Department of Obstetrics and GynecologyResidency Curriculum Goals and Education Objectives

Revised: February 2008

PGY-1I. Obstetrics- Labor Floor Day TeamGOALS AND OBJECTIVES: General exposure to all aspects of inpatient obstetrics including intrapartum and postpartum management

CORE COMPETENCIES:Patient Care -Manage patients on Postpartum Service

including all order writing, test ordering, discharges-Participate in management of patients admitted to Labor Floor including vaginal deliveries, cesarean deliveries-Triage second and third trimester patients presenting to the Perinatal Evaluation Center

Medical Knowledge -Understand possible postpartum complications of normal vaginal delivery and cesarean delivery-Become familiar with post-operative care as relates to cesarean delivery-Understand normal and abnormal labor as well as indications for operative and cesarean delivery-Understand fetal monitoring-Perform OB ultrasound for dating, biophysical profiles-Become adept at vaginal delivery and operative skills needed for cesarean delivery and laceration repair

Interpersonal and Communication Skills -Be able to counsel patients regarding contraceptive options-Work with Social Work team to optimize conditions for mother and child upon discharge-Communicate with patients and families in an urgent care setting-Optimize care provided by healthcare team by communicating with nursing staff, anesthesia, pediatrics

Professionalism -Demonstrate respect, compassion,

integrity, and responsiveness to needs of patients in labor and postpartum

Practice-Based Learning and Improvement -Participate in work and teaching rounds on Labor Floor and Postpartum Service-Attend Morning and Noon Conferences

Systems-Based Practice -Attend monthly M+M conferences to improve patient safety, learn from errors, become informed about complex medical issues-Use Baby Tracker system for data monitoring

II. Night Float- ObstetricsGOALS AND OBJECTIVES: General exposure to all aspects of inpatient obstetrics including intrapartum and postpartum management

CORE COMPETENCIES:Patient Care -Manage patients on Postpartum Service

-Participate in management of patients admitted to Labor Floor including vaginal deliveries, cesarean deliveries-Triage second and third trimester patients presenting to the Perinatal Evaluation Center

Medical Knowledge -Understand possible postpartum complications of normal vaginal delivery and cesarean delivery-Become familiar with post-operative care as relates to cesarean delivery-Understand normal and abnormal labor as well as indications for operative and cesarean delivery-Understand fetal monitoring-Perform OB ultrasound for dating, biophysical profiles-Become adept at vaginal delivery and operative skills needed for cesarean delivery and laceration repair

Interpersonal and Communication Skills -Communicate with patients and families in an urgent care setting-Optimize care provided by healthcare team by communicating with nursing staff, anesthesia, pediatrics

Professionalism -Demonstrate respect, compassion, integrity, and responsiveness to needs of

patients in labor and postpartumPractice-Based Learning and Improvement -Participate in work and teaching rounds on

Labor Floor and Postpartum Service-Attend Morning Conferences

Systems-Based Practice -Attend monthly M+M conferences to improve patient safety, learn from errors, become informed about complex medical issues-Use Baby Tracker system for data monitoring

III. Obstetrics- Antepartum GOALS AND OBJECTIVES: Exposure to inpatient and outpatient management of complicated pregnancies

CORE COMPETENCIES:Patient Care -Manage patients on Antepartum Service

including all order writing, test ordering, discharges, fetal monitoring interpretation-Triage second and third trimester patients presenting to the Perinatal Evaluation Center-Participate in outpatient prenatal care for high-risk pregnancies

Medical Knowledge -Manage high-risk pregnancies in inpatient and outpatient setting and understand criteria for inpatient admission-Understand and perform fetal testing and surveillance (NST, BPP)-Perform OB ultrasound for dating

Interpersonal and Communication Skills -Use consultants appropriately in inpatient and outpatient settings-Communicate with patients and families regarding plan of care on inpatient service-Optimize care provided by healthcare team by communicating with nursing staff, anesthesia, pediatrics, social work, consultants

Professionalism -Demonstrate respect, compassion, integrity, and responsiveness to needs of patients with complicated pregnancies

Practice-Based Learning and Improvement -Participate in work and teaching rounds on Labor Floor and Antepartum Service

-Attend Morning and Noon ConferencesSystems-Based Practice -Attend monthly M+M conferences to

improve patient safety, learn from errors, become informed about complex medical issues-Use Baby Tracker system for data monitoring

