A Note to Facilitators Dear Facilitator, Thank you for using Rural PREP’s materials to create an active learning experience for your site. Use this slide deck, along with the Facilitator Lesson Plan, to facilitate the Grand Rounds event at your site. Many of the slides contain additional information in the presenter notes area, so be sure to review the presentation and the notes prior to your Grand Rounds event.
Session Overview 10 minutes: Go over and discuss pre-assignment answers with the full group 20 minutes: Watch the John Waits Presentation 20 minutes: Facilitate the Team Activity 5 minutes: General Discussion and Social Charge 5 minutes: Evaluation of the Learning Materials as a group (5 minutes) Facilitator, Here are some time estimates to guide you as you move through each activity in this active learning session.
Infant Mortality in Rural Alabama: A Labor and Delivery Re-Opening Rural PREP Grand Rounds Presenter: John Waits, MD Cahaba Medical Services, Centreville, AL This presentation was originally recorded on November 30th, 2017, in front of several live, online sites connecting from different places across the country. Facilitator, Once you have gathered your teams in one place and confirmed that each person has brought with them a copy of their individual responses to the pre-assignment activities (from the web link you sent them), you can begin with this slide to introduce the TBL session.
Objectives The participant will be able to: Articulate a definition and community health applications of generally recognized measures of obstetric outcomes. Discuss the nuances of rural access to obstetrical and prenatal care, as it relates to infant mortality and other measures of rural well-being and health care infrastructure. Discuss the clinical and community health pitfalls in the delivery of care to women and children in the community when the in-patient labor and delivery infrastructure closes. Strategize hurdles and opportunities for providing obstetrical delivery in communities where labor and delivery has closed. Facilitator, Please review these learning objectives with your teams. At the end of the session, we will ask you to evaluate how we our materials meet these objectives.
Team Readiness Quiz Facilitator, You are about to begin the Team Readiness Quiz. The next few slides contain the questions and correct answers for the pre-assignment quiz. Everyone in the room should have their individual answers with them. When each question is presented, have teams discuss among themselves until they agree upon an answer. This may be very quick for easy questions or may take longer on tougher questions, where team members may disagree. An added way to enhance this portion of the event is to give each team colored pieces of paper with Letters printed on them (each group gets a green “A” or a yellow “B” so that team answers can easily be viewed by the entire group. The first question is on the next slide, and the correct answer is on the following slide.
Team Readiness Quiz Rural women in the U.S. experience higher rates of several health conditions and behaviors than their urban counterparts, including: Cigarette smoking Obesity Incidence of cervical cancer Motor vehicle-related deaths All of the above Facilitator, ask each team to agree upon an answer for the question. Once all teams have an answer, have one person report out from each team to the rest of the group. Now move on to the answer slide.
Team Readiness Quiz Rural women in the U.S. experience higher rates of several health conditions and behaviors than their urban counterparts, including: Cigarette smoking Obesity Incidence of cervical cancer Motor vehicle-related deaths All of the above Facilitator, Now that you have revealed the answer, facilitate a discussion among all the teams. Are there any disagreements? Repeat this process for the remaining questions and answers.
Team Readiness Quiz True or False: According to the Committee Opinion (2014) review of a study of women in Georgia with invasive breast cancer from 2000 to 2009, women in rural areas were less likely to receive radiotherapy as a first-course treatment than their urban counterparts.
Team Readiness Quiz True or False: According to the Committee Opinion (2014) review of a study of women in Georgia with invasive breast cancer from 2000 to 2009, women in rural areas were less likely to receive radiotherapy as a first-course treatment than their urban counterparts.
Team Readiness Quiz According to the Committee Opinion (2014) review paper, what was the 2010 percentage of U.S. counties lacked an obstetrician-gynecologist? 14% 26% 49% 78%
Team Readiness Quiz According to the Committee Opinion (2014) review paper, what was the 2010 percentage of U.S. counties lacked an obstetrician-gynecologist? 14% 26% 49% 78%
Team Readiness Quiz The American College of Obstetricians and Gynecologists recommend several initiatives to reduce rural health disparities, including: Encourage graduates of obstetric–gynecologic residency programs to participate in loan repayment programs that require practicing in rural locations for a specific length of time. Foster and participate in efforts to utilize effective telemedicine technologies. Advocate for increased access for rural women to contraceptive methods and emergency contraception. All of the above
Team Readiness Quiz The American College of Obstetricians and Gynecologists recommend several initiatives to reduce rural health disparities, including: Encourage graduates of obstetric–gynecologic residency programs to participate in loan repayment programs that require practicing in rural locations for a specific length of time. Foster and participate in efforts to utilize effective telemedicine technologies. Advocate for increased access for rural women to contraceptive methods and emergency contraception. All of the above
Team Readiness Quiz Traveling further for obstetric care is associated with: higher costs greater risk of complications longer lengths of stay financial, social, and psychological stress for patients all of the above
Team Readiness Quiz Traveling further for obstetric care is associated with: higher costs greater risk of complications longer lengths of stay financial, social, and psychological stress for patients all of the above
Team Readiness Quiz True or False: According to the Hung et al. study, rural private nonprofit and for-profit hospitals had 10 times higher odds of closing their units than rural public nonfederal hospitals.
