Effect of a shorter clerkship on third-year obstetrics and gynecology final examination scores

OBJECTIVE: To determine if either a shorter third-year obstetrics and gynecology (Ob/Gyn) student clerkship or the semester of rotation results in differences in a student's objective or subjective performance. STUDY DESIGN: Five hundred twenty-one students from 1995-1998 (8-week clerkship) and 112 students from 1998-1999 (6 weeks) in their third year of medical school were included. Final examination scores, subjective assessments for the Ob/Gyn clerkship, final grades and United States Medical Licensure Examination (USMLE) Step 1 scores were obtained (first attempts only). Student t tests, chi2 and univariate analysis (using USMLE Step 1 scores as a control) were used (P <. 05) to compare the Ob/Gyn clerkship scores/grades by both clerkship length and semester of rotation. RESULTS: The 8-week and 6-week clerkship mean final examination scores were 69.5 and 69.7, respectively; the USMLE Step 1 scores were 205.1 and 215.1, respectively (P < .001). After univariate analysis, lower examination scores were seen for students clerking on the 6-week rotation (P < .001) as well as for those clerking in the first semester (first semester, 68.1; second, 71.3; P < .001). Based upon these results, the 8-week clerkship scores were calculated to be approximately 3.4 points higher than those of the 6-week clerkship, potentially lowering the final grades of 15.2% of the 6-week students. No significant differences were seen with the comparisons of a student's subjective assessments. CONCLUSION: A shorter third-year Ob/Gyn student clerkship appears to lower Ob/Gyn final examination scores. Lower examination scores are also seen for students with a first-semester clerkship. These lower scores could lead to lower final grades.     

Video Playback as an Educational Tool for Improving Resident Laparoscopic Performance: A Randomized Controlled Trial

Study ObjectiveIn this single-masked randomized controlled study, we evaluate whether watching video recordings of oneself performing Fundamentals of Laparoscopic Skills (FLS) exercises results in an improvement on the 30-point Global Operative Assessment of Laparoscopic Skills (GOALS) assessment among Obstetrics and Gynecology (Ob/Gyn) residents.DesignTwenty-three Ob/Gyn residents in the 2020–2021 academic year completed the FLS exercises while being timed, video recorded, and receiving real-time feedback from an Ob/Gyn faculty member. Baseline GOALS assessment was completed by participants and faculty. After the intervention, all participants then repeated the FLS exercises while being timed and were again scored using the GOALS assessment. Each participant completed the study in a single session. In addition, all participants completed a pre- and post-test survey.SettingUniversity of Louisville Laparoscopic Skills Labortaory.ParticipantsUniversity of Louisville Ob/Gyn residents in the 2020–2021 academic year.InterventionTwelve participants were randomized to the intervention and were allowed to watch their video recording in addition to receiving verbal feedback whereas the remaining 11 received verbal feedback only.Measurements and Main ResultsThere were significant improvements in faculty (p <.01) and self-reported GOALS scores (p <.01) when comparing both the intervention and control group with baseline scores. The intervention group improved by 3.2 points more than that of the control group based on masked faculty evaluation (95% confidence interval, 1.4–5.0 points; p <.01). The difference was not significant in resident self-scores. Overall time improved for all participants (15:54 ± 0.21 minutes before and 13:13 ± 0.14 minutes after), but this difference was not significant between the 2 groups. Higher postgraduate year (PGY) residents reported significantly more comfort performing laparoscopic tasks, earned higher GOALS score (faculty and self-scores), and completed the first set of exercises in less time. A significant interaction between PGY and intervention was detected with improvement in GOALS score most strongly associated with PGY4 residents (p <.01).ConclusionAlthough all learners objectively benefit from watching recordings of themselves performing surgical tasks, advanced learners may benefit the most when video recordings are used as an educational tool.     

Does the North American Society for Pediatric and Adolescent Gynecology Short Curriculum Increase Resident Knowledge in Pediatric and Adolescent Gynecology?

