The Importance of Creating a Supportive Environment During OB/GYN Residency Training Anthony R. Pivarunas, DO Lindsey Marugg, MD
Conflicts of Interest None
Learning Objectives Background Accreditation/ACGME requirements How we do it How it can be done elsewhere Resident perspectives
Sisters of Charity Hospital Located in Buffalo, New York Part of Catholic Health System Formed in 1998 with affiliation of 4 Catholic Hospitals and the Buffalo Diocese Sisters Hospital is the oldest hospital in Buffalo Started in 1848 when 6 Sisters of Charity arrived from Baltimore Helped with the cholera epidemic on 1849 1852 established an infant asylum and maternity hospital
Background Beds: 310 GYN Surgeries: 2,777 Births (2017): 3,485 Twins: 85 Triplets: 3 Level III Perinatal Center Neonatology and Maternal-Fetal Medicine ACGME approved Residency Programs Obstetrics and Gynecology 4 years Internal Medicine 3 years Family Medicine 3 years
Residency Program Accreditation Residency is an essential dimension of the transformation of the medical student to the independent practitioner along the continuum of medical education. It is physically, emotionally, and intellectually demanding, and requires longitudinally-concentrated effort on the part of the resident. The Accreditation Council for Graduate Medical Education (ACGME) is an independent, not-for-profit, physician-led organization that sets and monitors the professional educational standards essential in preparing physicians to deliver safe, high-quality medical care to all Americans.
ACGME Member Organizations
ACGME - 2017-2018 ~11,200 ACGME-accredited residency and fellowship programs 180 specialties and subspecialties 830 Sponsoring Institutions ~135,000 active full-time and part-time residents and fellows 1 out of 7 active physicians in the US is a resident or fellow.
Importance of ACGME Accreditation 1965 Social Security Act Funding for Graduate Medical Education Pays for direct and indirect expenses associated with training of residents Medicare % per case add-on= Multiplier X ((1 + IRB) 0.405-1) ACGME or American Osteopathic Association (AOA) Certification of Residency Program needed to receive this funding Completion of an ACGME or AOA accredited program required for Board Certification through the American Board of Medical Specialties (ABMS) or AOA Board Certification required for privileges at most hospitals or to participate in insurance plans
Path to Medical Practice
ACGME OB/GYN Residency Review Committee (RRC) OB/GYN Physicians who have oversight to assure programs are meeting the Program Requirements Program Requirements 34 pages specifying the details of a Residency Training Program in OB/GYN
ACGME OB/GYN Statistics Residency Stats 5844 Approved positions 5501 Filled positions 76% of residents from US LCME Medical Schools* 82% of residents are female* 74 residents left program early* 3.3 is average number of participating sites (SD=1.9)* 6.1 years is mean of program direct tenure (median=4.7)* *2016-2017 Academic Year
Accreditation Process Continued Initial
Accreditation Statuses (as of 3/18/2018)
Annual Review
Procedure Numbers
Sisters Program Timeline Original Accreditation Date: December 17, 1947 Size 1947-2006: 2 residents per year 2007-2013: 3 residents per year 2013- : 4 residents per year Accreditation difficulties In mid 1980s - probation In 2000 - probation My tenure at Sisters
Family Planning
How We Do It Environment Applicants Rotations
Environment Majority of the 4 years of training is done at Sisters of Charity Hospital We do not perform sterilization or abortion procedures Our resident clinic does not provide artificial contraception Our core faculty are all committed to the ERDs.
Applicants Upfront with resident applicants about the training they will receive If you want to become a well-rounded, competent, generalist obstetrician-gynecologist you will get great training here. If you want to get into a subspecialty, it will take extra effort on your part, but possible. If your life goal is to be a director of a Planned Parenthood, this program is probably not the type you are interested in.
Rotations Family Planning 4 week required rotation A M PM Monday Tuesday Wednesday Thursday Friday Continuity Continuity Clinic/ Education Clinic/ Case Network Case Network Fertility Care Center Neighborhood Health Center Neighborhood Health Center Fertility Care Center Neighborhood Health Center Goals and Objectives: This rotation is an opportunity for the resident to become more familiar with the modalities of family planning that are not provided at our institution. Residents with moral, ethical or religious objections are not required to participate in all aspects of this rotation and may opt out. Residents wishing to opt out must complete only the required elements and arrange their own elective time or independent study in some other area (natural family planning, research, office-based procedures, etc.).
Obstacles for Residents Elsewhere Philosophical Obstacles Program Director Faculty Residents Environmental Obstacles Sterilizations at rotation sites Postpartum contraception at rotation sites Contraception in resident clinics Feeling of isolation
How It Can Work Elsewhere Devil in the details of working out the day-to-day specifics before starting the program Flexible Education Experience in Obstetrics & Gynecology rarely used variation in training program experience for a single resident
So what does this look like to residents?
But how do you handle things like
Utilizing Conscience Objection An appeal to conscience in refusing to do acts that threaten a person s sense of integrity. Patients as well as physicians and nurses may appeal to conscience in refusing treatment or procedures. Vs. d Limits of Conscientious Refusal in Reproductive Medicine : Physicians have a duty to refer patient in a timely manner to other provider in an emergency in which referral is not possible or might negatively impact a patient s physical or mental health, providers have an obligation to provide medically indicated and requested care.
Reproductive Endocrinology Rotation Operating room: myomectomies, tubal reversals, endometriosis removal, hysteroscopies, etc. Office: hormone profiles, ultrasounds, infertility workup
Family Planning Rotation FertilityCare TM Center Federally Qualified Health Center
What about residents who aren t Catholic? Disclosure in residency interviews Communication in difficult scenarios Consistency among decisions Mutual respect
Mentoring is key Source: University of Maine Faculty
Questions?