Core Competencies

1. Core Competencies Society of Obstetric and Gynecologic Hospitalists

2. Who determines Competencies ? ACGME American Board Of Medical Specialities American Board of Obsterics and Gynecology ACOG SOGH States Hospitals Insurance Companies

3. Core Competencies Education Training Certification Experience Personal attributes

4. ACGME Competencies • Patient Care • Medical Knowledge • Practice-based Learning and Improvement • Interpersonal and Communication Skills • Professionalism • Systems-based Practice

5. ACGME- Patient Care • Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems an the promotion of health.

6. ACGME-Medical Knowledge • Fellow must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care.

7. ACGME- Practice-based Learning and Improvement • Fellows are expected to develop skills and habits to be able to meet the following goals: • Systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement • Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems.

8. ACGME- Interpersonal and Communication Skills • Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.

9. ACGME- Professionalism • Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.

10. ACGME-Systems-based Practice • Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.

11. Fellow evaluation • Feedback of fellow. • Feedback of faculty. • Feedback of facility. • Examinations

12. Forms of attaining medical knowledge Medical School Residency CME Experience Personal endeavors

13. One Sponsoring Institution Must Accept Ultimate Responsibility for the Program • Train • Verify quality education/educators • Document/store information of compliance • Determine eligibility of fellowship

14. Determination of Training • Medical License • Board Certification (ABOG) • Fellowhip • Hospitalist • Critical care • Specific CME • Traditional • Simulation

15. Fellowship • Critical Care • Anesthesia • 12 months full time, contiguous, 10 months in primary program • Surgery • 12 months full time or 24 months part time.

16. SOGH Certification? • ABOG certification is current • In good standing • MOC current • CME

17. ABOG Subspecialty Requirements • Program evaluation • Who determines what is needed to know. • Performance of members • Test results • Current license • No disciplinary actions • Research

18. ABOG requires participation of subspeciality organization in the fellowship process. • SMFM SGO, ASRM, SREI.

19. Fellowship • Didactic conferences • Clinical • Teaching rounds weekly • Must include a variety of cases. • Thesis • Graduate courses- at least two • Statistics, etc.

20. Options • OB/Gyns who work shifts in the hospital. • OB/Gyns with some special skills. • Subspecialists • Official fellowship program • Meet specific training, etc goals and receive certification from SOGH.

21. What All OB/Gyn Hospitalists are expected to do. • Faster response. • Multi task. • More complete workup of acute conditions. • Know what to do in OB emergencies.

22. Simulation Training-Does it Work? • Technology-Enhanced Simulation • Knowledge • Time Skills • Process Skills • Product Skills • Behavior • Effect on patient care

23. Simulation Training • Knowledge • Learn the skill. Assessment of skill. • Time • Perform the skill in less time. • Process measures • Global ratings of performance • Ecomomy of movements • Minor errors

24. Simulation Training • Product skills • Procedural success • Quality of finished product • Failure to detect key abnormalities • Behavior • Evaluation of behaviors while caring for patients. Procedural errors. • Effects on patient care • Procedural success, patient discomfort, complication rate, patient survival.

25. Meta-analysis of Effectiveness of Simulation • All measured results were significant with all being largely significant with effect on patient care as moderately significant. • All measures have large inconsistencies in results. • 10,903 articles. 609 in meta-analysis • Cook DA, Hatala, R, Brydges R, et al.Technology-Enhanced Simulation for Health Professions Education. A Systemic Review and Meta-analysis. JAMA. 2011;306(9):978-988.

26. Core Competencies • Hospital / System expectations • Patient expectations • Nursing expectations • Obstetric provider expectations

27. Core Competencies • Obligations of a program and individual physicians to: • Provide a defined level of medical care. • Perform specific types of medical and other health care services.

28. SOGH’s Role in Core Competencies • Define the skills required to perform OB / Gyn Hospitalist services. • Including skills separate from those obtained in conventional OB/Gyn training. • Offer a mechanism to determine which providers have those skills. • Facilitate physicians to acquire and maintain those skills.

29. Reasoning for Establishing Core Competencies • There is no nationally accepted agency or association that specifically defines, monitors, and provides educational services to physicians whose sole practice is in the field of OB / Gyn Hospital Medicine.

30. ROUGH DRAFT • Qualifications • Certified by the American Board of Obstetrics and Gynecologists (ABOG) • Member of Society of Obstetric and Gynecologic Hospitalists (SOGH) • Active Participant of SOGH practice competencies program.

31. Core Competencies • Obstetric triage • Emergency medical examination • Outpatient prenatal care • Management of labor • Fetal heart rate interpretation • Vaginal delivery and laceration repair • Repair of complicated obstetric lacerations • Operative deliveries • Labor ultrasound

32. Core Competencies • Management of OB Complications • Shoulder dystocia • Postpartum hemorrhage • Eclampsia • Twins • Breech

33. Core Competencies • Surgical skills • Cesarean section • Tubal ligation • Immediate postpartum curettage

34. Core competencies • Gynecologic competencies • Gynecologic exam including pelvic • Post operative hemorrhage management • DVT prevention, diagnosis, and management

35. Extended (Optional) Competencies • Skills that may be recommended or required. (Required by some programs and beneficial to all) • Skills that some but not all providers need to have. (Required by some but not needed by some) • Skills that are ideal but may not be able to be maintained by all Hospitalists.

36. Extended Competencies • Demonstration of adequacy through simulation training • Demonstration of adequacy through managing simulation training • Full Obstetric Ultrasound • Circumcision

37. Extended Competencies • Advanced Obstetric Surgery • C-Hysterectomy • Ectopic pregnancy • Miscarriage • Gynecologic Surgery • Laparoscopy • Cystoscopy • Exploratory laparotomy • Hysterectomy (LAVH,TVH,TAH)

38. Extended Competencies • ACLS • NRP • High Risk Obstetrics • Diabetes, severe preeclampsia, PPROM, chorioamnionitis, PTL, thyroid storm, asthma, placenta previa, abruptio placenta, IUGR, oligohydramnios, infections (GBS, pyelonephritis, HSV, MRSA, influenza), drug addiction.

39. Extended Competencies • Critical Care Obstetrics • Management of renal, cardiac, pulmonary failure, sepsis. • Gynecology • Wound care, PID

40. Extended Competencies • Hospital Systems • Communication • Leadership • Technology (HIT) • Education (teaching) • Safety / risk management / peer review / problem physicians • Psychosocial • Fetal demise, maternal death, family crisis, etc.