bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a Medical Student Online Case Study Curriculum: Cases in Obstetrics and Gynecology (COGs)
Authors: Pierson Rebecca , Schnee D. Mark , Di Corcia Mark , Litwiller Abigail 
Published: September 2016

BACKGROUND:
As the size of medical school classes grows, the challenges of standardizing the educational experience also increase, particularly when schools must use multiple educational sites to accommodate large groups of students. Here we describe the development, validation, and implementation of an online system of interactive Ob/Gyn case studies that help address this issue. Other clerkships have successfully used this type of curricula but nothing of this kind is available for Ob/Gyn clerkships.

METHODS:
A series of 25 online, interactive cases were developed that included obstetric and gynecologic topics that were linked to the APGO Medical Student Educational Objectives.

RESULTS:
Comparison of National Board of Medical Examiners (NBME) subject exam scores for the year of implementation to historical data showed no significant difference in mean score by rotation as well as no significant difference in first time pass rate. Subjective data were also captured on student opinions and perceptions regarding contribution to general Ob/Gyn knowledge and usefulness of cases in exam preparation. A majority of students felt that the cases enhanced their clerkship experience and were useful for subject exam preparation (77.5% and 65.3% respectively).

DISCUSSION:
The case series is a useful addition to standard Ob/Gyn clerkship curriculum which increases student exposure to a standardized set of topics and increases positive perception of the Ob/Gyn clerkship.
Evaluation of Ethics Education in Ob-Gyn: A Survey of Resident Physicians
Authors: Byrne John , Derby Katherine , Chor Julie 
Published: September 2016

BACKGROUND:
Ob-Gyn residents face a myriad of ethically challenging situations, both specialty-specific and universal to all medical specialties. Ob-Gyn-specific Milestones require programs to assess residents' abilities to implement key ethical principles and behaviors. However, there is limited research evaluating resident preparedness in addressing ethically complex situations.

METHODS:
A cross-sectional, web-based survey was deployed to residents from 9 of 11 ACGME accredited Ob-Gyn residency programs in Chicago. The survey was modified from a prior survey of Ob-Gyn residency program directors and developed in collaboration with a professional survey lab at the University of Chicago. Descriptive statistics were used to analyze data.

RESULTS:
Of 191 eligible ob-gyn residents, 111 (58%) responded to the survey. Most respondents were from university-based programs (n=90, 81%) without religious affiliation (n=81, 73%). Only 23% (n=26) of respondents indicated their program included ethics in its core educational curriculum. Eighty percent (n=89) of respondents stated their program dedicated 0–5 hours per year to ethics. The vast majority of residents (n=90, 81%) would like “more” to “a lot more” ethics education and believed it should be required (n=72, 65%) for residency completion. Forty-two percent (n=47) of respondents stated they felt “somewhat” or “very unprepared” to deal with ethically challenging situations. Residents identified curricular crowding (n=87, 78%) and limited faculty expertise (n=69, 62%) as barriers to receiving formal ethics education.

DISCUSSION:
Although barriers such as time constraints and faculty inexperience exist, Ob-Gyn residents desire greater ethics education in residency training.
Implementation of a Novel iOS Application to Improve Patient Handoffs
Authors: Turner Taylor , Bevis Kerri , Yan Tony , Yeh Jason 
Published: September 2016

BACKGROUND:
Shift changes are complex and present opportunities for error. At Duke University, inpatient services have a pager number that must be linked to a specific resident's pager, requiring seven phone calls and 168 keystrokes. A single error can prevent communication between nursing staff and residents. An application for iOS was released January 2015, reducing the total keystrokes to seven.

METHODS:
An anonymous survey was sent to all residents who had the application available to them. Phone records were reviewed for handoff errors before and after implementation of the application. Each transition of care was evaluated for timely re-assignment of pagers.

RESULTS:
Twenty-five of 38 residents (66%) responded to the survey. Ninety percent of respondents had an iOS compatible device and 40% installed the application. Eighty percent of those with it installed used the application, and 100% of users felt it reduced errors. Two hundred total handoff events were evaluated. Pre-implementation there was a 29.9% error rate, with the application available the error rate was 31.6%.

