REVISIONS IN THE PBOG HANDBOOK OF OPERATIONS

1. REVISIONS IN THE PBOG HANDBOOK OF OPERATIONS

2. Note:Statements in green font will be deleted, while the red font is the revision/update.

3. Section 2: The Residency Training Program Levels of Health Care in Obstetrics and Gynecology 5. Performance of Minor Surgical Procedures for diagnosis and treatment: Excision/Section Biopsies (include Keyes punch biopsy of the vulva) Cervical / endometrial biopsies Curettage: diagnostic, endometrial and/or endocervical, fractional, for completion of abortion (optional MVA) except H. mole, septic abortion, and postpartum hemorrhage Incision and drainage of abscess(es) Analgesia: local infiltration, pudendal block, paracervical block, pain control Delivery: Spontaneous, Outlet forceps, or Vacuum extraction (optional) Episiotomy and repair Repair of lacerations

4. Secondary Level (LEVEL II) - Second Year Level7. Performance of simple anduncomplicated abdominal surgeryObstetrical Cesarean section: primary & repeat; classical, low cervical, transverse or verticalIdentification and isolation of uterine arteries Hysterotomy Postpartum Bilateral Tubal Ligation Gynecological Adnexal surgery: Salpingectomy. Salpingostomy, salpingo- oophorectomy, partial oophorectomy, oophorocystectomy.

5. TERTIARY LEVEL (LEVEL III & IV): Third and Fourth Year3. Performance of more complicated vaginal procedures ObstetricalPartial breech extraction, (at least 1) vaginal, multigravida (optional)or during CSGynecologic:Vaginal hysterectomy and anterior posterior repairVaginal repair of neglected fourth degree perineal tear with or without cystocoele (4th year)The following are optional procedures: ( to be done by 4th year residents)Surgical correction, urinary stress incontinenceManchester-Fothergill operation ColpocleisisFistula repair (rectovaginal, vesicovaginal)B-LynchUterine artery ligation

6. RESIDENTS' IN-SERVICE EXAMINATION Since November 6, 1983, upon the initiation of Dr. Julita Ramoso-Jalbuena, the Residents In-Service Examination was started for residents in training for objectives that have been reiterated to the present. This examination was initially a requirement for all residents of the accredited programs from the second year level and above, as a requisite for their continuing accreditation. Since 1998, all residents from first to fourth year levels are required to take the examination. Residents of non-accredited hospitals are, likewise, eligible to take the examination on a voluntary basis. Appendix C shows the number of residents who have taken the PBOG Residents In-Service Examination from 1983-2005 in different testing centers in the country.

7. HOSPITAL ACCREDITATION AND RE-ACCREDITATION1. Any hospital applying for re-accreditation of its residency training program must have a standing accreditation for service level II-A by the Committee on Hospital Accreditation for Service of the POGS/2. The hospital seeking for accreditation shall apply in writing to the Secretary of the PBOG who shall upon receipt, send the following to the former: a. Official application form b. Guidelines for evaluation c. Rules and regulations regarding application d. Payment of Fees3. The hospital shall submit the application form together with payment of fees not later than the date set by the PBOG.

8. 4. Applying hospitals must complete the following requirements with the submission of the application form (*shall be exhibited during the visit):a. h. 4-year OB-GYN statistical reports on operations, deliveries and number of cases done by each residentb. i. 4-year OPD censusc. List of consultant staff and their subspecialties(with at least 1 consultant certified by PSUOG)d. Names of residents with their corresponding year levelNOTE: Training programs without the full complement of residents per year level may accept lateral entry residents provided the 3rd and 4th year lateral entry residents must have trained in an accredited training hospital. However, the 1st and 2nd year lateral entry residents may come from a non-accredited institution.e. k. Weekly activitiesf. e. List of residents who rotated in Pathology and Ultrasound DELETEother subspecialty areas. The pathologist training the residents should be board certified.

9. HOSPITAL ACCREDITATION AND RE-ACCREDITATIONg.a. Residency Training Program based on the standard training program (as approved in June 1995) • h. b. Photo copy of Certificate of Accreditation for Training • i j. Log book of major, minor and OPD procedures ofeach residents should be ready for inspection • j g.Statistical data toCertification from Committee on Nationwide Statistics (ISIS or written of the past three years) • km. Community activities (documents or pictures) • l f. Number of service beds • l. CREED’s report on the Residents Evaluation Form for the past year/years. • Site inspection of the hospital and evaluation of its residency training program shall be accomplished by designated members of the PBOG at the time set after the receipt of the application form and corresponding fees. Notice of date of visit shall be announced 48 hours prior to inspection. • After Inspection and evaluation, the hospital shall be notified in writing by the PBOG Secretary about the decision of the PBOG. A "WARNING "REVISIT is given for six months for minor lapses in the compliance with requirements. No extension shall be given to fulfill major requirements if these have not been complied with at the time of inspection and evaluation.

