Department of Obstetrics and Gynecology
St. Francis Hospital & Medical Center
PGY-3 Learning Objectives
Urogynecology Rotation
I. Educational Purpose
The PGY-3 urogynecology rotation provides core knowledge of office urodynamic
evaluation, advanced incontinence and pelvic floor surgery, and perioperative management
of the incontinent patient.
II. Goals and Objectives
By completion of the PGY-3 year, the resident should demonstrate proper surgical
technique, have mastered basic and advanced urogynecological procedures, perform key
aspects of major urogynecological surgeries, and skillfully manage incontinence patients.
The resident should exhibit competence in all areas listed below.
By the end of the rotation, the PGY-3 resident should be able to:
1. Medical Knowledge
 Explain the normal anatomic supports of the vagina, rectum, bladder, urethra, and
uterus (or vaginal cuff in the setting of prior hysterectomy), including the bony pelvis,
pelvic floor nerves and musculature, and connective tissue
 Describe the static and dynamic interrelationships and function of the pelvic organs
and support mechanisms
 Summarize the normal function of the lower urinary tract during the filling and voiding
phases, and the mechanisms responsible for urinary continence
 Summarize the potential psychological, social, and sexual consequences of
urogynecologic disorders
 Describe the principal etiologies of pelvic support defects, urinary incontinence, and
fecal incontinence, including effects of pregnancy and delivery
 Describe abnormal conditions, including urethral syndrome, urethritis, and diverticuli,
interstitial cystitis
 Describe the etiologies, prevention, diagnostic techniques, and approaches to
repairing various fistulae that may involve the pelvic organs
 Describe the symptoms that may be experienced by a patient with pelvic support
defects, urinary incontinence, or fecal incontinence
 Describe the types of injuries or complications that may occur related to medical and
surgical treatments of urogynecologic disorders and the approaches to management
 Describe appropriate follow up for a patient who has been treated for a
urogynecologic disorder
2. Patient Care (Clinical Skills)
 Identify the anatomic defects associated with various aspects of pelvic support
disorders
 Characterize the major types of urinary incontinence
 Characterize and explain various types of urinary voiding disorders
 Elicit a pertinent history in a patient with a suspected pelvic support defect, urinary
incontinence, or fecal incontinence
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Department of Obstetrics and Gynecology
St. Francis Hospital & Medical Center
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Perform a focused physical examination to identify and characterize specific pelvic
support defects, including:
i. Anterior compartment
ii. Urethral hypermobility
iii. Posterior compartment
iv. Apical compartment (cervix/uterus or vaginal cuff)
Perform a focused physical exam in a patient with urinary and/or fecal incontinence,
including assessment of:
i. Bladder and urethral support
ii. Perineal, levator, and anal sphincter strength
iii. Neurologic status
Perform and interpret the results of selected tests to characterize urinary
incontinence disorders, including:
i. Assessment of residual urine volume
ii. Simple cystometry
iii. Q-tip test
Describe the indications for and interpret the results of diagnostic tests, such as:
i. Urinalysis
ii. Urine culture
iii. Cystourethroscopy
iv. Multichannel cystometry
v. Urethral profilometry
vi. Uroflowmetry
vii. Radiologic tests
3. Patient Care (Management Skills). By end of the rotation, the resident should be
comfortable performing the following procedures:
 Anti-incontinence (urinary) procedures
 Anterior colporrhaphy (including urethropexy)
 Posterior colporrhaphy
 Culdoplasty
 Enterocele repair
 Cystometrography
 Pressure-flow study (urodynamics)
 Q-tip test
 Urethral pressure profilometry
4. Practice-Based Learning
 Formulate and answer clinical questions that arise from patient care interactions to
discuss with faculty and the healthcare team
 Use personal experience with challenging patients to optimize relationships with
future patients
 Incorporate feedback from evaluations to improve skill base
 Update work-hour logs on a weekly basis and work efficiently to maintain compliance
with the 80-hour work week
 Keep an updated patient log as detailed in the ACGME website
 Participate in quality assurance activities of the department
 Read core textbooks and demonstrate the ability to use information technology:
UpToDate, Emedicine, PubMed literature search, Cochrane Database, etc.
