Download - To Enhance or Not to Enhance
ObjectivesTo review the current state of enhanced skills programs, both surgical and non-surgical in Canada
To envision the future of enhanced skills programs in the Triple C era
What are enhanced skills in maternity care?Family physicians bring two
enhanced skills sets to maternity care: enhanced maternity skills (EMS) and enhanced surgical skills (ESS) including C/S.
Community need may dictate that an FP has one, the other or both of these skill sets
Current state of Enhanced Maternity Skills programsWhat we believe – primarily a vehicle
for added volume, added confidence, required for privileges/teaching
What we hope – enhanced skills programs provide skills that lead to enhanced scope and are used in practice.
What we know – limited data available from the U.S., currently Canadian study in progress
Will triple C change the need for and nature of enhanced skills programs?
Revisit and redefine the core competencies expected at the start of practice
If each resident has these competencies how will enhanced skills programs change?
What will the transition look like?
What role should Enhanced Skills Programs fill?1. Provide a specific, expanded skill set –
e.g. C-section, breech delivery, forceps delivery
2. Prepare for specific practice settings - e.g. high volume, rural/remote, specific populations
3. Prepare for the role of maternity care teacher
4. In some settings, required for privileging
Other jurisdictions and approachesAmerican streaming approach
Three tiersCan be completed within 3 year residencyHas an impact for residency training for those
not in the enhanced skills stream
ESS -Current LandscapeOne single program in Canada that
offers a full R3 program in ESSPrince AlbertOver subscribed and graduates two physicians
per year
AlbertaSix month surgical obstetrics programs availableTentative full R3 program in Grande Prairie
Other ProvincesSurgical Obstetrics available on an irregular
basis
What should the Enhanced Maternity Skills curriculum look like? Comments
of Participants
Need to define core before we can define enhanced, should we be paying attention to EMS when if we fail to meet core competencies?
Enhancement vs remediationUltrasound in pregnancy – some
core, some enhanced?
ALARM/ALSO – core or enhanced?Special populations/difficult populationsAble to advise and consult in a pregnancyEnhanced skills program should not a
place to train those that do OB only (as EM as done)
Not an R3 yearWho will do the teaching? Where will we
get the teachers?Research?Are there other ways to provide
confidence/volume eg mentoring
How do you find a place? Do we have the capacity to meet the need?
Generalist enhanced skills – respecting an MD who wants more than one enhanced skill set
Mandatory FM mentorVacuum – core vs enhanced –
independent vs supervisedBreech deliveryDiabetes, gestational HTN – core,
spectrum, enhanced
If there isn’t enough learning opportunities – who gets them? Do we ‘force’ the resident who has their mind made up?
Newborn skills – core vs enhanced. Providing volume – ensure paeds not just OB our supports
Teaching the future teachersDo we have different standards for
IMGs?
Exposed (core) vs expert (enhanced)Breastfeeding, tongue tie release –
core vs enhanced.Ability to work in environments with
less back-up (eg no surgical service)C-section assist
Enhanced Surgical SkillsFPs with ESS may have a focussed
obstetrical skill set (eg C/S alone) or a broader skill set including parts of general surgery, ENT and plastics
ESS has been approved as a SIFP with the hopes that one day ESS will be a Certificate of Added Compentence
Current draft of the national working group ESS CurriculumModular in format
Basic Operative Management Management of Abdominal Presentation in the
Non-Pregnant Patient in Rural and RemoteManagement of Pregnancy in Rural and
Remote Management of Non-Abdominal Presentations
in Rural and Remote Basic Principles Trauma
Management of Pregnancy in Rural and RemoteComplications of Labour & Delivery
operative vaginal delivery, C-section, obstetrical trauma, uterine inversion, PPH, retained placenta; ALARM, NRP
First Trimester Pain and Bleeding D&C, ectopic
What should the Enhanced Surgical Skills Curriculum look like?D&C and management of early preg
lossBroad enough skill set to maintain
the OR and the overall surgical program
How do we ensure the Enhanced Skills Programs respond to community needs?How can we provide volume for our
learners if we have volume caps?Accreditation, privileges – what if we
give them skills and then they aren’t allowed to use them?
What if you can’t get privileges without the enhanced skills time even if you have the skills after the core?
How does return of service influence the skills that a resident needs and gets?