POSTGRADUATE YEAR III
Ambulatory - Two Months
The ambulatory rotation is designed for the more senior resident to refine his/her skills in management of
abnormal cervical/vaginal/vulvar cytology and pathology, reproductive endocrinology and infertility,
family planning, and office urogynecology. Learning objectives are both didactic (self-study, 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. 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.
Technical Goals and Objectives
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 with cervical/vaginal/vulvar biopsy
2. LEEP
3. Cryotherapy
4. Paracervical block
5. Ultrasound for evaluation of infertility/response to treatment
6.
IVF
7. ICSI
8. Gamete donation
9. Preimplantation genetic diagnosis
10. Hysterosalpingography
11. Hysterosonography
12. Hysteroscopic submucosal fibroid/polyp resection
13. Hysteroscopic resection of uterine septum
14. Diagnostic laparoscopy
15. Laparoscopic chromopertubation, lysis of adhesions, fulguration/excision of endometriosis,
fimbrioplasty, salpingostomy/salpingectomy
16. Metroplasty
17. Tubal anastamoses
18. Vaginal construction/reconstruction
19. Laminaria placement
20. First trimester surgical termination of pregnancy
21. First trimester medical termination of pregnancy
22. Second trimester surgical termination of pregnancy
23. Performance of POP-Q exam
24. Office cystoscopy
25. Bladder instillation
26. Pessary fitting and removal
Following completion of the rotation, the resident is expected to have competence in:
1. Colposcopy with cervical/vaginal/vulvar biopsy
2. LEEP
3. Cryotherapy
4. Paracervical block
5. Ultrasound for evaluation of infertility/response to treatment
6. Hysterosonography
7. Hysteroscopic submucosal fibroid/polyp resection
8. Diagnostic laparoscopy
9. Laparoscopic chromopertubation, lysis of adhesions, fulguration/excision of endometriosis,
salpingostomy/salpingectomy
10. Laminaria placement
11. First trimester surgical termination of pregnancy
12. First trimester medical termination of pregnancy
13. Early/uncomplicated second trimester surgical termination of pregnancy
14. POP-Q exam
15. Office cystoscopy
16. Bladder instillation
17. Uncomplicated pessary fitting and removal
Medical Knowledge
A. Colposcopy
1. The resident will understand guidelines for the management of abnormal cervical/vulvar/vaginal
cytology and pathology including the role of colposcopy, biopsy, LEEP, cryotherapy, medical
management, laser, and excision.
B. Reproductive Endocrinology and Infertility
1. 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.
2. The resident will be able to describe major developmental anomalies, there implications for
sexual function, menstruation, fertility, and reproductive outcome, including: hymenal
abnormalities, vaginal agenesis, vaginal septum, uterine septum, and unicornuate or bicornuate
uterus.
3. 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 hormonal therapy, and serve as
estrogen and progesterone receptor modulators.
4.
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.
5. The resident will be able to describe the causes of galactorrhea/hyperprolactinemia, perform
appropriate history and physical exam, order and interpret diagnostic studies (prolactin, TSH,
pituitary imaging), initiate treatment, describe long-term follow-up, outline indications for
neurosurgical referral, and describe the management of pituitary adenoma in pregnancy.
6. 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.
7. The resident will be able to define precocious puberty, outline principal causes, interpret results
of tests such as ultrasonography, gonadotropin assays, and x-ray studies for bone age, and
describe treatments and long-term prognosis for these patients.
8. The resident will be understand the principal causes of delayed puberty, perform an appropriate
physical exam, interpret related diagnostic tests, and outline indications for referral.
9. The resident will be able to describe common causes of recurrent pregnancy loss, elicit a pertinent
history, perform an appropriate physical exam, perform and interpret appropriate diagnostic tests,
and provide counseling and treatment as appropriate.
10. The resident will be able to describe the indications, basic procedures, and potential
complications of: IVF, GIFT, ZIFT, ICSI, gamete donation,and preimplantation genetic
diagnosis.
C. Family Planning
1. Discuss available methods of contraception, their relative efficacies, advantages, 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.
D. Urogynecology
1.
Obtain an appropriate history related to: involuntary los of urine, painful urination, incomplete
bladder emptying, frequency, urgency, nocturia, and associated factors such as medications and
past medical history.
2. Perform an appropriate physical exam for: involuntary loss of urine, alterations in bladder and
urethral support, neurologic disorders, and evidence of infection.
3. Understand the role of diagnostic studies including: urinalysis and culture, post-void residual,
physical function tests (valsalva, urethral angle, perineal muscle testing), cystometry,
cystourethrography, cystoscopy, and uroflowmetry.
