bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does an Advocacy Curriculum Focused on Healthcare Disparities Improve Residents' Knowledge and Utilization of Community Resources?
Authors: Hamm Jennifer , Conklin Kendra , Gaskins Jeremy 
Published: September 2016

Local Mentor: Sara Petruska, MD

APGO Advisor: Lee A. Learman, MD, PhD

BACKGROUND:
Knowledge regarding health care disparities and local resources available to combat them is an important objective of resident education.

OBJECTIVE:
To evaluate resident knowledge of healthcare disparities and reported utilization rates of related community services before and after participation in a newly developed advocacy curriculum.

METHODS:
This was a prospective, cohort study of University of Louisville Ob-Gyn residents. Knowledge of health care disparities and local resources, as well as utilization rates were assessed via online survey before, immediately following, and 3-month after participating in a healthcare advocacy workshop. Nonparticipating residents completed the pre-course and 3-month follow-up surveys. A 3-point scale was used to assess disparity and resource knowledge (very, somewhat, not at all) and resource utilization rates (frequent, occasional, never).

RESULTS:
The 16 workshop participants had response rates for the pre-course, post-course, and 3-month follow up surveys of 100%, 75%, and 50%, respectively. The 4 non-participants had response rates of 100% pre-course and at 3-month. Baseline disparity knowledge (1.98, 1.55), local resource knowledge (1.44, 1.40) and resource utilization (1.77, 1.57) scores were similar for both groups. Immediately post-workshop, participants demonstrated a global increase in disparity knowledge (2.38) and local resource knowledge (2.29). Three-month disparity knowledge (2.45, 2.22), local resource knowledge (2.27, 2.10) and resource utilization rates (2.21, 2.10) were similar in participants and non-participants.

CONCLUSION:
Resident participation in a health care advocacy curriculum was followed by an immediate increase in reported knowledge of healthcare disparities and local resources. However, similar gains were seen among non-participants at 3-months post-course.
Impact of Faculty Development on Feedback of OBGYN Resident Performance
Authors: Brooks Alison 
Published: September 2016

Local Mentor: John Gianopoulos, MD

APGO Advisor: Lee A. Learman, MD, PhD

PURPOSE:
To improve the quantity and quality of faculty feedback on OBGYN resident performance.

BACKGROUND:
Resident performance feedback is a faculty expectation and an ACGME requirement. In 2015 our residency program received a score of 68% compliance for resident satisfaction with feedback after assignments, and identified a need for improvement.

METHODS:
A 30-minute didactic educational intervention on meaningful feedback was administered to the 19 residents and 19 faculty in our program. Immediately before and 3 months after the intervention, all OBGYN residents and faculty completed a questionnaire regarding quantity and quality of oral and written feedback after surgical and non-surgical encounters. Paired t test was performed comparing pre- and post-intervention data.

RESULTS:
Eighty-nine percent of residents and 95% of faculty participated in the intervention, and 100% in each group completed the pre- and post-intervention questionnaires. The percent of residents reporting “some” or “a lot” of oral feedback increased from 58% to 79% (P=.05). The percent of faculty reporting they provided “some” or “a lot” of oral feedback increased slightly from 83% to 95% (P=.19). The quantity of written feedback reported by residents did not improve (43% pre and post) and by faculty improved slightly from 48% to 61% (P=.28). The perceived quality of oral and written feedback did not improve.

DISCUSSION:
A short educational intervention was associated with marked improvement in the quantity of oral feedback but was not associated with improvements in written feedback nor the perceived quality of feedback from faculty to residents.
Is Direct Interaction With Preceptors Linked to Clerkship Satisfaction and Medical Knowledge Gain?
Authors: Schnee D. Mark , Pierson Rebecca C. , Stewart J. Ryan , Learman Lee A. 
Published: September 2016

Local Mentor: Lee A. Learman, MD, PhD

APGO Advisor: Alice R. Goepfert, MD

PURPOSE:
To evaluate the correlation between direct-interaction time of OBGYN students with preceptors and their clerkship satisfaction and medical knowledge acquisition.

