Gynecology Clerkship Research Articles

Does the Feedback Passport Influence Students' Perception of Feedback During Their Obstetrics and Gynecology Clerkship?

Does the Feedback Passport Influence Students' Perception of Feedback During Their Obstetrics and Gynecology Clerkship?

Interactive Spaced Education as an Adjunct to Lecture-Based Modules for Teaching Obstetrics and Gynecology to Medical Students

OBJECTIVE: To determine whether Interactive Spaced Education (ISE), a novel form of online education, is an effective and acceptable pedagogic tool for medical students during their 6-week obstetrics and gynecology clerkship. METHODS: This is a multi-institutional randomized controlled trial. Sixty third-year medical students completed a 20-item pretest on pregnancy-induced hypertension (PIH) and urinary incontinence (UI). Students were block randomized: cohorts A and B were exposed to standardized PIH/UI lectures. Cohort A received this intervention alone. Cohort B received ISE in addition to the didactic lectures. Cohort C received ISE alone. All participants then completed a posttest and a completion survey. RESULTS: 100% completion rate. No statistically significant differences between group pretest means (F[2,57] = 0.0266, P=.974) demonstrating similar base knowledge. Students who received the spaced education e-mails as an adjunct to didactic lectures demonstrated a significant 28.25% relative increase from their pretest scores, t(−10.876)=19 df, P<.001; There was a statistical difference between the mean (improvement or posttest score) of the three groups. (F[2,57]=3.269, P=.045). Eighty-eight percent of all participants requested to enroll in further ISE programs. Ninety-two percent agreed or strongly agreed that the ISE was effective as a method to learn and reinforce key aspects of PPH and SUI. CONCLUSION: Spaced education is an up and coming evidence-based form of education that has been demonstrated to enhance the effect of traditional didactic learning. Its potential for student and resident education is immense in the fast paced setting of Obstetrics.

Enhancing the Obstetrics and Gynecology Clerkship

OBJECTIVE: The study evaluates the implementation of a Practice and Feedback Simulation experience (PF-SIMs) to assess clinical competencies during the clerkships and to provide faculty with data to evaluate student performance. METHODS: The PF-SIMs was created and implemented for all third-year clerkships. The experience involves five clinical scenarios enabling students to practice and obtain feedback on their cultural competence, procedural skills, use of evidence in patient care, team skills, and response to feedback. The obstetrics and gynecology case challenges included understanding “noncompliance,” pelvic examination, literature search strategy, approaching a decompensating patient, and giving bad news. The PF-SIM is scheduled before the mid-clerkship evaluation and each student creates a personal learning plan afterwards. RESULTS: Data from 368 students were analyzed for 2012 through 2014. All questions are formatted with yes or no answers. Significantly lower scores were observed for the Procedure and Team Skills stations when compared with Contextual Competence and the Challenging interactions ones. No significant differences were found in student's performance by year or by rotation. Students provided positive feedback on their experiences, eg, recognize their strengths and weaknesses, appreciated the feedback received, learned good rationale and enhanced their cultural competence skills. CONCLUSION: PF-SIMs data enable identification of student strengths and weaknesses and focuses faculty on necessary quality improvement of the clerkship and student's performance. It also helps to better prepare our students for the USMLE step 2 CS.

Improving Anatomical Knowledge Through Nested Interactive Modules on the Obstetrics and Gynecology Clinical Clerkship

BACKGROUND: Deficits in retention of anatomy knowledge from the preclinical years to clinical application on the wards have been well-documented in medical education literature. OBJECTIVE: This study aims to determine if interactive clinically-oriented basic anatomy modules nested longitudinally in the curriculum increase anatomy knowledge in medical students on the obstetrics and gynecology clinical clerkship. METHODS: A 20-question multiple-choice examination was administered to 143 consenting third-year medical students at the beginning and end of each obstetrics and gynecology rotation at a large, urban medical school. Students participated in a 2-hour hands-on skills laboratory with preparatory e-modules linking basic anatomy to clinical application during each rotation. Topics included perineal muscle anatomy (obstetric laceration repair), anterior abdominal wall anatomy (cesarean delivery), vulvovaginal and uterine anatomy (intrauterine device insertion), and pelvic organ, vasculature, and neural anatomy (hysterectomy). Data were analyzed using a univariate analysis of variance with post-hoc t tests. RESULTS: Mean anatomy knowledge scores improved significantly after nesting of interactive modules, increasing from 57% to 69% (P<.001). Knowledge retention was the lowest in the topics of embryology (45%), uterine anatomy (47%), pelvic vasculature (46%), and fallopian tube anatomy (54%). Mean postrotation scores for uterine, vasculature, and fallopian tube anatomy increased significantly to 78% (P<.001), 72% (P<.001) and 71% (P<.001) respectively. CONCLUSIONS: Medical students' baseline anatomical knowledge before entering the obstetrics and gynecology clerkship is poor. Nesting anatomical science into the clinical curriculum through preparatory e-modules and hands-on anatomy laboratory sessions may improve pelvic anatomy knowledge. These data may be used to increase longitudinal integration of the various disciplines across the undergraduate medical curriculum.

