Department of Obstetrics and Gynecology



Department of Obstetrics and Gynecology

Residency Curriculum Goals and Education Objectives

Revised: June 2011

PGY-1

I. Obstetrics- Labor Floor Day Team

GOALS 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 on Labor Floor including |

| |admission, assessment of labor progress and fetal heart tracings |

| |-Perform vaginal deliveries, cesarean deliveries |

| |-Triage second and third trimester patients presenting to the |

| |Perinatal Evaluation Center |

| |-Triage beeper calls from patients; recognize common issues of |

| |pregnancy vs. emergency issues requiring further evaluation |

| |-Evaluate patients in High-risk Postpartum Clinic and provide |

| |contraceptive counseling and management |

| |-Insert IUDs and Implanon during postpartum period |

| |-Respond to emergencies arising on L+D, Postpartum, Antepartum |

| |services |

|Medical Knowledge |-Understand maternal physiology and changes that occur in the |

| |antenatal, labor, and postpartum periods |

| |-Understand prenatal care and routine screening |

| |-Understand common antepartum complications and appropriate |

| |evaluation and management as outlined by PEC guidelines |

| |-Know indications for admission to Labor and Delivery unit for |

| |observation vs. delivery |

| |-Know stages of labor and be able to recognize normal and |

| |abnormal labor |

| |-Understand indications for operative and cesarean delivery |

| |-Understand intrapartum fetal heart tracing guidelines and |

| |interpret |

| |-Perform OB ultrasound for dating, biophysical profiles |

| |-Become adept at vaginal delivery and operative skills needed for|

| |cesarean delivery and laceration repair |

| |-Understand possible postpartum complications of normal vaginal |

| |delivery and cesarean delivery |

| |-Become familiar with post-operative care as relates to cesarean |

| |delivery |

| |-Understand physiology of breastfeeding and be able to |

| |troubleshoot common related issues |

| |-Learn principles of midwifery |

|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 |

| |-Work with nurse practitioners to provide streamlined care for |

| |Postpartum service |

| |-Communicate with patients and families in an urgent care setting|

| |-Optimize care provided by healthcare team by communicating with |

| |nursing staff, anesthesia, pediatrics |

| |-Master a standardized effective signout process for optimal |

| |transitions of care |

|Professionalism |-Demonstrate respect, compassion, integrity, and responsiveness |

| |to needs of patients in labor and postpartum |

| |-Work with nursing towards common patient-centered care approach |

| |-Participate in Team Admissions |

| |-Participate in Risk Reduction initiatives |

| |-Participate in Quality Improvement and Patient Safety |

| |initiatives |

|Practice-Based Learning and Improvement |-Prepare to discuss management of patients on service using |

| |evidence-based medicine |

| |-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 |

| |-Use Sunrise to generate concise and relevant discharge documents|

| |-Use EPIC to document phone triage calls and PEC encounters to |

| |facilitate follow up |

II. Night Float- Obstetrics

GOALS AND OBJECTIVES: General exposure to all aspects of inpatient obstetrics including intrapartum and postpartum management

|Patient Care |-Manage patients on Postpartum Service including all order |

| |writing, test ordering, discharges |

| |-Participate in management of patients on Labor Floor including |

| |admission, assessment of labor progress and fetal heart tracings |

| |-Perform vaginal deliveries, cesarean deliveries |

| |-Triage second and third trimester patients presenting to the |

| |Perinatal Evaluation Center |

| |-Triage beeper calls from patients; recognize common issues of |

| |pregnancy vs. emergency issues requiring further evaluation |

| |-Evaluate patients in High-risk Postpartum Clinic and provide |

| |contraceptive counseling and management |

| |-Insert IUDs and Implanon during postpartum period |

| |-Respond to emergencies arising on L+D, Postpartum, Antepartum |

| |services |

|Medical Knowledge |-Understand maternal physiology and changes that occur in the |

