Redesigning Continuous Professional Development: Aligning Learning Needs With Clinical Practice.

Continuous professional development (CPD) in health care refers to the process of lifelong learning including the acquisition of new competencies, knowledge, and professional growth throughout the career of a health care professional. Since implementation, there has seen little change or innovation in CPD. This perspective will review the current state of CPD, including the challenges in traditional CPD models, foundations and strategies for redesign to meet the needs of current and future physicians, and suggestions for changes to modernize CPD. Precision education and the use of technology, including artificial intelligence, and their application to CPD will be discussed.

Understanding resident wellness: A path analysis of the clinical learning environment at three institutions.

PURPOSE: The clinical learning environment (CLE) affects resident physician well-being. This study assessed how aspects of the learning environment affected the level of resident job stress and burnout. MATERIALS AND METHODS: Three institutions surveyed residents assessing aspects of the CLE and well-being via anonymous survey in fall of 2020 during COVID. Psychological safety (PS) and perceived organizational support (POS) were used to capture the CLE, and the Mini-Z Scale was used to assess resident job stress and burnout. A total of 2,196 residents received a survey link; 889 responded (40% response rate). Path analysis explored both direct and indirect relationships between PS, POS, resident stress, and resident burnout. RESULTS: Both POS and PS had significant negative relationships with experiencing a great deal of job stress; the relationship between PS and stress was noticeably stronger than POS and stress (POS: B= -0.12, p=.025; PS: B= -0.37, p<.001). The relationship between stress and residents' level of burnout was also significant (B = 0.38, p<.001). The overall model explained 25% of the variance in resident burnout. CONCLUSIONS: Organizational support and psychological safety of the learning environment is associated with resident burnout. It is important for educational leaders to recognize and mitigate these factors.

Applicant Experience in Communication With Residency Programs After the Introduction of Program Signaling.

OBJECTIVE: Examine the applicant experience after introduction of program signaling for the 2023 obstetrics and gynecology (OBGYN) residency application cycle. DESIGN: Responses to an online survey of OBGYN applicants participating in the 2023 match who participated in residency program signaling were compared to responses from a similar survey conducted in 2022. Demographic information included personal and academic background and how applicants and advisors communicated with programs. Numbers of applications and interviews, second look visits, away rotations, manner of contact, and timing of communication was compared. Statistical analysis included ANOVA for interval data, and χ2 and Kruskal-Wallis tests for categorical data. RESULTS: A total of 711 of 2631 (27%) applicants responded in 2022 and 606 of 2492 (24.3%) responded in 2023. Approximately 2/3 of gold signals and 1/3 of silver signals led to an interview. There was no change in number of applications or interviews per applicant, but there was a broader distribution of interviews per applicant in 2023. Applicants in 2023 were less likely to engage in preinterview communication or do an away rotation to indicate interest in a program. There was decreased communication between applicants and programs after signaling was introduced. Informal communication continued to differ by racial and medical school background. Applicants from DO programs and international medical graduates (IMG) had more communication with programs than MD applicants but received fewer interview invitations. Fewer Black and Latin(x)/Hispanic applicants had faculty reach out to residency programs on their behalf compared to White and Asian applicants. There were differences in the number of interviews received based on racial and ethnic identity. CONCLUSIONS: In the first year after implementation of program signaling, there was a decrease in preinterview communication and a broader distribution of interviews among applicants. Further efforts to create standard means of program communication may help to begin leveling the uneven playing field for applicants.

Facilitating an Optimal Transition to Residency in Obstetrics and Gynecology.

The transition to residency in obstetrics and gynecology is difficult, threatening the well-being of residents as well as their preparedness to care for patients. In addition to essential foundational knowledge and skills, obstetrics and gynecology interns must develop professional identity and a growth mindset toward learning to acquire the self-directed learning skills required of physicians throughout their careers. The transition to residency is a critical opportunity for learning and development. A group of educators and learners from around the country created a preparedness program building on available resources. The result is a national curriculum for improving the transition to obstetrics and gynecology residency on three levels: self-directed learning, facilitated small-group workshops, and coaching. Sharing tools for preparing matched applicants for residency in obstetrics and gynecology ensures adequate residency preparation for all interns, independent of medical school attended. This program aims to address potential threats to equity in the training of our future workforce and to ensure that all obstetrics and gynecology interns are prepared to thrive in residency training.

