2012 ACM District III Resident Reporter Reports

Melanie Kaufer, MD

This May, I was fortunate to participate in the ACOG Annual Clinic Meeting Ob/Gyn Reporter Program as a representative from District III.  When my program director asked me if I was interested in the program, I was eager to participate, but I was unsure about what to expect.  I did some research and learned that each ob/gyn reporter was responsible for attending the ACM and submitting a report afterwards documenting what we had experienced.  I was incredibly excited when I learned that I was selected to be part of the program – between the prospects of learning more about OB/GYN, meeting others in OB/GYN from across the country, and seeing a new city, I was really looking forward to it.  I became even more excited when I received my schedule.  When I got to San Diego, I was certainly not disappointed.

Our first event as ob/gyn reporters was a welcome program and dinner.  It was wonderful to meet other residents from other parts of the country and even the world.  I was particularly inspired to hear from ACOG leaders, including Dr. Sterling Williams, ACOG vice president for education, Dr. James Martin, ACOG president, and Dr. Ravi Gada, JFCAC chair.  They truly made it seem like being an active member of ACOG was attainable, as well as necessary for the organization.  As Dr. Patrice Weiss said, “We are ACOG.”  I realized that ACOG is not just a nebulous organization that gives us practice bulletins and publishes the Green Journal.  Instead, it is an organization that represents all of us – from residents to fellows to attendings – and we must all take an active role in giving back.  With this in mind, I eagerly looked forward to the other events that I would be attending as a ob/gyn reporter.

The following morning started out with a breakfast with the other ob/gyn reporters and a lecture from Dr. Patrice Weiss about emotional intelligence that was fun and enlightening.  I then had a post graduate course on minimally invasive hysterectomy.  As a second year resident, my experience in GYN surgery has been limited to mostly minor cases.  This course made me look forward to doing the more major cases that I will be doing as a senior resident during the next two years.  I also learned about surgical technique and the newest expert opinions and evidence about the different techniques  to perform hysterectomy.  The course was so interesting and full of information, it was hard to believe that the entire course lasted over eight hours – the day went by so quickly!  At night, I went to the ACOG Welcome Reception, where it was incredible to see how many physicians and their families were taking part in the ACM.  It was a great day, and I was excited to see what awaited me the next one.

The next day began with a breakfast and lecture by Dr. Owen Montgomery about domestic violence with the other ob/gyn reporters.  The lecture was packed with information about maternal mortality and intimate partner violence.  It will certainly affect my practice patterns, as I plan now to screen for domestic violence more widely than before.  The rest of the morning was spent at the ACOG ACM Opening Ceremony, followed by the President's Program, featuring three lectures on preeclampsia.  These lectures were outstanding and full of the latest information about diagnosis of preeclampsia and what the next research will be.  Perhaps the most memorable lecture, however, was given by Mrs. Eleni Z. Tsigas.  Her talk about preeclampsia from a patient's perspective was moving and thought-provoking.  While I always knew that preeclampsia could be a devastating illness to patients and their families, I realized that I only rarely stop and think about it when treating my patients on a daily basis.  Mrs. Tsigas's lecture will forever change the way I take care of my patients, as well as how I educate my medical students and junior residents about this disease.  Immediately following the president's program on preeclampsia, I had a lecture on strategies for induction of labor.  It was enlightening to see the latest data for each method that is currently available.  In particular, I was interested to learn about the use of Foley catheters and Cook catheters for induction of labor.  I was encouraged by the data that was presented, particularly for the Foley catheter, and I plan to try to introduce this method to my institutions in order to improve our successful induction of labor rates.  Following this lecture, I spent some time walking through the exhibit hall, where I met with many vendors and learned about a variety of products.  I especially enjoyed trying out the surgical equipment that was available to practice on.

