Obstetrics, Gynecology & Reproductive Sciences€¦ · Obstetrics, Gynecology & Reproductive...

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2015 Annual Departmental Report

Obstetrics, Gynecology & Reproductive Sciences

Obstetrics, Gynecology & Reproductive Sciences Annual Report 2015

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Table of Contents Academic ................................................................................................................................................... 1

Postgraduate Education Saskatoon ............................................................................................. 3

Postgraduate Education Regina .................................................................................................... 5

Undergraduate Education Saskatoon ..................................................................................... 7

Undergraduate Education Regina ............................................................................................ 8

Teaching Coordinator Prince Albert ...................................................................................... 10

Resident Research Committee ................................................................................................... 11

Clinical Head Gynecology Saskatoon Health Region .......................................................... 13

Clinical Head Obstetrics Saskatoon Health Region ............................................................. 15

Clinical Head Obstetrics & Gynecology Regina Qu'Appelle Health Region .............. 17

Quality Assurance & Safety .......................................................................................................... 21

Publications ......................................................................................................................................... 24

Teaching Awards ............................................................................................................................... 27

Academic Promotions ..................................................................................................................... 28

Faculty ..................................................................................................................................................... 29

Community Based Faculty ............................................................................................................ 30


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Academic

John Thiel

It has been another exciting year in the Department of Obstetrics, Gynecology and Reproductive Sciences with major announcements coming from the University, the College and from our department. As the year comes to an end, we are preparing to close the book on the two year interim leadership and begin the five year cycle of building excellence in clinical work, teaching and research. The academic leadership in our department faced a challenging year with the introduction of a new curriculum in the pre-clerkship years, the ongoing implementation of improvements to meet the undergraduate curriculum accreditation requirements and the accreditation of our postgraduate program in the fall. In each case, the organization, innovation and enthusiasm of the academic coordinators brought about the necessary changes. The teaching faculty responded to the call for more teaching hours, a change in how we teach and more supervision of junior students. The result was full accreditation of the medical school and a relatively seamless transition to the new curriculum. The Royal College Accreditation of the postgraduate program took place in the late fall. There was excellent participation of the clinical faculty at all sites, demonstrating that in a program without large numbers of university based faculty, there is still a commitment to teaching. The accreditation report will serve as the impetus for making some needed changes in the program, and we are confident that when the Royal College returns for a visit in two years all of the identified issues will be resolved. Another significant change in the department started this year with the move towards the one faculty model and the introduction of a plan to offer all University of Saskatchewan based faculty a chance to resign and move to either private practice or into an Academic Clinical Funding Plan. Drs. Pierson and Baerwald will continue in our department as university faculty, but by next year the remainder of our current university department will be working in a new relationship with the College of Medicine.


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The first annual Keith Crocker Memorial Lecture was presented by Dr. Medge Owen of Wake Forest University. This lecture was made possible by an endowment from Dr. Crocker’s sons in honour of the work that Dr. Crocker did as a member of the department. Among the other firsts for our department this year, we sponsored the first Patient Conference on Endometriosis and Chronic Pelvic Pain. It was attended by over 100 people and was very well received. The growing sense of a provincial department was seen in the addition of Saskatoon as a site for the Treatment Results of Uterine Sparing Technologies (TRUST) study. The surgeons involved in the study became the third group in Canada to offer this technology to their patients. It was with great pride that I was able to announce that the University of Saskatchewan named Dr. Roger Pierson a Distinguished Professor in honor of his ground breaking and widely cited work in reproductive medicine and ultrasound. Dr. Pierson is continuing his research program, although in the coming year he will be working in several venues around the world. As we move into the New Year, we do so knowing that three long serving members of the teaching faculty, Dr. Natalia Podilsky, Dr. Mo Abed and Dr. Betsy Brydon, are taking a well-deserved retirement from life as clinicians and educators. Dr. Charlie Simpson is also moving on from his role as the Clinical Clerkship and Off Service Residency Coordinator. We will later inform them that teachers never retire, and they can expect their phones to continue to ring with requests to teach. We are fortunate to see our faculty continue to grow. Dr. Adewumi Adanlawo joined us from Ottawa with his fellowship in Maternal Fetal Medicine, and is working and teaching in Regina. Dr. Brian Tsai joined the Regina faculty as a locum, while Dr. Jennifer Hilton completes her Reproductive Medicine fellowship in Vancouver. In Saskatoon, Dr. Lara Wesson completed her fellowship and has joined the division of Maternal Fetal Medicine. Dr. Sheena Changela has also joined the department in Saskatoon as a generalist Obstetrician and Gynecologist. As we look at 2016 stretched out before us, there are going to be some significant challenges in the delivery of clinical care, and our education programs. These challenges can only serve to direct us to new and innovative ways to deliver care, and to teach the next generation of physicians.


