Department of Obstetrics and Gynecology Residency Curriculum Goals and Education Objectives Revised: June 2011 PGY-2 I. Obstetrics- Labor Floor Day Team GOALS AND OBJECTIVES: Continued general exposure to all aspects of obstetrics with focus on operative vaginal deliveries and cesarean delivery, maternal and fetal assessment, and development of labor management skills especially in patients with high-risk pregnancies CORE COMPETENCIES: Patient Care Medical Knowledge Interpersonal and Communication Skills Professionalism -Actively manage laboring patients admitted to Labor Floor -Participate in operative vaginal deliveries and complicated cesarean deliveries -Participate in management of antepartum patients admitted to Labor Floor -Care for OBGYN patients in the outpatient Dickens Center setting -Understand normal and abnormal labor as well as indications for operative and cesarean delivery -Know management of term and preterm delivery with associated medical complications -Become familiar with principles of Obstetric anesthesia -Be familiar with obstetric emergencies and team-based management i.e. shoulder dystocia, stat c/s, breech -Communicate with patients and families in an urgent care setting -Optimize care provided by healthcare team by communicating with nursing staff, anesthesia, pediatrics -Master a standardized effective signout process for optimal transitions of care -Demonstrate respect, compassion, integrity, and responsiveness to needs of patients in labor and postpartum -Work with nursing towards common patient-centered care approach Practice-Based Learning and Improvement Systems-Based Practice -Communicate with senior residents, fellows and attendings with regards to changes in patient status -Participate in Team Admissions -Participate in Risk Reduction initiatives -Participate in Quality Improvement and Patient Safety initiatives -Prepare to discuss management of patients on service using evidence-based medicine -Participate in work and teaching rounds on Labor Floor and Postpartum Service -Attend monthly M+M conferences to improve patient safety, learn from errors, become informed about complex medical issues -Attend Morning and Noon Conferences -Adopt and encourage debriefing as critical component of team-based care and practice-based learning -Use Baby Tracker system for data monitoring -Adopt Pitocin protocol, Second stage protocol II. Obstetrics—Night Float GOALS AND OBJECTIVES: Continued general exposure to all aspects of obstetrics with focus on operative vaginal deliveries and cesarean delivery, maternal and fetal assessment, and development of labor management skills CORE COMPETENCIES: Patient Care Medical Knowledge Interpersonal and Communication Skills Professionalism -Actively manage laboring patients admitted to Labor Floor -Participate in operative vaginal deliveries and complicated cesarean deliveries -Participate in management of antepartum patients admitted to Labor Floor -Care for OBGYN patients in the outpatient Dickens Center setting -Understand normal and abnormal labor as well as indications for operative and cesarean delivery -Know management of term and preterm delivery with associated medical complications -Become familiar with principles of Obstetric anesthesia -Be familiar with obstetric emergencies and team-based management i.e. shoulder dystocia, stat c/s, breech -Communicate with senior residents, fellows and attendings with regards to changes in patient status -Communicate with patients and families in an urgent care setting -Optimize care provided by healthcare team by communicating with nursing staff, anesthesia, pediatrics -Master a standardized effective signout process for optimal transitions of care -Demonstrate respect, compassion, integrity, and responsiveness to needs of patients with complicated pregnancies, in labor and postpartum -Work with nursing towards common patient-centered care approach -Participate in Team Admissions -Participate in Risk Reduction initiatives Practice-Based Learning and Improvement Systems-Based Practice -Participate in Quality Improvement and Patient Safety initiatives -Prepare to discuss management of patients on service using evidence-based medicine -Participate in work and teaching rounds on Labor Floor and Postpartum Service -Attend monthly M+M conferences to improve patient safety, learn from errors, become informed about complex medical issues -Attend Morning Conferences -Adopt and encourage debriefing as critical component of team-based care and practice-based learning -Use Baby Tracker system for data monitoring -Adopt Pitocin protocol, Second stage protocol III. Gynecology- Benign GOALS AND OBJECTIVES: Exposure to all aspects of gynecology including but not limited to: 1. Outpatient preoperative evaluation 2. Medical and surgical treatments for common benign gynecologic conditions 3. Surgical procedures 4. Postoperative care of patients undergoing surgical procedures for benign gynecologic conditions 5. Gynecologic consultation 6. Diagnosis and management of early pregnancy CORE COMPETENCIES: Patient Care -Cover operating room cases, majors and minors at HUP, Presbyterian Hospital -Perform abdominal hysterectomy -Assist vaginal hysterectomy -Perform advanced laparoscopic surgery -Assist with robotic procedures -Participate