- Email: [email protected]
APOG Abstract Program 38th Annual Meeting
The Association of Professors of Obstetrics & Gynaecology of Canada
L’Association des professeurs d’obstétrique et gynécologie du Canada
APOG ABSTRACT PROGRAM th 38 Annual Meeting Introduction / Foreword
E
ducational Research is an important component of our program that can assist each of our member departments, at all levels, with the task of transferring educational knowledge to learners.
With the many new emerging technologies, the implementation of the CanMEDS framework, and increased emphasis on Interprofessional Education, there are always new ways to improve the methods we currently use to educate faculty, residents, and medical students. I would therefore like to encourage each of you to share your experiences by submitting abstracts for future meetings. You can make a difference in facilitating the exchange of knowledge in educational scholarship with your colleagues! Respectfully yours,
Dr Alan Bocking President, APOG
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APOG APOG ORAL PRESENTATIONS AP-V01 ADJUSTING WITH THE TIMES: PROSPECTIVE EVALUATION OF A NEW CALL SYSTEM DESIGNED TO FIT WITHIN A NEW RESIDENT CONTRACT Laurina Leyenaar,1Joan Wenning2 1, 2
Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS Introduction: The relationship between work hours and patient safety, as well as resident well-being, has influenced contracts that govern resident work hours. A night float system for gynaecologic coverage was instituted within the Obstetrics and Gynaecology Residency Program at Dalhousie University in April 2009, following adoption of a new resident contract. Objective: To prospectively evaluate the institution of a resident night float system for gynaecologic call coverage. Methods: Guidelines for call coverage and an evaluation form were developed. The evaluation form was completed on a voluntary basis. Areas reviewed included number of consults, operative experience and attendance at educational sessions. Participants were also invited to comment on their satisfaction with the new call system. Results were reviewed and tabulated where appropriate; subjective comments were reviewed to identify themes. Results: The initial evaluation period covered a thirteen-week period; 8 of 13 evaluations were returned (61.5%). Residents were satisfied with the handover procedure and did not feel pressure to stay at work during their days off. The average number of emergency room consults was 3.5 (range = 1-12) and the average number of operative procedures was 1.25 (range = 0–4). Overall residents were satisfied with the new system and felt that it should continue. Conclusions: Prospective evaluation of the night float system demonstrated a high level of resident satisfaction and confirms that novel solutions can be effective in achieving the necessary balance between contractual requirements and the provision of appropriate clinical service.
AP-V02 CaRMS PORTFOLIO EVALUATION: ARE THERE ANY PEARLS IN THE OYSTERS? Kelly Dore, Donna Fedorkow, John Lamont, Joe Azzam, Nancy Dzaja McMaster University, Hamilton, ON Introduction: Increasing numbers of residency candidates and a complicated candidate dossier has made it difficult for one individual to rank all applicants. Differences between undergraduate program structures, documentations, and evaluations render comparison of candidates from different institutions daunting. Objectives: This study used a 19-item, 10-point Likert scale to make candidate assess more objectively, identify the utility of various component of the dossier, and to assess the inter-rater reliability for evaluators within and between levels of training (faculty and resident). The aim was to make candidate assessment more objective and the component of the dossier that best differentiated the applicants. In addition, rater agreement was assessed. Methods: Two faculty and two residents independently reviewed all 103 applications received for the Obstetrics and Gynecology residency program at McMaster University. Evaluation items included all aspects of the CaRMS portfolio. Scores generated for each item along with a final score generated by each evaluator were calculated for each applicant. The 55 top-scoring applicants
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were invited for interview. Data was analyzed using SPSS and Generalizability Theory. Results: Inter-rater reliability within level of training was very high across all subscales. There was also high reliability across sub-sections. All raters found limited value to the transcript portion of the dossier, except as a red flag, because of inconsistent presentation across schools. Item Analysis identified several components of the subscale that may be omitted as they accounted for limited variability between applicants. Conclusions: Overall, this process provided a framework to develop a more objective assessment to ensure fairer evaluation of applicants.
AP-V03 EXPLORING HOW IPE TRAINING INFLUENCES FUTURE PROFESSIONAL PRACTICE: A QUALITATIVE STUDY Beth Murray-Davis Midwifery Education Program, McMaster University, Hamilton ON Introduction: The rationale for interprofessional education (IPE) is based on the assumption that it results in improved interprofessional practice. Despite the evidence that pre-qualifying IPE may be able to modify attitudes and provide knowledge and skills for collaboration, this evidence tells us little about whether these skills and attitudes can be transferred to professional practice. Objective: To explore how midwifery students who participate in pre-qualification IPE projects apply their learning to the context of professional practice. Methods: A theoretical sample of midwifery students, midwifery educators, Heads of Midwifery and newly qualified midwives from four universities throughout the UK participated in semi-structured interviews and focus groups. Emerging themes were developed using the principles of Grounded Theory. Categories and themes were organized using NVIVO. Results: Barriers preventing the application of IPE to clinical practice included the perceived lack of relevance of IPE competencies, the marginalisation of IPE curriculum from profession specific training, and the minimal support for the IPE agenda within the clinical setting. However, a continuum of IPE experiences throughout professional training, in both the academic and clinical setting, involving interaction with health professionals encountered in practice was found to promote transfer to practice. Conclusions: Novice practitioners were better able to apply their IPE training when interprofessional working and learning was made explicit within both the university learning environment and the clinical workplace. This understanding of how IPE influences professional practice is useful for IPE curriculum development for students and for continuing education for obstetric care providers.
