Impact of an educational intervention on patient safety culture among gynecology-obstetrics' healthcare professionals.

BACKGROUND: In recent years, patient safety has begun to receive particular attention and has become a priority all over the world. Patient Safety Culture (PSC) is widely recognized as a key tenet that must be improved in order to enhance patient safety and prevent adverse events. However, in gynecology and obstetrics, despite the criticality of the environment, few studies have focused on improving PSC in these units. This study aimed at assessing the effectiveness of an educational program to improve PSC among health professionals working in the obstetric unit of a Tunisian university hospital. METHODS: We conducted a quasi-experimental study in the obstetric unit of a university hospital in Sousse (Tunisia). All the obstetric unit's professionals were invited to take part in the study (n = 95). The intervention consisted of an educational intervention with workshops and self-learning documents on patient safety and quality of care. The study instrument was the French validated version of the Hospital Survey on Patient Safety Culture. Normality of the data was checked using Kolmogorov-Smirnov test. The comparison of dimensions' scores before and after the intervention was carried out by the chi2 test. The significance level was set at 0.05. RESULTS: In total, 73 participants gave survey feedback in pre-test and 68 in post-test (response rates of 76.8% and 71.6, respectively). Eight dimensions improved significantly between pre- and post-tests. These dimensions were D2 "Frequency of adverse events reported" (from 30.1 to 65.6%, p < 0.001), D3 "Supervisor/Manager expectations and actions promoting patient safety" (from 38.0 to 76.8%, p < 0.001), D4 "Continuous improvement and organizational learning" (from 37.5 to 41.0%, p < 0.01), D5 "Teamwork within units" (from 58.2 to 79.7%, p < 0.01), D6 "Communication openness" (from 40.6 to 70.6%, p < 0.001), and D7 "Non-punitive response to error" (from 21.1 to 42.7%, p < 0.01), D9 "Management support for patient safety" (from 26.4 to 72.8%, p < 0.001), and D10 "Teamwork across units" (from 31.4 to 76.2%, p < 0.001). CONCLUSIONS: Educational intervention, including workshops and self-learning as pedagogical tools can improve PSC. The sustainability of the improvements made depends on the collaboration of all personnel to create and promote a culture of safety. Staff commitment at all levels remains the cornerstone of any continuous improvement in the area of patient safety.

Investigating racial/ethnic differences in procedure experience in obstetrics & gynecology trainees at a single academic institution: a retrospective cohort study.

BACKGROUND: Discrimination is common in medical education. Resident physicians of races and ethnicities underrepresented in medicine experience daily discrimination which has been proven to negatively impact training. There is limited data on the impact of resident race/ethnicity on OB/GYN surgical training. The objective of this study was to investigate the impact of race/ethnicity on procedural experience in OB/GYN training. METHODS: A retrospective analysis of graduated OB/GYN resident case logs from 2009 to 2019 was performed at a single urban academic institution. Self-reported race/ethnicity data was collected. Association between URM and non-URM were analyzed using t-tests. Trainees were categorized by self-reported race/ethnicity into underrepresented in medicine (URM) (Black, Hispanic, Native American) and non-URM (White, Asian). RESULTS: The cohort consisted of 84 residents: 19% URM (N = 16) and 79% non-URM (n = 66). Difference between URM and non-URM status and average case volume was analyzed using t-tests. There was no difference between non-URM and URM trainees and reported mean number of Total GYN (349 vs. 334, p = 0.31) and Total OB (624 vs. 597, P = 0.11) case logs. However, compared with non-URM, on average URM performed fewer Total procedures (1562 vs. 1469, P = 0.04). Analyzing individual procedures showed a difference in average number of abortions performed between URM and non-URM (76 vs. 53, P = 0.02). There were no other statistically significant differences between the two groups. CONCLUSIONS: This single institution study highlights potential differences in trainee experience by race/ethnicity. Larger national studies are warranted to further explore these differences to identify bias and discrimination, and to ensure equitable experience for all trainees.

Need for formalized robotic training and curriculum in obstetrics and gynecology residency: an examination of current resident outlooks and perspectives.

