OB/GYN Curriculum Overview of Progressive Authority
The yearly curriculum is operated on a 4 week Block schedule consisting of 12 total Blocks each academic year. Goals and Objectives accompany each rotation. These are reevaluated annually.
Changes may occur year-to-year in the rotation schedule depending on the educational needs of the residents and the patient care requirements of the institution.
Overview of Block Rotations by PGY Level
PGY1 residents have close supervision by a resident and/or attending to provide guidance in evaluation and management of patients. Developing a broad knowledge base in uncomplicated obstetrics and benign gynecology is expected along with application to patient clinical care. Professionalism and appropriate communication to patients, families, and other healthcare co-workers is also emphasized to develop effective behaviors that are built upon in later years.
The PGY1 year consists of 7 Obstetric Blocks, 2 Gynecology Blocks, 2 Ambulatory GYN/Ultrasound Blocks, and 1 ICU Block. This year provides a strong base of normal obstetrics and post-partum and introduces high/risk obstetrics during the second half of the year. Gynecologic surgery skills are expanded throughout the year. A rotation in the ICU provides a comprehensive education in care of critically ill patients, volume and blood product replacement, and respiratory failure.
PGY1 Sample Schedule:
In the PGY2 year, residents are able to approach complicated obstetrical cases and a more in-depth evaluation of gynecologic surgical and office care. Critical self-assessment of patient care provided fosters resident self-improvement. Communication skills require further development as rotations in complicated obstetrics and more detailed gynecologic surgery address a higher level and acuity of care. More independent practice is allocated to residents upon advancement to the PGY2 year but with close supervision provided by the PGY3 and PGY4 residents and attending physicians. Additionally completion of their first formal scholarly activities (Grand Rounds and an oral case report) requires the resident to critically evaluate the literature and utilize speaking and authorship skills when presenting.
PGY2 Sample Schedule:
During the PGY3 year, education and supervision become a focus of the resident’s activities. Complex obstetric cases and gynecologic cases necessitate an in-depth understanding of all aspects of pelvic anatomy, technical skills, and emergent situations. The resident’s role becomes one of manager of the various services and increasing independence is allowed to the resident with the availability of assistance from the PGY4 and/or attending physicians. Presentation and defense of their senior research projects requires a multifaceted understanding of data analyses, statistics, topic content, and application to improving the practice and systems of healthcare.
While a PGY3, the resident serves as the upper-level resident while on Oncology, Urogynecology, and Maternal-Fetal Medicine (MFM). In addition, 2 Blocks of L&D Days, 2 Blocks of NF, 2 Blocks of Gynecology, and 1 Block of REI further develop surgical skills and knowledge base. The PGY3 resident is expected to assist the PGY2 is providing care to the high-risk obstetric patients on L&D. This is a key year in the educational development of the physician as the PGY3 resident role expands beyond reporter and interpreter. All PGY3 residents participate in Chief Resident Leadership training. For promotion to the final year of residency, the PGY3 should be well versed in nearly all subspecialty areas of obstetrics and gynecology.
PGY3 Sample Schedule:
The final chief year of residency provides an experience rich in autonomy yet with supervision available from attending physicians as needed. Presentation of research at regional or national meetings is strongly encouraged. Teaching skills are emphasized throughout the year, and it is expected the resident will review their own learning style and teaching weaknesses and strengths.
Advanced knowledge in the breadth and depth of OB/GYN is required to adequately supervise and guide the other residents on service. Independent management of the patients fosters the development of PGY4 residents to become fully functioning practicing physicians.
PGY4 Sample Schedule:
Journal Clubs are a long standing tradition in residency training dating back to the days of Dr. William Osler when the goal was to share expensive text books and review the literature as a group. Over time, the goals have evolved to encompass reviews of current medical literature in order to teach the concept of evidence-based medicine and develop resident skills for critical appraisal of published medical literature. The ultimate goal sought is to improve patient care by incorporating evidence into the practice of our specialty.
Simulation in the OB department provides instruction and assessment in skills such as shoulder dystocia, vaginal breech delivery, operative vaginal delivery, maternal cardio pulmonary resuscitation, and post-partum hemorrhage. These sessions are paired with a didactic to combine both the cognitive and psycho-motor skill domains of learning. Residents are also individually assessed in a multi-disciplinary, inter-professional simulation that includes a feedback debriefing session.
GYN Surgical Skills Curriculum
Didactic sessions mixed with small group hands-on skills and simulation practice provides residents opportunity to practice surgical skills. Videos and other simulation tools also supplement the educational component of surgical skills. At least annually, residents attend a cadaver course workshop to study pelvic anatomy and practice gynecologic surgical skill.
Fundamentals of Laparoscopic Surgery
All residents will participate in a baseline assessment of FLS skills at the beginning of the structured FLS curriculum. This session will not include any direct teaching or feedback. Rather, it is designed to allow residents a baseline understanding of their current skill level, in order to allow them to focus on subsequent skill training encounters in the most efficient manner possible. The FLS training for peg transfer, cutting, and ligation will only be offered one time in a formal setting. However, the expectation is that these skills will be practiced during subsequent sessions, ensuring that residents that miss these sessions while on night float or vacation will have other opportunities to learn these skills. The extra-corporeal suturing and intra-corporeal suturing are much more important. As such, residents are assigned to two sessions for each of these skills.
Senior Research Project
Each resident is required to complete a senior research project under the guidance of a faculty member to be eligible for graduation. While case reports are encouraged throughout residency, they do not suffice as a senior project. Residents present their research proposal to the research committee prior to IRB approval, and the Ob/Gyn Residency Research Committee maintains electronic contact with residents throughout the year. All senior research projects are presented at the Matt Weis Symposium in the spring of the PGY-3 year and are also encouraged for oral presentation at the Mercy Research Colloquium.
PGY2 Case Report
Each year every PGY2 resident will present one case report in the spring over a case of his/her choice. The faculty mentor should be available to assist with tips on preparing the case report. The presentation of the case reports is done in May.
It is well known that residency is a time of fatigue and stress, and it is important to recognize and actively provide training and education on wellness strategies. The AMA has a comprehensive online curriculum covering various topics of resident wellness and fatigue that the residents complete through institutional access.
The Employee Assistance Program (EAP) is a free service provided by the institution for residents to seek counseling services. Any resident can use this service, and arrangements are available to foster resident access during work hours. All information is confidential. Residents are strongly encouraged to utilize these services in helping to manage the stress and burnout that can be associated with residency. The EAP staff also participates in resident discussion throughout the academic year as an opportunity to introduce their services to the residents.
Wellness Wednesday topics have been chosen for their proven efficacy and for the benefits each topic may provide to enhance personal self-care. Beginning to understand the importance of life balance to long term health and the use of practitioners specializing in holistic healing practices will aid residents in making choices meeting their own philosophical and health needs. Discussions surrounding fatigue mitigation and the essentials of fueling our bodies well, will allow residents to have concrete tools from which to maintain health. As we move through the seasons and the inevitable decrease in sunlight a we will discuss the use of light therapy as well as exercise to promote health through our Midwest winters. In hopes of providing a well-rounded array of topics on self-care, emphasis has been placed on evidence based useful complimentary modalities.
All residents are invited to participate throughout the year in activities emphasizing the various facets of wellness – physical, emotional, environmental, motivational and others. Our program also participates in the annual ACOG/CREOG wellness week.