The Female Pelvic Medicine and Reconstructive Surgery Milestone Project

A Joint Initiative of

The Accreditation Council for Graduate Medical Education,

The American Board of Obstetrics and Gynecology,

and

The American Board of Urology

July 2015 The Female Pelvic Medicine and Reconstructive Surgery Milestone Project

The Milestones are designed only for use in evaluation of fellows in the context of their participation in ACGME- accredited residency or fellowship programs. The Milestones provide a framework for assessment of the development of the fellow in key dimensions of the elements of physician competency in a specialty or subspecialty. They neither represent the entirety of the dimensions of the six domains of physician competency, nor are they designed to be relevant in any other context.

Female Pelvic and Reconstructive Surgery Milestones Chair: Dee Fenner, MD

Working Group Advisory Group AnnaMarie Connolly, MD Michael Coburn, MD Laura Edgar, EdD, CAE Timothy P. Brigham, MDiv, PhD Dee Fenner, MD Mary Ciotti, MD Elizabeth Ann Gormley, MD, MS Larry C. Gilstrap III, MD Fred Govier, MD Gerald H. Jordan, MD Rebecca Rogers, MD Hal C. Lawrence III, MD, FACOG John R. Potts III, MD

*Acknowledgement: Special thanks to Michael Coburn, MD, who was an active member of both the Working and Advisory Groups.

ii Milestone Reporting

This document presents milestones designed for programs to use in semi-annual review of fellow performance and reporting to the ACGME. Milestones are knowledge, skills, attitudes, and other attributes for each of the ACGME competencies organized in a developmental framework from less to more advanced. They are descriptors and targets for fellow performance as a fellow moves from entry into fellowship through graduation. In the initial years of implementation, the Review Committee will examine milestone performance data for each program’s fellows as one element in the Next Accreditation System (NAS) to determine whether fellows overall are progressing.

For each period, review and reporting will involve selecting milestone levels that best describe a fellow’s current performance and attributes. Milestones are arranged into numbered levels. Tracking from Level 1 to Level 5 is synonymous with moving from novice to expert in the subspecialty.

Selection of a level implies that the fellow substantially demonstrates the milestones in that level, as well as those in lower levels (see the diagram on page v).

Level 1: The fellow demonstrates milestones expected of an incoming fellow.

Level 2: The fellow is advancing and demonstrates additional milestones, but is not yet performing at a mid-fellowship level.

Level 3: The fellow continues to advance and demonstrate additional milestones, consistently including the majority of milestones targeted for fellowship.

Level 4: The fellow has advanced so that he or she now substantially demonstrates the milestones targeted for fellowship. This level is designed as the graduation target.

Level 5: The fellow has advanced beyond performance targets set for fellowship and is demonstrating “aspirational” goals which might describe the performance of someone who has been in practice for several years. It is expected that only a few exceptional fellows will reach this level.

iii Additional Notes

Level 4 is designed as the graduation target and does not represent a graduation requirement. Making decisions about readiness for graduation is the purview of the fellowship program director. Study of Milestone performance data will be required before the ACGME and its partners will be able to determine whether milestones in the first four levels appropriately represent the developmental framework, and whether Milestone data are of sufficient quality to be used for high-stakes decisions.

Examples are provided with some milestones. Please note that the examples are not the required element or outcome; they are provided as a way to share the intent of the element.

Some milestone descriptions include statements about performing independently. These activities must occur in conformity to the ACGME supervision guidelines, as well as institutional and program policies. For example, a fellow who performs a procedure independently must, at a minimum, be supervised through oversight.

The completion of the Female Pelvic and Reconstructive Surgery (FPMRS) Milestones does not ensure that all of the eligibility requirements for American Board of Obstetrics and Gynecology (ABOG) or American Board of Urology (ABU) certification have been met. Candidates for FPMRS certification must be familiar with the requirements published by the Boards. The final decision regarding eligibility for Board certification is made by ABOG and ABU.

Answers to Frequently Asked Questions about Milestones are available on the Milestones web page: http://www.acgme.org/acgmeweb/Portals/0/MilestonesFAQ.pdf.

The diagram below presents an example set of milestones for one sub-competency in the same format as the ACGME Report Worksheet. For each reporting period, a fellow’s performance on the milestones for each sub-competency will be indicated by selecting the level of milestones that best describes that fellow’s performance in relation to the milestones.

