Curricular Milestones
Milestones for Residents to become proficient in:
Patient Care
- Antepartum Care and Complications of Pregnancy
- First-Trimester Bleeding
- Care of Patients in the Intrapartum Period
- Care of Patients in the Postpartum and Interconception Period
- Obstetrical Technical Skills
- Critically Ill Obstetric Patients and Obstetric Emergencies
- Peri-Procedural Care
- Endoscopic Procedures (Hysteroscopy and Cystoscopy) Laparoscopic Procedures
- Vulvar-Vaginal Procedures
- Open Procedures (excludes Cesarean section)
- Family Planning
- Ambulatory Gynecology and Office-Based Procedures Consultations
Systems-Based Practice
- Patient Safety
- Quality Improvement (QI)
- System Navigation for Patient-Centered Care - Coordination of Care
- System Navigation for Patient-Centered Care - Transitions of Care
- Community and Population Health
- Physician Role in Health Care Systems
- Clinical and didactic teaching of junior residents
- Clinical and didactic teaching of medical students and other learners
Professionalism
- Professional Behavior
- Ethical Principles
- Accountability/Conscientiousness
- Well-Being
Practice-Based Learning and Improvement
- Evidence-Based and Informed Practice
- Reflective Practice and Commitment to Personal Growth
Interpersonal and Communication Skills
- Patient and Family-Centered Communication
- Patient Counseling and Shared Decision Making
- nterprofessional and Team Communication
- Communication within Health Care Systems
Medical Knowledge
- Anatomy and Pathophysiology of Female Reproduction
- Differential Diagnosis
Obstetrics - Rotation Goals
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
GYN Rotation Goals
Required Reading: Williams Gynecology: Pertinent and assigned chapters
By the end of the rotation, the resident should be proficient in diagnosing, counseling,
and providing management options for each of the following gynecological conditions.
By the PGY4 year, the resident should be expert and be able to teach these skills
to junior residents.
Ambulatory
Patient Care and Medical Knowledge
- Vaginal discharge
- Sexually-transmitted infections
- Amenorrhea
- Abnormal uterine bleeding
- Uterine leiomyoma
- Postmenopausal bleeding
- Menopausal symptoms
- Oral contraception pills, patches, rings
- Long-acting reversible contraceptive methods
- Permanent sterilization
- Pelvic mass
- Well woman exam
- Abnormal pap smear
- Vulvar complaints
- Breast complaints
- Chronic pelvic pain
- Dysmenorrhea
In-patient
Patient Care and Medical Knowledge
- Pre-op assessment including necessary consultations
- Pre-op counseling
- Routine postoperative care
- Post-operative complications
Professionalism
- Reliable, efficient, team-player
- Communicates well with patients and families
- Uses resources to enhance knowledge and skills
- Coordinates with consultants effectively
- Respectful to staff and team members
- Educates lower-level residents and medical students
GYN/MIGS Surgical Skills Objectives
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)
REI Rotation Goals
Required Reading: Speroff's Clinical Gynecologic Endocrinology and Infertility: Assigned and pertinent chapters
Patient Care and Medical Knowledge
The following basic science concepts should be understood.
- Describe the development and maturation of the hypothalamic-pituitary-ovarian axis from conception through menopause.
- Understand and be able to outline steroid biosynthesis and abnormalities as they may relate to various reproductive problems.
- Describe the normal and disorders of mullerian, ovarian and genital development and their genetic basis.
- Describe the physiology of the normal menstrual cycle, gamete transport in the female reproductive tract, fertilization and implantation.
- Describe the biosynthesis, metabolism and mechanism of action, and the role of hypothalamic, pituitary, ovarian, adrenal and thyroid hormones.
- Discuss the mechanisms of action, indications for, physiologic and anatomic changes
resulting from, and complications associated with the use
- of exogenous estrogens, progesterone/progestins, androgens,
- oral contraceptives,
- dopamine agonists,
- clomiphene and other SERMs, letrazole (and other aromatase inhibitors),
- gonadotropins, and GnRH-agonists (leuprolide) and antagonists (elagolix).
By the end of the REI rotation, the resident should be proficient in diagnosing, counseling, and providing management options for each of the following conditions. By the PGY4 year, the resident should be expert and be able to teach these skills to junior residents.
- Infertility
- primary and secondary amenorrhea
- hyperprolactinemia
- chronic anovulation and oligo-ovulation
- androgen excess disorders (hirsutism)
- the menopausal transition and menopause
- osteoporosis
- premenstrual syndrome
- endometriosis
Patient Care (Clinical Skills)
- Perform diagnostic laparoscopy and hysteroscopy and recognize pelvic anatomy as well as the common disorders detected by these techniques.
- Understand the use of clomiphene citrate, letrozole, metformin, and gonadotropins in ovulation induction.
- Perform and describe the components of a complete semen analysis
- Be able to describe and discuss laboratory procedures which are integral to assisted
reproductive technologies including IVF. Residents are expected to observe;
- Oocyte retrieval procedure
- Embryo transfer procedure
- Intrauterine insemination procedure
- Perform and be proficient in transvaginal ultrasonography. Specifically, at the end of the rotation the resident should be able to detect endometrial growth and follicular development during the menstrual cycle.
- Understand the indications for hysterosalpingogram and sonohysterograms, and ultimately perform and interpret the information obtained by a well-performed study.
- Understand TVUS skills and measurements of CRL, gestational sac, yolk sac, and FHM in early pregnancies from 6 to 10 weeks.
- TVUS and SHG case experience lists must be maintained by the resident.
Professionalism
- Reliable, efficient, team-player
- Communicates well with patients and families
- Uses resources to enhance knowledge and skills
- Coordinates with consultants effectively
- Respectful to staff and team members
- Educates lower-level residents and medical students
St. Jude Rotation Goals
Required reading
Week 2 General Approaches
Week 3 Screening and Management
Week 4 Pediatric Blood Cancer
Week 5 Pubertal Induction
Patient Care and medical knowledge
By the end of the rotation, the resident should be proficient in diagnosing, counseling, and providing management options for each of the following conditions.
- Normal and abnormal pubertal milestones
- Abnormal uterine bleeding disorders, menorrhagia
- Contraception
- Tumor-treatment effects on gynecological function
- Premature ovarian insufficiency
Professionalism
- Reliable, efficient, team-player
- Communicates well with patients and families
- Uses resources to enhance knowledge and skills
- Coordinates with consultants effectively
- Respectful to staff and team members
- Educates lower-level residents and medical students