Download Goals and Objectives R-I

POSTGRADUATE YEAR ONE
Ambulatory Rotation - One Month
The ambulatory rotation is designed to provide early exposure to the subspecialties of obstetrics &
gynecology and to initiate skill development in ultrasound and other office-based procedures. It aims to
allow the resident to obtain a basic fund of knowledge and experience in a variety of areas which will
allow increasingly meaningful participation in the other rotations and in the resident’s continuity clinic.
The ambulatory rotation is a particularly appropriate time for the resident to begin forming mentoring
relationships with faculty and fellows and to become involved in a research project. Learning objectives
are both didactic (self reading, lectures and conferences, and patient evaluation), and technical
(procedural skills).
At the completion of the rotation, the resident is to have read and have an
understanding of the didactic objectives outlined below. These objectives, whether covered during
lecture, rounds, conference, or resident self learning are to be considered a minimum for resident learning
during the rotation. Technical objectives will be evaluated on an ongoing basis by more senior residents
and Faculty.
Didactic and Management Goals and Objectives
The resident should make extensive use of the current literature to apply evidence-based
techniques for the rational management of medical and surgical obstetric conditions.
All
residents have access to online literature (i.e. Up to Date, Medscape, etc) and there are numerous
Obstetrics Books (most recent editions) available in the Resident Call Rooms, and the Resident
Clinic. In addition, all of the clinical sites have full service medical libraries with the more recent
OB/GYN journals available.
Patient Care
The patient care aspect in this rotation involves learning various different techniques and
procedures. The experience obtained during this rotation is an evolutionary process. Residents
will be exposed to various procedures commensurate with their level of training.
Some
procedures will require continued exposure to achieve competence while others will be mastered
after minimal exposure. Competence in these procedures will allow the resident to be able to
adequately take care of patients.
Following completion of the rotation, the resident is expected to have had experience, under
supervision, in:
1. Performance of first trimester ultrasound
2. Performance of fetal anatomic survey and fetal biometry
3. Performance of ultrasound for placental location, amniotic fluid index, fetal position, and
biophysical profile
4. Performance of transvaginal cervical length measurement
5. Performance of ultrasound to evaluate the non-pregnant uterus and adnexa
6. Performance of saline infusion sonography
7. Performance of POP-Q exam
8. Performance of office cystoscopy
9. Performance of pessary fitting and removal
10. Placement of laminaria for cervical dilation
11. Performance of first trimester surgical termination of pregnancy
Following completion of the rotation, the resident is expected to be competent in:
1. Performance of first trimester ultrasound with measurement of fetal pole and documentation of
cardiac motion
2. Performance of fetal biometry
3. Performance of ultrasound for placental location, amniotic fluid index, fetal position, and
biophysical profile
4. Performance of early first trimester cervical dilation and surgical termination of pregnancy
5. Determining presence or absence of adequate uterine aspirate from first trimester pregnancy
termination
Medical Knowledge
A. The resident will understand the components and techniques of the following ultrasound exams:
1. Non-pregnant uterus and adnexa
2. Early pregnancy ultrasound exam including: determination of fetal number and chorionicity,
identification and measurement of gestational sac, yolk sac, and fetal pole, and nuchal
translucency measurement
3. Second trimester dates and anatomy scan
4. Fetal ultrasound for the purpose of growth measurement, presentation, placental location,
amniotic fluid index, and biophysical profile
5. Transvaginal measurement of cervical length
6. Saline infusion sonography
B. The resident will understand the appropriate components of a family history taken for the purpose of
genetic evaluation, as well as the counseling involved in cases of advanced maternal age, a prior fetus
with neural tube defect, maternal diabetes, cystic fibrosis carrier testing, and decisions to undergo
invasive testing.
C. The resident will understand the performance and interpretation of urogynecologic studies such as
POP-Q, urodynamics, and office cystoscopy. In addition, the resident will understand basic lifestyle and
medical management of urinary complaints, the variety of pessary types and their appropriate uses, and
indications for pelvic floor physical therapy.
D. The resident will be able to describe the indications for the following procedures to assess breast
disorders and will be able to perform and/or interpret the indications for and results of each of them.
1. Needle aspiration of a cyst or abscess.
2. Collection of nipple discharge for cytological examination and/or culture.
3. Fine needle aspiration of a mass.
4. Needle localization biopsy.
5. Excisional biopsy.
6. Mammography.
7. Ultrasonography.
8. MRI.
E. The resident will be able to evaluate a patient’s personal or family history of breast cancer, including
the risk associated with BRCA 1 or BRCA2.
F. The resident will be able to describe the physiology of:
1. The hypothalamic-pituitary-ovarian axis.
2. Adrenal steroid and catecholamine synthesis.
3. The thyroid gland and thyroid hormone synthesis.
4. Female and male gametogenesis.
5. Bone formation and resorption.
6. The relationship between ovarian and adrenal androgen production and hyperinsulinemia.
7. The normal menstrual cycle.
8. The physiologic changes that occur at the times of puberty and menopause.
G. The resident will be able to describe the normal embryology of Mullerian and ovarian development,
the pathogenesis of abnormal Mullerian development, and the pathogenesis of disorders of sexual
differentiation.
H. The resident will be able to describe the pharmacology of medications used to: induce ovulation,
inhibit ovulation (GNRH agonists and antagonists, steroid contraceptives), inhibit the effects of
progesterones (mifepristone), treat hyperprolactinemia, serve as hormone therapy and estrogen and
progesterone receptor modulators.
I.
The resident will be able to describe the clinical features and diagnostic criteria for PCOS, as well as
perform an appropriate physical exam. In addition, the resident will understand how to interpret
selected tests to determine the diagnosis and to describe appropriate initial management for patients
who do and do not desire pregnancy.
J. The resident will be able to describe the principal causes of primary and secondary infertility, to
elicit a pertinent history and perform a pertinent physical exam, and to interpret diagnostic tests such
as basal body temperature, luteal phase progesterone, thyroid function, and prolactin. In addition,
the resident will have an understanding of the roles and interpretation of imaging studies and semen
analysis.
K. The resident will be able to:
1. Discuss available methods of contraception, their relative efficacies, basic advantages and
limitations, non-contraceptive benefits, relative and absolute medical contraindications, and
appropriately counsel patients on their proper use.
2. Discuss available methods of emergency contraception and their use.
3. Understand the public health context of safe, elective abortion and describe the various surgical
abortion procedures and the gestations for which they are appropriate.
4. Understand options for pain management in surgical abortion.
5. Understand the complications of first and second trimester abortions and their management.
6. Discuss the protocols used for medical abortion and their relative efficacies.
7. Describe side effects and complications associated with medical abortion and their appropriate
treatments.
8. Explain the methods of cervical preparation for second trimester abortion including the process of
laminaria insertion.
9. Discuss the use of misoprostol and other agents for induction termination in the second trimester
and be able to provide appropriate counseling regarding the benefits and disadvantages of
induction versus surgical evacuation for elective abortion, IUFD, and fetal anomalies.
10. Explain the process of examining uterine aspirate.
11. Explore ethical questions surrounding abortion and clarify personal feelings about the role of
abortion in the resident’s future practice.