The objectives of this study were to evaluate current robotic surgery training methodologies for ACGME-accredited obstetrics and gynecology (OB/GYN) residency programs, better understand current resident perspectives, and explore potential areas for improvement within resident education. A cross-sectional study was done of ACGME-accredited OB/GYN residents in the 2023-2024 academic year. The study was done on a national setting via web-based survey. 75 surveys were included. The study was conducted via a 33-question survey study using a mixture of multiple choice, multiple answer, and Likert scale questions. Participants noted that 98.7% of their institutions perform robotic surgery and 90.7% have access to robotic console trainers. Outside of the operating room, slightly more than half of participants (57.3%) have formalized robotics training curriculums. A variety of training modalities were noted to be utilized by residents with the most helpful being hands-on training (67.7%) followed by dual-assist console (45.6%). The least helpful was noted to be online modules (58.7%). Most residents either strongly agree (45.3%) or agree (36.0%) that standardized robotics curriculums should be implemented for all OB/GYN residency programs. The largest barriers to completion of this training were noted to be attending comfort with resident participation in the case (74.0%), personal time (58.9%), and availability or access to trainers (42.5%). A formalized and standardized robotic training curriculum should be considered for OB/GYN residents with a multi-modal model utilizing a combination of training modalities as well as dedicated didactic hours.

Inequities at the Transition to Obstetrics and Gynecology Residency.

OBJECTIVE: Although approximately one-fifth of obstetrics and gynecology (OBGYN) residents matriculate from osteopathic or international medical schools, most literature regarding the transition to residency focuses on allopathic medical school graduates. To create comprehensive interventions for this educational transition, we must understand the needs of all incoming residents. Our objective was to examine OBGYN residents' perceptions of their transition to residency, and to understand how residents' background and medical school environment influence their perceived sense of readiness. DESIGN: A 16-item survey asked questions about demographics, the transition to residency, resident well-being, burnout, and the transition to fellowship. Perception of preparedness was assessed with the question "I felt that I was well-prepared for the first year of residency" (1=strongly agree, 5=strongly disagree). Chi-squared and Fisher's exact tests and logistic regression explored association of perceived preparedness with residents' backgrounds. SETTING: Survey administered at time of the in-training examination in 2022. PARTICIPANTS: All OBGYN residents. RESULTS: Of 5761 eligible participants, 3741 (64.9%) provided consent and completed the survey. Of the 3687 participants who answered the question, 2441 (66.2%) either agreed or strongly agreed that they felt well-prepared. Fewer osteopathic graduates reported feeling prepared compared to allopathic graduates (379/610, 62.1% vs 1,924/2,766, 69.6%) (OR 0.72, 95%CI 0.60-0.86, p < 0.01). International medical school graduates were seven times less likely to report feeling prepared compared to those from allopathic institutions (137/304, 45.1% vs 1924/2776, 69.6%) (OR 0.60, 95%CI 0.53-0.68, p < 0.01). Respondents from underrepresented racial and ethnic backgrounds were less likely to report feeling prepared compared to White respondents (276/535, 51.6% vs 1738/2387, 72.8%) (OR 0.39, 95%CI 0.33-0.48, p < 0.01). CONCLUSIONS: Differences in residents' perceptions of their transition to residency highlight the need to begin offsetting pervasive inequities with comprehensive and accessible resources.

Paving the Way for Medical Students: How Smooth Should the Road Be?

Clerkship directors must balance the mental wellbeing of their medical students with the demanding schedule that rotations in procedural specialties such as surgery and obstetrics and gynecology require. In this paper, the Undergraduate Medical Education Committee of the Association of Professors of Obstetrics and Gynecology argues the importance of maintaining adequate clinical exposure for learners. Involving students in overnight call provides additional clinical involvement, improved relationships with the clinical team, and a better perspective on specialist lifestyle. Educators should improve the experience for students by promoting resilience and creating a welcoming learning environment. Preparing medical students for the rigorous requirements of these clerkships allows them to thrive in the learning environment while still providing a realistic preview of the clinical experiences and demands of these specialties.

Utilizing Complexity Leadership Theory to Promote Faculty Mentorship and Resident Leadership.

