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Abstracts From the Proceedings of the 2012 AnnualMeeting of the Council on Resident Education inObstetrics and Gynecology (CREOG) and Association ofProfessors of Gynecology and Obstetrics (APGO)John L. Dalrymple a , Sonya Erickson b , Nancy Hueppchen c , Nadine T. Katz d & Mark B.Woodland ea Department of Obstetrics, Gynecology & Reproductive Sciences, University of TexasMedical School, Houston, Texas, USAb Department of Obstetrics and Gynecology, University of Colorado School of Medicine,Aurora, Colorado, USAc Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine,Baltimore, Maryland, USAd Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College ofMedicine, Bronx, New York, USAe Department of Obstetrics and Gynecology, Drexel University College of Medicine,Philadelphia, Pennsylvania, USAPublished online: 26 Mar 2013.

To cite this article: John L. Dalrymple , Sonya Erickson , Nancy Hueppchen , Nadine T. Katz & Mark B. Woodland (2013)Abstracts From the Proceedings of the 2012 Annual Meeting of the Council on Resident Education in Obstetrics and Gynecology(CREOG) and Association of Professors of Gynecology and Obstetrics (APGO), Teaching and Learning in Medicine: AnInternational Journal, 25:2, 171-177, DOI: 10.1080/10401334.2013.772006

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Teaching and Learning in Medicine, 25(2), 171–177Copyright C© 2013, Taylor & Francis Group, LLCISSN: 1040-1334 print / 1532-8015 onlineDOI: 10.1080/10401334.2013.772006

ALLIANCE FOR CLINICAL EDUCATION (ACE) ABSTRACTSAbstracts From the Proceedings of the 2012 Annual Meetingof the Council on Resident Education in Obstetrics andGynecology (CREOG) and Association of Professors ofGynecology and Obstetrics (APGO)

John L. DalrympleDepartment of Obstetrics, Gynecology & Reproductive Sciences, University of Texas Medical School,Houston, Texas, USA

Sonya EricksonDepartment of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora,Colorado, USA

Nancy HueppchenDepartment of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore,Maryland, USA

Nadine T. KatzDepartment of Obstetrics and Gynecology and Women’s Health, Albert Einstein College of Medicine,Bronx, New York, USA

Mark B. WoodlandDepartment of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia,Pennsylvania, USA

The mission of the Association of Professors of Gynecology andObstetrics (APGO) is to promote excellence in women’s healthcare by providing optimal resources and support to educatorswho inspire, instruct, develop, and empower women’s healthcare providers of tomorrow. Each year, APGO holds a jointmeeting with the Council on Resident Education in Obstetricsand Gynecology, which focuses on improving medical educa-tion for students and residents studying women’s health. The2012 meeting entitled “Embracing Transitions in Healthcare:Educating for Tomorrow, Today” was held March 7 to 10, 2012,in Orlando, Florida, and exhibited a wide variety of abstractsand breakout sessions, including the first annual Film Festivalfeaturing videos for learners related to teaching procedural, clin-ical, and educational skills. The main plenary sessions includedDavid Irby, PhD, from UCSF School of Medicine, whose ad-dress “Rethinking How We Educate Physicians Across the Con-tinuum” focused on the sweeping changes occurring as a result

Correspondence may be sent to John L. Dalrymple, 6431Fannin Street, Suite 3.112, Houston, TX 77030, USA. E-mail:john.dalrymple@uth.tmc.edu

of the 2010 Carnegie report, and Valerie Arkoosh, MD, PhD,President of the National Physicians Alliance, whose lecture“Educating for Tomorrow: The Future of Health Care and Ed-ucation Under the Patient Protection and Affordable Care Act(PPACA)” addressed the impact the changes brought about bythe PPACA will have on medical education.The following oral abstracts, as selected by representatives fromboth organizations, address several topics including the impactnew innovations and curricula have on learners’ experiences, is-sues related to residency training including the balance betweenservice and education and the impact of duty hour restrictions.