Selecting a response box in the middle of a Selecting a response box on the line in between levels level implies that milestones in that level and indicates that milestones in lower levels have been in lower levels have been substantially substantially demonstrated as well as some milestones demonstrated. in the higher level(s).

10/2013 THE FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY MILESTONES: ACGME REPORT WORKSHEET

General Pelvic Floor Evaluation — Patient Care

Level 1 Level 2 Level 3 Level 4 Level 5 Elicits basic medical, Elicits a comprehensive Evaluates for co-existing Elicits and interprets a Evaluates the cost utility of surgical, obstetric, and history which incorporates a environmental factors or history of a complex diagnostic testing gynecologic history directed history that diseases which may impact patient utilizing identifies all pelvic floor patient selection or response to appropriate terminology Develops novel techniques Performs a basic pelvic disorders treatment for evaluating pelvic floor examination Creates a differential disorders Integrates the use of Interprets and reports diagnosis and establishes a standardized quality of life, standardized quality of life, care plan based on quality symptom severity and symptom severity, and sexual of life, symptom severity, sexual health measures in health measures ancillary testing, physical the evaluation of pelvic floor examination, and patient disorders Performs and interprets goals diagnostic tests and imaging to Performs a focused pelvic evaluate pelvic floor disorders Demonstrates floor physical examination parsimonious use of Performs a detailed pelvic floor diagnostic testing and Understand indications for examination, including: imaging modalities for diagnostic testing and neurological status; pelvic floor evaluation of pelvic floor imaging to evaluate pelvic muscle and anal sphincter disorders floor disorders strength; pelvic floor support defects; urethral hypermobility; Utilizes appropriate structural anatomic and terminology for the congenital malformations; and description of pelvic floor signs of urinary and anal dysfunction incontinence

Comments: Not yet rotated

Copyright (c) Pending. The Accreditation Council for Graduate Medical Education, The American Board of Obstetrics and Gynecology, and The American Board of Urology. All rights reserved. The copyright owners grant third parties the right to use the Female Pelvic Medicine and Reconstructive Surgery Milestones on a non- exclusive basis for educational purposes. 1

10/2013 THE FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY MILESTONES: ACGME REPORT WORKSHEET

Urinary Incontinence and Overactive Bladder Treatment — Patient Care

Level 1 Level 2 Level 3 Level 4 Level 5 Counsels patients on use of Fits and manages anti- Recognizes and manages Integrates combined Teaches and supervises anti-incontinence devices incontinence devices anti-incontinence device therapies for complex combined therapies and behavioral and physical complications patients therapy Identifies appropriate Teaches advanced surgical functional interventions Integrates non-surgical and Initiates behavioral and techniques to residents and Assesses functional surgical options into physical treatments and junior fellows contributions to urinary Initiates anti-incontinence therapeutic plans for complex functional interventions incontinence medications patients Incorporates cost awareness Manages pharmacotherapy and risk-benefit principles Assesses patients for use of Performs anti-incontinence Integrates anti-incontinence in complex patients into all clinical scenarios medications for the procedures on and hormonal therapies treatment of urinary uncomplicated patients Manages complications and continence Performs a variety of anti- failures following anti- Performs cystoscopy to incontinence procedures on incontinence procedures Assists in first-line surgical evaluate for iatrogenic injury complex patients treatments Recognizes and manages Performs neuromodulation intra- and post-operative Performs cystoscopy on procedures complications uncomplicated patients Anticipates intra- and post- Performs placement of operative complications ureteral catheter

Demonstrates the ability to initiate complex therapeutic interventions independently

Comments: Not yet rotated

10/2013 THE FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY MILESTONES: ACGME REPORT WORKSHEET

