OBGYN Clerkship Research Articles

Prevalence of pelvic examinations on anesthetized patients without informed consent.

The pelvic examination is a fundamental tool for the evaluation and diagnosis of women's health conditions and an important skill for all medical students to learn as future physicians for the early detection of treatable conditions such as infection or cancer. Although the American College of Obstetricians and Gynecologists (ACOG) asserts that performing pelvic examinations under anesthesia for educational purposes should only occur if the patient provides explicit and informed consent, there still have been reports of medical students performing pelvic examinations on anesthetized patients across the country, and many states are now starting to pass bills requiring informed patient consents to conduct pelvic examinations under anesthesia. The objectives of this study are to evaluate the prevalence of pelvic examinations performed by osteopathic medical students on anesthetized patients without consent while fulfilling their third-year OB-GYN clerkship requirements. The survey was administered and distributed to all osteopathic medical schools in the country via the Student Osteopathic Medical Association's (SOMA's) chapter emails, outreach emails, and SOMA's social media accounts to collect data. Inclusion criteria included third- or fourth-year osteopathic medical students who completed their OB-GYN clerkship rotations when taking the survey. The exclusion criteria included any osteopathic medical student who had not completed their OB-GYN clerkship rotation. We utilized descriptive analysis to summarize the final data. We received 310 responses. The final number of responses was 291 after meeting the exclusion criteria. Most osteopathic medical students (94.2 %, n=274) considered the practice of performing pelvic examinations on anesthetized patients without their explicit consent unethical. Among theparticipants, 40.9 % (n=119) admitted to performing pelvic examinations on patients under anesthesia while on OB-GYN rotations, but most of them (57.1 %, n=68) did so without obtaining prior consent from the patients. Notably, the number of pelvic examinations performed by medical students on patients under anesthesia ranged widely from 1 to 25 with a median number of 10. Moreover, 58.9 % (n=70) indicated that they had not been properly educated to obtain specific consent before performing pelvic examinations under anesthesia. Many participants cited efficiency of practice, lack of policy awareness and personal education by medical students, andfailure to refuse to perform pelvic examinations on anesthetized patients as trainees when asked by their seniors or preceptors. This study demonstrates that although most osteopathic medical students consider performing pelvic examinations on anesthetized patients unethical, many still admit to practicing pelvic examinations on patients under anesthesia, while on OB-GYN rotations for efficiency of practice, lack of policy awareness and personal education, and being in unique positions in which grades are determined by seniors and preceptors for their willingness to do what is asked even if the practice does not align with their conviction. This study highlights the importance of ongoing research and implementation of policies at institutional and state levels that will procure the value of pelvic examinations while protecting and upholding the ethics of patients' rights and autonomy of medical students.

Evaluation of family planning and abortion education in preclinical curriculum at a large midwestern medical school

ObjectiveEvaluate a Midwestern medical school's current pregnancy termination and family planning undergraduate medical curriculum (UMC) in accordance with Association of Professors of Gynecology and Obstetrics (APGO) guidelines. Assess 1) student interest 2) preparedness to counsel patients, and 3) preferred modality of instruction. Study designA survey assessed students about UMC. Course syllabus learning objectives and APGO educational guidelines were compared. ResultsThere were 309 responses total; six did not complete all survey questions and were excluded. Participants (n = 303) were primarily female (62%) and White (74%). Across all class levels, many (61%) students expected to learn about family planning and contraception in UMC. While most (84–88%) participants who completed the preclinical course with or without the clerkship felt prepared to counsel about common, non-controversial pharmacotherapies, only 20% of students felt prepared to counsel on abortion options, and 75% of students who had completed both the preclinical and OBGYN clerkship felt unprepared for abortion counseling Overall, 86% of all students surveyed believed that the medical school should enhance its reproductive health coverage in UMC. Traditional lectures, panels, and direct clinical exposure were the most popular instructional modalities. ConclusionWe identified potential gaps in UMC where students expressed high level of interest with low level of preparedness regarding abortion options counseling, even among senior students. Considering the high percentage of students expecting to learn about pregnancy termination and family planning in their UMC, this expectation is not being met. Students were open to a variety of modalities of instruction, indicating that several possible options exist for curricular integration. ImplicationsDespite evidence of need for training in family planning and abortion, few medical institutions have a standardized curriculum. Little available literature exists on curricula covering pregnancy options and contraception counseling, signifying a gap of knowledge and an opportunity to study how to integrate these important topics into UMC.