Study ObjectiveTo determine if the North American Society for Pediatric and Adolescent Gynecology (NASPAG) Short Curriculum improves self-reported knowledge in pediatric and adolescent gynecology (PAG) among obstetrics and gynecology (Ob/Gyn) residents, at programs without PAG-trained faculty.DesignProspective, cross-sectional exposure to the NASPAG short curriculum with a follow-up questionnaire.SettingOb/Gyn residency training programs without PAG faculty.ParticipantsOb/Gyn residents in training from February 2015 to June 2015.InterventionsExposure to the NASPAG Short Curriculum.Main Outcome MeasuresImprovement in self-perceived knowledge after completion of curriculum.ResultsTwo hundred twenty-seven residents met inclusion criteria; 34 completed the study (15% response). Less than 50% of residents reported adequate knowledge in the areas of prepubertal vaginal bleeding, vulvovaginitis, precocious and delayed puberty, Home environment, Education and Employment, Eating, peer-related Activities, Drugs, Sexuality, Suicide/depression, Safety from injury and violence (HEEADSSS) interview, pelvic pain, and bleeding management in teens with developmental delay. After completion of the curriculum, self-reported knowledge improved in 8 of 10 learning objectives, with no significant improvement in bleeding disorders or Müllerian anomalies. There was no association between pretest knowledge and level of residency training, type of residency program, previous exposure to PAG lectures, and previous exposure to patients with PAG complaints.ConclusionSignificant deficiencies exist regarding self-reported knowledge of core PAG topics among Ob/Gyn residents at programs without PAG-trained faculty. Use of the NASPAG Short Curriculum by residents without access to PAG-trained faculty resulted in improved self-reported knowledge in PAG.     

Don't ask,don't tell: a change in medical student attitudes after obstetrics/gynecology clerkships toward seeking consent for pelvic examinations on an anesthetized patient

OBJECTIVE: We explore whether the completion of an obstetrics/gynecology clerkship is associated with a decline in the importance that students place on seeking permission from the patient before conducting a pelvic examination while she is anesthetized. STUDY DESIGN: Students at five Philadelphia area medical schools (n = 401 students) were asked how important it would be for a patient to be told that a medical student will perform a pelvic examination while she is anesthetized. We examined associations between the completion of an obstetrics/gynecology clerkship and attitudes toward consent with the use of linear regression to adjust for gender and the total amount of clerkship experience. RESULTS: After the data were controlled for gender and the total number of clerkships that had been completed, we found that students who had completed an obstetrics/gynecology clerkship thought that consent was significantly less important than did those students who had not completed a clerkship (P =.01). CONCLUSION: To avoid this decline in attitudes toward seeking consent, clerkship directors should ensure that students perform examinations only after patients have given consent explicitly.     

Endoscopy teaching in Canada: a survey of obstetrics and gynecology program directors and graduating residents

OBJECTIVE: To examine the current state of basic and advanced gynecologic endoscopy teaching in Canadian Obstetrics and Gynecology (Ob/Gyn) residency programs. METHODS: On Institutional Research Board approval, 2 pretested anonymous questionnaires were developed: one distributed to all Canadian Ob/Gyn program directors and a second to graduating residents (Canadian Task Force classification III). Two mailings were sent to maximize response, and some department chairs received personal telephone calls by the senior author to encourage participation. Residents on maternity leave were excluded from the study. RESULTS: Fifteen of 16 (94%) program directors, and 47 of 62 (76%) residents participated. Directors expect all residents to be knowledgeable and competent performing basic endoscopic procedures on graduation. However, considerable variation exists among programs that teach advanced endoscopy. Some of the more important factors limiting integration of advanced endoscopic teaching include paucity of trained faculty, lack of attending interest, scarcity of operating time, and financial constraints. Most graduating residents consider undertaking additional gynecologic endoscopy fellowships. CONCLUSION: Most Ob/Gyn program directors and graduating residents consider endoscopic surgery essential to contemporary practice. There is consensus to improve resident teaching in gynecologic endoscopy and commitment to better prepare future practitioners to ensure patient safety. Paucity of trained faculty and fiscal constraints appear to be important limiting factors.     

Teaching Pelvic Examinations Under Anaesthesia: What Do Women Think?