Revitalizing Obstetrics and Gynecology Clerkship Best Practices Using Student Feedback

Revitalizing Obstetrics and Gynecology Clerkship Best Practices Using Student Feedback

Evaluation of an Evidence-Based Intimate Partner Violence Module for Medical Students on the Obstetrics and Gynecology Clerkship

Evaluation of an Evidence-Based Intimate Partner Violence Module for Medical Students on the Obstetrics and Gynecology Clerkship

Effect of a Mid-Rotation Clerkship Director Meeting on Student Perception of the Obstetrics and Gynecology Clerkship

Effect of a Mid-Rotation Clerkship Director Meeting on Student Perception of the Obstetrics and Gynecology Clerkship

Effectiveness of Labor Cervical Examination Simulation in Medical Student Education.

To estimate whether simulation training improves medical students' cervical examination accuracy. The training paradigm for the labor cervical examination exposes patients to additional examinations, lacks a gold standard, and does not objectively assess trainee competence. To address these issues and optimize training, we assessed the effectiveness of cervical examination simulation in third-year medical students. During the obstetrics and gynecology clerkship, a cohort study was performed in which third-year students were assigned to receive cervical examination simulation (n=50) or vaginal delivery simulation (n=48), with each group serving as a simulation-naive control for the other skill. As a final assessment, students performed 10 cervical examinations using task trainers. Exact accuracy and accuracy within 1 cm were compared between groups. Cumulative summation analyses were performed on the cervical examination group to assess competence and the average number of repetitions needed to achieve it. Cervical examination students were significantly more accurate (Mann-Whitney, P<.001) in assessing dilation (73% exact, 98% within 1 cm) and effacement (83% and 100%) than vaginal delivery students (dilation 52% and 82%, effacement 51% and 96%). In the cumulative summation analyses, 65-100% of students attained competence during the clerkship depending on the level of accuracy and cervical parameter assessed. On average, competence was achieved with 27-44 repetitions. Simulation training dramatically improved student accuracy in labor cervical examinations. Because not all students achieved competence, the cumulative summation analyses suggest that more than 100 repetitions would be needed if the goal was for the entire class of students to achieve competence. II.

Characterization of a Novel Obstetrics Communication Assessment Tool for Undergraduate Medical Education

BACKGROUND: Dedicated obstetric (OB) communication training is lacking, despite the wealth of uniquely sensitive and difficult clinical topics that are often unaddressed by conventional communication curricula. OBJECTIVE: To characterize the psychometric properties of an Obstetric Communication Assessment Tool (OCAT) for a novel OB communication module. METHODS: We developed four difficult OB Standardized Patient (SP) scenarios: Religious Beliefs (RB), Angry Father (AF), Maternal Smoking (MS), and Intimate Partner Violence (IPV). A trial run was performed with SPs and 21 third-year obstetrics and gynecology clerkship students. Five trained Standardized Patient Reviewers (SPRs) independently scored 24 randomized video-recorded encounters. Internal consistency (IC) was estimated with Cronbach's alpha. Inter-rater reliability (IRR) was estimated using the Intraclass Correlation Coefficient-2 (ICC-2) test. Systematic variability in reviewer responses was assessed using the Stuart-Maxwell test. RESULTS: IC was acceptable to excellent with alpha values (95% confidence intervals): RB 0.91 (0.86, 0.95), AF 0.76 (0.62, 0.87), MS 0.91 (0.86, 0.95), and IPV 0.94 (0.91, 0.97). IRR was unacceptable with ICC-2: RB 0.46 (0.40, 0.53), AF 0.48 (0.41, 0.54), MS 0.52 (0.45, 0.58), and IPV 0.67 (0.61, 0.72). Stuart-Maxwell analysis indicated systematic variability in reviewer scoring. CONCLUSION: We have developed the OCAT with high IC but unacceptable IRR. Our findings suggest that the OCAT effectively discriminates learner performance but systematic differences in SPR rigor require a revised training regimen to improve reliability. We propose the optimization of the OCAT as an essential step toward development of a focused OB communication module and discuss future directions of the project.

