Tanner Colegrove, MD
Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Northwestern Lake Forest Hospital, Lake Forest, IL, 60045

Jennifer R. Butler, MD
Department of Obstetrics and Gynecology, University of California, Irvine, Orange, CA 92868

Catherine S. Stika, MD
Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL 60611

Brigid McCue, MD PhD
Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, South Shore University Hospital, Bay Shore, NY 11706

Corresponding Author

Tanner Colegrove, MD
Department of Obstetrics and Gynecology Northwestern University, Northwestern Lake Forest Hospital

Core Competencies Leadership Committee

Tanner Colegrove, MD (Chair)
Jennifer R. Butler, MD
Brigid McCue, MD, PhD
Catherine S. Stika, MD

Core Competencies Task Force*

Tanner Colegrove, MD (Chair) - Northwestern Lake Forest Hospital, Lake Forest, IL
Jennifer R. Butler, MD - University of California, Irvine Medical Center, Orange CA
Joseph Cioffi, MD – Winthop University Hospital, Mineola, NY
Rakhi Chaudhuri Dimino, MD – OB Hospitalist Group, Houston, TX
Micah Garb, MD - Northwestern Lake Forest Hospital, Lake Forest, IL
Susan Lareau, MD – UPMC Magee-Womens Hospital, Pittsburgh, PA
Jennifer Lincoln, MD - Providence St. Vincent Medical Center, Portland, OR
Brigid McCue, MD - Oschner Health System, New Orleans, LA
Trina Pagano, MD - Cleveland Clinic, Cleveland, OH
Raquel Pelayo, MD - Kaiser Permanente, Orange County, CA
Craig Salcido, MD – Mission Regional Medical Center, Mission Viego, CA
Catherine S. Stika, MD - Northwestern Memorial Hospital, Chicago, IL
Brook A. Thomson, MD - Baylor College of Medicine at The Children’s Hospital of San Antonio, San Antonio, TX
Vanessa Torbenson, MD - Mayo Clinic, Rochester, MD
Jane van Dis, MD – St. Joseph Providence Hospital, Burbank, CA

*Hospital affiliation at time of service on this committee

Core Competencies Editorial Board*

Tanner Colegrove, MD (Chair) - Northwestern Lake Forest Hospital, Lake Forest, IL
Jennifer R. Butler, MD - University of California, Irvine Medical Center, Orange CA
Rakhi Chaudhuri Dimino, MD - OB Hospitalist Group, Houston, TX
Jennifer Lincoln, MD - Providence St. Vincent Medical Center, Portland, OR
Brigid McCue, MD - Oschner Health System, New Orleans, LA
Trina Pagano, MD - Cleveland Clinic, Cleveland, OH
Raquel Pelayo, MD - Kaiser Permanente, Orange County, OH
Craig Salcido, MD - Mission Regional Medical Center, Mission Viego, CA
Catherine S. Stika, MD - Northwestern Memorial Hospital, Chicago, IL
Brook A. Thomson, MD - Baylor College of Medicine at The Children’s Hospital of San Antonio, San Antonio, TX
Vanessa Torbenson, MD - Mayo Clinic, Rochester, MD
Jane van Dis, MD – St. Joseph Providence Hospital, Burbank, CA