AP-V04 EVALUATING THE IMPACT OF A MATERNITY CARE IPE PROGRAM ON UNDERGRADUATE STUDENTS: A QUALITATIVE ANALYSIS Filomena Meffe, St. Michael’s Hospital, Toronto, ON S. Espin, C. Moravac, M. Sharpe Introduction: Three nursing, three midwifery and three medical students participated in a 30 hour, 5 week hospital based program on interprofessional collaboration in maternity care. This
APOG
the “definitely interested” group listed good role models and positive clinical experiences as critical factors.
presentation will focus specifically on an analysis of transcripts from a focus group in which students reflected on their learning experiences. This presentation will review the method, process and outcome of the analysis of transcripts. Objective: The primary research question was: ”Does participation in the interprofessional education program on maternity care increase student knowledge, enhance skills and/or improve attitudes and level of motivation towards practicing collaborative care?” A series of quantitative measures were used to elicit an answer to this multi-dimentional question. The quantitative outcomes were richly enhanced by the data collected from the student focus group along with other qualitative measurement tools. Methods: Four researchers reviewed the verbatim transcripts from the student focus group. An iterative constant comparative approach was used to identify emerging themes. Consistency of coding and reliability was monitored by the team. Emergent themes were collapsed, re-analyzed, regrouped, and defined. Results: The students’ comments focused on key areas: (1) woman-centred care
Conclusions: Good role models and positive clinical experiences early in training have a deciding influence on career selection. The males in this survey report less early exposure to positive clinical experiences in Ob/Gyn (they were less knowledgeable on subject matter, sometimes felt excluded from clinical encounters by patients or nurses, and saw male Ob/Gyn role models only later in training after career paths were chosen). Addressing these concerns may encourage greater ongoing involvement by men in Ob/Gyn.
POSTER PRESENTATIONS
AP-P01 EFFECTIVE USE OF SIMULATION IN AN UNDERGRADUATE OBSTETRICS AND GYNECOLOGY CURRICULUM Margaret Burnett and M. Ford The University of Manitoba, Department of Obstetrics, Gynaecology and Reproductive Sciences, Winnipeg, MB
(2) interprofessional practice:
Introduction: Traditionally, undergraduate medical education consisted of a theoretical component followed by a clinical component. The student was expected to acquire factual knowledge and then learn to apply it by participating in patient care. Simulation provides new opportunities to facilitate the transition between books and the bedside.
(i) the transformational process in conflict resolution (ii) relationships (iii) communication (3) interprofessional process / uptake
Aims: To describe the integration of a graduated series of simulation sessions into an undergraduate Obstetrics and Gynecology program based on principles of adult learning.
Conclusions: The transcripts of the focus group clearly demonstrated evidence of increased student knowledge, improved attitudes towards interprofessional collaborative care and increased levels of motivation to practice interprofessional collaborative care. Students found that the program was generalizable to other areas of health care. Some found the experience to be transformational.
Methods: The educational objectives of the clerkship program were reviewed to explore those which might be achieved using simulation. We also identified areas where simulation was already being used successfully. A task analysis was performed to decide which specific skills were to be targeted. Simulators were identified by searching the medical education literature and attending clinical meetings, networking, and brainstorming. Trial and error were used extensively. Learners provided verbal and written feedback after each session.
AP-V05 PUTTING THE ‘GUY’ BACK INTO GYNAECOLOGY
Results: Simulated patients are used to teach communication skills, speculum examination and bimanual examination during Med I and again in clerkship. Speculum insertion, specimen collection, bimanual examination, and assessment of the labouring cervix are taught using pelvic models. Noelle® is used for the abdominal examination of a pregnant woman. Normal delivery is conducted using the Prompt® Birth Simulator. Suturing skills and episiotomy repair are performed on a beef tongue. Students generally found the simulation sessions enjoyable and felt better prepared to enter the clinical milieu.
Jessica Bogach (Meds 2011), Phil Hahn and Robert L. Reid Department of Obstetrics and Gynaecology, Queen’s University, Kingston, ON Introduction: There are currently equal numbers of male and female Ob/Gyns in Canada; however, the future looks “pink” as 80-90% of new applicants are female. The reasons for this dramatic shift in interest are unclear but some have suggested that males may feel less welcome to the specialty. Objective: To explore reasons for this gender shift and to make recommendations about how to encourage more males to consider the specialty of Ob/Gyn. Methods: A web-based survey was designed and distributed using StudentVoice to 400 Queen’s medical students in the current academic year. The survey elicited career preferences as well as factors that influenced these decisions. Results: 225 surveys were returned for a response rate of 56%. 114 (51%) respondents were male and 111 (49%) were female. Of all respondents 53% (114/215) reported Ob/Gyn was ‘definitely not’ what they wanted to do: 60% (68/114) male and 40% (46/114) female; (43%) 93/215 of the group remain undecided. The “definitely not” group males were twice as likely as females to cite ‘disinterest in the field’ and ‘not wanting to work only with women’ and three times more likely to indicate they were ‘uncomfortable with the subject area’ as reasons. Perhaps more importantly 77%(71/92) of the undecided group expressed “interest” in the specialty but cited ‘lack of exposure’ (45%, 41/92) as a reason for uncertainty. Three students indicated they did not want to work in an environment with mostly female colleagues. Not surprisingly
Conclusions: Simulation provides a stimulating educational environment that satisfies the principles of adult learning. Simulation represents an intense use of resources. Therefore, informationsharing about effective simulation and simulators is essential.
