Maya Hammoud - Academia.edu (original) (raw)
Papers by Maya Hammoud
Medical Education Online, 2019
Background: Evidence to support coaching in medical education has grown over the past decade lead... more Background: Evidence to support coaching in medical education has grown over the past decade leading educators to search for resources to aid the development of their own coaching programs. A sample of medical schools in the USA were surveyed to describe coaching programs to assist other institutions in the development and implementation of programs. Methods: Participants representing 32 medical schools attending a coaching conference in October 2018 were surveyed via email regarding their undergraduate medical education (UME) coaching programs. The 19-item instrument contained questions on program demographics, program characteristics, coach characteristics, coach training and coach assessment and program evaluation. Results: The response rate was 100% (32/32 programs). Nearly all respondents had a coaching program (53%, 17/32) or were developing one (44%, 14/32) with the majority being implemented in the past five years (82%, 14/17). Professional identity formation (80%, 20/25), professionalism (76%, 19/25), and academic performance (76%, 19/25) were the most commonly identified programmatic goals. The majority of coaches (64%, 16/25) received between 5-25% full time equivalent effort to support their role. Coaches did not formally assess students in any domain at most programs (84%, 21/25) or directly observe their students clinically (76%, 19/25). The majority of programs had formal coach training (88%, 22/25). Conclusion: These results demonstrate that coaching is being used to improve performance, professionalism, and professional identity formation in UME. This sample of coaching programs informs the discussion of coaching in medical education as educators strive to implement effective coaching programs.
Obstetrics & Gynecology, 2018
Medical Teacher, 2019
Purpose: With the growing recognition of the role of coaching in competency-based medical educati... more Purpose: With the growing recognition of the role of coaching in competency-based medical education, many medical education training programs are investing significant resources into developing coaching programs. However, there is a lack of rigorous research on academic coaching programs in medical education and recommended coaching practices are based on expert opinion without incorporating the student perspective. The aim of this study was to investigate factors that affect a students' perception of a successful coaching experience. Materials and method: This was a qualitative study performed in November 2018 at a medical school in the United States with a formal coaching program. Appreciative inquiry was the theoretical framework used to develop the question guide. The authors facilitated two focus groups and then used Colaizzi's phenomenological analysis approach to analyze the transcripts. Results: A total of 21 students participated in the focus groups. The analysis revealed four themes that describe students' perceptions of successful coaching experiences: coach attributes, relational skills, coaching skills, and utilization of coaching. Each of these themes had specific dimensions. Conclusions: The findings from this study illuminate the student stakeholder perspectives on successful coaching relationships, and should be considered when developing a coaching program and faculty development.
Medical Science Educator, 2019
Leadership development plays a critical role in preparing collaborative, systems-based physicians... more Leadership development plays a critical role in preparing collaborative, systems-based physicians. Medical schools across the globe have dedicated significant effort towards programming for medical student leadership development. Students report a variety of existing leadership opportunities, ranging from formal didactics to leadership positions within the community. Students identify lack of time, funding, and the hierarchy of medicine as significant barriers for engaging in leadership opportunities. Students favor a formal leadership curriculum coupled with hands-on opportunities to practice leadership skills. In order to train medical students to be engaged physician leaders, it is imperative to foster practical opportunities for leadership development.
Obstetrics & Gynecology, 2017
A total of 40 students completed the questionnaire, 22 in the didactic cohort and 18 in the case-... more A total of 40 students completed the questionnaire, 22 in the didactic cohort and 18 in the case-based cohort. A greater proportion of students undergoing the case-based curriculum felt that their educational sessions were time well spent (67% versus 18%, P5.004) and that they were of greater quality than the curricula of other clerkships (44% versus 0%, P5.002). No differences were identified between career interest or perception of faculty engagement in student learning. There were no differences between cohorts in shelf examination scores, time spent in preparation, or subjective readiness for the examination. DISCUSSION: Medical students reported greater satisfaction with single-facilitator, case-based learning over traditional lecture-based curriculum in the Obstetrics and Gynecology clerkship. Although no differences were noted between interest in the field or performance on national standardized examinations, positive experiences during their clerkship may lead to enhanced engagement with the content, perceptions of the specialty, and care for patients with obstetric or gynecologic diagnoses.
BMC Complementary and Alternative Medicine, 2017
Background: Evidence indicates traditional medicine is no longer only used for the healthcare of ... more Background: Evidence indicates traditional medicine is no longer only used for the healthcare of the poor, its prevalence is also increasing in countries where allopathic medicine is predominant in the healthcare system. While these healing practices have been utilized for thousands of years in the Arabian Gulf, only recently has a theoretical model been developed illustrating the linkages and components of such practices articulated as Traditional Arabic & Islamic Medicine (TAIM). Despite previous theoretical work presenting development of the TAIM model, empirical support has been lacking. The objective of this research is to provide empirical support for the TAIM model and illustrate real world applicability. Methods: Using an ethnographic approach, we recruited 84 individuals (43 women and 41 men) who were speakers of one of four common languages in Qatar; Arabic, English, Hindi, and Urdu, Through in-depth interviews, we sought confirming and disconfirming evidence of the model components, namely, health practices, beliefs and philosophy to treat, diagnose, and prevent illnesses and/or maintain well-being, as well as patterns of communication about their TAIM practices with their allopathic providers. Results: Based on our analysis, we find empirical support for all elements of the TAIM model. Participants in this research, visitors to major healthcare centers, mentioned using all elements of the TAIM model: herbal medicines, spiritual therapies, dietary practices, mind-body methods, and manual techniques, applied singularly or in combination. Participants had varying levels of comfort sharing information about TAIM practices with allopathic practitioners. Conclusions: These findings confirm an empirical basis for the elements of the TAIM model. Three elements, namely, spiritual healing, herbal medicine, and dietary practices, were most commonly found. Future research should examine the prevalence of TAIM element use, how it differs among various populations, and its impact on health.