IV. Gynecologic OncologyGOALS AND OBJECTIVES: Exposure to all aspects of inpatient Gyn Oncology

CORE COMPETENCIES:Patient Care -Manage patients on the Gyn Oncology

inpatient service-Become adept at performing minor outpatient procedures, Benign and Oncologic including: laparoscopic BTL, LEEP, cold knife cone, hysteroscopy, D+E-Care for OBGYN patients in the outpatient Dickens Center setting

Medical Knowledge -Become familiar with post-op management of patients with concurrent medical illness-Recognizing criteria for inpatient admission for women with gynecologic malignancies-Learn principles of chemotherapy-Learn surgical technique and principles of laparoscopy, hysteroscopy

Interpersonal and Communication Skills -Perform as an integral team member and patient advocate-Providing compassionate care to patients who are critically ill, coping with cancer diagnosis and associated treatments

Professionalism -Demonstrate respect, compassion, integrity, and responsiveness to needs of patients with complicated medical illness, cancer diagnoses

Practice-Based Learning and Improvement -Prepare cases for Gyn Oncology Conference-Master the organizational skills necessary to provide care for an inpatient service

Systems-Based Practice -Attend monthly M+M conferences to improve patient safety, learn from errors, become informed about complex medical issues

-Learn use of ACGME database for case collection

V. Internal Medicine- Inpatient WardsGOALS AND OBJECTIVES: General exposure to inpatient medicine therapy and patient management

CORE COMPETENCIES:Patient Care -Caring for male and female patients with

chronic illness in an inpatient settingMedical Knowledge -Pathophysiology of common chronic

diseases: hypertension, diabetes, cardiac, renal, gastrointestinal-Medical treatments for the above and pharmacology-Geriatric medicine

Interpersonal and Communication Skills -Taking a comprehensive history from patients with illness-Recording thorough H+Ps and progress notes

Professionalism -Appropriate utilization of ancillary resources

Practice-Based Learning and Improvement -Attending daily rounds and conferences as scheduled by Department of Internal Medicine

Systems-Based Practice -Attend M+M conferences to improve patient safety, learn from errors, become informed about complex medical issues

VI. Surgical Intensive Care UnitGOALS AND OBJECTIVES: General exposure to all aspects of intensive care of postoperative patients

CORE COMPETENCIES:Patient Care -Recognition of the critically ill patient that

needs intensive care-Insertion of lines for invasive monitoring

Medical Knowledge -Understand principles of mechanical ventilation, equipment, and settings-Understand invasive monitoring, hemodynamics-Fluid management and principles of transfusion-ACLS

Interpersonal and Communication Skills -Perform as an integral team member and

patient advocate-Provide compassionate care to patients who are critically ill and communicating with families

Professionalism -Acting as effective member of team comprised of physicians of varying specialties-Participating in call schedule

Practice-Based Learning and Improvement -Attending daily rounds as conducted by Unit Surgery or Anesthesia Chief/ Attending

Systems-Based Practice -Charting as per SICU department

VII. Emergency MedicineGOALS AND OBJECTIVES: General exposure to all aspects of emergency and acute care

CORE COMPETENCIES:Patient Care -Triage patients presenting to Emergency

Room and be able to make distinction between emergent/urgent/routine medical issues-Stabilize patients in need of further care-Order appropriate diagnostic tests-Understand criteria for inpatient admission-Assess need for operative intervention

Medical Knowledge -Disease processes and complications-ACLS

Interpersonal and Communication Skills -Calling for appropriate consultations and conveying patient history and physical in a clear and concise manner-Cooperating with physicians and ED staff to provide effective care

Professionalism -Being a reliable member of the Emergency Department team-Establishing good relationships in the ED

Practice-Based Learning and Improvement -Attending daily rounds as conducted by ED attending

Systems-Based Practice -Ordering appropriate tests keeping in mind cost-effective care-Understanding the role of the ED within the scope of inpatient admission/ continuity of outpatient care

VIII. Ambulatory Women’s HealthGOALS AND OBJECTIVES: General exposure to common women’s health issues

CORE COMPETENCIES:Patient Care -Perform routine well-woman examinations

with familiarization of periodic health assessment based on age-Exposure to non OBGYN specialties related to women’s health (Dermatology, Gastroenterology, Breast)