Current Communication Practices Between Obstetrics and Gynecology Residency Applicants and Program Directors.

Importance: In order to equitably improve the residency application process, it is essential to understand the problems we need to address. Objective: To determine how obstetrics and gynecology (OBGYN) applicants and faculty communicate applicants' interest to residency programs, and how program directors report being influenced by these communications. Design, Setting, and Participants: This survey study was conducted with email surveys of OBGYN application stakeholders in 2022. Included participants were OBGYN applicants, clerkship directors, and residency program directors in medical education associations' email listservs. Exposures: Surveys sent by the American Association of Medical Colleges, Association of Professors of Gynecology and Obstetrics, and Council on Resident Education in Obstetrics and Gynecology. Main Outcomes and Measures: Whether applicants themselves, or faculty on their behalf, communicated to residency programs, and the influence program directors reported placing on these communications for their decision-making. Descriptive statistics and χ2 tests were used to analyze differences. Results: A total 726 of 2781 applicants (26.1%) responded to the survey and were included in analysis (79 of 249 [31.7%] clerkship directors; 200 of 280 [71.4%] program directors). The self-reported racial and ethnic demographics of the 726 applicant respondents were 86 Asian (11.8%), 54 Black (7.4%), 41 Latinx (5.6%), 1 Native Hawaiian or Pacific Islander (0.1%), 369 White (52.2%), 45 with multiple racial identities (6.2%), and 91 (21.5%) preferring not to answer. The majority of applicants (590 [82.9%]) sent communications at some point in the application process. Applicants who identified as White (336 [88.7%]) or Asian (75 [87.2%]) were more likely than those who identified as Black (40 [74.1%]) or Latinx (33 [80.5%]) to reach out to programs (P = .02). There were also differences in type of medical school, with 377 of 427 MD applicants (88.3%), 109 of 125 DO applicants (87.2%), and 67 of 87 International Medical Graduate applicants (77.7%) reporting sending communications (P = .02). Approximately one-third (254 applicants [35.7%]) had faculty reach out to programs on their behalf. White (152 [40.1%]) and Asian (37 [43.0%]) applicants were more likely to have faculty reach out compared with Black (6 [11.1%]) and Latinx (12 [29.3%]) applicants (P = .01). Program directors reported that preinterview communications from faculty they knew (64 [32.2%]) and other program directors (25 [12.6%]) strongly influenced their decisions, and otherwise rarely reported that communications strongly influenced their decisions. Conclusions and Relevance: The current state of communications may increase inequities in residency application processes; differences between faculty communications for applicants from different racial and ethnic backgrounds are particularly concerning given that program directors are more likely to weigh communications from faculty in their decision-making. A centralized, equitable means for applicants to signal their interest to programs is urgently needed.

How We Do It: Student Perspectives on Changes to the Obstetrics and Gynecology Residency Application Process.

OBJECTIVE: To describe the perspectives of obstetrics and gynecology (OBGYN) residency applicants regarding new standards for the 2019 to 2020 application cycle. DESIGN: An anonymous electronic survey was sent to all OBGYN residency applicants to US programs retrospectively evaluating 5 new recommended standards for the application process. This 15-item survey assessed the importance of the proposed standards and their impact on applicants' anxiety. SETTING: The OBGYN residency application process is marked by increasing application numbers and no standardization for managing interview offers. The Association of Professors of Gynecology and Obstetrics (APGO) received a 5-year Reimagining Residency grant from the American Medical Association to improve the transition from undergraduate medical education (UME) to graduate medical education (GME) within OBGYN. The multiphase project, "Transforming the UME to GME Transition for Obstetrics and Gynecology- Right Resident, Right Program, Ready Day One (RRR)," began with Standardizing the OBGYN Application and Interview Process (SOAIP). This group recommended 5 new standards for all US OBGYN residency programs and applicants. PARTICIPANTS: Applicants for US OBGYN residency programs for the 2019 to 2020 application cycle completed the survey, with a 904/2508 (36.0%) response rate, including 762 complete responses (30.4%). RESULTS: Applicants reported that all 5 of the new standards would cause the least self-perceived anxiety (range 76.8% - 96.5%). The impact of the standards on perceived anxiety varied by student group, with International Medical Graduates (IMGs) and students with USMLE Step I scores <200 describing lesser impact compared to others. Despite these differences, all 5 standards were consistently noted to cause the least anxiety for all groups. Despite varying degrees of effects in different groups, the new OBGYN residency application standards caused the least anxiety for all subgroups of applicants. CONCLUSIONS: Implementing universal standards for the OBGYN residency application process was favorably perceived by applicants and caused the least anxiety for applicants.

