CREED RevReassessment of Min Comp...OBJECTIVES •To identify the current challenges in Obstetrics...

QUADRIPARTITEMEETINGJuly23,2020

• QuantitativeandQualitativeParametersforAssessmentofTrainingProgramsduringthePandemic

• HospitalAccreditationVisits• OnlineExams

QUANTITATIVE PARAMETERS FOR ASSESSMENT OF TRAINING

PROGRAMS DURING THE COVID-19 PANDEMIC

Maria Jesusa Banal-Silao, M.D.

OBJECTIVES

• To identify the current challenges in Obstetrics and Gynecology Residency Training, brought about by the COVID pandemic.

• To assess the quantitative and qualitative parameters of the Residency Training Program.

• To propose modifications of certain parameters of the Residency Training Program to address the challenges brought about by the pandemic.

• To set recommendations based on the deliberations that will arise from the Quadripartite Meeting.

IMPACT OF COVID-19 ON RESIDENCY TRAINING

Classroom Teaching• Suspension of classroom-based teaching and

conversion to video-conferencing platform to conduct the following: lectures, histopathology/morbidity and mortality, staff conferences, ward endorsements, post duty rounds

• Lack of protected teaching time; since schedule of duties were modified depending on the bulk of COVID infected patients and health care workers (HCW) per institution.

IMPACT OF COVID-19 ON RESIDENCY TRAINING

Clinical Skills Teaching• Insufficient caseload from cancellation of elective cases

during enhanced community quarantine (ECQ)

• Minimizing number of staff from managing ‘high infection risk’ cases

• Suspension of cross-institutional subspecialty rotation, pathology rotation, and potential loss of learning opportunities

• Suspension of OPD clinics during ECQ/GCQ; reduced patient consults when clinics opened

• Teleconsultation

IMPACT OF COVID-19 ON RESIDENCY TRAINING

Procedural Training

• Difficulties with performing surgeries with personal protective equipment (loss of dexterity, need for sterility and increased psychological stress)

• Cancellation of difficult surgical procedures

• Reduction in procedures for junior residents; high-risk cases often decked to senior residents

• Decrease or absence of consultant supervision of surgeries

IMPACT OF COVID-19 ON RESIDENCY TRAINING

Assessment and Feedback

• Decreased number of assessors

• Difficulty in implementation of residency evaluation forms, OSCE, written and oral exams: manner, frequency

• Clinical and psychological stress can impact performance of the residents

• Lack of effective mentorship for mentor–mentee

Accreditation Council for Medical EducationCouncil for Residents’ Education, Enhancement and Development

Minimum Graduates through

June 30, 2018* ECME MINIMUM

REC

Minimum Graduates on or after June 1, 2019

ECME MINIMUM REC (ACGME)

CREED

Spontaneous vaginal delivery 200 200 70

Cesarean delivery 145 145 30

Operative vaginal delivery 15 15 10

Obstetric ultrasound 50 50 15 (5/5/5)

Abdominal hysterectomy 35 15 10

Vaginal hysterectomy 15 15 2

Minimally invasive hysterectomy (including vaginal/laparoscopic hysterectomy,laparoscopic assisted vaginal hysterectomy, robotic hysterectomy)

35 70

Hysterectomy-total number (minimally invasive & abdominal) 70 85 15

Incontinence and pelvic floor procedure (excludes cystoscopy) 25 25

Cystoscopy 10 10

Laparoscopy 60 60 1

Hysteroscopy 40 40 1

Transvaginal ultrasound 50 50

Surgery for invasive cancer 25 25

Episiorrhaphy 35

Outlet forceps extraction and/or vacuum extraction 30

Dilatation and curettage (abortion ACGME) 20 20 40

Manual Extraction of the placenta 3

Adnexal surgery 15

Peripartum Hysterectomy 1

Vaginal evacuation of hydatidiform mole 1

Abdominal myomectomy 2

Identification of hypogastric arteries 3

Minimum Surgical Competencies Per Year Level

10

Minimum Surgical Competencies Per Year Level

Minimum Surgical Competencies Per Year Level

1. Performance of the above procedures must be certified by the training officer or consultants.

2. Of the breech deliveries, at least one (1) should be a vaginal partial breech extraction of a live baby weighing at least 1.5 kg assisted by a consultant or by a senior resident.