Interpersonal and Communication Skills
1. Sustain therapeutic and ethically sound relationships with patients, patients’ families, and
colleagues.
2. Provide effective and professional consultation to other physicians and health care professionals.
3. Provide instruction and constructive feedback to other members of the health care team as
appropriate to the team member and resident’s level of training.
4. Communicate effectively with patients in language that is appropriate to their age and
educational, cultural, and socioeconomic background.
5. Maintain comprehensive, timely, and legible medical records.
Professionalism
1. Demonstrate respect, compassion, integrity, responsiveness, and accountability to the needs of
patients and society that supersedes self-interest.
2. Demonstrate a commitment to excellence and ongoing professional development.
3. Describe basic ethical concepts such as: autonomy, beneficence, justice, and nonmalefisence.
4. Describe the process of informed healthcare decision making, including the specific components
of an informed-consent discussion.
5. Demonstrate an understanding of the use of advanced directives, living wills, and durable power
of attorney for health care, as well as strategies for the resolution of ethical conflicts.
6. Discuss important issues regarding stress management, substance abuse, and sleep deprivation.
7. Describe current standards for the protection of health-related patient information.
8. Describe the procedures for obtaining and maintaining medical licensure, board certification,
credentialing, hospital staff privileges, and liability insurance.
Systems-Based Practice
1. Describe how types of medical practice and delivery systems differ from one another, including
methods of controlling health care costs and allocating resources.
2. Advocate for quality patient care and assist patients in dealing with system complexities.
3. Demonstrate the ability to discuss errors in management with peers and patients to improve patient
safety.
4. Describe basic medical-legal concepts regarding a professional liability claim and list the steps in
processing a claim.
Practice-Based Learning
1. Identify areas for personal and practice improvement and implementation strategies to enhance
knowledge, skills, attitudes, and processes of care.
2. Make a commitment to life-long learning.
3. Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health
problems.
4. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and
other information on diagnostic and therapeutic effectiveness.
5. Use information technology to manage information, access online medical information, and
support their education.
Evaluations
The PG I resident rotating on the Ambulatory service is evaluated using 360 evaluations. They
are evaluated by their faculty, their patients, the ancillary staff, and themselves. The Ambulatory
faculty completes the summative evaluations at the end of the rotation. The evaluations are done
based on the core competencies as outlined in the Goals and Objectives that are listed above for
this rotation. Self evaluations are used to determine whether or not a resident achieved
competency with the management of a specific goals.
Reading Assignments
Comprehensive Gynecology: Morton A. Stenchever, MD (Author), William Droegemueller,
MD (Author), Arthur L. Herbst, MD
(Author), Daniel Mishell Jr. MD (Author)
Clinical Urogynecology -Mickey M. Karram, MD and Mark D.Walters, MD
Willaims Gynecology
Clinical Gynecologic Endocrinology and Infertility: Leon Speroff (Author), Marc A. Fritz
(Author)
ACOG compendium and Committee Opinions
Medical Management of Tubal Pregnancy
Management of Infertility Caused by Ovulatory Dysfunction
Polycystic Ovary Syndrome
Benefits and Risks of Sterilization
Urinary Incontinence
Intrauterine Device
Medical Management of Abortion
Emergency Contraception
POSTGRADUATE YEAR ONE
Continuity Clinic-Weekly
The goals and objectives of the weekly continuity clinic are to provide the resident and patient the
opportunity to establish a professional relationship that enhances resident learning while providing a
continuum of high quality patient care. The resident is expected to hone skills in patient education and
counseling, while making appropriate recommendations for treatment and therapy.
These
recommendations may be related to a specific illness or treatment or related to education regarding
lifestyle issues including such things as diet, exercise, contraception, immunizations, weight loss,
substance abuse, and domestic violence. Continuity of care should be provided across both primary care
and the OB/GYN spectrum. The resident will focus on continuity clinic patients and provide normal
obstetrical prenatal care and treat common gynecologic problems such as contraception, family planning,
menstrual irregularities, and sexually transmitted infections. At the completion of the rotation, the
resident is to have read and have an understanding of the didactic objectives outlined below. These
objectives, whether covered during lecture, rounds, conference, or resident self learning are to be
considered a minimum for resident learning during the rotation. Technical objectives will be evaluated on
an ongoing basis by more senior residents and faculty.
Didactic and Management Goals and Objectives
The resident should make extensive use of the current literature to apply evidence-based techniques for
the rational management of medical and surgical obstetric conditions. All residents have access to online
literature (i.e. Up to Date, Medscape, etc) and there are numerous Obstetrics Books (most recent editions)
available in the Resident Call Rooms, and the Resident Clinic. In addition, all of the clinical sites have
full service medical libraries with the more recent OB/GYN journals available.
Patient Care
The resident is expected to establish a professional relationships with their patients. The care that they
provide to their patients should enhance their learning while providing a continuum of high quality
patient care. The resident is expected to hone skills in patient education and counseling, while making
appropriate recommendations for treatment and therapy. The patient care that is provided can be related
to specific illness or treatment or it can be related to related to lifestyle issues that involve things such as
diet, exercise, contraception, immunizations, weight loss, substance abuse, and domestic violence.
Technical and procedure experience is an evolutionary process and the residents will be exposed to
various procedures commensurate with their level of training. Some procedures will require continued
exposure to achieve competence while others will be mastered after minimal exposure.
Following completion of the rotation, the resident is expected to have had, under supervision, experience
in:
1. Insertion of Intrauterine Device
2. Endometrial Biopsy
Medical Knowledge
A. The resident should have an understanding of the general principles of aging in women including:
1. Normal age-related mental, anatomic, and physiologic changes.
2. Age-related changes in the organ systems including those of special surgical importance such as
respiratory, cardiovascular, renal, and gastrointestinal.
3. Age-related changes in common laboratory values.
4. The demographics of aging including projected growth of the aging population, health care needs,
and living arrangements.
B. The resident should have an understanding of the functional assessment of the geriatric patient
including:
1. The ability to assess functional capability in the areas of everyday living and socioeconomic
status as they relate to level of independence associated with the proposed surgery and
preoperative and postoperative care.
2. Cognitive screening assessments including cognitive function and affect, mini-mental status
examination, and depression screening.
3. Basic visual and hearing screening.
4. Activities of daily living using Katz scale.
5. Home safety, gait and balance and social and physical environment including falls and fall
prevention.
C. The resident should perform or refer as appropriate periodic health assessments and screening exams
as appropriate to patient demographics and risk factors.
D. The resident should be able to describe the stages of the normal sexual response and describe the
principal disorders of sexual function, including: hypoactive sexual desire disorder, female sexual
arousal disorder, sexual aversion disorder, female orgasmic disorder, vaginismus, and dyspareunia.
E. The resident should be sensitive and knowledgeable regarding methods to promote health for lesbian
and transgendered patients.
F. The resident should have familiarity with the diagnosis and basic management of nongynecologic
conditions including: allergic rhinitis, asthma, hypertension, abdominal pain, gastrointestinal
disorders, urinary tract disorders, headache, depression, PMS/PMDD, anxiety, skin disorders,
diabetes, thyroid disease, low back pain, and osteoporosis.
Interpersonal and Communication Skills
6. Sustain therapeutic and ethically sound relationships with patients, patients’ families, and
colleagues.
