and attitude (2.6 vs. 2.8, P<.05). Compared to the immediate post-workshop, students' scores slightly decreased at 3 months, but were overall significantly higher than the pre-workshop scores.

CONCLUSIONS:
A stress management workshop can improve medical students' knowledge towards the impact of stress as well as their confidence, perceived skills, and attitude of using adaptive stress coping strategies.
Development of a “Teaching to Teach” Curriculum for Residents
Authors: Kirton Donald 
Published: September 2018

Local Mentor:

Heather Sankey, MD

APGO Advisor:

Nancy Hueppchen, MD

OBJECTIVES:
To develop a Resident as Teachers (RAT) Curriculum for the Ob/Gyn residency at UMMS-Baystate. To demonstrate improvement in resident teaching skills, confidence of our residents in teaching, and ability to provide feedback for students.

METHODS:
This IRB exempt project was performed using a single-group pretest posttest design. A needs assessment was performed utilizing three focus groups of Ob/Gyn residents and faculty to outline the curriculum content. Local interdisciplinary faculty were identified to create and implement 8 educational sessions. Residents were surveyed about comfort level in teaching and feedback skills before and after the curriculum was implemented. Medical student assessments of resident teaching for 6 blocks prior to the intervention were compared to evaluations for 6 months post-intervention.

RESULTS:
Only 2 residents had received prior teacher training. All aspects regarding confidence in teaching and giving feedback showed improvement (mean pre-scores 3.57 and 3.56, post-scores 3.93 and 3.94, respectively). Student evaluations of residents showed improvement in effectiveness as teacher (4.3 to 4.68), giving feedback (4.1 to 4.65), being respectful (4.45 to 4.86), learning environment (4.3 to 4.78), being supportive (4.27 to 4.76) and acting as role model (4.35 to 4.84). Identifying the need to improve teaching skills decreased from 24% to 7%.

CONCLUSION:
The RAT curriculum showed improvement in all domains regarding confidence in teaching and giving feedback. The curriculum has resulted in improvement in student evaluations of residents in regards to teaching skills and giving feedback. The teaching skills sessions will be incorporated into the Educational Sessions for our OB/GYN residency program going forward.
Needs Assessment for Integration of Supportive Care Into Obstetrics and Gynecology Practice
Authors: Nugent Elizabeth 
Published: September 2018

Local Mentor:

Pamela Promecene, MD

APGO Advisor:

Kimberly Kenton, MD

PROBLEM:
Supportive medicine provides comprehensive care for patients with life-limiting illness, focusing on symptom management and quality of life. Obstetrician gynecologists provide lifelong care to their patients, necessitating their ability to provide these services. No standardized curriculum for palliative care is available for obstetrician gynecology learners.

INTERVENTION:
This intervention sought to comprehensively identify learner's needs as a first step to developing a teaching curriculum specific to supportive medicine for obstetrician gynecologists.

CONTEXT:
A comprehensive assessment was performed which included a literature review of available curricula in other fields and focus groups with a variety of specialists in palliative care (ICU, supportive care, gynecologic oncology, general OB/GYN, NPs, social work). A survey was distributed to local OB/GYN residents and fellows to determine learner comfort with supportive medicine skills and their value for future practice. Then information was synthesized and reviewed to ensure validity.

OUTCOME/LESSONS LEARNED:
Results demonstrate >50% of learners were uncomfortable with narcotic rotation, management of lymphedema, and management of actively dying adult patients. Fetal concerns included management of seizures and air hunger. Sixty-eight percent of learners felt comfortable giving bad news, but 50% had no method for providing the news and 33% had no formal training. Eighty percent of learners desired additional active training in providing bad news. Learners generally valued palliative care skills and their importance to future practice. Focus groups suggested themes of poor learner understanding of pain management, delivery of bad news, and difficulty with patient planning and preparation for neonatal death.
Development of an Evidence-based Robotic Surgery Curriculum in a Community Based OB/GYN Residency Program
Authors: Patel Ashwin 
Published: September 2018

Local Mentor:

Todd Beste, MD

APGO Advisor:

Hope Ricciotti, MD

PROBLEM:
The current robotic surgery training curriculum at our community based Ob/Gyn residency program is fragmented, out-of-date, and not well implemented. The goal of this project is to develop and begin implementing a formalized robotic surgery curriculum utilizing evidence based training modalities and other existing curricular components.

INTERVENTION:
The new curriculum will provide tools to verify the residents' competency of robotic-assisted surgery upon graduation. It will employ existing online training modules, in-service training sessions, virtual reality and real-life simulation exercises. Supervised cases as both the assistant and console surgeon are required and performance will be assessed using a modified, validated evaluation tool.

