bluuebunny/crossref_metadata_2025_split huggingface dataset:
Critical Incident Debriefing: Impact of a Teaching Module for OB/GYN Residents
Authors: Cutler Abigail , Black Jonathan , Sheth Sangini , Pathy Shefali 
Published: September 2016

BACKGROUND:
Healthcare professionals commonly confront suffering and death as well as other unique sources of stress. The cumulative effects of these experiences can be psychologically taxing, particularly on trainees. Debriefing has been proposed as a way to alleviate work-related stress. Minimal data exist about the role of debriefing during medical training.

METHODS:
Eligibility included all OBGYN residents at a single academic hospital. Participants completed surveys immediately prior to and following a 2-hour teaching module on critical incidents in medicine. Using a Likert scale, participants responded to statements that evaluated their perceptions of CI debriefing, familiarity with identifying CI, and comfort with post-incident debriefing. Responses were analyzed using a paired samples t test.

RESULTS:
Twelve participants were enrolled; 46% reported having experienced a CI. Following the teaching module, participants showed increased comfort identifying CI (P=.025), initiating a debriefing (P=.005) and facilitating a debriefing (P=.003). Following the teaching module, participants reported a stronger belief that post-incident debriefing is useful (P=.046), that learning to lead a debriefing is useful to their work (P=.017), and that they could identify situations where team members might require further interventions beyond debriefing (P=.007).

DISCUSSION:
Incidents experienced as critical by OBGYN residents are common. Our teaching module may positively affect how residents confront and process CI. Future studies are needed to assess the long-term impact of debriefing on resident wellbeing and patient care.
Evaluation of Challenger® as an OB/GYN Residency Self-learning Tool
Authors: Sookram Janhvi , Myers John , Jaspan David , Goldberg Jay 
Published: September 2016

BACKGROUND:
Challenger® is a commercially available on-line educational package, which offers focused readings on a variety of OB/GYN topics with self-assessments tests. It was utilized during the night float block to comply with duty hour restrictions, while still providing educational enrichment. Each resident completed 2–3 modules weekly, including a pre-test, educational content, and a post-test. The Challenger® program allows supervision and monitoring of resident progress. The total cost of Challenger® was approximately $6,000.

METHODS:
After one year of usage of Challenger®, residents completed a quality assessment questionnaire which evaluated the reading assignments, test questions, and their perception of its usefulness as a learning tool.

RESULTS:
Sixteen residents completed the quality assessment questionnaire on Challenger®. One hundred percent of residents found the reading assignments were easy to understand. Seventy-five percent of residents learned “sometimes/rarely” from the modules. Eighty-one percent of residents rated the question quality as “poor/fair.” Seventy-five percent of residents believed it to not be worthwhile. Eighty-one percent did not believe that it helped to prepare for boards exams. Eighty-eight percent were unlikely to endorse continuation or recommend Challenger® to other residency programs.

DISCUSSION:
Challenger® was not a useful learning tool for OB/GYN resident education. Some readings were outdated. Some questions were of poor quality in assessing knowledge base. As pre- and post-test questions were the same, and residents often finished an entire module's reading section plus the pre- and post-tests within 30 minutes, it is uncertain whether the readings were actually completed.
Impact of a Resident-as-Teachers Objective Structured Teaching Examination (OSTE) on Medical Student Vaginal Delivery Learning Outcomes
Authors: Nuthalapaty Francis , Boland Jill , Tonismae Tiffany 
Published: September 2016

BACKGROUND:
One of the most common procedures learned by medical students on the OBGYN clerkship is normal vaginal delivery. Currently, students learn this procedure at the bedside, from residents who have had no formal instruction in optimal teaching methods.

