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R4 Objectives

Highland Hospital

The Highland Hospital rotation is six to seven weeks in length. The R4 is responsible for overseeing the gynecology and obstetrics services at HH. The R4 first assists on appropriate OR cases. The R4 acts as the “attending” for continuity clinic patients in labor. The R4 takes two weekend calls at HH during the block.

Medical Knowledge

  • Develop core knowledge of:
    • Critical care for the gynecological patient
    • Vaginal surgery procedures
    • Pelvic floor defects
  • Build on core knowledge of:
    • Normal obstetrics
    • Disease processes that adversely affect pregnancy
    • Disease processes that pregnancy adversely affects

Patient Care

  • Perform:
    • Complex operative laparoscopy
    • Laparoscopic total hysterectomy
    • Laparoscopic assisted vaginal hysterectomy
    • Vaginal hysterectomy
    • Complex operative hysteroscopic such as uterine septum resection
    • Endomyometrial resection
    • Anterior colporrhaphy
    • Posterior colporrhaphy
    • Surgical management of stress incontinence
    • Refine skills from surgeries learned as a first, second, and third year
  • Demonstrate and refine the skills learned during previous years
  • Demonstrate leadership skills with the junior level residents and medical students
  • Coordinate care for any patient in the intensive care unit

Interpersonal and Communication Skills

  • Coordinate the care for all patients on the gynecology and obstetrical services with the appropriate junior resident
  • Demonstrate leadership skills with the junior residents and medical students
  • Elicit support from nursing, social work and ancillary services to provide comprehensive care of patients
  • Assign appropriate surgeries to the junior residents
  • Elicit support from nursing, social work and ancillary services to provide comprehensive care of patients
  • Ensure an adequate daily signout to the on call team

Professionalism

  • Become aware of the differences in teaching techniques and use the ones most effective for your team
  • Improve conflict resolution skills
  • Refine your skills dealing with difficult patients
  • Accept primary responsibility of management of staff patients
  • Become aware of the differences in teaching techniques and use the ones most effective for your team
  • Improve conflict resolution skills

Practice Based Learning

  • Identify essential books for your practice
  • Identify essential web based programs to enhance knowledge
  • Prepare for written OB/Gyn Boards

System Based Practice

  • Increase awareness in the different cost of malpractice
  • Become familiar with home health care agencies and the services they can provide for patients at home

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.