*Hospital affiliation at time of service on this committee

Core Competencies Contributing Authors*

Renee Simone Yolanda Allen, MHSc., MD
Lauren M. Bergeron, MD
Kristine D. Boyd, MD
Sarah Bradley, MD
Phillip L. Bressman, MD
Amy M. Burkett, MD
Jennifer R. Butler, MD
Martin Caliendo, MD
Brendan Carroll, MD
Tanner Colegrove, MD
Rakhi Chaudhuri Dimino, MD, MMM, CPE
Margaret Dow, MD
Rebecca Dunsmoor-Su, MD, MSCE
Kaci Durbin, MD
Robert J. Fagnant, MD
Diana Glasser, MD
Robyn A. Gray Puleo, DO, MHL
Erica Heilman, MD
Sheila Hill, MD
Kollier Hinkle, MD
Jill Hutton, MD, MPH
Deannah Jibril, DO
Carrie Lynn Johnson, MD
Robert J. Kaminski, MD
Tyler J. Katz, MD
Melissa Larsen, MD
Moises Lichtinger, MD
Jennifer Lincoln, MD, IBCLC
Brigid McCue, MD, PhD
Tiffany Morgan, DO
Nahille I. Natour, MD
Stacy L. Norton, MD
Oroma Nwanodi, MD
Rob Olson, MD
Jennifer Reason, DO
Tiffany Remsing, MD
Craig Salcido, MD
Karen M. Schneider, MD
Scott A. Shainker, DO, MS
Mark N. Simon, MD
Ira John Sites III, MD
Avi Sklar, MD
Catherine S. Stika, MD
Vasiliki Tatsis, MD
Brook A. Thomson, MD
Jana Thor, DO
Vanessa Torbenson, MD
Jane van Dis, MD
Amy VanBlaricom, MD
Dympna Lynch Weil, MD
DeAnna Young, MD

*One author requested not to be listed

Over the past decade, the hospitalist model in Obstetrics and Gynecology has grown rapidly as more maternity units implement programs and physicians transition to this type of practice in increasing numbers. While there have been many drivers of this trend, perhaps the most significant was the rapid expansion of the hospitalist model in Internal Medicine and the growing body of evidence showing its benefits between the late 1990s and early 2000s.[1],[2],[3] As evidence of improved quality, efficiency, and patient satisfaction spread, other specialties began to adopt the model, most notably Pediatrics, Neurology, and Obstetrics and Gynecology. Some consider hospitalist programs in OB/GYN to be simply those that provide 24/7 in-house coverage of the Maternity unit or women’s service. However, while in-house coverage is a critical component, optimal implementation of the OB/GYN hospitalist program goes beyond this criteria and provides patients with a unique set of proficiencies, including clinical knowledge, procedural skills, leadership, and systems expertise. Based on this vision and in response to the increasing number of providers entering the field, the Society of OB/GYN Hospitalists (SOGH) set a goal in 2017 to establish core competencies in order to standardize the practice model, provide a consistent curriculum for fellowship training, and better define the leadership role of hospitalists in women’s health. A few years, countless hours, and one pandemic later, SOGH is proud to introduce the first edition of the Core Competencies for OB and OB/GYN Hospitalists (the Core Competencies). This document describes the methods by which the Core Competencies were developed and recognizes those who contributed to this important work. First and foremost, SOGH would like to acknowledge the Society of Hospital Medicine whose leadership in establishing the hospitalist model paved the way for other specialties and whose Core Competencies for Medicine Hospitalists provided inspiration for this project.[4]

What are core competencies?

Core competencies delineate the proficiencies required to function effectively as an OB/GYN hospitalist. Core competencies do not assess competence but rather establish standards expected of competent hospitalists in OB/GYN.

Who will use the Core Competencies?

In a 2009 survey of Fellows of the American College of Obstetrics and Gynecology, 1,020 clinicians (15% of respondents) self-identified as obstetrics/gynecology hospitalists or laborists.[5] A study of hospitals belonging to the National Perinatal Information Center/Quality Analytic Services in 2010 revealed that 40% (28 of 68 respondents) had laborist programs.[6] The Society of OB/GYN Hospitalists has steadily grown since its inception in 2011 to a current membership of 1,349 individuals (data provided by Veritas Meetings Solutions on August 24, 2021). Currently, there are 11 OB/GYN hospitalist fellowship programs around the country, with more to be established in the coming years. These data show that the hospitalist model in OB/GYN has clearly gained traction, yet no standards exist that define the role or what should be expected of hospitalists, nor is there a standard curriculum for OB/GYN hospitalist fellowship programs. The Core Competences fill this void. Directors of fellowship and residency programs, medical school clerkships, and continuing medical education programs can utilize the Core Competencies to guide curriculum targeted to residents and physician hospitalists in OB/GYN. Providers who wish to become OB/GYN hospitalists can assess their current skill sets and seek out additional learning opportunities. Employers can ensure that their OB/GYN hospitalist team is well resourced and understand the depth and breadth of skill and knowledge that is expected and maintained. Ultimately, codifying the role of hospitalists in OB/GYN will support the continued development of this model as an important component of women’s health.