Team Leaders Experience Greater Stress thanNon-leaders during Obstetric Emergencies

Pamela Andreatta [pandreat@umich.edu],David A. Marzano, Diana Curran

University of Michigan, Ann Arbor, Michigan, USA

Background: Stress can lead to decreases in overall per-formance across psychomotor and cognitive domains, with

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172 J. L. DALRYMPLE ET AL.

negative emotions decreasing the ability to think clearly, crit-ically, and comprehensively. When experienced by physiciansduring emergency situations, stress may potentially limit theireffectiveness as clinicians and team leaders. The purpose ofthis study was to assess stress levels of clinical team members(leaders and nonleaders) during the management of obstetricemergencies.Methods: A purposive sample of 68 physicians, residents, andnurses from obstetrics, emergency medicine, anesthesia, andneonatology participated in simulation-based drills to manageobstetric emergencies as interdisciplinary teams. Fifty-eightcases were included in the drills and ranked as low, moder-ate, or high according to clinical or logistical difficulty. Teamsmet weekly for 2 hr over the 6-month study period, with eachteam member completing at least six cases. Baseline, peak, andmean heart rates (HR) were captured during the drills for eachmember using wrist-worn HR monitors. Peak stress levels werecalculated as the difference between baseline and peak HR andsynchronously matched to drill activities. Sustained stress lev-els were calculated as the difference between baseline and meanHR. The influence of case complexity and team leader status onstress levels was assessed by comparing peak- and sustained-stress levels using a multivariate analysis of variance. Directmeasurement of clinical performance related to stress level wasnot measured because it was not known whether or when stressresponses were in effect.Results: Mean HRs across all cases were 81.01(SD = 28.39)beats per minute for team leaders and 59.26 (SD = 18.77) beatsper minute for nonleaders. There were significantly higher HRsindicating peak-stress levels, t(58) = −21.071, p = .000, andsustained stress levels, t(58) = −18.842, p = .000, for all partici-pants across all cases. Increasing case complexity correspondedto increased peak-stress levels, F(2, 56) = 3.824, p = .028,and sustained stress levels, F(2, 56) = 6.746, p = .002, for allmembers. Team leaders experienced significantly higher peak-stress levels, F(1, 57) = 11.326, p = .001, and sustained stresslevels, F(1, 57) = 13.556, p = .001, than nonleaders. Case dif-ficulty did not contribute to peak-stress levels for non leaders,but more challenging cases increased sustained stress, F(2, 42)= 5.882, p = .006. For team leaders, increased case difficultyfurther increased peak-stress, F(2, 14) = 6.464, p = .012, andsustained-stress, F(2, 14) = 6.198, p = .014.Conclusions: Stress reactions are in effect and are measur-able among clinicians during obstetric emergency simulationdrills. Although all members experience stress, team leadershave significantly greater stress and sustained stress. Thesefindings suggest the value of simulation-based training for de-veloping stress inoculation behaviors to gain optimal perfor-

mance for all members, but especially for team leaders duringcrises.

Self-Reported Sleep Dysfunction by Ob/GynResidents Limited to a 16 Hours/Shift Compared

to Residents Working 24–30 Hours/Shift

Robert V. Higgins[robert.higgins@carolinashealthcare.org], Susan Kullstam

Carolinas Medical Center, Charlotte, North Carolina, USA

Background: The ACGME limits PGY-1 residents to a maxi-mum 16 hr of work/shift to decrease resident fatigue. The pur-pose of this study was to compare fatigue related to sleep de-privation of PGY-1 residents limited to 16 hours/shift to upperlevel residents who worked 24–30 hours/shift.Methods: All residents (n = 24) between July 1, 2010, and June30, 2011, completed a validated sleep survey, the PittsburghSleep Quality Index (PSQI) at the completion of month-longrotations. Six PGY-1 residents (Group 1) were assigned dutyhours limited to a maximum of 16 hours/shift. Duty hours forthe 18 upper-level residents (Group 2) conformed to the 2010ACGME duty hour rules. The PSQI 10-item questionnaire in-cluded questions related to duration of sleep, sleep disturbance,sleep latency, days dysfunctional due to sleepiness, sleep effi-ciency, overall sleep quality, and need for medication to assistwith sleep. Chi-square and Kruskal-Wallis statistical tests wereused to compare the responses between Groups 1 and 2.Results: Each resident completed an average of six (range= 5–7) surveys. The duty hours/week was 59.8 and61.9 hr for Groups 1 and 2, respectively. Group 1 averaged1.6 days off/week and completed 30 night shifts compared to1.4 days/week and 60 night shifts for Group 2. There were nostatistical differences in response rates between the two groupsfor the following items: duration of sleep, number of days dys-functional due to sleepiness, sleep efficiency, and need for med-ication to sleep. The overall quality of sleep was significantlyworse for Group 1 compared to Group 2 ( p = .029). Althoughnot statistically significant, there was a trend of Group 1 report-ing less sleep disturbance ( p = .063) but more sleep latency( p = .076) than Group 2.Conclusions: At our institution, PGY-1 residents reportedpoorer overall quality of sleep but did not report more sleep dys-function than upper-level residents who worked longer shifts.The poorer quality of sleep among interns may be stress-relatedfrom adaption to resident lifestyle. Future areas of researchcould include surveys among larger groups of residents andresidents of various specialties.