Anal Incontinence and Defecatory Dysfunction Treatment — Patient Care

Level 1 Level 2 Level 3 Level 4 Level 5 Identifies and evaluates Counsels patients on use of Integrates non-surgical and Initiates and integrates Performs and manages stool consistency, behavioral and physical surgical options into combined therapies for repair and treatment of frequency, and type therapy for anal incontinence therapeutic plans for complex complex patients complex and/or recurrent patients obstetric sphincter injury Assesses impact of diet and Assesses impact of diet and Manages pharmacotherapy following vaginal delivery current medications on current medications and Identifies appropriate in complex patients bowel function functional contributions to functional interventions Teaches and supervises a anal incontinence Manages complications and combination of therapies Initiates anti-incontinence failures following anti- Assesses patients for use of medications incontinence procedures Teaches surgical techniques medications for the treatment of anal Performs neuromodulation Recognizes and manages Incorporates cost awareness incontinence procedures intra- and post-operative and risk-benefit principles complications into all clinical scenarios Assists in surgical treatments Anticipates intra- and post- for anal incontinence operative complications Performs sphincteroplasty on uncomplicated patients

Comments: Not yet rotated

10/2013 THE FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY MILESTONES: ACGME REPORT WORKSHEET

Pelvic Organ Prolapse Treatment — Patient Care

Level 1 Level 2 Level 3 Level 4 Level 5 Counsels patients on use of Fits and manages pessaries Recognizes and manages Integrates combined therapies Teaches and supervises pessaries, and behavioral pessary complications for complex patients combined therapies and physical therapy Identifies appropriate functional interventions Integrates non-surgical Initiates behavioral and physical Teaches advanced surgical Assesses functional and surgical options into treatments, and functional techniques contributions to pelvic Initiates hormonal therapy therapeutic plans for interventions organ prolapse for urogenital atrophy complex patients Incorporates cost awareness Manages pharmacotherapy in and risk-benefit principles Assesses patients for Performs primary prolapse Assesses complications of complex patients into all clinical scenarios treatment of urogenital procedures on hormonal therapy atrophy uncomplicated patients Performs a variety of surgical Performs a variety of approaches tailored to Assists in surgical prolapse procedures on individual patients, including treatments complex patients vaginal, open abdominal, minimally invasive approaches, Anticipates intra- and and the use of grafts post-operative complications Demonstrates the ability to perform complex therapeutic interventions independently

Recognizes and manages intra- and post-operative complications

Comments: Not yet rotated

10/2013 THE FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY MILESTONES: ACGME REPORT WORKSHEET

Urogenital Fistulas and Urethral Diverticula Treatment — Patient Care

Level 1 Level 2 Level 3 Level 4 Level 5 Elicits history relevant to Performs in-office evaluation Performs and/or interprets Manages complications Teaches surgical techniques fistulas and diverticula of integrity of lower urinary appropriate ancillary testing following fistula repair and tract to distinguish type and diverticulectomy Incorporates cost awareness Performs physical location of fistulas and risk-benefit principles examination relevant to Initiates conservative Performs fistula repair and into all clinical scenarios fistulas and diverticula management of fistulas and Evaluates patients for other diverticulectomies on diverticula etiologies of fistulas complex patients Participates in programs for advocacy or treatment of Assists in surgical treatments Evaluates timing and route of Recognizes and manages genital urinary fistulas repair intra- and post-operative complications Performs fistula repair and diverticulectomies on Recognizes the need for a uncomplicated patients multi-disciplinary approach for complex patients Anticipates intra- and post- operative complications

Comments: Not yet rotated

10/2013 THE FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY MILESTONES: ACGME REPORT WORKSHEET

Painful Bladder Syndrome Treatment — Patient Care

Level 1 Level 2 Level 3 Level 4 Level 5 Performs a targeted history Diagnoses painful bladder Prescribes medications and Treats painful bladder Develops patient-centered and physical exam for syndrome using standard behavior modification for the syndrome with multi-modal care protocols pelvic pain definitions and urinary treatment of painful bladder therapy, including physical diaries syndrome therapy and Participates in local, Evaluates impact of pain on neuromodulation regional, or national quality of life Initiates diagnostic work-up Reassesses therapy for advocacy groups for complicated painful efficacy and staged treatment Coordinates the multi- Utilizes accepted bladder syndrome approach disciplinary approach for terminology for the patients with painful bladder description of painful syndrome bladder syndrome

Comments: Not yet rotated

10/2013 THE FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY MILESTONES: ACGME REPORT WORKSHEET

Urinary Tract Infection (UTI)— Patient Care

Level 1 Level 2 Level 3 Level 4 Level 5 Evaluates impact of Initiates diagnostic work-up Prescribes prophylactic Coordinates treatment of Develops patient-centered recurrent UTIs on quality of for complicated UTIs treatment for UTI multi-drug resistant care protocols life organism infections Treats complicated UTI Treats uncomplicated UTIs

