Deliberate practice improves obstetrics and gynecology residents' hysteroscopy skills.
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ABSTRACT:
SUBMITTER: Rackow BW
PROVIDER: S-EPMC3444186 | biostudies-other | 2012 Sep
REPOSITORIES: biostudies-other
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Project description:ObjectiveCompetency based medical education (CBME) requires novel approaches to surgical education. Significant investment has been made in laparoscopic simulation, which has been shown to foster skill development prior to patient encounters. However, research suggests variable voluntary use of these resources by residents, and little is known about the motivational factors that influence their utilization. The purpose of this study was to characterize factors that motivate residents to seek laparoscopic simulation experience outside of the formal curriculum.DesignWe developed a questionnaire grounded in Expectancy Value Theory, an established psychological theory of motivation, by adapting validated measures to fit the study context. We conducted a cross sectional survey of Canadian obstetrics and gynecology residents.SettingWe invited residents enrolled in English-language obstetrics and gynecology training programs in Canada to participate.ParticipantsAll residents engaged in clinical duties during Winter 2018 were invited to complete the questionnaire. Forty-four Obstetrics and Gynecology (Ob/Gyn) residents participated in the study.ResultsResidents reported limited use of simulation resources and identified multiple barriers including lack of time, access, and supervision. They expressed concern about development of bad habits during independent practice, and simulation use was positively correlated with perceived utility. Compared to junior residents, senior residents reported greater enjoyment of laparoscopic surgery, less emotional costs, and higher self-efficacy for learning laparoscopy.ConclusionsResidents' perception of utility and barriers impede voluntary simulation use and overall use was limited. As programs undertake curricula redevelopment for CBME, mitigating barriers and improving perceived utility of laparoscopic simulation is vital to increase use and enhance skill development.
| S-EPMC7117757 | biostudies-literature
Project description:IntroductionOperating room experience alone is insufficient for surgical training. In the current era of graduate medical education, work hour restrictions and the expectations of patients and the public limit residents' ability to participate in surgical cases. We aimed to create a laparoscopy curriculum for gynecology residents that teaches the fundamentals of laparoscopy utilizing self-learning modules complemented by skill-focused and faculty-guided laboratories to maximize learning time outside of the operating room.MethodsThe curriculum consists of five electronic modules on the basics of laparoscopy. Residents are expected to complete these on their own. In addition, quarterly simulation labs are taught by faculty and allow residents to practice, with guidance, key skills as derived from a previously published laparoscopic surgery skills curriculum. Residents are then evaluated using an objective structured assessment of technical skill comprised of the Global Rating Scale of Operative Performance and time metrics for each skill. We also evaluate resident confidence and satisfaction.ResultsIn our initial year, residents' confidence regarding laparoscopy ability and satisfaction in training did demonstrate improvement. With concentrated practice, residents' observed skills also showed advancement. Furthermore, the implementation of the curriculum was feasible with reasonable cost and limited resident and faculty time.DiscussionWhile simulation is well accepted as a modality for teaching surgery, its implementation is often limited due to concerns for time and money. Our experience illustrates that simulation is an effective teaching tool for residents without becoming a burden on a department.
| S-EPMC6464452 | biostudies-literature
Project description:BackgroundResident physicians provide much of the clinical teaching for medical students during their clerkship rotations, but often receive no formal preparation or structure for teaching and mentoring students.ObjectiveWe sought to evaluate a medical student mentoring program (MSMP) for students during their obstetrics and gynecology clerkship at a midwestern teaching hospital during the 2013-2014 academic year.MethodsA senior resident physician was assigned 1 to 2 medical students for a 6-week rotation. Students were provided MSMP information during clerkship orientation; residents were given information on MSMP requirements and were randomly assigned to students. We surveyed students and residents about their experience with the MSMP.ResultsOf 49 eligible medical students, 43 (88%) completed postsurveys. All students reported not having a mentoring program on other clerkships. Postclerkship, students indicated that they would participate in the MSMP again (32 of 38, 84%), and felt that having a mentor on other clerkships (30 of 36, 83%) would be beneficial. Students reported receiving educational (20 of 41, 49%) and procedural (33 of 41, 80%) instruction, personal development feedback (23 of 41, 56%), and career advice (14 of 41, 34%) from resident mentors. Out of a total of 45 possible surveys by residents, 17 (38%) were completed. Residents did not feel burdened by students (14 of 17, 82%), and all responded that they would participate in the MSMP again.ConclusionsFeedback from medical students suggests that a mentoring program during clerkships may provide potential benefits for their careers and in 1-on-1 instruction.
