1. Department of Obstetrics and Gynecology Residency Program “A-FIT” Report “A-FIT”: Areas For ImprovemenT November 4, 2015

2. Monthly A-FIT Report Monthly Updates
Duty Hour “Time-out”
Evaluations / Feedback:
Rotational and myTIPreport
Continuity Clinic Check-In
Areas for Improvement (A-FIT) report
Updates
Milestone of the Month
Faculty and Resident Development
Topic of the Month

3. Duty Hour Standard / # Violations
Duty Hour “Time Out”!! AY
Duty Hour Standard / # Violations
Block Number
80 hr work week
1 day off in 7
24/28 hr rule
10 hrs between shifts
In-House Call 1 2
1 and 2 3 4
3 and 4 5 6
5 and 6 11
Total possible number of violations: Violation Rate: In 4 week block: 3136 In 4 week block: 0.06% In 7 week block: 5487 In 7 week block: 0.1%

4. Faculty/Fellow Wednesday Conference Attendance

5. Rotation Evaluations: Completed w/i 2 weeks
87.5% Completion
for the last block
88% Completion for
latest completed block
ACGME
Requirement

6. Rotation Evaluations: Completed w/i 2 weeks
60% Completion for
latest completed block
ACGME
Requirement

7. Resident Feedback

8. Resident Feedback

9. Continuity Clinic Follow-up
1. Educational Sessions 2. Milestone Worksheet Completion
Month
Total Possible Sessions
Completed Sessions
Percentage Completed
Milestone Feedback Completed
November *
October 36 22
61%
September 34 24
71%
August 19
56%
July 18
82%

10. Areas for Improvement: 2015 ACGME Survey and Internal Survey
QI Training
Value of Conferences:
Grand Rounds
M and M
Satisfaction with feedback
Education not compromised by…
Service
Other trainees
Provided data about practice habits
Fatigue
Instructed how to manage fatigue
Provided a way to transition care when fatigued

11. Area #1: QI Training Low = 1, High = 5 1 2 3 4 5
Quality Improvement training and involvement
(4.26%)
(8.51%) 10
(21.28%) 18
(38.30%) 13
(27.66%)

12. Area #1: QI Training Brimmage QI Project:
Low = 1, High = 5 1 2 3 4 5
Quality Improvement training and involvement
(4.26%)
(8.51%) 10
(21.28%) 18
(38.30%) 13
(27.66%)
Not bad (34% neutral or low value responses) but room for improvement…
Brimmage QI Project:
-First four modules of the QI training released
-Participation is open to faculty and fellows
-Class QI projects in development
-Operationalize Jan – March,2016
-Review results: April, 2016
-Present results: May, 2016

13. Area #2: Value of Conferences
Low = 1, High = 5 1 2 3 4 5
Grand Rounds
(4.55%)
(6.06%) 10
(15.15%) 29
(43.94%) 20
(30.30%)
Morbidity and Mortality
(2.99%) 7
(10.45%) 12
(17.91%) 26
(38.81%)
(29.85%)

14. Area #2: Value of Conferences
Low = 1, High = 5 1 2 3 4 5
Grand Rounds
(4.55%)
(6.06%) 10
(15.15%) 29
(43.94%) 20
(30.30%)
Morbidity and Mortality
(2.99%) 7
(10.45%) 12
(17.91%) 26
(38.81%)
(29.85%)
Not bad (25-30% neutral or low value responses) but room for improvement…

15. Area #2: Value of Conferences
Low = 1, High = 5 1 2 3 4 5
Grand Rounds
(4.55%)
(6.06%) 10
(15.15%) 29
(43.94%) 20
(30.30%)
Morbidity and Mortality
(2.99%) 7
(10.45%) 12
(17.91%) 26
(38.81%)
(29.85%)
Not bad (25-30% neutral or low value responses) but room for improvement…
Proposed Improvement Plan:
Grand Rounds: Proposed:
Invited speakers ID’ing how talk content is particularly relevant to Specialist Practice
M and M Programming Changes
--Programmatic focus on clinical reasoning
--4 cases per conference
--Active “management” of questions/answer session:
----Discussants
----Presenting Chiefs

16. Area #2: Value of Conferences
M&M Conference
Focus: Clinical Reasoning Areas
Underway
Low = 1, High = 5 1 2 3 4 5
Grand Rounds
(4.55%)
(6.06%) 10
(15.15%) 29
(43.94%) 20
(30.30%)
Morbidity and Mortality
(2.99%) 7
(10.45%) 12
(17.91%) 26
(38.81%)
(29.85%)
Not bad (25-30% neutral or low value responses) but room for improvement…
Proposed Improvement Plan:
Grand Rounds: Proposed:
Invited speakers ID’ing how talk content is particularly relevant to Specialist Practice
M and M Programming Changes
--Programmatic focus on clinical reasoning
--4 cases per conference
--Active “management” of questions/answer session:
----Discussants
----Presenting Chiefs

