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Copy of The Clinical Learning Environment in OBGYN

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by

Mark Woodland

on 23 September 2014

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Transcript of Copy of The Clinical Learning Environment in OBGYN

Clinical
Learning Environment

So where does this take us?
Professionalism
a sense of ownership
a sense of pride
a sense of contribution
a sense of giving back
a sense of personal development
a sense of professional growth
Mark B. Woodland, MS, MD
Vice Dean for GME
Program Director OBGYN

No financial, personal or professional (to my knowledge)
Disclosures:
The Clinical Learning Environment in OBGYN

"Environmental Impact on Clinical Learning"

Objectives
Reinforce the concept of clinical learning environment
Promote perspective of new technologies on CLE (ie robotics and genomics)
Emphasize impact of patient safety, supervision and professionalism on CLE and outcomes of training programs
I Love being
an OBGYN!
HIV Task Force GWU
Cigarette Black Box Warning
1st GYN to do LAVH in Philly (1992)
Top Docs GYN Surgery
Resident Educator Recognition
PA ACOG
Greater Philadelphia OBGYN Review Course
CREOG National Recognition
116th President of Obstetrical Society of Philadelphia (2005)
Faculty Cooper Hospital University Medical Center

My Learning Environment
What did I bring to the table?
What do you bring to the table?
Begs the question...
Nature or nurture??????
Promoted by the ACGME
CLER
6 areas of focus:
Supervision
Patient Safety
Quality Improvement
Transitions in Care
Duty hour oversight & fatigue management
Professionalism
Supervision &
Evolving Workforce

24/7 Supervision
Decrease in resident autonomy
Anticipated physician shortage
2010 - 35% OBGYN > 55
Increase Females in OBGYN
More part-time
Fewer patient care hours
GME Pipeline limits
Changes in practice patterns
Laborists
Ambulatory Care
MIGS, UROGYN, MFM
REI, GONC, RID

Robotic Surgery
Advantages:
improves surgical finesse
decrease complications
improves surgical outcomes
Disadvantages:
increases costs
impacts resident education
limited to trained surgeons
Genomics &
Clinical Practice
Medicine in the future
Genomic map of our patients
Personal genetic services (ie 23&me)
How will we use this?
Where will this lead us?
What type of ethical issues does this present?
"Laparoscopy, a procedure looking for a reason" - ACOG 1992
What happened to:
LASERS
CRYO
PAPNET
Forceps
PUBS
New & Evolving Technologies
Patient Safety &
Quality Improvement
Electronic Medical Record
Algorithms
Check Lists
Timeout
Medical Education
Simulation
Patient Education
Accreditation status
DUCOM IHelP
Future
Robotic Technology
What if....we create mini robots
diagnostic
therapeutic
Robot Impact on Hysterectomy
JAMA 2013

Consider your learning environment.
32 full time faculty (13 women, 17 men)
3 part time (3 women)
16 residents (12 women & 5 men)
Patient Care
3,600 OB/2,000 GYN
600 hysterectomies
Level III NICU
41 Post-partum beds (17 high risk)
? Robots & Teaching Console
? BMI >30 (40-50%)
? Minority Status (50%)
Mentors
Who are your mentors and how do they occur?
Situational (nurture)
Inherent Interest (nature)
Impact of the CLE
My Mentors
Jack Carlson, MD
C. Evert Koop, MD
Steve Corson, MD
Ron Jaffe, MD
Sterling Williams, MD
Peter Schwartz, MD
Objectives Revisited
Reinforce the concept of clinical learning environment

Promote perspective of new technologies on CLE (ie robotics and genomics)

Emphasize impact of patient safety, supervision and professionalism on CLE and outcomes of training programs
1980's
1960's
Transitions in Care
Transfer between teams
Transfer between units
Follow Up Care

Disconnect with new duty hour rules
Intern duty hours differ from resident duty hours

Improve communication
Improve signouts
Duty Hours, Fatigue Mitgation and Management
80 hour work week
Interns: 12 hour shifts
PGY2 & >: 24 hour shifts
Increased TOC
Divided teams
6 night nght float
No education improvement
Less reading
No impact on patient safety
Full transcript