Curriculum by mikeholy


									                                                      Department of Obstetrics and Gynecology
                                                         St. Francis Hospital & Medical Center

                             PGY-2 Learning Objectives

                                     Obstetrics Rotation

I. Educational Purpose

   The PGY-2 obstetrics rotation is the opportunity to enhance training in inpatient obstetrical
   care. During this rotation, the PGY-2 resident will manage routine obstetric patients during
   the intrapartum and postpartum periods, and begin to teach and mentor the PGY-1 resident.
   The PGY-2 resident develops proficiency in the management of high-risk obstetric patients
   on Labor & Delivery, triaging new patients, and managing complicated postpartum patients.
   The resident develops competence with performing operative vaginal delivery and repeat
   cesarean deliveries and are introduced to the management of multiple gestations.

II. Goals and Objectives

   By completion of the PGY-2 year, the resident should demonstrate skillful management of
   more complicated intrapartum and postpartum patients as described within the context of
   the ACGME core competencies (in addition to those skills attained in the PGY-1 year).

   The resident should be able to:

   1. Medical Knowledge

         Compare and contrast the major physiologic changes in each organ system during
          complicated and normal pregnancies
         Act on the impact of pregnancy on maternal medical conditions and, conversely, the
          impact of various maternal medical conditions on pregnancy outcome
         Order, interpret, and act on results of common diagnostic tests in the context of the
          normal and abnormal physiologic changes of pregnancy
         Demonstrate accurate and timely interpretation of intrapartum fetal heart rate
          patterns and implement appropriate interventions
         Perform, interpret, and act on assessments of fetal well-being, including: biophysical
          profile and non-stress testing
         Identify abnormalities of labor in a timely manner and perform appropriate corrective
         Utilize the various methods of cervical ripening / labor induction, recognize potential
          complications, and act on them
         Counsel parturients on the more common forms of obstetrical anesthesia and their
          complications, including: local, intravenous, pudendal, epidural, spinal, and general
         Demonstrate proficiency in ordering pharmacologic agents commonly used in
          obstetrics (such as labor-inducing agents, tocolytics, analgesics, antibiotics, insulin,
          heparin, etc.) and act on their complications
         Anticipate the need for immediate care for the newborn, including: neonatal
          resuscitation, Apgar score assignment, and cord blood analysis
         Anticipate maternal complications that may arise in the postpartum period and act to
          prevent and treat them
         Provide individualized supportive care of the normal and complicated postpartum
          patient, including: contraceptive needs, emotional evaluation, and lactation

                                                   Department of Obstetrics and Gynecology
                                                      St. Francis Hospital & Medical Center

2. Patient Care (Clinical Skills)

        Conduct focused patient histories and physical examinations on patients with
         uncomplicated and complicated pregnancies of low acuity, including:
          i. Comprehensive physical examination
         ii. Focused examination of the complicated obstetric patient
        iii. Serial cervical examination of parturients in labor
        iv. Clinical pelvimetry
         v. Leopold’s maneuvers, including clinical estimation of fetal weight
        vi. Assessment of presenting fetal part and position
       vii. Basic ultrasound examination including: fetal biometry, presentation, and
             placental localization
       viii. Assessment of maternal and fetal wellbeing
        Evaluate symptoms and physical findings in complicated pregnant patients to
         distinguish physiologic from pathologic findings
        Demonstrate ability to perform an amnioinfusion, biophysical profile (BPP)
        Determine fetal lie by ultrasound and physical exam
        Demonstrate level-appropriate skills in operative vaginal delivery
        Demonstrate level-appropriate skills in repeat cesarean delivery

3. Patient Care (Management Skills)

       Assist the PGY-1 in management of all antepartum and intrapartum patients in the
        Delivery Room, with particular attention to complicated patients
       Anticipate adverse pregnancy outcomes and prepare strategies to effectively
        manage them in a timely fashion
       Respond to acute intrapartum emergencies with appropriate interventions under
        direct supervision
       Continually update patient care team (attending physician, PGY-3, PGY-4, nursing
        staff, NICU staff, anesthesia, etc) on status of patient(s)
       Supervise and lend guidance to medical student, PGY-1, and nursing student

4. Practice-Based Learning

       Formulate and answer basic clinical questions that arise from patient care
       Accept and 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 (such as team training,
        fetal-heart rate monitoring certification)
       Use of information technology: Emedicine, UpToDate, 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

                                                   Department of Obstetrics and Gynecology
                                                      St. Francis Hospital & Medical Center

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
      Counsel patients in language and manner appropriate to their level of education and
      Continually update patient care team (attending physician, nursing staff, NICU staff,
       anesthesia, etc) on status of patient(s)
      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
      Provide constructive feedback to fellow residents, medical students, and nurses-in-