| S-EPMC4597953 | biostudies-literature
Project description:Background: The course "Psychosomatic Primary Care" has been part of the training curriculum of obstetrics and gynecology in Germany since 2003. The aim of the course is to train up physicians, whose prior training primarily focussed on somatic care, to enable them to offer care also taking into account biopsychosocial aspects. Taking the guidelines for psychotherapy as a template, the aim of psychosomatic primary care is to recognize the etiological links between psychological and somatic factors which contribute to diseases. The necessity for a compulsory course as part of training in gynecology was recently critically discussed. Major points discussed included the question whether the current forms of teaching, consisting of courses, are outdated and whether the required skills should be part of regular daily training. Method: A 3-part online questionnaire consisting of 30 items was developed and sent to 2431 residents in the period from September to December 2012 through the online mailing list of the DGGG. Results: The 540 residents who responded to the questionnaire were predominantly female (83.3?%) with an average age of 30 years; 50.3?% were in their 1st to their 4th year of training. Over the longer term, the majority of respondents (56.1?%) hoped to continue working in a hospital and regularly (84.6?%) attended teaching courses voluntarily. 70.9?% of them had already attended the course "Psychosomatic Primary Care". Of the group who had completed the course, 29.4?% were satisfied with the offer. The main criticism directed against the course was its scope which 24.1?% considered completely inadequate. 24.5?% considered the course to be an important part of training, while 16.5?% would have preferred that the course be abolished. 18?% of respondents reported that psychosomatic medicine did not feature regularly in their daily clinical routine. Perspective: Because of the huge gap between what is currently offered and the experiences reported by the respondents, the Young Forum of the DGGG and the DGPFG have expanded the program of courses offered by the DGPFG, which will offer practice-oriented courses to future gynecologists across Germany in cooperation with the DAGG. The first courses are held in Heidelberg and Erlangen in 2014.
| S-EPMC4069216 | biostudies-literature
Project description:Background: To evaluate fertility knowledge among current Obstetrics and Gynecology (OB-GYN) residents using a recently published validated instrument, the Fertility and Infertility Treatment Knowledge Score (FIT-KS).Methods: OB-GYN residents in the United States were recruited through an email to all residency coordinators nationwide. They were asked to voluntarily respond to a short questionnaire including demographic information and the FIT-KS instrument, through an online survey platform. Of approximately 5000 OB-GYN residents in the country, 177 responded.Results: The sample was 91% female, with 69% between the ages of 26 and 30. Participants evenly represented all 4 years of training. Mean FIT-KS score was 21.2 (73% correct; range 17-26). No statistically significant differences were noted across the level of training. Several knowledge gaps were noted. Residents could define the common assisted reproductive technologies; however overestimated their success rates per cycle.Conclusions: Substantial gaps exist in fertility knowledge among OB-GYN residents, with understanding of male fertility and success rates of Assisted Reproductive Technologies (ART) being particularly limited. Knowledge of fertility does not change throughout residency training, demonstrating consistent gaps in fertility knowledge. Knowledge during post graduate year (PGY)-1?year is consistent with mean scores found in prior research in Internal Medicine residents (65%), as well as a cohort of female medical students and obstetrics and gynecology residents and fellows (64.9%) (Fertil Steril 108:711-7, 2017; Fertil Steril 110:e239, 2018).
| S-EPMC7724860 | biostudies-literature
Project description:BackgroundResidency applications have increased in the last decade, creating growing challenges for applicants and programs.ObjectiveWe evaluated factors associated with application and match into obstetrics and gynecology residency.MethodsDuring the annual in-training examination administered to all obstetrics and gynecology residents in the United States, residents were surveyed on the residency application process.ResultsNinety-five percent (5094 of 5347) residents responded to the survey. Thirty-six percent reported applying to 30 or fewer programs, 26.7% applied to more than 31 programs, and 37.1% opted not to answer this question. Forty-nine percent of residents received honors in their obstetrics and gynecology clerkship and 37.1% did not. The majority of residents (88.6%) reported scoring between 200 and 250 on USMLE Step 1. Eighty-six percent matched into one of their top 5 programs. The only factor associated with matching in residents' top 5 programs was receiving honors in their clerkship (OR 1.29; 95% CI 1.08-1.54; P < .005). The only factor associated with matching below the top 5 programs was a couples match (OR 0.56; 95% CI 0.43-0.72; P < .001). In choosing where to apply, residents identified program location and reputation as the most important factors, while for ranking, location and residency culture were the most important.ConclusionsMost obstetrics and gynecology residents reported matching into their top 5 choices. Receiving an honors grade in the clerkship was the only factor associated with matching in applicants' top 5 programs. Location was the most important factor for applying to and ranking of programs.
| S-EPMC8054595 | biostudies-literature
Project description:IntroductionFor pediatric interns, it takes deliberate practice to translate the knowledge of what to do in emergencies into the procedural and communication skills required of a team member or team leader. This curriculum taught interns through simulations with rapid cycle deliberate practice (RCDP). This method focused on teaching time-sensitive team-based activities in simulation. The RCDP structure alternated practice with immediate expert feedback. This alternating pattern gave the learner chances to practice the correct way to perform these skills.MethodsThe curriculum was developed iteratively based on common gaps in intern skills and knowledge; it was well suited for groups of four to six interns and to be given by one or two instructors over a 6-hour period of time. After an initial warm-up case, a series of simulations used RCDP to move interns through cases focusing on management of respiratory distress, upper airway obstruction, shock, intubation, complications of intubation, and pulseless arrest. Feedback was interspersed throughout the experience with detailed explanations provided as the interns required them to complete the simulations.ResultsThis technique was well received by a group of 81 interns who provided positive feedback on the sessions. In particular, when asked if the course "improved my teamwork and leadership skills" they agreed with a mean score of 4.9 out of 5.DiscussionThis curriculum taught and integrated the procedural skills, communication skills, and teamwork needed to participate in pediatric resuscitations. The methods described in this curriculum improved confidence of pediatric interns and merits further study.
