AAGL and “Choosing Wisely”: Five Practices to Question
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. State the purpose and background of the Choose Wisely Program 2. List the five Things Providers and Patients Should Question that have been submitted by the AAGL
Estimated time to complete activity: 0.25 hours
Ashley Comfort, MD, FACOG is the Director of Medical Content, ObG Project.
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Ashley Comfort, MD, has a financial interest in Pfizer and has no other conflicts of interest to disclose.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
“Choosing Wisely” is a joint ABIM Foundation / Consumer Reports program. The goal of the program is to promote clinician-patient conversation and improve care by enabling patients to choose tests or procedures that meet the following criteria:
Not duplicating previous tests or procedures
Free from harm
In response, professional organizations have been submitting “Things Providers and Patients Should Question”. The AAGL, the largest international, professional society in minimally invasive gynecology, has submitted the following:
Do not perform laparotomy for non-malignant disease when an indicated surgery can be performed using a vaginal, laparoscopic or robotic-assisted approach
Factors to consider in selection of the appropriate approach include
Surgeon and equipment ability
Consideration of costs and reduction of complications
Do not perform routine oophorectomy in premenopausal women undergoing hysterectomy if there is no evidence of malignancy and the patient is at low risk for ovarian cancer
Oophorectomy in this age group is associated with higher rates of coronary heart disease and cardiovascular death
Increased risk of adverse outcomes is of particular concern among women <45 to 50 years of age and not on estrogen therapy
Prophylactic antibiotics are not indicated in low-risk laparoscopic procedures
Women undergoing vaginal or abdominal hysterectomy should receive single-dose antimicrobial prophylaxis
Women undergoing diagnostic laparoscopy or exploratory laparotomy should not receive antibiotic prophylaxis
Avoid removing endometrial polyps without direct visualization when hysteroscopic guidance is available and can be safely performed
Removal of polyps without direct visualization is associated with low sensitivity and therefore negative predictive value of success compared to hysteroscopy and guided biopsy
Avoid opioid misuse in patients with chronic pelvic pain
Good care and pain control can still be provided with the following
FDA and CDC guidance
Knowledge of risk factors associated with opioid misuse
Responsible opioid prescribing
Follow up with patients on chronic opioid therapy to identify signs of misuse
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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