Obstetrics & Gynecology, 2016
BACKGROUND: Preparing future physicians to work collaboratively with nurses is a must for today&#... more BACKGROUND: Preparing future physicians to work collaboratively with nurses is a must for today's educators. Effective physician-nurse collaboration improves patient care and health outcomes. Medical students' views of the physician-nurse relationship and how these views may evolve during their clerkships have not been well examined. METHODS: Medical students on their first clinical clerkship completed the Jefferson Survey of Attitudes Towards Physician-Nurse Collaboration on the first and last day of their 6-week obstetrics and gynecology clerkship. This 20-question instrument addresses areas of responsibility and collaboration between physicians and nurses and has construct validity and reliability. All questions used a 4-point Likert scale (1=strongly disagree, 4=strongly agree). Pre- and post-clerkship scores were compared using paired t tests. RESULTS: Twenty-five students completed the pre- and post-surveys with a 100% response rate. Students overall had positive views of the physician-nurse relationship. At the completion of the clerkship, medical students felt more strongly that “during their education; medical and nursing students should be involved in teamwork in order to understand their respective roles” (pre: 3.82, post: 3.95, P=.042), and that “there are many overlapping areas of responsibility between physicians and nurses” (pre: 3.26, post: 3.57, P=.008). DISCUSSION: Our work reveals promising data that medical students begin their clinical clerkships with positive views of the physician-nurse relationship. Furthermore after the completion of their first clerkship, the students had significantly higher views of the importance of collaboration and shared responsibility.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, Jan 27, 2016
To evaluate the implementation of a new clinical protocol utilizing on-unit simulation for team t... more To evaluate the implementation of a new clinical protocol utilizing on-unit simulation for team training. A prospective observational study was performed at the obstetrics unit of Von Voightlander Women's Hospital, Michigan, USA, between October 1, 2012 to April 30, 2013. All members of the labor and delivery team were eligible for participation. Traditional education methods and in-situ multi-disciplinary simulations were used to educate labor and delivery staff. Following each simulation, participants responded to a survey regarding their experience. To evaluate the effect of the interventions, paging content was analyzed for mandated elements and adherence to operating room entry-time tracking was examined. In total, 51 unique individuals participated in 12 simulations during a 6-month period. Simulation was perceived as a valuable activity and paging content improved. Following the intervention, the inclusion of a goal time for reaching the operation room increased from 7% t...
Medical Science Educator, 2016
The true adoption of Competency-Based Medical Education (CBME) should allow for information about... more The true adoption of Competency-Based Medical Education (CBME) should allow for information about individual learners to be fed forward from Undergraduate Medical Education (UME) to Graduate Medical Education (GME). An obstetrics and gynecology residency preparation elective for senior medical students was utilized to create a milestone-based educational handover that reported individual learner performance for 25 of the 28 level one milestones. The authors describe the process and the questions that arose about the implications of reporting competency-based information for learners of all levels. The authors posit that CBME will be a transformative shift only if barriers of communication can be broken down between UME and GME.
Obstetrics & Gynecology, 2015
PURPOSE: To examine the knowledge of fourth-year medical students on a multiple-choice examinatio... more PURPOSE: To examine the knowledge of fourth-year medical students on a multiple-choice examination based on the obstetrics and gynecology Milestones level 1 and compare their performance to third-year medical students who completed the same questions during their obstetrics and gynecology clerkship. BACKGROUND: Currently, there is no available standardized tool to assess the knowledge of incoming interns in obstetrics and gynecology as described in Milestones level 1. METHODS: The Association of Professors of Obstetrics and Gynecology (APGO) Testing and Technology Committee developed a 105 multiple choice question assessment based on the obstetrics and gynecology Milestones level 1. This preparation for obstetrics and gynecology Residency Knowledge Assessment consisted of 50 items drawn from APGO uWISE quizzes for third-year students and 55 new items. The assessment was piloted with fourth-year medical students who matched in obstetrics and gynecology and were taking residency preparatory courses. The percentage of fourth-year students answering the uWISE questions correctly was compared with the percentage of third-year students who answered those same questions correctly during their third year using a Student t test. RESULTS: Thirty-four fourth-year medical students representing 12 different institutions completed the assessment. Forty-one percent of students passed on the first attempt (passing 70%). The average percent correct on the questions drawn from uWISE was 54.3% compared with 78.2% on the same questions taken by third-year students (P<.0001). Similar results were found when examined by field: obstetrics 54.2% compared with 78.4% (P<.0001), gynecology 51.7% compared with 79.4% (P<.0001), and office-based practice 57.3% compared with 76.8% (P<.0001). DISCUSSION: Medical students' knowledge on essential topics in obstetrics and gynecology declines significantly from their third to fourth year. This highlights the need for implementation of residency preparatory courses.
