Program Information
The Center for Family Medicine at Columbia University Medical Center was founded in 1994. The program's first residency class was recruited in 1996, creating an interface with twelve different departments at New York Presbyterian Hospital. In that same year, a residency training grant for women’s health within the department was funded for $450K.
In 1998, the Center for Family Medicine established a Faculty Development Research Fellowship in conjunction with the Mailman School of Public Health at Columbia University. In 2004, the residency program's family health center completed 25,500 ambulatory patient visits and 842 inpatient adult and pediatric admissions. Our family health center saw 1,809 patients for well woman exams and managed 281 prenatal patients. Over the past year, our 18 residents have performed 42 colposcopies, 295 vaginal deliveries and 41 continuity deliveries. Unfortunately we do not compile data regarding the number of contraception counseling visits completed at our family health center, and this is one of the improvements we would like to integrate into our program during the upcoming year.
Our gynecology curriculum has evolved along with the residency program. Complementing the three-year longitudinal learning experience in ambulatory women’s health in the family health center, the second year of residency offers each resident the opportunity to deepen and broaden expertise through a one-month structured didactical/clinical rotation in ambulatory gynecology.
Over the course of the month, the residents rotate through a family planning/contraception clinic affiliated with Columbia University Medical Center. This Title X-funded clinic, that sees 30,000 patient encounters annually, focuses primarily on contraception and is staffed by family planning fellows, one of whom is a graduate of our residency program.
Also of note, this family planning clinic is affiliated with a young men's clinic, which our residents rotate through during their pediatric rotation, thereby gaining experience with counseling adolescent males about contraception and STD's.
During their gynecology rotation, residents spend two sessions per week in gynecology procedure clinic performing colposcopies and endometrial biopsies with an OB-GYN who works within our Family Health Center. Residents also cover one shift per week on gynecology consult service at the Allen Pavilion Hospital. These focused experiences afford the residents the opportunity to improve clinical acumen and learn specific skills from their respective supervisors. With regards to didactics, we offer a monthly lecture known as "Women's Health Corner" in the weekly residency conference series. Topics over the past year have included "Management of Post-Abortion Phone Triage Complaints", "Surgical Abortion” and “Medication Abortion” (please see attached lecture series summary).
All evaluation methodologies are currently maintained in electronic form via the internet-based program “Evalues”. Evaluation methodologies for individual resident competencies include a competency-based evaluation of residents by faculty and an electronic procedure log maintained by residents and verified by supervising attendings which is reviewed at each resident’s biannual evaluation meetings. Evaluation of the gynecology and contraceptive curricula includes evaluations of the rotation by residents. Please see attached reports for evaluation content and summaries of results.
Plans for improvement of our teaching methodologies over the coming year are as follows: We have recently integrated an abortion clinic into our own family health center, staffed by three family medicine attendings including a family planning fellow. This clinic will be included for the first time as a weekly session in the residents's gynecology rotation as of November, 2005.
We also plan to make two interventions at the family health center based on two studies of provider and patient practices around emergency contraception, both conducted over the past three years. The first study examined MDs' patterns of prescribing emergency contraception (EC) for patients in the clinic, and identified specific barriers that MD's perceived to prescribing EC. In particular, MD’s were uncertain about the safety and efficacy profiles of EC, about the time period within which EC could be provided and about the ethics of calling in refills of EC for patients with whom they were not familiar.
The second study was based on a survey of 100 patients in the family health center, and had three statistically significant findings: first, that English as a primary language and younger age were positive predictors of familiarity with EC; second, that knowledge of the mechanism of action of EC was a positive predictor of willingness to use EC; and third, that moral concerns in particular predicted unwillingness to use EC.
Based on these two studies, we plan to make the following interventions in the family health center over the next year to increase awareness of emergency contraception among providers and patients: First, we plan to create a premenopausal well-woman exam template, using our electronic medical record program. This template will include prompts to discuss birth control, use of folate, safer sex and emergency contraception, with a particular emphasis on emergency contraception’s mechanism of action and patients’ potential moral concerns about using it, in response to the data we collected from our survey. Along the same lines, we will add an automatic pop-up message for any visit with a female patient between the ages of 16 and 45, reminding providers to discuss birth control and emergency contraception, and add a more detailed birth control/family planning section to the adolescent patient template already in use.
Second, we plan to initiate an annual inservice for providers discussing the mechanism of action and safety protocol of emergency contraception, with the intent of increasing provider comfort with prescribing and calling in refills of emergency contraception for patients.
Lastly, we will add informational handouts about emergency contraception to the residency’s provider website for easy access and distribution to patients in the clinic.
In order to measure the success of these interventions, we plan to perform a pre- and post-intervention survey of the frequency of documented contraceptive counseling at visits with female patients between the ages of 16 and 45, adding a question about this to a quality assurance survey that we already routinely carry out.
We feel that our gynecology curriculum responds to the program requirement as outlined by providing a month of structured curriculum in gynecology that gives comprehensive exposure to and experience in contraceptive counseling in the setting of a specialized family planning clinic. In addition to this, our longitudinal ambulatory care curriculum emphasizes women’s health and contraception in a context of general well woman care. We hope to institutionalize the tradition of incorporating contraceptive counseling into routine visits by modifying our electronic medical record as we have described. We are also beginning to train residents in medical and surgical terminations.
Our model is replicable in its lecture curriculum, its evaluation process and its proposed incorporation of a standardized contraception template for use in the electronic medical record. In addition, many institutions have access to a family planning clinic that could be incorporated into the gynecology rotation.
We have used an evidence-based model for training by gathering our own data in clinic in order to respond to barriers to acceptance and use of emergency contraception by providers and patients.
We use quantitative evaluation methods that respond to the core competencies by including them into the evaluation categories of individual residents by faculty (see attached evaluation form).