bluuebunny/crossref_metadata_2025_split huggingface dataset:
Delivering Bad News in Obstetrics and Gynecology Residency: A Pilot Curriculum to Address Identified Training Gaps
Authors: Murphy Jessica , Jeronis Stacey , Kean Kristin , Rose Marisa 
Published: September 2016

BACKGROUND:
A recent literature review identified no publications on resident training in diagnosing and counseling patients on fetal demise. A previous needs assessment identified resident training gaps in the following areas: 1) communication skills in delivering bad news, 2) bereavement support and 3) counseling and consenting for the postmortem evaluation of the stillborn.

METHODS:
A 3-pronged curriculum, created and implemented to address the identified needs, included: directed readings, didactic lectures, and standardized patient simulation. Residents were surveyed pre and post-intervention to assess impact of the curriculum. Results were compared using McNemar's Test.

RESULTS:
Fourteen of 21 residents completed the curriculum. Resident self-assessed confidence significantly increased in: initiating proper workup after stillbirth (85.7% post versus 50% pre-intervention, P=.025), addressing patient anxiety and grief (100% post versus 71.43% pre, P=.045), and consenting for autopsy (100% post versus 50% pre, P=.008). The curriculum successfully addressed the gaps in training identified in grief management and autopsy counseling. A post-intervention objective measure demonstrated significant improvement in resident knowledge.

DISCUSSION:
This novel curriculum significantly improved residents' confidence and competence in diagnosing and counseling a fetal demise. Our department has integrated this successful training program into the residents' formal curriculum. We are sharing it as a model with neighboring institutions to further evaluate and expand this project.
Do Faculty and Residents Agree on Obstetrics and Gynecology Surgical Training Needs?
Authors: Braun Kelli , Swift Steven , Stepleman Lara 
Published: September 2016

BACKGROUND:
Surgical education is an essential, complex, component of residency training. Resident and faculty needs are important in guiding the educational agenda; studies demonstrate that these groups do not always agree on needs.

METHODS:
A 50-item needs assessment tool was administered during scheduled meetings at our single academic center to capture resident and faculty perceptions of the adequacy of our program's surgical training; all items were ranked on a 5-point agreement scale. Content domains included feedback, surgical preparation, intra-operative performance, simulation, and the Ob-Gyn Milestones procedures (we assessed satisfaction with training and the perceived helpfulness of simulation to improve performance of those procedures).

RESULTS:
Twelve surgical faculty (80%) and 13 residents (87%) completed the needs assessment; t tests compared resident/faculty group differences. Both groups agreed on the adequacy of surgical content domains, however, faculty consistently self-reported delivering feedback at a significantly higher level than residents' perceived receiving it (P<.05). Both groups were least satisfied with training in cystotomy repair, breech vaginal delivery, and 3rd/4th-degree laceration repair. Both rated simulation in breech vaginal delivery and vaginal hysterectomy as most useful for improving performance. For all procedures, faculty consistently rated at significantly higher levels, simulation's usefulness to improve procedure performance.

DISCUSSION:
Although residents and faculty agree on areas needing most improvement, differences exist in perception of feedback and usefulness of simulation to improve performance.
Does an Intensive and Multimodal Intern Boot-Camp Prepare Incoming Residents for Level 1 Milestones?
Authors: Tschirhart Monica , DeSilva Nirupama 
Published: September 2016

BACKGROUND:
Residents coming from different medical schools often have variations in their knowledge and skill sets. This has led to frustration and confusion amongst the not only the new residents, but also the upper-level residents and the faculty. Furthermore, many residents entered PGY1 achieving few level 1 Milestones.

METHODS:
We prepared an intensive curriculum focusing on achievement of level 1 Milestones during orientation for PGY1 residents that consisted of lectures, simulations, and e-modules. The residents' readiness was assessed before and after orientation using the PrepforRes: The APGO Preparation for Residency Knowledge Assessment Tool. The residents also took a post-orientation survey to assess their satisfaction with the curriculum. They will retake the survey in December and June to assess longer term satisfaction with the curriculum.