| |antenatal, labor, and postpartum periods |

| |-Understand prenatal care and routine screening |

| |-Understand common antepartum complications and appropriate |

| |evaluation and management as outlined by PEC guidelines |

| |-Know indications for admission to Labor and Delivery unit for |

| |observation vs. delivery |

| |-Know stages of labor and be able to recognize normal and |

| |abnormal labor |

| |-Understand indications for operative and cesarean delivery |

| |-Understand intrapartum fetal heart tracing guidelines and |

| |interpret |

| |-Perform OB ultrasound for dating, biophysical profiles |

| |-Become adept at vaginal delivery and operative skills needed for|

| |cesarean delivery and laceration repair |

| |-Understand possible postpartum complications of normal vaginal |

| |delivery and cesarean delivery |

| |-Become familiar with post-operative care as relates to cesarean |

| |delivery |

| |-Understand physiology of breastfeeding and be able to |

| |troubleshoot common related issues |

| |-Learn principles of midwifery |

|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 |

| |-Work with nurse practitioners to provide streamlined care for |

| |Postpartum service |

| |-Communicate with patients and families in an urgent care setting|

| |-Optimize care provided by healthcare team by communicating with |

| |nursing staff, anesthesia, pediatrics |

| |-Master a standardized effective signout process for optimal |

| |transitions of care |

|Professionalism |-Demonstrate respect, compassion, integrity, and responsiveness |

| |to needs of patients in labor and postpartum |

| |-Work with nursing towards common patient-centered care approach |

| |-Participate in Team Admissions |

| |-Participate in Risk Reduction initiatives |

| |-Participate in Quality Improvement and Patient Safety |

| |initiatives |

|Practice-Based Learning and Improvement |-Prepare to discuss management of patients on service using |

| |evidence-based medicine |

| |-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 |

| |-Use Sunrise to generate concise and relevant discharge documents|

| |-Use EPIC to document phone triage calls and PEC encounters to |

| |facilitate follow up |

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 |

| |-Assist with consultation requested by other services and |

| |emergency department |

|Medical Knowledge |-Manage high-risk pregnancies in inpatient and outpatient setting|

| |and understand criteria for inpatient admission and discharge |

| |-Understand and perform fetal testing and surveillance (NST, BPP)|

| |-Perform OB ultrasound for dating |

| |-Understand common antepartum complications and appropriate |

| |evaluation and management as outlined by PEC guidelines |

| |-Understand risks and management of common medical complications |

| |in pregnancy i.e. diabetes, hypertension |

| |-Understand risks and management of surgical complications in |

| |pregnancy |

| |-Understand risks and management of obstetric complications of |

| |pregnancy i.e. PPROM, abruption, abnormal placentation, IUGR |

| |-Understand risks and management of multiple gestations |

| |-Understand fetal/ maternal indications for preterm delivery |

| |-Understand complications associated with extreme prematurity/ |

| |preterm delivery |

|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/ NICU, social work, |

| |consultants |

| |-Assist with meaningful consultation to requesting services and |

| |coordination of care |

|Professionalism |-Demonstrate respect, compassion, integrity, and responsiveness |

| |to needs of patients with complicated pregnancies |

| |-Offer a team-based approach to patient-centered care with |

| |attending, fellow, resident, nurse practitioner |

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

| |Antepartum Service |

| |-Attend weekly MFM Division meeting |

| |-Attend weekly MFM Journal Club |

| |-Review all triage cases from PEC with senior resident/ attending|

| |and solicit feedback |

|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 |

| |-Use Sunrise to generate concise/ comprehensive discharge |

| |documentation |

| |-Use EPIC to facilitate outpatient follow-up |

IV. Gynecologic Oncology

GOALS 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|

| |-Wound care |

|Medical Knowledge |-Become familiar with post-op management of patients with |

| |concurrent medical illness and particularly with cancer diagnosis|

| |-Understand parameters for hemodynamic stability |

| |-Understand wound healing |

| |-Diagnose and treat common post-op complications |

| |-Recognize criteria for inpatient admission for women with |

| |gynecologic malignancies |

| |-Learn principles of chemotherapy |

| |-Know risk factors, diagnosis, treatment, and prognosis for |

| |gynecologic malignancies |

| |-Know staging for endometrial, ovarian, cervical cancer |

| |-Be familiar with common tumor markers for various ovarian |

| |pathology |

| |-Learn surgical technique and principles of laparoscopy, |

| |hysteroscopy |

|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 |

| |-Provide compassionate support to family members of patients |

| |-Master a standardized effective signout process for optimal |

| |transitions of care |

|Professionalism |-Demonstrate respect, compassion, integrity, and responsiveness |

