Sketches
ajog.org
Measuring the impact of attending physician teaching in an obstetrics and gynecology residency program Anthony M. Vintzileos, MD
S
everal weeks ago, as the Chair of the Department of Obstetrics and Gynecology (ob/gyn), I was asked to give a farewell speech during a social gathering honoring the retirement of an ob/gyn attending physician (Dr PV). Dr PV had worked in our department and taught residents for 40 years. I accepted the challenge immediately. Dr PV had been a superb clinician and mentor for our ob/gyn residents. Then, I started thinking about the possible impact of the teaching efforts of Dr PV, wondering how many patient lives this physician must have touched by teaching residents. Violating one of my cardinal rules to not prepare for this kind of speech, I decided to find out by doing some research. During his career of 40 years, based on our Graduate Medical Education files, Dr PV actively participated in the teaching of 127 ob/gyn resident graduates, all of whom were in practice from a few days to 40 years with an average duration of practice being 20 years. The next step was to determine the average number of patients seen by a practicing ob/gyn physician. This number was reported in a 2003 American Congress of Obstetricians and Gynecologists survey as approximately 92 patient encounters per week, which includes both new and repeat encounters.1 Patient encounters include office, hospital, clinic, and emergency room visits. Given that approximately 12% of patient encounters involve new patients,2,3 I was able to determine not only the total number of patient encounters but also the number of individual lives (individual patients) that Dr PV may have touched through his resident teaching. The Table shows 2 formulas. Formula 1 can be used to estimate the total number of patient encounters reached by a teaching ob/gyn attending physician. Assuming that a practicing ob/gyn physician takes, on average, a 4-week vacation a year, the number of patient encounters per year per practicing ob/gyn physician is estimated to be 4416 (92 patient encounters per week 48 weeks); however, this number can be adjusted according to individual circumstances. From the total number of encounters, 12% represent new patients, thus From the Department of Obstetrics and Gynecology, New York University Winthrop Hospital, Mineola, NY. Received July 18, 2017; accepted July 18, 2017. The author reports no conflict of interest. Corresponding author: Anthony M. Vintzileos, MD. avintzileos@ nyuwinthrop.org 0002-9378/$36.00 ª 2017 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajog.2017.07.028
reflecting the total number of individual patients reached. Thus, formula 2 (Table) reflects the total number of individual patient lives reached. For Dr PV, the formulas showed he had reached 11,216,640 patient encounters (127/gyn resident graduates 20 practice years 4416 patient encounters) and 1,345,997 individual patient lives (11,216,640 0.12). These staggering numbers are actually underestimates as they do not include the lives touched by the resident graduates’ teaching other residents. Never once did I imagine or guess correctly such a tremendous impact. Prior to the farewell speech, I had my regularly scheduled meeting with my medical students and, as always, I explained to them the value and the far-reaching effects of teaching and research in patients’ lives. I spoke to them about the retirement of Dr PV indicating to them that he was in practice for 40 years and this was the only specific number I provided to them. Of course, the students were also aware of our current number of graduating residents per year. Then, I asked them for an estimate of the number of patient encounters and/or patient lives Dr PV had touched via his teaching. Their responses were astonishingly underestimates ranging from 1000-10,000. During my opening remarks of the farewell speech for Dr PV, I posed the same question to the audience. The audience included residents, physician colleagues Dr PV had worked very closely with during his career, and some of his family members. The responses were, yet again, grossly underestimated; estimates ranged from 1000-100,000 patient encounters. When I indicated the correct estimate was a 7-figure number, one physician guessed that the right number of encounters could have been 1 million. I explained the step-by-step formulas and how I derived the final number of 11,216,640 patient encounters and 1,345,997 individual patient lives. To put this in perspective, I reminded everyone that the number of patient encounters that Dr PV had reached surpassed the entire population of Greece. Following my speech, Dr PV and his family members could not thank me enough for, as they said, “making them realize the tremendous impact Dr PV had in so many patients’ lives.” What sealed my surprise was a text message I received from one of my senior faculty members who was in the audience that read: “That was one of the most insightful and best speeches I have heard.” As a matter of fact, this faculty member, who had my speech video-taped on his smart phone, suggested we use this video during the orientation day for our incoming residents to emphasize the impact of MONTH 2017 American Journal of Obstetrics & Gynecology
1
Sketches TABLE
Formulas measuring the impact of attending physician teaching Formula 1: NPER ¼ NG GANYP NPEY Formula 2: NPLR ¼ [NG GANYP NPEY] 0.12 GANYP, graduates’ average no. of years in practice; NG, no. of graduates; NPER, no. of patient encounters reached; NPEY, no. of patient encounters per year per practicing obstetrics and gynecology physician; NPLR, no. of patient lives reached. Vintzileos. Formula for attending physician teaching impact. Am J Obstet Gynecol 2017.