RESULTS:
Average PGY1 score prior to orientation was 60 with a standard deviation of 8.4. No incoming resident passed the exam. After the “boot-camp” average score was 82 with a standard deviation of 1.8 and every resident passed the exam. Overall there was a 37% increase in scores. Survey results indicated that the residents were satisfied with the curriculum. They all reported that they felt an increased connection as a class and indicated a desire to continue group study activities.

DISCUSSION:
A more robust orientation curriculum provided a substantial increase in resident readiness as measured by the PrepforRes test. Additionally the residents were satisfied with the curriculum and feel that it was helpful before starting residency. We will resurvey these residents at 6 months and 1 year to determine any additions or adjustments to the program. A side benefit seen was that the standard deviation decreased significantly from the pretest to the posttest. This may serve to place all the PGY1 residents on a more even footing when interacting with both other residents and faculty.
How Does the First Clerkship Affect Medical Students' Views of the Relationship Between Physicians and Nurses?
Authors: Morgan Helen , Skinner Bethany , Bailey Joanne , Hammoud Maya 
Published: September 2016

BACKGROUND:
Preparing future physicians to work collaboratively with nurses is a must for today's educators. Effective physician-nurse collaboration improves patient care and health outcomes. Medical students' views of the physician-nurse relationship and how these views may evolve during their clerkships have not been well examined.

METHODS:
Medical students on their first clinical clerkship completed the Jefferson Survey of Attitudes Towards Physician-Nurse Collaboration on the first and last day of their 6-week obstetrics and gynecology clerkship. This 20-question instrument addresses areas of responsibility and collaboration between physicians and nurses and has construct validity and reliability. All questions used a 4-point Likert scale (1=strongly disagree, 4=strongly agree). Pre- and post-clerkship scores were compared using paired t tests.

RESULTS:
Twenty-five students completed the pre- and post-surveys with a 100% response rate. Students overall had positive views of the physician-nurse relationship. At the completion of the clerkship, medical students felt more strongly that “during their education; medical and nursing students should be involved in teamwork in order to understand their respective roles” (pre: 3.82, post: 3.95, P=.042), and that “there are many overlapping areas of responsibility between physicians and nurses” (pre: 3.26, post: 3.57, P=.008).

DISCUSSION:
Our work reveals promising data that medical students begin their clinical clerkships with positive views of the physician-nurse relationship. Furthermore after the completion of their first clerkship, the students had significantly higher views of the importance of collaboration and shared responsibility.
Impact of Incivility and Self-Compassion on Burnout in Healthcare Workers
Authors: Stewart Tamika , Hadaya Ola , Jaber Sara , Sangha Roopina , Jesse Michelle , Richardson David 
Published: September 2016

BACKGROUND:
There is a large body of literature discussing CS, BO and STS in physicians, residents, medical students and nurses. Mid-level providers (MLPs) have not previously been assessed. Incivility has correlated to burnout in other professions, but not been assessed in a healthcare environment. Other constructs of psychological flexibility have rarely been evaluated.

METHODS:
A survey was sent to 501 MLPs. One hundred fifty-five completed the survey. The survey included: demographics, the Professional Quality of Life Scale, the Self Compassion Scale (SCS), the Perceived Stress Scale, the Satisfaction with Life Scale, the Interpersonal Reactivity Index, the Resilience Scale, the Workplace Incivility Scale, and the Health Provider Shame Scale.

RESULTS:
Approximately 38% of respondents fulfilled criteria for BO and 20% reported a high degree of incivility in the workplace. Residents and staff physicians were identified most often as the culprits. Significant predictors of BO included: SCS (β=−0.203, P=.04), incivility (β=0.233, P=.003), and perceived stress score (β=0.159, P=.001).

