Program Goal

Increase capacity among General Surgeons working in rural and remote communities, and/or global surgery environments to provide safe surgical obstetrical and emergency gynecology care to maintain high quality maternity care and critical women’s health services for patients close to home.

Program Rationale

Providing maternity care close to home is a quality of life issue for women and their families and is crucial to maintaining vibrant communities and culturally supportive local health care services. General Surgeons have the operative competencies to acquire the necessary procedural skills to support safe operative delivery and maternal care in rural communities. This partnership is intended to provide a competency-based training opportunity for practicing General Surgeons to gain these skills.

Program Eligibility

Eligible applications must be practicing General Surgeons or be enrolled in a General Surgery Residency Training Program.

Program

Eligible surgeons can choose to take the Course Component as a standalone post-graduate course, or can complete ALL components to receive a Certificate of Recognition.

COURSE COMPONENT

  • Canadian Surgery Forum (CSF) Master Class – Operative Delivery and Maternal Care for General Surgeons: Managing Challenging Cases and Complications
    • Includes:
      • Didactic lectures, interactive participant discussion and case review

2021 Masterclass

Due to the virtual nature of the 2021 Canadian Surgery Forum (CSF), the Masterclass course components will be offered through a series of webinars offered September 2021 – February 2022, with the opportunity to attend a half-day hands-on Skills Simulation Session at CSF 2022.

Target Audience
This interactive webinar series is designed for practicing surgeons and residents both actively involved and interested in providing operative delivery and maternal care support in rural and remote communities and global surgery programs.

Course Overview
The course consists of a 4-part 1.5h webinar series of combined didactic lectures, interactive participant discussions and case review around the assessment and management of challenging cases and complications in operative delivery for the General Surgeon.

Webinar series participants will have the opportunity to participate in a half-day hands-on Simulation program to practice skills introduced in the webinar series at the next in-person CSF [date and cost TBD]

Reference Textbook
Posner, G., Dy, J., Black A., and Jones, GD. (2013) Oxorn-Foote Human Labor and Birth (6e). Mc-Graw-Hill.

Co-Chairs
Dr. Glenn Posner, Dr. Cait Champion, Dr. Roy Kirkpatrick

Course Learning Objectives
By the end of the webinar series participants will be able to:

  • Identify and describe safe surgical management principles and approaches to complex surgical deliveries
  • Develop and implement a stepwise approach to assessment and management of Post-Partum Hemorrhage (PPH)
  • Describe an approach to assessment and surgical management of complications following vaginal delivery and caesarean section
  • Initiate collaborative approaches to operative maternal care team building and local quality assurance around high-acuity low-occurrence obstetrical complications in rural and remote settings

Accreditation
This event is an Accredited Self-Assessment Activity (Section 3) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada and approved by Canadian Association of General Surgeons.  You may claim a maximum of 1.5 hours for each webinar attended.

Wednesday, February 16, 2022, 7:00-9:00pm ET

*Due to the popularity of this session at the 2021 Canadian Surgery Forum, this is a repeat of Session #1 for anyone not able to join us at CSF.

By the end of this session participants will be able to:

  • Identify and describe safe surgical principles and potential pitfalls in repeat caesarean section
  • Identify and describe safe surgical principles and potential pitfalls in approaching the patient with a classical caesarean incision
  • Identify and describe safe surgical principles and potential pitfalls in breech delivery and malpresentation
  • Identify and describe safe surgical principles and potential pitfalls to operative delivery in late second stage arrest, including management of an impacted fetal presentation
  • Identify and describe safe surgical principles and potential pitfalls in high risk operative delivery including cord prolapse and twin delivery

Thursday, October 7, 2021, 7:00-9:00pm ET

By the end of this session participants will be able to:

  • Define post-partum hemorrhage and identify patient risk factors and principles of prevention
  • Develop a stepwise approach to initial assessment and medical management of post-partum hemorrhage
  • Identify and describe indications for operative intervention in post-partum hemorrhage and approaches to surgical management including use of Bakri balloon, compression sutures, subtotal hysterectomy
  • Describe an evaluation and management approach to the patient with post-partum hemorrhage due to retained products of conception