AP-P02 COMPARING THE EFFICACY OF VARYING LEARNING MODALITIES FOR COMPUTER-BASED EDUCATION IN ANATOMY Zaid Khot,1 Kate Quinlan,1 Marianne Baxter,1 Bruce Wainman,2 Geoff Norman3 1 Bachelor of Health Science (Honours) Program, McMaster University, Hamilton ON 2
Education Program in Anatomy, McMaster University, Hamilton ON
3
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton ON Introduction: The increased usage and accessibility of online resources can drastically alter how anatomy can be taught and
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learned. We must identify whether online material is comparable to traditional lab-based study with anatomical specimens. Objective: To determine the most effective mode of instruction for nominal and functional anatomy.
AP-P04 MONITORING SURGICAL EXPOSURE DURING RESIDENCY Karen Splinter
Methods: Twenty university students with no prior experience in anatomy and physiology were chosen. Subjects first completed the Vandenberg Mental Rotations Test (MRT), and then completed four stations testing different anatomical regions: static model (knee), dynamic model (upper arm), static illustration (pelvis), or dynamic illustration (foot). Subjects were given 10 minutes to study at each station, and 15 minutes to complete a quiz consisting of 15 nominal questions and five functional questions. Results: There was no correlation between MRT scores and test performance. Subjects scored significantly better on nominal questions when learning with model modalities (p<0.001). However, there was no statistical difference in performance on functional questions for static vs. dynamic learning (p = 0.557) or for model vs. illustration learning (p = 0.784). Overall, subjects scored highest on the dynamic model (arm station). Conclusions: Models are invaluable tools for learning nominal anatomy. However, models and illustrations are equally effective for learning functional anatomy. The use of static vs. dynamic modalities did not affect learning of either nominal or functional anatomy. A follow-up study is in progress, testing a single anatomical region (pelvis) for all modalities.
AP-P03 PERCEIVED VALUE OF RESIDENT CHARACTERISTICS: FACULTY AND RESIDENT PERSPECTIVE Sarah McQuillan and Kelly DoreMcMaster University, Hamilton, ON Introduction: The Royal College of Physicians and Surgeons of Canada have developed the CanMEDS roles, 7 areas of competence they deem important for all physicians. However, the relative value of each of these areas has yet to be assessed for our specialty. In order to develop more consistent and objective standards for admissions and in-program assessment it is important to consult stakeholders to determine perceived value of these qualities. Objective: This study was an attempt to assess the relative value of these characteristics in obstetrics and gynaecology residents. Methods: A survey of stakeholders, including faculty and residents, identified 7 characteristics based on the CanMEDS roles. A paired-comparison survey was then sent to all faculty and residents at McMaster. The survey presented the characteristics in all possible unique pairings; seven characteristics resulted in 21-paired presentations. Participants then decided which characteristic in each pair was more important for a resident. Paired comparison analysis was then performed, and all preferences were converted to z-scores. Results: Overwhelmingly, “ethical” was deemed to be the most important characteristic on which selection tools should be based (z = 8.97). The qualities of critical thinking and giving of oneself were perceived to have lower importance (z scores of 2.41 and 0.43 respectively). Conclusion: This study underscores the importance of determining in advance the more desirable characteristics for candidates. Future research would seek to assess the stability of these results on a national level, looking for differences between subspecialties as well as level of training.
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Memorial University, St John’s, NL Introduction: Surgical training is an integral part of OB/GYN residency and requires repeated exposure to the OR. Objectives: A questionnaire was created to determine if there were any significant differences in surgical exposure among OB/GYN residency programs in Canada and compare how surgical exposure was documented. Methods: The members of the SOGC Junior member committee were sent an online survey (2 resident members from each program). The survey contained multiple choice and open ended questions. Results: 20 residents responded, representing 14 of 16 programs. A majority of residents reported being a first assist in general obstetrics (90%) and gynaecology (74%) procedures in first year. Approximately half of residents will begin as the primary surgeon in obstetrics during their first year (47%). Sub-specialty exposure in the operating room was related to rotation order, with most rd th residents gaining exposure in 3 or 4 year (35% +/- 17% and 47% +/- 14%, respectively). In order to increase OR time, the majority of programs arrange out of town electives from second to fifth year. 31% of respondents used an online system for logging procedures. 31% relied on keeping OR slips, 25% used informal review with program director and 12% reported no system at all to monitor OR exposure. Conclusions: Although residents continue to seek increases in operating room time, there does not appear to be any significant differences in exposure. Programs using an organized system to monitor residents’ OR logs will be able to identify any differences in exposure among residents and hopefully rectify it before disparity in skills emerge.