Medical Knowledge -Periodic health assessment, age-based-Know screening tests and when appropriate-Common medical problems (diabetes, hypertension, hypercholesterolemia) and how they affect the reproductive system

Interpersonal and Communication Skills -Eliciting accurate history and performing thorough physical exam-Understanding the needs of the well-woman presenting for an outpatient visit and incorporating education, preventive medicine into a meaningful encounter

Professionalism -Maintaining a professional appearance -Develop and maintain habits of punctuality and efficiency

Practice-Based Learning and Improvement -Demonstrate responsiveness to instruction and feedback -Use knowledge from textbooks and up-to-date studies to guide patient care

Systems-Based Practice -Understand the basics of insurance, documentation, and coding principles

PGY-2I. Obstetrics- Labor Floor Day TeamGOALS AND OBJECTIVES: Continued general exposure to all aspects of obstetrics with focus on operative vaginal deliveries and cesarean delivery, maternal and fetal assessment, and development of management skills

CORE COMPETENCIES:Patient Care -Actively manage laboring patients

admitted to Labor Floor-Participate in operative vaginal deliveries and cesarean deliveries-Participate in management of antepartum patients admitted to Labor Floor -Care for OBGYN patients in the

outpatient Dickens Center setting

Medical Knowledge -Understand normal and abnormal labor as well as indications for operative and cesarean delivery-Know management of term and preterm delivery with associated medical complications-Become familiar with principles of Obstetric anesthesia

Interpersonal and Communication Skills -Be able to counsel patients regarding vaginal delivery, operative vaginal delivery, vaginal birth after cesarean, cesarean delivery-Communicate with patients and families in an urgent care setting-Optimize care provided by healthcare team by communicating with nursing staff, anesthesia, pediatrics, obstetrics-Provide thorough, concise signout to night team

Professionalism -Demonstrate respect, compassion, integrity, and responsiveness to needs of patients in labor -Participate in team admissions

Practice-Based Learning and Improvement -Participate in work and teaching rounds on Labor Floor -Attend Morning and Noon Conferences

Systems-Based Practice -Attend monthly M+M conferences to improve patient safety, learn from errors, become informed about complex medical issues-Use Baby Tracker system for data monitoring

II. Night Float- ObstetricsGOALS AND OBJECTIVES: Continued general exposure to all aspects of obstetrics with focus on operative vaginal deliveries and cesarean delivery, maternal and fetal assessment, and development of management skills.

CORE COMPETENCIES:Patient Care -Actively manage laboring patients

admitted to Labor Floor-Participate in operative vaginal deliveries and cesarean deliveries

-Participate in management of antepartum patients admitted to Labor Floor -Care for OBGYN patients in the outpatient Dickens Center setting

Medical Knowledge -Understand normal and abnormal labor as well as indications for operative and cesarean delivery-Know management of term and preterm delivery with associated medical complications-Become familiar with principles of Obstetric anesthesia

Interpersonal and Communication Skills -Be able to counsel patients regarding vaginal delivery, operative vaginal delivery, vaginal birth after cesarean, cesarean delivery-Communicate with patients and families in an urgent care setting-Optimize care provided by healthcare team by communicating with nursing staff, anesthesia, pediatrics, obstetrics

Professionalism -Demonstrate respect, compassion, integrity, and responsiveness to needs of patients in labor -Participate in team admissions

Practice-Based Learning and Improvement -Participate in work and teaching rounds on Labor Floor

Systems-Based Practice -Attend monthly M+M conferences to improve patient safety, learn from errors, become informed about complex medical issues-Use Baby Tracker system for data monitoring

III. Gynecology- BenignGOALS AND OBJECTIVES: Exposure to all aspects of gynecology

CORE COMPETENCIES:Patient Care -Cover operating room cases, majors and

minors at HUP, Presbyterian Hospital, VA-Participate in postoperative care for Benign Gynecologic surgery patients as well as inpatient admissions-Attend to emergency room and inpatient

consults and become familiar with gynecologic surgical emergencies and admissions- Care for OBGYN patients in the outpatient Dickens Center setting-Counsel patients regarding medical vs. surgical management of benign gynecologic conditions

Medical Knowledge -Understand and execute surgical procedures including: operative laparoscopy/ hysteroscopy, abdominal/vaginal/laparoscopic hysterectomy, myomectomy-Know medical and surgical management of ectopic pregnancy/ SAB-Understand the menstrual cycle and alterations, treatment of disturbances-Postoperative management and treatment of complications

