Download Goals and Objectives R-IV

POSTGRADUATE YEAR FOUR
Continuity Clinic – Weekly
The goals and objectives of the weekly continuity clinic at the PG-IV level are to provide a
continuum of care for normal and high risk obstetrics, reproductive endocrinology and infertility,
diagnostic and work-up for pre-invasive and invasive malignant conditions and complete preand postoperative gynecologic management. The resident will have a complete understanding of
the diagnosis and management of primary health care for women. The PG-IV resident will be
able to handle the above issues with minimal consultation from faculty. Learning objectives will
be both didactic, ie., self reading, rounds and lectures, and patient evaluation, as well as
technical, ie., 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
No specific didactic and management goals and objectives are set for this rotation with the
exception of continued learning in the area of geriatric and adolescent medicine. Residents are
expected to read from appropriate sources regarding their continuity patients. All residents have
access to online literature (i.e. Up to Date, Medscape, etc) and there are numerous books in the
resident clinic for use at all times.
Patient Care
The resident will learn to take care of normal and high risk obstetrics, reproductive
endocrinology and infertility, diagnostic and work-up for pre-invasive and invasive malignant
conditions and complete pre- and postoperative gynecologic management. 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. The fourth year
the resident is expected to be competent in the following procedures.
1. Vulvar biopsy.
2. Ultrasonography, vaginal and abdominal.
3. Cautery and cryotherapy.
4. IUD insertion.
5. Fitting of pessary.
6. Implanon insertion and removal.
Medical Knowledge:
A. The resident will have a thorough understanding of the pharmacology, pharmacokinetics, and
pharmacodynamics associated with medications and age-associated changes in drug
absorption, distribution, metabolism, and elimination including:
1. Evaluation for causes of poor compliance such as vision or hearing difficulties, poor
memory, lack of access to pharmacy, or inability to pay.
2. The dose, route, and frequency alterations to compensate for age-associated changes in
clearance, bioavailability, and volume and distribution.
B. The resident will have a thorough understanding of adverse drug effects in the elderly patient
including:
1. Impact on mental or functional status.
2. Will use strategies to limit adverse drug effects.
3. Will have an understanding of age-associated uses of multiple medications and drug
interactions.
C. The resident will have a thorough understanding of ethical and legal issues involving the
geriatric patient including:
1. Family education and informed consent.
2. Determination of capacity.
3. Surrogate decision-making.
4. Evaluation of quality of life and refusal of treatment.
D. The resident will be able to develop techniques for harm-prevention using beneficence, nonmaleficence, autonomy, guardianship, and civil commitment.
E. The resident will understand and have the ability to communicate about life-sustaining
medical treatments versus futile treatments.
F. The resident will encourage advance directives and will have an understanding of:
1. Living will and durable power of attorney.
2. Do not resuscitate or hospitalize orders.
3. Withdrawal of treatment.
4. Aggressive palliation of pain and suffering.
G. The resident will have an understanding of elder abuse and neglect.
H. The resident will have a thorough understanding of coding and reimbursement issues of the
geriatric patient including:
1. Global service coverage.
2. Evaluation and Management and Preventive Services.
3. Laboratory evaluations.
4. Medicare and Medicaid coverage, coding, and reimbursement for office, inpatient, and
outpatient surgery.
Interpersonal and Communication Skills
Following completion of this rotation, the resident is expected to be able to:
1. Demonstrate leadership skills with the junior residents and medical students
2. Promote the team approach of patient care with nursing staff, social workers and all ancillary
staff to ensure comprehensive care of the clinic patient
4. Supervise the care of all patients at clinic
5. Communicate effectively with all patients and their family members both in person and on the
phone
Professionalism
Following completion of this rotation, the resident is expected to be able to:
1. Demonstrate respectfulness and compassion to all patients
2. Demonstrate respectfulness to all staff and allied health workers
2. Demonstrate respectfulness to all other residents and faculty members
3. Demonstrate honesty and integrity when interacting with patients and staff
4. Accept responsibility for patient care and management plans
5. Accept the teaching responsibilities of all medical students working with the RIV
Systems Based Practice
Following completion of this rotation, the resident is expected to be able to:
1. Be familiar with billing codes for common outpatient conditions and procedures
2. Identify system issues that contribute to poor patient care
3. Be familiar with home health care systems and community agencies that can improve patient
care
4. Effectively utilize systematic approaches to reduce errors and improve patient care
5. Effectively utilize hospital resources and outside resources to improve patient care
Practice Based Learning
Following completion of this rotation, the resident is expected to be able to:
1. Effectively utilize technology to manage information for patient care and self improvement
2. Know the essential books associated with the management of the outpatient
4. Know how the access ACOG Bulletins, Committee Opinions regarding the standards of
practice
5. Know how to access all online services to obtain pertinent up to date information regarding
outpatient issues
Evaluations
The PG IV 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)
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
Any topic pertinent to patients seen during continuity clinic
POSTGRADUATE YEAR FOUR
Family Health Center – Two Months
The PG-IV resident on the Family Health Center rotation is responsible, under supervision of
faculty, for management of the ambulatory care rotation and will assist in supervision of the
Family Health Center team in areas of primary care, routine and high risk prenatal care,
ambulatory GYN care, and resident continuity clinics. In addition, the resident will assist in
supervision of the following clinics:
colposcopy, urogynecology, endocrine/infertility,
ultrasound, GYN preoperative, and corresponding continuity clinics. Learning objectives will be
both didactic, ie., self reading, rounds and lectures, and patient evaluation, as well as technical,
ie., 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 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 clinic patients and conditions. All residents have
access to online literature (i.e. Up to date, Medscape, etc) and there are numerous Obstetric and
Gynecologic books available in the resident clinic. The PG-IV resident will also hold weekly
didactic sessions for medical students and bi-monthly didactic sessions for Family medicine
residents.
Patient Care
The resident will learn to handle the ambulatory care needs of the patients. They will learn to
manage high risk obstetrics patients and with patients who have gynecologic issues. 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. The
fourth year the resident is expected to be competent in the following procedures.
