Faculty Bibliography
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Response to: "Contraceptive Knowledge Assessment: Methodological Issue on Reliability Analysis. " [Letter]
PMID: 28263748
ISSN: 1879-0518
CID: 2476962
Obstetricians and Gynecologists of the Future: A Survey of Medical Students Applying to Residency
OBJECTIVE: To understand the characteristics and career goals of medical students selecting a career in obstetrics and gynecology. METHODS: In 2015-2016, medical students invited for interviews for obstetrics and gynecology residency at the University of Colorado, University of Washington, University of California San Francisco, Loyola University, and New York University received a voluntary 20-item electronic survey regarding factors influencing their choice of medical specialty. RESULTS: Two hundred twenty-six of 356 students responded (63%). Mean age was 27 years, and 88% (n=199) were women. General surgery was the most common alternate specialty (36%, n=81). The most commonly cited drawback to obstetrics and gynecology was "long hours" (66%, n=148). After residency, 157 (70%) applicants planned to complete fellowship training, 127 (56%) pursue international work, 156 (69%) seek an academic position, and 207 (92%) practice in an urban setting. One hundred twenty-four applicants (55%) planned to work 51-60 hours per week and 111 (49%) planned to take 2-3 nights of call per month. Two thirds (n=150) predicted they will have greater than $100,000 educational debt on graduation. CONCLUSION: Contemporary residency applicants have high educational debt and disproportionately plan to pursue fellowship, international work, careers in academic medicine, and work in urban centers. Based on the projected career plans among obstetrics and gynecology applicants, the workforce needs of the population may not be met.
PMID: 28937512
ISSN: 1873-233x
CID: 2707812
Work Hour Limits Versus Wellness Interventions in Reducing Resident Burnout [Comment]
PMCID:5646934
PMID: 29075396
ISSN: 1949-8357
CID: 2756392
Reflection as a Learning Tool in Graduate Medical Education: A Systematic Review
BACKGROUND /UNASSIGNED:Graduate medical education programs employ reflection to advance a range of outcomes for physicians in training. However, the most effective applications of this tool have not been fully explored. OBJECTIVE /UNASSIGNED:A systematic review of the literature examined interventions reporting the use of reflection in graduate medical education. METHODS /UNASSIGNED:. No language or date limits were applied. The search yielded 1308 citations between inception for each database and June 15, 2015. A total of 16 studies, encompassing 477 residents and fellows, met eligibility criteria. Study quality was assessed using the Critical Appraisal Skills Programme Qualitative Checklist. The authors conducted a thematic analysis of the 16 articles. RESULTS /UNASSIGNED:Outcomes studied encompassed the impact of reflection on empathy, comfort with learning in complex situations, and engagement in the learning process. Reflection increased learning of complex subjects and deepened professional values. It appears to be an effective tool for improving attitudes and comfort when exploring difficult material. Limitations include that most studies had small samples, used volunteers, and did not measure behavioral outcomes. CONCLUSIONS /UNASSIGNED:Critical reflection is a tool that can amplify learning in residents and fellows. Added research is needed to understand how reflection can influence growth in professional capacities and patient-level outcomes in ways that can be measured.
PMCID:5559236
PMID: 28824754
ISSN: 1949-8357
CID: 2956122
Interactive case-based learning improves resident knowledge and confidence in reproductive endocrinology and infertility
Resident physicians' scores on the REI section of the CREOG exam are traditionally low, and nearly 40% of house staff nation-wide perceive their REI knowledge to be poor. We aimed to assess whether an interactive case-based group-learning curriculum would narrow the REI knowledge gap by improving understanding and retention of core REI concepts under the time constraints affecting residents. A three-hour case-based workshop was developed to address four primary CREOG objectives. A multiple-choice test was administered immediately before and after the intervention and 7 weeks post-workshop, to evaluate both knowledge and confidence. Following the intervention, residents self-reported increased confidence with counseling and treatment of PCOS, ovulation induction cycle monitoring, counseling and treatment of POI, and breaking bad news related to infertility (p < 0.05). The multiple-choice exam was re-administered 7 weeks post-intervention, and scores remained significantly improved compared to pre-workshop scores (p < 0.05). At that time, all residents either strongly agreed (91.7%) or agreed (8.3%) that the case-based interactive format was preferable to traditional lecture-based teaching. In conclusion, a nontraditional curriculum aimed at teaching core REI concepts to residents through interactive case-based learning can be successfully integrated into a residency curriculum, and significantly improves knowledge and confidence of critical concepts in REI.
