PGY2 Program Educational Objectives
& Curriculum Outline

Curriculum Goals for the PGY2 Resident:
A
At the completion of the second year, the resident should be able to demonstrate an ongoing development of the skills learned in the first year as well as:

General:

1. Perform focused and efficient Histories and Physicals with an increasing recognition of disease patterns and presentations.
2. Communicate efficiently with staff and colleagues
3. Demonstrate continued commitment to the field of obstetrics and gynecology.
4. Demonstrate progress in learning through regular study, reading, literature review, conference attendance and participation
5. Show a commitment to continuing education by assisting in the education of medical students and acting as a role model for junior residents
6. Begin to understand cost and other systems-issues with respect to diagnostic and therapeutic technology

Ambulatory Care:

1. Provide more extensive counseling and education of patients and their families
2. Manage basic non-gynecologic ambulatory problems including but not limited to: URI, otitis media, HTN, DM, asthma, gastritis, arthritis etc.
3. Understand religious, political and cultural issues surrounding contraception and abortion, and discuss them with patients and families

Obstetrics:

1. Recognize and counsel patients regarding the normal physiologic changes of pregnancy
2. Understand and recognize normal and abnormal fetal anatomy and physiology and begin to understand the implications for management of the pregnancy
3. Develop a more detailed understanding of genetics, genetic counseling, and prenatal diagnostic tests including amniocentesis, CVS and blood studies.
4. Provide preconception/prenatal care and counseling to uncomplicated patients as well as some high risk patients with supervision (eg Hypertensives, diabetics etc)
5. Provide first line management of obstetric emergencies such as post-partum hemorrhage, dystocia and eclampsia.
6. Understand and interpret more complicated antenatal surveillance tests and develop management plans
7. Understand the category system for the use of drugs in pregnancy and choose appropriate medical therapy for pregnant patients with medical conditions.
8. Identify and manage 2nd trimester pregnancy losses, PTL, PROM, bleeding in pregnancy, multiple gestation IUGR, Rh disease, post-date pregnancy, IUFD, VBAC
9. Perform normal vaginal deliveries and complicated deliveries with dystocia with assistance
10. Repair more difficult obstetrical lacerations (3rd and 4th degree) with supervision
11. Place a pudendal block
12. Manage complicated labors
13. Perform outlet and low forceps deliveries with assistance
14. Perform uncomplicated cesarean sections with assistance
15. Develop a more thorough understanding of obstetrical anesthesia and analgesia and complications
16. Initiate care of a neonate in distress
17. Provide post-partum care for uncomplicated and complicated patients, and recognize and manage most post-partum complications
18. Provide counseling about lactation
19. Perform basic ultrasound, including assessment of gestational age and basic fetal anatomy with supervision

Gynecology:

1. Identify and develop management plans for common gynecologic disorders including but not limited to abnormal uterine bleeding, vaginal and vulvar infections, dermatologic conditions, STD's, pelvic masses, chronic pelvic pain, endometriosis, benign breast disease
2. Identify pelvic support defects, learn to evaluate them and learn about management options
3. Manage patients in the intensive care unit (Toxic-shock syndrome, sepsis, ARDS, PE etc)
4. Manage early pregnancy loss, including surgical/medical therapy for ectopic pregnancy
5. First assist on abdominal procedures including TAH, ovarian cystectomy, oophorectomy, myomectomy, salpingostomy, salpingectomy, basic laparoscopy/hysteroscopy and understand the principles of repair of bladder and bowel injuries and indications for these procedures
6. Demonstrate an ability to provide appropriate preoperative counseling, informed consent and evaluation for routine GYN procedures
7. Identify, evaluate and develop management plans for patients with recurrent pregnancy loss
8. Place cervical cerclage with supervision
9. Perform colposcopy, polypectomy, I&D of vulvar abscesses, vulvar biopsies, cone biopsies, cryosurgery under supervision

Reproductive Endocrinology

1. Assist with infertility procedures including egg retrieval, IUI, ET, laparoscopy, hysteroscopy, HSG and sonohysterogram
2. Develop an understanding of common endocrine presentations in OB/GYN and their management
3. Demonstrate an ability to read and interpret REI literature
4. Construct a differential diagnosis for reproductive endocrine and infertility disorders

Oncology:

1. Independently perform the initial evaluation of a patient with a suspected gynecologic malignancy.
2. Demonstrate an understanding of the principles of radiotherapy.
3. Demonstrate an understanding of the histology of gynecologic malignancies
4. Demonstrate an understanding of the principles of chemotherapy for gynecologic malignancies

Laparoscopic Surgery:

Skills:

1.        Demonstrate the ability to safely place a veress needle and the primary trocar.

2.        Routinely demonstrate the course of the ureters with minimal assistance.

3.        Perform simple adhesiolysis with guidance.

4.        Utilize laparoscopic clips, the endoloop, and the endobag in an appropriate manner.

5.        Learn the principles of diagnostic cystoscopy.

6.        Perform diagnostic hysteroscopy with minimal assistance.

7.        Begin to develop skills in operative hysteroscopy

Knowledge

1. Demonstrate knowledge of how to recognize and manage an enterotomy or cystotomy.

2. Understand the various approaches to management of adnexal masses. .

3. Begin to understand procedure specific complications and their management.

4. Begin to understand post-operative complications and their management.

5. Begin to understand the principles of fluid management during hysteroscopy

6. Begin to understand the principles of global endometrial ablation devices.

7. Begin to counsel patients regarding complications of hysteroscopy.        
    

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 talks on advanced topics in obstetrics and gynecology utilizing the medical literature.