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Department of Obstetrics and Gynecology
St. Francis Hospital & Medical Center
5. Communication / Interpersonal Skills
 Present pertinent urogynecological history and physical findings to team members
and consultants in a clear and concise fashion
 Demonstrate caring and respectful interactions with the patient and her family
 Counsel patients in language and manner appropriate to their level of education and
understanding
 Continually update urogynecology team on patients’ status
 Interact respectfully and professionally with all members of the patient care team,
including: attending physicians, nursing staff, resident staff, medical students, social
services, translators, etc.
6. Professionalism
 Demonstrate accountability for one’s actions and clinical decisions
 Acknowledge errors or omissions in patient care, and work toward timely resolution
 Demonstrate truthful and timely disclosure of adverse outcomes to the appropriate
staff members
 Advocate for patients within the healthcare system
 Maintain sensitivity to issues of diversity with patients and staff
 Uphold the ethical principles of our specialty as detailed by ACOG and AMA
 Abide by HIPPA regulations
 Abide by the guidelines set forth in the Residency Handbook, including: logging in
work hours, acting on MyEvaluations.com evaluations, logging in the ACGME work
log, and consistently attending the Friday Resident lecture series
 Demonstrates ability to receive both positive and negative feedback with appropriate
insight and professionalism
7. Systems-Based Practice
 Order diagnostic tests with attention to clinical relevance and cost-effectiveness
 Effectively use consultants and ancillary personnel services
 Demonstrate judicious and efficient resource utilization
 Demonstrate an understanding for the roles and responsibilities of healthcare team
members
 Participate in quality improvement activities of the department
Types of Clinical Encounters
The PGY-3 resident on this rotation is responsible for examining and caring of all patients
who present to the urogynecology consult service. These patients include, but are not
limited to, emergency room and in-patient consultations.
The PGY-3 resident will assist in the management of a wide variety of medical conditions
affecting the urogynecological health of a woman as well as gynecology-related
complications, including:
 Diseases of the urinary system and pelvic support defects
 Infectious diseases
 Psychiatric disorders
 Substance abuse
 Emergency care / trauma
 Postoperative complications
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Department of Obstetrics and Gynecology
St. Francis Hospital & Medical Center
III. Rotation Structure
The PGY-3 resident will review in detail the goals of the rotation before the first day of the
rotation. The PGY-3 resident will actively participate in:
 Round on UROGYN and/or GYN inpatients (Monday through Friday)
 Assist in minor and major surgical cases
 Outpatient urogynecology clinic with Dr. Mendelovici
IV. Resident Supervision
The PGY-3 resident’s activities are directly supervised by the UROGYN Attending Physician
during daily rounds, in-patient consults, etc., which provides opportunity for immediate
feedback. All surgical procedures are performed under the direct supervision of the
Attending Physician at all times.
V. Reading List and Educational Materials
 Textbooks: (i) Katz’s Comprehensive Gynecology and TeLinde’s Operative
Gynecology; (ii) Ostergard Urogynecology and Pelvic Floor Dysfunction (iii) Pelvic
anatomy
 ACOG Compendium
 UpToDate Clinical Reference Library
 Emedicine
 PubMed
 Cochrane Perinatal Database
VI. Method of Evaluation
 The PGY-3 resident will receive on-site timely formative feedback from the UROGYN
Attending Physicians during this rotation
 Evaluations of PGY-3 residents are performed at the completion of the rotation by select
UROGYN faculty and reflect input from the attending staff, nurses, medical students,
and patients. These evaluations will be available to the residents via the My
Evaluations.com system and will be reviewed by the resident with the Ob/Gyn
Residency Program Director and/or Chairman during the resident’s semi-annual
evaluation meetings.
 Cognitive assessment of the residents’ urogynecological skills is achieved by the
urogynecological score from the CREOG examination
 Dictations
 Completion of work-hours log
 Completion of ACGME procedure log
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Department of Obstetrics and Gynecology
St. Francis Hospital & Medical Center
Resident
I have/have not accomplished the educational aims and objectives as noted above for
this rotation.
_______________________________________
Resident Printed Name
_______________________________________
Resident Signature
__________________________
Date
Faculty
Based upon written evaluations, and observed competency assessment, The Clinical
Competency Committee of the faculty has determined that the resident has/has not met
educational aims and objectives for this rotation.
Program Director
Based upon self evaluation and the Methods of Evaluation listed in VII above, the
resident has/has not met the educational aims and objectives as noted above for this
rotation.
_______________________________________
Program Director/Associate Program Director
Signature
Last Updated:
August 25, 2010
has
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Date