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Postgraduate Education Saskatoon

Matt Schubert

In 2015 Dr. Rattray and I completed our first year of partnership in guiding the program. By most accounts this has worked well, and the groundwork for assessing and improving our program has been laid. We certainly have had lots of interesting moments and have enjoyed our time working with the Residents. We started with a very busy CaRMs season where we looked at many candidates, and matched our four spots in the first round. Ultimately, we welcomed Drs. Batchelor, Forke, Hsaio and Sander, and at this time they are unraveling the mysteries of first year residency. CaRMs was followed by the rebirth of Resident Research Day which was successfully hosted by our Regina site. The Coach charter was much appreciated by all, especially veterans of the first Sim Lab experience. Multiple presentations and posters were made; the best of the best was Dr. Jenkins, who went on to again present her study on endometrial growth dynamics as influenced by ovulation induction protocols, in Toronto at APOG. May and June brought us the infamous Block 10 Call Schedule, which heavily influenced the way we arranged rotations in the following academic year, a clear improvement. We also had a large contingent in Quebec City for SOGC. The meeting, networking and socializing were well received. We were a little disappointed at the decline in medical student representation nationally, however Saskatchewan did well. Drs. Changela, Usmani and Perry made us 3 for 3 in the Royal College Certification process. September brought the return to Academia and the introduction of the Off Site Retreat held at Elk Ridge. The emphasis was on team building and there were many memorable moments. The theme of the next retreat will need to address the accreditation findings. In October, I attended ICRE for the in depth CBME introductory course. Make no mistake, it is coming and it makes sense in many ways. In general, I would be very surprised if this shortened residency for all but a few. Its launch will also probably take longer than the Royal College expects.


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Many other specialties will be making all the initial mistakes and adjustments, and we will thankfully benefit from this. December brought the Royal College accreditation visit upon us. They correctly identified our struggles with REI. After review of their initial feedback, we believe there are some inconsistent criticisms which ultimately we will challenge. Unfortunately, we have not received a timely completed report that we can act on, and we patiently await its arrival. December also saw the University of Saskatchewan program return to the national forum of program management at both the Royal College and The Association of Professors of Obstetrics and Gynecology. We are very much representative of the mainstream, the real difference here is more geography, less people; therefore one of the only truly distributed programs. In summary, despite our challenges physicians are eager to train at the University of Saskatchewan, and our emphasis has been hands on management.


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Postgraduate Education Regina

Darrien Rattray

2015 has been an exciting year in the Regina Postgraduate Obstetrics and Gynecology Residency Program. We started off by matching two excellent candidates through CaRMS for the 2015/2016 year: Drs. Marissa Topping and Lawrence Woo. Our residents continue to do well on their Royal College Exams. Drs. Sarah Hudgins and Adeloye Soyege were both successful in their endeavors and are now practicing in Angola and Moose Jaw, respectively.

We have strived to improve the quality of the “hands-on” education in our program with the development of a simulation course to add to the Academic Half Day. So far, we have had simulations on laparoscopic energy sources, DKA, shoulder dystocia, operative vaginal delivery, placental abruption, septic abortion, and ectopic pregnancies. As the nature of Obstetrics and Gynecology is one of “high acuity, low frequency” events, the use of simulation will better prepare our residents for their roles as consultants. With the assistance of the department, we have been able to purchase high resolution, state of the art, laparoscopic towers (including cameras and light sources) for both the Regina and Saskatoon campuses, thereby increasing the fidelity of the resident’s simulation experience.

In an effort to improve the objective evaluation of residents and to help prepare them for writing their Royal College exams, we have implemented two extra examinations per year (one in General Obstetrics and one in General Gynecology). These exams were constructed with questions submitted by the entire department and showcase everyone’s willingness to contribute. Along the same lines of objective evaluation, we have changed the format of OR evaluations to use a validated operative scoring tool, the O-Score, which is designed to gauge a resident’s ability to perform a specific surgery as opposed to some of the generic evaluations that we’ve used in the past.

Research remains a priority in the Residency program, and is highlighted by the quality of the projects that the Regina residents are putting efforts into. Their projects have been submitted and accepted for presentations at International conferences including the European Society for Gynecologic Endoscopy (ESGE), and the American Association of


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Gynecologic Laparoscopy (AAGL) in 2015. More completed projects and “works in progress” will be presented at the annual Department of Obstetrics and Gynecology Resident Research Day in Saskatoon on March 4, 2016.

The format of the annual resident retreat has been altered to be more in line with the rest of the University programs and other Obstetrics and Gynecology programs across the country. The residents will now have an overnight combination business and social retreat. In 2015 this was held at Elk Ridge Resort in Waskesiu, and it was a great success.

The University of Saskatchewan Postgraduate programs underwent a Royal College External Review in December of 2015. While the official report is still pending, we are looking forward to working with the department and its members to make the necessary changes for the betterment of the program over the next few years.

Once again, thank you for your commitment to residency education, and for all of your hard work over the past academic year.


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Undergraduate Education Saskatoon

Melissa Mirosh

I took over the role of Clerkship Coordinator (formerly JURSI/Phase D) in January, 2016 after Charlie Simpson retired. It was a challenging place to pick up the role as we are midstream in the changeover from the old to the new curriculum. The first group of the new 2+2 curriculum will enter their clinical segment in August 2016, at the same time as the final group of the old curriculum. We will have a double set of students on our rotation through most of the academic year in 2016-17. This will require some creative planning, and full participation from our entire O&G faculty to absorb this extra clinical time. Our SIM lab participation is in full swing, and is being used both for the pre-clerkship students and the students on clinical rotations. They are able to get some “hands-on” delivering a baby, and working through shoulder dystocia before hitting the ward. So far the reviews have been favorable. The Undergraduate Medical Education Program returned to full accreditation as of October 16, 2015, and this has been extended until March of 2018. This is excellent news and the product of a very significant amount of hard work and effort from all involved at the College of Medicine.