Interpersonal and Communication Skills -Work with other services to provide emergency and/or consult care appropriately-Pre and post-surgical counseling-Address advanced directives for gynecologic admissions-Provide informed consent

Professionalism -Respond to consult requests in a timely manner

Practice-Based Learning and Improvement -Participate in work and teaching rounds-Attend weekly GYN Case Conference

Systems-Based Practice -Attend monthly M+M conferences to improve patient safety, learn from errors, become informed about complex medical issues-Continue use of ACGME database for case collection

IV. Gynecologic OncologyGOALS AND OBJECTIVES: General exposure to all aspects of inpatient Gynecologic Oncology

CORE COMPETENCIES:Patient Care -Cover operating room cases, majors and

minors with Gyn Onc fellows and attendings

-Participate in postoperative care for surgery patients -See known Gyn Onc patients presenting through emergency room and determine need for admission- Care for OBGYN patients in the outpatient Dickens Center setting

Medical Knowledge -Continue complicated management of post-operative patients with concurrent medical illness-Recognize criteria for inpatient admission for women with gynecologic malignancies-Learn principles of chemotherapy-Principles of fundamental and radical oncologic surgery and staging procedures

Interpersonal and Communication Skills -Perform as an integral team member and patient advocate-Provide compassionate care to patients who are critically ill, coping with cancer diagnosis and associated treatments-Coordinate inpatient and outpatient care-Signout to gynecology night coverage

Professionalism -Demonstrate respect, compassion, integrity, and responsiveness to needs of patients with complicated medical illness, cancer diagnoses

Practice-Based Learning and Improvement -Prepare cases for Gyn Onc Conference-Participate in work and teaching rounds with fellows and attendings

Systems-Based Practice -Attend monthly M+M conferences to improve patient safety, learn from errors, become informed about complex medical issues-Continue use of ACGME database for case collection

V. AmbulatoryGOALS AND OBJECTIVES: Exposure to specialized and unique aspects of obstetric and gynecologic care

CORE COMPETENCIES:Patient Care -Care for OBGYN patients in the

outpatient Dickens Center setting

-Evaluate for urogynecologic conditions under the supervision of Dr. Arya-Perform obstetric ultrasound in MFM department-Diagnose and manage breast disease with Dr. Tchou-Family planning: counsel and treat patients with complex contraceptive needs

Medical Knowledge -High-risk obstetric conditions -Pelvic prolapse, urinary incontinence, and medical and surgical options-Principles of ultrasound-Understand benign and malignant breast disease, diagnosis and treatment options-Understand hormonal, non-hormonal, short-term, long term contraception, modes of action, contraindications

Interpersonal and Communication Skills -Develop ability to counsel pregnant women regarding management of complex maternal and/or fetal conditions-Counsel patients with urogynecologic conditions regarding medical and surgical options for intervention-Assist women in choosing the most appropriate form of contraception

Professionalism -Demonstrate respect, compassion, integrity, and responsiveness to needs of patients

Practice-Based Learning and Improvement -Review of ultrasound images with MFM attendings with feedback -Learn by shadowing attending physicians -Formulate plans of care with fellows and attendings in clinic

Systems-Based Practice -Compare different outpatient practice settings (resident clinic, private offices, ultrasound units, procedure units) and identify factors which contribute to effective quality care-Provide thorough and accurate documentation for various types of encounters (routine, problem visits, preoperative counseling, procedure notes)

VI. Reproductive Endocrinology and Infertility

GOALS AND OBJECTIVES: Exposure to basic office infertility and endocrinology with outpatient evaluation

CORE COMPETENCIES:Patient Care -Care for OBGYN patients in the

outpatient Dickens Center setting -See patients in the REI faculty practice office in order to become familiar with basic office infertility and endocrinology -Perform ultrasounds and hysterosalpingograms

Medical Knowledge -Assessment of the infertile couple-Understanding normal physiology and abnormalities of the menstrual cycle-Assessment of ovulation and management of ovulatory dysfunction-Principles of ultrasound; scanning for follicular development and early pregnancy-Principles of oocyte retrieval

Interpersonal and Communication Skills -Communicate effectively with patients in language appropriate to age, educational, cultural, socioeconomic background-Convey information to colleagues in a concise, effective manner