Home-grown apps for ObGyn clerkship students

Home-grown apps for ObGyn clerkship students

Medical students' experiences in learning to perform pelvic examinations: a mixed-methods study.

ObjectivesWe aimed to explore learning experiences among medical students learning to perform pelvic examinations and to identify factors that facilitate their training. MethodsA mixed-methods study including a web-based survey and focus group discussions (FGDs) was conducted among medical students who had completed their obstetrics and gynaecology (ObGyn) clerkship. The FGDs were recorded, transcribed and analysed using qualitative content analysis with systematic text condensation. Survey factors were compared using the χ2 test or Fisher's exact test. Results160 students (97 female, 61 male, two other) at six universities in Sweden responded to the survey. Two mixed FGDs were conducted. The majority (87%) of the students experienced confidence in performing pelvic examinations, stating that sufficient, repeated training opportunities and support from a clinical tutor were crucial components of the learning experience. Prior to the ObGyn clerkship, negative expectations were more common among male students. The male participants experienced having a disadvantage because of their gender, while female students considered their gender an advantage (p<0.001, N=121, Fisher's Exact Test). The clinical tutor and the use of professional patients (PPs) had a fundamental role in providing learning opportunities by including the student in patient care activities. ConclusionsThe importance of the clinical tutor, as well as the use of PPs, are important factors when planning education in pelvic examinations, and this knowledge could be used when educating other intimate examinations during medical school. In addition, similar investigations on students' experience in training other intimate examinations could be considered.

An Innovative STI Curriculum for Medical Students

PROBLEM: Student feedback regarding the 50-minute didactic session on sexually transmitted infections (STIs) in the Ob-Gyn Clerkship was poor, and students wanted more interactive instruction methods in our curriculum. INTERVENTION: We created a new curriculum for STIs that is more interactive and appropriate for adult learners. Students begin with a self-directed assignment, where they are referred to specific resources and national guidelines to build their fund of knowledge. We replaced the previous didactic lecture with an interactive case-based session that demonstrates clinical application of the material. Small groups of students discuss four clinical vignettes: STI screening, a patient with a genital ulcer, a woman with pelvic inflammatory disease (PID), and a victim of sexual assault. To assess the effectiveness of our method, we will review student feedback on the new curriculum and student performance on the National Board of Medical Examiners subject exam for Obstetrics and Gynecology. We are also conducting a survey for fourth year students that asks how they would manage a patient with PID and a patient requesting STI screening. CONTEXT: Screening, diagnosis, and treatment of sexually transmitted infections (STIs) are critical areas of competency for medical students, and interactive teaching methods are increasingly utilized in the modern medical curriculum. OUTCOME/LESSONS LEARNED: The current session has been very positively received by students. There has not been a significant change in exam scores. We will conduct our fourth-year survey in the coming academic year to determine whether there is a significant difference in approach to the two vignettes.

Efficacy of a Flipped Classroom Obstetrics Didactics Module in the OBGYN Clerkship

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Characterizations of motivation and identity in medical students’ reflections about challenging patient interactions

Purpose: Students’ negative emotions in patient interactions can relate to their learning motivation and identity. Educators can support learning from these interactions by advocating for reflection. We explored how students, in reflection essays about emotionally difficult patient interactions that challenged their notions of professionalism, described aspects of motivation and identity.Materials and Methods: All third-year medical students on the ob-gyn clerkship complete written reflections about a “clinical situation that challenged or affirmed your professionalism.” We conducted directed content analysis of essays (academic years 2014–2017) using relevant theories (self-determination, goal orientation and identity formation) based on previous work and organized the data into categories.Results: In 265 essays (of 396, 67%), students described patient interactions that challenged their notions of professionalism, of which 90% included descriptions of their emotions. When reflecting on these interactions, students described psychological needs acknowledged in self-determination theory, competence, autonomy in patient care and connection to the team. Students indicated challenges in identity when advocating for patients due to team hierarchy and evaluation concerns.Conclusions: Reflection essays about difficult patient interactions allow students to explore emotions, motivation and identity. They help educators understand whether the clinical learning environment is meeting students’ needs to support learning in challenging interactions.

