The Association of Professors of Obstetrics & Gynaecology of Canada
L’Association des professeurs d’obstétrique et gynécologie du Canada
APOG ABSTRACT PROGRAM th 36 Annual Meeting Introduction / Foreword ducational Research is an important component of the APOG Annual Meeting as it assists each of our member departments, at all levels, with the difficult task of transferring educational knowledge to learners. The 2007 APOG Abstract Program had a wide field of topics all of which stimulated interest and discussion. As a partner in the STIRRHS program, APOG was pleased to have also had the opportunity to showcase some posters from students involved in transdisciplinary research.
With the many new emerging technologies, and the implementation of the CanMEDS framework, there are always new ways to improve the methods we currently use to educate faculty, residents, and medical students. The APOG Abstract Program facilitates this process by allowing all of our members to build on each other’s success. I would like to take this opportunity to thank each of our abstract presenters and organizers for contributing to the success of our meeting. We look forward to seeing you at APOG’s 37th Annual Meeting in December.
Dr. Patrick Mohide President, APOG
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APOG APOG ORAL PRESENTATIONS AP-V01 COMPETENCIES FOR GYNAECOLOGICAL ENDOSCOPY IN OB/GYN TRAINING: THE CANADIAN ENDOSCOPY EDUCATION STUDY S. Singh,1 A. M. Ternamian, V. Marcoux, V. Cheung, D. Martin 1University of Ottawa, Department of Ob/Gyn, Ottawa, Ontario, Canada
Introduction: Contemporary Canadian guidelines for operative laparoscopy and hysteroscopy education in general Ob/Gyn training programs do not exist. The complexities of surgical education in this field with the added challenges of a lack of qualified mentors and limited resources for teaching require program development at a national level. Objective: To identify a set of core competencies, through expert consensus, for a standardized endoscopy curriculum in general Ob/Gyn residency programs. Methods: All 16 academic Ob/Gyn residency programs in Canada were asked and agreed to participate. Each program nominated an endoscopy educator to represent them in the consensus process. The Delphi technique for consensus building was applied using on-line anonymous surveys in three consecutive rounds. Results: Key competencies for endoscopy education in gynaecology in the technical and knowledge domains were established through literature review. Round 1 determined the list of core competencies to be included in a general Obstetrics and Gynaecology residency program. Competencies that did not achieve consensus and any new suggestions were reviewed through two additional rounds until consensus was obtained. Overall, 213 objectives were reviewed and 93% (199) of the items reached consensus agreement. Competencies that were deemed outside the realm of general residency education were also collated and may represent a guide to sub-specialty fellowship training in the future. Conclusions: This study offers a national expert consensus regarding gynaecologic endoscopy teaching competencies. Using the results of this study, a contemporary and comprehensive national curriculum in endoscopy may be developed.
AP-V02 CURRICULUM DEVELOPMENT: USING FILM TO TEACH DIVERSITY AND INCLUSION IN MEDICINE J.L. Bodley,1 M. Farrugia 1University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Introduction: Teaching and learning about diversity in medicine is an essential component of postgraduate training for many reasons and relates to several CanMEDS Roles including: Health Advocate, Communicator, Collaborator, Professional and Manager. In an effort to expand the obstetrics and gynaecology postgraduate curriculum at the University of Toronto a new teaching session was created and introduced to senior trainees (PGY3-5). Objective: The objective of this new curriculum is to promote teaching and learning about diversity in medicine in an innovative
manner that is meaningful and specifically relevant to the topic and the related CanMEDS roles. Methods: A three hour teaching session was divided into a 40minute discussion about diversity, racism, CanMEDS roles, and the patient-physician relationship, followed by the viewing of a popular film that illustrated many of the related issues and problems. This was followed by a brief discussion regarding the importance of ongoing reflection both as it related to the film as well as to our own experiences. Results: To date, this new curriculum has received positive feedback from the attendees and initial evaluation scores averaged 4.7/5. Verbal comments have supported the use of film to maintain interest and heighten awareness around the topics introduced. Conclusions: Teaching and learning about diversity in medicine in an obstetrics and gynaecology postgraduate program is enhanced by the use of film and open discussion that relates to everyday experiences.
