Obstetrics and Gynecology Clinical Privileges

Obstetrics and Gynecology Clinical privileges

Name: ______

Effective from ______/______/______to ______/______/______

❏Initial privileges (initial appointment) ❏Renewal of privileges (reappointment)

All new applicants must meet the following requirements as approved by the Health Authority or Hospital, effective: ____/____/____. (Date accepted by PQASC)

Applicant: Check the “Requested” box for each privilege requested. Applicants are responsible for producing required documentation for a proper evaluation of current competence, current clinical activity, and other qualifications and for resolving any doubts related to qualifications for requested privileges. Please provide this supporting information separately.

[Department/Program Head or Leaders/ Chief]: Check the appropriate box for recommendation on the last page of this form and include your recommendation for any required evaluation.If recommended with conditions or not recommended, provide the condition or explanation on the last page of this form.

With respect to the "standards for currency", the currency for exams or procedures suggested as a threshold are developed by practitioners in the field and are believed to be fair and reasonable and are not intended as a barrier to practice or service delivery. The focus of the standard is on those who are close to or below the threshold, so the situation can be discussed with the department head, and is not on the precise number for those who are well above the threshold. Regardless of the currency number, acceptable results must be demonstrated, especially for procedures with significant risk. Please review the four principles document for more information.

Other requirements

•Note that privileges granted may only be exercised at the site(s) and/or setting(s) that have sufficient space, equipment, staffing, and other resources required to support the privilege.

•This document is focused on defining qualifications related to competency to exercise clinical privileges. The applicant must also adhere to any additional organizational, regulatory, or accreditation requirements that the organization is obligated to meet.

Note: The dictionary will be reviewed over time to ensure it is reflective of current practices, procedures and technologies.

Grandparenting: Physicians holding privileges prior to implementation of the dictionary will continue to hold those privileges as long as they meet currency and quality requirements.

Description

Obstetrics and Gynecology is that branch of medicine concerned with the study of women’s health and reproduction. The specialty encompasses medical, surgical and obstetrical and gynecologic knowledge and skills for the prevention, diagnosis and management of o broad range of conditions affecting women’s general and reproductive health.Specialists in Obstetrics and Gynecology provide clinical care and education in normal and complicated Obstetrics and Gynecology.

Qualifications for obstetrics and gynecology

Initial privileges: To be eligible to apply for privileges in obstetrics and gynecology (OB/GYN), the applicant must meet the following criteria:

Be certified as a specialist in Obstetrics and Gynecology by the Royal College of Physicians and Surgeons of Canada (RCPSC)

AND/OR[EB1]

Be recognized as a specialist in Obstetrics and Gynecology by the College of Physicians and Surgeons of British Columbia (CPSBC) by virtue of credentials earned in another country that are acceptable to both the CPSBC and the governing body of (Health Authority)

AND

Required current [EB2]experience:

Renewal of privileges: To be eligible to renew privileges in OB/GYN, the applicant must meet the following criteria:

Return to currency (for core privileges):

Return after 3 or more years: minimum 3 month preceptorship at a training center acceptable to the Royal College, with supervision of core procedures relevant to the intended scope of practice. Currency requirements should be met after 1 year of practice.[EB3]

Core privileges:

❑RequestedObstetrics

❑RequestedGynecology

Admit, evaluate, diagnose, treat, and provide consultation to patients and/ or provide medical and surgical care of the female reproductive system, genitourinary system and associated disorders. Assess, stabilize, and determine the disposition of patients with emergent conditions consistent with medical staff policy regarding emergency and consultative call services[EB4]. The core privileges in this specialty include the procedures on the attached procedures list and such other procedures that are extensions of the same techniques and skills.

Core procedures list: Obstetrics

This is not intended to be an all-encompassing procedures list. It defines the types of activities/procedures/privileges that the majority of practitioners in this specialty perform at this organization and inherent activities/procedures/privileges requiring similar skill sets and techniques.

To the applicant: If you wish to exclude any procedures, please strike through the procedures that you do not wish to request, and then initial and date.