7. Colposcopy.
8. Vulvar biopsy.
9. Urethroscopy.
10. Simple cystometric studies.
11. Ultrasonography, vaginal and abdominal.
12. Hysteroscopy.
13. Laser, cautery and cryotherapy.
14. IUD insertion.
15. Fitting of pessary.
16. LEEP procedures.
17. Urethral dilatation.
18. Implanon insertion and removal.
19. Essure procedure
Medical Knowledge
Particular focus should be placed on screening, evaluation and counseling and immunization
history for the teen, reproductive, and peri- and postmenopausal woman.
The resident will have a thorough understanding of the diagnosis and management of patients
presenting with chronic pelvic pain including:
1. Historical factors such as duration of pain greater than 6 months, characteristics,
disability, predisposing pelvic pathology, physical or sexual abuse, depression, and
associated non-gynecologic conditions.
2. Physical examination findings including pelvic mass or nodularity, point-specific
myofascial component, cervical or vaginal discharge, or evidence of physical abuse.
3. Diagnostic studies to include appropriate cultures, ultrasound, identification of trigger
points, laparoscopy, and assessment of depression or anxiety disorders.
4. Differential diagnosis including specific pelvic pathology, non-gynecologic disorders,
myofascial syndrome, physical or sexual abuse, and pain of undetermined etiology
5. Possible management interventions including surgical correction, long-term antiinflammatory treatment, trigger point injections, antidepressants or counseling.
6. Factors influencing decisions regarding interventions including identified pathology,
degree of disability, presence of non-gynecologic disorders, affective disorders.
7. Potential complications of intervention including surgical and drug side effects.
8. Potential complications of non-intervention including progression f pathology, worsening
of symptoms and disability or continued physical or sexual abuse or continued
psychologic impairment.
9. Follow-up including patient education and counseling.
The resident will also have medical knowledge in the following areas:
1. Routine and high risk prenatal care.
2. Sexually transmitted diseases.
3. Contraception and counseling and pregnancy alternatives.
4. Reproductive endocrinology and infertility.
5. Urogynecology.
6. Preoperative evaluation and work-up for gynecologic surgeries.
7. Vaginal and abdominal ultrasound
8. Essure procedure-optimal candidates and counseling
Interpersonal and Communication Skills
Following completion of this rotation, the resident is expected to be able to:
1. Demonstrate leadership skills with the junior residents and medical students
2. Promote the team approach of patient care with nursing staff, social workers and all ancillary
staff to ensure comprehensive care of the clinic patient
4. Supervise the care of all patients at clinic
5. Communicate effectively with all patients and their family members both in person and on the
phone
Professionalism
Following completion of this rotation, the resident is expected to be able to:
1. Demonstrate respectfulness and compassion to all patients
2. Demonstrate respectfulness to all staff and allied health workers
3. Demonstrate respectfulness to all other residents and faculty members
4. Complete and fulfill responsibilities and respond promptly when paged
5. Demonstrate honesty and integrity when interacting with patients and staff
6. Accept responsibility for patient care and management plans
7. Accept the teaching responsibilities of all junior residents and medical student
8. Ensure all laboratory and pathology results are reviewed and communicated to patients as
necessary each day.
Systems Based Practice
Following completion of this rotation, the resident is expected to be able to:
1. Be familiar with billing codes for common outpatient conditions and procedures
2. Identify system issues that contribute to poor patient care
3. Be familiar with home health care systems and community agencies that can improve patient
care
4. Effectively utilize systematic approaches to reduce errors and improve patient care
5. Effectively utilize hospital resources and outside resources to improve patient care
Practice Based Learning
Following completion of this rotation, the resident is expected to be able to:
1. Effectively utilize technology to manage information for patient care and self improvement
2. Know the essential books associated with the management of the outpatient
4. Know how the access ACOG Bulletins, Committee Opinions regarding the standards of
practice
5. Know how to access all online services to obtain pertinent up to date information regarding
outpatient issues
Evaluations
The PG IV resident rotating on the FHC-SA service is evaluated using 360 evaluations. They are
evaluated by their faculty, their patients, the ancillary staff, the junior 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 specific outpatient conditions.
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
Urinary Incontinence
Pelvic Organ Prolapse
Medical Management of Tubal Pregnancy
Hormonal Contraception in Women with Co-existing Medical Conditions
Medical Management of Endometriosis
Management of Anovulatory Bleeding
Premenstrual Syndrome
Management of Infertility Caused by Ovulatory Dysfunction
Polycystic Ovary Syndrome
Osteoporosis
Menopause topics
Intrauterine Device
Human Papillomavirus
Vaginitis
POSTGRADUATE YEAR FOUR
Family Health Center – Two Months
The PG-IV resident on the Family Health Center rotation is responsible, under supervision of
faculty, for management of the ambulatory care rotation and will assist in supervision of the
Family Health Center team in areas of primary care, routine and high risk prenatal care,
ambulatory GYN care, and resident continuity clinics. In addition, the resident will assist in
supervision of the following clinics:
colposcopy, urogynecology, endocrine/infertility,
ultrasound, GYN preoperative, and corresponding continuity clinics. Learning objectives will be
both didactic, ie., self reading, rounds and lectures, and patient evaluation, as well as technical,
ie., 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 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 clinic patients and conditions. All residents have
access to online literature (i.e. Up to date, Medscape, etc) and there are numerous Obstetric and
Gynecologic books available in the resident clinic. The PG-IV resident will also hold weekly
didactic sessions for medical students and bi-monthly didactic sessions for Family medicine
residents.
Patient Care
The resident will learn to handle the ambulatory care needs of the patients. They will learn to
manage high risk obstetrics patients and with patients who have gynecologic issues. They will
be involved in the management of subspecialty issues such as infertility, oncology, and family
planning.
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. The
fourth year the resident is expected to be competent in the following procedures.