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ACE ABSTRACTS FROM 2012 APGO PROCEEDINGS 173

Robotics Surgery: Changing Resident OperativeEducation and Experience

Kimberly H. Hopkins [Kimhhopkins@gmail.com],Jaclyn B. Van Nes, Nikki B. Zite, Alison P. McNabb,

Patrick B. Barlow, Tiffany SmithUniversity of Tennessee Graduate School of Medicine,

Knoxville, Tennessee, USA

Background: As more gynecologists incorporate robotics intotheir practice, residency programs have also been incorporat-ing robotics into their educational training. The purpose of thestudy is to determine the impact of robotic surgery on residentoperative experiences in various approaches to a common gy-necological surgery, hysterectomy.Methods: A 21-item online survey designed to determine theprevalence and impact of robotic surgery on resident opera-tive hysterectomy experiences was sent to PGY-3 and PGY-4OB/GYN residents throughout the country. Descriptive statisticswere used to examine the distribution of survey responses as wellas test for meeting statistical assumptions. Items related to resi-dent confidence with the various hysterectomy procedures wereanalyzed using Pearson r correlations, and the differences inaverage confidence were analyzed using independent t-test andnon-parametric Mann–Whitney U procedures, as appropriate.Results: Sixty-one PGY-3 and PGY-4 residents respondedrepresenting programs of all sizes (< 6 to > 28 total) andfrom all geographic regions. Overall, participants in thissurvey tended to be more traditionally trained (n = 58,68.9%) than robotically, but 11 (n = 14, 18.1%) describedtheir program as more robotic than traditional or mostlyrobotic. Although 32 (52.5%) felt that robotic surgery trainingenhanced the resident experience, 22 (36.7%) felt it distractedfrom traditional training. Only 8 (13.1%) residents reportedrobotic training affected their decision about where to train.Those who had more traditional training were less likely tobelieve that their time on the robotic console was sufficient fordeveloping proficiency ( p = .005). Residents who were morerobotically trained felt they were less likely to be confidentabout abdominal hysterectomies at the end of their residency( p = .030). Residents who were more confident in their abilityto perform vaginal hysterectomies were less confident in theirability to perform robotic hysterectomies ( p < .001).Conclusions: Robotic surgery has become an integral partof many residency training programs, mirroring its placein the gynecology field. Although most residents believethey have gained valuable experiences with the addition ofrobotics, many have less experience with traditional skillsthat are the foundation of gynecology. As training programsincorporate robotics, it is essential that graduating residents arestill adequately trained in traditional abdominal, vaginal andlaparoscopic hysterectomies.

Obstetrics and Gynecology Resident Competencein Technical Skills: Is Four Years Enough Time?

Charlie C. Kilpatrick [ccki@hotmail.com],John L. Dalrymple, Petra M. Casey, Lubna Chohan,

Patrice Weiss, Christopher Zahn, Francisco J. OrejuelaUniversity of Texas Medical School, Houston, Texas, USA