7. Provide effective and professional consultation to other physicians and health care professionals.
8. Provide instruction and constructive feedback to other members of the health care team as
appropriate to the team member and resident’s level of training.
9. Communicate effectively with patients in language that is appropriate to their age and
educational, cultural, and socioeconomic background.
10. Maintain comprehensive, timely, and legible medical records.
Professionalism
9. Demonstrate respect, compassion, integrity, responsiveness, and accountability to the needs of
patients and society that supersedes self-interest.
10. Demonstrate a commitment to excellence and ongoing professional development.
11. Describe basic ethical concepts such as: autonomy, beneficence, justice, and nonmalefisence.
12. Describe the process of informed healthcare decision making, including the specific components
of an informed-consent discussion.
13. Demonstrate an understanding of the use of advanced directives, living wills, and durable power
of attorney for health care, as well as strategies for the resolution of ethical conflicts.
14. Discuss important issues regarding stress management, substance abuse, and sleep deprivation.
15. Describe current standards for the protection of health-related patient information.
16. Describe the procedures for obtaining and maintaining medical licensure, board certification,
credentialing, hospital staff privileges, and liability insurance.
Systems-Based Practice
1. Describe how types of medical practice and delivery systems differ from one another, including
methods of controlling health care costs and allocating resources.
2. Advocate for quality patient care and assist patients in dealing with system complexities.
3. Demonstrate the ability to discuss errors in management with peers and patients to improve
patient safety.
4. Describe basic medical-legal concepts regarding a professional liability claim and list the steps in
processing a claim.
Practice-Based Learning
6. Identify areas for personal and practice improvement and implementation strategies to enhance
knowledge, skills, attitudes, and processes of care.
7. Make a commitment to life-long learning.
8. Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health
problems.
9. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and
other information on diagnostic and therapeutic effectiveness.
10. Use information technology to manage information, access online medical information, and
support their education.
Evaluations
The PG I resident charts are reviewed to ensure appropriate questions are asked at each type of visit
including New OB, Gynecology visits and Annual Well Women exams.
Reading Assingments:
Comprehensive Gynecology: Morton A. Stenchever, MD (Author), William Droegemueller, MD
(Author), Arthur L. Herbst, MD (Author), Daniel Mishell Jr. MD (Author)e
Williams Obstetrics: Cunningham
ACOG Compendium and Committee Opinions
Any topic pertinent to patients seen during continuity clinic
POSTGRADUATE YEAR ONE
Family Health Center Clinic Rotation – Two Months
The initial block rotation in the ambulatory clinic is designed to initiate the development of skills in
ambulatory obstetrics and gynecology. Particular importance should be paid to the general objectives
described above, as they pertain to information management, communication skills, and initial patient
assessment and management. This rotation will focus on routine prenatal care, identification of high risk
obstetrical conditions, basic primary care, and routine gynecologic conditions including the well woman
examination.
Learning objectives are both didactic (self reading, rounds and lectures, and patient
evaluation) and technical (procedural skills). At the completion of the rotation, the resident is to have
read and have an understanding of the didactic objectives outlined below. These objectives, whether
covered during lecture, rounds, conference, or resident self learning are to be considered a minimum for
resident learning during the rotation. Technical objectives will be evaluated on an ongoing basis by more
senior residents and faculty.
Didactic and Management Objectives
The resident should make extensive use of the current literature to apply evidence-based
techniques for the rational management of medical and surgical obstetric conditions.
All
residents have access to online literature (i.e. Up to Date, Medscape, etc) and there are numerous
Obstetrics Books (most recent editions) available in the Resident Call Rooms, and the Resident
Clinic. In addition, all of the clinical sites have full service medical libraries with the more recent
OB/GYN journals available.
Patient Care
The resident will focus on routine prenatal care, identification of high risk obstetrical conditions,
basic primary care, and routine gynecologic conditions including the well woman examination.
Technical and procedure experience is an evolutionary process through the four years of training.
Residents will be exposed to various procedures commensurate with their level of training.
Some procedures will require continued exposure to achieve competence while others will be
mastered after minimal exposure.
Following completion of the rotation, the resident is expected to have under supervision,
experience in:
1. Colposcopy
2. Endometrial, endocervical, and cervical biopsy
3. IUD insertion and removal
4. Transvaginal ultrasound
5. LEEP Procedure
Following completion of the rotation, the resident is expected to be competent in:
1. Performance of a complete breast and pelvic examination
2. Performance of a Pap smear
3. Performance of appropriate vaginal and cervical cultures
Medical Knowledge
A. Primary care objectives
1. Identification of appropriate age or behavior related health risk factors.
2. Identification and utilization of appropriate screening tests for risk assessment.
3. Knowledge of leading causes of death and morbidity by age group.
4. Knowledge of and counseling for sexuality, fitness, and psychosocial issues.
5. Knowledge of periodic immunization and high risk groups.
6. Performance of a well woman exam including Pap smear, pelvic, and breast exam.
7. Identification and management of simple upper respiratory conditions including
pharyngitis, otitis.
8. Identification and management of uncomplicated respiratory conditions such as
bronchitis and pneumonia.
9. Medical therapy for uncomplicated hypertension, counseling for cardiovascular disease.
10. Dietary management of chronic disorders of elimination, microbial flora bowel disease.
11. Uncomplicated depression, simple headache, anxiety disorders.
12. Domestic violence and sexual abuse.
13. Management of uncomplicated sunburn, irritative or inflammatory skin disorders, simple
biopsy.
14. Uncomplicated diabetes mellitus, hypothyroidism.
B. The resident is expected to have an understanding of the aspects of providing routine
antepartum care This will include:
1. An understanding of the physiologic changes in pregnancy in all major organ systems.
2. The impact of physiologic changes in organ systems and their effect on diagnostic
studies.
3. Obtaining an appropriate history including past pregnancies, menstrual history, medical,
family, and genetic history.
4. An understanding of appropriate initial prenatal laboratory tests including indications for
sexually transmitted infection testing.
5. An understanding of timing and indications for follow-up testing to include ultrasound,
serum and ultrasound screening, amniocentesis, Rhig, group B strep, and diabetes
screening.
6. Evaluation of risk factors for preterm labor, pregnancy induced hypertension, and fetal
growth abnormalities.
7. Routine prenatal care parameters based on gestational age.
8. Prenatal counseling and education classes.
9. Postpartum sterilization and contraception.
10. Breastfeeding.
C. The resident will have an understanding of the diagnosis and management of vaginal and
vulvar infections to include:
1. An understanding of signs and symptoms and impact of sexual history.
2. Characteristic findings on physical examination.
3. Diagnostic studies including culture, wet mount, and colposcopy.
4. Possible interventions including topical, hygiene, and antibiotics.
5. Complications of intervention and nonintervention including impact on pregnancy.
6. Patient education and follow-up-treatment of partners.
D. The resident will have an understanding of the diagnosis and treatment of sexually
transmitted infections to include:
1. Appropriate symptoms, sexual activity, and history of assault.
2. Physical findings including fever, vaginal discharge, abdominal findings, skin and
mucous membrane lesions, signs of pelvic inflammatory disease and sepsis.
