Department of Obstetrics and Gynecology by liaoqinmei

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									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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