4. Be able to diagnose: disorders of support, structural or traumatic disorders, infection, and
incontinence (including stress, urge, overflow, and mixed).
5. Have an understanding of possible interventions including medical, surgical, and behavioral.
6. Understand factors influencing intervention including age, severity of dysfunction, previous
therapy, and medical comorbidities.
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
3. 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
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
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 outpatient
issues
Evaluations
The PG III resident rotating on the Ambulatory service is evaluated using 360 evaluations. They are
evaluated by their faculty, their patients, the ancillary staff, the junior residents 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 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
Hormonal Contraception in Women with Co-existing Medical Conditions
Management of Infertility Caused by Ovulatory Dysfunction
Emergency Contraception
Medical Management of Abortion
Intrauterine Device
Additional reading assignments will be given by ambulatory instructors
POSTGRADUATE YEAR THREE
Continuity Clinic - Weekly
The goals and objectives of the weekly continuity clinic at the PG-III level are to foster a continuum of
care across primary care, obstetrical, and gynecologic practice. The PG-III resident should be able to
counsel and screen patients for all primary care conditions across all age groups. The resident will further
have a thorough understanding of preoperative management for all gynecologic surgery.
By the
completion of the third year the resident should be able to manage all antepartum high risk conditions
with minimal supervision from faculty. 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
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.
Technical Goals and Objectives
The resident may enhance or complete the technical goals and objectives outlined for the Family Health
Center rotation at the completion of the PG-III continuity experience.
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 preconceptual care including:
1. History and assessment of risk factors to including genetic abnormalities by pedigree analysis,
effects of pregnancy on chronic medical conditions, effects of chronic medical conditions on
pregnancy, potential teratogenicity of prescribed and illicit substances, and alternatives to
traditional pregnancy
2. Possible interventions in high risk pregnancy such as modification of lifestyle, infertility or
genetic counseling, and appropriate medical and preventive interventions
3. Risk-benefit implications of various interventions or non-interventions including alterations in
cardiovascular health, carbohydrate metabolism, risk of prematurity, disorders of intrauterine
growth, late pregnancy bleeding abnormalities, and risk of operative delivery
B. The resident will have a thorough understanding of the concepts of genetic counseling including:
1. Pedigree analysis, advanced maternal/paternal age, teratogen exposure, ethnic and racial
background, recessive disorders including X-linked and autosomal, dominant disorders including
X-linked and autosomal, balanced translocations, recurrent spontaneous abortion, multi-factorial
disorders, and disorders of metabolism.
2. The resident will have a thorough knowledge of common genetic disorders including Trisomy-21,
Trisomy-18, Trisomy-13, 47 XXY, 45 X, congenital adrenal hyperplasia, fragile X syndrome,
cystic fibrosis, sickle cell disease, and Tay-Sachs disease
3. Physical characteristics that may indicate genetic disorder including IUGR, oligohydramnios, and
polyhydramnios
4. Diagnostic studies including serum screening and nuchal translucency measurement and targeted
screening based on family history and maternal age
5. Amniocentesis, chorionic villus sampling, and PUBS
6. Diagnosis and work-up for fetal death including
post-mortem exam, photographs, genetic
studies, amniocentesis, maternal laboratory testing, post-mortem imaging, and autopsy.
7. Possible interventions including medical, surgical, and preconception counseling
8. Follow-up including management plan for specific diagnosis and education and counseling.
C. The resident should be able to evaluate the geriatric patient for preoperative and postoperative care
including:
1. Returning the patient to maximum functional capacity following surgery.
2. Evaluating the effectiveness of diminished physiologic reserve and the potential effects of
anesthesia, surgery, and medical comorbidities.
D. The resident will have a thorough understanding of preoperative evaluation and management
including:
1. Assessment of functional reserve
2. Assessment of cognitive, nutritional, and functional status
3. Assessment of host and hospital risk factors for delirium
4. Assessment of medical comorbidities
5. Assessment of socioeconomic status and resources including availability of necessary
postoperative family and household aid services.
6. Patient education, informed consent, and advanced directives.
7. Complete medication review including preoperative medications for medical optimization and
risk reduction
E. The resident will have a thorough understanding of operative management and anesthesia including:
1. Choice of anesthesia selection and age-associated alterations in morbidity and mortality with
general and regional techniques
2. Appropriate patient positioning and padding to avoid injury
3. Prevention of intraoperative hypothermia
4. Thromboembolic prophylaxis
F. The resident will have a thorough understanding of postoperative management including:
1. The concept of early mobilization
2. Appropriate fluid and electrolyte management in the elderly
3. Pain management and its alterations in the geriatric patient
4. Understanding, recognition, prevention, and treatment of behavioral and mental changes
5. Initiation of rehabilitation and fall prevention
6. Appropriate consultation with physical therapy, occupational therapy, pain management, and
nutrition services
7. Initiation of discharge planning including caregiver education, household assistance, home health
consultation, and skilled nursing care.
