Download International Teaching, Other

FRIDAY, MARCH 6, 2015
9:30 am – 10:45 am
CONCURRENT SESSIONS
ABSTRACT PRESENTATIONS
Group 3 (International Teaching, Other)
Bringing Laparoscopy to Haiti: A Pilot Program
Nancy Z. Tang, MD
Maimonides Medical Center, Stony Brook University Hospital, New York, NY
Christina Pardo Maxis, MD , Xun Lian, MD , Christophe Milien, MD , Meredith Jean
Baptiste, CNM
Objective: To create a collaborative and sustained partnership between Physicians for
Haiti, Stony Brook University Hospital and the gynecology department at Hôpital
Universitaire de Mirebalais (HUM) in Haiti to provide continued medical education on
laparoscopic surgery.
Methods: The gynecology department at HUM identified a need for learning minimally
invasive surgical techniques for improved patient care. Eleven Haitian OBGYN
physicians were enrolled in a one week didactic and simulation-based laparoscopy pilot
workshop. Participants were given a knowledge assessment before and after the
course. The learners attended eight hours of lecture, integrated with six hours of
simulation training.
Results: All eleven participants stated that their knowledge of laparoscopy prior to the
workshop was “poor” but were “very interested” in increased training. 82% reported
having observed at least one laparoscopic case, but only 18% reported assisting in any
of those procedures. The average knowledge evaluation before training was 44.6% and
upon completion was 75.9%. Most providers identified diagnostic laparoscopy and tubal
sterilization as the initial surgeries that would be most beneficial for clinical training.
Conclusion: This collaborative pilot workshop demonstrates that while baseline
knowledge of laparoscopy is limited in this setting, improvement in knowledge over the
one-week training was attainable. This multi-year educational collaboration will
subsequently include additional teaching, simulation and subsequent mentorship for
clinical integration of newly acquired skills. This pilot demonstrates foundational training
for a sustained collaboration to provide fundamental knowledge and experience in
laparoscopic gynecologic surgery in a tertiary care center in rural Haiti.
Key Words: Global Health, Laparoscopy
Improving Resident Hand-Off: Implementing a Standardized Electronic Hand-Off
System
Marie C. Nelson, MD
Alegent Creighton Health - Creighton University Medical Center, Omaha, Nebraska
Rena Lohr, DO, Christopher Glowacki, MD
Objective: We aimed to improve transitions in patient care and resident efficiency by
implementing a standardized electronic hand-off system that would provide a HIPPA
compliant, up-to-date, consistent method for recording and transmitting patient
information among residents.
Methods: We met with members of the Creighton Transitions in Care committee to
evaluate current needs for improving transitions in patient care. We determined that a
standardized electronic hand-off system that could be implemented across all residency
programs within the Creighton University system was the best model to improve patient
safety and resident efficiency.
We surveyed all residents in the Creighton University Medical Center system to
evaluate current practices in transitions in patient care. After implementing the eHandoff™ system, we re-surveyed residents to evaluate resident perceptions of how
the electronic system was affecting patient care.
Results: Initial survey results revealed a wide variety of hand-off methods with 64% of
residents satisfied or very satisfied with their handoff systems. However, more than 50%
of residents surveyed reported errors of omission occurring in hand-offs greater than
once per week. After implementation of e-handoff, 71% of residents were satisfied with
the new hand-off system and 90% of residents felt that errors of omission had either
decreased or stayed the same since the transition.
Conclusions: Transitions in patient care are a necessary component of caring for
patients in the hospital setting. Implementing a standardized electronic hand-off for
residents improves efficiency and may reduce errors of omission in transitions of care
that could negatively impact patient care.
Key Words: transition, e-handoff
The Effect of Resident Participation on Outcomes in High-Order Cesarean
Sections
Mirella Mourad, MD
Icahn School of Medicine at Mount Sinai, New York, New York, New York, NY
Simi Gupta, Stephanie Melka, Andrei Rebarber, Daniel H. Saltzman, Nathan S. Fox
Study Objective: To estimate the effect of resident participation on outcomes in
women undergoing high-order cesarean sections.