ObjectiveMedical students need to undertake supervised pelvic examinations to achieve competence. This experience is frequently obtained by conducting pelvic examinations on anaesthetized patients who are undergoing gynaecological surgery. Our research was carried out to determine patients’ expectations of medical students performing intraoperative pelvic examinations.MethodsPatients at the Calgary Pelvic Floor Disorders Clinic were asked to complete questionnaires including items about who would be present in the OR, what procedures students might undertake, and whether patients would give consent for students doing pelvic exams during surgery. A sample size calculation determined that 100 questionnaires were required.ResultsCompleted questionnaires were received from 102 women. Their mean age was 57 years, range 21 to 91; 64 (63%) had previously undergone gynaecological surgery; 56 (55%) expected a medical student would be present during surgery; 80 (78%), wanted to be told if a medical student would be present; 19 (19%) were aware that a medical student might do a pelvic examination in the OR; 73 (72%) expected to be asked for consent before medical students undertook pelvic examinations under anaesthesia. Fifty-eight respondents (62%) said they would consent to medical students doing pelvic examinations, 5 (5%) would consent for female students only, 17 (18%) were not sure, and 13 (14%) would refuse.ConclusionThe majority of patients wish to help medical students to learn but expect consent to be sought if medical students are to perform pelvic examinations on anaesthetized patients. Before introducing explicit consent in Canadian teaching centres, it will first be necessary to determine the feasibility of seeking consent specifically for this procedure.     

Medical student self-assessment of performance on an obstetrics and gynecology clerkship

OBJECTIVE: The purpose of this study was to evaluate the accuracy of medical student self-assessment of performance on an obstetrics and gynecology clerkship and to assess the influence that demographic and temporal factors had on the accuracy of that assessment. STUDY DESIGN: From June 1990 to July 2000, 1152 students predicted examination and clerkship grades at the beginning and end of their obstetrics and gynecology clerkship. The effects of class rank, gender, rotation length, semester, prediction type, and timing on the accuracy of prediction were evaluated with logistic regression. RESULTS: Students more often correctly predicted clerkship than examination grades. Students with higher grades tended to underestimate their performance; the students who received lower grades tended to overestimate their performance. All factors had a significant effect on the outcome (all, P <.001). Odds ratios for the overestimation were greatest for the lower one third of the class compared with the upper one third of the class (odds ratio, 4.38) and for students who completed the 6-week clerkship compared with the 8-week clerkship (odds ratio, 3.61) CONCLUSION: Better performing medical students tend to underestimate their performance; poorer performing students tend to overestimate their performance. Below-average students have the potential to derive the most benefit from formal feedback.     

Dealing with Female Sexuality: Training,Attitude, and Practice of Obstetrics and Gynecology Residents from a Developing Country

IntroductionThere is little research on how obstetrics and gynecology (Ob/Gyn) residents deal with female sexuality, especially during pregnancy.AimThe aim of this study was to assess the training, attitude, and practice of Ob/Gyn residents about sexuality.MethodsA cross-sectional survey of Brazilian Ob/Gyn residents enrolling in an online sexology course was conducted. A questionnaire assessed their training in sexuality during medical school and residency and their attitude and practice on sexual issues during pregnancy.Main Outcome MeasuresTraining, attitude, and practice of Ob/Gyn residents regarding sexuality were the main outcome measures.ResultsA total of 197 residents, from 21 different programs, answered the online questionnaire. Mean age was 27.9 ± 2.2, most were female (87%), single (79%), and had graduated in the last 5 years (91%). Almost two-thirds (63%) stated that they did not receive any training at all and 28% reported having only up to 6 hours of training about sexuality in medical school. Approximately half of the respondents (49%) stated that they had received no formal training about sexuality during their residency up to that moment and 29% had received ≤6 hours of training. Over half (56%) never or rarely took a sexual history, 51% stated that they did not feel competent or confident to answer their pregnant patients’ questions about sexuality, and 84% attributed their difficulties in dealing with sexual complaints to their lack of specific knowledge on the topic.ConclusionThe vast majority of Brazilian Ob/Gyn residents enrolling in a sexuality course had little previous formal training on this topic in medical school and during their residency programs. Most residents do not take sexual histories of pregnant patients, do not feel confident in answering questions about sexuality in pregnancy, and attribute these difficulties to lack of knowledge. These findings point to a clear need for additional training in sexuality among Brazilian Ob/Gyn residents. Vieira TCSB, de Souza E, da Silva I, Torloni MR, Ribeiro MC, and Nakamura MU. Dealing with female sexuality: Training, attitude, and practice of obstetrics and gynecology residents from a developing country. J Sex Med 2015;12:1154–1157.     