20. Colposcopy.
21. Vulvar biopsy.
22. Urethroscopy.
23. Simple cystometric studies.
24. Ultrasonography, vaginal and abdominal.
25. Hysteroscopy.
26. Laser, cautery and cryotherapy.
27. IUD insertion.
28. Fitting of pessary.
29. LEEP procedures.
30. Urethral dilatation.
31. Implanon insertion and removal.
32. Essure procedure
Medical Knowledge
Particular focus should be placed on screening, evaluation and counseling and immunization
history for the teen, reproductive, and peri- and postmenopausal woman.
The resident will have a thorough understanding of the diagnosis and management of patients
presenting with chronic pelvic pain including:
10. Historical factors such as duration of pain greater than 6 months, characteristics,
disability, predisposing pelvic pathology, physical or sexual abuse, depression, and
associated non-gynecologic conditions.
11. Physical examination findings including pelvic mass or nodularity, point-specific
myofascial component, cervical or vaginal discharge, or evidence of physical abuse.
12. Diagnostic studies to include appropriate cultures, ultrasound, identification of trigger
points, laparoscopy, and assessment of depression or anxiety disorders.
13. Differential diagnosis including specific pelvic pathology, non-gynecologic disorders,
myofascial syndrome, physical or sexual abuse, and pain of undetermined etiology
14. Possible management interventions including surgical correction, long-term antiinflammatory treatment, trigger point injections, antidepressants or counseling.
15. Factors influencing decisions regarding interventions including identified pathology,
degree of disability, presence of non-gynecologic disorders, affective disorders.
16. Potential complications of intervention including surgical and drug side effects.
17. Potential complications of non-intervention including progression f pathology, worsening
of symptoms and disability or continued physical or sexual abuse or continued
psychologic impairment.
18. Follow-up including patient education and counseling.
The resident will also have medical knowledge in the following areas:
9. Routine and high risk prenatal care.
10. Sexually transmitted diseases.
11. Contraception and counseling and pregnancy alternatives.
12. Reproductive endocrinology and infertility.
13. Urogynecology.
14. Preoperative evaluation and work-up for gynecologic surgeries.
15. Vaginal and abdominal ultrasound
16. Essure procedure-optimal candidates and counseling
Interpersonal and Communication Skills
Following completion of this rotation, the resident is expected to be able to:
1. Demonstrate leadership skills with the junior residents and medical students
2. Promote the team approach of patient care with nursing staff, social workers and all ancillary
staff to ensure comprehensive care of the clinic patient
4. Supervise the care of all patients at clinic
5. Communicate effectively with all patients and their family members both in person and on the
phone
Professionalism
Following completion of this rotation, the resident is expected to be able to:
1. Demonstrate respectfulness and compassion to all patients
2. Demonstrate respectfulness to all staff and allied health workers
3. Demonstrate respectfulness to all other residents and faculty members
4. Complete and fulfill responsibilities and respond promptly when paged
5. Demonstrate honesty and integrity when interacting with patients and staff
6. Accept responsibility for patient care and management plans
7. Accept the teaching responsibilities of all junior residents and medical student
8. Ensure all laboratory and pathology results are reviewed and communicated to patients as
necessary each day.
Systems Based Practice
Following completion of this rotation, the resident is expected to be able to:
1. Be familiar with billing codes for common outpatient conditions and procedures
2. Identify system issues that contribute to poor patient care
3. Be familiar with home health care systems and community agencies that can improve patient
care
4. Effectively utilize systematic approaches to reduce errors and improve patient care
5. Effectively utilize hospital resources and outside resources to improve patient care
Practice Based Learning
Following completion of this rotation, the resident is expected to be able to:
1. Effectively utilize technology to manage information for patient care and self improvement
2. Know the essential books associated with the management of the outpatient
4. Know how the access ACOG Bulletins, Committee Opinions regarding the standards of
practice
5. Know how to access all online services to obtain pertinent up to date information regarding
outpatient issues
Evaluations
The PG IV resident rotating on the FHC-SA service is evaluated using 360 evaluations. They are
evaluated by their faculty, their patients, the ancillary staff, the junior 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 specific outpatient conditions.
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
Urinary Incontinence
Pelvic Organ Prolapse
Medical Management of Tubal Pregnancy
Hormonal Contraception in Women with Co-existing Medical Conditions
Medical Management of Endometriosis
Management of Anovulatory Bleeding
Premenstrual Syndrome
Management of Infertility Caused by Ovulatory Dysfunction
Polycystic Ovary Syndrome
Osteoporosis
Menopause topics
Intrauterine Device
Human Papillomavirus
Vaginitis
POSTGRADUATE YEAR FOUR
Gynecology – Two Months
The PG-IV resident on the Gynecology rotation is responsible, under supervision of faculty, for
the management of the benign Gynecology Service and Emergency Room. The PG-IV resident
will be responsible for assigning junior residents to surgical cases commensurate with their
ability and level of training. The primary goals and objectives for this rotation are for the PG-IV
resident to focus upon more complicated surgical procedures including abdominal and vaginal
urogynecologic operations, operative laparoscopic procedures such as LAVH and adnexal
surgery and pelvic surgery where pelvic anatomy may be altered such as with large pelvic
masses, severe endometriosis, or pelvic inflammatory disease. Learning objectives will be both
didactic, i.e., self reading, rounds and lectures, and patient evaluation, as well as technical, i.e.,
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 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 gynecologic conditions. The PGIV resident should also review in detail the preoperative, operative, and postoperative
management of the geriatric patient. All residents have access to online literature (i.e. Up to
Date, Medscape, etc) and there are numerous Major Gynecology 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 be involved in the management of patients with complex gynecologic
disorders. They should be able to understand that certain procedures should only be done in
certain cases. 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. The fourth year the resident is expected to be competent in the following procedures.
