POSTGRADUATE YEAR II
Continuity Clinic – Weekly
The goals and objectives of the weekly continuity clinic are to further enhance the professional
relationship between the PG-II resident and patient. Counseling regarding lifestyle issues and preventive
health care should be emphasized. Continuity of care should be provided across both primary care and
the OB/GYN spectrum. The resident should become more familiar with prenatal care management of
common high risk conditions such as diabetes, hypertension, preterm labor, and genetic counseling.
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
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
No specific technical goals and objectives are designed for this rotation. The resident may enhance or
complete the technical goals and objectives outlined for the Family Health Center rotation at the
completion of the PG-II continuity experience.
Medical Knowledge
A. The resident will have a thorough understanding of fetal development and physiology including:
1. Basic science principles of placental and fetal development
2. Acceptance of the fetal allograft by the maternal immune system
3. Normal and abnormal placentation
4. Vascular interaction of the placenta with the maternal and fetal circulation
5. Development of the placental membranes, as well as their permeability and endocrine functions
6. Basic principles of placental transfer
B. The resident will have a thorough understanding of the concepts of cell reproduction, development,
and function in terms of molecular genetics including:
1. DNA replication, RNA replication, messenger, ribosomal, and transfer RNA
2. Genes, alleles, transcription, translation, and genetic code
3. Differentiation of meiosis, mitosis, non-disjunction, translocation, deletion, mosaicism, and
spontaneous mutation
4. Gametogenesis in the male and female gonad
5. Common procedures and indications for karyotype determination
6. Process of human fertilization
7. Lyon hypothesis
8. Embryology and developmental abnormalities including timing and mechanism of neural tube
closure, development of hematopoiesis, migration of germ cells, formation and development of
the male and female external genitalia
9. Fetal cardiovascular and respiratory development
C. The resident should have a thorough understanding of the preventive health services associated with
care of the geriatric patient including:
1. The prevention of disease, identification of treatable conditions, delay of onset of dependency,
and promotion of good nutrition
2. Performing periodic evaluation, physical examination, diagnostic tests, health education, and
other preventive care as recommended by ACOG, including: history and physical examination,
laboratory tests, including PAP, mammography, cholesterol screening, fecal occult blood testing,
referral for sigmoidoscopy/colonoscopy, and screening for diabetes and thyroid disease
3. Oral health
4. Lifestyle counseling including exercise, sexuality, safety, nutrition, weight control, and sleep
patterns
5. Assessment and management of bladder and bowel function
6. Medication history
7. Vaccination including influenza, pneumococcal, and zoster vaccines as appropriate to the patient
8. Screening for depression, anxiety, mental status, and domestic and elder abuse
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 the RII
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 II 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)
Williams Obstetrics: Cunningham (Author)
ACOG Compendium and Committee Opinions
Any topic pertinent to patients seen during continuity clinic
POSTGRADUATE YEAR TWO
Family Health Center – Two Months
The second block rotation at the Family Health Center is designed to build upon the skills developed in
ambulatory obstetrics and gynecology during the PG-I year. The resident should continue to refine skills
outlined in the general objectives as they pertain to information management, communication skills, and
patient assessment. This rotation will focus on more complicated obstetrical care, identification and
management of high risk antepartum conditions, as well as routine and more advanced gynecologic
procedures.
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
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. Colposcopy
2. IUD insertion and removal
3. Transvaginal ultrasound
4. LEEP procedure
5. Paracervical block
6. Incision and drainage of Bartholin’s cyst and abscess
7. Management of gestational and pregestational diabetes mellitus
8. Management of HIV in pregnancy
9. Management of obstetrical patients with history of preterm delivery
Following completion of this rotation, the resident is expected to be competent in the following
procedures:
1. Endometrial biopsy
2. Endocervical curettage
3. Cervical biopsy
4. IUD insertion and removal
Medical Knowledge
A. The resident will continue to refine patients presenting with urgent and primary care illnesses as
follows:
1. Identification of appropriate age or behavior related health risk factors
2. Identification and utilization of appropriate screening tests for risk assessment
3. Knowledge of leading causes of death and morbidity by age group
4. Knowledge or and counseling for sexuality, fitness, and psychosocial issues
5. Knowledge of periodic immunization and high risk groups
6. Performance of a well woman exam including pap smear and appropriate STI screening
7. Simple upper respiratory conditions including pharyngitis and otitis
8. Uncomplicated respiratory conditions such as bronchitis and pneumonia
9. Medical therapy for uncomplicated hypertension and counseling for cardiovascular disease
10. Dietary management of chronic disorders of elimination, and microbial flora bowel disease
11. Uncomplicated depression, simple headache, and anxiety disorders
12. Domestic violence and sexual abuse
13. Management of uncomplicated sunburn, irritative or inflammatory skin disorders, and simple
biopsy procedures
14. Uncomplicated diabetes mellitus and hypothyroidism
B. The resident should have an understanding of reproductive alternatives and options including:
1. Focused obstetrical history related to LMP, positive biochemical test for pregnancy, and
ultrasound dating
2. Confirmation of pregnancy by physical exam including the size of the uterine fundus and the
presence of adnexal disease
3. Identification of pregnancy approaching a gestational age governed by legal limits imposed by
state or local statutes
4. Characteristics of the pregnancy based on gestational age that dictate the type of induced abortion
to be performed
5. Possible interventions to include suction curettage, D&E, intrauterine installations, and extrauterine prostaglandin administration
6. Potential complications of intervention including medical and psychosocial considerations
7. Follow-up including patient education and counseling
C. The resident should understand the concepts of sexual development as well as the physiology of
