QUADRIPARTITE MEETING July 23, 2020 • Quantitative and Qualitative Parameters for Assessment of Training Programs during the Pandemic • Hospital Accreditation Visits • Online Exams
QUADRIPARTITEMEETINGJuly23,2020
• QuantitativeandQualitativeParametersforAssessmentofTrainingProgramsduringthePandemic
• HospitalAccreditationVisits• OnlineExams
QUANTITATIVE PARAMETERS FOR ASSESSMENT OF TRAINING
PROGRAMS DURING THE COVID-19 PANDEMIC
Maria Jesusa Banal-Silao, M.D.
OBJECTIVES
• To identify the current challenges in Obstetrics and Gynecology Residency Training, brought about by the COVID pandemic.
• To assess the quantitative and qualitative parameters of the Residency Training Program.
• To propose modifications of certain parameters of the Residency Training Program to address the challenges brought about by the pandemic.
• To set recommendations based on the deliberations that will arise from the Quadripartite Meeting.
IMPACT OF COVID-19 ON RESIDENCY TRAINING
Classroom Teaching• Suspension of classroom-based teaching and
conversion to video-conferencing platform to conduct the following: lectures, histopathology/morbidity and mortality, staff conferences, ward endorsements, post duty rounds
• Lack of protected teaching time; since schedule of duties were modified depending on the bulk of COVID infected patients and health care workers (HCW) per institution.
IMPACT OF COVID-19 ON RESIDENCY TRAINING
Clinical Skills Teaching• Insufficient caseload from cancellation of elective cases
during enhanced community quarantine (ECQ)
• Minimizing number of staff from managing ‘high infection risk’ cases
• Suspension of cross-institutional subspecialty rotation, pathology rotation, and potential loss of learning opportunities
• Suspension of OPD clinics during ECQ/GCQ; reduced patient consults when clinics opened
• Teleconsultation
IMPACT OF COVID-19 ON RESIDENCY TRAINING
Procedural Training
• Difficulties with performing surgeries with personal protective equipment (loss of dexterity, need for sterility and increased psychological stress)
• Cancellation of difficult surgical procedures
• Reduction in procedures for junior residents; high-risk cases often decked to senior residents
• Decrease or absence of consultant supervision of surgeries
IMPACT OF COVID-19 ON RESIDENCY TRAINING
Assessment and Feedback
• Decreased number of assessors
• Difficulty in implementation of residency evaluation forms, OSCE, written and oral exams: manner, frequency
• Clinical and psychological stress can impact performance of the residents
• Lack of effective mentorship for mentor–mentee
Accreditation Council for Medical EducationCouncil for Residents’ Education, Enhancement and Development
Minimum Graduates through
June 30, 2018* ECME MINIMUM
REC
Minimum Graduates on or after June 1, 2019
ECME MINIMUM REC (ACGME)
CREED
Spontaneous vaginal delivery 200 200 70
Cesarean delivery 145 145 30
Operative vaginal delivery 15 15 10
Obstetric ultrasound 50 50 15 (5/5/5)
Abdominal hysterectomy 35 15 10
Vaginal hysterectomy 15 15 2
Minimally invasive hysterectomy (including vaginal/laparoscopic hysterectomy,laparoscopic assisted vaginal hysterectomy, robotic hysterectomy)
35 70
Hysterectomy-total number (minimally invasive & abdominal) 70 85 15
Incontinence and pelvic floor procedure (excludes cystoscopy) 25 25
Cystoscopy 10 10
Laparoscopy 60 60 1
Hysteroscopy 40 40 1
Transvaginal ultrasound 50 50
Surgery for invasive cancer 25 25
Episiorrhaphy 35
Outlet forceps extraction and/or vacuum extraction 30
Dilatation and curettage (abortion ACGME) 20 20 40
Manual Extraction of the placenta 3
Adnexal surgery 15
Peripartum Hysterectomy 1
Vaginal evacuation of hydatidiform mole 1
Abdominal myomectomy 2
Identification of hypogastric arteries 3
Minimum Surgical Competencies Per Year Level
10
Minimum Surgical Competencies Per Year Level
Minimum Surgical Competencies Per Year Level
1. Performance of the above procedures must be certified by the training officer or consultants.
2. Of the breech deliveries, at least one (1) should be a vaginal partial breech extraction of a live baby weighing at least 1.5 kg assisted by a consultant or by a senior resident.