3. Of the thirty (30) cesarean sections, at least one (1) should be a classical cesarean section.

4. Transfer of technical responsibility must NOT be more than 40% for major surgical procedures.

5. Technical transfer of responsibility (TTR) is NOT allowed in the following procedures: Outlet forceps extraction or vacuum extraction, Vaginal breech delivery, Vaginal evacuation of a hydatidiform mole, Peripartum hysterectomy, Vaginal hysterectomy, Abdominal myomectomy

6. Refer to the instructional design for ultrasound for the learning outcomes expected of residents.

RECOMMENDATIONS• The minimum number of cases for surgical competencies remains

the same, with a few exceptions (gynecologic endoscopy cases will be deferred to 2021).

• Full implementation of integrated training in gynecologic endoscopy will be deferred to 2021.

• Transfer of technical responsibility may be increased to, but not more than 60% for major surgical procedures.

• Transfer of technical responsibility for special procedures will be allowed for graduating residents,

• Credit all cases done on outside rotation (from networking/MOA hospitals) for graduating residents.

RECOMMENDATIONS

• The Residency Inservice Exam (RISE) will be moved to October 11, 2020.

• The eligibility period for certification will be extended by one year for any resident, who merits an extension due to mitigating circumstances brought about by the COVID-19 public health crisis.

• The training program has the final authority to make decisions about the duration and completion of a residency. This includes verification that a resident has met the program’s requirements, and is eligible for promotion to the next year level (for RPT I to III), or graduation (for senior residents).

REFERENCES1. Accreditation Council for Graduate Medical Education (ACGME)

Common Program Requirements (Residency) 20182. Council for Residents’ Education, Enhancement and Development

(CREED) Handbook. 20183. Obstetrics and Gynecology and Subspecialty Certification Standards-

COVID-19 Policy. The American Board of Obstetrics & Gynecology. March 13, 2020

4. Haywood L. Brown, MD, Sandra A. Carson, MD, and Hal C. Lawrence III, MD Medical Education: Consensus Statement. The First National Summit on Women’s HealthThe Future of Obstetrics and Gynecology Training. Obstet Gynecol2018

5. Philippine Society of General Surgeons Accreditation and Eligibility Provisions 2020

PROPOSEDQualitativeParameters

inOBGYNTrainingProgram

WhatResidencyTrainingProgrammustdo– RelevantandTimely

1. Reviewcorecompetencies2. Revisitcurriculum,rotations,schedulesand

evaluationtoolsontelemedicine3. Reevaluatetrainingstrategies4. Evaluatemilestonesandskillsdevelopment

Dr.Tumbocon,SLMC

OB-GYNTRAININGPROGRAMChallenges

1. Howtoutilizeandmaximizee- learningplatforms2. Howtocontinuetoassessandgivetimely

feedbackforallexpectedcompetencies/outcomes.

3. Howtousestrategiestoshortenthesurgical“learningcurveSurgicalspecialtytrainingprogramwhichreliesheavilyinacquisitionofskills.