Project to decrease medical student refusal in the Obstetric and Gynecology Clinic at the University of Iowa

Purpose: To describe the frequency at which students are refused from patient care, and to evaluate the impact of interventions designed to reduce medical student refusal. Background: Medical student refusal from patient care is perceived to be a common problem during the Ob-Gyn clerkship at the University of Iowa. Review of the literature shows that medical student refusal is common in a variety of clerkships1-4. Few studies have evaluated interventions to reduce the rate of refusal. Methods: Beginning in 2016, surveys measuring medical students’ perception of refusal were administered upon completion of the Ob-Gyn clerkship. Interventions to reduce refusal of medical student participation were implemented and/or modified with each subsequent clerkship block starting in 2017. Results: Over the 2017 calendar year, 86% (85% among females and 88% among males) of students reported being refused from patient interaction in any clerkship because they are a medical student, 88% reported being refused in their Ob-Gyn clerkship because they are a medical student, and 85% percent of male students reported being refused in their Ob-Gyn clerkship because of their gender. The data show no clear correlations with refusal and gender nor with the interventions put in place. Multiple qualitative responses describe patient discomfort with the presence of male students. Discussion: The data suggest that exclusion from patient care in the Ob-Gyn clerkship occurs for the majority of medical students queried. Further, gender based exclusion may be a related problem. So far, the data have not shown a clear improvement following interventions. Possible explanations are explored and future interventions are discussed.

“Guiding Light” to Reduce Incidence of Medical Student Refusal in the Obstetric &amp; Gynecology Clinic

PURPOSE: Characterize and reduce the frequency at which medical students are 'cast off' from patient care in the Ob-Gyn clerkship. BACKGROUND: For optimal medical education and patient care, it is imperative to have 'all hands on deck'. Review of the literature shows that medical student refusal is an issue nationally in Ob-Gyn as well as other clerkships (1-3). Review of our Ob-Gyn clerkship data shows that students report that patients refuse their involvement in 14% of patient interactions. Furthermore, in 19% of interactions, students felt refusal was related to their gender. METHODS: Beginning in 2017, surveys measuring medical students' perception of refusal were administered upon completion of our Ob-Gyn clerkship. Interventions to reduce refusal of these 'castaways' were implemented with each subsequent clerkship. Faculty mentors: Sarah Shaffer DO &amp; Colleen Stockdale MD, MS. RESULTS: Data collection is on-going. To date, 85% reported exclusion from a patient interaction on the Ob-Gyn clerkship due to being a medical student. Twenty-three percent reported greater than five episodes of exclusion from patient care. Forty-three percent perceived that restricted participation was related to their gender with multiple qualitative responses describing patient discomfort with the presence of male 'comrades'. DISCUSSION: Data from our institution suggests that exclusion from patient care in the Ob-Gyn clerkship occurs for the majority of medical students queried. Further, gender-based exclusion is likely a related problem. Future exploration includes analysis of trends after the implementation of interventions designed to keep patients and staff 'abreast' of the presence and role of medical students.

Improved Strategies for Teaching Surgical Skills to Medical Students: Simulation and Beyond

PURPOSE: Develop a curriculum to optimize surgical skills and to increase operating room (OR) opportunities for medical students. BACKGROUND: Simulation-based strategies for teaching surgical skills are evolving. Using an innovative task trainer, we compared one-on-one deliberate practice to video-based self-guidance in the performance of two-handed knot tying and subcuticular suturing during the OBGYN clerkship. METHODS: A randomized prospective trial compared two groups of third year medical students in the same clerkship rotations. Group A received one-on-one deliberate practice undergoing three sessions with an instructor and Group B received unlimited access to video-based self-guided practice over six weeks. At the end of the clerkship, surgical performance was assessed using the validated checklist. Self-reported data regarding OR experience was collected using a specifically designed phone application. RESULTS: Fifty-nine students participated in the study. Group A demonstrated a statistically significant improvement in two-handed knot tying and subcuticular suturing in pre-post assessments (knot-tying +4.34, P&lt;.001; suturing +19.4, P&lt;.001). Group B demonstrated a statistically significant improvement (knot-tying +6.03, P&lt;.001; suturing +22.3, P&lt;.001). No significant differences were found between groups in overall knot-tying (P=.13), suturing (P=.14), hours practiced (P=.90), or number of OR cases (P=.49). DISCUSSION: The use of simulation significantly improved surgical skills for all students from baseline. No differences were found between one-on-one deliberate practice and video-based self-guided practice. Both instructional strategies provided equal efficacy in teaching surgical skills and optimizing surgical performance for students during the OBGYN clerkship.