Professionalism -Demonstrate a commitment to excellence and interest in ongoing professional development

Practice-Based Learning and Improvement -Attend REI conferences-Attend morning resident conferences

Systems-Based Practice -Use Blackboard on-line curriculum to broaden knowledge base and improve patient care

PGY-3I. Obstetrics- Labor Floor Day TeamGOALS AND OBJECTIVES: Exposure to all aspects of normal and high-risk pregnancies, active management of labor, and supervision of the labor floor

CORE COMPETENCIES:Patient Care -Actively manage laboring patients

admitted to Labor Floor-Participate in operative vaginal deliveries and complicated cesarean deliveries-Participate in management of antepartum patients admitted to Labor Floor

-Participate in postpartum care for women with complicated deliveries-Care for OBGYN patients in the outpatient Dickens Center setting

Medical Knowledge -Prenatal diagnosis and treatment-Understand and teach fetal and maternal invasive and non-invasive monitoring-Repair of 3rd and 4th degree lacerations

Interpersonal and Communication Skills -Be able to counsel patients regarding vaginal delivery, operative vaginal delivery, vaginal birth after cesarean, cesarean delivery-Communicate with patients and families in an urgent care setting-Optimize care provided by healthcare team by communicating with nursing staff, anesthesia, pediatrics, obstetrics-Provide thorough, concise signout to night team

Professionalism -Provide effective mentoring and role modeling for junior residents and students

Practice-Based Learning and Improvement -Run Fetal High-Risk Conference in conjunction with fellows-Attend Pediatric/OB Conference

Systems-Based Practice -Present at monthly M+M conferences to improve patient safety, learn from errors, become informed about complex medical issues-Use Baby Tracker system for data monitoring

II. Gynecology- BenignGOALS AND OBJECTIVES: Exposure to all aspects of benign gyn surgery with further development of operative skills and techniques and expertise in postoperative management

CORE COMPETENCIES:Patient Care -Cover operating room cases, majors and

minors at HUP, Presbyterian Hospital, VA-Participate in postoperative care for Benign Gynecologic surgery patients as well as inpatient admissions-Attend to emergency room and inpatient consults and become familiar with gynecologic surgical emergencies and

admissions- Care for OBGYN patients in the outpatient Dickens Center setting-Counsel patients regarding medical vs. surgical management of benign gynecologic conditions

Medical Knowledge -Pelvic anatomy-Understand and execute surgical procedures including: operative laparoscopy/ hysteroscopy, abdominal/vaginal/laparoscopic hysterectomy, myomectomy-Perform more complex surgeries with greater independence including operative laparoscopy, vaginal surgery and reconstruction, lysis of adhesions-Postoperative management and treatment of complications

Interpersonal and Communication Skills -Assist chief with delegation of responsibilities and with teaching of junior residents-Work with other services to provide emergency and/or consult care appropriately-Pre and post-surgical counseling-Address advanced directives for gynecologic admissions-Provide informed consent-Follow up for early pregnancy patients tracked in quant book

Professionalism -Provide effective mentoring and role modeling for junior residents and students-Respond to consult requests in a timely manner

Practice-Based Learning and Improvement -Provide educational experiences to Gyn team with presentations of consults-Participate in work and teaching rounds-Attend weekly GYN Case Conference

Systems-Based Practice -Present at monthly M+M conferences to improve patient safety, learn from errors, become informed about complex medical issues-Continue use of ACGME database for case collection

III. Gynecology- Chester County Hospital

GOALS AND OBJECTIVES: Exposure to all aspects of benign gyn surgery with further development of operative skills and techniques and expertise in postoperative management

CORE COMPETENCIES:Patient Care -Achieve the level of first surgical

assistant/ primary surgeon on gynecologic surgical cases-Provide post-operative follow up and inpatient care

Medical Knowledge -Pelvic anatomy-Broaden experience with varying surgical techniques, laparoscopic and open

Interpersonal and Communication Skills -Cooperate with residents from Pennsylvania Hospital to provide effective patient care

Professionalism -Maintain a good work ethic, punctuality, and efficiency as representatives of HUP

Practice-Based Learning and Improvement -Use personal clinical experience to improve knowledge and surgical skills in the operating room-Seek instruction and feedback from attendings with a commitment to practice improvement

Systems-Based Practice -Attend monthly M+M conferences to improve patient safety, learn from errors, become informed about complex medical issues-Continue use of ACGME database for case collection

IV. Gynecologic OncologyGOALS AND OBJECTIVES: Exposure to all aspects of Gyn Oncology including operative technique, pre and post-operative management, chemotherapy. This rotation is designed to give the resident experience in managing a surgical service as the primary decision-maker working closely with the fellows.