OBJECTIVE: To create and evaluate a structured combined faculty mentorship/resident leadership program based on complexity leadership theory. DESIGN: In 2021, a logic model was used to create a 5 part bi-monthly resident leadership series utilizing administrative, adaptive, and enabling components of complexity leadership theory. Each of the 5 sessions had a nationally prominent senior faculty member mentor 3 junior faculty in creation of an interactive workshop that was delivered to resident physicians during scheduled didactics. Validated surveys were used to assess faculty post-mentorship experience and resident self-perception of leadership skills pre-and post-series. Descriptive statistics and 2-way ANOVA were performed; text comments underwent content analysis. SETTING: A large academic OB/GYN department at Baylor College of Medicine in Houston, Texas. PARTICIPANTS: Five faculty mentors, 15 junior faculty, and 48 residents participated in this program. All faculty mentors (5/5) and 87% (13/15) of mentees completed the post-mentorship survey. Resident response rate was 60% (29/48) pre-series and 63% (30/48) post-series. RESULTS: Both mentors and mentees rated the experience favorably (4.62 versus 5.29, p = 0.51). In open-ended comments, enabling components of mentorship process, such as approachability and expertise of the mentors, were most often noted as positive. Both mentees and mentors suggested administrative changes to the experience, such as longitudinal relationships between mentors and mentees. The mean score on the resident leadership questionnaire improved from 3.82 to 3.96 (5-point Likert scale, p = 0.30) with self-reported leadership skills improving in 8/9 domains, although none reaching statistical significance. Open-ended comments revealed that residents also most desired administrative changes in the leadership series, such as increased leadership opportunities and more interactive workshops. CONCLUSIONS: A structured combined faculty mentorship/resident leadership program formed utilizing complexity leadership theory was positively received. Participants most liked the enabling components of the series, with requested administrative changes in the future.

Social media trends in obstetrics and gynecology residency programs on Instagram and X (Twitter).

BACKGROUND: During the COVID pandemic, residency program's social media presence increased to aid in residency recruitment by attempting to increase engagement and readily available information for applicants across specialties. However, little information exists on what characteristics and content on obstetrics and gynecology (OBGYN) residency program accounts attract more followers or engagement. OBJECTIVES: To identify social media trends in OBGYN residencies and determine which aspects of programs influence the number of followers and interaction with content posted. METHODS: We performed a retrospective review of ACGME accredited OBGYN programs and determined their presence on Instagram and X in the fall of 2021. Content from the thirty programs with the most followers was analyzed independently by two authors. Multivariate analysis and a linear mixed model were used to characterize and evaluate content on Instagram and X. RESULTS: Most programs utilized Instagram (88.5%, N = 262/296) and were managed solely by residents (84.4%, N = 108/128). Number of followers on Instagram positively correlated with features such as program size, Instagram profile duration, and Doximity rankings (p < 0.0x01). Programs on X had more followers if their profile had a longer duration, followed more individuals, or were ranked higher on Doximity. The most posted Instagram content was biographical and social in nature. Instagram posts with the highest engagement were awards and/or the Match. CONCLUSIONS: Understanding what social media content attracts more followers and increases engagement is crucial as it likely impacts OBGYN resident recruitment. Professional groups should establish guidelines for social media use in recruitment for the protection of both residents and applicants.

Training in obstetrics and gynecology between reality and vision: results of a JAGO-NOGGO survey in 601 physicians (NOGGO-Monitor-12 trial).

PURPOSE: The primary objective of this study was to establish a benchmark by collecting baseline data on surgical education in obstetrics and gynecology in Germany, including factual number of operations performed. MATERIALS AND METHODS: A nationwide anonymous survey was conducted in Germany between January 2019 and July 2019 utilizing a specially designed questionnaire which addressed both residents and senior trainers. RESULTS: A total of 601 participants completed the survey, comprising 305 trainees and 296 trainers. The trainees reported performing a median of 125 non-obstetric surgeries (IQR: 41-332) and 75 obstetric procedures (IQR: 27-168) independently. While most last-year residents managed to meet the targeted numbers for minor surgical procedures outlined in the logbook, they fell short of achieving the required numbers for major operations, such as hysterectomies or more complex laparoscopies. Although both trainees and trainers emphasized the significance of surgical training, the overall quality of the training was rated poorly, particularly by trainees. This was attributed to a high proportion of administrative tasks and a deficiency in teaching time within the operating theater. External fellowship and mentoring programs, as well as the implementation of regular, centralized reviews of residency training, were identified as potentially beneficial by both trainees and trainers. CONCLUSION: The findings of this survey should serve as a wake-up call both within and outside of Germany, highlighting the importance of comprehensive and structured surgical training to enhance long-term patient care and increase satisfaction among obstetrics and gynecology trainees.

