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  • Overall Goals
    		•

    PGY1 Program Educational Objectives
    & Curriculum Outline

    Curriculum Goals for the PGY1 Resident

    At the completion of the first year the resident should be able to:
    General:

    1. Perform comprehensive H&Ps, recognize obstetric and gynecologic problems, indications for surgical intervention and identify coexisting medical problems
    2. Share data obtained from H&P's with colleagues in an organized, clear, concise and logical manner in both written and oral forms
    3. Demonstrate a developing appreciation for the basic ethical principles involved in the field of Ob/Gyn
    4. Demonstrate an ongoing learning through regular study, reading, literature review, conference participation and attendance, and education of medical students.
    5. Develop responsible practices in medical record keeping.
    6. Use information technology to manage information and access on-line medical information
    7. Demonstrate interest and develop skill in teaching the field of obstetrics and gynecology to students and staff
    8. Take responsibility as a physician, make judgements and decisions regarding patient care in basic settings, and learn when to ask for help.
    9. Behave professionally and communicate well with colleagues, nurses, staff and other members of the health-care team
    10. Achieve a score that is no lower than 1 standard deviation below the mean (for the year of training) on the annual CREOG in-service examination.  Residents who score 2 standard deviations below the mean are subject to academic probation if other academic concerns arise. 

    Ambulatory Care:

    1. Select appropriate lab tests and diagnostic studies
    2. Demonstrate an ability and willingness to teach patients and families about disease processes and interventions.
    3. Act respectfully when interacting with patients, families and colleagues.
    4. Demonstrate familiarity with and recommendations for age specific care/screening/immunizations
    5. Recognize psychosocial problems of patients and their families
    6. Perform an adequate speculum exam, Pap smear and cervical cultures
    7. Perform an adequate and sensitive bimanual exam
    8. Begin to demonstrate independence in selecting and performing certain diagnostic/therapeutic procedures including but not limited to: FNA, colposcopy, LEEP, cryosurgery, endometrial biopsy, word catheter placement
    9. Demonstrate competence in counseling patients regarding contraception and in evaluating the appropriateness of the use of various modalities
    10. Perform diagnostic tests such as wet-mount and interpret the results obtained
    11. Demonstrate proficiency in providing emergency medical care including airway management and CPR
    12. Recognize emergent conditions requiring hospitalization, and be able to identify appropriate consultants
    13. Recognize and treat basic emergency room problems
    14. Perform emergency procedures such as intravenous line and central line placement, blood gas sampling, nasogastric tube placement, lumbar puncture, mask ventilation etc.

    Obstetrics:

    1. Demonstrate an understanding of the anatomic and physiologic changes of pregnancy
    2. Demonstrate an understanding of fetal development and physiology
    3. Understand basic genetics and be able to develop pedigrees
    4. Provide preconception care/counseling for uncomplicated patients
    5. Provide routine prenatal care for uncomplicated patients
    6. Understand modalities available for performing antepartum fetal surveillance, and develop an understanding of how to interpret these data
    7. Recognize potential high risk OB patients
    8. Identify obstetric emergencies and understand/participate in developing management plans
    9. Perform uncomplicated vaginal deliveries
    10. Understand indications for operative vaginal delivery and begin to understand the different modalities available to accomplish it
    11. Perform an uncomplicated cesarean section with guidance
    12. Perform repairs of uncomplicated obstetric lacerations and be able to recognize complicated ones
    13. Understand and communicate the indications for induction of labor
    14. Understand the modalities available for obstetric analgesia/anesthesia
    15. Identify neonatal emergencies
    16. Assess APGAR scores and perform cord blood gas analysis
    17. Provide routine post-partum care and identify post-partum complications
    18. Perform postpartum tubal ligation with guidance
    19. Perform basic ultrasound (AFI, position check, biometry)

    Gynecology:

    1. Identify common disorders of the urogenital tract such as abnormal bleeding, vaginal and vulvar infections, dermatoses, sexually transmitted diseases etc.
    2. Recognize and evaluate chronic pelvic pain
    3. Show an ability to recognize and describe pelvic masses, and demonstrate an appreciation of management strategies
    4. Understand the pathophysiology of endometriosis
    5. Recognize benign breast disease
    6. Assist in the care of critically ill patients, understand hemodynamic monitoring, fluid management and CPR
    7. Recognize and evaluate early pregnancy loss and develop management plans
    8. Perform D&C with guidance
    9. Second-assist in common gynecologic procedures
    10. Demonstrate proficiency in surgical skills including: knot tying, suturing, skin closure, trocar and Veress needle placement, manipulation of surgical instruments
    11. Identify postoperative complications of common gynecologic procedures

    Reproductive Endocrinology:

    1. Demonstrate an understanding of basic reproductive anatomy and physiology
    2. Understand the factors involved in infertility
    3. Recognize disorders of menstruation, androgen excess, prolactin, thyroid disorders, etc.
    4. Be able to construct an initial history from consultation with a new patient
    5. Understand the logistics and basic techniques involved in reproductive surgery

    Oncology:

    1. Demonstrate familiarity with the epidemiology and clinical presentation of gynecologic malignancies.
    2. Demonstrate an awareness of the recommendations regarding screening for gynecologic malignancies.
    3. Perform an initial assessment for gynecologic malignancies and be familiar with the FIGO staging systems.
    4. Understand basic treatment options available for gynecologic malignancies
    5. Indicate understanding of the therapeutic options available for gynecologic malignancies.

    Minimally Invasive Surgery:

    Skills

    1.        Demonstrate ability to appropriately position patients in the operating room.

    2.        Demontrate abilty to prepare and drape a patient for surgery in sterile fashion.

    3.        Place a foley catheter and a uterine manipulator with minimal assistance.

    4.        Place ancillary trocars with some guidance.

    5.        Understand principles of suction/irrigation, fascial closure, skin closure and dressing the incisions.

    6.        Perform an abdomino-pelvic survey and recognize normal and abnormal anatomy.

    7.        Begin to develop skills as a surgical assistant.

    8.        Demonstrate an ability to perform, with assistance, tubal ligation, chromopertubation, ablation, diagnostic laparoscopy, ablation of endometriosis

    9.        Core skills that will be developed throughout the course of the residency training include: camera management, instrument management, bimanual dexterity, and development of visual-spatial skills.

    Knowledge:

    1.        Begin to develop skills in pre-operative evaluation, decision making and informed consent

    2.        Understand the various methods of laparoscopic entry into the abdominal cavity including: pneumoperitoneum, direct entry, open entry (Hasson), optical entry, Palmer’s point, cul-de-sac or transuterine insufflation.

    3.        Understand laparoscopic anatomy and landmarks.

    4.        Understand indications for: administration of antibiotics, antithrombotic prophylaxis, intraoperitive anesthesia and postoperative analgesia.

    5.        Develop understanding of energy sources including unipolar, bipolar and ultrasonic energy. 

    6.        Understand the effects of pneumoperitoneum on the pulmonary system

    7.        Demonstrate knowledge of the various techniques of sterilization.

    8.        Demonstarte knowledge of the management of adnexal torsion and ectopic pregnancy.

     

    Geriatrics/Hospice:

    Knowledge

    1. Basic science knowledge about demography and epidemiology of aging, theories of aging, normal aging, anatomic and histologic changes associated with aging, pharmacology, pathology and physiology of aging.
    2. Knowledge of geriatric syndromes and conditions including dementia, inappropriate prescribing of medications, incontinence, depression, delirium, falls, osteoporosis, sensory impairments, dysmobility, pressure ulcers, atypical presentation of disease
    3. Knowledge of diseases and disorders more common or have particular features in older persons
    4. Knowledge of psychosocial issues affecting older persons
    5. Knowledge of ethical issues in geriatric care including advance directives
    6. Knowledge of Health Care financing
    7. Awareness of cultural aspects affecting the health care of older persons

    Skills

    1. Comprehensive Geriatric Assessment, including standardized methods for assessing physical, cognitive, emotional and social functioning, specific examples include screening examinations for mental status, geriatric depression, functional status.
    2. Physical diagnosis skills including mobility assessment, gait and balance assessment, pre-operative assessment, recognizing normal vs. abnormal findings associated with aging
    3. Palliative Care Management
    4. Evaluation of Decision-Making Capacity
    5. Counseling patients and families about medical decision-making