4. Howtoaddresscompromisedautonomyofresidents.

”

LEARNINGACTIVITIESHandbookofCREED,page84-86

• Demonstration-ReturnDemonstration• Roleplaying

E-TEACHINGLEARNINGACTIVITIES

COXMODELFORBEDSIDETEACHING1. ExperienceCycle– preparation,briefing,clinicalencounter,debriefing2. ExplanationCycle– Reflection,Explication,Workingknowledge

ASSESSMENTMETHODSOutcomes Facetoface

assessmentAsynchronous Synchronous

Knowledge Quizzes,exercises,selfassessmentquestions,writtenexams

Emailedexercises OnlinequizzesOnlineexamination

Problemanalysisandthinking

Cases/TriggersWrittenexamReport

EmailedcasediscussionBlogsCasereports

DiscussionboardsE-PBLoutputsReportsOnlineexamination

Creativethinking ProjectsDesignsPortfolios

InfographicsAudio-visualpresentationE-portfolio

OnlinedesignsBlogsE-portfolios

Communicationskills

RecitationOralreportEssayexamination

Pre-recordedvideoEmailedreportsInfographics

Reportsduringsynchronousdiscussion

ASSESSMENTMETHODSOutcomes Facetoface

assessmentAsynchronous Synchronous

TechnicalSkills

Logs,DOPSPracticalExamOSPE,OSATS

Prerecordedvideobystudentanduploadedforfeedback/grading

SynchronousmeetingwithreturndemoOnlinepracticalexamination

Attitudes Moral/ethicaldilemmasJournalsPeerevaluationReflectionpaper

VideoofethicaldilemmaandanalysisEmailedreflectionE-Portfolio

SynchronousDebates,discussionsPeerevaluationReflectionBlogsE-portfolio

Clinical/Community

D.O. withSPfamilyMini-CEX,CBD,MSFOSCE

PrerecordedSPencounterE-mailed case/PMP

ObservationofVPencounter/CBDE-OSCE

Shortenthelearningcurve• Useofsurgicalvideosforteaching.

• Liveobservationofsurgeriestosupplementlearningthroughsurgicalassists.

• Livesurgerywebcastwithconsultantleddiscussion

• Constructivedirectsupervisionofsurgicalproceduresoftrainees

• Standardizedassessmentandtimelyfeedbacktomaximizetransferofskillsandknowledge

Dr.Tumbocon,SLMC

Dr.Tumbocon,SLMC

OTHERACTIVITIES TEACHINGMETHODS/ASSESSMENT

DEPTCONFERENCES E-Learning,Zoomconferences– postduty,adm conf,Video-OSCE

SUBSPECIALTYROTATION • Reviewpathologyslidesonline• Patientrecords(partograph,CTG

interpretation,documentationofEINC)

• ReviewrecordedultrasoundresultsRESEARCH • Meta-analysis

• Descriptiveresearch• Caseseries• Virtualresearchteammeetings

EVALUATIONMETHOD REF- clinicalcompetence,surgicalskills,conference,casepaper,researchpaper,attitudeONLINEFORM- likegoogleforms

EXAMINATIONQuizzes,quarterly&yearlyexamination; RISE

OnlineexaminationE-Proctoring

REFERENCES1. AccreditationCouncilforGraduateMedicalEducation

(ACGME)CommonProgramRequirements(Residency)2018

2. CouncilforResidents’Education,EnhancementandDevelopment(CREED)Handbook.2018

3. PhilippineSocietyofGeneralSurgeonsAccreditationandEligibilityProvisions2020

4. IntegratingELearningintheResidencyTrainingProgram,July15,2020LectureofDr.Melflor Atienza,UERM

5. “OngoingChallengesinMedicalEducationandTrainingofSurgicalSpecialtiesduringCovid 19Pandemic”,JAAcostaMD,SLMCWebinar

HospitalAccreditationVisits

MilaZaragoza-Ibay,M.D.CREED

OBJECTIVES

q Toidentifyhospitalvisitsbasedonthepurposeandrecommendedschedule

q TopresentguidelinesforE-MENTORINGandE-MONITORING

q Toidentify hospitalsforvirtualvisitsin2020q Todiscussrevisionsinthe Version2020CREED