BACKGROUND:
Historically, physician-teaching ratings by students have predicted NBME subject exam scores and level of interest in the preceptor's specialty. Finding that direct-interaction time is also important could justify increased faculty support for teaching.

METHOD:
MS3 students (n=176) enrolled in the OBGYN clerkship were eligible for this IRB-approved study. Students received the study overview and instructions during clerkship orientation. Participating students texted logged minutes daily to a designated phone number linked to a secured database. The NBME score, clerkship satisfaction survey and logged interaction time were merged into a de-identified database for analysis. Spearman correlation coefficients were calculated to estimate associations of participation in minutes logged, NBME scores and clerkship satisfaction.

RESULTS:
26.7% (n=47) of eligible students reported their direct interaction time. The median direct interaction time was 633 minutes. Associations between numbers of minutes reported with NBME scores, clerkship satisfaction, and level of interest in OBGYN before and after rotation were small and not statistically significant. No difference in clerkship satisfaction was found between students reporting minutes versus no minutes.

DISCUSSION:
The low participation rate increases the likelihood of reporting bias in which motivated students were more likely to participate. Documentation of the precise number of minutes daily was also subject to student motivation. In this small study, no statistical association was found between the number of minutes reported with test scores or clerkship satisfaction.
Knowledge of Cost Consciousness in Obstetrics and Gynecology Residents
Authors: Cantrell Leigh A. , Reddy Madhuri 
Published: September 2016

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

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

PURPOSE:
To evaluate the short and long-term retention of knowledge of cost effective care gained by residents after a pilot intervention.

BACKGROUND:
Increasingly, physicians are expected to practice cost conscious medicine. Resident education must include a basic understanding of cost for their future practice patterns and to fulfill an ACGME milestone.

METHODS:
A high value care module was developed and implemented at 2 academic Obstetrics and Gynecology residency programs comprising 32 residents. Module development is described in a separate report. A survey assessing knowledge was developed, pre-tested, refined and conducted before and after the intervention to determine immediate knowledge change and then at 3 months post intervention to determine knowledge decay.

RESULTS:
Of the 26 residents participating in the intervention, 62% reported no prior education regarding cost-effective care and as the remainder reported their prior education as “on the fly with an Attending.” The percent reporting somewhat to very little knowledge of cost effective care principles fell from 85% to 65% immediately after the intervention (t=1.61; P=.06) and to 63% after 3 months. Residents' tested knowledge improved from 31% correct to 69% immediately post intervention (t=2.95; P=.002) and decayed to 46% at 3 months (t=1.13; .13).

DISCUSSION:
A module addressing the cost-effective care milestone for Obstetrics and Gynecology residents improved low baseline knowledge with moderate decay after 3 months. Next steps will include a larger study of multidisciplinary residents with ongoing study of methods to reinforce knowledge long-term.
Resident Feedback to Improve Bootcamp Effectiveness
Authors: Mendez Melissa D. , Khamsi Naima , Rondeau Nancy U. 
Published: September 2016

Local Mentor: Veronica T. Mallett, MD, and J. Christopher Carey, MD

APGO Advisor: John L. Dalrymple, MD

PURPOSE:
To incorporate resident feedback into a boot camp course and assess resident learner satisfaction.

BACKGROUND:
APGO/CREOG Milestone One outlines the knowledge and skills an Ob/Gyn intern should have upon starting residency. Some institutions conduct an intern boot camp; an intense, short course designed to meet Milestone One. Our first boot camp was conducted July 2014 and our second July 2015 and included 19 topics and 5 skills stations.

METHODS:
IRB approval was obtained. After each boot camp, incoming and returning residents were surveyed to assess perceptions of the interns' performance, satisfaction with preparation for internship, and suggestions for additional boot camp topics. A 5-point Likert scale was used to determine topic relevance.