DISCUSSION:
Perceived incivility in the workplace can significantly impact BO, STS, and a decrease in CS in health care workers. The lack self-compassion increases individual's risk for BO. Programs to decrease burnout must look at not only how we relate to others, but how we relate to ourselves.
Implementation of a Maternal Health Curriculum and Distance-Learning Program in South Sudan
Authors: Espinoza Cholene , Achiek Mayen , Clunes Mark , Kokar Chatchai , Silverstein Zach , Wong Melissa 
Published: September 2016

BACKGROUND:
Every woman in South Sudan has a 1 in 7 chance of dying in childbirth. There are no post-graduate training programs in Obstetrics and Gynecology, so that MBBS-qualified doctors remain especially underprepared in maternal and neonatal care. Due to concerns for political instability and safety, a distance learning module was needed.

METHODS:
We first identified topics most pertinent to undergraduate MBBS education in maternal health. We next developed a delivery system for the content as well as obtained funding. We sought resources for the content of the didactics themselves and a method to ensure effective interactive learning.

RESULTS:
From our university's core lectures, we identified critical topics pertinent to maternal care in South Sudan. We secured funding through a nonprofit organization to obtain 84 digital tablets. Eighty-one pre-recorded lectures were loaded onto the devices, which were then distributed to the MBBS students. Two hours daily of small group discussion by our university's facilitator accompanied the lectures. Written tests (n=187) following the intervention showed substantial knowledge acquisition (mean score=63%; SD±12.8%). Debriefing sessions revealed unanimously positive responses to the intervention, particularly to the group discussions.

DISCUSSION:
The use of pre-recorded lectures on tablets and facilitated discussion resulted in successful implementation of a distance-learning program for maternal health in an underserved country. Future research will assess the sustainability and effectiveness of this intervention.
Perceived Stress on Labor and Delivery (L&D) During OB/GYN Clerkship From Students, Residents, and Faculty's Perspectives
Authors: Chen Xiaodong , Johnson Natasha 
Published: September 2016

BACKGROUND:
Appropriate stress levels can stimulate medical trainees to think and react quickly. However, little is known about the effects of stress on medical students' learning on L&D which is characterized by a complex, dynamic and unpredictable teamwork environment. Likewise the specific factors contributing to students' stress on L&D have not been reported.

METHODS:
Individual interviews were conducted with 3 consecutive cohorts of students at the end of their OB/GYN clerkships and a group of OB/GYN residents and faculty through convenience sampling in 2015. Participants were asked to identify the most stressful clinical setting during the clerkship and factors contributing to the stress in this environment. Thematic analysis and manual coding were applied to code and synthesize the data to identify the perceived stressful factors among students, residents, and faculty.

RESULTS:
L&D was the most stressful learning environment during the OB/GYN clerkship as reported by 14/19 students (73.7%). A total of 11 stressful factors from 4 categories were identified: 2 (terminology, interacting with residents) classified as Interpersonal Communication; 4 (pace, logistics, intrinsic sensitive nature of L&D, non-routine schedule) considered as Context; 3 (crisis, emergency, patient refusal of student involvement) fell into Clinical Scenario; 2 (student role and assignment, the amount of new knowledge and skills required) identified as Learning Tasks. Most residents and faculty (75%) reported that factors from Context would contribute to students' stress on L&D, and all students (100%) agreed. The majority of residents and faculty believed factors from Learning Tasks were stressful for students; but only 26.3% of students shared the same perception.

DISCUSSION:
Context factors contributing to stress were perceived by students, residents and faculty alike as contributing to stress and considered non-controllable, whereas OB/GYN residents and faculty differed in the perception of the effects of Learning Tasks on stress from students' perception. Clerkship programs are encouraged to integrate preparation of Context into curriculum through educational interventions to optimize students' stress level without increasing residents' and faculty's teaching pressure.
Resident Education Using a Novel, Low-Cost Postpartum Hemorrhage Simulator With Quantifiable Blood Loss
Authors: Porter Blake , Levy Deborah , Mundy David , Babbar Shilpa , Williams Karen , Maulik Dev 
Published: September 2016

BACKGROUND:
Postpartum hemorrhage is a common and potentially life threatening obstetrical emergency that has shown to be amenable to simulation.