AP-P06 STATUS OF ENDOSCOPIC TRAINING IN CANADIAN OB/GYN RESIDENCY PROGRAMS: AN SOGC JUNIOR MEMBER COMMITTEE SURVEY Kristina Arendas,1Ardelle Stauffer,2 Sukhbir S. Singh1 1 Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON 2 Department of Obstetrics and Gynecology, University of Saskatchewan, Saskatoon, SK
Introduction: There is a need for a standardized gynaecologic endoscopy curriculum for Ob/Gyn postgraduate training. Currently every university program sets their curriculum and provides diverse teaching in gynaecologic endoscopy. This may create discrepancy in the type and amount of endoscopic training residents from various programs receive. Objectives: To identify the current status of endoscopic training in Canadian Ob/Gyn postgraduate training programs and to determine whether there is a need for an endoscopy training course at the national level. Methods: A national survey of Ob/Gyn residents through the SOGC Junior Member (JM) Committee. Each university’s JM committee representative received an on-line survey. The representatives polled local residents and summarized the feedback requested from the survey on their behalf. Results: Fourteen of sixteen Canadian Ob/Gyn postgraduate programs surveyed completed the questionnaire. 85% of programs who responded have endoscopic training programs at their university. The type of training varies greatly from one
APOG
program to another. There is 100% interest in a Canadian national endoscopic training course among respondents. Residents would prefer a mobile course if it were possible consisting of primarily hands-on lab training. Comments were also collected and will be presented.
clinical encounter log. Students are aware that preference is given to topics to which the student has had direct clinical exposure. Objective: To determine whether linking the log and assessment improved logging accuracy and encouraged self-directed study.
Conclusion: There currently is a need to further address endoscopic training in Ob/Gyn in Canada. A national endoscopic training course would be welcomed by all residents surveyed. APOG and national stakeholders should pursue such an initiative.
Method: A cohort of students were asked to complete an anonymous web-based survey on two occasions: after completing the core ob/gyn rotation in which the log is linked to assessment and after completing the core surgery rotation where there is no link. The survey explored logging habits and study habits related to the logged objectives as well as students views about the log and its impact on their learning.
AP-P07 CAN FORMAL INSTRUCTION AND SIMULATION IN CAESAREAN SECTION ALLEVIATE TRAINEE STRESS?
Results: Students on the ob/gyn rotation logged more frequently but not with more accuracy or honesty. They consider the log an administrative task with only a minority finding it useful to their learning. Students found that there was a lack of awareness amongst faculty and residents about student learning objectives.
Hisham Khalil,1 Hassan Shenassa,1 Glenn Posner,1 Dante Pascali.1
Conclusion: Students continue to believe that the clinical log lacks educational value. There was no apparent benefit in linking it to assessment.
1 University of Ottawa, Department of Obstetrics and Gynecology, Ottawa, ON
Introduction: Residents routinely perform Caesarean sections during their training. Despite mounting evidence regarding the benefits of simulation, little research has examined the training residents receive prior to performing a Caesarean section. Among first year obstetrics and gynecology residents at the University of Ottawa, none reported formal training prior to performing their first Caesarean section. Objective: To determine if formal instruction and simulation in Caesarean section can alleviate trainee stress and increase surgical knowledge. Methods: We piloted a Caesarean section course and simulation adapted from the Structured Operative Obstetrics (SOO) course developed by the Canadian Network for International Surgery (CNIS). Resident comfort and knowledge were evaluated using a Likert based questionnaire. Results: We identified a 22% increase in confidence performing caesarean section, and a 21% increase in comfort with suturing skills following completion of the course. We also captured a 17% increase in knowledge based test scores. Conclusion: In this pilot study, trainee confidence and surgical knowledge improved following of Caesarean section simulation and formal instruction.
AP-P08 DEVELOPMENT AND IMPLEMENTATION OF A LOG-BASED ASSESSMENT TOOL IN A CORE OBSTETRICS AND GYNAECOLOGY CLERKSHIP ROTATION Susan M. Chamberlain, and Phil Hahn Department of Obstetrics and Gynaecology, Queen’s University, Kingston ON Introduction: LCME medical school accreditation mandates student logging of clinical experiences during core clerkship rotations. However, students do not fully engage in this endeavour as they don’t perceive any personal educational benefit. In addition to the MCQ examination, a structured oral examination (SOE) was implemented to assess knowledge in the core ob/gyn clerkship rotation. Topics examined in the SOE are based on LMCC objectives and are selected after reviewing the student’s
AP-P10 DO PODCASTS MEASURE UP? MEDICAL STUDENTS’ PERCEPTIONS OF THE UTILITY OF PODCASTS IN MEDICAL EDUCATION Lyana Sisca,1Lynne Zolis,1 Filomena Meffe,2 Michele Farrugia2 1
University of Toronto, Toronto, ON
2
Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON Introduction: There has been an increasing interest in web based tools, such as podcasts, for dissemination of research and education. Podcasts are digital media files available in both audio and audio-visual formats. Podcasts have the advantages of being inexpensive, easily accessible, and can be conveniently listened to almost anywhere with a portable MP3 player or laptop computer. Many educational institutions use technologies such as podcasts to supplement curriculum. Medical student have limited time, particularly in their clinical years, requiring them to multitask. Podcasts can deliver a digestible amount of information on demand, making them an attractive tool for medical education. Objective: To assess the perceived utility of Obstetrical and Gynaecological podcasts among undergraduate medical students during their Obstetrics and Gynaecology rotation at the University of Toronto. Methods: We have created 6 podcasts, 15-30 minutes in length, covering Obstetrics and Gynaecology topics. The podcasts review relevant course material as outlined by the course objectives and are posted on the internet for free download. During this academic year, approximately 240 third-year medical students will rotate through a 6-week Obstetrics and Gynaecology block and will have access to these podcasts. At the end of each of the rotations, the medical students will be provided with a questionnaire assessing the use of digital study tools and the perceived utility of the obstetrics and gynaecology podcasts for their learning of the material and preparation for their examination. Results: The questionnaires will be collated as each group of students completes their rotations for further analysis. Conclusions: In progress.