DISCUSSION:
A mobile application to improve patient care handoffs was not widely used despite high levels of software compatibility. There was no improvement in error rates of pager assignments in our preliminary evaluation, however residents using the application felt it reduced errors. This study demonstrates the difficulty in implementing technology-based tools to reduce errors in handoffs, in both utilization rates and predicting efficacy. Future development efforts should consider these issues.
Network Analysis of Mentoring: A Tool for the Assessment and Management of Mentoring
Authors: Smith Roger , Learman Lee 
Published: September 2016

BACKGROUND:
Mentoring works only when the goals of both the mentor and mentee are well aligned. The most effective mentoring relationships must include feedback, which is possible only in acknowledged, bilateral, relationships. Social network analysis tools lend themselves well to evaluating these aspects of mentoring.

METHODS:
Network analysis tools were used to create network maps and descriptive quantification of mentoring relationships. Data were obtained over a 2-year period using a standardized tool, which provided definitions of mentoring and asked faculty to list their mentors and mentees and perceived strength of each relationship.

RESULTS:
Thirty faculty (93.8% of possible responders) participated in 2013 and 33 (94.3%) participated in 2014. Network analysis in the first year showed a robust, but clustered, network of mentoring consisting of 4 communities, which became more diverse (6 communities) in the second year. The number of faculty without an identified departmental mentor declined by half, from 6 (20.0%) in 2013, to 3 (9.1%) in 2014 (P=.22). The number of faculty who reported no mentees declined steeply from 22 (73.3%) to 9 (27.3%) (P<.01). The mentor acknowledged one or more relationships in 75.0% of cases in 2013 and 70.4% of cases in 2014 (P=.54).

DISCUSSION:
Network analysis is a promising tool to assess mentoring in an academic department, identify gaps and track changes over time.
Ob Gyn Intern Boot Camp: Educational Outcomes-Council for Residency Education in Obstetrics and Gynecology Examinations and Preparedness for Clinical Care
Authors: Haver Mary , Rauth Virginia , Borahay Mostafa , Jain Sangeeta , Bastien Sherry , Wen Tony 
Published: September 2016

BACKGROUND:
Traditional resident education were weekly lectures, M&M and surgical training involving “see one; do one and teach one.” In more recent time, clinical training in both medical school and residency has been significantly impacted by national educational policies, a focus on patient safety and a decrease financial support for indigent health care.

METHODS:
IBC 3-days curriculum was composed of reading materials and lectures on prenatal care, labor, contraception, surgical techniques, abortion (Ab) and ectopic pregnancy, ward emergencies, postpartum hemorrhage (PPH), postoperative fever and postpartum care, fluid/electrolytes and pain management. The simulation trainings included pap/bimanual exam, vaginal and cesarean delivery, knot and suturing, IUD insertion, episiotomy repair, Ob ultrasound, and ward emergency, postop infection and pulmonary emboli (PE) management. Data on medical school graduates, gender, USMLE step 1 and 2 exams were compared. A 17-questions survey on their clinical skill preparedness in various Ob Gyn clinical settings scored on a 7-likert scale with score of 1–3 for not well-prepared and score of 5–7 for well-prepared for patient evaluation/management and Ob Gyn procedures.

RESULTS:
The IBC and NBC groups were similar in gender, medical school attended and step 1. The IBC group did score significantly higher on step 2. There was a trend for higher CREOG and higher portion of residents scored above the national mean of 200. The IBC group felt better prepared to manage in Ob triage (4.27), clinic (4.47), postop fever (4.80), PE (4.13), Ab (4.47), and ectopic (4.40). However, IBC group felt less prepared to perform procedures: suturing (4.47), SVD (4.47), CS (3.33), D&C (3.93), Colpo (4.80), and IUD insertion (4.47) and to manage ward call (3.93) and PPH (3.87).

