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
Change in assessment practices
EPA development
Rounds 2013 – Introduction of
EPA’s, Competency by Design to
Department of Obstetrics and Gynecology
 Grand
2014 – development of
preliminary working set of EPA’s while
reviewing residency objectives
 Summer
EPA development
2014 –
Development of Scope of Practice EPA’s
 July 2015 –
Development of Stage-Specific EPA’s with
identification of relevant associated
milestones
 January
Transitions to discipline EPA’s
1.
2.
3.
4.
5.
6.


Perform a history and physical in a pregnant patient. (Jr OB and Jr Clinics –
Blocks 1-2)
Perform a gynecologic history and physical examination. (Jr Clinics –
Blocks 1-2)
Demonstrate basic knowledge of obstetric and gynecologic presentations.
(Jr OB and Jr clinics)
Perform a basic assessment of a patient arriving to labour and delivery. (Jr
OB)
Perform a basic assessment of a patient arriving in the ER. (Jr OB)
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
Provide low-risk antenatal care in the outpatient setting. (Jr clinics )
Perform basic Obstetric USS. (Jr OB)
Assess and triage patients arriving to Labour and Delivery.(Jr OB, on-call)
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)
1.
2.
3.
4.
Foundations EPA’s
Rotations – PGY 1/2:
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
 Jr
Foundations EPA’s
1.
2.
Provide low-risk antenatal care in the outpatient setting. (Jr clinics )
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)
Manage gynecologic patients requiring family planning. (women’s clinic)
Diagnose and manage general gynaecologic presentations. (on-call, Jr clinics)
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)
6.
7.
8.
Manage Normal Labour and Childbirth
Core Activities
Key and
Enabling
Competencies
Assess and triage
Manage normal
labour
Manage normal
vaginal birth
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,
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 5.1. 5.2
CL 1.1, 1.2, 1.3
CL 2.1,2.2,
CL 3.2
L1.2
L2.1, 2.2
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 5.1. 5.2
CL 1.1, 1.2, 1.3
CL 2.1,2.2,
P 1.1, 1.2
P 1.1, 1.2
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,
CM 4.1,
CM 5.1. 5.2
CL 1.1, 1.2, 1.3
CL 2.1,
P 1.1, 1.2
L 1.2
L2.1, 2.2
Core of discipline EPA’s
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Provide high-risk antenatal care in the outpatient setting. (MFM)
Perform Obstetric USS. (MFM)
Manage Complicated Labour and Childbirth. (Sr OB)
Manage complications in the post-partum patient.(Sr OB)
Diagnose and manage gynaecologic presentations in the pediatric and adolescent population.
(REI)
Manage presentations in the menopausal population.( REI)
Diagnose and manage general gynaecologic presentations.
Diagnose and manage basic reproductive medicine presentations. (REI)
Diagnose and manage basic gynaecologic oncology presentations with referral to subspecialty
care as necessary. (Gyne onc)
Assess and treat patients with Cervical dysplasia (Gyne Onc)
Diagnose and manage basic urogynecologic presentations. (Urogyne)
Provide surgical management of gynaecologic patients including surgical treatment and perioperative care. (Chief, Sr Gyne)
Provide consultation on Obstetric and Gynecologic problems to other Health Care Providers. (Sr
OB, Chief)
Diagnose and manage sexual health concerns in women. (Sr Clinics, Chief)
Provide care to multiple services and patients as an on-call physician. ( Sr on-call)
Engage in self-regulated learning including, self-assessing, planning, and monitoring progress
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
3.
Provide high-risk antenatal care in the outpatient setting. (MFM)
Perform Obstetric USS. (MFM)
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)
Manage presentations in the menopausal population.( REI)
Diagnose and manage general gynaecologic presentations.
Diagnose and manage basic reproductive medicine presentations. (REI)
Diagnose and manage basic gynaecologic oncology presentations with referral to subspecialty
care as necessary. (Gyne onc)
Assess and treat patients with Cervical dysplasia (Gyne Onc)
Diagnose and manage basic urogynecologic presentations. (Urogyne)
Provide surgical management of gynaecologic patients including surgical treatment and perioperative care. (Chief, Sr Gyne)
Provide consultation on Obstetric and Gynecologic problems to other Health Care Providers. (Sr
OB, Chief)
Diagnose and manage sexual health concerns in women. (Sr Clinics, Chief)
Provide care to multiple services and patients as an on-call physician. ( Sr on-call)
Engage in self-regulated learning including, self-assessing, planning, and monitoring progress
Support others’ learning including formal and bedside teaching and assessment
1.
2.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Manage complications in the postpartum patient
Core Activities
Inpatient postpartum
care
Outpatient postpartum
care – clinic
encounter/on-call
Key and Enabling
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,
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 5.1. 5.2
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
Competencies
Assessment
 Based


on observation of clinical activities
Mid-rotation feedback forms
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
Skills observation
Assessment – Steps/progress to
date
 Review
of Rotation Objectives PGY1-5
(spring 2014)




Is it assessable?
Is it currently assessed?
Identification of means of assessment for all
objectives
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
Developed rubrics for – SVD, Patient triage, Postpartum 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
Assessment – Steps/progress to
date

Introduction to Faculty and residents – Sept
2014 Grand Rounds





Reviews of EPA’s, Milestones, Competency by
Design
Description of rubrics
Clarification of expectations for completion of rubrics
and checklist
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
Senior resident On-call
PGY-2 rotation assessment
Assessment – Challenges!
 Document



completion
Fast-paced service
Resident hesitancy – don’t want to bother
staff, discomfort with face-to-face feedback
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)