Teaching Lesbian, Gay, Bisexual, Transgendered, and Queer Family Building in a Third Year OBGYN Clerkship

PURPOSE: To explore third year medical students' fund of knowledge and attitudes about LGBTQ family building and third party reproduction. BACKGROUND: Medical student knowledge and attitudes about family building for LGBTQ families and third party reproduction (TPR) varies based on student prior experience and pre-clinical teaching. The OBGYN clerkship is a unique opportunity for students to learn medical knowledge and reflect on attitudes about this subject. METHODS: A quantitative study of knowledge and attitude among third year medical students done after IRB approval. The intervention consisted of a one hour lecture on TPR and participating in a group discussion about LGBTQ family building. Students (231) completed a survey asking about their knowledge and attitudes prior to starting the rotation and 178 completed the survey following the intervention. Survey respondents rated items using a Likert scale and completed a knowledge assessment. Changes in knowledge scores were investigated using t-tests. RESULTS: Survey respondents were 51% female, 48% male, 1% gender non-conforming; heterosexual 93%; and partnered 59%. Comfort with same sex couples was endorsed by 92%. 56% of students felt that opting out of assisting a patient with family building was not an option. Fertility knowledge increased from after intervention significantly (P&lt;.0001). Some students, 29%, thought that infertility was hard to discuss, but 67% felt it would be hard to discuss for same sex couples. DISCUSSION: Medical students' fund of knowledge was increased with lecture and small group discussion about TPR and LGBTQ patients. Students report being comfortable with TPR and LGBTQ families but have some discomfort with varied pathways to parenthood. Most feel that opting out of care for LGBTQ families is not an option.

The Use of Standardized Patients to Increase Medical Student Awareness of and Confidence in Screening for Human Trafficking

Local Mentor: Laurie Erickson, MD APGO Advisor: Jody Steinauer, MD, MAS PROBLEM: Human trafficking is a growing problem, but is often unrecognized. Victims are frequently kept in isolation with little freedom and autonomy, limiting their access to resources and recovery. Skilled health care providers can be the first to intervene on the victim’s behalf. A healthcare provider’s knowledge of the signs/symptoms of trafficking, the use of skillful communication techniques, and a familiarity of the patient's rights and resources are vital. INTERVENTION: Medical students are assigned a web-based independent learning module about human trafficking, its signs and symptoms, intervention strategies, and resources. Each student then participates in a simulation with a standardized patient (SP) who is a victim of trafficking, a detail the student must uncover with history taking. They then complete reflective writing, receive individual feedback from the SP, and participate in a group faculty/peer debrief session. CONTEXT: The intervention occurs at the University of Arizona College of Medicine – Phoenix during the required OBGYN clerkship, with the standardized patient and follow-up experiences occurring during the final week of the six-week clerkship. OUTCOME/LESSONS LEARNED: Comparing pre-and post-intervention surveys of medical students identified a significant rise in confidence both in their ability to identify and also support victims of sex trafficking. In reflective essays, students most often feel sad, disappointed, or helpless during the SP encounter, but they remain committed develop rapport, provide resources, and empower their patient. These findings suggest that this is an effective educational intervention to teach medical students about sex trafficking.

Substituting Lectures with Interactive Teaching in OBGYN Clerkship: Integrating Hands-on Learning with Theory

Substituting Lectures with Interactive Teaching in OBGYN Clerkship: Integrating Hands-on Learning with Theory

Examining Unprofessional Behavior in the OBGYN Clerkship: A Qualitative Study of Essays Written by Students

BACKGROUND: Hearing directly from students, in the midst of the rotation, provides a unique view of students' experiences and developing professionalism. METHODS: We conducted an IRB-approved qualitative study analyzing professionalism themes from essays written on the required OBGYN Clerkship. Essays were analyzed from a total of 220 students and coded into eight domains with subcategories. Inter-rater reliability was established, with two coders with high levels of correlation (Kappa agreement 0.73, 95% CI 0.57–0.88). Frequencies were used for descriptive purposes. RESULTS: Most students chose to write about negative incidents of professionalism that they observed. The most common domain themes were: medical team dynamics (37%), patient interactions (39%), and inappropriate remarks about a patient (28%). A third of the essays also included an observation of a positive demonstration of professionalism, most commonly about prioritizing the patient's needs. DISCUSSION: Third-year students often struggle with their transition to the wards. At this time, students also start to demonstrate decreased empathy. Repeated exposures to faculty behaviors shape student clinical behavior and can normalize unprofessional behavior. These essays provide a window into students' real-time experiences and insight into how these experiences shape professional development. The act of writing requires that students process and reflect which creates an opportunity to improve the culture of professionalism. This study provides concrete examples to drive resident and faculty development and to reduce unprofessional behavior in the future.