AP-V03 PRÉSENTATION DU PORTFOLIO DE RECHERCHE POUR LES RÉSIDENTS EN GYNÉCOLOGIE OBSTÉTRIQUE ET EN ENQUÊTE INITIALE SUR SA PERTINENCE J. Pasquier,1 J. St. Laurent, S. Desindes 1Université de Sherbrooke, Sherbrooke, Quebec, Canada
Introduction : Le portfolio a plusieurs objectifs : faire un bilan des compétences, visualiser le parcours de l’étudiant, favoriser l’auto-évaluation, développer l’autonomie et être un moyen de communication. Les résidents en gynécologie-obstétrique de Sherbrooke doivent élaborer un projet de recherche. Nous avons mis en place un portfolio de recherche remis en fin de première année au résident. Il se présente sous la forme d’un cartable divisé en 4 sections reprenant la progression proposée par l’APOG. Un e-portfolio complémentaire est en cours de réalisation. Objectif : Évaluer la perception initiale d’un portfolio de recherche par les résidents en gynécologie obstétrique. Méthodologie : Une enquête d’opinion anonyme été réalisée auprès de nos résidents testant leurs croyances et attitudes par rapport à l’utilisation, la pertinence et la satisfaction d’un tel outil pour la recherche Résultats : Soixante-quinze pour cent des résidents ont complété le questionnaire. Quartre-vingt-deux pour cent ont trouvé le portfolio pertinent pour l’élaboration et la réalisation de leur projet de recherche. La majorité ont répondu bien vouloir l’utiliser lors de leur prochain projet de recherche. En revanche 16 % répondants ont exprimé ne pas penser prendre du temps avec le mentor de recherche pour commenter le contenu du portfolio. Vingt-cinq pour cent des répondants ont trouvé que le portfolio était complet et la majorité a exprimé des suggestions pour l’ajout de matériel didactique. Conclusion : L’utilisation du Portfolio en recherche est un outil original en cours de constitution et d’évaluation qui a reçu un premier accueil favorable de la part des résidents qui vont l’utiliser.
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AP-V04 Survivors Teaching Students E. Ross,1 M.I. Fitch, F. Turner, A. McAndrew 1Ovarian Cancer Canada, Toronto, Ontario, Canada
Introduction: Survivors Teaching Students is a national program for medical/nursing students designed to sensitize them to the symptoms of and, risk factors for, ovarian cancer; increase awareness of hereditary aspects of ovarian cancer; present positive ways of breaking bad news, and use statistics in meaningful ways when discussing prognosis. Ovarian cancer survivors share personal experiences with the students in a classroom setting. They are especially trained to give these presentations. Methodology: The two-stage evaluation process includes the survivors’ evaluation of their training and the students’ evaluation of the survivor presentations. The survivors complete post-training evaluations. Follow-up survivor interviews are conducted following a student presentation. During the second stage of the evaluation, students are asked to complete pre- and post-presentation surveys. They have the option to complete a third online survey in six months. Results: Survivor study results are based on four training sessions across Canada. Twenty-nine survivors completed the post-training evaluation. Data for the student presentations were collected from nineteen sessions across Canada. Six hundred and eighty-five students have completed the pre-presentation survey and seven hundred and twenty-six have completed the post-presentation survey. Fifty-four have completed the online survey. Data collection continues. Conclusions: The survivors view the training as a positive experience and this program as an excellent opportunity to influence future healthcare professionals. The students reported the presentation increased their awareness of ovarian cancer, and its symptoms. The stories put a human face to a devastating illness such as ovarian cancer.
AP-V05 Gender and Unintended Pregnancy: A Web-based Teaching Modality for Learners of Women’s Health. C. Jones,1 D. Costescu,1 B. Lent, D. Penava 1Schulich School of Medicine and Dentistry, London, Ontario, Canada
Introduction: Web-based learning is an emerging component of medical curricula. This technology allows for the expansion of the breadth of medical education to include a greater number of topics, some that have been difficult for both learners and facilitators to teach in traditional didactic settings.
pregnancy and interested medical educators reviewed the content both in terms of information and presentation. Results: The project took approximately 40 hours of collective work. Use of the SAT requires orientation and training; however ease-of-use improved with time. Creating the module allowed both authors and learners to gain knowledge in the area of unintended pregnancy and pregnancy options counselling. Content can be updated in whole or in part over time. Conclusions: Creating web-based academic material provides opportunities for both learners and students interested in medical education to gain knowledge in topics that may be difficult to address in the didactic setting. Most medical students would be able to complete such a module during elective time.
