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R2 Objectives

Highland Hospital Obstetrics and Gynecology

The HH rotation is six to seven weeks in length. The R2 takes call on a rotating basis, which may include coverage of the oncology service. The R2 first assists on appropriate OR procedures including hysterectomies and operative laparoscopies. The R2 assists on labor and delivery as needed.

Medical Knowledge

  • Develop a core knowledge of:
    • Disease processes that adversely affect pregnancy
    • Disease processes that pregnancy adversely affects
    • Management of multiple gestations
    • Intrapartum complications
    • Premalignant lesions of the female reproductive tract
    • Abdominal surgery principles
    • Operative hysteroscopic procedures
    • Laser principles
    • Laparoscopic surgery principles
    • Preoperative evaluation of healthy patients
  • Build on core knowledge of:
    • Normal and abnormal labor
    • Medical complications of pregnancy
    • Antenatal testing modalities for fetal well-being
    • Intraoperative techniques and core knowledge of pelvic anatomy
    • Types of anesthesia appropriate for pain control
    • Postpartum care
    • Gynecological emergencies
    • Normal and abnormal pelvic anatomy
    • Postoperative management

Patient Care

  • Take a targeted history and perform a relevant physical on the obstetrical patient who presents to triage
  • Appropriately triage patients who present for urgent evaluation and labor checks
  • Identify and manage these obstetrical complications:
    • First trimester bleeding
    • Intrauterine growth restriction
    • Third trimester bleeding
    • Postdates pregnancy
    • Oligohydramnios
    • Polyhydramnios
    • Incompetent cervix
    • Nonvertex presentation at term
    • Nonreactive nonstress test
    • Abnormal biophysical profile
    • Positive contraction stress test
  • Perform:
    • External cephalic version
    • Delivery of multiple gestations by cesarean section or vaginal delivery
    • Vacuum delivery
    • Repeat low transverse cesarean delivery
    • Classical cesarean delivery
    • Neonatal resuscitation
    • Appropriate interventions for an abnormal fetal heart rate pattern
    • Appropriate labs and diagnostic tests for complicated patients
    • Abdominal hysterectomy
    • Laparotomy
    • Hymenectomy
    • Laparoscopic salpingo-oophorectomy
    • Cervical cerclage

Interpersonal and Communication Skills

  • Communicate with attendings and the team regarding patient status and plan on patients evaluated in triage
  • Discuss management in the triage setting with patients and their families
  • Counsel patients in regards to:
    • Prolonged bed rest
    • Fetal bradycardia and stat Cesarean section
    • Common antepartum conditions such as preeclampsia and PPROM
    • Normal physiological changes after a vaginal birth
    • Normal hospital course after a cesarean section
    • Use of vacuum at the time of delivery

Professionalism

  • Deliver the diagnosis of fetal demise in a compassionate manner
  • Assess the social situation and needs of a patient preparing for discharge
  • Provide adequate sign out for obstetrics and gynecology patients to the cross covering team at night
  • Provide an adequate transfer summary when transferring a patient to SMH

Practice Based Learning

  • Increase awareness of rules regarding transfer to a tertiary care facility
  • Enhance student involvement in patient care
  • Become more aware of ACOG resources that outline acceptable medical practices
  • Use consultative services to improve patient care
  • Increase awareness of the hospital formulary drugs
  • Demonstrate an understanding of how to schedule patients for surgery
  • Dictate operative notes and discharge summaries in a timely fashion

System Based Practice

  • Increase awareness of the support services for patients who have experienced a perinatal loss
  • Understand the admission criteria for Level I, II, and III nursery
  • Understand the difference between a Level I, II and III hospital facility
  • Understand the cost of a cesarean section versus a vaginal delivery to the patient and society

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.