| |to needs of patients with complicated medical illness, cancer |

| |diagnoses |

| |-Offer a team-based approach to patient-centered care with |

| |attending, fellow, resident, nurse practitioner |

| |-Model attending physicians |

|Practice-Based Learning and Improvement |-Prepare cases for Gyn Oncology Conference |

| |-Attend monthly M+M conferences to improve patient safety, learn |

| |from errors, become informed about complex medical issues |

|Systems-Based Practice |-Master the organizational skills necessary to provide care for |

| |an inpatient service |

| |-Introduction to hospice |

| |-Introduction to end-of-life issues |

| |-Learn use of ACGME database for case collection |

V. Benign Gynecology

GOALS AND OBJECTIVES: Exposure to all aspects of gynecology

CORE COMPETENCIES:

|Patient Care |-Scrub on operating room cases, primarily outpatient cases, |

| |hysteroscopy, basic laparoscopy, D+E |

| |-Perform office LEEP in Dickens |

| |-Perform endometrial biopsy, IUD placement |

| |-Participate in postoperative care for Benign Gynecologic surgery|

| |patients as well as inpatient admissions |

| |-Participate in postoperative care for Urogynecology and REI |

| |patients as well as inpatient admissions |

| |-Attend to emergency room and inpatient consults and become |

| |familiar with gynecologic surgical emergencies and admissions |

| |under supervision of senior resident |

| |- Care for OBGYN patients in the outpatient Dickens Center |

| |setting |

| |-Participate in preop clinic: counsel patients regarding medical |

| |vs. surgical management of benign gynecologic conditions |

| |-Become familiar with Quant Book and review daily |

|Medical Knowledge |-Become familiar with abdominal wall opening and closure |

| |-Be familiar with suture selection |

| |-Know principles of electrosurgery |

| |-Understand and execute surgical procedures including: basic |

| |laparoscopy/ hysteroscopy, D+E, CKC |

| |-Know management of PUL, medical and surgical management of |

| |abnormal intrauterine pregnancy, ectopic pregnancy |

| |-Know diagnosis, medical and surgical management of lower tract |

| |infections vs. upper tract infections/ PID |

| |-Understand the menstrual cycle and differential diagnosis for |

| |alterations of |

| |-Know options for treatment of acute vaginal bleeding |

| |-Postoperative management and treatment of complications |

|Interpersonal and Communication Skills |-Work with other services to provide emergency and/or consult |

| |care appropriately under supervision of senior resident |

| |-Preop counseling and informed consent for hysteroscopy, |

| |laparoscopy, D+E, BTL |

| |-Offer a team-based approach to patient-centered care with |

| |attending, fellow, resident, nurse practitioner |

| |-Address advanced directives for gynecologic admissions |

|Professionalism |-Review procedures and patient history prior to participation in |

| |surgical procedure |

| |-Respond to consult requests in a timely manner |

| |-Participate in medical student education |

|Practice-Based Learning and Improvement |-Participate in work and teaching rounds |

| |-Attend bi-monthly gyn preop conference |

|Systems-Based Practice |-Attend monthly M+M conferences to improve patient safety, learn |

| |from errors, become informed about complex medical issues |

| |-Be familiar with criteria for inpatient hospitalization and |

| |review daily to ensure proper utilization of resources |

| |-Continue use of ACGME database for case collection |

VI. Internal Medicine- Inpatient Wards

GOALS 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 setting |

|Medical 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 |

VII. Surgical Intensive Care Unit

GOALS 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 |

VIII. Emergency Medicine

GOALS AND OBJECTIVES: General exposure to all aspects of emergency and acute care, including but not limited to:

