Department of Obstetrics and Gynecology
St. Francis Hospital & Medical Center
PGY-2 Learning Objectives
Night Float Rotation
I. Educational Purpose
The PGY-2 night float experience is an opportunity to enhance training in in-patient
obstetrical care within the residency program. In this rotation, the PGY-2 resident learns to
manage routine obstetrical patients during the intrapartum and postpartum periods and
begin to teach the PGY-1 residents. The PGY-2 resident develops proficiency in the
management of high-risk obstetric patients in The Delivery Room, in triaging Emergency
Department patients, in the postpartum management of complicated patients, and in
managing postoperative gynecology patients. Residents develop competence performing
operative vaginal deliveries and repeat cesarean deliveries. They are introduced to
supervising the Emergency Department consultations, postoperative gynecology in-patient
management, and emergency surgical cases.
II. Goals and Objectives
By completion of the PGY-2 year, the resident should demonstrate skillful management of
more complicated intrapartum and postpartum patients, Emergency Department
consultations, and postoperative care of the gynecology patient within the context of the
ACGME core competencies.
The resident should be able to:
1. Medical Knowledge
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Compare and contrast the major physiologic changes in each organ system during
complicated versus normal pregnancies
Act on the impact of pregnancy on maternal medical conditions and, conversely, the
impact of various maternal medical conditions upon pregnancy outcome
Order, interpret, and act on results of common diagnostic tests in the context of the
normal and abnormal physiologic changes of pregnancy
Demonstrate accurate and timely interpretation of intrapartum fetal heart rate
patterns and implement appropriate interventions
Perform, interpret, and act on assessments of fetal well-being, including: contraction
stress testing, biophysical profile, vibroacoustic stimulation
Identify abnormalities of labor in a timely manner, and perform appropriate corrective
actions
Identify appropriate indications for induction of labor
Utilize the various methods of cervical ripening / labor induction, recognize potential
complications for each, and act on them
Counsel parturients regarding various forms of obstetric anesthesia and their
complications, including: local, intravenous, pudendal, epidural, spinal and general
Demonstrate proficiency in ordering pharmacologic agents commonly used in
obstetrics (including labor-inducing agents, tocolytics, analgesics, antibiotics, insulin,
heparin, etc.) and act on their complications
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Department of Obstetrics and Gynecology
St. Francis Hospital & Medical Center
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Anticipate the need for 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 and
participate in strategies to resolve them
Provide individualized supportive care of the normal and complicated postpartum
patient, including: contraceptive needs, emotional evaluation, and lactation
consultation
Summarize changes that occur in the cardiopulmonary function of a patient after
anesthesia
2. Patient Care (Clinical Skills)
 Conduct focused patient histories and physical examinations on patients with
uncomplicated pregnancies of low acuity, including:
i. Comprehensive physical examination
ii. Focused examination of the 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 fetal presentation, position, and station
vii. Basic ultrasound examination including: fetal biometry, presentation, and
placental localization
viii. Interpret and act on fetal heart rate monitoring
ix. Place and interpret data from external and internal contraction monitors
 Evaluate symptoms and physical findings in pregnant patients to distinguish
physiologic from pathologic findings
 Demonstrate ability to perform amnioinfusion, fetal scalp sampling, oxytocin
challenge test (OCT), and biophysical profile (BPP)
 Determine fetal lie by ultrasound and physical exam
 Demonstrate level-appropriate skills in operative vaginal delivery
 Demonstrate level-appropriate skills in repeat cesarean delivery
 Interpret diagnostic tests ordered to evaluate acute vaginal bleeding, acute
abdominal pain, and vaginal discharge
 Interpret diagnostic tests ordered to work-up fever, bleeding, or pain in a postoperative gynecological patient
 Properly triage ED consults and postoperative gynecological patients that need
emergent surgical intervention
3. Patient Care (Management Skills)
 Assist the PGY-1 resident in the management of all antepartum and intrapartum
patients on Labor & Delivery and in the Emergency Department, with particular
attention to complicated patients
 Anticipate adverse pregnancy outcomes and prepare strategies to effectively
manage them in a timely fashion
 Respond to acute intrapartum emergencies with appropriate interventions
 Continually update patient care team (attending physician, PGY-3 and -4 residents,
nursing staff, NICU staff, anesthesia, etc) on status of patient(s) and anticipate
staffing needs
 Supervise and lend guidance to medical student, PGY-1, and other student
education
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Department of Obstetrics and Gynecology
St. Francis Hospital & Medical Center
4. Practice-Based Learning
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Formulate and answer basic clinical questions that arise from patient care
interactions
Accept and incorporate feedback from evaluations to improve skill base
Update work-hour logs on a weekly basis and work efficiently to maintain compliance
with Duty Hour Requirements
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
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Present pertinent obstetrical history and physical findings to team members and
consultants in a clear, concise fashion
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
Continually update patient care team (attending physician, nursing staff, NICU staff,
anesthesia, etc) on status of patient(s)
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
Give constructive feedback to medical students
6. Professionalism