PMID: 28277140
ISSN: 1473-0766
CID: 2477202
Whose Problem Is It? The Priority of Physician Wellness in Residency Training
OBJECTIVE: Physician wellness is associated with improved outcomes for patients and physicians. Wellness is a priority of the Accreditation Council on Graduate Medical Education, and many residencies have programs in place to improve wellness. This study sought to understand how stakeholders in graduate medical education perceive wellness among other educational priorities and whether these programs are improving the experience and training of residents. METHODS: The Council on Resident Education in Obstetrics and Gynecology (OBGYN)/Association of Professors in Gynecology Wellness Task Force created a survey and distributed it electronically to all OBGYN residents and program directors (PDs) in 2015. The survey included demographics, questions about the priority of wellness in the educational programs, experience with wellness programming, and problems with resident wellness (burnout, depression, binge drinking, suicide/suicide attempts, drug use, or eating disorders). Data rated on a Likert scale were analyzed using Kruskal-Wallis and Mann-Whitney U tests. RESULTS: Among 248 OBGYN PDs, 149 (60%) completed the survey. Of a total 5274 OBGYN residents nationally, 838 (16%) completed the survey. Most of the residents, 737 (89.4%) reported that they or a colleague experienced some problem with wellness. Many PDs also reported problems with wellness, but 46 (33.9%) reported not being aware of problems in the previous 5 years. When asked to rate the priority of wellness in resident education, <1% (1) PD stated that this was not a priority; however, 85 residents (10%) responded that wellness should not be a priority for residency programs. Resident reports of problems were higher as year in training increased (depression chi2 = 23.6, p
PMID: 27810465
ISSN: 1878-7452
CID: 2297422
Contraceptive Knowledge Assessment: Validity and Reliability of a Novel Contraceptive Research Tool
OBJECTIVES: Clinicians and researchers need an accurate tool assessing contraceptive knowledge in order to understand the effectiveness of teaching efforts. However, most widely used indices are outdated. The objective of this study is to create an evidence-based assessment tool and determine its validity and reliability for measuring contraceptive knowledge. STUDY DESIGN: The study team developed the 25-question multiple-choice tool entitled the Contraceptive Knowledge Assessment (CKA). Expert reviewers examined content validity and semi-structured patient interviews acquired feedback on subject matter and comprehension. A two-tiered approach explored criterion validity via (1) comparison with the gold standard (Contraceptive Knowledge Inventory) and (2) comparison between groups with lower and higher contraceptive knowledge. Repeat testing after 2-4 weeks evaluated test-retest reliability. RESULTS: Six experts and 7 patients provided feedback on the initial CKA. One hundred and two reproductive-aged male and female patients and 27 medical students completed the final CKA with an overall mean patient score of 9.0/25 (36%). The mean score on the CKA was higher than the mean score on the gold standard (9.1 vs. 5.8, p<.001). Patients scored lower on the CKA than did medical students (9.1 [36.4%] vs.19.4 [77.6%], p<.005). There were no differences within patients' results with repeat testing over time (p=.667). CONCLUSIONS: The CKA is a valid and reliable tool to measure a patient's level of knowledge regarding contraception. This research tool may allow for the assessment of baseline knowledge, educational gaps, and improvement after an intervention. Knowledge may be lower than previous studies suggest, signifying need for improved education on contraception and better understanding of the relationship between knowledge and behavior change. IMPLICATIONS: The Contraceptive Knowledge Assessment provides an evidence-based, reliable, and validated assessment of contraceptive knowledge. This modern tool may help to determine the effectiveness of interventions to improve education on contraception.