sexual relations including the stages of normal sexual response. This will also include:
1. Patterns in which sexual response may be altered by physical or emotional disease and aging
2. An understanding of the role of sexual counseling in his or her practice
3. The principles of obtaining a sexual history and interviewing techniques
4. A familiarity with and established comfort in discussing issues related to sexual orientation
5. The ability to diagnose and manage loss of desire, arousal, and organism as well as treatment for
inappropriate resolution, vaginismus, and dyspareunia
D. The resident will have an understanding of the diagnosis and treatment of intrauterine fetal demise
including:
1. Historical factors such as vaginal bleeding, lack of fetal movement, maternal trauma, illicit drug
use, and underlying maternal disease
2. Assessment by physical examination including uterine size and dates discrepancy and lack of
fetal heart tones
3. Utilization of diagnostic studies including i
4. Managing and monitoring, maternal blood tests including Kleihauer-Betke, D-antibody and other
antibody status, amniotic fluid and cervical cultures, toxicology, and assessment of maternal
disease
5. Possible interventions including prostaglandins, D&E, oxytocin induction, and D&C
6. An understanding of factors influencing decisions regarding intervention including gestational
age, underlying cause of death, fetal anomaly, maternal disease, cervical status, and assessment of
maternal emotional reaction
7. Follow-up of potential etiologies including pathologic assessment, chromosomal abnormalities,
and maternal metabolic or immunologic disorders
8. Counseling for emotional support
E. The resident will develop an understanding of the management of diabetes in pregnancy including:
1. Rationale and criteria for gestational diabetes screening in pregnancy
2. Historical factors related to age of onset and duration of symptoms, as well as symptoms of
microvascular disease
3. Differentiation among Type I, Type II, and gestational diabetes
4. History of diabetes in previous pregnancy
5. Assessment of physical signs including retinopathy, neuropathy, and skin changes
6. Maternal diagnostic studies including glucose determinations, hemoglobin A1C, 24-hour urine
for total protein and creatinine clearance, EKG as indicated, and ophthalmologic studies as
indicated
7. Possible interventions for the control of diabetes including insulin, oral hypoglycemic, diet, and
exercise
8. Management of second and third trimester diabetics with fetal surveillance, amniocentesis, and
decisions regarding mode of delivery
9. An understanding of factors influencing intervention including glucose control, microvascular
disease, fetal condition, macrosomia, and shoulder dystocia
10. Intrapartum management of blood glucose via intravenous fluids and insulin drip
11. Post-pregnancy management of glucose control
F. The resident will have an understanding of the etiology, diagnosis, and management of patients with
fetal growth restriction including:
1. Historical factors including previous SGA infant, maternal medical complications, maternal age
greater than 35 years, exposure to teratogens, and social and recreational drug use
2. Physical examination to assess for maternal hypertension, inadequate weight gain, and size/dates
discrepancy
3. Diagnostic studies including fetal size parameters, amniotic fluid volume, and amniocentesis for
karyotype and lung maturity
4. An understanding of possible interventions including fetal surveillance and timing of delivery
5. Potential complications of intervention including prematurity and complications of operative
delivery
6. Potential complications of non-intervention including perinatal morbidity and mortality and longterm neurologic sequelae
G. The resident will have an understanding of the diagnosis, work-up, and management of the abnormal
Pap smear including:
1. Assessment of risk factors, previous Pap results, and impact of HPV
2. Assessment on physical examination of lesions and cervical friability
3. Diagnostic studies to include colposcopy, Pap smear, acetic acid test, cervical biopsy, and
endocervical curettage
4. The role of conization (LEEP), laser, and cryotherapy in the outpatient setting
5. Possible management interventions appropriate for age of patient, future fertility, classification of
disease, and underlying medical conditions
6. The role of Gardasil vaccination
7. Potential complications of intervention
8. Potential complications of non-intervention
9. Follow-up, patient education, and counseling
H. The resident will have an understanding of the diagnosis, work-up and management of patients with
abnormal uterine bleeding unrelated to pregnancy including:
1. Historical symptoms of abnormal bleeding such as onset amount, duration, and pattern, systemic
signs of coagulopathy, and medication use
2. Physical examination to reveal source of bleeding, visible lesions, evidence of trauma
3. Diagnostic studies to include imaging, cytologic and histologic, bacterial cultures, and
hysteroscopy
4. Diagnostic criteria for neoplastic infectious and endocrine disorders related to abnormal bleeding
5. Possible interventions including hormonal therapy, antimicrobial agents, uterine curettage, and
repair of genital tract injury
6. Factors influencing intervention including age of patient, desire for pregnancy, sexual function,
and possibility of malignant disease
7. Potential complications of intervention, operative complications, and adverse drug reactions
8. Potential complications of non-intervention including malignancy, anemia, progression of
infection, potential for further trauma
9. Follow-up, plans for long-term therapy and patient education and counseling
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 II resident rotating on the FHC-SA service is evaluated using 360 evaluations. They are evaluated
by their faculty, their patients, the ancillary staff, the junior residents and themselves. The FHC-SA
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)
Williams Obstetrics: Cunningham (Author)
ACOG Compendium and Committee Opinions
Medical Management of Tubal Pregnancy
Hormonal Contraception in Women with Co-existing Medical Conditions
Management of Anovulatory Bleeding
Premenstrual Syndrome
Management of Infertility Caused by Ovulatory Dysfunction
Osteoporosis
Menopause topics
Human Papillomavirus
POSTGRADUATE YEAR TWO
Gynecologic Oncology– Two Months
The goals and objectives of the R-2 rotation on gynecologic oncology will focus on further didactic
learning in gynecologic malignancies, critical care medicine, and a more significant presence in the
operating room with experience in surgical treatment of gynecologic malignancies. The resident will
review as needed, the didactic and technical goals and objectives from the PG-1 rotation on gynecologic
oncology.