RESULTS:
Five interns (100%) and ten residents (82%) were included in the study. Topics scoring the highest number of “somewhat” and “very” important were given priority for inclusion in the second boot camp. Laparoscopic skills, sutures and hypertension in pregnancy were added into the second boot camp. After the first boot camp, 60% (6/10) of the residents and 60% of the interns (3/5) interns felt that the boot camp was helpful to the interns. After the second boot camp, 100% (6/6) of the residents and 80% of the interns (4/5) felt the boot camp was helpful to the interns.

DISCUSSION:
Our results indicate that resident input and feedback on bootcamp development and effectiveness resulted in high satisfaction rates and readiness perception by both interns and residents. We plan to continually expand and improve our curriculum each year.
Impact of Video-Based Coaching on Gynecologic Resident Laparoscopic Suturing
Authors: Donnellan Nicole , Rindos Noah , Biglan Minhnoi Wroble 
Published: September 2016

BACKGROUND:
Laparoscopic surgery affords patients superior outcomes to traditional open surgery. Despite this ubiquitous data, barriers to implementation stem from current resident training, including work hour restrictions and increased procedural oversight, thus necessitating greater emphasis on simulation curriculums. Coaching enhances performance by identifying, focusing on, and achieving specifics goals. Historically attributed to athletics, performance coaching has become a professional development tool in business, education and medicine. Thus, we aimed to evaluate the addition of video-based coaching to an established laparoscopic simulation curriculum on suturing performance.

METHODS:
Twenty OB/GYN residents (7-R1s, 7-R2s, 5-R3s and 1-R4) undergoing a 5-week laparoscopic simulation curriculum were video-recorded weekly performing a suturing task. Residents were randomized to receive standard curriculum or standard curriculum plus weekly video review/coaching meetings with a single expert laparoscopic surgeon. Two different expert laparoscopic surgeons independently graded videos. Primary outcome measure was comparison of weekly GOALS score of the suturing task.

RESULTS:
R3s started with significantly higher GOALS scores than R1 and R2s (P<.001), with no difference in GOALS scores across groups (P=.406). All residents showed significant improvement in suturing over the 5-week period (P=.005), with R1s showing greater improvement than R3s (P=.001). There were significantly improved GOALS average scores following the initial video intervention in R1/R2s compared to the control R1/R2s (3.14 versus 3.79, P<.043) with more gradual improvement seen in both groups in subsequent weeks.

DISCUSSION:
Video-based coaching during simulation training has its greatest impact early on novice learners skill acquisition, providing another tool to supplement simulation training.
Interventions to Maximize Medical Student Learning of Cystoscopy
Authors: Brincat Cynthia , Taege Susanne , Shah Arpeet 
Published: September 2016

BACKGROUND:
We have sought to involve medical students in our cases by having them perform the cystourethroscopy portion of the case. This typically takes place at the end of the case, and is a low risk procedure where a camera is placed through the urethra into the bladder to assess bladder and ureteral integrity. Presently it is a see one, do one teaching technique.

METHODS:
After IRB exemption, we sought to assess medical student skills at cystourethroscopy after varying teaching interventions and correlate if student satisfaction correlated with skill level. An investigator blinded to the intervention assessed medical students doing cystourethroscopy with the OSATs checklist in each of three groups: 1-students rotating on urogynecology will experience the routine teaching of see one, do one. Two-students rotating on urogynecology will view a slideshow lecture in orientation and then have the routine standard teaching of see one, do one. Three-students rotating on urogynecology will have the opportunity to practice cystoscopy on a low cost simulation model, as well as view a slideshow lecture in orientation.

RESULTS:
Data are still being collected. We will assess 1) skill level, 2) satisfaction with the clerkship, and 3) assess if there is any correlation between the two, or their intervention group.

DISCUSSION:
We hypothesize that skill level does not correlate with intervention, however the more involved intervention will correlate with improved clerkship satisfaction.
Laparoscopic Salpingectomy: A Simulation-Based Resident as Surgical Teacher (RAST) Program
Authors: York-Best Carey , Bengtson Joan , Stagg Amy 
Published: September 2016

BACKGROUND:
The ACGME considers resident teaching skills to be a core competency. Simulation is a time efficient way to teach laparoscopic surgical skills.