1. Anterior and posterior colporrhaphy.
2. Colpotomy.
3. Repair of fistulas.
4. Excision of vaginal and uterine septi.
5. Perineorrhaphy.
6. Repair of enterocele and uterosacral plication.
7. Abdominal hysterectomy.
8. Vaginal hysterectomy.
9. Hysteroscopy.
10. Myomectomy.
11. Oophorectomy.
12. Ovarian cystectomy.
13. Salpingostomy and salpingectomy.
14. Abdominal exploration.
15. Exposure of major vessels and ureters.
16. Repair of bowel injuries.
17. Repair of bladder injuries.
18. Cystourethropexy.
19. Complex operative laparoscopy
20. Refine skills form surgeries learned as a second and third year resident
MEDICAL KNOWLEDGE
Following completion of this rotation, the resident is expected to have core knowledge of:
1. Work up and surgical and medical management of ectopic pregnancy
2. Indications and all complications of all Major GYN
3. Vaginal and abdominal urogynecologic procedures.
4. Anterior and posterior colporrhaphy.
5. Pelvic floor and support reconstruction.
6. Indications and complications of Laparoscopic surgery
7. Abdominal exploration.
8. Critical care of the GYN patient
9. Preoperative and Postoperative care of the Gynecologic patient
10. Management of patients with Pelvic Inflammatory Disease
11. Management of benign Adnexal Masses
12. Staging and management of endometriosis
13. Management of uterine abnormalities (i.e. fibroids)
14. Management of wound dehiscence and or complications
INTERPERSONAL AND COMMUNICATION SKILLS
Following completion of this rotation, the resident is expected to be able to:
1. Demonstrate leadership skills with the junior residents and medical students
2. Promote the team approach of patient care with nursing staff, social workers and all ancillary
staff to ensure comprehensive care of the gynecologic patient
3. Communicate effectively with other services and the ER regarding consultations
4. Coordinate the care of all patients on the Gynecology service
5. Communicate effectively with all patients—in particular difficult patients
PROFESSIONALISM
Following completion of this rotation, the resident is expected to be able to:
1. Demonstrate respectfulness and compassion to all patients
2. Demonstrate respectfulness to all staff and allied health workers
3. Demonstrate respectfulness to all other residents and faculty members
4. Complete and fulfill responsibilities and respond promptly when on call or paged
5. Demonstrate honesty and integrity when interacting with patients and staff
6. Accept responsibility for patient care and management plans
7. Accept the teaching responsibilities of all junior residents and medical students
8. Communicate effectively with other services and the ER regarding consultations
9. Coordinate the care of all patients on the Gynecology service along with the Attending
SYSTEMS BASED PRACTICE
Following completion of this rotation, the resident is expected to be able to:
1. Be familiar with billing codes for common gynecologic procedures
2. Identify system issues that contribute to poor patient care
3. Be familiar with home health care systems and agencies that can assist patients at home
4. Effectively utilize systematic approaches to reduce errors and improve patient care
5. Effectively utilize hospital resources and outside resources to improve patient care
PRACTICE BASED LEARNING
Following completion of this rotation, the resident is expected to be able to:
1. Effectively utilize technology to manage information for patient care and self improvement
2. Know the essential books associated with the management of Gynecologic surgeries and
Management of Gynecologic Issues
3. Prepare cases for M&M and stats presentations
4. Know how the access ACOG Bulletins, Committee Opinions regarding the standards of
practice
5. Know how to access all online services to obtain pertinent up to date information regarding
Gynecologic issues and management
Evaluations
The PG IV resident rotating on the Gynecology service is evaluated using 360 evaluations. They
are evaluated by their faculty, their patients, the ancillary staff, the junior residents and
themselves. The Gynecology and the Urogynecology faculty complete the summative
evaluations at the end of the rotation. Once during each rotation, the PG IV resident on the
Gynecology Service prepares a case list as they would need to do for their Oral Board
Certification Examination. These cases are presented and questions are asked by the entire
faculty during our M&M educational session. This M&M or case list presentation evaluates the
resident knowledge of the patients and prepares the resident for their oral boards. 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 gynecologic disorder or had only
exposure to a specific disorder or procedure.
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
Willaims Gynecology
Clinical Gynecologic Endocrinology and Infertility: Leon Speroff (Author), Marc A. Fritz
(Author)
ACOG Compendium and Committee Opinions
Urinary Incontinence
Antibiotic Propylaxis for GYN procedures
Pelvic Organ Prolapse
Medical Management of Tubal Pregnancy
Surgical Alternatives to Hysterectomy
Patient Safety in Obstetrics and Gynecology (CO #447 2009)
Hormonal Contraception in Women with Co-existing Medical Conditions
Abortion Access and Training (CO #424 January 2009)
POSTGRADUATE YEAR FOUR
GYN Oncology – Two Months
The PG-IV resident on Gynecologic Oncology is responsible, under supervision of the faculty,
for management of the GYN/Oncology service. The goals and objectives of this rotation will
ensure that the PG-IV resident has a thorough understanding of the anatomy of the reproductive
tract in order to appropriately treat patients with gynecologic malignancies. The resident will
focus learning on surgical anatomy, vascular and lymphatic supply to the pelvic organs, and
anatomic relationships of non-gynecologic viscera encountered during surgical therapy.
In
addition, the resident will focus on embryologic and developmental biology in order to
appreciate tumor potential related to gonadal migration, gonadal dysgenesis, and ovarian germ
cells.
The resident will develop a thorough understanding in the areas of pharmacology,
chemotherapy, and medical complications of treatment of oncology patients.
Learning objectives will be both didactic, i.e., self reading, rounds and lectures, and patient
evaluation, as well as technical, i.e., 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 Faculty.
Didactic and Management Goals and Objectives
The resident will review the aspects of critical care outlined in the goals and objectives for the
PG-II oncology rotation, and the resident will review the goals and objectives related to the
management of the terminal care patient outlined in the PG-I rotation. All residents have access
to online literature (i.e. Up to Date, Medscape, etc) and there are numerous Major Gynecology
and Oncology 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 the critically ill patient that has some type of gynecologic
cancer. They will learn to be able to give bad new to patients with cancer. 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. The fourth year
the resident is expected to be competent in the following procedures.
