Resident Policy and Procedure Handbook 2013-2014 F

FLORIDA STATE
UNIVERSITY
College of Medicine
Resident Policy and Procedure Handbook
2013-2014
Table of Contents
Table of Contents ..................................................................................................................2
INTRODUCTION TO RESIDENCY .......................................................................................5
Introduction ...........................................................................................................................5
Mission statement ..................................................................................................................6
Statement of commitment to Graduate Medical Education...................................................7
Educational goals for the program.........................................................................................8
Faculty .................................................................................................................................10
Resident staff .......................................................................................................................12
Mentoring program ..............................................................................................................13
Residency support personnel ...............................................................................................14
Resident recruitment policy .................................................................................................15
Resident committee participation ........................................................................................16
Master rotation schedule......................................................................................................17
Clinic Schedule ....................................................................................................................18
Continuity clinic guidelines .................................................................................................19
RESIDENT EDUCATION ......................................................................................................20
Regulatory and service organizations ..................................................................................20
Important dates ....................................................................................................................22
Required text books .............................................................................................................23
Long-term educational plan deadlines.................................................................................24
Lecture template ..................................................................................................................26
ACGME essentials of accredited residency programs ........................................................27
Resident teaching responsibilities .......................................................................................27
General clinical competencies for residents in Obstetrics and Gynecology........................28
Rotational educational goals & objectives ..........................................................................34
Continuity care clinic ......................................................................................................34
Primary and preventative ambulatory healthcare PGY-1 ................................................48
Primary and preventative ambulatory healthcare PGY-4 ................................................49
Night float PGY-1 ...........................................................................................................49
Night float PGY-2 ...........................................................................................................53
Night float PGY-3 ...........................................................................................................55
Night float PGY-4 ...........................................................................................................57
Rural medicine ................................................................................................................59
Obstetrical and gynecological ultrasound .......................................................................62
Obstetrics - Private rotation (OB-P) ................................................................................64
Obstetrics PGY-1 ............................................................................................................70
Obstetrics PGY-2 ............................................................................................................76
Obstetrics PGY-3 ............................................................................................................82
Obstetrics PGY-4 ............................................................................................................88
Maternal fetal medicine PGY-3 ......................................................................................89
Maternal fetal medicine PGY-4 ......................................................................................94
Genomics .........................................................................................................................98
Gynecology PGY-1 .........................................................................................................99
Gynecology PGY-2 .......................................................................................................104
Gynecology PGY-3 .......................................................................................................108
Gynecology PGY-4 .......................................................................................................114
2
Reproductive endocrinology and infertility...................................................................122
Surgical ICU ..................................................................................................................133
Neonatal ICU.................................................................................................................135
Gynecologic oncology PGY-3 ......................................................................................138
Gynecologic oncology PGY-4 ......................................................................................147
Family Planning Rotation ..............................................................................................150
Elective Rotation PGY-3 ...............................................................................................153
D.O. specific rotational requirements for licensure in Florida ..........................................155
Research goals and objectives ...........................................................................................156
RESIDENT DUTY HOURS .................................................................................................159
Documentation of resident work hours .............................................................................159
Example call schedule .......................................................................................................160
On-call activities ................................................................................................................160
EVALUATIONS ...................................................................................................................162
Faculty evaluations ............................................................................................................162
Resident methods of evaluations .......................................................................................162
Method of evaluation / Competency matrix ......................................................................163
ADMINISTRATIVE GUIDELINES ....................................................................................167
Documentation of clinical and surgical experience ...........................................................167
Background checks and drug screen .................................................................................167
HIPAA privacy and security..............................................................................................167
Policies and guidelines for pharmaceutical / vendor interactions .....................................168
General disaster plan .........................................................................................................172
Harassment policy .............................................................................................................174
Residency closure / reduction ............................................................................................179
Accomodation of residents with disabilities......................................................................179
Physician impairment and substance abuse .......................................................................180
Resident promotion, probation, and termination ...............................................................182
Policies on supervision ......................................................................................................187
Resident levels of care and supervisory lines of responsibility .........................................191
Faculty notification policy .................................................................................................195
Learning / work environment ............................................................................................195
Professionalism policy.......................................................................................................198
Program meetings ..............................................................................................................199
Legal documents ................................................................................................................200
Outside professional activities ...........................................................................................200
Certificate of completion ...................................................................................................200
Roadmap for Florida licensure ..........................................................................................201
FINANCIAL SUPPORT AND BENEFITS: .........................................................................202
Stipend ...............................................................................................................................202
FICA Alternative Plan – BENCOR ...................................................................................202
Health, Life and Disability insurance, Worker’s Compensation insurance.......................203
Professional liability coverage...........................................................................................203
Medical requirements ........................................................................................................203
Institutional leave policy ...................................................................................................204
Vacation .............................................................................................................................205
Medical educational allowances ........................................................................................205
Leave for interviewing.......................................................................................................205
Holidays .............................................................................................................................206
3
Vacation and call changes .................................................................................................206
Sick leave / FMLA ............................................................................................................206
Pregnancy / adoption / paternity policy .............................................................................206
Libraries .............................................................................................................................207
Communications ................................................................................................................208
Resident and fellow loan deferment requests ....................................................................208
Meal vouchers ...................................................................................................................208
PATIENTS CHARTS / MEDICAL RECORDS: ..................................................................209
Documentation ..................................................................................................................209
Chart completion ...............................................................................................................209
Coding ...............................................................................................................................210
Charting for perinatal death ...............................................................................................211
Discharge summaries.........................................................................................................211
Discharge summary format ...........................................................................................212
Operative reports ...............................................................................................................212
Operative report format .................................................................................................212
Appendix I – Gynecologic oncology specific instructions ................................................214
Rotational duties and expectations on the gyn oncology service ..................................214
Appendix II – Moonlighting policy ...................................................................................216
Appendix III – Programmatic moonlighting approval form..............................................219
Appendix IV – Non-programmatic moonlighting approval form .....................................221
Appendix V – Use of prescriptions ...................................................................................223
Appendix VI – OB/GYN journals online at the FSUCOM library ...................................224
Appendix VII – OB/GYN books online at the FSUCOM library .....................................225
Appendix VIII – Internet social networking and blogging policy.....................................226
Appendix IX – Schedule change request...........................................................................228
Appendix X – Impaired physician policy and support ......................................................229
Consent to release of drug test results ...........................................................................234
Appendix XI – CREOG core curriculum in OB/GYN 10th ed. .........................................236
Appendix XII – Procedure logger .....................................................................................236
Appendix XIV – Sacred Heart Health System dictation tips and tricks ............................242
Appendix XV – Evaluations ..............................................................................................243
Assessment of professional behavior of resident ..........................................................243
Patient evaluation of resident ........................................................................................248
Global evaluation ..........................................................................................................249
Praise card .....................................................................................................................251
Concern card..................................................................................................................252
Surgical score card ........................................................................................................253
Appendix XVI – Sick leave policy ....................................................................................254
Appendix XVII – Family planning rotation opt out form .................................................255
(Revised June 2013)
4
INTRODUCTION TO RESIDENCY
Introduction
This Resident Policy and Procedure Handbook is designed to improve quality of patient
care, minimize conflicts, equalize burdens, and allow you to spend more time and energy
on your basic goal – that of learning the art and science of Obstetrics & Gynecology.
That is why we are here. “Training begins with a task, and learning begins with a
question.” In this program, you will find both with abundance.
We are available and will be happy to talk with you about anything at any time. As
Faculty of the Obstetrics & Gynecology Residency Program, it is our responsibility to
provide the opportunities for your education and to finally place the stamp of completion
on your residency documents. We look forward to the coming year.
Julie Zemaitis DeCesare, MD
Program Director
Suzanne Bush, MD
Clyde Dorr II, MD
Joseph Peterson, MD
Sharon Seidel, MD
5
DIVISION OF OBSTETRICS AND GYNECOLOGY
FLORIDA STATE UNIVERSITY
– PENSACOLA Mission statement
An Academic Program with a Community Focus
Mission: The FSU College of Medicine will educate and develop exemplary physicians who
practice patient-centered health care, discover and advance knowledge, and are responsive to
community needs, especially through service to elder, rural, minority, and underserved populations
The FSU College of Medicine academic Obstetrics and Gynecology Residency Program’s mission is
to train well-rounded, obstetric and gynecologic generalists. Our focus is to deliver care to the rural,
geriatric, minority and underserved women in the region, with exposure to alternate, patient-centered
care-delivery systems. The training of our resident physicians places emphasis on academic
excellence within the community setting.
Vision: The FSU College of Medicine will lead the nation in preparing compassionate
physicians to deliver the highest quality 21st Century patient-centered medicine to communities of
greatest need, advancing the science of this care, and developing innovative educational programs in
these communities.
Values: The FSU COM is committed to a culture of:
•
•
•
•
•
•
Collaboration with our colleagues and communities
Respect and open communication
Emphasis on our residents, students and patients
A constant commitment to innovation and continuous improvement
Teamwork and motivation to work with others to achieve results
Excellence in all we do
6
Statement of commitment to Graduate Medical
Education
The Florida State University College of Medicine (FSU COM) is committed to Graduate
Medical Education (GME) as central to its mission to maintain a scholarly environment
that is dedicated to excellence in education, medical care and research. The FSU COM
seeks to educate tomorrow’s physicians and medical scientists and will financially
support our infrastructure to do so. We will provide educational and human recourses to
in order to achieve, at minimum, substantial compliance with the Accredited Council for
Graduate medical Education (ACGME) Institution, Common and individual Program
Requirements. We further commit ourselves to doing regular assessments (Internal
Reviews) of the quality of the GME programs, the performance of their residents, and the
use of outcome assessment results for program improvement.
The FSU COM provides an environment of organized GME programs in which residents
develop personal, ethical, clinical and professional competence under careful guidance
and supervision. Programs will assure the safe and appropriate care of patient and the
progression of residents/physician responsibility consistent with each trainee’s
demonstrated clinical experience. The Graduate Medical Education program is designed
to provide residents and fellows with knowledge, skills and values that can serve as the
basis for competent and compassionate clinical practice, scholarly research and public
service.
Residents are encouraged to develop a process for self-evaluation and moral reflection to
sustain a lifetime of responsible and committed practice of medicine. The education
program prepares residents to continue their own education and to teach their patients,
colleagues and medical residents throughout their careers. We are committed to ensuring
that our graduates understand the scientific foundation of medicine and apply that
knowledge to clinical practice and extend that knowledge through scholarly activities. In
addition, we provide the experience necessary for residents to master the clinical skills
necessary to evaluate and care for their patients.
The FSU COM is committed to having an organized administration system, including a
Graduate Medical Education Committee (GMEC) and Designated Institutional Official
(DIO) that complies with the ACGME Institutional Requirements.
7
Educational goals for the program
The educational objective of the Division of Obstetrics and Gynecology of the Florida
State University, College of Medicine in Pensacola is to provide an academic
environment that promotes a structured educational experience. It is dedicated to
effective and efficient patient care, stressing a graduated experience of resident
responsibility.
The faculty is dedicated toward active participation in your education, with emphasis on
your independent thought and decision-making capabilities.
By meeting these objectives, upon graduating from this program you will be able to enter
into the practice of obstetrics and gynecology, obtain fellowship positions in
subspecialties, actively participate in research, and pursue academic careers. The program
utilizes the CREOG booklet entitled “Educational Objectives for Residents in Obstetrics
& Gynecology”. This booklet is provided electronically on New Innovations to each
resident for his/her utilization and review.
Residents are expected to participate in the yearly CREOG examination. The results of
this examination are used to identify areas of weakness in the resident’s knowledge.
These areas will be addressed with special readings, direct tutoring or the creation of
specialized study plans.
Each resident will be evaluated monthly by the attending physician(s) on the service
assignment. You are to review your electronic evaluations monthly and may sit down for
additional feedback with your faculty mentor and/or the Program Director. Your
progress will be closely monitored throughout your training. The faculty will discuss
each resident’s progress at scheduled quarterly Clinical Competency Meetings. Resident
progress will be formally reviewed with the Program Director twice per year, at the semiannual review and the end-of-year review.
Contracts will be offered on a yearly basis in April prior to the coming academic year.
Contracts are offered to those residents who have demonstrated the ability to matriculate
to the next PGY level.
The resident program at the Florida State University is four years in duration. After
satisfactory completion of four years of training, you will be expected to participate in the
American Board of Obstetrics and Gynecology (ABOG) Examination Part I. It is
anticipated and expected by the Department that you will subsequently participate in Part
II of the ABOG Examination which is usually scheduled two years after passage of Part I.
8
In order to assure quality educational opportunity and care, accurate record keeping is
mandatory. Duty hour’s statistics are to be submitted on a weekly basis. ACGME cases
are to be submitted weekly. Duty hours and ACGME cases are reviewed by the
Residency Director weekly for compliance. ACGME case logs are reviewed in depth by
the program director quarterly. Copies of your completed caselogs will be available to
you at graduation.
Residents are expected to keep up-to-date hospital discharge summaries and O.R. reports.
All O.R. summaries are to be completed on the day of surgery. Discharge summaries
must be completed on the day of discharge. JHACO and SHH policies require dictations
to be made within 24 hours of the patient encounter.
Guidelines regulating maternity leave, absences and vacations have been established and
are included in this handbook.
We anticipate that your four years of training will be satisfactory and rewarding to you.
We are proud to include you as members of our Program and are dedicated to your
success in pursuing a career in the field of obstetrics and gynecology.
9
Faculty
Program Director
Julie Z. DeCesare, M.D., Program Director, Clinical Associate Professor, Director of Medical
Education
FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY
Clyde H. Dorr II, M.D., Clinical Professor
OBSTETRICS AND GYNECOLOGY
Suzanne Y. Bush, M.D., Clinical Associate Professor
Joseph E. Peterson, M.D., Clinical Assistant Professor, Assistant Program Director, Director
of Resident DidaticsSharon L. Seidel, M.D., Clinical Assistant Professor, Director of
Ambulatory Medicine
PART TIME FACULTY
Dean Altenhofen, M.D., Part Time Clinical Assistant Professor
E.A. Antonetti, M.D., Part Time Clinical Assistant Professor
Jairan Duke-Elmore, D.O., Part Time Clinical Assistant Professor
John W. Ervin, M.D., Part Time Clinical Assistant Professor
Melinda L. Graham, M.D., Part Time Clinical Assistant Professor
John B. Grammer, M.D., Part Time Clinical Assistant Professor
Kimberly Hood, M.D., Part Time Clinical Assistant Professor
J. Elizabeth Kenton-Haney, M.D., Part Time Clinical Assistant Professor
William R. Lile, Jr., D.O., Part Time Clinical Assistant Professor
C. Shane Medlock, M.D., Part Time Clinical Assistant Professor
Dina M. Navarro, D.O., Part Time Clinical Assistant Professor
Anne Marie Piantanida-Whitlock, M.D., Part Time Clinical Assistant Professor
Jill M. Prafke, M.D., Part Time Clinical Assistant Professor
Brian Sontag, D.O., Part Time Clinical Assistant Professor
Todd Stalnaker, D.O., Part Time Clinical Assistant Professor
Sidney Stuart, M.D., Part Time Clinical Assistant Professor
GYNECOLOGIC ONCOLOGY
Steven L. DeCesare, M.D., Clinical Associate Professor and Director
Angela Zeibarth, MD Clinical Assistant Professor
MATERNAL-FETAL MEDICINE
James A. Thorp, M.D., Clinical Professor and Director
William Dobak, D.O., Clinical Assistant Professor
Timothy Beiswenger, M.D., Clinical Assistant Professor
10
REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY
Barry A. Ripps, M.D., Clinical Associate Professor and Director Research
OB/GYN RESIDENCY COORDINATOR
Julie Floyd
ADDITIONAL FACULTY
Donna Maxwell, DNP CNM ARNP Clinical Assistant Professor
Jeanne Madden, PA-C Clinical Instructor
11
Resident staff
NAME
PGY MEDICAL SCHOOL
Kathie N. Petro, M.D.
Ashley M. Poe, M.D.
Dawn M. Hannah, D.O.
4
4
4
University of Alabama
University of Alabama
NOVA Southeastern University
Cecily A. Collins, M.D.
Jessica R. Jackson, M.D.
Gail R. Joseph, M.D.
Natasha Spencer, M.D.
3
3
3
3
University of Alabama
University of Toledo
University of Pittsburgh
Florida State University
Lakeema B. Bruce, M.D.
Benjamin D. Osterrieder, M.D.
Brett Tidwell, D.O.
2
2
2
Florida State University
University of South Florida
Philadelphia Col. of Osteopathic Medicine
Ana Antonetti, M.D.
Caitlin Dunham, M.D.
Lindsey McAlpin, M.D.
Brittney Williams, M.D.
1
1
1
1
St. Matthew’s University
Florida State University
University of Texas Houston
University of Utah
12
Mentoring program
“A dynamic, reciprocal relationship in a work environment between an advanced career
incumbent (mentor) and a beginner (mentee) aimed at promoting the development of both”
Sambunjak JAMA 2006
Faculty/Resident Mentoring Program:
Hospital-based Faculty Employed by the hospital as faculty
•
•
Cover all subspecialties
Clinical, research, and education
Community-based faculty
•
In private practice
Hold part-time faculty appointments
Goals of the Formal Mentoring Program:
To provide a role model, coach or counselor to facilitate your academic residency goals and
possible career plans. This faculty member will meet with you five times per year;
1. July (informal meeting, review academic goals created from June evaluation session)
2. October (informal meeting, faculty member fills out academic goals progress report)
3. January (formal meeting, PD present as part of your midpoint evaluation)
4. April (informal meeting, faculty member fills out academic goals progress report)
5. June (formal meeting, PD present as part of your midpoint evaluation)
Faculty mentors are assigned via academic year:
•
•
•
•
PGY-1 - Dr. Peterson
PGY-2 - Dr. Seidel
PGY-3 - Dr. Bush
PGY-4 - Dr. Dorr
Goals of the Peer to Peer Mentoring Program “Resident Families”:
To provide peer to peer network, to provide a safe and supportive network to integrate you in
to the residency culture. The “resident family” will be selected at random. The goal is to
have your peer family meet/communicate in an informal basis at least monthly. The Team
will meet with Dr Dee three times per year for meeting.
Hannah
Joseph
Tidwell
Antonetti
Petro
Jackson
Spencer
Osterrieder
McAlperin
13
Poe
Collins
Bruce
Dunham
Williams
Residency support personnel
The residency coordinator, Julie Floyd, is available to assist you with any clerical or
informational needs that you may have. She will handle reimbursements for course fees or
licensure fees, as well as issue meal tickets.
The ACGME Designated Institutional Official (DIO) is Dr. Joan Younger Meek, Associate
Dean for GME at FSU COM. The FSU COM Program Manager for GME is Mrs. Connie
Donohoe (850.645.6867, [email protected]).
14
Resident recruitment policy
The policy outlined in the ACGME institutional requirements section II-A on residents
eligibility and selection is considered.
All residency positions will be filled via the NRP, and ERAS will be utilized. Any candidate
not utilizing NRP/ERAS will not be considered.
All applicants from LCME or AOA medical schools will be considered first. Applicants from
medical schools outside the US and Canada will be considered for vacant interview spots.
This applicant must take the USMLE step 1 and 2, or both of the complex step 2 clinical
skills and medical knowledge.
Minimum of 40 applicants will be interviewed.
Interview days will be coordinated by the residency program coordinator, and will average
between 8-12 candidates.
Interviews this year will be on 5 seperate days. All available residents, plus any interested
faculty member may participate in the day long event. There will be a combination of
individual interviews with 2 faculty members, and 1-2 residents as well as a team based
scenario. All candidates will meet with the Program Director. The applicants will be ranked
at the end of the day. The final rank order list will be developed at the final rank meeting.
The committee will be composed by any faculty who have interviewed, as well as one
representive from each class. This meeting will be held after the last interview date. Th
program director will have the final say in the rank order list.
An informal dinner the night prior to the interview will be scheduled, with all available
residents attending. A significant other may participate in the interview dinner.
15
Resident committee participation
GME Committee (voting members):
1st Thurs. QTR 12:00 Noon
Medstaff A
Rachel Carter: x 6108
• Dr. Dawn Hannah
• Dr. Gail Joseph
Bio-Ethics Committee:
1st Wed, MO 12:00 Noon
Admin Bd. Rm.
Charlene Holmes [email protected]
• Dr. Cecily Collins
Residents Forum
8/16/13 and 11/15/13, 7:30 A.M. Lecture Hall
One week prior to GME Committee Meeting
• Dr. Tanner Eiden – President
• Dr. Gail Joseph – Vice President
Patient Safety Committee
Jessica Jackson, MD
Lindsey McAlpin, MD
Clinic Committee
Quarterly meetings
Shannon Floyd [email protected]
Quarterly
ACOG District XII - Section 1
Junior Fellow Chair - Dr. Dawn Hannah
Junior Fellow Vice Chair- Dr. Gail Joseph
16
Master rotation schedule
FOOO means 1 float week, 3 weeks onc
OFFF means 1 onc weeks, 3 float weeks
June 16 is a 2 week block
M/O/F* 2 weeks MFM/OB and 1 week float
Rural/F means 3 weeks rural and 1 week float
PGY 4
1-Jul
29-Jul
26-Aug
23-Sep
21-Oct
18-Nov
16-Dec
27-Jan
24-Feb
24-Mar
21-Apr
19-May
16-Jun
Hannah
MFM/OB
GYN
ONC/F
OB/MFM
GYN
ONC/F
MFM/OB
ONC/F
MFM/OB
AMB/ONC GYN
Study
Poe
GYN
F/ONC
MFM/OB
GYN
F/ONC
MFM/OB
GYN
MFM/OB ONC/F
GYN
MFM/OB
AMB
Study
Petro
ONC/F
OB/MFM
GYN
F/ONC
MFM/OB
GYN
ONC/F
GYN
AMB/ONC GYN
MFM/OB
Study
PGY 3
1-Jul
29-Jul
26-Aug
23-Sep
21-Oct
18-Nov
16-Dec
27-Jan
GYN
MFM/OB
24-Feb
24-Mar
21-Apr
19-May
16-Jun
Spencer
MFM/OB
Rural
F/ONC
GYN
MFM/OB
Elective/FP
F/ONC
GYN
MFM/OB
Rural/F*
ONC/F
GYN
F/MFM
Collins
GYN
MFM/OB
Elective/FP
ONC/F
GYN
OB/MFM
Rural
ONC/F
GYN
Onc/F
Rural/F*
MFM/OB
MFM/F
Joseph
F/ONC
GYN
OB/MFM
Elective/FP
ONC/F
GYN
OB/MFM
Rural
ONC/F
M/O/F*
GYN
FOOO
Rural
Jackson
Rural
ONC/F
GYN
MFM/OB
Elective/FP F/ONC
GYN
MFM/OB Rural
GYN
M/O/F*
OFFF
ONC
PGY 2
Bruce
1-Jul
OB
29-Jul
26-Aug
23-Sep
21-Oct
18-Nov
16-Dec
27-Jan
24-Feb
24-Mar
21-Apr
19-May
16-Jun
GYN
Float
REI
GYN
Rural
REI
OB-P
Float
GYN
GYN
REI
Osterrieder GYN
Float
OB
GYN
Rural
REI
GYN
REI
GYN
Float
REI
OB-P/OB
OB-P
Tidwell
OB
SICU(GYN)
Rural
REI
GYN
OB-P/NICU GYN
REI
REI
Float
GYN
GYN
Float
PGY 1
1-Jul
29-Jul
26-Aug
23-Sep
21-Oct
18-Nov
16-Dec
27-Jan
24-Feb
24-Mar
21-Apr
19-May
OB
16-Jun
Dunham
OB/Float
US
Float/OB
GYN
Float
OB
AMB
GYN
OB
MFM
AMB
GYN
AMB
Antonetti
GYN
OB/Float
US
Float/OB
OB
GYN
Float
AMB
GYN
OB
MFM
AMB
Float
McAlpin
Float/OB
GYN
OB/Float
US
GYN
AMB
OB
Float
AMB
GYN
OB
MFM/Float
Williams
US
Float/OB
GYN
OB/Float
AMB
Float
GYN
OB
MFM
AMB
GYN
OB/Float
5/2/2013
17
OB
GYN
Clinic Schedule
AM
PM
MON
GYN3/4
NP
TUES
PROCEDURE
NP
ELECTIVE PGY3
PA
WED
PROCEDURE
NP
PA
OB3/4
THURS
NP
GYN3/4
Williams
NP
Dunham
Tidwell
NP
McAlpin
Bruce
Osterreider
NP
MFM3/4
Antonetti
NP
FRI
LD - NP
NP
PREOP – GYN3/4
WWE/DFS – GYN1/2
FP – ENDO*
CMG/HSC – OB3/4**
WORKIN – OB2 or AMB
US – US at WCC
ONC – on rotation
LD – MFM/OB1
All others report to clinic –
loose work and ED workins
*Can swap with MFM based on call schedule
**Based on call schedule
LD – OB intern and OB3/4
MFM3/4
(PGY-2 covers L&D for the first 3 rotation blocks)
Clinic schedule caveats
1. AMB resident covers procedures.
AMB resident may be assigned a clinic schedule if necessary.
GYN1 Covers Tuesday and NP Wednesday if no AMB resident for procedures.
2. AMB is extra when on rotation, except for their continuity clinic.
3. All residents go to their rotation, except when assigned to their continuity clinic.
4. AMB resident to St. Joe’s Wednesda afternoon (When McAlpin AMB, then CC moves to the
morning.
5. NAVY resident can do FP, WWE and EMBs. Will be scheduled in FP clinic 1-2 times per
rotation.
6. IM resident will have one WWE ever 30 minutes, max 5 patients per ½ day.
7. When Tidwell is ENDO resident, his continuity clinic moves to Monday afternoon.
8. Interns will have an NP working with them through 10/22/13.
9. No assigned clinics while on rural, oncology, night float or family planning rotations.
18
Continuity clinic guidelines
1. All pts scheduled in a resident’s continuity clinic schedule will automatically be assigned
to their continuity clinic.
2. Residents may recruit patients by checking box on the D/C instruction sheet.
3. Attendings are the only one who may take a patient out of an assigned continuity clinic.
4. If patients need to be seen emergently (or the resident’s schedule is full), she may be
scheduled with another doctor. Inform her that this is just temporary, and she will not be
switched to another doctor’s clinic unless she requests to do so.
5. Continuity Clinic for PGY-1 and PGY-2 are scheduled on specific days. For PGY-3 and
PGY-4, Continuity Clinics are rotation based.
6. Residents will see their own post op patients. They will then become a contunity clinic
patient for that resident.
7. Residents are expected to sign off on their own labs/loose work. They are paired up with
a partner who will help sign their loose work when out of clinic due to a night float
rotation or vacation.
Clinic Partners 2013-2014
Dawn Hannah and Lindsay McAlpin
Ashley Poe and Brittney Williams
Katie Petro and Ana Antonetti
Natasha Spencer and Caitlin Dunham
Gail Joseph and Brett Tidwell
Jessica Jackson and Lakeema Bruce
Cecily Collins and Benjamin Osterrieder
19
RESIDENT EDUCATION
Regulatory and service organizations
The following is a list of the key organizations that have an impact on resident education in
Obstetrics and Gynecology:
The American Board of Obstetrics and Gynecology, Inc. (ABOG)
2915 Vine Street
Dallas, TX 75204
(214)871-1619 – phone
(214)871-1943 – fax
www.ABOG.org
ABOG is the certifying organization for the OB/GYN specialty. Its function is to test the
qualifications of voluntary candidates for certification and recertification and to issue
certificates of competence to eligible physicians who have demonstrated special
knowledge and professional competence. Written examinations are given each year and
may be taken after completion of an accredited residency program. Oral examinations,
designed to evaluate the candidate’s knowledge and skills in solving OB/GYN clinical
problems, are conducted each fall. Prerequisites for the oral examination include: a
passing grade on the written examination, an unrestricted license to practice medicine,
active engagement in unsupervised practice, unrestricted hospital privileges, and a listing
of patients dismissed from care in hospitals for a 12-month period.
Accreditation Council for Graduate Medical Education (ACGME)
515 North State Street, Suite 2000
Chicago, IL 60610
(312)464-4920 – phone
www.ACGME.org
ACGME is composed of representatives of the American Board of Medical Specialties,
the American Hospital Association, the American Medical Association (AMA), the
Association of American Medical Colleges, the Council of Medical Society Specialties,
and the federal government, plus a resident and a public representative. The ACGME
gives delegated accreditation authority to the Residency Review Committee. To be
accredited, a residency program must meet the “General Requirements” and “Special
Requirements” listed in Essentials of Accredited Residencies published by the AMA.
