# Improving Family Medicine Residency Training in Women’s Health-Related Procedures at a Community Hospital

## TL;DR

This study shows how a training program improved family medicine residents' performance of women's health procedures using a bundled intervention.

## Contribution

A bundled intervention successfully increased resident training in gynecological procedures at community hospitals.

## Key findings

- The average number of procedures per resident per month increased from two to six.
- Poisson regression analysis showed significant increases in procedural volume during phases 1 and 3.
- Documentation of procedural competency at graduation improved over time.

## Abstract

Introduction: The Accreditation Council for Graduate Medical Education requires family medicine (FM) residents to be trained in outpatient procedures. The Society of Teachers of Family Medicine (STFM) group on hospital and procedural training compiled a core list of procedures that all FM residents should perform by graduation. We implemented a quality improvement project using a bundled intervention to enhance resident training in outpatient gynecological procedures.

Materials and methods: This quasi-experimental study evaluated a multifaceted bundled intervention. Baseline data were collected from January 2018 to June 2019, with intervention phases occurring from June 2019 to February 2020 and March 2021 to November 2022. Stakeholders collaborated to identify barriers using process mapping and Ishikawa diagrams. The JMP Pro 17 software (JMP Statistical Discovery LLC, Cary, NC, USA) was used to create an X-mR statistical process control (SPC) chart for phase analysis. Poisson regression analysis was conducted to assess the impact of the intervention on the number of women’s health-related procedures performed per resident per month. Residents’ graduation portfolios were reviewed for documentation of procedural competency.

Results: The intervention increased the average number of procedures from two to six per resident per month. Significant increases in procedural volume were observed during phase 1 (roll-out) and phase 3 (post-intervention), with a temporary stall in phase 2 due to COVID-19 disruptions. Poisson regression analysis showed statistically significant increases in incidence rate ratios during phases 1 and 3 (p<0.005). Documentation of competency in women’s health-related procedures at graduation also improved over time.

Conclusions: An FM residency training program successfully utilized a multifaceted, bundled intervention to increase the number of gynecological procedures performed at FM practice sites, aligning resident training with STFM recommendations.