Following completion of this rotation, the resident is expected to be competent in the following
procedures:
1. Colposcopy.
2. Vulvar biopsy and excision of mass.
3. Abdominal or vaginal hysterectomy.
4. Oophorectomy and ovarian cystectomy.
5. Uterine and internal iliac artery ligation.
6. Pelvic lymph node sampling and resection.
7. Omentectomy.
8. Exposure of major vessels and ureters.
9. Repair of bowel and bladder injuries.
10. Appendectomy.
Medical Knowledge:
Following completion of this rotation, the resident is expected to have core knowledge of:
1. Surgical and medical management of patients with invasive carcinoma of the cervix.
2. Surgical and medical management of patients with carcinoma of the endometrium.
3. Surgical and medical management of patients with carcinoma of the ovary.
4. Surgical experience in radical hysterectomy
5. Surgical experience in debulking procedures.
6. Surgical experience in pelvic lymphadenectomy
7. Surgical experience in bowel and urinary diversion procedures.
8. Chemotherapeutic protocols for GYN malignancy.
9. Repair of fistulas.
A. The resident will also have a thorough understanding of preinvasive vulvar lesions including:
1. Historical factors such as itching, bleeding, mass, recurrent vulvitis.
2. Findings on physical examination including red, white, or pigmented lesions, redness,
excoriation, and masses.
3. Diagnostic studies including colposcopy and biopsy.
4. Differential diagnosis to include vulvar dystrophies and dermatoses, carcinoma insitu and
Paget’s disease.
5. Management interventions including topical medical therapy and surgery.
6. Factors influencing intervention including stage and extent of disease, age of patient, and
preferences.
7. Complications of intervention including adverse drug reactions, operative complications,
and cosmetic deformity.
8. Complications of non-intervention including pain, discomfort, psychosocial implications,
and malignancy.
9. Follow-up, patient education and counseling.
B. The resident will have a thorough understanding of the diagnosis and treatment of vulvar
carcinoma including:
1. Historical factors such as itching, bleeding, and chronic vulvitis.
2. Physical
examination
including
bleeding,
mass,
ulceration,
and
inguinal
lymphadenopathy.
3. Diagnosis studies such as biopsy.
4. Diagnosis, FIGO classification and staging.
5. Possible management interventions including surgical, radiation, and chemotherapy.
6. Factors influencing intervention including age, stage of disease, patient preference,
underlying medical conditions.
7. Potential complications of intervention including drug, operative, and radiation sideeffects.
8. Potential complications of non-intervention including morbidity and mortality.
9. Appropriate follow-up including patient education, counseling, and multidisciplinary
approach.
C. The resident will have a thorough understanding of the diagnosis and treatment of
preinvasive vaginal/cervical neoplasia including.
1. Historical aspect of risk factors, HPV, and PAP test.
2. Findings on physical examination.
3. Diagnostic studies including PAP smear, colposcopy and biopsy.
4. Differential diagnosis to exclude benign lesions.
5. Possible management interventions including observation, biopsy, or cry laser or topical
cytotoxic treatments.
6. Factors influencing intervention including age, classification of disease, future fertility.
7. Potential complications of intervention including operative and topical agent
complications.
8. Potential complications of non-intervention including progression of underlying infection
and underlying malignancy.
D. The resident will have a thorough understanding of the diagnosis and management of
carcinoma of the vagina including:
1. Historical aspects of bleeding, pain, discharge and DES exposure.
2. Physical
examination
revealing
mass,
ulceration,
abnormal
epithelium,
or
lymphadenopathy.
3. Diagnostic studies including PAP smear, colposcopy, and biopsy.
4. Differential diagnosis to exclude other causes of vaginal lesions as well as staging and
classification of vaginal carcinoma including squamous, adeno, clear cell, and sarcoma.
5. Possible management interventions including local or radical excision, laser ablation,
radiation therapy or chemotherapy.
6. Factors influencing decisions regarding intervention including age, stage of disease and
cell type, patient preference, previous therapy, and patient condition.
7. Potential complications of intervention including side effects of radiation, drugs and
surgery.
8. Potential complications of non-intervention including morbidity and mortality.
9. Follow-up including education and counseling, multidisciplinary approach, patterns and
timing of recurrence, and management of recurrence.
E. The resident will have a thorough understanding of the diagnosis and management of uterine
sarcoma including:
1. Historical findings of abnormal bleeding, pain, and abdominal pass.
2. Physical examination revealing uterine enlargement or adenopathy.
3. Diagnostic studies including endocervical and endometrial sampling, imaging studies,
and tumor markers.
4. Diagnosis to include differential diagnosis of benign disease and classification of
endometrial, mullerian, and leiomyosarcoma.
5. Management interventions including surgery, radiation, and chemotherapy.
6. Factors influencing intervention including classification of disease, age, and future
fertility.
7. Potential complications of intervention including side effects of drugs, radiation, and
surgery.
8. Potential complications of non-intervention including morbidity and mortality.
9. Follow-up including patient education and counseling, continued evaluation and
observation, and multidisciplinary approach.
F. The resident will have a thorough understanding of the diagnosis and management of ovarian
cancer including:
1. Historical findings of abdominal pain, bloating, early satiety, vagueness of symptoms.
2. Physical examination revealing ovarian enlargement.
3. Diagnostic studies including CA-125, CT imaging, Ultrasound.
4. Differential diagnosis of ovarian cancer and the different types.
5. Management interventions including surgery and chemotherapy.
6. Factors influencing intervention including stage of disease, age, future fertility.
7. Potential complications of non-intervention including morbidity and mortality.
8. Follow-up including patient education and counseling, continued evaluation and
observation, and multidisciplinary approach.