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
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. Dilatation and curettage/endocervical curettage for diagnosis of cervical and endometrial
malignancies
2. Operative experience as an assistant for radical hysterectomy
3. Operative experience in the surgical staging and debulking of ovarian malignancies
4. Management of the critically ill patient
5. Surgical experience as an assistant in urinary and bowel diversion procedures
6. Surgical experience in pelvic lymph node sampling and resection
7. Omentectomy
8. Ovarian transposition
9. Cervical conization
10. Total abdominal hysterectomy
11. Surgical experience as an assistant in vulvectomy
12. Laser therapy of the vulva/vagina
Following completion of this rotation, the resident is expected to be competent in the following
procedures:
1. Abdominal and pelvic exploration
2. Surgical incisions and closure of the abdomen
3. Dilatation and curettage
4. Cervical conization
Medical Knowledge
A. The resident will have an understanding of the diagnosis and management of ovarian cancer
including:
1. Historical factors such as abdominal distension, pain, cramping, weight loss, dyspepsia, and
familial cancer syndromes
2. Physical examination including abdominal distension, pelvic mass, and supraclavicular
adenopathy
3. Diagnostic studies including imaging, paracentesis, thoracentesis, and tumor markers
4. Establishing a differential diagnosis including non-gynecologic cancer and benign tumor
5. Classification and staging of epithelial, germ cell, sex cord, and metastatic disease to the ovary
6. Interventions including surgical staging, conservative and cytoreductive procedures, as well as
chemotherapy and radiation
7. Factors influencing intervention including age, histology, future fertility, and underlying medical
conditions
8. Potential complications of intervention including side effects, operative complications, and
fertility impairment
9. Follow-up including multidisciplinary approach, patient education and counseling, psychosocial
support, management of recurrence, and palliative care
B. The resident will have an understanding of the diagnosis and management of gestational trophoblastic
disease including:
1. Historical factors such as bleeding, early onset obstetrical hypertension, hyperemesis, and
hyperthyroidism
2. Appropriate physical findings including size dates discrepancies, bleeding, ovarian cysts, absent
fetal heart tones, blood pressure elevation, and thyromegaly
3. Diagnostic studies including ultrasound, quantitative hCG, chest x-ray, CT scan, and thyroid
studies
4. Possible interventions including hysterectomy and suction curettage
5. Factors influencing intervention including classification of disease, age of patient, medical
comorbidities, and future fertility
6. Potential complications including radiation effects, drug effects, operative complications, and
fertility impairment
7. Follow-up approach including patient education and counseling, hCG level, pelvic exam,
ultrasound, and chest x-ray
C. The resident will have an understanding of the diagnosis and management of malignant gestational
trophoblastic disease including:
1. Historical factors such as bleeding, early onset obstetrical hypertension, hyperemesis, and
hyperthyroidism
2. Appropriate physical findings including size dates discrepancies, bleeding, ovarian cysts, absent
fetal heart tones, blood pressure elevation, and thyromegaly
3. Diagnostic studies including ultrasound, quantitative hCG, chest x-ray, CT scan, and thyroid
studies
4. Diagnosis of metastatic and nonmetastatic disease with assessment of prognosis
5. Management interventions including surgery with chemotherapy, chemotherapy alone, and
radiation therapy
6. Factors influencing intervention including staging, age, medical comorbidities, and future fertility
7. Complications of intervention including radiation, drug side effects, operative complications, and
future fertility impairment
8. Follow-up including patient education and counseling, recurrence patterns and timing,
appropriate contraception, and psychosocial support
D. The resident will have an understanding of the general principles of radiation therapy either as a
primary treatment or as adjunctive treatment for gynecologic neoplasms including:
1. Physical exam suggesting patient is or is not amenable to radiation therapy
2. Diagnostic studies to assess the patient ability to tolerate radiation therapy
3. Assessment of predicted response to radiation therapy based on cancer type
4. Management interventions including intracavitary, external-beam, interstitial radioisotope, and
palliative radiotherapy
5. Factors influencing decisions regarding intervention such as stage of disease, disease histology,
age of patient, medical comorbidities, future fertility, and maximal dose tolerance of selected