Distributions of Residency Interviews With the Implementation of Virtual Interviews and Standardization of Interview Offer Dates.

OBJECTIVE: Virtual interviews were widely implemented alongside many other changes in the 2021 residency application process. We investigated how these many interventions may have influenced interview distributions and completions. DESIGN: Cross-sectional survey distributed electronically to obstetrics and gynecology (OBGYN) residency applicants in February 2021. Distributions of interview invitations, interviews completed, and percent of interview offers completed were compared to the previous application cycle. The odds ratios of receiving interviews were calculated based on applicant characteristics including test scores, number of applications, and race/ethnicity. SETTING: All OBGYN residency applicants registered through the Electronic Residency Application Service. PARTICIPANTS: The 915 (36%) of 2577 total OBGYN applicants who responded to the survey. RESULTS: US allopathic medical students received fewer interview offers in 2021 (median 13 [interquartile range 9-19]) compared to 2020 (median 15 [interquartile range 11-20]). There was no difference in the absolute numbers of interviews completed. A United States Medical Licensing Exam Step 1 score ≥221 resulted in more than a five-fold increase in adjusted odds of receiving at least 12 interviews for allopathic students. Black or African American US allopathic seniors had a 2.3 odds ratio for receiving at least 12 interview invitations compared to White non-Hispanic or Latino US allopathic seniors, adjusted for Step 1 score and the number of programs applied to. Interview offers released on standardized dates had a mitigating effect on completing more interviews among allopathic seniors with at least 12 interview invitations. CONCLUSIONS: Virtual interviews did not change the overall number of interviews completed. Standardization of interview offer dates mitigated excessive virtual interviewing, yet additional measures are needed to curb interview inflation and the effects on interview distributions.

Stakeholder Perspectives on Limiting Residency Applications and Interviews in Obstetrics and Gynecology.

PURPOSE: Application inflation in the current residency application process leads to congestion, inefficiency, and perceptions of inequity. The authors aimed to assess the interest of key stakeholders on the topic of capping applications and interviews, and their perceptions regarding equity of the process. METHODS: An anonymous survey was electronically distributed in March 2021 to Obstetrics and Gynecology (OBGYN) residency applicants, clerkship directors, program directors, and student affairs deans after the submission of the rank order list for the 2021 application cycle and prior to the release of final Match results. Participants answered questions regarding the perceived equity of the current process (no limits on applications submitted or interviews completed) compared with limiting the number of applications and interviews students could submit or complete. Respondents supporting caps reported the number they considered a reasonable cap for applications and interviews. Associations between the profiles of applicants and program directors and their interest in application and interview caps were explored using chi-squared tests for non-parametric statistics and t-tests for normally distributed interval data. The University of Michigan determined the study exempt from IRB review. RESULTS: The overall response rate was 36.0% (1167/3243), including 34.0% of applicants (879/2579), 50.3% of program directors (143/284), 41.8% of clerkship directors (94/225) and 32.9% of student affairs deans (51/155). All groups reported application caps for either all applicants or the most competitive applicants to be more equitable than the current process, and suggested a median application cap ranging from 25 (clerkship directors and program directors) to 40 (applicants). All groups also believed interview caps to be more equitable than the current process, and suggested a median interview cap ranging from 12 (clerkship directors) to 15 (applicants, program directors, and student affairs deans). CONCLUSIONS: Stakeholders in the OBGYN application process consider caps to applications and interviews a promising means to improve equity in the Match.