Background: Increasing technologic skills, combined with dutyhour restrictions (DHR) have made attainment and documenta-tion of OB/GYN resident competence challenging. The purposeof this study was to determine the attitudes of OB/GYN edu-cators concerning resident competence in skills necessary forindependent practice, and whether an extra year of training isrequired to demonstrate competence.Methods: A 21-item survey was developed through a multistageprocess involving nationwide OB/GYN educators from multi-ple disciplines. Association of Professors of Gynecology andObstetrics members were surveyed by e-mail. Nonresponderswere sent the e-mail an additional two times at 2-week intervals.Demographic information was collected and questions focusedon resident’s acquisition of technical skills. Factors believedto influence competency in technical skills were assessed in-cluding questions as to whether an additional year of trainingwould be beneficial. Univariate analysis was performed usingthe chi squared test for categorical variables and Student’s T testfor continuous variables. Multiple logistic regression examinedpotential predictors of different recommendations.Results: Of the 1,212 surveys, 568 responded (46.9%). De-mographic information included age (< 40 years: 25%,41–50: 28.7%, > 51: 46.3%), graduation year related to DHR(2007–present: 7.5%, 2004–2006: 12.0%, 2003 and prior:80.4%), program director status (23.9%), practice setting (com-munity based: 32.7%, university based: 65.5%), and specialty(generalists: 62.8%). Nearly all (98.7%) felt residents shoulddemonstrate competence in technical skills prior to promo-tion/graduation, and 50.4% felt they had adequate time for this;81.0% have supervised residents with difficulty demonstratingcompetence; 77.0% believed DHR made it more difficult todemonstrate competence. Approximately 38% felt an extra yearof training was necessary to attain/document competence. Uni-variate analysis of factors predicting agreement with an extrayear revealed age > 40 years ( p = .024), and community-basedpractice setting ( p = .041) to be significant, whereas graduation< 2003 approached significance ( p = .064). Generalist practiceand program director status were not significant.Conclusions: The majority of OB/GYN educators believe thatcompetence in technical skills should be required for promotion/graduation. Practitioners at community-based/university af-filiated programs, and those older than 40 were in favor oflengthening training. Given the multiple factors affectingOB/GYN resident education, additional training should be

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174 J. L. DALRYMPLE ET AL.

considered. Future discussions should include current residentsin order to ensure technical competence given the currentrestraints the system is under.

Disclosure of Adverse Events and MedicalErrors: Performance of OB/GYN Residents

During Video Recorded Sessions WithStandardized Patients

Lia Labrant [lia.labrant@gmail.com], Leslie Carranza,Douglas Brock Suzanne Peterson, Sara Kim,

Thomas BenedettiUniversity of Washington Medical Center, Seattle,

Washington, USA

Background: Disclosure of medical errors to patients byphysicians is expected. Although trainees have been personallyinvolved with errors, discussing these events with patientsremains challenging. For the OB/GYN resident, little is knownabout their skills and practice patterns with error disclosure.The purpose of this study was to determine what subjectivecomponents successfully improved or negatively impactedscores during simulated patient (SP) disclosures.Methods: Residents at an academic medical center were videorecorded disclosing adverse events or errors to an SP duringa case control study comparison, which received prior Institu-tional Review Board l by the University of Washington HumanSubjects Division. The cases included (a) brachial plexus injuryafter shoulder dystocia, (b) missed Rhogam dose leading to Rhalloimmunization, and (c) magnesium toxicity in a preeclampticpatient with unrecognized worsening renal function. All studyparticipants received a 1-hr lecture on error disclosure by a con-tent expert. Five independent raters subsequently evaluated sub-jective components of the interaction using a behavioral codingsheet and a global rating scale. Various components evaluatedincluded timing of disclosure and apology, empathy, body lan-guage, use of nonverbal communication cues, and number ofactivities requested and performed.Results: A total of 27 error disclosures were video recordedduring a 12-month period: 7 residents each for Cases 1 and 2,and 13 for Case 3. Residents completed 84%, 85%, and 78% ofthe eight requested activities for Cases 1, 2, and 3, respectively.Interrater reliability analysis showed an average kappa of 0.76(range = 0.54–1.0). The most commonly missed activities wereprobing the SP for understanding of what happened and solicit-ing questions (15/27), discussing preventive efforts (15/27), andproviding additional future information (n = 8/23). All residentsapologized for the mistake and were perceived as open, honest,and forthcoming. Cases 2 and 3 averaged 10 min long, and theword mistake or error occurred on average at 2:40. Ownership ofthe mistake closely followed, usually within 1 min, and apologyoccurred on average before the halfway point after the admit-tance of fault (5:16). Top-rated behaviors included validation ofpatient’s emotions, honest empathy, showing humanity without

compromising clinical competence, avoiding making excuses,taking ownership, and discussing plans for prevention instead ofshowing frustration toward the system. Behaviors perceived asdetrimental included overemphasizing medical facts and jargon,emotional distancing from personal error, condescending atti-tude, blame, and not investigating understanding of the events.Conclusions: Despite the expectation of appropriate and timelydisclosure of medical error, studies indicate physicians and res-idents are uncomfortable and even reluctant to do so. In thisstudy, residents completed most requested activities when pre-disclosure training was provided, and mentioned the word erroror mistake early on, yet consistently struggled with probing forunderstanding of the event(s) and discussing preventive efforts.Future efforts should focus on understanding the unique barriersto error disclosure and in the development and assessment oferror disclosure curriculum.

