CBME – Department of CBME – Department of OB/GYNOB/GYN

Sue ChamberlainSue Chamberlain

CBME workshop CBME workshop

Sept 2015Sept 2015

CBME – Where we are atCBME – Where we are at

Transition to CBME occurring on 2 levelsTransition to CBME occurring on 2 levels Development of EPA’s and identification of Development of EPA’s and identification of

milestonesmilestones Change in assessment practicesChange in assessment practices

EPA developmentEPA development

Grand Rounds 2013 – Introduction of Grand Rounds 2013 – Introduction of EPA’s, Competency by Design to EPA’s, Competency by Design to Department of Obstetrics and GynecologyDepartment of Obstetrics and Gynecology

Summer 2014 – development of Summer 2014 – development of preliminary working set of EPA’s while preliminary working set of EPA’s while reviewing residency objectivesreviewing residency objectives

EPA developmentEPA development

January 2014 – January 2014 –

Development of Scope of Practice EPA’s Development of Scope of Practice EPA’s July 2015 – July 2015 –

Development of Stage-Specific EPA’s with Development of Stage-Specific EPA’s with identification of relevant associated identification of relevant associated milestonesmilestones

Transitions to discipline EPATransitions to discipline EPA’’ss

1.1. Perform a history and physical in a pregnant patient. (Jr OB and Jr Clinics – Perform a history and physical in a pregnant patient. (Jr OB and Jr Clinics – Blocks 1-2)Blocks 1-2)

2.2. Perform a gynecologic history and physical examination. (Jr Clinics – Perform a gynecologic history and physical examination. (Jr Clinics – Blocks 1-2)Blocks 1-2)

3.3. Demonstrate basic knowledge of obstetric and gynecologic presentations. Demonstrate basic knowledge of obstetric and gynecologic presentations. (Jr OB and Jr clinics)(Jr OB and Jr clinics)

4.4. Perform a basic assessment of a patient arriving to labour and delivery. (Jr Perform a basic assessment of a patient arriving to labour and delivery. (Jr OB)OB)

5.5. Perform a basic assessment of a patient arriving in the ER. (Jr OB)Perform a basic assessment of a patient arriving in the ER. (Jr OB)6.6. Assist in the operating room and write basic post-op orders for obstetric and Assist in the operating room and write basic post-op orders for obstetric and

gynecologic patients. (Jr OB)gynecologic patients. (Jr OB)

Curriculum/rotations – JR OB, JR clinics, Boot camp, attendance at Curriculum/rotations – JR OB, JR clinics, Boot camp, attendance at clerkship seminarsclerkship seminars

Assessment – Clerkship oral examinations, Direct observation with Patient Assessment – Clerkship oral examinations, Direct observation with Patient encounter forms for clinics and L&Dencounter forms for clinics and L&D

Foundations EPAFoundations EPA’’ss

1.1. Provide low-risk antenatal care in the outpatient setting. (Jr clinics )Provide low-risk antenatal care in the outpatient setting. (Jr clinics )2.2. Perform basic Obstetric USS. (Jr OB)Perform basic Obstetric USS. (Jr OB)3.3. Assess and triage patients arriving to Labour and Delivery.(Jr OB, on-call)Assess and triage patients arriving to Labour and Delivery.(Jr OB, on-call)4.4. Diagnose and manage common inpatient obstetric complications including preterm Diagnose and manage common inpatient obstetric complications including preterm

labour, pre-eclampsia and PPROM. (Jr OB, on-call)labour, pre-eclampsia and PPROM. (Jr OB, on-call)5.5. Manage Normal Labour and Childbirth and post-partum. (Jr OB, on-call)Manage Normal Labour and Childbirth and post-partum. (Jr OB, on-call)6.6. Manage gynecologic patients requiring family planning. (womenManage gynecologic patients requiring family planning. (women’’s clinic)s clinic)7.7. Diagnose and manage general gynaecologic presentations. (on-call, Jr clinics)Diagnose and manage general gynaecologic presentations. (on-call, Jr clinics)8.8. Provide surgical management of gynaecologic patients including surgical treatment Provide surgical management of gynaecologic patients including surgical treatment