A national survey on current practice of ultrasound in labor ward.

OBJECTIVES: Use of ultrasonography has been suggested as an accurate adjunct to clinical evaluation of fetal position and station during labor. There are no available reports concerning its actual use in delivery wards. The aim of this survey was to evaluate the current practice regarding the use of ultrasonography during labor. METHODS: A questionnaire was sent to members of the Italian Society of Ultrasound in Obstetrics and Gynecology employed in delivery wards. The qFeuestionnaire was made up of 22 questions evaluating participant characteristics and the current use of ultrasound in labor in their hospital of employment. The answers were grouped according to participant characteristics. RESULTS: A total of 200 participants replied. Ultrasound was considered useful before an operative vaginal delivery by 59.6 % of respondents, while 51.8 and 52.5 % considered it useful in the management of prolonged first and second stages of labor, respectively. The major indication for ultrasound use during labor was the assessment of fetal occiput position. The major difficulties in its application were the perceived lack of training and the complexity of the ultrasound equipment use. Participants that reported fewer difficulties were those employed in hospitals with a higher number of deliveries or having delivery units with more years of experience using ultrasound in labor, or those who had attended specific training courses. CONCLUSIONS: The results indicate that, despite the reported evidence of a higher accuracy of ultrasound compared to clinical evaluation in assessing fetal position and station, its use is still limited, even amongst maternal-fetal medicine practitioners specialized in ultrasonography.

The Effect of a Simulation-based Intervention on Emergency Medicine Resident Management of Early Pregnancy Loss.

Background: The evaluation of patients with first-trimester vaginal bleeding and concern for early pregnancy loss (EPL) frequently occurs in the emergency department (ED), accounting for approximately 1.6% of all ED visits.1 Unfortunately, these patients consistently report negative experiences with ED care.2-8 In addition to environmental concerns, such as long wait times, patients often describe negative interactions with staff, including a perceived lack of empathy, the use of insensitive language, and inadequate counseling.2,3 These patients and their partners often view EPL as a traumatic loss of life and commonly experience prolonged grief reactions, including anxiety and depression.9-11 Poor satisfaction with care has been associated with worse mental health outcomes.12 These complaints represent an important opportunity for improvement in emergency medicine (EM) training.13 While no published literature to date describes the performance of EM residents in managing patients presenting with EPL, studies suggest that even obstetrics and gynecology (OB/GYN) residents find these interactions challenging.14,15 Simulation- and didactic-based training has been shown to be beneficial in improving OB/GYN resident EPL counseling and has been associated with improved patient outcomes.16 To our knowledge, this has yet to be replicated in EM residency training. Objectives: We aimed to develop and evaluate a simulation-based educational intervention to improve EM resident management of patients presenting with EPL.

The COVID-19 pandemic and OBGYN residency training: We have a problem and it's not just masks.