organ systems
6. Follow-up including patient education and counseling, short- and long-term implications, sexual
function and cosmetic concerns, and psychosocial support
E. The resident will have an understanding of the general principles of chemotherapy and understand
when chemotherapy is indicated either as primary treatment or as adjunctive therapy. This would
include:
1. Physical examination suggesting patient is or is not amenable to chemotherapy
2. Diagnostic studies including imaging and assessment of vital organ function and bone marrow
function
3. Response of each type of cancer to specific chemotherapeutic agents
4. Interventions with specific chemotherapeutic agents and mechanisms of action of alkylating
agents,
antimetabolites,
vinca
alkaloids,
antibiotics,
hormones,
heavy
metals,
and
immunotherapeutic agents
5. Factors influencing decisions regarding intervention including classification and stage of disease,
age of patient, medical comorbidities, future fertility, concomitant therapy, and maximal dose
tolerance of selected organs
6. Potential complications of intervention and non-intervention
7. Follow-up including long and short-term complications, psychosocial and medical complications,
and psychosocial support
F. The resident will have an understanding of the diagnosis and management of critical care conditions
including:
1. Septic shock
2. Acute respiratory distress syndrome
3. Hemodynamic compromise
4. Cardiopulmonary resuscitation
5. Allergic drug reactions
6. Thromboembolic disease
Interpersonal and Communication Skills
Following completion of this rotation, the resident is expected to be able to:
1. Demonstrate leadership skills with the 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 oncology patient
3. Communicate effectively with other services and the ER regarding consultations
4. Coordinate the care of all patients on the Gynecology/Oncology 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/Oncology service along with the Attending and
Fellow
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 oncology 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 Oncology surgeries and
Management of Gynecologic Oncology 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 Oncology issues and management.
Evaluations
The PG II resident rotating on the Gynecology/Oncology service is evaluated using 360 evaluations. They
are evaluated by their faculty, their patients, the ancillary staff, the junior residents and themselves. The
Gynecology/Oncology attendings and fellows complete the summative evaluations at the end of the
rotation. The evaluations are done based on 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 gynecologic oncology cases.
Reading Assignments:
TeLinde’s Operative Gyecology: John A. Rock (Editor), Howard W Jones (Editor)
Clinical Gyecologic Oncology: DiSaia and Creasman (Authors)
Normal Pelvic Floor Anatomy: K. Strohbehn, MD
ACOG Compendium and Committee Opinions
Prophylactic Oophorectomy
Role of General Ob/Gyn in Early Detection of Ovarian Cancer
Diagnosis and Treatment of Cervical Carcinomas
Management of Endometrial Cancer
Management of Abnormal Cervical Cytology and Histology
POSTGRADUATE YEAR TWO
First Obstetrical Rotation – Three Months
(UCI L&D Days, LB L&D Days & Nights)
The first obstetrical rotation of the PG-II year is designed, under the supervision of the chief resident and
faculty to take a more active role in the management of the high risk obstetrical patient. The resident will
supervise the Obstetrical Emergency Room, make disposition decisions on these patients, and triage
admissions to the labor and delivery floor and antepartum ward. Under the supervision of the more senior
in-house resident and faculty, the PG-II resident will manage the labor and delivery board, taking initial
responsibility for the management of the high risk admissions, and will assist in supervising the PG-1 in
the management of more routine obstetrical patients. 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
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. Assessment of gestational age using ultrasound
2. Amniocentesis for fetal lung maturity
3. Operative vaginal delivery including forceps and vacuum
4. Primary, elective repeat, and emergent cesarean section
5. Management of shoulder dystocia
6. Management of hypertensive disorders of pregnancy
7. Management of third and fourth degree lacerations
8. External cephalic version
9. Adnexal surgery at the time of cesarean section
10. Cervical length measurement by ultrasound
Following completion of this rotation, the resident is expected to be competent in the following
procedures:
1. Assessment of gestational age using ultrasound
2. Use of cervical ripening agents
3. Assessment of Bishop score
4. Management of vaginal and cervical lacerations
Medical Knowledge
A.