Comments: Not yet rotated

10/2013 THE FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY MILESTONES: ACGME REPORT WORKSHEET

Pelvic Floor Anatomy and Physiology — Medical Knowledge

Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates knowledge Describes the vascular and Describes the inter- Understands and Discusses current of pelvic anatomy, nerve supply to each of the relationships and function of interprets the controversies involving the including genital, urinary, pelvic organs and structures, the pelvic organs and support pathophysiology of pelvic anatomy and colorectal, and including the external genitalia, mechanisms floor disorders pathophysiology of pelvic musculoskeletal elements uterus, kidney, ureter, bladder, floor disorders and recto-sigmoid colon Describes the physiology of Demonstrates proficiency colorectal function, including in teaching residents and Designs and executes Explains the normal anatomic neurologic and anatomic junior fellows anatomy, innovative teaching and supports of the vagina, rectum, factors physiology, and assessment tools for the bladder, urethra, and uterus, pathophysiology of pelvic understanding of pelvic including the bony pelvis, pelvic Understands the floor disorders anatomy and floor nerves and musculature, neurophysiology of normal pathophysiology and connective tissue and abnormal lower urinary tract and colorectal function Describes the normal function of the lower urinary tract during storage and micturition, and the mechanisms responsible for urinary continence

Describes normal utero-vaginal physiology and function across the lifespan

Comments: Not yet rotated

10/2013 THE FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY MILESTONES: ACGME REPORT WORKSHEET

Urinary Incontinence and Overactive Bladder Treatment — Medical Knowledge

Level 1 Level 2 Level 3 Level 4 Level 5 Describes behavioral Describes how bladder Knows indications, Evaluates quality of studies Teaches and supervises treatments for urinary training and time voiding contraindications, effectiveness, establishing comparative complex anti-incontinence incontinence are used to treat urinary and compliance with behavioral effectiveness, complication procedures incontinence interventions rates, and costs of Knows the drugs and class behavioral therapy Conducts comparative of drugs used to treat Describes lower urinary Describes effectiveness, side effectiveness studies urinary incontinence tract receptors and effects (including prevalence), Evaluates quality of studies mediators (detrusor, rates of long-term continuation, establishing comparative Performs systematic review Knows the indications, bladder neck, urethra), and and compliance with effectiveness, complication of pharmacologic therapies contraindications, and safe potential sites for pharmacologic therapy rates, and costs of and effective doses pharmacologic manipulation pharmacologic therapy to treat various types of Understands risks and benefits Demonstrates knowledge urinary incontinence of complex anti-incontinence Describes the indications of anti-incontinence surgery and complications of anti- surgical procedures Understands risks and incontinence procedures benefits of common anti- Discusses alternatives, incontinence surgery advantages, disadvantages, and Evaluates quality of studies evidence for anti-incontinence establishing comparative procedures at the time of effectiveness, complication vaginal and abdominal prolapse rates, and costs of surgical surgery therapy

Comments: Not yet rotated

10/2013 THE FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY MILESTONES: ACGME REPORT WORKSHEET

Anal Incontinence and Defecatory Dysfunction Treatment — Medical Knowledge

Level 1 Level 2 Level 3 Level 4 Level 5 Describes behavioral Describes how management Knows indications and Describes how patient Teaches non-surgical treatments for anal of stool type and frequency contraindications, characteristics and history management of anal incontinence impacts therapeutic options effectiveness, and impact treatment choices incontinence and defecatory compliance with behavioral and outcomes dysfunction Knows prescription and Knows the drugs and class of interventions non-prescription drugs used to treat anal Evaluates complication rates Performs systematic review pharmaceuticals to treat incontinence, including the Describes effectiveness, side and costs of pharmacologic of pharmacologic therapies constipation and diarrhea indications, effects, rates of long-term therapy contraindications, and safe continuation, and compliance Conducts comparative Demonstrates knowledge and effective doses with pharmacologic therapy Describes the indications for, effectiveness studies of surgical procedures for intra- and post-operative anal sphincter laceration Demonstrates knowledge of Understands risks and complications of, and following vaginal delivery common anti-incontinence benefits of complex controversies surrounding surgical treatments continence surgery complex anti-incontinence procedures Understands risks and Understands the role of a benefits of common anti- multi-disciplinary approach to incontinence surgery patient care

