Department of Obstetrics and Gynecology
St. Francis Hospital & Medical Center
PGY-4 Learning Objectives
Obstetrics Rotation
I. Educational Purpose
The PGY-4 obstetric experience is the opportunity to develop leadership skills in providing
inpatient obstetric care within the residency program with minimal supervision. In this
rotation, the resident supervises the PGY-1, PGY-2 and PGY-3 residents in the
management of routine low-risk obstetric patients during the intrapartum and postpartum
periods and coordinate patient care with the charge nurse and the other members of the
health care team. The PGY-4 resident should also acquire the leadership skills to manage
high-risk obstetric patients on Labor & Delivery, in the triage area, the antepartum unit, and
the postpartum unit under normal and acute circumstances under the supervision of the
Attending Physician. Residents develop competence with management of patients with
critical care obstetric complications.
II. Goals and Objectives
By completion of the PGY-4 year, the resident should demonstrate skillful management of
complicated intrapartum and postpartum patients under normal and acute settings,
appropriately delegate responsibilities to care for these patients to junior residents, and
demonstrate leadership in utilizing personnel and other resources to optimize patient care
under these circumstances as described within the context of the ACGME core
competencies.
The resident should be able to:
1. Medical Knowledge
 Demonstrate understanding of the major physiologic changes in each organ system
during complicated and normal pregnancies by teaching junior residents and medical
students
 Anticipate and act on the effects of maternal medical conditions on pregnancy
outcome and, conversely, the impact of various maternal medical conditions upon
pregnancy outcome in normal and emergent settings
 Teach junior residents how to order, interpret, and act on results of common
diagnostic tests in the context of the normal and abnormal physiologic changes of
pregnancy
 Organize junior residents and medical students to facilitate accurate and timely
interpretation of intrapartum fetal heart rate patterns other assessments of fetal wellbeing and assist them in the implementation of appropriate interventions
 Provide guidance for junior residents and medical students to follow patients through
the normal course of labor; assist them in the identification of abnormalities of labor
in a timely manner, and differentiate urgent from non-urgent cesarean deliveries
 Identify appropriate indications for induction of labor
 Choose the most appropriate method of cervical ripening / labor induction for any
given indication, anticipate potential complications for each, and initiate strategies to
prevent these complications
 Counsel parturients regarding the more common types of obstetric anesthesia and
their complications, including: local, intravenous, pudendal, epidural, spinal and
general
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Department of Obstetrics and Gynecology
St. Francis Hospital & Medical Center
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Instruct junior residents in ordering appropriate pharmacologic agents commonly
used in obstetrics (such as labor-inducing agents, tocolytics, analgesics, antibiotics,
insulin, heparin, etc.) and act on their complications
Facilitate the provision of immediate care for the newborn, including: neonatal
resuscitation, Apgar score assignment, and cord blood analysis
Anticipate maternal complications that may arise in the postpartum period,
implements preventative measures, and participates in methods for their resolution
with minimal supervision
Train junior residents to provide individualized supportive care of the normal and
complicated postpartum patient, including: contraceptive needs, emotional
evaluation, and lactation consultation
2. Patient Care (Clinical Skills)
 Conduct and teach junior residents on how to perform focused patient histories and
physical examinations on patients with uncomplicated and complicated pregnancies
of low acuity and directly perform clinical assessments in high acuity, emergent
settings, including:
i. Comprehensive physical examination
ii. Focused examination of the complicated obstetric patient
iii. Serial cervical examination of parturients in labor
iv. Clinical pelvimetry
v. Leopold’s maneuvers, including clinical estimation of fetal weight
vi. Assessment of presenting fetal part and position, including asynclitism
vii. Basic ultrasound examination including: fetal biometry, presentation, and
placental localization
viii. Assessment of maternal and fetal wellbeing
 Instruct junior residents and students how to evaluate symptoms and physical
findings in complicated pregnant patients to distinguish physiologic from pathologic
findings
 Teach and assist junior residents how to perform an amnioinfusion, biophysical
profile (BPP); and how to act on the results
 Illustrate to junior residents how to determine fetal lie by ultrasound and physical
examination
 Assist medical students and junior residents in performing spontaneous vaginal
delivery, episiotomy repair, repair of a 3rd degree perineal laceration, and operative
vaginal delivery
 Assist junior residents in performing cesarean delivery
3. Patient Care (Management Skills)
 Assist the PGY-1 and PGY-2 residents in the management of all antepartum and
intrapartum patients on Labor & Delivery, with particular attention to complicated
patients
 Optimize the use of obstetrical anesthesia in accordance with patient preference and
clinical situation
 Anticipate adverse pregnancy outcomes and prepare strategies to effectively
manage them in a timely fashion
 Respond to acute intrapartum emergencies with appropriate interventions and
demonstrate the ability to delegate responsibilities to a variety of staff members
 Anticipate staffing needs
 Continually update the Attending Physician on the status of patients
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Department of Obstetrics and Gynecology
St. Francis Hospital & Medical Center
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Delegate appropriate levels of responsibility to medical students, junior residents,
and nurses
4. Practice-Based Learning
 Formulate and answer clinical questions that arise from patient care interactions
 Exemplify the ability to interact with the most challenging patients to give junior
residents and students a role model to follow
 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 (such as team training,
fetal-heart rate monitoring certification)
 Use of information technology: UpToDate, Emedicine, PubMed literature search,
Cochrane Database, etc.