PMID: 27621043
ISSN: 1879-0518
CID: 2246902
MedEdPORTAL : the journal of teaching & learning resources. 2016:12.DOI: 10.15766/mep_2374-8265.10493
Narrative Medicine: A Writing Workshop Curriculum for Residents
Introduction/UNASSIGNED:Reflection is a critical part of the learning cycle. Narrative medicine has been shown to help physicians-in-training develop both empathy and professional identity. A narrative medicine curriculum focused on the experience of the physician and challenging patient experiences creates opportunities in which to process complicated aspects of the experience of both patient and physician with other members of the training community. Methods/UNASSIGNED:Fifteen 1-hour small-group reflective writing workshops comprise a 2-year narrative medicine curriculum. Each workshop uses selected literature to focus a discussion and a prompt for written reflection and can be integrated into a didactic curriculum. Teacher guides have been created to help untrained preceptors lead small-group sessions. Feedback forms are distributed to participating residents. Results/UNASSIGNED:= 4; 17%). Discussion/UNASSIGNED:A narrative medicine curriculum is a powerful tool for promoting reflection about the challenging work of training in obstetrics and gynecology and other specialties. Reflective writing workshops have been found to be acceptable to obstetrics and gynecology residents, and the curriculum has been successfully implemented at several training programs.
PMCID:6440423
PMID: 30984835
ISSN: 2374-8265
CID: 4095952
Narrative Medicine Workshops for Obstetrics and Gynecology Residents and Association With Burnout Measures
OBJECTIVE: To determine whether a workshop Narrative Medicine curriculum can improve burnout among obstetrics and gynecology residents. METHODS: A Narrative Medicine curriculum was conducted at three obstetrics and gynecology training programs. An explanatory research design examined correlation between Narrative Medicine attendance and changes in survey responses. Residents completed a pretest and 1-year posttest survey that included validated measures of burnout and empathy. A within-participants design used baseline pretest scores as an internal control and measured changes in individual scores. The primary outcome of the study was change in burnout rates. Mann-Whitney U and Kruskal-Wallis tests were used to analyze the data. RESULTS: A total of 66 residents at three institutions participated in the Narrative Medicine curriculum. Of those, 54 (81%) enrolled in the study by completing any part of the surveys, and 43 (80%) of those enrolled had complete data for analysis. Burnout was high on all Maslach Burnout Inventory subscales and increased over 1 year. Participants with high Narrative Medicine attendance had decreased burnout on the Emotional Exhaustion subscale (-4.1 [+/-8.1]) points compared with an increase of 0.5 (+/-6.0) for low-attendance participants (U=134, P=.02, d=0.65). Lower self-care ratings were associated with improved Personal Accomplishment (+0.5 [+/-5.0]) compared with +2.0 (+/-2.7), U=84, P=.01]. Other characteristics did not significantly correlate with burnout or empathy. CONCLUSION: Burnout was high and worsened over time among obstetrics and gynecology residents in these three programs. Higher attendance at Narrative Medicine workshops was associated with improved Emotional Exhaustion.
PMID: 27662003
ISSN: 1873-233x
CID: 2255012
Assessment of Developmental Progress Using an Objective Structured Clinical Examination-Simulation Hybrid Examination for Obstetrics and Gynecology Residents
OBJECTIVE: The Test of Integrated Professional Skills (TIPS) is an objective structured clinical examination-simulation hybrid examination that assesses resident integration of technical, cognitive, and affective skills in Obstetrics and Gynecology (OBGYN) residents. The aim of this study was to analyze performance patterns and reactions of residents to the test to understand how it may fit within a comprehensive assessment program. DESIGN: A retrospective, mixed methods review of the design and implementation of the examination, patterns of performance of trainees at different levels of training, focus group data, and description of use of TIPS results for resident remediation and curriculum development. SETTING: OBGYN residents at New York University Langone Medical Center, a tertiary-care, urban academic health center. PARTICIPANTS: OBGYN residents in all years of training, postgraduate year-1 through postgraduate year, all residents completing the TIPS examination and consenting to participate in focus groups were included. RESULTS: In all, 24 residents completed the TIPS examination. Performance on the examination varied widely among individuals at each stage of training, and did not follow developmental trends, except for technical skills. Cronbach alpha for both standardized patient and faculty ratings ranged from 0.69 to 0.84, suggesting internal consistency. Focus group results indicated that residents respond to the TIPS examination in complex ways, ranging from anxiety about performance to mixed feelings about how to use the data for their learning. CONCLUSION: TIPS assesses a range of attributes, and can support both formative and summative evaluation. Lack of clear developmental differences and wide variation in performance by learners at the same level of training support the argument for individualized learning plans and competency-based education.
PMID: 26868313
ISSN: 1878-7452
CID: 1948782