Student response to gynecologic teaching associates

Gynecologic teaching associates teach the communication and psychomotor skills for breast and pelvic examinations in most medical schools in the United States and Canada. Evaluations of these gynecologic teaching associate programs have included faculty impressions of program effectiveness and measurement of student retention of skills but not student evaluations of the effectiveness and value of such programs. At the University of Illinois at Chicago students evaluated their gynecologic teaching associate program. High ratings were given to program organization and content; the knowledge, ability, and professionalism of the teaching associates; and the outcomes of the sessions with respect to the learning skills needed to perform the examinations. Students emphasized the importance of the ability of the teaching associates to provide immediate informative feedback and to reduce anxiety during the teaching sessions. Students tended to view their ability to perform breast examination to be greater than for the pelvic examinations but felt they learned more about both in the sessions. This information supports the value of the gynecologic teaching associate model in medical education.     

Selection of obstetrics and gynecology residents on the basis of medical school performance

OBJECTIVE: The purpose of this study was to determine whether United States Medical Licensing Examination scores during medical school predict resident-in-training examination scores and whether other criteria of medical student performance correlate with the faculty's subjective evaluation of resident performance. STUDY DESIGN: United States Medical Licensing Examination step I and II scores for 24 residents were compared to their scores on in-training examinations. Faculty evaluated 20 graduated residents by rating both their cognitive and noncognitive clinical performance. Scores from these evaluations were compared with several criteria of their medical school performance. Statistical analysis for all comparisons was linear regression. RESULTS: United States Medical Licensing Examination scores positively correlated with in-training examination scores. United States Medical Licensing Examination scores, honor grades in student clinical rotations, and student interview scores did not correlate with the faculty evaluation of resident performance. CONCLUSION: Standardized tests of medical student cognitive function predict the resident's performance on standardized tests. Selection criteria that are based on other medical school achievements do not necessarily correlate with overall performance as residents in obstetrics and gynecology.     

Effect of obstetrics-gynecology clerkship duration on medical student examination performance

OBJECTIVE: To compare medical student performance on the obstetrics and gynecology national board subject examination during two different clerkship rotation formats. METHODS: We compared medical student performance on the National Board of Medical Examiners (NBME) subject examination in obstetrics and gynecology for 2 years before and 2 years after the length of the clerkship at the University of Florida was decreased from 8 to 6 weeks. Medical College Admission Test (MCAT) and United States Medical Licensing Examination (USMLE) step 1 and step 2 scores were used to assess comparability between groups. Student t test and chi2 analysis were used as appropriate. RESULTS: Medical school classes were similar with respect to MCAT and USMLE step 1 and step 2 scores. Collectively, 231 students who completed the 8-week clerkship scored significantly higher on the subject examination than 239 who completed the 6-week clerkship (618.6 versus 593.5, P = .001). When analyzed by semester, students who completed the clerkship in the second half of the academic year scored similarly regardless of clerkship length (630.6 versus 616.7, P = .11); however, students who completed the clerkship during the first half of the academic year scored significantly higher with the 8-week than the 6-week clerkship (607.3 versus 569.7, P < .001). Students who took the clerkship in the last half of the academic year scored higher than students who took the clerkship in the first half for both the 8-week (630.6 versus 607.3; P = .02) and 6-week (616.7 versus 569.7; P < .001) formats. Those differences persisted on examination letter grade assignment. CONCLUSION: Decreasing the duration of the obstetrics-gynecology medical student clerkship resulted in lower subject examination scores, especially for students who matriculated in the first half of the academic year.     