10. 7. Accreditation for training shall become effective on the first day of January following the notice of approval. Full accreditation shall remain in effect for a period of four years and shall expire on December 31 of the last year of accreditation unless earlier revoked DELETE (accreditation and reaccreditation of hospitals for service are effective immediately upon approval by the POGS Board of Trustees). P30, #7 in the current handbook Effectivity of accreditation will start a month after the en banc deliberation. Approval need not necessarily start on the first day of January following the notice of approval and expire on December 31 of the last year of accreditation. • The PBOG reserves the right to re-inspect and reevaluate any time during the four years of accreditation. • After due notification, accreditation may be revoked at any time during the four years for non-compliance with the requirements. Reaccreditation may be granted after correction of deficiencies. Failure to comply with the requirements within the six months (WARNING) REVISIT period deserves SUSPENSION of accreditation for six months. For reinstatement after suspension, re-application is not required for a revisit by the committee on accreditation. After REVOCATION of accreditation of a program, re-application is required before a revisit by the committee. Residency training in a suspended or terminated program is not recognized as accredited during the time of suspension. The residents will have to extend their residency training to complete the four-year residency training program. 10. The PBOG shall notify the hospital concerned about the expiration of accreditation during the first three months of the last year of accreditation. Application form for reaccreditation shall be accomplished within the designated time set by the PBOG.

11. CONSORTIUM OF RESIDENCY TRAINING PROGRAMS In the past, accredited training programs had been allowed to link only with other accredited programs. However, some programs were allowed to form a consortium to train residents with a common curriculum sharing common resources with success. Currently, accredited programs can now link in a consortium with a non-accredited program eligible for training but which cannot by itself fulfill the requirements for accreditation for training. Recognizing how these non-accredited programs can benefit from linkages with the accredited programs, such consortium was approved. The former will provide the academic resource and environment while the latter will share the clinical materials for the training of their residents. This is intended to assist a program until it is fully established to stand on its own as an accredited training program. Necessary guidelines have been set that include such criteria as proximity or accessibility of institutions, common curriculum, common consultants, availability for supervision, common conferences, sharing of patients and responsibility, and others that should be worked out to define the relationship in a memorandum of agreement and approved by the PBOG and POGS Board of Trustees. Residents who are foreign medical graduates are excluded from participating in a consortium and cannot rotate in other centers because of PRC licensing requirements. LATERAL ENTRY OF RESIDENTS TO TRAINING PROGRAMS Training programs without the full complement of residents per year level may accept lateral entry residents provided the 3rd & 4th year lateral entry must have trained in an accredited training hospital, however, the 1st & 2nd year lateral entry may come from a non-accredited institution.

12. SECTION 4: THE CERTIFICATION PROCESS POGS MEMBERSHIP AND THE CERTIFICATION PROCESS Junior membership of the Philippine Obstetrical and Gynecological society is conferred once a year upon the candidate who passes the Diplomate Part I Examination and submits all other requirements as stipulated by the Committee on Credentials and Membership, recommended by the PBOG and approved by the POGS Board of Trustees. The applicant eligible for Junior membership must apply to the PBOG within one month after the announcement of the results of Part I examination. Junior membership for three months is a pre-requisite for the Part II (oral) examination. Junior membership is valid for 5 years and is renewable. Expiration of Junior membership prior to passing Part II examination requires re-application. Diplomate status is conferred by the POGS Board of Trustees upon the recommendation of the PBOG and the Committee on Credentials and Membership to graduates of accredited training programs who have passed the Part I & II Examinations. The title of "Fellow" is conferred by the POGS Board of Trustees after a prescribed period upon the recommendation of the Committee on Credentials and Membership and the Committee on Ethics (Art.IV Section 1, POGS Constitution and By-Laws). The PBOG recommends a candidate after passing the Diplomate Part II (Oral) Examination (and Practical Examination, if required) and fulfilling all requirements for certification.