3. Diagnostic studies to include serologic tests, gram stain, blood smear, dark field, and the
role of biopsy.
4. Factors influencing intervention including severity, impact on fertility, risk of
transmission, and patient compliance.
5. Specific diagnosis and management of syphilis, gonorrhea, chlamydia, chancroid,
granulomatous disease, HIV, herpes simplex, trichomonas, human papilloma virus and
parasitic infection.
6. Patient education, follow-up, preventive and support measures, and evaluation and
treatment of the partner.
E. The resident will have a basic understanding of contraceptive techniques including the risks,
benefits, indications, effectiveness, and contraindications to: progesterone-only and
combined oral contraceptives, transdermal and transvaginal hormonal contraceptives, barrier
methods, intrauterine devices, Depo-Provera, natural family planning, implantable methods,
and surgical sterilization.
F. The resident is expected to have a basic understanding of first trimester abdominal and
vaginal ultrasound for the diagnosis of early pregnancy to include:
1. Dating of first trimester pregnancy.
2. Diagnosis of multiple gestations.
3. Diagnosis of missed or incomplete abortion.
G. The resident will have an understanding of the evaluation of a patient with abnormal bleeding
including:
1. Historical assessment including onset, amount, pattern, LMP and contraception.
2. Conditions which may impact on vaginal bleeding including coagulopathy, pregnancy,
trauma, and medications.
3. Physical examination to determine source of bleeding, visible lesions, signs of pregnancy,
signs of trauma, and signs of malignant disease.
4. Diagnostic studies including the role for hCG, imaging, cytologic and histologic
evaluations, bacterial cultures, and endoscopic procedures.
5. Utilizing the above, the resident will be able to classify abnormal bleeding into the
categories of obstetrical, neoplastic, infectious, traumatic, and endocrine disorders.
6. The resident will have an understanding of possible interventions including hormonal
therapy, antimicrobials, uterine evacuation, treatment for ectopic pregnancy, and repair of
genital tract injury.
7. The resident will have an understanding of the factors influencing intervention as well as
the complications of intervention and non intervention.
8. The resident will have knowledge of appropriate follow-up measures.
Interpersonal and Communication Skills
11. Sustain therapeutic and ethically sound relationships with patients, patients’ families, and
colleagues.
12. Provide effective and professional consultation to other physicians and health care
professionals.
13. Provide instruction and constructive feedback to other members of the health care team
as appropriate to the team member and resident’s level of training.
14. Communicate effectively with patients in language that is appropriate to their age and
educational, cultural, and socioeconomic background.
15. Maintain comprehensive, timely, and legible medical records.
Professionalism
17. Demonstrate respect, compassion, integrity, responsiveness, and accountability to the
needs of patients and society that supersedes self-interest.
18. Demonstrate a commitment to excellence and ongoing professional development.
19. Describe basic ethical concepts such as: autonomy, beneficence, justice, and
nonmalefisence.
20. Describe the process of informed healthcare decision making, including the specific
components of an informed-consent discussion.
21. Demonstrate an understanding of the use of advanced directives, living wills, and durable
power of attorney for health care, as well as strategies for the resolution of ethical
conflicts.
22. Discuss important issues regarding stress management, substance abuse, and sleep
deprivation.
23. Describe current standards for the protection of health-related patient information.
24. Describe the procedures for obtaining and maintaining medical licensure, board
certification, credentialing, hospital staff privileges, and liability insurance.
Systems-Based Practice
1. Describe how types of medical practice and delivery systems differ from one another,
including
methods of controlling health care costs and allocating resources.
2. Advocate for quality patient care and assist patients in dealing with system complexities.
3. Demonstrate the ability to discuss errors in management with peers and patients to
improve
patient safety.
4. Describe basic medical-legal concepts regarding a professional liability claim and list the
steps in processing a claim.
Practice-Based Learning
11. Identify areas for personal and practice improvement and implementation strategies to
enhance knowledge, skills, attitudes, and processes of care.
12. Make a commitment to life-long learning.
13. Locate, appraise, and assimilate evidence from scientific studies related to their patients’
health problems.
14. Apply knowledge of study designs and statistical methods to the appraisal of clinical
studies and other information on diagnostic and therapeutic effectiveness.
15. Use information technology to manage information, access online medical information,
and support their education.
Evaluations
The PG I resident rotating on the FHC-SA service is evaluated using 360 evaluations. They are
evaluated by their faculty, their patients, the ancillary staff, the senior residents and themselves.
The FHC-SA faculty completes the summative evaluations at the end of the rotation. The
evaluations are done based on the core competencies as outlined in the Goals and Objectives that
are listed above for this rotation. Self evaluations are used to determine whether or not a resident
achieved competency with the management of a specific goals.
Reading Assingments:
Comprehensive Gynecology: Morton A. Stenchever, MD (Author), William Droegemueller,
MD (Author), Arthur L. Herbst, MD (Author), Daniel Mishell Jr. MD (Author)
Clinical Urogynecology -Mickey M. Karram, MD and Mark D.Walters, MD
Clinical Gynecologic Endocrinology and Infertility: Leon Speroff (Author), Marc A. Fritz
(Author)
ACOG Compendium and Committee Opinions
Intrauterine Device
Medical Management of Tubal Pregnancy
Medical Management of Endometriosis
Management of Anovulatory Bleeding
Premenstrual Syndrome
Osteoporosis
Intrauterine Device
Human Papillomavirus
Vaginitis
Breast Cancer Screening
POSTGRADUATE YEAR ONE
Gynecologic Oncology Rotation- Two Months
The initial rotation on the gynecologic oncology service is designed to expose the resident to
both medical and surgical management of patients with gynecologic malignancies. The resident
will develop experience with preoperative and postoperative management and associated
complications more prevalent in these sometimes critically ill patients. The resident will have a
basic understanding of alterations of host defense mechanisms in patients undergoing extended
surgical procedures and those receiving chemotherapy and radiation therapy. The resident will
develop, through participation in the operating room, a thorough understanding of anatomy,
including vascular, lymphatic, and neuronal supply to the pelvis. Learning objectives are both
didactic (self reading, rounds and lectures, and patient evaluation) and technical (procedural
skills). At the completion of the rotation, the resident is to have read and have an understanding
of the didactic objectives outlined below. These objectives, whether covered during lecture,
rounds, conference, or resident self learning are to be considered a minimum for resident
learning during the rotation. Technical objectives will be evaluated on an ongoing basis by more
senior residents and Faculty.
Didactic and Management Goals and Objectives
The resident should make extensive use of the current literature to apply evidence-based
techniques for the rational management of medical and surgical obstetric conditions.
All
residents have access to online literature (i.e. Up to Date, Medscape, etc) and there are numerous
Obstetrics Books (most recent editions) available in the Resident Call Rooms, and the Resident
Clinic. In addition, all of the clinical sites have full service medical libraries with the more recent
OB/GYN journals available.
Patient Care
In this rotation, the resident is exposed to both medical and surgical management of patients with
gynecologic malignancies. In addition, the resident will develop experience with preoperative
and postoperative management and associated complications more prevalent in these sometimes
critically ill patients.
Technical and procedure experience is an evolutionary process through the four years of training.