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L’Association des professeurs d’obstétrique et gynécologie du Canada
APOG ABSTRACT PROGRAM th 38 Annual Meeting Introduction / Foreword
E
ducational Research is an important component of our program that can assist each of our member departments, at all levels, with the task of transferring educational knowledge to learners.
With the many new emerging technologies, the implementation of the CanMEDS framework, and increased emphasis on Interprofessional Education, there are always new ways to improve the methods we currently use to educate faculty, residents, and medical students. I would therefore like to encourage each of you to share your experiences by submitting abstracts for future meetings. You can make a difference in facilitating the exchange of knowledge in educational scholarship with your colleagues! Respectfully yours,
Dr Alan Bocking President, APOG
JANUARY JOGC JANVIER 2010 l
77
APOG APOG ORAL PRESENTATIONS AP-V01 ADJUSTING WITH THE TIMES: PROSPECTIVE EVALUATION OF A NEW CALL SYSTEM DESIGNED TO FIT WITHIN A NEW RESIDENT CONTRACT Laurina Leyenaar,1Joan Wenning2 1, 2
Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS Introduction: The relationship between work hours and patient safety, as well as resident well-being, has influenced contracts that govern resident work hours. A night float system for gynaecologic coverage was instituted within the Obstetrics and Gynaecology Residency Program at Dalhousie University in April 2009, following adoption of a new resident contract. Objective: To prospectively evaluate the institution of a resident night float system for gynaecologic call coverage. Methods: Guidelines for call coverage and an evaluation form were developed. The evaluation form was completed on a voluntary basis. Areas reviewed included number of consults, operative experience and attendance at educational sessions. Participants were also invited to comment on their satisfaction with the new call system. Results were reviewed and tabulated where appropriate; subjective comments were reviewed to identify themes. Results: The initial evaluation period covered a thirteen-week period; 8 of 13 evaluations were returned (61.5%). Residents were satisfied with the handover procedure and did not feel pressure to stay at work during their days off. The average number of emergency room consults was 3.5 (range = 1-12) and the average number of operative procedures was 1.25 (range = 0–4). Overall residents were satisfied with the new system and felt that it should continue. Conclusions: Prospective evaluation of the night float system demonstrated a high level of resident satisfaction and confirms that novel solutions can be effective in achieving the necessary balance between contractual requirements and the provision of appropriate clinical service.
AP-V02 CaRMS PORTFOLIO EVALUATION: ARE THERE ANY PEARLS IN THE OYSTERS? Kelly Dore, Donna Fedorkow, John Lamont, Joe Azzam, Nancy Dzaja McMaster University, Hamilton, ON Introduction: Increasing numbers of residency candidates and a complicated candidate dossier has made it difficult for one individual to rank all applicants. Differences between undergraduate program structures, documentations, and evaluations render comparison of candidates from different institutions daunting. Objectives: This study used a 19-item, 10-point Likert scale to make candidate assess more objectively, identify the utility of various component of the dossier, and to assess the inter-rater reliability for evaluators within and between levels of training (faculty and resident). The aim was to make candidate assessment more objective and the component of the dossier that best differentiated the applicants. In addition, rater agreement was assessed. Methods: Two faculty and two residents independently reviewed all 103 applications received for the Obstetrics and Gynecology residency program at McMaster University. Evaluation items included all aspects of the CaRMS portfolio. Scores generated for each item along with a final score generated by each evaluator were calculated for each applicant. The 55 top-scoring applicants
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were invited for interview. Data was analyzed using SPSS and Generalizability Theory. Results: Inter-rater reliability within level of training was very high across all subscales. There was also high reliability across sub-sections. All raters found limited value to the transcript portion of the dossier, except as a red flag, because of inconsistent presentation across schools. Item Analysis identified several components of the subscale that may be omitted as they accounted for limited variability between applicants. Conclusions: Overall, this process provided a framework to develop a more objective assessment to ensure fairer evaluation of applicants.
AP-V03 EXPLORING HOW IPE TRAINING INFLUENCES FUTURE PROFESSIONAL PRACTICE: A QUALITATIVE STUDY Beth Murray-Davis Midwifery Education Program, McMaster University, Hamilton ON Introduction: The rationale for interprofessional education (IPE) is based on the assumption that it results in improved interprofessional practice. Despite the evidence that pre-qualifying IPE may be able to modify attitudes and provide knowledge and skills for collaboration, this evidence tells us little about whether these skills and attitudes can be transferred to professional practice. Objective: To explore how midwifery students who participate in pre-qualification IPE projects apply their learning to the context of professional practice. Methods: A theoretical sample of midwifery students, midwifery educators, Heads of Midwifery and newly qualified midwives from four universities throughout the UK participated in semi-structured interviews and focus groups. Emerging themes were developed using the principles of Grounded Theory. Categories and themes were organized using NVIVO. Results: Barriers preventing the application of IPE to clinical practice included the perceived lack of relevance of IPE competencies, the marginalisation of IPE curriculum from profession specific training, and the minimal support for the IPE agenda within the clinical setting. However, a continuum of IPE experiences throughout professional training, in both the academic and clinical setting, involving interaction with health professionals encountered in practice was found to promote transfer to practice. Conclusions: Novice practitioners were better able to apply their IPE training when interprofessional working and learning was made explicit within both the university learning environment and the clinical workplace. This understanding of how IPE influences professional practice is useful for IPE curriculum development for students and for continuing education for obstetric care providers.