G. The resident will have an understanding of the impact on aging and communication skills and
interpersonal interactions including:
1. The effect of nihilist and ageist attitudes of physicians, caregivers, and family members
2. Identification of pitfalls specific to communication with older patients including visual and
hearing defects
3. Quality of life concerns including independence and autonomy issues
4. Techniques to improve patient comprehension and task performance.
H. The resident will have an understanding of the common diseases, disorders, and health concerns of
the aging woman including:
1. Cardiovascular disease
2. Nutrition and malnutrition
3. Cognitive impairment including Alzheimer’s and vascular dementia
4. Delirium
5. Depression, anxiety, grieving, and bereavement
6. Urinary incontinence
7. Bowel dysfunction
8. Sleep disorders.
9. Mobility issues
10. Hearing and visual problems
11. Sexuality
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 RIII
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 III 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 THREE
Elective– One Month
The goal of the PG-III elective rotation is to allow the resident to create a personalized educational and
training experience in order to: expand upon the competencies achieved through established rotations,
gain exposure to related fields, further research interests, participate in international medicine, and/or to
work with mentors in other institutions in preparation for fellowship application. In preparation for the
rotation, the resident will establish specific goals and objectives. Progress toward these individualized
goals will be evaluated at the end of the rotation.
Evaluation
The resident will be evaluated by their mentors during their elective rotation
POSTGRADUATE YEAR THREE
Gynecology UCI – One Month
The goals and objectives for the PG-III resident assigned to the UCI gynecology rotation are to enhance
skills in operative gynecology with emphasis on abdominal and vaginal hysterectomy, laparoscopy,
operative hysteroscopy, and urogynecologic procedures. Following the completion of this rotation, the
resident, using the previous gynecologic rotations as a foundation for surgical technique, will develop
skills to allow performance of these procedures under minimal faculty supervision in preparation for the
fourth year. Learning objectives are both didactic (self-study, 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.
Technical Goals and Objectives
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. Abdominal hysterectomy with and without adnexal removal
2. Vaginal hysterectomy with and without adnexal removal
3. Laparoscopic assisted vaginal hysterectomy
4. Total laparoscopic hysterectomy
5. Burch/MMK procedures
6. Operative laparoscopy
7. Abdominal, laparoscopic, and vaginal myomectomy
8. Diagnostic and operative hysteroscopy
9. Non-hysteroscopic endometrial ablation procedures
10. Anterior and posterior colporrhaphy
11. Pelvic floor suspension procedures
12. Vesicovaginal fistula repair
13. Rectovaginal fistula repair
14. Robotic surgery
15. Interstim procedures
16. Second trimester surgical termination of pregnancy
Following completion of this rotation, the resident is expected to have begun establishing
competency 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. Total laparoscopic hysterectomy
5. Operative laparoscopy
6. Abdominal, laparoscopic, and vaginal myomectomy
7. Diagnostic and operative hysteroscopy
8. Non-hysteroscopic endometrial ablation procedures
9. Anterior and posterior colporrhaphy
10. Pelvic floor suspension procedures
11. Second trimester surgical termination of pregnancy
Medical Knowledge
A. The resident will have a thorough understanding of operative techniques and complications of total
abdominal hysterectomy including:
1. Preservation or removal of adnexa
2. Techniques for management of the cuff
3. Exposure of the ureters
4. Repair of incidental bowel injury
5. Repair of incidental cystotomy
B. The resident will have a thorough understanding of operative techniques and complications of vaginal
hysterectomy including:
1. Removal of adnexa
2. Cuff closure
3. Repair of enterocoele
4. Morcellation techniques
C. The resident will have a thorough understanding of operative techniques and complications of
laparoscopic assisted vaginal hysterectomy and total laparoscopic hysterectomy
D. The resident will have a thorough understanding of operative techniques and complications of
abdominal incontinence procedures including:
1. Anatomy of the space of retzious
2. Burch/MMK procedures
3. Sling procedures
4. Complications of the above techniques
E. The resident will have a thorough understanding of operative techniques and complications of
laparoscopic adnexal surgery including:
1. Oophorectomy
2. Cystectomy and ectopic pregnancy
F. The resident will have a thorough understanding of operative techniques and complications of open,
laparoscopic, and vaginal myomectomy
G. The resident will have a thorough understanding of operative techniques and complications of
diagnostic and operative hysteroscopy, as well as non-hysteroscopic endometrial ablation techniques
H. The resident will have a thorough understanding of operative techniques and complications of
cystocele and rectocele repair
I.
