Curricular Milestones

PGY-1

• Demonstrates ability to thoroughly counsel and consent patient for Cesarean delivery
• Demonstrates proper procedure for scrubbing, gowning, and gloving
• Independently prepares patient and equipment (performs patient positioning, surgical site preparation, draping, ensures correct equipment is set up for case and performs safety checks)
• Identifies all surgical instruments and sutures commonly used in Cesarean delivery
• Demonstrates competence in basic surgical skills (knot tying, suturing)
• Demonstrates appropriate tissue handling
• Demonstrates knowledge of applicable anatomy
• Independently performs primary Cesarean delivery of cephalic fetus, using appropriate instruments and suture
• Identifies when abnormal conditions have arisen (e.g. malpresenting fetus, atony, hemorrhage, anatomic abnormalities) and requests assistance as appropriate

PGY-2

• Accurately appraises maternal and fetal status and assigns appropriate classification of urgency in setting of unplanned Cesarean delivery (STAT, urgent, unscheduled)
• Reviews prior operative reports and develops surgical plan based on anticipated potential difficulties
• Independently performs straightforward repeat Cesarean delivery
• Independently performs Cesarean delivery (primary or repeat) of malpresenting fetus
• Identifies indications for and independently performs classical Cesarean delivery and repair of classical hysterotomy
• Independently performs STAT Cesarean delivery
• Recognizes personal surgical limitations or deteriorating patient condition and appropriately requests assistance

PGY-3

• Guides junior residents in performance of primary Cesarean delivery
• Demonstrates understanding of when deviation from standard surgical protocols may be warranted
• Employs, with coaching, alternate methods for completing surgical steps when preferred method is not feasible
• Identifies excessive ongoing blood loss, informs Anesthesia and nursing teams, and employs appropriate medical management
• Demonstrates knowledge of surgical technique for hemorrhage control (e.g. O’Leary, B-Lynch sutures) and can perform with coaching

PGY-4

• Guides junior residents in performance of primary or straightforward repeat Cesarean delivery
• Independently performs complex or higher-order Cesarean delivery
• Independently employs surgical techniques for hemorrhage control in setting of uterine preservation
• Independently identifies patients that are at elevated risk of complications and develops surgical plan accordingly.
• Coordinates care with other team members (Anesthesia, NICU, nursing, subspecialists, etc.) in setting of medical comorbidities or unanticipated conditions that may arise during surgery
• Demonstrates fluid versatility in surgical skills when faced with unexpected conditions (i.e. dense adhesions, hysterotomy extension, hemorrhage)
• Identifies need for peripartum hysterectomy and independently initiates procedure
• Recognizes need for surgical subspecialist intervention and requests as appropriate

PGY-1

• Independently performs surgical site prep
• Prepares patient and equipment (e.g., positioning, draping, docking)
• Performs diagnostic hysteroscopy and cystoscopy
• Assists during laparoscopic procedures (e.g., port placement, bedside assistant)
• Demonstrates basic skills (e.g., knot tying, skin suturing)

PGY-2

• Independently performs simple operative hysteroscopy
• Demonstrates basic MIS skills (e.g., uterine manipulator placement, camera assist)
• Independently performs simple laparoscopic procedures (e.g., salpingectomy)
• Performs simple vulvar-vaginal procedures (e.g., wide local excision)
• Assists during complex vaginal surgery (e.g., hysterectomy, TVT, A&P repair)
• Opens and closes abdominal incisions
• Demonstrates basic open surgical skills (e.g., knows anatomy, tying off clamps)

PGY-3

• Independently performs complex operative hysteroscopy
• Demonstrates MIS skills (e.g., retroperitoneal dissection to locate ureter, cuff closure)
• Independently performs fascial skin closure (Hassan, Pfannenstiel)
• Independently performs simple open surgical procedures (ovarian cystectomy)

PGY-4

• Independently performs complex hysteroscopic procedures in altered anatomy
• Independently performs MIS (e.g., retroperitoneal dissection to locate ureter, cuff closure)
• Performs complex vaginal surgery (hysterectomy, TVT, A&P repair)
• Independently performs complex open surgical procedures (e.g., difficult TAH)