Comments: Not yet rotated

10/2013 THE FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY MILESTONES: ACGME REPORT WORKSHEET

Pelvic Organ Prolapse Treatment — Medical Knowledge

Level 1 Level 2 Level 3 Level 4 Level 5 Describes behavioral Compares non-surgical and Understands how to fit and Describes management of Conducts comparative treatments for pelvic organ surgical treatment options manage pessaries pessary complications effectiveness studies prolapse for symptomatic anterior, apical, and posterior prolapse Knows indications and Describes the indications, Performs systematic review Discusses therapies in contraindications for, intra- and post-operative of prolapse therapies management of urogenital Knows factors which impact effectiveness of, and complications of, and atrophy successful pessary fitting for compliance with pessary use controversies surrounding prolapse, including: stage, complex prolapse Demonstrates knowledge genital hiatus, type of Describes effectiveness, side procedures of primary surgical pessary, presence of uterus, effects, rates of long-term procedures and sexual activity continuation, and compliance Evaluates quality of studies with hormone replacement establishing comparative Discusses the role of pelvic therapy effectiveness, complication floor physical therapy in rates, and costs of surgical management of prolapse Understands risks and therapy benefits of complex prolapse Understands risks and surgery benefits of common prolapse surgery Discusses evidence-based advantages and disadvantages for approaches to prolapse surgery, including vaginal vs. abdominal, minimally invasive vs. open, grafts vs. no graft

Comments: Not yet rotated

10/2013 THE FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY MILESTONES: ACGME REPORT WORKSHEET

Urogenital Fistulas and Urethral Diverticula Treatment — Medical Knowledge

Level 1 Level 2 Level 3 Level 4 Level 5 Describes risk factors for Describes tests to diagnose Describes evidence-based Describes how the timing of Understands epidemiology genitourinary fistulas and genitourinary fistulas and alternatives, risks, benefits, surgical repair and post- of fistula urethral diverticula diverticula complications, and success operative management rates for surgical influence outcomes Conducts research into Demonstrates knowledge of management mechanisms of fistula surgical procedures used to Describes the indications, development and repair treat genitourinary fistulas Understands the role of the and intra- and post- and diverticula multi-disciplinary approach to operative complications of patient care procedures

Comments: Not yet rotated

10/2013 THE FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY MILESTONES: ACGME REPORT WORKSHEET

Painful Bladder Syndrome Treatment — Medical Knowledge

Level 1 Level 2 Level 3 Level 4 Level 5 Describes differential Understands signs, Describes evidence-based Understands the role of the Conducts research in painful diagnosis for pelvic pain symptoms, and diagnostic alternatives, risks, benefits, multi-disciplinary approach bladder syndrome evaluation of painful bladder complications, and success to patient care for complex syndrome rates for pharmacologic and urinary tract infection and Leads a multi-disciplinary non-pharmacologic painful bladder syndrome approach to patient care for management painful bladder syndrome

Understands role of behavioral therapy, physical therapy, pharmacologic therapy, and neuromodulation in the management of painful bladder syndrome

Comments: Not yet rotated

10/2013 THE FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY MILESTONES: ACGME REPORT WORKSHEET

Urinary Tract Infection — Medical Knowledge

Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates knowledge Describes the indications for Describes alternatives, risks, Describes prophylactic Conducts research in the of the pathophysiology and cystourethroscopy and upper benefits, complications, treatment of UTIs area of UTI role of host factors for tract imaging for both UTIs success rates, and levels of lower and upper UTIs and painful bladder evidence for pharmacologic Demonstrates knowledge of syndrome and non-pharmacologic the treatment and Describes diagnostic management management of infection methods and diagnostic Describes treatment options with multi-drug resistant criteria for the various for an uncomplicated UTI Describes treatment options organisms types of UTIs for complicated UTIs Understands the role of the Describes techniques, multi-disciplinary approach accuracy, sensitivity, to patient care for complex specificity, and UTI and painful bladder interpretation of diagnostic syndrome urine tests for primary and recurrent UTIs

Comments: Not yet rotated

10/2013 THE FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY MILESTONES: ACGME REPORT WORKSHEET