METHODS:
Fourth year OB/GYN residents participated in a standardized simulation scenario of management of a PPH, prior to and after an educational intervention. The scenario used a novel simulator that quantifies blood loss and was built from low-cost, readily available materials. Residents then underwent an educational debriefing including instruction on PPH management and quantified feedback from their performance during the pretest simulation. Two months later, residents underwent posttesting using a similar PPH simulation. Statistical analysis used paired t test with P-value of less than .05 considered significant.

RESULTS:
Seven residents completed the pilot study. After the educational debriefing, residents performed corrective interventions earlier in the hemorrhage scenario. The primary outcome, total blood loss at the time of decision to perform exploratory laparotomy, significantly decreased 23% from 2,271 mL on pretest as compared to 1,743 mL on posttest simulation (P=.03). The residents' ability to accurately estimate blood loss improved, however this trend did not reach statistical significance (P=.15).

DISCUSSION:
Simulation training using this novel, low-cost PPH simulator allows for blood loss at the time of interventions to be accurately recorded and used in educational debriefings. Debriefing using management guidelines and quantified information on resident performance improved resident performance on follow up testing at 2 months.
Retention of Laparoscopic and Robotic Skills 12 Weeks After Simulation Training
Authors: Orlando Megan , Thomaier Lauren , Abernethy Melinda , Chen Chi Chiung Grace 
Published: September 2016

BACKGROUND:
Although minimally invasive simulation modeling provides a supplement for traditional surgical training, there is less objective data on longer-term skills retention.

METHODS:
We present the second stage of a randomized single-blinded controlled trial in which 40 simulation-naive medical students were randomly assigned to practice pegboard transfer tasks on either laparoscopic (N=20, Fundamentals of Laparoscopic Surgery, VT Medical Inc., Waltham, MA) or robotic (N=20, dV-Trainer, Mimic, Seattle, WA) platforms. In the first stage, two expert surgeons evaluated participants on both tasks immediately after training using previously validated global rating scales of laparoscopic operative performance. In the second stage, participants were evaluated on both tasks 12 weeks after training.

RESULTS:
Of the 40 participants who participated in the initial training phase, 23 (11 laparoscopic and 12 robotic) underwent repeat evaluation. Twelve weeks after training, there were no significant differences between groups in objective measures or global rating scale composite scores for the laparoscopic task. However, the robotic practice group demonstrated significantly higher global rating scale composite scores on the robotic simulation task (11.8 versus 9.4, P=.04). Robotic training was associated with improved economy of motion (P=.017) and fewer ring drops (P=.018) on the robotic platform.

DISCUSSION:
Robotic skills acquired through simulation appear to be easier to maintain than laparoscopic skills gained via simulation.
Description and Evaluation of Peer Review of Teaching in an Integrated Medical School Curriculum
Authors: Strafford Katherine , Tartaglia Kimberly , Mahan John , Nagel Rollin , Verbeck Nicole , Davis John 
Published: September 2016

Local Mentor: John Davis, MD

APGO Advisor: Nancy Hueppchen, MD, MSc

PURPOSE:
(Hypothesis) Using a group of Expert Educators, reliable peer review of clinical didactics can be provided to medical school faculty in an integrated curriculum.

BACKGROUND:
Recognition of effective teaching and faculty development to promote excellence in teaching should be curricular goals. Peer review can be a challenging component of teaching evaluation to institute. We sought to evaluate the consistency of reviewers in a newly implemented peer review program.

METHODS:
In an observational study of teaching in integrated clerkships, faculty leading didactic sessions were peer-reviewed by select faculty, “Expert Educators” (EEs). EEs reviewed sessions across all disciplines in the 3rd year clinical curriculum. EEs underwent faculty development training in peer observation and the giving of feedback, and used standard twelve item forms created using resources from the Stanford Faculty Development Program. Where possible, EEs were paired to provide a review on the same didactic session. We compared paired reviews using percent agreement as a means of assessing the consistency of feedback generated.