Checklist(UnifiedwithPBOG)q Topresentrecommendationsfortherevised

curriculum

MajorfunctionofCREED

qTooverseetheimplementationoftheresidencytrainingprograminPBOG-accreditedhospitals

qToperformHospitalvisitsintendedtoassesstheprogram’sreadinessfortheaccreditationorreaccreditation

qToevaluateifthestandardsoftrainingisbeingmaintained

qToactasarecommendatorybodytothePBOGpriortoaccreditationorreaccreditation

CREEDHOSPITALVISITS

qMENTORINGVISITforNewApplicationforAccreditation

qMONITORINGVISITpriortoRe-accreditation:Ø a.YEAR2 pre-accreditationØ b.YEAR3 pre-accreditation

qMENTORINGVISIT– forhospitalsapplyingforre-instatement oraccreditationafterrevocationq REVISITasrecommendedbyCREED-priortoPBOG

application

üTheCREEDrecommendationisanintegral partoftheaccreditationrequirements beforePBOGwill

accepttheapplication

Summaryofhospitalsforvisitpriortothepandemic

Total=40qREVISITS: 4HOSPITALS(1inRegionI,2in

Region3,and1inNCR)qMENTORING: 2HOSPITALS(RegionsIIandX)qYEAR3VISITS: 3HOSPITALS(AllNCR)qYEAR2VISITS: 31HOSPITALS(3inRegionI;1inRegionIII;16inNCR;2inRegionV;3inRegionVI;4inRegionVII;1inRegionIXand1inRegionXI

q E-MENTORINGq E-MONITORINGq BLENDEDCREEDVISITS- Tocombine

E-mentoringandatargetedphysicalvisit(ifrecommended for2021orpostpandemic)

NewtypesofCREEDvisitsasmitigatingmeasuresduringthepandemic

Summaryofhospitalsforvirtualvisitduringthepandemic

Total=26qREVISITS: 4HOSPITALS(1inRegionI,2in

Region3,and1inNCR)qMENTORING: 3HOSPITALS(NCR,RegionsII&X)qYEAR3VISITS: 3HOSPITALS(AllNCR)qYEAR2VISITS: 16HOSPITALS(AllNCR)

qPHASE1qSubmissionofdepartmentalprofilesinPDF-q AccomplishmentoftheCREEDCHECKLIST(v.2018)q pogs.creed@gmail.comqmitigatingmeasuresandcontingenciesduringpandemic

qReviewandevaluationofthehospitalreportsandpreviousPBOGandCREEDrecommendations

qScheduleviaZOOMwiththePOGSsecretariat-ensurestableWIFIconnectivity

TheCREEDVirtual HospitalVisit2020

qPHASE2qTheactuale-mentoring/monitoringviaZOOMqHIGHLIGHTS:Ø Measuresimplementedtoaddressprevious

recommendationsØ Mitigatingmeasures:staffing,clinicalcases,e-

learningactivities,subspecialtyrotations,scientificworks

qSubmissionofdepartmentstatisticstoPNS

TheCREEDVirtual HospitalVisit2020

qPHASE3qEn bancdiscussionofobservationsandrecommendations

qFinalreporttoPBOGandDepartmentChairqEndorsementofsubmittedhospitalfilestoCREEDArchives

qEndorsementofCommitteereportstothenextCouncilmembers

TheCREEDVirtual HospitalVisit2020

Corerequirementsforfirst-timeapplicationorpriortore-instatementafterarevocationofaccreditation:

qDOHlicensetooperateatleastLevelIIqPOGSLevelII(ForService)certificateqFullcomplementofresidentsatthetimeofPBOGvisit

qAllrequirementsinthechecklistsatisfactorilymetasperCREEDassessmentandmaintaineduntilthePBOGvisit

qCREEDEVALUATIONISQUALITATIVEANDFORMATIVE

qPBOGEVALUATIONISQUANTITATIVEANDSUMMATIVE

RECOMMENDATIONS

• RevisittheCREEDcurriculumtointegrateresolutionsandnewmeasures intheactivitiesofthecommittee

• CollaboratewithSubspecialtysocietiesregardingspecificchangesintheresidencyrotationsandtrainingcurricula

• Ensureeffective communicationbetweenCREED,PBOGandthetraininghospitals

PBOGHOSPITALACCREDITATION

Ma.VictoriaV.Torres,M.D.PBOG

…AMIDSTtheCOVID19Pandemic

Important ISSUES:1.PBOG Hospital Accreditation:

• Hospital accreditation 2020 SUSPENDED due to the pandemic

• 2021 Accreditation – 2 sets (2020 and 2021)?

