PGY3 Program Educational Objectives
& Curriculum Outline

General:

1. Research, develop and deliver a scholarly presentation on a topic in Obstetrics and Gynecology
2. Continue to demonstrate appropriate skill and commitment to the education of junior residents, medical students and other health care professionals.
3. Demonstrate a general practice of evidence-based medicine
4. Understand the common methods of health care financing and their implications for

Ambulatory care:

1. Take responsibility for evaluating and diagnosing and managing common outpatient problems.
2. Function as a counselor and educator with respect to issues of contraception, abortion, family planning and sexuality.
3. Utilize resources to allow intervention in crises such as abuse, rape, etc and perform appropriate exams with documentation.
4. Perform the following office procedures with minimal supervision: PAP, colposcopy with biopsy, FNA, HSG, I&D of abscesses, EMB, paracervical block, cyst aspiration, insertion and removal of contraceptive devices.
   

Obstetrics:

1. Advise patients regarding normal and abnormal signs and symptoms of the physiologic changes of pregnancy.
2. Demonstrate familiarity with normal and abnormal fetal development and physiology and implement management plans for these complications during pregnancy.
3. Provide detailed counseling regarding genetic testing and risks, and perform genetic amniocentesis.
4. Provide preconception and prenatal care to complicated high risk patients with supervision.
5. Place a cerclage with minimal assistance and perform non-obstetric surgery on pregnant patients.
6. Perform and interpret complicated antenatal testing.
7. Manage complicated vaginal deliveries (ie dystocia, vaginal breech and twin delivery) and vacuum, low/outlet forceps deliveries with minimal assistance.
8. Recognize and manage most obstetric emergencies.
9. Perform complicated cesarean sections.
10. Provide first line care for newborn emergencies.
11. Manage antepartum, intrapartum and postpartum care and provide appropriate follow up care for complicated and uncomplicated patients.
12. Perform more complicated obstetric ultrasound including cervical evaluation.
13. Recognize and manage complications of lactation.
    

Gynecology:

1. Implement management plans for most gynecologic disorders and discuss them with patients.
2. Develop management plans for disorders of pelvic support and perform uncomplicated vaginal surgery including but not limited to TVH, colporrhaphy, retropubic urethropexy, suburethral sling
3. Manage common breast disorders, and discuss plans with patients
4. Demonstrate an understanding of the diagnostic modalities available for the assessment of breast disorders
5. Take more responsibility for care of patients in the ICU
6. Manage early pregnancy loss and initiate plans for future pregnancies
7. Perform more complicated abdominal surgery as primary operator and first assistant
8. Demonstrate an ability to act as a teacher for uncomplicated GYN cases
9. Recognize and manage complications of gynecologic surgery
   

Reproductive Endocrinology:

1. Understand more complicated endocrinologic disorders and develop management plans
2. Assist on more complicated surgery for infertility management.
3. Understand laboratory testing, procedures and related treatments in ART (IVF).
4. Understand and manage male infertility
   

Oncology:

1. Demonstrate an ongoing understanding of disease patterns, pathology and comprehensive management of all gynecologic malignancies
2. Perform a wide local excision and partial vulvectomy with supervision
3. Demonstrate familiarity with retroperitoneal pelvic anatomy and be able to perform pelvic lymph node dissection with assistance
4. Interpret radiologic findings present on pelvic ultrasound, abdominal and pelvic CT, and pelvic MRI
   

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Gynecology:
This rotation is divided among the 3 affiliated hospital sites during the course of the year, as follows:

At GWU the resident is assigned to the Gynecology service. Attendance at office sessions with the GYN faculty is required. This includes evaluation and management of routine and complicated benign gynecologic patients. There is ample opportunity for residents to learn and practice office procedures such as colposcopy, vaginal and vulvar biopsies, EMB, and LEEP. The resident is also assigned to benign gynecologic surgical procedures. Postoperative care is emphasized in the learning experience with these patients. Residents are expected to attend a weekly gynecology conference, and take primary responsibility for presenting general gynecology topics, patients for case discussions, and articles for journal club, etc. Daily rounds are run by the gynecology attending of the month on an as-needed basis with the chief resident and medical students. 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: this rotation is an approximately 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 learns increasingly more advanced 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, and these cases take on increasing complexity with an emphasis on pelviscopy and hysteroscopy. 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 and these cases take on increasing complexity throughout eac year of training with an emphasis on vaginal surgery, pelviscopy and hysteroscopy in the senior years. Surgical cases are assigned by the administrative chief resident. 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 1 month on the High Risk 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. 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 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. The resident is responsible for choosing articles from the current literature for regular discussion by the antepartum team. 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. There is increasing responsibility for management of more complicated patients, abnormal labors,
multifetal pregnancies, and operative vaginal deliveries.
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. There is increasing responsibility for management of more complicated patients, abnormal labors, multifetal pregnancies, and operative vaginal deliveries.
Faculty Contact: Dr. Imad S. Mufarrij

Breast Diseases:
The resident spends a half day per week over a 6-week rotation (the GWU GYN 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

Night Float Rotation:
A PGYIII resident spends 6 weeks total during the academic year positioned as the night float resident at Fairfax Hospital. The total 6 weeks is split into two three-week blocks that are integrated into the PGY III float resident blocks at this site. This resident works Sunday through Thursday night from 7pm until 7am. At 7am they are relieved of their duties by the day OB resident, who covers from 7am until 7pm. Friday and Saturday day and night coverage is under a traditional call system. The night float resident principal duties include care of patients that present in the obstetrical triage unit as well as continued management of patients admitted to the labor and delivery ward. In addition, they are responsible for covering cesarean sections performed by clinic staff as well as private attending physicians. When appropriate, this resident can also cover for the gynecology resident on call, covering the emergency department as well as the antepartum, postpartum and gynecology inpatient floors. Their patient assessments and management plans are continually supervised by a 24 hour in-house attending as well as the chief resident on call.

Teaching:
Residents are always expected to provide informal teaching to medical students and junior residents, in the clinics, ORs and on labor and delivery. During the first half of the PGY 3 year each resident is assigned to be "teaching resident" These responsibilities include several meetings weekly with medical students for formal and informal educational conferences and student presentations. It is expected that as the resident advances through the residency the amount of time and quality of teaching efforts will increase. 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 student. 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.
Faculty Contact: Dr. Nancy D. Gaba

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