Residency Review Committee for OB/GYN (RRC)
515 North State Street
Chicago IL 60610
(312)464-4920 – phone
The RRC has the authority to accredit residency programs in the OB/GYN specialty. It is
composed of representatives appointed by the Board of Trustees of the AMA upon
recommendation of the Council on Medical Education, the American Board of Obstetrics
and Gynecology, the American College of Obstetricians and Gynecologists, and a
resident representative. Programs listed in the Directory of Residency Training
20
Programs, published by AMA, may be designated independent (intramural), affiliated, or
integrated, as defined in the Special Requirements for Residency Training in
Obstetrics/Gynecology.
The American Congress of Obstetricians and Gynecologists (ACOG)
409 12th Street, S.W.
Washington, DC 20024-2188
(202)863-2402 or 1-800-673-8444
www.ACOG.org
ACOG is the national professional society for the specialty of obstetrics and gynecology.
Its objectives are to foster and stimulate improvements in all aspects of women’s health
care within the scope of obstetrics and gynecology. It establishes high standards in
practice, ethics and education, maintains dignity and efficiency in its relationship to
public welfare, and promotes publication of medical and scientific literature. National
and local leaders are elected by the members. Junior fellowship in ACOG is designed for
the professional in training or in the early years of independent practice.
Council on Resident Education in Obstetrics and Gynecology (CREOG)
409 12th Street, S.W.
Washington, DC 20024
(202)863-2554 or 1-800-673-8444
www.ACOG.org
CREOG is a no regulatory organization providing services that promote and maintain
high standards in resident education. Composed of six national organizations, CREOG’s
unique intersocietal structure brings together representatives from its member
organizations. Volunteer representatives from each organization, plus an equal number
of representatives from the American College of Obstetricians and Gynecologists, serve
as program directors. These program directors, who are prominent members of the
specialty, apply their knowledge and experience in governing CREOG and carrying out
its objectives. Major services include consultation, publications, conferences, and a
referral clearinghouse.
21
Important dates
CREOG in-training examination:
January 23-25, 2014
ABOG written examination application window:
Sept.1 ,2013-Oct. 18, 2013
Nov 18, 2013 (late)
Dec 18, 2013 (final)
Application available online at www.abog.com
ABOG written examination:
Resident Research Day
June 30, 2014
TBD
Resident graduation:
June 20, 2014
22
Required text books
Obstetrics
Williams Obstetrics 23rd edition
ISBN10: 0071497013
Normal and Problem Pregnancies – 6th edition
By Steven G. Gabbe, Jennifer R. Niebyl, Mark Landon, Joe Leigh Simpson, Laura Goetzl
ISBN: 0443069301
Maternal-Fetal Medicine – 6th edition
By Robert K. Creasy, Robert Resnik, Jay D. Iams
ISBN: 0721600042
Gynecology
Telinde’s Operative Gynecology – 10th edition
By John Rock, Howard W. Jones
ISBN: 13; 9780781772341
Comprehensive Gynecology – 6th edition
By Vern L. Katz, David Gershenson, Rogerio A. Lobo, Gretchen Lentz
ISBN: 0323029515
Ostergard’s Urogynecology and Pelvic Floor Dysfunction-6th edition
By Alfred E. Bent (Editor), Donald R. Ostergard, Geoffrey W. Cundiff, Steven E. Swift
ISBN:13; 9780781770958
REI
Precis: Reproductive Endocrinology and Infertility 3rd Edition
Clinical Gynecologic Endocrinology and Infertility – 8th edition
By Leon Speroff, Marc Fritz
ISBN: 0781747953
Gynecology Oncology
Clinical Gynecologic Oncology-8th edition
By Philip J. Disaia, William T. Creasman
ISBN: 13; 9780323039786
Primary Care
PRECIS Series Primary and Preventive Care – 3rd edition
23
Long-term educational plan deadlines
This residency program has numerous deadlines regarding educational and scholarly activity
over the academic year. To streamline and clarify these deadlines, I am outlining this plan
for each resident to sign at the start of the academic year.
1. Institute for Health Care Improvement Patient Safety/QA Modules (IHI.org) due
June 1
2 Patient safety modules
2 QA/QI modules
Progress will be tracked at midpoint and end of the year reviews. Must choose new ones each
academic year. Each module has several parts (3-4 parts) and will not be considered
complete until all parts are finished, and completion certificate is printed. Program suggests
2 due Jan 1, but not mandatory. Julie Floyd can track progress.
2. Resident QA/QI project due June 15
Project complete and loaded into NI by June 15. Project extensions can be granted at the
discretion of PD, but requests must come at least 1 week prior to deadline. One new project
due per year, and if extensive may count for 2 years.
3. Life Long Learning Articles
These articles, along with the quizzes are chosen and designed to enhance self -study in
residency programs. They are created and maintained by ABOG, and are released four times
per year: March, May, September and November. They are due to Julie Floyd the first day of
the month the next set are released. The March set are due May 1, May set due Sept 1,
Sept set due Nov 1, and Nov set due March 1.
4. Resident Research projects
PGY 1-idea created, study hypothesis, met with mentor, Drs Ripps and Amin
PGY2-Data collected
PGY 3-Present at research night (spring)
PGY 4-data submitted for publication
5. USMLE step 3-June 30
Completion of this exam is a requirement to finish PGY-1. Intern completion certificates
will not be complete until this requirement is completed. Program pays for this exam if taken
by July 1 of the upcoming year, unless specific permission to miss is obtained from the PD.
6. ABOG exam-Sep 1, 2013
Registration will start for written test 9/1/13. Program will pay for exam.
7. Focused CREOG study program-weekly Sat at midnight
The residents with the 3 lowest scores on the exam (except the interns who automatically
participate in the program) will be responsible for creating 5 questions from the references
from items that they missed. The quiz will be reviewed every Friday in didactics. An
additional test will be given in June (written or oral) to determine who will continue on the
program. At this time, the 3 lowest scoring residents, plus the 3 incoming interns will be
required to participate in this program. Other residents may participate if desired.
24
8. Complete all assigned Friday Morning Didactic assignments and presentations.
Dr. Dawn Hannah will complete and post Resident Education Assignment.
9. Oral Exam and Case List collection
The residents will be required to complete a case list for mock oral exam to be given every
June. This case list will consist of OB/GYN and Office Pratice cases, and will be turned in
April 15, 2014.
10. Safety Huddle Participation
Each resident will participate in 8 Safety Huddles per academic year. They will record their
participation under Scholarly Activity in New Innovations, on the Safety Huddle Participation
form.
I HAVE READ THIS EDUCATION PLAN, AS WELL AS THE RESIDENT POLICY
AND PROCEDURE HANDBOOK.
I UNDERSTAND THAT I AM RESPONSIBLE FOR THE CONTENT ON THIS PAGE
SPECIFICALLY, AS WELL AS THE REMAINING CONTENT IN THE RESIDENT
POLICY AND PROCEDURE HANDBOOK, INCLUDING ALL INTENDED AND
IMPLIED RESPONSIBILITIES.
_____________________________________________________________
NAME
DATE
25
Lecture template
Lectures are scheduled at 7:30-11:00
7:30 OBGYN or Adult Grand Rounds
8:30 Open topic/Journal Club/M&M
9:30 Gyn Staffing
10:30 PBL/Quiz
12:30 Clinic Start Time
First Friday
Gyn Onc
Second Friday
MFM/OB
Third Friday
REI
Last Fri
5th Friday
Adult GR
Gyn/OR Skills
Gyn/OR Skills
Journal clubs/M and M
Every other month
PBL/Compendium Quiz
Weekly
Resident QI/QA meeting
Quarterly
CREOG Review/Quiz
Weekly
Staffing Conference
Every Friday 9:30
OSCE
Annually
FSU GMEC Resident Forum - minimum of four times annually
Evaluations/ Portfolio review Dec/June
Resident Retreat Twice Yearly (Fall/Spring)
Dr Dee is available on a weekly basis for residents use. You may schedule at your
discrection. It is the resident’s responsibility to let Julie Floyd and the Administrative Chief
resident know.
26
ACGME essentials of accredited residency programs
The Accreditation Council for Graduate Medical Education (ACGME), composed of
representatives of five national associations interested in medical education, and the
Residency Review Committee accredit graduate education programs which meet the General
and Special Requirements of the Essentials for Accredited Residencies.
Resident teaching responsibilities
Teaching resident’s who are junior to you is one of the most important resident activities.
Residents’ responsibilities will vary with the service.
Because of the leadership qualities this residency is designed to foster, teaching will continue
to be expected, and excellence in this area will be formally recognized. The opposite is also
true. Those who fail to use common courtesy in dealing with other residents, who neglect
their role as leaders and who deal with other residents in an antagonistic, counterproductive
manner will be subject to disciplinary action. Chronic behavior of this nature may be
grounds for probation or termination.
The residency program will provide education on teaching resident physicians to be teachers
as part of the routine didatics, as well as in orientation.
At the end of each third year medical rotation, you may be expected to complete a resident
evaluation form and make comments on the resident’s progress. These forms are a vital part
of your duties and must be completed in a thorough, candid, and constructive manner as
promptly as possible.
27
General clinical competencies for residents in Obstetrics
and Gynecology
There are six competencies in which residents will be trained and regarding which they will
be evaluated on during their tenure in our program:
1. Patient Care
Residents must be able to provide care that is compassionate, appropriate, and effective for
the treatment of health problems and the promotion of health. Residents are expected to do
the following:
A. Demonstrate caring and respectful behaviors when interacting with patients and their
families. (PC, P, ICS)
B. Gather essential information about patients by performing a complete and accurate
medical history and physical examination. (PC, ICS, MK)
C. Make informed decisions about diagnostic and therapeutic interventions based on patient
information and preferences, up-to-date scientific evidence, and clinical judgment. (PC,
PBLI, MK)
D. Develop, negotiate, and implement effective patient management plans. (PC, ICS, P, SBP)
E. Counsel and educate patients and their families. (PC, PBLI, ICS, P, MK)
F. Use information technology to support patient care decisions and patient education. (PC,
PBLI, SBP)
G. Perform competently all medical and invasive procedures considered essential for
generalist practice in the discipline of obstetrics and gynecology. (PC, MK)
H. Understand the differences between screening and diagnostic tests essential for generalist
practice in obstetrics and gynecology. (PC, MK)
I. Provide health care services aimed at preventing health problems or maintaining health.
(PC, SBP, PBLI)
J. Work with health care professionals, including those from other disciplines, to provide
patient-focused care. (PC, SBP, P, ICS)
2. Medical Knowledge
Residents must demonstrate knowledge about established and evolving biomedical, clinical,
and cognitive (eg, epidemiologic and social behavior) sciences and apply this knowledge to
patient care. Residents are expected to do the following:
A. Demonstrate an investigative and analytic thinking approach to clinical situations. (MK,
PBLI)
28
B. Demonstrate a sound understanding of the basic science background of women’s health
and apply this knowledge to clinical problem solving, clinical decision making, and critical
thinking. (MK, PBLI, PC, SBP)
3. Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication skills that assist in
effective information exchange and be able to team with patients, patients’ families, and
professional associates. Residents are expected to do the following:
A. Sustain therapeutic and ethically sound relationships with patients, patients’ families, and
colleagues. (ICS, P)
B. Provide effective and professional consultation to other physicians and health care
professionals. (ICS, P, SBP, MK, PBLI)
C. Obtain and provide information using effective listening, nonverbal, explanatory,
questioning, and writing skills. (ICS, P)
D. Communicate effectively with patients in language that is appropriate for their ages and
educational, cultural, and socioeconomic backgrounds. (ICS, P, PC)
E. Maintain comprehensive, timely, and legible medical records. (ICS, P, PC)
F. Communicate effectively with others as a member or leader of a health care team or other
professional group. (ICS, SBP, P)
IV. Professionalism
Residents must demonstrate a commitment to carrying out professional responsibilities,
adherence to ethical principles, and sensitivity to a diverse population. Residents are expected
to do the following:
A. Demonstrate respect, compassion, integrity, and responsiveness to the needs of patients
and society that supersedes self-interest. (P, ICS)
B. Demonstrate accountability to patients, society, and the profession.
1. Demonstrate uncompromised honesty. (P, ICS)
2. Develop and maintain habits of punctuality and efficiency. (P)
3. Maintain a good work ethic (ie, positive attitude and high level of initiative). (P)
C. Demonstrate a commitment to excellence and ongoing professional development. (P,
PBLI)
D. Demonstrate a commitment to ethical principles pertaining to the provision or withholding
of clinical care. (P, PC)
E. Describe basic ethical concepts, such as autonomy, beneficence, justice, and
nonmaleficence. (P, ICS)
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F. Describe the process of informed health care decision making, including the elements that
must exist and the specific components of an informed-consent discussion. (P, ICS, PC)
G. Demonstrate an understanding of the use of advanced directives, living wills, and durable
power of attorney for health care and strategiesfor the resolution of ethical conflicts. (P, PC)
H. Describe surrogate decision making for incapacitated patients, including who can act and
should act as a proxy decision makerand what standards they should use to make health care
choices for another. (P, PC, ICS)
I. Examine their personal values and preferences for end-of-life treatment and the values of
diverse patients. (P, PBLI)
J. Differentiate between institution-based “do not resuscitate” (DNR) orders, communitybased DNR orders (also called out-of-hospital or portable DNR orders), and advance
directives. Describe the legal, ethical, and emotional issues surrounding withholding and
withdrawing medical therapies. (P, MK, SBP, PC)
K. Describe when it is appropriate to use all available technology to sustain a life and when it
is appropriate to limit treatment. (P, ICS,SBP, PC)
L. Describe the principle of justice and the use of limited medical resources. (P, MK)
M. Describe the differences in ethical decision making if the patient is an adult or a child. (P,
PC)
N. Describe ethical implications of commonly used obstetric and gynecologic technologies.
(P, MK, SBP, PC)
O. Analyze an ethical conflict and develop a course of action that is ethically defensible and
medically reasonable. (P, PC, MK, ICS)
P. Describe important issues regarding stress management, substance abuse, and sleep
deprivation.
1. List preventive stress-reduction activities and describe the value of these activities. (P,
MK)
2. Identify the warning signs of excessive stress or substance abuse within themselves
and in others. (P, MK, ICS)
3. Intervene promptly when evidence of excessive stress or substance abuse is exhibited
by themselves, family members, or professional colleagues. (P, ICS, MK, PC)
4. Understand the signs of sleep deprivation and intervene promptly when they are
exhibited by themselves or professional colleagues. (P, MK, PC, ICS)
Q. Maintain confidentiality of patient information.
1. Describe current standards for the protection of health-related patient information. (P,
SBP, ICS)
2. List potential sources of loss of privacy in the health care system. (P, SBP)
30
R. Demonstrate sensitivity and responsiveness to the culture, ages, sexual preferences,
behaviors, socioeconomic status, beliefs, and disabilities of patients and professional
colleagues. (P, ICS)
S. Describe the procedure for and the significance of maintaining medical licensure, board
certification, credentialing, hospital staff privileges, and liability insurance. (P, SBP, ICS)
5. Practice-Based Learning and Improvement
Residents must be able to use scientific evidence and methods to investigate, evaluate, and
improve patient care practices.
A. Identify areas for personal and practice improvement and implement strategies to enhance
knowledge, skills, attitudes, and processes of care, as well as making a commitment to lifelong learning. (MK, P, SBP, PBLI)
B. Analyze and evaluate personal practice experience and implement strategies to continually
improve the quality of patient care provided using a systematic methodology. (PBLI, SBP, P,
MK, PC)
C. Locate, appraise, and assimilate evidence from scientific studies related to their patients’
health problems. (PBLI, MK, PC)
D. Obtain and use information about their population of patients and the larger population
from which their patients are drawn. (PBLI, SBP, PC)
E. Demonstrate receptiveness to instruction and feedback. (PBLI,ICS, P)
F. Apply knowledge of study designs and statistical methods to the appraisal of clinical
studies and other information on diagnostic and therapeutic effectiveness. (PBLI, MK, PC)
G. Use information technology to manage information, access online medical information,
and support their education. (PBLI, P, MK)
H. Facilitate the learning process for students and other health care professionals. (PBLI,
ICS, SBP, MK)
6. Systems-Based Practice
Residents must demonstrate an awareness of and responsiveness to the larger context and
system of health care and the ability to effectively call on system resources to provide care
that is of optimal value. Residents are expected to do the following:
A. Understand how their patient care and other professional practices affect other health care
professionals, the health care organization, and the larger society, and how these elements of
the system affect their practices.
B. Understand the processes for obtaining licensure, receiving hospital privileges, and
credentialing. (SBP, PC, P, ICS)
31
C. Describe how types of medical practice and delivery systems differ from one another,
including methods of controlling health care costs and allocating resources. (SBP, ICS, PC)
1. List common systems of health care delivery, including various practice models. (SBP,
PC)
2. Describe common methods of health care financing. (SBP, PC)
3. Describe common business issues essential to running a medical practice. (SBP, P,
ICS)
4. Apply current procedural and diagnostic codes to reimbursement requests. (SBP, PC,
ICS)
D. Practice cost-effective health care and resource allocation that do not compromise quality
of care. (SBP, PC, P)
E. Advocate for the patient, women’s health, and the profession of obstetrics and gynecology.
(SBP, ICS, P)
1. Recognize that social, economic, and political factors are powerful determinants of
health and the delivery of health care.
2. Demonstrate knowledge of disparities in health and health care in a variety of
populations and exhibit cultural competency in health care delivery.
3. Recognize the role of the women’s health care provider to advocate for patient
populations and the individual patient, particularly poor and vulnerable women, and help
develop methods of care that are effective, efficient, and accessible to all women.
4. Use the American College of Obstetricians and Gynecologists’ resources and other
resources to advocate on behalf of underserved and vulnerable populations.
5. Learn to communicate effectively about women’s health concerns to the public.
6. Recognize the role of the physician in legislative activities as they relate to women’s
health policy.
7. Work with the American College of Obstetricians and Gynecologists and other
professional societies to advocate for physicians and the sustainability of the practice and
profession of obstetrics and gynecology.
F. Acknowledge that patient safety is always the first concern of the
physician.
1. Demonstrate the ability to discuss errors in management with peers and patients to
improve patient safety. (SBP, ICS, P, PBLI)
2. Develop and maintain a willingness to learn from errors and use errors to
improve the system or process of care. (SBP, P, ICS, PBLI, PC, MK)
3. Participate in hospital/departmental quality improvement activities and patient
safety initiatives (SBP, P, PBLI, ICS)
4. Recognize the value of input from all members of the health care team and methods by
which to facilitate communication among team members. (SBP, ICS, P, PC, PBLI)
5. Demonstrate understanding of institutional disclosure processes and participate
in disclosure and discussions of adverse events with patients. (SBP, ICS, P, PC)
G. Partner with health care managers and health care providers to assess, coordinate, and
improve health care and know how these activities can affect system performance. (P, ICS,
PC, PBLI)
1. Describe the process of quality assessment and improvement, including the role
of clinical indicators, criteria sets, and utilization review. (SBP, ICS, P, PC)
32
2. Participate in organized peer-review activities and use outcomes of such reviews to
improve personal and system-wide practice patterns. (SBP, P, ICS, PBLI, PC)
3. Demonstrate an ability to cooperate with other medical personnel to correct system
problems and improve patient care. (SBP, P, ICS, PC, PBLI)
H. Understand risk management and professional liability.
1. List the major types and providers of insurance. (SBP)
2. Describe the most common reasons for professional liability claims. (SBP, P, ICS)
3. Describe a systematic plan for minimizing the risk of professional liability claims in
clinical practice. (SBP, PC, P, ICS)
4. Describe basic medical–legal concepts regarding a professional liability claim and list
the steps in processing a claim. (SBP, P, ICS)
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Rotational educational goals & objectives
Continuity care clinic
Goals and Objectives:
Obstetrician–gynecologists provide primary health care services to their patients both within
and outside the traditional purview of reproductive medicine. As primary care physicians,
obstetrician–gynecologists establish relationships with their patients that transcend the
disease spectrum and extend to routine assessments, preventive care, early intervention, and
management of medical disorders. Periodic assessments provide an excellent opportunity to
counsel patients about preventive care. These assessments should include screening,
evaluation, and counseling based on age and risk factors. As the major providers of
reproductive health care for women, obstetrician–gynecologists are responsible for all aspects
of care of reproductive disorders. Both the role of primary care physician and the role of
reproductive health care provider require specialized skills and training. These skills should
be recognized as essential components in the practice of obstetrics and gynecology in that
they not only provide care for their patients, but may serve as the gateway to health care for
their patients’ significant other(s). Even when certain disorders extend beyond the scope of
their practices and require referral, obstetrician–gynecologists serve in a consultant capacity
in which they are involved in the continuing health maintenance of their patients.
These primary care objectives cover resident’s continuity clinics. The continuity clinic
occurs weekly through out the residents 4 years of training, with the exception of Night Float,
Rural Medicine, and Gynecology Oncology rotations. A minimum of 30 months of continuity
clinics, not interrupted by more then 8 weeks will occur.
I. PERIODIC HEALTH ASSESSMENTS
A. Perform initial assessment
To gain the patient’s confidence and cooperation in obtaining the history and performing the
physical examination, the resident should appreciate the effects of age; racial, ethnic, and
cultural backgrounds; sexual orientation; personality; mental status; and the patient’s level of
comfort and modesty. (PBLI, P)
1. Obtain a complete medical history, including a history of genetic diseases. (PC, ICS,
P)
2. Perform an appropriate general or focused physical examination.(PC, P)
3. Develop and communicate an ongoing management plan for the patient’s needs or
concerns (PC, P, MK, ICS)
B. Perform routine screening for selected diseases
Major causes of morbidity and mortality by age can direct attention to areas that warrant
special care. The content and frequency of routine health examinations for screening and
counseling should be tailored to risk factors and the patient’s age using the following periodic
assessments. (PC, MK, P)
1. Ages 12 years and younger
34
For the preadolescent patient, the obstetrician–gynecologist usually serves as a
consultant. Primary care can be performed by a pediatrician or family physician after
assessment of the specific problem for which the patient was referred. (PC)
Specific objectives for the obstetrician–gynecologist in this
patient population are found in Reproductive Endocrinology and Infertility, J. Pediatric
gynecology (birth to menarche).
2. Ages 13–18 years
For adolescents, the obstetrician–gynecologist serves either as a consultant or as a
primary health care provider, depending on the nature of his or her practice and level of
expertise in the spectrum of reproductive tract disorders. (These disorders are described
in Reproductive Endocrinology and Infertility, M. Adolescent gynecology.) The
following areas warrant special attention in this age group:
a. Assess patients for evidence of substance use (tobacco, alcohol, and other
drugs). (PC, ICS, P)
b. Assess sexual health concerns, such as the following: (P, PC,MK)
(1) Conception
(2) Prevention of sexually transmitted infections (STIs)
(3) Pregnancy issues
(4) Noncoital sexual activity
(5) Sexual orientation
c. Test sexually active adolescents for STIs, such as the following: (PC, P)
(1) Gonorrhea
(2) Chlamydia
(3) Syphilis
(4) Hepatitis B
(5) Human immunodeficiency virus (HIV) infection
(6) Herpes simplex virus
d. Counsel adolescents about behavior and personal safety, such as the following:
(PC, ICS, P)
(1) Bicycle helmets
(2) Automobile safety belts
(3) Sporting equipment and apparel
(4) Weapon safety
(5) Inappropriate sexual contact
(6) Appropriate use of social media
e. Evaluate psychosocial well-being, including issues regarding abuse. (PC, ICS,
P)
(1) Promote confidentiality in health care relationships
(2) Facilitate the parent–child relationship
f. Assess nutritional and growth status and level of physical activity. (PC, P)
g. Offer vaccinations against the following: Human papillomavirus; influenza;
tetanus, diphtheria, and pertussis; measles, mumps, and rubella; hepatitis B;
varicella; and meningitis. (PC, P)
3. Ages 19–39 years
35
The obstetrician–gynecologist usually is the chief health care provider for women aged
19–39 years and provides both specialist care in obstetrics and gynecology and primary
preventive health care. The following areas warrant special attention in this age group:
a. Describe normal reproductive physiology, including issues such as fecundity
and sexual health. (MK, P)
b. Assess reproductive concerns, such as the following: (P, PC, MK)
(1) Family planning and preconception care
(2) Prevention of STIs
(3) Pregnancy and postpartum care
(4) Infertility
(5) Sexuality and sexual activity
(6) Breast care
c. Treat menstrual disorders, such as the following: (PC, MK, P)
(1) Amenorrhea
(2) Oligomenorrhea
(3) Abnormal uterine bleeding
d. Evaluate and manage breast disorders, such as the following :(PC, MK)
(1) Mastitis
(2) Galactorrhea
(3) Mastodynia
(4) Breast masses
e. Evaluate psychosocial well-being, including issues regarding abuse. (PC, ICS,
P)
f. Describe the principal reproductive health care issues of women with
developmental delay and physical disabilities. (MK)
g. Counsel adolescents about behavior and personal safety (PC, ICS, P)
h. Offer appropriate vaccinations (PC, MK)
i. Assess nutritional status and level of physical activity. (PC, P)
4. Ages 40–64 years
Women aged 40–64 years are in a time of transition and may face reproductive and
perimenopausal concerns, medical conditions, and psychosocial issues. The following
areas warrant special attention in this age group:
a. Assess and manage reproductive concerns, such as the following: (PC, MK, P)
(1) Family planning until menopause
(2) Prevention of STIs
(3) Pregnancy care (eg, offering genetic counseling/prenatal diagnosis
with amniocentesis or chorionic villus sampling)
(4) Infertility
b. Evaluate and treat perimenopause/menopause concerns. (PC,MK, P)
(1) Normal aging, lifestyle modifications, and hormone therapy
(2) Risk factors for and prevention of osteoporosis
c. Assess cancer risks (eg, lung, breast, endometrium, ovary, colon, and skin)
(PC, MK, P)
d. Evaluate psychosocial risks and well-being, including issues of abuse,
depression and anxiety. (PC, ICS, P)
e. List the major risk factors for cardiovascular disease. (MK)
36
f. Assess cancer risks (eg, lung, breast, endometrium, ovary, colon, and skin).
(PC, MK)
g. Describe the appropriate assessment for urinary and fecal incontinence. (PC,
MK)
h. Offer appropriate vaccinations (PC, MK)
i. Assess nutritional status and level of physical activity. (PC, P)
5. Ages 65 years and older
The goal of health maintenance in women 65 years and older is improvement of the
quality of life and prolongation of a disease-free state. The following areas warrant
special attention in these patients:
a. Describe the biologic effect of aging on major organ systems.
(MK)
b. Describe the psychologic problems that may be associated with aging, such as
the following: (MK)
(1) Depression
(2) Emotional abuse or neglect
(3) Change in sexual function
c. Describe the appropriate interventions to prevent fractures in women. (MK)
d. Describe the appropriate assessment for urinary and fecal incontinence. (MK)
e. List the major risk factors for cardiovascular disease. (MK)
f. Assess cancer risks (eg, lung, breast, endometrium, ovary, colon, and skin).
