to enhance or not to enhance

21
Lisa Graves MD CCFP FCFP Fred Janke MD CCFP FCFP Kate Miller MD CCFP FCFP

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To Enhance or Not to Enhance. Lisa Graves MD CCFP FCFP Fred Janke MD CCFP FCFP Kate Miller MD CCFP FCFP. Conflicts of Interest. All three panelists have no conflicts to declare. Objectives. To review the current state of enhanced skills programs, both surgical and non-surgical in Canada - PowerPoint PPT Presentation

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Lisa Graves MD CCFP FCFPFred Janke MD CCFP FCFP

Kate Miller MD CCFP FCFP

Conflicts of InterestAll three panelists have no conflicts

to declare

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?