Perspectives of Stakeholders About an Early Result Acceptance Program to Complement the Residency Match in Obstetrics and Gynecology.

Importance: The residency application process is flawed, costly, and distracts from the preparation for residency. Disruptive change is needed to improve the inefficiencies in current selection processes. Objective: To determine interest in an early result acceptance program (ERAP) among stakeholders in obstetrics and gynecology (OBGYN), and to estimate its outcome in future application cycles. Design, Setting, and Participants: Surveys of stakeholders in March 2021 queried interest in ERAP across the US. Respondents included OBGYN residency applicants, members of the Association of American Medical Colleges Group on Student Affairs, OBGYN clerkship directors, and residency program directors. Statistical analysis was performed from March to April 2021. Exposures: Respondents completed surveys sent by email from the Association of American Medical Colleges (to OBGYN applicants and members of the Group on Student Affairs), the Association of Professors of Gynecology and Obstetrics (to clerkship directors), and the Council on Resident Education in Obstetrics and Gynecology (to program directors). Main Outcomes and Measures: Applicants and program directors indicated their interest in participating in ERAP, and clerkship directors and members of the Group on Student Affairs indicated their likelihood of recommending ERAP using a 5-point Likert scale. Results: Respondents included 879 (34.0%) of 2579 applicants to OBGYN, 143 (50.3%) of 284 residency program directors, 94 (41.8%) of 225 clerkship directors, and 51 (32.9%) of 155 student affairs deans. The majority of respondents reported being either somewhat or extremely likely to participate in ERAP, including 622 applicants (70.7%) and 87 program directors (60.8%). Interest in ERAP was independent of an applicant's reported board scores, medical school type, race, number of applications submitted, or number of interviews completed. Among program directors, those at university programs were more likely to participate. Stakeholders supported a limit of 3 applications for ERAP, to fill 25% to 50% of residency positions. Estimating the outcome of ERAP using these data suggests 26 280 to 52 560 fewer applications could be submitted in the regular match cycle. Conclusions and Relevance: Stakeholders in the OBGYN application process expressed broad support for the concept of ERAP. The majority of applicants and programs indicated that they would participate, with potentially substantial positive impact on the application process. Careful pilot testing and research regarding implementation are essential to avoid worsening an already dysfunctional application process.

The Case for Capping Residency Interviews.

OBJECTIVE: To determine 2020 residency cycle application practices and to model potential consequences in the 2021 cycle if (1) applicants scheduled an uncapped number of interviews; (2) applicants were capped to schedule 12 interviews; (3) residency programs kept their number of interview offers unchanged; and (4) programs increased their interview offers by 20%. DESIGN AND SETTING: The authors sent an anonymous survey to all obstetrics and gynecology applicants registered through the Electronic Residency Application Service in February 2020 asking respondents to share demographics and number of interview offers received and completed. Based on prior estimates that 12 interviews are needed to match in obstetrics and gynecology, respondents were divided into Group 12+ (those receiving ≥12 interview offers) and Group <12 (those receiving <12 offers). Model assumptions were (1) applicants can complete all interviews they are offered because they are virtual; (2) interview offers that applicants in Group 12+ decline are subsequently offered to applicants in Group <12; (3) the proportions of interviews offered to Group 12+ and Group <12 will remain the same if programs chose to increase their total number of interview spots. PARTICIPANTS: Among 2508 applicants, 750 (30%) provided the number of interview offers received and completed: 417 (56%) in Group 12+ and 333 (44%) in Group <12. RESULTS: In models where applicants are uncapped in the number of interviews, Group <12 applicants receive <1 interview offer, even if programs increase the number of interviews offered and performed. If applicants are capped at 12 interviews, Group <12 applicants will receive 9 interview offers on average and will reach 12 if programs increase the number of interviews offered by 20%. CONCLUSIONS: This work highlights how current inefficiencies may lead to negative consequences with virtual interviews. Interview caps and preference signaling systems need to be urgently considered.

