RURAL OPERATIVE SKILL TRACKDAVID KERMODE DO FACOSMERCY MEDICAL CENTER DES MOINES IOWA

TARA BLALOCK, AUD, DOMERCY FAMILY MEDICINE RESIDENCY-PGY1

HOW I LANDED HERE?

Roots!!

Background

WhyFamilyMedicine?

• ObstetricsandPeds• Widescopeofpractice• RuralandGlobalHealth• HealthPolicy• It’smycalling!

DreamJob!!

• Ruralsetting• HeavyObstetrics• ManyProcedures• Opportunitytooperate• Becomeatrustedmemberofacommunity• Participateinhealthpolicy• Havethetoolstoserveglobally

Proceduresyousay?Operateyousay?

• C-sections• D&C• TL• Scopes• Appy• Leeps• AssistGS• WhynotOBorGS?

Willitbehard?

• YES!• 4th year• Relationshipswithspecialists• Highstandards• Highexpectations• Comfortzone• Changingaculture• Choosingtherightperson

But…

Wewillbevictorious!!!

THE SPACE BETWEENF.P. (REST)

RURAL PATIENT

General SurgeonOB/GYN

PARTNERSHIP

WHAT “THEY” THINK VS WHAT WE THINK

WORKING TOGETHER

SKILL SET NEEDED EVERYWHERE

USING THE GOOD WORK OF OTHERS

PERCEPTION VS REALITY

CORE PROCEDURES LISTHead and NeckChestAbdomenPelvis

ScrotumExtremitiesOperative Obstetrics

HEAD AND NECKT & AI&D peritonsillar abscess

CHESTTube Thoracostomy

ABDOMENEndoscopy and interventionAppendectomyHerniorraphyHemorrhoids Fistulas perianal/rectal abscesses, warts

PELVISDiagnostic laparoscopyTubal ligationD&CHysteroscopy

Ectopic PregnancyBartholin abscess

SCROTUMVasectomyCircumcisionTesticular torsion

EXTREMITIESSmall skin flapsDigital AmputationCarpal TunnelExtensor tendon repair

GanglionectomyTrigger finger

OPERATIVE OBSTETRICSVaccum deliveryManual rotationLow forcepsC section

Repair or 3rd and 4th degree perineal tearsManual removal of retained placental Repair of bladder injuries D&C

DESIGN/BUILDConsensus Opinion of our working group is that this cannot be done in the context of a 3 year FP residency

We have progressed to developing a 4th year fellowship after Family Medicine Residency

Our current opinion is that a cirriculum can be built into a 2nd

and 3rd year FM residency that will enhance the trainees transition into this fellowship

?????1. Can you think of any other procedures that need to be taught?

2. How much of a need it there for this skill set in your community?

3. Do you think that patients would accept these practitioners in your community?4. How much cooperation would these practitioners have in developing “communities” of practice in your area with referring OB/GYN and general surgeons?