Effect of Obstetrics and Gynecology Clerkship Order on National Board of Medical Examiners Scores

APGO Advisor: Sonya Erickson, MD PURPOSE: To examine the effect of rotation order on the end-of-clerkship National Board of Medical Examiners (NBME) Obstetrics and Gynecology Subject Examination scores. BACKGROUND: Integrated clerkships are intended to improve overall comprehension and critical thinking skills. At our university, a 15‐week interval is divided into 5 weeks blocks of general surgery, obstetrics and gynecology, and surgical subspecialties, in any order. During the 16th week, students take the NBME Subject Examinations for obstetrics and gynecology and surgery. METHODS: The NBME Obstetrics and Gynecology Subject Examinations scores of all students were reviewed. Rotation groups were defined by proximity to shelf exam. Group 1 completed obstetrics and gynecology first, furthest away from the exam, group 2 completed obstetrics and gynecology second, and group 3 completed obstetrics and gynecology last, closest to the test. Average shelf exam scores were compared. RESULTS: Data were obtained for 281 students (100 students in group 1, 90 in group 2, and 91 in group 3). Scores ranged from 55 to 99 with an overall mean of 72.7 and standard deviation of 7.4 (standard deviation [SD]). Mean (SD) NBME score was 72.1 (7.1) in group 1, 73.0 (7.3) in group 2, and 73.1 (7.8) in group 3. The differences were not statistically significant (F[2,278]=.484, P=.617). DISCUSSION: Rotation order does not affect NBME Obstetrics and Gynecology Subject Examination scores in a 15-week clerkship.

A Prospective Cohort Study Using e-Learning Modules as a Supplemental Teaching Resource for Obstetrics and Gynaecology Clerkship Students.

Increasing enrolment in medical schools in Canada has necessitated the development of distributed clinical learning sites to provide appropriate clinical experience. The Faculty of Medicine at Dalhousie University has clinical clerkship sites distributed across Nova Scotia, New Brunswick, and Prince Edward Island, with diverse educational exposures. This study was designed to examine the influence of online learning modules, developed to standardize learning across education sites during the clinical clerkship, on the acquisition of knowledge by medical students during their obstetrics and gynaecology clerkship rotation. The third year medical school class was divided into two natural cohorts for the purposes of this study. Group 1 had their obstetrics and gynaecology rotation from September 2012 to March 2013 (n = 54), and Group 2 had their rotation from April to September 2013 (n = 60). All students were given the opportunity to complete an online formative examination before their summative multiple choice examination; only Group 2 students had access to six obstetrics and gynaecology e-learning modules, upon which the formative examination was based. Forty-seven students in Group 1 (87%) and 45 students in Group 2 (75%) completed the formative examination, with an overall participation rate of 81%. There was no difference in median scores between Group 1 (score 9, IQR 8 to 10) and Group 2 (score 9, IQR 8 to 11, P = 0.08). Having access to six e-learning modules did not improve the third year medical students' scores on a formative examination completed before their summative multiple choice examination.

Overcoming Electronic Medical Record Challenges on the Obstetrics and Gynecology Clerkship.

This article, for the "To the Point" series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, supplies educators with a review of best practices regarding incorporation of the electronic medical record (EMR) into undergraduate medical education. The unique circumstances of the obstetrics and gynecology clerkship require specific attention as it pertains to medical student use of the EMR. An outline of the regulatory requirements and authoritative body recommendations provides some guidance for implementation in the undergraduate medical education setting. A review of the basic framework for development of an EMR curriculum and examples of curricular innovations published in the literature offers solutions for obstacles that may be encountered by students and medical educators.

Residents as Medical Student Mentors During an Obstetrics and Gynecology Clerkship

Residents as Medical Student Mentors During an Obstetrics and Gynecology Clerkship

Does Clinical Experience Influence Medical Knowledge on Obstetrics and Gynecology Clerkships? [102

INTRODUCTION:The Liaison Committee on Medical Education Standard 6.2 requires that medical schools define the types of patients and clinical conditions that medical students encounter. The underlying message is a robust, diverse clinical experience may lead to better medical knowledge and preparatio

Improving Accuracy of Estimating Blood Loss Through Learning Style–Specific Didactic Sessions [124

INTRODUCTION: To determine whether accuracy in estimating blood loss is improved by participating in a didactic session that is aimed toward an individual's learning style. METHODS: This was a prospective, single-blind study of obstetrics and gynecology residents and medical and physician assistant students rotating through their obstetrics and gynecology clerkship. Participants took an online survey that determined their learning style—visual, auditory, or kinesthetic. Participants were randomized between three groups: group 1 had no didactic session; group 2 had a generic session; and group 3 had a style-specific session. Participants then estimated blood loss in simulated scenarios. A three-way analysis of variance was used to determine accuracy for each learning group. A dichotomous agreement variable indicated whether a participant's estimate identified a hemorrhage in each scenario. RESULTS: Forty-two participants completed the study with 16 visual learners, 15 auditory learners, and 11 kinesthetic learners. Fourteen participants were assigned to the no learning group, 13 assigned to the generic group, and 15 assigned to the style-specific group. No statistical significance was found between the accuracies of each group. A trend toward significance was noted in group 3's ability to identify a clinical hemorrhage. CONCLUSION: There was a trend toward significance with the style-specific group being more likely to identify a clinical hemorrhage, although there was no statistical significance among learning groups. Results of this study support previous work, showing that health care providers across all levels of training are poor visual estimators of blood loss. This study emphasizes the importance of having formal training for health care providers who estimate blood loss.

