Impact of Question Bank Use for In-Training Examination Preparation by OBGYN Residents - A Multicenter Study.

OBJECTIVE: To examine the impact of access to and utilization of a commercially available question bank (TrueLearn) for in-training examination (ITE) preparation in Obstetrics and Gynecology (OBGYN). DESIGN: This was a retrospective cohort study examining the impact of TrueLearn usage on ITE examination performance outcomes. Produced by the educational arm of the American College of Obstetricians and Gynecologists, the Council on Resident Education in Obstetrics and Gynecology (CREOG) exam is a multiple-choice test given to all residents annually. Residency programs participating in this study provided residency program mean CREOG scores from the year prior (2015), and the first (2016) and second (2017) years of TrueLearn usage. Programs also contributed resident-specific CREOG scores for each resident for 2016 and 2017. This data was combined with each resident's TrueLearn usage data that was provided by TrueLearn with residency program consent. The CREOG scores consisted of the CREOG score standardized to all program years, the CREOG score standardized to the same program year (PGY) and the total percent (%) correct. TrueLearn usage data included number of practice questions completed, number of practice tests taken, average number of days between successive tests, and percent correct of answered practice questions. SETTING: OBGYN Residency Training Programs. PARTICIPANTS: OBGYN residency programs that purchased and utilized TrueLearn for the 2016 CREOG examination were eligible for participation (n = 14). Ten residency programs participated, which consisted of 212 residents in 2016 and 218 residents in 2017. RESULTS: TrueLearn was used by 78.8% (167/212) of the residents in 2016 and 84.9% (185/218) of the residents in 2017. No significant difference was seen in the average CREOG scores available on a per- program level before versus after the first year of implementation either using the CREOG score standardized to all PGYs (mean difference 1.0; p = 0.58) or standardized to the same PGY (mean difference 3.1; p = 0.25). Using resident-level data, there was no significant difference in mean CREOG score standardized to all PGYs between users and non-users of TrueLearn in 2016 (mean, 199.4 vs 196.7; p = 0.41) or 2017 (mean, 198.2 vs 203.4; p = 0.19). The percent of practice questions answered correctly on TrueLearn was positively correlated with the CREOG score standardized to all PGYs (r = 0.47 for 2016 and r = 0.60 for 2017), as well as with the CREOG total percent correct (r = 0.47 for 2016 and r = 0.61 for 2017). Based on a simple linear regression, for every 500 practice questions completed, the CREOG score significantly increased for PGY-2 residents by an average (±SE) of 7.3 ± 2.8 points (p = 0.013); the average increase was 0.7 ± 2.5 (p = 0.79) for PGY-3 residents and 5.8 ± 3.3 points (p = 0.09) for PGY-4 residents. CONCLUSIONS: Adoption of an online question bank did not result in higher mean CREOG scores at participating institutions. However, performance on the TrueLearn questions correlated with ITE performance, supporting predictive validity and the use of this question bank as a formative assessment for resident education and exam preparation.

Family planning training at Catholic and other religious hospitals: a national survey.

BACKGROUND: Catholic and other faith-based hospitals often restrict family planning service provision based on institutional doctrine. Approximately 11% of US accredited obstetrics and gynecology residency programs occur at such hospitals, creating a challenge to educational leaders who must ensure comprehensive family planning training. OBJECTIVE: To evaluate and summarize family planning training at obstetrics and gynecology residency programs that are affiliated with Catholic and other faith-based hospitals that restrict reproductive services. MATERIALS AND METHODS: Using an online database search and survey screening questions, we identified 30 of 278 accredited 2017-2018 programs in which at least 70% of resident time is spent in faith-based hospitals that restrict family planning services; Jewish programs were excluded. We queried program leaders between March 2017 and April 2018 about education and training using an online or paper survey, and asked them to report on training settings, provision of family planning services in such settings, and to rate aspects of training as "poor," "adequate," or "strong." We compared responses at Catholic versus other faith-based programs using Fisher exact tests, χ2 analyses, and median tests. RESULTS: Among 30 programs, 25 responded (83%); the majority of respondents were program directors (88%) and represented Catholic hospitals (76%). All reported adequate contraceptive training, with 47% of Catholic programs relying on off-site locations. The majority of Catholic sites (84%) relied on off-site sterilization training sites. Survey respondents from Catholic programs most commonly endorsed concerns for inadequate training in postpartum tubal ligations (53% of Catholic respondents versus 0% of other faith-based program respondents, P = .05). Approximately one-half (56%) offered abortion training as part of the curriculum ("routine"), 32% offered residents the opportunity to arrange training ("elective"), and 12% did not offer; the majority (84%) relied on off-site collaborations. Catholic sites were more likely than other religious programs to report poor abortion training (47% versus 0%, P = .04). Five Catholic programs (26% of Catholic programs) reported that their residents did not meet the graduate training requirement for completion of 20 dilation and curettage procedures. One-third reported a prior Residency Review Committee family planning citation(s), and many commented that these citations helped provide leverage for improved training. CONCLUSION: Although Catholic and other restrictive, faith-based obstetrics and gynecology residency training programs have developed strategies in response to institutional restrictions, many report ongoing deficiencies, and almost one-half reported they were noncompliant with abortion training requirements. Programs with deficient trainings may benefit from strategic approaches, including enhanced onsite education and collaborations with off-site facilities.