(minor surgeries) and peri-operative care. (Jr gyne, Jr gyne onc)(minor surgeries) and peri-operative care. (Jr gyne, Jr gyne onc)9.9. Provide consultation on common and uncomplicated Obstetric and Gynecologic Provide consultation on common and uncomplicated Obstetric and Gynecologic

problems in the Emergency Department. (Jr OB, on-call, jr gyne )problems in the Emergency Department. (Jr OB, on-call, jr gyne )10.10. Resuscitate, stabilize, and triage patients in an emergency department, delivery 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. room, or inpatient acute care setting and transfer to a higher level of care as required. (Jr OB. on-call, ER rotation, jr gyne)(Jr OB. on-call, ER rotation, jr gyne)

11.11. Participate in handover. (Jr OB, on-call)Participate in handover. (Jr OB, on-call)

Foundations EPAFoundations EPA’’ss

Rotations – PGY 1/2: Rotations – PGY 1/2: Jr clinics – 2 blocksJr clinics – 2 blocks Jr OB – 4 blocksJr OB – 4 blocks ER – 1 block ER – 1 block womenwomen’’s clinic – 1 blocks clinic – 1 block Jr gyne – 4 blocksJr gyne – 4 blocks Jr gyne onc – 4 blocksJr gyne onc – 4 blocks on-call – through first 2 yearson-call – through first 2 years

Foundations EPAFoundations EPA’’ss

1.1. Provide low-risk antenatal care in the outpatient setting. (Jr clinics )Provide low-risk antenatal care in the outpatient setting. (Jr clinics )2.2. Perform basic Obstetric USS. (Jr OB)Perform basic Obstetric USS. (Jr OB)3.3. Assess and triage patients arriving to Labour and Delivery.(Jr OB, on-call)Assess and triage patients arriving to Labour and Delivery.(Jr OB, on-call)4.4. Diagnose and manage common inpatient obstetric complications including preterm Diagnose and manage common inpatient obstetric complications including preterm

labour, pre-eclampsia and PPROM. (Jr OB, on-call)labour, pre-eclampsia and PPROM. (Jr OB, on-call)5.5. Manage Normal Labour and Childbirth and post-partum. (Jr OB, on-call)Manage Normal Labour and Childbirth and post-partum. (Jr OB, on-call)6.6. Manage gynecologic patients requiring family planning. (womenManage gynecologic patients requiring family planning. (women’’s clinic)s clinic)7.7. Diagnose and manage general gynaecologic presentations. (on-call, Jr clinics)Diagnose and manage general gynaecologic presentations. (on-call, Jr clinics)8.8. Provide surgical management of gynaecologic patients including surgical treatment Provide surgical management of gynaecologic patients including surgical treatment

(minor surgeries) and peri-operative care. (Jr gyne, Jr gyne onc)(minor surgeries) and peri-operative care. (Jr gyne, Jr gyne onc)9.9. Provide consultation on common and uncomplicated Obstetric and Gynecologic Provide consultation on common and uncomplicated Obstetric and Gynecologic

problems in the Emergency Department. (Jr OB, on-call, jr gyne )problems in the Emergency Department. (Jr OB, on-call, jr gyne )10.10. Resuscitate, stabilize, and triage patients in an emergency department, delivery 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. room, or inpatient acute care setting and transfer to a higher level of care as required. (Jr OB. on-call, ER rotation, jr gyne)(Jr OB. on-call, ER rotation, jr gyne)