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Undergraduate Education Regina

Rashmi Bhargava

2015 has been a great year for the Undergraduate Program here in Regina, as we have seen significant modifications and improvements in the delivery of education to the JURSIs. The biggest change came with the advent of an “OB Academic Half-Day” - this protected three-hour session occurs every Wednesday morning, and is packed with quality teaching from dedicated preceptors in our department on mandatory topics to help prepare the JURSIs for the LMCC examination. As a bonus, the students are given time “off-call” the night before so that they can be awake and interactive for the sessions! This “half-day” has definitely made a positive impact on the overall JURSI Obstetrics and Gynecology learning experience. With the help of the College of Medicine, we have created a JURSI Supervisor Role (position is filled by Family Doc’s with OB privileges) to aid the JURSIs in managing patients in Triage in a timely fashion in case a Resident is not on duty. This has allowed the JURSIs to be more proactive in the management of labouring patients as well as to carry out procedural tasks in a safe and supervised environment. This is always a bonus when accreditation committees come around! The weekly SIM lab continues to be a hit with the JURSIs as it provides them with an opportunity to experience obstetrical, and soon gynecological, emergencies first hand as they take on simulated roles as the “Attending OB” or the “Family Doc”. This is followed by a debriefing session where the case is reviewed and take home points are highlighted. Now my goal is to bring back the end of the rotation OSCEs (aka OBSCEs!!) with every six week session. We just had a dry run with the new set of JURSIs (Class of 2017) in February and they absolutely LOVED it. I am hoping to use the OSCE as part of their final rotation mark starting August 2016, as we embark on the new “2+2 curriculum”. We have some great ideas as to how we will be dealing with the overlap of students, and I thank you as the support staff in accommodating the JURSIs into your busy offices and ORs!!


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I want to conclude by welcoming Dr. Melissa Mirosh and Dr. Joanne Sivertson, my consorts in Saskatoon and PA, as my fellow Clerkship Coordinators. It is a pleasure to work with you side by side in making this Undergraduate Program truly what the program should be - “one program, three sites!!” I look forward to another year of camaraderie and success! I would also like to thank all the part-time Obstetrics and Gynecology teaching staff in Regina as the success of the Undergraduate Program is a direct result of their hard work and commitment! I thank you!


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Teaching Coordinator Prince Albert

Joanne Sivertson

Prince Albert continues to expand in our educational role. We continue to spend one month with each of the first year OBGYN residents and we are very much enjoying our opportunity to have them back for another month in fourth year. In addition, we have 12 full time family medicine residents, four to six JURSIs, and two enhanced surgical skills residents each year, which keeps us teaching year round. We endeavor to provide each learner with individualized, level-appropriate opportunities in general community obstetrics and gynecology. Prince Albert provides multiple valuable learning opportunities. We have a disproportionately high volume of diabetics, HIV positive patients, and morbidly obese patients. With our unique population in the North, much of our teaching focuses on consideration of the social and cultural factors affecting women’s health and access to care. The residents are encouraged to facilitate patient follow up, which addresses the CanMeds roles of Health Advocate and Collaborator. There are now a couple of residents who are doing their research projects based out of Prince Albert, which is a new and exciting opportunity for us. During the next couple of years we are also hoping to establish a resident led early pregnancy loss clinic, and a more robust Women’s Health clinic. Hopefully this will allow better care for our patients, and more learning opportunities for our learners. It is always a pleasure to have residents who are interested and knowledgeable in Obstetrics and Gynecology. We appreciate the opportunity to work with and teach them.


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Resident Research Committee

Almereau Prollius

Summary of 2015:

1. Ratified new Committee Terms of Reference. 2. Developed new Journal Club evaluation form and guide for evaluation. 3. Hosted Research Coffee House. 4. Hosting Resident Research Symposium. 5. Developed Biostatistics update for PGY5 residents to help improve performance at

the Royal College exam. Specific Responsibilities include:

1. To develop and maintain a mentoring program for core trainees. 2. To maintain a list of supervisors and/or resources for research projects. 3. To advise the Program Director(s) on research requirements of core trainees and

educational activities necessary to achieve those requirements. (See Resident Research Checklist.)

4. To inform core trainees of: • requirements for research during their program • opportunities for research • opportunities for presenting research projects • available awards and grants for their research projects. (To be developed.)

5. To submit valid requests to the Resident Education Fund Committee. The fund guidelines will be determined by the Resident Education Committee with the intent to support Residents including their research endeavors. Fund guidelines will be communicated to the Resident Research Committee. Residents must submit a formal request including a rationale and budget to support their requests (#7 below).


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6. To document the ongoing and completed research carried out by the core trainees and to issue an annual report.

7. To review and evaluate project applications submitted by core trainees, and advise trainees on funding where appropriate. This includes the evaluation of research proposals for research electives with recommendations that would be provided to the Resident Program Committee.

8. To advise core trainees on issues related to research. 9. To assist the Research Committee in the planning and implementation of the annual

Research Day of the Resident Program Committee. 10. To review abstracts submitted by trainees for Research Day, and make

recommendations on suitability for oral or poster presentation. 11. To propose and award prizes for trainee presentations at Research Day, and for other

research endeavors as appropriate.


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Clinical Head Gynecology Saskatoon Health Region

Annette Epp

Main OR - Saskatoon City Hospital Our department has a strong core of generalists as well as subspecialists in Minimally Invasive Surgery and Pelvic Floor Surgery. We continue to provide high quality safe gynecologic surgical care for the women of Saskatchewan.

A new procedure for fibroid management, ACESSA, is now being offered in Saskatoon. A mentorship program under the guidance of Drs. Thiel and Rattray provided training for several physicians (Drs. Regush, Tyson, Sheridan and Davidson) to perform this innovative procedure. Dr. Laura Wiens has joined our department and offers advanced surgical skills in Minimally Invasive Gynecology after a fellowship with Drs. Thiel and Rattray in Regina. In addition to performing Total Laparascopic Hysterectomy for large fibroids (up to 20 week size) and advanced endometriosis surgery, she is also able to offer Laparascopic Myomectomy and Laparascopic Tubal Reanastomosis.