METHODS:
An OSTE (Objective Structured Teaching Examination) was devised to evaluate senior resident teaching skills and an OSATS (Objective Structured Assessment of Technical Skills) was devised to evaluate junior resident laparoscopic skills. Resident teacher/learner dyads performed a simulated laparoscopic salpingectomy and were evaluated by a faculty observer. The resident pair also evaluated each other. After didactic teaching the pairs were re-evaluated. Residents were surveyed pre and post the program on their attitudes around surgical teaching.

RESULTS:
Most residents initially felt comfortable/neutral in their ability to teach surgery and felt neutral that they had received instruction on surgical teaching. Post-workshop residents showed increased confidence in teaching and acknowledged they had received instruction on teaching surgery. Faculty observers noted a 1.3 point increase in the OSTE scores of the senior residents (P=.006). Junior residents noted a 0.43 point increase in teaching scores (P=.004). Faculty noted a 0.73 point increase in OSATS score of the junior residents (P=.004), compared with a 0.35 point increase noted by senior residents (P=.10).

DISCUSSION:
The Laparoscopic Salpingectomy Simulation-Based RAST Program provides a time efficient, reproducible means for residents to learn and practice surgical teaching. Residents felt it supplemented previous teaching. Faculty observers noted significant improvement in OSTE scores of senior residents. The smaller improvement noted by the junior residents was largely because they ranked their senior residents highly even on the initial simulation.
The Educational Value and Feasibility of a Video-Capture System in the Surgical Training of OBGYN Residents
Authors: Pellini Timothy , Martino Martin , Patruno Joseph 
Published: September 2016

BACKGROUND:
Many professions utilize video-capture technology for training and skill improvement. This study explores the utility, sustainability, and effectiveness of this technology as part of a resident surgical evaluation process. In order to optimize surgical training we utilized video-capture technology (SimCapture) as residents performed surgical procedures. Point-of care feedback using standard evaluation tools and video-review, using the same evaluation tools was also conducted.

METHODS:
We recorded a group of OBGYN residents performing one of four surgeries over 8 weeks. This project was considered IRB exempt. An ACGME milestone evaluation and OPRS (operative performance rating system) specific to the procedure was used to evaluate performance. The video was then evaluated by another faculty member, blinded to the resident's level of training, using the milestone and OPRS forms. Data were collected and analyzed regarding the value of the process as a tool to optimize surgical teaching.

RESULTS:
We hoped to assess approximately 25% of cases for our pilot project. Surgical evaluation and survey data regarding the educational value of the experience was collected. Data were assessed and compared using Spearman's Rho correlation statistical assessment using SPSS 16.0.

DISCUSSION:
Our pilot study offers benefit in other areas including surgical training, measuring surgical competence, and optimizing patient care. We hope to provide a video portfolio of resident surgical performance which can be used to display technical skills when pursuing future professional opportunities. This technology may also serve a role in the credentialing and remediation process.
Dual Console Technology Robotic Platform Intraoperative Handoffs: “Near Miss” Prevention and Patient Safety Enhancement
Authors: Breen Michael 
Published: September 2016

BACKGROUND:
Dual Console Robotic training has been used in resident training and assessment as well as faculty development. A trans cockpit authority gradient coupled with poor communication skills during robotic arm handoffs contributed in several “near misses” over 6 years of dual console instruction and curriculum development and assessment. These events prompted development of an intraoperative handoff with verbal declaration followed by verbal confirmation. This mirrors current aviation cockpit safety models. Pre and post study Lickert questionnaires utilizing Lickert scale evaluated factors such as comfort levels of teacher and learner, arm assignment confusion, and apprehension. Near misses were tracked. Percentage of complete handoffs were tracked. This study outlines a safe, easily adopted communication and teaching skill that enhances patient safety and reduces near misses.