Impact of an Obstetrical Hospitalist Program on the Safety Events in a Mid-Sized Obstetrical Unit.

OBJECTIVE: Because internal medicine hospitalist programs were developed to address issues in medicine such as a need to improve quality, improve efficiency, and decrease healthcare cost, obstetrical (OB) hospitalist models were developed to address needs specific to the obstetrics and gynecology field. Our objective was to compare outcomes measured by occurrence of safety events before and after implementation of an OB hospitalist program in a mid-sized OB unit. METHODS: From July 2012 to September 2014, 11 safety events occurred on the labor and delivery floor. A full-time OB hospitalist program was implemented in October 2014. RESULTS: From October 2014 to December 2016, there was 1 safety event associated with labor and delivery. CONCLUSION: It has been speculated that implementation of an OB hospitalist model would be associated with improved maternal and neonatal outcomes; our regional OB referral hospital demonstrated a statistically significant decrease in OB safety events after the OB hospitalist program implementation.

Epidemiologic Surveillance of Teenage Birth Rates in the United States, 2006-2012.

OBJECTIVE: To investigate the geographic variation in the average teenage birth rates by county in the contiguous United States. METHODS: Data from the National Center for Health Statistics were used in this retrospective cohort to count the total number of live births to females aged 15-19 years by county between 2006 and 2012. Software for disease surveillance and spatial cluster analysis was used to identify clusters of high or low teenage births in counties or areas of greater than 100,000 teenage females. The analysis was then adjusted for percentage of poverty and high school diploma achievement. RESULTS: The unadjusted analysis identified the top 10 clusters of teenage births. The cluster with the highest rate was a city and the surrounding 40 counties, demonstrating an average teen birth rate of 67 per 1,000 females in the age range, 87% higher than the rate in the contiguous United States. Adjustments for poverty rates and high school diploma achievement shifted the top clusters to other areas. CONCLUSION: Despite an overall national decline in the teenage birth rate, clusters of elevated teenage birth rates remain. These clusters are not random and remain higher than expected when adjusted for poverty and education. This data set provides a framework to focus targeted interventions to reduce teenage birth rates in this high-risk population.

Do Educational Seminars for the Human Papillomavirus Vaccine Improve Attitudes Toward the Value of Vaccination?

STUDY OBJECTIVE: This study aimed to determine the effectiveness and effect of educational seminars given at 2 sites in north central Florida on the knowledge of human papillomavirus (HPV), perceived barriers to HPV vaccination, and willingness to vaccinate against HPV in eligible patients. DESIGN, SETTING, AND PARTICIPANTS: This study was performed in conjunction with the Committee for the Healthcare of Underserved Women, District XII, American College of Obstetrics and Gynecology. One hundred participants, ages 18-65 years, were included in the study. INTERVENTIONS: Community outreach educational seminars, approximately 30 minutes in length, were given at 2 sites in Gainesville, Florida. MAIN OUTCOMES MEASURES: Before and after seminar surveys were given to evaluate the effect of the seminars on knowledge of HPV, willingness to vaccinate against HPV, and barriers to vaccination. RESULTS: There was a statistically significant improvement in the willingness to accept the HPV vaccine and an improvement in knowledge of several HPV-related facts. There was a statistically significant decrease in several perceived barriers to HPV vaccination. CONCLUSION: This study illustrates the utility of educational seminars in patients' acceptance of health care options. Improving the educational opportunities of patients and families in relation to the HPV vaccine has the opportunity to make a significant outcome on vaccination rates.

Postpartum Contraception Use Rates of Patients Participating in the Centering Pregnancy Model of Care Versus Traditional Obstetrical Care.