CORE COMPETENCIES:Patient Care -Management of service as the senior

resident -Organize coverage of all gyn oncology operative cases and act as first assistant/surgeon on complex surgical cases-Assess the need for admission to inpatient service for patients presenting through office or emergency room

-Cover Colposcopy clinicMedical Knowledge -Advanced management of the gyn

oncology surgical and post-operative patient-Surgical approach to the treatment of gynecologic malignancies and staging procedures-Principles of chemotherapy and radiation-Familiarity with GOG protocols

Interpersonal and Communication Skills -Perform as a team leader and patient advocate-Provide compassionate care to patients who are critically ill, coping with cancer diagnosis and associated treatments-Coordinate inpatient and outpatient care-Signout to gynecology night coverage

Professionalism -Provide effective mentoring and role modeling for junior residents and students

Practice-Based Learning and Improvement -Conduct morning work rounds-Participate in afternoon rounds with Oncology fellow/attending-Participate in Gyn Onc Conferences and case presentations

Systems-Based Practice -Present at monthly M+M conferences to improve patient safety, learn from errors, become informed about complex medical issues-Continue use of ACGME database for case collection

V. Night Float- GynecologyGOALS AND OBJECTIVES: Postoperative management, emergency gyn consultation, and surgery

CORE COMPETENCIES:Patient Care -Provide care/coverage for all gynecology

inpatients-Act as primary consultant to the ED-Determine need for and cover OR cases for all gynecologic emergencies-Assist with the labor floor team as necessary

Medical Knowledge -Management of routine and emergent postoperative issues-Evaluation and management of patients presenting to the Emergency Department

-Understanding criteria for inpatient admission of gynecologic patients-Diagnosis and management of ectopic pregnancy-Emergency surgical skills

Interpersonal and Communication Skills -Respond to ED consult requests in a timely and efficient manner-Provide whole and compassionate care to gyn patients in an urgent care setting-Triage surgical emergencies efficiently and work with OR staff to expedite cases appropriately

Professionalism -Provide effective mentoring and role modeling for junior residents and students-Adhere to attending supervision guidelines and protocols

Practice-Based Learning and Improvement -Follow quant book data to compare clinical impressions and outcomes-Attend weekly GYN Case Conference

Systems-Based Practice -Practice cost-effective health care and resource allocation that does not compromise quality of care

VI. Reproductive Endocrinology and InfertilityGOALS AND OBJECTIVES: Exposure to basic office infertility and endocrinology with the evaluation of outpatients

CORE COMPETENCIES:Patient Care -Care for OBGYN patients in the

outpatient Dickens Center setting -See patients in the REI faculty practice office in order to become familiar with basic office infertility and endocrinology -Perform ultrasounds and hysterosalpingograms-Cover major and minor cases with REI fellows and attendings

Medical Knowledge -Assessment of the infertile couple-Understanding normal physiology and abnormalities of the menstrual cycle-Assessment of ovulation and management of ovulatory dysfunction-Principles of ultrasound; scanning for follicular development and early pregnancy-Principles of oocyte retrieval

Interpersonal and Communication Skills -Communicate effectively with patients in language appropriate to age, educational, cultural, socioeconomic background-Convey information to colleagues in a concise, effective manner

Professionalism -Demonstrate a commitment to excellence and interest in ongoing professional development

Practice-Based Learning and Improvement -Attend REI conferences-Attend morning resident conferences

Systems-Based Practice -Use Blackboard on-line curriculum to broaden knowledge base and improve patient care

VII. ElectiveGOALS AND OBJECTIVES: Focused project for career development

CORE COMPETENCIES:Patient Care -Care for OBGYN patients in the

outpatient Dickens Center setting -varies by elective

Medical Knowledge -varies by electiveInterpersonal and Communication Skills -varies by electiveProfessionalism -varies by electivePractice-Based Learning and Improvement -varies by electiveSystems-Based Practice -varies by elective

PGY-4I. Obstetrics- Labor Floor Day TeamGOALS AND OBJECTIVES: Exposure to normal and high-risk obstetrics as the first-line decision-maker on patient management issues. This rotation is designed to promote leadership and administrative skills and promoting readiness for independent management of antepartum, laboring, and postpartum patients.