DISCUSSION:
Residents who received IBC training felt better prepared to manage Ob triage, clinic, postop fever, PE, ab, and ectopic, but less prepared to manage labor, PPH and to perform Ob Gyn procedures. Despite scoring higher in CREOG, they still felt less prepared.
Obstetric Hemorrhage: Improving Readiness and Response in a Community Hospital
Authors: Gupta Ankita , Daniels Kelli 
Published: September 2016

BACKGROUND:
The rates of PPH in the US have steadily increased over the years up to almost 3% in 2006. In order to improve the safety of patient care and decrease the rates of morbidity from PPH, a QI project was designed.

METHODS:
The planning phase of our PDSA cycle assessed current deficits including lack of provider skill with procedures like Bakri balloon and B lynch suture placement and systems errors like a lack of a specific PPH reporting form. An intervention was designed including lectures, on site simulation drills and skills workshops to address these deficiencies. A severe maternal morbidity reporting form has been proposed. A mobile based app was developed as a quick reference tool for providers to aid in the management of PPH. The results of this intervention were studied using paired t tests for analysis of pre and posttest questionnaires judging knowledge and provider comfort with procedures.

RESULTS:
A statistically significant difference was noted between provider comfort in diagnosing PPH, calculating estimated blood loss, placing a Bakri balloon, placing a B-lynch suture and requesting blood products for management of PPH with P<.05.

DISCUSSION:
A simple, low-cost intervention including simulation drills, skills workshops and a free mobile app, can improve provider knowledge and comfort with management of PPH, impacting patient safety.
Peer-to-Peer Interactive Breast Health Training With Simulation: Effect on Medical Student Anxiety and Exam Scores
Authors: Steen Claire , Hou Melody 
Published: September 2016

BACKGROUND:
Changes in national screening guidelines have decreased student clinical experience with breast health, which may be ameliorated using a case-based simulation model in the curriculum.

METHODS:
A case-based interactive peer-to-peer didactic using a breast simulation model was introduced to the OB/GYN clerkship curriculum at the University of California, Davis School of Medicine during AY2013-2014. Students who underwent the didactic completed pre- and post-didactic surveys assessing anxiety regarding breast health. The post-didactic survey was compared to a survey of students from AY2012-2013 who did not experience this didactic, as were each group's OB/GYN shelf exam performance on breast health questions.

RESULTS:
Fifty of 96 students (52%) from AY2012-13 and 63 of 97 students (65%) from AY2013-14 completed the survey. Among AY2013-14 students, there was no significant difference in anxiety before and after the didactic (P=.12), nor when compared with AY2012-13 students (P=.25). However, 26 of 63 (41%) of students from AY2013-14 reported anxiety about differentiating malignant versus benign disease, compared with 35 of 50 (70%) students from AY2012-13 (P=.002). On the OB/GYN shelf exam, AY2013-14 students collectively performed 13% higher than national average on breast health questions, while AY2012-13 students performed 3% higher than national average.

DISCUSSION:
A case-based simulation model did not improve anxiety regarding breast health. However, students who experienced this didactic session had improved confidence in benign versus malignant differentiation and improved exam performance compared to students who did not.
Surgical Case Logging Habits and Attitudes: A Multi-Specialty Survey of Residents
Authors: Cadish Lauren , Fung Vicki , Lane Felicia , Campbell Eric 
Published: September 2016

BACKGROUND:
The Accreditation Council for Graduate Medical Education measures surgical residents' experience by mandating that residents log each procedure in which they have participated. This system is the primary mechanism by which breadth and depth of surgical training are documented.

METHODS:
Investigators developed and administered a voluntary, 45-item survey to all general surgery, obstetrics and gynecology, orthopedics, urology, neurosurgery, otolaryngology, and plastic surgery residents at a large academic medical center. Resident demographic data, program details, logging behaviors, and attitudes were examined using descriptive statistics. Authors used multivariate logistic regression to assess characteristics associated with logging habits.

RESULTS:
Eighty-two of 126 surgical residents participated, yielding a response rate of 65%. Overall, 7.5% considered the system highly inaccurate, 28.8% somewhat inaccurate, 52.5% somewhat accurate, and 11.3% highly accurate. Nearly half (48.1%) use an incorrect metric to log their role as surgeon or assistant. Half logged monthly or less frequently. The longest time residents reported falling behind ranged from less than a week to more than a year, with about half (51.4%) reporting backlogs of 3 months or longer. Approximately two-thirds considered the system difficult to navigate (64.2%) and burdensome (68.8%).