    Attitudes

    1. Awareness of myths and stereotypes related to older persons
    2. Recognition that ageism affects all levels and aspects of society, including health professions, and can adversely affect optimal care of older persons.
    3. Recognition of the heterogeneity of older persons
    4. Willingness to work in interdisciplinary fashion
    1. Appreciation for the importance of functional optimization in addition to quality of life considerations and personal preferences in decision-making

    Neonatal Care:

    1. Discuss neonatal respiratory distress syndrome
    2. Provide and understand thermal management of the newborn
    3. Understand sepsis in the newborn
    4. Perform an initial evaluation of term and preterm infants
    5. Demonstrate understanding of intracerebral hemorrhage in term and preterm infants
    6. Understand the management issues related to infants of diabetic mothers
    7. Recognize and assist with the care of infants with meconium aspiration syndrome
    8. Perform circumcision

    Anesthesia:

    1. Understand types of regional anesthesia and indications for providing anesthesia to laboring patients
    2. Demonstrate understanding of the use of general anesthesia in obstetrics
    3. Understand and observe the techniques of placement of epidural and spinal anesthesia
    4. Recognize and begin to treat complications of anesthesia including nausea/vomiting, hypotension, spinal headaches and epidural hematomas. 

    Emergency Medicine

    1.  Residents should gain an understanding of the nature of emergency care and how it relates to outpatient care.
    2. Residents are also expected to learn to evaluate and stabilize patients before their admission to the hospital.
    3. They will gain further knowledge in the initial management of acute conditions such as acute myocardial infarction, sepsis, respiratory failure and gastrointestinal bleeding.
    4. They will also learn to understand and appreciate the Emergency Department's role in the ongoing management of patients. Residents will also gain an appreciation for the capabilities and limitations of the Emergency Department.
    5. Residents will gain experience in evaluating patients that may not be part of their regular inpatient or outpatient medicine experience. This includes pediatric patients and a variety of surgical and surgical sub-specialty patients. The residents should gain a level of comfort with the emergent management of stabilization of these patients as well as the evaluation of a variety of emergent and non-emergent conditions in these groups of patients
    6. Learn and perform technical skills such as placement of central lines, airway management, arterial blood gas collection, and other invasive maneuvers.

    Continuity Clinic

    1. Perform comprehensive histories, including medical, nutritional, sexual, family, genetic, and social behavior data, and the develop the ability to assess health risks
    2. Perform a complete physical examination
    3. Demonstrate appropriate use of laboratory studies and diagnostic techniques
    4. Perform patient education and counseling
    5. Perform screening appropriate to patients of various ages and risk factors
    6. Discuss necessary immunizations for patients of specific ages and under specific circumstances
    7. Diagnose and treat common non-reproductive illnesses affecting women
    8. Learn appropriate use of community resources and other physicians through consultation when necessary
    9. Become aware of and knowledgeable about the behavioral and societal factors that influence health among women of differing socioeconomic and cultural backgrounds
    10. Counsel patients regarding behavioral medicine and psychosocial problems, including domestic violence, sexual assault, and substance abuse
    11. Evaluate and manage ambulatory primary care problems of the geriatric patient
    12. Understand and utilize the basics concepts of epidemiology, statistics, data collection and management, and use of medical literature
    13. Demonstrate appropriate use of  medical ethics and medical jurisprudence
    14. Learn principles of community medicine, including health promotion and disease prevention
    15. Understand health care delivery systems and practice management
    16. Demonstrate appropriate information processing and decision making
    17. Demonstrate concern and respect for patient safety

    Research:

    1.        Demonstrate an ability to perform a literature search on a particular clinical question and utilize this information to improve patient care.

    2.        Prepare and give educational lectures on basic topics in obstetrics and gynecology.

    3.        Identify areas of interest for future research and a faculty mentor to assist in this process if the resident desires to pursue research during their residency.

    4.        Demonstrate a basic understanding of the principles of evidence based medicine, including epidemiology, statistics and critical analysis of the literature.