in postoperative care for Benign Gynecologic surgery patients as well as inpatient admissions Participate in postoperative care for Urogynecology and REI surgical patients as well as inpatient admissions -Attend to emergency room and inpatient Medical Knowledge Interpersonal and Communication Skills Professionalism consults and become familiar with gynecologic surgical emergencies and admissions under supervision of senior resident - Care for OBGYN patients in the outpatient Dickens Center setting -Attend colposcopy clinic—1000 Courtyard -Attend Dickens preop clinic -Counsel patients regarding medical vs. surgical management of benign gynecologic conditions -Understand and execute surgical procedures including: operative laparoscopy/ hysteroscopy, abdominal/vaginal/laparoscopic hysterectomy, myomectomy -Know medical and surgical management of ectopic pregnancy/ SAB -Use ultrasound to diagnose ectopic pregnancy/ SAB -Understand the menstrual cycle and alterations, treatment of disturbances -Know ASCCP guidelines for management of abnormal pap smears and risks associated with preinvasive cervical disease -Recognize the acute abdomen and know gyn differential diagnosis -Understand preop evaluation of the gynecologic patient -Postoperative management and treatment of complications -Work with other services to provide emergency and/or consult care appropriately -Pre and post-surgical counseling -Address advanced directives for gynecologic admissions -Provide informed consent for all outpatient procedures -Learn how to provide informed consent for hysterectomy -Perform Quant book follow up phone calls and letter correspondence -Prepare for cases by reviewing patient chart and reviewing surgical procedure Practice-Based Learning and Improvement Systems-Based Practice -Respond to consult requests in a timely manner -Participate in medical student education -Participate in work and teaching rounds -Attend Gyn preop conference and lead article reviews -Attend Colposcopy conference -Attend monthly M+M conferences to improve patient safety, learn from errors, become informed about complex medical issues -Continue use of ACGME database for case collection IV. Gynecologic Oncology GOALS AND OBJECTIVES: General exposure to all aspects of inpatient Gynecologic Oncology CORE COMPETENCIES: Patient Care -Cover operating room cases, majors and minors with Gyn Onc fellows and attendings -Participate in postoperative care for surgery patients -See known Gyn Onc patients presenting through emergency room and determine need for admission - Care for OBGYN patients in the outpatient Dickens Center setting Medical Knowledge -Continue complicated management of post-operative patients with concurrent medical illness -Recognize criteria for inpatient admission for women with gynecologic malignancies -Learn principles of chemotherapy -Principles of fundamental and radical oncologic surgery and staging procedures Interpersonal and Communication Skills -Perform as an integral team member and patient advocate -Provide compassionate care to patients who are critically ill, coping with cancer diagnosis and associated treatments -Coordinate inpatient and outpatient care Professionalism -Demonstrate respect, compassion, integrity, and responsiveness to needs of patients with complicated medical illness, cancer diagnoses -Prepare cases for Gyn Onc Conference -Participate in work and teaching rounds with fellows and attendings -Attend monthly M+M conferences to improve patient safety, learn from errors, become informed about complex medical issues -Continue use of ACGME database for Practice-Based Learning and Improvement Systems-Based Practice case collection V. Urogynecology GOALS AND OBJECTIVES: Exposure to subspecialty of urogynecolopgy with indepth exposure to outpatient referral-based specialty and complex surgical procedures for treatment of urinary incontinence and pelvic organ prolapse CORE COMPETENCIES: Patient Care Medical Knowledge Interpersonal and Communication Skills -Care for OBGYN patients in the outpatient Dickens Center setting -Evaluate patients in outpatient setting for urinary incontinence and pelvic organ prolapse -Fit pessaries -Perform and interpret urodynamics -Perform outpatient cystoscopy -Participate in data collection to quantify symptoms and QOL -AUGS modules -Pelvic anatomy including support structures -Understand urinary system and nerves, musculature that play role in maintaining continence -Understand sexual function and factors that lead to dysfunction -Understand chronic pelvic pain, treatments especially diagnosis and treatment of interstitial cystitis/ painful bladder syndrome -Interpretation of urodynamic parameters -Medical options for urinary incontinence -Be familiar with various types of pessaries and indications for use -Be comfortable with assessment of pelvic organ prolapse using POP-Q -Be familiar with Baden-Walker classification for pelvic organ prolapse -Understand indications for and use of biofeedback -Know surgical options for correction of urinary incontinence and pelvic organ prolapse -Counsel patients with urogynecologic conditions regarding medical and surgical options for intervention Professionalism Practice-Based Learning and Improvement Systems-Based Practice -Shadow fellows and attendings