Why are core competencies important?

While there is significant overlap in the clinical knowledge and skills between OB/GYN hospitalists and traditional OB/GYN providers, the unique constellation of highly honed clinical knowledge and skills, especially in high-acuity, low volume emergencies and procedures, coupled with expertise in system-based thinking, differentiates hospitalists from non-hospitalists in OB/GYN. For example, OB/GYN hospitalists have clinical expertise and leadership training to optimize care during emergencies and are trained in quality improvement and the safety sciences to lead or participate in projects that elevate care. OB/GYN hospitalists bring experience in adult learning and simulation, providing a resource for education and training for their department and hospital system. These and other key attributes defined by the Core Competencies shape the role of hospitalists within the specialty of Obstetrics and Gynecology and continue to advance high-quality, safe, and equitable care for hospitalized women.

Phase 1 – Preparation and Planning

The SOGH Board of Directors established the Core Competencies Leadership Committee (CCLC) in February 2017 to oversee and manage the project. Committee responsibilities included developing a high-level strategy, establishing a timeline and deliverables, recruiting and overseeing other committees necessary for the project, and serving as senior editors.

Early in the planning phase, the CCLC researched other examples of core competencies to help inform the process. Among those reviewed were the Core Competencies published by the Society of Hospital Medicine (SHM) in 2006. The Core Competencies in Hospital Medicine are a collection of chapters, each focusing on a specific topic relevant to Hospital Medicine.4 Chapters are divided into 3 categories – Clinical Conditions, Procedures, and Healthcare Systems. Each chapter begins with an introductory paragraph followed by a bulleted list of learning objectives. Informed by educational theory, the learning objectives in each chapter cover 3 domains – the cognitive domain (knowledge), the psychomotor domain (skills), and the affective domain (attitudes). Additionally, a 4th domain called System Organization and Improvement is included in each of the Clinical Conditions and Procedures chapters. This domain integrates the knowledge, skills, and attitudes outlined in each chapter and emphasizes the systems approach to care, which is the core of the hospitalist model.

Along with the Core Competencies, SHM published several companion articles. In “Core Competencies in Hospital Medicine: Development and Methodology,”[7] the authors outline the thoughtful process that was undertaken to develop the Core Competencies, including establishing a task force and editorial board, developing a list of topics, recruiting authors, and executing several rounds of reviews and revisions. The article “How to Use The Core Competences in Hospital Medicine: A Framework for Curriculum Development”[8] explains educational theory, its application to the Core Competencies, and how medical educators can use the competencies to develop curricula for training current and future hospitalists. After reviewing these articles and given the similarities between hospitalists across specialties, the CCLC felt that the Core Competencies in Hospital Medicine and their intended purpose were well aligned with our organization’s vision for core competencies for hospitalists in OB/GYN. Therefore, a similar strategy for developing and designing the Core Competencies for OB and OB/GYN Hospitalists was presented to and approved by the SOGH Board of Directors in April 2017 (See Figure 1). Figure 2 represents the timeline and process the project actually followed.

Figure 1. Proposed Process and Timeline.

Figure 2. Actual Process and Timeline.

Phase 2 – Topic Development

The goal of Phase 2 was to establish a list of topics to be included in the Core Competencies. A diverse task force was formed to ensure that topics reflected the breadth and depth of practicing OB/GYN hospitalists. An invitation to apply was sent to all SOGH members. OB/GYN physicians with past or present hospitalist experience were recruited from hospitals of varying sizes and settings. Applications were reviewed by the CCLC, and 11 hospitalists joined the CCLC to form the 15-person Core Competencies Task Force (CCTF).