The resident will have a thorough understanding of operative techniques and complications of uterine
and pelvic floor suspension procedures
J. The resident will have a thorough understanding of operative techniques and complications of repair
of vesicovaginal and rectovaginal fistulas
K. The resident will have a thorough understanding of the diagnosis and management of pelvic support
defects including:
1. Historical factors of pelvic pressure, difficulty in voiding or defecating, pain or discomfort, and
bulge in the vagina
2. Physical examination findings of partial or complete procidentia, herniation of bladder, urethra or
rectum, herniation of abdominal contents in the rectovaginal space, gaping vaginal introitus, and
loss of muscular perineal support
3. Diagnostic studies including valsalva maneuver, erect anatomic assessment, and tenaculum
traction on the cervix
4. Diagnosis of uterine procidentia, cystocele, cystourethrocele, enterocele, rectocele, and healed
vaginal and perineal lacerations
5. Possible management interventions including lifestyle, hormonal, exercise, pessary, and surgical
treatment
6. Factors influencing decisions regarding intervention including patient preference, age, desire for
future fertility, severity of symptoms, degree of disability, and presence of medical comorbidities
7. Potential complications of intervention including bleeding, injury to adjacent tissue, prolapse,
urinary or fecal incontinence, and fistula formation
8. Potential complications of non-intervention including progression of symptoms and disability,
sexual and social dysfunction, and inability to void or defecate without splinting
9. Follow-up including post-op and non-operative assessment, patient education and counseling
L. The resident will have a thorough understanding of second trimester surgical termination of
pregnancy including patient counseling, preoperative preparation, surgical technique, and
management of complications.
M. The resident will be introduced to robotic surgery and begin to develop an understanding of its
technique, indications, complications, and limitations.
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 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 III 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. 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, William Droegemueller, MD, Arthur L.
Herbst, MD, Daniel Mishell Jr. MD (Authors)
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
Chronic Pelvic Pain
Urinary Incontinence
Antibiotic Propylaxis for GYN procedures
Pelvic Organ Prolapse
Medical and Surgical Management of Tubal Pregnancy
Surgical Alternatives to Hysterectomy in the management of leiomyomas
Management of Adnexal Masses
Management of Anovulaory Bleeding
POSTGRADUATE YEAR THREE-Kaiser Irvine
Gynecology Kaiser – Two Months
The goals and objectives for the PG-III resident assigned to the Kaiser gynecology rotation are to further
enhance skills in operative gynecology with emphasis on abdominal and vaginal hysterectomy,
laparoscopy, operative hysteroscopy, and urogynecologic procedures. In addition, the rotation is designed
to further exposure in the area of gynecologic oncology. Following the completion of this rotation, the
resident, using the previous gynecology rotations as a foundation for surgical technique, will develop
skills to allow performance of these procedures under minimal faculty supervision in preparation for the
fourth year.
Learning objectives are both didactic (self-study, 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 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.
Technical Goals and Objectives
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. Abdominal hysterectomy with and without adnexal removal
2. Vaginal hysterectomy with and without adnexal removal
3. Laparoscopic assisted vaginal hysterectomy
4. Total laparoscopic hysterectomy
5. Burch/MMK procedures
6. Operative laparoscopy
7. Abdominal, laparoscopic, and vaginal myomectomy
8. Diagnostic and operative hysteroscopy
9. Non-hysteroscopic endometrial ablation procedures
10. Anterior and posterior colporrhaphy
11. Pelvic floor suspension procedures
12. Vesicovaginal fistula repair
13. Rectovaginal fistula repair
14. Cystoscopy
15. Radical hysterectomy
16. Staging and debulking procedures for ovarian/peritoneal malignancy
17. Lymph node dissection
18. Vulvectomy
19. Laser procedures of the vulva/vagina
20. Cervical conization
Following completion of this rotation, the resident is expected to have begun establishing
competency 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. Total laparoscopic hysterectomy
5. Operative laparoscopy
6. Abdominal, laparoscopic, and vaginal myomectomy
7. Diagnostic and operative hysteroscopy
8. Non-hysteroscopic endometrial ablation procedures
9. Anterior and posterior colporrhaphy
10. Pelvic floor suspension procedures
11. Cystoscopy
12. Cervical conization
Medical Knowledge
A. The resident will have a thorough understanding of operative techniques and complications of total
abdominal hysterectomy including:
1. Preservation or removal of adnexa
2. Techniques for management of the cuff
1. Exposure of the ureters
2. Repair of incidental bowel injury
3. Repair of incidental cystotomy
B. The resident will have a thorough understanding of operative techniques and complications of vaginal
hysterectomy including:
1. Removal of adnexa
2. Cuff closure
3. Repair of enterocele
4. Morcellation techniques
C. The resident will have a thorough understanding of operative techniques and complications of
laparoscopic assisted vaginal hysterectomy and total laparoscopic hysterectomy
D. The resident will have a thorough understanding of operative techniques and complications of
abdominal incontinence procedures including:
1. Anatomy of the space of retzius
2. Burch/MMK procedures
3. Sling procedures
4. Complications of the above techniques
E. The resident will have a thorough understanding of operative techniques and complications of
laparoscopic adnexal surgery including:
1. Oophorectomy
2. Cystectomy and ectopic pregnancy
F. The resident will have a thorough understanding of operative techniques and complications of open,
laparoscopic, and vaginal myomectomy
G. The resident will have a thorough understanding of operative techniques and complications of
diagnostic and operative hysteroscopy, as well as non-hysteroscopic endometrial ablation techniques
H. The resident will have a thorough understanding of operative techniques and complications of
cystocele and rectocele repair
I.