Interpersonal and Communication Skills
Following completion of this rotation, the resident is expected to be able to:
1. Demonstrate leadership skills with the junior residents and medical students
2. Promote the team approach of patient care with nursing staff, social workers and all ancillary
staff to ensure comprehensive care of the gynecologic oncology patient
3. Communicate effectively with other services and the ER regarding consultations
4. Coordinate the care of all patients on the Gynecology/Oncology service
5. Communicate effectively with all patients—in particular difficult patients
Professionalism
Following completion of this rotation, the resident is expected to be able to:
1. Demonstrate respectfulness and compassion to all patients
2. Demonstrate respectfulness to all staff and allied health workers
3. Demonstrate respectfulness to all other residents and faculty members
4. Complete and fulfill responsibilities and respond promptly when on call or paged
5. Demonstrate honesty and integrity when interacting with patients and staff
6. Accept responsibility for patient care and management plans
7. Accept the teaching responsibilities of all junior residents and medical students
8. Communicate effectively with other services and the ER regarding consultations
9. Coordinate the care of all patients on the Gynecology/Oncology service along with the
Attending and Fellow
Systems Based Practice
Following completion of this rotation, the resident is expected to be able to:
1. Be familiar with billing codes for common gynecologic oncology procedures
2. Identify system issues that contribute to poor patient care
3. Be familiar with home health care systems and agencies that can assist patients at home
4. Effectively utilize systematic approaches to reduce errors and improve patient care
5. Effectively utilize hospital resources and outside resources to improve patient care
Practice Based Learning
Following completion of this rotation, the resident is expected to be able to:
1. Effectively utilize technology to manage information for patient care and self improvement
2. Know the essential books associated with the management of Gynecologic Oncology surgeries
and Management of Gynecologic Oncology Issues
3. Prepare cases for M&M and stats presentations
4. Know how the access ACOG Bulletins, Committee Opinions regarding the standards of
practice
5. Know how to access all online services to obtain pertinent up to date information regarding
Gynecologic Oncology issues and management.
Evaluations
The PG IV resident rotating on the Gynecology/Oncology service is evaluated using 360
evaluations. They are evaluated by their faculty, their patients, the ancillary staff, the junior
residents and themselves. The Gynecology/Oncology attending and fellows complete the
summative evaluations at the end of the rotation. Once during each rotation, the PG IV resident
on the Gynecology/Oncology Service
prepares a case list as they would need to do for their Oral Board Certification Examination.
These cases are presented and questions are asked by the entire faculty during our M&M
educational session. This M&M or case list presentation evaluates the resident knowledge of the
patients and prepares the resident for their oral boards. 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 specific gynecologic oncology cases.
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
Prophylactic Oophorectomy
Prevention of Deep Vein Thrombosis and Pulmonary Embolism
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 FOUR-Kaiser Anaheim
Kaiser – Two Months
OBSTETRICAL CARE:
1.
At the end of this rotation, the fourth year resident will be able to evaluate, diagnose and
manage the intrapartum and postpartum care of routine and complicated obstetrical patients.
2.
The resident will be able to discuss the differential diagnosis and treatment options including
the risks, benefits and complications of each option.
GYNECOLOGICAL SURGERY:
1.
At the end of this rotation, the fourth year resident -will be able to perform a wide range of
gynecological procedures including. abdominal hysterectomy, vaginal hysterectomy,
laparoscopy both diagnostic and operative, adnexal surgery, appendectomy, myomectomy,
minor surgeries such as dilatation and curettage, cold knife cone biopsy, laser ablation and
vaginal/vulvar excisional biopsies.
2.
The resident will be able to discuss the procedures performed along with the risks, benefits,
and complications of each. The resident will be able to discuss the variations of each
procedure performed.
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 clinic patients and conditions. All residents have
access to online literature (i.e. Up to date, Medscape, etc) and there are numerous Obstetric and
Gynecologic books available in call rooms. In addition, there is a full service medical library
with the most recent Ob/Gyn articles available.
Patient Care
The resident will be able to manage the antepartum, intrapartum and post partum care of 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. The
fourth year the resident is expected to be competent in the following procedures:
1. Abdominal hysterectomy with and without adnexal removal
2. Vaginal hysterectomy with and without adnexal removal
3. Laparoscopic assisted vaginal hysterectomy
4. MMK and Burch procedures
5. Operative pelviscopy
6. Myomectomy
7. Diagnostic and operative hysteroscopy
8. Anterior and posterior colporrhaphy
9. Pelvic floor suspension procedures
10. Vesicovaginal fistula
11. Rectovaginal fistula
12. Cold knife cone
13. Laser ablation of vagina/vulva
14. Vulvar/vaginal excisional biopsies
Medical Knowledge:
1.
Indications and complications of all major GYN procedures
2. Vaginal and abdominal urogynecologic procedures
3. Anterior and posterior colporrhaphy
4. Pelvic floor and support reconstruction
5. Indications and complications of Laparoscopic surgery
6. Abdominal exploration
7. Preoperative and postoperative care of the GYN patient
8. Management of pelvic masses
9. Staging and management of endometriosis
10. Management of uterine abnormalities
11. Management of wound dehiscence or other wound complications
12. Use of diagnostic and operative hysteroscopy
13. Causes and management of fistulas
14. Vaginal and cervical malignancies
Interpersonal and Communication skills
Following completion of this rotation, the resident is expected to be able to:
1. Promote the team approach of patient care with nursing staff, social workers and all ancillary
staff to ensure comprehensive care of the obstetrics and gynecology patient
2. Communicate effectively with other services including ER physicians and staff
3. Communicate effectively with all patients and families—in particular difficult situations
Professionalism
Following completion of this rotation, the resident is expected to be able to:
1. Demonstrate respectfulness and compassion to all patients
2. Demonstrate respectfulness to all staff and allied health workers
3. Demonstrate respectfulness to all other residents and faculty members
4. Complete and fulfill responsibilities and respond promptly when on call or paged
5. Demonstrate honesty and integrity when interacting with patients and staff
6. Accept responsibility for patient care and management plans
7. Communicate effectively with other services
Systems Based Practice
Following completion of this rotation, the resident is expected to be able to:
1. Be familiar with billing codes for common obstetric and gynecologic procedures
2. Identify system issues that contribute to poor patient care
3. Effectively utilize systematic approaches to reduce errors and improve patient care
4. Effectively utilize hospital resources and outside resources to improve patient care
Practice Based Learning
Following completion of this rotation, the resident is expected to be able to:
1. Effectively utilize technology to manage information for patient care and self improvement
2. Know the essential books associated with the management of Obstetrics and Gynecology
3. Know how the access ACOG Bulletins, Committee Opinions regarding the standards of
practice
4. Know how to access all online services to obtain pertinent up to date information regarding
Obstetric and Gynecologic issues and management
Evaluations
The PG IV resident rotating on the Kaiser service is evaluated using 360 evaluations. They are
evaluated by their faculty, their patients, the ancillary staff, and themselves. The Kaiser 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 and gynecologic cases.