AP-V04 EVALUATING THE IMPACT OF A MATERNITY CARE IPE PROGRAM ON UNDERGRADUATE STUDENTS: A QUALITATIVE ANALYSIS Filomena Meffe, St. Michael’s Hospital, Toronto, ON S. Espin, C. Moravac, M. Sharpe Introduction: Three nursing, three midwifery and three medical students participated in a 30 hour, 5 week hospital based program on interprofessional collaboration in maternity care. This
APOG
the “definitely interested” group listed good role models and positive clinical experiences as critical factors.
presentation will focus specifically on an analysis of transcripts from a focus group in which students reflected on their learning experiences. This presentation will review the method, process and outcome of the analysis of transcripts. Objective: The primary research question was: ”Does participation in the interprofessional education program on maternity care increase student knowledge, enhance skills and/or improve attitudes and level of motivation towards practicing collaborative care?” A series of quantitative measures were used to elicit an answer to this multi-dimentional question. The quantitative outcomes were richly enhanced by the data collected from the student focus group along with other qualitative measurement tools. Methods: Four researchers reviewed the verbatim transcripts from the student focus group. An iterative constant comparative approach was used to identify emerging themes. Consistency of coding and reliability was monitored by the team. Emergent themes were collapsed, re-analyzed, regrouped, and defined. Results: The students’ comments focused on key areas: (1) woman-centred care
Conclusions: Good role models and positive clinical experiences early in training have a deciding influence on career selection. The males in this survey report less early exposure to positive clinical experiences in Ob/Gyn (they were less knowledgeable on subject matter, sometimes felt excluded from clinical encounters by patients or nurses, and saw male Ob/Gyn role models only later in training after career paths were chosen). Addressing these concerns may encourage greater ongoing involvement by men in Ob/Gyn.
POSTER PRESENTATIONS
AP-P01 EFFECTIVE USE OF SIMULATION IN AN UNDERGRADUATE OBSTETRICS AND GYNECOLOGY CURRICULUM Margaret Burnett and M. Ford The University of Manitoba, Department of Obstetrics, Gynaecology and Reproductive Sciences, Winnipeg, MB
(2) interprofessional practice:
Introduction: Traditionally, undergraduate medical education consisted of a theoretical component followed by a clinical component. The student was expected to acquire factual knowledge and then learn to apply it by participating in patient care. Simulation provides new opportunities to facilitate the transition between books and the bedside.
(i) the transformational process in conflict resolution (ii) relationships (iii) communication (3) interprofessional process / uptake
Aims: To describe the integration of a graduated series of simulation sessions into an undergraduate Obstetrics and Gynecology program based on principles of adult learning.
Conclusions: The transcripts of the focus group clearly demonstrated evidence of increased student knowledge, improved attitudes towards interprofessional collaborative care and increased levels of motivation to practice interprofessional collaborative care. Students found that the program was generalizable to other areas of health care. Some found the experience to be transformational.
Methods: The educational objectives of the clerkship program were reviewed to explore those which might be achieved using simulation. We also identified areas where simulation was already being used successfully. A task analysis was performed to decide which specific skills were to be targeted. Simulators were identified by searching the medical education literature and attending clinical meetings, networking, and brainstorming. Trial and error were used extensively. Learners provided verbal and written feedback after each session.
AP-V05 PUTTING THE ‘GUY’ BACK INTO GYNAECOLOGY
Results: Simulated patients are used to teach communication skills, speculum examination and bimanual examination during Med I and again in clerkship. Speculum insertion, specimen collection, bimanual examination, and assessment of the labouring cervix are taught using pelvic models. Noelle® is used for the abdominal examination of a pregnant woman. Normal delivery is conducted using the Prompt® Birth Simulator. Suturing skills and episiotomy repair are performed on a beef tongue. Students generally found the simulation sessions enjoyable and felt better prepared to enter the clinical milieu.
Jessica Bogach (Meds 2011), Phil Hahn and Robert L. Reid Department of Obstetrics and Gynaecology, Queen’s University, Kingston, ON Introduction: There are currently equal numbers of male and female Ob/Gyns in Canada; however, the future looks “pink” as 80-90% of new applicants are female. The reasons for this dramatic shift in interest are unclear but some have suggested that males may feel less welcome to the specialty. Objective: To explore reasons for this gender shift and to make recommendations about how to encourage more males to consider the specialty of Ob/Gyn. Methods: A web-based survey was designed and distributed using StudentVoice to 400 Queen’s medical students in the current academic year. The survey elicited career preferences as well as factors that influenced these decisions. Results: 225 surveys were returned for a response rate of 56%. 114 (51%) respondents were male and 111 (49%) were female. Of all respondents 53% (114/215) reported Ob/Gyn was ‘definitely not’ what they wanted to do: 60% (68/114) male and 40% (46/114) female; (43%) 93/215 of the group remain undecided. The “definitely not” group males were twice as likely as females to cite ‘disinterest in the field’ and ‘not wanting to work only with women’ and three times more likely to indicate they were ‘uncomfortable with the subject area’ as reasons. Perhaps more importantly 77%(71/92) of the undecided group expressed “interest” in the specialty but cited ‘lack of exposure’ (45%, 41/92) as a reason for uncertainty. Three students indicated they did not want to work in an environment with mostly female colleagues. Not surprisingly
Conclusions: Simulation provides a stimulating educational environment that satisfies the principles of adult learning. Simulation represents an intense use of resources. Therefore, informationsharing about effective simulation and simulators is essential.
