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R3 Objectives

Ambulatory

The ambulatory rotation is six to seven weeks in length. The R3 staffs the Contraceptive and Family planning clinic if she chooses to participate, the Special Care Clinic and the colposcopy clinic at HH. The R3 takes call once a week at HH and two to three Saturdays at SMH. The R3 works closely with the other members of the ambulatory team.

Medical Knowledge

  • Develop a core knowledge of:
    • Outpatient care of women
  • Build on a core knowledge of:
    • Contraceptive options and counseling
    • High risk antepartum conditions
    • Management of cervical and vulvar dysplasia
    • Options for elective termination of pregnancy

Patient Care

  • Perform:
    • Colposcopy and cervical biopsy
    • Office conization
    • IUD placement and removal
    • First trimester medical terminations of pregnancy
    • First trimester surgical terminations of pregnancy
    • Laminaria placement
    • Transvaginal ultrasound in the first trimester
  • Understand conscious sedation techniques
  • Provide risk appropriate prenatal care for patients with these medical diseases:
    • Diabetes mellitus
    • Urinary tract disorders
    • Hematological disorders
    • Cardiopulmonary disorders
    • Gastrointestinal disorders
    • Neurological disorder
    • Endocrine disorders
    • Collagen vascular disorders
  • Evaluate and triage patients in the ambulatory setting

Interpersonal and Communication Skills

  • Communicate abnormal tests results to the patient and her family including:
    • Diagnosis of missed abortion or fetal demise
    • Abnormal genetic testing
  • Coordinate comprehensive care for patients including social work, psychiatric, and nutrition services
  • Transfer care from the outpatient site to the inpatient service smoothly
  • Counsel the diabetic patient regarding her treatment and risks
  • Arrange appropriate consults for the high risk obstetrical patient
  • Counsel patients regarding termination of pregnancy

Professionalism

  • Deliver bad news such as fetal demise in a sensitive and empathetic manner
  • Respond to constructive criticism
  • Increase sensitivity and awareness to patients who have limited income and resources for home health care
  • Accept teaching responsibilities for students and other residents
  • Provide consultative services for nurse practitioners and nurses
  • Demonstrate sensitivity when performing a transvaginal ultrasound

Practice Based Learning

  • Access the CDC’s website regarding women’s health care policies, such as guidelines for treating GBS, hepatitis B prophylaxis, etc
  • Provide appropriate follow-up for patient undergoing colposcopy
  • Improve your knowledge of ICD-9 and CPT codes

System Based Practice

  • Become familiar with home health care agencies and the services they can provide for patients at home
  • Increase awareness of a financial counselors role in a practice
  • Become aware of state and federal regulations regarding termination of pregnancy

Learning Resources

  • The Resident Resource Room and the clinic have major obstetrics and 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.