3. Of the thirty (30) cesarean sections, at least one (1) should be a classical cesarean section.
4. Transfer of technical responsibility must NOT be more than 40% for major surgical procedures.
5. Technical transfer of responsibility (TTR) is NOT allowed in the following procedures: Outlet forceps extraction or vacuum extraction, Vaginal breech delivery, Vaginal evacuation of a hydatidiform mole, Peripartum hysterectomy, Vaginal hysterectomy, Abdominal myomectomy
6. Refer to the instructional design for ultrasound for the learning outcomes expected of residents.
RECOMMENDATIONS• The minimum number of cases for surgical competencies remains
the same, with a few exceptions (gynecologic endoscopy cases will be deferred to 2021).
• Full implementation of integrated training in gynecologic endoscopy will be deferred to 2021.
• Transfer of technical responsibility may be increased to, but not more than 60% for major surgical procedures.
• Transfer of technical responsibility for special procedures will be allowed for graduating residents,
• Credit all cases done on outside rotation (from networking/MOA hospitals) for graduating residents.
RECOMMENDATIONS
• The Residency Inservice Exam (RISE) will be moved to October 11, 2020.
• The eligibility period for certification will be extended by one year for any resident, who merits an extension due to mitigating circumstances brought about by the COVID-19 public health crisis.
• The training program has the final authority to make decisions about the duration and completion of a residency. This includes verification that a resident has met the program’s requirements, and is eligible for promotion to the next year level (for RPT I to III), or graduation (for senior residents).
REFERENCES1. Accreditation Council for Graduate Medical Education (ACGME)
Common Program Requirements (Residency) 20182. Council for Residents’ Education, Enhancement and Development
(CREED) Handbook. 20183. Obstetrics and Gynecology and Subspecialty Certification Standards-
COVID-19 Policy. The American Board of Obstetrics & Gynecology. March 13, 2020
4. Haywood L. Brown, MD, Sandra A. Carson, MD, and Hal C. Lawrence III, MD Medical Education: Consensus Statement. The First National Summit on Women’s HealthThe Future of Obstetrics and Gynecology Training. Obstet Gynecol2018
5. Philippine Society of General Surgeons Accreditation and Eligibility Provisions 2020
PROPOSEDQualitativeParameters
inOBGYNTrainingProgram
WhatResidencyTrainingProgrammustdo– RelevantandTimely
1. Reviewcorecompetencies2. Revisitcurriculum,rotations,schedulesand
evaluationtoolsontelemedicine3. Reevaluatetrainingstrategies4. Evaluatemilestonesandskillsdevelopment
Dr.Tumbocon,SLMC
OB-GYNTRAININGPROGRAMChallenges
1. Howtoutilizeandmaximizee- learningplatforms2. Howtocontinuetoassessandgivetimely
feedbackforallexpectedcompetencies/outcomes.
3. Howtousestrategiestoshortenthesurgical“learningcurveSurgicalspecialtytrainingprogramwhichreliesheavilyinacquisitionofskills.