Our service, through a number of initiatives and standardization of processes, was able to decrease the late running gynecology rooms at SCH from 89 percent to 29 percent.

Dr. Harding has volunteered to be a part of the New Products Committee. She participates in the evaluation of new equipment for the Main OR and will also be involved in initiatives to streamline case carts, and cut unnecessary costs for our service. We appreciate her efforts on our behalf.

The post-operative surgical ward at SCH amalgamated in January 2016 to a single unit caring for gynecology patients, orthopedic patients, oromaxillofacial patients and some general surgery patients. The nursing staff complement exceeds 200. Despite some growing pains, gynecology patients continue to receive excellent post-operative care. Length of stay is very short for our service and our post-operative complication rates remain low.

Drs. Harding and Epp provided five education sessions for nursing staff in the fall of 2015 to specifically address the needs of the postoperative gynecology patient with an emphasis on bladder care. The sessions were very well received and appreciated by the staff.


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Gynecologic Oncology - Royal University Hospital The Gynecologic Oncology service has been operating one day per week at RUH. Starting in June of 2015, their OR days were extended to allow two major cases to be done each OR day. This initiative came out of discussions at the level of Surgical Operations because of the high demand for Gynecologic Oncology and the difficulties in meeting target wait times. Nursing staff volunteered to work later shifts, and the Department of Anesthesia offered extra help to stay late on those OR days. This will not continue after December 2015 because of budget constraints. The Gynecologic Oncology service will move two Mondays per month to RUH from SCH to accommodate complex cases that require more intensive post-operative care.

We are in the process of recruiting a new Gynecologic Oncologist to join Drs. Giede and Agrawal. Approval for this position was achieved in the fall of 2015. The need for additional human resources in this area is reflected in the high demand for initial consultations, and surgical wait times. The target start date for a new Gynecologic Oncologist is spring 2016. We appreciate the hard work that Drs. Giede and Agrawal continue to do for Saskatchewan women facing a diagnosis of cancer.

Women’s Health Center Our service continues to do many cases in the WHC and this has freed up Main OR time for other more complex cases. The surgical volume continues to increase in the WHC. In the last year, there were between 150 and 190 cases done per month. Women spend on average 3 hours, 35 minutes in hospital and complication rates are exceedingly low.

Myosure has moved out of the Main OR for select patients, and adds to the armamentarium of procedures that can be done in the WHC. As of November 2015, there were 95 Essure Hysteroscopic Tubal Ligations and 263 Novasure Endometrial Ablations done in the WHC.

Dr. Caroline Lee, a resident in our program, is conducting a comprehensive review of all procedures done in the last year in WHC. We look forward to her results.

We appreciate the excellent nursing staff under the guidance of Joan Santoro, the WHC manager.

Pelvic Floor Pathway The PFP continues to offer comprehensive conservative care for women with pelvic floor disorders. The Nurse Practitioners (Margaret Phelan and Celeste Begrand) and Physiotherapists (Juliette Seargent and Bree Rutten) continue to see between 50 and 100 new referrals per month. Patients are mainly referred by family physicians but specialists also have access to this pathway for their patients. A recent patient satisfaction survey showed 93% of patients to be extremely satisfied (5/5) with their experience at the Pelvic Floor Pathway.


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Clinical Head Obstetrics Saskatoon Health Region

Jocelyne Martel

Deliveries 5499 FAU visits 2993 Maternal services continue to grow with volumes of all types of care increasing. We are still facing the challenges of working in a very old building with lapses in water and power occurring regularly. This underlines the need for new space, and happily the construction of the new hospital providing Maternal and Child services is underway. We are able to announce with great excitement the start of in house family medicine obstetrics coverage in June. This is a long desired improvement in patient care and learner supervision. Thank you to all the doctors who participate in the rotation, and to Dr. Hey (Head of Family Medicine Obstetrics), Leanne Smith (Director of Maternal Services) and SHR for working out the details and the agreement. It has been worth the wait! Maternal birth experience at cesarean section has been improved by initiatives to allow the mother to see the baby immediately after birth through a clear drape and immediate skin to skin contact. We are working on improved patient care by using new tools to evaluate acuity by a triage tool and the risk of sepsis. Initiatives to ensure that planned cesarean deliveries are being performed at a gestation that maximizes fetal maturity (> 39 weeks) have been very successful. This process will now be transitioned to the induction of labour booking protocol. We have examined our cesarean section rate both as a department, and as individuals with an eye to evaluate what can be done to decrease our rate and provide the best care.


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Welcome to Dr. Lara Wesson who joins the division of Maternal Fetal Medicine. She brings a fresh perspective to our service and has been a godsend to Drs. Mytopher and Martel, and the Fetal Assessment Unit. Dr. Natalia Podilsky announced her retirement in December after many years of service to our patients, students and residents. Thank you Dr. Podilsky! Updated policies this year include:

• Magnesium for fetal neuroprotection • High dose oxytocin infusion • Management of premature pre-labour rupture of membranes

MOREOB MOREOB completed its third year including well attended and evaluated workshops on communication. Post-test scores and engagement broke all records! Go team! Thank you to all members of the MOREOB team for their enthusiasm. Children’s Hospital of Saskatchewan Two large cranes are on site and construction has begun. The maternal services floor will be the largest floor in the building and will include Assessment, Labour and Birth, Antepartum, ORs, Fetal Assessment Unit as well as team work, teaching and call rooms. Planning has been underway for several years and now we are moving forward on a family centered model of care as we transition to this new space. Future directions We are working on initiatives to improve patient care and experience by looking into the following projects in the next year:

• Intrapartum fetal lactate testing • Optimizing timing of medically indicated induction of labour • Change in daytime intrapartum coverage for Obstetrics • Early pregnancy assessment clinic • Antenatal homecare program

Thank you all for the excellent care you provide to each of our obstetrical patients.


