Fear of inadequate training (new program)

[Dsaab]

Hey all, Just wanted to see if people are experiencing the same issue I am at my residency program.

Our program is a brand new residency program that started in 2013 academic year. Although it is a beautiful facility, and GME staff are very supportive, I worry that me and my colleagues are receiving inadequate training. For example, we do not have an OB/GYN residency program, and most of the Attending are old school; in that they have not worked with residents since early days in their training. So when you do a rotation with them, they barely let you see their patients. Mostly it is a tag-along experience, with heavy shadowing. So since being on OB twice this year, I've only delivered 2 babies with assistance. Moreover, I've done zero colposcopy exams, and zero vag exams, on my own.

OB is just one example; numerous others exist. For example in our continuity clinic, the majority of patients I see at least, are inherited from other providers and mainly chronic pain patients. While I realize its important to learn how to manage these patients, im frustrated that I'm not seeing more varied pathology. I rarely see children, because our clinic is part of a "government funded health center facility"; so patients are required to only see their PCP, unless their PCP is out or gone. So we only see patients without providers, or walking on occasion. For some reason, this is rarely children.

The ED has been more successful for learning purposes, as has IM service.

Im a PGY1 going on PGY2; feel weak with OB care, pediatric management, and procedures.

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[MedicineMan99]

I think every new program experiences those problems.

Residency is what you make of it. You have to be very proactive. When you shadow these "old school" doctors, ask them if you can do more. Ask to do colpos, ask to do more deliveries. If you show some enthusiasm, they will likely be happy to give you more responsibility. Your clinic experience does sound weak... perhaps you can do electives. Also, interns don't really spend much time at clinic. Wait until next year to get some continuity with your patients.

Keep in mind that there are standards to all family medicine programs. I.e., if you aren't delivering at least 40 babies and have continuity babies as well, you aren't going to graduate. Unless you see 1,650 patients at clinic over your 3 years, you won't graduate. But there's no way your program would have started unless they feel they can successfully produce that type of experience. You have a lot ahead of you! Use your electives to improve your weaknesses.

 

[TPBC]

Where did the requirement of 40 deliveries come from? Continuity visits totally 1650 are specified but not 40 deliveries.

 

[MedicineMan99]

Where did the requirement of 40 deliveries come from? Continuity visits totally 1650 are specified but not 40 deliveries.

You are right. Starting today, residents do not need numbers of deliveries, they just need to provide some type of "continuity OB care". But, the way it used to be (yesterday and before), FM residents needed at least 40 deliveries throughout residency and an additional 10 deliveries which were "continuity deliveries". Most programs were not strict about this but my program was super strict so it was very hard to and a huge pain to get all those continuity deliveries.

 

[JustPlainBill]

Hey all, Just wanted to see if people are experiencing the same issue I am at my residency program.

Our program is a brand new residency program that started in 2013 academic year. Although it is a beautiful facility, and GME staff are very supportive, I worry that me and my colleagues are receiving inadequate training. For example, we do not have an OB/GYN residency program, and most of the Attending are old school; in that they have not worked with residents since early days in their training. So when you do a rotation with them, they barely let you see their patients. Mostly it is a tag-along experience, with heavy shadowing. So since being on OB twice this year, I've only delivered 2 babies with assistance. Moreover, I've done zero colposcopy exams, and zero vag exams, on my own.

OB is just one example; numerous others exist. For example in our continuity clinic, the majority of patients I see at least, are inherited from other providers and mainly chronic pain patients. While I realize its important to learn how to manage these patients, im frustrated that I'm not seeing more varied pathology. I rarely see children, because our clinic is part of a "government funded health center facility"; so patients are required to only see their PCP, unless their PCP is out or gone. So we only see patients without providers, or walking on occasion. For some reason, this is rarely children.

The ED has been more successful for learning purposes, as has IM service.

Im a PGY1 going on PGY2; feel weak with OB care, pediatric management, and procedures.

Well -- your concerns are not new -- just ask anyone in an opposed program who has to fight for their procedures/experiences -- heck, I actually had the OB attending who was running the outpatient OB clinic where we were supposed to get our culpo experiences tell me that FM residents were not doing culpos at that institution...ever. If you're that concerned, do some shopping, prepare to move BEFORE you start PGY2 due to funding issues with ACGME and get over to a rural unopposed program...otherwise, realize you can get most of the "procedures" at the National Procedures Institute --- also realize that for insurance reasons, most hospitals will not let FM deliver. I typically don't do culpos since the management of a bad result generally involves Gyn surgery which I don't do.....this may be much ado about nothing....

 

[MedicineMan99]

Let's not forget, however, that regardless of how opposed or urban a Family Medicine residency is, they all abide by the same standards and need to provide the same minimal procedure experience.

I went to a very urban, very opposed Family Medicine residency program. But, in our Family Medicine clinic we had time blocked off for "Procedure Clinics" for every procedure a rural Family Physician would ever need to do, including plenty of colpos with our own FM attendings. Although we delivered plenty of babies with OB attendings, they were mostly done with our own FM attendings.