4. Howtoaddresscompromisedautonomyofresidents.
”
LEARNINGACTIVITIESHandbookofCREED,page84-86
• Demonstration-ReturnDemonstration• Roleplaying
E-TEACHINGLEARNINGACTIVITIES
COXMODELFORBEDSIDETEACHING1. ExperienceCycle– preparation,briefing,clinicalencounter,debriefing2. ExplanationCycle– Reflection,Explication,Workingknowledge
ASSESSMENTMETHODSOutcomes Facetoface
assessmentAsynchronous Synchronous
Knowledge Quizzes,exercises,selfassessmentquestions,writtenexams
Emailedexercises OnlinequizzesOnlineexamination
Problemanalysisandthinking
Cases/TriggersWrittenexamReport
EmailedcasediscussionBlogsCasereports
DiscussionboardsE-PBLoutputsReportsOnlineexamination
Creativethinking ProjectsDesignsPortfolios
InfographicsAudio-visualpresentationE-portfolio
OnlinedesignsBlogsE-portfolios
Communicationskills
RecitationOralreportEssayexamination
Pre-recordedvideoEmailedreportsInfographics
Reportsduringsynchronousdiscussion
ASSESSMENTMETHODSOutcomes Facetoface
assessmentAsynchronous Synchronous
TechnicalSkills
Logs,DOPSPracticalExamOSPE,OSATS
Prerecordedvideobystudentanduploadedforfeedback/grading
SynchronousmeetingwithreturndemoOnlinepracticalexamination
Attitudes Moral/ethicaldilemmasJournalsPeerevaluationReflectionpaper
VideoofethicaldilemmaandanalysisEmailedreflectionE-Portfolio
SynchronousDebates,discussionsPeerevaluationReflectionBlogsE-portfolio
Clinical/Community
D.O. withSPfamilyMini-CEX,CBD,MSFOSCE
PrerecordedSPencounterE-mailed case/PMP
ObservationofVPencounter/CBDE-OSCE
Shortenthelearningcurve• Useofsurgicalvideosforteaching.
• Liveobservationofsurgeriestosupplementlearningthroughsurgicalassists.
• Livesurgerywebcastwithconsultantleddiscussion
• Constructivedirectsupervisionofsurgicalproceduresoftrainees
• Standardizedassessmentandtimelyfeedbacktomaximizetransferofskillsandknowledge
Dr.Tumbocon,SLMC
Dr.Tumbocon,SLMC
OTHERACTIVITIES TEACHINGMETHODS/ASSESSMENT
DEPTCONFERENCES E-Learning,Zoomconferences– postduty,adm conf,Video-OSCE
SUBSPECIALTYROTATION • Reviewpathologyslidesonline• Patientrecords(partograph,CTG
interpretation,documentationofEINC)
• ReviewrecordedultrasoundresultsRESEARCH • Meta-analysis
• Descriptiveresearch• Caseseries• Virtualresearchteammeetings
EVALUATIONMETHOD REF- clinicalcompetence,surgicalskills,conference,casepaper,researchpaper,attitudeONLINEFORM- likegoogleforms
EXAMINATIONQuizzes,quarterly&yearlyexamination; RISE
OnlineexaminationE-Proctoring
REFERENCES1. AccreditationCouncilforGraduateMedicalEducation
(ACGME)CommonProgramRequirements(Residency)2018
2. CouncilforResidents’Education,EnhancementandDevelopment(CREED)Handbook.2018
3. PhilippineSocietyofGeneralSurgeonsAccreditationandEligibilityProvisions2020
4. IntegratingELearningintheResidencyTrainingProgram,July15,2020LectureofDr.Melflor Atienza,UERM
5. “OngoingChallengesinMedicalEducationandTrainingofSurgicalSpecialtiesduringCovid 19Pandemic”,JAAcostaMD,SLMCWebinar
HospitalAccreditationVisits
MilaZaragoza-Ibay,M.D.CREED
OBJECTIVES
q Toidentifyhospitalvisitsbasedonthepurposeandrecommendedschedule
q TopresentguidelinesforE-MENTORINGandE-MONITORING
q Toidentify hospitalsforvirtualvisitsin2020q Todiscussrevisionsinthe Version2020CREED
Checklist(UnifiedwithPBOG)q Topresentrecommendationsfortherevised
curriculum