(PC, MK)
g. Describe the altered pharmacokinetics of drugs in the elderly population and
the likelihood of drug interactions with medications commonly prescribed in this
age group. (MK)
h. List the drugs that most commonly cause adverse reactions in
elderly patients. (MK)
i. Summarize age-related changes in common laboratory values.(MK)
j. Offer appropriate vaccinations (PC, MK)
k. Assess nutritional status and level of physical activity. (PC,MK)
l. Perform a basic assessment of functional status, including the following: (PC,
MK, P)
(1) Activities of daily living
(2) Mini-mental status examination, including assessment for dementia
(3) Capacity for independent decision making
C. Counsel Patients
Counseling encourages patients to adopt healthy behavior and to seek regular preventive care
that may reduce the prevalence of disorders later in life. The obstetrician–gynecologist is in a
position to evaluate the patient’s general health and to counsel her regarding general health
risk behavior. Patients should be counseled about high-risk behavior and health maintenance
behavior at least annually. Counseling should include factors such as the following: (PC, ICS,
MK, P)
1. The importance of a healthy diet and exercise
2. Risk factors and health problems associated with substance abuse
3. Weight management
4. Contraception
5. Prevention of STIs
37
6. Prevention of accidents in the home and workplace
7. Preserving good dental health, such as regular tooth brushing and flossing and regular
dental appointments
8. Psychosocial issues
9. Prevention of osteopenia and osteoporosis
10. Sexual health and well-being
D. Provide immunizations
Describe the appropriate indications and schedule for selective immunizations for human
papillomavirus; rubella; measles; meningitis; varicella; hepatitis A and hepatitis B; influenza;
pneumococcal pneumonia; tetanus, diphtheria, and pertussis; and herpes zoster. (PC, MK)
II. FOCUSED AREAS IN GYNECOLOGIC CARE
A. Contraception
The gynecologist is in a unique position to serve as a resource person for the community or
the individual regarding family planning and contraception. On the community level, the
obstetrician–gynecologist should be able to speak to any audience on the subject of birth
control. He or she should be able to discuss the cultural, societal, ethical, and religious
implications of contraceptives as well as describe their effectiveness, medical
benefits, and adverse effects. (P, PC, MK, ICS, PBLI)
1. Define the terms: method effectiveness and user effectiveness. (MK)
2. Describe national and local policies that affect control of reproduction. (MK, SBP)
3. Describe how religious, ethical, and cultural differences affect providers and users of
contraception. (PBLI)
4. Describe the effect of contraception on population growth in the United States and
other nations. (MK, SBP)
5. Describe the factors that influence the individual patient’s choice of contraception.
(MK, PBLI)
6. Obtain a pertinent history from a patient requesting information about contraception.
(PC, ICS, P)
7. Perform a focused physical examination to detect findings that might influence the
choice of contraception. (P, PC)
8. Interpret the results of selected laboratory tests that might influence a patient’s choice
of contraception. (MK)
9. Describe the advantages, disadvantages, failure rates, mechanisms of action and
complications associated with the following methods of contraception: (MK)
a. Sterilization
b. Oral steroid contraception
c. Transdermal steroid contraception
d. Vaginal steroid contraception
e. Injectable steroid contraception
f. Implantable steroid contraception
g. Intrauterine devices
h. Barrier methods
i. Natural family planning
j. Abstinence
10. Describe the pharmacology of hormonal contraception. (MK)
11. Describe appropriate methods for postcoital contraception. (MK)
38
12. Describe the appropriate follow-up for a woman using any of the aforementioned
methods of contraception. (MK)
B. Induced abortion
One should be able to counsel pregnant patients on all the alternatives available to them,
including induced abortion. Residents who decide not to provide this service because of a
moral objection still should be able to counsel patients, make appropriate referrals, and
manage postabortal complications. (PC, ICS, PBLI, P)
1. Obtain a pertinent history from a patient requesting an induced abortion. (ICS,P)
2. Perform a targeted physical examination to confirm the presence of an intrauterine
pregnancy, accurately determine gestational age, and identify other abnormal physical
findings that may influence the choice of abortion method. (PC, P)
3. Order and interpret selected laboratory tests in patients requesting induced abortion.
(PC)
4. Describe the principal techniques for pregnancy termination, such as: (PC, MK, P)
a. Suction curettage
b. Dilation and evacuation
c. Medical abortion
d. Induction termination
5. Describe and treat the principal complications of induced abortion. (PC, MK, P)
6. Perform postprocedure care and counseling
7. Describe the possible psychologic aftermath of induced abortion. (PC, MK, P)
C. Sexual health
The obstetrician–gynecologist should understand the concepts of sexual development and
identity, as well as the psychology of sexual relations. The practitioner also should
understand the ways in which a patient’s sexuality may be altered by physical or
psychological conditions, including menopause and advancing age. The obstetrician–
gynecologist should be familiar and comfortable with the terminology used in sexual
counseling and should understand the range of disorders of sexual function. (PC, ICS, PBLI)
1. Describe the stages of the normal sexual response: desire, arousal, orgasm, resolution,
and refractory period. (MK)
2. Describe the principal disorders of sexual function, including: (PC, MK)
a. Hypoactive sexual desire disorder
b. Female sexual arousal disorder
c. Sexual aversion disorder
d. Female orgasmic disorder
e. Pelvic pain disordrs, including vaginismus and dyspareunia
3. Obtain a complete sexual history. (PC, ICS)
a. Sexual activity and masturbation
b. Use of devices and appliances (including storage)
4. Perform a targeted physical examination to evaluate sexual dysfunction. (PC)
5. Describe possible interventions for patients with disorders of sexual function. (PC,
MK)
6. Be able to discuss common sexual concerns with patients with understanding of their
background, religious/moral beliefs, age, and social situation. (PC, ICS, P)
7. Understand the effects of age and menopause on sexual function, and be able to
discuss these effects with patients. (PC, P)
8. Know the effects of common medications on sexual function. (MK)
39
a. Contraceptives
b. Antidepressants and antipsychotics
c. Antihypertensives
d. Antiepileptics
e. Alcohol
e. Illicit drugs (cocaine, marijuana, narcotics)
9. Describe the appropriate long-term follow-up for patients with disorders of sexual
function. (PC)
D. Lesbian health
The obstetrician–gynecologist should be sensitive and knowledgeable regarding methods to
promote health for lesbian women. (PBLI, P)
1. Display sensitivity to sexual orientation and describe ways to promote an office
environment that is respectful of a patient’s sexuality. (PBLI, P)
2. Describe health risks that may be higher or lower in the lesbian population and conduct
appropriate health screening for lesbian patients. (PC, MK, P)
3. Address reproductive concerns and options (PC, ICS, MK, P)
E. Transgender health
The obstetrician–gynecologist should be sensitive and knowledgeable regarding methods to
promote health for transgender women. (PBLI, P)
1. Display sensitivity to gender identity and describe ways to promote an office
environment that is respectful of a patient’s gender identity. (PBLI, P)
2. Describe health risks that may be higher or lower in the transgender population and
conduct appropriate health screening for transgender patients. (PC, MK, P)
3. Describe the various surgical procedures that might be requested
by a
transgendered patient. (MK)
4. Refer, when appropriate, to specialists, such as reproductive endocrinologists,
urologists and urogynecologists. (PC, P)
F. Crisis intervention
The obstetrician–gynecologist should be able to identify an abused woman, provide
immediate medical evaluation and treatment for her and, if indicated, assist with referrals for
legal assistance and psychologic counseling. (PC, ICS, SBP, P)
1. Discuss the principal types of violence against women of all ages:
a. Incest
b. Rape
c. Physical abuse
d. Psychologic abuse
2. Obtain a pertinent history from a possible victim of physical, psychologic, or sexual
abuse. (PC, ICS, P)
3. Perform a focused mental status examination and physical examination to detect
findings of physical, psychologic, or sexual abuse. (PC, P)
4. Describe the appropriate legal safeguards that must be observed in evaluating a victim
of abuse, such as maintaining the proper chain of evidence in handling laboratory
specimens and reporting the crime to the appropriate authorities. (SBP)
5. Perform or order selected laboratory tests to evaluate a victim of abuse. (PC, P)
6. Provide immediate treatment for the victim of abuse: (PC, P)
a. Prophylaxis for STIs
40
b. Postcoital contraception
7. Provide appropriate follow-up care and referrals for victims of abuse. (PC, SBP, P)
8. Assess a patient’s environment for safety and possible placement (PC, ICS, P)
III. MANAGEMENT OF NONGYNECOLOGIC CONDITIONS
Many nongynecologic conditions can be managed effectively with a team approach in which
the obstetrician–gynecologist plays a key role. The obstetrician–gynecologist is encouraged
to develop collaborative relationships with other specialists to allow timely referrals as well
as to enhance clinical skills. Residents must be able to diagnose and treat many
uncomplicated nongynecologic conditions and know when and to whom patients should be
referred. (PC, SBP, P)
A. Allergic rhinitis
1. Describe the signs and symptoms of allergic rhinitis. (MK)
2. Obtain a history and perform a targeted physical examination to diagnose allergic
rhinitis. (PC, ICS, P)
3. Describe the differential diagnosis of allergic rhinitis. (MK)
4. Counsel patients about the effect of environmental allergens and initiate basic medical
treatment for allergic rhinitis. (P, PC, ICS)
B. Respiratory tract infection
1. Discuss the differential diagnosis of respiratory tract infection. (MK)
2. Obtain a pertinent history in a patient with suspected respiratory tract infection. (PC,
ICS)
3. Describe the usual signs and symptoms of respiratory tract infection. (MK)
4. Perform a targeted physical examination to diagnose respiratory tract infection. (PC, P)
5. Interpret the results of selected tests to diagnose respiratory tract infection, such as:
(PC, MK)
a. Chest x-ray
b. Tuberculin skin test
6. Treat uncomplicated respiratory tract infection.
7. Describe the indications for referral of a patient with a more severe respiratory tract
infection.
C. Asthma
1. Obtain a pertinent history from a patient with asthma. (PC, ICS, P)
2. Perform a targeted physical examination to detect findings associated with asthma.
(PC, P)
3. Interpret the results of basic pulmonary function tests, such as a.forced
expiratory volume in 1 second (FEV1). (MK)
4. Describe the differential diagnosis of asthma. (MK)
5. Treat mild asthma with appropriate medications. (PC)
6. Describe the indications for referral of a patient with more severe asthma. (PC, MK,
SBP)
D. Hypertension
1. Describe the criteria for the diagnosis of hypertension. (MK)
2. Describe the major causes of hypertension. (MK)
41
3. Describe the long-term consequences of untreated hypertension. (MK)
4. Describe the principal symptoms of hypertension. (MK)
5. Initiate a treatment plan for mild hypertension. (PC)
6. Describe the indications for referral of a patient with hypertension. (PC, SBP)
E. Abdominal pain
1. Obtain a pertinent history in a patient with abdominal pain. (PC, ICS, P)
2. Perform a targeted physical examination to evaluate a patient with abdominal pain.
(PC, P)
3. Describe the differential diagnosis of abdominal pain. (MK)
4. Interpret the results of selected laboratory, radiologic, and endoscopic tests to
determine the etiology of abdominal pain. (PC, MK)
5. Treat selected patients with abdominal pain, and describe the indications for referral.
(PC, SBP)
F. Gastrointestinal disorders
1. Describe the signs and symptoms of common gastrointestinal disorders, such as: (PC,
MK)
a. Acute diarrhea
b. Constipation
c. Diverticulosis/diverticulitis
d. Gastroenteritis
e. Gastroesophageal reflux
f. Irritable bowel syndrome
2. Obtain a pertinent history and perform a targeted physical examination to evaluate a
patient with gastrointestinal symptoms. (PC, ICS, P)
3. Interpret the results of selected laboratory, radiologic, and endoscopic tests to
determine the etiology of a patient’s gastrointestinal symptoms. (PC, MK)
4. Treat selected patients with gastrointestinal disorders and
describe the
indications for referral. (PC, SBP)
G. Urinary tract disorders
Residents should understand the treatment of acute urethritis, acute cystitis, acute
pyelonephritis, and ureteral calculi. Learning objectives for the management of
conditions affecting the urinary system are found in Gynecology PGY-2, E. Urinary tract
disorders (infection, nephrolithiasis). (PC, MK)
H. Headache
1. Describe the principal causes of headache including migraine, tension, stress, sinus and
intracranial lesions. (MK)
2. Obtain a pertinent history and perform a focused physical examination to evaluate a
patient with headaches. (PC, ICS, P)
3. Treat muscle tension headaches, mild migraine and menstrual migraines. (PC)
4. Describe indications for referral of patients with unusual/severe headaches. (PC, SBP)
I. Depression
1. Describe risk factors for depression. (MK)
2. Describe the signs and symptoms of depression. (PC, MK)
3. Discuss the differential diagnosis of depression. (MK)
42
4. Describe the use and interpretation of screening instruments for the identification of
depression. (PC, MK)
5. Obtain a pertinent history from a patient with signs of depression. (PC, ICS, P)
6. Identify patients at risk for suicide or other harmful acts. (PC, MK, P)
7. Treat depression with interventions, such as administration of antidepressants or
referral for counseling. (PC, SBP)
J. Premenstrual syndrome and premenstrual dysphoric disorder
1. Define premenstrual symptoms, premenstrual syndrome (PMS), and premenstrual
dysphoric disorder (PMDD). (MK)
2. Describe the signs and symptoms of PMS/PMDD. (PC, MK)
3. Describe the differential diagnosis of PMS/PMDD. (MK)
4. Describe the relevance of a symptom diary in the diagnosis of PMS/PMDD. (PC, MK)
5. Obtain a pertinent history from a patient with signs of PMS/PMDD. (PC, ICS, P)
6. Treat PMS/PMDD with interventions, such as lifestyle changes, supplements,
nonprescription analgesics and prescription medications. (PC)
K. Anxiety
1. Describe the differential diagnosis of patients with an apparent anxiety disorder. (MK)
2. Obtain a pertinent history for a patient with signs of an anxiety disorder. (PC, ICS, P)
3. Treat mild anxiety with interventions such as administration of anxiolytic agents or
referral for counseling. (PC, SBP)
L. Skin disorders
Involvement of obvious gynecologic epithelial surfaces is covered in Gynecology PGY2, B. Vulvar dystrophies, dermatoses and vulvar pain syndromes.
1. Obtain a history relevant to dermatologic risk factors: (PC, ICS, P)
a. Environmental exposure to ultraviolet light
b. Personal and hygienic habits predisposing to skin lesions
2. Perform a physical examination of all areas of skin, including those susceptible to
chronic exposure to ultraviolet light. (PC, P)
3. Perform a skin biopsy and interpret the results of the biopsy. (PC, MK)
4. Treat selected dermatologic conditions, such as: (PC)
a. Uncomplicated sunburn
b. Uncomplicated irritative or inflammatory skin disorders
c. Poison ivy, oak, or sumac.
d. Contact dermatitis
e. Insect bites
f. Fungal dermatitis
g. Eczematous lesions
h. Mild acne
5. Describe the characteristic physical findings of basal cell carcinoma, squamous cell
carcinoma, melanoma, and Paget disease. (PC, MK)
6. Describe skin conditions that may be manifestations of significant systemic diseases.
(MK)
7. Describe the indications for referral of patients with skin disorders. (PC, SBP)
M. Diabetes
43
1. Describe the American Diabetes Association classification of diabetes, including
prediabetes, type 1, type 2, and gestational. (MK)
2. Describe risk factors for diabetes. (PC, MK)
3. Describe signs and symptoms of diabetes. (PC, MK)
4. Obtain a pertinent history in a patient with suspected diabetes. (PC, ICS, P)
5. Describe the criteria for the diagnosis of diabetes mellitus. (MK)
6. Describe the use of diet, oral hypoglycemic agents, and insulin for treatment of
diabetes. (PC, MK)
7. Assess glycemic control by laboratory studies. (PC)
8. Describe indications for referral of patients with diabetes. (PC, SBP)
N. Thyroid diseases
1. Describe the most common causes of hypothyroidism and hyperthyroidism. (MK)
2. Describe the most common signs and symptoms of hypothyroidism and
hyperthyroidism. (PC, MK)
3. Obtain a pertinent history and perform a targeted physical examination to evaluate
thyroid disease, including thyroid cancer, benign nodules, and hypothyroidism or
hyperthyroidism. (PC, ICS, P)
4. Interpret the results of selected diagnostic tests to confirm the diagnosis of
hypothyroidism or hyperthyroidism. (PC, MK)
5. Describe the indications for referral of a patient with thyroid disease. (PC, SBP)
O. Low back pain
1. Describe the differential diagnosis of low back pain. (MK)
2. Obtain a pertinent history in a patient with low back pain. (PC, ICS, P)
3. Perform a targeted physical examination to evaluate low back pain symptoms to
evaluate possible gynecologic causes. (PC)
4. Describe indications for referral of patients with more severe low back pain. (PC, SBP)
P. Osteoporosis
1. Describe risk factors for osteoporosis. (MK)
2. Describe the use and interpretation of screening tests for the identification of
osteoporosis. (PC, MK)
3. Describe the evaluation of secondary causes of osteoporosis. (MK)
4. List preventive measures for osteoporotic bone loss and fracture. (MK)
5. Treat osteoporosis and provide appropriate follow-up care. (PC, SBP)
Q. Overweight and obesity
1. Define overweight and obesity. (MK)
2. Calculate a patient’s body mass index using her height and weight. (MK, PC)
3. Discuss overweight and obesity in a culturally sensitive manner. (ICS, PC, P)
4. Obtain a pertinent history from a patient who is overweight or obese. (PC, ICS, P)
5. Describe the gynecologic effect of being overweight or obese. (MK)
6. Educate patients regarding medical and surgical options for weight loss. (MK, PC,
ICS, SBP)
7. Promote regular physical activity. (PC, ICS)
R. Arthritis and joint disorders
1. Know the common disorders that affect joints, including the following: (MK)
44
a. Childhood arthritis
b. Fibromyalgia
c. Gout
d. Lupus
e. Osteoarthritis
f. Rheumatoid arthritis
2. Recognize arthritis as a public health problem. (MK, SBP)
3. Provide early diagnosis and appropriate management, including consultation/referral to
a specialist. (PC, SBP)
4. Counsel patients regarding joint-related disorders. (PC, ICS)
45
CONTINUITY CLINIC PROCEDURE COMPETENCIES
Procedure
Level of Training
Understanding
Understanding
& Perform
Arterial blood gas assessment
R1
X
Auditory acuity testing
R1
X
Bone densitometry studies
R1
X
Complete physical examination
R1
Electrocardiography
R1
X
External auditory canal and
tympanic membrane examination
R1
X
Fecal occult blood testing
R1
X
Fitting of diaphragm or cervical cap
R1
X
X
Funduscopic examination (basic) R1
Gastrointestinal endoscopy
Insertion and removal of
intrauterine device
X
R1
X
R1
X
Insertion and removal of implantable
steroid contraception
R1
X
Peak expiratory flow (FEV)
determination
R1
Pulse oximetry
R1
X
Skin biopsy
R1
X
Scraping of skin lesions for
microscopy
R1
X
Visual acuity testing
(i.e., standard eye chart)
R1
X
Visual field deficit testing
R1
X
X
46
CONTINUITY CLINIC
WEEKLY SCHEDULE
Please refer to the clinic schedule and continuity clinic guidelines in the first section of
this handbook
CONTINUITY CLINIC
READING SCHEDULE
Précis Series Primary and Preventive care,4rd edition
ACOG Committee Opinion on Primary Care number no 483 April 2011
47
Primary and preventative ambulatory healthcare PGY-1
Goals and Objectives:
Basics of outpatient medicine, as well as office based procedures are key for obstetrician and
gynecologist. This rotation encompasses many of the objectives of the continuity of care
rotation, with an additional focus on office based procedures. This rotation is two weeks in
length, is paired with night float, and includes coverage of the procedure clinics (colposcopy,
endometrial biopsy. LEEP, SIS), family planning procedures (Implanon, IUD insertions,
diaphragm fittings).
All specific objectives are identical to those for the Continuity Clinic objectives
All required procedures are identical to the Continuity Clinic procedure list
PRIMARY AND PREVENTATIVE AMBULATORY HEALTHCARE
WEEKLY SCHEDULE
See Clinic schedule in the first section of this handbook
PRIMARY AND PREVENTATIVE AMBULATORY HEALTHCARE
READING SCHEDULE
Précis Series Primary and Preventive care,4rd edition
ACOG Committee Opinion on Primary Care number no 483 April 2011
Comprehensive Gynecology 6th ed Chapters 28, 29, 30
48
Primary and preventative ambulatory healthcare PGY-4
Goals and Objectives:
Basics of outpatient medicine, as well as office based procedures are key for obstetrician and
gynecologist. This rotation encompasses many of the objectives of the continuity of care
rotation, with an additional focus on office based procedures as well as management of the
overall flow of an outpatient clinic. This rotation is two weeks in length, is paired with night
float, and includes coverage of the procedure clinics (colposcopy, endometrial biopsy. LEEP,
SIS), family planning procedures (Implanon, IUD insertions, diaphragm fittings). The senior
resident will be expected to function as a consultant for junior residents as well as managing
the clinic schedules, flow and personalle. This resident will work with with Dr Seidel,
director of ambulatory medicine on general clinic issues.
All specific objectives are identical to those for the Continuity Clinic objectives
All required procedures are identical to the Continuity Clinic procedure list
PRIMARY AND PREVENTATIVE AMBULATORY HEALTHCARE
WEEKLY SCHEDULE
Monday-Friday Women’s Care Center
See Google Calender for day-based assignements
PRIMARY AND PREVENTATIVE AMBULATORY HEALTHCARE
READING SCHEDULE
Précis Series Primary and Preventive care,4rd edition
ACOG Committee Opinion on Primary Care number no 483 April 2011
Comprehensive Gynecology 6th ed Chapters 28, 29, 30
Night float PGY-1
49
Goals and Objectives:
The PGY-1 rotation is 10 weeks in length, divided into 2-4 week segments over the year.
The resident is assigned to the night float team, and is supervised by the senior resident also
assigned to the night float team.
A. Labor and delivery
1. Obtain an accurate history, describing onset of uterine contractions and ruptured
membranes. (PC)
2. Describe appropriate indications for induction of labor. (MK)
3. Perform a pertinent physical examination to assess: (PC)
a. Status of membranes
b. Presence of vaginal bleeding
c. Fetal presentation
d. Fetal position
e. Fetal weight
f. Cervical effacement
g. Cervical dilatation
h. Station of the presenting part
i. Clinical pelvimetry
j. Uterine contractility
4. Describe appropriate indications for, and complications of, cervical ripening agents.
(MK)
5. Describe appropriate indications for, and complications of, labor-inducing agents.
(MK)
6. Describe the normal course of labor. (MK)
7. Assess the progress of labor. (PC)
8. Describe the risk factors for abnormal labor. (MK)
9. Identify abnormalities of labor. (MK)
a. Failed induction
b. Prolonged latent phase
c. Protracted active phase
d. Arrest of dilatation
e. Protracted descent
f. Arrest of descent
10. Describe the appropriate role for, and complications of, the following interventions
for abnormal labor: (MK)
a. Analgesia/anesthesia
b. Amniotomy
c. Augmentation of labor
d. Uterine contraction monitoring
e. Episiotomy
f. Operative vaginal forceps/vacuum delivery
g. Cesarean delivery
11. Recognize and appropriately evaluate abnormal fetal presentations and positions.
(PC)
12. Select and perform the most appropriate procedure for delivery. (PC)
13. Recognize and manage delivery complications, such as the following: (MK, PC)
a. Shoulder dystocia
50
b. Obstetric lacerations
c. Postpartum hemorrhage
d. Retained placenta
e. Uterine inversion
f. Uterine rupture
g. Perineal hematoma
14. Counsel patients about the prognosis for cesarean delivery versus vaginal delivery in
a subsequent pregnancy. (ICS, P)
B. The intern is expected to see patients in triage, work up and diagnosis related obstetrical as
well as non-obstetrical issues, in a timely and efficient manner. (PC, MK)
C. The intern is expected to cover emergency room consults, and work these consults up in
an appropriate and timely fashion. (PC, MK)
D. Floor calls on low risk postpartum, gynecology patients, and high risk patients will also be
handled. (MK, PC, IC, P)
E. After proper coaching and pratice, the intern will be expected to present all active patients
in the transition of care in AM report- under the supervision of the senior resident and
supervising attending, as well receive accurate check out in the evening. (IC, SBP)
F. Understand the basic maneuvers for shoulder dystocia protocol, and be able to utilize
systems based maneuvers as well as systemic activation - calling time, nursing assist, debrief,
documentation, etc. (MK, PC, SBP).
51
ACGME duty hour rules
Night float and call schedule
Night floats are rotation based
1. Maximum of 80 hours logged per week.
2. PGY-1’s may not work more then 16 hours
3. Should have 10 hours off, must have 8 hours off between shifts.
4. Must have one 24 hour duty free period per week.
Sunday
Call Senior Shift
Call Junior Shift
Float Senior Shift
Float Junior Shift
7:00 am-7:00 pm Transition of Care 7:00-7:30pm
7:00 am-7:00 pm Transition of Care 7:00-7:30pm
7:00 pm-7:00 am Transition of Care 7:00-7:30am
7:00 pm-7:00 am Transition of Care 7:00-7:30am
Monday
Float Senior Shift
Float Junior Shift
7:00 pm-7:00 am Transition of Care 7:00-7:30am
7:00 pm-7:00 am Transition of Care 7:00-7:30am
Tuesday
Float Senior Shift
Float Junior Shift
7:00 pm-7:00 am Transition of Care 7:00-7:30am
7:00 pm-7:00 am Transition of Care 7:00-7:30am
Wednesday
Float Senior Shift
Float Junior Shift
7:00 pm-7:00 am Transition of Care 7:00-7:30am
7:00 pm-7:00 am Transition of Care 7:00-7:30am
Thursday
Float Senior Shift
Float PGY-2 Shift
Float PGY-1 shift
7:00 pm-7:00 am Transition of Care 7:00-7:30am
7:00 pm-7:00 am Transition of Care 7:00-7:30am
7:00 pm-7:00 am Transition of Care 7:00-7:30 am
Friday
Didactics
*Call Senior Shift
*Call PGY-2 Shift
7:30am-11:00 am (float team stays for lectures)
7:00 pm-7:00 am Transition of Care 7-7:30 am
7:00 pm-7:00 am Transition of Care 7-7:30 am
Saturday
Call Senior Shift
Call Junior Shift
Call Junior Shift
7:00 am-7:00 am Transition of Care 7:00-7:30pm
7:00 am-7:00 pm Transition of Care 7:00-7:30pm
7:00 pm-7:00 am Transition of Care 7:00-7:30am
52
Night float PGY-2
Goals and Objectives:
The PGY-2 rotation is 4 weeks in length and occurs once over the academic year. The
resident is assigned to the night float team, and is supervised by the senior resident also
assigned to the night float team. This rotation occurs at the early part of the academic year,
and involves supervision of the intern physician on the first night float rotation.
A. Labor and delivery
1. Obtain an accurate history, describing onset of uterine contractions and ruptured
membranes. (PC)
2. Describe appropriate indications for induction of labor. (MK)
3. Perform a pertinent physical examination to assess: (PC)
a. Status of membranes
b. Presence of vaginal bleeding
c. Fetal presentation
d. Fetal position
e. Fetal weight
f. Cervical effacement
g. Cervical dilatation
h. Station of the presenting part
i. Clinical pelvimetry
j. Uterine contractility
4. Describe appropriate indications for, and complications of, cervical ripening agents.
(MK)
5. Describe appropriate indications for, and complications of, labor-inducing agents.
(MK)
6. Describe the normal course of labor. (MK)
7. Assess the progress of labor. (PC)
8. Describe the risk factors for abnormal labor. (MK)
9. Identify abnormalities of labor. (MK)
a. Failed induction
b. Prolonged latent phase
c. Protracted active phase
d. Arrest of dilatation
e. Protracted descent
f. Arrest of descent
10. Describe the appropriate role for, and complications of, the following interventions
for abnormal labor: (MK)
a. Analgesia/anesthesia
b. Amniotomy
c. Augmentation of labor
d. Uterine contraction monitoring
e. Episiotomy
f. Operative vaginal forceps/vacuum delivery
g. Cesarean delivery
11. Recognize and appropriately evaluate abnormal fetal presentations and positions.
(PC)
53
12. Select and perform the most appropriate procedure for delivery. (PC)
13. Recognize and manage delivery complications, such as the following: (MK, PC)
a. Shoulder dystocia
b. Obstetric lacerations
c. Postpartum hemorrhage
d. Retained placenta
e. Uterine inversion
f. Uterine rupture
g. Perineal hematoma
14. Counsel patients about the prognosis for cesarean delivery versus vaginal delivery in
a subsequent pregnancy. (ICS, P)
B. The resident is expected to see patient in triage, work up and diagnosis related obstetrical
as well as non-obstetrical issues, in a timely and efficient manner. (PC, MK)
C. The resident is expected to cover emergency room consults, and work these consults up in
an appropriate and timely fashion. (PC, MK)
D. Floor calls on low risk postpartum, gynecology patients, and high risk patients will also be
handled. (MK, PC, IC, P)
E. The resident will be expected to present all active patients in the transition of care in am
report, as well receive accurate check out in the afternoon. (IC, SBP)
F. Understand the basic maneuvers for shoulder dystocia protocol, and be able to utilize
systems based maneuvers as well as systemic activation - calling time, nursing assist, debrief,
documentation, etc. (MK, PC, SBP).
Please see the ACGME duty hour rules and Night Float and Call Schedule immediately after
the Nightfloat PGY-1 description.