teaching clinical medicine. In my career as Chair, I had the distinct pleasure to give several farewell speeches for retiring teaching attendings but, according to my senior faculty audience, this speech was different. The reality is that the only difference was that I had given the audience a metric to gauge the impact of Dr PV’s teaching in people’s lives. I always thought that medical schools, residencies, and fellowships have not emphasized the impact of teaching and research in peoples’ lives. I hope this monograph provides a reasonable metric that serves as a reminder of the impact of
2 American Journal of Obstetrics & Gynecology MONTH 2017
ajog.org teaching our ob/gyn residents in clinical medicine. I believe the formulas I propose can also be applied to specialties other than ob/gyn, and hopefully can be used at farewell speeches of teaching attending physicians as a reminder of the tremendous impact of their teaching efforts. It is also my hope that this monograph may stimulate others to develop a formula estimating the number of human lives reached by someone’s research; it is only then that we could evaluate the impact of the academic physician’s scholarly activity in its totality. -
REFERENCES 1. American College of Obstetricians and Gynecologists. Profile of ob-gyn practice. Available at: https://www.acog.org/w/media/ Departments/Practice/ProfileofOb-gynPractice1991-2003.pdf?dmc¼1. Accessed June 23, 2017. 2. National Center for Health Statistics. Patterns of ambulatory care in obstetrics and gynecology. The National Ambulatory Medical Care Survey, United States, January 1980-December 1981. Vital Health Stat 13 1984;76:1-62. 3. Cherry DK, Hing E, Woodwell DA, Rechtsteiner EA. National Ambulatory Medical Care Survey: 2006 summary. Natl Health Stat Report 2008;3:1-39.
ajog.org
Measuring the impact of attending physician teaching in an obstetrics and gynecology residency program Anthony M. Vintzileos, MD
S
everal weeks ago, as the Chair of the Department of Obstetrics and Gynecology (ob/gyn), I was asked to give a farewell speech during a social gathering honoring the retirement of an ob/gyn attending physician (Dr PV). Dr PV had worked in our department and taught residents for 40 years. I accepted the challenge immediately. Dr PV had been a superb clinician and mentor for our ob/gyn residents. Then, I started thinking about the possible impact of the teaching efforts of Dr PV, wondering how many patient lives this physician must have touched by teaching residents. Violating one of my cardinal rules to not prepare for this kind of speech, I decided to find out by doing some research. During his career of 40 years, based on our Graduate Medical Education files, Dr PV actively participated in the teaching of 127 ob/gyn resident graduates, all of whom were in practice from a few days to 40 years with an average duration of practice being 20 years. The next step was to determine the average number of patients seen by a practicing ob/gyn physician. This number was reported in a 2003 American Congress of Obstetricians and Gynecologists survey as approximately 92 patient encounters per week, which includes both new and repeat encounters.1 Patient encounters include office, hospital, clinic, and emergency room visits. Given that approximately 12% of patient encounters involve new patients,2,3 I was able to determine not only the total number of patient encounters but also the number of individual lives (individual patients) that Dr PV may have touched through his resident teaching. The Table shows 2 formulas. Formula 1 can be used to estimate the total number of patient encounters reached by a teaching ob/gyn attending physician. Assuming that a practicing ob/gyn physician takes, on average, a 4-week vacation a year, the number of patient encounters per year per practicing ob/gyn physician is estimated to be 4416 (92 patient encounters per week 48 weeks); however, this number can be adjusted according to individual circumstances. From the total number of encounters, 12% represent new patients, thus From the Department of Obstetrics and Gynecology, New York University Winthrop Hospital, Mineola, NY. Received July 18, 2017; accepted July 18, 2017. The author reports no conflict of interest. Corresponding author: Anthony M. Vintzileos, MD. avintzileos@ nyuwinthrop.org 0002-9378/$36.00 ª 2017 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajog.2017.07.028
