The University of Texas Rio Grande Valley
Graduate Medical Education UTRGV School of Medicine
Border & Underserved Obstetrics & Gynecology Leadership Development (BOLD) Track
The Border & Underserved Obstetrics & Gynecology Leadership Development (BOLD) residency track at the University of Texas Rio Grande Valley (UTRGV) aims to graduate specialists in obstetrics and gynecology (OBGYN) prepared to assume leadership roles in the care of border and underserved populations and skillfully address their unique healthcare needs.
Background:
In 2017 the American College of Obstetricians and Gynecologists (ACOG) hosted the first National Summit on Women’s Health to identify challenges in OBGYN residency education and propose solutions. Stakeholders concluded that, despite numerous transformations in the specialty over the past 50 years, residency education has not significantly changed. Approximately 30% of current OBGYN residency graduates pursue fellowships or focused practice training. At the same time, skills expected of OBGYN specialists have become increasingly broad and challenging to address in the current training model. Participants advocated for a reassessment of current OBGYN residency training structure and increased flexibility of training content. Stakeholders discussed a 5-year tracked model of residency training for both subspecialists and comprehensive OBGYN specialist practice, acknowledging that minimum training standards for all OBGYN residents are not the same as the range of competencies required of specialists. Participants noted that OBGYNs serve as primary care providers for many women, and residency graduates must be able to offer basic ambulatory medical care, particularly in rural, underserved, and low-income communities.1
GME leaders are tasked with training residents to meet the Institute for Healthcare Improvement’s Triple Aim Framework of improving the patient experience, improving population health, and reducing cost, while concurrently training physicians to function as leaders of care teams.2 A number of innovative residency programs and tracks have been initiated to address these goals in the context of specific population needs, such as the UCSF/Zuckerberg San Francisco General Hospital’s Primary Care Internal Medicine Residency, the Doris and Howard Hiatt Residency in Global Health Equity & Internal Medicine at Brigham and Women’s Hospital, and the Northwestern Family Medicine Program at Erie Family Health. However, these programs have been focused in the traditional primary care specialties of family medicine, internal medicine, and pediatrics. Similar innovations in surgical residency programs have been limited to pre-fellowship and rural tracks, with OBGYN having one rural track, started in 2017 at the University of Wisconsin, Madison.
The Rio Grande Valley (RGV), a border region of South Texas encompassing a four-county area of 5,000 square miles, attained notoriety for being one of the most expensive healthcare markets in the country.3 While healthcare spending has reached more reasonable levels, persistent concerns remain, such as poor distribution of healthcare services and lack of evidence-based care in one of the poorest areas of the county. UTRGV enrolled its first class in 2015 and serves as a comprehensive academic and research institution serving the broad community. The community-based UTRGV School of Medicine enrolled its first class in 2016, with a mission of serving the unique health needs of its 1.3-2 million, often binational, population. The first residency programs, including OBGYN, began in 2015, based primarily in a large physician-owned health system, Doctors Hospital at Renaissance (DHR), which has one of the highest obstetric delivery volumes in the country (over 8,000/year). Unique features of our medical school include its multiple Area Health Education Centers and Unimovil (mobile clinic) providing women’s health and other primary care services in underserved areas.
Our traditional OBGYN residency program is dedicated to training well-rounded, socially conscious physicians who will serve as leaders within OBGYN specialist practice, its subspecialties, and their communities. Our curriculum focuses on professionalism and leadership skill development and includes resident participation in hospital committees and professional organizations, as well as a fourth-year ambulatory leadership experience that involves coordination of community outreach services, integrated behavioral health, and oversight of quality improvement initiatives. The BOLD track is an extension of these initiatives, providing intensive training in these and related areas for residents striving to lead OBGYN specialty care for border and underserved populations.
The success of our residency track will be grounded in self-determination theory. By providing longitudinal experiences linking skill development to more effectively serving the underserved border population, we will increase self-directed learning and facilitate earlier competence attainment. The track curriculum will integrate a graduate certificate addressing foundations in healthcare administration. Areas of clinical curricular focus will include: diabetes, hypertension, obesity, mental health, substance use disorders, preventive healthcare, infectious disease, complex ambulatory OBGYN, and office procedures. Areas of non-clinical focus will include: public health, quality improvement, interprofessional collaboration, leadership & management, healthcare policy, and disparities. Curricular goals will be addressed through both traditional block rotations and longitudinal experiences. We will integrate individualized education plans to further guide specific curricular content and experiences for track residents.
PGY-1 Rotation Schedule:
PGY-1 Schedule
- Ultrasound/Genetics
- Department of State Health Services (DSHS)
- OB/GYN Resident Clinic
- Family Medicine Outpatient
- Critical Care
- Obstetrics Days
- Obstetrics & Gynecology Nights
- Gynecology
- Research/Quality Improvement
- Breast/Communication Skills
Continuity Experiences: AHEC San Carlos Clinic, DSHS, Respite Center
References:
- Brown HL, Carson SA, Lawrence HC. The first National Summit on Women’s Health.Obstet Gynecol 2018;132:755-62.
- Institute for Healthcare Improvement Triple Aim: The best care for the whole population at the lowest cost.
- Gawande A. “The cost conundrum.” The New Yorker, June 2009.