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R1 Objectives

Highland OB/Gyn

The HH rotation is six to seven weeks in duration. The R1 takes night call on a rotating basis with the post call day completely free of clinical duties. The R1 is assigned to appropriate OR cases, triages obstetrical patients, manages labor and delivery, and evaluates emergency department consults.

Medical Knowledge

  • Develop a core knowledge of:
    • The components of prenatal care
    • Prenatal labs
    • Normal and abnormal labor
    • Antepartum and intrapartum fetal monitoring
    • Normal physiological changes of pregnancy
    • Obstetrical lacerations
    • Routine postpartum care
    • Circumcision
    • Postpartum contraceptive options
    • Gynecological emergencies
    • Infections that primarily affect the vagina and vulva
    • Pelvic anatomy
    • Sterile technique
    • Informed consent process
    • Normal postoperative care
    • Postoperative pain management
  • Develop a differential diagnosis of:
    • Types of abortion
    • Bleeding in pregnancy
    • Abdominal pain in pregnancy
    • Vaginal bleeding (not pregnant)
    • Abdominal pain (not pregnant)
  • Recognize an intrauterine pregnancy, an ectopic pregnancy and adnexal mass on ultrasound
  • Interpret BHCG results in normal and abnormal pregnancy

Patient Care

  • Recognize common abnormalities in the obstetrical exam such as abnormal fundal height, abnormal blood pressure
  • Perform:
    • Appropriate prenatal labs for uncomplicated patients
    • Obstetrical dating
    • Fundal height
    • Fetal heart tones
    • Leopold’s maneuver for presentation and estimated fetal weight
    • Cervical dilation, effacement, station and position
    • Spontaneous vaginal delivery
    • Outlet vacuum delivery
    • Midline episiotomy and repair
    • Repair first and second degree lacerations
    • Primary low transverse cesarean delivery
    • Fetal scalp electrode placement
    • Artificial rupture of membranes
    • Intrauterine pressure catheter placement
    • Amnioinfusion
    • Sterile speculum exam to diagnose ruptured membranes
    • Neonatal circumcision
    • Pelvic exams
    • Pap smear
    • Wet prep
    • pH of the vagina
    • Nonpregnant dilation and curettage
    • Insertion of Ward catheter
    • Diagnostic hysteroscopy
    • Diagnostic laparoscopy
    • Laparoscopic bilateral tubal ligation
    • Postpartum tubal ligation
    • Cervical conization (LEEP)
    • A forensic exam on the sexually assaulted patient
  • Prescribe:
    • RhoGAM
    • Postpartum contraception
    • Postpartum analgesia
    • Medical therapy for an ectopic
    • Antibiotics
    • Pitocin
    • Cervical ripening agents
  • Interpret a reactive nonstress test
  • Recognize factors in the history or physical that indicate possible medical, genetic or obstetrical complications

Interpersonal and Communication Skills

  • Provide patients with an explanation of pain control options in labor
  • Provide patients with an explanation of routine procedures such as intrauterine pressure catheter placement, artificial rupture of membranes and fetal scalp electrode placement
  • Counsel patients regarding:
    • Safe sex
    • Sexually transmitted disease
    • Family planning
    • HIV testing
  • Provide an adequate sign out to the on call team to ensure adequate continuity of care
  • Provide care to the sexually assault patient in an emotionally sensitive manner

Professionalism

  • Understand the components of informed consent
  • Demonstrate a commitment to patient confidentiality
  • Incorporate the team concept in taking care of patients which includes the attending, students and nurses
  • Increase awareness of the patient’s expectation of her birthing experience
  • Demonstrate sensitivity to patient’s anxiety regarding a pelvic exam
  • Become tolerant of value systems different than your own

Practice Based Learning

  • Dictate intraoperative notes and discharge summaries in a timely fashion
  • Concentrate on using only hospital approved abbreviations
  • Write orders based on the pharmacy protocol to prevent medical errors
  • Have an awareness and comply with teaching physician regulations
  • Practice proper sterile technique

System Based Practice

  • Offer patients who are breast feeding the option of a lactation consultant if necessary
  • Understand the criteria that necessitates neonatal physician presence at a delivery
  • Understand patient, family and neonatal issues that require social work intervention
  • Become familiar with the criteria for inpatient versus outpatient surgery
  • Increase awareness of the cost of surgical versus medical options for treating a disease such as fibroids and ectopic pregnancies

Learning Resources

  • The Resident Room has major obstetrics and gynecology textbooks and access to computers
  • Residents attend Thursday morning Grand Rounds followed by protected teaching time from 9-11am
  • Daily sign-outs at 7AM and 5PM. Team members will give short educational lectures at the morning sign-out.

Evaluations

  • Faculty and resident colleagues are encouraged to provide direct verbal feedback so that resident performance can be commended or improved during the rotation.
  • Residents are evaluated via a Web-based evaluation system at MyEvaluations.com at the end of each rotation using a standardized evaluation form given to supervising OB/GYN attendings and upper-level residents. Attending evaluations are available for immediate review by the resident once completed.
  • Problems , , which appear to be of a more urgent nature, will be brought immediately to the attention of the resident and residency program director for discussion.
  • Residents will receive a form at the end of each rotation via MyEvaluations.com soliciting feedback regarding the rotation, upper-level residents, and faculty. This information is shared anonymously and used for course/faculty improvement activities.