DISCUSSION:
Inconsistency of logging habits and perceived lack of accuracy raise concerns about use of the system for assessing surgical preparedness or accrediting training programs.
Training Costs in a Surgical Subspecialty
Authors: Buys Elizabeth , Galvin Shelley 
Published: September 2016

BACKGROUND:
Resident training is expensive, ∼$80,000/resident/year. As the healthcare system evolves, residencies must evolve to produce physicians competent to meet future needs and challenges. Yet additional GME dollars haven't accompanied IOM calls for a larger, high-quality physician workforce. Current funding may already be insufficient. We wanted more clarity about the real costs of training in a surgical subspecialty.

METHODS:
The minimum thresholds for surgeries performed by generalist OBGYNs are: Cesarean=145; TAH=35; TVH=15; TLH=20; Incontinence=25; Cystoscopy=10; Laparoscopy=60; Hysteroscopy=40; Total=350. We assigned each PGY a proportional threshold and OR time based on historical reports—longer durations to novice-advanced beginners and shorter durations to competent-proficient surgeons. We estimated hours of surgery-related clinical activities (CA). Faculty: surgery conference (1-h/wk); outpatient pre-op and post-op appointments and checkouts (4-h/wk and 2-h/wk); inpatient pre-op (5 min/procedure); rounding-morning (1-h/shift×5-days×4-residents); rounding-evening (1-h/shift×5-days); case preparation (30-min/procedure); case logs (5 min/procedure) evaluation (5 min/procedure); and simulation (16-h/year×4-faculty). Residents: surgery conference (1-hr/wk); outpatient pre-op and post-op appointments and checkouts (4-h/wk and 4-h/wk, respectively); inpatient pre-op (5 min/procedure); inpatient supervision (1-h/shift×5-days); case preparation (15-min/procedure); evaluation (5 min/procedure); and simulation (16-h/resident). We calculated the mean generalist hourly wage (salary+benefits/40 hours/52 weeks; no call) and the mean hourly wage by PGY (salaries+benefits/80 hours/52 weeks).

RESULTS:
Total costs=$323,389: Faculty=$194,462 (OR=$70,836; CA=$123,626); Residents=$128,927 (OR=$9,281; CA=$119,646).

DISCUSSION:
Meeting minimum surgical thresholds exceeds the ∼$320,000/resident/4 years. To include training costs of L&D, ambulatory care, cancer procedures and other experiences of robust physician education, funding streams, (direct and indirect dollars) must evolve also.
A Quality Improvement Curriculum in Ambulatory Obstetrics and Gynecology: Development and Implementation With OBGYN Residents
Authors: Habak Patricia , Manriquez Maria , Ayutyanont Napatkamon 
Published: September 2016

Local Mentor: Maria Manriquez, MD

APGO Advisor: Lee A. Learman, MD, PhD

PURPOSE:
To develop a quality improvement (QI) curriculum for Obstetrics and Gynecology (OBGYN) residents using on-line modules from the Institute for Healthcare Improvement's Open School.

BACKGROUND:
OBGYN residents need to acquire knowledge and skills in quality improvement to be prepared to participate in this process in ambulatory practice.

METHODS:
We designed a QI curriculum for residents using on-line modules from the Institute for Healthcare Improvement's Open School. The curriculum comprised three introductory modules supplemented with small group sessions during which ambulatory based QI projects were developed. Completion of the curriculum was a required component of residency training.

EVALUATION PLAN:
Residents completed a pre and post-curriculum survey. The survey included an eleven-question test of knowledge and a nine-question assessment of attitudes and confidence. Knowledge questions were drawn directly from the modules and graded on number of items correct; attitude and confidence questions were scored on a 5-point, Likert-type scale with 5 representing greatest confidence and perceived value surrounding QI issues. Mean knowledge scores increased from 7.25 to 8.72 following completion of the curriculum (P<.001). Similarly, mean attitude scores increased from 3.51 to 3.98 (P<.001). Ninety-seven percent of residents completed the modules and all small groups were successful in development of proposed ambulatory-based quality improvement projects.

