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Introduction As postgraduate medical education moves to a competency-based training framework, we anticipate that a strong and comprehensive orientation to specialty will be essential for a smooth transition to the junior level of training. Objectives To develop and evaluate a 4-week Foundations rotation for incoming OBGYN residents at the University of Ottawa to improve the transition into postgraduate training. Methods We organized a group of stakeholders in education and identified existing strengths that could be leveraged within the undergraduate and postgraduate curriculum. We partnered with Surgical Foundations and our Simulation Centre colleagues to incorporate multiple domains of education designed to both build on existing knowledge and expand skills training needed to be prepared for expectations of a PGY-1 level trainee. Results This 4-week comprehensive rotation included wellness, orientations, workshops, certifications, simulation labs, lectures, and service initiations. Skills and simulation sessions incorporated practise models with C-section, perineal laceration repairs, vaginal deliveries, ultrasound, and obstetrical emergencies. Certification courses in Fetal Heart Surveillance in Labour and Neonatal Resuscitation were completed along with the mandatory bootcamp for Surgical Foundations. Residents joined the undergraduate curriculum and attended a wide range of didactic lectures on pertinent OBGYN topics. All open time was spent shadowing senior residents on core rotations. Based on evaluations completed by the trainee this rotation was extremely well received. A final assessment for each trainee was completed highlighting professionalism and collaboration and added to their resident file. Conclusions The “Foundations” rotation was assessed as a comprehensive orientation which facilitated smooth transition to discipline from medical students to junior residents in the OBGYN department.

ABSTRACT

As post graduate medical education moves from a time and process-based system to a competency-based training framework, our program acknowledged that a strong orientation is essential to a new medical graduate’s successful transition to a junior resident. “Transition to Discipline” is at the base of the CanMEDs Competence Continuum and so well constructed foundational rotation is necessary for incoming OBGYN residents. The overarching objective was to develop an appropriate orientation and transition into the discipline following a competency based education model.

INTRODUCTIONANDOBJECTIVES

The rotation focused on orientation, skills development, simulation, and necessary certifications. Below is a breakdown of the rotation curriculum.

METHODS

The “Foundations” block has been very well received and had a positive impact on incoming residents. Below are examples of comments obtained for the various Foundations sessions.

RESULTS

DISCUSSION

The comprehensive orientation was well received by the residents who then felt better prepared to complete future rotations in Obstetrics and Gynecology. This also provided a better evaluation process for incoming residents and led to earlier identification of trainees who may need additional support or orientation. Since we are trying to move towards Competency Based Education, we felt this rotation helped change the learning environment from removed to direct observation of the learners. Limitations: Some of the didactic lectures were in collaboration with the third year medical student orientation to rotation lectures. Many of the incoming residents felt that these lectures were not at the appropriate level to prepare them as residents. Next Steps: We hope to improve the evaluation process to include a self-evaluation. We have been taking feedback from the residents over the past two years who have gone through the foundations rotation and hope to make modifications to improve the experience for future residents. For example, we hope to have separate lectures for the residents from the medical students so they can be better tailored to their level. Without medical students in the lectures they may also feel more comfortable asking questions.

CONCLUSIONA well devised transition from undergraduate medical education to postgraduate medical education can lead to a more successful residency experience. This initiative promotes the development of group cohesion allowing resident colleagues to mentor new residents helping them navigate through unchartered territory thus promoting a sense of belonging and team environment. The development and implementation of a foundation block rotation for new residents improves competence and confidence and promotes a more successful transition to junior residency.

REFERENCES

Minha, S., Shefet, D., Sagi, D., Berkenstadt, H., & Ziv, A. (2016). “See One, Sim One, Do One”- A National Pre-Internship Boot-Camp to Ensure a Safer "Student to Doctor" Transition. Plos One, 11(3). doi:10.1371/journal.pone.0150122 Busing, N. et al (2017). Smoothing the Transition Points in Canadian Medical Education. Academic Medicine, Nov 21. Don: 10.1097 Blackmore, C., Lopushinsky, S., Lockyer, J., & Paolucci, E. O. (2015). Targeted needs assessment for a transitional “boot camp” curriculum for pediatric surgery residents. Journal of Pediatric Surgery, 50(5), 819-824. Garofalo, M., & Aggarwal, R. (2017). Competency-Based Medical Education and Assessment of Training: Review of Selected National Obstetrics and Gynaecology Curricula. Journal of Obstetrics and Gynaecology Canada, 39(7).

SalinaKanji,MD1;LauraHopkins,MD,FRCSC1;TracyMitchell,CMEA11DepartmentofObstetricsandGynecology,UniversityofOMawa,OMawa,Canada

AcMveManagementofTransiMontoResidency

Administration and clinical orientation: - Very useful and informative - Orientation booklet and electronic handouts were very helpful - Disseminating the slides was extremely helpful - Highly recommend these lectures to new PGY1s

Fetal Heart Tracing Certification: - Helpful to have this workshop early in the block - Not taught in med school – therefore beneficial to have a better understanding of the underlying physiology behind fetal heart rates and how to interpret tracings - Extremely informative and valuable - More examples and more focus on physician care

Didactic Lectures: - It would be better to have us participate in academic half days during foundations block, instead of missing them for the medical student lectures. Would also prefer self-study or smaller group learning as opposed to just being added into the medical students lectures.

•  Individual hospital “onboarding” orientations (1 day per hospital) •  Post Graduate Medical Education orientation (1 day) •  OBGYN administration and clinical orientation (1/2 day) •  Cesarean section workshop (1/4 day) •  Perineal laceration workshop (1/4 day) •  Introduction to Obstetrics Simulation Session (1/2 day) •  Ultrasound course (1/2 day) •  Neonatal resuscitation certification (1 day) •  Surgical Foundations “bootcamp” (5 days)

•  Fetal Heart Tracing certification (1 day) •  Didactic lectures: complications of L+D, third trimester bleeding, tracings, first

trimester bleeding, benign disorders of vulva/vagina/cervix, endometriosis, pelvic mass/pain, patient safety, domestic violence/sexual assault, pelvic anatomy, urinary incontinence/prolapse, pregnancy complications, infertility/virulization/hirsuitism, medical complications of pregnancy/HTN (2.5 days)

•  Shadowing on Obstetrics or Gynecology core rotations (5 days) •  Summer Wellness Social (1/2 day)

During this block residents may also have weekend day call, but did not participate in overnight call to ensure they were not post-call for any educational sessions. Each session was then evaluated by the residents with an option to provide constructive comments. Modifications to the block were made each year based on the collected evaluations.

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