OBJECTIVE: To examine whether postpartum contraceptive rates are higher in the CenteringPregnancy population as compared to patients who choose to participate in traditional prenatal care. Centering Pregnancy is a model of obstetrical care that allows for enhanced contraceptive education. STUDY DESIGN: All patients who were delivered within the Florida State University College of Medicine Obstetrics and Gynecology residency from October 31, 2010, to October 31, 2011, were included in the study. A retrospective chart review was undertaken to compare the postpartum contraceptive use of patients in traditional obstetric care versus patients in CenteringPregnancy. RESULTS: A total of 472 obstetrical charts were reviewed, with 350 women participating in traditional care and 122 women in CenteringPregnancy. Using Fisher's exact test, the 2 groups' postpartum contraceptive use was compared. Analysis revealed that 57.4% of CenteringPregnancy patients returned for postpartum contraception, vs. 37.7% of traditional prenatal care patients. Furthermore, 24.5% of CenteringPregnancy patients chose long-acting reversible contraception as compared to only 8.28% of traditional patients. CONCLUSION: Centering Pregnancy leads to an increase in use of postpartum contraception when compared to traditional prenatal care. Long-acting reversible contraceptive usage rates were also significantly higher among CenteringPregnancy patients and were the most frequently chosen method of family planning.

Advocacy skills in resident doctors.

BACKGROUND: The objective of this project was to study whether a standardised patient clinical encounter learning exercise improved an Obstetrics and Gynaecology (OBGYN) resident's ability to perform patient advocacy, a systems-based practice skill. METHODS: Case-control study: each of the 12 residents functioned as their own control. Additionally, aggregate data from the programme was reviewed. RESULTS: Twelve residents from a mid-sized OBGYN residency programme performed a standardised patient clinical encounter exercise in March of 2014. As demonstrated by the Assessment for Professional Behavior (APB) 360° evaluation, the overall total scores for the programme on patient advocacy improved, with statistical significance, when analysed by the signed ranked test. Additionally, the residents' self-identified capability to perform advocacy improved after the programme, with statistical significance, when analysed by the signed rank test. CONCLUSIONS: A standardised patient clinical encounter, used as a learning exercise, can demonstrate meaningful improvement in the advocacy skills of a resident doctor.

Interconception Care Opportunities for Mom and Baby.

IMPORTANCE: Interconception care provides an irreplaceable opportunity to address existing chronic disease and correct maladaptive health behaviors. OBJECTIVE: Utilizing the postpartum visit as an opportunity to improve interconception health and provide education to patients will not only improve the patient's life, but also impact any future offspring. EVIDENCE ACQUISITION/RESULTS: Optimization of interconception health has the potential to improve population wellbeing and reduce the societal burden poor birth outcomes. Evidence-based recommendations are described.

Centering Pregnancy: practical tips for your practice.

IMPORTANCE: With increased access to care, current health delivery systems will need expansion to meet higher demands and needs. PURPOSE: To define Centering Pregnancy and practical tips for implementation into both private and academic practices. METHODS/EVIDENCE ACQUISITION: Evidence was gathered through literature reviews. RESULTS: It was found that Centering Pregnancy offers a patient-centered, evidence-based approach to helping with access issues, as well as improving outcomes. CONCLUSIONS: This article describes the benefits of Centering Pregnancy to the practice, the provider, and the patient. RELEVANCE: Practical implementation tips will be offered, with suggestions for negating common implementation barriers.

Relationship of prenatal depression and comorbidities to infant outcomes.

OBJECTIVE: The purpose of this study was to provide information on the effect of prenatal depression and anxiety as assessed in the context of obstetrical care on key infant outcomes (gestational age at birth, birth weight, and APGAR scores), while simultaneously considering interactions with maternal medical conditions among primarily Medicaid enrollees. METHODS: Obstetrical medical records of 419 women presenting consecutively for prenatal care at a health system serving primarily Medicaid patients were examined. Information on maternal characteristics (age, race, education) and maternal medical health (BMI, high blood pressure, diabetes, and kidney problems), as well as mental health information, was extracted. Depression was assessed as part of routine care using the Patient Health Questionnaire-9 (PHQ-9), and any documentation of depression or anxiety by the obstetrics clinician was also used in the analyses. RESULTS: Approximately one-third of the sample showed some evidence of prenatal depression, either based on PHQ-9 score (≥10) or clinician documentation of depression, and close to 10% showed evidence of anxiety. Multivariate analyses showed significant interactions between depression and anxiety on gestational age and birth weight, between depression and high blood pressure on gestational age, and also between anxiety and kidney problems on gestational age. CONCLUSION: Among this sample, the effect of maternal depression and anxiety on birth outcomes was more evident when considered along with maternal chronic medical conditions. This information may be used to assist prenatal care clinicians to develop risk assessment based on knowledge of multiple risk factors that may exert and additive influence on poor birth outcomes.