54
Night float PGY-3
Goals and Objectives:
The PGY-3 rotation is 8 weeks in length, divided into 2 week segments over the year. This
two week rotation is tandemed with the resident’s GYN ONC rotation. The resident is
assigned to the night float team, and is responsible for supervising the junior resident also
assigned to the night float team.
A. Labor and delivery-The senior resident is responsible for developing and
communicating plans of care for the following labor and delivery objectives; (SBP)
1. Obtain an accurate history, describing onset of uterine contractions and ruptured
membranes. (PC)
2. Describe appropriate indications for induction of labor. (MK)
3. Perform a pertinent physical examination to assess: (PC)
a. Status of membranes
b. Presence of vaginal bleeding
c. Fetal presentation
d. Fetal position
e. Fetal weight
f. Cervical effacement
g. Cervical dilatation
h. Station of the presenting part
i. Clinical pelvimetry
j. Uterine contractility
4. Describe appropriate indications for, and complications of, cervical ripening agents.
(MK)
5. Describe appropriate indications for, and complications of, labor-inducing agents.
(MK)
6. Describe the normal course of labor. (MK)
7. Assess the progress of labor. (PC)
8. Describe the risk factors for abnormal labor. (MK)
9. Identify abnormalities of labor. (MK)
a. Failed induction
b. Prolonged latent phase
c. Protracted active phase
d. Arrest of dilatation
e. Protracted descent
f. Arrest of descent
10. Describe the appropriate role for, and complications of, the following interventions
for abnormal labor: (MK)
a. Analgesia/anesthesia
b. Amniotomy
c. Augmentation of labor
d. Uterine contraction monitoring
e. Episiotomy
f. Operative vaginal forceps/vacuum delivery
g. Cesarean delivery
55
11. Recognize and appropriately evaluate abnormal fetal presentations and positions.
(PC)
12. Select and perform the most appropriate procedure for delivery. (PC)
13. Recognize and manage delivery complications, such as the following: (MK, PC)
a. Shoulder dystocia
b. Obstetric lacerations
c. Postpartum hemorrhage
d. Retained placenta
e. Uterine inversion
f. Uterine rupture
g. Perineal hematoma
14. Counsel patients about the prognosis for cesarean delivery versus vaginal delivery in
a subsequent pregnancy. (ICS, P)
B. The senior resident is expected to supervise and manage all patients in triage worked up
and diagnosed by the junior residents, in all related obstetrical as well as non-obstetrical
issues, in a timely and efficient manner. The senior resident is responsible for communicating
all plans of care to the in house supervising attending physician. (PC, MK, SBP)
C. The resident is expected to supervise and manage the junior residents to cover emergency
room consults, and work these consults up in an appropriate and timely fashion. (PC, MK,
SBP)
D. The resident is expected to supervise and manage the following actions performed by the
junior residents; floor calls on low risk postpartum, gynecology patient, and high risk
patients. (MK, PC, IC, P, SBP)
E. The resident will be expected to supervise the junior resident presenting all active patients
in the transition of care in AM report, as well receive accurate check out in the afternoon. It
is the responsibility of the senior resident to furnish missing or incomplete presentation
information to the team. (IC, SBP)
F. Understand the basic maneuvers for shoulder dystocia protocol, and be able to utilize
systems based maneuvers as well as systemic activation - calling time, nursing assist, debrief,
documentation, etc. (MK, PC, SBP).
G. The resident will be expected to round on, and manage all gynecology oncology patients
admitted in patient. Additionally, ER consults on the gyn oncology service will be handled
by the senior resident, under the supervision of the gyn oncology faculty. (MK, PC, IC).
Please see the ACGME duty hour rules and Night Float and Call Schedule immediately after
the Nightfloat PGY-1 description.
56
Night float PGY-4
Goals and Objectives:
The PGY-4 rotation is 8 weeks in length, divided into 2 week segments over the year. This
two week rotation is tandemed with the resident’s GYN ONC rotation. The resident is
assigned to the night float team, and is responsible for supervising the junior resident also
assigned to the night float team. Additionally, this resident functions as chief of the gyn
oncology service, even while performing night floats duties.
A. Labor and delivery-The senior resident is responsible for developing and
communicating plans of care for the following labor and delivery objectives; (SBP)
1. Obtain an accurate history, describing onset of uterine contractions and ruptured
membranes. (PC)
2. Describe appropriate indications for induction of labor. (MK)
3. Perform a pertinent physical examination to assess: (PC)
a. Status of membranes
b. Presence of vaginal bleeding
c. Fetal presentation
d. Fetal position
e. Fetal weight
f. Cervical effacement
g. Cervical dilatation
h. Station of the presenting part
i. Clinical pelvimetry
j. Uterine contractility
4. Describe appropriate indications for, and complications of, cervical ripening agents.
(MK)
5. Describe appropriate indications for, and complications of, labor-inducing agents.
(MK)
6. Describe the normal course of labor. (MK)
7. Assess the progress of labor. (PC)
8. Describe the risk factors for abnormal labor. (MK)
9. Identify abnormalities of labor. (MK)
a. Failed induction
b. Prolonged latent phase
c. Protracted active phase
d. Arrest of dilatation
e. Protracted descent
f. Arrest of descent
10. Describe the appropriate role for, and complications of, the following interventions
for abnormal labor: (MK)
a. Analgesia/anesthesia
b. Amniotomy
c. Augmentation of labor
d. Uterine contraction monitoring
e. Episiotomy
f. Operative vaginal forceps/vacuum delivery
g. Cesarean delivery
57
11. Recognize and appropriately evaluate abnormal fetal presentations and positions.
(PC)
12. Select and perform the most appropriate procedure for delivery. (PC)
13. Recognize and manage delivery complications, such as the following: (MK, PC)
a. Shoulder dystocia
b. Obstetric lacerations
c. Postpartum hemorrhage
d. Retained placenta
e. Uterine inversion
f. Uterine rupture
g. Perineal hematoma
14. Counsel patients about the prognosis for cesarean delivery versus vaginal delivery in
a subsequent pregnancy. (ICS, P)
B. The senior resident is expected to supervise and manage all patients in triage worked up
and diagnosed by the junior residents, in all related obstetrical as well as non-obstetrical
issues, in a timely and efficient manner. The senior resident is responsible for communicating
all plans of care to the in house supervising attending physician. (PC, MK, SBP)
C. The resident is expected supervise and manage the junior residents to cover emergency
room consults, and work these consults up in an appropriate and timely fashion. (PC, MK,
SBP)
D. The resident is expected to supervise and manage the following actions performed by the
junior residents; floor calls on low risk postpartum, gynecology patient, and high risk
patients. (MK, PC, IC, P, SBP)
E. The resident will be expected to supervise the junior resident presenting all active patients
in the transition of care in am report, as well receive accurate check out in the afternoon. It is
the responsibility of the senior resident to furnish missing or incomplete presentation
information to the team. (IC, SBP)
F. Understand the basic maneuvers for shoulder dystocia protocol, and be able to utilize
systems based maneuvers as well as systemic activation - calling time, nursing assist, debrief,
documentation, etc. (MK, PC, SBP).
G. The resident will be expected to round on, and manage all gynecology oncology patients
admitted in patient. Additionally, ER consults on the gyn oncology service will be handled
by the senior resident, under the supervision of the gyn oncology faculty. This resident will
also function as chief of the gyn oncology service, and be a resource and to supervise the
PGY-3 also assigned the gyn oncology service. (MK, PC, IC).
Please see the ACGME duty hour rules and Night Float and Call Schedule immediately after
the Nightfloat PGY-1 description.
58
Rural medicine
Goals and Objectives:
The goal of this rotation is to gain enhanced exposure to routine obstetrical care in a rural
community hospital setting. This rotation occurs at the PGY-2-3 level. Residents will be
assigned to the Sacred Heart Hospital Emerald Coast labor and delivery unity, and will be
actively managing and participating in the care for the four FSU faculty physicians laboring
patients. Residents will be assigned to the unit, and will be tasked with logging and
monitoring their own hours, and functioning under the supervision of the FSU faculty.
The Florida Legislature recognizes that residency programs are an important part of the
health care safety net and that medical residents who complete a program are likely to
practice in that area. This rotation is sponsored thru state funds to meet this mission. It is also
state policy to enhance access to primary care in rural communities. Offering financial and
training motivation for rotations in rural and underserved areas for primary care medical
residents provides the opportunity to recruit and retain primary care physicians in these
communities, improving health access through integrated training programs.
Faculty Members:
Dr. Melissa Graham
Dr. Kimberly Hood
Dr. J. Elizabeth Kenton-Haney
Dr. Ann Marie-Piantanida-Whitlock
Resident Rotation Assignments 2013-2014:
Jessica Jackson, MD: 7/1-7/25/13
Natasha Spencer, MD: 7/29-8/22/13
Brett Tidwell, DO: 9/23-10/17/13
Benjamin Osterrieder, MD: 10/21-11/14/13
Lakeema Bruce, MD: 11/18-12/12/13 (off 11/28-29,Thanksgiving)
Cecily Collins, MD: 12/16-12/19/13; 1/13-1/16/14; 1/22-1/23/14 (This rotation is a little
different due to the holidays.)
Gail Joseph, MD: 1/27-2/20/14
Jessica Jackson, MD: 3/3-3/21/14
Natasha Spencer, MD: 3/31-4/17/14
Cecily Collins, MD: 4/21-5/8/14
Gail Joseph, MD: 6/16-6/26/14
All specific goals and objectives are the same as the OB PGY-2 goals and objectives
59
RURAL MEDICINE
WEEKLY SCHEDULE
Sunday thru Thursday 7:00am-7:00pm (leaves early on Thurs to drive to Pensacola)
Friday didactics 7:30-11:00
RURAL MEDICINE
READING SCHEDULE:
Obstetrics Normal and problem Pregnancies 6th edition
Chapters 3, 4, 9, 10, 14, 15, 18, 22, 25, 26, 28, 29, 30, 31, 32, 33, 37,
or
Williams 23 edition (chapters same as in 22 edition)
Chapters 4,5,6,10,16,23,24,27,34,35,36,37,38,39,40,52
60
OBSTETRICS ROTATIONS
Obstetrician–gynecologists must be able to recognize the physiologic changes of
pregnancy and describe the gross anatomic changes of pregnancy. They must be able to
recognize those factors in the history and physical examination that indicate possible medical
or obstetric complications. They must understand how to obtain and apply information from
the history, physical examination, and diagnostic studies to evaluate the course of pregnancy.
In evaluating patients for preconception care, obstetrician–gynecologists must assess those
factors of the history, physical examination, and diagnostic studies that pregnancy would
alter; assess the patient’s access to, and compliance with, a plan of prenatal care; and consult
with, or refer her to, other experts on specific conditions that may arise during the pregnancy.
In the clinical management of a normal term pregnancy, an understanding of the labor
and delivery process is mandatory. Obstetrician–gynecologists must be able to determine the
correct timing of delivery and to perform spontaneous vaginal, operative vaginal, as well as
abdominal deliveries. The principles and practice of immediate newborn resuscitation remain
an important function for the obstetrician and should be taught at the appropriate
postgraduate level in conjunction with the obstetrics component of the residency curriculum.
Although the obstetrics resident is trained to address a variety of normal and
complicated obstetric conditions, the resident should recognize that additional expertise may
be required in certain patients and should refer to subspecialty- trained physicians as
appropriate. The obstetrician–gynecologist must be familiar with the principles of obstetric
anesthesia, including conduction anesthesia, general anesthesia, and local anesthesia
techniques. Although the performance of these procedures is usually the responsibility of
attendants trained in anesthesia, the obstetrician must be aware of the indications and
contraindications for different anesthetic techniques and must be capable of managing
anesthetic-related complications such as hypotension, seizures, and respiratory arrest.
61
Obstetrical and gynecological ultrasound
Goals and Objectives:
This PGY-1 rotation is 4 weeks in length, and occurs during the first 4 rotation blocks for the
PGY-1 residents. As the current PGY-2 residents did not have this rotation, they will also
complete this four week rotation as part of the PGY-2 year level. This rotation occurs in the
regional perinatal testing center, under the supervision of the Maternal Fetal Medicine
faculty.
The main objective of this rotation is an introduction to the proper techniques and basics of
obstetrical and gynecological ultrasound.
A. Gynecologic ultrasound competencies
a.
Able to accurately locate and determine position of uterus
b.
Accurate uterine measurements in sagital and transverse planes
c.
Correct identification and measurement of the endometrial stripe
d.
Locate and measure leiomyomas when present
e.
Able to correctly identify both ovaries and /or the location of the iliac vessels
f.
Able to accurately measure both visualized adnexa in sagital and transverse
planes
g.
Able to correctly identify and measure adnexal pathology in sagital and
transverse planes
h.
Able to correctly characterize adnexal pathology
i.
Correct localization of the cul-de-sac and identification of any free fluid
j.
Identify and measure ectopic pregnancy when present
k.
Identify dilated fallopian tubes when present
B. Obstetrical ultrasound competencies
a. Able to correctly identify double decidual sign
b. Able to correctly identify and measure mean sac diameter
c. Able to correctly identify and measure Yolk sac and fetal pole
d. Able to correctly identify fetal heart beat and rate
e. Able to correctly identify and localize the placenta
f. Able to correctly identify the position and number of fetuses
g. Able to correctly measure BPD, AC and FL
h. Able to correctly calculate the AFI
i. Able to correctly perform BPP
j. Able to correctly identify the number of umbilical vessels
k. Able to demonstrate 4 chamber cardiac view
l. Able to identify cervical length
62
ULTRASOUND ROTATION
WEEKLY SCHEDULE*
Monday
AM US RPC
PM US RPC
Tuesday
AM US RPC
PM US RPC
WEEKS 1-3
Wednesday
AM US RPC
PM US RPC
Thursday
AM US RPC
PM US RPC
Friday
Didatics
US WCC
*Continuity Clinics are scheduled for one ½ full day per week. It is a fixed day, and the
resident will miss their scheduled rotation to participate in this ACGME required
clinic. See the Continuity Clinic rotation for the schedule
Week 1-3 RPC Monday thru Thursday except for the day based continuity clinic.
Friday am will be spent in didactics, and Friday afternoon will be spent performing US
at the resident clinic- The Womens Care Center.
Monday
AM US WCC
PM US WCC
Tuesday
AM US WCC
PM US WCC
WEEK 4
Wednesday
AM US RPC
PM US WCC
Thursday
AM US WCC
PM US WCC
Friday
Didatics
US WCC
Week 4 Residents clinic Monday thru Thursday except for the day based continuity
clinic. Friday am will be spent in didactics and Friday afternoon will be spent
performing US at the resident clinic-The Womens Care Center.
ULTRASOUND
READING SCHEDULE
Williams, 23 ed Chapter 16 Fetal Imaging
Comprehensive Gynecology Chapter 17 Ectopic Pregnancy and Chapter 18 Benign
Gynecologic Lesions
63
Obstetrics - Private rotation (OB-P)
Goals and objectives:
The PGY-2 rotation is 4 weeks in length, at times divided over the year as scheduling needs
dictate. The resident is assignet to LD, and expected to participate in the care of the private
pateitns of the part time faculty members. Expecttions including managing patients on the
labor unit- including triage, attend deliveries and surgeries, and make postpartum rounds on
the floor- all unider the supervision of the part time faculty member. The focus of this
rotation is to gain as much exposure to basic obstetrics as possible. Residents are expected to
attend all deliveries of faculty physicians that occur during this time period, including those
at night if possible without hours violations occurring.
A. Physiology
1. Describe the major physiologic changes in each organ system during pregnancy. (MK)
2. Evaluate symptoms and physical findings in a pregnant patient to distinguish
physiologic from pathologic findings. (MK)
3. Interpret common diagnostic tests in the context of the normal physiologic changes of
pregnancy. (MK, PC, SBP)
B. Preconception care
1. Obtain a thorough history, assessing historical and ongoing risks that may affect future
pregnancy. (PC, ICS)
2. Counsel a patient regarding the effect of pregnancy on maternal medical conditions.
(PC, MK, ICS, P)
3. Counsel a patient regarding the effect of maternal medical conditions on pregnancy.
(PC, MK, ICS, P)
4. Counsel a patient regarding appropriate lifestyle modifications conducive to favorable
pregnancy outcome. (PC, MK, ICS, P)
5. Counsel a patient regarding appropriate preconception testing. (SBP)
6. Counsel a patient regarding pregnancy-associated risks of maternal conditions. (MK,
ICS, PC, P)
C. Labor and delivery
1. Obtain an accurate history, describing onset of uterine contractions and ruptured
membranes. (PC)
2. Describe appropriate indications for induction of labor. (MK)
3. Perform a pertinent physical examination to assess: (PC)
a. Status of membranes
b. Presence of vaginal bleeding
c. Fetal presentation
d. Fetal position
e. Fetal weight
f. Cervical effacement
g. Cervical dilatation
h. Station of the presenting part
i. Clinical pelvimetry
j. Uterine contractility
64
4. Describe appropriate indications for, and complications of, cervical ripening agents.
(MK)
5. Describe appropriate indications for, and complications of, labor-inducing agents.
(MK)
6. Describe the normal course of labor. (MK)
7. Assess the progress of labor. (PC)
8. Describe the risk factors for abnormal labor. (MK)
9. Identify abnormalities of labor. (MK)
a. Failed induction
b. Prolonged latent phase
c. Protracted active phase
d. Arrest of dilatation
e. Protracted descent
f. Arrest of descent
10. Describe the appropriate role for, and complications of, the following interventions
for abnormal labor: (MK)
a. Analgesia/anesthesia
b. Amniotomy
c. Augmentation of labor
d. Uterine contraction monitoring
e. Episiotomy
f. Operative vaginal forceps/vacuum delivery
g. Cesarean delivery
11. Recognize and appropriately evaluate abnormal fetal presentations and positions.
(PC)
12. Select and perform the most appropriate procedure for delivery. (PC)
13. Recognize and manage delivery complications, such as the following: (MK, PC)
a. Shoulder dystocia
b. Obstetric lacerations
c. Postpartum hemorrhage
d. Retained placenta
e. Uterine inversion
f. Uterine rupture
g. Perineal hematoma
14. Counsel patients about the prognosis for cesarean delivery versus vaginal delivery in
a subsequent pregnancy. (ICS, P)
D. Preterm labor
1. Describe the multifactorial etiology of preterm labor. (MK)
2. Obtain a complete obstetric history in patients with preterm labor. (PC)
3. Perform a thorough physical examination to determine uterine size, fetal presentation
and fetal heart rate, and to assess cervical effacement and dilatation. (PC)
4. Perform and interpret biophysical, biochemical, and microbiologic tests to assess
patients with suspected preterm labor.(PC)
5. Recognize the indications for, and complications of, interventions for preterm labor,
such as: (MK, PC)
a. Antibiotics
b. Tocolytics
c. Corticosteroids
65
d. Amniocentesis
e. Agent for neuroprotection
6. Describe the expected frequency and severity of neonatal complications resulting from
preterm delivery, and describe the survival rates for preterm neonates based on age and
weight. (MK)
7. Appropriately counsel patients about management options for the extremely premature
fetus. (ICS, P)
8. Counsel patients about recurrence risk and preventive measures for preterm delivery.
(ICS, P)
E. Bleeding in late pregnancy
1. Describe the etiology of bleeding in late pregnancy. (MK)
2. Describe the factors that predispose to placenta previa and abruptio placentae. (MK)
3. Perform a focused physical examination in patients with bleeding in late pregnancy.
(PC)
4. Order and interpret diagnostic tests. (MK)
5. Perform the following diagnostic tests: (PC)
a. Abdominal ultrasonography to localize the placenta and evaluate for possible
placental separation.
b. Endovaginal or transperineal ultrasonography to localize the placenta.
6. Determine the appropriate timing and method of delivery in patients with bleeding in
late pregnancy. (MK, PC)
7. Manage serious complications of abruptio placentae and placenta previa, such as
hypovolemic shock and coagulopathy. (PC)
8. Counsel patients about the recurrence risk for placenta previa and abruptio placentae.
(MK, ICS, P)
F. Hypertension in pregnancy
1. Describe the possible causes of hypertension in pregnancy. (MK)
2. Describe the usual clinical manifestations of chronic hypertension, gestational
hypertension, and preeclampsia. (MK)
3. Perform a physical examination pertinent to patients with hypertension. (PC)
4. Perform tests to do the following: (MK, PC)
a. Determine the etiology of chronic hypertension.
b. Differentiate chronic hypertension from preeclampsia and gestational
hypertension.
c. Assess the severity of chronic hypertension, gestational hypertension, and
preeclampsia.
5. Assess fetal well-being in patients with hypertension in pregnancy (see Obstetrics
PGY-1, D. Antepartum Fetal Monitoring). (PC)
6. Treat hypertensive disorders of pregnancy. (PC)
7. Recognize and treat possible maternal complications of hypertension in pregnancy,
such as: (PC)
a. Cerebrovascular accident
b. Seizure
c. Renal failure
d. Pulmonary edema
e. Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome
f. Abruptio placentae
66
8. Describe and assess factors that determine timing and mode of delivery (MK, PC)
9. Counsel patients about recurrence risk for gestational hypertension and preeclampsia in
a subsequent pregnancy. (MK, ICS, P)
G. Postterm pregnancy
1. Determine gestational age using a combination of menstrual history, physical
examination, and ultrasound examination. (MK)
2. Describe the potential fetal and neonatal complications of postterm pregnancy, such as
the following: (MK)
a. Macrosomia
b. Meconium aspiration syndrome
c. Oligohydramnios
d. Hypoxia
e. Dysmaturity syndrome
f. Fetal demise
3. Perform and interpret surveillance tests for the postterm fetus. (PC)
4. Describe appropriate indications for timing and mode of delivery in the postterm
pregnancy. (MK)
H. Premature rupture of membranes
1. Describe the possible causes of premature rupture of membranes (PROM) in preterm
and term patients. (MK)
2. Perform diagnostic tests to confirm rupture of membranes. (PC)
3. Assess patients with PROM for lower and upper genital tract infection. (PC)
4. Describe the indications for, and complications of, expectant management in preterm
and term patients with PROM. (MK)
5. Describe the indications for, and complications of, induction of labor in preterm and
term patients with PROM. (MK)
6. Describe the role and possible complications of the following interventions in patients
with preterm PROM: (MK)
a. Tocolytics
b. Corticosteroids
c. Antibiotics
d. Amniocentesis
I. Vaginal birth after cesarean delivery
1. Document an accurate history of a patient’s previous operative delivery. (PC)
2. Counsel a patient about risks and benefits of vaginal birth after cesarean delivery
(VBAC). (ICS, P)
3. Describe the appropriate criteria for, and contraindications to VBAC, including
criteria for anesthesia and hospital policies. (MK, PC, PBLI, SBP)
4. Recognize and treat possible complications of VBAC, such as scar dehiscence,
hemorrhage, fetal compromise, and infection. (PC)
J. Shoulder dystocia
1. List risk factors for shoulder dystocia. (MK)
2. Counsel a patient about material and fetal risks of shoulder dystocia. (ICS, P)
3. Recognize signs of shoulder dystocia. (MK)
4. Know and perform maneuvers to resolve shoulder dystocia. (MK)
67
5. Document shoulder dystocia management using standard descriptions. (PC)
6. Counsel patients about delivery events and short-term and longterm
sequelae of shoulder dystocia. (ICS, PC)
K. Operative vaginal delivery
1. Understand indications and contraindications for forceps and vacuum deliveries. (MK)
2. Know types of forceps and vacuum devices and how to choose the appropriate
instrument. (MK)
3. Counsel a patient about maternal and fetal risks and benefits of operative vaginal
delivery. (ICS, PC)
4. Recognize and treat maternal complications of operative vaginal delivery. (MK, PC)
5. Know how to apply forceps and vacuum devices and perform low and outlet operative
vaginal delivery. (MK)
6. Document operative vaginal delivery using standard terminology. (PC)
L. Anesthesia
1. Describe the types of anesthesia that are appropriate for control of pain during labor
and delivery: (MK)
a. Epidural
b. Spinal
c. Pudendal
d. Local infiltration
e. General
f. Intravenous analgesia/sedation
2. Describe appropriate indications for and contraindications to these forms of
anesthesia/analgesia.(MK)
3. Recognize and treat maternal and fetal complications of anesthesia and analgesia.
(MK, PC)
4. Perform selected procedures related to anesthesia and analgesia (see the list of
procedures at the end of the OB section). (PC)
68
OBSTETRICS PRIVATE
WEEKLY SCHEDULE*
Monday
AM L&D
PM L&D
Tuesday
AM L&D
PM L&D
Wednesday
AM L&D
PM L&D
Thursday
AM L&D
PM L&D
Friday
Didatics
PM L&D
*Continuity Clinics are scheduled for one ½ full day per week. It is a fixed day, and the
resident will miss their scheduled rotation to participate in this ACGME required
clinic. See the Continuity Clinic rotation for the schedule.
OBSTETRICS PRIVATE
READING SCHEDULE
Obstetrics Normal and problem Pregnancies 6th edition
Chapters 3, 4, 9, 10, 14, 15, 18, 22, 25, 26, 28, 29, 30, 31, 32, 33, 37
or
Williams 23 edition (chapters same as in 22nd edition)
Chapters 4, 5, 6, 10, 16, 23, 24, 27, 34, 35, 36, 37, 38, 39, 40, 52
69
Obstetrics PGY-1
Goals and Objectives:
The PGY-1 rotation is 4 weeks in length, divided over the year. It occurs 3 times over the
academic year. The resident is assigned to Labor and Delivery, and makes postpartum rounds
on the floor. The first rotation is split into two weeks of day L&D coverage, followed by two
weeks of night coverage. The focus of this rotation is to gain as much basic obstetrical
experience as possible. Residents are expected to attend all deliveries of faculty physicians
that occur while on the unit.