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Clinical Head Obstetrics & Gynecology Regina Qu'Appelle Health Region

Corrine Jabs

Regina Clinical Report 2015 was a year of continued camaraderie and excellence in clinical care by the Department of Obstetrics and Gynecology within Regina Qu’Appelle Health Region. Our ability to influence the system we work in continues to grow as members and colleagues become involved in many areas of health care and management. Dr. John Thiel has been our acting Unified Head for academic and research, emphasizing our College of Medicine’s support for distributed medical education. Dr. George Carson has been our Senior Medical Officer in Regina Qu’Appelle Heath Region since 2014, and he continues to serve the region and sits on the Senior Leadership Team. Dr. Carson will also be our SOGC president in 2016. Sharon Garrett, our previous Executive Director of Women and Children’s Health, has been promoted to Vice President and also sits on the Senior Leadership Team with portfolios including Women & Children’s Health, Surgery and Ambulatory Care Services. We continue to be supported by Dr. David McCutcheon, Vice President of Integrated Care and Physician Services, who acted as mentor to me during participation in the Saskatchewan Leadership Program. It is important to have friends in high places who understand the issues and challenges within our realm of clinical care. Engagement surveys in 2011 and 2014 have shown some improvement in staff and physician engagement, but the mean engagement score remains very low at 35% for staff and physicians both in RQHR and the province. Our department stands out as an extreme outlier with a physician engagement score of 82% in 2014. Our ability to collaborate, standardize and work together towards mutual goals is noteworthy, and we are often used as an example of a well-functioning group of physicians with excellent collaboration with our administrative colleagues. We look forward to 2016 as we continue to work towards our goals of excellence in patient care, teaching and research for the women of southern Saskatchewan.


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Obstetrics With 4113 deliveries, 8035 outpatient visits and a cesarean delivery rate of 22.8%, we have added significantly to the population of southern Saskatchewan. Our deliveries have increased by 50% over the last decade leading to challenges in flow and ability to manage inductions. Flow in the care of our postpartum mothers and babies care have been the focus to attempt to reduce our challenges for managing our inpatient care. Our NICU colleagues, with the guidance of their Department Head, Dr. Juliet Soper, have worked on their processes to reduce the length of time we are in overcapacity. Daily huddles during NICU overcapacity days have improved communication and allowed all to share in the decision making around antenatal maternal transports. Preprinted orders continue to be our main tool to make it easy to do the right thing on a busy unit. Management of labour is facilitated by orders related to intrapartum care, postpartum care for vaginal and cesarean deliveries, GBS prophylaxis, induction, magnesium sulfate use, premature ruptured membranes, tocolytics, HIV, and care of severe hypertension. Keeping these preprinted orders current, and in alignment to SOGC guidelines and MoreOB is a continual process. While house officers have been used for years to fill gaps in our call schedule, this service has been augmented by the Family Medicine Supervisor Program to assist with supervision of medical students, and improve the quality teaching in our labour and delivery unit. We welcomed the collaboration with our family medicine colleagues with whom we share our labour and delivery unit in the development of this program. This has allowed our family medicine physicians to take a much more active role in teaching. Our midwifery program, part of the Family Medicine Department, has struggled with capacity and is rebuilding the number of providers in the program. We welcomed the addition of Dr. Adewumi Adanlawo, who comes to us following his Maternal Fetal Medicine fellowship in Ottawa. He joined our Fetal Assessment Unit in October, and has become an active member of our department becoming involved in MoreOB, Perinatal Services Committee and in teaching our residents and students. We welcome his clinical work within the Fetal Assessment Unit, outreach clinics including the Harm Reduction and Four Directions clinics, as well as with our most complicated inpatients. We are currently purchasing an additional ultrasound machine, and seeking increased funding for sonography to support his practice. MOREOB We are now into our twelfth year of MOREOB with involvement of all providers in nursing, family medicine, midwifery and obstetrics along with representation from Risk Management. The MOREOB Core Committee is a multidisciplinary committee with emphasis on education, skills drills, a culture of safety, and communication. Our co-chairs are Dr. George Carson and Leah Thorpe. Leah has taken over the co-chair from Sharon Garrett and has introduced a fresh approach to our meetings. MOREOB education topics this year included hypertension in pregnancy, gestational dating, and cultural competence. Updates were received regarding an early labour audit, family centered care, midwifery and perinatal loss. Training of our