Initial meetings of the CCTF were dedicated to developing a shared vision for the project. The SHM Core Competencies and companion articles were distributed to the task force members to provide a basis for discussion. A survey was utilized to elicit task force members’ ideas on the purpose of core competencies, the target audience, and strategies for determining topics. The task force agreed with many of the principles set forth by SHM. Specifically, the Core Competencies for OB and OB/GYN hospitalists should define the knowledge, skills, and professionalism expected of hospitalists and should provide a framework for educating and training current and future hospitalists. Additionally, the Core Competencies should establish the standard that hospitalists have expertise in leadership, communication, quality and safety, education and simulation. The Core Competencies need be not an exhaustive list of everything an OB/GYN hospitalist should know; hospitalists will likely manage conditions or perform procedures that are not included in the competencies. However, the Core Competencies should focus on topics that are critical and unique to the role and should be designed with the future hospitalist in mind. Not all hospitalists practicing today will manage all conditions or perform every skill outlined in the Core Competencies, but this body of work should drive the training of hospitalists in OB/GYN to ensure that over time maternity units are staffed with clinicians who possess the knowledge, skills and attitudes needed in many settings today. The CCTF also endorsed the CCLC’s recommendation to organize the Core Competencies in a manner similar to SHM’s using 3 categories - Clinical Conditions, Procedures, and Healthcare Systems. Additionally, the task force agreed on a standard format for each chapter including an introductory paragraph followed by learning objectives separated into 4 domains: Knowledge, Skills, Self-Awareness and Collaborative Attitudes, and System Organization and Improvement.

The task force divided into 3 teams to develop a list of topics for each category. The Clinical Conditions and Procedures teams created a comprehensive list of conditions and procedures which included the most common diagnosis codes and procedures performed by OB/GYN hospitalists at their institutions as well as topics covered by ACOG practice bulletins, committee opinions, CREOG learning objectives, and AIM bundles. Each condition and procedure was vetted using the following criteria:

• Does the condition or procedure involve a serious or life-threatening situation in which the presence of a hospitalist could impact the patient outcome?
• Beyond individual patient care, does the condition or procedure present an opportunity for hospitalists to impact quality or safety on a broad scale?
• Is the condition or procedure universal, i.e., does it have relevance across settings and locations?

The initial list of Healthcare Systems topics was created based on existing OB/GYN hospitalist fellowship program curricula and the examples provided by the Core Competencies in Hospital Medicine. This list was then modified based on feedback from the CCTF and focused on the most important Healthcare Systems topics encountered by OB/GYN hospitalists. Through iterative discussions over 8 months, the group reached consensus on an initial list of topics for the 3 categories.

The CCTF then developed an author application and selection process. An online application was created where applicants submitted their CV and provided information about their hospital setting, number of deliveries per year, personal clinical, teaching, writing or editing experience, and indicated how many and which chapters they were interested in authoring. A flyer calling for applications was drafted which provided a brief summary of the project, outlined author responsibilities, and included a link to the list of topics and sample chapters written by the CCTF members.

An overarching goal was to achieve consistency in style, language and format across all chapters in the Core Competencies. To that end, the CCTF developed an orientation program which all authors were required to complete. A 60-minute webinar reviewed the purpose and goals of the project, the organizational structure of the chapters, and presented sample chapters. A 15-page orientation packet was also provided which included a chapter template and sample chapters, guidelines on writing the introductory paragraph, and tips on writing learning objectives.

Phase 3 – Author Selection and Content Development

The first step of Phase 3 was to establish the Core Competencies Editorial Board which would be responsible for selecting and orienting the authors, overseeing content development, editing the document, and coordinating the reviews by the SOGH Board of Directors and authors. Given that each member of the CCTF had demonstrated a commitment to the project and had developed a keen sense of the vision and goals, each was invited by the CCLC to join the Editorial Board and 8 accepted.

