Pelvic and breast examination skills curricula in United States medical schools: a survey of obstetrics and gynecology clerkship directors.

BACKGROUND: Learning to perform pelvic and breast examinations produces anxiety for many medical students. Clerkship directors have long sought strategies to help students become comfortable with the sensitive nature of these examinations. Incorporating standardized patients, simulation and gynecologic teaching associates (GTAs) are approaches gaining widespread use. However, there is a paucity of literature guiding optimal approach and timing. Our primary objective was to survey obstetrics and gynecology (Ob/Gyn) clerkship directors regarding timing and methods for teaching and assessment of pelvic and breast examination skills in United States medical school curricula, and to assess clerkship director satisfaction with current educational strategies at their institutions. METHODS: Ob/Gyn clerkship directors from all 135 Liaison Committee on Medical Education accredited allopathic United States medical schools were invited to complete an anonymous 15-item web-based questionnaire. RESULTS: The response rate was 70%. Pelvic and breast examinations are most commonly taught during the second and third years of medical school. Pelvic examinations are primarily taught during the Ob/Gyn and Family Medicine (FM) clerkships, while breast examinations are taught during the Ob/Gyn, Surgery and FM clerkships. GTAs teach pelvic and breast examinations at 72 and 65% of schools, respectively. Over 60% of schools use some type of simulation to teach examination skills. Direct observation by Ob/Gyn faculty is used to evaluate pelvic exam skills at 87% of schools and breast exam skills at 80% of schools. Only 40% of Ob/Gyn clerkship directors rated pelvic examination training as excellent, while 18% rated breast examination training as excellent. CONCLUSIONS: Pelvic and breast examinations are most commonly taught during the Ob/Gyn clerkship using GTAs, simulation trainers and clinical patients, and are assessed by direct faculty observation during the Ob/Gyn clerkship. While the majority of Ob/Gyn clerkship directors were not highly satisfied with either pelvic or breast examination training programs, they were less likely to describe their breast examination training programs as excellent as compared to pelvic examination training-overall suggesting an opportunity for improvement. The survey results will be useful in identifying future challenges in teaching such skills in a cost-effective manner.

To the point: obstetrics and gynecology global health experiences for medical students.

This article, from the To the Point series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, provides educators with an overview of considerations for obstetrics and gynecology global health experiences for the medical student. Options for integration of obstetrics and gynecology global health into undergraduate medical curricula are discussed. Specific considerations for global health clinical experiences for medical students, including choosing a clinical location, oversight and mentorship, goals and objectives, predeparture preparation, and evaluation, are reviewed.

Lessons learned from a resident-led clinical trial in obstetrics.

BACKGROUND: Completion of a randomised controlled trial is one way by which the resident research requirement can be met in Canadian obstetrics and gynaecology programmes. However, little is known about the specific challenges of performing clinical trials within the specialty, let alone as a resident project. PURPOSE: A resident-led randomised controlled trial comparing two methods of labour induction at term was halted due to insufficient patient enrolment. A structured review of the study design and recruitment process was conducted to identify factors contributing to poor recruitment. METHODS: In addition to completing a literature review and internal review by the research team, we surveyed obstetricians and residents regarding recruitment efforts and barriers to participation. We solicited feedback on trial design and the expectations of clinicians with respect to participation in research studies. RESULTS: Eight obstetricians (67%) and 13 residents (93%) responded to the survey. All were able to identify eligible patients, though only 60% had invited one or more patients to participate during the recruitment period. Failure to consider trial participation and excessive clinical workload were the most commonly cited barriers for clinicians. Resistance to the test intervention was the major barrier to patient participation. Several residents cited a lack of personal incentive to recruit patients as a significant barrier. LIMITATIONS: The research team was unable to contact patients directly, thus limiting the scope of our review to our internal methods and feedback from clinicians. CONCLUSIONS: Poor recruitment in a resident-led clinical trial in obstetrics resulted from multiple coexisting factors. A structured review provided valuable insight for the research team. Academic clinicians and trainees in all specialties should be encouraged to share their experiences in the hope of improving the likelihood of success in future research endeavours.

e-Professionalism: a new frontier in medical education.