 Complete annual on-line certification courses and other requirements for hospital
privileges (such as PPD testing) in a timely manner
5. Communication / Interpersonal Skills
 Present pertinent obstetrical history and physical findings to team members and
consultants in a clear, concise fashion and assist the junior residents and medical
students in preparing their presentations
 Demonstrate caring and respectful interactions with the obstetric patient and her
family
 Counsel patients in language and manner appropriate to their level of education and
understanding
 Coordinate the care of complicated patients by continually updating patient care
team (attending physician, nursing staff, NICU staff, anesthesia, etc) on status of
patients
 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.
 Interact respectfully and professionally with departmental and hospital administrative
staff
 Provide constructive feedback to fellow residents, medical students, and nurses-intraining
6. Professionalism
 Participate actively in the education of fellow residents, medical students, and
nurses-in-training
 Delegate an appropriate level of responsibility to junior residents and medical
students on the Labor & Delivery and postpartum unit, and fill in as needed to assure
a smooth transition
 Acknowledge limitations in knowledge and skills and exercise good judgment in
seeking assistance from peers, attendings, and nurses
 Demonstrate accountability for one’s actions, the actions of one’s junior residents,
and clinical decisions under high acuity settings
 Demonstrate truthful and timely disclosure of adverse outcomes to the appropriate
staff members
 Advocate for patients within the healthcare system
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Department of Obstetrics and Gynecology
St. Francis Hospital & Medical Center
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Demonstrate respect and sensitivity to issues of diversity with patients, peers,
nurses, and administrative staff
Uphold the ethical principles of our specialty as detailed by ACOG and AMA
Recognizes when to seek help from fellow residents, fellows, attendings, or nurses
Abides by HIPPA regulations
Demonstrate 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
 Coordinate use of consultants and ancillary services personnel to create an effective
patient care team
 Anticipate patient needs in discharge planning and follow-up
 Follow clinical pathways as detailed in triage and Labor & Delivery protocols
 Demonstrate judicious and efficient resource utilization
 Coordinate and define the roles and responsibilities of healthcare team members
 Represent the residency in quality improvement activities of the department
 Demonstrate effective use of hospital computer system (Carelink), digital imaging
system, CPN, medical records, and the dictation system
Types of Clinical Encounters
The PGY-4 resident on this rotation works closely with the MFM Attendings and Supervising
Attendings to render care to all patients presenting to the triage area of Labor & Delivery as
well as the inpatient management of all laboring and postpartum patients. A wide variety of
both normal and abnormal obstetric pathology is encountered in these antepartum,
intrapartum, and postpartum patients.
The PGY-4 resident will participate in the management of a variety of medical conditions
complicating pregnancy, including:
 Diabetes mellitus
 Diseases of the urinary system
 Infectious diseases
 Hematologic disorders
 Cardiopulmonary disease
 Gastrointestinal disease
 Neurologic disease
 Endocrine disorders
 Collagen vascular disorders
 Psychiatric disorders
 Substance abuse
 Emergency care / trauma
In addition, the PGY-4 resident will assist the PGY-2 and PGY-3 residents in caring for
patients with the following complications, including:
 Cervical insufficiency
 Second and third trimester bleeding
 Multiple pregnancy
 Fetal malpresentation
 Preterm labor and preterm PROM
 Isoimmunization
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Department of Obstetrics and Gynecology
St. Francis Hospital & Medical Center
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Hypertensive disorders of pregnancy
Fetal growth restriction
Intrauterine fetal death
Post-term pregnancy
III. Rotation Structure
The PGY-4 resident will review in detail the goals of the rotation before the first day of the
rotation. The resident will actively participate in:
 Supervise rounds, focusing on complicated postpartum patients (both vaginal and
cesarean deliveries)
 Morning Report (daily)
 Sign-out Rounds
 At all other times, it is expected that the PGY-4 resident will supervise junior
residents and medical students on the labor floor and attending to postpartum
complications
 Assist junior residents in performing vaginal deliveries
 Supervise primary coverage of the Triage area on Labor & Delivery and the
postpartum service
IV. Resident Supervision
The PGY-4 resident’s daily activities fall under the management of the MFM Attendings and
Supervising Attendings, which provides opportunity for immediate feedback. Deliveries and
procedures are performed under the direct supervision of the Doc-in-the-Box Attending
Physician at all times, including nights, weekends, and holidays. This is ensured by 24-hour
in-house coverage by attending staff.
V. Reading List and Educational Materials
 Textbooks: (i) William’s Obstetrics; (ii) Gabbe S, et al (editors). Obstetrics: Normal and
Problem Pregnancies; (iii) Briggs GG, et al (editors). Drugs in Pregnancy and Lactation;
(iv) Creasy and Resnick (editors). Maternal-Fetal Medicine.
 ACOG Compendium
 UpToDate Clinical Reference Library
 Emedicine
 PubMed
 Cochrane Perinatal Database
VI. Method of Evaluation
 The PGY-4 resident will receive on-site timely formative feedback from the MFM
Attendings and Supervising Attendings during this rotation.
 Global evaluations of PGY-4 residents are performed at the completion of the 4-week
rotation by select Obstetric faculty and reflect input from the attending staff, nurses,
medical students, and patients. These evaluations will be available to the residents via
the MyEvaluations.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.
 Nursing staff will complete evaluations of selected skills of each resident at the
completion of each block.
 Cognitive assessment of the residents’ obstetric skills is achieved by the obstetric score
from the CREOG examination.
 CREOG Competency cards: S-fac, C-fac, and Fac-1 cards
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Department of Obstetrics and Gynecology
St. Francis Hospital & Medical Center
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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 18, 2010
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Date