METHODS:
Analytic Observational Cohort Study. Lickert Pre and Post intervention. Setting: University Teaching Hospital. Patient Population: All from faculty practice associated with Medical School. All agreed to resident participation in their care.

RESULTS:
No interventions were required. No near misses in the study. No adverse events occurred during intraoperative handoffs. No confusion over control of robotic arms. There were incomplete surgical handoffs identified.

DISCUSSION:
Dual console robotic technology provides an unique teaching opportunity for surgical education. Aviation cockpit verbal handoffs are well documented to enhance aviation safety. The robotic intraoperative handoff can mimic this and is an easily adopted and useful teaching method to minimize confusion in co surgeons and minimize risks to patients in dual console robotic surgical procedures.
Quality of Quality Measurement
Authors: Glance Laurent G. , Li Yue , Dick Andrew W. 
Published: September 2016

Abstract

Background
The validity of basing healthcare reimbursement policy on pay-for-performance is grounded in the accuracy of performance measurement.

Methods
Monte Carlo simulation was used to examine the accuracy of performance profiling as a function of statistical methodology, case volume, and the extent to which hospital or physician performance deviates from the average.

Results
There is extensive variation in the true-positive rate and false discovery rate as a function of model specification, hospital quality, and hospital case volume. Hierarchical and nonhierarchical modeling are both highly accurate at very high case volumes for very low-quality hospitals. At equivalent case volumes and hospital effect sizes, the true-positive rate is higher for nonhierarchical modeling than for hierarchical modeling, but the false discovery rate is generally much lower for hierarchical modeling than for nonhierarchical modeling. At low hospital case volumes (200) that are typical for many procedures, and for hospitals with twice the rate of death or major complications for patients undergoing isolated coronary artery bypass graft surgery at the average hospital, hierarchical modeling missed 90.6% of low-quality hospitals, whereas nonhierarchical modeling missed 65.3%. However, at low case volumes, 38.9% of hospitals classified as low-quality outliers using nonhierarchical modeling were actually average quality, compared to 5.3% using hierarchical modeling.

Conclusions
Nonhierarchical modeling frequently misclassified average-quality hospitals as low quality. Hierarchical modeling commonly misclassified low-quality hospitals as average. Assuming that the consequences of misclassifying an average-quality hospital as low quality outweigh the consequences of misclassifying a low-quality hospital as average, hierarchical modeling may be the better choice for quality measurement.
Electronic Learning–Spaced Education to Facilitate Resident Knowledge and Guide Program Didactics
Authors: Gandhi Manisha , Beasley Anitra , Vinas Emily , Sangi-Haghpeykar Haleh , Ramin Susan M. , Kilpatrick Charlie C. 
Published: September 2016

OBJECTIVE:
To evaluate the use of mobile technology to facilitate resident learning, assess clinical knowledge, and guide curricular development in a busy clinical environment.

METHODS:
This was a cross-sectional study conducted in a large (N=48) urban obstetrics and gynecology residency program. Question sets were created in the following areas: office gynecology, general obstetrics, gynecologic surgery and urogynecology, maternal–fetal medicine and ultrasonography, reproductive endocrinology and pediatric gynecology, and gynecologic oncology. Using an educational mobile application (app), questions were sent monthly to resident smartphones with immediate feedback on answer accuracy along with answer explanation and references. Outcomes included app use, which was determined by how quickly participants answered questions (very active–active indicates questions answered within 7 days) and proficiency (mean percentage correct) calculated for individuals, resident class level, and by content area.

RESULTS:
All 48 residents participated and 77.4% were very active or active app users. On average, participants answered correctly 61.0% on the first attempt and improved to 78.3% on repeat attempt (P<.001). Proficiency was lowest for gynecologic surgery and highest for general obstetrics.

CONCLUSION:
A mobile app to support e-learning was successfully implemented in our program; its use was associated with knowledge retention and identification of low-proficiency topics to guide curriculum development.