A call for author applications was deployed to SOGH members via email and the SOGH newsletter in May 2018. The Editorial Board received 47 applications of which 45 met the desired criteria. Forty-two of these (93.3%) were practicing hospitalists, one was a Maternal-Fetal Medicine specialist, one was a consultant in OB/GYN Hospital Medicine with former hospitalist experience, and one was a Chief Medical Officer of an OB/GYN hospitalist staffing company, also with prior hospitalist experience. Of the hospitalists, approximately half reported practicing gynecology in addition to obstetrics in their hospitalist role. Authors represented hospitals in all size categories, from smaller hospitals with < 2000 deliveries/year to large centers with > 8000 deliveries/year. Academic and community hospitals were represented, as were a variety of employment categories including academic faculty members, contracted providers, hospital employees, and employees of staffing companies. All but two applicants agreed to write more than one chapter. In addition to the 45 authors selected, 7 members of the task force also agreed to write chapters. In total, a diverse panel of 52 individuals contributed as authors to the Core Competencies. Chapters were assigned based on author expertise and preference.

Contributing authors completed the orientation program in August 2018 and began writing content for the 70 chapters. Each author was paired with one member of the Editorial Board who provided guidance and support. First drafts were submitted to the Editorial Board in October 2018.

Phase 4 – Reviews and Revisions

Each chapter of the Core Competencies was rigorously edited to ensure accurate representation of the role of the hospitalist in OB/GYN and that each competency reflected an appropriate level of proficiency. Each chapter was also edited for consistency in style and tone. The Editorial Board completed the first round of edits from October 2018 through May 2019. Each chapter was edited by three members, two of which were senior editors. It was noted during this round that four pairs of Clinical Conditions and Procedures chapters had significantly overlapping content. In each of these cases, the two chapters were combined into one and the final chapters were categorized as Clinical Conditions. These were Cervical Insufficiency (CC) and Cerclage (P), now Cervical Insufficiency (CC); Cardiopulmonary Arrest/Cardiac Collapse (CC) and Advanced Cardiac Life Support (P), now Cardiopulmonary Arrest (CC); Pelvic Masses (CC) and Management of Adnexal Problems: LSC/Laparotomy (P), now Pelvic Masses (CC); and Labor (CC) and Vaginal Delivery (P), now Parturition (CC).

SOGH contracted with Abbie Young, MS, CGC, ELS(D), a board-certified medical editor with extensive experience in editing, writing and developing health-related content, to edit the Core Competencies. Beginning in March 2019 through October 2019, Ms. Young edited each chapter for consistency of style and language.

Third round edits were completed by the entire Core Competencies Editorial Board. Drafts of every chapter were sent to all members with an online survey. Members reviewed each chapter then selected one of three responses in the survey: “approve as is,” “approve with edits” (space was provided for reviewers to suggest edits by free text), or “requires further discussion.” Edits were vetted by the four senior editors and accepted based on consensus. Chapters requiring further discussion were vetted by the entire Editorial Board and changes were made based on consensus. Due to the pandemic, progress stalled during this phase and the project fell behind timeline. Third round edits were completed in December 2020.

The plan at the outset of the project was to share chapters with authors at this stage and to invite external organizations to participate in the review process. However, given the project delays, the decision was made to move the content on to the Board of Directors for review/approval prior to sending back to the authors. Additionally, because each chapter was reviewed by many individuals from various backgrounds within SOGH, the decision was made to forego external reviews. In December 2020, a draft of the entire compilation was distributed to board members along with an online survey. Reviewers indicated whether they supported or did not support each chapter and were able to provide comments by free text in the survey. Each chapter was reviewed by at least two board members. The majority of chapters were approved as written. All comments were reviewed by the senior editors. Minor edits were accepted or rejected at the discretion of the senior editor assigned to the chapter. Edits of more significance were discussed among all senior editors and changes were made based on consensus. This phase of the review process was complete in early March 2021.

In late March 2021, chapters were sent back to the contributing authors for final review. The majority of chapters were approved without further changes. A few minor edits were suggested and accepted. Chapters were prepared for publication and provided to SOGH in early September 2021.

Phase 5 – Publication/Distribution

Throughout the development of the Core Competencies, the Editorial Board and Board of Directors had several discussions regarding publication. After much consideration, the decision was made to publish the work on a web-based educational platform. This modality will optimize the dissemination of this body of work; SOGH members will have ready access and non-members will have access for a small fee. Specific chapters will be selected for publication in the Journal of OB/GYN Hospital Medicine.

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