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Demonstrate responsibility for the welfare of all patients on the Labor & Delivery and
postpartum units
Acknowledge limitations in knowledge and skills and exercise good judgment in
seeking assistance from peers, attendings, and nurses
Demonstrate accountability for one’s actions and clinical decisions under moderate
acuity settings
Acknowledge errors or omissions in patient care, and work toward timely resolution
or alleviation of such
Demonstrate truthful and timely disclosure of adverse outcomes to the appropriate
staff member(s)
Advocate for patients within the healthcare system
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, AMA
Recognizes when to seek help from fellow residents, fellows, attendings, or nurses
Abide by HIPPA regulations
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Department of Obstetrics and Gynecology
St. Francis Hospital & Medical Center
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Demonstrates ability to receive both positive and negative feedback with appropriate
insight and professionalism
Provide constructive feedback to fellow residents, medical students, and nurses-intraining
7. Systems-Based Practice
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Order diagnostic tests with attention to clinical relevance and cost-effectiveness
Effectively use 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 Delivery Room protocols
Demonstrate judicious and efficient resource utilization
Support the roles and responsibilities of healthcare team members
Participate in quality improvement activities of the department
Demonstrate effective use of hospital computer system, medical records, and the
hospital dictation system
Types of Clinical Encounters
PGY-2 residents work closely with PGY-1 residents to care for all patients presenting to the
triage area of the Delivery Room, the in-patient management of all laboring and postpartum
patients, and Emergency Department consults. A wide variety of both normal and abnormal
obstetric pathology is encountered in these antepartum, intrapartum, and postpartum
patients.
The PGY-2 resident will participate in the management of a variety of medical conditions
complicating pregnancy, including:
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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-2 resident will assist the PGY-3 and PGY-4 residents in caring for
patients with the following complications, including:
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Cervical insufficiency
Second and third trimester bleeding
Multiple pregnancy
Fetal malpresentation
Preterm labor and preterm PROM
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Department of Obstetrics and Gynecology
St. Francis Hospital & Medical Center
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Isoimmunization
Hypertensive disorders of pregnancy
Fetal growth restriction
Intrauterine fetal death
Post-term pregnancy
Procedures to be mastered in the PGY-2 year:
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Preterm vaginal delivery
Administration of anesthetic: local, pudendal
Assessment of biophysical profile (BPP)
Repeat cesarean delivery
Procedures introduced in the PGY-2 year (but mastered in the PGY-3 and PGY-4 year):
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Vaginal delivery of twins
Operative vaginal delivery
Emergent cesarean delivery
Repair of 3rd & 4th degree perineal laceration
Repair of cervical laceration
III. Rotation Structure
The PGY-2 resident will review in detail the goals of the rotation before the first day of the
rotation. The PGY-2 resident will actively participate in:
 Sign-out Rounds
 At all other times, the PGY-2 resident will assist the PGY-1 resident in the Delivery
Room, and take responsibility for performing circumcisions and attending to
postpartum complications
 Assist the PGY-1 resident in performing vaginal deliveries from the Women’s Center,
MFM Practice, Private Practices, and Midwifery Service
 Provide primary coverage of the triage area of the Delivery Room and postpartum
floor with some assistance from the PGY-1 resident
 Triage all Emergency Department consults as requested by the Chief Resident
 Assist in emergent gynecological surgeries as requested
 Round on gynecologic inpatients as required
 Morning Report
IV. Resident Supervision
The resident’s nightly activities fall under the supervision of the Chief Resident and
Attending Physician, who provide opportunity for immediate feedback.
Deliveries and procedures are performed under the direct supervision of the Attending
Physician at all times, including nights, weekends, and holidays. This is ensured by 24-hour
in-house coverage by attending staff.
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Department of Obstetrics and Gynecology
St. Francis Hospital & Medical Center
V. Reading List and Educational Materials
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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;
(iii) Creasy (editor). Management of Labor and Delivery; (iv) Creasy & Resnick (editors).
Maternal-Fetal Medicine; (v) TeLinde's Operative Gynecology
ACOG Compendium
UpToDate Clinical Reference Library
Emedicine
PubMed
Cochrane Perinatal Database
VI. Method of Evaluation
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Residents will receive on-site timely formative feedback from the Chief Resident and
Attending Physician(s) during this rotation.
Global evaluations of PGY-2 residents are performed at the completion of the rotation by
select 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’ obstetrical skills is achieved by the obstetrical
score from the CREOG examination.
CREOG Competency cards: S-fac, C-fac, and Fac-1 cards
Dictations-to be performed immediately after a procedure
Completion of work-hours log- done weekly
Completion of ACGME procedure log-done weekly
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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.
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Resident Printed Name
_______________________________________
Resident Signature
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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
has
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Date