2. Lists of Hospitals for Accreditation – 2020 and 2021

3. Contingency Plan: (…if and when the pandemic continues…)

a. Virtual Hospital Accreditation

b. PNSS Data for those hospitals for accreditation for 2021

4. Alignment between PBOG’s and CREED’s Strategies for Hospital Accreditation

1. Batangas Medical Center

2. Brokenshire Integrated Health Ministries

3. Cebu Doctors University Hospital

4. Cotabato Regional and Medical Center

5. Southern Philippines Medical Center

6. Davao Regional and Medical Center

7. De La Salle University Medical Center

8. East Avenue Medical Center

9. Fatima University Medical Center

10.Gov. Celestino Gallares Memorial Hospital

11.Jose B. Lingad Memorial General Hospital

12. Manila Doctors Hospital

13.Mariano Marcos Memorial Medical Center

14. Our Lady of Lourdes Hospital

15. Pasay City General Hospital

16. Perpetual Help Medical Center (LP)

17. Rizal Medical Center

18. San Pedro Hospital

19. Seamens Hospital

20. St. Paul’s Hospital

21. Veterans Regional Hospital

22. Vicente Sotto Memorial Medical Center

2020 PBOG Hospital Visits (30 Hospitals)

A. HOSPITALS FOR REACCREDITATION (22)

B. HOSPITALS ACCREDITED IN 2018 FOR MANDATORY REVISIT IN 2020 (2)*(Accredited- 2019-2022)

1. St. Luke’s Global Medical Center

2.James L. Gordon Memorial HospitalC. HOSPITALS REACCREDITED IN 2019 BUT FOR MONITORING REVISIT IN 2020 (3)

*(Accredited- 2020-2023)

1. AFP Medical Center

2. Mary Johnston Hospital

3. General Emilio Aguinaldo Medical CenterD. NEW APPLICATION FOR ACCREDITATION (2)

1. Las Piñas General Hospital and Satellite Trauma Center

2. University of Cebu Medical Center

E. APPLICATION FOR REACCREDITATION AFTER REVOCATION (1)

1. Pablo Torre Memorial Medical Center –

HOSPITALS ACCREDITED FROM 2018-2021…(FOR ACCREDITATION: 2021)

1. Amang Rodriguez Memorial Hospital2. Angeles University Foundation Medical Center3. Bulacan Medical Center4. Cagayan Valley Medical Center5. Iloilo Mission Hospital6. Ospital ng Makati7. Region 1 Medical Center8. SLU Hospital of the Sacred Heart9. Tarlac Provincial Hospital10. Valenzuela Medical Center11. Eastern Visayas Regional Medical Center12. Pasig City General Center13. Medical Center Manila14. MCU Hospital15. Dr. Victor R. Potenciano Medical Center

A. VIRTUAL Hospital Accreditation1. Zoom Platform- 3 simultaneous meeting rooms2. Checklist for Hospital Accreditation:

- MOSTLY can be pre-evaluated by the documents they submitted on application. The following need to be assessed virtually...

a. PART A- Infrastructure and equipment for trainingb. PART B- Actual checking of logbooks for attendance, personal

logbooks of residents, evaluation tools, exams, etcc. PART C- personal logbooks (competencies), Didactics, Technical skills

CHALLENGES:

•It is doable but very challenging- very hard to check logbooks, exams, evaluation tools, etc. virtually

•Are all institutions equipped with strong/stable internet connections in their localities?