METHODS:
A quasi-experimental time-sequential static group study. Obstetrics and Gynecology (OBGYN) residents were exposed to a RaT curriculum consisting of a didactic session, an OSTE using a standardized student and NOELLE birthing simulator. Third-year medical students on the 6-week OBGYN clerkship logged all vaginal delivery experiences during academic years preceding and following the RaT curriculum, recording their level of involvement in each of 16 procedural steps (Likert-type scale: 1=Observed; 2=Assisted; 3=Performed with assistance; 4=Performed without assistance). The level of involvement ratings for each procedural step, were compared pre and post RaT intervention, using the χ2 test. P<.05 was considered statistically significant.

RESULTS:
A total of 240 and 204 delivery experiences, were recorded by students pre and post the RaT curriculum, respectively. Following the curriculum, a significantly greater proportion of student delivery experiences occurred with chief residents (PGY-4) than prior to the curriculum (19.6% versus 4.6%, P<.01). Mean student level of involvement scores for setting up the delivery table, patient draping, postpartum hemorrhage preventive measures, and inspection of the cervix/vagina/perineum were significantly higher post-curriculum, as compared to pre (2.53 versus 2.02, P<.01; 2.15 versus 1.87, P<.01; 2.56 versus 2.36, P=.01; 2.25 versus 2.05, P<.01).

DISCUSSION:
A residents-as-teachers vaginal delivery OSTE may increase engagement of PGY-4 residents in student teaching and the level of student involvement in certain aspects of actual vaginal delivery experiences.
Job Satisfaction Amongst OB/GYN and Surgical Residents at an Academic Center
Authors: Hutchinson-Colas Juanna , Brug Pamela , Patel Nell Maloney 
Published: September 2016

BACKGROUND:
The association with physician burnout has been correlated with increasing perceived medical errors, and decreased productivity and compassion. Major components to satisfaction is work-life balance, ability to engage in desired activities, and ability to have time to unwind away from patient care demands.

METHODS:
This study composed of two independent surveys: The Maslach Burnout Inventory, and the Job Satisfaction Survey. Surveys were distributed to the 278 residents at Robert Wood Johnson Medical School with 190 respondents (68%) Residents surveyed included family medicine, general internal medicine, obstetrics and gynecology, emergency medicine, radiology, psychiatry, general surgery. This aspect of the study was to assess the status of the surgical related residencies programs. Respondents were 23/41 for surgery and 14/18 Ob&Gyn residents.

RESULTS:
There was no statistical difference between the two residency programs in the analysis. Job satisfaction General Surgery (18.9) and Obstetrics and Gynecology (17.4) demonstrating for both below average job satisfaction (15.1–20). Burnout score again was not statistically significant—General Surgery burnout score was 85.5 and Obstetrics and Gynecology score −79.0. There was no statistical difference noted across race, gender, marital status, religion and being a parent.

DISCUSSION:
Surgical related residents demonstrate job dissatisfaction and are a threat for burn out but there were no statistically significant findings between the specialties.
Laparoscopic and Robotic Skills Are Transferable in a Simulation Setting: A Randomized Controlled Trial
Authors: Thomaier Lauren , Abernethy Melinda , Grace Chen Chi Chiung 
Published: September 2016

BACKGROUND:
Residents are increasingly being trained on robotic techniques instead of traditional laparoscopy. Although simulation training does provide an effective supplement for traditional surgical training, less is known if skills are transferable between the laparoscopic and robotic platforms.

METHODS:
In a randomized single-blinded controlled trial of 40 simulation-skill-naive medical students, participants completed a baseline evaluation on a robotic pegboard-transfer task (Mimic dV-Trainer) and laparoscopic peg-transfer task (Fundamentals of Laparoscopic Surgery). Skills were evaluated using validated objective and subjective global rating scales (GRS) by two blinded expert surgeons. Participants were randomized to practice on either the robotic (N=20) or laparoscopic (N=20) task. After practice, participants were reevaluated performing both tasks.

RESULTS:
At baseline, there were no significant differences in objective measures (time to task completion, motion metrics) or composite GRS scores on both tasks between the groups. Participants performed their respective tasks faster (P<.001, P<.003), more efficiently (P<.001) and with a higher percent improvement in composite GRS scores (P<.001). The laparoscopic group improved their robotic performance with an increase in mean composite GRS scores of 15–20 but this change did not reach statistical significance (P=.091). Participants who practiced robotically significantly improved their laparoscopic performance with an increase in mean composite GRS scores of 15–19 (P<.02).

