Needs Assessment for Integration of Supportive Care Into Obstetrics and Gynecology Practice

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Abstract

Local Mentor:

Pamela Promecene, MD

APGO Advisor:

Kimberly Kenton, MD

PROBLEM:

Supportive medicine provides comprehensive care for patients with life-limiting illness, focusing on symptom management and quality of life. Obstetrician gynecologists provide lifelong care to their patients, necessitating their ability to provide these services. No standardized curriculum for palliative care is available for obstetrician gynecology learners.

INTERVENTION:

This intervention sought to comprehensively identify learner's needs as a first step to developing a teaching curriculum specific to supportive medicine for obstetrician gynecologists.

CONTEXT:

A comprehensive assessment was performed which included a literature review of available curricula in other fields and focus groups with a variety of specialists in palliative care (ICU, supportive care, gynecologic oncology, general OB/GYN, NPs, social work). A survey was distributed to local OB/GYN residents and fellows to determine learner comfort with supportive medicine skills and their value for future practice. Then information was synthesized and reviewed to ensure validity.

OUTCOME/LESSONS LEARNED:

Results demonstrate >50% of learners were uncomfortable with narcotic rotation, management of lymphedema, and management of actively dying adult patients. Fetal concerns included management of seizures and air hunger. Sixty-eight percent of learners felt comfortable giving bad news, but 50% had no method for providing the news and 33% had no formal training. Eighty percent of learners desired additional active training in providing bad news. Learners generally valued palliative care skills and their importance to future practice. Focus groups suggested themes of poor learner understanding of pain management, delivery of bad news, and difficulty with patient planning and preparation for neonatal death.

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