to learn how to present recommendations -Develop dynamic interaction with fellows and attendings to maximize educational experience -Present case at fellows urogynecology conference -Work with benign gynecology team to care for post-op inpatient service -Demonstrate respect, compassion, integrity, and responsiveness to needs of patients -Learn how to perform outpatient consultation and provide summary of recommendations to requesting physician -Participate in and attend fellows urogynecology conference -Formulate plans of care with fellows and attendings in clinic -Compare different outpatient practice settings (resident clinic, private offices, ultrasound units, procedure units) and identify factors which contribute to effective quality care -Provide thorough and accurate documentation for various types of encounters (routine, problem visits, preoperative counseling, procedure notes) VI. Ambulatory-- Reproductive Endocrinology and Infertility GOALS AND OBJECTIVES: Exposure to basic office infertility and endocrinology with outpatient evaluation CORE COMPETENCIES: Patient Care Medical Knowledge Interpersonal and Communication Skills Professionalism Practice-Based Learning and Improvement Systems-Based Practice -Care for OBGYN patients in the outpatient Dickens Center setting -See patients in the REI faculty practice office in order to become familiar with basic office infertility and endocrinology -Perform transvaginal ultrasounds and hysterosalpingograms -Assessment of the infertile couple -Understanding normal physiology and abnormalities of the menstrual cycle -Assessment of ovulation and management of ovulatory dysfunction -Principles of ultrasound; scanning for follicular development and early pregnancy -Principles of oocyte retrieval -Communicate effectively with patients in language appropriate to age, educational, cultural, socioeconomic background -Convey information to colleagues in a concise, effective manner -Perform accurate and focused history and physical exam, develop an appropriate differential diagnosis and be able to discuss treatment options -Appropriately consult with other medical specialties as needed -Demonstrate a commitment to excellence and interest in ongoing professional development -Exposure to ASRM -Attend REI conferences -Attend morning resident conferences -Use Blackboard on-line curriculum to broaden knowledge base and improve patient care -Recognize disparities with ART access based on race, socioeconomic status, insurance I. Ambulatory—Penn Family Planning and Pregnancy Loss GOALS AND OBJECTIVES: Exposure to comprehensive family planning, options counseling, and induced and spontaneous abortion. Experience in this rotation includes but is not limited to: 1. Working with Divisions of Maternal Fetal Medicine and Genetics in the management of pregnancies with diagnosed fetal anomalies, second-trimester pregnancy complications, and serious maternal conditions 2. Providing a range of options for the management of pregnancy loss or miscarriage 3. Providing education, access to contraception, and counseling to prevent unplanned pregnancies. CORE COMPETENCIES: Patient Care Medical Knowledge -Care for OBGYN patients in the outpatient Dickens Center setting -Care for women referred from MFM and Genetics with diagnosed fetal anomalies, second-trimester pregnancy complications, and serious maternal conditions -Care for patients presenting with pregnancy loss or miscarriage -Care for patients in need of contraception, especially those with serious medical conditions -Perform transvaginal ultrasound to assess early pregnancy -Perform office MVA -Perform D+E in first and second trimester -Perform medical management of pregnancy loss or miscarriage -Provide LARC- Mirena, Paragard, Implanon -Be familiar with history of contraception -Understand mechanism of COCs, progestin-only contraception, LARC -Understand physiologic effects of pregnancy and contraception -Be familiar with fetal anomalies and maternal and fetal conditions that complicate pregnancy -Understand HCG, TVS and diagnosis of PUL vs. IUP vs. ectopic and management -Understand medical management of early pregnancy loss or miscarriage Interpersonal and Communication Skills -Communicate effectively with patients in language appropriate to age, educational, cultural, socioeconomic background -Convey information to colleagues in a concise, effective manner -Perform accurate and focused history and physical exam, develop an appropriate assessment and be able to discuss treatment options -Appropriately consult with other medical specialties as needed -Exhibit appropriate sensitivity to patients during a critical decision-making process Professionalism -Demonstrate a commitment to excellence and interest in ongoing professional development -Discuss opt-out with supervising attendings on as needed basis -Practice with consideration of values exercise and address on as needed basis -Present monthly contraception talk at Resident Didactics -Attend morning resident conferences -Present cases at M+M -Use Blackboard on-line curriculum to broaden knowledge base and improve patient care -Recognize disparities with contraceptive access based on race, socioeconomic status, insurance Practice-Based Learning and Improvement Systems-Based Practice