PGY roles
OB:
PGY-1: run tracing at sign-out, familiarize with common OB problems, help team share workload (see low risk triage, postpartum, antepartum), do primary C/S, report to PGY3/4
PGY-2: sign out the board, assign tasks, take most responsibility in seeing triage pts and transfers, help outside rotators and medical students, do repeat C/S, report to PGY3/4
PGY-3/4: lead the team, report to attendings, approve management decisions, cosign notes, help out with difficult cases, approve transfer cases at PDC, update faxed lab work, give scripts to juniors.
GYN:
PGY-1: familiarize with common GYN problems, see some ED consults, help PM round, report to PGY3/4
PGY-2: make to-do-list, carry ED pager, take most responsibility in seeing ED consults and PM round, report to PGY3/4
PGY3/4: UROGYN senior (PGY-4) will lead GYN rounds, GYN ONC senior (PGY-4) will lead in seeing ONC patients. Receive pm round reports from juniors and report to attendings at sign out. PGY-3: help pm round/ED consults when there is only one junior on GYN service, give scripts to juniors.
PGY-1/2 Junior
D&C
Postpartum tubal ligation
Primary C/S
Treatment of Bartolin's Gland
LEEP
Cold Knife Cone
PGY-1/2 Junior
Repeat C/S
Laparoscopy (simple adnexal cases, BTL)
Diagnostic hysteroscopy
Endometrial ablation
Mini laparotomy
Cerclage
PGY-3/4 Senior
PGY-3/4 Senior
TAH
Laparoscopy (complex adnexal cases, ectopic)
Stat C/S (general anesthesia)
Operative Hysteroscopy
Essure
LAVH
TLH
TVH
Pelvic floor repair
Oncology cases
Who are my chiefs?
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Administrative Chief and Keeper of the Schedule: Dr. Shahrestani
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Medical Students & Show Me the Money! (Back up): Dr. Vohra
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The Others (Outside rotators) + Wellness : Dr. Nalamala
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Didactics + Community Outreach: Dr. Etemadi
How to give constructive criticism?
Joseph Cooper, MD
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Set the stage: Provide clear expectations. Sometimes this requires going the extra mile and providing a written document rather than verbally setting expectations at the beginning of a rotation/week on service. I have drafted my own “expectations,” that I email to all learners prior to coming on service. This step is key to providing useful feedback at the end of a rotation, because the learner can’t say “well, I didn’t know I was supposed to do XYZ.” Setting the stage also applies to the environment in which feedback is given: in a timely manner, and one that is private, protected, and confidential.
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Ask open-ended questions: You can never go wrong with this. With patients or with learners. This is a skill most of us accept as important, but often fail to use correctly. Beginning a feedback session by allowing the learner to self-reflect on his or her successes will usually allow for an easier transition to discussion of areas where the learner needs improvement. A simple introduction such as: “So, what did you think of the past week?” is non-threatening, open-ended, and allows the learner to start and (importantly) control the dialogue.
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Use the “sandwich” technique: This is only a bit different from the infamous “breaking bad news,” dialogue, but the sandwich technique is an effective way to deliver constructive feedback and promote change in the skills and behavior of the learner. To use the sandwich technique, first reinforce and give positive feedback on skills and behaviors that you directly observed. This fosters confidence in the learner, promotes positive reinforcement, and usually encourages the learner to seek feedback from others. After this step, ask the learner to identify deficiencies and areas in which he or she thinks improvement is needed. If the learner has already identified areas that need improvement (in the open-ended dialogue in step 2 above), you already taken the first step. Provide them with specific examples on how they can improve and in the behavior/skills that you directly observed that could be refined. When giving positive feedback, it is best delivered immediately, while “on the spot.” When giving constructive feedback, I’ve found it best to keep a log, and review situations at a formal feedback session near the end of the learning experience.
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Seek confirmation and end with a plan: The goal of a constructive feedback session is to be non-confrontational and to give the learner tools and skills to facilitate change. At times, these sessions may be emotionally charged, and the learner may take the feedback personally and feel “singled out.” Following steps 1-3 above will help avoid this angst. Finally, have the learner make an action plan before leaving the session. (E.g., exactly how to approach a patient and care plan.) Have the learner give you their summative assessment and then facilitate and form an action plan for moving forward.
It's all about "Make it Safe!"
" The mistake most of us make in our crucial conversations is we believe that we have to choose between telling the truth and keeping a friend. Grenny said this at the summit and it grabbed my attention. This is one of, if not the main reason, most conversations stop and things do not move forward. Fear. Fear of a relationship ending, something stopping, getting fired or hurting someone. Yet, if we don't tell the truth, we often can't be a friend."
"People rarely become defensive simply because of what you’re saying. They only become defensive when they no longer feel safe. The problem is not the content of your message, but the condition of the conversation. If you are a boss and want honest feedback and conversation, people can't fear for their jobs or that you will yell at them. "
"When we feel the need to push our ideas on others, it’s generally because we believe we’re right and everyone else is wrong. This is another way the previous one. If you find yourself pushing your ideas, you aren't having a good dialogue and instead are simply giving out orders. That may be your leadership style, but it won't accomplish a healthy team environment and in the end, your church or business will never reach its full potential."