POSTER PRESENTATIONS AP-P01 Evaluating Interprofessional Education Among Obstetric Learners A.M. Malott McMaster University, Hamilton, Ontario, Canada
Introduction: Numerous recent reports have identified the need for collaboration among maternity care providers. Collaboration is dependent on effective communication and having a clear understanding of interprofessional roles. Strategies for effective communication and collaboration are learned. Interprofessional education is one way to reduce barriers to collaboration and to better prepare clinicians for interprofessional practice. Objectives: The purpose of this study was to determine whether an interactive, interprofessional workshop on consultation in obstetrics enhanced interprofessional understanding? Methods: A combined qualitative and quantitative questionnaire designed to assess interprofessional understanding was administered to obstetrical residents and level 3 midwifery students. Participants were anonymously asked how an interactive workshop on consultation influenced their understanding of interprofessional collaboration. They rated components of the session, the use of scenarios to enhance understanding and relevance to one’s career.
Objectives: Two medical students interested in Obstetrics and Gynaecology, as part of a self-directed fourth-year elective course, pursued the development of an online, case-based teaching module through www.genderandhealth.ca addressing unintended pregnancy.
Results: Twenty-four of 28 participants (86%) completed the evaluation tool. Overall satisfaction was high for both groups with mean scores from 5.5 to 6.37 on a seven point Likert scale. Mean scores were not significantly different between groups with highest value placed on career relevance. Responses to qualitative questions revealed the importance of respectful, effective communication and understanding roles and scope of practice. Participants valued case based discussions with perspectives of other disciplines. References were made to collaboration improving patient care.
Methods: The authors identified a topic, and reviewed academic literature, medical organizations, lay press, and the Internet for ‘article’ content. The module content consists of series of articles, pictures, and interactive questions, presented in a case-based format. The module was constructed with the “Self-Authoring Tool” (SAT), a web-based authoring tool. Experts in unintended
Conclusion: An interactive interprofessional workshop on consultation in obstetrics enhanced interprofessional understanding in obstetrical residents and midwifery students. Participants welcomed interprofessional education and requested more such opportunities.
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APOG Abstract Program
AP-P02 A Hands-on Approach to Improving a High Risk Obstetrical Rotation During Third Year Clerkship 1
J. L. Bodley, J. Barrett 1University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Introduction: During a six week mandatory clerkship rotation in obstetrics and gynaecology at our centre, medical students are assigned to a high risk obstetrics inpatient service (HRS). This component accounts for one sixth of the overall rotation and has often received poor ratings on final evaluations and exit interviews. Many students have commented that there is either inconsistent (or no) teaching and that the learning is theoretical with little opportunity for clinical practice. Objectives: To determine if the provision of specific guidelines for learning with an open discussion at orientation about the nature of the HRS rotation will improve the medical students’ experience as reflected in the comments provided at the end of rotation. To assess impact on teaching evaluation scores of HRS faculty following this intervention. Methods: Specific learning objectives were developed by one of the authors (JLB) from the overall course objectives and reviewed by the Chief of the service. These objectives were given to the students at the commencement of the rotation and to each teaching member of the HRS division. A comparison of students’ comments as well as teaching effectiveness scores for the HRS division on mandatory evaluations completed at end of rotation (pre and post intervention) will be compared. Results: The results will be based upon the teaching effectiveness scores of the group as a whole and individually pre and post intervention. (This is research in progress). Conclusions: We will hopefully demonstrate that the communication of clear learning objectives to both students and staff is an effective intervention to improve the learning experience of the students on an HRS rotation.
