OB/GYN Curriculum Overview of Progressive Authority

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, 1 Ambulatory GYN/Ultrasound Block, 1 Oncology Block, 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.  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:

The Maternal-Fetal Medicine Service at Mercy Hospital - St. Louis supports the large, general obstetrical service. Resident physicians work with the maternal-fetal medicine specialists to provide care to high risk obstetrical patients throughout all four years of residency. Management of critically ill pregnant patients including diabetes, hypertension, maternal heart disease, and asthma provide excellent teaching opportunities for residents. Residents also will have the opportunity to care for patients with common obstetrical complications including pre-eclampsia, preterm labor, and premature rupture of membranes.

Residents are formally trained in the performance of ultrasound through the Perinatal Center as well as bedside instruction in Labor and Delivery by the maternal-fetal medicine specialists. They also participate in invasive procedures including amniocentesis, intravenous transfusion therapy for isoimmunization, delivery of high order multiples including a twins, triplets, and on occasion quadruplets. Close interaction with the maternal-fetal medicine staff and direct care of these patients allows the resident physicians to develop skill in caring for critically ill gravid patients.

The John F. Kennedy (JFK) Clinic is a resident-run clinic located on campus that offers a wide cultural, social, and economic patient mix. Each resident spends one half day per week in Continuity of Care Clinic. Each clinic day is attended by a generalist in the field of obstetrics and gynecology and residents attend the same clinic day with the same attending throughout the entire four years of training. The clinic experience provides an opportunity for residents to manage both simple and complex obstetrics and gynecology problems in a supportive environment. The JFK Clinic offers an invaluable education for the residents as they follow their obstetrical patients from conception to delivery and follow their gynecology patients through presentation to either medical or surgical treatment. Procedures taught within the clinic include endometrial sampling, colposcopy and LEEP procedures, and bedside ultrasound for pregnancy as well as gynecological concerns.

Working with gynecologic oncologists, residents experience office practice as well as operative surgical experience. They are responsible for office evaluation, preoperative and postoperative care, and participate in the surgery of patients with gynecologic malignancies.  Residents rapidly advance their surgical skills during intense surgical experience with complex cases. One-on-one instruction with the attending is highly regarded as one of the outstanding features of this rotation.

The breadth and depth of Gynecological Oncology is offered on this stimulating rotation. Cervical, uterine, and ovarian cancer are well represented. Additionally more rare problems including gestational trophoblastic disease and fallopian cancer are seen.   Residents are also given instruction in radiation therapy, outpatient chemotherapy, as well as the complications that can accompany surgery in oncologic patients. Additionally, the Gynecological Oncology Service participates in surgically difficult benign cases and occasional obstetrical emergencies.  Gynecologic oncologists instructs resident physicians in colposcopy in the JFK Colposcopy Clinic. They are also exposed to the principles of colposcopy in the oncologist's own office.

This challenging rotation is widely regarded by the resident staff as a critical step in their understanding of the care of complicated surgical patients.

In both the second and third year, a four-week rotation in Urogynecology is provided. Residents work daily under the direction of a urogynecologist. Techniques of vaginal reconstruction, bladder neck suspension, correction for urinary and rectal incontinence comprise the fundamentals of this rotation. 

The Reproductive Endocrinology rotation occurs in both the second and third year. A four-week rotation in the second year serves as an introduction to the principles of eliciting a reproductive history, first exposure to techniques of ovulation induction as well as surgical correction for infertility and evaluation of patients with endocrinopathy. A follow up four-week rotation occurs in the third year for which the residents again have exposure to the evaluation of infertility and the different modalities that are available to these couples.

Led by reproductive endocrinologists, teaching includes insemination, ovulation induction with oral and injectable gonadotrophins, and in vitro fertilization. Additionally, residents are trained in ultrasound for follicle development and confirmation of ovulation, diagnosis of and management of ectopic treatment both medically and surgically, and the psychosocial issues that often accompany the diagnosis of infertility. The scope of surgery in this rotation includes management of uterine myoma both laparoscopically and through laparotomy, laparoscopic laser ablation, and microsurgical techniques.