Residents will be exposed to various procedures commensurate with their level of training.
Some procedures will require continued exposure to achieve competence while others will be
mastered after minimal exposure.
Following completion of the rotation, the resident is expected to have had, under supervision,
experience in:
1. Insertion of prolonged indwelling catheters
2. Thoracentesis
3. Paracentesis
4. Cone Biopsy/LEEP
5. Management of abdominal surgical incisions and closure
6. Surgical assist in standard and radical hysterectomy
7. Surgical assist for second look or debulking procedures
8. Insertion and removal of surgical drains
Following completion of the rotation, the resident is expected to have competence in:
1. Dilatation and curettage
2. Cervical biopsy
3. Management of surgical drains, catheters, and lines
Medical Knowledge
A. The resident will have an understanding of the epidemiology and risk factors for:
1. Cancer of the breast
2. Cancer of the cervix
3. Cancer of the uterus
4. Cancer of the ovary and peritoneum
5. Gestational trophoblastic neoplasia
B. The resident will have an understanding of the management of cervical cancer including:
1. Previous Pap results, history of HPV, and assessment of risk factors.
2. Findings on physical exam such as bleeding, discharge, ulceration, and adenopathy.
3. Diagnostic studies including Pap, colposcopy, endocervical curettage, conization and
biopsy.
4. The resident will have an understanding of the differential diagnosis, classification, and
staging of cervical cancer.
5. The resident will have an understanding of possible interventions and complications of
therapy for cervical cancer including surgery, chemotherapy, immunotherapy and
radiation
6. The resident will have an understanding of patient education and counseling,
psychosocial support, and appropriate follow-up of patients with cervical cancer.
C. The resident will have an understanding of evaluation and management of endometrial
hyperplasia including:
1. Obesity, anovulation, age of menarche and menopause, unopposed estrogen and family
history.
2. Physical findings including bleeding, pelvic exam, and lymphadenopathy.
3. Diagnostic studies including endometrial sampling and imaging studies.
4. Possible interventions including hormonal and surgical.
5. Factors influencing intervention including age and fertility desires.
6. Potential complications of therapy.
7. Follow-up and patient counseling.
D. The resident will have an understanding of the diagnosis and management of carcinoma of
the endometrium including:
1. Historical risk factors including abnormal bleeding, anovulation, unopposed estrogen,
and family history.
2. Physical findings and pelvic exam including lymphadenopathy.
3. Diagnostic studies including endometrial sampling and imaging studies, tumor markers,
hysteroscopy, and estrogen and progesterone receptors.
4. Classification and staging.
5. Possible interventions including surgery, radiation, and chemotherapy.
6. Factors influencing intervention including stage of disease and histology.
7. Potential complications of therapy.
8. Follow-up and patient counseling.
E. The resident should be able to recognize and know the principles of treatment for the
following postoperative complications:
1. Incision complications.
2. GI complications including ileus and obstruction.
3. Respiratory complications including atelectasis, pneumonia, and pulmonary embolism.
4. Hemorrhage.
5. Pelvic hematomas.
6. Post operative infection in the wound, cuff, urinary tract, and abdomen.
7. Dehiscence and wound evisceration.
F. The resident should have an understanding of care of the terminal patient including:
1. Symptoms of recurrent or metastatic cancer.
2. Physical findings suggestive of metastatic disease.
3. Work-up of various organ systems for detection of disease.
4. Possible interventions including operative, medical, pain management, and management
of associated morbidities.
5. Management of the complications of chemotherapy, radiation, and advanced
malignancies including: nausea and vomiting, chronic constipation, hematologic
abnormalities, radiation cystitis and colitis, and depression.
6. Implications on quality of life.
7. Hospice care.
8. DNR including medical, ethical, legal and advanced directive.
9. Dealing with emotional and social issues related to end of life care.
10. Appropriate teamwork between the primary service, consulting services, case
management, social work, home health services, and ancillary staff.
Interpersonal and Communication Skills
16. Sustain therapeutic and ethically sound relationships with patients, patients’ families, and
colleagues.
17. Provide effective and professional consultation to other physicians and health care
professionals.
18. Provide instruction and constructive feedback to other members of the health care team
as appropriate to the team member and resident’s level of training.
19. Communicate effectively with patients in language that is appropriate to their age and
educational, cultural, and socioeconomic background.
20. Maintain comprehensive, timely, and legible medical records.
21. Communicate effectively with other services including the ER during consultations
Professionalism
25. Demonstrate respect, compassion, integrity, responsiveness, and accountability to the
needs of patients and society that supersedes self-interest.
26. Demonstrate a commitment to excellence and ongoing professional development.
27. Describe basic ethical concepts such as: autonomy, beneficence, justice, and
nonmalefisence.
28. Describe the process of informed healthcare decision making, including the specific
components of an informed-consent discussion.
29. Demonstrate an understanding of the use of advanced directives, living wills, and durable
power of attorney for health care, as well as strategies for the resolution of ethical
conflicts.
30. Discuss important issues regarding stress management, substance abuse, and sleep
deprivation.
31. Describe current standards for the protection of health-related patient information.
32. Describe the procedures for obtaining and maintaining medical licensure, board
certification, credentialing, hospital staff privileges, and liability insurance.
Systems-Based Practice
1. Describe how types of medical practice and delivery systems differ from one another,
including methods of controlling health care costs and allocating resources.
2. Advocate for quality patient care and assist patients in dealing with system complexities.
3. Demonstrate the ability to discuss errors in management with peers and patients to
improve patient safety.
4. Describe basic medical-legal concepts regarding a professional liability claim and list the
steps in processing a claim.
Practice-Based Learning
16. Identify areas for personal and practice improvement and implementation strategies to
enhance knowledge, skills, attitudes, and processes of care.
17. Make a commitment to life-long learning.
18. Locate, appraise, and assimilate evidence from scientific studies related to their patients’
health problems.
19. Apply knowledge of study designs and statistical methods to the appraisal of clinical
studies and other information on diagnostic and therapeutic effectiveness.
20. Use information technology to manage information, access online medical information,
and support their education.
Evaluations
The PG I resident rotating on the Gynecologic Oncology service is evaluated using 360
evaluations. They are evaluated by their faculty, their patients, the ancillary staff, the senior
residents and themselves. The Gyn/Onc faculty completes the summative evaluations at the end
of the rotation. The evaluations are done based on the core competencies as outlined in the
Goals and Objectives that are listed above for this rotation. Self evaluations are used to
determine whether or not a resident achieved competency with the management of a specific
goals.
Reading Assignments:
TeLinde’s Operative Gyecology: John A. Rock (Editor), Howard W Jones (Editor)
Clinical Gyecologic Oncology: DiSaia and Creasman (Authors)
Normal Pelvic Floor Anatomy: K. Strohbehn, MD
ACOG Compendium and Committee Opinions
Diagnosis and Treatment of Cervical Carcinomas
Cervical Cytology Screening
Diagnosis and Treatment of Gestational Trophoblastic Disease
Management of Endometrial Cancer
Management of Abnormal Cervical Cytology and Histology
POSTGRADUATE YEAR ONE
Gynecology Rotation - Two Months
The goals and objectives of this rotation are to provide the resident with experience in the
management of pre-op and post-op patients undergoing major and minor gynecological
procedures. The resident will also be exposed to operative gynecologic procedures as primary
surgeon commensurate with the level of training. In addition, they will function as operative
assistants on more advanced surgical procedures. Learning objectives are both didactic (self
reading, rounds and lectures, and patient evaluation) and technical (procedural skills). At the
completion of the rotation, the resident is to have read and have an understanding of the didactic
objectives outlined below.