MajorfunctionofCREED
qTooverseetheimplementationoftheresidencytrainingprograminPBOG-accreditedhospitals
qToperformHospitalvisitsintendedtoassesstheprogram’sreadinessfortheaccreditationorreaccreditation
qToevaluateifthestandardsoftrainingisbeingmaintained
qToactasarecommendatorybodytothePBOGpriortoaccreditationorreaccreditation
CREEDHOSPITALVISITS
qMENTORINGVISITforNewApplicationforAccreditation
qMONITORINGVISITpriortoRe-accreditation:Ø a.YEAR2 pre-accreditationØ b.YEAR3 pre-accreditation
qMENTORINGVISIT– forhospitalsapplyingforre-instatement oraccreditationafterrevocationq REVISITasrecommendedbyCREED-priortoPBOG
application
üTheCREEDrecommendationisanintegral partoftheaccreditationrequirements beforePBOGwill
accepttheapplication
Summaryofhospitalsforvisitpriortothepandemic
Total=40qREVISITS: 4HOSPITALS(1inRegionI,2in
Region3,and1inNCR)qMENTORING: 2HOSPITALS(RegionsIIandX)qYEAR3VISITS: 3HOSPITALS(AllNCR)qYEAR2VISITS: 31HOSPITALS(3inRegionI;1inRegionIII;16inNCR;2inRegionV;3inRegionVI;4inRegionVII;1inRegionIXand1inRegionXI
q E-MENTORINGq E-MONITORINGq BLENDEDCREEDVISITS- Tocombine
E-mentoringandatargetedphysicalvisit(ifrecommended for2021orpostpandemic)
NewtypesofCREEDvisitsasmitigatingmeasuresduringthepandemic
Summaryofhospitalsforvirtualvisitduringthepandemic
Total=26qREVISITS: 4HOSPITALS(1inRegionI,2in
Region3,and1inNCR)qMENTORING: 3HOSPITALS(NCR,RegionsII&X)qYEAR3VISITS: 3HOSPITALS(AllNCR)qYEAR2VISITS: 16HOSPITALS(AllNCR)
qPHASE1qSubmissionofdepartmentalprofilesinPDF-q AccomplishmentoftheCREEDCHECKLIST(v.2018)q pogs.creed@gmail.comqmitigatingmeasuresandcontingenciesduringpandemic
qReviewandevaluationofthehospitalreportsandpreviousPBOGandCREEDrecommendations
qScheduleviaZOOMwiththePOGSsecretariat-ensurestableWIFIconnectivity
TheCREEDVirtual HospitalVisit2020
qPHASE2qTheactuale-mentoring/monitoringviaZOOMqHIGHLIGHTS:Ø Measuresimplementedtoaddressprevious
recommendationsØ Mitigatingmeasures:staffing,clinicalcases,e-
learningactivities,subspecialtyrotations,scientificworks
qSubmissionofdepartmentstatisticstoPNS
TheCREEDVirtual HospitalVisit2020
qPHASE3qEn bancdiscussionofobservationsandrecommendations
qFinalreporttoPBOGandDepartmentChairqEndorsementofsubmittedhospitalfilestoCREEDArchives
qEndorsementofCommitteereportstothenextCouncilmembers
TheCREEDVirtual HospitalVisit2020
Corerequirementsforfirst-timeapplicationorpriortore-instatementafterarevocationofaccreditation:
qDOHlicensetooperateatleastLevelIIqPOGSLevelII(ForService)certificateqFullcomplementofresidentsatthetimeofPBOGvisit
qAllrequirementsinthechecklistsatisfactorilymetasperCREEDassessmentandmaintaineduntilthePBOGvisit
qCREEDEVALUATIONISQUALITATIVEANDFORMATIVE
qPBOGEVALUATIONISQUANTITATIVEANDSUMMATIVE
RECOMMENDATIONS
• RevisittheCREEDcurriculumtointegrateresolutionsandnewmeasures intheactivitiesofthecommittee
• CollaboratewithSubspecialtysocietiesregardingspecificchangesintheresidencyrotationsandtrainingcurricula
• Ensureeffective communicationbetweenCREED,PBOGandthetraininghospitals
PBOGHOSPITALACCREDITATION
Ma.VictoriaV.Torres,M.D.PBOG
…AMIDSTtheCOVID19Pandemic
Important ISSUES:1.PBOG Hospital Accreditation:
• Hospital accreditation 2020 SUSPENDED due to the pandemic
• 2021 Accreditation – 2 sets (2020 and 2021)?