Obstetrics & Gynecology, 2015
OBJECTIVE: To compare medical student performance, clerkship evaluations, and interest in obstetr... more OBJECTIVE: To compare medical student performance, clerkship evaluations, and interest in obstetrics and gynecology after a formal restructuring of the 6-week clerkship. METHODS: In 2012, the obstetrics and gynecology clerkship was restructured such that all students spent 2 weeks on labor and delivery, and 2 weeks on two of the other core services of benign gynecology, gynecologic oncology, MFM, minimally invasive surgery, REI, and urogynecology. Students were also assigned two continuity generalist providers to meet with 1/2 day per week. Before 2012, each student spent 1 week on each of the core services, and was assigned one continuity generalist provider for 1/2 day per week. Student performance on the National Board of Medical Examiners (NBME) examination, and response to the clerkship evaluation questions “overall quality of clerkship” and “quality of ambulatory care experiences” for the 2 years prior and after the restructuring were compared using paired t tests. The percent of the medical school class who matched in obstetrics and gynecology were also compared using &khgr;2 analysis. RESULTS: Students' evaluations of the “overall quality of clerkship” improved from 3.51±0.31 to 3.84±0.35 (P<.006), and “quality of ambulatory care experiences” improved from 3.97±0.30 to 4.21 ±0.26 (P<.020) (5-point Likert scale). The percent of the medical school class who matched in obstetrics and gynecology residencies increased from 4.6% before 9.6% after the curricular change (P=.015). Performance on the NBME examination was unchanged. CONCLUSION: A formal restructuring of the obstetrics and gynecology clerkship improved student satisfaction and recruitment to the specialty.
Obstetrics & Gynecology, 2015
PURPOSE: To evaluate the effectiveness of a preoperative skills curriculum, and to assess compete... more PURPOSE: To evaluate the effectiveness of a preoperative skills curriculum, and to assess competence in associated level 1 Milestones. BACKGROUND: With implementation of the Milestones, medical educators must ensure that incoming interns have met various level 1 Milestones, including those related to preoperative skills for which formal education is lacking. METHODS: Thirteen fourth-year medical students completed the Decision to Incision curriculum which taught preoperative consent, patient positioning, Foley catheter placement, surgical scrub, and preoperative time out. Knowledge, skills, and competency were assessed using checklists before and after the educational intervention. Performance was measured using a 5-point Likert scale, and competency was assessed as present or absent. Change in performance was analyzed using &khgr;2 and t tests. RESULTS: Overall performance significantly improved for 3 of 5 skills with scores improving from 2.69 to 4.33 (P<.001) for consent, 2.08–4.3 (P<.001) for positioning, and 2.23–3.69 (P<.001) for time out. The percentage meeting Milestone competency significantly improved from 30.8% to 84.6% (P=.005) for consent, 0–100% (P<.001) for positioning, 69.2–100% (P=.03) for scrub, and 15.4–100% (P<.001) for time out. Overall, competence was achieved in 93.8% (61/65) of skills assessments. DISCUSSION: The Decision to Incision Curriculum significantly improves preoperative skills, particularly skills students are unlikely to perform during medical school but may perform on day 1 of residency. This curriculum also facilitates achievement and documentation of competence in multiple Milestones.
MedEdPORTAL, 2015
Abstract Introduction The purpose of alphanumeric clinical pages is to relay important informatio... more Abstract Introduction The purpose of alphanumeric clinical pages is to relay important information between health care providers. Junior residents field a large number of pages during patient care ...
The Clinical Teacher, 2015
Background : The objectives of this curricular innovation project were to implement a fl ipped cl... more Background : The objectives of this curricular innovation project were to implement a fl ipped classroom curriculum for the gynaecologic oncology topics of the obstetrics and gynaecology medical student clerkship, and to evaluate student satisfaction with the change. Methods : Four short online videos on the topics of endometrial hyperplasia, cervical dysplasia, evaluation of an adnexal mass, and ovarian cancer were created, and students were instructed to view them prior to a class-time active learning session. The Learning Activity Management System (LAMS) open-source online
Obstetrics & Gynecology, 2015
ABSTRACT As a result of growing surgical volume, the University of Michigan implemented a dedicat... more ABSTRACT As a result of growing surgical volume, the University of Michigan implemented a dedicated surgical team to perform scheduled procedures in the labor and delivery department with the goals of starting at 8 AM, reducing case delays, and preventing cancellations. Despite implementation, health care providers at the frontline continued to observe inefficiencies. Lean problem-solving methods were used to develop a current-state analysis and to identify measures to improve efficiency (Lean problem solving has been adapted from processes applied in the manufacturing setting, where processes are examined, areas of waste are uncovered, and interventions are implemented by front-line workers). Using Lean, the current state of the scheduled operating room team was analyzed between August and January 2013 by determining average operating room start times, performing an operating room "gemba" visit, and surveying frontline workers about observed problems and suggestions. A root-cause analysis was completed to identify key areas requiring improvement for the first plan-do-check-act cycle of quality improvement. Review of operating room start times for scheduled procedures was found to be 47 minutes after a goal start time of 8 AM. Lack of anesthesia availability was identified as the leading cause of delays (17.5%). Other identified areas include nursing (15.4%), preoperative laboratory completion (12.3%), operating room turnover time (12.3%), team dynamics (9.2%), addition of add-on cases (7.7%), communication (7.7%), preoperative workup (7.7%), lack of on-start time (6.2%), and other (3.1%). Application of Lean principles allowed for a systematic review of the current state of the operating room team and identification of key areas contributing to inefficiency. Consequently, targeted measures have been implemented. In this case, a dedicated anesthesia faculty has been implemented as part of the first plan-do-check-act cycle with a plan to review efficiency in 6 months.