The resident will have an understanding of the diagnosis and treatment of patients with pre-term
labor including:
1. The accurate assessment of gestational age using historical and imaging techniques
2. Estimation of gestational age using physical examination
3. Differential diagnosis of pre-term labor including PPROM, chorioamnionitis, cervical
incompetence, and multiple gestation
4. Possible interventions for treatment including bed rest, tocolytic therapy with agents such as
magnesium sulfate, beta-mimetics, and prostaglandin synthetase inhibitors
5. Factors influencing decisions regarding intervention including gestational age, status of fetal
membranes, uterine activity, cervical change over time, status of fetal fibronectin, and preexisting maternal medical conditions
6. Potential complications of intervention
7. Potential complications of non-intervention
B.
The resident will have an understanding of the diagnosis and management of abnormal labor
including:
1. Historical factors in previous pregnancies, i.e., macrosomia, previous mode of delivery,
diabetes, and post-term pregnancy
2. Assessment of clinical pelvimetry, estimated fetal weight, malpresentation, and fetal station
3. Assessment of protraction and arrest of labor
4. Possible interventions including sedation, amniotomy, oxytocin stimulation, and operative
delivery
5. Factors influencing decisions regarding intervention such as fetal condition and progress of
labor
6. Potential complications of intervention or non-intervention
7. Follow-up assessment of progress of labor and fetal surveillance
C.
The resident will refine techniques in assessment of fetal well-being including the
pathophysiology and assessment of normal and abnormal fetal heart rate tracings
D.
The resident will have an understanding of the indications and methods for induction of labor
including:
1. Factors that predispose to indicated induction including medical and obstetrical complications
and fetal factors
2. The use of induction and ripening agents including oxytocin, prostaglandins, and mechanical
dilators
3. Assessment of Bishop score
4. Potential complications of induction such as failed induction, chorioamnionitis, reproductive
tract injury, and fetal compromise
5. Potential complications of non-intervention including maternal morbidity, fetal compromise
and demise
E.
The resident will have an understanding of the management of acute hypertension in pregnancy
including:
1. Historical factors such as headache, visual disturbances, epigastric and right upper quadrant
pain, pre-existing hypertension, and family history
2. Assessment by physical examination including blood pressure, edema, hepatic tenderness,
occular changes, and hyperreflexia
3. Maternal diagnostic studies to assess systemic disease including CBC, platelet count,
creatinine, uric acid, hepatic enzymes, and coagulation studies
4. Assessment of fetal status including ultrasound, fetal heart rate monitoring, and maturation
studies
5. Differential diagnosis to rule-in or out gestational hypertension, preeclampsia, and related
disorders
6. Interventions including bed rest, antihypertensives, anticonvulsant therapy, invasive
hemodynamic monitoring , and delivery
7. Factors influencing decisions for intervention including severity of hypertension and fetal
condition
8. Potential complications of intervention including prematurity
9. Potential complications of non-intervention including fetal morbidity and mortality,
eclampsia, renal failure, and coagulopathy
10. Maternal follow-up including assessment of response to treatment and delivery and
identification of need for postpartum work-up
11. Management of hypertensive urgency and eclampsia
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. Prepare cases for STATs each Friday while at UCI
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 Obstetric
issues and management
Evaluations
The PG II resident rotating on the Obstetrics services are 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. Each Friday while at
UCI, the PG II will present two cases to all faculty and residents. This allows faculty to evaluate the
resident knowledge of the patients and prepares the resident for their oral boards. 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
Multiple Gestation
Ultrasonography in Pregnancy
Antiphospholipid Syndrome
Nausea and Vomiting of Pregnancy
Diabetes in Pregnancy
Antepartum Fetal Surveillance
Thromboembolism in Pregnancy
Assessment of Fetal Lung Maturity
POSTGRADUATE YEAR TWO
Second Obstetrical Rotation – Three Months
(UCI L&D Days, LB L&D Days & Nights)
During the second obstetrical rotation of the PG-II year under the supervision of the chief resident and
faculty, the resident will continue to refine experience in the management of high risk obstetrical patients.
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
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. Assessment of gestational age using ultrasound
2. Amniocentesis for fetal lung maturity
3. Operative vaginal delivery including forceps and vacuum
4. Primary, elective repeat, and emergent cesarean section
5. Management of shoulder dystocia
6. Management of hypertensive disorders of pregnancy
7. Management of third and fourth degree lacerations
8. External cephalic version
9. Adnexal surgery at the time of cesarean section
Following completion of this rotation, the resident is expected to be competent in the following
procedures:
1. Assessment of gestational age using ultrasound
2. Amniocentesis for fetal lung maturity
3. Low and outlet operative delivery
4. Primary, elective repeat, and emergent cesarean section
5. Management of shoulder dystocia
6. Management of third and fourth degree lacerations
7. Management of hypertensive disorders of pregnancy
Medical Knowledge
A. The resident will have an understanding of the diagnosis and management of bleeding in late
pregnancy to include:
1.