Developing Committed Resident Leaders: A Survey of the Administrative Chief Resident Experience in Surgical Fields.

OBJECTIVE: Administrative chief residents (ACRs) are integral to residency programs, however little research has been done on the experiences, training, and support of ACRs in surgical fields. The objective of this study was to define the challenges and experiences of surgical ACRs and identify support needed to make them successful. DESIGN: A Qualtrics survey was electronically distributed to participants. Response styles included multiple choice questions, yes/no, Likert scales, and short answers. Question topics included demographics, ACR duties, support, and experiences. SETTING: Obstetrics & Gynecology and General Surgery residency programs in the United States. PARTICIPANTS: Current and past administrative chief residents (2019-2020; 2018-2019) and program directors from Obstetrics & Gynecology and General Surgery residency programs. RESULTS: Seventy-nine surveys were completed by 48 (61%) ACRs and 31 (39%) program directors. The majority (52%) were from academic programs with a median of 6 residents and 2 ACRs per year. On a 10-point Likert scale, mean perceived support from faculty, program director, administration, and other residents was 7.0, 8.8, 6.7, and 7.7 respectively; however, mean stress level was also perceived to be high. Regarding preparation for the role, 56% of administrative chief residents do not receive a job description, 41% do not have a formal handoff process, 42% do not have formal leadership training, and only 61% agreed or strongly agreed that the administrative chief role was clear prior to starting. Common challenges reported by ACR's are limited preparation and training, conflict resolution, and workload management. Many ACRs felt they would benefit from formal leadership training and protected time. CONCLUSIONS: These results summarize the experiences of ACRs in surgical residencies. Best practices and formal training in identified challenge areas should be added to residency curriculum and used to develop toolkits to support ACRs nationwide.

Stakeholder Perspectives on Standardizing the Residency Application and Interview Processes.

OBJECTIVE: The purpose of this study was to examine stakeholder perspectives on recommended standards for the obstetrics and gynecology (OBGYN) residency application and interview processes proposed for the 2019 to 2020 application cycle. The authors aimed to assess the acceptance and perception of key stakeholders on the feasibility of implementing the standards as well as the effect of these changes on applicant anxiety. DESIGN AND SETTING: The authors electronically distributed an anonymous survey in February 2020 to OBGYN residency applicants, clerkship directors, student affairs deans, program directors, and program managers. Participants received a 15-item survey, with questions assessing the importance and adoption of the guidelines, as well as their effect on perceived applicants' anxiety. Responses were measured on a 5-item Likert scale. Multiple regression analysis was used to explore which residency factors were associated with compliance with the standards. IRB exemption was granted by the University of Michigan. PARTICIPANTS: A total of 1358 participants completed the survey for an overall response rate of 39.26%. Response rates were 36.04% for applicants (904/2508), 46.67% for CDs (105/225), 34.84% for members of GSAs (34/155), 59.43% for program directors (167/281), and 51.03% for program managers (148/290). RESULTS: The overall response rate was 39.26% (1358/3459) with 36.04% of applicants (904/2508), 46.67% of clerkship directors (105/225), 34.84% of student affairs deans (34/155), 59.43% of program directors (167/281), and 51.03% of program managers (148/290). The recommendations were perceived as important by all stakeholders. More than 90% of program directors reported compliance with some or all of the recommendations and more than 90% of all applicants, clerkship directors and student affairs deans reported that the standards reduced applicant anxiety. All stakeholders rated each guideline to be important to extremely important. CONCLUSIONS: This study demonstrates the feasibility and acceptance of universal standards for the residency application process in the field of OBGYN. The vast majority of stakeholders surveyed supported the initiative and participated in the guidelines. Applicant respondents perceived the guidelines to be important and to decrease anxiety surrounding the application and interview timelines. These findings are important for other specialties when considering similar interventions.

A Model for Exploring Compatibility Between Applicants and Residency Programs: Right Resident, Right Program.