Qatar Foundation Annual Research Forum Proceedings, 2012
Background: Novel survey instrument development requires reliability testing, but limited informa... more Background: Novel survey instrument development requires reliability testing, but limited information informs the preferred approach in Qatar. The testing of survey characteristics of the Multi-Cultural Assessment Inventory-Qatar (MAI-Q), a novel multicultural assessment tool in Arabic, English, Hindi and Urdu, provided the opportunity to investigate survey distribution procedures. Objective: To determine willingness to participate, and response rates during survey reliability testing by mail and in person. Methodology: To examine participation preferences and rates, patients were recruited through HMC and six primary health centers. When recruited, subjects could choose to take the MAI-Q a second time for the reliability testing in person or by mail. Subjects were either scheduled for follow-up in-person, or were sent the survey in a prepaid, preaddressed envelope. Results: Among 387 subjects who initially took the survey, 177 (46%) declined taking the survey a second time for reliability testing. Of 210 subjects who agreed to take the survey a second time for reliability testing, 145/210 (69%) chose mail, and 65/210 (31%) were offered and chose in person follow-up. Actual follow-up to complete reliability testing was only 29/145 (21%) by post but 40/65 (63%) in person. Conclusion: These findings reveal challenges researchers face when developing and distributing surveys in Qatar. Nearly half of subjects initially recruited were not willing to participate in follow-up testing. Among those agreeing to follow-up testing, the majority chose mail, but only a fifth of them returned instruments. The majority of subjects who chose in person follow up completed testing. These data inform researchers about the tough choices for developing and conducting surveys in Qatar.
Qatar Foundation Annual Research Forum Proceedings, 2010
AbstractIntroduction:The United States Agency for Healthcare Research and Quality has invested he... more AbstractIntroduction:The United States Agency for Healthcare Research and Quality has invested heavily in the Consumer Assessment of Healthcare Providers and Systems (CAHPS). Funded by the Qatar National Research Fund, a research team formed of 3 collaborative institutions; Weill Cornell Medical College-Qatar (WCMC-Q), Hamad Medical Corporation (HMC) and University of Michigan (UM), is working on translating, adapting and modifying CAHPS to generate QCAHPS, an instrument relevant to Qatar and the region population. It is a five-phase project.Objectives:To translate the existing CAHPS into Arabic, Hindi and Urdu, identify “translation dilemmas”, and to explore patients’ assessment of translation dilemmas and quality of ambulatory care visits based on their own cultural context and preferred language with four linguistic groups, English, Arabic, Hindi, and Urdu.Methods:Recruitment of qualified research assistants and reviewers (Qatar team) followed by training on interviewing, coding and naming protocols wa...
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2013
ABSTRACT Introduction/Background: The University of Michigan Department of Obstetrics planned to ... more ABSTRACT Introduction/Background: The University of Michigan Department of Obstetrics planned to institute a new classification system for cesarean section urgency. Specific protocols for paging clinical teams when an urgent or emergent event occurs do exist but compliance had been inconsistent and there was little shared understanding of the levels of urgency. Recent adoption of a more defined prioritization scheme for urgency led to the need to educate our clinical staff of the new protocols. These protocols included specific definitions for urgent, emergent, add-on and scheduled cases. We designed and implemented a program to educate a large number of learners from multiple disciplines in a short time interval about these levels of urgency and the requisite paging protocol for each level of urgency. Our secondary goal was to introduce faculty and staff to the use of in-situ simulation. Methods: A curriculum was designed with a three-pronged approach: 1) Web based educational model, 2) On-unit simulations and 3) Evaluation for sustainability. A web based power point presentation was created that reviewed each of the new urgency classifications. All participants were instructed to complete the module, which included a post-test evaluation. A simulation curriculum was created with 12 cases representing clinical cases for each of the 4 categories. Over a six month period, bi-weekly simulations were run with participants from Obstetrics, Anesthesia, Nursing and OR staff. Debriefing exercises were performed to address agreement on the level of urgency, the use of simulation for learning a new protocol and attitudes toward the new paging protocol. Participants included faculty, residents, nurses and scrub technicians from the both obstetrics and anesthesia (N=72). The level of agreement in urgency for emergent vs. urgent cases was congruent (p<0.000, t-test). Overall, simulation was rated a valuable activity. (See Table 1). The new paging system overall was rated as positive. (See Table 2) Results: Conclusion: A simulation-based curriculum can be used to educate a large multidisciplinary team to a new protocol. The University of Michigan successfully used a simulation-based curriculum prior to a policy change as a means of reaching all members of the team. For many participants, this was their first simulation experience. For all participants, this was their first exposure to in-situ simulation. Overall both the use of simulation and the attitude toward the new paging protocol was positive. After completion of all faculty participation (this program continued beyond the six month study period), the University of Michigan Department of Obstetrics and Gynecology has made participation in obstetric simulations a mandatory requirement for maintenance of privileges. Simulation was a useful tool to publicize the policy change and educate participants through hands on, in-situ learning. This program innovation can serve as a means to implement new protocols across disciplines. Disclosures: None.
Global journal of health science, Jan 25, 2012
Economic globalization and advances in technology have made it more feasible and even necessary t... more Economic globalization and advances in technology have made it more feasible and even necessary to develop international research collaborations in global public health. Historically, collaborations in global research described in the literature have been mostly "North-South" collaborations in which the more developed "North" country works together with a developing "South" country to conduct research in the latter. This type of collaboration has for the most part, represented unequal partnership and rarely left behind a lasting impact. Recently, the opportunity for a new kind of international research partnership has emerged in which the host country has significant financial resources, but relatively limited expertise in research Methodology or techniques and research implementation. This type of collaboration features a relative equalization of power between the international partners. The purpose of this paper is to describe the process of building...