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nursing staff through the MOREOB program was related to newborn transition, use of scalp lactate and rapid transfusion training. The simulation centre was used for skills drills related to hypertension/eclampsia and bradycardia/hyperstimulation by multidisciplinary teams with the use of Noelle as our standard simulated patient along with immediate debrief. The Regina Qu’Appelle Health Region underwent accreditation and was surveyed in 2015. As our MOREOB committee is already involved with safety and education, and was responsible for ensuring compliance with required operating procedures of an accredited facility. In May 2015, it was announced that RQHR had received full accreditation with 90% of the accreditation standards met. Gynecology We receive 7000 urgent and elective gynecology referrals per year distributed amongst our department members. We are into our fourth year of pooled referrals with 31% of urgent gynecology, and 51% of elective gynecology going to the next available gynecologist. While there remains significant variability in wait times for various gynecologists, the pooled referral process does allow significant load leveling. The mean wait time for an appointment for urgent gynecology referrals is currently 31 days and for elective gynecology referrals it is 51 days. March 31, 2015 marked the end of the Saskatchewan Surgical Initiative with its goal of no patients waiting more than three months to be offered surgery. Our service accomplished this goal with a combination of expanding capacity through use of an aesthetic time in the Women’s Health Centre for procedures appropriate for that site, monthly monitoring of surgeons waitlists, flexibility of surgeons to pick up time within the gynecology service or from other services vacated time and adjustment of OR allocated time. Our goal this year was to maintain this wait time. This has been a challenge for the entire region, and wait times are expanding in all services due to budget constraints and increasing demand for emergency and elective surgery. Despite increasing wait times, our elective gynecology wait times remain under six months and we have maintained cancer wait times under three weeks. The Saskatchewan Surgical Initiative allowed our service to provide better access to care for women in a variety of ways and looked at the entire patient journey. Examples of initiatives that directly benefitted our patients included the initiation of Pooled Referrals as well as the Pelvic Floor Pathway. The Pelvic Floor Pathway is situated in the Surgical Assessment Centre, and receives 650 referrals per year and educates 480 women per year in group sessions or by Telehealth. The Pelvic Floor Pathway staff is trialing online education utilizing a video developed by the RQHR Pelvic Floor Pathway team, and a pathway educational booklet which is available in print and online. Our gyne flex time for class 3 emergencies continues to provide excellent care for our emergency population of patients. We continued to monitor its use and make adjustments to our flex time process as time became available in the Women’s Health Centre anesthetic time as wait times came down. When we met our goal of three month surgical waits, we lobbied RQHR to use our nursing resources within the WHC to meet the provincial goal of


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reduced emergency room waits, and 2016 will be spent developing and refining an Urgent Gynecology Clinic within the WHC to serve the patients currently seen in the emergency room. An environmental scan of Early Pregnancy Clinic units across the country has taken place, and best practices will be brought to our centre to improve the care of women with early pregnancy complications and to assist patient navigation of the system regardless of the final outcome of their pregnancy. The Women’s Heath Centre continues to be a multifunctional unit providing care for women requiring procedures under local anesthetic with or without moderate sedation including colposcopies, D&C, hysteroscopic and vulvar procedures. The staff and management of the WHC should be commended for how they managed and coped with the many changes related to the use of anesthetic time and gyne flex time during the Saskatchewan Surgical Initiative. This has been a tremendous accomplishment. They now are ready, willing and able to develop new processes to provide outpatient emergency care for our gyne patients, and reduce use of the emergency room by our service providing a more private, supportive atmosphere for our patients. Our MIS program continues to thrive with a new fellow joining us each summer under the mentorship of Drs. Thiel, Rattray and Kamencic. We said farewell to Anet Maksymowicz who returned to Winnipeg, and welcomed Jaclyn Madar from London, Ontario. This team continues to ensure our department remains on the cutting edge of technology and techniques. The majority of department members use laparoscopic hysterectomy as their main mode of care, and this allows our department to manage most benign gynecology as outpatients through our day surgery unit. The Short Stay Surgical unit was developed by a Rapid Process Improvement Workshop led by Dr. Jabs, and has increased the inpatient capacity of the surgical program and reduced length of stays by streamlining care, and discharge for our short-stay patients. There have been no cancellations of surgical gynecology patients due to lack of beds in 2015. The Gynecology Services Committee was revitalized with a change from quarterly to monthly meetings, and renewal of membership. The multidisciplinary committee, co-chaired by Dr. Huse Kamencic, Section Head of Gynecology, and Jacki Shannon, Manager of the WHC, also has representation from OR scheduling, day surgery, short stay unit, and inpatient services. This productive committee can take an issue, and with a short discussion can accomplish a plan of action as all necessary stakeholders are present. Monitoring of wait times for both the OR and WHC takes place at this committee. Our gynecology inpatient beds moved from 5E to 5F, and this committee was instrumental to manage the move and problem solve as issues arose. Late pregnancy losses continue to be a struggle for the system as nursing expertise has been eroded by turnover of staff, and the move from one ward to another. Currently, inductions for second trimester losses are managed in labour and birth as the care for this population of patients is similar to those with stillbirths. A process has been discussed where a group of nurses with interest and expertise care for these patients wherever they may be within the Regina General Hospital. This would bring services to the patient, and increase continuity of care from the patient’s perspective.


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Quality Assurance & Safety

Emmanuel Yeboah

This document provides an Executive Summary of the activities of the Quality Assurance and Safety Committee of the Department of Obstetrics and Gynecology for the period of January to December 2015.

Committee Background: The background of this committee was articulated in the previous years’ report and the committee still works under the same Terms of Reference.

Summary of Activities:

The first half of the year, the committee dealt with issues regarding Rh globulin administration for Rh negative patients having therapeutic termination of pregnancy at the Women’s Health Unit. Safety issues that were brought forth to the committee were discussed, dealt with and resolved.

There were issues relating to the developed Short Labour and Delivery discharge Summary forms that were brought forth by the Health Records representation on the committee. The issues were discussed and their recommendation was brought to the attention of the members of the department. That issue has been resolved.

External audit on Narcotic Security at the Labour and Delivery was completed. The summary was shared with the Committee.

Communication issues that were felt to have an impact on safety were dealt with by the committee. Communication is deemed to be very important to patient safety. The committee seeks to promote and improve communication between the members of our unit, and also between departments. Communication issues between Obstetrics and Anesthesia were particularly articulated, and improvements seem to have been made.


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The former AEMS reporting has been replaced by the Safety Alert System. The AEMS report was used by the committee as a way of collecting safety reporting within the department. The committee plans to use the New Safety Alert system in the same way.