| S-EPMC7678026 | biostudies-literature
Project description:BackgroundPostpartum haemorrhage (PPH) is a major cause of maternal morbidity and one of the leading causes of maternal mortality worldwide. Many medical treatments and interventions are available nowadays, but surgical treatment is sometimes required when less invasive methods are unsuccessful. This study aimed to assess the theoretical and practical knowledge of French residents of Obstetrics and Gynecology concerning the surgical treatment of postpartum haemorrhage.Study designWe performed a questionnaire study for senior residents of Obstetrics and Gynecology in France (fourth and fifth year of training). An anonymous survey was sent by email. Between December 2013 and April 2014, a total of 370 residents responded.ResultThe response rate was 47.6% (176/370). Only 156 questionnaires were fully completed and included for analysis. In all, 74% (115/156) of residents reported not mastering sufficiently or at all the technique for bilateral ligation of uterine arteries, 79% (123/156) for uterine compression sutures, 95% (148/156) for ligation of the internal iliac arteries, and 78% (122/156) for emergency peripartum hysterectomy. More than half of respondents (55%, 86/156) stated that they had not mastered any of these techniques.ConclusionAn alarmingly high number of French senior residents in Obstetrics and Gynecology report that they have not acquired the sufficient surgical skills during their training to be able to perform the surgeries required for the management of PPH.
| S-EPMC6415489 | biostudies-literature
Project description:BACKGROUND: Internal medicine residents must be competent in advanced cardiac life support (ACLS) for board certification. OBJECTIVE: To use a medical simulator to assess postgraduate year 2 (PGY-2) residents' baseline proficiency in ACLS scenarios and evaluate the impact of an educational intervention grounded in deliberate practice on skill development to mastery standards. DESIGN: Pretest-posttest design without control group. After baseline evaluation, residents received 4, 2-hour ACLS education sessions using a medical simulator. Residents were then retested. Residents who did not achieve a research-derived minimum passing score (MPS) on each ACLS problem had more deliberate practice and were retested until the MPS was reached. PARTICIPANTS: Forty-one PGY-2 internal medicine residents in a university-affiliated program. MEASUREMENTS: Observational checklists based on American Heart Association (AHA) guidelines with interrater and internal consistency reliability estimates; deliberate practice time needed for residents to achieve minimum competency standards; demographics; United States Medical Licensing Examination Step 1 and Step 2 scores; and resident ratings of program quality and utility. RESULTS: Performance improved significantly after simulator training. All residents met or exceeded the mastery competency standard. The amount of practice time needed to reach the MPS was a powerful (negative) predictor of posttest performance. The education program was rated highly. CONCLUSIONS: A curriculum featuring deliberate practice dramatically increased the skills of residents in ACLS scenarios. Residents needed different amounts of training time to achieve minimum competency standards. Residents enjoy training, evaluation, and feedback in a simulated clinical environment. This mastery learning program and other competency-based efforts illustrate outcome-based medical education that is now prominent in accreditation reform of residency education.
| S-EPMC1828088 | biostudies-other
Project description:IntroductionThe number of abdominal hysterectomies (AHs) performed by OB/GYN residents has decreased dramatically. Thus, there is a need for simulation training to complement operating room experience.MethodsA low-fidelity AH simulator was constructed from craft-store supplies costing less than $40. OB/GYN residents in a single academic program completed the simulation between July and September of 2015. The 1-hour simulation experience included a pretest, a 5-minute presentation, the simulation, and a posttest. On the pre- and posttests, participants rated their confidence with the steps of AH as not at all, somewhat, or very confident.ResultsEighty-six percent (32 of 37) of possible residents completed the session, with even representation from all levels of training (nine PGY 1, seven PGY 2, eight PGY 3, and eight 8 PGY 4 residents). Knowledge of the steps of the procedure and instrumentation improved for all levels of trainees (p < .001). One hundred percent (16 out of 16) of the PGY 1 and PGY 2 residents rated their confidence as increased afterwards, while only 25% (four out of 16) of the PGY 3 and PGY 4 residents did so. Ninety-four percent (30 out of 32) rated the session as very helpful on a scale of not at all, somewhat, or very helpful.DiscussionA low-fidelity, low-cost simulator showed an increase in trainee confidence with AH, particularly in the first- and second-year trainees. Nearly all participants found the exercise helpful, suggesting that it may be beneficial to incorporate into OB/GYN training programs nationwide.
| S-EPMC6338252 | biostudies-literature