Neuro-Urology — Medical Knowledge

Level 1 Level 2 Level 3 Level 4 Level 5 Describes the Demonstrates knowledge of Describes evaluation of Describes the management Performs research in neuro- pathophysiology of a complete neuro-urologic bladder storage and voiding plan to protect the upper urology neurologic conditions history elucidating relevant function using urodynamic urinary tract from which affect the bladder neurologic conditions and testing and standard neurogenic bladder and lower urinary tract gross motor and sensory terminology dysfunction deficits Describes the Understands the risks of Understands the pathophysiology of the Understands assessment of: bladder dysfunction to upper pathophysiology and risks associated with lower limb reflexes and urinary tract function management of autonomic neurogenic lower urinary sensory and motor function; dysreflexia tract dysfunction perineal sensation and Describes options for bladder reflexes; and pelvic floor and emptying Describes the use of surgical anal sphincter muscle management of the strength Describes the use of neurogenic bladder pharmacological management of the Understands the need for a neurogenic bladder multi-disciplinary approach for the patient with neurogenic bladder

Comments: Not yet rotated

10/2013 THE FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY MILESTONES: ACGME REPORT WORKSHEET

Computer Systems — Systems-based Practice

Level 1 Level 2 Level 3 Level 4 Level 5 Retrieves basic patient Retrieves complex patient Generates orders, Uses EMR to its full Recommends changes to information from the information from the EMR communicates with referring potential, and facilitates computer systems/records electronic medical record physicians, documents integration of computer- to provide additional useful (EMR) communication with patients based communication with functionality team

Comments: Not yet achieved Level 1

Health Care Economics — Systems-based Practice

Level 1 Level 2 Level 3 Level 4 Level 5 Has a basic understanding Has a basic understanding of Has a basic practical Has an advanced practical Has a basic understanding of of the advantages and the economics of inpatient understanding of the pre- understanding of the pre- current state and national disadvantages of different vs. outpatient care and the certification process, benefits certification process, health care policies and their payment systems impact of quality managers, structured benefits managers, implications improvement incentives computer-based order entry structured computer-based systems, and order entry systems, and Develops understanding of Medicare/Medicaid Medicare/Medicaid cost utility procedure and report procedure and report requirements requirements

Comments: Not yet achieved Level 1

10/2013 THE FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY MILESTONES: ACGME REPORT WORKSHEET

Works and coordinates patient care effectively in various health care delivery settings and systems — Systems-based Practice

Level 1 Level 2 Level 3 Level 4 Level 5 Knows unique roles of and Manages and coordinates Discusses non-pharmacologic Is adept at systems thinking Creates a process for services provided by local care and care transitions and non-procedural patient screening patients at risk health care delivery across multiple delivery resources (such as physical Capably leads the health (e.g., long-term care) systems, and how to access systems, including therapy, social work, care team, understanding these resources for patient ambulatory, sub-acute, alternative medicine personal role as leader Incorporates cost awareness care acute, rehabilitation, and providers, chaplains, etc.) and risk-benefit principles skilled nursing with patients and families Contributes meaningfully to into all clinical scenarios Knows and appreciates the inter-professional teams roles of a variety of health Advocates for quality patient Demonstrates how to lead a care providers, including care and optimal patient care health care team by utilizing consultants, therapists, systems the skills and coordinating nurses, home care workers, the activities of inter- pharmacists, and social professional team members workers (physician extenders/mid- levels, nurses, medical Advocates for quality students, allied health patient care workers, etc.)

Negotiates patient-centered care among multiple care providers

Comments: Not yet achieved Level 1

10/2013 THE FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY MILESTONES: ACGME REPORT WORKSHEET

Scholarly Activity — Practice-based Learning and Improvement

Level 1 Level 2 Level 3 Level 4 Level 5 Critically reviews and Identifies research mentor(s) Demonstrates expertise in Writes publishable scientific Obtains extramural funding interprets publications with statistical analyses and thesis, including: for research study the ability to identify study Designs a hypothesis-driven epidemiology . Abstract aims, hypotheses, design, or hypothesis-generating . Introduction Publishes thesis in peer- and biases study, including: Conducts research ensuring . Methods reviewed journal . Defining the knowledge data quality and safety . Results Explains validity, bias, gap in the literature . Discussion confounding, and effect . Developing specific aims Complies with local, regional, . Summary modification; describes . Defining exposures and and national research . References commonly used study outcomes using oversight regulations designs (e.g., RCT, cohort, standardized measures Presents study findings to case-control, cross- . Determining the sample Analyzes data peers for review and critique sectional); distinguishes size between association and . Determining appropriate Explores local, regional, and causation; and knows statistical analysis national funding mechanisms criteria for causal inference . Identifying strengths and limitations of study design Maintains data safety and Demonstrates knowledge patient monitoring to ensure of basic principles Applies the principles of continued protection of underlying the ethical ethics and good clinical human subjects conduct of research and practice to the protection of the protection of human human subjects recruited to subjects participate in research