     
    Curriculum & Description of Rotations:      

    Fairfax Clinic

    The residents spend 1-2 months on this rotation, spending their time primarily in the ob/gyn clinic at Fairfax Hospital.  Monday is diabetic clinic, Tuesday is high-risk clinic and the remainder of the week the clinic resident sees a combination of obstetric and gynecologic patients.  This resident is also part of the post-partum rounding team, and is expected to participate in the care of the postpartum patients, to learn circumcision skills and management of postpartum complications.  This resident is in the call pool at GW, and takes weekday and weekend call as either the OB or GYN intern.  Supervision while in the clinic is provided by the clinic attendings and evaluation is by this faculty at the end of the rotation.  
    Faculty Contacts: Dr Samantha Buery, Dr Erika Latchis

    Recommended Reading: Chapters on antenatal care and postpartum care in Williams or Gabbe. 

    Gynecology

    The resident spends 1-2 months on this rotation at the George Washington University Hospital.  This resident will often act as a “substitute” when another resident is on vacation to take the role of night float or antepartum for a week.  This resident will spend time in a variety of roles during their rotation and the time will be divided between attending office hours at the MFA with a faculty member and assisting in the operating room at GW. This is an opportunity to work on basic skills such as performing Pap smears, endometrial biopsies,  knot tying and suturing.  Call is at GW.  Supervision is provided by the gyn attending of the month. 

    Faculty contact: Dr Jennifer Keller

    Recommended Reading:  Telinde’s chapters on surgical instruments, sutures and pelvic anatomy. 

    Gynecologic Oncology
    The resident spends 1-2 months on this service, participating in the care of outpatients, including initial evaluation and preoperative management, as well as assisting in inpatient care of patients postoperatively, cancer chemotherapy, and other hospitalized patients with cancer. There is an opportunity to develop basic surgical skills. The resident is expected to be proficient in knot tying and to understand basic surgical technique prior to this rotation. The resident is directly supervised by the chief resident and attending physician. Dr. MacKoul will evaluate residents at the completion of the rotation, based on the mastery of the goals and objectives.
    Faculty Contact: Dr Paul MacKoul

    Recommended Reading: Practical Gynecologic Oncology (Berek and Hacker) Residents are expected to have read the chapters regarding pre-invasive disease, epithelial ovarian cancer, uterine cancer and cervical cancer prior to the rotation.

    Antepartum:
    George Washington University:

    The resident spends 1-2 months on this service at GWU, participating in both inpatient and outpatient care of high-risk antepartum, intrapartum and postpartum patients. There is intensive involvement in the care of intrapartum patients on L&D, and this resident is responsible for managing labor and delivery from 7a-7p daily with the guidance of a third year resident.

    A weekly teaching conference is held to discuss all high risk patients, and the resident participates in their care during the weekly high risk clinic. The resident is responsible for preparation of morning conferences with help from the OB chief resident.  The chief resident and attending physician always directly supervise the resident.  There are weekend call responsibilities. Dictations of discharge summaries and surgical cases are the responsibility of the PGY1 resident on this and other rotations unless the resident is told otherwise. Inpatient rounds and progress notes are to be completed prior to sign-out rounds each day.  Evaluation is performed by Dr Bathgate and Dr Macri Dr Bathgate and Dr Macri evaluate the resident at the completion of the rotation.
    Faculty Contact: Dr. Susanne L. Bathgate

    Fairfax Hospital: The resident spends 1 –2 months on this service at Fairfax. There is intensive involvement in the care of hospitalized antepartum patients on a busy High Risk Perinatal unit, with daily rounds led by perinatologists. The chief resident on the service provides immediate supervision. There are obstetric night-call responsibilities. There is a weekly high risk clinic as well as a weekly diabetic clinic, supervised by chief residents and perinatologists, where the resident primarily evaluates and learns to develop plans for high risk obstetric patients.  The MFM faculty evaluate the resident at the end of the rotation. 
    Faculty Contact: Dr Alfred N. Khoury

    Recommended Reading: Creasy and Resnick’s Maternal Fetal Medicine.  Residents are expected to read chapters related to patients they are caring for as well as chapters covering basic topics such as diabetes and hyptertension in pregnancy.  