3.    Continue to work with a faculty mentor to develop a research project if desired. 

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

Curriculum & Description of Rotations:

Gynecology:
 At Holy Cross Hospital the second year resident spends one block assigned to assist on private and clinic cases in the operating room including basic laparoscopy cases as well as abdominal hysterectomies and myomectomies.  The resident is responsible for postoperative care of all patients.  An additional 5 weeks are spent in the busy ob-gyn clinic, where patients present with a variety of problems as well as for routine care.  The resident will gain experience in the evaluation of gynecologic patients as well as in their pre-operative evaluation.  A dedicated gynecology clinic is held once a week. Supervision is provided by the 24-hour in-house attending physician, with whom surgical cases can be scheduled if necessary. A weekly dysplasia clinic is held, during which the resident begins to learn the principles of managing abnormal PAP smears, colposcopy and LEEP. This is supervised by Dr Palmer, and the 24-hour staff. On-call responsibilities include coverage of both Obstetrics and Gynecology for service as well as private patients.

Faculty Contact: Dr. Imad S. Mufarrij

At Fairfax Hospital the second year residents have both a basic gynecology rotation as well as an endoscopy rotation.  As a member of the gynecology team, both of these residents will be assigned to a wide variety of level appropriate cases in the operating room.  They will also assume care of patients who are admitted to the gynecology service through the emergency department.  There is ample surgical experience with private physicians as well as with clinic cases. The resident is responsible for the post-operative care of all patients. On call responsibilities include backup for the obstetrics service, triaging of patient phone calls, coverage of the ER and assisting with emergency GYN surgery as well as weekend obstetric call.  Residents are expected to present at GYN conference during this rotation.
Faculty Contact: Dr. Fred E. Mecklenburg

Obstetrics and High Risk Obstetrics:
At Fairfax Hospital a second year resident spends one month on the High Risk Obstetrics service.  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. There are weekly day-call responsibilities, with increasing responsibility for interpretation of antenatal testing of hospitalized patients and outpatients. 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 increasingly takes more responsibility in the development of management plans for high risk obstetric patients. The second year resident also spends 5 weeks as the daytime labor and delivery resident where uncomplicated and high-risk obstetrics are learned through the care of service patients on Labor and Delivery. Evaluation is by the MFM attending during the antepartum rotation and by the 24 hour attendings during the time spent on Labor and Delivery.   Residents are expected to present at AP conference during this rotation.
Faculty Contact: Dr Alfred N. Khoury

At Holy Cross Hospital the resident spends one block on the antepartum service. A weekly high risk clinic is held, supervised by chief residents and perinatologists where the resident primarily evaluates and increasingly takes more responsibility in the development of management plans for high risk obstetric patients. There is some exposure to ultrasound, advanced fetal monitoring, and amniocentesis. Residents are responsible for the care of all hospitalized antepartum patients (service and private). Uncomplicated obstetrics is learned through the care of service patients in the clinic and L&D suite as well as by assisting on cesarean sections with private physicians. Second year residents also spend 6 weeks as the Labor and Delivery Night Float resident at Holy Cross, where they work directly with the 24 hour attending to manage the clinic patients on labor and delivery. During this rotation the residents begin to gain autonomy in management of these uncomplicated patients, and to feel more comfortable managing complicated laboring patients.  This resident also serves as the assistant to private cesarean sections occurring during the night time hours. 

Faculty Contact: Dr Imad Mufarrij

Reproductive Endocrinology:
This is a one-month rotation at GWU. The resident is integrated into all division activities during this rotation. Didactic teaching occurs during REI journal club, medical student presentations, faculty presentations and case discussions. Residents are provided a schedule of regular weekly sessions (journal clubs, case reviews, research meetings) and are expected to attend. The resident is assigned to clinic sessions, ultrasound monitoring, hysterosalpingogram and sonohysterogram sessions. Depending on the interest of the resident rotation in the IVF-genetics lab can be arranged as well. Introductory knowledge of REI and medical endocrinology will be reviewed.

Residents are also expected to spend one half-day per week in the breast center (see below) and to spend two half days per month learning both obstetric and gynecologic ultrasound in the MFA with Dr Keller and Dr Gaba.
Faculty Contact: Dr. Paul R. Gindoff

Breast Diseases:
The resident spends a half-day per week over a 6-week rotation (the GWU REI rotation) evaluating patients in the GWU breast clinic with the general surgery service. There is exposure to mammography, FNA, follow up of patients with cancer who have had treatment, and evaluation of patients with new diagnoses of cancer or other breast diseases.
Faculty Contact: Dr. Christine Teal

Teaching:

• Residents are always expected to provide informal teaching to medical students and junior residents, in the clinics, ORs and on labor and delivery.
• Residents are expected to set an example of professional behavior at all times for medical students.
• During the latter half of the PGY 2 year each resident is assigned to be "teaching resident" These responsibilities include daily meetings with medical students for formal and informal educational conferences and student presentations.
• The teaching resident is responsible for providing verbal feedback to each student at the midpoint of the rotation, and notifying the clerkship director of any problems.
• A meeting of all the residents at each site is held at the end of the student rotation period and the teaching resident is responsible for leading a grading conference and writing an evaluation of each students with the help of the chief resident.
• Evaluations of students are to be submitted to the clerkship director's office no later than one week after the completion of each rotation.
• If the resident has a vacation during the month they are assigned as teaching resident they are responsible for finding a "sub" in their absence.
• Residents are expected to attend seminars on teaching skills provided as part of the didactic curriculum each year.

Faculty Contacts: Dr. Nancy D. Gaba, Dr Charles Macri, Dr Samantha Buery (FFX)

< top >