To Enhance or Not to Enhance - The College of Family Physicians
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Transcript To Enhance or Not to Enhance - The College of Family Physicians
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 nonsurgical in Canada
To envision the future of enhanced
skills programs in the Triple C era
en·hance:
intensify, increase, or further
improve the quality, value, or
extent of.
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 programs
What 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 approaches
American streaming approach
Three tiers
Can be completed within 3 year residency
Has an impact for residency training for those not in the
enhanced skills stream
ESS -Current Landscape
One single program in Canada that offers a
full R3 program in ESS
Prince Albert
Over subscribed and graduates two physicians per year
Alberta
Six month surgical obstetrics programs available
Tentative full R3 program in Grande Prairie
Other Provinces
Surgical 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 remediation
Ultrasound in pregnancy – some core, some
enhanced?
ALARM/ALSO – core or enhanced?
Special populations/difficult populations
Able to advise and consult in a pregnancy
Enhanced skills program should not a place to
train those that do OB only (as EM as done)
Not an R3 year
Who 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 mentor
Vacuum – core vs enhanced – independent vs
supervised
Breech delivery
Diabetes, 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 teachers
Do 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 Skills
FPs 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 Curriculum
Modular in format
Basic Operative Management
Management of Abdominal Presentation in the Non
Pregnant Patient in Rural and Remote
Management of Pregnancy in Rural and Remote
Management of Non-Abdominal Presentations in Rural
and Remote
Basic Principles
Trauma
Management of Pregnancy in Rural and
Remote
Complications 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 loss
Broad 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?
Thank you