You can and should still get outstanding training at opposed, urban programs.

 

[Rowdy Burns]

Hey all, Just wanted to see if people are experiencing the same issue I am at my residency program.

Our program is a brand new residency program that started in 2013 academic year. Although it is a beautiful facility, and GME staff are very supportive, I worry that me and my colleagues are receiving inadequate training. For example, we do not have an OB/GYN residency program, and most of the Attending are old school; in that they have not worked with residents since early days in their training. So when you do a rotation with them, they barely let you see their patients. Mostly it is a tag-along experience, with heavy shadowing. So since being on OB twice this year, I've only delivered 2 babies with assistance. Moreover, I've done zero colposcopy exams, and zero vag exams, on my own.

OB is just one example; numerous others exist. For example in our continuity clinic, the majority of patients I see at least, are inherited from other providers and mainly chronic pain patients. While I realize its important to learn how to manage these patients, im frustrated that I'm not seeing more varied pathology. I rarely see children, because our clinic is part of a "government funded health center facility"; so patients are required to only see their PCP, unless their PCP is out or gone. So we only see patients without providers, or walking on occasion. For some reason, this is rarely children.

The ED has been more successful for learning purposes, as has IM service.

Im a PGY1 going on PGY2; feel weak with OB care, pediatric management, and procedures.

I hate to be the guy that lectures you, but any new program is going to have growing pains. A applicant should know that when evaluating a place and that should be a factor in how they rank programs. Secondly, a person needs to decide what type of program they want, opposed or unopposed. Both have their benefits and drawbacks, but a good rule of thumb is numbers are going to be much easier to come by in unopposed setting.

 

[JustPlainBill]

Let's not forget, however, that regardless of how opposed or urban a Family Medicine residency is, they all abide by the same standards and need to provide the same minimal procedure experience.

I went to a very urban, very opposed Family Medicine residency program. But, in our Family Medicine clinic we had time blocked off for "Procedure Clinics" for every procedure a rural Family Physician would ever need to do, including plenty of colpos with our own FM attendings. Although we delivered plenty of babies with OB attendings, they were mostly done with our own FM attendings.

You can and should still get outstanding training at opposed, urban programs.

You are correct and thanks for pointing that out -- our residency was lame and looked for ways to "meet the requirement" but just barely so -- kinda like ISO 9001 certification standards -- you just have to have your process documented -- doesn't have to work or make sense but has to be documents and bingo, you're certified.....

 

[cabinbuilder]

I think it's safe to say that no program is perfect, even in well established ones. While I had great training in an unopposed program in lots of procedures, splinting, casting, joint injections, excisions, lac repairs, biopsies, central lines, foot care, nail removal, etc. my program was seriously lacking in OB/GYN (all I did was watch pelvics and use the doppler), I think I watched one colposcopy, I never delivered a baby, never did prenatal care, never did inpatient peds, never did newborn care. Don't ask me how they got around the whole "you have to have so many deliveries, etc" because I don't know that answer.

 

[DocBlin]

I am weighing in, though I have only the observations via my son. He just completed his FM residency passed FM boards, is Urgent Care attending (already working shifts). He had the opportunity of doing a prelim year in GS. That was a 'game changer' for him, in that the procedures from suturing, biopsies, colonoscopies, central lines, tubes, chest tubes were all certified from that prelim GS year. During his FM 3 years he taught suture techniques to his co residents, first assisted or was primary surgeon in GYN/OB, delivered more than required amounts (though he plans never to do OB), ran cardiac arrests, did PEDS ICU, wards, off. Thus to me his FM training was well enough rounded but that year of GS puts him over the top. Thus if you really desire exposure maybe, just maybe a year of prelim surgery or being in OR more to learn procedures. For example, his first shift as Urgent Care attending he did 3 paronychia drainages, something he did not see in FM residency but he saw in GS prelim year. It is up to each individual to seek out exposure to as much or as little as they desire to learn. Regards Dr B (34 years as a Plastic Surgeon)

 

[styphon]

I think it's safe to say that no program is perfect, even in well established ones. While I had great training in an unopposed program in lots of procedures, splinting, casting, joint injections, excisions, lac repairs, biopsies, central lines, foot care, nail removal, etc. my program was seriously lacking in OB/GYN (all I did was watch pelvics and use the doppler), I think I watched one colposcopy, I never delivered a baby, never did prenatal care, never did inpatient peds, never did newborn care. Don't ask me how they got around the whole "you have to have so many deliveries, etc" because I don't know that answer.

My program required 40 vaginal deliveries - I had done over 70 because I looked for any opportunity possible..

Insurance will not stop most family medicine from delivering - it is more finding back up, if you do not have c/s privileges (which in NY is >250 c/sections) than you need an OB/gyn backup. You would also need to find a way to find vacation coverage. During my job search almost every suburban/rural hospital that had a L&D would allow me to deliver - even the inner city childrens hospital would give me practicing rights.

I also do colposcopies currently - and my PA also does them. We refer to an OB/gyn who is contracted with us if they need further management.