International Journal of Gynecology & Obstetrics, 2008
Medical Education Online, 2019
Background: Evidence to support coaching in medical education has grown over the past decade lead... more Background: Evidence to support coaching in medical education has grown over the past decade leading educators to search for resources to aid the development of their own coaching programs. A sample of medical schools in the USA were surveyed to describe coaching programs to assist other institutions in the development and implementation of programs. Methods: Participants representing 32 medical schools attending a coaching conference in October 2018 were surveyed via email regarding their undergraduate medical education (UME) coaching programs. The 19-item instrument contained questions on program demographics, program characteristics, coach characteristics, coach training and coach assessment and program evaluation. Results: The response rate was 100% (32/32 programs). Nearly all respondents had a coaching program (53%, 17/32) or were developing one (44%, 14/32) with the majority being implemented in the past five years (82%, 14/17). Professional identity formation (80%, 20/25), professionalism (76%, 19/25), and academic performance (76%, 19/25) were the most commonly identified programmatic goals. The majority of coaches (64%, 16/25) received between 5-25% full time equivalent effort to support their role. Coaches did not formally assess students in any domain at most programs (84%, 21/25) or directly observe their students clinically (76%, 19/25). The majority of programs had formal coach training (88%, 22/25). Conclusion: These results demonstrate that coaching is being used to improve performance, professionalism, and professional identity formation in UME. This sample of coaching programs informs the discussion of coaching in medical education as educators strive to implement effective coaching programs.
Obstetrics & Gynecology, 2018
Medical Teacher, 2019
Purpose: With the growing recognition of the role of coaching in competency-based medical educati... more Purpose: With the growing recognition of the role of coaching in competency-based medical education, many medical education training programs are investing significant resources into developing coaching programs. However, there is a lack of rigorous research on academic coaching programs in medical education and recommended coaching practices are based on expert opinion without incorporating the student perspective. The aim of this study was to investigate factors that affect a students' perception of a successful coaching experience. Materials and method: This was a qualitative study performed in November 2018 at a medical school in the United States with a formal coaching program. Appreciative inquiry was the theoretical framework used to develop the question guide. The authors facilitated two focus groups and then used Colaizzi's phenomenological analysis approach to analyze the transcripts. Results: A total of 21 students participated in the focus groups. The analysis revealed four themes that describe students' perceptions of successful coaching experiences: coach attributes, relational skills, coaching skills, and utilization of coaching. Each of these themes had specific dimensions. Conclusions: The findings from this study illuminate the student stakeholder perspectives on successful coaching relationships, and should be considered when developing a coaching program and faculty development.
Medical Science Educator, 2019
Leadership development plays a critical role in preparing collaborative, systems-based physicians... more Leadership development plays a critical role in preparing collaborative, systems-based physicians. Medical schools across the globe have dedicated significant effort towards programming for medical student leadership development. Students report a variety of existing leadership opportunities, ranging from formal didactics to leadership positions within the community. Students identify lack of time, funding, and the hierarchy of medicine as significant barriers for engaging in leadership opportunities. Students favor a formal leadership curriculum coupled with hands-on opportunities to practice leadership skills. In order to train medical students to be engaged physician leaders, it is imperative to foster practical opportunities for leadership development.
Obstetrics & Gynecology, 2017
A total of 40 students completed the questionnaire, 22 in the didactic cohort and 18 in the case-... more A total of 40 students completed the questionnaire, 22 in the didactic cohort and 18 in the case-based cohort. A greater proportion of students undergoing the case-based curriculum felt that their educational sessions were time well spent (67% versus 18%, P5.004) and that they were of greater quality than the curricula of other clerkships (44% versus 0%, P5.002). No differences were identified between career interest or perception of faculty engagement in student learning. There were no differences between cohorts in shelf examination scores, time spent in preparation, or subjective readiness for the examination. DISCUSSION: Medical students reported greater satisfaction with single-facilitator, case-based learning over traditional lecture-based curriculum in the Obstetrics and Gynecology clerkship. Although no differences were noted between interest in the field or performance on national standardized examinations, positive experiences during their clerkship may lead to enhanced engagement with the content, perceptions of the specialty, and care for patients with obstetric or gynecologic diagnoses.
BMC Complementary and Alternative Medicine, 2017
Background: Evidence indicates traditional medicine is no longer only used for the healthcare of ... more Background: Evidence indicates traditional medicine is no longer only used for the healthcare of the poor, its prevalence is also increasing in countries where allopathic medicine is predominant in the healthcare system. While these healing practices have been utilized for thousands of years in the Arabian Gulf, only recently has a theoretical model been developed illustrating the linkages and components of such practices articulated as Traditional Arabic & Islamic Medicine (TAIM). Despite previous theoretical work presenting development of the TAIM model, empirical support has been lacking. The objective of this research is to provide empirical support for the TAIM model and illustrate real world applicability. Methods: Using an ethnographic approach, we recruited 84 individuals (43 women and 41 men) who were speakers of one of four common languages in Qatar; Arabic, English, Hindi, and Urdu, Through in-depth interviews, we sought confirming and disconfirming evidence of the model components, namely, health practices, beliefs and philosophy to treat, diagnose, and prevent illnesses and/or maintain well-being, as well as patterns of communication about their TAIM practices with their allopathic providers. Results: Based on our analysis, we find empirical support for all elements of the TAIM model. Participants in this research, visitors to major healthcare centers, mentioned using all elements of the TAIM model: herbal medicines, spiritual therapies, dietary practices, mind-body methods, and manual techniques, applied singularly or in combination. Participants had varying levels of comfort sharing information about TAIM practices with allopathic practitioners. Conclusions: These findings confirm an empirical basis for the elements of the TAIM model. Three elements, namely, spiritual healing, herbal medicine, and dietary practices, were most commonly found. Future research should examine the prevalence of TAIM element use, how it differs among various populations, and its impact on health.