Historical factors which may predispose to late pregnancy bleeding
2. Signs associated with bleeding in late pregnancy including abdominal pain, shock, fetal
compromise, malpresentation, and trauma
3. Diagnostic studies to assess maternal compromise including CBC, coagulation studies,
ultrasound, and double set-up
4. Nature and severity of fetal compromise including fetal heart rate monitoring, ultrasound, APT
test, and Kleihauer-Betke test
5. Diagnosis of placenta previa, abruptio placenta, uterine rupture, and vasa previa
6. Indications for intervention including blood pressure complications, bleeding, cardiovascular
status, coagulopathy, and fetal status
7. Factors influencing decisions for intervention including maternal condition and systemic disease,
fetal condition, and anticipated mode of delivery
8. Potential complications of intervention such as operative delivery, prematurity, and transfusion
reactions
9. Potential complications of non-intervention including maternal and fetal morbidity and mortality
10. Management of shock and maternal short and long-term complications
B. The resident will have an understanding of the management of pre-term and term premature rupture
of membranes including:
1. Historical factors aiding in diagnosis such as loss of fluid, assessment of gestational age, and
uterine activity
2. Sterile speculum examination for confirmation including nitrazine, ferning, and pooling
3. Avoidance of pelvic examination in pre-term PROM
4. Appropriate cultures including group B strep
5. Possible management interventions including hospitalization, delivery, antibiotics, and
amniocentesis
6. Factors
influencing
decisions
regarding
intervention
including
fetal
condition
and
chorioamnionitis
7. Potential complications of intervention including prematurity
8. Potential complications of non-intervention including neonatal morbidity or mortality and
maternal infection
9. Follow-up including maternal and fetal surveillance, medical therapy, timing and route of
delivery, and utilization of corticosteroids
C. The resident will have a thorough understanding of operative vaginal delivery procedures including:
1. Historical factors such as previous operative delivery, diabetes, macrosomia, and epidural
anesthesia in the current pregnancy
2. Physical findings including estimated fetal weight, clinical pelvimetry, and fetal position
3. Indications for operative vaginal delivery such as protraction and arrest of second stage labor,
fetal malposition, maternal exhaustion, maternal medical conditions, and abnormal fetal heart rate
4. Definition of procedures by appropriate category including outlet, low, and mid-forceps and
outlet and low vacuum extraction
5. Prerequisites and indications for operative intervention
6. Factors influencing decisions regarding intervention including fetal condition, fetal position, fetal
station, and type of anesthesia
7. Potential complications including maternal and fetal trauma, shoulder dystocia
8. Potential complications of non-intervention including maternal exhaustion, and maternal and fetal
morbidity and mortality
9. Awareness of construction, purpose, special attributes, and limitations of classical forceps, special
forceps, and vacuum extraction
D. The resident will have a thorough understanding of operative abdominal delivery including:
1. History of previous cesarean section, uterine anomaly, pre-existing maternal disease
2. Indications for cesarean section including failure to progress, malpresentation, fetal intolerance of
labor, prior classical incisions, placental disorders, fetal anomalies, and maternal medical
indications
3. Cesarean section interventions including LTCS, low vertical, and classical
4. Potential complications including infection, hemorrhage, thromboembolism, and anesthetic
complications
5. Complications of non-intervention including maternal and fetal morbidity and mortality
6. Appropriate follow-up
7. Management of operative complications
E. The resident will have an understanding of the diagnosis and management of thromboembolism
including:
1. Historical factors such as pain, edema, erythema, complicated delivery, hemoptysis, chest pain,
and dyspnea
2. Physical examination including tenderness, Homan sign, edema, erythema, tachycardia,
tachypnea, cardiovascular collapse, and arrhythmia
3. Diagnostic studies including doppler, venography, impedance plethysmography, ventilation
perfusion scan, CT, and pulmonary angiography
4. Differential diagnosis including superficial, deep vein, septic, and pulmonary embolism
5. Possible interventions including bed rest, antibiotics, and anticoagulants
6. Factors influencing intervention including location, associated infection, and embolic
complications
7. Potential complications of anticoagulant therapy including hemorrhage, hematoma, and
thrombocytopenia
8. Potential complications of non-intervention including vascular compromise, pulmonary
embolism, and death
9. Appropriate short and long-term follow-up
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. Prepare cases for STATs each Friday while at UCI
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 Obstetric
issues and management
Evaluations
The PG II resident rotating on the Obstetrics services are 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. Each Friday while at
UCI, the PG II will present two cases to all faculty and residents. This allows faculty to evaluate the
resident knowledge of the patients and prepares the resident for their oral boards. 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
Premature Rupture of Membranes
Management of Herpes in Pregnancy
Intrauterine Growth Restriction
Operative Vaginal Delivery
Fetal Macrosomia
External Cephalic Version
Diagnosis and Management of Preeclampsia and Eclampia
Assessment of Risk Factors for Preterm Birth
Obstetric Analgesia and Anesthesia
Review all reading assignments from Obstetrics 1 objectives
POSTGRADUATE YEAR TWO
High Risk Obstetrics – Long Beach WPG– Two Months
The high risk obstetrical rotation at Long Beach Memorial Hospital is intended to provide the resident
with experience in the inpatient management of complicated and high risk pregnancies. This includes the
management of hypertensive disease in pregnancy, premature labor, preterm premature rupture of
membranes, second and third trimester bleeding, and experience in operative vaginal delivery, cesarean
section, and post-partum sterilization.