DISCUSSION:
Skills learned on either the robotic or laparoscopic platform appear to be transferable; however, robotic skills appear to be more transferable to the laparoscopic platform, than vice versa.
Military Sexual Assault Provider OSCE: Agreement of Self-reported Assessment and Standardized Patient Evaluation in Medical and Graduate Nursing Students
Authors: Lucas Cara , Petersen Scott 
Published: September 2016

BACKGROUND:
Sexual assault is one of the most underreported crimes in the U.S. military. Sexual trauma education programs have been successful in increasing awareness of this problem throughout the DoD, however now more emphasis is being placed on provider education early in training. Educators at USU have developed a sexual assault education module in order to improve provider comfort and communication in a crisis situation.

METHODS:
Surveys were designed to evaluate students on the eight essential elements of communication (EEC). A cohort of 179 USU medical and graduate nursing students completed these surveys after participating in an interview with a simulated sexual assault victim. The standardized patient portraying the victim also completed a mirrored survey evaluating student's communication.

RESULTS:
No significant differences in means between medical and graduate nursing student OSCE responses were discovered. Students similarly underrated themselves on encounters. Weighted kappas were calculated and showed fair agreement between self-assessment and standardized patients.

DISCUSSION:
No significant differences in interactions between medical and graduate nursing students were identified. OSCE is an important teaching modality for hands-on application of knowledge; student feedback was helpful in planning future simulations and identified some areas for improvement with this simulation. Exposing students to sensitive encounters and emphasizing importance of communication, especially in these situations, will assist students in their clinical growth and development.
Preparing for the First Milestone: Room for Improvement?
Authors: Jordan Scott , Zhao Huaqing , Ferriss James , Glowacki Carol 
Published: September 2016

BACKGROUND:
Specialty specific clinical milestone assessment begins with milestone level one, expected of incoming interns. In 2014, the ACGME required medical schools offer post match in-specialty training with the goal of attaining milestone level one.

METHODS:
An online survey was sent to Ob/Gyn interns nationwide in early 2015 assessing participation in required training and perceived entry-level skill sets. A free response section solicited suggestions for improvement of the milestones program. Of 1,276 interns, 145 (11.4%) responses were received. The χ2 test was used to compare responses between groups.

RESULTS:
Of respondents, 19.31% stated they participated in specialty specific milestones training. Among those taking the course, a statistically significant increase in interns feeling “very prepared” for Labor and Delivery duties was noted (23.08% versus 5.61%) (P=.036). No significant differences were perceived in overall preparedness, gynecologic surgery, or office based Ob/Gyn.

DISCUSSION:
This study highlights a lack of both universal implementation and a standardized curriculum, as well as a misunderstanding of program goals and milestone evaluation criteria. Many respondents suggest better training for triage, obstetrical emergencies, office gynecology, and minor gynecologic procedures. Improved participation and creation of realistic participant expectations at the outset, a greater focus on role playing simulations, and implementation of feedback may improve the effectiveness of the course.
Tabletop Simulation to Assess Teamwork Competency in OB/GYN Resident Candidates
Authors: Ma Mary , Kenny Bronwyn , Feldman Nathalie , Mann Stephanie , Nicholas Cate 
Published: September 2016

BACKGROUND:
Selecting new residents for an OBGYN training program is a high-stakes undertaking for both candidates and the programs to which they apply. Determining which candidates would work well within their cohort is of paramount importance to the success of a program. In addition, the quality of patient care has been shown to be positively impacted by inter-professional collaboration and well-functioning healthcare teams.