Obstetrics & Gynecology, 2016
BACKGROUND: Preparing future physicians to work collaboratively with nurses is a must for today&#... more BACKGROUND: Preparing future physicians to work collaboratively with nurses is a must for today's educators. Effective physician-nurse collaboration improves patient care and health outcomes. Medical students' views of the physician-nurse relationship and how these views may evolve during their clerkships have not been well examined. METHODS: Medical students on their first clinical clerkship completed the Jefferson Survey of Attitudes Towards Physician-Nurse Collaboration on the first and last day of their 6-week obstetrics and gynecology clerkship. This 20-question instrument addresses areas of responsibility and collaboration between physicians and nurses and has construct validity and reliability. All questions used a 4-point Likert scale (1=strongly disagree, 4=strongly agree). Pre- and post-clerkship scores were compared using paired t tests. RESULTS: Twenty-five students completed the pre- and post-surveys with a 100% response rate. Students overall had positive views of the physician-nurse relationship. At the completion of the clerkship, medical students felt more strongly that “during their education; medical and nursing students should be involved in teamwork in order to understand their respective roles” (pre: 3.82, post: 3.95, P=.042), and that “there are many overlapping areas of responsibility between physicians and nurses” (pre: 3.26, post: 3.57, P=.008). DISCUSSION: Our work reveals promising data that medical students begin their clinical clerkships with positive views of the physician-nurse relationship. Furthermore after the completion of their first clerkship, the students had significantly higher views of the importance of collaboration and shared responsibility.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, Jan 27, 2016
To evaluate the implementation of a new clinical protocol utilizing on-unit simulation for team t... more To evaluate the implementation of a new clinical protocol utilizing on-unit simulation for team training. A prospective observational study was performed at the obstetrics unit of Von Voightlander Women's Hospital, Michigan, USA, between October 1, 2012 to April 30, 2013. All members of the labor and delivery team were eligible for participation. Traditional education methods and in-situ multi-disciplinary simulations were used to educate labor and delivery staff. Following each simulation, participants responded to a survey regarding their experience. To evaluate the effect of the interventions, paging content was analyzed for mandated elements and adherence to operating room entry-time tracking was examined. In total, 51 unique individuals participated in 12 simulations during a 6-month period. Simulation was perceived as a valuable activity and paging content improved. Following the intervention, the inclusion of a goal time for reaching the operation room increased from 7% t...
Medical Science Educator, 2016
The true adoption of Competency-Based Medical Education (CBME) should allow for information about... more The true adoption of Competency-Based Medical Education (CBME) should allow for information about individual learners to be fed forward from Undergraduate Medical Education (UME) to Graduate Medical Education (GME). An obstetrics and gynecology residency preparation elective for senior medical students was utilized to create a milestone-based educational handover that reported individual learner performance for 25 of the 28 level one milestones. The authors describe the process and the questions that arose about the implications of reporting competency-based information for learners of all levels. The authors posit that CBME will be a transformative shift only if barriers of communication can be broken down between UME and GME.
Obstetrics & Gynecology, 2015
PURPOSE: To examine the knowledge of fourth-year medical students on a multiple-choice examinatio... more PURPOSE: To examine the knowledge of fourth-year medical students on a multiple-choice examination based on the obstetrics and gynecology Milestones level 1 and compare their performance to third-year medical students who completed the same questions during their obstetrics and gynecology clerkship. BACKGROUND: Currently, there is no available standardized tool to assess the knowledge of incoming interns in obstetrics and gynecology as described in Milestones level 1. METHODS: The Association of Professors of Obstetrics and Gynecology (APGO) Testing and Technology Committee developed a 105 multiple choice question assessment based on the obstetrics and gynecology Milestones level 1. This preparation for obstetrics and gynecology Residency Knowledge Assessment consisted of 50 items drawn from APGO uWISE quizzes for third-year students and 55 new items. The assessment was piloted with fourth-year medical students who matched in obstetrics and gynecology and were taking residency preparatory courses. The percentage of fourth-year students answering the uWISE questions correctly was compared with the percentage of third-year students who answered those same questions correctly during their third year using a Student t test. RESULTS: Thirty-four fourth-year medical students representing 12 different institutions completed the assessment. Forty-one percent of students passed on the first attempt (passing 70%). The average percent correct on the questions drawn from uWISE was 54.3% compared with 78.2% on the same questions taken by third-year students (P<.0001). Similar results were found when examined by field: obstetrics 54.2% compared with 78.4% (P<.0001), gynecology 51.7% compared with 79.4% (P<.0001), and office-based practice 57.3% compared with 76.8% (P<.0001). DISCUSSION: Medical students' knowledge on essential topics in obstetrics and gynecology declines significantly from their third to fourth year. This highlights the need for implementation of residency preparatory courses.
