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R2 Objectives

MFM Outpatient

The MFM rotation is six to seven weeks in length. The R2 attends the faculty and resident high-risk obstetrics clinics. The R2 takes responsibility for assuring comprehensive care for the resident clinic patients. One half day a week the R2 attends Dr. Howard’s pelvic pain clinic. One half day a week the R2 participates in the SMH Colposcopy clinic with Dr. Foster and the Outpatient R4. The R2 works closely with the other members of the ambulatory team. The R2 takes weekday call at HH once a week and occasional Saturdays at SMH.

Medical Knowledge

  • Develop a core knowledge of:
    • Common genetic disorders and describe their clinical significance
    • Disease processes that adversely affect pregnancy
    • Disease processes that pregnancy adversely affects
    • Preconceptional counseling and care
    • Prenatal care for patients with medical diseases
    • Multiple gestations
    • Fetal testing
    • Chronic pelvic pain
    • Medical options for pain control
    • Cervical dysplasia
    • Vulvovaginal dysplasia and dermatoses
  • Expand knowledge of:
    • Basic ultrasound
    • Normal obstetrics
    • Anatomy of the external female genitalia

Patient Care

  • Recognize common abnormalities in the obstetrical exam such as abnormal fundal height, abnormal blood pressure
  • Perform a detailed genetic history that is appropriate for a patient’s age, ethnicity, race, teratogen exposure
  • Provide risk appropriate prenatal care for patients with these medical diseases:
    • Diabetes mellitus
    • HIV
    • Urinary tract disorders
    • Hematological disorders
    • Cardiopulmonary disorders
    • Gastrointestinal disorders
    • Neurological disorder
    • Endocrine disorders
    • Collagen vascular disorders
    • Multiple gestation
  • Perform
    • Comprehensive exam for patient with pelvic pain
    • Colposcopy
    • Cervical biopsy
    • Vulvar biopsy
    • TCA treatment
    • Office cervical conization
  • Provide management options for common causes of pain in women including:
    • Endometriosis
    • Irritable bowel syndrome
    • Interstitial cystitis

Interpersonal and Communication Skills

  • Counsel patients in regards to:
    • Advanced maternal age
    • Common genetic problems such as sickle cell anemia, cystic fibrosis, congenital heart disease, and neural tube defect
    • Serum screening for neural tube defects, Trisomy 21 and 18
    • Fetal antenatal testing
    • Preconception care
    • Follow-up of an abnormal Pap smear
  • Understand how to communicate your recommendations to a physician requesting a patient consultation

Professionalism

  • Understand the anxiety of a patient with a prior poor obstetrical outcome
  • Understand the role a genetic counselors performs in patient care
  • Treat the woman with chronic pelvic pain in a supportive manner

Practice Based Learning

  • Become aware of the professional components of a private practice
  • Increase awareness of preauthorization for medical services provided
  • Increase awareness of different insurance requirements, such as co-payments, preauthorization for tests and referrals, and deductibles

System Based Practice

  • Increase awareness of the supportive services for patients who have experienced a perinatal loss
  • Understand costs of management of complicated pregnancies
  • Understand costs to society of delivery of premature infants

Learning Resources

  • The Resident Resource Room and the clinic have major gynecology textbooks, instructional videos and access to computers.
  • Residents attend Thursday morning Grand Rounds followed by protected teaching time.
  • The resident prepares charts for formal review prior to the high-risk obstetrical clinic with the team and perinatologist.
  • Colposcopy clinic is preceded by a conference where slides are reviewed with Dr. Foster and members of the pathology department.
  • The resident attends the weekly REI noon conference when able.

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.