Obstetrics[EB5]

Management of pregnancy, labour and delivery for singleton and multiple gestation
Management of malpresentation
Low or outlet operative vaginal delivery using vacuum or forceps
Repair of perineal and vaginal tears, including third and fourth degree tears and cervical lacerations
Cesarean section
Evacuation of the pregnant uterus: dilation and curettage (core)[EB6]
Manual removal of the placenta
Cesarean hysterectomy
Repair of uterine rupture
Paracervical block and pudendal block
Management of post-partum hemorrhage
Cerclage

Neonatal Care

Basic neonatal resuscitation

Core procedureslist: Gynecology

To the applicant: If you wish to exclude any procedures, please strike through the procedures that you do not wish to request, and then initial and date.

Open Gynecologic Procedures

Total abdominal hysterectomy
Salpingo-oophorectomy
Oophorectomy
Ovarian cystectomy
Management of ectopic pregnancy
Abdominal myomectomy
Omentectomy
Peritoneal biopsy

Vaginal Gynecologic Procedures

Vaginal hysterectomy
Anterior colporrhaphy
Posterior colporrhaphy and perineorrhaphy
Drainage and marsupialization of Bartholin’s gland abscess

Endoscopic Procedures

Diagnostic laparoscopy with assessment of tubal patency
Laparoscopic sterilization
Management of ectopic pregnancy
Laparoscopic lysis of adhesions
Laparoscopic ovarian cystectomy and salpingo-oophorectomy[EB7]
Diagnostic hysteroscopy
Hysteroscopic endometrial sampling and polyp removal
Ablative procedures of the endometrium
Diagnostic cystoscopy

Other Gynecologic Procedures

Dilatation and curettage
Insertion and removal of an intrauterine contraceptive device
Cystotomy repair
Culdocentesis and paracentesis

Description- Gynecologic Oncology[EB8]

Gynecologic Oncology is a subspecialty of Obstetrics and Gynecology directed to the diagnosis and management of female genital tract cancers. Gynecologic Oncology integrates multiple modes of therapy to improve the care of women presenting with genital cancer.

Qualifications for gynecologic oncology

Initial privileges: To be eligible to apply for privileges in gynecologic oncology, the applicant must meet the following criteria:

The same as for OB/GYN above, plus be certified as a sub-specialist in Gynecologic Oncology by the Royal College of Physicians and Surgeons of Canada (RCPSC)

AND/OR

Be recognized as a sub-specialist in Gynecologic Oncology by the College of Physicians and Surgeons of British Columbia (CPSBC) by virtue of credentials earned in another country that are acceptable to both the CPSBC and the governing body of (Health Authority)

AND

Required current experience:

Renewal of privileges: To be eligible to renew privileges in OB/GYN, the applicant must meet the following criteria:

Return to currency (for core privileges):

Core privileges: Gynecologic Oncology

❑ Requested Admit, evaluate, diagnose, treat, and provide consultation and surgical and therapeutic treatment to female patients with gynecologic cancer and complications resulting there from, including carcinomas of the cervix, ovary and fallopian tubes, uterus, vulva, and vagina and the performance of procedures on the bowel, urethra, and bladder. May provide care to patients in the intensive care setting in conformance with unit policies. Assess, stabilize, and determine the disposition of patients with emergent conditions consistent with medical staff policy regarding emergency and consultative call services. The core privileges in this specialty include the procedures on the attached procedures list and such other procedures that are extensions of the same techniques and skills.

Core procedures list: Gynecologic Oncology

To the applicant: If you wish to exclude any procedures, please strike through the procedures that you do not wish to request, and then initial and date.

Gynecologic oncology

• Performance of history and physical exam

• Treatment of malignant disease with chemotherapy

• Lymphadenectomies (inguinal, femoral, pelvic, para-aortic)

• Microsurgery

• Myocutaneous flaps, skin grafting

• Para-aortic and pelvic lymph node dissection

• Pelvic exenteration (anterior, posterior, total)

• Hysterectomy (vaginal, abdominal, radical, laparoscopic assisted)

• Vaginectomy (simple, radical)

• Vulvectomy (skinning, simple, partial, radical)

• Treatment of malignant disease with chemotherapy, including gestational trophoblastic disease