Attitudinal Changes Toward SupportingBreastfeeding Following a 12-Week

Interdisciplinary Lactation Curriculumfor Third-Year Medical Students

Michele Manting [Michele.manting@ttuhsc.edu]Texas Tech University, El Paso, Texas, USA

Background: A longitudinal breast health microcurriculumidentified an “in-time” opportunity to develop clinical skillsof breastfeeding promotion during third-year clerkships. Theimpact of this interdisciplinary lactation curriculum for third-year medical students on attitudes toward breastfeeding wasassessed.Methods: During the 2010–2011 academic year, the OB/GYNand pediatrics clerkships collaborated on a 12-week inter-disciplinary cross-clerkship microcurriculum for third-yearstudents. Institutional Review Board approval was obtainedas an expedited study. This combined lactation curriculumwas modified from the open educational online resource(http://www.wellstart.org) and consisted of (a) a pretest estab-lishing baseline knowledge and attitudes, (b) three online mod-ules reviewing basic science and introducing problems withlactation, (c) video clips demonstrating key concepts, (d) a se-ries of clinical encounter requirements spanning both rotations,and (e) an identical posttest. The 50-question pre/posttest as-sessed both knowledge and attitudes, from which 24 questionsfocusing on breastfeeding attitudes and experiences were ana-lyzed. A two-tailed student t test was performed on deidentifieddata with statistical significance defined at p = .05. The entirepre/posttest was modified from the American Academy of Pedi-atrics Breastfeeding Residency Curriculum and designed to bedevelopmentally appropriate for third-year students.Results: Of 120 students, 114 initially agreed to participate(95.0%) with 110 consenting to complete the posttest (91.7%completion rate). Statistical significance for a positive shift in at-titudes was demonstrated for 18 of 24 items. Significant findings

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ACE ABSTRACTS FROM 2012 APGO PROCEEDINGS 175

included higher levels of confidence in offering breastfeedingadvice, increased ability to answer parental questions on lac-tation, and ability to manage common breastfeeding problems.Review of student documentation in an electronic proceduredatabase identified a tenfold increase in the reported amountof ambulatory lactation counseling and prenatal visit breast ex-ams compared to previous years. No change was seen in theperceived health benefits of breastfeeding, recognition of theinnate capacity of most women to breastfeed, and recognitionof breastfeeding as optimal nutrition for newborns.Conclusions: Significant changes in student attitudes towardtheir ability to assist in delivering supportive lactation care weredemonstrated. These attitudinal changes toward breastfeedingcould ultimately impact practice in many specialties. Furtherresearch may be directed at determining if this curriculum issuperior to conventional approaches.

Emotional Intelligence Characteristicsin a Cohort of Faculty, Residents,

and Medical Students

Dotun Ogunyemi, Sukrant Mehta[sukrant.mehta@cshs.org], Christina Penfield,

David S. Kim, Carolyn AlexanderCedars-Sinai Medical Center, Los Angeles, California, USA

Background: Emotional intelligence (EQ) has been defined asthe ability to recognize and understand emotions, and the abil-ity to use this awareness to manage oneself and relationshipswith others. EQ has been linked to performance with studiesdemonstrating associations with team building, leadership suc-cess, employee morale, job satisfaction, conflict resolution andclient satisfaction. In this study, we sought to assess EQ andthe construct validity of the EQ Appraisal survey amongst a co-hort of academic OB/GYN faculty and residents, and medicalstudents during their OB/GYN clerkship.Methods: From 2010 to 2011, all 155 eligible medical educa-tion personnel participated in 4 self-administered surveys. Thesurvey was administered at one time in either online or paperformat. The EQ Appraisal survey measures self-awareness, self-management, social awareness, and relationship management.The DISC survey defines 4 personality domains: Dominance,Influence, Steadiness/Submissiveness, and Conscientious/Compliance. The Thomas-Kilmann Conflict Instrument defines5 conflict styles: competing, collaborating, compromising, ac-commodating, and avoiding. The Interpersonal Influence Inven-tory categorizes 4 behavior styles: openly aggressive, assertive,concealed aggressive, and passive behaviors. Chi-square testwas used for comparison of discrete variables, a student’s t testfor continuous variables, and a Spearman rank analysis for cor-relation analysis. An analysis of variance was used for multiplecomparisons, and a Bonferroni post hoc test was performed formultiple comparisons. The study was approved by the Institu-tional Review Board.