18. Area # 3: Satisfaction With Feedback
Evaluation
“Yes”
(UNC ’14-’15)
(UNC ’13-’14)
(National)
Satisfied with feedback after assignments
57%
70%

19. Area # 3: Satisfaction With Feedback
Evaluation
“Yes”
(UNC ’14-’15)
(UNC ’13-’14)
(National)
Satisfied with feedback after assignments
57%
70%
Proposed Improvement Plan from Rotation Huddles:
-myTIPreport use
-Mid-rotation feedback
-Continue to track evaluation completion
-Utilizing Bae-Jump and Strauss approach to rotational feedback

20. Area #4: Education not compromised…
“Yes”
(UNC ‘14-’15)
(Nat’l)
…by service obligations
50%
32%
69%
…by other trainees
75%
100%
91%

21. Rotation Huddle Items Rotation Service over education
Education compromised by other trainees
Improve satisfaction with feedback
Ares for fatigue teaching and awareness
Transition care when fatigue is identified
Onc
WakeMed OB
REI
Urogyn
Benign

22. Rotation Huddle Items
Rotation
Service over education
Education compromised by other trainees
Improve satisfaction with feedback
Ares for fatigue teaching and awareness
Transition care when fatigue is identified
Onc
WakeMed OB
REI
Urogyn
Benign
Huddle teams have met, items for tracking being collated.

23. Area #5: Provided data about practice habits
“Yes”
(UNC ‘14-’15)
(National)
Provided data about practice habits
50%
68%
Proposed Improvement Plan:
-Rotation Directors to discuss
-May have a LOT to do with “labeling” work regarding Practice Based Learning and Improvement

24. Area #6: Mitigating effects of fatigue and excessive stress
“Yes”
(UNC ‘14-’15)
(National)
Instructed on how to manage fatigue
79%
82%
92%
Provided a way to transition care when fatigued
64%
61%
80%
Proposed Improvement Plan:
“Resiliency corner”: Feature of new monthly Residency Program Update (The next issue will be arriving in your inbox this week, keep an eye out!)
Reinstitute twice yearly programming with Dr. Meltzer-Brody
Possible “departmental engagement” work in AY 15-16

25. Professional Development Opportunities…
Get to know our Milestones!
Professional Development Topic-of-the-Month

26. Professional Development Opportunities…
Get to know our Milestones!
Antepartum Care and Complications of Pregnancy
Professional Development Topic-of-the-Month
Duty Hours for OBGYN Residency

27. Milestone of the Month Antepartum Care and Complications of Pregnancy:
Demonstrates basic knowledge of normal obstetrical care and common medical complications seen in pregnancy
Provides complete antepartum care for women with uncomplicated pregnancies
Recognizes basic risk factors, symptoms, and signs of common medical complications (e.g., hypertension, diabetes, infectious diseases)
Recognizes basic risk factors symptoms, and signs of common obstetrical conditions (e.g., post-term gestation, abnormal placentation, third trimester bleeding)
Manages common medical complications (e.g., hypertension, diabetes, infectious diseases)
Manages common obstetrical complications (e.g., previous Cesarean section, abnormal fetal growth, multifetal gestation)
Demonstrates a comprehensive understanding of the varying patterns of presentation and treatment options for a variety of medical and obstetrical complications
Recognizes atypical presentations of medical and obstetrical complications; identifies indications for consultation, referral, and/or transfer of care for patients with medical and obstetrical complications
Effectively supervises and educates lower level residents in antepartum care
Collaborates and provides consultation to other members of the health care team in antepartum care
Manages patients with complex and a typical medical and obstetrical complications
Applies innovative approaches to complex and atypical antepartum conditions and implements treatment plans based on emerging evidence

28. Duty Hours for OBGYN Residency
Average no more than 80 hours per week (averaged over 4 weeks)
1 day off in 7 (averaged over 4 weeks)
10 hours off between shifts
Shift length no greater than 24/28
PGY1s no more than 16 hour shift

29. Residency Interviews Residency Interviews are completed!!
We had over 880 applicants
We interviewed 97 applicants

30. Department of Obstetrics and Gynecology Residency Program “a-FIT” Report “a-FIT”: areas For ImprovemenT Thank you for all you do!