Anesthesia concerns regarding some logistic issues with equipment that had the potential to impact safety were discussed, and dealt with by the committee.

Other safety issues that were brought to the committee during the first half of the year involved the use of magnesium sulfate for neuro-protection. The committee felt the recommendation for use of magnesium sulfate for neuro-protection was not uniformly being applied by department members. The subject was revisited, Quality Assurance and Safety Rounds were held, and the committee feels the issue has improved. Hopefully ongoing monitoring will be done.

Mislabelling of specimens was another issue consistently reported to the committee. The nursing managers are continuing to monitor this. There seem to be fewer incidents.

The committee traditionally breaks for the summer thus there are no meetings for the months of July and August.

The second half of the year the committee dealt with many issues and remain unresolved.

Midwifery has been part of this committee, and some of the issues raised by midwifery relate to water births, home births, and previous cesarean section home births. Various aspects of these issues have been raised, and discussed at our meetings. Educational rounds have been held on these issues all in the interest of safety in delivering care. Overall, it is worthy to note that, the Quality, Assurance and Safety Committee, and the department at large is working jointly with Midwifery to ensure safe delivery of care to maternity patients.

The Family Medicine in House Coverage The Family Medicine In House Coverage at Labor and Delivery has been a big success for the Quality Assurance and Safety Committee, and the department as a whole. The implementation of this project this past year is deemed a big boost to safety in delivering care to obstetrical patients. So far no safety issues have been raised regarding the implementation of the project.

Quality Assurance and Safety Rounds The Quality Assurance and Safety Rounds that were formalized last year are going well with no major issues.

Challenges for the Committee The Quality Assurance and Safety Committee have a number of unresolved issues that continue to be challenges for the committee.

1. Morbidity and Mortality and Obstetrical and Gynecological Indicator audits.

The committee has been trying to develop a system of capturing and assembling of Morbidity and Mortality data based on selected indicators. This has gone through various hurdles and obstacles, and still continues to plague the committee. This is deemed to be


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an important component of Quality Assurance. The committee will continue to pursue this course until resolved to the standard acceptable and in line with other disciplines.

2. NICU Overcapacity

NICU overcapacity is been a chronic problem. It has a direct impact on safety and the committee has made its position known to the appropriate authorities. Some progress has been made, but the problem is far from complete resolution.

3. Increase in Cesarean Section Rate

This is a relatively recent problem identified as a safety concern. This involved Obstetrics, Anesthesia and Nursing. The safety concerns by the various departments have been brought forward, and multi-disciplinary groups are looking into ways of addressing this safety concern.

4. Infant Security System

As far as the committee is aware, there is no Infant Security System. Work is still in progress to address this concern.

5. OTAS (Obstetrical Triage Acuity Scale) This is another big safety issue that is on our agenda at this moment.


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Publications Manuscripts Shah T, Gastal M, Tazawa S, Da Silva de Tarso, S, Hales D, Cuervo-Arango J, Baerwald A, and Gastal E. 2015. The Mare as a Model for Luteinized Unrupture Follicle Syndrome in Women: Intrafollicular Endocrine Milieu. Reproduction. Dec 8: epub ahead of print. Vanden Brink H, Robertson DM, Lim H, Lee C, Chizen D, Harris G, Hale G, Burger H, and Baerwald A. 2015. Associations Between Antral Ovarian Follicle Dynamics and Hormone Production Throughout the Menstrual Cycle as Women Age. Journal of Clinical Endocrinology and Metabolism. 100(12): 4553-62. Yapura, J., I. Badea, G. Zamberlam, C. Price, R. Mapletoft, R. Pierson, J. Singh, G.P. Adams. 2015. Formulation and testing of a non-steroidal aromatase inhibitor intravaginal device for the control of ovarian function in cattle. Animal Reproduction Science 156:91-102. Christ, J.P., H. VandenBrink, E.D. Brooks, R.A.Pierson, D.R. Chizen and M.E. Lujan. 2015. Ultrasonographic Features of Polycystic Ovaries Relate to the Degree of Reproductive and Metabolic Disturbance in Polycystic Ovary Syndrome (PCOS). Fertility and Sterility 103(3):787-794. Conference Proceedings Pierson, R.A. 2015. Focus on the Endometrium: Predicting Receptivity in Assisted Reproduction. Proceedings of the StartART 2015 Reproductive Endocrinology Nurses Conference, Las Vegas, NV. pp 148-157. Abstracts Jenkins S, Baerwald A, and Chizen D. 2015. Are Endometrial Growth Dynamics Suboptimal in Women with Polycystic Ovarian Syndrome undergoing Different Ovarian Stimulation Treatment Protocols? Proceedings of the Annual Resident Research Day. Department of Obstetrics, Gynecology and Reproductive Sciences. University of Saskatchewan. Abstracts: 6. Swan J, Schubert M, and Baerwald A. 2015. Rationalization for a Standardized Protocol for Second Trimester Termination of Nonviable Pregnancies. Proceedings of the Annual Resident Research Day. Department of Obstetrics, Gynecology and Reproductive Sciences. University of Saskatchewan. Abstracts: 2.