13. SECTION 5: THE CERTIFYING EXAMINATIONS OBJECTIVES The OBJECTIVES (general and specific) of the examinations shall be applied to all examinations (written, oral, practical and other forms of evaluation.) A. GENERAL To evaluate the candidate's knowledge, skills and attitudes in solving clinical problems in Obstetrics and Gynecology B. SPECIFIC 1. To demonstrate the capability of performing independently the major gynecological operations, assisting in spontaneous as well as performing operative deliveries, and managing complications thereof. 2. To demonstrate the capability of performing independently the essential diagnostic procedures required of a consultant in Obstetrics and Gynecology 3. To demonstrate competence as Consultants in Obstetrics and Gynecology to serve other physicians in the community outside of the specialty. 4. To demonstrate skills necessary for the application of basic knowledge to management of clinical problems such as: a. obtaining needed information b. interpretation and use of data obtained c. selecting and implementing appropriate care d. following and continuing care

14. The Written Examination consists of 200 objective type questions to be answered in four and a half (4 1/2) hours consisting of 80% from general Obstetrics and Gynecology and 20% subspecialties. The types of questions are distributed as follows: 20% recall, 40% analysis and interpretation and 40% problem-solving. Grading is criterion-referenced, the passing grade set according to the minimum pass level (MPL) as determined by the PBOG. Validity, reliability and relevance of examinations are established by a test blue print based on the curriculum and item analysis. The official results of the written examination shall be posted in the official POGS Website(www.pogsinc.org)POGS Buildingand mailed to the candidatebefore the Oral and Practical Examinations.

15. SECTION 5: THE CERTIFYING EXAMINATIONS • BASIC REQUIREMENTS FOR EXAMINATION • A. The Candidate must be: • 1. a Filipino citizen • 2. a Graduate of a recognized Medical School • 3. Duly licensed to practice medicine in the Philippines • 4. a Graduate of a PBOG-accredited Residency Training Program in Obstetrics and • Gynecology of at least four years (or a 6-year modular residency training program) • P42 in the current handbook • 4 a. graduates of newly accredited hospitals must have completed training for two (2) years under the accredited program. • 5. an Associate Member desiring Diplomate status • 6. a Candidate who availed of the moratorium (1985-1998) but did not succeed • B. The Candidate must submit the following: • Duly accomplished POGS application form (in duplicate), with 2 passport size pictures and endorsement signatures of 3 POGS Fellows • Official documents (photocopy) • a. Medical Diploma • b. Professional Regulation Commission (PRC) License • c. Certificate of PBOG Accreditation for Residency Training during the candidate’s period of training • d. Certificate of Training and Rotation duly signed by Department Chair or Hospital Director or • Certificate of Associate membership (if applicable), or PBOG certification of examination results • during the Moratorium. • e. PBOG certification of in-service examination results (issued to training hospitals) during the Moratorium (if applicable) • f. One (1) Case study and one (1) scientific paper • g.Checklist of requirements duly checked and noted by Department Chairman. • 3. A compilation of 100 major cases in Obstetrics and Gynecology (combined) performed within 5 years prior to application (whether during or after residency) and reported as follows:

16. FOR CASES DONE DURING RESIDENCY: • Submit a typewritten tabulation of the 100 cases in the format specified by the PBOG, arranged according to type of procedure and using uniform and standard nomenclature. • Submit a separate typewritten tabulation (in the same format as item 3a) for the 35 cases prescribed by the PBOG as minimum requirements for residency training specifically • Total Abdominal Hysterectomy 15 • Cesarean or Postpartum Hysterectomy 1 Vaginal Hysterectomy 1 Adnexal Procedures 10 • Vaginal Evacuation of H. Mole 1 • Indicated Manual Extraction of Placenta 1 • Breech Deliveries (done during CS)1 • Outlet Forceps or vacuum 5

17. Details of these 35 cases must be typewritten in the PBOG official form for cases. Distribution of cases are as follows:Twenty four (24) cases transfer of technical responsibility and eleven (11) cases applicants own cases Each case must be accompanied by a legible photocopy of the following: front sheet of the patient’srecord,operative record/technique (typewritten) stamped “certified true copy by the medical records sectionand attested by the chair or training officer”and histopathology report (if applicable). In case original operative technique was not typed, include photocopy of original record. c. Submit an Original certification from, the department Chair of Hospital Director attesting to the authenticity of cases reported and managed by the candidate. d. In cases where technical (surgical ) responsibility has been entrusted to the candidate, original certificates from the attending physicians must accompany the report of cases. Starting 2006, only 70% of cases with complete transfer of technical responsibility is allowed. e. ERASURES WILL INVALIDATE DOCUMENTS

18. FOR CASES DONE AFTER RESIDENCY: Submit a typewritten tabulation of cases, separate from those done during residency. Reporting of cases shall follow the same specifications in items 3a-3e. 4. Photocopy of one (1) case study and one (1) scientific paper C. All requirements specified under item B must be compiled in sequence and arrangement specified by the PBOG, and properly softboundbookbound. D. Cases submitted by the applicants are considered final. E. All candidates must apply for the Certifying Examinations, pay the necessary fees and fulfill all requirements prior to the announced deadline. F. Candidates who fail to appear on the date of examination must inform the PBOG Secretary immediately to clarify requirements for the next examination. G. Application fee will be forfeited if the applicant withdraws at anytime. H. If the candidate is not allowed to take the written exam for a valid reason, the application fee may be used the next time he/she applies provided he/she takes the exam the following year. I. The submitted requirements shall be considered POGS property and will no longer be returned to the applicant.

