CBME – Department of OB/GYN Sue Chamberlain CBME workshop Sept 2015

CBME – Where we are at  Transition to CBME occurring on 2 levels Development of EPA’s and identification of milestones Development of EPA’s and identification of milestones Change in assessment practices Change in assessment practices

EPA development  Grand Rounds 2013 – Introduction of EPA’s, Competency by Design to Department of Obstetrics and Gynecology  Summer 2014 – development of preliminary working set of EPA’s while reviewing residency objectives

EPA development  January 2014 – Development of Scope of Practice EPA’s  July 2015 – Development of Stage-Specific EPA’s with identification of relevant associated milestones

Transitions to discipline EPA’s 1. Perform a history and physical in a pregnant patient. (Jr OB and Jr Clinics – Blocks 1-2) 2. Perform a gynecologic history and physical examination. (Jr Clinics – Blocks 1-2) 3. Demonstrate basic knowledge of obstetric and gynecologic presentations. (Jr OB and Jr clinics) 4. Perform a basic assessment of a patient arriving to labour and delivery. (Jr OB) 5. Perform a basic assessment of a patient arriving in the ER. (Jr OB) 6. Assist in the operating room and write basic post-op orders for obstetric and gynecologic patients. (Jr OB)  Curriculum/rotations – JR OB, JR clinics, Boot camp, attendance at clerkship seminars  Assessment – Clerkship oral examinations, Direct observation with Patient encounter forms for clinics and L&D

Foundations EPA’s 1. Provide low-risk antenatal care in the outpatient setting. (Jr clinics ) 2. Perform basic Obstetric USS. (Jr OB) 3. Assess and triage patients arriving to Labour and Delivery.(Jr OB, on-call) 4. Diagnose and manage common inpatient obstetric complications including preterm labour, pre-eclampsia and PPROM. (Jr OB, on-call) 5. Manage Normal Labour and Childbirth and post-partum. (Jr OB, on-call) 6. Manage gynecologic patients requiring family planning. (women’s clinic) 7. Diagnose and manage general gynaecologic presentations. (on-call, Jr clinics) 8. Provide surgical management of gynaecologic patients including surgical treatment (minor surgeries) and peri-operative care. (Jr gyne, Jr gyne onc) 9. Provide consultation on common and uncomplicated Obstetric and Gynecologic problems in the Emergency Department. (Jr OB, on-call, jr gyne ) 10. Resuscitate, stabilize, and triage patients in an emergency department, delivery room, or inpatient acute care setting and transfer to a higher level of care as required. (Jr OB. on-call, ER rotation, jr gyne) 11. Participate in handover. (Jr OB, on-call)

Foundations EPA’s Rotations – PGY 1/2:  Jr clinics – 2 blocks  Jr OB – 4 blocks  ER – 1 block  women’s clinic – 1 block  Jr gyne – 4 blocks  Jr gyne onc – 4 blocks  on-call – through first 2 years

Foundations EPA’s 1. Provide low-risk antenatal care in the outpatient setting. (Jr clinics ) 2. Perform basic Obstetric USS. (Jr OB) 3. Assess and triage patients arriving to Labour and Delivery.(Jr OB, on-call) 4. Diagnose and manage common inpatient obstetric complications including preterm labour, pre-eclampsia and PPROM. (Jr OB, on-call) 5. Manage Normal Labour and Childbirth and post-partum. (Jr OB, on-call) 6. Manage gynecologic patients requiring family planning. (women’s clinic) 7. Diagnose and manage general gynaecologic presentations. (on-call, Jr clinics) 8. Provide surgical management of gynaecologic patients including surgical treatment (minor surgeries) and peri-operative care. (Jr gyne, Jr gyne onc) 9. Provide consultation on common and uncomplicated Obstetric and Gynecologic problems in the Emergency Department. (Jr OB, on-call, jr gyne ) 10. Resuscitate, stabilize, and triage patients in an emergency department, delivery room, or inpatient acute care setting and transfer to a higher level of care as required. (Jr OB. on-call, ER rotation, jr gyne) 11. Participate in handover. (Jr OB, on-call)