The resident on this rotation should review the goals and
objectives for the first and second PG-II rotation in obstetrics as needed. 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
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. Assessment of gestational age using ultrasound
2. Amniocentesis for fetal lung maturity
3. Amniocentesis for prenatal diagnosis
4. Primary, elective repeat, and emergent cesarean section
5. Management of shoulder dystocia
6. Management of hypertensive disorders of pregnancy
7. Management of third and fourth degree lacerations
8. External cephalic version
9. Adnexal surgery at the time of cesarean section
10. Low and outlet vacuum and forceps procedures
11. Cervical cerclage
12. Vaginal breech delivery
Following completion of this rotation, the resident is expected to be competent in the following
procedures:
1. Assessment of gestational age using ultrasound
2. Amniocentesis for fetal lung maturity
3. Primary, repeat, and emergent cesarean delivery
4. Management of shoulder dystocia
5. Management of hypertensive disorders of pregnancy
6. Management of third and fourth degree lacerations
7. Low and outlet operative vaginal delivery
Medical Knowledge
A. The resident will have an understanding of the diagnosis and management of urinary tract disease
including:
1. Historical signs and symptoms as well as other medical problems that predispose to urinary tract
disease
2. Physical examination for flank tenderness and fever
3. Diagnostic studies to assess severity of disease including urinalysis, urine culture, 24-hour urine,
serum creatinine, IVP, and renal ultrasound
4. Differential diagnosis including asymptomatic bacteriuria, cystitis, pyelonephritis, calculi, acute
renal failure, and chronic renal disease
5. Interventions including antibiotics, dietary management, fetal surveillance, tocolysis, delivery and
dialysis
6. Factors influencing intervention including renal failure, premature labor, fetal status, and
associated maternal factors such as abruption and hypertension
7. Potential complications of intervention including prematurity and adverse drug reactions
8. Potential complications of non-intervention including prematurity, IUGR, IUFD, and
deterioration of maternal renal function
9. Appropriate follow-up including test for cure and renal function
B. The resident will have an understanding of common infectious diseases and their signs and symptoms
including:
1.
Historical factors of previous infection, predisposing medical and surgical conditions, and
symptomatology from major organ systems
2. Physical findings including erythema, tenderness, fever, hypotension, mucopurulent discharge,
rash , nuchal rigidity, obtundation, and IUGR
3. Diagnostic studies including CBC, bacterial and viral cultures, antibody titres, gram stain, and
skin testing
4. Effects on the fetus as measured by ultrasound, fetal surveillance, and amniocentesis
5. Diagnostic modalities for bacteremia, cystitis and pyelonephritis, pulmonary infection, viremia,
meningitis, chorioamnionitis, congenital viral disease, STIs, and peritonitis
6. Management interventions including antibody or antivirals, pressors, supportive measures,
tocolysis, and delivery
7. Factors influencing intervention including maternal condition, fetal condition, labor, and
gestational age
8. Complications of intervention including complications of diagnostic procedures, adverse drug
reactions, and prematurity
9. Potential complications of intervention such as maternal sepsis or death, preterm labor, and
preterm delivery with neonatal morbidity or mortality
10. Follow-up including antibiotic therapy, surgery, and maternal, fetal, or newborn surveillance
C. The resident will have an understanding of hematologic disorders which may present or complicate
pregnancy including:
1. Historical features such as fatigue, bone pain, chest pain, easy bruisability, diet, recurrent
infection, and family history
2. Physical findings including pallor, tachycardia, and ecchymosis
3. Diagnostic studies including CBC, iron, folate, and B-12 levels, hemoglobin electrophoresis,
coagulation studies, and bone marrow aspiration
4. Impact on the fetus including fetal surveillance and prenatal diagnosis
5. Diagnosis for iron deficiency anemia, folate deficiency, hemoglobinopathies, hemolytic anemias,
platelet disorders, and coagulation defects
6. Management interventions including iron, folate, blood product transfusion, oxygen,
plasmapheresis, fetal surveillance, and delivery
7. Factors influencing decisions for intervention including maternal anemia, hemolytic crisis,
bacterial infection, fetal condition, and maternal thrombocytopenia
8. Complications of intervention including prematurity, transfusion, and isoimmunization
9. Complications of non-intervention including anemia, excessive maternal blood loss,
thromboembolism, and maternal death
10. Appropriate long-and short-term follow-up
D. The resident will have an understanding of the diagnosis and management of chronic and newly
diagnosed cardiac disease in pregnancy including:
1. Etiology of cardiac disease, previous diagnostic and therapeutic procedures, risk factors for SBE,
and symptoms of palpitations, syncope, and exercise intolerance
2. Physical examination for CHF, cyanosis, murmur, and third and fourth heart sounds
3. Diagnostic studies including CBC, EKG, chest x-ray, echo, arterial blood gases, exercise
tolerance, cardiac catheterization
4. Diagnostic classification systems
5. Diagnosis of congenital, rheumatic, cardiomyopathic disease, arrhythmia, acquired heart disease,
and pulmonary hypertension