CONTEXT:
The robotic surgery curriculum will consist of two tracts: Tract 1 is designed to educate and promote safety of robotic-assisted surgery; Tract 2 is designed for residents interested in obtaining a robotic training equivalency certificate. Of the existing robotic curricula available, many have shown the above components to be effective tools for educating trainees. Some of these tools have been validated specifically for a robotic surgery curriculum.

OUTCOME/LESSONS LEARNED:
Implementation of this curriculum was started during the current academic year. Residents with prior training experience will assimilate into the appropriate tract. Using these evaluation methods, assessment of robotic surgical skills will be easier to track and provide feedback for improvement. Future steps will involve a survey of graduated residents prior to and after its implementation to assess the perceived effectiveness of the curriculum, ease of obtaining robotic privileges, and their comfort using robotic assisted surgery after graduation.
OB/GYN Clerkship Learning Environment Themes Identified on Qualitative Review of End-of-Clerkship Evaluations
Authors: Previte Colby 
Published: September 2018

Local Mentor:

Ruth Anne Queenan, MD, MBA

APGO Advisor:

Lee,Learman, MD, PhD

PROBLEM:
The OB/GYN learning environment presents unique challenges to learners and educators. Consistent with national trends, the University of Rochester (UR) OB/GYN clerkship ranks lower than other clerkships.

INTERVENTION:
To evaluate clerkship strengths and weaknesses, and narrative themes regarding the student experience, content analysis was performed on 2016-2017 end-of-clerkship evaluations. The evaluation asks students to comment on clinical site “strengths and weaknesses” and “positive and/or negative experiences about the learning environment” of the clerkship.

CONTEXT:
Since 2010, clerkship resources pertaining to learning objectives, expectations, reference resources, orientation materials, weekly didactics, and feedback mechanisms have expanded. Residents participate in yearly teaching, learning, and feedback didactics. Despite updates, student feedback remains consistent that integration into clinical teams and learning in the clinical environment is challenging.

OUTCOME/LESSONS LEARNED:
Consistent with previous literature, negative feedback themes include inconsistent teaching, insufficient hands-on experiences, lack of clarity regarding expectations, and difficulty integrating into clinical teams. Positive themes include diversity of experiences in OB/GYN, relationships with patients and families, and procedural learning. Each UR site possesses unique strengths, including exposure to sub-specialists and care of complex patients, for continuity relationships with nurses, and for interdisciplinary learning with family medicine and midwifery. Open ended questions led to varying lengths and level of detail in students' responses. Feedback themes varied over the course of the academic year. These findings precluded accurate statistical analysis of the content. Faculty development interventions, including a faculty educator series addressing narrative themes, will be developed to guide improvement in the OB/GYN clerkship educational experience.
Integrating Student Reproductive Health Educators into a Hospital-Based OB/Gyn Resident Clinic—Stakeholder Views on Trainee Impact
Authors: Salcedo J , Elia J , Tschann M 
Published: September 2018

Local Mentor:

Tod Aeby, MD, MEd

APGO Advisor:

Jody Steinauer, MD, MAS

OBJECTIVE:
To evaluate stakeholder views on the impact of integrating a student reproductive health educator (RHE) program into an OB/Gyn resident clinic on resident and medical student education.

METHODS:
Thirty-seven semi-structured interviews were conducted over three time points. Stakeholders included resident and attending physicians, clinic staff, departmental educational leaders, and RHEs (undergraduate and graduate students). Interviews were double-coded and discrepancies resolved through consensus. The code list and sampling were revised at each time point and key themes were identified through an iterative process.

RESULTS:
Residents should demonstrate competence in providing the patient education supported by RHEs before delegating such responsibilities. RHE support may be most valuable to senior residents, allowing them to focus on other patient issues and relieving clinic time pressure. RHEs should be fully integrated into the residency program curriculum by participating in mock counseling sessions and serving as patient education mentors early in residency. RHE-type programs provide residents with skills in team-based healthcare. Medical students are not adequately equipped to provide patient education in reproductive health and serve primarily in a shadowing role in the clinic. The RHE program should be fully integrated into student education; students can observe RHE education sessions and provide education with RHE support. Adequate patient volume ensures that an RHE program will not detract from student education.

CONCLUSION:
Student reproductive health educator programs are viewed by stakeholders as potentially valuable to both resident and medical student education and should be fully integrated into the curriculum of participating training programs.
Making CLER Clear: A Novel Approach to CLER Education
Authors: Seidel Sharon L. , Brooks Parker A. , Battistini Stephanie S. , McAlpin Lindsey M. , Golla Shalini 
Published: September 2018

Local Mentor:

Julie Z. DeCesare, MD

APGO Advisor:

Kimberly Kenton, MD

PROBLEM:
The Clinical Learning Environment Review (CLER) program is a component of NAS for which all ACGME accredited institutions must undergo. At our institution, understanding of the CLER program and the importance of interdisciplinary teams varies because not all clinical service lines have a residency-training program. Multidisciplinary collaboration is important across all clinical service lines in order achieve safe and high-quality patient care. We set out to create a hospital wide initiative to promote an institutional understanding of CLER.