Reshaping pre-clerkship years in reproductive medicine education

The educational program of the Paul L. Foster School of Medicine in El Paso, Texas integrates the basic and clinical sciences and organizes them according to the organ-system based units. The reproduction unit focuses on human reproduction, pregnancy and illnesses associated with the female genital tract and breast. The sequence of 13 clinical presentations is structured so that the concepts developed during the study of one topic lays down a foundation for subsequent topics. Students are provided with a brief definition and a statement of clinical significance for each clinical presentation, which serves as the foundation for presentations of both clinical and basic science information. In the Medical Skills Course, students practice skills and behaviors associated with obstetrics and gynecology (Ob Gyn) history taking, culturally sensitive communication skills, conducting and recording of physical and pelvic examinations as they relate to clinical presentations. The Society, Community and Individual Course focuses on real life experience in a local community clinic setting and improves the understanding of the social determinants of female reproductive health. We believe that our pedagogical approach enhances knowledge comprehension, improves knowledge retention of the basic science and promotes the development of clinical reasoning, enabling easier transition to the clerkship years.     

Oocyte donors as gynecologic teaching associates

Objective: To fulfill the need for gynecologic teaching associates for an expanded pelvic examination module for third-year medical students, we sought women who were able to provide feedback to medical students. Oocyte donors were hypothesized as a useful potential pool of gynecologic teaching associates.Methods: Gynecologic teaching associates were recruited from a pool of women who were involved in our oocyte donor program. Students were evaluated on a scale of 1 (best) to 5 (worst) on their performance on the pelvic examination by themselves (n = 91), by the gynecologic teaching associate (n = 10), and by the supervising faculty (n = 6). Students were shown their evaluations, and these were reviewed at the end of the session to provide students with immediate feedback.Results: Students consistently ranked their skills lower than either the gynecologic teaching associate or supervising faculty member for all four categories evaluated (communication skills, technical skills, professional demeanor, and overall performance) (P < .001). Students gave their communications skills the highest mean rankings, whereas gynecologic teaching associates gave them the lowest. The highest correlation and agreement between pairs of evaluators were between the gynecologic teaching associate and the supervising faculty member. Gynecologic teaching associates and faculty members also were more likely to praise the students’ performance in written comments (χ² 58.2, P < .001), whereas no student found anything praiseworthy in his or her performance.Conclusion: Oocyte donors represent a useful pool of potential gynecologic teaching associates. They provide important feedback to students. Their evaluation of the proficiency of the student correlates well with that of the supervising faculty member.     

Incorporating problem-based learning into an obstetrics/gynecology clerkship: impact on student satisfaction and grades

OBJECTIVE: The purpose of this study was to describe the effect of the problem-based learning method on student grade and on student and faculty satisfaction. STUDY DESIGN: The problem-based learning method was instituted at 2 of 5 obstetrics/gynecology clerkship sites. Students and faculty were surveyed, with the use of a Likert scale, regarding aspects of satisfaction with the clerkship. Responses were compared according to problem-based learning usage. Student performance was also assessed according to problem-based learning usage, with a comparison of several grade components. Statistical analysis involved t-tests and Kendall's tau-C. RESULTS: For the year that was assessed, 54 of 156 students used the problem-based learning method. Mean student satisfaction responses were significantly higher for students who used the problem-based learning method. Faculty satisfaction was also significantly higher for the problem-based learning method, compared with other teaching methods. Mean scores on the National Board of Medical Examiners subject examination were higher for problem-based learning but did not reach statistical significance. Grade distribution was not significantly different for the groups. CONCLUSION: The problem-based learning method was associated with improved student and faculty satisfaction and did not affect student grades negatively.     

An obstetric and gynecologic clerkship''s influence on a medical community: The Washington, Alaska, Montana, and Idaho Anchorage obstetric and gynecologic clerkship

OBJECTIVES: Our purpose was to explore the influences of an obstetric and gynecologic medical student clerkship on a remote medical community. Return of physicians to Alaska and faculty perceptions of their experience were central foci.STUDY DESIGN: Data were obtained on former clerks to determine choice of speciality and location of practice. Data regarding all physicians new to Alaska was correlated with the University of Washington Medical School graduate data. Additionally, a questionnaire with a Likert-type scale evaluated the 10 clinical faculty members participating in the clerkship.RESULTS: Between 1978 and 1991 we trained 266 clerks. A total of 77 of 374 (21%) new physicians in Alaska (1978 to 1991) were graduates of the University of Washington; 26 of those 77 (34%) were our former Anchorage obstetrics and gynecology clerks. The clinical faculty reported both positive and negative effects of their participation in the clerkship.CONCLUSION: The desired benefit, the return of new physicians to Alaska, seemed supported. Questionnaire results hinted at additional benefits for the supervising faculty physicians in this isolated community. The formal affiliation effected by the clerkship seemed to have a positive impact on patient care, communication, consultation, and shared action among the participating physicians. (Am J Obstet Gynecol 1997;176:1363-7.)     

