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, including recognition of obstetric and gynecologic problems, indications for surgical intervention and identification of 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 process of 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, making 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 with scores lower than 2 standard deviations below the mean are subject to academic probation at the discretion of the program director.)

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)
    

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 and 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.

Geriatrics:

1. Discuss the concept of palliative care
2. Plan care for patients when comfort is the goal
3. Appreciate the value of an interdisciplinary care team for geriatric patients and function as part of that team.
4. Understand that care of a dying patient involves family and other care givers and demonstrate the ability to communicate with patients and family members about death and dying
5. Understand the use of Advanced Directives and be able to discuss issues related to dying such as hydration and nutrition
6. Demonstrate an understanding of pain management and palliative care
7. Understand hospice care and its benefits

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 intrecerebral 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
   

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Class of 2011

Obstetrics and Gynecology:
The resident spends approximately 5 months learning general obstetrics and gynecology in the ambulatory and hospital setting at GW and at FFx. There is night call in both Ob and Gyn. Night call is also taken in general Ob/Gyn while on subspecialty rotations such as geriatrics. Daily assignments are made by the administrative chief resident. Residents are expected to learn the skills described in section II. 1. All medical records are expected to be completed in a thorough and timely fashion. 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 expected to be completed prior to sign-out rounds each day. Residents are evaluated by the generalist faculty at each site.
Faculty Contact: Dr. Nancy D. Gaba

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 o this rotation. The resident is directly supervised by the chief resident and attending physician. Recommended text: Practical Gynecologic Oncology (Berek and Hacker). The resident is expected to have read the chapters regarding pre-invasive disease, epithelial ovarian cancer, uterine cancer and cervical cancer prior to the rotation. Residents will be evaluated by Dr. Lin at the completion of the rotation, based on the mastery of the goals and objectives.
Faculty Contact: Dr. Jeffrey Y. Lin

High Risk Obstetrics:
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. 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 attends a monthly conference to discuss selected cesarean sections from the prior month, and prepares presentations of these patients with help from the OB chief resident. The resident is always directly supervised by the chief resident and attending physician.
Faculty Contact: Dr. Susanne L. Bathgate

The resident spends 1 month (sometimes two) on this service at FFx.. There is intensive involvement in the care of hospitalized antepartum patients on a busy High Risk Perinatal unit, with daily rounds led by perinatologists. Immediate supervision is provided by the chief resident on the service, with whom all cases are reviewed prior to daily rounds. There are weekly day-call responsibilities, with supervised responsibility for interpretation of antenatal testing of hospitalized and outpatients. There is a weekly high risk clinic, supervised by chief residents and perinatologists, where the resident primarily evaluates and learns to develop plans for high risk obstetric patients.
Faculty Contact: Dr Alfred N. Khoury

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Geriatrics
The resident spends one month on this service, and is exposed to nursing home and hospice settings. Several teaching conferences are held weekly. Supervision is at the attending and fellow level. The resident takes general Ob/Gyn night call while on this service.

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, iatrogenesis, 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

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

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
5. Appreciation for the importance of functional optimization in addition to quality of life considerations and personal preferences in decision-making

Suggested (not required) Reading List:

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. "Ten Commandments of Drug Therapy."
5. "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.
6. "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.
7. "Hospice of Northern Virginia Dosage Chart"
8. . "Performance -Oriented Assessment of Mobility Problems in Elderly Patients." Journal of American Geriatrics Society. 1986. 34: 119-126. By Mary E. Tinetti, MD.
9. "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.)
10. "Preventive Medicine and Screening in Older Adults." JAGS; 45:344-354, 1997. By: Drs. Goldberg and Chavin. (Link requires MDConsult account.)
11. "Geriatric Rehabilitation: State of the Art." JAGS; 45: 1371-1381, 1997. By Drs. Hoenig, Nusbaum, Brummel-Smith. (Link requires MDConsult account.)
12. "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.)
13. "Nursing Home Visits: An efficient system for the busy physician." Geriatrics., Vol. 52 No. 5 May 1997. By: Drs. R. McCartney and B. McCartney.
14. "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.)
15. "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

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Emergency Medicine
Goals:
The educational mission of the rotation is to provide an intense learning experience in all facets of emergency care. Residents should gain an understanding of the nature of emergency care and how it relates to outpatient care. Residents are also expected to learn to evaluate and stabilize patients before their admission to the hospital. The experience during the month includes working shifts in the Emergency Department alongside of residents from emergency medicine, surgery, internal medicine and primary care. There is 24-hour attending supervision of the residents at all times. There are required morning conferences, four mornings per week, for the residents who are working at that time. The attending physicians and the senior residents in the department teach these conferences.