The resident will have a thorough understanding of operative techniques and complications of uterine
and pelvic floor suspension procedures
J. The resident will have a thorough understanding of operative techniques and complications of repair
of vesicovaginal and rectovaginal fistulas
K. The resident will have a thorough understanding of the diagnosis and management of pelvic support
defects including:
1. Historical factors of pelvic pressure, difficulty in voiding or defecating, pain or discomfort, and
bulge in the vagina
2. Physical examination findings of partial or complete procidentia, herniation of bladder, urethra or
rectum, herniation of abdominal contents in the rectovaginal space, gaping vaginal introitus, and
loss of muscular perineal support
3. Diagnostic studies including valsalva maneuver, erect anatomic assessment, and tenaculum
traction on the cervix
4. Diagnosis of uterine procidentia, cystocele, cystourethrocele, enterocele, rectocele, and healed
vaginal and perineal lacerations
5. Possible management interventions including lifestyle, hormonal, exercise, pessary, and surgical
treatment
6. Factors influencing decisions regarding intervention including patient preference, age, desire for
future fertility, severity of symptoms, degree of disability, and presence of medical comorbidities
7. Potential complications of intervention including bleeding, injury to adjacent tissue, prolapse,
urinary or fecal incontinence, and fistula formation
8. Potential complications of non-intervention including progression of symptoms and disability,
sexual and social dysfunction, and inability to void or defecate without splinting
9. Follow-up including post-op and non-operative assessment, and patient education and counseling
L. The resident will review the Didactic and Management Goals & Objectives of the R-1 and R-2
gynecologic oncology rotations.
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 obstetric 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 III 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
Surgical Alternatives to Hysterectomy
Urinary Incontinence
Pelvic Organ Prolapse
Antibiotic Prophylaxis for GYN procedures
Chronic Pelvic Pain
Human Papillomavirus
Management of Abnormal Cervical Cytology and Histology
Management of the Adnexal Mass
POSTGRADUATE YEAR THREE
Gynecology Long Beach Memorial – Two Months
Gynecology/Ultrasound Long Beach Memorial – Two Months
The goals and objectives for the PG-III resident assigned to the Long Beach gynecology rotation are to
further enhance skills in operative gynecology with emphasis on abdominal and vaginal hysterectomy,
laparoscopy, operative hysteroscopy, and urogynecologic procedures. Following the completion of this
rotation, the resident, using the previous gynecology rotations as a foundation for surgical technique, will
develop skills to allow performance of these procedures under minimal faculty supervision in preparation
for the fourth year. In addition, while on the ultrasound component of the rotation, the resident is
expected to further the objectives of the R-1 ambulatory rotation in ultrasound. Learning objectives are
both didactic (self-study, 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.