Results: Faculty and residents had a higher social awarenessEQ score compared to medical students, 79.33 (SD = 8) ver-sus 75.59 (SD = 10.3), p = .012. Mean EQ scores correlatedpositively with influence (ρ = 0.298, p = .021) and steadiness/submissiveness (ρ = .286, p = .027) but correlated negativelywith the dominance (ρ = −0.429, p = .001) personality do-main. In addition, the EQ appraisal survey demonstrated sig-nificant positive correlations with collaborating conflict styleand assertive behavior, but significant negative correlations withconcealed aggression and passive behaviors.Conclusion: In this cohort of physicians and medical students,emotional intelligence varied with the level of training. The datasuggest that emotional intelligence competence may be achievedthrough collaboration and assertive behaviors utilizing influenceand steadiness/submissiveness behavior traits.

Service versus Education in Obstetrics andGynecology Residency Training

Silka Patel [spatel87@jhmi.edu], Heather L. Straub,Karen Schneider, Lisa Hollier, Pamela Promecene

University of Texas Medical School, Houston, Texas, USA

Background: The Accreditation Council for Graduate MedicalEducation Resident Survey asks, “In your opinion, how oftendo your rotations and other major assignments provide an ap-propriate balance between your residency education and otherclinical demands?” Such language places service and educa-tion as mutually exclusive events that compete for residents’time. This study surveys OB/GYN residents to determine theiropinion to what extent certain tasks are service or educationalactivities.Methods: An electronic survey was administered to OB/GYNresidents in an academic department. Eighteen common activ-ities were rated on a 5-point scale, 1 representing a service ac-tivity and 5 an educational activity. Descriptive and chi-squaredanalysis was applied. This study was exempt by the Universityof Texas, Houston Institutional Review Board.Results: Forty-seven residents were surveyed with a 96.3% re-sponse rate. Of the 18 activities, 3 were considered mostly ed-ucational (work rounds, preparing and attending didactics), 9mostly service (e.g., collecting paperwork for OR cases, fol-lowing patient labs, dictating operative/discharge summaries),and 6 equally service/educational (e.g., rounds with attending,board check out, performing vaginal deliveries, cesarean sec-tions, tubal ligations, and D&C). No activity was considered100% service, and upper-level residents tended to find someactivities more educational then lower level residents. A statis-tically significant difference for dictating discharge summarieswas noted where 83.3% PGY1 and 100% PGY2 rated as “mostlyservice” versus 54.5% PGY3 and 63.6% PGY4 ( p = .05). Al-though not statistically significant, similar trends were seen withprocedure-related activities including vaginal deliveries, where

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41.7% PGY1 rated as “mostly service” and 58.3% “equallyservice/education” versus 90.9% PGY4 rated as “equally ser-vice/educational” and 9.1% “mostly educational.”Conclusions: This study demonstrates that residents perceivetheir daily activities as a combination of service and education.The extent to which an activity is more service or more educa-tional changes with level of training. A better understanding ofwhat contributes to these changes will lead to a better determi-nation of which activities are critical to resident education.

Renewal of an OB/GYN Clerkship: The Effectsof Medical Student Mentoring on Student

Performance and Satisfaction

Lindsey B. Sward [lbsward@uams.edu], Dora M. Smith,Katrina R. Davis, R. B. Govindan, T. Mac Bird