Reading Assignments
Williams Obstetrics: Cunningham (Author)
Obstetrics: Gabbe (Author)
TeLinde’s Operative Gynecology: John A. Rock (Editor), Howard W Jones (Editor)
Comprehensive Gynecology:
Morton A. Stenchever, MD, William Droegemueller, MD,
Arthur Herbst, MD, Daniel Mishell Jr. MD (Authors)
Clinical Gynecologic Oncology: Disaia and Creasman (Authors)
ACOG Compendium and Committee Opinions
Management of Preterm Labor
Chronic Hypertension in Pregnancy
Diagnosis and Management of Preeclampsia and Eclampsia
Surgical Alternatives to Hysterectomy
Urinary Incontinence
Antibiotic Prophylaxis for GYN procedures
Pelvic Organ Prolapse
Chronic Pelvic Pain
Human Papillomavirus
Management of Abnormal Cervical Cytology and Histology
POSTGRADUATE YEAR FOUR
LBMC – Two Months
The PG-IV resident on the LBMC rotation is responsible, under supervision of faculty, for the
management of the benign Gynecology Service and Ambulatory clinics.
The PG-IV resident
will be responsible for assigning junior residents to surgical cases commensurate with their
ability and level of training. The primary goals and objectives for this rotation are for the PG-IV
resident to focus upon more complicated surgical procedures including abdominal and vaginal
urogynecologic operations, operative laparoscopic procedures such as LAVH and adnexal
surgery and pelvic surgery where pelvic anatomy may be altered such as with large pelvic
masses, severe endometriosis, or pelvic inflammatory disease. Learning objectives will be both
didactic, ie., self reading, rounds and lectures, and patient evaluation, as well as technical, ie.,
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 faculty.
Didactic and Management Goals and Objectives
The didactic objectives for the Gynecology PG-I, II, and III levels, as well as obstetrical high
risk objectives should be reviewed as appropriate. The resident should make extensive use of the
current literature to apply evidence-based techniques for the rational management of medical and
surgical obstetrical and gynecologic conditions.
Patient Care
The resident should primarily focus upon more complicated surgical procedures including
abdominal and vaginal operations. There should learn laparoscopic procedures such as LAVH
and adnexal surgery and pelvic surgery where pelvic anatomy may be altered such as with large
pelvic masses, severe endometriosis, or pelvic inflammatory disease.
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. The
fourth year the resident is expected to be competent in the following procedures.
1. Anterior and posterior colporrhaphy
2. Colpotomy
3. Repair of fistulas
4. Excision of vaginal and uterine septi
5. Perineorrhaphy
6. Repair of enterocele and uterosacral plication
7. Abdominal hysterectomy
8. Vaginal hysterectomy
9. Hysteroscopy
10. Myomectomy
11. Oophorectomy
12. Ovarian cystectomy
13. Salpingostomy and salpingectomy
14. Abdominal exploration
15. Exposure of major vessels and ureters
16. Repair of bowel injuries
17. Repair of bladder injuries
18. Cystourethropexy
Medical Knowledge:
Following completion of this rotation, the resident is expected to have core knowledge of:
1. Medical and surgical management of ectopic pregnancy
2. Vaginal and abdominal hysterectomy
3. Vaginal and abdominal urogynecologic procedures
4. Anterior and posterior colporrhaphy
5. Pelvic floor and support reconstruction
6. Abdominal exploration
7. Indications and complications of all major GYN and OB procedures
8. Management of the benign adnexal mass
9. Management of wound dehiscence and or complications
10. Management of the high risk obstetric patient
11. Indication for cesarean section
12. Diagnosis and management of ovarian torsion
13. Diagnosis and management of vaginal bleeding in pregnancy
14. Management of obstetrical emergencies
Interpersonal and Communication skills
Following completion of this rotation, the resident is expected to be able to:
1. Demonstrate leadership skills with the junior residents and medical students
2. Promote the team approach of patient care with nursing staff, social workers and all ancillary
staff to ensure comprehensive care of the obstetrics and gynecology patient
3. Communicate effectively with other services including ER physicians and staff
4. Coordinate the care of all patients on the Long Beach clinic service
5. Communicate effectively with all patients and families—in particular difficult situations
Professionalism
Following completion of this rotation, the resident is expected to be able to:
1. Demonstrate respectfulness and compassion to all patients
2. Demonstrate respectfulness to all staff and allied health workers
3. Demonstrate respectfulness to all other residents and faculty members
4. Complete and fulfill responsibilities and respond promptly when on call or paged
5. Demonstrate honesty and integrity when interacting with patients and staff
6. Accept responsibility for patient care and management plans
7. Accept the teaching responsibilities of all junior residents and medical students
8. Communicate effectively with other services
9. Coordinate the care of all patients on the Long Beach clinic service along with the Attending
Systems Based Practice
Following completion of this rotation, the resident is expected to be able to:
1. Be familiar with billing codes for common obstetric and gynecologic procedures
2. Identify system issues that contribute to poor patient care
3. Effectively utilize systematic approaches to reduce errors and improve patient care
4. Effectively utilize hospital resources and outside resources to improve patient care
Practice Based Learning
Following completion of this rotation, the resident is expected to be able to:
1. Effectively utilize technology to manage information for patient care and self improvement
2. Know the essential books associated with the management of Obstetrics and Gynecology
3. Know how the access ACOG Bulletins, Committee Opinions regarding the standards of
practice
5. Know how to access all online services to obtain pertinent up to date information regarding
Obstetric and Gynecologic issues and management
Evaluations
The PG IV resident rotating on the Long Beach service is evaluated using 360 evaluations. They
are evaluated by their faculty, their patients, the ancillary staff, the junior residents and
themselves. The Long Beach 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 and gynecologic cases.