• Insertion of intracavity radiation application

• Salpingo-oophorectomies

• Omenectomies

• Surgery of the gastrointestinal tract and upper abdomen, including placements of feeding jejunostomy/gastrostomy, resections and reanastomosis of small bowel, bypass procedures of small bowel, mucous fistula formations of small bowel, ileostomies, repair of fistulas, resection and reanastomosis of large bowel (including low-anterior resection and reanastomosis), bypass procedures of the large bowel, mucous fistula formations of large bowel, colostomies, splenectomies, and liver biopsies

• Surgery of the urinary tract: cystectomy (partial, total), repairs of vesicovaginal fistulas (primary, secondary), cystotomy, ureteroneocystostomies with and without bladder flaps or psoas fixation, end-to-end ureteral reanastomoses, transuretero-ureterostomies, small-bowel interpositions, cutaneous ureterostomies, repairs of intraoperative injuries to the ureter, and conduits developed from the ileum and colon

• Incision and drainage of abdominal or perineal abscesses

• Reconstruction procedures, including development of neovagina (split-thickness skin grafts, pedicle grafts, and myocutaneous grafts) and development of a new pelvic floor (omental pedicle grafts and transposition of muscle grafts)

• Evaluation procedures (cystoscopies, laparoscopies, colposcopies and loop excisions, sigmoidoscopies, breast mass fine-needle aspirations, and needle biopsies)

• Management of operative and postoperative complications

Description - Maternal–Fetal Medicine[EB9]

Maternal –Fetal Medicine is a medical subspecialty concerned with the prevention, diagnosis and treatment of those conditions responsible for morbidity and mortality of the mother, fetus and early newborn.

Qualifications for maternal–fetal medicine

Initial privileges: To be eligible to apply for privileges in maternal-fetal medicine, the applicant must meet the following criteria:

AND

Required current experience:

Renewal of privileges: To be eligible to renew privileges in OB/GYN, the applicant must meet the following criteria:

Return to currency (for core privileges):

Core privileges: Maternal–fetal medicine

❑ Requested Admit, evaluate, diagnose, treat, and provide consultation to adolescent and adult female patients with medical and surgical complications of pregnancy, such as maternal cardiac, pulmonary, and metabolic complications, connective tissue disorders, and fetal malformations, conditions, or disease. May provide care to patients in the intensive care setting in conformance with unit policies. Assess, stabilize, and determine the disposition of patients with emergent conditions consistent with medical staff policy regarding emergency and consultative call services. The core privileges in this specialty include the procedures on the attached procedures list and such other procedures that are extensions of the same techniques and skills.

Core procedures list: Maternal–fetal medicine

To the applicant: If you wish to exclude any procedures, please strike through the procedures that you do not wish to request, and then initial and date.

Maternal–fetal medicine

• Performance of history and physical exam

• Amnioreduction

• Chorionic villi sampling

• Diagnostic laparoscopy

• External cephalic version of abnormal lie

• Fetal assessment: nonstress test, contraction stress test, biophysical profile, vibroacoustic stimulation test, and Doppler velocimetry (antepartum) and fetal heart rate monitoring and scalp stimulation (intrapartum)

• Genetic amniocentesis

• Intrauterine fetal therapy (thoracentesis, paracentesis, administration of medications, placement of thoracic shunt, and placement of urinary catheter)

• In-utero fetal transfusion

• Interoperative support to obstetrician as requested, including operative first assist

• Laparoscopic enterolysis

• Ultrasound examination, including first-, second, and third-trimester targeted anatomic fetal evaluation and cardiac evaluation, including color Doppler, Doppler velocimetry (fetal umbilical artery, fetal middle cerebral artery, and maternal uterine artery), cervical and placental evaluation, and 3-D and 4-D ultrasound

• Percutaneous umbilical blood sampling

• Transvaginal cervical cerclage

• Cephalocentesis

• Complicated cesarean delivery

• Cesarean hysterectomy

• Medical and surgical control of hemorrhage

• Episiotomy and vaginal laceration repair

• Induction of labor

• Manual removal of placenta

• Neonatal resuscitation

• Operative vaginal deliveries

• Sterilization procedures

• Breech delivery (spontaneous, assisted, application of forceps)

• Delivery of multiple gestations

• Version of second twin

Description - Gynecological Reproductive Endocrinology and Infertility[EB10]

Gynecological Reproductive Endocrinology and Infertility (GREI) is a subspecialty of Obstetrics and Gynecology. It is concerned with the prevention, diagnosis and treatment of those disorders of the reproductive endocrine system that interfere with reproductive health at any age, and endocrine and other conditions that interfere with the human procreative process.

