Department of Obstetrics and Gynecology
St. Francis Hospital & Medical Center
PGY-4 Learning Objectives
Outpatient Clinic Rotation
I. Educational Purpose
The PGY-4 outpatient clinical rotation provides core knowledge and the opportunity to
develop leadership skills in providing outpatient gynecologic and obstetric care. Residents
develop competence in performing office procedures and managing routine and urgent
clinical patient care.
II. Goals and Objectives
By completion of the PGY-4 year, the resident should demonstrate the ability to manage
office obstetric and gynecologic care. The resident should exhibit competence in all areas
listed below in addition to those expected of the PGY-3 resident.
The resident should be able to:
1. Medical Knowledge
 Describe the procedure for maintaining medical licensure, board certification,
credentialing, hospital staff privileges, and liability insurance
 List potential sources of loss of privacy in the health care system
 Discuss the principal types of violence against women of all ages
 Describe proper referral indications for high-risk pregnant patients
 Describe emergency protocols for bleeding during pregnancy
 Discuss the purpose of 1st trimester serum analyte and nuchal translucency
screening for fetal aneuploidy, and limitations of such tests
 Recommend appropriate follow-up for a patient with abnormal uterine bleeding
 Describe follow-up for a patient with a vulvar dystrophy or dermatosis, including the
risk, if present, for malignant change
 Interpret the results of imaging tests to evaluate a pelvic mass, including: MRI,
ultrasound, or tomographic imaging
 Summarize indications and success rates for interventions for chronic pelvic pain,
including: laparoscopy, presacral neurectomy, uterosacral nerve ablation,
adhesiolysis, and extirpative procedures
 Summarize the signs and symptoms, diagnosis, treatment, and potential sequelae
for septic abortion
 Describe the indications, contraindications, and complications of medical
management for ectopic pregnancy
2. Patient Care (Clinical Skills)
 Conduct and teach junior residents on how to perform focused patient histories and
physical examinations on patients presenting with gynecologic complaints
 Perform and interpret the results of selected diagnostic tests to determine the cause
of abnormal uterine bleeding
 Treat common vulvar dystrophies and dermatoses medically
 Triage urgent patients into appropriate care categories
 Triage pregnant patients with vaginal bleeding or leakage of fluid
 Triage gynecologic patients with heavy vaginal bleeding
 Triage gynecologic patients with abdominal pain
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Department of Obstetrics and Gynecology
St. Francis Hospital & Medical Center
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Describe the long-term follow up for patients with a STD, including assessment of the
patient’s sexual partner, discussion of preventive measures, and review of serious
sequelae
Counsel patients with a pelvic mass
Counsel patients with an abnormal prenatal aneuploidy screening test
Counsel patients with abnormal PAP smears
3. Patient Care (Management Skills). Teach and supervise PGY-2 and PGY-3 residents
in the proper technique of all the following procedures:
 Detailed GYN ultrasound evaluation
 Vulvar biopsy
 Endometrial Biopsy
 Colposcopy
 Excision of cyst (vulvar)
 Fitting a pessary
 Transabdominal sonography for basic fetal biometry
 Transvaginal sonography for first trimester pregnancy viability and dating
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 evidence-based medicine into daily practice
 Demonstrate understanding of deviations from standard practice and its implications
 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
 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
 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 the patient care
team on the status of the 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
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Department of Obstetrics and Gynecology
St. Francis Hospital & Medical Center
6. Professionalism
 Participate actively in the education of fellow residents, medical students, and
nurses-in-training
 Acknowledge limitations in knowledge and skills and exercise good judgment in
seeking assistance from peers, attendings, and nurses
 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 and AMA
 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
 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, medical records, and the dictation system
Types of Clinical Encounters
The PGY-4 resident on this rotation is responsible for examining and caring for all patients
who are scheduled to be seen during that clinical session. These patients include, among
others, women scheduled for routine obstetric and gynecologic care, outpatient
consultations, and emergency visits.
The PGY-4 resident will participate in the management of a variety of medical conditions
affecting the health of a woman as well as gynecologic-related complications, including:
 Diseases of the urinary system
 Infectious diseases
 Hematologic disorders
 Cardiopulmonary disease
 Gastrointestinal disease
 Neurologic disease
 Endocrine disorders (including diabetes mellitus)
 Collagen vascular disorders
 Psychiatric disorders
 Substance abuse
 Emergency care / trauma
 Pelvic inflammatory disease
 Endometriosis
 Postoperative complications
 First trimester pregnancy loss
 Pelvic mass
 Ectopic pregnancy
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Department of Obstetrics and Gynecology
St. Francis Hospital & Medical Center
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:
 8:30 AM-5:00 PM: Attend select outpatient clinics (below) and assist with all patients
that are scheduled to be seen during that session.
i. Monday: Resident GYN clinic in the Women’s Center
ii. Tuesday: Continuity Clinic
iii: Wednesday: Resident GYN/Colpo clinic in the Women’s Center
iv. Thursday: Resident GYN clinic in the Women’s Center/Urogyn PM
v: Friday: Resident Lecture Series
IV. Resident Supervision
The PGY-4 resident’s daily activities fall under the supervision of the Women’s Center
Attending, which provides opportunity for immediate feedback. Procedures are performed
under the direct supervision of the Attending Physician.
V. Reading List and Educational Materials
 Textbooks:
(i) William’s Obstetrics; Gabbe S, et al (editors). Obstetrics: Normal and Problem
Pregnancies;
(ii) Katz’s Comprehensive Gynecology,Te Linde’s Gynecology;
(iii) Pelvic anatomy
 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 Women’s
Center Attending Physicians during this rotation.
 Global evaluations of PGY-4 residents are performed at the completion of the 4-week
rotation by select Ob/Gyn 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.
 Cognitive assessment of the residents’ gynecologic skills is assessed by the gynecologic
score from the CREOG examination.
 CREOG Competency cards: S-fac, C-fac, and Fac-1 cards
 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 25, 2010
has
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Date