BACKGROUND: This article, prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, discusses the evolving challenges facing medical educators posed by social media and a new form of professionalism that has been termed e-professionalism. SUMMARY: E-professionalism is defined as the attitudes and behaviors that reflect traditional professionalism paradigms but are manifested through digital media. One of the major functions of medical education is professional identity formation; e-professionalism is an essential and increasingly important element of professional identity formation, because the consequences of violations of e-professionalism have escalated from academic sanctions to revocation of licensure. CONCLUSION: E-professionalism should be included in the definition, teaching, and evaluation of medical professionalism. Curricula should include a positive approach for the proper professional use of social media for learners.

To the point: a primer on medical education research.

This article, from the To the Point series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, provides educators with an introduction to medical educational research by describing the framework of educational scholarship, discussing the similarities and differences between clinical and educational research, reviewing the key steps in educational research, and providing examples of well-designed studies in the field of obstetrics and gynecology.

To the point: reviews in medical education-taking control of the hidden curriculum.

This article, the ninth in the "To the Point" series that is prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, discusses the role of the "hidden curriculum" in shaping the professional identity of doctors in training. The characteristics that distinguish the formal curriculum and hidden curriculum are defined. Specific examples of hidden curricula in clinical environments and the positive and negative impacts that may result are highlighted. Techniques to evaluate clinical training environments and to identify the hidden curriculum are provided and are followed by methods to promote its positive messages and lessen its negative ones.

The obstetrics and gynaecology resident as teacher.

In this article we discuss the role residents play in the clinical training and evaluation of medical students. A literature search was performed to identify articles dealing with research, curriculum, and the evaluation of residents as teachers. We summarize the importance of resident educators and the need to provide appropriate resources for house staff in this role, and we review evidence-based literature in the area of residents as teachers. Specific attention is given to the unique circumstances of the obstetrics and gynaecology resident, who is often faced with teaching in an emotionally charged and stress-filled environment. We present examples of curricula for residents as teachers and describe barriers to their implementation and evaluation.

To the Point: Integrating Patient Safety Education Into the Obstetrics and Gynecology Undergraduate Curriculum.

This article is part of the To the Point Series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee. Principles and education in patient safety have been well integrated into academic obstetrics and gynecology practices, although progress in safety profiles has been frustratingly slow. Medical students have not been included in the majority of these ambulatory practice or hospital-based initiatives. Both the Association of American Medical Colleges and Accreditation Council for Graduate Medical Education have recommended incorporating students into safe practices. The Accreditation Council for Graduate Medical Education milestone 1 for entering interns includes competencies in patient safety. We present data and initiatives in patient safety, which have been successfully used in undergraduate and graduate medical education. In addition, this article demonstrates how using student feedback to assess sentinel events can enhance safe practice and quality improvement programs. Resources and implementation tools will be discussed to provide a template for incorporation into educational programs and institutions. Medical student involvement in the culture of safety is necessary for the delivery of both high-quality education and high-quality patient care. It is essential to incorporate students into the ongoing development of patient safety curricula in obstetrics and gynecology.

The reliability and acceptability of the Multiple Mini-Interview as a selection instrument for postgraduate admissions.

BACKGROUND: The Multiple Mini-Interview (MMI) is useful in selecting undergraduate medical trainees. Postgraduate applicant pools have smaller numbers of more homogeneous candidates that must be actively recruited while being assessed. This paper reports on the MMI's use in assessing residency candidates. METHOD: Canadian and international medical graduates to three residency programs--obstetrics-gynecology and pediatrics (McMaster University) and internal medicine (University of Alberta)--underwent the MMI for residency selection (n = 484) in 2008 and 2009. Reliability was determined and candidates and interviewers completed an exit survey assessing acceptability. RESULTS: Overall reliability of the MMI was acceptable, ranging from 0.55 to 0.72. Using 10 stations would increase reliability to 0.64-0.79. Eighty-eight percent of candidates believed they could accurately portray themselves, while 90% of interviewers believed they could reasonably judge candidates' abilities. CONCLUSIONS: The MMI provides a reliable way to assess residency candidates that is acceptable to both candidates and assessors across a variety of programs.