A. Genetics
1. Describe the basic structure and replication of DNA. (MK)
2. Describe the processes of mitosis and meiosis. (MK)
3. Describe common terms associated with genetic expression: (MK)
a. Exon
b. Intron
c. Codon
d. Transcription
e. Translation
4. Describe the clinical significance of karyotype abnormalities, such as: (MK)
a. Trisomy
i. 13
ii. 18
iii. 21
b. Polyploidy
c. Monosomy
d. Sex chromosome abnormalities
e. Deletions
f. Inversions
g. Translocations
h. Mosaicism
i. Chimerism
5. Describe the normal process of gametogenesis. (MK)
6. Describe the normal process of fertilization and the combination of genetic
information. (MK)
B. Embryology and developmental biology
1. Describe the normal process of gametogenesis. (MK)
2. Describe the normal process of fertilization. (MK)
3. Describe the normal process of embryologic development of the singleton pregnancy.
(MK)
4. Describe the embryology of multiple gestations. (MK)
C. Anatomy
1. Describe the muscular and vascular anatomy of the pelvis and vulva. (MK)
2. Describe the anatomic changes in the mother caused by normal physiologic adaptation
to pregnancy. (MK)
70
3. Describe the anatomic changes that occur during the intrapartum period, such as
cervical effacement and dilatation. (MK)
4. Describe the anatomic changes that occur during the puerperium, such as alterations in
the breast and uterine involution. (MK)
D. Pharmacology
1. Describe the role for nutritional supplementation in pregnancy. (MK)
2. Describe the effect of pregnancy on serum and tissue drug concentrations and drug
efficacy. (MK)
3. Describe the factors that influence transplacental drug transfer, such as the following:
(MK)
a. Molecular size
b. Lipid solubility
c. Degree of ionization at physiologic pH
d. Protein binding
4. Describe the possible teratogenic effects of prescription drugs in pregnancy, such as
the following: (MK)
a. Antibiotics
b. Angiotensin-converting enzyme inhibitors and angiotensin antagonists
c. Dermatologic agents
d. Seizure medications
E. Depression, antipsychotics, and anxiolytic medications
5. Describe the possible teratogenic effects of nonprescription drugs, such as the
following: (MK)
a. Antiinflammatories/analgesics
b. Antihistamines/decongestants
c. Vitamins and supplements
C. Prenatal care
1. Obtain a comprehensive history and perform a physical examination. (ICS)
2. Order and interpret routine laboratory tests and those required because of risk factors
during pregnancy. (PC, SBP)
3. Counsel patients about lifestyle modifications that improve pregnancy outcome. (ICS,
P)
4. Counsel patients about warning signs of adverse pregnancy events. (ICS, P)
5. Schedule and perform appropriate antepartum follow-up visits for routine and high-risk
obstetric care. (PC, PBLI, SBP)
6. Counsel patients about appropriate immunizations during pregnancy. (ICS, SBP)
7. Counsel patients about the benefits of breast feeding. (ICS, SBP)
8. Counsel patients about guidelines for diet, exercise, weight gain, and weight loss. (ICS,
MK, SBP, PC)
9. Understand the effect of family structure, social factors, and economic factors on
access to care and pregnancy outcomes. (PC, SBP)
D. Dermatologic conditions in pregnancy
1. Obtain a diagnostic history and perform a physical examination in pregnant patients
with a dermatologic problem. (PC)
2. Recognize common skin changes in pregnancy, both physiologic and pathologic. (MK)
3. Order and interpret diagnostic tests to assess dermatologic conditions. (MK, PC)
71
4. Initiate therapy with consultation as necessary and manage the effect of the condition
on pregnancy. (PC, SBP)
E. Antepartum fetal monitoring
1. Describe the indications, contraindications, advantages, and disadvantages of
antepartum diagnostic tests, such as: (MK, PC)
a. Nonstress test
b. Contraction stress test
c. Biophysical profile and modified biophysical profile
d. Vibroacoustic stimulation test
e. Doppler velocimetry
2. Perform and interpret antepartum diagnostic tests accurately and integrate the
interpretation of such tests into clinical management algorithms. (MK, PC, SBP)
F. Intrapartum fetal assessment
1. Perform and interpret the following methods of fetal monitoring: (PC)
a. Intermittent auscultation
b. Electronic monitoring
c. Fetal scalp stimulation
d. Vibroacoustic stimulation
2. Describe fetal heart rate tracings using standard terminology. (PC)
3. Describe the possible causes for, and clinical significance of, abnormal fetal heart rate
patterns: (MK)
a. Bradycardia
b. Tachycardia
c. Variability
d. Early decelerations
e. Variable decelerations
f. Late decelerations
g. Sinusoidal waveform
4. Implement appropriate interventions, such as operative vaginal delivery and cesarean
delivery, for fetal heart rate abnormalities. (PC)
G. Fetal malpresentations
1. Describe the usual symptoms and clinical manifestations of fetal malpresentations.
(MK)
2. Describe the risk factors for and etiologies of fetal malpresentations. (MK)
3. Perform and interpret diagnostic tests to assess for fetal malpresentations. (MK, PC)
4. Counsel patients about fetal malpresentations in late pregnancy, including indications
and contraindications for interventions. (PC, ICS)
5. Manage fetal malpresentations in late pregnancy and at delivery. (PC)
H. Labor and delivery
1. Obtain an accurate history, describing onset of uterine contractions and ruptured
membranes. (PC)
2. Describe appropriate indications for induction of labor. (MK)
3. Perform a pertinent physical examination to assess: (PC)
a. Status of membranes
b. Presence of vaginal bleeding
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c. Fetal presentation
d. Fetal position
e. Fetal weight
f. Cervical effacement
g. Cervical dilatation
h. Station of the presenting part
i. Clinical pelvimetry
j. Uterine contractility
4. Describe appropriate indications for, and complications of, cervical ripening agents.
(MK)
5. Describe appropriate indications for, and complications of, labor-inducing agents.
(MK)
6. Describe the normal course of labor. (MK)
7. Assess the progress of labor. (PC)
8. Describe the risk factors for abnormal labor. (MK)
9. Identify abnormalities of labor. (MK)
a. Failed induction
b. Prolonged latent phase
c. Protracted active phase
d. Arrest of dilatation
e. Protracted descent
f. Arrest of descent
10. Describe the appropriate role for, and complications of, the following interventions
for abnormal labor: (MK)
a. Analgesia/anesthesia
b. Amniotomy
c. Augmentation of labor
d. Uterine contraction monitoring
e. Episiotomy
f. Operative vaginal forceps/vacuum delivery
g. Cesarean delivery
11. Recognize and appropriately evaluate abnormal fetal presentations and positions.
(PC)
12. Select and perform the most appropriate procedure for delivery. (PC)
13. Recognize and manage delivery complications, such as the following: (MK, PC)
a. Shoulder dystocia
b. Obstetric lacerations
c. Postpartum hemorrhage
d. Retained placenta
e. Uterine inversion
f. Uterine rupture
g. Perineal hematoma
14. Counsel patients about the prognosis for cesarean delivery versus vaginal delivery in
a subsequent pregnancy. (ICS, P)
I. Evaluation of the newborn
1. Perform an immediate assessment of the newborn infant and determine if resuscitative
measures are indicated. (MK, PC)
2. Resuscitate a depressed neonate: (PC)
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a. Properly position the baby in the radiant warmer.
b. Suction the mouth and nose.
c. Provide tactile stimulation.
d. Administer positive pressure ventilation with bag and mask.
e. Administer chest compressions.
3. Assign Apgar scores. (PC)
4. Describe the indications for cord blood gas analysis and interpret the test results. (MK)
5. Obtain cord blood for the following purposes: (PC)
a. Blood gas analysis
b. Determination of fetal blood type
c. Cord blood storage
6. Describe the rationale for administration of topical antibiotics to prevent neonatal
ophthalmic infection. (MK)
7. Counsel parents about the advantages and disadvantages of circumcision. (ICS, P)
J. The puerperium
1. Perform a focused physical examination in postpartum patients. (PC)
2. Identify and treat the most common maternal complications that occur in the
puerperium: (MK, PC)
a. Uterine hemorrhage
b. Infection
c. Wound dehiscence (abdominal incision and episiotomy)
d. Bladder instability
e. Postoperative ileus
f. Injury to the urinary tract
g. Breast engorgement and mastitis
h. Pulmonary embolism (including amnionic fluid)
i. Deep vein thrombosis
j. Uterine inversion
3. Recognize, treat, and refer as appropriate, postpartum affective disorders. (PC, ICS,
SBP, P)
4. Prescribe methods of reversible contraception. (MK)
5. Counsel patients about permanent sterilization. (ICS, P)
6. Perform postpartum surgical sterilization. (PC)
7. Counsel patients about the advantages of and answer questions related to breast
feeding. (ICS, P)
8. Counsel patients regarding future pregnancies. (ICS, P)
74
OBSTETRICS PGY-1
WEEKLY SCHEDULE*
Monday
AM L&D
PM L&D
Tuesday
AM L&D
PM L&D
Wednesday
AM L&D
PM L&D
Thursday
AM L&D
PM L&D
Friday
Didatics
PM L&D
*Continuity Clinics are scheduled for one ½ full day per week. It is a fixed day, and the
resident will miss their scheduled rotation to participate in this ACGME required
clinic. See the Continuity Clinic rotation for the schedule.
** The first L&D rotation that a resident participates in will have the first two weeks
during the day, and the second two weeks at night. The intern will be paired with a
PGY-2 that will shadow them during the day, as well as at night. The goal of this
experience is an enhanced orientation and introduction to the L&D experience.
OBSTETRICS PGY-1
READING SCHEDULE
Obstetrics Normal and problem Pregnancies 6th edition
Chapters 1, 2, 5, 6, 7, 8, 11, 12, 13, 16, 17, 19, 20, 21, 22, 23, 24, 26, 31, 23, 33
Or
Williams 23 edition (Chapters are same as in 22 edition)
Chapters1,2,3,6,7,8,12,13,14,15,16,17,18,19,20,21,22,25,26,28,29,30,31,32,33
75
Obstetrics PGY-2
Goals and Objectives;
The PGY-2 rotation is one month in length, divided over the year. The resident is assigned to
the L&D unit and makes postpartum rounds on the floor. The focus of this rotation is the
understanding of more complex obstetrical skills, as well as to facilitate teaching and
orientation of the new interns.
A. Physiology
1. Describe the major physiologic changes in each organ system during pregnancy. (MK)
2. Evaluate symptoms and physical findings in a pregnant patient to distinguish
physiologic from pathologic findings. (MK)
3. Interpret common diagnostic tests in the context of the normal physiologic changes of
pregnancy. (MK, PC, SBP)
B. Preconception care
1. Obtain a thorough history, assessing historical and ongoing risks that may affect future
pregnancy. (PC, ICS)
2. Counsel a patient regarding the effect of pregnancy on maternal medical conditions.
(PC, MK, ICS, P)
3. Counsel a patient regarding the effect of maternal medical conditions on pregnancy.
(PC, MK, ICS, P)
4. Counsel a patient regarding appropriate lifestyle modifications conducive to favorable
pregnancy outcome. (PC, MK, ICS, P)
5. Counsel a patient regarding appropriate preconception testing. (SBP)
6. Counsel a patient regarding pregnancy-associated risks of maternal conditions. (MK,
ICS, PC, P)
C. Labor and delivery
1. Obtain an accurate history, describing onset of uterine contractions and ruptured
membranes. (PC)
2. Describe appropriate indications for induction of labor. (MK)
3. Perform a pertinent physical examination to assess: (PC)
a. Status of membranes
b. Presence of vaginal bleeding
c. Fetal presentation
d. Fetal position
e. Fetal weight
f. Cervical effacement
g. Cervical dilatation
h. Station of the presenting part
i. Clinical pelvimetry
j. Uterine contractility
4. Describe appropriate indications for, and complications of, cervical ripening agents.
(MK)
5. Describe appropriate indications for, and complications of, labor-inducing agents.
(MK)
6. Describe the normal course of labor. (MK)
76
7. Assess the progress of labor. (PC)
8. Describe the risk factors for abnormal labor. (MK)
9. Identify abnormalities of labor. (MK)
a. Failed induction
b. Prolonged latent phase
c. Protracted active phase
d. Arrest of dilatation
e. Protracted descent
f. Arrest of descent
10. Describe the appropriate role for, and complications of, the following interventions
for abnormal labor: (MK)
a. Analgesia/anesthesia
b. Amniotomy
c. Augmentation of labor
d. Uterine contraction monitoring
e. Episiotomy
f. Operative vaginal forceps/vacuum delivery
g. Cesarean delivery
11. Recognize and appropriately evaluate abnormal fetal presentations and positions.
(PC)
12. Select and perform the most appropriate procedure for delivery. (PC)
13. Recognize and manage delivery complications, such as the following: (MK, PC)
a. Shoulder dystocia
b. Obstetric lacerations
c. Postpartum hemorrhage
d. Retained placenta
e. Uterine inversion
f. Uterine rupture
g. Perineal hematoma
14. Counsel patients about the prognosis for cesarean delivery versus vaginal delivery in
a subsequent pregnancy. (ICS, P)
D. Preterm labor
1. Describe the multifactorial etiology of preterm labor. (MK)
2. Obtain a complete obstetric history in patients with preterm labor. (PC)
3. Perform a thorough physical examination to determine uterine size, fetal presentation
and fetal heart rate, and to assess cervical effacement and dilatation. (PC)
4. Perform and interpret biophysical, biochemical, and microbiologic tests to assess
patients with suspected preterm labor.(PC)
5. Recognize the indications for, and complications of, interventions for preterm labor,
such as: (MK, PC)
a. Antibiotics
b. Tocolytics
c. Corticosteroids
d. Amniocentesis
e. Agent for neuroprotection
6. Describe the expected frequency and severity of neonatal complications resulting from
preterm delivery, and describe the survival rates for preterm neonates based on age and
weight. (MK)
77
7. Appropriately counsel patients about management options for the extremely premature
fetus. (ICS, P)
8. Counsel patients about recurrence risk and preventive measures for preterm delivery.
(ICS, P)
E. Bleeding in late pregnancy
1. Describe the etiology of bleeding in late pregnancy. (MK)
2. Describe the factors that predispose to placenta previa and abruptio placentae. (MK)
3. Perform a focused physical examination in patients with bleeding in late pregnancy.
(PC)
4. Order and interpret diagnostic tests. (MK)
5. Perform the following diagnostic tests: (PC)
a. Abdominal ultrasonography to localize the placenta and evaluate for possible
placental separation.
b. Endovaginal or transperineal ultrasonography to localize the placenta.
6. Determine the appropriate timing and method of delivery in patients with bleeding in
late pregnancy. (MK, PC)
7. Manage serious complications of abruptio placentae and placenta previa, such as
hypovolemic shock and coagulopathy. (PC)
8. Counsel patients about the recurrence risk for placenta previa and abruptio placentae.
(MK, ICS, P)
F. Hypertension in pregnancy
1. Describe the possible causes of hypertension in pregnancy. (MK)
2. Describe the usual clinical manifestations of chronic hypertension, gestational
hypertension, and preeclampsia. (MK)
3. Perform a physical examination pertinent to patients with hypertension. (PC)
4. Perform tests to do the following: (MK, PC)
a. Determine the etiology of chronic hypertension.
b. Differentiate chronic hypertension from preeclampsia and gestational
hypertension.
c. Assess the severity of chronic hypertension, gestational hypertension, and
preeclampsia.
5. Assess fetal well-being in patients with hypertension in pregnancy (see Obstetrics
PGY-1, D. Antepartum Fetal Monitoring). (PC)
6. Treat hypertensive disorders of pregnancy. (PC)
7. Recognize and treat possible maternal complications of hypertension in pregnancy,
such as: (PC)
a. Cerebrovascular accident
b. Seizure
c. Renal failure
d. Pulmonary edema
e. Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome
f. Abruptio placentae
8. Describe and assess factors that determine timing and mode of delivery (MK, PC)
9. Counsel patients about recurrence risk for gestational hypertension and preeclampsia in
a subsequent pregnancy. (MK, ICS, P)
G. Postterm pregnancy
78
1. Determine gestational age using a combination of menstrual history, physical
examination, and ultrasound examination. (MK)
2. Describe the potential fetal and neonatal complications of postterm pregnancy, such as
the following: (MK)
a. Macrosomia
b. Meconium aspiration syndrome
c. Oligohydramnios
d. Hypoxia
e. Dysmaturity syndrome
f. Fetal demise
3. Perform and interpret surveillance tests for the postterm fetus. (PC)
4. Describe appropriate indications for timing and mode of delivery in the postterm
pregnancy. (MK)
H. Premature rupture of membranes
1. Describe the possible causes of premature rupture of membranes (PROM) in preterm
and term patients. (MK)
2. Perform diagnostic tests to confirm rupture of membranes. (PC)
3. Assess patients with PROM for lower and upper genital tract infection. (PC)
4. Describe the indications for, and complications of, expectant management in preterm
and term patients with PROM. (MK)
5. Describe the indications for, and complications of, induction of labor in preterm and
term patients with PROM. (MK)
6. Describe the role and possible complications of the following interventions in patients
with preterm PROM: (MK)
a. Tocolytics
b. Corticosteroids
c. Antibiotics
d. Amniocentesis
I. Vaginal birth after cesarean delivery
1. Document an accurate history of a patient’s previous operative delivery. (PC)
2. Counsel a patient about risks and benefits of vaginal birth after cesarean delivery
(VBAC). (ICS, P)
3. Describe the appropriate criteria for, and contraindications to VBAC, including
criteria for anesthesia and hospital policies. (MK, PC, PBLI, SBP)
4. Recognize and treat possible complications of VBAC, such as scar dehiscence,
hemorrhage, fetal compromise, and infection. (PC)
J. Shoulder dystocia
1. List risk factors for shoulder dystocia. (MK)
2. Counsel a patient about material and fetal risks of shoulder dystocia. (ICS, P)
3. Recognize signs of shoulder dystocia. (MK)
4. Know and perform maneuvers to resolve shoulder dystocia. (MK)
5. Document shoulder dystocia management using standard descriptions. (PC)
6. Counsel patients about delivery events and short-term and longterm
sequelae of shoulder dystocia. (ICS, PC)
K. Operative vaginal delivery
79
1. Understand indications and contraindications for forceps and vacuum deliveries. (MK)
2. Know types of forceps and vacuum devices and how to choose the appropriate
instrument. (MK)
3. Counsel a patient about maternal and fetal risks and benefits of operative vaginal
delivery. (ICS, PC)
4. Recognize and treat maternal complications of operative vaginal delivery. (MK, PC)
5. Know how to apply forceps and vacuum devices and perform low and outlet operative
vaginal delivery. (MK)
6. Document operative vaginal delivery using standard terminology. (PC)
L. Anesthesia
1. Describe the types of anesthesia that are appropriate for control of pain during labor
and delivery: (MK)
a. Epidural
b. Spinal
c. Pudendal
d. Local infiltration
e. General
f. Intravenous analgesia/sedation
2. Describe appropriate indications for and contraindications to these forms of
anesthesia/analgesia.(MK)
3. Recognize and treat maternal and fetal complications of anesthesia and analgesia.
(MK, PC)
4. Perform selected procedures related to anesthesia and analgesia (see the list of
procedures at the end of the OB section). (PC)
80
OBSTETRICS PGY-2
WEEKLY SCHEDULE
AM
PM
Monday
L&D
L&D
Tuesday
L&D
L&D
Wednesday
L&D
L&D
Thursday
L&D
L&D
Friday
Lecture
L&D/Clinic
*Continuity Clinics are scheduled for one half day per week. It is a fixed day, and the
resident will miss their scheduled rotation to participate in this ACGME required
clinic. See the Primary Care rotation/Continuity Clinic rotation for the schedule.
OBSTETRICS PGY-2
READING SCHEDULE
Obstetrics Normal and problem Pregnancies 6th edition
Chapters 3, 4, 9, 10, 14, 15, 18, 22, 25, 26, 28, 29, 30, 31, 32, 33, 37
or
Williams 23 edition (chapters same as in 22nd edition)
Chapters 4, 5, 6, 10, 16, 23, 24, 27, 34, 35, 36, 37, 38, 39, 40, 52
81
Obstetrics PGY-3
Goals and Objectives:
The PGY-3 rotation is two 4 week blocks in length divided over the year. The third year
resident is assigned to labor and delivery, as well as is responsible for assisting in the care of
in patient ante partum patients. This resident works under the supervision of the Chief
Resident assigned to MFM, and the generalist Obstetrical faculty who is assigned to
L&D. This resident is responsible for supervising the intern in the running and management
of low risk obstetrical patients, as well as laboring high risk patients.
A. Pathology and neoplasia
1. Describe symptoms and physical findings suggestive of malignancy in the pregnant
patient. (MK)
2. In consultation with a medical or gynecologic oncologist, counsel a patient about
treatment options and the effect on pregnancy and the timing of delivery. (PC, ICS, P)
3. Describe the management of adnexal masses in pregnancy. (MK)
B. Microbiology and immunology
1. Describe the principal features of the host immunologic response. (MK)
2. Describe how the maternal immune response is altered by pregnancy. (MK)
3. Describe the basic features and timing of development of the fetal immunologic
response. (MK)
C. Diabetes mellitus
1. Classify diabetes mellitus in pregnancy. (MK)
2. Order and interpret screening tests for gestational diabetes. (MK, PC, SBP)
3. Monitor and control blood sugar in the pregnant patient with diabetes mellitus. (PC)
4. Assess, recognize, and manage fetal and maternal complications such as the following:
(MK, PC)
a. Fetal malformations
b. Disturbances in fetal growth
c. Diabetic ketoacidosis
5. Describe and assess factors that determine timing and mode of delivery. (PC)
6. Counsel patients with diabetes regarding future reproduction and the long-term health
implications of their medical condition. (ICS, P, SBP)
D. Diseases of the urinary system
1. Evaluate signs and symptoms of urinary tract pathology in pregnant patients. (PC)
2. Describe the indications for the common diagnostic tests for renal disease in
pregnancy. (PC)
3. Interpret the results of common diagnostic tests for renal disease in pregnancy. (MK,
PC, SBP)
4. Counsel patients about the possible adverse effects of diseases of the urinary tract on
fetal and maternal outcome, such as: (ICS, P, SBP)
a. Intrauterine growth restriction
b. Prematurity
c. Perinatal mortality
d. Hypertension
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5. Develop, in consultation with other specialists, a comprehensive plan for the perinatal
management of a patient with renal disease. (ICS, P, SBP, PBLI)
E. Infectious diseases
1. Obtain a focused history and perform a physical examination in pregnant patients who
have known or suspected infectious diseases. (PC)
2. Choose and perform laboratory tests to confirm the diagnosis of infection. (MK, PC,
SBP)
3. Assess the severity of a specific infection and its potential maternal, fetal, and neonatal
effect. (PC)
4. Describe the possible adverse maternal and fetal effects of antibiotics and antivirals
administered during pregnancy. (MK, PC, ICS)
5. Manage specific infections in consultation with other specialists, as indicated. (ICS, P,
SBP)
F. Hematologic disorders
1. Evaluate possible causes of anemia, thrombocytopenia, deep vein thrombosis, and
coagulopathy in pregnancy. (MK)
2. Institute appropriate acute and chronic management plans for these conditions,
including prophylaxis to minimize recurrence risk. (PC, SBP)
3. Counsel patients about the fetal and maternal effect of hematologic disorders in
pregnancy. (ICS, P)
E. Cardiopulmonary disease
1. Describe symptoms and physical findings suggestive of cardiopulmonary disease in
pregnancy. (MK)
2. Describe the indications for and interpret the results of common diagnostic tests for
cardiopulmonary disease in pregnancy. (MK, PC)
3. Classify maternal cardiac disease in pregnancy and describe the associated maternal
and fetal risks. (MK)
4. Order appropriate fetal evaluation in patients with congenital heart disease. (MK, PC)
5. Counsel patients about the effect of pregnancy on cardiopulmonary disease and the
effect of these diseases on pregnancy. (ISC, P)
6. Develop, in consultation with other specialists, a comprehensive plan for the perinatal
management of patients with cardiopulmonary disease. (P, SBP)
F. Gastrointestinal disease
1. Obtain a history and perform a physical examination for the diagnosis of
gastrointestinal disease in pregnancy. (PC)
2. Describe the indications for and interpret the results of common diagnostic tests for
gastrointestinal disease in pregnancy. (MK, PC)
3. Diagnose and provide initial management of common gastrointestinal diseases in
pregnancy. (MK, PC)
4. Counsel patients about the effect of gastrointestinal disease on pregnancy and the
effect of pregnancy on gastrointestinal disease. (ICS, P)
5. Develop, in consultation with other specialists, a comprehensive plan for the perinatal
management of patients with gastrointestinal disease. (P, SBP)
G. Neurologic disease
83
1. Obtain a focused history and perform a neurologic examination in pregnant patients
with a known or suspected neurologic disorder. (PC)
2. Describe the indications for and interpret the results of common diagnostic tests for
neurologic disease in pregnancy. (MK, PC)
3. Counsel pregnant patients regarding the effect of pregnancy on neurologic disease
and the effect of the disease on pregnancy. (ICS, P)
4. Develop, in consultation with other specialists, a comprehensive plan for the perinatal
management of patients with neurologic disease. (P, SBP)
H. Endocrine disorders (excluding diabetes mellitus)
1. Obtain a focused history and perform a physical examination in pregnant patients with
a known or suspected endocrine disease. (PC)
2. Describe the indications for and interpret the results of common diagnostic tests for
endocrine disease. (MK, PC)
3. Counsel patients about the effect of an endocrine disease and its treatment on
pregnancy and the effect of pregnancy on the endocrine disorder. (ICS, P)
4. In consultation with other specialists, develop a comprehensive plan for the perinatal
management of patients with an endocrine disorder. (P, SBP)
I. Collagen vascular and autoimmune disorders
1. Obtain a focused history and perform a physical examination in pregnant patients with
known or suspected collagen vascular disease. (PC)
2. Describe the indications for and interpret the results of common diagnostic tests for
collagen vascular disease in pregnancy. (MK, PC)
3. Counsel patients regarding the effect of collagen vascular disease and its treatment on
pregnancy and the effect of pregnancy on collagen vascular disease. (ICS, P)
4. Develop, in consultation with other specialists, a comprehensive plan for the perinatal
management of patients with collagen vascular disease. (P, SBP)
5. Counsel patients about the effect of autoimmune diseases on fetal and neonatal
outcomes. (ICS, PC)
J. Psychiatric disorders
1. Perform a mental status examination. (PC)
2. Describe the symptoms of common psychiatric disorders in pregnancy. (MK)
3. Assess the risk of psychiatric disorders and the safety of psychiatric medications in the
patient and her fetus. (PC,ICS)
4. Identify patients who require referral for psychiatric consultation. (P, SBP)
K. Emergency care during pregnancy
1. Obtain a diagnostic history and perform a physical examination in pregnant patients
with a medical or surgical emergency.(PC)
2. Order and interpret diagnostic tests, such as CT or MRI scan, lumbar puncture, and xrays, to assess for adverse effects of emergency conditions on the developing pregnancy.
(MK, PC)
3. Initiate therapy, in consultation as necessary, and describe the effect of the condition
on the pregnancy as well as the effect of the pregnancy on the emergent condition. (ICS,
P)
4. Describe the timing of delivery in obstetric patients with emergent conditions. (MK)
84
5. Assess and manage a pregnant patient with trauma, including indications for
perimortem cesarean delivery. (MK, PC, P)
L. Substance abuse in pregnancy
1. Describe behavior patterns suggestive of substance abuse. (MK)
2. Obtain a thorough history and perform a physical examination in patients suspected of
substance abuse in pregnancy. (PC)
3. Counsel patients about the effect of substance abuse on the fetus/neonate. (ICS, P)
4. Assess the fetus for adverse effects of substance abuse, such as congenital anomalies or
growth restriction. (MK)
5. Refer patients with known or suspected substance abuse for counseling and follow-up.
(P, SBP)
M. Second-trimester pregnancy loss
1. Describe the usual symptoms and clinical manifestations of a second-trimester
abortion. (MK)
2. Describe the risk factors for and etiologies of second-trimester pregnancy loss. (MK)
3. Perform a physical examination and order diagnostic tests to identify the site of genital
tract bleeding, assess cervical
effacement and dilatation, and evaluate uterine
contractions. (PC)
4. Perform diagnostic tests to assess patients with threatened second-trimester pregnancy
loss, such as: (PC)
5. Implement appropriate medical and surgical management (including cervical cerclage)
for patients with threatened second-trimester abortion. (PC)
6. Manage the complications of second-trimester pregnancy loss, such as the following:
(MK, PC)
a. Chorioamnionitis
b. Retained placenta
c. Uterine hemorrhage
7. Counsel patients who have experienced second-trimester pregnancy loss about
recurrence risk. (ICS, P)
N. Multiple gestation
1. Describe the factors that predispose to multiple gestation.(MK)
2. Describe the physical findings suggestive of multiple gestation.(MK)
3. Confirm the diagnosis of multiple gestation by performing an endovaginal or
abdominal ultrasound examination. (PC)
4. Describe the medical rationale for selective fetal reduction in higher-order multiple
gestation. (MK)
5. Describe, diagnose, and manage the maternal and fetal complications associated with
multiple gestation in diamniotic dichorionic, diamniotic monochorionic, and
monoamniotic monochorionic twins. (PC)
6. Perform tests to assess the general well-being of the fetuses of a multiple gestation.
(PC)
7. Counsel patients as to the antenatal testing and delivery plans for multiple gestations.
(ICS, P, PC)
O. Fetal death
1. Describe the clinical history indicative of fetal death. (MK)
85
2. Describe the possible causes of fetal death. (MK)
3. Confirm the diagnosis of fetal death by ultrasound examination. (PC)
4. Interpret the results of diagnostic tests to determine the etiology of fetal death. (PC)
5. Select and perform the most appropriate procedure for uterine evacuation based on
considerations of gestational age and maternal history. (PC)
6. Describe and treat the principal complications of a retained dead fetus. (MK)
7. Describe and treat the major complications of surgical and medical uterine evacuation.
(PC)
8. Describe the grieving process associated with pregnancy loss and refer patients for
counseling as appropriate. (PC)
9. Counsel patients about recurrence risk for fetal death. (ICS, P)
P. Intrauterine growth restriction
1. Describe the factors that predispose to fetal growth restriction. (MK)
2. Assess uterine size by physical examination and identify size/date discrepancies. (PC)
3. Evaluate the patient for causes of intrauterine growth restriction. (PC)
4. Perform an accurate ultrasound examination to assess fetal growth. (PC)
5. Order and interpret tests to monitor a fetus with suspected growth restriction, and
describe and assess factors that determine timing and mode of delivery. (PC)
6. Counsel patients about the recurrence risk for intrauterine growth restriction. (ISC, P)
Q. Isoimmunization and alloimmune thrombocytopenia
1. Describe the major antigen–antibody reactions that result in red cell isoimmunization
or thrombocytopenia. (MK)
2. Interpret serologic assays that quantify antibody titers. (PC)
3. Describe the appropriate indications for determination of paternal antigen status. (MK)
4. Describe the major fetal complications of isoimmunization and alloimmune
thrombocytopenia. (MK)
5. Develop, in consultation with other specialists, a comprehensive plan for the perinatal
management of patients with isoimmunization and alloimmune thrombocytopenia. (P,
SBP)
86
OBSTETRICS PGY-3
WEEKLY SCHEDULE
Monday
Tuesday
Wednesday
Thursday
Friday
AM L&D
L&D
L&D
Lecture
PM L&D
L&D
Continuity
Clinic*
L&D
L&D
L&D (or home
post call)
*This is the residents fixed, ½ day continuity clinic.