1 Beware of your initial facial expression. When you hear negative information about yourself, it’s normal to instantly react. Override your urge to frown, roll your eyes, or ignore the person. Exhibiting any of these behaviors can be off-putting and limit the amount of helpful feedback you receive in the future.
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Maintain either a welcoming facial expression or try to keep your face blank. This is especially important to partner relationships where emotions play a large role in dynamics.[1]
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Sending a negative facial signal can put an end to any further conversation. This also sends the message that you don’t find it helpful to learn from others. An attentive and encouraging look can signal to the person giving the criticism that you are open and ready to listen
2 Maintain open body language. Your body language can also steer others from giving you constructive feedback. Be mindful of how you are carrying your body when someone is discussing your behavior or performance.
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Something as simple as slouching or crossing your arms can signal to others that you are closed off or somehow reacting negatively to what is being said. Nervous movements or gestures can also send negative signals to others.[3]
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The best stance to use when actively listening to constructive criticism is one that shows you are open to listen with arms at your side, but standing tall and confident.
3 Listen to the entire message before speaking. Really listen to what is being said without running your reply in your head while it is being delivered. Practice non-reactive listening by not arguing or fighting about what is being said. The point is to turn that suggestion inward to learn from it, not to start an argument. By taking your defensive reaction out of the equation you are giving yourself more time and energy to connect with the person speaking and apply what you hear.[4]
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The basics of active listening are also helpful to show in a non-verbal way that you are listening and also hearing what is being said. This includes making eye contact, staying open by not folding your arms and leaning into the conversation.
4 Ask clarifying questions about the problem. See if the person has any suggestions for how you can correct the problem. Be very mindful of your tone of voice to avoid sounding anything but sincere when asking for suggestions and further information. Keep the conversation going by remaining open and engaged.[5]
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An example of a clarifying question would be: “When you say I did not take the assignment seriously, what did you mean?”
5Thank the person for the feedback. Make sure your body language matches the words you say when you thank them. Approach the opportunity to change as a positive challenge and frame it as such.[6]
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Example of genuine expressions of gratitude may include: “Thank you for coming to me to talk about ways I can work better on our team, I appreciate hearing there is room for improvement.” or “I value your opinion, thank you for the suggestions
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Consider your relationship with the person. Even if you don’t like what you are hearing, the relationship with the person can help you determine whether they are saying it to hurt you or help you. Is this your close friend or an enemy? Is the feedback coming from your boss or a competing coworker?
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The source can tell you a great deal about how much weight the criticism holds. If this person is someone you are close to the input may hold more weight than just a co-worker.
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Is the feedback coming from someone who always seems to have something to say about everything? In that case the input may be ignored.
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Think about the context of the feedback. Was the feedback delivered in the heat of the moment in front of other people or was it one-on-one after the fact? Did the situation seem emotional or sincere?
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Sometimes people say things in front of other people just because they have an audience and they may not even mean what was said. If there were heightened emotions involved the feedback may be less than constructive.
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A sincere delivery adds credibility to what was said and also works to create a supportive relationship.
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Get a second opinion. Do others agree that you need to work on this area? Ask someone you trust before you go making changes based on unhelpful feedback.
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In the event that the criticism is actually constructive, chances are there will be others who have noticed the same issue. Opening up and asking for suggestions may start a conversation with the people you ask for a second opinion that leads to further growth.
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Determine whether to use or discard the information. Just because you are receptive to constructive criticism does not mean you have to apply the suggestion to your life. Carefully assess the feedback you receive and choose suggestions that are beneficial to your personal growth.
1 Seek input from others. Get advice from others about how you can improve in the specified area. A good way to grow personally and professionally is through mentorship.[8] If you can, find a person who is good in the area in which you have a shortcoming. Ask the person if he or she is willing to give you some guidance in the area or allow you to shadow them.
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For instance, you might get some feedback on your speaking style in a public speech course. You can ask a friend or an instructor something like “I have heard when I get nervous I talk so fast that I am hard to understand. Any hints to help me calm down and focus on my delivery?”
2 Brainstorm possible solutions to correct your behavior. Remember brainstorming means being open to every suggestion without judgment. Write everything down and sort through them after the brainstorming process.
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In a journal, take 15 minutes to write down every possible solution. Keep writing the entire time without worrying about how realistic any one item is.
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After the initial list, go back and see if there are trends or ways to group the suggestions together. Once you identify trends you can start to flesh out details that are reasonable.
3 Take action on making these changes. Keep the written list of the changes for accountability. Commit the necessary time to see the changes all the way through. This will build trust and show you are open to the process of using constructive criticism for positive change.
4 Follow up with the person to reassess your progress at a later date. Approach the person in a positive manner and again show your appreciation for their help. Share your brainstorming process and the changes you have made. Ask for feedback about what he or she has seen as far as the changes being made.
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Returning to those who have given you feedback in a humble, help-seeking way truly inspires cooperation and teamwork. The person will more than likely be impressed that you are really taking their recommendations to heart. If appropriate, you may even be able to offer this individual positive constructive criticism to help him or her improve in some area.
