Original Study
Reliability Study for Pediatric and Adolescent Gynecology Case-Based Learning in Resident Education

https://doi.org/10.1016/j.jpag.2009.09.002Get rights and content

Abstract

Objective

To assess web-based teaching as a tool for resident education in pediatric and adolescent gynecology.

Study Design

Prospective Cohort involving 12 third year OB/GYN residents in a large university-based program. A second look reliability study on a previously utilized, web-based teaching case series in Pediatric and Adolescent Gynecology topics was evaluated. Residents' knowledge regarding the subject matter was assessed by pretest. After completion of the web-based teaching tool, a post test was administered. Residents were also given an opportunity to provide feedback regarding improvements to address future case series development for the tool and resident satisfaction in using this resource for resident education.

Results

The pre-test group mean score was 11.2 (58.9%), SD = 1.9. The post-test group mean score was 15.2 (80%), SD = 1.70. (P = 0.0002). Resident participants universally reported the case series was a useful teaching tool. Pooled results from 2005–2006 and 2007–2008 also yielded statistically significant scores from pre test to post test (power of >80% at the 95% confidence interval).

Conclusion

A computer-based learning tool is an effective resource to improve baseline knowledge among ob-gyn residents in the subspecialty field of Pediatric and Adolescent Gynecology.

Introduction

Obstetrician Gynecologists are frequently called upon to perform a gynecologic evaluation on a child or an adolescent female.1 The comfort level among Obstetrician Gynecologists may vary, depending on the degree of exposure to children and adolescents during residency training.2 Pediatric and Adolescent Gynecology (PAG) has been a part of residency training for many years in the fields of Pediatrics and Obstetrics and Gynecology (OB/GYN), but degree of exposure is not consistent in all programs. Standards for residency education in PAG have been outlined by the Council on Resident Education in Obstetrics and Gynecology (CREOG) as objectives for OB/GYN residents each year, including PAG learning goals.3 Ob/gyn training programs adhere strictly to these criteria as these are frequently criteria by which training can be objectively measured.3 Furthermore, competency may be required for credentialing forms following residency training.3

Some OB/GYN residency training programs have focused education in PAG, in part because of its increasing importance, but also due to increased need, as the population age burden has shifted to younger age groups.2 Traditionally, didactic lectures have been considered acceptable training substitutes. However, in the absence of an expert to provide organized teaching in this sub-specialty, didactic lectures may be inadequate. One study showed that only three hours of lecture time were dedicated to PAG in residency training within a 4-year program.4 The limitations placed on the work duty hours by the Accreditation Council of Graduate Medical Education (ACGME) further limit time allowed for teaching this subspecialty. Alternatives to lectures and direct patient care include simulated patient cases to enhance clinical learning.5 These simulated case experiences also meet the criteria set forth by the ACGME practice-based learning model. Simulated cases may occur in a variety of formats, one of which is an electronic-based modality.6, 7 This modality allows for flexibility in gaining exposure to PAG material without risking work hour violation, because this type of exercise can be completed at home, outside the parameters set forth by the ACGME.8

Section snippets

Methods

An electronic-based PAG case series was developed in 2005 at the Baylor College of Medicine in the Department of OB/GYN, based on criteria set forth by CREOG for in-training examinations.6 This case series was utilized as an adjunct to a formal one-month resident rotation in PAG. As a follow-up to the study in 2006, a second-look study was performed in 2007–2008. This second-look study was deemed exempt by the Baylor College of Medicine Institutional Review Board. Twelve third-year OB/GYN

Results

Twelve third-year residents (9 females and 3 males) between the years of 2007–2008 utilized the case-based teaching series throughout their PAG rotation. Six residents completed pre and post-tests. Three residents completed the pre-test only, one resident completed the post test only, and 2 residents failed to complete either test. One question on both pre and post-tests was discarded due to a problem with question validity. Therefore, scores were compared between pre-test and post-test groups

Discussion

The evaluation of children and adolescents is different than the evaluation of adult women and may be challenging to providers without formal training.1, 2, 10, 11 OB/GYNs caring for this population should be familiar with basic diagnoses and develop skill in managing common problems.5, 10, 11 Regardless of opportunities for formal training in PAG, residents can learn basic principles through teaching modules, similar to the one utilized for our residents.8

The future in medical education will

Conclusions

The description of our experience at Baylor College of Medicine is limited in that it represents the experience of only third year residents at one institution and may not be representative of other residents at other programs. Another limitation of the study may be that it is difficult to separate knowledge gained from this tool from other forms of interactive teaching and patient care over the course of the rotations. Additional centers need to document experience in teaching PAG as set forth

Acknowledgments

This study was undertaken at Baylor College of Medicine in Houston, Texas.

References (12)

There are more references available in the full text version of this article.

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