Holistic review of residency applications is touted as the gold standard for selection, yet vast application numbers leave programs reliant on screening using filters such as United States Medical Licensing Examination scores that do not reliably predict resident performance and may threaten diversity. Applicants struggle to identify which programs to apply to, and devote attention to these processes throughout most of the fourth year, distracting from their clinical education. In this perspective, educators across the undergraduate and graduate medical education continuum propose new models for student-program compatibility based on design thinking sessions with stakeholders in obstetrics and gynecology education from a broad range of training environments. First, we describe a framework for applicant-program compatibility based on applicant priorities and program offerings, including clinical training, academic training, practice setting, residency culture, personal life, and professional goals. Second, a conceptual model for applicant screening based on metrics, experiences, attributes, and alignment with program priorities is presented that might facilitate holistic review. We call for design and validation of novel metrics, such as situational judgment tests for professionalism. Together, these steps could improve the transparency, efficiency and fidelity of the residency application process. The models presented can be adapted to the priorities and values of other specialties.

Can Standardized Dates for Interview Offers Mitigate Excessive Interviewing?

OBJECTIVE: To determine the impact of specialty-specific guidelines for standardized interview offers on residency applicant behavior towards excessive interviewing. DESIGN: In 2019 to 2020, the Association of Professors of Gynecology and Obstetrics and the Council on Resident Education in Obstetrics and Gynecology (OBGYN) outlined standard dates for residency interview offers. A cross-sectional survey of applicants queried adherence to standardized interview offers, the number of interviews offers received, interviews completed, and application characteristics. Based on data that applicants in OBGYN with a mean number of 12 contiguous ranks are highly likely to match, factors associated with accepting an excessive percentage of interview offers were investigated in applicants with at least 12 interviews, using multiple logistic regression. SETTING: All OBGYN applicants were sent an anonymous electronic survey distributed through the Electronic Residency Application Service in February 2020, with the subset of US MD senior respondents selected for this analysis. PARTICIPANTS: There were a total of 1292 US MD senior applicants into OBGYN in 2020, with 505 (39%) providing their interview information through the survey. Three hundred and sixty (71%) of US MD senior respondents received at least 12 interviews. RESULTS: Applicants receiving at least 12 interview offers completed a median of 83% of their interviews, and excessive interviewing was defined as completing greater than this median percentage. Receiving most interview offers on standardized interview offer dates resulted in less excessive interviewing despite controlling for number of programs applied to, applying as a couple, and United States Medical Licensing Exams Step 1 score. CONCLUSIONS: The standardization of interview offer dates may mitigate interview inflation by altering applicant behavior. This promising pilot data suggests that applicants may be able to make more informed decisions about which interview offers to accept when all offers are received on predetermined dates.

Design and evaluation of a subcutaneous contraceptive implant training simulator.

OBJECTIVE: To design and fabricate a subcutaneous contraceptive implant insertion simulator, and to characterize the performance of nursing students trained with and without the simulator. METHOD: A cross-sectional study was conducted on nursing students in Ghana who had no previous training in the insertion of contraceptive implants. They were given standardized training in insertion of implants from 25 April to 26 April, 2016, and then were randomly assigned to an intervention or control group. The control group watched insertions of live implants while the intervention group practiced using the simulator. Local materials were used to fabricate the simulator. The performance of both groups was assessed after the training. RESULTS: The participants consisted of 50 nursing students. Those in the intervention group were more likely to: insert the implant accurately (95.2% vs 78.4%, P<0.001); take less time to complete an insertion (mean of 33.6 seconds vs 42.2 seconds, P<0.001); and commit fewer errors (1.9 vs 2.5, P=0.005) compared to the control group. In addition, participants rated the simulator high on 11/11 of the product requirements with the teaching (93.2%), learning (91.4%), and skill acquisition (88.6%) requirements being the highest rated. CONCLUSION: A low-cost, locally fabricated simulator is an effective tool for augmenting the current training protocol by improving insertion skills of contraceptive implants.

Improving the medical school-residency transition.