Methods: Historical cohort of patients in one obstetrical practice undergoing a tertiary
or higher order cesarean delivery from 2005-2014. Patients with placenta previa,
placenta accreta, or those whose cesarean section resulted from a failed VBAC were
excluded. We compared outcomes between patients whose operations were performed
by two attendings in the group to patients whose operations were performed by one
attending in the group and one resident. Regression analysis was performed to control
for confounding variables.
Results: 370 patients were included, 189 (51%) of whom had two attendings, and 181
(49%) of whom had one attending and one resident. The groups were similar at
baseline in all regards except the resident group trended towards fewer prior cesarean
sections. Controlling for this variable, there was no difference in measured outcomes
between the groups, including estimated blood loss, operative time, % drop in
hemoglobin, blood transfusion, operative complications (cystotomy, bowel injury),
postoperative endometritis, postoperative days in the hospital, and wound
complications. Among patients in the resident group, there was no difference in
outcomes between cases performed by a junior (1st or 2nd year) resident compared to a
senior (3rd or 4th year) resident.
Conclusions: Resident participation does not negatively affect outcomes in patients
undergoing high-order cesarean sections. Residents should be included in these
complicated cases as they can obtain a significant learning experience without
compromising patient safety.
Key Words: Cesarean, resident
Ob/Gyn Resident Attitudes Regarding First Trimester Elective Terminations
Geoffrey H Gordon, MD
Providence Hospital and Medical Centers, Southfield, Michigan
Alicja Sobilo, BS, Robert G Dodds, MD
Study Objective: Abortion training is required for all OB/Gyn residents training in
ACGME programs. We surveyed Ob/Gyn residents to determine if attitudes about
future practice of first trimester elective termination changed based on post graduate
year of training.
Methods: We identified 270 Ob/Gyn residency program directors (PD) and forwarded
the survey. The PD was asked to forward the link to their residents and respond as to
the number of residents included. The protocol was IRB approved and analyzed with
chi square on Prism Software. A P value of less than 0.05 was considered significant.
Results: We received 21 responses from PD for a total of 468 residents who received
the survey. The response rate was 54.9%. Predictors of performing first trimester
elective terminations (FTET) after residency were prior interest and currently performing
FTET (P<0.0001). We observed no significant difference between post-graduate year
in training regarding FTET attitudes. Only 33 respondents were training at religiously
affiliated institutions.
Conclusions: Post graduate year of training had no impact of future intentions for
practicing FTET. Our positive predictors were comparable to previous studies regarding
predictors of future practice in FTET. Factors that were not predictive of future FTET
included the academic affiliation and religious affiliation of the hospital. Our response
rate from residents training at religiously affiliated institutions was very low. Further
studies would be needed to truly evaluate the impact of training at a religious-based
institution on Ob/Gyn resident's future practice of FTET.
Key Words: Abortion, Termination, Training
Behavioral Interviewing and Correlation with Performance in Residency Training
Benjamin D. Beran, MD
Medical College of Wisconsin, Milwaukee, WI
Paul M. Lemen, MD, Raj Narayan, MD
STUDY OBJECTIVE: Behavioral interviewing (BI) uses past behaviors in an attempt to
predict future performance. Validation is demonstrated in some formats, especially
outside of the healthcare professions. We sought to validate our institution’s
incorporation of BI in the resident interview process by determining correlation of
behavioral and traditional interview scores to resident performance evaluations.
METHODS: Behavioral and traditional interview scores of 44 matched residents from
2006-2011 were analyzed with up to four years of performance evaluation data to
determine correlations. Traditional interview scores consisted of an average score from
four different faculty members, and a resident panel. Faculty and nursing teams
completed performance evaluations of residents on a rolling basis through the academic
year, and the average annual evaluation score for each resident was used for
comparative analysis. Using analysis of variance, correlations of each of the three
interview scores to resident performance evaluations were determined.
RESULTS: Behavioral interviewing scores did not correlate with resident performance
evaluation scores from either faculty or nursing teams. Traditional faculty interviews and
the resident panel interview scores correlated with resident performance evaluation by
faculty. The resident panel score had stronger correlation than the traditional faculty
interview score. In addition, only the resident panel interview score had correlation to
performance evaluations from the nursing teams.
CONCLUSION: Behavioral interviewing was not a valid predictor of resident
performance. This is contrary to previous reports in the literature.
KEY WORDS: behavioral interviewing, residency