Objectives:
Knowledge
Residents rotating through the Emergency Department will gain knowledge in all aspects of emergency care. They will have access to all of the patients who present to the Emergency Department. Through this experience it is expected that they will gain further knowledge in the initial management of acute conditions such as acute myocardial infarction, sepsis, respiratory failure and gastrointestinal bleeding. 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. 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.

Skills
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 physician 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.

Educational Environment
The GW Emergency Department sees approximately 46,000 patients per year, has it's own outpatient radiology service and a designated fast track area during the daytime hours. It is a Level I trauma center and sees patients from all walks of life. It is supervised 24 hours every day by a dedicated teaching faculty who run a successful emergency medicine residency program.

Evaluation and Feedback
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.

Emergency Medicine Reading List:
The residents are provided with a copy of the core curriculum in emergency medicine which is a series of readings on topics that are core to the specialty as well as topics that may not be part of other residencies such as environmental emergencies, toxicology, and envenomations. 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. There is an Internet accessible computer in the Emergency Department that all of the residents are encouraged to use. Faculty Contact: Dr. Yolanda Haywood

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Internal Medicine
The resident spends 2 months learning inpatient care of medical patients on the wards. Residents are assigned to rotations at GW, HC and the VA, but do not spend more than one month at each hospital. Residents spend one of these months in a critical care unit at the VA or at GW. These are mixed medical/surgical ICUs. For residents who spend a ward month at Holy Cross there is some additional intensive care experience. 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

Neonatal Care
Each resident spends one half day per week during their OB month(s)at GW rounding with the ICN and full term nursery teams. The resident presents a case each week which is discussed with the ICN team, attending, and fellow as well as the OB attending with an emphasis on the neonatology perspective of each case. Here, the topics outlined in the "Goals for PGY1 residents" will be covered. Attendance is also required at a weekly neonatology conference.

At weekly high risk conferences neonatal issues and outcomes are presented by the neonatology fellow and are discussed and evaluated by the OB team.
Faculty Contact: Dr Hani Aly

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Continuity Clinic
Goals:
Each PGY1-3 resident will spend ½ 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. 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. The experience will include the following ambulatory experiences:

Objectives:

1. Comprehensive history taking, including medical, nutritional, sexual, family, genetic, and social behavior data, and the ability to assess health risks
   
2. Complete physical examination
   
3. Appropriate use of laboratory studies and diagnostic techniques
   
4. Patient education and counseling
   
5. Screening appropriate to patients of various ages and risk factors
   
6. Immunizations needed at specific ages and under specific circumstances
   
7. Diagnosis and treatment of the common non-reproductive illnesses affecting women
   
8. Continuous management of the health care of women of all ages
   
9. Appropriate use of community resources and other physicians through consultation when necessary
   
10. Appropriate awareness and knowledge of the behavioral and societal factors that influence health among women of differing socioeconomic and cultural backgrounds
    
11. Behavioral medicine and psychosocial problems, including domestic violence, sexual assault, and substance abuse
    
12. Emergency care
    
13. Ambulatory primary care problems of the geriatric patient
    
14. Basics of epidemiology, statistics, data collection and management, and use of medical literature and assessment of its value
    
15. Ethics and medical jurisprudence
    
16. Community medicine, including health promotion and disease prevention
    
17. Health care delivery systems and practice management
    
18. Information processing and decision making
    
19. Patient safety

Educational Environment:
In addition to these clinical experience residents are expected to follow the Ambulatory Ob/Gyn Curriculum, which is a faculty-selected list of topics and reading assignments. These informal assignments are selected from current primary literature, textbooks and ACOG publications. There is a monthly schedule of topics and reading assignments, and the didactic schedule will also include lectures in related areas. Residents are encouraged to use these readings for journal club discussions, interactions with continuity-clinic attending physicians and student teaching sessions.

Evaluation and Feedback:
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.

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