11.11. Participate in handover. (Jr OB, on-call)Participate in handover. (Jr OB, on-call)

Manage Normal Labour and ChildbirthManage Normal Labour and Childbirth

Core ActivitiesCore Activities Assess and Assess and triagetriage

Manage Manage normal labournormal labour

Manage Manage normal vaginal normal vaginal birthbirth

Key and Key and Enabling Enabling CompetenciesCompetencies

ME 1.1, 1.2, 1.3, 1.4, 1.5, 1.6ME 1.1, 1.2, 1.3, 1.4, 1.5, 1.6

ME 2.1, 2.2, 2.3, 2.4ME 2.1, 2.2, 2.3, 2.4

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, 1.6CM 1.1, 1.2, 1.3, 1.4, 1.5, 1.6

CM 2.1, 2.2, 2.3, 2.4,CM 2.1, 2.2, 2.3, 2.4,

CM 3.1, CM 3.1,

CM 4.1, CM 4.1,

CM 5.1. 5.2CM 5.1. 5.2

CL 1.1, 1.2, 1.3CL 1.1, 1.2, 1.3

CL 2.1, CL 2.1,

P 1.1, 1.2 P 1.1, 1.2

ME 1.1, 1.2, 1.3, 1.4, 1.5, ME 1.1, 1.2, 1.3, 1.4, 1.5, 1.61.6

ME 2.1, 2.2, 2.3, 2.4ME 2.1, 2.2, 2.3, 2.4

ME 3.1, 3.2, 3.3, 3.4, ME 3.1, 3.2, 3.3, 3.4,

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, CM 1.1, 1.2, 1.3, 1.4, 1.5, 1.61.6

CM 2.1, 2.2, 2.3, 2.4,CM 2.1, 2.2, 2.3, 2.4,

CM 3.1, 3.2, CM 3.1, 3.2,

CM 4.1, 4.3, CM 4.1, 4.3,

CM 5.1. 5.2CM 5.1. 5.2

CL 1.1, 1.2, 1.3CL 1.1, 1.2, 1.3

CL 2.1,2.2, CL 2.1,2.2,

CL 3.2CL 3.2

L1.2L1.2

L2.1, 2.2L2.1, 2.2

P 1.1, 1.2P 1.1, 1.2

ME 1.1, 1.2, 1.3, 1.4, 1.5, ME 1.1, 1.2, 1.3, 1.4, 1.5, 1.61.6

ME 2.1, 2.2, 2.3, 2.4ME 2.1, 2.2, 2.3, 2.4

ME 3.1, 3.2, 3.3, 3.4, ME 3.1, 3.2, 3.3, 3.4,

ME 5.1, 5.2, 5.3ME 5.1, 5.2, 5.3

CM 1.1, 1.2, 1.3, 1.4, 1.5, CM 1.1, 1.2, 1.3, 1.4, 1.5, 1.61.6

CM 2.1, 2.2, 2.3, 2.4,CM 2.1, 2.2, 2.3, 2.4,

CM 3.1, 3.2,CM 3.1, 3.2,

CM 4.1, 4.3,CM 4.1, 4.3,

CM 5.1. 5.2CM 5.1. 5.2

CL 1.1, 1.2, 1.3CL 1.1, 1.2, 1.3

CL 2.1,2.2,CL 2.1,2.2,

L 1.2L 1.2

L2.1, 2.2L2.1, 2.2

P 1.1, 1.2P 1.1, 1.2

Core of discipline EPACore of discipline EPA’’s s 1.1. Provide high-risk antenatal care in the outpatient setting. (MFM)Provide high-risk antenatal care in the outpatient setting. (MFM)2.2. Perform Obstetric USS. (MFM)Perform Obstetric USS. (MFM)3.3. Manage Complicated Labour and Childbirth. (Sr OB)Manage Complicated Labour and Childbirth. (Sr OB)4.4. Manage complications in the post-partum patient.(Sr OB)Manage complications in the post-partum patient.(Sr OB)5.5. Diagnose and manage gynaecologic presentations in the pediatric and adolescent population. Diagnose and manage gynaecologic presentations in the pediatric and adolescent population.