METHODS:
Mr. Potato Head® tabletop simulation was adapted for use during the UVM OB/GYN Residency Interview Day. Six to 7 candidates were assigned to each team. Candidates were assessed by 2 OBGYN residents who received training on identifying behavioral anchors associated with performance. Results of the team work simulation were included in the holistic review of candidates at the completion of the interview day.

RESULTS:
Seventy-one percent of candidate respondents reported favorable feedback on a post-interview day survey, describing the activity as a unique experience reflecting the value our program places on teamwork. 30/46 candidates met expectations with 6/30 nearly exceeding expectations. 10/46 candidates were rated as borderline meeting expectations and 6/46 failed to meet baseline expectations. Of the 6 candidates rated as not meeting expectations, 3 (50%) were not ranked in our program. 13/14 interviewers found the Potato Head Simulation to be valuable in their assessment of candidates, with 10/14 reporting a moderate to significant influence. Behavior anchors associated with meeting expectations included good listening skills, treating others with respect, the ability to reflect and be open to feedback.

DISCUSSION:
Teamwork is a skill set that is difficult to evaluate. Traditional one on one-interview scenarios rarely provide the opportunity for candidates to demonstrate their ability to function within a team. Tabletop Simulation provides a feasible, engaging and well received activity during the interview day to assists programs in evaluating candidate team work skills.
An Educational Intervention to Improve Physician Confidence and Knowledge About Transvaginal Sonographic Cervical Assessment in Obstetric Patients
Authors: Keiser Sharon D. , Forstein David , Heberlein Emily , Parker Patti 
Published: September 2016

Local Mentor: David Forstein, DO

APGO Advisors: Jody Steinauer, MD, MAS, and Sonya Erickson, MD

PURPOSE:
To evaluate the effect of an educational intervention about transvaginal sonographic cervical length (CL) measurement on obstetrics and gynecology residents' confidence and knowledge.

BACKGROUND:
Preterm labor admissions are costly. Transvaginal ultrasound measurement of CL has a high negative predictive value for preterm delivery, and can help triage patients with symptoms. Education about transvaginal CL measurement may increase use of this screening tool when triaging patients with preterm labor symptoms.

METHODS:
This was a before and after study of OB/Gyn residents at a single institution. The intervention consisted of an educational module adapted from a preexisting module from AIUM. Nine pre- and post-test questions evaluated knowledge. Residents were asked about their confidence with each answer and in doing CL measurements. Chi-squared tests were used to compare proportions and ordinal data, and Wilcoxon rank sum test the proportion of correct answers.

RESULTS:
Twenty-one residents participated. The proportion of residents answering 89% or more of the questions correctly increased from 5% before to 81% (P<.01). The level of confidence about answers to knowledge-based questions about the technique increased significantly, (P<.01) however confidence in doing CL measurement did not change, with 52% of residents saying they were not confident before and 38% after the intervention (P=.4).

DISCUSSION:
An educational module can increase knowledge about the utility and performance of cervical length measurement, but does not change confidence in doing the measurement. Future efforts should include curricula to teach the actual measurement.
Developing a Pilot Curriculum to Foster Humanism in Graduate Medical Education
Authors: Howell Jennifer O. , Chuang Alice , Dotters-Katz Sarah , Weil Amy 
Published: September 2016

Local Mentor: Alice Chuang, MD

APGO Advisors: Sonya Erickson MD, and Jody Steinauer, MD, MAS

PURPOSE:
To design a pilot curriculum to foster humanism in Graduate Medical Education (GME).

BACKGROUND:
Humanistic values have been recently emphasized in medical education with the advent of professionalism competencies. Few curriculum interventions affect humanistic professional development at the GME level.

METHODS:
OB/GYN and Internal Medicine residents' narratives regarding challenges to humanistic behavior were analyzed as a needs assessment with three themes identified: compassion fatigue, communication challenges, and work-life balance. Three curriculum sessions focusing on these themes were chosen from an existing faculty development course. Ten subjects participated in the curriculum, and these ten participants and 10 control residents completed baseline and 60-day follow-up questionnaires that assessed burnout, compassion satisfaction, the ability to practice psychological medicine (Psychological Medicine Inventory [PMI]), and the number of ethical missteps made within the last 30 days4. The mean differences in scores between the control and intervention subjects were compared using a two-tailed χ2 test. The success of the intervention was also measured with 5-point Likert satisfaction surveys.