1. Perform an appropriate focused history and physical exam

2. Demonstrate an appropriate differential diagnosis

3. Develop and carry out basic treatment plans through admission or discharge

CORE COMPETENCIES:

|Patient Care |-Learn evaluation and management of patients presenting with |

| |common types of illness and injury |

| |-Careful and thorough assessment of individual patients |

| |-Generate an appropriate and complete differential diagnosis for |

| |an undifferentiated patient |

| |-Develop and carry out a basic treatment plan |

| |-Suturing, lumbar puncture, splinting, I/D abcess |

| |-Keep medical record that is accurate, complete, timely, and |

| |appropriate |

|Medical Knowledge |-Generate an appropriate and complete differential diagnosis for |

| |an undifferentiated patient |

| |-Acquire the skills necessary to identify life-threatening |

| |conditions and presentations |

| |-Develop rational test-ordering strategies |

| |-Appropriate interpretation of ECGs, laboratory and radiologic |

| |testing |

|Interpersonal and Communication Skills |-Data gathering: perform an appropriate focused history and |

| |physical exam |

| |-Demonstrate effective information exchange with patients, their |

| |families, and the emergency health care team |

| |-Develop vital interpersonal skills and strategies to work in a |

| |team environment |

|Professionalism |-Being a reliable member of the Emergency Department team |

| |-Establishing good relationships in the ED |

| |-Strive for efficiency: effectively manage 1.5 patients/ hour |

| |-Introduce self to patient and/or family |

| |-Be respectful of patient’s privacy and confidentiality |

| |-Demonstrate good grooming, keeping rested and physically active |

| |to maintain health |

| |-Demonstrate respect, compassion, and integrity in all aspects of|

| |care |

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

| |-Use appropriate information resources (ie texts, online |

| |websites, etc.) for care of patient |

|Systems-Based Practice |-Ordering appropriate tests keeping in mind cost-effective care |

| |-Understand basic resources available for care of the emergency |

| |department patient |

| |-Understanding the role of the ED within the scope of inpatient |

| |admission/ continuity of outpatient care, including arranging |

| |appropriate ongoing care of patients once consulted upon, |

| |admitted to an inpatient service, or referred for further |

| |outpatient care |

IX. Ambulatory Women’s Health

GOALS AND OBJECTIVES: General exposure to common women’s health issues in the outpatient setting, including but not limited to:

1. Radnor gynecology

2. Radnor urogynecology

3. Breast clinic

4. MFM Ultrasound

5. Genetics

6. 3701 Market Street—Division of General OBGYN

7. Dickens

CORE COMPETENCIES:

|Patient Care |-Perform routine well-woman examinations with familiarization of |

| |periodic health assessment based on age |

| |-Perform routine and high-risk OB care in the outpatient setting |

| |with attention to periodic screening |

| |-Exposure to women’s health care in comprehensive setting at |

| |Radnor |

| |-Exposure to non OBGYN specialties related to women’s health |

| |(Dermatology, Gastroenterology, Breast) |

| |-Exposure to specialized OBGYN evaluation in urogynecology, OB |

| |Ultrasound, Genetics |

|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|

| |-Routine OB screening tests and timing |

| |-Become familiar with OB ultrasound—First trimester screening and|

| |Level 2 |

| |-Know screening options for genetic disorders in pregnancy |

| |-Know FTS, SS, integrated screening options in pregnancy |

| |-Understand mammogram screening guidelines and interpretation |

| |-Become familiar with benign breast disorders |

| |-Understand diagnosis and treatment of breast cancer |

|Interpersonal and Communication Skills |-Eliciting accurate, focused, appropriate 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 |

| |-Introducing self to patient and/or family |

| |-Develop and maintain habits of punctuality and efficiency |

| |-Work with attending physicians to shadow, model encounters |

|Practice-Based Learning and Improvement |-Demonstrate responsiveness to instruction and feedback |

| |-Use knowledge from textbooks, websites, and up-to-date studies |

| |to guide patient care |

| |-Use of Blackboard curriculum |

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

| |principles |

| |-Understand patient referrals and interaction between ambulatory |

| |centers/ subspecialty clinics |

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