CORE COMPETENCIES:Patient Care -Direct and manage care of antepartum and

laboring patients admitted to the Labor Floor as the responsible decision-maker-Direct and manage care of patients admitted to the Postpartum Service-Perform cesarean sections with junior residents under attending supervision-Perform normal and operative vaginal deliveries with junior residents under attending supervision

-Provide antepartum care for high-risk obstetric patients at Dickens

Medical Knowledge -Understand management of normal and abnormal labor and delivery -Understand maternal and obstetric complications of pregnancy and management/ timing of delivery-Surgical skills to perform complicated repeat cesarean sections and laceration repair-Obstetric emergencies and interventions (postpartum hemorrhage, eclampsia, shoulder dystocia, malpresentation, cesarean hysterectomy)

Interpersonal and Communication Skills -Be able to counsel patients regarding vaginal delivery, operative vaginal delivery, vaginal birth after cesarean, cesarean delivery-Communicate with patients and families in an urgent care setting-Optimize care provided by healthcare team by communicating with nursing staff, anesthesia, pediatrics, obstetrics

Professionalism -Provide effective mentoring and role modeling for junior residents and students-Participate in team histories

Practice-Based Learning and Improvement -Present cases at High Risk OB Conference-Lead teaching at am and pm signout-Tracing review

Systems-Based Practice -Present at monthly M+M conferences to improve patient safety, learn from errors, become informed about complex medical issues-Use Baby Tracker system for data monitoring

II. Obstetrics- Antepartum GOALS AND OBJECTIVES: Exposure to high-risk, inpatient, and outpatient obstetrics as the first-line decision-maker on patient management issues

CORE COMPETENCIES:Patient Care -Direct and manage the Antepartum service

-Direct and manage the Perinatal Evaluation Center

-Provide prenatal care for high-risk patients at Dickens

Medical Knowledge -Complete management of high-risk obstetrical conditions (diabetes, hypertension/preeclampsia, cardiac disease, multiple gestation, IUGR, preterm labor/ PPROM)-Antepartum fetal surveillance- indications, frequency, interpretation

Interpersonal and Communication Skills - Educate inpatients regarding disease and how pregnancy is affected, discuss indications for inpatient care

Professionalism -Provide effective mentoring and role modeling for junior residents and students

Practice-Based Learning and Improvement -Present cases at High Risk OB Conference-Lead teaching at am and pm signout-Tracing review

Systems-Based Practice -Providing care in team setting with nursing, obstetrics, social work-Present at monthly M+M conferences to improve patient safety, learn from errors, become informed about complex medical issues-Use Baby Tracker system for data monitoring

III. Night Float- Obstetrics and GynecologyGOALS AND OBJECTIVES: Complete management of all inpatients, emergency and inpatient consults, and obstetric triage patients

CORE COMPETENCIES:Patient Care -Complete management of all inpatient

obstetric and gynecology admissions, triage, and consults

Medical Knowledge -Understand management of normal and abnormal labor and delivery -Understand maternal and obstetric complications of pregnancy and management/ timing of delivery-Surgical skills to perform complicated repeat cesarean sections and laceration repair-Obstetric emergencies and interventions (postpartum hemorrhage, eclampsia, shoulder dystocia, malpresentation,

cesarean hysterectomy)-Management of routine and emergent postoperative/ postpartum issues-Supervision of Emergency Department consults and recognition of surgical emergencies-Understanding criteria for inpatient admission of gynecologic patients-Diagnosis and management of ectopic pregnancy-Emergency surgical skills

Interpersonal and Communication Skills -Supervise junior residents and delegate responsibilities among team members to provide appropriate patient care

Professionalism -Provide effective mentoring and role modeling for junior residents and students

Practice-Based Learning and Improvement -Teaching junior residents: postoperative evaluation, labor and delivery, triage of obstetric patients, emergency room consultation, examination skills, surgical skills-Lead teaching at am and pm signout

Systems-Based Practice -Providing care in team setting with nursing, obstetrics, social work-Present at monthly M+M conferences to improve patient safety, learn from errors, become informed about complex medical issues-Use Baby Tracker system for data monitoring

IV. Gynecology- BenignGOALS AND OBJECTIVES: Exposure to the full range of preoperative, operative, and post-operative gynecologic conditions as the primary decision-maker. This rotation is designed to promote leadership, operative and administrative skill, along with the clinical management of outpatient and inpatient gyn patients.