RESULTS:
Twenty paired and 44 individual peer reviews were completed by EEs. Analysis of the paired reviews showed average agreement by case was 52% but rose to 87% when data were grouped by acceptable/not acceptable scores.

DISCUSSION:
EEs have moderate agreement when reviewing the same didactic session and high agreement when elements were analyzed as acceptable/not acceptable. We plan to use taped lecture review by 3–4 EEs to continue assessment of rater reliability. Additional future directions include comparisons of peer reviews with reviews from curriculum leaders, students and faculty self-reflections.
Determining the Minimum Number of Ultrasound Simulations to Establish Competency
Authors: Shanks Anthony , Durst Jennifer , Temming Lorene , Colvin Ryan 
Published: September 2016

Local Mentor: Eric Strand, MD

APGO Advisor: Nancy Hueppchen, MD, MSc

PURPOSE:
To determine the number of simulations that are required to provide the novice learner with comparable ultrasound skills to a PGY1 Intern.

BACKGROUND:
There is renewed emphasis on training medical students prior to the start of residency. The VIMEDIX OB simulator offers the ability to simulate ultrasound images although the ideal integration into training is unknown.

METHODS:
Prospective cohort study of OB/GYN residents (n=33) and medical students entering OB/GYN residency (n=12). IRB approval was obtained prior to the start of the study. Each resident took a timed test on US image fetal biometry acquisition (head circumference, abdominal circumference and femur length). Accuracy and mean times (seconds) were established for PGY1, PGY2, PGY3 and PGY4 years. Medical students comprised the intervention cohort. The students performed timed growth scans after completing 1, 5, 10 and 15 simulations. Accuracy was then compared to PGY1, PGY2, PGY3 and PGY4 years.

RESULTS:
Thirty-three residents completed the study. Resident accuracy in obtaining satisfactory images for growth US decreased with advancing PGY year from 85.7% as a PGY 1 to 50% as a PGY4. Ten medical students completed all simulations for analysis. Accuracy was 41.7% after one simulation and 90.9% after 5.

DISCUSSION:
The use of an ultrasound simulator demonstrated that novice learners had to perform 5 simulations to demonstrate comparable growth scan accuracy to a PGY 1. Ultrasound accuracy decreased with advancing year in residency suggesting that skills should be maintained during training.
Does Team-Based Learning Improve In-Training Exam Scores Among Obstetrics and Gynecology Residents?
Authors: Melendez Elizabeth 
Published: September 2016

Local Mentor: Sam Cullison, MD

APGO Advisor: John L. Dalrymple, MD

PURPOSE:
To determine if the incorporation of team-based learning into an OBGYN residency affects performance on in-training examinations.

BACKGROUND:
Residents at our institution spend more time on general obstetrics and gynecology (OBGYN). However, their scores on in-training examinations in these subject areas are lower than in the subspecialties. To improve knowledge in general OBGYN as measured by performance on the examination, team-based learning (TBL) was introduced.

METHODS:
Since July 2014, teams complete assignments prior to TBL sessions on general OBGYN topics. At the start of each session, residents take a readiness assessment test prior to applying knowledge through clinical scenarios. As these scenarios are discussed, test questions are reviewed for correct answers. OBGYN subject area scores from the in-training examination taken in January 2014 were compared to scores in 2015. Pre- and post-examination surveys were taken to assess attitudes toward TBL and perceived examination preparedness.

RESULTS:
Twelve residents participated in TBL sessions (3/year × 4). Total scores for all PGY levels improved after TBL was introduced, with the greatest improvement noted from PGY1 to PGY2 (57.3, SD 3.2 versus 62.7, SD 3.1). Scores from 3 years prior showed similar improvements. Among OBGYN subject areas, scores were higher in gynecology for all 4 PGY levels after TBL was introduced. More residents felt TBL better prepared them for the examination when surveyed before the examination compared to after (11 versus 8 residents).

DISCUSSION:
A TBL curriculum improved resident knowledge as measured on the in-service examination in gynecology, making TBL a useful tool in the armamentarium of resident educators.