OBSTETRICS PGY-3
READING SCHEDULE
Obstetrics Normal and Problem Pregnancies 6th edition
Gabbe, Niebyl and Simpson
Chapters 28 – 40
Williams Obstetrics 23 edition
Chapters 41-59
Creasy and Resnik Maternal Fetal Medicine 6th edition
Selected Chapters
87
Obstetrics PGY-4
Goals and Objectives:
The PGY-4 rotation in Obstetrics is two months in length divided over the year. The chief
resident manages the entire service, gaining in the administrative aspect of the obstetric care,
including risk management, case presentation and teaching responsibilities of the lower level
residents. The PGY-4 rotation is two blocks in length divided over the year. The fourth year
resident is assigned to L&D, is also responsible for assisting in the care of in patient ante
partum patients. This resident works under the supervision of the Generalist Obstetrical
faculty assigned to L&D, This resident is responsible for supervising the intern in the
running and management of low risk obstetrical patients, as well as laboring high risk
patients. Additional supervision of the PGY-3 assigned to MFM is also required.
All specific objectives are identical to those for the Obstetrics PGY-3
OBSTETRICS PGY-4
WEEKLY SCHEDULE
Monday
Tuesday
Wednesday
Thursday
Friday
AM L&D
L&D
L&D
Lecture
PM L&D
L&D
Contunity
Clinic*
L&D
L&D
L&D (or home
post call)
*This is the residents fixed, ½ day continuity clinic.
OBSTETRICS PGY-4
READING SCHEDULE
Obstetrics Normal and Problem Pregnancies 6th edition
Gabbe, Niebyl and Simpson
Chapters 28 – 40
Williams Obstetrics 23 edition
Chapters 41-59
Creasy and Resnik Maternal Fetal Medicine 6th edition
Selected Chapters
88
Maternal fetal medicine PGY-3
Goals and Objectives:
The PGY-3 rotation in Maternal Fetal Medicine and Obstetrics is 4 weeks in length. It
occurs three blocks at the PGY-3. This resident, under the supervision of the Obstetrical
Chief resident and the MFM faculty, rounds and manages all in patient antepartum
patients, as designated by the MFM faculty. Additionally, they will round and assist in the
care of MFM consults on private attending service patients. All MFM procedures amniocentesis, PUBS, and cerclages - will be managed by this resident. These residents will
act as the liaison for the MFM patients, and will be responsible for communicating and
implementing plans of care to the obstetrical team. The L&D team will managing any
antepartum patient that needs to be delivered.
A. Describe the general indications for genetically based diagnostics. (PC)
B. Perform or interpret genetic risk assessment through the following: (PC)
1. Pedigree analysis
2. Gene testing
a. Antenatal
b. Adult
C. Describe the sensitivity and specificity of various genetic tests and the implication of
these parameters in clinical practice. (PC)
D. Describe the role of genetics in drug metabolism and individual variation in drug
efficacy. (PC)
E. Describe the factors involved in the development of and recommendations for genetic
testing. (PC)
1. Frequency of the condition in the population.
2. Nature and range of severity of the condition.
3. Treatment, intervention, and/or prevention.
4. Reproductive options to avoid or reduce risk.
5. Test availability including prenatal screening and/or diagnostic testing.
6. Sensitivity, specifi city, and positive predictive value of the test.
7. Genotype-phenotype correlation.
8. Frequency of gene mutation in general population or selective sub-groups based on
ethnicity/race.
9. Cost and cost-effectiveness of screening.
10. Usefulness of test information to individual, to family and to society.
11. Availability of public and professional educational material/programs.
12. Availability of adequate genetic counseling services for follow-up.
13. Potential for uncertainty of tests results.
14. Potential for psychological, emotional, or physical harm to patient.
15. Potential for misuse of information and genetic discrimination.
F. List the types of genetic abnormalities that may result in clinically significant
abnormalities. (MK)
89
1. Deletions
2. Additions
3. Trinucleotide repeats
G. Describe stem cells and potential uses of stem cell
technology.
H. Basic mechanism of genetic inheritance
1. Describe the basic structure and replication of DNA. (MK)
2. Describe the processes of mitosis and meiosis. (MK)
3. Describe common terms associated with genetic expression. (MK)
a. Exon
b. Intron
c. Codon
d. Transcription
e. Translation
4. Describe the clinical significance of karyotype abnormalities, such as: (PC)
a. Trisomy
i. 13
ii. 18
iii. 21
b. Polyploidy
c. Monosomy
d. Sex chromosome abnormalities
e. Deletions
f. Inversions
g. Translocations
h. Mosaicism
i. Chimerism
5. Describe the normal process of gametogenesis. (MK)
6. Describe the normal process of fertilization and the combination of genetic
information. (MK)
I. Clinical implications of heritable disease
1. Describe the clinical significance of heritable diseases, such as cystic fibrosis, TaySachs disease, and hemophilia. (PC)
2. Counsel patients about the techniques for and implications of testing for heritable
diseases. (PC, ICS)
3. Discuss treatment and surveillance options for patients or
newborns with
genetically derived disease. (PC)
J. Genetic counseling
1. Obtain a history for inherited disorders, ethnic- or racespecific risks, and teratogen
exposure. (PC)
2. Describe screening techniques for couples at risk of the following: (MK)
a. Cystic fibrosis
b. Canavan disease
c. Tay–Sachs disease
d. Familial dysautonomia
90
e. Sickle cell disease and other hemoglobinopathies
f. Fragile X syndrome
g. Neural tube defects
3. Describe the concepts of penetrance and variable expression and their effect on
prognosis for a given genetic disorder. (MK, PC)
4. Distinguish between various forms of genetic inheritance: (MK)
a. Mendelian modes to include the following:
(1) Autosomal dominant
(2) Autosomal recessive
(3) X-linked
b. Nonmendelian modes to include the following:
(1) Mitochondrial
(2) Genomic imprinting
(3) Multifactorial and polygenic
(4) Mitochondrial
(5) Hereditary unstable DNA
5. Counsel patients about the manifestations of common genetic disorders. (PC, ICS)
6. Describe the indications for, and limitations of, noninvasive diagnostic tests for fetal
aneuploidy and structural malformations (e.g., ultrasonography, serum analytes, and free
fetal DNA). (PC, SBP)
7. List the genetic disorders often associated with the following ultrasound findings: (PC)
a. Duodenal atresia
b. Omphalocele
c. Nuchal translucency/nuchal skin fold
d. Echogenic bowel
e. Heart defects
f. Diaphragmatic hernia
g. Ventriculomegaly
8. Counsel patients about the risks and benefits of various methods of invasive fetal
testing, such as: (PC, ICS)
a. Chorionic villus sampling
b. Amniocentesis
c. Cordocentesis
d. Pre-implantation genetic testing
9. Order and interpret appropriate maternal and fetal/neonatal tests to evaluate possible
causes of fetal demise. (PC)
10. Counsel a patient with an abnormal fetus regarding management options. (PC, SBP,
ICS)
11. Counsel a patient and her family after adverse pregnancy outcome about such factors
as recurrence, future care, and possible interventions. (PC, SBP, ICS)
12. Counsel a patient and other health care professionals about fetal effects from
exposure to various pharmacologic agents or to indicate diagnostic studies utilizing
ionizing radiation. (PC, ICS)
13. Counsel a patient about the genetic implications of advancing maternal and paternal
age. (PC, ICS)
K. Uses for umbilical cord stem cells
1. Describe the indications and uses for umbilical cord stem cells. (PC, MK, ICS)
91
2. Counsel patients on the advantages and disadvantages of umbilical cord blood banking.
(PC, MK, ICS)
92
MFM PGY-3
WEEKLY SCHEDULE
Monday
Tuesday
Wednesday
Thursday
Friday
RPC
RPC
RPC
RPC
Rounds/Lecture
RPC
RPC
RPC
Continuity
Clinic
L&D/Clinic or
home post call
MFM PGY-3
READING SCHEDULE
Obstetrics Normal and Problem Pregnancies 6th edition
Gabbe, Niebyl and Simpson
Chapters 28 – 40
Williams Obstetrics 23 edition
Chapters 41-59
TeLinds Operative Gynecology 10th edition
Rock and Jones
Chapter 35
Creasy and Resnik Maternal Fetal Medicine 6th edition
Selected Chapters
93
Maternal fetal medicine PGY-4
The PGY-4 rotation in Maternal Fetal Medicine and Obstetrics is 4 weeks in length. It
occurs three blocks at the PGY-4 level. The chief resident manages the entire service, gaining
in the administrative aspect of the obstetric care, including risk management, case
presentation and teaching responsibilities of the lower level residents. The chief resident is
ultimately responsible for the lower level residents seeing patients in clinic, L&D, as well as
on the antepartum and postpartum services. Under the supervision of the Maternal Fetal
Medicine faculty, they will round and assist in the care of MFM consults on private
attending, as well as resident service patients. All MFM procedures-amino, PUBS, cerclages
will be managed by this resident. These residents will act as the liaison for the MFM patients,
and will be responsible for communicating and implementing plans of care to the obstetrical
team. .
All specific objectives are identical to those for the MFM PGY-3 rotation
MFM PGY-4
WEEKLY SCHEDULE
Monday
Tuesday
Wednesday
Thursday
Friday
RPC
RPC
RPC
RPC
Rounds/Lecture
RPC
RPC
RPC
Continuity
Clinic
L&D/Clinic
(Home if post
call)
MFM PGY-4
READING SCHEDULE
Obstetrics Normal and Problem Pregnancies 6th edition
Gabbe, Niebyl and Simpson
Chapters 28 – 40
Williams Obstetrics 23 edition
Chapters 41-59
TeLinds Operative Gynecology 10th edition
Rock and Jones
Chapter 35
Creasy and Resnik Maternal Fetal Medicine 6th edition
Selected Chapters
94
OBSTERICAL PROCEDURE COMPETENCIES
Procedure
Level of Training
Antepartum
Amniocentesis
2nd trimester-genetic dx
3rd trimester-asst. of
fetal lung maturity
Cervical cerclage
Transabdominal
Transvaginal
Chorionic villus sampling
Cordocentesis
Fetal assessment, antepartum
Biophysical profile
Contraction stress test
Nonstress test
Vibroacoustic stimulation
Intrauterine transfusion
Ultrasound examination
Abdominal and endovaginal
Abdominal ultrasonography,
targeted examination
Cervical length
Color Doppler ultrasonography
Three-dimensional ultrasonography
Doppler velocimetry
Version of breech, external
Intrapartum
Amnioinfusion
Amniotomy
Anesthetic/analgesic procedures
Administration of parenteral
analgesics/sedatives
Administration of narcotics
Epidural anesthesia
General anesthesia
Pudendal block
Spinal anesthesia
B-Lynch suture placement
Cesarean delivery
Classical
Low transverse
Low vertical
Cesarean hysterectomy
Curettage for adherent placenta
R2
Understanding
Understanding
and Perform
X
R2
X
R4
R3
X
R3
R3
X
X
X
R1
R1
R1
R1
R3
X
X
X
X
X
R1
X
R2
R3
R3
R4
R4
R3
X
X
X
X
X
X
R1
R1
X
X
R1
R1
R1
R1
R2
R1
R3
X
X
X
X
X
X
X
R2
R1
R1
R3
R2
X
X
X
X
X
95
Procedure
Level of Training
Dilation and evacuation for secondtrimester fetal death
Episiotomy and repair
Fetal assessment, intrapartum
Fetal heart rate monitoring
Fetal scalp pH determination
Fetal scalp stimulation test
Vibroacoustic stimulation test
Forceps delivery
Outlet
Low
Hypogastric artery ligation
Induction of labor
Manual removal of the placenta
Shoulder dystocia maneuvers
Skin incision
Vertical
Transverse
Suction evacuation for the firsttrimester fetal death
Uterine artery embolization
Uterine artery ligation
Uterine tamponade
Vacum extraction
Outlet
Low
Vaginal delivery, breech
R3
Vaginal delivery, spontaneous
Vaginal delivery, twins
Postpartum
Circumcision, neonatal (with
anesthesia)
Hematoma evacuation
Intraabdominal
Vulvar
Vaginal
Neonatal resuscitation, immediate R1
Repair of genital tract laceration
Cervical
R3
Perineal (second, third, and
fourth degree lacerations)R3
Vaginal
Sterilization
Wound Care
Debridement
Incision and drainage of
abscess or hematoma R3
Repair of dehiscence
Understanding
R3
R1
Understanding
and Perform
X
X
R1
R1
R1
R1
X
X
X
X
R3
R3
R3
R1
R1
R2
X
X
X
X
X
X
R2
R1
X
X
R1
R2
R3
R3
X
X
X
X
R1
R2
X
X
X
R1
R3
X
X
R1
X
R2
R3
R3
X
X
X
X
X
X
R1
R2
X
X
R2
X
X
R3
X
96
Procedure
Wound Care
Secondary closure
Level of Training
R3
Understanding
Understanding
and Perform
X
97
GYNECOLOGY ROTATION
The practice of gynecology includes both surgical and nonsurgical treatment of disorders of
the female reproductive tract. Once primarily a surgical specialty, as a result of advances in
therapeutic and diagnostic techniques, gynecology has increasingly become more officebased. In addition to primary office care, the gynecologist often cares for patients with more
specialized needs, including those of patients with endocrinologic disorders, infertility and
pregnancy loss, urologic disorders, cancer of the reproductive tract, and conditions requiring
acute and critical care. In acquiring skills and
knowledge in the general discipline of obstetrics and gynecology, residents should assimilate
diagnostic and therapeutic principles underlying a broader spectrum of medical and surgical
disorders. Once in clinical practice, the gynecologist often remains the primary health care
provider for patients who have been treated by subspecialists or by physicians outside the
specialty of obstetrics and gynecology.
Genomics
The rapid growth and clinical adaptation of genetically based information
and technology are fundamentally changing the practice of medicine generally
and obstetrics and gynecology specifically.
Therefore, it is felt important to introduce and encourage understanding in the following
areas of genetics with regards to Gynecology across all four years of training:
A. Basic mechanism of genetic inheritance
1. Describe the inheritance of hemoglobinopathies. (MK)
2. Summarize the genetic basis for hereditary cancer syndromes, such as the following in
women: (MK)
a. Breast cancer
b. Colon cancer
c. Ovarian cancer
d. Endometrial cancer
3. Describe the implications of the integration of viral genetic information into normal
cervical cells. (MK)
B. Clinical implications of genetic inheritance
1. Describe the role of genetics in the following: (MK)
a. Spontaneous abortion, including the incidence and types of chromosome
abnormalities in abortuses
b. Recurrent abortion
c. Uterine leiomyomas
98
Gynecology PGY-1
Goals and Objectives:
This PGY-1 rotation is 3 months divided over the year. Under the supervision of a chief
resident and faculty, the PGY-1 resident evaluates patients preoperatively and
postoperatively for primarily basic out-patient or minor surgical procedures.
A .Physiology (MK)
1. Describe the hemodynamic changes associated with blood loss.
2. Summarize the changes that occur in the cardiopulmonary function of an anesthetized
and postanesthetic patient.
3. Describe the physiology of wound healing.
4. Describe the physiology of blood pressure maintenance and abnormalities of blood
pressure.
5. Describe the physiologic changes related to the maintenance of adequate urine output.
6. Describe the physiology of thermoregulation in the anesthetized
and postanesthetic patient.
B. Embryology and developmental biology (MK)
See Reproductive endocrinology and infertility, E. Embryology and developmental biology.
C.Anatomy (MK)
See Gynecologic oncology PGY-3, D. Anatomy
D. Pathology and neoplasia (MK)
1. Summarize the pathogenesis and epidemiology of the common nonmalignant
neoplasms that affect the external and internal genitalia.
2. Describe the histology of the common non-malignant neoplasms that affect the
external and internal genitalia.
E. Microbiology and immunology (MK)
1. Describe the normal bacteriologic flora of the lower genital tract.
2. Describe the microbiologic principles germane to the diagnosis and treatment of
gynecologic infectious diseases.
3. Describe the epidemiologic principles involved in the spread of infectious diseases in
both patients and health care workers, including transmission and prevention of human
immunodeficiency virus (HIV) and hepatitis.
4. Discuss the immunologic response to infection.
F. Abnormal uterine bleeding
1. Describe the principal causes of abnormal uterine bleeding and the International
Federation of Gynecology and Obstetrics (FIGO) classification system. (MK)
2. Obtain a pertinent history to evaluate abnormal uterine bleeding. (PC)
3. Peform a focused physical examination to investigate the etiology of abnormal uterine
bleeding.
4. Perform and interpret the results of selected diagnostic tests to determine the cause of
abnormal uterine bleeding, such as the following: (PC)
a. Endometrial biopsy
99
b. Pelvic ultrasonography/saline infusion ultrasonography
c. Hysteroscopy
d. Laparoscopy
5. Interpret the results of other diagnostic tests, such as: (PC)
a. Serum/urine human chorionic gonadotropin (hCG) assay
b. Endocrinologic assays
c. Microbiologic cultures of the genital tract
d. Complete blood count
e. Coagulation profile
6. Treat abnormal uterine bleeding using both nonsurgical and surgical methods. (PC)
7. Recommend appropriate follow-up that is necessary for a patient with abnormal
uterine bleeding. (PC)
G. Vaginal and vulvar infections
1. Describe the principal infections that affect the vulva and vagina. (MK)
2. Obtain a pertinent history in a patient with a possible infection of the vulva or vagina.
(PC)
3. Perform a focused physical examination. (PC)
4. Perform and interpret the results of selected tests to confirm the diagnosis of vulvar or
vaginal infection, such as the following: (PC, MK)
a. Vaginal pH
b. Saline microscopy
c. Potassium hydroxide microscopy
d. Bacterial, fungal and viral culture
e. Colposcopic examination
f. Vulvar or vaginal biopsy
5. Treat vulvar and vaginal infections. (PC)
6. Describe the follow-up that is necessary for a patient with a vulvar or vaginal
infection, for example: (PC, P, SBP,ICS).
a. Assessing and treating sexual partner(s)
b. Requirements for reporting a communicable disease
c. Assessing the patient for other possible genital tract infections
d. Counseling the patient with respect to measures that prevent reinfection
H. Sexually transmitted diseases
1. Describe the most common STIs, including causes, symptoms, and risk of
transmission, such as the following: (MK)
a. Chlamydia
b. Gonorrhea
c. Syphilis
d. Hepatitis B and hepatitis C
e. Human immunodeficiency virus (HIV)
f. Herpes simplex
g. Human papillomavirus
h. Chancroid
2. Obtain a pertinent history in a patient with a suspected STI. (PC)
3. Perform a focused physical examination in a patient with a suspected STI. (PC)
4. Perform and/or interpret results of specific tests to confirm the diagnosis of an STI,
such as the following: (PC)
100
a. Bacterial and/or viral culture
b. Endocervical aspirate for Gram stain
c. Endocervical swab for nucleic acid detection
d. Endocervical culture
e. Cervical or vaginal cytologic screening (Pap test) and HPV testing
f. Scraping of an ulcer or chancre
g. Serologic assays
h. Tzanck smear
5. Treat STIs with appropriate antimicrobial and antiviral agents. (PC)
6. Describe the long-term follow-up for patients with a STI, including assessment of the
patient’s sexual partner, discussion of preventive measures, and review of serious
sequelae, such as: (PC, ICS, P, SBP)
a. Infertility
b. Ectopic pregnancy
c. Chronic pelvic pain
d. Pelvic inflammatory disease (PID)
e. Cervical dysplasia, neoplasiaI. Spontaneous abortion
1. Describe the principal causes of, or predisposing factors for, spontaneous firsttrimester abortion. (MK)
2. Describe the differential diagnosis of early spontaneous abortion.(MK)
3. Describe the usual symptoms and findings experienced by a patient with an early
pregnancy loss. (MK)
4. Perform a focused physical examination to confirm the diagnosis of and classification
of spontaneous abortion. (PC)
5. Perform and/or interpret the results of selected tests used in the diagnosis and
management of early pregnancy loss: (PC)
a. Quantitative serum hCG titer
b. Ultrasonography (abdominal and endovaginal)
c. Serum progesterone
d. Complete blood count
6. Treat a patient with an early spontaneous abortion, using nonsurgical or surgical
methods. (PC)
7. Describe and treat the complications that may develop as a result of treatment of a
spontaneous abortion, for example:(PC)
a. Genital tract infection
b. Uterine perforation
c. Retained products of conception
8. Describe the indications for anti-D immune globulin in patients experiencing a
spontaneous abortion. (MK)
9. Counsel patients regarding future fertility issues and risk of recurrent pregnancy losses
depending on the etiology (PC,ICS, P)
10. Summarize signs and symptoms, diagnosis, treatment, and potential sequelae for
septic abortion. (MK)
H. Pelvic inflammatory disease
1. Describe the diagnostic criteria for PID. (MK)
2. List the common pathogens implicated in PID. (MK)
3. Obtain a pertinent history from a patient suspected to have PID. (PC)
4. Perform a physical examination to confirm the diagnosis of PID. (PC)
101
5. Describe the appropriate diagnostic tests to confirm PID, including indications for the
tests, and how to perform and/or interpret the results: (PC)
a. Endocervical swab for culture or nucleic acid detection
b. Endometrial biopsy
c. Imaging studies
d. Laparoscopy
6. Treat PID with appropriate antimicrobial and surgical options. (PC)
7. Summarize the potential long-term effects and counsel patients regarding risks of
further complications, including the following: (PC, ICS, P)
a. Chronic pelvic pain
b. Infertility
c. Ectopic pregnancy
102
GYNECOLOGY PGY-1
WEEKLY SCHEDULE
Monday
Tuesday
Wednesday
Thursday
Friday
AM OR
OR
OR
OR
Lecture
PM OR
OR
OR
OR
Clinic
GYNECOLOGY PGY-1
READING SCHEDULE
Comprehensive Gynecology 6th edition
Lentz, Lobo, Gershenson, Katz
Chapters 1 – 19,23, 24, 25
*Continuity Clinics are scheduled for one full day per week. It is a fixed day, and the
resident will miss their scheduled rotation to participate in this ACGME required
clinic. See the Primary Care rotation/Continuity Clinic rotation for the schedule.
103
Gynecology PGY-2
Goals and Objectives:
This PGY-2 rotation is 4 months divided over the year. Under the supervision of the chief
resident and the faculty, the PGY-2 resident begins to evaluate surgical candidates patients
pre-operatively, and learn post-operative care.
A. Pharmacology (MK)
1. Describe the general principles of drug delivery, distribution, metabolism, and
excretion.
2. Summarize the pharmacology of medications used in the treatment of common
gynecologic disorders.
3. Explain the pharmacologic principles of drug therapy in prepubertal girls, women of
reproductive age, and elderly patients.
4. Describe the components of commonly used contraceptive agents and their mechanism
of action.
B. Embryology and developmental biology (MK)
See Reproductive endocrinology and infertility, E. Embryology and developmental biology.
C. Anatomy (MK)
See Gynecologic oncology PGY-3, D. Anatomy
D. Vulvar dystrophies, dermatoses and vulvar pain syndromes
1. Describe the principal types of vulvar dystrophies and dermatoses, such as the
following: (MK)
a. Squamous cell hyperplasia
b. Lichen sclerosus
c. Lichen planus
d. Lichen simplex chronicus
e. Atrophic dermatitis
f. Vulvar vestibulitis and vulvodynia
2. Obtain a pertinent history in a patient with a suspected vulvar dystrophy, dermatosis or
vulvar pain syndrome. (PC)
3. Perform a focused physical examination in a patient with a suspected vulvar dystrophy,
dermatosis or vulvar pain syndrome. (PC)
4. Perform and/or interpret the results of selected diagnostic tests to confirm the diagnosis
of a vulvar dystrophy or dermatosis, for example: (PC, MK)
a. Colposcopy
b. Staining with dyes to localize the affected area
c. Vulvar biopsy
5. Treat common vulvar dystrophies dermatoses and vulvar pair syndromes medically
and surgically. (PC)
6. Describe follow-up for a patient with a vulvar dystrophy or dermatosis, including the
risk, if present, for malignant change. (PC)
E. Urinary tract disorders (infection, nephrolithiasis)
104
1. Distinguish the types of urinary tract infection, including bacteruria, urethritis, cystitis,
and pyelonephritis. (MK)
2. Describe the pathophysiology related to urinary tract infection, including the
organisms commonly implicated in lower and upper urinary tract disorders, and host
factors, such as urinary retention, age, and pregnancy. (MK)
3. Describe the pathophysiology of the common forms of nephrolithiasis, including
patient risk factors for the development of nephrolithiasis. (MK)
4. Describe typical clinical presentations, and obtain a pertinent history, in a patient with
a possible urinary tract infection or nephrolithiasis. (PC)
5. Describe the diagnostic methods and diagnostic criteria for the various types of urinary
tract infections. (MK)
6. Summarize the methods used for the diagnosis of nephrolithiasis.(MK)
7. Describe modes of therapy for acute, chronic, and complicated urinary tract infections,
including prophylaxis for recurrent infection. (MK, PC)
8. Summarize therapeutic options for nephrolithiasis, and strategies to prevent recurrence.
(MK, PC)
F. Chronic pelvic pain
1. Define chronic pelvic pain. (MK)
2. Outline the principal gynecologic and nongynecologic causes of chronic pelvic pain,
and describe the pathophysiology of each cause. (MK)
3. Obtain a pertinent, detailed medical, menstrual, and sexual history to characterize the
patient’s chronic pelvic pain, including signs/symptoms emanating from nonreproductive organs. (PC)
4. Obtain an appropriate social and mental health history in a patient with chronic pelvic
pain. (PC)
5. Perform a focused physical examination, including attempts to localize the pain and an
evaluation of neurologic and musculoskeletal components. (PC)
6. Perform and/or interpret the results of the following selected diagnostic tests to
determine the cause of chronic pelvic pain: (PC, ICS)
a. Microbiologic cultures of the genitourinary tract
b. Radiologic imaging studies
c. Hysteroscopy
d. Laparoscopy
e. Injection of anesthetic agent at a specific trigger point.
f. Mental health examination, including screening for depression or dysphoria.
7. Treat patients with chronic pelvic pain, using nonsurgical and surgical methods. (PC)
8. Summarize indications and approximate success rates for interventions for chronic
pelvic pain, such as laparoscopy, presacral neurectomy, uterosacral nerve ablation,
adhesiolysis, and extirpative procedures. (MK, PC)
9. Describe the indications for referral of a patient to a specialist in urology or
gastroenterology. (PC, SBP)
10. Describe the indications for referral to a multidisciplinary group, including pain
management specialists and behavioral and/or mental health. (PC, SBP)
11. Describe the appropriate long-term goals and follow-up for a patient with chronic
pelvic pain. (PC, SBP, P)
G. Endometriosis and adenomyosis
1. Summarize the theories of the pathogenesis of endometriosis. (MK)
105
2. Describe the typical history of a patient with endometriosis and adenomyosis. (MK)
3. Perform a focused physical examination in a patient with suspected endometriosis or
adenomyosis and identify the principal abnormal clinical findings. (PC)
4. Perform and interpret the results of selected tests to confirm the diagnosis of
endometriosis and adenomyosis. (PC)
5. Describe various features of endometriosis on visual inspection with laparoscopy or
laparotomy. Compare the sensitivity of visual inspection with biopsy in diagnosing
endometriosis. (MK)
6. Describe the staging system for endometriosis according to the American Society for
Reproductive Medicine Classification of Endometriosis. (MK)
7. Describe the medical and surgical treatment of endometriosis. (PC)
8. Describe the appropriate long-term follow-up and outcome in patients who have
endometriosis, including infertility. (MK, PC)
H. Ectopic pregnancy
1. Describe the major factors that predispose to ectopic pregnancy. (MK)
2. Obtain a pertinent history in a patient with a suspected ectopic pregnancy. (PC)
3. Perform a focused physical examination in a patient with suspected ectopic pregnancy.
(PC)
4. Describe the differential diagnosis of ectopic pregnancy. (MK)
5. Perform and interpret the results of tests to confirm the diagnosis of ectopic pregnancy,
such as: (PC)
a. Endovaginal ultrasonography
b. Uterine curettage or aspiration
c. Laparoscopy
6. Interpret the results of other diagnostic tests, such as: (PC)
a. Quantitative serum hCG titer
b. Complete blood count
7. Describe the indications and contraindications for, and complications of, medical and
surgical management of an ectopic pregnancy. (PC)
8. Counsel a patient about the risks and effectiveness of medical and surgical therapy
for ectopic pregnancy.