Thursday, November 11, 2021, 7:00-9:00pm ET

By the end of this session participants will be able to:

  • Describe an approach to the identification, evaluation and management of early and late complications of caesarean section, including bladder and bowel injuries
  • Describe an approach to the identification, evaluation and management of early and late complications of vaginal deliveries, including vulvar hematomas and complex (grade 3&4) perineal tears
  • Compare and contrast post-operative care management principles for typical caesarean section and vaginal delivery patients and those with complications

Thursday, December 9, 2021, 7:00-9:00pm ET

Learning Objectives

By the end of this session participants will be able to:

  • Identify and describe approaches to collaborative quality improvement in maternal care in a low-resource setting, including development of local kits, protocols and cognitive aids
  • Identify and discuss an approach to managing interprofessional team dynamics in difficult maternal and child complications and outcomes in rural and remote settings
  • Develop a quality improvement approach to the disclosure and follow up of difficult maternal and child complications and outcomes in rural and remote settings

September 2022, half-day session

Course Overview

The course consists of a half day simulation session of practical surgical skills required in the assessment and management of challenging cases and complications in operative delivery for the General Surgeon.

Prerequisite: Completion of the CAGS Postgraduate Course – Operative Delivery and Maternal Care for General Surgeons: Managing Challenging Cases and Complications Webinar Series

Learning Objectives

By the end of this session participants will be able to:

  • Describe and demonstrate an approach to examination of the vaginal vault and cervix in a bleeding postpartum patient
  • Describe and demonstrate an approach to safe insertion and management of a Bakri balloon
  • Describe and demonstrate an approach to uterine compression sutures
  • Describe and demonstrate an approach to subtotal hysterectomy
  • Describe and demonstrate an approach to repair of postpartum complex perineal tears
  • Describe and demonstrate an approach to breech extraction in cesarean section
  • Describe and demonstrate an approach to fetal extraction in malpresentation and impacted head in the setting of cesarean section
  • Develop a list of components and set of cognitive aid adjuncts for an emergency surgical Postpartum Hemorrhage Kit

Accreditation
This event is an Accredited Simulation Activity (Section 3) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada and approved by Canadian Association of General Surgeons.  You may claim a maximum of 4 hours.

CLINICAL TRAINING EXPOSURE COMPONENT

  • 25 c-sections (minimum) as primary surgeon (case mix to include elective primary, elective repeat, urgent second stage, breech)
  • 5 D&C as primary surgeon
  • 5 salpingectomy/tubal ligation as primary surgeon (mix of laparoscopic and open)
  • Case log – This activity is considered an Accredited Practice Assessment (Section 3) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada and can be self-submitted through Mainport.

CAGS is in the process of identifying opportunities for clinical training.  We are also encouraging people to reach out locally through their own clinical networks to seek out learning opportunities guided by our clinical training minimum case volume criteria and evaluations.  Please contact us at cags@cags-accg.ca for more details.

CLINICAL TRAINING EXPOSURE EVALUATION

  • Cesarean Section
    • Submit 3 evaluations with mix of presentations and overall assessment of “I needed to be there just in case” or “I did not need to be there”
  • Tubal Ligation/Salpingectomy
    • Submit 1 evaluation with overall assessment of “I needed to be there just in case” or “I did not need to be there”
  • Dilation and Curettage
    • Submit 1 evaluation with overall assessment of “I needed to be there just in case” or “I did not need to be there”

Certificate of Recognition in Operative Delivery and Maternal Care for General Surgeons

The goal of this certificate program is to provide General Surgeons with a competency-based training opportunity to gain the skills and expertise to support safe operative delivery and maternal care programs in rural and remote communities and global surgery programs.

Requirements:

  • Completion of Course Component
  • Completion of Clinical Training Exposure Component including submission of Case Log
  • Completion of Clinical Training Exposure Evaluation minimum requirements

For more information on this program, contact cags@cags-accg.ca.