Qualifications for Gynecological Reproductive Endocrinology and Infertility

Initial privileges: To be eligible to apply for privileges in gynecologic oncology, the applicant must meet the following criteria:

The same as for OB/GYN above, plus be certified as a sub-specialist in Gynecological Reproductive Endocrinology and Infertility by the Royal College of Physicians and Surgeons of Canada (RCPSC)

AND/OR

Be recognized as a sub-specialist in Gynecological Reproductive Endocrinology and Infertility by the College of Physicians and Surgeons of British Columbia (CPSBC) by virtue of credentials earned in another country that are acceptable to both the CPSBC and the governing body of (Health Authority)

AND

Required current experience:

Renewal of privileges: To be eligible to renew privileges in OB/GYN, the applicant must meet the following criteria:

Return to currency (for core privileges):

Core privileges: Gynecological Reproductive Endocrinology and Infertility

❑ Requested Admit, evaluate, diagnose, treat, and provide inpatient or outpatient consultation to adolescent and adult patients with problems of fertility. May provide care to patients in the intensive care setting in conformance with unit policies. Assess, stabilize, and determine the disposition of patients with emergent conditions consistent with medical staff policy regarding emergency and consultative call services. The core privileges in this specialty include the procedures on the attached procedures list and such other procedures that are extensions of the same techniques and skills.

Core procedures list: Gynecological Reproductive Endocrinology and Infertility

To the applicant: If you wish to exclude any procedures, please strike through the procedures that you do not wish to request, and then initial and date.

Reproductive endocrinology

• Performance of history and physical exam

• Fertility restoration, including laparoscopy and laparotomy techniques used to reverse sterilization

• Diagnostic and therapeutic techniques, including hysterosalpingography, sonohysterography, tubal canalization, and endoscopy (laparoscopy and hysteroscopy)

• Infertility surgery, including all techniques used for reconstruction of uterine anomalies, myomectomies, resection of uterine synechiae, cervical cerclage, tuboplasty, resection of pelvic adhesions, ovarian cystectomies, staging and treating endometriosis, including pre- and postoperative medical adjunctive therapy

• Surgical treatment of developmental disorders, including all techniques used for neovaginal construction (dilation and surgical methods), correction of imperforate hymen, removal of vaginal and uterine septae, and correction of müllerian abnormalities

• Surgical treatment of ambiguous genitalia, including construction of unambiguous, functional female external genitalia and vagina (e.g., vaginoplasty, clitoral reduction, exteriorization of the vagina, feminizing genitoplasty, and techniques for prophylactic gonadectomy)

Qualifications for female pelvic medicine and reconstructive surgery (urogynecology)[EB11]

Initial privileges: To be eligible to apply for privileges in female pelvic medicine and reconstructive surgery, the applicant must meet the following criteria:

AND/OR

AND

Required current experience:

Renewal of privileges: To be eligible to renew privileges in female pelvic medicine and reconstructive surgery, the applicant must meet the following criteria:

Core privileges: Female pelvic medicine and reconstructive surgery/urogynecology

❑ Requested Admit, evaluate, diagnose, treat, and provide consultation and the pre-, intra-, and postoperative care necessary to correct or treat female patients of all ages presenting with injuries and disorders of the genitourinary system. Includes diagnosis and management of genitourinary and rectovaginal fistulae, urethral diverticula, injuries to the genitourinary tract, congenital anomalies, infectious and noninfectious irritative conditions of the lower urinary tract and pelvic floor, and the management of genitourinary complications of spinal cord injuries. May provide care to patients in the intensive care setting in conformance with unit policies. Assess, stabilize, and determine the disposition of patients with emergent conditions consistent with medical staff policy regarding emergency and consultative call services. The core privileges in this specialty include the procedures on the attached procedures list and such other procedures that are extensions of the same techniques and skills.