(REI)(REI)6.6. Manage presentations in the menopausal population.( REI)Manage presentations in the menopausal population.( REI)7.7. Diagnose and manage general gynaecologic presentations.Diagnose and manage general gynaecologic presentations.8.8. Diagnose and manage basic reproductive medicine presentations. (REI)Diagnose and manage basic reproductive medicine presentations. (REI)9.9. Diagnose and manage basic gynaecologic oncology presentations with referral to subspecialty Diagnose and manage basic gynaecologic oncology presentations with referral to subspecialty

care as necessary. (Gyne onc)care as necessary. (Gyne onc)10.10. Assess and treat patients with Cervical dysplasia (Gyne Onc)Assess and treat patients with Cervical dysplasia (Gyne Onc)11.11. Diagnose and manage basic urogynecologic presentations. (Urogyne)Diagnose and manage basic urogynecologic presentations. (Urogyne)12.12. Provide surgical management of gynaecologic patients including surgical treatment and peri-Provide surgical management of gynaecologic patients including surgical treatment and peri-

operative care. (Chief, Sr Gyne)operative care. (Chief, Sr Gyne)13.13. Provide consultation on Obstetric and Gynecologic problems to other Health Care Providers. (Sr Provide consultation on Obstetric and Gynecologic problems to other Health Care Providers. (Sr

OB, Chief)OB, Chief)14.14. Diagnose and manage sexual health concerns in women. (Sr Clinics, Chief)Diagnose and manage sexual health concerns in women. (Sr Clinics, Chief)15.15. Provide care to multiple services and patients as an on-call physician. ( Sr on-call)Provide care to multiple services and patients as an on-call physician. ( Sr on-call)16.16. Engage in self-regulated learning including, self-assessing, planning, and monitoring progressEngage in self-regulated learning including, self-assessing, planning, and monitoring progress17.17. Support othersSupport others’’ learning including formal and bedside teaching and assessment learning including formal and bedside teaching and assessment

Core of Discipline EPA’sCore of Discipline EPA’s

Rotations: PGY 3-5Rotations: PGY 3-5 MFM – 4 blocksMFM – 4 blocks REI – 4 blocksREI – 4 blocks Urogyne – 4 blocksUrogyne – 4 blocks Gyne Onc – 4 blocksGyne Onc – 4 blocks Sr OB – 4 blocksSr OB – 4 blocks Sr clinics – 2 blocksSr clinics – 2 blocks Chief – 4 blocksChief – 4 blocks On-Call On-Call

Core of discipline EPACore of discipline EPA’’s s 1.1. Provide high-risk antenatal care in the outpatient setting. (MFM)Provide high-risk antenatal care in the outpatient setting. (MFM)2.2. Perform Obstetric USS. (MFM)Perform Obstetric USS. (MFM)3.3. Manage Complicated Labour and Childbirth. (Sr OB)Manage Complicated Labour and Childbirth. (Sr OB)4.4. Manage complications in the post-partum patient.(Sr OB)Manage complications in the post-partum patient.(Sr OB)5.5. Diagnose and manage gynaecologic presentations in the pediatric and adolescent population. Diagnose and manage gynaecologic presentations in the pediatric and adolescent population.

(REI)(REI)6.6. Manage presentations in the menopausal population.( REI)Manage presentations in the menopausal population.( REI)7.7. Diagnose and manage general gynaecologic presentations.Diagnose and manage general gynaecologic presentations.8.8. Diagnose and manage basic reproductive medicine presentations. (REI)Diagnose and manage basic reproductive medicine presentations. (REI)9.9. Diagnose and manage basic gynaecologic oncology presentations with referral to subspecialty Diagnose and manage basic gynaecologic oncology presentations with referral to subspecialty

care as necessary. (Gyne onc)care as necessary. (Gyne onc)10.10. Assess and treat patients with Cervical dysplasia (Gyne Onc)Assess and treat patients with Cervical dysplasia (Gyne Onc)11.11. Diagnose and manage basic urogynecologic presentations. (Urogyne)Diagnose and manage basic urogynecologic presentations. (Urogyne)12.12. Provide surgical management of gynaecologic patients including surgical treatment and peri-Provide surgical management of gynaecologic patients including surgical treatment and peri-

operative care. (Chief, Sr Gyne)operative care. (Chief, Sr Gyne)13.13. Provide consultation on Obstetric and Gynecologic problems to other Health Care Providers. (Sr Provide consultation on Obstetric and Gynecologic problems to other Health Care Providers. (Sr