Using Patient Feedback as a Feedback and Assessment Tool for Medical Students

OBJECTIVE: To improve the quality of feedback and assessment of medical students through a patient satisfaction questionnaire about student performance. METHODS: To measure student performance from the patient’s perspective, five items were adopted from the validated Patient Satisfaction Questionnaire from the American Board of Internal Medicine. This was used to assess medical student skills in communication and professionalism, which were rated on a five-point Likert scale. All 3rd-year medical students rotating through the OBGYN clerkship participated in these unsupervised patient feedback encounters. Students then were asked to anonymously respond to a two-item questionnaire on usefulness of the patients’ feedback encounter and whether this process improved feedback that faculty provided to students. EVALUATION: This is a survey study; 65% (53 out of 81) of students found the patient feedback encounters helpful and 51% (34 out of 67) thought that the exercise encouraged preceptors to provide useful feedback. DISSEMINATION: The goal is to implement this feedback tool locally in the OBGYN Clerkship as well as other clerkships in our institution. The intention is to publish the results in peer-reviewed journal for wider dissemination. REFLECTIVE CRITIQUE: Providing feedback and assessment is an essential element of medical education. Feedback to medical students regarding their performance is usually provided by preceptors and standardized patients in simulated encounters. Little attention has been given to feedback provided directly by actual patients. Comments provided by patients have more positive impact compared to numerical rating. Empowering patients to participate in feedback improves the quality of feedback to students.

Medical Students Can Improve Health Literacy: Training Students to Educate Patients About Obstetric Venous Thromboembolism Prophylaxis

BACKGROUND: Medical schools are increasingly emphasizing patient education in the clerkship year. Effective education is essential to increase patient buy-in when spearheading quality initiatives. This project was designed to train 3rd-year medical students in teach-back education while concurrently enhancing a departmental QI effort to increase obstetric VTE prophylaxis. METHODS: Ob-Gyn clerkship students watched a student-created instructional video on teach-back teaching and a case-based presentation on VTE prophylaxis. Students assessed three patients for VTE risk and counseled patients on interventions. Students recorded pre- and postcounseling assessments of patient knowledge and responded to a survey about their experience. RESULTS: During the first clerkship block, 26 students participated in counseling and 75 patients were counseled. Following student counseling, a significantly increased number of patients exhibited understanding of: definition and consequences of VTE (56.25% increase, P&lt;.0001), VTE risk factors (212.5% increase, P&lt;.0001) and prophylactic interventions (169% increase, P&lt;.0001). Students agreed or strongly agreed that their participation improved: understanding of VTE prophylaxis (100%), confidence counseling patients (100%), quality of patient care (64%), and understanding of QI (93%). One hundred percent of students stated that they plan to use teach-back teaching in future patient encounters. DISCUSSION: Students felt that the experience was rewarding and contributed to their education, and students' assessment of patient understanding improved following counseling. This intervention demonstrates that medical students can effectively counsel patients and enhance a quality improvement intervention.

Interprofessional Education in the Obstetrics and Gynecology Clerkship: Do We Teach Collaboration?

Local Mentor: Glenna Bett, PhD APGO Advisors: Jody Steinauer, MD, MAS, and Sonya Erickson, MD PURPOSE: To ascertain how obstetrics and gynecology (Ob-Gyn) clerkships incorporate interprofessional education (IPE) into the curriculum and Ob-Gyn clerkship directors' opinions regarding IPE. BACKGROUND: The Association of American Medical Colleges (AAMC) identified IPE as a “horizon issue.” Literature review revealed 6 publications regarding IPE focused on the Ob-Gyn clerkship from the United States, Canada and United Kingdom. Most publications on IPE in Ob-Gyn investigated resident and attending perspectives. METHODS: The study used an online survey of Ob-Gyn clerkship directors at English-speaking LCME-accredited allopathic medical schools identified through the AAMC's website. Clerkship directors were identified through institutions' websites. The survey contained 16 questions about clerkship structure, if/how IPE activities are conducted, and clerkship director attitudes regarding IPE. RESULTS: One hundred fifty-four eligible medical schools were identified; 237 invitations were sent and 84 complete responses received. Seventy-two percent of clerkship directors believed that IPE should be included in the Ob-Gyn clerkship; 25% were unsure, and 4% did not. However, only 54% of Ob-Gyn clerkships incorporated IPE activities, 39% did not, and 7% planned to do so. The most common IPE activities were joint didactic sessions (58%) and interprofessional patient rounds (47%). The main barrier to implementing IPE was difficulty coordinating schedules (78%). DISCUSSION: The majority of respondents believed IPE should be included in the Ob-Gyn clerkship and had already done so. This is the first study to address practices and attitudes regarding IPE in the Ob-Gyn clerkship, a strength being its broad reach across LCME-accredited institutions. Potential weaknesses include response biases.