AP-P03 Motivation et Sentiment des Femmes Participant une Étude Contrôlée Randomisée en Périnatalité J. Pasquier,1 S. Moret
>20 minutes. Elles avaient le sentiment que l’étude était sérieuse et que leur participation pourrait aider d’autres parents. Par contre, 48% des femmes ayant refusé disaient avoir le sentiment d’être « prise pour un cobaye». Conclusion : Les résultats suggèrent qu’une information de qualité présentée par un médecin motivé semble influencer les femmes à participer à des études. En revanche, il semble être essentielle de rendre encore plus respectueuse les procédures envers les futurs sujets.
AP-P04 Barriers to Teaching by Obstetrics and Gynecology Residents N. Kent,1 M. Gogela-Spehar, L. Brotto, L. Sadownik 1University of British Columbia, Vancouver, BC, Canada
Introduction: Teaching is an integral part of every resident’s job description. As teachers, obstetrics and gynaecology residents face unique challenges. Objectives: The purpose of this study was to identify factors that obstetrics and gynaecology residents feel limit their teaching, with the ultimate goal of developing strategies for overcoming barriers. Methods: As a part of a larger study, a web-based questionnaire characterizing obstetrics and gynaecology residents as teachers of medical students, and assessing what barriers to teaching residents face, was developed. It was sent to 64 second to fifth year University of British Columbia, University of Calgary and University of Alberta obstetrics and gynaecology residents. Results: The survey had a 61% response rate. The majority of respondents had minimal teaching experience outside of residency. In residency, most had been neither instructed on how to teach nor evaluated on their teaching effectiveness. While residents were keen to receive formal instruction on how to be good teachers, they were reluctant to be evaluated on their teaching of medical students. 95% of the residents identified lack of time as the top barrier to their teaching. The second most commonly identified obstacle was poor attitude on the part of the medical students (47% of respondents). Lack of support from department members, including staff physicians and nursing staff, was seen as an obstacle by 29% of the residents. Conclusions: As teachers, obstetrics and gynaecology residents face important challenges. If CanMEDS objectives are to be met, these barriers need to be addressed by the residents’ training programs.
1Université de Sherbrooke, Sherbrooke, Québec, Canada
Introduction : En recherche, le recrutement d’un nombre adéquat de sujets est un problème constant et récurent. Le recrutement en périnatalité présente une situation unique : la décision de la mère implique autant sa santé que celle de son fœtus. Objectif : L’objectif de l’étude était d’examiner la motivation et le sentiment des mères qui ont accepté ou refusé de participer à un ECR sur les RPM. Méthode : Un ECR organisé dans 22 maternités afin de vérifier l’efficacité de la naissance prophylactique versus l’attitude expectative après une RPM (28-31 SA) a servi de support à l’étude. Un protocole d’information structuré était utilisé lors du recrutement des femmes et 56% des mères acceptèrent de participer à l’étude. Une semaine après la randomisation, les mères ayant accepté et ayant refusé de participer à l’ECR étaient invitées à compléter un questionnaire. Résultats : Les connaissances sur le RPM et le protocole étaient similaires dans les deux groupes. Au moment de prendre leur décision, les mères ayant accepté l’ECR mentionnaient plus souvent avoir reçu : une information de grande qualité,
AP-P05 (STIRRHS) Amsel Criteria Compared Gram Stain Method to Diagnosis of the Bacterial Vaginosis R. Behruzi,1 Z. Moussavi 1Université de Montréal, Faculty of Medicine, Montréal, Québec, Canada
Introduction: Two well-described diagnostic methods for bacterial vaginosis are clinical or wet-smear diagnosis (Amsel criteria) and Gram stain diagnosis (Nugent criteria). Objective: Our objective was to compare diagnostic Amsel criteria and Gram stain diagnosis of bacterial vaginosis. Methods: Between June 1999 and November 2001, all non-pregnant women aged 16 years or older who referred to gynecologic clinic with a complaint of vaginal discharge were examined for detection of bacterial vaginosis by diagnostic methods of Amsel and Gram stain. Clinical diagnosis of bacterial vaginosis (Amsel criteria) was
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considered positive if at least three of the following four characteristics were seen: a homogenous appearance of the discharge, pH value >4.5, release of a fishy amine odor on addition of potassium hydroxide (Whiff test) and presence of clue cells. Amsel criteria were compared with Gram stain diagnosis. Results: One hundred two patients were diagnosed with bacterial vaginosis. When compared Gram stain diagnosis of bacterial vaginosis as the standard method, Amsel criteria had sensitivity of 78% a specificity of 88% a positive predictive value of 95% and a negative predictive value of 58%. The utility of various single tests for the diagnosis of bacterial vaginosis as compared with the Gram stain showed lower diagnostic validity. Conclusion: Gram stain is a reproducible and reliable test for diagnosis of bacterial vaginosis and Amsel criteria must be confirm by Gram stain.