In the afternoon, I went to a series of lectures on transitioning from residency to life afterwards.  I learned a great deal about the use of social media in every day practice.  I never considered how to use platforms like Facebook and Twitter in my practice, but now I am definitely interested in using them to reach out to and educate my patients, as well as my colleagues.  I also never thought about getting a Twitter account, but now I am seriously considering it as a way to participate in the OB/GYN online presence.  I also learned about how to handle adverse events that occur in residency and beyond.  As physicians, we often feel like we have to silently handle our thoughts and feelings when we have a bad or unexpected outcome, and these emotions can have a detrimental effect on our personal and professional lives.  Additionally, adverse outcomes can lead to legal consequences, and it was refreshing to learn about how to handle them.  It was helpful to learn about how to cope with these events, and I plan on bringing what I learned to my own residency program.  Finally, we had a breakout session in which I met with fellows who are currently doing a reproductive endocrinology and infertility fellowship, which I am interested in.  Meeting with them was helpful and encouraging, and made me look forward to starting to get my application ready to apply next year.   The day was capped off with a reception for medical students and residents, and it was great to meet with students from throughout the country who are interested in OB/GYN.  It was refreshing to experience their enthusiasm, and it made me excited to come home to continue teaching my junior residents and students.  Overall, I had a fantastic day full of learning and networking, and I looked forward to continuing to do so the next day.

In the morning, we started out with an ACOG resident breakfast meeting.  It was great to meet other residents who were at the meeting.  I was truly encouraged by them to consider taking a leadership role in ACOG.  This was only further bolstered by a lecture given by Dr. Kevin Kiley about leadership.  I plan to use the things that I learned during his talk in my own program, and possibly even in my further participation in ACOG.  It was also enlightening to see the Junior Fellow Initiative Toolkit winner from the past year and to hear her talk about her project.  Finally, it was nice to hear the current Junior Fellow Congress Advisory Council Chair, Dr. Ravi Gada, speak about his past year in this role.  Overall, the meeting made me really want to participate more in ACOG.  This meeting was then followed by “Stump the Professors,” which was a fun and educational session.  I really enjoyed listening to the challenging cases and attempting to develop a differential diagnosis of my own.  Following this session, I spent some more time walking through the exhibit hall, and then went to a lunchtime conference on hormone therapy replacement.  I was particularly excited for this conference, as I did not previously know a great deal on this topic.  It was very interesting and helpful to speak to the “expert” at the table, as well as other OB/GYNs.  I learned a great deal and was inspired to go home and read more about this.  After lunch, I finished my walk through the exhibit hall, and then went to a special session on maternal mortality, moderated by Dr. James Martin and featuring Mrs. Christy Turlington-Burns and Mrs. Tonya Lewis Lee.  The session was fascinating and inspiring, and made me want to come back to my own program and spread their ideas and projects.  The night was completed with the President's Party, held at the San Diego Air and Space Museum.  It was a great deal of fun and a fabulous way to socialize with the residents and attendings present.

The final day of the conference was spent at the Presidential Inauguration and Convocation, followed by a lecture on obstetrical forceps.  I enjoyed the induction of the new ACOG fellows into The College, and I also liked hearing from the incoming president, Dr. James Breeden.  His initiatives for the upcoming year, including research on shoulder dystocia and the usage of social media, sounded intriguing.  Finally, the Hale lecture, given by Dr. Ralph Hale, on the history of obstetrical forceps and their use today was fascinating.  I particularly enjoyed the interactive portion of the lecture when he displayed photos of forceps and asked the audience to identify them, as well as when he spoke about the history of their use.  This was a fantastic way to wrap up the conference for me, as it was a fun, memorable lecture.

Overall, the ACM was an amazing experience for me.  I learned more than I could have ever imagined, met so many brilliant and interesting people from across the country, and became inspired to become more involved in ACOG.  I hope to be able to attend future meetings, as well as help to serve my district in any way possible.  This was an unforgettable trip and I hope to apply what I learned during my residency and beyond.

Audrey Merriam
Christiana Care Health System

Having the opportunity to attend the ACOG’s Annual Clinical Meeting was very educational and I am very grateful for the opportunity to be a Ob/gyn reporter.  My favorite educational sessions included the post-graduate course on REI, the preeclampsia talks to open the meeting and the lecture on use of forceps in current obstetrical practice.  Outside of the ACM lectures the morning programs given by Dr. Montgomery and Dr. Weiss were wonderful additions and I greatly appreciated them taking time out of their schedule to come and talk to the Ob/gyn reporters.  In addition to the great educational sessions being able to network with other junior fellows from across the country was enlightening and fun. 