DISSEMINATION:
Planned submission to the AAMC Med-Ed PORTAL.

REFLECTIVE CRITIQUE:
Residents showed gains in knowledge and confidence. Residents' development of quality improvement projects would have benefited from addition of a Quality Analyst. Our intent is to continue to develop and carry out the projects identified.
Assessing Qualitative and Quantitative Competence of Resident Knowledge in Communication of Procedure-Specific Risk for Suction Dilatation and Curettage and Vaginal Hysterectomy
Authors: White Amanda B. 
Published: September 2016

Local Mentors: John Gianopoulos, MD, and Amy Young, MD

APGO Advisor: Nancy Hueppchen, MD, MSc

PURPOSE:
Perform a knowledge assessment of OBGYN residents' communication of procedure-specific risk for two common gynecologic procedures.

BACKGROUND:
Informed consent is integral to patient autonomy. For surgical patients, satisfaction improves with understanding of the procedure performed. Standardized curriculum for the informed consent process has not been utilized to date. An assessment of resident knowledge in the communication of accurate and adequate information is essential to ensuring adequate disclosure.

METHODS:
Two medical students, 19 residents and 22 faculty were surveyed on understanding of informed consent process and knowledge source on the topic. Respondents identified procedure specific risks for dilation and curettage and vaginal hysterectomy as required by the Texas Medical Disclosure Panel. Statistical analysis was performed to determine knowledge adequacy (unsatisfactory, satisfactory, superior). Interest in formal curriculum was assessed.

RESULTS:
Overall response rate was 74%. Learners were predominantly female (89%) aged 25–29, and evenly distributed across training year. Interval from last surgical rotation was <1 month at all levels. R4/Faculty identified textbooks and American College of Obstetricians and Gynecologists bulletins as their source of knowledge more frequently than other learners (P<.05). Qualitative competence improved with training year (P=.04). Quantitative competence was unsatisfactory at all levels for suction D&C with no difference by PG year (P=.94). Quantitative competence was satisfactory at all levels for vaginal hysterectomy, with no difference by PG year (P=.762). Learners identified formal teaching and direct observation as desired instructional methods.

DISCUSSION:
Though qualitative competence improves with PG training year, the communication of adequate and accurate information remains a challenge at all levels, specifically for suction dilation and curettage. Standardized curriculum should be implemented to achieve competency.
Development of a High Value Care Educational Module for Obstetrics and Gynecology Residents
Authors: Reddy Madhuri , Cantrell Leigh A. 
Published: September 2016

Local Mentors: Carrie Wieneke, MD, and Michael Moxley, MD

APGO Advisors: Alice R. Goepfert, MD, and Lee A. Learman, MD, PhD

PURPOSE:
To develop an educational module introducing high value care concepts to obstetrics and gynecology residents.

BACKGROUND:
Cost effective care is one of the 28 ACGME milestones to be achieved during residency training. It is imperative that physicians are aware of the components of the cost of medical care and how to maintain quality while containing cost.

METHODS:
Needs assessment was performed by surveying graduating seniors and junior faculty. Knowledge gaps were identified and an introductory educational module was designed. This module provides basic information defining high value care and how it can be achieved in clinical settings using a few simple tools; it was presented as an interactive small group discussion with activities illustrating cost-effective care using real life examples.

EVALUATION PLAN:
Participants of the study were OB/GYN residents (n=26) at two academic institutions. The introductory module started with a pretest. Evaluation of knowledge gained and decay was performed by an immediate post-test and a retention test 3 months later. The testing results are reported elsewhere.

DISSEMINATION:
In addition to submission to CREOG-APGO Annual Meeting, the module can be disseminated through AAMC MedEdPORTAL.

REFLECTIVE CRITIQUE:
Traditionally, the attitude of American medical care has been to use all available resources. A shift to taking care of patents using only the appropriate resources is a culture shift for both learners and teachers. Creating a module that is informative and interesting while achieving the goal of changing practice styles was challenging. Development of a robust national curriculum for ob/gyns should be undertaken.