Gender Differences in Obstetrics and Gynecology Clerkship Evaluations [82

Gender Differences in Obstetrics and Gynecology Clerkship Evaluations [82

Toward a better understanding of gender-based performance in the obstetrics and gynecology clerkship: women outscore men on the NBME subject examination at one medical school.

To better understand why women outperform men in the obstetrics and gynecology (Ob/Gyn) clerkship. The authors conducted a retrospective cohort study of students who rotated in the Ob/Gyn clerkship from 2008 to 2011 and graduated by May 2012 from the Icahn School of Medicine at Mount Sinai in New York City. They compared female and male students' performance on preclerkship standardized tests (the Medical College Admission Test [MCAT] and United States Medical Licensing Examination [USMLE] Step 1) and on Ob/Gyn clerkship components (clinical skills achievement, oral and written case presentations, clinical evaluations, and National Board of Medical Examiners [NBME] subject examination). The study included 163 (53.4%) women and 142 (46.6%) men. Among students who took the MCAT, women scored lower than men with a mean (standard deviation) of 33.2 (3.2) versus 34.6 (3.3) (P=.001). Similarly, among all students, women scored lower than men on the USMLE Step 1: 227 (19.1) versus 232.5 (18.8) (P=.012). There were no significant gender differences on most clerkship components. However, women scored higher than men on the Ob/Gyn NBME subject examination: 78.0 (7.5) versus 74.8 (8.4) (P=.001). Consequently, female students achieved higher overall clerkship scores than men: 88.5 (5.6) versus 87.1 (5.1) (P=.024). Analysis of covariance confirmed that gender is associated with NBME subject examination score (P<.001). Women outscored men on the NBME subject examination in Ob/Gyn and thereby outperformed men in the Ob/Gyn clerkship.

Implementing a Prenatal Oral Health Program Through Interprofessional Collaboration

Interprofessional collaboration has become a critical component of accreditation standards in dentistry and medicine. This article reports on implementation in an academic setting of a prenatal oral health program (pOHP) that addresses coordinated care, accreditation standards, and new clinical practice guidelines. The pOHP is an educational intervention for third-year medical students, residents, and faculty members to deliver preventive oral health information and referral to a dental home for pregnant women. At the same time, senior dental students and faculty members are introduced to prenatal oral health principles and delivery of comprehensive oral health care to pregnant women. A systems-based approach was used to guide the pOHP implementation during the 2012-13 academic year. Participants were 96 third-year medical students (50% of the total in an obstetrics and gynecology clerkship) and all 81 fourth-year dental students. During that academic year, 126 dental referrals were made to the School of Dentistry, and 55 women presented for care, resulting in 50% (n=40) of dental students participating in the clinical experience and delivery of simple to complex oral health procedures. The prenatal period is a frequently missed opportunity to address oral health care. The pOHP is an interprofessional collaboration model designed to educate dental and medical providers and provide a system of referral for comprehensive clinical care of pregnant patients, including educating women about their oral health and that of their children. Such programs can help meet interprofessional accreditation standards and encourage implementation of practice guidelines.

Medical Male Students in Obstetrics and Gynecology Clerkship: Are they Guilty?

Medical Male Students in Obstetrics and Gynecology Clerkship: Are they Guilty?

Obstetrics and Gynecology Skills Orientation Improves Student Perception of Third-Year Clerkship

INTRODUCTION: The aim of this intervention was to assess the value of an orientation for medical students. METHODS: This study was a prospective cohort of third-year medical students assigned to an obstetrics and gynecology clerkship at a single academic center. Students were given surveys at the first day of their rotation and during the fifth week. An orientation to obstetrics–gynecology-specific skills was developed and provided to the intervention group. Number of obstetrics–gynecology-specific skills performed clinically was recorded by the students and satisfaction scores were recorded on a Likert scale (1–5). Data were compared with Student's t and Kruskal-Wallis tests. RESULTS: Sixty-four medical students participated from October 2011 to August 2013. Baseline comparison revealed no difference in number of obstetrics–gynecology-specific procedures previously performed in a clinical setting. At the conclusion of the clerkship, there was no significant difference in the number of most procedures performed during the rotation with the exception of cervical examinations (Table 1). Surveys at the completion of the rotation revealed students in the intervention group were more likely to report a positive perception of obstetrics–gynecology, to be satisfied with their rotation and to be satisfied with their obstetrics–gynecology-specific skills training.CONCLUSION: An orientation to obstetrics–gynecology-specific skills improves perception of obstetrics–gynecology and specialty-specific skills training.