These objectives, whether covered during lecture, rounds,
conference, or resident self learning are to be considered a minimum for resident learning during
the rotation. Technical objectives will be evaluated on an ongoing basis by more senior residents
and faculty.
Didactic and Management Goals and Objectives
The resident should make extensive use of the current literature to apply evidence-based
techniques for the rational management of medical and surgical obstetric conditions.
All
residents have access to online literature (i.e. Up to Date, Medscape, etc) and there are numerous
Obstetrics Books (most recent editions) available in the Resident Call Rooms, and the Resident
Clinic. In addition, all of the clinical sites have full service medical libraries with the more recent
OB/GYN journals available.
Patient Care
The resident will learn to care for patients who are undergoing major and minor gynecologic
procedures. They will learn how to manage both pre-op and post-op patients. Technical and
procedure experience is an evolutionary process. Residents will be exposed to various
procedures commensurate with their level of training. Some procedures will require continued
exposure to achieve competence while others will be mastered after minimal exposure.
Following completion of the rotation, the resident is expected to have had experience, under
supervision, in:
1. Abdominal wall incisions
2. Abdominal and vaginal hysterectomy as an assistant
3. Laparoscopic and open ectopic pregnancy procedures
4. Adnexal surgery (non ectopic)
5. Hysteroscopy
6. Cervical conization/LEEP
7. Pregnancy termination
8. Sterilization
9. Cystoscopy
Following completion of the rotation, the resident is expected to be competent in:
1. Dilatation and curettage
2. Suction curettage
3. Exploration of the abdomen
4. Opening and closing the abdomen
Medical Knowledge
A. The resident will have an understanding of the physiologic principles related to the surgical
patient including:
1. Hemodynamic changes associated with blood loss
2. Principles of volume expansion and fluid replacement
3. Principles of cardiopulmonary function in the anesthetized and recovering patient
4. An understanding of pain management techniques in the recovering surgical patient
5. Appropriate fluid and electrolyte balance
6. Management of the GI tract post surgery
B. The resident will have an understanding of the following anatomic areas:
1. The abdominal wall
2. Relationship of the nongynecologic viscera
3. Abdominal and pelvic gynecologic viscera
4. Anatomy of the external genitalia
C. The resident should have an understanding of the diagnosis and management of early
complications of pregnancy including threatened abortion, incomplete abortion, molar
pregnancy, and ectopic pregnancy including:
1. Historical assessment of LMP, vaginal bleeding, abdominal pain, and obstetrical history
2. Physical examination of abdomen, uterus, and cervix
3. Diagnostic studies including qualitative hCG, hCG titer, progesterone, ultrasound, and
diagnostic laparoscopy
4. Identify threatened, inevitable, and incomplete abortion
5. Be aware of management interventions including medical and surgical
6. Be aware of complications of intervention and nonintervention
7. Understand need for follow-up, education and counseling, and RHIG prophylaxis
8. Be aware of predisposing factors for ectopic pregnancy
9. Recognize hypovolemia and shock
10. Have an understanding of the medical and surgical management of ectopic pregnancy
D. The resident should be able to recognize the principles of treatment for the following
postoperative complications:
1. Incision complications including wound infection, seroma, and dehiscence
2. GI complications including illeus and obstruction
3. Respiratory complications including atelectasis, pneumonia, and pulmonary embolism
4. Hemorrhage
5. Pelvic hematomas
6. Post operative infection in the wound, cuff, urinary tract, abdomen
7. Hypovolemia and anemia
8. Deep venous thrombosis and pulmonary embolism
9. Delirium
E. The resident should have an understanding of the surgical techniques for pregnancy
termination and associated complications.
F. The resident should have an understanding of the surgical techniques for voluntary
sterilization including mini-laparotomy, laparoscopy, hysteroscopy, and associated
complications.
Interpersonal and Communication Skills
22. Sustain therapeutic and ethically sound relationships with patients, patients’ families, and
colleagues.
23. Provide effective and professional consultation to other physicians and health care
professionals.
24. Provide instruction and constructive feedback to other members of the health care team
as appropriate to the team member and resident’s level of training.
25. Communicate effectively with patients in language that is appropriate to their age and
educational, cultural, and socioeconomic background.
26. Maintain comprehensive, timely, and legible medical records.
27. Demonstrate leadership skills with the medical students
28. Communicate effectively with other services and the ER regarding consultations
Professionalism
33. Demonstrate respect, compassion, integrity, responsiveness, and accountability to the
needs of patients and society that supersedes self-interest.
34. Demonstrate a commitment to excellence and ongoing professional development.
35. Describe basic ethical concepts such as: autonomy, beneficence, justice, and
nonmalefisence.
36. Describe the process of informed healthcare decision making, including the specific
components of an informed-consent discussion.
37. Demonstrate an understanding of the use of advanced directives, living wills, and durable
power of attorney for health care, as well as strategies for the resolution of ethical
conflicts.
38. Discuss important issues regarding stress management, substance abuse, and sleep
deprivation.
39. Describe current standards for the protection of health-related patient information.
40. Describe the procedures for obtaining and maintaining medical licensure, board
certification, credentialing, hospital staff privileges, and liability insurance.
Systems-Based Practice
1. Describe how types of medical practice and delivery systems differ from one another,
including methods of controlling health care costs and allocating resources.
2. Advocate for quality patient care and assist patients in dealing with system complexities.
3. Demonstrate the ability to discuss errors in management with peers and patients to
improve patient safety.
4. Describe basic medical-legal concepts regarding a professional liability claim and list the
steps in processing a claim.
Practice-Based Learning
21. Identify areas for personal and practice improvement and implementation strategies to
enhance knowledge, skills, attitudes, and processes of care.
22. Make a commitment to life-long learning.
23. Locate, appraise, and assimilate evidence from scientific studies related to their patients’
health problems.
24. Apply knowledge of study designs and statistical methods to the appraisal of clinical
studies and other information on diagnostic and therapeutic effectiveness.
25. Use information technology to manage information, access online medical information,
and support their education.
Evaluations
The PG I resident rotating on the Gynecology service is evaluated using 360 evaluations. They
are evaluated by their faculty, their patients, the ancillary staff, the senior residents and
themselves. The Urogynecology and General Gynecology faculty completes the summative
evaluations at the end of the rotation. The evaluations are done based on the core competencies
as outlined in the Goals and Objectives that are listed above for this rotation. Self evaluations are
used to determine whether or not a resident achieved competency with the management of a
specific goals.