6. Understanding of maternal medical indications for operative/instrumented delivery
7. Management interventions including intensive observation, restriction on activities, diet,
cardiotropic medications, delivery, anesthesia, invasive monitoring, and cardiac surgery
8. Factors influencing intervention including etiology and severity of disease, CHF, pulmonary
hypertension, fetal condition, and maternal death
9. Complications of intervention including fetal prematurity, anesthesia complications, and maternal
circulatory collapse
10. Potential complications of non-intervention including fetal distress, maternal circulatory collapse,
and maternal death
11. Follow-up including short and long-term maternal and fetal surveillance
E. The resident will have an understanding of the diagnosis and management of chronic and acute
pulmonary complications of pregnancy including:
1. Symptoms, nature, severity of disease
2. Physical findings attributable to pulmonary disease
3. Use of appropriate diagnostic studies including chest x-ray, EKG, pulmonary function tests,
arterial blood gases, and TB skin testing
4. Diagnosis of asthma, TB, pneumonia, cystic fibrosis, and cancer
5. Appropriate management interventions including bronchodilators, corticosteroids, antibiotics, and
anti-TB chemotherapy
6. Factors influencing intervention including maternal pulmonary function and fetal complications
7. Complications of intervention including adverse drug reactions
8. Complications of non-intervention such as progression of disease, fetal compromise, and
maternal death
9. Appropriate follow-up for maternal and fetal surveillance
F. The resident will have an understanding of the diagnosis and treatment of acute and chronic
gastrointestinal disease in pregnancy including:
1. Symptoms of nausea, vomiting, diarrhea, RUQ and RLQ pain, fever, and jaundice
2. Appropriate abdominal and systemic examination
3. Diagnostic studies including CBC, stool studies, imaging, and endoscopy
4. Diagnosis of hyperemesis, esophagitis, ulcer disease, biliary disease, pancreatitis, liver disease,
hemorrhoidal disease, and inflammatory bowel disease
5. Management and interventions including diet, medications, hydration, hyperalimentation, and
surgery
6. Factors influencing intervention including maternal nutritional and hemodynamic status and fetal
condition
7. Complications of intervention including teratogenesis, adverse drug reaction, operative
complications, and prematurity
8. Complications of non-intervention including maternal and fetal compromise or death
9. Appropriate follow-up including maternal and fetal surveillance, antibody titres, medical and
surgical therapy
G. The resident will have an understanding of the diagnosis and management of diseases of the central
nervous system and their impact on pregnancy including:
1. Historical symptomatology including headache, aura, loss of coordination, known previous
disease, and therapy
2. Physical examination to include findings of altered sensorium, papilledema, focal neurologic
deficits
3. Diagnostic studies including EEG, CT, LP, anticonvulsant levels, EMG, and Tensilon test
4. Diagnosis of sinus, tension, cluster, and migraine headache, seizure disorders, cerebrovascular
disease
5. Management including medications, surgery, and supportive measures
6. Factors influencing intervention including frequency and severity of maternal signs and
symptoms
7. Potential complications of intervention
8. Potential complications of non-intervention
9. Follow-up including analgesia, prophylactic medications, seizure precautions, and surgery
H. The resident will have an understanding of the diagnosis and management of endocrine disease and
its impact on pregnancy including:
1. Extent of disease, previous and current therapy, and symptoms of visual field complaints, nausea,
anorexia, polyuria, polydipsia, headache, fatigue, heat or cold intolerance, altered mentation,
paresthesias, and failure of lactation
2. Physical examination including general, neurologic, and thyroid findings
3. Diagnostic studies including imaging, TFTs, and adrenal function tests
4. Diagnosis of thyroid, parathyroid, adrenal, hypothalamic, and pituitary disease
5. Management interventions including medication and surgery
6. Factors influencing intervention such as severity of maternal illness and fetal condition
7. Potential complications of intervention
8. Potential complications of non-intervention
9. Follow-up maternal and fetal surveillance
Interpersonal and Communication skills
Following completion of this rotation, the resident is expected to be able to:
1. Demonstrate leadership skills with the 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 and family members
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 Fellow and 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 II resident rotating on the Obstetrics services are 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. Each Friday while at
UCI, the PG II will present two cases to all faculty and residents. This allows faculty to evaluate the
resident knowledge of the patients and prepares the resident for their oral boards. 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
Intrauterine Growth Restriction
Operative Vaginal Delivery
Diagnosis and Management of Preeclampsia and Eclampia
Assessment of Risk Factors for Preterm Birth
Premature Rupture of Membranes
Prevention of Rh D Alloimmunization
Thromboembolism in Pregnancy
Chronic Hypertension in Pregnancy
Diagnosis and Management of Preeclampsia and Eclampsia
Thyroid Disease in Pregnancy
Neural Tube Defects
Multiple Gestation
Ultrasonography in Pregnancy
Hemoglobinopathies in Pregnancy
Asthma in Pregnancy