BACKGROUND: The COVID-19 pandemic has left no one untouched. Resident trainees have been driven to reconsider virtually every component of their daily lives. The purpose of this pilot study is to evaluate the impact of the COVID-19 pandemic on Obstetrics and Gynecology (OBGYN) residency training and education. METHODS: A cross-sectional pilot study was conducted between 2/2022 and 5/2022. A survey was created and distributed to OBGYN residents. The survey queried the effects of the pandemic on OBGYN residents' procedure skills training and mental health. RESULTS: A total of 95 OBGYN residents across programs affiliated with each American College of Obstetricians and Gynecologists (ACOG) district participated in the survey. Among them, just over half (n = 52, 55%) self-identified as under-represented minorities. A significant majority, 80% (n = 81), felt their gynecological training was inadequate, with 70% of fourth-year residents expressing a lack of confidence in their ability to independently practice gynecology after graduation. This lack of confidence among fourth-year residents suggests a notable disparity in readiness for independent gynecological practice, linked to meeting ACGME requirements before completing their residency (p = 0.013). Among the residents who reported a negative impact of the pandemic on their mental health (n = 76, 80%), about 40% (n = 31) had contemplated self-harm or knew a colleague who considered or attempted suicide (p < 0.001). This issue was especially pronounced in residents experiencing burnout (n = 44, 46%), as nearly half (n = 19, 43%) reported suicidal thoughts or knew someone in their program who had such thoughts or engaged in self-harm (p = 0.048). CONCLUSIONS: Residents expressed concerns about reduced hands-on gynecological training and doubts about their readiness for independent practice post-residency, highlighting the need for enhanced support through mentorship and revised training curriculums. Additionally, despite the availability of mental health resources to address pandemic-induced burnout, their underuse suggests a need for more accessible time for residents to use at their discretion and flexible training schedules that encourage mental health support resource utilization.

Use of In-Training Examination Scores as a Fellowship Candidate Evaluation Metric: Time for a Change.

ABSTRACT: In the field of obstetrics and gynecology (OB/GYN), the Council on Resident Education in Obstetrics and Gynecology (CREOG) administers an annual in-training examination to all OB/GYN residents as a formative educational tool for assessing medical knowledge and promoting self-improvement. Although the CREOG examination is not designed or intended for knowledge certification, many OB/GYN subspecialty fellowship programs request and use CREOG examination scores as a metric to evaluate fellowship candidates. Among the 57 gynecology-based urogynecology fellowship programs, 30 programs (53%) request CREOG examination scores to be submitted by candidates, as of March 2023. Although the use of CREOG examination scores as an evaluation metric may constitute a minor component within the fellowship match process, this practice fundamentally contradicts the intended purpose of the examination as an educational self-assessment. In addition, it introduces the potential for bias in fellowship recruitment, lacks psychometric validity in predicting specialty board examination failure, and shifts the CREOG examination from its original intention as low-stakes self-assessment into a high-stakes examination akin to a certification examination. For these reasons, we call upon the urogynecology community to prioritize the educational mission of the CREOG examination and reconsider the practice of requesting or using CREOG examination scores in the fellowship match progress.

Implementation and Evaluation of Educational Workshops to Increase Primary Care Provider and Medical Student Comfort in Psychiatric Care.

OBJECTIVE: Mental health treatment is often initiated in primary care settings, but many primary care providers (PCPs), residents, and medical students report discomfort in managing psychiatric conditions. This study evaluated the effect of an educational workshop that featured an evidence-based psychopharmacology clinical decision support tool (CDST) on trainee confidence and willingness to treat psychiatric conditions. METHODS: Participants completed pre- and post-workshop surveys. Nine months after the workshop, a subset of trainees participated in a focus group. RESULTS: Of the participants, 62.5% of the obstetrics-gynecology (OB-GYN) resident physicians (10/16) and 100% of the medical students (18/18) completed both pre- and post-surveys. Following the workshop, OB-GYN resident physicians reported significantly improved confidence in treating psychiatric disorders (p < 0.001), sense of having psychiatric support tools (p < 0.001), and knowledge of treating psychiatric disorders (p = 0.021). Medical students reported significantly improved confidence in treating psychiatric disorders (p < 0.001), willingness to devise treatment plans for psychiatric disorders (p = 0.024), sense of having psychiatric support tools (p < 0.001), knowledge of treating psychiatric disorders (p < 0.001), and comfort in presenting a psychiatric treatment plan to an attending (p = 0.003). Most focus group participants (93.75%; 15/16) reported that they continued to use the CDST, and it increased their confidence in formulating psychiatric treatment plans. CONCLUSIONS: These findings suggest that educational workshops that introduce high-quality psychopharmacology CDSTs may be an effective method for improving provider comfort in treating psychiatric disorders.

Successful Implementation of the AIUM Standardized 4-Year Residency Ultrasound Curriculum in Obstetrics and Gynecology: Lessons Learned and Way Forward.