Contingency Plan: …if and when the pandemic continues…

B. SURVEY of CASES (March-September(?) 2020), utilizing the data from the PNSS chaired by Dra. Anette Macayaon

OBJECTIVE:

To have a survey if there will be significant decrease in the number of cases during the pandemic (March – September (?) 2020 which will be a basis for the future plan/s of the Board.

STRATEGIES:

• PBOG coordinated with Dra Anette Macayaon• Provide PBOG the summary of the 2019 cases of hospitals for accreditation visit

on 2021, as the baseline for comparison• Inform and request the concerned hospitals to input and update their data regularly

from January until September or forward (?).

Alignment between PBOG’s and CREED’s Strategies for Hospital Accreditation

Effective communication between Heads of CREED & PBOG Committees on H.A.• Checklists are aligned with each other• Hospital visits are coordinated• Direct transfer of information regarding results of visits

ASSESSMENTS on Visits:• CREED- Qualitative (present/absent)• PBOG- Quantitative (scoring system)

Note:

A recommendation of CREED for PBOG visit of a certain hospital may not be a reassurance that

the institution will be given accreditation. The hospital should SATISFACTORILY meet the

standard (Passing Score) set by the BOARD to be accredited.

ONLINEexamPLATFORM:

WhatisNeededtoMoveHigh-stakesWrittenExams

Menefrida S.Reyes,M.D,PBOG

ComponentsofanOnlineExam1. SECUREDELIVERYSYSTEM(PASSWORD-PROTECTED)

2. VISUAL(ONLINE)PROCTORING,WITHZOOM

Decision-makingPoints

PRACTICALITY• Doable

STANDARD• High

COST• Low

“Whatisdoableandofhighstandardisusuallyexpensive;

Whatischeapanddoablemayreallybeoflowstandard;

Whatisofhighstandardandcheapisratherdifficulttofind.”

CONSIDERTHETRIANGULARCONUNDRUM:

MATRIXLMSOFCYPHERLEARNING

• Allowscreationofcontent(examcontent),UPLOADING&deliveryofonlineassessment/exam,EVALUATIONoflearners’/examinees’performance(withrubricsfeature)

www.matrixlms.com

Connectivity

Internetspeed(downloadmbps&uploadmbps),

Safety

“Onlinelearningisnotthenextbigthing,itistheNOWbigthing.”

- DonnaAbernathy(educator)

‘…there’snoturningback…let’sembracethechange!’!’

Online RISE

JudithG.Cabanela,M.D.CREED

RESIDENTS’INSERVICEEXAMINATION(RISE)

• AnnualwrittencomprehensiveexaminationconductedbytheCREEDforresidentsinOBGYN.

• Purpose:formativeexaminationforthe1st to3rdyearresidentsandsummativeforthe4th yearresidents.

OnlineRISE• Shallbeconductedperinstitution• Institution/Departmentshallprovidethepropervenuethatcanaccommodatethenumberofresidentsinthedepartment

• Examineemustprovidehis/herowngadget,preferablyapersonalcomputer/laptopforbetterviewingofMCQsandotherattachmentslikegraphs,images,photos,etc.

OnlineRISE

• TrainingCommitteesandDepartmentStafftoactasproctorsduringtheonlineRISEwithswappingofmemberswithothertraininghospitalsintheirarea,ifpossible

• Prepare1-2extralaptopsordesktopswithcameraforzoomproctoring

OnlineRISE• Preparethenecessaryinternetconnectionstoincludethecheckingofinternetconnectivityspeedbyusinganyspeedtest(e.g.speedtest.net orfast.com)

• SimulationoftheexamwillbedonepriortotheactualonlineRISE

• Eachresidentwillhavetheirownuserinterfaceanddashboard

Furtherdetailsonthesimulationandactualonline

RISEwillbeannounced,posted,emailedorpresentedinanother

meeting.