INTERVENTION:
This project aims to develop an online CLER curriculum for our leadership council. Six online modules will be created to address each CLER focus area and corresponding pathways. Once the modules are created, a subset of the institutional leadership council will complete the modules along with knowledge assessment before and after each module. This cohort will be queried regarding their perception of module effectiveness and utility. This feedback will be used to improve the module design.

CONTEXT:
Once the final modules are designed, all members of the leadership council will complete the online modules and knowledge assessment before and after each module. Subsequent data analysis will render individual improvement and effectiveness of this model of CLER education. If proven an effective educational tool, this resource will be shared with institutions to promote institutional awareness of a CLER culture.

OUTCOMES/LESSONS LEARNED:
Modules are still being created at present.
Transvaginal Hysterectomy Error Identification: A Pilot Study of OBGYN Residents
Authors: Wood Sara C. , Seiler Katherine B. , Wegleitner Elizabeth , Gala Rajiv B. , Veronikis Dionysios K. 
Published: September 2018

Local Mentor:

Dionysios K. Veronikis, MD

APGO Advisor:

Nancy Hueppchen, MD

OBJECTIVE:
To investigate the ability of obstetrics and gynecology (OBGYN) residents to identify the potential errors that occur during transvaginal hysterectomy (TVH).

METHODS:
A cognitive task analysis (CTA) on TVH with critical decision points and potential error was utilized as the framework for a cross-sectional questionnaire that was disseminated to OBGYN residents at a community-based residency program. They were provided the critical decision points and asked to identify the error and their confidence to avoid, recognize, and manage the error. Residents identified their post-graduate year (PGY) level and “surgeon” experience with TVH based on case logs. An iterative process was performed with three OBGYN faculty and one resident to score the resident answers as incorrect, partially correct, or correct. A predictive model was created to analyze the data.

RESULTS:
There were 21 responses with similar representation of PGY levels. The proportion of surgical errors accurately identified and PGY level was positively correlated (P=.002) with the greatest change between PGY2 and PGY3 (P=.012). There was a significant increase in the accurate identification of errors after 21 cases as “surgeon” (P=.013), which was the mean volume of PGY3 case experience. A significant association was noted between the number of TVH performed and accurate error identification in anterior entry and uterosacral and cardinal pedicle procurement (P<.05).

CONCLUSION:
Progression from PGY2 to PGY3 and 21 cases is associated with an increased accuracy in identification of TVH. The resident experience in performing TVH is the driving factor in a resident’s overall ability to accurately identify potential surgical error.
Preoperative Checklist Effects on Surgical Resident and Attending Physician Satisfaction
Authors: Betcher R. Edward , Kothapalli Akhila 
Published: September 2018

Faculty Advisor:

Amy Boardman, MD

PURPOSE:
Evaluate if a pre-operative checklist and huddle can improve surgeon satisfaction, efficiency, and safety in an academic tertiary referral center.

BACKGROUND:
Aviation has demonstrated the benefits of checklists to improve safety. A pre-operative checklist/huddle is part of the WHO Surgical Safety Protocol but isn’t widely used beyond the surgical timeout. Negative connotations are frequently associated with patient safety protocols. What if they could make surgery go smoother thereby improving surgeon satisfaction? Would this increase the likelihood of adaptation?

METHODS:
A brief (<3 minutes) checklist was developed incorporating patient issues, anesthesia issues, equipment issues, and miscellaneous for the use in surgical suites. Before implementation, a 10 question (scale of 1-10) survey about OR satisfaction was sent to all surgical/anesthesia residents and attending physicians. After a one-month implementation of the checklist, a second similar survey was sent out for comparison. Average case time, number of cases, turn over time, on time starts, and complication rates were also measured before and after implementation. Statistical analysis using student t-test was used for significance.

RESULTS:
32 pre-intervention and 21 post-intervention surveys were received. They showed no improvement in surgeon satisfaction (P=.84) and surgical team dynamics. Average case length was increased by 2 minutes. Number of cases increased by 117/month. Turn over time remained unchanged. On time starts reduced from 52% to 46%. Operating Room variances decreased by 9%.

DISCUSSION:
The use of a pre-operative checklist demonstrated no improvement in surgeon satisfaction. Additionally, it resulted in minimal impact to surgical efficiency and variance rate.