6. Professionalism

      Participate actively in the education of fellow residents, medical students, and
      Demonstrate responsibility for the welfare of all patients in the Delivery Room (4-9)
       and on the postpartum unit (4-1).
      Acknowledge limitations in knowledge and skills and exercise good judgment in
       seeking assistance from peers, attendings, and nurses
      Demonstrate accountability for one’s actions and clinical decisions
      Acknowledge errors or omissions in patient care, and work toward timely resolution
       or alleviation of such
      Demonstrate truthful and timely disclosure of adverse outcomes to the appropriate
       staff members
      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
      Recognizes when to seek help from fellow residents, fellows, attendings, or nurses
      Abide by HIPPA regulations and other SFH regulations (such as annual
       recertification on PPD Screening, Infection Control, Compliance, etc.)
      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
      Effectively use consultants and ancillary services personnel to create an effective
       patient care team
      Follow clinical pathways as detailed in triage and Delivery Room protocols
      Demonstrate judicious and efficient resource utilization
      Support the roles and responsibilities of healthcare team members
      Participate in quality improvement activities of the department
      Anticipate patient needs in discharge planning and follow-up

                                                    Department of Obstetrics and Gynecology
                                                       St. Francis Hospital & Medical Center

        Demonstrate effective use of hospital computer systems (IDX, CPN), digital imaging
         system, medical records, and the dictation system

Types of Clinical Encounters

 The PGY-2 resident on this rotation works closely with the PGY-1 residents to care for all
 patients presenting to the triage area of the Delivery Room as well as the inpatient
 management of all laboring and postpartum patients. A wide variety of both normal and
 abnormal obstetric pathology is encountered in these antepartum, intrapartum, and
 postpartum experiences.

 The PGY-2 resident will participate in the management of a variety of medical conditions
 complicating pregnancy, including:
     Diabetes mellitus
     Diseases of the urinary system
     Infectious diseases
     Hematologic disorders
     Cardiopulmonary disease
     Gastrointestinal disease
     Neurologic disease
     Endocrine disorders
     Collagen vascular disorders
     Psychiatric disorders
     Substance abuse
     Emergency care / trauma

 In addition, the PGY-2 resident will assist the PGY-3 and PGY-4 residents in caring for
 patients with the following complications, including:
      Cervical insufficiency
      Second and third trimester bleeding
      Multiple pregnancy
      Fetal malpresentation
      Preterm labor and preterm PROM
      Isoimmunization
      Hypertensive disorders of pregnancy
      Fetal growth restriction
      Intrauterine fetal death
      Post-term pregnancy

 Procedures to be mastered in the PGY-2 year:
     Preterm vaginal delivery
     Administration of anesthesia: local, pudendal
     Assessment of Biophysical Profile (BPP)
     Manual extraction of the placenta
     Cesarean delivery

 Procedures introduced in the PGY-2 year (but mastered in the PGY-3 and PGY-4 year):
     Operative vaginal delivery, including outlet forceps and vacuum extraction
     Repeat cesarean delivery
     Repair of 3rd and 4th degree perineal laceration
     Vaginal delivery of multiple pregnancy
     Emergent cesarean delivery

                                                         Department of Obstetrics and Gynecology
                                                            St. Francis Hospital & Medical Center

III. Rotation Structure

    The PGY-2 resident will review in detail the goals of the rotation before the first day of the
    rotation. The resident will actively participate in:
         Rounds focusing on complicated postpartum patients (both vaginal and cesarean
         7:15 Morning Report (daily)
         Sign-out Rounds
         At all other times, it is expected that the PGY-2 resident will assist the PGY-1 on the
            labor floor with direct patient care encounters and will take responsibility for attending
            to postpartum complications
         Assist the PGY-1 resident in performing vaginal deliveries
         Provide primary coverage of the Triage area in the Delivery Room and the
            postpartum wards with some assistance from the PGY-1 resident

IV. Resident Supervision

    The PGY-2 resident’s daily activities fall under the management of the PGY-3 and Chief
    Resident, which provides opportunity for immediate feedback. Deliveries and procedures
    are performed under the direct supervision of the Attending Physician at all times, including
    nights, weekends, and holidays. This is ensured by 24-hour in-house coverage by attending

V. Reading List and Educational Materials
    Textbooks: (i) William’s Obstetrics; (ii) Gabbe S, et al (editors). Obstetrics: Normal and
      Problem Pregnancies; (iii) Briggs GG, et al (editors). Drugs in Pregnancy and Lactation;
      (iv) Creasy and Resnick (editors). Maternal-Fetal Medicine.
    ACOG Compendium
    UpToDate Clinical Reference Library
    Emedicine
    PubMed
    Cochrane Perinatal Database

VI. Method of Evaluation
     The PGY-2 resident will receive on-site timely formative feedback from the Chief
       Resident and Attending Physician(s) during this rotation.
     Global evaluations are performed at the completion of the 4-week rotation by select
       Obstetric faculty and reflect input from the attending staff, nurses, medical students, and
       patients. These evaluations will be available to the residents via the
       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.
     Nursing staff will complete evaluations of selected skills of each resident at the
       completion of each block.
     Cognitive assessment of the residents’ obstetric skills is achieved by the obstetric score
       from the CREOG examination.
     CREOG Competency cards: S-fac, C-fac, and Fac-1 cards
     Morning Report/Lecture Evaluations
     Dictations-to be performed immediately after a procedure
     Completion of work-hours log- done weekly
     Completion of ACGME procedure log-done weekly

                                                 Department of Obstetrics and Gynecology
                                                    St. Francis Hospital & Medical Center


I have/have not accomplished the educational aims and objectives as noted above for
this rotation.

Resident Printed Name

_______________________________________              __________________________
Resident Signature                                   Date


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

_______________________________________              __________________________
Program Director/Associate Program Director          Date

Last Updated:
August 24, 2010


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