Manage Normal Labour and Childbirth Core Activities Assess and triage Manage normal labour Manage normal vaginal birth Key and Enabling Competencies ME 1.1, 1.2, 1.3, 1.4, 1.5, 1.6 ME 2.1, 2.2, 2.3, 2.4 ME 5.1, 5.2, 5.3, CM 1.1, 1.2, 1.3, 1.4, 1.5, 1.6 CM 2.1, 2.2, 2.3, 2.4, CM 3.1, CM 4.1, CM CL 1.1, 1.2, 1.3 CL 2.1, P 1.1, 1.2 ME 1.1, 1.2, 1.3, 1.4, 1.5, 1.6 ME 2.1, 2.2, 2.3, 2.4 ME 3.1, 3.2, 3.3, 3.4, ME 5.1, 5.2, 5.3, CM 1.1, 1.2, 1.3, 1.4, 1.5, 1.6 CM 2.1, 2.2, 2.3, 2.4, CM 3.1, 3.2, CM 4.1, 4.3, CM CL 1.1, 1.2, 1.3 CL 2.1,2.2, CL 3.2 L1.2 L2.1, 2.2 P 1.1, 1.2 ME 1.1, 1.2, 1.3, 1.4, 1.5, 1.6 ME 2.1, 2.2, 2.3, 2.4 ME 3.1, 3.2, 3.3, 3.4, ME 5.1, 5.2, 5.3 CM 1.1, 1.2, 1.3, 1.4, 1.5, 1.6 CM 2.1, 2.2, 2.3, 2.4, CM 3.1, 3.2, CM 4.1, 4.3, CM CL 1.1, 1.2, 1.3 CL 2.1,2.2, L 1.2 L2.1, 2.2 P 1.1, 1.2

Core of discipline EPA’s 1. Provide high-risk antenatal care in the outpatient setting. (MFM) 2. Perform Obstetric USS. (MFM) 3. Manage Complicated Labour and Childbirth. (Sr OB) 4. Manage complications in the post-partum patient.(Sr OB) 5. Diagnose and manage gynaecologic presentations in the pediatric and adolescent population. (REI) 6. Manage presentations in the menopausal population.( REI) 7. Diagnose and manage general gynaecologic presentations. 8. Diagnose and manage basic reproductive medicine presentations. (REI) 9. Diagnose and manage basic gynaecologic oncology presentations with referral to subspecialty care as necessary. (Gyne onc) 10. Assess and treat patients with Cervical dysplasia (Gyne Onc) 11. Diagnose and manage basic urogynecologic presentations. (Urogyne) 12. Provide surgical management of gynaecologic patients including surgical treatment and peri- operative care. (Chief, Sr Gyne) 13. Provide consultation on Obstetric and Gynecologic problems to other Health Care Providers. (Sr OB, Chief) 14. Diagnose and manage sexual health concerns in women. (Sr Clinics, Chief) 15. Provide care to multiple services and patients as an on-call physician. ( Sr on-call) 16. Engage in self-regulated learning including, self-assessing, planning, and monitoring progress 17. Support others’ learning including formal and bedside teaching and assessment

Core of Discipline EPA’s Rotations: PGY 3-5  MFM – 4 blocks  REI – 4 blocks  Urogyne – 4 blocks  Gyne Onc – 4 blocks  Sr OB – 4 blocks  Sr clinics – 2 blocks  Chief – 4 blocks  On-Call

Core of discipline EPA’s 1. Provide high-risk antenatal care in the outpatient setting. (MFM) 2. Perform Obstetric USS. (MFM) 3. Manage Complicated Labour and Childbirth. (Sr OB) 4. Manage complications in the post-partum patient.(Sr OB) 5. Diagnose and manage gynaecologic presentations in the pediatric and adolescent population. (REI) 6. Manage presentations in the menopausal population.( REI) 7. Diagnose and manage general gynaecologic presentations. 8. Diagnose and manage basic reproductive medicine presentations. (REI) 9. Diagnose and manage basic gynaecologic oncology presentations with referral to subspecialty care as necessary. (Gyne onc) 10. Assess and treat patients with Cervical dysplasia (Gyne Onc) 11. Diagnose and manage basic urogynecologic presentations. (Urogyne) 12. Provide surgical management of gynaecologic patients including surgical treatment and peri- operative care. (Chief, Sr Gyne) 13. Provide consultation on Obstetric and Gynecologic problems to other Health Care Providers. (Sr OB, Chief) 14. Diagnose and manage sexual health concerns in women. (Sr Clinics, Chief) 15. Provide care to multiple services and patients as an on-call physician. ( Sr on-call) 16. Engage in self-regulated learning including, self-assessing, planning, and monitoring progress 17. Support others’ learning including formal and bedside teaching and assessment