AP-P02 COMPARING THE EFFICACY OF VARYING LEARNING MODALITIES FOR COMPUTER-BASED EDUCATION IN ANATOMY Zaid Khot,1 Kate Quinlan,1 Marianne Baxter,1 Bruce Wainman,2 Geoff Norman3 1 Bachelor of Health Science (Honours) Program, McMaster University, Hamilton ON 2
Education Program in Anatomy, McMaster University, Hamilton ON
3
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton ON Introduction: The increased usage and accessibility of online resources can drastically alter how anatomy can be taught and
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learned. We must identify whether online material is comparable to traditional lab-based study with anatomical specimens. Objective: To determine the most effective mode of instruction for nominal and functional anatomy.
AP-P04 MONITORING SURGICAL EXPOSURE DURING RESIDENCY Karen Splinter
Methods: Twenty university students with no prior experience in anatomy and physiology were chosen. Subjects first completed the Vandenberg Mental Rotations Test (MRT), and then completed four stations testing different anatomical regions: static model (knee), dynamic model (upper arm), static illustration (pelvis), or dynamic illustration (foot). Subjects were given 10 minutes to study at each station, and 15 minutes to complete a quiz consisting of 15 nominal questions and five functional questions. Results: There was no correlation between MRT scores and test performance. Subjects scored significantly better on nominal questions when learning with model modalities (p<0.001). However, there was no statistical difference in performance on functional questions for static vs. dynamic learning (p = 0.557) or for model vs. illustration learning (p = 0.784). Overall, subjects scored highest on the dynamic model (arm station). Conclusions: Models are invaluable tools for learning nominal anatomy. However, models and illustrations are equally effective for learning functional anatomy. The use of static vs. dynamic modalities did not affect learning of either nominal or functional anatomy. A follow-up study is in progress, testing a single anatomical region (pelvis) for all modalities.
AP-P03 PERCEIVED VALUE OF RESIDENT CHARACTERISTICS: FACULTY AND RESIDENT PERSPECTIVE Sarah McQuillan and Kelly DoreMcMaster University, Hamilton, ON Introduction: The Royal College of Physicians and Surgeons of Canada have developed the CanMEDS roles, 7 areas of competence they deem important for all physicians. However, the relative value of each of these areas has yet to be assessed for our specialty. In order to develop more consistent and objective standards for admissions and in-program assessment it is important to consult stakeholders to determine perceived value of these qualities. Objective: This study was an attempt to assess the relative value of these characteristics in obstetrics and gynaecology residents. Methods: A survey of stakeholders, including faculty and residents, identified 7 characteristics based on the CanMEDS roles. A paired-comparison survey was then sent to all faculty and residents at McMaster. The survey presented the characteristics in all possible unique pairings; seven characteristics resulted in 21-paired presentations. Participants then decided which characteristic in each pair was more important for a resident. Paired comparison analysis was then performed, and all preferences were converted to z-scores. Results: Overwhelmingly, “ethical” was deemed to be the most important characteristic on which selection tools should be based (z = 8.97). The qualities of critical thinking and giving of oneself were perceived to have lower importance (z scores of 2.41 and 0.43 respectively). Conclusion: This study underscores the importance of determining in advance the more desirable characteristics for candidates. Future research would seek to assess the stability of these results on a national level, looking for differences between subspecialties as well as level of training.
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Memorial University, St John’s, NL Introduction: Surgical training is an integral part of OB/GYN residency and requires repeated exposure to the OR. Objectives: A questionnaire was created to determine if there were any significant differences in surgical exposure among OB/GYN residency programs in Canada and compare how surgical exposure was documented. Methods: The members of the SOGC Junior member committee were sent an online survey (2 resident members from each program). The survey contained multiple choice and open ended questions. Results: 20 residents responded, representing 14 of 16 programs. A majority of residents reported being a first assist in general obstetrics (90%) and gynaecology (74%) procedures in first year. Approximately half of residents will begin as the primary surgeon in obstetrics during their first year (47%). Sub-specialty exposure in the operating room was related to rotation order, with most rd th residents gaining exposure in 3 or 4 year (35% +/- 17% and 47% +/- 14%, respectively). In order to increase OR time, the majority of programs arrange out of town electives from second to fifth year. 31% of respondents used an online system for logging procedures. 31% relied on keeping OR slips, 25% used informal review with program director and 12% reported no system at all to monitor OR exposure. Conclusions: Although residents continue to seek increases in operating room time, there does not appear to be any significant differences in exposure. Programs using an organized system to monitor residents’ OR logs will be able to identify any differences in exposure among residents and hopefully rectify it before disparity in skills emerge.