RESULTS:
The curriculum met course objectives and was successfully incorporated into the residents' practice (mean score 4.8) There was a trend toward improved burnout and compassion satisfaction for the intervention group versus the control group (P=.13). There was no difference in PMI or reported ethical missteps.

DISCUSSION:
A pilot humanism curriculum for residents was well received. Participants showed a trend towards improved burnout and compassion satisfaction compared with non-participants. Development and evaluation of an expanded curriculum would further explore the feasibility and effectiveness of this type of intervention.
Formative Assessment by Direct Observation of Clinical Skills on the OB/GYN Clerkship Rotation
Authors: McNaught Jenna 
Published: September 2016

Local Mentor: Margaret Burnett, MD, FRCSC

APGO Advisor: John Dalrymple, MD

PURPOSE:
To determine the impact of requiring that medical students be observed taking a history or performing a pelvic examination by a physician during their OB/GYN clerkship rotation.

BACKGROUND:
One of the LCME standards for accreditation of a medical school is having physicians directly observe medical students in their clinical activities in order to provide formative feedback. Since 2009, 29.7–52.9% of each class of Manitoba medical graduates report having been observed taking a history on their OB/GYN clerkship rotation; 45.2–70.4% for observed physical examination.

METHOD:
Clerks are surveyed on the last day of their OB/GYN rotation to determine the number of observed histories and/or pelvic examinations. In September 2015, observed histories and pelvic examinations became a rotation requirement. A mini-CEX tool was developed and included in the student's logbook to facilitate documentation and provide feedback. The reported number of observed histories and pelvic examinations are compared before and after implementation of this process.

RESULTS:
Thirty-five percent of 69 students surveyed before implementation report having been observed performing a history by a physician. This rose to 64% (of 28 students) following implementation. All of them report being observed performing a pelvic examination, before and after, however only 53% documented this on the assessment tool.

DISCUSSION:
The number of observed histories has increased however there is room for further improvement. This may require additional faculty education and/or scheduled assessment for some students. The number reporting an observed pelvic examination continues to be 100% but improved documentation of this must be encouraged.
Labor and Delivery as a Learning Environment: Results From a Survey of Medical Students and Their Instructors
Authors: Hoffman Mark 
Published: September 2016

Local Mentor: Wendy Hansen, MD

APGO Advisors: Sonya Erickson, MD, and Jody Steinauer, MD, MAS

PURPOSE:
To evaluate labor and delivery as a learning environment during the third-year medical school obstetrics and gynecology course.

BACKGROUND:
Labor and delivery is a teaching environment for medical students during their third year OB/Gyn rotation. Based on the end-of-year student evaluations of the clerkship, labor and delivery was noted to be an area in need of improvement.

METHODS:
After IRB approval, the validated learning environment survey was sent to all third-year medical students who rotated through the labor and delivery unit at a single university hospital. Surveys were also sent to instructors who worked directly with students on labor and delivery, including OB/Gyn faculty, residents and nurses. De-identified responses were collected through Qualtrics software. Descriptive analyses were performed to identify differences in student and instructor responses.

RESULTS:
The overall response rate for the survey was 42% (77/183), with 85% (11/13) of faculty, 63% (10/16) of residents, 40% (38/95) of students and 31% (18/59) of nurses responding. Student and instructor responses were statistically different for 16/39 questions (41%). The section titled “Motivation/learning skills,” which included topics such as “I am eager to learn” and “I come to the clinical session prepared and ready,” contained the most significant difference in responses between students and teachers.

DISCUSSION:
Survey results reveal that students and instructor had different opinions of students' experiences on labor and delivery. The results of this survey will help clerkship leaders identify areas in need of improvement.