Obstetrics & Gynecology, 2015
OBJECTIVE: To compare medical student performance, clerkship evaluations, and interest in obstetr... more OBJECTIVE: To compare medical student performance, clerkship evaluations, and interest in obstetrics and gynecology after a formal restructuring of the 6-week clerkship. METHODS: In 2012, the obstetrics and gynecology clerkship was restructured such that all students spent 2 weeks on labor and delivery, and 2 weeks on two of the other core services of benign gynecology, gynecologic oncology, MFM, minimally invasive surgery, REI, and urogynecology. Students were also assigned two continuity generalist providers to meet with 1/2 day per week. Before 2012, each student spent 1 week on each of the core services, and was assigned one continuity generalist provider for 1/2 day per week. Student performance on the National Board of Medical Examiners (NBME) examination, and response to the clerkship evaluation questions “overall quality of clerkship” and “quality of ambulatory care experiences” for the 2 years prior and after the restructuring were compared using paired t tests. The percent of the medical school class who matched in obstetrics and gynecology were also compared using &khgr;2 analysis. RESULTS: Students' evaluations of the “overall quality of clerkship” improved from 3.51±0.31 to 3.84±0.35 (P<.006), and “quality of ambulatory care experiences” improved from 3.97±0.30 to 4.21 ±0.26 (P<.020) (5-point Likert scale). The percent of the medical school class who matched in obstetrics and gynecology residencies increased from 4.6% before 9.6% after the curricular change (P=.015). Performance on the NBME examination was unchanged. CONCLUSION: A formal restructuring of the obstetrics and gynecology clerkship improved student satisfaction and recruitment to the specialty.
Obstetrics & Gynecology, 2015
PURPOSE: To evaluate the effectiveness of a preoperative skills curriculum, and to assess compete... more PURPOSE: To evaluate the effectiveness of a preoperative skills curriculum, and to assess competence in associated level 1 Milestones. BACKGROUND: With implementation of the Milestones, medical educators must ensure that incoming interns have met various level 1 Milestones, including those related to preoperative skills for which formal education is lacking. METHODS: Thirteen fourth-year medical students completed the Decision to Incision curriculum which taught preoperative consent, patient positioning, Foley catheter placement, surgical scrub, and preoperative time out. Knowledge, skills, and competency were assessed using checklists before and after the educational intervention. Performance was measured using a 5-point Likert scale, and competency was assessed as present or absent. Change in performance was analyzed using &khgr;2 and t tests. RESULTS: Overall performance significantly improved for 3 of 5 skills with scores improving from 2.69 to 4.33 (P<.001) for consent, 2.08–4.3 (P<.001) for positioning, and 2.23–3.69 (P<.001) for time out. The percentage meeting Milestone competency significantly improved from 30.8% to 84.6% (P=.005) for consent, 0–100% (P<.001) for positioning, 69.2–100% (P=.03) for scrub, and 15.4–100% (P<.001) for time out. Overall, competence was achieved in 93.8% (61/65) of skills assessments. DISCUSSION: The Decision to Incision Curriculum significantly improves preoperative skills, particularly skills students are unlikely to perform during medical school but may perform on day 1 of residency. This curriculum also facilitates achievement and documentation of competence in multiple Milestones.
MedEdPORTAL, 2015
Abstract Introduction The purpose of alphanumeric clinical pages is to relay important informatio... more Abstract Introduction The purpose of alphanumeric clinical pages is to relay important information between health care providers. Junior residents field a large number of pages during patient care ...
The Clinical Teacher, 2015
Background : The objectives of this curricular innovation project were to implement a fl ipped cl... more Background : The objectives of this curricular innovation project were to implement a fl ipped classroom curriculum for the gynaecologic oncology topics of the obstetrics and gynaecology medical student clerkship, and to evaluate student satisfaction with the change. Methods : Four short online videos on the topics of endometrial hyperplasia, cervical dysplasia, evaluation of an adnexal mass, and ovarian cancer were created, and students were instructed to view them prior to a class-time active learning session. The Learning Activity Management System (LAMS) open-source online
Obstetrics & Gynecology, 2015
ABSTRACT As a result of growing surgical volume, the University of Michigan implemented a dedicat... more ABSTRACT As a result of growing surgical volume, the University of Michigan implemented a dedicated surgical team to perform scheduled procedures in the labor and delivery department with the goals of starting at 8 AM, reducing case delays, and preventing cancellations. Despite implementation, health care providers at the frontline continued to observe inefficiencies. Lean problem-solving methods were used to develop a current-state analysis and to identify measures to improve efficiency (Lean problem solving has been adapted from processes applied in the manufacturing setting, where processes are examined, areas of waste are uncovered, and interventions are implemented by front-line workers). Using Lean, the current state of the scheduled operating room team was analyzed between August and January 2013 by determining average operating room start times, performing an operating room "gemba" visit, and surveying frontline workers about observed problems and suggestions. A root-cause analysis was completed to identify key areas requiring improvement for the first plan-do-check-act cycle of quality improvement. Review of operating room start times for scheduled procedures was found to be 47 minutes after a goal start time of 8 AM. Lack of anesthesia availability was identified as the leading cause of delays (17.5%). Other identified areas include nursing (15.4%), preoperative laboratory completion (12.3%), operating room turnover time (12.3%), team dynamics (9.2%), addition of add-on cases (7.7%), communication (7.7%), preoperative workup (7.7%), lack of on-start time (6.2%), and other (3.1%). Application of Lean principles allowed for a systematic review of the current state of the operating room team and identification of key areas contributing to inefficiency. Consequently, targeted measures have been implemented. In this case, a dedicated anesthesia faculty has been implemented as part of the first plan-do-check-act cycle with a plan to review efficiency in 6 months.