2. Lists of Hospitals for Accreditation – 2020 and 2021
3. Contingency Plan: (…if and when the pandemic continues…)
a. Virtual Hospital Accreditation
b. PNSS Data for those hospitals for accreditation for 2021
4. Alignment between PBOG’s and CREED’s Strategies for Hospital Accreditation
1. Batangas Medical Center
2. Brokenshire Integrated Health Ministries
3. Cebu Doctors University Hospital
4. Cotabato Regional and Medical Center
5. Southern Philippines Medical Center
6. Davao Regional and Medical Center
7. De La Salle University Medical Center
8. East Avenue Medical Center
9. Fatima University Medical Center
10.Gov. Celestino Gallares Memorial Hospital
11.Jose B. Lingad Memorial General Hospital
12. Manila Doctors Hospital
13.Mariano Marcos Memorial Medical Center
14. Our Lady of Lourdes Hospital
15. Pasay City General Hospital
16. Perpetual Help Medical Center (LP)
17. Rizal Medical Center
18. San Pedro Hospital
19. Seamens Hospital
20. St. Paul’s Hospital
21. Veterans Regional Hospital
22. Vicente Sotto Memorial Medical Center
2020 PBOG Hospital Visits (30 Hospitals)
A. HOSPITALS FOR REACCREDITATION (22)
B. HOSPITALS ACCREDITED IN 2018 FOR MANDATORY REVISIT IN 2020 (2)*(Accredited- 2019-2022)
1. St. Luke’s Global Medical Center
2.James L. Gordon Memorial HospitalC. HOSPITALS REACCREDITED IN 2019 BUT FOR MONITORING REVISIT IN 2020 (3)
*(Accredited- 2020-2023)
1. AFP Medical Center
2. Mary Johnston Hospital
3. General Emilio Aguinaldo Medical CenterD. NEW APPLICATION FOR ACCREDITATION (2)
1. Las Piñas General Hospital and Satellite Trauma Center
2. University of Cebu Medical Center
E. APPLICATION FOR REACCREDITATION AFTER REVOCATION (1)
1. Pablo Torre Memorial Medical Center –
HOSPITALS ACCREDITED FROM 2018-2021…(FOR ACCREDITATION: 2021)
1. Amang Rodriguez Memorial Hospital2. Angeles University Foundation Medical Center3. Bulacan Medical Center4. Cagayan Valley Medical Center5. Iloilo Mission Hospital6. Ospital ng Makati7. Region 1 Medical Center8. SLU Hospital of the Sacred Heart9. Tarlac Provincial Hospital10. Valenzuela Medical Center11. Eastern Visayas Regional Medical Center12. Pasig City General Center13. Medical Center Manila14. MCU Hospital15. Dr. Victor R. Potenciano Medical Center
A. VIRTUAL Hospital Accreditation1. Zoom Platform- 3 simultaneous meeting rooms2. Checklist for Hospital Accreditation:
- MOSTLY can be pre-evaluated by the documents they submitted on application. The following need to be assessed virtually...
a. PART A- Infrastructure and equipment for trainingb. PART B- Actual checking of logbooks for attendance, personal
logbooks of residents, evaluation tools, exams, etcc. PART C- personal logbooks (competencies), Didactics, Technical skills
CHALLENGES:
•It is doable but very challenging- very hard to check logbooks, exams, evaluation tools, etc. virtually
•Are all institutions equipped with strong/stable internet connections in their localities?