9. Treat an affected patient using appropriate nonsurgical or surgical methods. (PC)
10. Describe the indications for anti-D immune globulin in patients with an ectopic
pregnancy. (MK)
11. Describe the follow-up that is indicated for a patient treated for an ectopic pregnancy.
(PC, ICS)
12. Counsel patients about the recurrence risk for an ectopic pregnancy and prognosis for
a normal intrauterine pregnancy. (PC, ICS, P)
106
GYNECOLOGY PGY-2
WEEKLY SCHEDULE
Monday
Tuesday
Wednesday
Thursday
Friday
AM OR
OR
OR
OR
Lecture
PM OR
OR
OR
OR
Clinic/HP Clinic
*Continuity Clinics are scheduled for one full day per week. It is a fixed day, and the
resident will miss their scheduled rotation to participate in this ACGME required
clinic. See the Primary Care rotation/Continuity Clinic rotation for the schedule.
GYNECOLOGY PGY-2
READING SCHEDULE
Comprehensive Gynecology 6th edition
Lentz, Lobo, Gershenson, Katz
Chapters 20,21,22, 24, 25
TeLinds Operative Gynecology 10th edition
Rock and Jones
Chapters 7,10,14,15,16,17,18,19, 32,33,34
107
Gynecology PGY-3
Goals and Objectives:
This PGY-3 rotation is 3 months divided over the year. This PGY-3 is assigned primarily to
the OR, and develops greater experience in the running and operations of the gynecologic
service. Under the supervision of the Chief Resident and the Faculty they will refine their
learning the principles of abdominal and vaginal surgery.
A. Basic mechanism of genetic inheritance
1. Describe the inheritance of hemoglobinopathies. (MK)
2. Summarize the genetic basis for hereditary cancer syndromes in women such as: (MK)
a. Breast cancer
b. Colon cancer
c. Ovarian cancer
d. Endometrial cancer
3. Describe the implications of the integration of viral genetic information into normal
cervical cells. (MK)
B. Clinical implications of genetic inheritance
1. Describe the role of genetics in the following: (MK)
a. Spontaneous abortion
b. Recurrent abortion
c. Uterine leiomyomata
C. Anatomy (MK)
See Gynecologic oncology PGY-3, D. Anatomy
D. Urogynecology (urinary incontinence and pelvic support defects)
1. Normal anatomy and general considerations
a. Explain the normal anatomic supports of the vagina, rectum, bladder, urethra,
and uterus (or vaginal cuff in the setting of prior hysterectomy), including the
bony pelvis, pelvic floor nerves and musculature, and connective tissue. (MK)
b. Describe the static and dynamic interrelationships and function of the pelvic
organs and support mechanisms. (MK)
c. Describe the principal etiologies of pelvic support defects, urinary
incontinence, and fecal incontinence. (MK)
d. Summarize the potential psychological, social, and sexual consequences of
urogynecologic disorders. (MK)
e. Describe the symptoms that may be experienced by a patient with pelvic
support defects, urinary incontinence, or fecal incontinence. (MK)
f. Obtain a pertinent history in a patient with a suspected pelvic
support defect, urinary incontinence, or fecal incontinence. (PC)
2. Pelvic support defects
a. Identify the anatomic defects associated with various aspects of pelvic support
disorders. (MK)
b. Perform a focused physical examination to identify and characterize specific
pelvic support defects, including the following: (PC)
(1) Anterior compartment
108
(2) Urethral hypermobility
(3) Posterior compartment
(4) Apical compartment (cervix/uterus or vaginal cuff)
c. Summarize and counsel patients regarding risks, benefits, and expected
outcomes of surgical and nonsurgical approaches to the management of pelvic
support disorders. (PC, ICS, P)
d. Treat urogynecologic disorders by both nonsurgical (eg, pelvic floor exercise
regimens, physical therapy, and pessary) and surgical methods. (PC)
e. Describe the types of injuries or complications that may occur related to
medical and surgical treatments of pelvic floor disorders and the approaches to
managing them. (PC)
f. Describe appropriate follow-up for a patient who has been treated for a pelvic
floor disorder. (PC, SBP, ICS)
3. Continence and incontinence
a. Summarize the normal function of the lower urinary tract during the filling and
voiding phases and the mechanisms responsible for urinary continence. (MK)
b. Characterize the major types of urinary incontinence. (MK)
c. Perform a focused physical examination in a patient with urinary and/or fecal
incontinence, including assessment of the following: (PC)
(1) Bladder and urethral support
(2) Perineal, levator, and anal sphincter strength
(3) Neurologic status
d. Perform and interpret the results of the following selected
tests to characterize urinary incontinence disorders: (PC)
(1) Urinalysis
(2) Urine culture
(3) Assessment of residual urine volume
(4) Simple cystometry
(5) Swab test
e. Describe the indications for and the implications of the results of other
diagnostic tests, such as the following: (PC)
(1) Cystourethroscopy
(2) Multichannel cystometry
(3) Urethral profilometry
(4) Uroflowmetry
(5) Radiologic tests
(6) Electromyography
(7) Assessment of anal sphincter integrity (eg, manometry, radiologic
imaging studies, and neurologic testing)
f. Summarize and counsel patients regarding risks, benefits, and expected
outcomes of surgical and nonsurgical approaches to the management of
incontinence disorders. (PC, ICS, P)
g. Treat incontinence disorders by both nonsurgical (eg, pelvic floor exercise
regimens, physical therapy, and pessary) and surgical methods. (PC)
h. Describe the types of injuries or complications that may occur related to
medical and surgical treatments of incontinence disorders and the approaches to
managing them. (PC)
i. Describe appropriate follow-up for a patient who has been treated for
incontinence. (PC, SBP, ICS)
109
4. Other urogynecologic conditions
a. Describe abnormal urethral conditions, including urethral syndrome, urethritis,
and diverticulitis. (MK)
b. Describe the possible etiologies, diagnostic strategies, and treatment
approaches for interstitial cystitis. (MK, SBP)
c. Describe the various types of urinary voiding disorders and their possible
etiologies, including medical and surgical causes. (MK)
d. Describe the etiologies, prevention, diagnostic techniques, and approaches to
repairing various fistulae that may involve the pelvic organs. (MK)
E. Pelvic masses
1. Describe the major causes of pelvic masses, including nongynecologic sources and
those arising from the female genital tract, such as: (MK)
a. Uterine fibroids
b. Adnexal cystic and solid masses
c. Tuboovarian abscess
d. Adnexal torsion
e. Ovarian cysts/benign neoplasms
f. Diverticulitis
g. Appendicitis
2. Obtain a pertinent history suggestive of a pelvic mass, such as: (PC)
a. Weight loss or weight gain
b. Gastrointestinal symptoms
c. Menstrual abnormalities
d. Pelvic pain or pressure
3. Perform a focused physical examination to confirm the diagnosis of a pelvic mass.
(MK)
4. Perform and/or interpret tests such as endovaginal or abdominal ultrasonography to
confirm the diagnosis of a pelvic mass. (PC)
5. Interpret the results of other tests, such as MRI or tomographic imaging, in the
evaluation of a pelvic mass. (PC, SBP)
6. Discuss the role of serum markers in the evaluation and monitoring of a patient with a
pelvic mass. (MK)
7. Treat benign pelvic masses, using nonsurgical or surgical methods, considering such
factors as the patient’s: (MK)
a. Age
b. General health
c. Treatment preference
d. Desire for future childbearing
e. Symptom complex
8. Describe the appropriate follow-up for patients who have been treated for a benign
pelvic mass. (PC, SBP)
F. Benign disorders of the breast
1. Describe the clinical history and principal pathophysiologic conditions that affect the
breast, such as: (MK, PC)
a. Breast mass
b. Nipple discharge
c. Pain
110
d. Infection (mastitis)
e. Asymmetry
f. Excessive size
g. Underdevelopment
2. Perform a focused physical examination to evaluate for an abnormality of the breast.
(PC)
3. Describe the indications for the following procedures to assess breast disorders. Be
able to perform and/or interpret the indications for and results of each of them: (PC)
a. Needle aspiration of a cyst or abscess
b. Collection of nipple discharge for cytologic examination and/or culture
c. Fine needle aspiration of a mass
d. Needle localization biopsy
e. Excisional biopsy
f. Mammography
g. Ultrasonography
h. MRI
G. Preoperative care
1. Conduct detailed preoperative assessment with consideration given to the needs of
special patient groups, such as: (PC, ICS, P, SBP)
a. Children and adolescents
b. The elderly
c. Patients with coexisting medical conditions, such as cardiopulmonary
disease or coagulation disorders
d. Non-English speaking patients
2. Describe indications for and perform appropriate preoperative evaluation and/or
referral, including laboratory tests, radiographic imaging, and EKG. (PC, SBP)
3. Be able to obtain informed consent, with special regard to: (PC, ICS, P)
a. Alternatives to surgery
b. Alternative surgical procedures
c. Interopartive complications
d. Indications for transfusion
4. Compose appropriate preoperative preparation plans for patients undergoing
gynecologic surgery, including antibiotic and thromboembolic prophylaxis and
appropriate preoperative anesthesia consultation. (MK, PC)
H. Postoperative care
1. Choose appropriate pain control based on the surgical procedure, degree of patient
discomfort, and patient characteristics, including age and presence of coexisting
morbidities. (MK, PC)
2. Obtain an appropriate history, perform a physical examination, perform and/or
interpret appropriate tests, and manage common postoperative complications, such as:
(PC)
a. Fever
b. Gastrointestinal ileus/obstruction
c. Infection
d. Wound complications
e. Fluid or electrolyte imbalances, including abnormalities of urinary output
f. Respiratory problems
111
g. Thromboembolism
h. Injury to urinary or gastrointestinal tract
3. Manage and counsel patients about normal postoperative recovery. Include the
following topics: (PC, ICS, SBP)
a. Advancement of diet and return to normal dietary and bowel function
b. Ambulation
c. Management of urethral catheterization and return to normal urinary function
d. Thromboembolism prophylaxis
e. Wound care
f. Return to normal activity levels and/or appropriate restrictions, including
sexual activity
g. Surgical menopause
h. Postoperative pain management
4. Arrange for appropriate post hospitalization care, including visiting nurse, physical
therapy, social services, and other resources to optimize patient outcomes. (SBP)
112
GYNECOLOGY PGY-3
WEEKLY SCHEDULE
Monday
Tuesday
Wednesday
Thursday
Friday
AM*
Continuity
Clinic/OR
Continuity
Clinic/OR
OR
OR
OR
Lecture
OR
OR
OR
Pre Op
Conference
H&P’s
*Continuity Clinics are scheduled for one half day per week. The resident will miss
their scheduled rotation to participate in this ACGME required clinic. In the GYN 3
rotation, it flips between Monday am and Monday pm with the GYN 4. This clinic is
cancelled if one resident is on vacation.
GYNECOLOGY PGY-3
READING SCHEDULE
TeLinds Operative Gynecology 10th edition
Rock and Jones
Chapters 7, 8, 9, 23-32, 35, 36-40
113
Gynecology PGY-4
Goals and Objectives:
This PGY-4 rotation is 4 months divided over the year. The PGY-4 is assigned primarily to
the OR, and develops greater experience in the running and operations of the gynecologic
service. They are responsible for all inpatient and outpatient gynecologic patients under the
resident’s service, including consults. They delegate and supervise their more junior
residents, as well as coordinate care with the service attendings.
A. Anatomy (MK)
See Gynecologic oncology PGY-3, D. Anatomy
B. Intraoperative care
1. Understand the importance of patient safety measures in the operating room, including
a surgical time out. (ICS, SBP)
2. Describe the options for intraoperative pain control, including the risks and benefits of
each method. (MK)
3. Choose appropriate suture and surgical instruments as dictated by the procedure. (MK,
PC)
4. Be able to properly position the patient for the procedure and understand the
consequences of improper positioning. (PC)
5. Understand and demonstrate the incisions and instruments used for abdominal entry in
laparoscopy and laparotomy, including Cherney, Maylard, Midline, Paramedian, and
Pfannenstiel. (MK, PC)
6. Demonstrate the proper use of retractors and understand the consequences of improper
use. (MK, PC)
7. Name and be able to properly use surgical instruments. (MK, PC)
8. Describe the various electrosurgical sources, indications, alternatives, and
complications of each. (MK, PC)
9. Recognize common intraoperative complications associated with gynecologic
procedures and describe the appropriate management of each. (MK, PC)
C. Necrotizing fasciitis and toxic shock syndrome
1. Describe the pathogenesis and microbiology of necrotizing fasciitis and toxic shock
syndrome (TSS). (MK)
2. Describe the typical signs and symptoms of a patient with necrotizing fasciitis and TSS
and distinguish signs/symptoms according to the infectious agent. (PC)
3. Perform a focused physical examination to confirm the diagnosis of necrotizing
fasciitis and TSS, and assess the severity of the patient’s illness. (PC)
4. Interpret the results of diagnostic tests to evaluate necrotizing fasciitis and TSS. (PC)
5. Describe the principles of treatment of necrotizing fasciitis and TSS, and the possible
need for consultation with a critical care or infectious disease specialist. (PC, SBP)
D. Septic shock
1. Explain the pathophysiology of septic shock. (MK)
2. Describe the usual causes of septic shock in obstetric and gynecologic patients. (MK)
3. Describe the typical symptoms experienced by a patient with septic shock. (MK, PC)
114
4. Perform a focused physical examination to confirm the diagnosis of septic shock,
attempt to determine the etiology of the disorder, and assess the severity of the patient’s
illness. (PC)
5. Describe indications for, and interpret the results of, the following diagnostic
tests: (MK, PC)
a. Microbiologic cultures
b. Serum evaluation of complete blood count
c. Liver and renal function tests
d. Coagulation profile
e. Arterial blood gases
f. Appropriate radiologic testing
g. Central hemodynamic monitoring
6. Describe the principles of management of septic shock, including antimicrobial and
supportive therapy. (MK, PC)
7. Manage a patient with septic shock, consulting an appropriate specialist as needed.
(PC, SBP)
E. Adult respiratory distress syndrome
1. Identify the principal causes of adult respiratory distress syndrome (ARDS). (MK)
2. Explain the pathophysiology of ARDS depending on the etiology. (MK)
3. Describe the usual signs and symptoms manifested by a patient with ARDS. (MK, PC)
4. Perform a focused physical examination to aid in the diagnosis of ARDS and assess the
severity of the condition. (PC)
5. Interpret the results of diagnostic tests such as: (PC)
a. Chest x-ray
b. Pulse oximetry
c. Arterial blood gases
d. Pulmonary function tests
e. Central hemodynamic monitoring
6. Describe the principles of treatment of ARDS. (PC)
7. Manage a patient with ARDS, consulting an appropriate specialist as needed. (PC,
SBP, ICS)
F. Hemodynamic assessment
1. Describe the conditions most likely to cause cardiovascular dysfunction in obstetric
and gynecologic patients. (MK)
2. Perform a focused physical examination to detect signs of hemodynamic
derangements, such as: (PC)
a. Hypotension or hypertension
b. Bradycardia or tachycardia
c. Apnea or tachypnea
d. Signs of poor tissue perfusion (e.g., oliguria, delayed capillary refill)
e. ARDS
f. Myocardial failure
g. Altered mental status
3. Explain the indications for central hemodynamic monitoring (right heart
catheterization). (MK, PC)
115
4. Interpret the results of central hemodynamic monitoring and describe management of
patients in whom central monitoring is being performed based on hemodynamic
parameter obtained. (MK, PC)
5. Describe the complications of central hemodynamic monitoring and consult with an
appropriate specialist, as needed, when managing those complications. (MK, PC, SBP)
G. Cardiopulmonary resuscitation
1. Perform a rapid, focused physical examination to identify the patient who requires
cardiopulmonary resuscitation and attempt to determine the cause of the patient’s
decompensation. (MK, PC)
2. Perform basic cardiac life support as per American Heart Association guidelines. (MK,
PC)
3. Describe the principles of Advanced Cardiac Life Support (ACLS), and in conjunction
with an ACLS team, participate in the performance of ACLS according to American
Heart Association guidelines. (MK)
H. Allergic drug reactions
1. List the drugs most likely to produce allergic reactions in obstetric and gynecologic
patients. (MK)
2. Describe the typical symptoms associated with a drug reaction. (MK)
3. Describe the varying degrees of severity of a drug reaction, including anaphylaxis.
(MK)
4. Perform a focused physical examination to confirm the diagnosis of a drug reaction
and assess the severity of the reaction. (PC)
5. Describe the differential diagnosis of a drug reaction. (MK)
6. Describe the principles of treatment of a drug reaction. Manage a patient with a drug
reaction, in consultation with an appropriate specialist, as needed. (MK, PC, SBP)
I. Acute blood loss
1. Describe the pathophysiology of acute blood loss.
2. Describe the laboratory evaluation of acute blood loss, including:
a. Complete blood count
b. Evaluation of coagulopathy
c. Electrolyte evaluation
d. Evaluation of acute renal failure
3. Describe the treatment of acute blood loss, including:
a. Fluid and electrolyte replacement
b. Blood transfusion
c. Correction of coagulopathies
d. Medical, mechanical, and surgical treatment options
J. Surgical Care of the Geriatric Patient
1. Explain surgical options for a given indication in a geriatric patient, accounting for the
patient’s medical condition and functional status. (MK, PC, ICS)
2. Assess the effect of the proposed surgical intervention on a patient’s capacity for
independent living, including assessment of availability of assistance, or need for
assistance during treatment or the recovery period. (PC, ICS)
3. Summarize complications of anesthesia that are more common in the elderly patient.
(MK)
116
4. Assess the geriatric patient’s capacity for independent decision making related to
surgical consent. (PC, ICS, P)
5. Counsel patients and family members about advance directives, living wills, DNR
orders, power of attorney, and surrogate decision-making. (PC, ICS, P, SBP)
6. Describe the appropriate preoperative evaluation for a geriatric patient, including
consultation with other medical disciplines as indicated. (PC, SBP)
7. Describe the unique considerations related to preoperative, intraoperative, and
postoperative care of the geriatric patient, such as: (PC, ICS, SBP)
a. Entrapment (pressure) neuropathies
b. Hypothermia
c. Fluid and electrolyte imbalances
d. Thromboembolism
e. Pain management
f. Adverse drug events
g. Mental status changes
h. Incontinence
i. Infection
j. Nutrition
k. Stress-induced gastrointestinal ulceration
l. Pressure ulcers
m. Ambulation difficulties
n. Prevention of falls
o. Functional decline
p. Possible referral to an assisted-living facility or possible need for assistance
within the home.
117
GYNECOLOGY PGY-4
WEEKLY SCHEDULE
Monday
Tuesday
Wednesday
Thursday
Friday
AM Continuity
Clinic/ OR
PM
OR/Continuity
Clinic
OR
OR
OR
Lecture
OR
OR
OR
Pre Op
conference
H&P’s
*Continuity Clinics are scheduled for one half day per week. The resident will miss
their scheduled rotation to participate in this ACGME required clinic. In the GYN 3
rotation, it flips between Monday am and Monday pm with the GYN 4. This clinic is
cancelled if one resident is on vacation.
GYNECOLOGY PGY-4
READING SCHEDULE
TeLinds Operative Gynecology 10th edition
Rock and Jones
Chapters 23-32, 41, 42, 43, 44
Urogynecology and Urodynamics Theory and Practice
Ostergard and Bent
Selected Chapters
118
GYNECOLOGY PROCEDURE COMPETENCIES
Procedure
Level of Training
Abdominal sacrocolpopexy
R4
Ablation and excision of
endometriosis implants R2
Ablative procedure cervix
R2
Ablative procedure endometrium
R2
Anoscopy
R2
Appendectomy
R2
Biopsy
Cervix
R1
Endocervix
R1
Endometrium
R1
Skin
R1
Vagina
R1
Vulva
R1
Peritoneum
R1
Breast, cyst aspiration
R3
Breast biopsy
R3
Cervical conization
R1
Colonic endosopy
R1
Colpocleisis
R4
Colporrhapy
Anterior (incl. urethropexy) R3
Posterior
R3
Colposcopy, with directed biopsy of
cervix, vagina or vulva R1
Colposuspension
R3
Culdoplasty
R3
Cystometrography
Simple
R2
Complex (mutichannel)
R3
Cystotomy repair
R3
Cystourethroscopy
R2
Dilation and curettage
R1
Enterocele repair
R3
Enterotomy repair
R3
Excision of cyst
R1
(ovarian, tubal, vaginal, vulvar)
Excision of Bartholin’s gland
R1
Fistula repair
Rectovaginal
R3
Vesicovaginal
R4
Ureterovaginal
R4
Urethrovaginal
R4
Understanding
Understanding
and Perform
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
119
Procedure
Level of Training
Herina repair (incisional)
Hymonotomy
Hypogastric artery ligation
Hysterectomy
Laparoscopic, total or supracervical
Abdominal, total or supacervical
Vaginal
Vaginal, laparoscopically assisted
Hysterosalpingography
R2
Hysteroscopy
Diagnostic
Operative
Incision and drainage of an
abscess or hematoma
Laparoscopy, diagnostic
and/or operative
Laparotomy incisions, abdominal
Lysis of adhesions
Abdominal
Laparoscopic
Marsupialization of Bartholin’s cyst
Myomectomy
Omentectomy, infracolic
Oopphorectomy
Ovarian biopsy
R1
Ovarian or paraovarian cystectomy
Ovarian drilling, laparoscopic
Ovarian transposition
Paravaginal repair
Perineorrhaphy
R3
Perineoplasty
Pessary fitting
Polypectomy
Presacral neurectomy
Salpingectomy and/or oophorectomy
Salpingotomy
Sterilization
Abdominal
Laparoscopic
Hysteroscopic
Swab test
Trachelectomy
Trigger point injection
R2
Understanding
R3
R1
R3
Understanding
and Perform
X
X
X
R4
R3
R3
R3
X
X
X
X
X
R1
R2
R1
X
X
X
R2
X
R2
X
R3
R3
R1
R2
R3
R2
X
X
X
X
X
X
X
R1
R1
R2
R3
X
X
X
X
X
R3
R2
R2
R4
R1
R1
X
X
X
X
X
X
R2
R2
R2
R1
R4
X
X
X
X
X
X
120
Procedure
Level of Training
Ultrasonography
Abdominal
Endovaginal
Saline infusion ultrasonography
Urethral bulking procedures
Urethral diverticulum repair
Urethral pressure profilometry
R3
Ureteroureterostomy
Ureteral reimplantation
R4
Uterine artery embolization
Uterine evacuation (for pregnancy
termination, incomplete
abortion, fetal death)
Dilation and evacuation
Mechanical or osmotic
preprocedural cervical preparation
Suction curettage
Vaginal sling for urinary incontinence R3
Vulvectomy, simple
Wide local excision (vulva)
Wound care
Debridement
Incision and drainage
Placement of fascial or skin graft
Repair of dehiscence
Secondary closure
Understanding
R1
R1
R1
R3
R3
X
X
R4
X
Understanding
And Perform
X
X
X
X
X
R2
X
R1
X
R1
R1
X
X
X
R3
R2
R2
R2
R4
R3
R3
121
X
X
X
X
X
X
X
Reproductive endocrinology and infertility
The practice of reproductive endocrinology requires a thorough knowledge of
disorders of development as well as disorders associated with infertility or failure in human
reproduction. Manifestations of disorders that become evident at the time of sexual
maturation may have their beginnings as developmental or genetic abnormalities. An
understanding of the association between early developmental and genetic problems and their
later manifestations is important to appreciate the hormonal interactions that occur within the
female reproductive tract. Likewise, the metabolic implications of disorders should be
recognized.
For many gynecologists, evaluating and treating fertility disorders constitute their
entire practice. This area of the specialty includes identifying disorders related to pregnancy
loss as well as causes of infertility. Although the resident in obstetrics and gynecology is not
expected to master the actual techniques of assisted reproduction, knowledge of the scientific
basis for these procedures, including a thorough knowledge of gamete development,
embryology, and physiology of the hypothalamic–pituitary–ovarian axis, is imperative. The
science underlying these techniques represents the cognitive information important to the
application of these technologic skills.
Women today spend more than one-third of their lifetimes in the
post reproductive years. This area of medicine is becoming increasingly important as the life
expectancy of U.S. women increases. The medical management of post reproductive women
usually falls to the obstetrician– gynecologist specialist rather than the subspecialist.
Therefore, the resident should have a thorough understanding of the changes that occur in the
hypothalamic–pituitary–ovarian axis at the time of menopause and the importance of these
changes as they relate to alteration in other body systems,
particularly the cardiovascular and skeletal systems. In addition, the resident
should understand the appropriate use of hormone therapy
Goals and Objectives:
This three month rotation occurs during the second year. The resident is expected to be in
frequent contact with Dr. Ripps, and as such obtain a weekly schedule of office patients and
surgery
A. Genetics-Basic mechanism of genetic inheritance
1. Describe the genetic basis of the following conditions: (MK)
a. Normal and abnormal Müllerian development
b. Disorders of androgen excess
c. Repetitive pregnancy loss
d. Ambiguous genitalia
2. Describe the principles of preimplantation genetic diagnosis for single gene disorders,
tranlocations, and aneuploidies. (MK)
3. Discuss Mendelian and non-Mendelian patterns of inheritance. (MK)
a. Mendelian modes to include:
(1) Autosomal dominant
(2) Autosomal recessive
(3) X-linked
122
b. Nonmendelian modes to include:
(1) Mitochondrial
(2) Genomic imprinting
(3) Multifactorial and polygenic
(4) Hereditary unstable DNA
B. List the role of genetics in the development and evaluation of infertility. (MK)
1. Male
a. Klinefelter’s syndrome
b. Congenital vas deferens absence and azoospermia
c. Y-chromosome deletions
2. Female
a. Age-related aneuploidy
b. Diminished ovarian reserve/premature ovarian failure
C. Discuss the role of genetics in the timing of both normal and abnormal menopause.
(MK)
D. Physiology
1. Describe the physiology of: (MK)
a. The hypothalamic–pituitary–ovarian axis
b. Adrenal steroid and catecholamine synthesis
c. The thyroid gland and thyroid hormone synthesis
d. Female and male gametogenesis
e. Hormonally regulated tissue receptors
f. Bone formation/resorption
2. Describe the normal process of steroid hormone biosynthesis. (MK)
3. Describe the relationship between ovarian and adrenal androgen production and
hyperinsulinemia. (MK)
4. Describe the physiology of the normal menstrual cycle. (MK)
5. Describe physiologic changes that occur at the time of puberty and menopause. (MK)
E. Embryology and developmental biology
1. Describe the normal embryology of Müllerian and ovarian development. (MK)
2. Describe the pathogenesis of abnormal Müllerian development. (MK)
3. Describe the pathogenesis of disorders of sexual differentiation. (MK)
F. Anatomy
1. Describe and interpret normal and abnormal reproductive tract anatomy visualized by
imaging procedures. (MK, PC)
2. Describe normal and abnormal reproductive tract anatomy visualized grossly,
hysteroscopically and laparoscopically. (PC)
3. Describe the anatomic appearance of Müllerian abnormalities (MK)
4. Describe the anatomic abnormalities that occur in patients with disorders of sexual
differentiation. (MK)
5. Describe the anatomy of the central nervous system as it relates to menstrual function.
(MK)
6. Describe the anatomic changes that occur to the reproductive organs and breasts at the
time of puberty and menopause. (MK)
123
G. Pharmacology
1. Describe the pharmacology of medications used to: (MK)
a. Induce ovulation
b. Inhibit ovulation (e.g., gonadotropin-releasing hormone agonists and
antagonists, steroid contraceptives)
c. Inhibit the effects of prostaglandins
d. Inhibit the effects of progesterones (mifepristone)
e. Treat hyperprolactinemia
2. Describe the pharmacology of hormone therapy and selective estrogen and
progesterone receptor modulators (MK)
3. Describe the pharmacology of medications used to inhibit bone resorption and
stimulate bone formation. (MK)
H. Pathology and neoplasia
1. Describe the histologic appearance of endometriosis. (MK)
2. Describe the histologic changes of the endometrium associated with: (MK)
a. The normal menstrual cycle
b. Ovulation-inducing or ovulation-inhibiting agents
c. Chronic anovulation
3. Describe the histologic appearance of the ovary: (MK)
a. In its normal state
b. In androgen-excess disorders, such as polycystic ovary syndrome and
hyperthecosis
I. Microbiology and immunology
1. Describe histologic alterations in the endometrium and fallopian tubes associated with
infection and their effect on fertility. (MK)
2. Describe immunologic causes of infertility. (MK)
J. Pediatric gynecology (birth to menarche)
1. Describe gynecologic problems experienced by pediatric patients: (MK)
a. Vulvovaginitis
b. Vulvar disease
c. Prepubertal vaginal bleeding
d. Trauma
e. Foreign body in the vagina
f. Sexual abuse
g. Abnormal pubertal development
h. Ambiguous genitalia
2. Obtain a pertinent history and a focused physical examination appropriate for the
patient’s age. (PC, ICS, P)
3. Perform and/or interpret selected tests to diagnose a specific gynecologic disorder in a
pediatric patient. (PC)
4. Understand the medical and surgical treatment of pediatric gynecologic disorders, such
as the following: (MK, PC)
a. Vulvovaginitis
b. Vulvar disease
c. Prepubertal vaginal bleeding
124
d. Trauma
e. Foreign body in the vagina
f. Sexual abuse
g. Abnormal pubertal development
h. Ambiguous genitalia
5. Describe the indications for referral to a sub-specialist. (PC, SBP)
6. Counsel the patient and her family about long-term prognosis and the effect of specific
conditions on reproduction and sexual function. (ICS)
7. Perform a forensic examination (including appropriate laboratory tests) to evaluate
sexual abuse. (PC, SBP)
a. Describe the standards for diagnosis of sexual abuse and for maintenance of the
chain of evidence.
b. Describe the mandated reporting law for sexual abuse in the physician’s
practice location.
c. Collaborate with appropriate health professionals regarding the follow-up of
pediatric patients evaluated for sexual abuse.