    Night Float

    The resident spends 1 month (sometimes 2) managing Labor and Delivery from 7 pm to 7 am Sunday through Thursday with the assistance of a chief resident.  This rotation allows the resident to begin to become comfortable with the basic management of laboring patients, triaging obstetric patients, managing postpartum complications and performing cesarean sections, vaginal deliveries and laceration repairs.  Attending physicians evaluate the resident at the end of the rotation. 

    Recommended Reading: Williams and/or Gabbe’s Obstetrics chapter on normal Labor and delivery, intrapartum evaluation, malpresentation, and cesarean delivery.

    Ultrasound:
    This is a 1 month in which the resident spends one week in the antenatal testing center at Fairfax Hospital, observing and performing ultrasounds on clinic and private patients referred there for evaluation of both normal and high risk pregnancies. The resident learns basic ultrasound technique, including vaginal probe and transabdominal scanning.

    The remainder of the rotation is divided between triage and the operating room.  In triage, in addition to developing skills needed to accurately and efficiently assess patients and make decisions about their treatment plan, the resident should practice their ultrasound skills with the guidance of a chief resident.  The ultrasound resident will, on occasion, be assigned to basic gyn cases in the operating room such as diagnostic hysteroscopy, D+C and tubal ligations. 

    Finally, this resident is also a member of the antepartum team and is responsible for rounding on no more than 4 hospitalized antepartum patients.  Attendance at antepartum rounds is required daily. At the end of the rotation the resident delivers a formal 45-minute lecture on a topic of his/her choice to the residents at Fairfax, supervised by a perinatologist. Evaluation is done by the MFM faculty at Fairfax.

    Faculty Contact: Dr Alfred N. Khoury

    Recommended Reading: Chapters on obstetric ultrasound in an obstetric textbook.

     Geriatrics
    The resident spends one month on this service and experiences one week each of Hospice, Geriatric outpatient care, NICU and obstetric anesthesia.  Residents are excused from department conferences, but are expected to attend the conferences held by the department they are rotating with. Supervision is at the attending and fellow level. The resident takes general Ob/Gyn night call while on this service.

    Faculty Contact:  Geriatrics: Dr Elizabeth Cobbs, Hospice: Dr Carlos Gomez, NICU: Dr Hany Ali, Anesthesia: Labor and Delivery Attending
     

    Recommended Reading:

    1. "Drug Prescribing for Elderly Patients." Mayo Clin Proc 1995; 70:685-693. By Drs. Chutka, Evans, Fleming, Mikkelson. (Link only available on campus.)
    2. "Dementia: Diagnosis and Evaluation." Mayo Clin Proc 1995; 70:1093-1107. By Dr.S Fleming, Adams, Petersen. (Link only available on campus.)
    3. "Constipation and Fecal Incontinence in the Elderly Population." Mayo Clin Proc 1996; 71: 81-92. By: Drs. Romero, Evans, Fleming, Phillips. (Link only available on campus.)
    4. "Evaluation and Management of Problem Pressure Sores." ADVANCE for Nurse Practitioners: May 1994. 25-28. By: Deanna Gray-Miceli, MSN, RN, CS, and Donald Leaman, MS.
    5. "Comprehensive Geriatric Assessment: Helping your Elderly Patients Maintain Functional Well-Being." Vol 103, No 3, March 1998, PostGraduate Medicine, Geriatric Assessment. By: Drs. Rockwood, Silvius, Fox.
    6. . "Performance -Oriented Assessment of Mobility Problems in Elderly Patients." Journal of American Geriatrics Society. 1986. 34: 119-126. By Mary E. Tinetti, MD.
    7. "Program of All-inclusive Care for the Elderly (PACE): An Innovative Model of Integrated Geriatric Care and Financing." JAGS; 45:223-232, 1997. By Drs, Eng, Pedulla, Eleazer, McCann, Fox. (Link requires MDConsult account.)
    8. "Preventive Medicine and Screening in Older Adults." JAGS; 45:344-354, 1997. By: Drs. Goldberg and Chavin. (Link requires MDConsult account.)
    9. "Geriatric Rehabilitation: State of the Art." JAGS; 45: 1371-1381, 1997. By Drs. Hoenig, Nusbaum, Brummel-Smith. (Link requires MDConsult account.)
    10. "Evidence-Based Medicine Holds the Key to the Future for Geriatric Medicine." JAGS; 45:1268-1272, 1997. By: Drs. Burns, Pahor, Shorr. Link requires MDConsult account.)
    11. "Nursing Home Visits: An efficient system for the busy physician." Geriatrics., Vol. 52 No. 5 May 1997. By: Drs. R. McCartney and B. McCartney.
    12. "Incontinence in the Nursing Home." Annals of Internal Medicine; Vol. 122 No. 6, March 15, 1997. By: Drs. Ouslander and Schnelle. (Link only available on campus.)
    13. "Treating postmenopausal osteoporosis: The Benefits of Individualizing Therapy." Family Practice Recertification; Vol 19 No 9 (suppl), September 1997. Jennifer Jones Educational Coordinator 08/20/98
    14. Anesthesia: Chapter in Gabbe or Williams on obstetric anesthesia
    15. NICU: Neonatal care chapter in Gabbe or Williams