OB, Chief)OB, Chief)14.14. Diagnose and manage sexual health concerns in women. (Sr Clinics, Chief)Diagnose and manage sexual health concerns in women. (Sr Clinics, Chief)15.15. Provide care to multiple services and patients as an on-call physician. ( Sr on-call)Provide care to multiple services and patients as an on-call physician. ( Sr on-call)16.16. Engage in self-regulated learning including, self-assessing, planning, and monitoring progressEngage in self-regulated learning including, self-assessing, planning, and monitoring progress17.17. Support othersSupport others’’ learning including formal and bedside teaching and assessment learning including formal and bedside teaching and assessment

Manage complications in the post-Manage complications in the post-partum patientpartum patient

Core ActivitiesCore Activities Inpatient postpartum Inpatient postpartum carecare

Outpatient Outpatient postpartum care – postpartum care – clinic encounter/on-clinic encounter/on-callcall

Key and Enabling Key and Enabling

CompetenciesCompetencies ME 1.1, 1.2, 13, 1.4, 1.5, 1.6ME 1.1, 1.2, 13, 1.4, 1.5, 1.6

ME 2.1, 2.2, 2.3, 2.4ME 2.1, 2.2, 2.3, 2.4

ME 3.1, 3.2, 3.3, 3.4ME 3.1, 3.2, 3.3, 3.4

ME 4.1ME 4.1

ME 5.2ME 5.2

CM 1.1, 1.2, 1.3, 1.4, 1.5, 1.6CM 1.1, 1.2, 1.3, 1.4, 1.5, 1.6

CM 2.1, 2.2, 2.3, 2.4CM 2.1, 2.2, 2.3, 2.4

CM 3.1, 3.2CM 3.1, 3.2

CM 4.1, 4.3CM 4.1, 4.3

CM 5.1, 5.2CM 5.1, 5.2

CL 1.1, 1.2, 1.3CL 1.1, 1.2, 1.3

CL 2.1, 2.2, CL 2.1, 2.2,

CL 3.1, 3.2CL 3.1, 3.2

L 1.2, L 1.2,

L 2.2L 2.2

A 1.1, 1.2., 1.3A 1.1, 1.2., 1.3

P 1.1, 1.3P 1.1, 1.3

P 3.1P 3.1

P 4.3P 4.3

ME 1.1, 1.2, 1.3, 1.4, 1.5, 1.6ME 1.1, 1.2, 1.3, 1.4, 1.5, 1.6

ME 2.1, 2.2, 2.3, 2.4ME 2.1, 2.2, 2.3, 2.4

ME 3.1, 3.2, 3.3, 3.4, ME 3.1, 3.2, 3.3, 3.4,

ME 4.1, 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, 1.6CM 1.1, 1.2, 1.3, 1.4, 1.5, 1.6

CM 2.1, 2.2, 2.3, 2.4,CM 2.1, 2.2, 2.3, 2.4,

CM 3.1, 3.2, CM 3.1, 3.2,

CM 4.1, 4.2, 4.3, CM 4.1, 4.2, 4.3,

CM 5.1. 5.2CM 5.1. 5.2

CL 1.1, 1.2, 1.3CL 1.1, 1.2, 1.3

CL 2.1,2.2, CL 2.1,2.2,

CL 3.1, 3.2CL 3.1, 3.2

L1.2L1.2

L2.1, 2.2L2.1, 2.2

L3.1L3.1

A 1.1, 1.2, 1.3, A 1.1, 1.2, 1.3,

S 2.1, 2.3, S 2.1, 2.3,

P 1.1, 1.2, 1.3, 1.4, 1.5P 1.1, 1.2, 1.3, 1.4, 1.5

Assessment Assessment

Based on observation of clinical activitiesBased on observation of clinical activities Mid-rotation feedback forms Mid-rotation feedback forms Online ITERs – One45Online ITERs – One45

