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Obstetrics and Gynecology Residency: Program Curriculum |
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Residency & Fellowship Programs > Obstetrics & Gynecology > Obstetrics and Gynecology Residency: Program Curriculum |
The curriculum is designed to fulfill the standards established by the Council on Resident Education in Obstetrics and Gynecology. Completion of the curriculum should lead to certification by The American Board of Obstetrics and Gynecology. A commitment to flexibility and adaptability keeps the program under constant evaluation and revision. Most recent changes have ensured compliance with the ACGME Duty Hour policy. We have maintained all rotations, however, including the opportunity for research and an "away" elective. Two Months Ambulatory Medicine: The resident will spend a total of four months on Ambulatory medicine - two months in the first year and two months in the second year. The focus of this rotation is primary care and ambulatory procedures, such a colposcopy and introduction to Gyn ultrasound. Introductory experience will also be provided in the Breast Care Center and the Women's Center for Pelvic Health, with a focus on the diagnosis and management of pelvic relaxation. Additionally, the resident will strengthen her/his skills in preventive medicine and general well-patient care. With the Emergency Room and Intensive Care rotations, this rotation fulfills the requirement for ambulatory medicine experience during the residency. Four Months Obstetrics: As the intern on the Obstetrics team, the resident admits all patients to labor and delivery, formulates a plan of management and presents it to the chief resident or attending for approval/revision. She/he then follows the course of labor, supervising any medical students who may also be assigned to the patient. She/he reports the patient's progress to the chief resident periodically and immediately obtains consultation for any deviations from normal. The resident participates fully in the delivery process and will develop competence in spontaneous vertex deliveries, episiotomy incision and repair, outlet forceps deliveries and other technical skills. She/he makes daily rounds on postpartum patients. By the end of the first year, the intern will be comfortable with performing most cesarean deliveries at term. The resident attends the weekly obstetrical clinic, with a focus on initial prenatal visits and early pregnancy counseling. Opportunity is provided to learn principles of managing obstetrical anesthesia under the direction of the full-time obstetrical anesthesiologist. The resident will also work with the pediatrics team to participate in neonatal resuscitation. Four Months Gynecology: The intern on the Gynecology Team is active in the in-patient care of oncology patients and performs straightforward procedures. The chief resident will assign cases, with increasingly challenging cases as surgical skills increase. By the end of the first year, the resident will develop competence in performing D & Cs, abdominal incision and closure, laparoscopic tubal ligations and adnexectomy. Second assisting on onclolgy cases will provide the opportunity to learn pelvic anatomy. She/he makes twice daily rounds on all gynecologic patients. One Month Medical Intensive Care Unit The resident spends one month in a medical intensive care unit following individual patients under the supervision of a senior medical resident. She/he participates fully in the management of critically ill patients and learns the principles of intensive care medicine. Experience is gained in cardio-pulmonary monitoring and airway management. One Month Emergency Medicine: The resident is expected to develop the ability to triage with particular reference to the acute abdomen, and differentiate between medical, surgical, and gynecological etiologies. She/he also develops skills in CPR, management of hemorrhagic shock and abdominal trauma. Two Months GYN (FAHC): The resident develops further skills in admitting, diagnosing and managing more complex problems as assigned by the chief resident. She/he is expected to develop competence in performing conization of the cervix, adnexectomy, endoscopic surgery, and ovarian cystectomy. She/he begins to develop skills in abdominal hysterectomy techniques, cystoscopy, colposcopy, urogynecology, proctoscopy, and radium application. The resident is first consultant on emergency room calls. Two Months Ambulatory Medicine: This second rotation is similar to the first year, with the additional opportunity to learn how to perform surgical pregnancy terminations. Two Months Endocrinology/Infertility: The resident attends endocrine and infertility clinic and acquires skill in the evaluation and treatment of the infertile couple, with one-on-one work with REI subspecialists. . The management of menopause, hirsutism, dysfunctional bleeding, pelvic pain, endometriosis, amenorrhea-galactorrhea and other endocrinopathies is stressed. Patients with reproductive endocrine disorders resulting from genetic disorders, e.g. Turners Syndrome, are evaluated and treated by the resident. The resident admits and manages all gyn endocrine patients and assists at extensive endoscopic surgery, laser surgery, and tubal micro-surgery under the supervision of the fellow and attending. Four Months Ambulatory Subspecialty Rotation: This rotation includes increased exposure to urogynecology, focusing on urodynamic testing and evaluation for urogynecologic procedures. Additionally, the resident will be exposed to more advanced reproductive endocrinology patient management, including separate clinics for pediatric and adolescent endocrine problems as well as menopause clinics. The resident will develop a greater appreciation for abnormal and normal puberty and the management of these complex problems. The menopause clinic will help the resident determine new ways of managing menopausal problems and offer insights into the rapidly changing approach to hormone replacement therapy. Time will be spent in Dermatology to allow the resident to appreciate different approaches to the management of vulvovaginal disorders. Finally, time will be spent in gynecologic ultrasound