Technical Goals and Objectives
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. Abdominal hysterectomy with and without adnexal removal
2. Vaginal hysterectomy with and without adnexal removal
3. Laparoscopic assisted vaginal hysterectomy
4. Total laparoscopic hysterectomy
5. Burch/MMK procedures
6. Operative laparoscopy
7. Abdominal, laparoscopic, and vaginal myomectomy
8. Diagnostic and operative hysteroscopy
9. Non-hysteroscopic endometrial ablation procedures
10. Anterior and posterior colporrhaphy
11. Pelvic floor suspension procedures
12. Vesicovaginal fistula repair
13. Rectovaginal fistula repair
Ultrasound component:
1. Detailed fetal anatomic evaluation
2. First trimester fetal ultrasound including nuchal translucency measurement
3. Cervical length measurement
4. Umbilical artery doppler studies
5. MCA doppler studies
Following completion of this rotation, the resident is expected to have begun establishing
competency 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. Total laparoscopic hysterectomy
1. Operative laparoscopy
2. Abdominal, laparoscopic, and vaginal myomectomy
3. Diagnostic and operative hysteroscopy
4. Non-hysteroscopic endometrial ablation procedures
5. Anterior and posterior colporrhaphy
6. Pelvic floor suspension procedures
Ultrasound component:
1. Detailed fetal anatomic evaluation
2. First trimester fetal ultrasound
3. Cervical length measurement
Medical Knowledge
A. The resident will have a thorough understanding of operative techniques and complications of total
abdominal hysterectomy including:
1. Preservation or removal of adnexa
2. Techniques for management of the cuff
3. Exposure of the ureters
4. Repair of incidental bowel injury
5. Repair of incidental cystotomy
B. The resident will have a thorough understanding of operative techniques and complications of vaginal
hysterectomy including:
7. Removal of adnexa
8. Cuff closure
9. Repair of enterocele
10. Morcellation techniques
C. The resident will have a thorough understanding of operative techniques and complications of
laparoscopic assisted vaginal hysterectomy and total laparoscopic hysterectomy.
D. The resident will have a thorough understanding of operative techniques and complications of
abdominal incontinence procedures including:
1. Anatomy of the space of retzius
2. Burch/MMK procedures
3. Sling procedures
4. Complications of the above techniques
E. The resident will have a thorough understanding of operative techniques and complications of
laparoscopic adnexal surgery including:
1. Oophorectomy
2. Cystectomy and ectopic pregnancy
F. The resident will have a thorough understanding of operative techniques and complications of open,
laparoscopic, and vaginal myomectomy.
G. The resident will have a thorough understanding of operative techniques and complications of
diagnostic and operative hysteroscopy, as well as non-hysteroscopic endometrial ablation techniques.
H. The resident will have a thorough understanding of operative techniques and complications of
cystocele and rectocele repair.
I.
The resident will have a thorough understanding of operative techniques and complications of uterine
and pelvic floor suspension procedures.
J. The resident will have a thorough understanding of operative techniques and complications of repair
of vesicovaginal and rectovaginal fistulas.
K. The resident will have a thorough understanding of the diagnosis and management of pelvic support
defects including:
1. Historical factors of pelvic pressure, difficulty in voiding or defecating, pain or discomfort, and
bulge in the vagina
2. Physical examination findings of partial or complete procidentia, herniation of bladder, urethra or
rectum, herniation of abdominal contents in the rectovaginal space, gaping vaginal introitus, and
loss of muscular perineal support
3. Diagnostic studies including valsalva maneuver, erect anatomic assessment, and tenaculum
traction on the cervix
4. Diagnosis of uterine procidentia, cystocele, cystourethrocele, enterocele, rectocele, and healed
vaginal and perineal lacerations
5. Possible management interventions including lifestyle, hormonal, exercise, pessary, and surgical
treatment
6. Factors influencing decisions regarding intervention including patient preference, age, desire for
future fertility, severity of symptoms, degree of disability, and presence of medical comorbidities
7. Potential complications of intervention including bleeding, injury to adjacent tissue, prolapse,
urinary or fecal incontinence, and fistula formation
8. Potential complications of non-intervention including progression of symptoms and disability,
sexual and social dysfunction, and inability to void or defecate without splinting
9. Follow-up including post-op and non-operative assessment, and patient education and counseling
L. While on the ultrasound component of the rotation, the resident will expand understanding of and
competency in: fetal anatomic ultrasound including cardiac outflow tracts, first trimester ultrasound,
cervical length measurement, umbilical artery doppler studies, and MCA doppler studies.
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. 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
Gynecologic issues and management
Evaluations
The PG III 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 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 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, William Droegemueller, MD, Arthur L.
Herbst, MD, Daniel Mishell Jr. MD (Authors)
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
Chronic Pelvic Pain
Urinary Incontinence
Antibiotic Propylaxis for GYN procedures
Pelvic Organ Prolapse
Medical and Surgical Management of Tubal Pregnancy
Surgical Alternatives to Hysterectomy in the management of leiomyomas
Management of Adnexal Masses
Management of Anovulaory Bleeding
Ultrasonography in Pregnancy
Cervical Insufficiency
POSTGRADUATE YEAR THREE
UCI Nights High Risk Obstetrics – Two Months
The goals and objectives for this PG-III rotation are to refine and enhance the skills obtained on the PG-II
high risk obstetrical rotations. These skills include medical and surgical management of pregnancy
complications, prenatal diagnosis and genetic counseling, and basic obstetrical ultrasound skills. In
addition, the resident will further their ultrasound skills under the guidance of perinatal faculty. Learning
objectives are both didactic (self-study, 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.