Quarterly reviews of all residents by all Quarterly reviews of all residents by all department members department members

Assessment OB/GYNAssessment OB/GYN

Goal to replace current forms with Goal to replace current forms with systematic observation of resident systematic observation of resident performanceperformance CARSCARS Skills observationSkills observation

Assessment – Steps/progress to Assessment – Steps/progress to datedate

Review of Rotation Objectives PGY1-5 Review of Rotation Objectives PGY1-5 (spring 2014)(spring 2014) Is it assessable?Is it assessable? Is it currently assessed?Is it currently assessed? Identification of means of assessment for all Identification of means of assessment for all

objectivesobjectives Identification of objectives that do not Identification of objectives that do not

currently have documented assessment currently have documented assessment (beyond ITER)(beyond ITER)

Assessment – Steps/progress to Assessment – Steps/progress to datedate

Revision of Rotation Objectives for PGY 1 Revision of Rotation Objectives for PGY 1 rotations – JR OB, Ambulatory clinics (summer rotations – JR OB, Ambulatory clinics (summer 2014)2014) Identified Core Clinical Activities that encompassed Identified Core Clinical Activities that encompassed

the rotation objectivesthe rotation objectives Developed rubrics for – SVD, Patient triage, Post-Developed rubrics for – SVD, Patient triage, Post-

partum care and discharge, Buddy Call, Informed partum care and discharge, Buddy Call, Informed Consent, MSF and other core activities (Thank-you to Consent, MSF and other core activities (Thank-you to Surgery, Peds, Family Med and others!)Surgery, Peds, Family Med and others!)

Skills checklist – to ensure that residents were Skills checklist – to ensure that residents were observed and deemed competent in procedural skills observed and deemed competent in procedural skills before these were entrustedbefore these were entrusted

Assessment – Steps/progress to Assessment – Steps/progress to datedate

Introduction to Faculty and residents – Sept Introduction to Faculty and residents – Sept 2014 Grand Rounds 2014 Grand Rounds Reviews of EPA’s, Milestones, Competency by Reviews of EPA’s, Milestones, Competency by

DesignDesign Description of rubricsDescription of rubrics Clarification of expectations for completion of rubrics Clarification of expectations for completion of rubrics

and checklistand checklist Circulation for revisions/feedback prior to Circulation for revisions/feedback prior to

implementationimplementation

Piloting with PG1’s: Sept 2014 – June 2015Piloting with PG1’s: Sept 2014 – June 2015

Assessment – Steps/progress to Assessment – Steps/progress to datedate

Implementation with PG1’s: July 2015Implementation with PG1’s: July 2015 Fall 2015 – introduction of new rubrics for Fall 2015 – introduction of new rubrics for

piloting piloting Journal ClubJournal Club Senior resident On-callSenior resident On-call PGY-2 rotation assessment PGY-2 rotation assessment

Assessment – Challenges!Assessment – Challenges!

Document completionDocument completion Fast-paced serviceFast-paced service Resident hesitancy – don’t want to bother Resident hesitancy – don’t want to bother

staff, discomfort with face-to-face feedbackstaff, discomfort with face-to-face feedback Communication/understanding of Communication/understanding of

expectations (residents and faculty) expectations (residents and faculty)

Assessment – Steps/progress to Assessment – Steps/progress to datedate

Revision of Rotation Objectives for PGY 1 Revision of Rotation Objectives for PGY 1 rotations – JR OB, Ambulatory clinics rotations – JR OB, Ambulatory clinics (summer 2014)(summer 2014)