AP-P06 STATUS OF ENDOSCOPIC TRAINING IN CANADIAN OB/GYN RESIDENCY PROGRAMS: AN SOGC JUNIOR MEMBER COMMITTEE SURVEY Kristina Arendas,1Ardelle Stauffer,2 Sukhbir S. Singh1 1 Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON 2 Department of Obstetrics and Gynecology, University of Saskatchewan, Saskatoon, SK
Introduction: There is a need for a standardized gynaecologic endoscopy curriculum for Ob/Gyn postgraduate training. Currently every university program sets their curriculum and provides diverse teaching in gynaecologic endoscopy. This may create discrepancy in the type and amount of endoscopic training residents from various programs receive. Objectives: To identify the current status of endoscopic training in Canadian Ob/Gyn postgraduate training programs and to determine whether there is a need for an endoscopy training course at the national level. Methods: A national survey of Ob/Gyn residents through the SOGC Junior Member (JM) Committee. Each university’s JM committee representative received an on-line survey. The representatives polled local residents and summarized the feedback requested from the survey on their behalf. Results: Fourteen of sixteen Canadian Ob/Gyn postgraduate programs surveyed completed the questionnaire. 85% of programs who responded have endoscopic training programs at their university. The type of training varies greatly from one
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program to another. There is 100% interest in a Canadian national endoscopic training course among respondents. Residents would prefer a mobile course if it were possible consisting of primarily hands-on lab training. Comments were also collected and will be presented.
clinical encounter log. Students are aware that preference is given to topics to which the student has had direct clinical exposure. Objective: To determine whether linking the log and assessment improved logging accuracy and encouraged self-directed study.
Conclusion: There currently is a need to further address endoscopic training in Ob/Gyn in Canada. A national endoscopic training course would be welcomed by all residents surveyed. APOG and national stakeholders should pursue such an initiative.
Method: A cohort of students were asked to complete an anonymous web-based survey on two occasions: after completing the core ob/gyn rotation in which the log is linked to assessment and after completing the core surgery rotation where there is no link. The survey explored logging habits and study habits related to the logged objectives as well as students views about the log and its impact on their learning.
AP-P07 CAN FORMAL INSTRUCTION AND SIMULATION IN CAESAREAN SECTION ALLEVIATE TRAINEE STRESS?
Results: Students on the ob/gyn rotation logged more frequently but not with more accuracy or honesty. They consider the log an administrative task with only a minority finding it useful to their learning. Students found that there was a lack of awareness amongst faculty and residents about student learning objectives.
Hisham Khalil,1 Hassan Shenassa,1 Glenn Posner,1 Dante Pascali.1
Conclusion: Students continue to believe that the clinical log lacks educational value. There was no apparent benefit in linking it to assessment.
1 University of Ottawa, Department of Obstetrics and Gynecology, Ottawa, ON
Introduction: Residents routinely perform Caesarean sections during their training. Despite mounting evidence regarding the benefits of simulation, little research has examined the training residents receive prior to performing a Caesarean section. Among first year obstetrics and gynecology residents at the University of Ottawa, none reported formal training prior to performing their first Caesarean section. Objective: To determine if formal instruction and simulation in Caesarean section can alleviate trainee stress and increase surgical knowledge. Methods: We piloted a Caesarean section course and simulation adapted from the Structured Operative Obstetrics (SOO) course developed by the Canadian Network for International Surgery (CNIS). Resident comfort and knowledge were evaluated using a Likert based questionnaire. Results: We identified a 22% increase in confidence performing caesarean section, and a 21% increase in comfort with suturing skills following completion of the course. We also captured a 17% increase in knowledge based test scores. Conclusion: In this pilot study, trainee confidence and surgical knowledge improved following of Caesarean section simulation and formal instruction.
AP-P08 DEVELOPMENT AND IMPLEMENTATION OF A LOG-BASED ASSESSMENT TOOL IN A CORE OBSTETRICS AND GYNAECOLOGY CLERKSHIP ROTATION Susan M. Chamberlain, and Phil Hahn Department of Obstetrics and Gynaecology, Queen’s University, Kingston ON Introduction: LCME medical school accreditation mandates student logging of clinical experiences during core clerkship rotations. However, students do not fully engage in this endeavour as they don’t perceive any personal educational benefit. In addition to the MCQ examination, a structured oral examination (SOE) was implemented to assess knowledge in the core ob/gyn clerkship rotation. Topics examined in the SOE are based on LMCC objectives and are selected after reviewing the student’s
AP-P10 DO PODCASTS MEASURE UP? MEDICAL STUDENTS’ PERCEPTIONS OF THE UTILITY OF PODCASTS IN MEDICAL EDUCATION Lyana Sisca,1Lynne Zolis,1 Filomena Meffe,2 Michele Farrugia2 1
University of Toronto, Toronto, ON
2
Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON Introduction: There has been an increasing interest in web based tools, such as podcasts, for dissemination of research and education. Podcasts are digital media files available in both audio and audio-visual formats. Podcasts have the advantages of being inexpensive, easily accessible, and can be conveniently listened to almost anywhere with a portable MP3 player or laptop computer. Many educational institutions use technologies such as podcasts to supplement curriculum. Medical student have limited time, particularly in their clinical years, requiring them to multitask. Podcasts can deliver a digestible amount of information on demand, making them an attractive tool for medical education. Objective: To assess the perceived utility of Obstetrical and Gynaecological podcasts among undergraduate medical students during their Obstetrics and Gynaecology rotation at the University of Toronto. Methods: We have created 6 podcasts, 15-30 minutes in length, covering Obstetrics and Gynaecology topics. The podcasts review relevant course material as outlined by the course objectives and are posted on the internet for free download. During this academic year, approximately 240 third-year medical students will rotate through a 6-week Obstetrics and Gynaecology block and will have access to these podcasts. At the end of each of the rotations, the medical students will be provided with a questionnaire assessing the use of digital study tools and the perceived utility of the obstetrics and gynaecology podcasts for their learning of the material and preparation for their examination. Results: The questionnaires will be collated as each group of students completes their rotations for further analysis. Conclusions: In progress.
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