Reading Assignments
TeLinde's Operative Gynecology: John A. Rock (Editor), Howard W Jones (Editor)
Comprehensive Gynecology: Morton A. Stenchever, MD (Author), William Droegemueller,
MD (Author), Arthur L. Herbst, MD
(Author), Daniel Mishell Jr. MD (Author)
Normal Pelvic Floor Anatomy- K. Strohbehn, MD
Clinical Urogynecology -Mickey M. Karram, MD and Mark D.Walters, MD
Clinical Gynecologic Endocrinology and Infertility: Leon Speroff (Author), Marc A. Fritz
(Author)
ACOG Compendium and Committee Opinions
Urinary Incontinence
Antibiotic Propylaxis for GYN procedures
Medical Management of Tubal Pregnancy
Medical and surgical management of Abortion
Chronic Pelvic Pain
Wound management in the postoperative patient
POSTGRADUATE YEAR ONE
FIRST OBSTETRICAL ROTATION - 2 MONTHS
(Labor & Delivery Days & Nights)
The initial block rotation on Labor and Delivery at the PG-I level is designed primarily to introduce the
resident to the management of routine, term, uncomplicated laboring patients. The resident will learn to
function as a team member under the direct supervision of faculty, fellows, and upper level residents.
Learning objectives are both didactic (self reading, rounds and lectures, and patient evaluation) and
technical (procedural skills). At the completion of the rotation, the resident is to have read and have an
understanding of the didactic objectives outlined below. These objectives, whether covered during
lecture, rounds, conference, or resident self learning, are to be considered a minimum for resident learning
during the rotation. Technical objectives will be evaluated on an ongoing basis by more senior residents
and faculty.
Didactic and Management Goals and Objectives
The resident should make extensive use of the current literature to apply evidence-based techniques for
the rational management of medical and surgical obstetric conditions. All residents have access to online
literature (i.e. Up to Date, Medscape, etc) and there are numerous Obstetrics Books (most recent editions)
available in the Resident Call Rooms, and the Resident Clinic. In addition, all of the clinical sites have
full service medical libraries with the more recent OB/GYN journals available.
Patient Care
The resident will learn to manage routine, term, uncomplicated laboring patients.
Technical and
procedure experience is an evolutionary process. Residents will be exposed to various procedures
commensurate with their level of training. Some procedures will require continued exposure to achieve
competence while others will be mastered after minimal exposure.
Following completion of the rotation, the resident is expected to have had, under supervision, experience
in:
1. Normal labor management and spontaneous vaginal delivery
2. Midline episiotomy repair
3. Repair of cervical and vaginal lacerations.
4. Repair of third and fourth degree lacerations.
5. Primary cesarean section.
6. Operative vaginal delivery with forceps and vacuum.
7. Circumcision using two or more techniques.
8. Postpartum tubal ligation.
9.
Management of labor induction.
Following completion of this rotation, the resident is expected to be competent in the following
procedures:
1. Assessment of cervical dilatation, effacement, station, and presenting part.
2. Assignment of Bishop score.
2. Application of external and internal fetal monitors including artificial rupture of membranes.
3. Application of equipment and performance of amnioinfusion.
4. The use of ultrasound to determine fetal position and number.
Medical Knowledge:
The resident by the end of the rotation will be able to obtain/perform:
A.
Historical assessment of low risk patient
1. Risk factors for pregnancy, onset of labor, status of membranes, presence of bleeding.
2. Level of prenatal care.
B.
Physical assessment
1. Admission physical exam.
2. Evaluation of status (frequency, duration, intensity) of contractions.
3. Fetal position and lie.
4. Pelvic exam for dilatation, effacement, station, and presenting part.
5. Assessment of maternal neurologic function.
6. Assessment of maternal and fetal vital signs.
C.
D.
Graphic identification of normal and abnormal labor patterns.
Indications for intrapartum fetal monitoring
1. Recognition of reassuring and non-reassuring heart rate patterns.
2. Understanding of pathophysiology of fetal heart rate patterns.
3. Role of further assessment of fetal well being including use of fetal scalp electrodes and
vibroacoustic and scalp stimulation techniques.
E. A basic understanding of the management of pain relief during labor.
F. A basic understanding of the role of ultrasound in determining fetal presentation.
G. A basic understanding of the causes of third trimester bleeding.
H. A basic understanding of the causes of and risk factors for postpartum hemorrhage.
I.
A basic understanding of risk factors for and treatment of chorioamnionitis and endometritis.
I.
A basic understanding of the risk factors for shoulder dystocia.
J. Immediate assessment of the newborn
1. Apgar score.
2. Principles of neonatal resuscitation.
3. Physical examination and assessment of gestational age, SGA, premature, LGA.
K. Maternal Postpartum Care
1. Routine postpartum physiologic changes
including assessment of abdominal and perineal
wounds.
2. Routine postpartum course.
3. Routine postpartum laboratory evaluation.
4. Recognition of causes of postpartum febrile morbidity.
5. A basic understanding of postpartum contraception options.
An understanding of the physiology of lactation and treatment of lactation complications
Interpersonal and Communication Skills
29. Sustain therapeutic and ethically sound relationships with patients, patients’ families, and
colleagues.
30. Provide effective and professional consultation to other physicians and health care professionals.
31. Provide instruction and constructive feedback to other members of the health care team as
appropriate to the team member and resident’s level of training.
32. Communicate effectively with patients in language that is appropriate to their age and
educational, cultural, and socioeconomic background.
33. Maintain comprehensive, timely, and legible medical records.
Professionalism
41. Demonstrate respect, compassion, integrity, responsiveness, and accountability to the needs of
patients and society that supersedes self-interest.
42. Demonstrate a commitment to excellence and ongoing professional development.
43. Describe basic ethical concepts such as: autonomy, beneficence, justice, and nonmalefisence.
44. Describe the process of informed healthcare decision making, including the specific components
of an informed-consent discussion.
45. Demonstrate an understanding of the use of advanced directives, living wills, and durable power
of attorney for health care, as well as strategies for the resolution of ethical conflicts.
46. Discuss important issues regarding stress management, substance abuse, and sleep deprivation.
47. Describe current standards for the protection of health-related patient information.
48. Describe the procedures for obtaining and maintaining medical licensure, board certification,
credentialing, hospital staff privileges, and liability insurance.
Systems-Based Practice
1. Describe how types of medical practice and delivery systems differ from one another, including
methods of controlling health care costs and allocating resources.
2. Advocate for quality patient care and assist patients in dealing with system complexities.
3. Demonstrate the ability to discuss errors in management with peers and patients to improve
patient safety.
4. Describe basic medical-legal concepts regarding a professional liability claim and list the steps in
processing a claim.
Practice-Based Learning
26. Identify areas for personal and practice improvement and implementation strategies to enhance
knowledge, skills, attitudes, and processes of care.
27. Make a commitment to life-long learning.
28. Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health
problems.
29. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and
other information on diagnostic and therapeutic effectiveness.
30. Use information technology to manage information, access online medical information, and
support their education.
Evaluations
The PG I resident rotating on the Obstetrics service is evaluated using 360 evaluations. They are
evaluated by their faculty, their patients, the ancillary staff, the senior residents and themselves. The
Obstetrics faculty completes the summative evaluations at the end of the rotation. The evaluations are
done based on the core competencies as outlined in the Goals and Objectives that are listed above for this
rotation. Self evaluations are used to determine whether or not a resident achieved competency with the
management of a specific obstetric goals.