BACKGROUND: Significant disparities in sonographic education exist in Obstetrics and Gynecology programs in the United States. To address the lack of standardization in ultrasound teaching, the American Institute of Ultrasound in Medicine (AIUM) assembled a multi-society task force in 2018 that resulted in the publication of a Consensus Report outlining a standardized ultrasound curriculum and competency assessment. OBJECTIVES: The primary objective of the study was to implement the AUIM standardized curriculum within an Obstetrics and Gynecology residency program at a tertiary medical center, and report on the early implementation experience. The secondary objective was to assess current national practices in ultrasound training in Obstetrics and Gynecology residency programs. STUDY DESIGN: Study design was an effectiveness-implementation hybrid study of a structured ultrasound educational program based on the 2018 AIUM Consensus Report. The theoretical portion of the curriculum consisted of 26 hours of didactic lectures distributed over 4 years. For the practical component, residents received instruction from faculty and sonographers and independently acquired the required images as part of their regular clinical work. Simulator app access was also provided for additional opportunities to practice and acquire images. Deidentified images for the required competencies were uploaded to a WhatsApp group for review. Theoretical knowledge was assessed with a series of multiple-choice exams. Practical skills were assessed through grading of images submitted through WhatsApp as well as direct observations of resident scans. At the completion of 4 years, the assessment of both theoretical knowledge and practical skills was carried out using the ISUOG Basic Training Examination. National patterns in the area of ultrasound education were assessed with a four-question electronic survey of Obstetrics and Gynecology program directors in the United States. Analysis of both portions of the study was primarily descriptive. RESULTS: Four Obstetrics and Gynecology residents completed the curriculum spanning postgraduate years 1 through 4. The number of competencies completed ranged from 7 to 19 out of 41. All of the residents passed the theoretical and practical components of the ISUOG Basic Training Examination. For the residency program director survey portion of the study, response rate was 20% (59 of 290). Among the respondents, 55.9% reported having a structured curriculum and 34.4% reported implementing the AIUM curriculum. The two most commonly cited obstacles to implementation of structured ultrasound teaching were uncertainty with how to start the process (49.2%) and lack of faculty engagement (49.2%). CONCLUSIONS: Implementation of the AIUM Curriculum within the framework of an Obstetrics and Gynecology residency program at a tertiary medical center is feasible. In our experimental group, completion of the curriculum resulted in passing of an internationally recognized validated assessment. Obstacles to implementation in our program included a wide range of engagement and participation among residents, and limited opportunities to obtain some of the required competencies. Identification of obstacles to implementation from the perspective of residency program directors is critical for developing targeted approaches to ensure widespread implementation. Successful standardized validated sonographic training of graduating Obstetrics and Gynecology residents is crucial for this operator-dependent modality that has tremendous implications on patient safety and clinical care.

Training of young medical professionals: implementation of modern training concepts, taking into account the changed framework conditions for training-a pilot project for operational subjects.

INTRODUCTION: For years, generations of medical students have complained that practice-oriented learning is neglected in medical studies. Further training assistants also complain about limited opportunities to learn subject-specific practical activities. MATERIAL AND TECHNIQUES: We are presenting a pilot project at the University Women's Hospital in Homburg, in which medical students complete an endoscopic hands-on course as part of the block internship gynaecology and obstetrics. During the course the students perform classic skills training and hand-eye coordination exercises and learn the first steps in endoscopic suturing (suture and rows of knots). The training concepts used can be implemented on simple boxing trainers and can therefore also be reproduced in clinics or in a private setting. OUTCOME: Altogether, 73 medical students did participate in the laparoscopy course. We were able to prove that the knotting time for a simple knot can be reduced from an average of 247 s to 40 s (80%) after completing our training programme. Based on the evaluation sheet that the students filled out after the course, we found a very-high acceptance for surgical simulation training within the student cohort. DISCUSSION: Practical surgical exercises can complement the curriculum well and, as we can show with our work, are rated very positively by the students. For students in higher semesters, such practical courses can also provide an insight into the respective subject area and thus counteract the lack of skilled workers in surgical subjects. The practical year should not be the first contact with these practical courses, as at this timepoint a certain favoured subject has often already being chosen by the students.