CORE COMPETENCIES:Patient Care -Direct and manage the Benign

Gynecology service-Oversee all Emergency Room and floor consults and formulate plan of care- Care for OBGYN patients in the outpatient Dickens Center setting, with emphasis on preoperative counseling and

postoperative follow up-Prepare patients for outpatient and inpatient benign gynecologic surgery-Coordinate coverage for all cases at HUP, VA, Presbyterian Hospital-Supervise patients followed in quant book and intervene with treatment as deemed necessary

Medical Knowledge -Full range of gynecologic procedures as primary operating surgeon-Medical and surgical options/ indications for benign gynecologic disease-OR complications and management-Postoperative care and management of complications-Treatment options for early pregnancy failure and ectopic pregnancy-Treatment for acute vaginal bleeding

Interpersonal and Communication Skills -Supervise junior residents and delegate responsibilities among team members to provide appropriate patient care-Communicate with Gyn attending regarding floor admissions and emergencies-Communicate with patients followed in quant book regarding diagnosis and plan of care

Professionalism -Provide effective mentoring and role modeling for junior residents and students-Supervise ER and floor consults and provide coordinated, timely care-Discuss scheduled OR cases with attending prior to admission

Practice-Based Learning and Improvement -Attend morning conferences-Present cases at Tuesday Gyn Case Conference

Systems-Based Practice -Present at monthly M+M conferences to improve patient safety, learn from errors, become informed about complex medical issues-Continue use of ACGME database for case collection

V. Ambulatory- Dickens Center

GOALS AND OBJECTIVES: Exposure to and management of outpatient obgyn primary care, allowing the establishment of continuity of care, office practice management, knowledge of ambulatory medicine, and assessment of patients requiring inpatient and surgical treatments

CORE COMPETENCIES:Patient Care -Providing outpatient management of

routine and complex gynecologic issues-Providing follow-up for patients seeking care through the emergency room setting and facilitating their entry into the system-Prepare patients for outpatient and inpatient benign gynecologic surgery-Assist Antepartum Chief with outpatient management of prenatal care for high-risk obstetric patients

Medical Knowledge -Age-appropriate preventive medicine skills-Ambulatory procedures (colposcopy, endometrial biopsy, IUD insertion)-Appropriate follow-up treatment for abnormal screening imaging and/or lab abnormalities

Interpersonal and Communication Skills -Identify patient needs and coordinate care in comprehensive fashion with awareness of clinic resources

Professionalism -Provide effective mentoring and role modeling for junior residents and students-Ensure smooth and timely flow during resident clinic sessions.-Follow up lab results in a timely/ appropriate fashion

Practice-Based Learning and Improvement -Attend morning resident conferences-Attend High-Risk OB conferences

Systems-Based Practice -Know proper coding for preventive and evaluation/management visits-Advise junior residents regarding patient flow and proper documentation for office visits-Appropriately use knowledge of clinic resources (nursing, social work, nutrition, financial)to optimize patient care

VI. Reproductive Endocrinology and InfertilityGOALS AND OBJECTIVES: Exposure to complex surgical procedures as evaluation and treatment of infertility

CORE COMPETENCIES:Patient Care -Acting as primary or assistant operating

surgeon for all complex REI operative procedures such as myomectomy, operative hysteroscopy, operative laparoscopy, tuboplasty/ reanastamosis, endometriosis, treatment of ectopic pregnancy

Medical Knowledge -Full range of gynecologic REI procedures as primary or assistant operating surgeon-Medical and surgical options/ indications for evaluation and treatment of infertility-OR complications and management-Postoperative care and management of complications

Interpersonal and Communication Skills -Communicate effectively with patients in language appropriate to age, educational, cultural, socioeconomic background-Convey information to colleagues in a concise, effective manner; especially with coordination of care with benign GYN service

Professionalism -Demonstrate a commitment to excellence and interest in ongoing professional development

Practice-Based Learning and Improvement -Attend REI conferences-Attend morning resident conferences

Systems-Based Practice -Use Blackboard on-line curriculum to broaden knowledge base and improve patient care