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    The intangibles of medical training: No benchmark established



    Photo of Yalda Afshar, MD, PhDIn this era of highly regulated medical training, most residency and fellowship programs establish rigorous educational objectives and procedural curricula for their trainees. Guided by the expectations set by ACOG and ABOG, Ob/Gyn training programs rely upon structured didactic sessions and guided reading recommendations to keep their residents in compliance with these benchmarks. Residents and fellows track their case and procedure counts in order to meet the minimum thresholds set by ACGME, and all of these criteria must be met within an 80-hour work week, with 10 hours off between each shift, and with at least one 24-hour period off per week.

    With these objectives, rules, and regulations in place, some of the most meaningful lessons learned in our medical training cannot be found in an educational syllabus. Many of the invaluable pearls that we learn in residency and fellowship cannot be measured, quantified, or evaluated by any reasonable metric. These are the nuances hidden amidst the daily interactions with patients and their families. Some are lessons we must learn on our own, by virtue of showing up to work, engaging in the lives of our patients, and going home at the end of the day with the weight of what we have experienced.

    Obstetrics is a unique field in that it involves the concomitant care of two (or more) patients, not one. Shared decision making still stems directly from discussions between the patient and the physician; however, the fetus must also be placed within the algorithm of care. Most often, the interests of the pregnant woman and her fetus converge, and optimizing the maternal condition will provide for the best interest of both parties – mother and fetus. Sometimes this mantra does not stand.


    Yalda Afshar, MD, PhD
    Dr. Afshar is a Maternal-Fetal Medicine Fellow in the Department of Obstetrics and Gynecology, University of California, Los Angeles


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