Reading Assignments
Williams Obstetrics: Cunningham
Obstetrics: Gabbe
ACOG Compendium and Committee Opinions
Premature Rupture of Membranes
Operative Vaginal Delivery
Management of Preterm Labor
Antepartum Fetal Surveillance
Induction of Labor
Chronic Hypertension in Pregnancy
Shoulder dystocia
Vaginal Birth after Previous Cesarean Delivery
Management of Postterm Pregnancy
Intrapartum Fetal Heart Rate Monitoring
Episiotomy
Postpartum Hemorrhage
POSTGRADUATE YEAR ONE
Second Obstetrical Rotation - Two Months
(Labor & Delivery Days & Nights)
The second block rotation on Labor and Delivery at the PG-I level is designed primarily to
solidify the resident’s understanding of the management of routine, term, uncomplicated laboring
patients, and in addition, to develop a basic understanding of some common antepartum and
intrapartum complications. The resident will continue to develop teamwork skills, with an
emphasis on prioritizing activities and establishing efficient work habits. Greater attention
should be paid to teaching activities. Learning objectives are both didactic (self reading, rounds
and lectures, and patient evaluation) and technical (procedural skills). At the completion of the
rotation, the resident is to have read and have an understanding of the didactic objectives
outlined below.
These objectives, whether covered during lecture, rounds, conference, or
resident self learning are to be considered a minimum for resident learning during the rotation.
Technical objectives will be evaluated on an ongoing basis by more senior residents and faculty.
Didactic and Management Objectives
The resident should make extensive use of the current literature to apply evidence-based
techniques for the rational management of medical and surgical obstetric conditions.
All
residents have access to online literature (i.e. Up to Date, Medscape, etc) and there are numerous
Obstetrics Books (most recent editions) available in the Resident Call Rooms, and the Resident
Clinic. In addition, all of the clinical sites have full service medical libraries with the more recent
OB/GYN journals available.
Patient Care
The resident will learn to take care of patients with routine uncomplicated labor. The resident
will also participate in the management of some common antepartum and intrapartum
complications. Technical experience is an evolutionary process through the four years of
training. Residents will be exposed to various procedures commensurate with their level of
training. Some procedures will require continued exposure to achieve competence while others
will be mastered after minimal exposure.
Following completion of the rotation, the resident is expected to have had experience in:
1. Repair of cervical and vaginal lacerations
2. Repair of third and fourth degree lacerations
3. Primary and elective repeat cesarean section
4. Operative vaginal delivery with forceps and vacuum
5. Management of shoulder dystocia
6. Induction of labor using various techniques
Following completion of this rotation, the resident is expected to be competent in the following
procedures:
1. Normal labor management and spontaneous vaginal delivery
2. Repair of first and second degree perineal, as well as vaginal lacerations
3. Circumcision using Mogen and Gomco techniques
4. Postpartum tubal ligation
5. Basic neonatal resuscitation
6.
Placement of cervical ripening agents and cervical foley balloons
Medical Knowledge:
A.
Indications for induction of labor and cervical ripening
1. Complications of induction of labor.
2. Use and complications of cervical ripening agents.
3. Assignment of a Bishop score.
B.
1.
Identification of abnormal labor
Identification of risk factors for abnormal labor.
2.
Identification of possible interventions for abnormal labor including augmentation of
labor, uterine hyper and hypotonus.
3.
Maternal and fetal complications of intervention and nonintervention strategies.
4.
Understanding of the indications for, and risks of, operative vaginal delivery including
outlet forceps and vacuum delivery.
C.
Management of labor in a patient with a previous cesarean delivery (VBAC) including
maternal and fetal complications.
D. Risk factors for shoulder dystocia and neonatal complications
1. Therapeutic maneuvers for the management of shoulder dystocia.
E.
F.
Identification of risk factors for postpartum hemorrhage.
Identification of patients with pregnancy induced hypertension
1. Management of magnesium sulfate for the prevention of maternal seizures.
2. Maternal and neonatal complications of magnesium sulfate therapy.
G.
Identification of patients who present with PROM
1. Management of PROM at term.
2. Management of preterm PROM.
H.
A thorough understanding of neonatal resuscitation
Interpersonal and Communication Skills
34. Sustain therapeutic and ethically sound relationships with patients, patients’ families, and
colleagues.
35. Provide effective and professional consultation to other physicians and health care
professionals.
36. Provide instruction and constructive feedback to other members of the health care team
as appropriate to the team member and resident’s level of training.
37. Communicate effectively with patients in language that is appropriate to their age and
educational, cultural, and socioeconomic background.
38. Maintain comprehensive, timely, and legible medical records.
Professionalism
49. Demonstrate respect, compassion, integrity, responsiveness, and accountability to the
needs of patients and society that supersedes self-interest.
50. Demonstrate a commitment to excellence and ongoing professional development.
51. Describe basic ethical concepts such as: autonomy, beneficence, justice, and
nonmalefisence.
52. Describe the process of informed healthcare decision making, including the specific
components of an informed-consent discussion.
53. Demonstrate an understanding of the use of advanced directives, living wills, and durable
power of attorney for health care, as well as strategies for the resolution of ethical
conflicts.
54. Discuss important issues regarding stress management, substance abuse, and sleep
deprivation.
55. Describe current standards for the protection of health-related patient information.
56. Describe the procedures for obtaining and maintaining medical licensure, board
certification, credentialing, hospital staff privileges, and liability insurance.
Systems-Based Practice
1. Describe how types of medical practice and delivery systems differ from one another,
including
methods of controlling health care costs and allocating resources.
2. Advocate for quality patient care and assist patients in dealing with system complexities.
3.
Demonstrate the ability to discuss errors in management with peers and patients to
improve
patient safety.
4. Describe basic medical-legal concepts regarding a professional liability claim and list the
steps in
processing a claim.
Practice-Based Learning
31. Identify areas for personal and practice improvement and implementation strategies to
enhance knowledge, skills, attitudes, and processes of care.
32. Make a commitment to life-long learning.
33. Locate, appraise, and assimilate evidence from scientific studies related to their patients’
health problems.
34. Apply knowledge of study designs and statistical methods to the appraisal of clinical
studies and other information on diagnostic and therapeutic effectiveness.
35. Use information technology to manage information, access online medical information,
and support their education.
Evaluations
The PG I resident rotating on the Obstetrics service is evaluated using 360 evaluations. They are
evaluated by their faculty, their patients, the ancillary staff, the senior residents and themselves.
The Obstetrics faculty completes the summative evaluations at the end of the rotation. The
evaluations are done based on the core competencies as outlined in the Goals and Objectives that
are listed above for this rotation. Self evaluations are used to determine whether or not a resident
achieved competency with the management of a specific obstetric goals.
Reading Assignments
Williams Obstetrics: Cunningham
Obstetrics: Gabbe
ACOG Compendium and Committee Opinions
Premature Rupture of Membranes
Operative Vaginal Delivery
Management of Preterm Labor
Antepartum Fetal Surveillance
Induction of Labor
Chronic Hypertension in Pregnancy
Shoulder dystocia
Vaginal Birth after Previous Cesarean Delivery
Management of Postterm Pregnancy
Intrapartum Fetal Heart Rate Monitoring
Episiotomy
Postpartum Hemorrhage