PGY2 Program Educational Objectives
& Curriculum Outline

Curriculum Goals for the PGY2 Resident:
At the completion of the second year, the resident should be able to demonstrate and 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
   

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
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 syndrom 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 principles, repair of bladder and bowel injuries and understand the 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 in 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
   

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Gynecology:
This rotation is divided between the 3 hospital sites over the course of the year, as follows:

At GWU the resident is primarily assigned to reproductive endocrinology (see below), but takes night call for general GYN, and may attend office sessions with the GYN faculty if activities on the REI service do not preclude this. (The responsibilites and educational experiences of the REI rotation takes precedence). Office sessions include routine benign Gynecology such as annual examinations, contraception counseling, evaluation of common gynecologic problems, colposcopy etc. If scheduling permits, the resident may also be assigned to some benign gynecologic surgical procedures. Residents are expected to attend the weekly GYN conference. All lab studies and procedures performed on outpatients and inpatients are to be followed up on and plans discussed with the attending physician. There is limited exposure to obstetrics during this block, except as backup.
Faculty Contact: Dr. Jeffrey Y. Lin

At Holy Cross Hospital the rotation is approximately a 4-month block, during which the resident learns general obstetrics and gynecology. Several gynecology clinics are held each 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 Lin, and the 24-hour staff. On-call responsibilities include coverage of both Obstetrics and Gynecology for service as well as private patients. 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. Regular conferences are held with the 24-hour faculty.
Faculty Contact: Dr. Imad S, Mufarrij

At Fairfax Hospital outpatient experiences include a busy gynecology clinic once each week. 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 Regular conferences are held. On call responsibilities include backup for the obstetrics service, triaging of patient phone calls, coverage of the ER and assisting with emergency GYN surgery.
Faculty Contact: Dr. Fred E. Mecklenburg

Obstetrics and High Risk Obstetrics:
The resident spends 6 weeks on the High Risk Obstetrics service at Fairfax Hospital. 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 increasing responsibility for interpretation of antenatal testing of hospitalized patients and outpatients. There is a weekly high risk clinic, supervised by chief residents and perinatologists, where the resident primarily evaluates and increasingly takes more responsibility in the development of management plans for and care of high risk obstetric patients. 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.
Faculty Contact: Dr Alfred N. Khoury

During the 4-month rotation at Holy Cross Hospital there is regular exposure to high risk obstetrics. 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 and care of high risk obstetric patients. There is some exposure to ultrasound, advanced fetal monitoring, and amniocentesis. Regular conferences are held with the perinatologists. 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.

Reproductive Endocrinology:
This is a 6-week rotation at GWUMC. 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 (patient) 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.
Faculty Contact: Dr. Paul R. Gindoff

Ultrasound:
This is a 6-week rotation in which the resident spends 4 days of the 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 resident participates in amniocentesis for genetic studies and for determination of fetal lung maturity. 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.

Faculty Contacts: At FFx, Dr Alfred N. Khoury;

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 Paul Gindoff

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