OB/delivery numbers

[medicienne]

Can graduation be delayed if delivery numbers are not met? I am finding it very difficult to meet the 40 required in my program & have not had any continuity delivery yet. When asked, everyone said 'you will get it' but nobody really answered if you can be held back for this.😕

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[deleted87716]

Ask your PD. It's pretty much up to them.

 

[JackADeli]

Can graduation be delayed if delivery numbers are not met? I am finding it very difficult to meet the 40 required in my program & have not had any continuity delivery yet. When asked, everyone said 'you will get it' but nobody really answered if you can be held back for this.😕

As BD stated, you need to have a talk with your PD.

However, more importantly than if you graduate now or delay, is the question, "will you meet the requirements to sit for your boards at the time you graduate?". Usually, the answer is "no" if you fail to meet the training numbers.

Thus, PDs allow extension of time to graduate as graduating someone not eligible to sit for boards is black mark on the program and a red flag for the ACGME.

 

[lowbudget]

You need to have all of your training requirements done by June 30 in order to sit for the Summer boards.

If you're going to be working after fellowship, you need to really shoot to take the summer boards because the next one would be in the winter, which only delays you getting credentialed on insurance panels... which means you won't be paid. 3-6 months without pay can be a drag.

 

[lowbudget]

Wait... I just re-read your OP... What year are you? Zero continuity?!

Getting the 40 is easy. If you can't get it in your program, worse comes to worse, you can do an away rotation either rural, county, or at a military base and you will deliver like crazy. Continuity's what's hard to come by... why aren't you getting any continuity? People are having unprotected sex all over the damn place.

Give it a couple of months. The 9 month mark from Thanksgiving, Christmas, New Year's is upon us...

 

[medicienne]

Wait... I just re-read your OP... What year are you? Zero continuity?!

Getting the 40 is easy. If you can't get it in your program, worse comes to worse, you can do an away rotation either rural, county, or at a military base and you will deliver like crazy. Continuity's what's hard to come by... why aren't you getting any continuity? People are having unprotected sex all over the damn place.

Give it a couple of months. The 9 month mark from Thanksgiving, Christmas, New Year's is upon us...

I just started PGY-2 and will be assigned continuity only after completing my 2nd OB rotation. That's the whole problem. I know that eventually I'll get 40 delivery somehow but the 10 continuity deliveries are going to be really difficult- my seniors are losing them left & right as they deliver in the middle of the night/post-call /when they r on away rotations or office hours, etc.

 

[lowbudget]

Common scenario which is not going to get better with the new work hour rules coming out.

If residents are at-risk of losing numbers, your OB coordinator & chief (or any active resident) should work out a new strategy. What are the rules to continuity in your program? RRC does not define it, if I remember correctly so each program is left to their devicess on what constitutes continuity.

At my old program, they defined continuity patient as someone whom you've seen at least twice and you deliver them. So, if you see a 36 wker, again at 37, deliver at 38, that counts. Or, if you see them at 16 wks, & for who know why (like they go on a crack binge) you don't see them again until 33 wks, & you deliver, that counted at my old program. Ideally, you follow them throughout the entire pregnancy but in most residencies, the patient population you work with...

Anyways, if your residency defines continuity the way mine did, in order to minimize the continuities disappearing because of the reasons you stated, we tag teamed. For example if you're on a rotation where your clinic time doesn't sync with the patient's, we put them on a fellow resident's schedule. Ideally, you get an R3 to pair up with an R2 & you cross-schedule the patient so that they see both the R2 & the R3 at least twice (for example). Then, when it's time to deliver, BOTH the R2 & R3 gets called. If one of you guys can't make it (post-call, clinic, time off), at least the other person can still count the continuity. So, what happens if both the R2 & R3 show up to the delivery?... RRC does not set up rules on this. They say that if a resident supervises another resident on a procedure, both resident may count the procedure (just document perform vs supervise). However, if I remember right, only ONE may count the continuity. So if both R2 & R3 show up to the delivery, the R3 can supervise/assist delivery the R2, the delivery counts towards both R2 & R3's 40 delivery but only one of you may count it towards the 10 continuity. That's 1 strategy

 

[lowbudget]

Oh & 1 last thing... you need to get your program to change the rules on when you can start getting assigned continuity. After your 2nd OB rotation is too late because someone or two every gets screwed because their rotation lands in the latter part of the year. So you have 1-1.5 years to follow 10 people worse case 9 months? That's too tight. Do you at least have 1 OB rotation your 1st year? It should start after your 1st OB rotation. You're not going to learn OB unless you have patients who you follow & obscess over & the earlier you obscess over them, the better you get at the back end. I mean, what incremental advantage does starting continuity after 2nd block add? Nothing. Confidence? No, it's everyone's first dance regardless & it's OB for crying out loud so it doesn't matter. No matter how many deliveries you've done, you still need to think on your feet.

That said, if everyone seems to hit their numbers at your program, don't worry about it. Sounds like the system works somehow magically.

 

[VA Hopeful Dr]

I just started PGY-2 and will be assigned continuity only after completing my 2nd OB rotation. That's the whole problem. I know that eventually I'll get 40 delivery somehow but the 10 continuity deliveries are going to be really difficult- my seniors are losing them left & right as they deliver in the middle of the night/post-call /when they r on away rotations or office hours, etc.

Where I'm at, we always page the continuity resident when their patient comes in laboring. You're allowed to drop everything and go catch that baby (s'why back-up exists).

 

[JackADeli]

Where I'm at, we always page the continuity resident when their patient comes in laboring. You're allowed to drop everything and go catch that baby (s'why back-up exists).

That's what they did during all my FM rotations in school. Also, FM residents kept a fairly up to date list of women expecting soon and so all were aware what resident may be getting called to deliver.