Comments: Not yet achieved Level 1

10/2013 THE FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY MILESTONES: ACGME REPORT WORKSHEET

Implements Quality Improvement Project — Practice-based Learning and Improvement

Level 1 Level 2 Level 3 Level 4 Level 5 Identifies problems in Begins working on a quality Continues to develop a Completes a quality Develops and leads complex health care delivery improvement project, either quality improvement project, improvement project quality improvement as an individual or team employing methods to projects and is able to lead a member measure and analyze the Displays effective teamwork root-cause analysis data skills

Comments: Not yet achieved Level 1

10/2013 THE FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY MILESTONES: ACGME REPORT WORKSHEET

Professional Ethics and Accountability — Professionalism

Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates integrity, Accountable in completion of Acknowledges errors with Serves as a role model for Demonstrates leadership in respect, honesty, and duties, records, and patient program director, faculty honesty, integrity, the department and compassion care members, and/or patients professionalism, and professional organizations compassionate patient care Honest and truthful in all Sensitive and responsive to Takes on responsibility circumstances; reliably diverse patient population related to learning, Demonstrates commitment ethical and needs, regardless of coordination of care, patient to self-improvement gender, age, race, sexual care, Continuous Quality Understands HIPAA policies orientation, religion, or Improvement (CQI), and Responds well to and appropriate use disabilities compliance issues constructive criticism concepts Demonstrates knowledge of Prioritizes patient needs Demonstrates timeliness in local, regional, and national over self-interest completion of assigned regulations for billing and rotations, reports, state coding Advocates for quality patient licensure, and duties care

Operates professionally and independently in various educational and patient care environments

Comments: Not yet achieved Level 1

10/2013 THE FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY MILESTONES: ACGME REPORT WORKSHEET

Health Care Teamwork — Interpersonal and Communication Skills

Level 1 Level 2 Level 3 Level 4 Level 5 Communicates clearly and Communicates results of Discusses and advises Discusses and advises Independently acts as a effectively, and works well routinely performed referring health care referring health care consultant during with all members of the procedures in a clear and providers about the providers about the interdisciplinary conferences health care team concise fashion, verbally, in appropriateness of appropriateness of written procedure reports, procedures in routine clinical procedures in complex, and in electronic records situations uncommon situations

Communicates results of complex, less common procedures in a clear and concise fashion, verbally, in written procedure reports, and electronically

Comments: Not yet achieved Level 1

10/2013 THE FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY MILESTONES: ACGME REPORT WORKSHEET

Effective Communication — Interpersonal and Communication Skills

Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates adequate Exhibits basic communication Delivers bad news to the Role models effective Demonstrates highly skills of listening without skills in non-stressful family about complications communication to residents proficient counseling interrupting, ensuring that situations and in some and death, and is capable of and junior fellows behaviors that are his or her message is stressful, challenging informing the family of a personalized and understood, and allowing situations medical error that caused Capable of effective participatory, allowing opportunity for questions harm communication in the most predictive recommendations Able to deliver bad news to challenging and emotionally with high resolution of the Exhibits basic the patient or family related Provides patient-centered charged situations, and anticipated benefits and communication skills to condition severity counseling in cases of acute effectively invites possible risks and during medical interviews, and probable terminal illness participation from all complications counseling and education, Demonstrates patient- stakeholders and hospitalization updates centered skills while where the patient counseling and obtaining condition is non-acute or informed consent across a life-threatening diverse set of situations involving serious illness Consistently checks for patient understanding and Condition-specific invites questions information related to risks, benefits, and treatment Demonstrates sensitivity to options is mostly complete patients’ cultures and accurate

Comments: Not yet achieved Level 1