University of Vermont

OB/Gyn Clerkship: Feedback Matters

John Caravello, M.D., and Elise Everett, M.D.
John Caravello, M.D., receives the Department of Obstetrics and Gynecology's award from Elise Everett, M.D.,

In the last 18 months, Obstetrics and Gynecology Clerkship has undergone a transformation, based on student feedback and forward-thinking faculty. As we transitioned to our new clerkship structure in 2011, a careful analysis of student outcome data, evaluation data from the Class of 2013 and targeted focus groups revealed that the Obstetrics and Gynecology Clerkship was in need of an overhaul.

The administrative appointments of Clerkship Director Elise N. Everett, MD, in August 2011; Department Chair Ira Bernstein, MD, in July 2012; and Residency Director Ellie Wegner, MD, in August 2012, reinvigorated the team, along with a plan to reorganize learning activities and a commitment to soliciting feedback from students and taking action. The resultant clerkship changes and faculty commitment have had dramatic results and the revamped clerkship earned the 2012 Best Clerkship of the Year Award (based on student ratings) for the rotations at St. Mary’s Medical Center.

Student feedback is a critical component for improvement, and many changes to the Clerkship were driven by feedback and suggestions. Feedback is requested after orientation, at the mid-rotation feedback session, and at the end of the clerkship. Students have the opportunity to anonymously evaluate residents, faculty, the Clerkship Director, the Clerkship Coordinator, and the overall clerkship, and all evaluations are reviewed by the Clerkship Director every 6 weeks. A composite of the reviews is compiled twice a year (after rotation 4 and after rotation 7) and disseminated to the Chair, the Residency Director and then to all the residents and faculty and all the clerkship sites. This information is also summarized and presented by the Clerkship Director twice a year to the residents and faculty, during grand rounds after rotation 4 and at the yearly education retreat after rotation 7. This forum encourages open discussion about strengths, weaknesses, opportunities, and barriers, as well as best practices.

Internal evaluation data have allowed us to track clerkship improvements and a student-led accreditation survey of the Class of 2014 revealed that all 15 measured factors significantly improved over the previous survey results from the Classes of 2012 and 2013. The survey showed that more than 80% of students were satisfied/very satisfied in all areas. Five areas were highlighted as strengths of the program (greater than 90% satisfaction), including timeliness of grade reporting, fairness of exams and grading, feedback on student performance during the clerkship, general clerkship organization and clarity and appropriate use of objectives.

“Since making the changes in response to the student feedback, we have seen every objective and subjective marker trend in a positive direction,” said Clerkship Director Elise N. Everett, MD. “We have seen more students become interested in Ob/Gyn as a specialty, and our residents and faculty have become reinvigorated in their role as teachers and mentors.”

Thanks to the engagement of the medical students, the response of the faculty and program leaders, and the ongoing dialogue to stay on track, the OB/Gyn Clerkship keeps improving.

OB/Gyn Clerkship Recent Changes

1.      Changes in administration:

  • New Clerkship Director: Elise N. Everett, MD, started August 2011
  • New Residency Director: Ellie Wegner, MD, started August 2012
  • New Chair: Ira Bernstein, MD, started August 2012

2.      Changes to orientation:

  • Two days
  • All students from all sites oriented at FAHC
  • Basic core lectures attended in person during orientation by all students
  • Simulation component (simulated birth, knot tying, pelvic exam, breast exam, scrub training)
  • Breast/pelvic refresher with standardized patients

3.      Changes to structure of clerkship:

  • 2 weeks of Ob, 2 weeks of clinic/outpatient, 2 weeks of OR/inpatient
  • No more 24 hour call
  • Night float system
  • Students paired with a resident team to facilitate teacher/learner relationship

4.      Changes to mid-rotation feedback:

  • Mandatory
  • Scheduled during orientation at 3 week mark.
  • Standardized form to document interaction

5.      Changes to grading system:

  • Shelf exam maxed at 30% of grade
  • Clinical performance is 70% of grade (advisor evaluation, preceptor evaluation, task evaluations)
  • Honors given to top 25% in each flight
  • CSE is pass/fail and not used to determine honors

6.      Changes to lectures:

  • Lectures available in multiple formats (powerpoint slides, video recordings-visual/audio)
  • Lecture time now more flexible for small group learning, active learning, PBL, case discussions, Q and A
  • Lectures moved to Med Ed with better video conferencing technology for offsite learners

7.      Changes to advisor/advisee role:

  • Opportunity to have H and P/note reviewed with a faculty member
  • Opportunity to practice presenting a patient to a faculty member
  • 4 hours of private one on one education with a faculty member

8.      Changes to clinical evaluations:

  • Added task based evaluations to capture more of the students’ clinical performance
  • Encourages students to ask for feedback
  • Encourages faculty to give face to face feedback
  • Improves direct observation of clinical skills

9.      Changes to Clinical Skills Exam:

  • Added a medical note
  • Added a patient presentation

10.  Changes to teaching environment:

  • Education has been reinstated as a priority in our department under new leadership
  • Faculty expectations in regards to student education have been more clearly defined and reinforced
  • Resident expectations in regards to student education have been more clearly defined and reinforced
  • The clerkship has been critically reviewed by the students, the residents, the faculty, the COM, FAHC and strengths and weakness have been identified. Data has been distributed. Changes have been made. Improvements have been seen, documented, and disseminated.
  • Faculty and residents have been publically recognized for their excellence in teaching through “apple” pins, certificates, recognition at grand rounds, faculty meetings, resident meetings, etc.
  • Mentoring potlucks: Clerkship students, AI students, Ob/Gy student interest group students, residents, junior faculty are invited to the clerkship director’s house every 6 weeks for a mentoring potluck where we discuss student issues, the field of ob/gyn, applying to residency, etc.