19. P43 D in the current Handbook • Falsification of documents submitted for the examination is sufficient ground for outright rejection of the application. The candidate who has falsified documents for eligibility to take the Diplomate examinations is disqualified to take the exams for two (2) years. Proper documentation of intellectual dishonesty by reviewing patient’s hospital record is a pre-requisite for disbarment. • P44 in the current Handbook • J. The submitted requirements shall be returned to the candidates. Should the candidate fail to claim it within one (1) month after the examinations, it shall be destroyed by the POGS secretariat.

20. DIPLOMATE PART II ( ORAL) EXAMINATION OBJECTIVES To evaluate the Candidate’s capability to manage a given hypothetical patient with an Obstetrical or Gynecological problem or health scenario with regards to a. Formulation of prompt and logical diagnosis based on the relevant clinical data, appropriate laboratory and diagnostic reports b. Identification of immediate needs and problems and rationalization of their proposed intervention and alternatives c. Demonstration of critical judgment and expertise in clinical problem-solving and decision making d. Demonstration of equanimity and logical reasoning under stressful conditions SCOPE OF EXAMINATION Questions will be chosen from any areas of coverage as the Diplomate Part 1 (written) Examination. The questions will test the candidate’s ability to correlate and analyze and rationalize his/her clinical judgement.

21. GUIDELINES AND REQUIREMENTS • FOR THOSE TAKING THE ORAL EXAMINATION FOR THE FIRST TIME, THE CANDIDATE MUST: • 1. have passed the Diplomate Part I (Written) Examination. • 2. be a Junior member of POGS in good standing for at least 3 months prior to the examination • 3. submit a Certificate of Junior Membership • 4. submit an application for examination • submit the following in the prescribed format: • a. separately bound typewritten duplicate copies of 20 major and minor Obstetrical and Gynecological cases/operations: (10 variedmajor cases: 6 OB and 4 GYNE) and 10 minor cases (5 OB and 5 GYNE) done by him/her in private practice within two years prior to the oral examination. (Transfer of technical responsibility is not allowed). All of these must be presented in the following format: • 1. Table of contents certified by the chair or medical records officer • 2. Photostat copies of legible operative sheets, actual typewritten techniques of operation. In case original operative technique was not typed, include photocopy of original record.

22. Each case must be accompanied by a legible photocopy of the following: operative record/technique (typewritten) stamped “certified true copy and attested by the chair or training officer” and histopathology report if applicable). • 3. Histopathological reports • Records of hospital stay, course of illness and complications, if any. • b. five (5) different major OB-GYN cases (from the 20 cases listed in A6a) with • their respective DISCUSSIONS properly referenced. These cases must have a separate table of contents. The candidate must check with the secretariat regarding the approval of the above-mentioned documents prior to the date of the examination.

23. DIPLOMATE PART II PRACTICAL EXAMINATION The PBOG will determine, from among the candidates who passed Part I and Part II Examinations, who will be given the Practical Examination. The following candidates will require Practical Examination: a. Graduates of Residency Training Programs which have been accredited one (1) year after the candidate's graduation b. Those who passed Diplomate Part II Examination after three (3) attempts c. Any Graduate from an accredited, modular or foreign residency training program on a case- to- case basis OBJECTIVE To demonstrate the capability of a candidate to perform any obstetrical or gynecological procedure according to currently accepted standards. This includes the preoperative and postoperative evaluation, care and management of complications.

24. SCOPE OF THE EXAMINATION Any major OB-GYN operation specified by the examiner. CONDUCT OF THE EXAMINATION Any member of the PBOG designated by the PBOG Chair to conduct the Practical Examination shall observe and evaluate the actual performance of a major Obstetrical or Gynecological surgical procedure within the prescribed period. The practical exam must be taken within a year of passing the oral examination. RE-EXAMINATION A candidate has a maximum of three attempts on the Practical Examination. Whoever failed in the Practical Examination for the third attempt shall undertake a recognized tutorial program approved by PBOG for a period of six (6) months before repeating the Practical Examination.

25. List of documents to be reviewed during visit Submitted documents Attendance during conferences topics/date of conferences 3. Schedule of subspecialty rotations 4. Evaluation of residents schedule/type/results per resident 5. Residents’ accomplishments 6. List of researches/case reports 7. List of graduates who took the PBOG exam during the last 4 years & the outcome 8. Documentation of supervisions

26. Activities during visit 1. Presentation of training program Review of documents Observation of actual conference Session with residents 5. Surgical skills evaluation per year level