Technical Goals and Objectives
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. Amniocentesis for prenatal diagnosis and fetal lung maturity
2. External cephalic version
3. Interpretation of NST and CST
4. Biophysical profile
5. Ultrasound for biometry and fetal anatomy
6. Surgical procedures in the pregnant patient
7. Cervical cerclage placement and removal
Following completion of this rotation, the resident is expected to be competent in the following
procedures:
1. Amniocentesis for prenatal diagnosis and fetal lung maturity
2. Outlet and low operative vaginal delivery
3. Repair of perineal, cervical, vaginal, and rectal lacerations
4. Low transverse, low vertical, and classical cesarean section
Medical Knowledge
A. The resident will have a thorough understanding of the diagnosis and management of multiple
gestation and its complications including:
1. Historical aspects of advanced maternal age, family history, ovulation induction, and ART
2. Physical examination including excessive increase in fundal height and maternal weight gain
3. Diagnostic studies including ultrasound, fetal heart rate testing, amniocentesis for FLM, and
genetic studies
4. The impact of multiple gestation on maternal complications such as anemia, early onset
hypertensive disorders of pregnancy, PPROM, and preterm labor
5. Diagnostic significance of multiple fetuses, zygocity, fetal anomalies and malpresentation,
discordant fetal growth, twin-twin transfusion syndrome, and hydramnios
6. Possible interventions including bed rest, tocolytic therapy, fetal reduction procedures, treatment
of twin-twin transfusion syndrome, route of delivery, and delivery of second twin
7. Factors influencing intervention including gestational age, number and presentation of fetuses,
zygocity, and preterm labor
8. Potential complications of intervention including prematurity and complications of tocolysis,
amniocentesis, and operative delivery
9. Potential complications of non-intervention including prematurity and perinatal morbidity and
mortality
10. Follow-up including patient education and counseling, risk factors, and prevention of preterm
delivery
B. The resident will have experience in external cephalic version including:
1. Timing of procedure
2. Complications including need for immediate cesarean section
3. Prognostic factors for success/failure
C. The resident will have experience in isoimmunization in pregnancy including:
1. Historical features of past obstetrical history, blood transfusion, change in consort,
isoimmunization risk with regular and irregular antibiotics
2. Diagnostic studies to include antibody identification and titer, paternal antigen status,
amniocentesis , ultrasonography, and PUBS
3. Diagnosis including antigen type and severity
4. Management interventions including intrauterine transfusion and timing of delivery
5. Factors influencing intervention including antibody type and titer, optical density, fetal
hematocrit, fetal hydrops, and fetal lung maturity
6. Complications of intervention including transfusion complications and prematurity
7. Complications of non-intervention including perinatal morbidity, mortality, and long-term
neurologic sequelae
8. Follow-up including patient education and counseling regarding subsequent pregnancies
D. The resident will have an understanding of the diagnosis and management of post-term pregnancy
including:
1. Determination of gestational age
2. Physical examination based on historical uterine size, fundal height, and estimation of fetal size
by abdominal exam
3. Diagnostic studies to include ultrasound confirmation at various gestational ages, amniocentesis,
and biophysical profile
4. Diagnosis including prolonged pregnancy, macrosomia, meconium, fetal hypoxia, and placental
insufficiency
5. Management interventions including identification of Bishop’s score and fetal compromise
6. Factors influencing decisions for intervention including condition of the cervix, fetal condition,
and gestational age
7. Potential complications of intervention including prematurity, fetal hypoxia, and risk for
operative delivery
8. Potential complications of non-intervention including perinatal morbidity and mortality and longterm neurologic sequelae
9. Follow-up including patient education, antepartum surveillance, and timing and route of delivery
E. The resident is expected to have a thorough understanding of collagen vascular disorders as they
impact on pregnancy including:
1. Historical symptoms of arthralgias/myalgias, fatigue, hypertension, renal involvement, evidence
of chronic pregnancy loss, and peripheral vascular insufficiency
2. Physical examination for signs of skin, connective tissue, joint, vascular, and cardiac
manifestations
3. Diagnostic studies including anti-DNA, ANA, VDRL false positivity, rheumatoid factor, CBC,
24-hour urine for total protein and creatinine clearance, serum creatinine, chest x-ray, and EKG
4. Diagnosis of SLE, rheumatoid arthritis, and other collagen vascular diseases
5. Possible management interventions including medical therapy and mode of delivery
6. Factors influencing intervention including visceral involvement, fetal condition, and acute and