Reading Assignments
Williams Obstetrics: Cunningham
Obstetrics: Gabbe
TeLinde’s Operative Gynecology: John A. Rock (Editor), Howard W Jones (Editor)
Comprehensive Gynecology: Morton A. Stenchever, MD (Author), William Droegemueller,
MD (Author), Arthur Herbst, MD (Author), Daniel Mishell Jr. MD (Author)
ACOG Compendium and Committee Opinions
Prevention of Rh D Alloimmunization
Thrombocytopenia in Pregnancy
Intrauterine Growth Restriction
Management of Recurrent Early Pregnancy Loss
Prenatal Diagnosis of Fetal Chromosomal Abnormalities
Thyroid Disease in Pregnancy
Management of Preterm Labor
Chronic Hypertension in Pregnancy
Diagnosis and Management of Preeclampsia and Eclampsia
Medical Management of Tubal Pregnancy
Surgical Alternatives to Hysterectomy
POSTGRADUATE YEAR FOUR
Obstetrics – Two Months
The PG-IV resident will, under supervision of the faculty, be responsible for running the labor
and delivery unit and the antepartum and postpartum service. Management decisions on all
normal and high risk patients are the ultimate responsibility of the Chief Resident on obstetrics.
The PG-IV resident will coordinate patient care amongst other clinical services as dictated by
patient need. Learning objectives will be both didactic, ie., self reading, rounds and lectures, and
patient evaluation, as well as technical, ie., 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 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 manage both the low and high-risk obstetric patients. The resident will also
help to coordinate the care of the patients with other services. 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. The fourth year the
resident is expected to be competent in the following procedures.
1. Genetic amniocentesis
2. External cephalic version
3. Cervical cerclage
4. Vaginal breech delivery
5. Gynecologic surgery in the pregnant patient, ie., appendectomy, adnexal surgery, cesarean
hysterectomy, management of pelvic hematomas
6. Assisted outlet vaginal delivery
7. Management of shoulder dystocia
Medical Knowledge
Following completion of this rotation, the resident is expected to have core knowledge of:
1. Work up and management of the preeclamptic patient
2. Work up and management of PPROM
3. Indications for cesarean section
4. Management of shoulder dystocia
5. All aspects of vaginal delivery
6. Outlet assisted vaginal delivery
7. Surgical and postoperative management of cesarean hysterectomy
8. Management of pyelonephritis in pregnancy
9. Management of diabetes in pregnancy
10. Management of wound dehiscence and or complications
11. Knowledge of major fetal anomalies/chromosome abnormalities
12. Work up of anemia
13. Work up and management of IUFD or recurrent pregnancy loss
14. Management of all obstetric emergencies
15. Management of preterm labor
Interpersonal and Communication skills
Following completion of this rotation, the resident is expected to be able to:
1. Demonstrate leadership skills with the junior residents and medical students
2. Promote the team approach of patient care with nursing staff, social workers and all ancillary
staff to ensure comprehensive care of the obstetric patient
3. Communicate effectively with other services
4. Coordinate the care of all patients on the Obstetric service
5. Communicate effectively with all patients—in particular difficult patients
Professionalism
Following completion of this rotation, the resident is expected to be able to:
1. Demonstrate respectfulness and compassion to all patients
2. Demonstrate respectfulness to all staff and allied health workers
3. Demonstrate respectfulness to all other residents and faculty members
4. Complete and fulfill responsibilities and respond promptly when on call or paged
5. Demonstrate honesty and integrity when interacting with patients and staff
6. Accept responsibility for patient care and management plans
7. Accept the teaching responsibilities of all junior residents and medical students
8. Communicate effectively with other services
9. Coordinate the care of all patients on the Obstetric service along with the Attending
Systems Based Practice
Following completion of this rotation, the resident is expected to be able to:
1. Be familiar with billing codes for common obstetric procedures
2. Identify system issues that contribute to poor patient care
3. Effectively utilize systematic approaches to reduce errors and improve patient care
4. Effectively utilize hospital resources and outside resources to improve patient care
Practice Based Learning
Following completion of this rotation, the resident is expected to be able to:
1. Effectively utilize technology to manage information for patient care and self improvement
2. Know the essential books associated with the management of Obstetrics
3. Prepare cases for M&M and stats presentations
4. Know how the access ACOG Bulletins, Committee Opinions regarding the standards of
practice
5. Know how to access all online services to obtain pertinent up to date information regarding
Obstetric issues and management
Evaluations
The PG IV resident rotating on the Obstetrics service is evaluated using 360 evaluations. They
are evaluated by their faculty, their patients, the ancillary staff, the junior residents and
themselves. The Obstetrics faculty completes the summative evaluations at the end of the
rotation. Once during each rotation, the PG IV resident on the Obstetric Service prepares a case
list as they would need to do for their Oral Board Certification Examination. These cases are
presented and questions are asked by the entire faculty during our M&M educational session.
This M&M or case list presentation evaluates the resident knowledge of the patients and prepares
the resident for their oral boards. 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 cases.
Reading Assignments
Williams Obstetrics: Cunningham
Obstetrics: Gabbe
ACOG Compendium and Committee Opinions
Premature Rupture of Membranes
Prevention of Rh D Alloimmunization
Thrombocytopenia in Pregnancy
Intrauterine Growth Restriction
Operative Vaginal Delivery
Management of Recurrent Early Pregnancy Loss
Prenatal Diagnosis of Fetal Chromosomal Abnormalities
Thyroid Disease in Pregnancy
Management of Preterm Labor