University of Arkansas for Medical Sciences, Little Rock,Arkansas, USA

Background: Mentoring programs for medical professionalgroups, especially nurses, have been in place since the 1990s butappear to be lacking for medical students.1,2 With few formalmentoring programs available for medical students, effective-ness is unknown. The purpose of this study was to evaluate theeffects of the medical student mentoring program adopted by theOB/GYN clerkship on student academic performance as wellas on student perception of the clerkship.Methods: A formal mentoring program for medical studentsrotating through the OB/GYN clerkship was introduced dur-ing the 2009–10 academic year as part of a university-wideeffort to improve student scores on the National Board of Med-ical Examiners (NBME) subject exam and to improve studentsatisfaction during the clerkship. Each student was assigned afaculty mentor and met weekly during the 6-week clerkship. Noformal curriculum was implemented. Guidelines for discussionof basic topics in OB/GYN were provided allowing for flexi-bility of focus on individual student need. Approval from theInstitutional Review Board was obtained. NMBE scores from2009 and 2010 were compared with scores from the previoustwo academic years. Medical College Admission Test (MCAT)scores were also compared as a measure of innate test-takingability. End-of-clerkship surveys related to clarity, organization,content, participation, fairness, student participation, and over-all satisfaction from the same years were also reviewed. Scoreswere compared using student’s t-test and survey results werecompared using a paired t test.Results: Prior to initiation of the mentoring program, meanNBME scores were 69.68 (2007) and 70.86 (2008) and increasedto 71.69 (2009) and 74.64 (2010) after implementation. Signif-icantly higher scores were observed when comparing the years2007 versus 2009, 2007 versus 2010, and 2008 versus 2010 inpost hoc analysis. Mean MCAT scores from these groups were

27.3, 27.8, 29.3, and 27.3 (2007–2010, respectively), with theslight increase in the 2009 scores revealing a statistically signifi-cant difference. Survey mean responses from the postmentoringgroup were statistically significantly higher compared to theprementoring group ( p < .001).Conclusions: At our institution, the addition of a mentoring pro-gram to the OB/GYN clerkship is associated with improved stu-dent academic performance, as shown by higher NBME scoresand improvement in student perception and satisfaction. Con-tinued analysis is planned to determine if these changes are longterm.

REFERENCES1. Buddeberg-Fischer B, Herta KD. Formal mentoring programmes for medi-

cal students and doctors—A review of Medline literature. Medical Teacher2006;28(3):248–57.

2. Buddeberg-Fischer B, Stamm M, Buddeberg C. Academic career inmedicine: Requirements and conditions for successful advancements inSwitzerland. BMC Health Services Research 2009;9:70.

Toward Medical Student Competence in PatientSafety: The Use of Log Books Increases

Situational Awareness

Donna Woods [woods@northwestern.edu], Mallori L.Kelley, Jie Ping, Nicole Muller, Caroline A. Mazurek,

Lindsay DiMarco, Pat M. GarciaNorthwestern University Feinberg School of Medicine,

Chicago, Illinois, USA

Background: The Institute of Medicine’s report “To Err Is Hu-man” established the magnitude of the patient safety problemfor the U.S healthcare system. There is a great need to develop acurriculum that will expose medical students to the fundamentalknowledge and skills necessary to practice in the safest manner.The purpose of this study was to assess the effectiveness of Pa-tient Safety Logs (PSL) as a method to integrate patient safetylearning into an OB/GYN clerkship.Methods: PSL listing patient safety practices relevant toOB/GYN were developed and deployed in four of eight 3rd-year OB/GYN rotations. Institutional Review Board approvalwas received for this project. Students noted on the log: observedpractices performed, practices that should be performed butwere not, and student-performed practices on a weekly basis.Students were assigned to three learning conditions: log (Group1), no log (Group 2), or cumulative log if they logged in previousclerkships (pediatrics, primary care; Group 3). Student assess-ment occurred through identification of safety practices/risks asdepicted in a video on vaginal delivery with safety issues em-bedded. The assessment was conducted pre- and postrotation.Paired t test was used to compare pre–post assessments. Oddsratios were calculated to compare learning conditions and toassess the likelihood of practice/risk identification.

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ACE ABSTRACTS FROM 2012 APGO PROCEEDINGS 177

Results: Eighty-two students participated in one of four rota-tions. A statistically significant increase in awareness of patientsafety practices/risks was observed for students who completedPSL compared with those who did not (17% increase, p = .01).Students who previously logged displayed a higher level ofperformance than those who logged once or not at all. For ex-ample, students who used the PSL and also logged in a previousclerkship were 13.5 times more likely than their nonloggingcounterparts to identify the patient safety behavior of “readback”

being performed correctly or incorrectly ( p ≤ .05). Similarly,students who used only the OB/GYN log were 7.9 times morelikely than their nonlogging counterparts to identify when thisbehavior was performed correctly or incorrectly ( p ≤ .01).Conclusions: Use of PSL on the OB/GYN clerkship is an ef-fective method for increasing situational awareness and teach-ing students to identify safety practices/risks in clinical care.Repeated logging also appears to further increase sensitivity tothese practices/risks.

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