Limitations of the pelvic examination for evaluation of the female pelvic organs.

OBJECTIVE: To assess factors influencing an accurate pelvic examination under the best possible circumstances. METHODS: Before undergoing laparoscopy or laparotomy, 84 women under general anesthesia underwent pelvic examinations by an attending gynecologist, a gynecology resident, and a medical student blinded to the indication for surgery. Surgical findings were compared with the examiners' findings. Dependent variables (uterine size, uterine contour, and presence of adnexal masses) and effect modifiers (examiner experience and body mass index) were analyzed. RESULTS: The overall pelvic examination was accurate 70.2% of the time for attending gynecologists, 64.0% for residents, and 57.3% for medical students. The sensitivity to detect adnexal masses was much lower than the sensitivity to assess uterine size or uterine contour. Obesity noticeably reduced detection of adnexal masses. CONCLUSION: The bimanual examination appears to be a limited screening test for the female upper genital tract even under the best possible circumstances. Uterine assessment appears to be more accurate than adnexal assessment.     

Outcomes of teaching medical students core skills for women's health: the pelvic examination educational program

OBJECTIVE: The purpose of this study was to evaluate the outcomes of introducing an educational program that teaches medical students how to approach taking relevant and sensitive gynecologic histories and to perform pelvic examinations with the use of role-play with well women from the general community. STUDY DESIGN: Medical students and the women recorded their perceptions of the program over a 2-year period. The outcomes of the program were evaluated by a comparison of medical student perceptions of confidence, competence, and anxiety; the mean number of pelvic examinations that were performed during their course both before and after the introduction of the program and results of students' continuous and summative assessment are given. RESULTS: In the year before the introduction of the program, students performed a mean of 2.6 pelvic examinations (95% CI, 2.1, 3.0) compared with 4.1 pelvic examination (95% CI, 3.8, 4.4) in the first year of implementation and 4.0 (95% CI, 3.7, 4.3) in the second year of implementation (P <.05). Students reported improved competence and reduced anxiety to perform a pelvic examination without supervision (P <.05). All students passed their continuous assessment. Between 92% and 100% of students and women agreed that the program had clear learning objectives, was well organized, and was a useful and appropriate method of teaching that helped prepare them for the clinical setting. CONCLUSION: This pelvic examination educational program has been evaluated positively by students and participant women and has resulted in a significant improvement in the amount of pelvic examination experience that medical undergraduates obtain.     

Profile of student clerkship administration in obstetrics and gynecology

To determine a current profile of clerkships in obstetrics and gynecology, a national survey was conducted. The average clerkship director is 48 years old and has held that post for 6 years. Board certification has been accomplished by 91%, of whom 23% are also certified in a subspecialty. An advanced degree in education is held by 14%. Of full-time faculty, 81% are actively involved with medical student teaching; of part-time faculty, 62% teach students. The average number of 16 students completing the clerkship each 7 weeks is similar to that in previous reports. Evaluation of student performance varies but generally involves assessment of clinical activities (98% of programs), a written examination (96%), and an oral examination (54%). Clerkship directors find the responsibility of coordinating undergraduate education an important task from which they derive personal satisfaction.     

Evaluating student performance in an obstetrics and gynecology clerkship.

The development of a comprehensive evaluation system for an obstetrics and gynecology clerkship at the Unviersity of Utah is described and the results of two years experience using it are presented. Seven different measurement procedures were developed and used with 111 junior medical students including pre- and post-tests, oral examination, clinical performance ratings by residents, and ratings by faculty on oral and written presentations and participation in tutorial sessions. Learning gains as measured by pre-post test scores were significant at the 0.001 level. Only six of 37 correlations among the evaluation measures were significantly related at the 0.01 level; furthermore, little relationship could be found between measures of student achievement in cognitive as compared to clinical skill areas. The need for multiple sources of information on student performance in clerkships is discussed.