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Pierson, R.A. 2015. Focus on the Endometrium: Predicting Receptivity in Assisted Reproduction. Proceedings of the StartART 2015, Reproductive Endocrinology Nurses Conference, Las Vegas, Abstracts: 147. McBreairty, L., G. Zello, J. Rooke, S. Serrao, R. Pierson, D. Chizen, and P. Chilibeck. 2015. Long-Term Effect of a Pulse-Based Diet and Exercise Training Intervention on Body Composition and Dietary Intake in Women with Polycystic Ovarian Syndrome Federation of American Societies for Experimental Biology Journal. 29:912.5 Rattray D, Thiel P, Suchet I, Thiel J. 2015. Post-placement imaging of Essure microinserts in unintended pregnancies using a 10 year retrospective database. Gynecological Surgery 12:S108. Kamencic H, Ferguson J, Kot E, Thiel J, Thiel L. 2015. The aetiology of surgery for pelvic pain following placement of the Essure permanent birth control system. Gynecological Surgery 12:S115. Pineda-Rivas M, Rattray D, Suchet I, Thiel J. 2015. Laparoscopic resection of a 16 week pregnancy in a rudimentary uterine horn. Gynecological Surgery 12:S243. Ferguson J, Kot E, Thiel L, Karreman E, Rattray D, Thiel J. 2015. Morphologic and histologic changes in hysterectomies after Novasure ablation: a retrospective chart review. Journal of Minimally Invasive Gynecology 22:S187. Berman JM, Thiel J, Brucker SY. 2015. Reproductive outcomes in subjects following radiofrequency volumetric thermal ablation (RFVTA) of their symptomatic myomas: a retrospective case series. Journal of Minimally Invasive Gynecology 22:S237. Pineda-Rivas M, Rattray D, Suchet I, Thiel J. 2015. Laparoscopic resection of a 16 week pregnancy in a rudimentary uterine horn. Journal of Minimally Invasive Gynecology 22:S126. Fortin, C, Thiel J, Sanders B, Rattray D, Weins L. 2015. Procedure tolerability and pain management techniques for a new device for endometrial ablation. Obstetrics and Gynecology 125:34S-35S. Epp, A. “Evaluation of Immediate Post-Operative Voiding Dysfunction in Women after AJUST Single Incision Sling for Stress Urinary Incontinence”. Poster Presentation. International Continence Society Meeting. Nice, France June 2015.


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Copyrights Pierson, R.A. and J.J. Deptuch. 2015. Imagyne_Matris. Version 2.4. Image analysis software for predicting probability of implantation in ART using endometrial mophology. Pierson, R.A. and J.J. Deptuch. 2015. eQ2, Version 2.6. Computer-assisted image analysis software for evaluating endometrial and subendometrial ultrasonographically visualized uterine contractions. Graduate Student Programs Completed Supervisor Dominique Singh, B.Sc. (Nursing). M.Sc. Thesis title: An Expanded Role for the RN as a Research Coordinator in Investigator Initiated Clinical Trials. Health Sciences Graduate Program. 4 November 2014. Advisory Committee Orleigh Bogle. B.Sc.: Ph.D. Advisory Committee. Thesis title: Nerve Growth Factor: Its Role in Male Fertility as an Ovulation Inducer. Department of Veterinary Biomedical Sciences. Supervisor, G.P. Adams. 16 December 2015. Brittany Gadzosa. M.Sc. Advisory Committee. Thesis title: Does 12 Weeks of Exercise Training Reduce the Risk of Infertility in Obese Females? A Pilot Study. College of Kinesiology. Supervisor, Carol Rogers. 14 January 2015.


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Teaching Awards

David Popkin Award for Excellence in Postgraduate Teaching (Saskatoon)

Dr. Almereau Prollius

Bob Sollars Award for Excellence in Postgraduate Teaching (Regina)

Dr. Angela Poole

Tom MacLachlan Award for Excellence in Undergraduate Teaching (Saskatoon)

Dr. Matt Schubert

Peter Woodrow Award for Excellence in Undergraduate Teaching (Regina)

Dr. Amos Akinbiyi

Academic Professionals in Obstetrics & Gynecology of Canada Carl Nimrod Award for Teaching Excellence

Dr. Huse Kamencic


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Academic Promotions

Clinical Associate Professor

Annette Epp


Corrine Jabs


Ann Ravichander


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Faculty Academic Department Head

John Thiel

Saskatoon Clinical Department Head - Obstetrics

Jocelyne Martel

Saskatoon Clinical Department Head - Gynecology

Annette Epp

Regina Clinical Department Head - Obstetrics & Gynecology

Corrine Jabs

Professors

Dr. Femi Olatunbosun Dr. Roger A. Pierson

Associate Professors

Dr. Donna R. Chizen Dr. K. Christopher Giede

Assistant Professors

Dr. Anita Agrawal Dr. Angela Baerwald Dr. Melissa Mirosh


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Community Based Faculty Clinical Professors

Amos Akinbiyi George Carson Barry Gilliland

Jocelyne Martel John Thiel

Clinical Associate Professors Rey Cardoso-Medinillia

Anne Doig Annette Epp Corrine Jabs

Ann Ravichander Mark Sheridan

Emmanuel Yeboah

Clinical Assistant Professors Adewumi Adanlawo Huse Kamencic Matt Schubert

Maryam Al-Hayki Christine Lett Debra Shephard Carlos Aspe Lucero Carmen Mircea Joanne Sivertson Rashmi Bhargava Kristine Mytopher Trina Stryker

Martha Briggs Michelle Ng Brian Tsai Sheena Changela Olanrewaju Onasanya Nerissa Tyson

Eric Clark Natasha Payton Vijayalakshmi Udayasankar Marilyn Davidson Angela Poole Laura Weins

Jennifer Duda Almereau Prollius Lara Wesson Anita Harding Darrien Rattray Nureni Yusuf Jennifer Hilton Lexy Regush

Active Retired Faculty Mohammed Abed Natalia Podilsky

Ahmed Ezzat Charles Simpson Lorne Hanson Thirza Smith

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