The reproductive endocrinology all day course on Sunday was some of the best teaching in REI I have ever received.  It was an extremely comprehensive review.  The instructors were very knowledgeable.  In addition to answering questions about the lecture material they were willing to discuss cases that providers had questions on and it was very helpful to see the information being presented being applied to cases during the session.  One of the most helpful things for me was seeing how REI is practiced at different institutions.  Since patients have so much invested in their infertility treatment I feel like the REI groups at my institution have become very set in patterns of doing things that they have had success with but I did not realize how much the work-up and treatment of these patients could vary.  For instance, ovarian drilling is not often done by the groups at my institution so I did not know much about the practice or the research behind it and after this session I now know that it is a considered a second-line treatment for infertility and that it is still used in parts of the country for infertility patients.  The lecturers were also very up-to-date, discussing relatively new concepts like measuring anti-mullerian hormone as a marker for infertility and using pre-implantation genetic diagnosis before implanting embryos. 

The series of three preeclampsia lectures to open the conference were informative.  The second lecture was especially important to attend and I feel like I was able to come back to my program and educate others about the upcoming changes to the preeclampsia diagnosis.  Hearing the patient perspective on preeclampsia was also a nice reminder that just because preeclampsia is a disease process we deal with almost daily because we are residents it is not something as routine to the patients that have pregnancies complicated by preeclampsia.  The forceps lecture on Wednesday was equally as interesting.  Personally, my program does not have a lot of exposure to forceps any more.  I was intrigued to learn how many providers in the audience still used forceps, although part of this may have been selection bias as providers who still used forceps may have been more likely to go to that lecture.  The lecture was a nice review of the types of forceps and the data behind forceps use.

Having Christy Turlington-Burns and Tonya Lewis Lee attend the conference to speak about their personal projects on women’s health was great for publicity for the conference but I don’t know how educational that part of the program was.  Both of their causes are great and I think they are doing great work but having them come and talk to an audience of women’s health providers was an interesting venue.  I would have appreciated the lecture more if there were some experts to speak toward the topics as well.

Outside of the ACM associated events, the events geared toward the ob/gyn reporters were also very informative.  Dr. Weiss and Dr. Montgomery were both great speakers and very engaging even at 6:30 in the morning.  I particularly enjoyed Dr. Weiss’ talk about emotional intelligence.  I have already discussed with my program director how I think this would be an important topic to have during one of our resident education sessions during the upcoming year.  I think no matter how well you think your interpersonal skills are having a reminder like Dr. Weiss’ lecture is vital.  The domestic violence talk was also interesting, primarily due to the discussion points that it led to between the residents and the foreign conference attendees from Japan about domestic violence education and screening in their home institutions. 

The connections with other junior fellows continued outside the morning lectures.  Throughout my five days in San Diego I made multiple new connections to other residents that I hope will continue throughout my career.  Having the opportunity to discuss differences and similarities in the way people practice across the country was enlightening.  Many in-depth discussions were sparked over sharing patient stories and discussing management styles. 

I greatly appreciated the opportunity to attend the ACM through the Ob/Gyn Reporter program.  I learned a great deal not only from the lectures but from my discussions with residents from across the country.  The meeting reenergized my commitment to women’s health and made me excited to come back and work.  Thank you for this wonderful opportunity. 

Nigel Pereira, MD

I was delighted to hear that I had been selected to represent District III at ACOG’s annual clinical meeting as an Ob/Gyn reporter. Reading the congratulatory e-mail from Dr. Williams filled my otherwise slow and tiring post-call day with a new sense of excitement.  Although, initially I was unaware of what an Ob/Gyn reporter was or what he/she did, skimming the initial e-mail gave me the impression that this would be a busy, educational and fun-filled program.  And yes, I was correct.

 

I realized how big and truly global the program was after attending the welcome dinner. Drs. Martin and Williams summed-up how and why each reporter deserved to be in San Diego and stressed how important it was to be committed to the program and all its activities.  I was impressed about the program’s long and fruitful history and what erstwhile Ob/Gyn reporters were doing currently.  Talking to residents from other states in the US as well countries as far as Japan and Chile was fascinating.  We exchanged notes about medical school structure, residency requirements, research opportunities, and even call schedules and family.  Many of us exchanged contacts to stay in touch even after the program. 