as well as the fetal diagnostic center to help the resident improve ultrasonographic skills. Two Months High-Risk Obstetrics: The Maternal Fetal Medicine resident is a member of the Obstetric team who is responsible for the admission and management of all high-risk patients. The resident works one-on-one with the MFM sub-specialist attending on service. She/he formulates a plan, presents it to the chief resident or perinatal fellow and after approval/ revision, implements it. She/he develops skills in ultrasonography, amniocentesis, genetic counseling and stress testing. Extensive experience with management of patients with complex medical and obstetrical problems is acquired. The resident attends the weekly high-risk clinics and the regular obstetric clinic as well as her/his own continuity clinic. Two Months Gynecology (FAHC): The resident refines skills in management of difficult gynecologic cases. She/he will demonstrate competence in colposcopy, urogynecology, abdominal hysterectomies, endoscopic surgery, and the management of problems such as bowel obstruction, hyperalimentation and fistulae. She/he assists at radical oncologic procedures. The resident again participates in the gynecology and oncology clinics and her/his weekly continuity clinic. Four Months Obstetrics/Night-Float: The resident is on the night float rotation for two blocks of 2 months in each half of the year. The resident acts as the senior resident in the hospital. The resident is in charge of the Night Float team, which consists of the night float resident, a PGY-1 or 2, and one of the certified nurse midwives. The resident oversees and directs the management of all patients, learning how to triage and oversee the junior residents. During this rotation, the resident hones on independent decision making skills and increasing responsibility. There is 24 hour in-house attending coverage. Two Months Elective: The resident has this block of time available to use as she/he wishes subject to the approval of the program director. Four weeks should take place locally, with time for research or additional study of interest to the resident (ie: obstetric anesthesia, rotations with other specialties, etc). The resident has the option of an "away" rotation for 4 weeks, most commonly used to explore fellowship or job opportunities. Rotations at other institutions are initiated by the resident. Two Months High-Risk Obstetrics: This rotation is similar to that of the PGY-2, with additional independence and decision making skills. The resident increases her/his responsibility in the management of high-risk patients and refines her/his skills in ultrasonography, fetal assessment, and evaluation and management of critically ill obstetrical patients. She/he attends the obstetric clinic, the thrice weekly high-risk clinic as well as her/his continuity clinic. Two Months Endocrinology/Infertility: The resident gains increasing experience in the management and evaluation of more complex endocrine patients as well as refining her/his skills in transvaginal ultrasound, and endoscopic and laser surgery. All residents will have the expectation of laser certification by the end of this rotation. Four Months Chief of Obstetrics: The chief resident manages the total obstetrical service with final authority and decision-making capability under the ultimate supervision of the attending faculty. She/he supervises and teaches the junior residents and medical students. The resident attends and supervises the regular obstetric clinic. The chief resident service includes all resident obstetrical patients as well as high-risk transport patients. The obstetric chief resident is responsible for the bimonthly case presentations and statistics. Four Months Chief of Gynecology: The resident is responsible for the preoperative evaluation of all benign gynecologic cases, assignment of surgical duties, and postoperative management. The resident demonstrates skills in all vaginal surgery and is available for all difficult abdominal and endoscopic cases. Four Months Chief of Oncology: The resident assists at all oncology surgery and acts as primary surgeon when appropriate under the supervision of Dr. Wong. She/he is responsible for the management of all gynecologic oncology patients, under the guidance of the attending staff. Extensive experience in preoperative preparation and management of post-operative complications is acquired. The resident participates in the weekly oncology clinic and may attend colposcopy clinic as well as her/his own continuity clinic. All residents have their own continuity care clinics once weekly. These clinics are held even when the resident is on off service rotations. Residents develop their private practice in obstetrics and gynecology and care for the women in this practice throughout the four year residency. This clinical practice allows the resident to provide primary care to women of our community under the direct supervision of obstetrical and gynecologic faculty. The residents have the opportunity to evaluate both the program and the faculty. The Program Director and the Chair meet with the residents during protected time monthly. Continuous resident evaluation occurs informally on a day-to-day basis. The faculty all attempt to give residents immediate feedback as they interact in daily clinical situations. If significant deficiencies are felt to be present in any resident's cognitive, behavioral, or technical development, the Program Director immediately informs the resident and develops with her/him a plan for corrective action. A more formal evaluation is performed on each resident by the faculty at six-month intervals. This consists of a detailed evaluation form plus narrative statements which each faculty member submits for each resident. The results are discussed by the Program Director with each individual in an effort to assure satisfactory progress toward excellence and continual self-development. The goal of the program is to train individuals to become independent and competent in the practice of obstetrics and gynecology, with a special emphasis on the understanding of physiology that will enable them to continue with life-long learning. |
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