Contingency Plan: …if and when the pandemic continues…
B. SURVEY of CASES (March-September(?) 2020), utilizing the data from the PNSS chaired by Dra. Anette Macayaon
OBJECTIVE:
To have a survey if there will be significant decrease in the number of cases during the pandemic (March – September (?) 2020 which will be a basis for the future plan/s of the Board.
STRATEGIES:
• PBOG coordinated with Dra Anette Macayaon• Provide PBOG the summary of the 2019 cases of hospitals for accreditation visit
on 2021, as the baseline for comparison• Inform and request the concerned hospitals to input and update their data regularly
from January until September or forward (?).
Alignment between PBOG’s and CREED’s Strategies for Hospital Accreditation
Effective communication between Heads of CREED & PBOG Committees on H.A.• Checklists are aligned with each other• Hospital visits are coordinated• Direct transfer of information regarding results of visits
ASSESSMENTS on Visits:• CREED- Qualitative (present/absent)• PBOG- Quantitative (scoring system)
Note:
A recommendation of CREED for PBOG visit of a certain hospital may not be a reassurance that
the institution will be given accreditation. The hospital should SATISFACTORILY meet the
standard (Passing Score) set by the BOARD to be accredited.
ONLINEexamPLATFORM:
WhatisNeededtoMoveHigh-stakesWrittenExams
Menefrida S.Reyes,M.D,PBOG
ComponentsofanOnlineExam1. SECUREDELIVERYSYSTEM(PASSWORD-PROTECTED)
2. VISUAL(ONLINE)PROCTORING,WITHZOOM
Decision-makingPoints
PRACTICALITY• Doable
STANDARD• High
COST• Low
“Whatisdoableandofhighstandardisusuallyexpensive;
Whatischeapanddoablemayreallybeoflowstandard;
Whatisofhighstandardandcheapisratherdifficulttofind.”
CONSIDERTHETRIANGULARCONUNDRUM:
MATRIXLMSOFCYPHERLEARNING
• Allowscreationofcontent(examcontent),UPLOADING&deliveryofonlineassessment/exam,EVALUATIONoflearners’/examinees’performance(withrubricsfeature)
www.matrixlms.com
Connectivity
Internetspeed(downloadmbps&uploadmbps),
Safety
“Onlinelearningisnotthenextbigthing,itistheNOWbigthing.”
- DonnaAbernathy(educator)
‘…there’snoturningback…let’sembracethechange!’!’
Online RISE
JudithG.Cabanela,M.D.CREED
RESIDENTS’INSERVICEEXAMINATION(RISE)
• AnnualwrittencomprehensiveexaminationconductedbytheCREEDforresidentsinOBGYN.
• Purpose:formativeexaminationforthe1st to3rdyearresidentsandsummativeforthe4th yearresidents.
OnlineRISE• Shallbeconductedperinstitution• Institution/Departmentshallprovidethepropervenuethatcanaccommodatethenumberofresidentsinthedepartment
• Examineemustprovidehis/herowngadget,preferablyapersonalcomputer/laptopforbetterviewingofMCQsandotherattachmentslikegraphs,images,photos,etc.
OnlineRISE
• TrainingCommitteesandDepartmentStafftoactasproctorsduringtheonlineRISEwithswappingofmemberswithothertraininghospitalsintheirarea,ifpossible
• Prepare1-2extralaptopsordesktopswithcameraforzoomproctoring
OnlineRISE• Preparethenecessaryinternetconnectionstoincludethecheckingofinternetconnectivityspeedbyusinganyspeedtest(e.g.speedtest.net orfast.com)
• SimulationoftheexamwillbedonepriortotheactualonlineRISE
• Eachresidentwillhavetheirownuserinterfaceanddashboard
Furtherdetailsonthesimulationandactualonline
RISEwillbeannounced,posted,emailedorpresentedinanother
meeting.