BACKGROUND: In response to calls to improve the continuum between undergraduate and graduate medical education, many medical schools are creating electives designed to prepare students for residency training. There is a need for data that link improvements from these residency preparation courses to residency itself. Data is needed that links improvements from these residency preparation courses to residency OBJECTIVE: To examine senior medical student performance on the Association of Professors of Gynecology and Obstetrics (APGO) Preparation for Residency Knowledge Assessment before and after an obstetrics and gynaecology residency preparation elective, and to determine whether the knowledge improvements persisted to the start of the residency. METHODS: All 13 students enrolled in the course completed the APGO knowledge assessment on the first and last day of the elective. Three months later, the students were asked to re-take the assessment immediately prior to the start of their residency. RESULTS: There was improvement in mean scores from the pre-test score of 66.4 per cent to the post-test score of 77.4 per cent. At the time of the pre-test, three of the 13 students (23%) had passing scores (70% or greater), and at the time of the post-test, 11 of the 13 (85%) had passing scores. Nine of the 13 students (69%) completed the APGO knowledge assessment immediately prior to the start of their residency. Those nine students had a mean pre-residency score of 76.4 per cent. Eight of the nine students (89%) passed the pre-residency test. CONCLUSIONS: Our data support the value of residency preparation electives for improving knowledge, and suggest that senior medical school electives can help to bridge the continuum between undergraduate and graduate medical education.

Evaluation of a simulation-based curriculum for implementing a new clinical protocol.

OBJECTIVE: To evaluate the implementation of a new clinical protocol utilizing on-unit simulation for team training. METHODS: A prospective observational study was performed at the obstetrics unit of Von Voightlander Women's Hospital, Michigan, USA, between October 1, 2012 to April 30, 2013. All members of the labor and delivery team were eligible for participation. Traditional education methods and in-situ multi-disciplinary simulations were used to educate labor and delivery staff. Following each simulation, participants responded to a survey regarding their experience. To evaluate the effect of the interventions, paging content was analyzed for mandated elements and adherence to operating room entry-time tracking was examined. RESULTS: In total, 51 unique individuals participated in 12 simulations during a 6-month period. Simulation was perceived as a valuable activity and paging content improved. Following the intervention, the inclusion of a goal time for reaching the operation room increased from 7% to 61% of pages and the proportion of patients entering to operating room within 10 minutes of the stated goal increased from 67% to 85%. CONCLUSION: The training program was well received, and the accuracy of the communication and the goal set for reaching the operating room improved.

The Decision to Incision Curriculum: Teaching Preoperative Skills and Achieving Level 1 Milestones.

OBJECTIVE: To evaluate the effectiveness of a preoperative skills curriculum, and to assess and document competence in associated Obstetrics and Gynecology Level 1 Milestones. DESIGN: The Decision to Incision curriculum was developed by a team of medical educators with the goal of teaching and evaluating 5 skills pertinent to Milestone 1: Preoperative consent, patient positioning, Foley catheter placement, surgical scrub, and preoperative time-out. Competence, overall skill performance, and knowledge were assessed by evaluator rating using checklists before and after the educational intervention. Differences between preintervention and postintervention skills performance and competence were assessed using Wilcoxon rank test and Fisher exact test, respectively. SETTING: Clinical Simulation Center at an academic medical center. PARTICIPANTS: Overall, 29 fourth year medical students matriculating into Obstetrics and Gynecology residencies. RESULTS: The proportion of participants meeting Milestone competence significantly increased in all 5 skills, with competence achieved in 95.6% (95% CI: 92.1-99.0) of posttest skills assessments. Median overall performance also significantly improved for all 5 skills, with 83.6% (95% CI: 77.3-89.9) earning scores of 4 out of 5 or greater on the posttest. For knowledge testing, the proportion of correct responses significantly increased for both topics evaluated, from 45.2% to 99.7% (p < 0.0001) for positioning and from 32.8% to 83.1% (p < 0.0001) for time-out. CONCLUSIONS: The decision to incision curriculum significantly improved preoperative skills, including skills that may be required on day 1 of residency. This curriculum also facilitated achievement and documentation of competence in multiple Milestones.