Milestones: A Surgical and Clinical Case Study at Howard University Hospital

Deittra HallResidency Program CoordinatorDepartment of Obstetrics and GynecologyHoward University Hospital, Washington, DCdehall@huhosp.org

Howard University HospitalDepartment of Obstetrics & Gynecology Residency Training Program2041 Georgia Avenue, NWWashington, D.C. 20060

DisclosureI do not have commercial conflict

of interest to disclosures.

LEARNING OBJECTIVES At the end of the presentation, the

listener will learn ways of creating milestones for their own program.

The listener will be able to understand how the milestones should be implemented in their program.

The listener will be able to assist the residents in their training program with achieving their milestones based on their PGY level of attainment.

Meeting the Objectives: The Training Program

PGY- 4

PGY- 3

PGY- 2

PGY- 1

Milestones: Why Are They Being Created?

The ACGME has been discussing milestones for more than 3 years.

Milestones are being developed by the ACGME to better assist all residency programs with assessing the levels of competency of their residents.

ACGME is trying to further standardize the training of all residents Nationwide.

Milestones:Implementation at Howard University Hospital

At Howard University Hospital, Dr. Diana Broomfield, Residency Program Director realized the need for a form of measurement of training skills and implemented milestones in 2009.

We identified and created the milestones to encourage the residents to reach median levels of training as they progress from PGY 1 to PGY 4.

Milestones:Navigating the Unknown

The milestones created are not sanctioned by the ACGME, as milestones for the Obstetrics and Gynecology residency programs have yet to be instituted.

The OB/GYN milestones from ACGME have an anticipated date of 2014 for their release.

ACGME National Case Log Report

2009 2010 2011 20120

1

2

3

4

5

6

7

SurgeonTeacherBoth

Creating the Program’s Milestones

Milestones at Howard University Hospital were created from the case log system of ACGME.

For each procedure that a resident

is responsible for learning, a milestone was developed.

Achieving milestones are based on the benchmarks and PGY level of training.

Creating Milestones: The Benchmarks

PGY-1

Clinical

Normal LaborPost Partum HemorrhagePregnancy Induced Hypertension

Surgical

Primary C-SectionSpontaneous Vaginal Delivery

PGY-2

Repeat C-SectionStat C-Section Total Abdominal HysterectomyDiagnostic HysteroscopyOperative Delivery Vacuum

EclampsiaPost-Operative Complications

Creating Milestones: The Benchmarks

PGY-3

Clinical

Diabetes in Pregnancy

Surgical

Total Laparoscopic HysterectomyOperative Delivery ForcepsOperative Hysteroscopy

PGY-4Incontinence & Pelvic Floor

HUH Milestones Cases for Milestones

 

PGY 1PGY 2PGY 3PGY 4Vaginal Deliveries X

 Operative Vaginal Deliveries (Forceps Deliveries) X 

 

Operative Vaginal Deliveries (Vacuum Deliveries) X X

 

C-section  1° X

RepeatXStat X

Multi-Fetal Deliveries X

AmnioX 

Abdominal Hysterectomy X

Vaginal Hysterectomy X 

Laparoscopy Hysterectomy X  

HUH Milestones Cases for Milestones

PGY 1 PGY 2 PGY 3 PGY 4

Incontinence and Pelvic Floor X

Operative Laparoscopy X

Hysteroscopy X Conenization of the Cervix (LEEP) X

Conenization of the Cervix (CKC) X

D & C X

Surgical Sterilization X

Non Surgical Sterilization X

Transvaginal Ultrasound X

Surgery for Invasive Cancer X

Milestones: Implementation The Residency Program Coordinator

will prepare a chart to input all case log labels and the expected goal to reach, as each resident progresses through their training.

The Coordinator will monitor the chart as the residents advance from one PGY level to the next.

The charts are maintained and updated on a bi-weekly basis. The case logs are also discussed bi-weekly with the residents during our scheduled Program Director Conference.

Program Case Log Report Chart

2009 2010 2011 20120

50100150200250300350400450

Vaginal DeliveriesC-SectionOperative Deliveries

Milestones: Implementation

In our program, we have set our milestones at 30% above the National median.

The National median changes each year that the ACGME releases new information for case log achievements.

At HUH, the last graduating residents of 2012 all met or exceeded the National Average without the program receiving any citations for case log requirements.

Milestones: Chart (PGY-4)

Vaginal Deliveries C-section OP Deliveries Forcep Deliveries Vacuum Deliveries

Dr. A. 230 183 29 3 26

Dr. B 298 220 38 5 33

Dr. C 326 251 41 4 37

Dr. D 350 239 42 4 38

HUH Milestones 365 321 36 12 26

Nat Average - Teaching 319 272 30 10 20

Nat Average - Surgeon 281 247 28 9 19

Nat Ave - Surgeon - 30% 235 202 19 3 13

Nat Ave - Teaching - 30% 265 227 21 3 13

Conclusion

Milestones will be required for all training programs.

The development of milestones will assist residency programs with tools to further assess the skills of their residents.

Milestones will not only enhance resident training, they will also aid Faculty in education and refining residents’ clinical skills. These will be key elements in preparing for the Next Accreditation System (NAS).

REFERENCES Sealy, P. L., “Howard University

Hospital, Graduate Medical Education RedesignRationale: Preparation for the Future”, Presented on October 12, 2013

Miller, GE. The assessment of clinical skills/performance. Academic Medicine (Supplement) 1990; 65: S63-S7.

Thank You