pre-clerkship included clinical application exercises (CAE) and tutorial performance. The clerkship evaluation methods comprised of 20 independent clinical encounters using encounter cards, completion of 23 e-learning modules, and performance in clinical placements in hospital and ambulatory Obstetrics/Gynaecology setting as well as results from the National Medical Board Examination (Obstetrics and Gynaecology) and performance in an OSCE. Conclusions: The new curriculum in Reproduction and Obstetrics/Gynaecology has revitalized education at McMaster. The development of an Objectives grid as part of the instructional analysis and design was critical in this renewal.
Keywords: Amsel criteria; Gram stain; Bacterial vaginosis
AP-P06 The Ten Week Curriculum in Obstetrics & Gynecology: The Development, Design and Implementation of an Objective Driven Curriculum at Mcmaster University. A. J. Cullimore,1 V. M. Mueller,1 D. Campeau,1 P. T. Mohide,1 A. Levinson,2 K. L. Dore2 1McMaster University, Department of Obstetrics and Gynecology, 2Program for Educational Research and Development, Hamilton, Ontario, Canada
Objective: To review the process of curriculum renewal that occurred at McMaster University in reproduction and Obstetrics and Gynaecology. Methods: Using multiple resources, the Undergraduate Obstetrics and Gynaecology Education Committee developed objectives for both the pre-clerkship and clerkship programs. The curriculum was designed and developed so that concepts were sequenced throughout, such that students continued to build on their knowledge base and clinical skills. In this way the pre-clerkship and clerkship would not function in isolation from each other. Results: Following analysis and design, an innovative curriculum was developed through identifying key elements within an objectives ‘grid’ or matrix, including: objectives, timing within the curriculum, teaching method, evaluation methodology, competencies and resources. The reproductive pre-clerkship curriculum included PBL, clinical skills and large group sessions. Clinical clerkship teaching methods included the development of e-learning modules, simulation, discussion forums and small group learning sessions. Evaluation techniques for the
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What are the Components of Humanized Childbirth in a Highly SpecializeD Hospital? An Organizational Case Study R. Behruzi,1 M. Hatem, L. Goulet, D. Francoeur, N. Leroux, N. Leduc, L. Lamothe 1Université de Montréal, Faculty of Medicine, Montréal, Québec, Canada
Introduction: During the past decades, giving birth has developed into a highly medicalized procedure. Humanizing birth is considered as an alternative model for medical and technological childbirth. While the literature is abundant regarding the humanization of low risk obstetrical care, the context of a highly specialized level 4 hospital where most of pregnancies are at high risk and have special needs that request special attention are less addressed. Objectives: 1) to define the specific components of the humanized care that brings satisfaction to the concerned population and 2) to explore the organizational and cultural dimensions in the institutional framework which would act as barriers or facilitators for birth practices ensuring such humanizing care in a highly specialized, and university affiliated hospital in Quebec. Methods: A case study with embedded levels is the chosen research strategy. The study population is composed of individuals from different administrative and health professional levels of the hospital as well as women (at different levels of obstetrical risk) who are admitted to deliver their babies in the maternity wards of Saint-Justine’s Hospital. Multiple sources of data are to be used: documentation, archival records, semi-structured in-depth interviews, direct observations, and self-administered questionnaires assessing women’s satisfaction with the quality of care. Qualitative and quantitative data analysis will be realised. Expected Results: The findings of the present study will be used to develop a conceptual model of care to promote, protect and support humanized childbirth in highly specialized hospitals.