 

The next few days were filled with a myriad of educational activities from seminars to small-group discussions and poster sessions to clinical update talks.  Particularly impressive were the reporter-dedicated breakfast seminars.  Topics for discussion included the importance of emotional intelligence in professional life and its possible ramifications, as well as how common yet elusive domestic violence can be.  It was a delight to hear from the experts themselves and ask them related questions.  These seminars were a personal highlight for me as they focused on subjects that are generally unexplored by most academic residency curricula.  In addition to the seminars, the small-group and poster sessions gave me a chance to appreciate, understand, and also explore latest scientific data coming into light.  Several other lectures were highly informative and intellectually stimulating, and these included the series of talks by the national workforce on hypertension and preeclampsia as well as the Ralph Hale lecture on obstetric forceps.  “Stump the Professors” deserves special mention.  Clinical cases were presented by residents from around the world, which required significant mental gymnastics to be solved by the panel of professors, not to forget the desperate attempts of many members of the audience to formulate a diagnosis. 

Several non-academic, but equally important career and professional contact building seminars, workshops and get-togethers punctuated the academic itinerary of the program.  The ICD coding workshop was a great primer for the labyrinthine world of billing and coding, skills and knowledge important in real-world practice.  Similarly, the junior-fellow organized workshop focusing on the role of social media and professional ethics, malpractice liability, as well as authentic advice about a future career in general Ob/Gyn or a sub-specialty was indeed worthwhile.  In addition, the workshop gave me the opportunity to speak to medical students from around the country, listen to their aspirations, provide them with genuine support and advice, all of which was extremely worthwhile.  Rubbing shoulders with the most renowned Ob/Gyn physicians from the US and around the world in social gatherings was an added bonus.  I had the opportunity to meet some of my research mentors as well as clinical faculty after a gap of over 6 years, which made me realize how small the academic world really is. 

Returning back to Philadelphia was bittersweet, however, I was excited to share all the knowledge that I had assimilated during the Ob/Gyn reporter program with my colleagues at Drexel.  In today’s dynamic world, where scientific principles are challenged, clinical guidelines are modified and the practice of Ob/Gyn is influenced immensely by medico-legal climate, the Ob/Gyn reporter program strives to invest in the development of professionally and culturally competent, socially aware, ethically sound and confident Ob/Gyn physician-leaders in and around the world.  This holistic approach in making the leaders of tomorrow is praise-worthy, and I will always remain grateful for the opportunity that ACOG and the Ob/Gyn reporter provided me. 


                                                                             Amanda Rohn, MD

I was lucky to be chosen as a Ob/Gyn Reporter for ACOG’s 2012 Annual Clinical Meeting. The program let us meet new friends, learn about cutting-edge topics in ob-gyn, and make connections that will be valuable throughout our careers.

After arriving in beautiful San Diego, I attended a welcome dinner for all of the ob/gyn reporters. I didn’t know anyone, and chose a table at random. About half the people at my table turned out to be members of the Japanese delegation, and we talked about differences between training and clinical practice in our respective countries. Although our backgrounds were very different, we seemed to have similar perspectives on challenges in the field.  Before dinner, Dr. James Martin, ACOG President, personally welcomed us to the program. We learned that he had slipped away from his suite at the Hilton where a VIP party was going on!

When dinner was over, one of the JFCAC members from District III introduced me to at least a dozen other people, and we all went to a local Mexican restaurant to celebrate Cinco de Mayo with (a responsible number of) margaritas. Somehow, everyone I met was interesting and we talked about all sorts of things, from how to support women in leadership to what it’s like to practice as an academic generalist in different areas of the country.

Jet lag forced me to turn in early. I was glad I got up for a 6:30 breakfast meeting the next morning because it featured Dr. Patrice Weiss giving a lecture about emotional intelligence. I found it inspiring to think about how to approach my work and my professional relationships in the most productive fashion.