    Emergency Medicine

    This one month rotation at The George Washington University involves working shifts in the Emergency Department alongside residents from emergency medicine, surgery, internal medicine and primary care.  Throughout the rotation in the Emergency Department residents will have access to all patients who present this busy, level I trauma center. They will often be the first physicians evaluating these patients. The history and physical examinations on a variety of patients with all kinds of emergent and non-emergent conditions should become routine. Through the supervision of the senior residents, the attending physician and the teaching resident in emergency medicine, residents have the opportunity to discuss their evaluation techniques, specific historical or physical findings, and the thought process that goes into stabilizing and further assessing these patients. Residents should also become very comfortable in ordering appropriate laboratory and radiological examinations in an emergent setting when necessary. 

    Residents who are rotating through the Emergency Department will have the opportunity to work on many technical skills that are important to their residency such as placement of central lines, airway management, arterial blood gas collection, and other invasive maneuvers. In addition, they will perform many pelvic examinations that should add to their experience with obstetrics and gynecologic patients.

    Monthly evaluations of the obstetrics and gynecology residents that rotate through the department are filled out by the residency director. Specific feedback is given to the residents throughout the month by the various faculty and senior residents in emergency medicine who are in the department.

    Faculty Contact: Dr. Yolanda Haywood

    Recommended Reading:
    There is a full emergency medicine textbook library available in the Emergency Department that includes textbooks in internal medicine, pediatrics, surgery and surgical sub-specialties. 

    Internal Medicine/ICU
    The resident spends one month learning inpatient care of medical patients on the wards and one month in the med/surg ICU at GW. Supervision is through senior residents and attending physicians including intensivists with backgrounds in surgery, anesthesia, pulmonary medicine and general medicine. Evaluations are done by attending physicians at each site.
    Faculty Contact: Dr. Jehan El-Bayoumi

    Recommended Reading: Internal Medicine Textbook 

    Continuity Clinic
     Each PGY1-3 resident will spend ˝ day per week assigned to a specific panel of patients at either GW, Fairfax or Holy Cross Hospitals. Even when clinical rotations require the resident to be stationed at other sites or off-service (as during the PGY1 year) the resident will travel to the assigned site each week for the continuity experience. Residents are excused when on their ICU rotation or on Night Float but are expected to attend post-call.  Each resident will have an ongoing experience with this panel of patients under the supervision of attending physicians. Patients will be obstetric and gynecologic patients with a variety of problems. 

    The primary goal of this experience is for residents to learn ambulatory obstetrics and gynecology in a setting that encourages continuity of care. Increasing responsibility will be given to the resident under the supervision of a qualified, on-site, attending staff/faculty member.  

    Attending physicians will provide quarterly feedback to the residents in written and verbal form. Specific feedback is given to the residents throughout the year by the faculty supervising the continuity clinics. Particular attention will be paid to assessing competency in interpersonal and communication skills, professionalism, and systems-based practice.

    Faculty Contact: Dr Nancy D Gaba (GW), Dr Erika Latchis (FFX), Dr Joel Palmer (HCH) 

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