Manage complications in the post- partum patient Core Activities Inpatient postpartum care Outpatient postpartum care – clinic encounter/on-call Key and Enabling Competencies ME 1.1, 1.2, 13, 1.4, 1.5, 1.6 ME 2.1, 2.2, 2.3, 2.4 ME 3.1, 3.2, 3.3, 3.4 ME 4.1 ME 5.2 CM 1.1, 1.2, 1.3, 1.4, 1.5, 1.6 CM 2.1, 2.2, 2.3, 2.4 CM 3.1, 3.2 CM 4.1, 4.3 CM 5.1, 5.2 CL 1.1, 1.2, 1.3 CL 2.1, 2.2, CL 3.1, 3.2 L 1.2, L 2.2 A 1.1, 1.2., 1.3 P 1.1, 1.3 P 3.1 P 4.3 ME 1.1, 1.2, 1.3, 1.4, 1.5, 1.6 ME 2.1, 2.2, 2.3, 2.4 ME 3.1, 3.2, 3.3, 3.4, ME 4.1, ME 5.1, 5.2, 5.3, ME 5.1, 5.2, 5.3, CM 1.1, 1.2, 1.3, 1.4, 1.5, 1.6 CM 2.1, 2.2, 2.3, 2.4, CM 3.1, 3.2, CM 4.1, 4.2, 4.3, CM CL 1.1, 1.2, 1.3 CL 2.1,2.2, CL 3.1, 3.2 L1.2 L2.1, 2.2 L3.1 A 1.1, 1.2, 1.3, S 2.1, 2.3, P 1.1, 1.2, 1.3, 1.4, 1.5

Assessment  Based on observation of clinical activities Mid-rotation feedback forms Mid-rotation feedback forms Online ITERs – One45 Online ITERs – One45  Quarterly reviews of all residents by all department members

Assessment OB/GYN  Goal to replace current forms with systematic observation of resident performance CARS CARS Skills observation Skills observation

Assessment – Steps/progress to date  Review of Rotation Objectives PGY1-5 (spring 2014) Is it assessable? Is it assessable? Is it currently assessed? Is it currently assessed? Identification of means of assessment for all objectives Identification of means of assessment for all objectives Identification of objectives that do not currently have documented assessment (beyond ITER) Identification of objectives that do not currently have documented assessment (beyond ITER)

Assessment – Steps/progress to date  Revision of Rotation Objectives for PGY 1 rotations – JR OB, Ambulatory clinics (summer 2014) Identified Core Clinical Activities that encompassed the rotation objectives Identified Core Clinical Activities that encompassed the rotation objectives Developed rubrics for – SVD, Patient triage, Post- partum care and discharge, Buddy Call, Informed Consent, MSF and other core activities (Thank-you to Surgery, Peds, Family Med and others!) Developed rubrics for – SVD, Patient triage, Post- partum care and discharge, Buddy Call, Informed Consent, MSF and other core activities (Thank-you to Surgery, Peds, Family Med and others!) Skills checklist – to ensure that residents were observed and deemed competent in procedural skills before these were entrusted Skills checklist – to ensure that residents were observed and deemed competent in procedural skills before these were entrusted

Assessment – Steps/progress to date  Introduction to Faculty and residents – Sept 2014 Grand Rounds Reviews of EPA’s, Milestones, Competency by Design Reviews of EPA’s, Milestones, Competency by Design Description of rubrics Description of rubrics Clarification of expectations for completion of rubrics and checklist Clarification of expectations for completion of rubrics and checklist Circulation for revisions/feedback prior to implementation Circulation for revisions/feedback prior to implementation  Piloting with PG1’s: Sept 2014 – June 2015

Assessment – Steps/progress to date  Implementation with PG1’s: July 2015  Fall 2015 – introduction of new rubrics for piloting Journal Club Journal Club Senior resident On-call Senior resident On-call PGY-2 rotation assessment PGY-2 rotation assessment

Assessment – Challenges!  Document completion Fast-paced service Fast-paced service Resident hesitancy – don’t want to bother staff, discomfort with face-to-face feedback Resident hesitancy – don’t want to bother staff, discomfort with face-to-face feedback Communication/understanding of expectations (residents and faculty) Communication/understanding of expectations (residents and faculty)

Assessment – Steps/progress to date  Revision of Rotation Objectives for PGY 1 rotations – JR OB, Ambulatory clinics (summer 2014)