Qatar Foundation Annual Research Forum Proceedings, 2012
Background: Novel survey instrument development requires reliability testing, but limited informa... more Background: Novel survey instrument development requires reliability testing, but limited information informs the preferred approach in Qatar. The testing of survey characteristics of the Multi-Cultural Assessment Inventory-Qatar (MAI-Q), a novel multicultural assessment tool in Arabic, English, Hindi and Urdu, provided the opportunity to investigate survey distribution procedures. Objective: To determine willingness to participate, and response rates during survey reliability testing by mail and in person. Methodology: To examine participation preferences and rates, patients were recruited through HMC and six primary health centers. When recruited, subjects could choose to take the MAI-Q a second time for the reliability testing in person or by mail. Subjects were either scheduled for follow-up in-person, or were sent the survey in a prepaid, preaddressed envelope. Results: Among 387 subjects who initially took the survey, 177 (46%) declined taking the survey a second time for reliability testing. Of 210 subjects who agreed to take the survey a second time for reliability testing, 145/210 (69%) chose mail, and 65/210 (31%) were offered and chose in person follow-up. Actual follow-up to complete reliability testing was only 29/145 (21%) by post but 40/65 (63%) in person. Conclusion: These findings reveal challenges researchers face when developing and distributing surveys in Qatar. Nearly half of subjects initially recruited were not willing to participate in follow-up testing. Among those agreeing to follow-up testing, the majority chose mail, but only a fifth of them returned instruments. The majority of subjects who chose in person follow up completed testing. These data inform researchers about the tough choices for developing and conducting surveys in Qatar.
Qatar Foundation Annual Research Forum Proceedings, 2010
AbstractIntroduction:The United States Agency for Healthcare Research and Quality has invested he... more AbstractIntroduction:The United States Agency for Healthcare Research and Quality has invested heavily in the Consumer Assessment of Healthcare Providers and Systems (CAHPS). Funded by the Qatar National Research Fund, a research team formed of 3 collaborative institutions; Weill Cornell Medical College-Qatar (WCMC-Q), Hamad Medical Corporation (HMC) and University of Michigan (UM), is working on translating, adapting and modifying CAHPS to generate QCAHPS, an instrument relevant to Qatar and the region population. It is a five-phase project.Objectives:To translate the existing CAHPS into Arabic, Hindi and Urdu, identify “translation dilemmas”, and to explore patients’ assessment of translation dilemmas and quality of ambulatory care visits based on their own cultural context and preferred language with four linguistic groups, English, Arabic, Hindi, and Urdu.Methods:Recruitment of qualified research assistants and reviewers (Qatar team) followed by training on interviewing, coding and naming protocols wa...
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2013
ABSTRACT Introduction/Background: The University of Michigan Department of Obstetrics planned to ... more ABSTRACT Introduction/Background: The University of Michigan Department of Obstetrics planned to institute a new classification system for cesarean section urgency. Specific protocols for paging clinical teams when an urgent or emergent event occurs do exist but compliance had been inconsistent and there was little shared understanding of the levels of urgency. Recent adoption of a more defined prioritization scheme for urgency led to the need to educate our clinical staff of the new protocols. These protocols included specific definitions for urgent, emergent, add-on and scheduled cases. We designed and implemented a program to educate a large number of learners from multiple disciplines in a short time interval about these levels of urgency and the requisite paging protocol for each level of urgency. Our secondary goal was to introduce faculty and staff to the use of in-situ simulation. Methods: A curriculum was designed with a three-pronged approach: 1) Web based educational model, 2) On-unit simulations and 3) Evaluation for sustainability. A web based power point presentation was created that reviewed each of the new urgency classifications. All participants were instructed to complete the module, which included a post-test evaluation. A simulation curriculum was created with 12 cases representing clinical cases for each of the 4 categories. Over a six month period, bi-weekly simulations were run with participants from Obstetrics, Anesthesia, Nursing and OR staff. Debriefing exercises were performed to address agreement on the level of urgency, the use of simulation for learning a new protocol and attitudes toward the new paging protocol. Participants included faculty, residents, nurses and scrub technicians from the both obstetrics and anesthesia (N=72). The level of agreement in urgency for emergent vs. urgent cases was congruent (p<0.000, t-test). Overall, simulation was rated a valuable activity. (See Table 1). The new paging system overall was rated as positive. (See Table 2) Results: Conclusion: A simulation-based curriculum can be used to educate a large multidisciplinary team to a new protocol. The University of Michigan successfully used a simulation-based curriculum prior to a policy change as a means of reaching all members of the team. For many participants, this was their first simulation experience. For all participants, this was their first exposure to in-situ simulation. Overall both the use of simulation and the attitude toward the new paging protocol was positive. After completion of all faculty participation (this program continued beyond the six month study period), the University of Michigan Department of Obstetrics and Gynecology has made participation in obstetric simulations a mandatory requirement for maintenance of privileges. Simulation was a useful tool to publicize the policy change and educate participants through hands on, in-situ learning. This program innovation can serve as a means to implement new protocols across disciplines. Disclosures: None.
Global journal of health science, Jan 25, 2012
Economic globalization and advances in technology have made it more feasible and even necessary t... more Economic globalization and advances in technology have made it more feasible and even necessary to develop international research collaborations in global public health. Historically, collaborations in global research described in the literature have been mostly "North-South" collaborations in which the more developed "North" country works together with a developing "South" country to conduct research in the latter. This type of collaboration has for the most part, represented unequal partnership and rarely left behind a lasting impact. Recently, the opportunity for a new kind of international research partnership has emerged in which the host country has significant financial resources, but relatively limited expertise in research Methodology or techniques and research implementation. This type of collaboration features a relative equalization of power between the international partners. The purpose of this paper is to describe the process of building...
International Journal of Gynecology & Obstetrics, 2008