reflecting the total number of individual patients reached. Thus, formula 2 (Table) reflects the total number of individual patient lives reached. For Dr PV, the formulas showed he had reached 11,216,640 patient encounters (127/gyn resident graduates 20 practice years 4416 patient encounters) and 1,345,997 individual patient lives (11,216,640 0.12). These staggering numbers are actually underestimates as they do not include the lives touched by the resident graduates’ teaching other residents. Never once did I imagine or guess correctly such a tremendous impact. Prior to the farewell speech, I had my regularly scheduled meeting with my medical students and, as always, I explained to them the value and the far-reaching effects of teaching and research in patients’ lives. I spoke to them about the retirement of Dr PV indicating to them that he was in practice for 40 years and this was the only specific number I provided to them. Of course, the students were also aware of our current number of graduating residents per year. Then, I asked them for an estimate of the number of patient encounters and/or patient lives Dr PV had touched via his teaching. Their responses were astonishingly underestimates ranging from 1000-10,000. During my opening remarks of the farewell speech for Dr PV, I posed the same question to the audience. The audience included residents, physician colleagues Dr PV had worked very closely with during his career, and some of his family members. The responses were, yet again, grossly underestimated; estimates ranged from 1000-100,000 patient encounters. When I indicated the correct estimate was a 7-figure number, one physician guessed that the right number of encounters could have been 1 million. I explained the step-by-step formulas and how I derived the final number of 11,216,640 patient encounters and 1,345,997 individual patient lives. To put this in perspective, I reminded everyone that the number of patient encounters that Dr PV had reached surpassed the entire population of Greece. Following my speech, Dr PV and his family members could not thank me enough for, as they said, “making them realize the tremendous impact Dr PV had in so many patients’ lives.” What sealed my surprise was a text message I received from one of my senior faculty members who was in the audience that read: “That was one of the most insightful and best speeches I have heard.” As a matter of fact, this faculty member, who had my speech video-taped on his smart phone, suggested we use this video during the orientation day for our incoming residents to emphasize the impact of MONTH 2017 American Journal of Obstetrics & Gynecology
1
Sketches TABLE
Formulas measuring the impact of attending physician teaching Formula 1: NPER ¼ NG GANYP NPEY Formula 2: NPLR ¼ [NG GANYP NPEY] 0.12 GANYP, graduates’ average no. of years in practice; NG, no. of graduates; NPER, no. of patient encounters reached; NPEY, no. of patient encounters per year per practicing obstetrics and gynecology physician; NPLR, no. of patient lives reached. Vintzileos. Formula for attending physician teaching impact. Am J Obstet Gynecol 2017.
teaching clinical medicine. In my career as Chair, I had the distinct pleasure to give several farewell speeches for retiring teaching attendings but, according to my senior faculty audience, this speech was different. The reality is that the only difference was that I had given the audience a metric to gauge the impact of Dr PV’s teaching in people’s lives. I always thought that medical schools, residencies, and fellowships have not emphasized the impact of teaching and research in peoples’ lives. I hope this monograph provides a reasonable metric that serves as a reminder of the impact of
2 American Journal of Obstetrics & Gynecology MONTH 2017
ajog.org teaching our ob/gyn residents in clinical medicine. I believe the formulas I propose can also be applied to specialties other than ob/gyn, and hopefully can be used at farewell speeches of teaching attending physicians as a reminder of the tremendous impact of their teaching efforts. It is also my hope that this monograph may stimulate others to develop a formula estimating the number of human lives reached by someone’s research; it is only then that we could evaluate the impact of the academic physician’s scholarly activity in its totality. -
REFERENCES 1. American College of Obstetricians and Gynecologists. Profile of ob-gyn practice. Available at: https://www.acog.org/w/media/ Departments/Practice/ProfileofOb-gynPractice1991-2003.pdf?dmc¼1. Accessed June 23, 2017. 2. National Center for Health Statistics. Patterns of ambulatory care in obstetrics and gynecology. The National Ambulatory Medical Care Survey, United States, January 1980-December 1981. Vital Health Stat 13 1984;76:1-62. 3. Cherry DK, Hing E, Woodwell DA, Rechtsteiner EA. National Ambulatory Medical Care Survey: 2006 summary. Natl Health Stat Report 2008;3:1-39.
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