Faculty Bibliography

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 However, most widely used indices are outdated.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.

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.

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.

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.

Simulation in obstetrics and gynecology (OBGYN) training captures a range of interpersonal, cognitive, and technical skills. However, trainee perspectives on simulation-based assessment remain unexplored. After an observed structured clinical examination (OSCE) simulation hybrid exam, two focus groups of residents were conducted. Analysis grounded in a thematic coding guided the qualitative research process. Responses suggest a valuation of cognitive and technical skills over interpersonal skills. Realism was seen as critical and residents perceived the assessment as more valuable for the educator than the learner. Feedback was highly valued. Resident perspectives on this exam give insight into their perceptions of simulation-based assessment as well as their conceptions of their own learning through simulations.

Objectives: In order to develop effective teaching methods for contraceptive education, researchers require a validated, reliable tool to measure subjects' contraceptive knowledge. However, most widely used indices are outdated and no longer useful. The objective of this study was to create and assess the validity and reliability of a novel assessment tool for measuring contraceptive knowledge. Method: The study tool was validated using both qualitative and quantitative methods. The tool was developed by the research team and then reviewed by a selected group of experts. Participants for testing the tool included English-speaking men and women ages 15- 45 at a single institution. Structured interviews were conducted with a randomly selected group of patients for qualitative feedback regarding the readability and ease of administration and the study tool was adapted accordingly. Quantitative tests included (1) comparison with a gold standard; (2) test-retest reliability; (3) comparison between a group with low contraceptive knowledge and a group with high contraceptive knowledge. Results: Qualitative feedback was obtained on the 25-question knowledge assessment tool from 6 experts and 7 patients. The study tool was administered to a total of 102 patients, with a mean score of 9.0. In comparison with the gold standard, the mean score was significantly higher (new tool 9.1 vs. gold standard 5.8, p<0.001). Test-retest reliability was demonstrated via repeat testing within 2- 4 weeks, demonstrating no difference between test and retest in the same subjects (p=0.667). When compared to medical students, patients' mean scores were significantly lower as expected (patients 9.1 vs. medical students 19.4, p<0.005). Conclusions: We have designed a valid and reliable study tool to measure a person's level of knowledge regarding contraception. This tool will allow the assessment of baseline knowledge, educational gaps, and post-educational knowledge achievements after an intervention

BACKGROUND: Ovarian vein thrombophlebitis is commonly considered to be a postpartum or postoperative disease. We describe an unusual case of ovarian vein thrombophlebitis in a nonpuerperal patient without recent surgery that was associated with venous compression by a large uterine myoma. CASE: A 32-year-old nulligravid woman presented with fever, leukocytosis, and severe abdominal pain. Ultrasound demonstrated an enlarged uterus measuring 16.6x7.9x9.6 cm with a dominant left exophytic myoma; computed tomography scan revealed an intraluminal thrombus in the left ovarian vein. The patient recovered with antibiotics and anticoagulation. Abdominal myomectomy was performed to remove the structural contributor for thrombosis formation. CONCLUSION: Ovarian vein thrombophlebitis should be considered in patients with abdominal pain, fever, and evidence of venous stasis, even if they are lacking typical risk factors of pregnancy or surgery.

BACKGROUND: Assessment of obstetrics-gynecology residents' ability to integrate clinical judgment, interpersonal skills, and technical ability in a uniform fashion is required to document achievement of benchmarks of competency. An observed structured clinical examination that incorporates simulation and bench models uses direct observation of performance to generate formative feedback and standardized evaluation. METHODS: The Test of Integrated Professional Skills (TIPS) is a 5-station performance-based assessment that uses standardized patients and complex scenarios involving ultrasonography, procedural skills, and evidence-based medicine. Standardized patients and faculty rated residents by using behaviorally anchored checklists. Mean scores reflecting performance in TIPS were compared across competency domains and by developmental level (using analysis of variance) and then compared to standard faculty clinical evaluations (using Spearman rho). Participating faculty and residents were also asked to evaluate the usefulness of the TIPS. RESULTS: Twenty-four residents participated in the TIPS. Checklist items used to assess competency were sufficiently reliable, with Cronbach alpha estimates from 0.69 to 0.82. Performance improved with level of training, with wide variation in performance. Standard faculty evaluations did not correlate with TIPS performance. Several residents who were rated as average or above average by faculty performed poorly on the TIPS (> 1 SD below the mean). Both faculty and residents found the TIPS format useful, providing meaningful evaluation and opportunity for feedback. CONCLUSIONS: A simulation-based observed structured clinical examination facilitates observation of a range of skills, including competencies that are difficult to observe and measure in a standardized way. Debriefing with faculty provides an important interface for identification of performance gaps and individualization of learning plans.