Is Direct Interaction With Preceptors Linked to Clerkship Satisfaction and Medical Knowledge Gain?

Local Mentor: Lee A. Learman, MD, PhD APGO Advisor: Alice R. Goepfert, MD PURPOSE: To evaluate the correlation between direct-interaction time of OBGYN students with preceptors and their clerkship satisfaction and medical knowledge acquisition. BACKGROUND: Historically, physician-teaching ratings by students have predicted NBME subject exam scores and level of interest in the preceptor's specialty. Finding that direct-interaction time is also important could justify increased faculty support for teaching. METHOD: MS3 students (n=176) enrolled in the OBGYN clerkship were eligible for this IRB-approved study. Students received the study overview and instructions during clerkship orientation. Participating students texted logged minutes daily to a designated phone number linked to a secured database. The NBME score, clerkship satisfaction survey and logged interaction time were merged into a de-identified database for analysis. Spearman correlation coefficients were calculated to estimate associations of participation in minutes logged, NBME scores and clerkship satisfaction. RESULTS: 26.7% (n=47) of eligible students reported their direct interaction time. The median direct interaction time was 633 minutes. Associations between numbers of minutes reported with NBME scores, clerkship satisfaction, and level of interest in OBGYN before and after rotation were small and not statistically significant. No difference in clerkship satisfaction was found between students reporting minutes versus no minutes. DISCUSSION: The low participation rate increases the likelihood of reporting bias in which motivated students were more likely to participate. Documentation of the precise number of minutes daily was also subject to student motivation. In this small study, no statistical association was found between the number of minutes reported with test scores or clerkship satisfaction.

Satisfaction With an Electronic Feedback Tool for the OBGYN Clerkship

Local Mentor: Bruce Meyer, MD, MBA APGO Advisor: Alice R. Goepfert, MD PURPOSE: To develop an electronic feedback tool and evaluate clerkship student and faculty satisfaction. BACKGROUND: Provision of formative feedback during clerkships is mandated by the Liaison Council on Medical Education as important in the development of clinical competence. A common concern in medical student education is the dichotomy wherein faculty believe that feedback has been provided but students do not recognize feedback was given. There is need for a simple tool that documents and collects feedback. No recent literature has cited use of an electronic feedback tool. METHODS: An electronic feedback tool, using elements of the AAMC Entrustable Professional Activities, was developed following a needs assessment survey administered to students and ObGyn faculty. This tool, housed on a secure institutional website, was available to both clerkship students and faculty using smartphone, tablet or computer. The project was IRB exempt. EVALUATION PLAN: The electronic tool was offered at family planning and ambulatory gynecology clinics to 31 clerkship students and the 11 attending faculty. Thirty student satisfaction surveys and 7 faculty satisfaction surveys were collected. Satisfaction with the electronic tool was assessed using an online survey. Sixty percent of students and 100% faculty were neutral or dissatisfied with the electronic tool. Commonly cited issues were electronic access problems and adequacy of training. DISSEMINATION: Information in this survey will be helpful in the further development of electronic tools in the clinical setting. REFLECTIVE CRITIQUE: Future development will need to incorporate strategies to enrich faculty training and improve access.

Assessing the Knowledge of Fourth-Year Medical Students in Milestones Level 1

Currently, there is no available standardized tool to assess the knowledge of incoming interns in OBGYN as described in Milestones Level 1. We examined the knowledge of fourth-year medical students on a multiple-choice examination based on the OBGYN Milestones Level 1 and compared their performance to students who completed the same questions during their OBGYN clerkship. Medical students’ knowledge on essential topics in OBGYN significantly declined from their OBGYN clerkship to end of their fourth year. This decline in knowledge retention over the continuum of education from UME to GME highlights the need for implementation of residency preparatory courses.