chronic hypertension
7. Potential complications of intervention including prematurity and adverse drug reactions
8. Potential complications of non-intervention including fetal compromise, stillbirth, and
progression of maternal disease
9. Follow-up maternal and fetal surveillance for progression of disease, hypertensive disorders of
pregnancy, mode of delivery, and puerperal evaluation and counseling
F. The resident will have a thorough understanding of the impact of psychiatric disorders preceding,
during, and following pregnancy including:
1. Symptoms of affective disorders, past and current medications, substance abuse history, and
family history
2. Physical examination including inappropriate affect, impaired mental status, thyroid disease,
signs of substance abuse, and nutritional deficiency
3. Diagnostic studies including evaluation of mental status and studies to exclude organic disease
4. The diagnosis of affective and anxiety disorders, psychosis, somatization, and eating disorders
5. Management of possible interventions including psychiatric consultation and referral
6. Factors influencing decisions regarding intervention including risk of patient’s behavior to self or
others, social and family support, gestational age, and duration and severity of symptoms
7. Potential complications of intervention including maternal and fetal adverse reactions to therapy
8. Potential complications of non-intervention including deterioration of work, family, social status,
physical health, and physical harm to the patient or others
9. Follow-up including psychiatric counseling and referral, hospitalization, and family counseling
and support
G. The resident will have an understanding of the diagnosis and treatment of malignancies in pregnancy
including:
1. Historical symptoms of bleeding or discharge, cough or hoarseness, change in bowel or bladder
habits, non-healing lesions, changes in skin lesions and pigmentation, and impact of previous
malignancy
2. Physical examination including signs of primary and metastatic disease
3. Diagnostic studies to evaluate severity and extent of maternal malignancy
4. Diagnosis of leukemia, Hodgkin’s disease, breast cancer, melanoma, and bowel cancer
5. Management interventions including surgery, chemotherapy, radiation, induced abortion,
delivery, and fetal surveillance
6. Factors influencing intervention including type and extent of malignancy and fetal condition
7. Potential complications of intervention including side effects of maternal therapy and prematurity
8. Potential complications of non-intervention including progression of malignancy, fetal
compromise or death, and maternal death
9. Follow-up including maternal and fetal surveillance
H. The resident will have a thorough understanding of antepartum tests of fetal well-being including:
1. Indications for antepartum fetal monitoring
2. Physical examination to include maternal cardiovascular status, size/dates discrepancy, amniotic
fluid volume, presentation and lie
3. Diagnostic studies including NST, CST, acoustic stimulation, and BPP
4. Diagnosis of abnormal fetal heart rate patterns including influence of disease and medications and
false-negative and false-positive rates of normal and abnormal tests
5. Management interventions including further testing, expectant management, induction of labor,
and cesarean delivery
6. Factors influencing decisions regarding intervention including confirmatory diagnostic studies,
fetal condition, severity of underlying maternal disease, medications, and fetal presentation
7. Potential complications of intervention including prematurity, neonatal death, and complications
of induction and delivery
8. Follow-up documentation of findings and continued surveillance
I.
The resident will have a thorough understanding of the basic physical principles and indications for
medical ultrasonography including:
1. Relevant principles of acoustics, effects on human tissues, basic operating principles, Doppler
instrumentation, signal processing, artifact, measuring systems, and image recording, storage and
analysis
2. Investigation of early pregnancy including number of fetuses, amnionicity and chorionicity, CRL,
early pregnancy failure, molar pregnancy, cervical length measurement, and evaluation of the
adnexa
3. Normal fetal anatomy at 18 to 20 weeks including skull, nuchal fold, face, brain and posterior
fossa, spine, heart at the 4-chamber view, abdomen, genitalia, and limbs
4. Fetal biometry including biparietal diameter, head circumference, abdominal circumference,
humerus length, femur length, and cerebellar diameter
5. Estimation of gestational age
6. Assessment of fetal growth
7. Assessment of biophysical profile
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. 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
issues and management
Evaluations
The PG III 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. 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
Rubella Vaccination
Asthma in Pregnancy
Fetal Macrosomia
Shoulder Dystocia
Use of Progesterone to reduce Preterm Birth
HIV in Pregnancy
Hepatitis in Pregnancy
Prevention of Rh D Alloimmunization