Team Readiness Quiz True or False: According to the Hung et al. study, rural private nonprofit and for-profit hospitals had 10 times higher odds of closing their units than rural public nonfederal hospitals. (3 times higher odds)
Team Readiness Quiz True or False: Lower financial status of the local population may negatively influence a hospital’s capacity to maintain obstetric services.
Team Readiness Quiz True or False: Lower financial status of the local population may negatively influence a hospital’s capacity to maintain obstetric services.
Team Readiness Quiz In Hung et al., potential predictors associated with obstetric unit closures include annual birth volume, county-level supply of OBGYNs, county-level supply of family physicians, and county- level median family income. Identify these predictors for your institution: Annual birth volume: Number of OB-GYNs in your county: Number of family physicians in your county: County median family income:
Infant Mortality in Rural Alabama: A Labor and Delivery Re-Opening Rural PREP Grand Rounds Presenter: John Waits, MD Cahaba Medical Services, Centreville, AL Launch the Presentation Now Facilitator, It is now time to play the presentation by John Waits. Click on the “Launch the Presentation Now” link in the slide (https://www.youtube.com/watch?v=Pog_pY-7dT4&feature=youtu.be) to play the video, which is 18:30 minutes long.
Team Activity Facilitator, Now that you’re finished playing the presentation, it is time to begin the team activity portion of the session. The next four slides each contain a case. Review each case with the full group. You may consider printing the next four slides (individually, or in notes form) to distribute to each group. In a few slides, you will be prompted to assign each team a case (or multiple cases, depending on how many teams you have).
Team Activity Case #1: New Mexico You are in your first year of family medicine practice, as an employed physician in a hospital-owned practice, in a rural community. Four years prior to your arrival, the hospital’s maternity program was discontinued and L&D closed. Furthermore, no one is doing prenatal care now. In addition to the Internist and the two senior fam med docs in the practice, there is an NP who had some women’s health rotations and enjoys women’s health care. What are your options, and what would you do?
Team Activity Case #2: North Dakota You are a hospital administrator. Your senior OB is 2 years away from retirement; malpractice is up; two new doctors want to continue doing OB but don’t want to take call every other night. What are your options, and what would you do?
Team Activity Case #3: Alabama You are a fellowship-trained FM-OB, and have been in practice for a decade. State-funding for Medicaid, controversial at best, is set to have a major shortfall the next fiscal year, putting your program in jeopardy. You are at the state capitol with the medical association’s advocacy day, and as you are prepping with some colleagues, an Ob- Gyn and a Gyn-Onc doc ask you, “Why don’t we just consolidate the funding and invest in better state highways and the EMS system, rather than the antiquated system of county hospitals, especially since they ‘often have poorer outcomes’ anyway?” How would you respond?
Team Activity Case #4: Ohio You are a woman early in a third pregnancy with a history of rapid labors, whose family doctor just quit doing OB with the closure of the labor and delivery unit of the local hospital 15 minutes from your home. Now the closest prenatal care and hospital with maternity services is a 90-minute drive. What are your options?
Team Activity Case #1: New to practice, and maternity unit is closed Case #2: Hospital administrator with too few docs Case #3: Medicaid funding for EMS and highways Case #4: Rapid labor Facilitator, Assign each team a different case, or multiple cases. You may want to go back through the Case slides for each team, if you haven’t already printed and distributed a paper copy for each group. Allow teams enough time (maybe 10 minutes) to determine how they would respond to the case before moving on the the next slide. You could also come up with your own cases if you need more for your group.
Discussion Facilitator, Allow a member of each team to share their case and report on how they would respond to the case to the entire group. You may wish to ask questions about each case as it relates to your particular rural context.
Social Charge What are you personally going to do with this information? Facilitator, As a group, consider how you might use this information to improve your rural practice.
Evaluation Please evaluate these learning materials as a group: https://goo.gl/forms/93XZvFJk9izEO4eI3 Facilitator, While you still have everyone together, please take a few minutes to provide us with some feedback so we can better serve you. Complete the following form: https://goo.gl/forms/93XZvFJk9izEO4eI3 You only need to submit one form for your entire group.