Next was my 060 course, Practical Approaches to Common Obstetrical Dilemmas: Art and Evidence. This course moved fast and covered an incredible amount of ground in eight hours. I learned cutting-edge perspectives on prematurity, IGUR, thrombophilias, abdominal surgery during pregnancy, depression in pregnancy, preeclampsia, fetal monitoring, and several other topics. We generally covered the evidence base, the recommendations from ACOG, SMFM, or other bodies, and finally practical approaches (often flow sheet based) to best practices. This was a huge amount of information!

That evening was the Welcome Party, on the grounds of the Hilton by the bay. It was a beautiful setting and another opportunity to meet new and old friends. Again, we couldn’t stay out too late, as we had another 6:30 breakfast seminar. This one was a powerful presentation on domestic violence by Dr. Montgomery.

Although it felt like I had already learned a massive amount, it was only Monday and time for the Opening Ceremonies! I got there early enough to enjoy the music by the Naval Band prior to hearing an incredible trio of lectures on preeclampsia. The first lecture, by Dr. James Roberts, covered the history and future of scientific research on the disease. I am far from a basic scientist, and this lecture managed to be completely understandable and approachable even while discussing things like the coagulation cascade and angiogenic factors. It presented a huge amount of information in a very manageable way, and has actually changed the way I explain the disease to patients!

Next, Dr. John Barton reviewed the findings of the Hypertension in Pregnancy Task Force.  This was a very important talk, covering definitions (some of which are newly clarified by the task force), research findings, and recommendations for practice. I couldn’t write fast enough to get everything down--although I tried because I didn’t want to have to wait for publication! I am looking forward to the summary of recommendations, and also particularly to the downloadable information that will be available for patients.

Finally, Ms. Eleni Tsigas gave a very moving presentation about the personal effects of preeclampsia, reminding us about how different it is to face a diagnosis like this as a patient, and how important communication is.

As if this weren’t enough for one day, I next rushed to my clinical seminar, Managing Prolapse in the Frail and Elderly.  This presentation by Dr. Gary Sutkin was one long string of clinical pearls. He first covered pessaries, discussing fitting, choice of pessary type, management of atrophy while using a pessary, long term complications, and what stock to acquire if you want to start using pessaries in your office. Next he talked about colpocleisis: Le Fort (or partial) vs. total, use of levator myorrhaphy, choosing hysterectomy or not, clinical outcomes, and management of post-op incontinence. We then discussed what to do for someone who is high risk for surgery but has failed a pessary (you can use two pessaries at once! Or do a perineorrhaphy under local anesthesia), how to handle prolapse in the setting of vaginal cancer (it’s all about risk vs. benefit), and what to do with an incarcerated pessary in an asymptomatic patient (unfortunately, it should come out).

That afternoon we had a session on Preparing for Life after Residency, featuring talks about medicolegal aspects of practice, social networking in practice, and taking care of ourselves and colleagues when adverse outcomes happen. The lectures were followed by a round table discussion about getting started in generalist practice, and then the Medical Student, JFCAC, and Young Physician reception, where I met some very impressive medical students and discussed the residency application process with them.

On Tuesday, after a Junior Fellow breakfast meeting, was the Stump the Professors session, certainly one of the funniest events of the conference. I have to admit, the Junior Fellows stumped me too! After spending some time in the exhibit halls I attended “Lunch with the Experts” during which Dr. William Patton presented a remarkably elegant approach to dysfunctional uterine bleeding. I’m keeping his slides in a safe place for future reference.  The afternoon was spent checking out new surgical tools and other gadgets in the exhibit hall, followed by the Special Session on Maternal and Child Mortality.  This was another chance to see different perspectives on the issues we deal with every day, and very moving.

The President’s Party at the Air and Space Museum took place Tuesday evening. I met several interesting Fellows, who were kind enough to give me advice on topics ranging from managing dyspareunia to balancing work with having a family. (I also spent some time enjoying the museum and listening to stories from the docents!)

On the final day of the conference was the Presidential Inauguration and Convocation, following which the new Fellows were inducted into ACOG. It made me look forward to attending a future ACOG clinical meeting and being inducted as a fellow myself! After having this opportunity to attend the meeting, I feel much more prepared to enter practice, and look forward to being involved with ACOG throughout my career.

 


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Ann Honebrink, MD
Webmaster
honebria@pahosp.com
 
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