 

[hippiedoc13]

As noted above, the RRC does not strictly define what constitutes a "continuity" delivery and so this is left up to each program to define. My program's definition is much stricter than the examples above. In order to count a continuity, we must have seen the patient at least twice for prenatal care in clinic (not just triage on L&D), do the delivery, round on mom and baby every day postpartum in the hospital, AND see mom back for a 6wk postpartum visit in clinic, before we can count a continuity.

As far as the exact numbers requirements, it's actually a little fuzzy so there is some leeway with the RRC. The RRC does not actually say that EVERY SINGLE individual resident must do exactly 40+ NSVDs and 10+ continuity deliveries...at least as far as RRC requirements are concerned, if you only had 39 deliveries, the RRC won't keep you from graduating. (But your program may.) The RRC requirement is just that ON AVERAGE for the program, residents are doing at least 40 NSVDs and 10 continuities. (This does NOT mean that if I do 65 deliveries and my classmate only does 20, that it would be cool. However, if I do 45 deliveries and my classmate does 39, that's probably fine from RRC perspective.) Again, the specifics of this is left up to the program to decide. So practically speaking, the easiest thing for the residency to do is to set a requirement for every single individual resident that they have to do 40/10 in order to graduate. Our FM PD has become quite rigid about this in recent years, and if residents are not hitting their numbers on time to graduate, they will get pulled from ambulatory rotations and sent to L&D for extra time to hit the minimum numbers. So basically it is always ok for your individual program to define internal requirements in ways that are MORE specific/demanding than the general RRC requirements.

 

[JackADeli]

...As far as the exact numbers requirements, it's actually a little fuzzy so there is some leeway with the RRC. The RRC does not actually say that EVERY SINGLE individual resident must do exactly 40+ NSVDs and 10+ continuity deliveries...at least as far as RRC requirements are concerned, if you only had 39 deliveries...

You might want to check the ACGME program requirements for FM. It's (i.e. numbers) not fuzzy at all...

…Each resident must perform a minimum of 40 deliveries over the three-year program, of which a minimum of ten must be continuity deliveries. At least 30 of the total deliveries must be vaginal deliveries...

…For the minimum of ten continuity patient deliveries, each resident must assume responsibility for provision of antenatal, natal, and postnatal care during their three years of training...

 

[lowbudget]

AND see mom back for a 6wk postpartum visit in clinic, before we can count a continuity.

This was our requirement as well when I started as an intern and had fallen away/unenforced when I graduated. Many of our patients were seen on a self-pay sliding scale basis through their pregnancy and at delivery became eligible for emergency Medicaid that lasted until 6 weeks post-partum. For many, after delivery, enrolled in an Medicaid HMO product, which required them to designate a PCP. Residents, however, aren't on that PCP list (even though the attending was), so many patients simply pick some other doctor in the community as their designated PCP. We lost a lot of post-partum patients that way.

The program felt that the residents shouldn't be penalized for something that so far out of their control and felt that the spirit of the RRC requirement was still fulfilled, so our program dropped that 6 weeks post-partum requirement. If I remember correctly, I don't think RRC fussed on that regard.

 

[JustPlainBill]

RRC must be fuzzy...one program I know of counts continuity as someone you've seen in clinic and are standing in the room while the attending delivers the baby......and they learn deliveries on the OB deck from the midwives.....Interesting.....

 

[JackADeli]

RRC must be fuzzy...one program I know of counts continuity as someone you've seen in clinic and are standing in the room while the attending delivers the baby......and they learn deliveries on the OB deck from the midwives...

That's not RRC being fuzzy. That is an issue of resident logging integrity and honesty with RRC site visit. Also, it is a matter of PD's honesty & integrity. Counting a delivery you didn't do falls on the resident and PD.

Neither of which is an RRC being "fuzzy"....

…Each resident must perform...

 

[lowbudget]

RRC must be fuzzy...one program I know of counts continuity as someone you've seen in clinic and are standing in the room while the attending delivers the baby......and they learn deliveries on the OB deck from the midwives.....Interesting.....

Huh-larious!
May as well just stop by, sign the sign-in sheet & leave.

How has the RRC not shut down the program yet?

 

[JustPlainBill]

Huh-larious!
May as well just stop by, sign the sign-in sheet & leave.

How has the RRC not shut down the program yet?

Good question - I guess no one has the guts to tell the truth.....from what I hear, they're regularly providing 'plausible deviations from the truth' about hours also....

 

[lowbudget]

Good question - I guess no one has the guts to tell the truth.....from what I hear, they're regularly providing 'plausible deviations from the truth' about hours also....

*sigh*... in my opinion, there's a difference between the "rule" and the "exception".

If your attending jumps in to deliver because baby has a shoulder dystocia and you've done McRoberts, suprapubic pressure, Rubin 2, Woods, and on you're way to Reverse Woods or a Zavenelli, you're damn right I'm counting that continuity even if the attending delivers the baby. That's an "exception". If your program's "rule" is for your butt to sit in that corner and watch how the pros do a NSVD (x10 that you've followed all the way through pregnancy whom you've developed an awesome relationship with mom) that has millions of years of evolution working in your favor... I'd be insulted. That's just straight up disrespect. 3rd year medical students interested in Psych and Path do better than that.

I'd look to get out of the program now if you're an intern. It's better to get out now as an intern than it is to maintain the status quo as an upper level because of your fear of speaking out to RRC for fear of shutting down the program when you're so close to graduation... know what I'm saying?

If this is a long-standing practice, I'd be surprised if RRC hasn't already given you a citation. You can look at ACGME.org to see if your program is on probation. It's really hard to keep that many people quiet. Really hard.

Ugh. Iceberg. Dead ahead.

 

[medicienne]

Thanks