K. Precocious puberty
1. Define precocious puberty. (MK)
2. Describe the principal causes of precocious puberty. (MK)
3. Obtain a history and perform a focused physical examination to evaluate the diagnosis
of precocious puberty. (PC, ICS)
4. Interpret the results of indicated serologic and radiologic tests to evaluate precocious
puberty. (PC)
5. Describe the treatment and long-term prognosis for patients with precocious puberty,
especially in regard to reproduction and sexual function. (PC)
L. Developmental anomalies of the urogenital tract
1. Describe the major developmental anomalies and their implications for sexual
function, menstruation, fertility, and reproductive outcome, including: (MK)
a. Hymenal abnormalities
b. Vaginal agenesis with or without a uterus
c. Vaginal septum
d. Uterine septum
e. Unicornuate or bicornuate uterus
2. Describe the features of a patient’s history suggestive of a developmental anomaly of
the urogenital tract. (MK)
3. Perform a focused physical examination to identify developmental anomalies of the
urogenital tract and associated somatic anomalies. (PC)
4. Interpret indicated radiologic and serologic to confirm the diagnosis of a
developmental anomaly, its etiology, and its potential clinical implications: (MK, PC)
5. Describe appropriate medical and surgical treatments for patients with developmental
anomalies. (PC)
6. Counsel patients and their families about the effect of genital tract anomalies on
reproduction and sexual function. (ICS)
7. Describe the indications for referral to a subspecialist. (SBP)
M. Adolescent gynecology
125
1. Discuss the diagnosis and management of gynecologic issues often experienced by
adolescent women, such as: (MK, PC)
a. Normal and abnormal pubertal development
b. Normal psychosocial development
c. Pituitary disorders
d. Primary amenorrhea
e. Breast mass
f. Menstrual irregularities
g. Dysmenorrhea
h. Vulvovaginitis
i. Sexuality
j. Contraceptive needs
k. Sexually transmitted diseases
l. Pregnancy
m. Sexual abuse
n. Ovarian diseases and masses
o. Endometriosis
p. Chronic pelvic pain
2. Obtain a pertinent medical and sexual history from an adolescent patient. (ICS)
3. Perform a physical examination with special attention to the needs of an adolescent
patient. (PC, P)
4. Provide for the primary care needs of the adolescent, demonstrating knowledge in
areas as listed in Continuity care clinic, I.B.2 (Ages 13-18 years).
5. Provide patient and parent education in the following areas: (ICS)
a. Normal anatomic and psychosocial development
b. Personal hygiene
c. Menses
d. Sexuality
e. Prevention of pregnancy and STDs
f. Psychosocial concerns
6. Perform or interpret selected tests to confirm the diagnosis of specific gynecologic
disorders in an adolescent patient, such as: (MK, PC)
a. Microbiologic tests
b. Endocrinologic assays
c. Ultrasonography, sonohysterography, hysterosalpingography,
hysteroscopy, and laparoscopy
d. CT or MRI
7. Treat adolescent gynecologic disorders medically or surgically.(PC)
8. Describe the indications for referral. (SBP)
9. Counsel the patient and her family about the long-term prognosis of her condition on
reproduction and sexual function. (ICS)
N. Delayed puberty
1. Understand the principal causes of delayed puberty. (MK)
2. Describe the history of a patient with delayed puberty. (MK)
3. Perform a physical examination and describe indications for and interpretion of
radiologic and endocrinologic tests to evaluate the etiology of delayed puberty. (PC)
4. Describe the treatment options of a patient with delayed puberty. (PC)
5. Describe the indications for referral to a subspecialist. (SBP)
126
6. Counsel a patient and her family about her long-term follow-up and prognosis and the
effect of her condition on reproduction and sexual function. (ICS)
O. Dysmenorrhea
1. Describe the classification of dysmenorrhea (ie, primary versus secondary). (MK)
2. List the principal causes of primary and secondary dysmenorrhea. (MK)
3. Obtain a pertinent history to evaluate dysmenorrhea. (ICS)
4. Perform a focused physical examination to evaluate dysmenorrhea. (PC)
5. Perform and/or interpret indicated tests to evaluate dysmenorrhea. (PC)
6. Describe medical and surgical treatment options for dysmenorrhea. (PC)
7. Describe long-term follow-up and prognosis for a patient with dysmenorrhea,
especially regarding reproduction and sexual function. (PC)
8. See Gynecology PGY-2, G. Endometriosis and adenomyosis.
P. Abnormal uterine bleeding
See Gynecology PGY-1, F. Abnormal uterine bleeding.
Q. Amenorrhea
1. Describe the classification of amenorrhea (ie, primary versus secondary). (MK)
2. List the major causes of primary and secondary amenorrhea. (MK)
3. Obtain a pertinent history to evaluate amenorrhea. (ICS)
4. Perform a focused physical examination to evaluate amenorrhea. (PC)
5. Perform and interpret indicated diagnostic tests to evaluate amenorrhea. (PC)
6. Interpret other indicated serologic and diagnostic tests. (PC)
7. Describe the medical and surgical treatment options for amenorrhea. (MK)
8. Describe the long-term follow-up for a patient with amenorrhea, focusing particularly
on the risks of endometrial hyperplasia and hypoestrogenism. (PC)
R. Galactorrhea/Hyperprolactinemia
1. Describe the causes of galactorrhea/hyperprolactinemia. (MK)
2. Obtain a pertinent history to evaluate galactorrhea/hyperprolactinemia. (ICS)
3. Perform a targeted physical examination to evaluate galactorrhea/hyperprolactinemia.
(PC)
4. Order and interpret indicated diagnostic studies. (MK, PC)
5. Describe treatment options for galactorrhea/hyperprolactinemia. (PC)
6. Describe the indications for referral to a neurosurgeon for surgical treatment of a
pituitary adenoma. (SBP)
7. Describe long-term follow-up for the patient with galactorrhea/
hyperprolactinemia/pituitary adenoma focusing particularly on the risk of complications,
such as the following: (PC)
a. Headaches
b. Visual field defects
c. Infertility
d. Hypoestrogenism
8. Describe the management of patients with a pituitary adenoma in pregnancy. (PC)
S. Premenstrual syndrome and premenstrual dysphoric disorder
See Continuity care clinic, III.J Premenstrual syndrome and premenstrual dysphoric
disorder.
127
T. Hirsutism
1. Describe the principal causes of hirsutism. (MK)
2. Obtain a pertinent history to evaluate hirsutism. (ICS)
3. Perform a focused physical examination to evaluate hirsutism. (PC)
a. Demonstrate familiarity with the Ferriman–Gallwey scale. (MK)
b. Distinguish between hirsutism and virilization. (MK, PC)
4. Perform and interpret indicated tests to determine the etiology of hirsutism. (PC)
5. Describe medical and surgical treatment options for hirsutism. (PC)
6. Describe the indications for referral to a subspecialist. (SBP)
7. Describe long-term follow-up for an affected patient and counsel her about the possible
effects on reproduction. (PC, ICS)
U. Polycystic ovary syndrome
1. Describe the diagnostic criteria and clinical features of polycystic ovary syndrome
(PCOS). (MK)
2. Describe the pathogenesis of PCOS. (MK)
3. Obtain a pertinent history to evaluate PCOS. (ICS)
4. Perform a focused physical examination to evaluate PCOS. (PC)
5. Perform and/or interpret indicated tests to determine the diagnosis. (PC)
6. Describe the medical treatment for PCOS in patients who do not desire pregnancy.
(PC)
7. Describe the medical and/or surgical treatment for PCOS in patients who desire
pregnancy and require ovulation induction. (PC)
8. Describe the indications for referral to a subspecialist. (SBP)
9. Describe the long-term follow-up for an affected patient that includes consultation
about the effects of ovulatory dysfunction and insulin resistance on reproduction and
long-term health, and metabolic syndrome. (PC, ICS)
V. Recurrent pregnancy loss
1. Describe the criteria for and causes of recurrent first-trimester and mid-trimester
pregnancy loss. (MK)
2. Obtain a pertinent history in a patient with recurrent first trimesterand mid-trimester
pregnancy losses, including issues such as the following: (ICS)
a. Family history and pedigree analysis
b. Detection of underlying medical disorders
c. Exposure to toxins
d. Identification of a hereditary thrombophilia
3. Perform a focused physical examination to identify possible causes of recurrent firsttrimester and mid-trimester pregnancy loss, such as the following: (PC)
a. Genital tract malformations
b. Sequelae of long-term diabetes/uncontrolled diabetes
4. Perform and interpret the results of indicated diagnostic tests and procedures to
determine the etiology of recurrent early pregnancy loss. (PC)
5. Describe medical and surgical treatment options for patients with a history of recurrent
pregnancy loss depending on etiology. (PC)
6. Describe the indications for referral to a subspecialist. (SBP)
7. Counsel patients about the prognosis for successful treatment of recurrent pregnancy
loss. (ICS)
128
W. Evaluation of infertility
1. Describe the classification of infertility (ie, primary versus secondary). (MK)
2. List the principal causes of primary and secondary infertility. (MK)
3. Obtain a pertinent history of both partners to evaluate infertility. (ICS)
4. Perform a focused physical examination to evaluate infertility. (PC)
5. Perform and/or interpret selected diagnostic tests and procedures to determine the most
likely cause of infertility. (PC)
6. Describe treatment options with infertile patients who have irregular ovulation,
nongonadotropin therapy. (PC)
7. Describe risks/benefits/indications/alternatives for surgical procedures to treat
infertility. (PC)
8. Describe the indications for referral to a subspecialist. (SBP)
9. Counsel patients about the long-term prognosis for their conditions and alternatives to
childbearing, such as adoption, donor gametes, surrogacy. (ICS, P)
10. Counsel patients regarding sexual activity during fertility treatment. (ICS)
X. Reproductive technologies for infertility
1. Describe indications for assisted reproductive technology procedures, such as the
following: (MK)
a. In vitro fertilization (IVF)
b. Gamete intrafallopian transfer (GIFT)
c. Zygote intrafallopian transfer (ZIFT)
d. Intracytoplasmic sperm injection (ICSI)
e. Gamete donation
f. Preimplantation genetic diagnosis
2. Describe the prognosis for and complications of assisted reproductive technology.
(MK)
Y. Ethical considerations of infertility
1. Describe the ethical implications surrounding fertility treatment. (MK, P, ICS)
2. Describe the health care resource allocation concerns pertaining to diagnosis and
treatment of infertility. (MK, P, ICS)
Z. Evaluation of the climacteric
1. Describe typical symptoms experienced by a woman at the time of menopause.
2. Perform a focused physical examination on a menopausal patient.
3. Interpret selected laboratory tests to evaluate menopause.
4. Assess the risk of osteoporosis by history, examination, and testing (including the use
of the risk assessment tools, such as the FRAX score).
AA. Management of the climacteric
1. Manage perimenopausal and menopausal conditions, including osteoporosis, using
interventions, such as the following: (PC)
a. Pharmacologic treatment, including hormonal and nonhormonal
b. Nonpharmacologic treatments, including behavioral and lifestyle modifications
2. Discuss the long-term follow-up indicated for menopausal patients on continued
hormonal therapy or osteoporosis treatment. (MK)
129
3. Counsel patients regarding physical, emotional, and relationship based issues
concerning female sexuality and aging. (ICS)
4. Describe the indications for and interpret the results of other screening tests that should
be performed in menopausal patients (see Continuity care clinic, I.B.4 Ages 40-64 and
I.B.5 Ages 65 and older).
5. Diagnose and manage common sexual dysfunctions in perimenopausal and
menopausal women. (MK, PC)
130
REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY
WEEKLY SCHEDULE*
Monday
Tuesday
Wednesday
Thursday
Friday
AM
REI/OFFICE
PM
REI/OFFICE
REI/OR
REI/OFFICE
Lecture
REI/OR
REI/OFFICE
Tubals/REI
office
Essures/Tubals
Tubal H&P
Clinic
*Continuity Clinics are scheduled for one full day per week. It is a fixed day, and the
resident will miss their scheduled rotation to participate in this ACGME required
clinic. See the Primary Care rotation/Continuity Clinic rotation for the schedule.
REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY
READING SCHEDULE
Precis: Reproductive Endocrinology and Infertility 3rd Edition
Required entire text
Clinical Gynecology, Endocrinology and Infertility 8th edition
Speroff, Glass, Kase
Supplemental reading assigned by Dr. Ripps
131
REI PROCEDURE COMPETENCIES
Procedure
Level of Training
Assisted reproductive technologies
IVF
ICSI
Gamete donation
Preimplantation genetic
Diagnosis
GIFT
Hysterosalpingography
R2
Hysterosongraphy
Hysteroscopy
Diagnostic
Operative
Submuscosal Fibroid
Resection
Polyp Resection
Incision of vaginal septum
Laparoscopy
Diagnostic
Operative
Chromopertubation
Lysis of adhesions
Fimbrioplasty
Salpingostomy R2
Metroplasty
Abdominal
Hysteroscopic resection of uterine
septum
Tubal anastomosis
Vaginal reconstruction
R2
Understanding
R2
R2
R2
X
X
X
R2
R2
X
X
Understanding
and Perform
X
R2
X
R2
X
R2
R2
R2
R2
R2
X
X
X
X
R2
R2
R2
X
X
X
X
R2
X
R2
R2
X
X
X
132
Surgical ICU
Primary Supervisor: Dr. Bill Goldmith
[email protected]
Cell 850-384-6761
Rotation dates: 8/26-9/22 (Tidwell only)
Goals and Objectives;
This PGY-2 rotation is a 1 month rotation is required for DO residents wishing to be
liscenced in Florida. It is also available as an elective rotation for PGY-3 residents. The
resident is assigned to the surgical intensive care faculty, and is responsible for all surgical
critical care consults/ICU patients.
Patient Care:
1. Under the supervision of the faculty, the resident will become familiar with ICU medicine,
and understand the basic path physiology of critical ill patients.
2. Recognize and be able to manage critically ill postoperative patients.
Medical Knowledge:
1. Understand the patholophysiology of the following; toxic shock syndrome, Septic shock,
ARDS, Hemodynamic assessment of the critically ill patients, and cardiopulmonary
resuscitation.
Practice-based Learning and Improvement:
1. Learn to identify strengths, deficiencies, and limits in one’s knowledge and expertise.
2. Set learning and improvement goals.
3. Identify and perform appropriate learning activities.
4. Systematically analyze practice using quality improvement methods, and implement
changes with the goal of practice improvement;
5. Incorporate formative evaluation feedback into daily practice;
6. Locate, appraise, and assimilate evidence from scientific studies related to their patients’
health problems.
7. Use information technology to optimize learning.
8. Participate in the education of patients, families, students, residents and other health
professionals.
9. Understand the basics of epidemiology, statistics, data collection, management and its use
of medical literature and assessment of it value.
Interpersonal and Communication Skills:
1. Communicate effectively with patients, families, and the public, as appropriate, across a
broad range of socioeconomic and cultural backgrounds.
2. Communicate effectively with physicians, other health professionals, and health related
agencies.
3. To work effectively as a member or leader of a health care team or other professional
group;
4. To act in a consultative role to other physicians and health professionals.
5. To maintain comprehensive, timely, and legible medical records, if applicable.
133
6. To have the fundamentals of good medical history taking and thoughtful, meticulous
physical examination. Information gained by these procedures must be carefully recorded in
the medical record. A reliable measure of the quality of a program is the quality of hospital
records. These records should include daily appropriate progress notes by residents, together
with a discharge summary.
Professionalism
1. Residents must demonstrate compassion, integrity, and respect for others.
2. Demonstrate responsiveness to patient needs that supersedes self-interest.
3. Develop respect for patient privacy and autonomy.
4. Demonstrate accountability to patients, society and the profession.
5. Demonstrate sensitivity and responsiveness to a diverse patient population, including but
not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual
orientation.
6. Construct a framework for ethical decision making, and medical jurisprudence.
Systems-based Practice
1. Work effectively in various health care delivery settings and systems relevant to their
clinical specialty;
2. Coordinate patient care within the health care system relevant to their clinical specialty;
3. Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or
population-based care as appropriate;
4. Advocate for quality patient care and optimal patient care systems;
5. Work in interprofessional teams to enhance patient safety and improve patient care quality.
6. Participate in identifying system errors and implementing potential systems solutions.
134
Neonatal ICU
Primary Supervisor: Dr. Ramak Amjad
Rotation dates: 12/2-12/15 (Tidwell only)
Goals and Objectives:
The PGY-2 rotation is weeks of one rotation block for DO residents who wish to be liscenced
in the state of Florida. It is also available as an elective at the PGY 3 level. The resident is
assigned to the NICU faculty, and is responsible for the care of low risk, premature infants.
This rotation occurs in the latter part of the second year, to prepare the resident for the
responsibilities of caring for critically sick antepartum patients, and appropriate
understanding of the care of the premature infant. This understanding will facilitate
counseling of high risk moms, and setting realistic expectations regarding pregnancy
outcomes.
Patient Care
1. Perform an immediate assessment of the newborn infant and determine if resuscitative
measures are indicated. (MK, PC)
2. Resuscitate a depressed neonate: (PC)
a. Properly position the baby in the radiant warmer.
b. Suction the mouth and nose.
c. Provide tactile stimulation.
d. Administer positive pressure ventilation with bag and mask.
e. Administer chest compressions.
3. Assign Apgar scores. (PC)
Medical Knowledge
1. Under the supervision of the faculty, the resident will become familiar with NICU
medicine, and understand the basic path physiology of critical ill newborns
Practice-based Learning and Improvement:
1. Learn to identify strengths, deficiencies, and limits in one’s knowledge and expertise.
2. Set learning and improvement goals.
3. Identify and perform appropriate learning activities.
4. Systematically analyze practice using quality improvement methods, and implement
changes with the goal of practice improvement;
5. Incorporate formative evaluation feedback into daily practice;
6. Locate, appraise, and assimilate evidence from scientific studies related to their patients’
health problems.
7. Use information technology to optimize learning.
8. Participate in the education of patients, families, students, residents and other health
professionals.
9. Understand the basics of epidemiology, statistics, data collection, management and its use
of medical literature and assessment of it value.
Interpersonal and Communication Skills:
135
1. Communicate effectively with patients, families, and the public, as appropriate, across a
broad range of socioeconomic and cultural backgrounds.
2. Communicate effectively with physicians, other health professionals, and health related
agencies.
3. To work effectively as a member or leader of a health care team or other professional
group;
4. To act in a consultative role to other physicians and health professionals.
5. To maintain comprehensive, timely, and legible medical records, if applicable.
6. To have the fundamentals of good medical history taking and thoughtful, meticulous
physical examination. Information gained by these procedures must be carefully recorded in
the medical record. A reliable measure of the quality of a program is the quality of hospital
records. These records should include daily appropriate progress notes by residents, together
with a discharge summary.
Professionalism
1. Residents must demonstrate compassion, integrity, and respect for others.
2. Demonstrate responsiveness to patient needs that supersedes self-interest.
3. Develop respect for patient privacy and autonomy.
4. Demonstrate accountability to patients, society and the profession.
5. Demonstrate sensitivity and responsiveness to a diverse patient population, including but
not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual
orientation.
6. Construct a framework for ethical decision making, and medical jurisprudence.
Systems-based Practice
1. Work effectively in various health care delivery settings and systems relevant to their
clinical specialty;
2. Coordinate patient care within the health care system relevant to their clinical specialty;
3. Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or
population-based care as appropriate;
4. Advocate for quality patient care and optimal patient care systems;
5. Work in interprofessional teams to enhance patient safety and improve patient care quality.
6. Participate in identifying system errors and implementing potential systems solutions.
136
GYNECOLOGIC ONCOLOGY ROTATION
The detection and treatment of gynecologic malignancies are important objectives in
gynecologic practice. Although a select group of physicians devote their full practices to the
care of patients with gynecologic malignancies, residents in obstetrics and gynecology should
become familiar with the therapeutic principles underlying the treatment of these patients
and, more important, the identification of patients who are at risk of or who may already have
malignancies of the pelvic organs or breast.
Much of the improvement in the survival of women with gynecologic cancer can be
attributed to more reliable screening techniques and an enhanced awareness of early
symptoms on the part of both physicians and patients. Because the distinction between a
precursor lesion and its malignant counterpart is often subtle, knowledge of both
premalignant and malignant lesions of the reproductive tract is necessary. The treatment—
whether surgical, radiologic, or chemotherapeutic—of a particular patient may or may not
fall to the practicing general gynecologist, but he/she is expected to provide education,
counseling, and follow-up for these patients. To do so, residents must possess a basic
understanding of the principles underlying radiation therapy, chemotherapy, and terminal
care.
137
Gynecologic oncology PGY-3
Goals and Objectives:
This PGY-3 rotation is 4 weeks in length in combination with a night float rotation for 3
blocks out of the year. The PGY-3 resident is responsible, under the guidance of the chief
year resident and the attending gyn oncologist, for the complete care of the gynecologic
oncological patient over this four month rotation.
A. Genetics (MK)
1. Describe the clinical relevance of other oncogenes and of tumor suppressor genes.
(MK)
2. Describe the mechanisms of actions of oncogenes to include the
following: (MK)
a. Transduction
b. Translocation
c. Point mutation
d. Insertion mutation
e. Amplification
3. Describe the inheritance patterns for malignancies of the pelvic organs and breast.
4. Describe the current indications for screening for BRCA1, BRCA2 and hereditary
nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome.
5. Describe the cell replication cycle and identify the phases of the cycle most sensitive to
radiation and chemotherapy.
B. Physiology (MK)
1. Describe the ability of vital organ systems to tolerate cancer therapy and define the
concept of therapeutic index.
2. Describe the changes in cell and organ physiology that result from injury due to
radiation and chemotherapy.
C. Embryology and developmental biology (MK)
1. Describe the embryology of gonadal migration and its role in the pathogenesis of
epithelial and germ cell neoplasms.
2. Describe the embryologic origins of cell types found in benign and malignant germ
cell tumors.
D. Anatomy (MK)
1. Describe the anatomy of the anterior and posterior abdominal wall.
2. Describe the anatomy of the pelvic floor retroperitoneal and paraaortic spaces.
3. Describe the gross and histologic anatomy of the external genitalia pelvic organs and
the breast.
4. Describe the vascular, lymphatic, and nerve supply to the breast, external genitalia and
each of the pelvic organs.
5. Describe the anatomic relationship between the reproductive organs and the nongynecologic abdominal and pelvic viscera (ie, bladder, ureters, and bowel).
6. Describe the likely changes in the anatomic relationships of the pelvic and abdominal
viscera created by surgical or radiation treatment for a malignancy of the pelvic organs.
138
E. Epidemiology and risk assessment of gynecologic cancer
1. Evaluate a patient’s personal or family history of breast cancer, including the risk
associated with BRCA1 or BRCA2. (PC)
2. Describe the inherited syndromes that increase a woman’s likelihood of developing
ovarian cancer. (MK)
3. Describe the genetics of familial syndromes (eg, hereditary nonpolyposis colorectal
cancer, also known as Lynch syndrome). (PC)
4. Describe the screening protocols that may identify patients who have an inherited form
of ovarian cancer. (PC)
5. Describe the epidemiology and genetics of hydatidiform mole. (MK)
F. Pharmacology (MK)
1. List the major chemotherapeutic agents used for treatment of malignancies of the
reproductive organs and breast.
2. Describe the principal adverse effects of these major chemotherapeutic agents.
3. List supportive care methods/medications which can be used to ameliorate the
following treatment complications:
a. Marrow suppression
b. Nausea and vomiting
c. Hemorrhagic cystitis
d. Peripheral neuropathy
e. Renal toxicity
f. Cardiac toxicity
G. Pathology and neoplasia (MK)
1. Describe the histology of malignant and pre-malignant conditions of the pelvic organs
and breast.
2. Describe risk factors contributing to the pathogenesis of malignancies of the pelvic
organs and breast.
3. Describe the prognosis for the major malignancies of the breast and pelvic organs.
H. Microbiology and immunology (MK)
1. Describe the role of viruses in the pathogenesis of gynecologic tumors.
2. Describe the influence of immunosuppression on the risk of acquiring gynecologic
cancers.
3. Describe the effect of cancer and its therapies on the immune system.
4. List the principal consequences of immunosuppression in the cancer patient (e.g.,
increased susceptibility to infection and poor wound healing).
I. Epidemiology and risk assessment of breast cancer
1. Evaluate a patient’s personal or family history of breast cancer, including the risk
associated with BRCA1 or BRCA2. (PC)
2. Evaluate other epidemiologic factors to assess a woman’s risk for developing breast
cancer, such as the following: (PC)
a. Patient age
b. Parity
c. Ethnicity
d. Lactation
e. Hormone replacement
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f. Alcohol consumption
3. Counsel patients regarding breast cancer prevention strategies. (ICS)
4. Counsel patients regarding the use of screening methods, such as mammography.
(ICS)
5. Refer patients appropriately for genetic counseling and testing. (PC, SBP)
J. Diagnosis of invasive carcinoma of the breast
1. Obtain a focused history and perform a physical examination in women with signs or
symptoms of breast cancer. (PC, ICS)
2. Order and explain to the patient appropriate diagnostic tests for evaluating a suspicious
breast lesion. (PC, ICS)
3. Describe the indications for and interpret for the patient the results of needle aspiration
of a breast cyst and fine needle biopsy of a solid lesion. (PC, ICS)
4. Describe the indications for and interpret for the patient the results of other diagnostic
studies, such as: (PC)
a. Mammography
b. Ultrasonography
c. Magnetic resonance imaging
d. Core-needle biopsy
e. Excisional biopsy
K. Management of invasive breast cancer (MK)
1. Describe the staging of breast cancer and the prognostic significance of histologic type,
regional lymph node metastasis, distant metastasis, and hormone receptor status.
2. Describe the indications for lumpectomy vs. mastectomy.
3. Describe the indications for adjuvant therapy with hormonal treatment, chemotherapy,
or radiation therapy.
4. Describe the effect Ultrasonography
of pregnancy on the treatment and prognosis of breast cancer.
L. Breast cancer survivorship
1. Describe the psychosocial effect of breast cancer on family dynamics, sexuality, and
stress management and make appropriate referral to support groups and healthcare
professionals. (PC, SBP)
2. Manage the adverse effects of antiestrogen medications, such as tamoxifen and
aromatase inhibitors. (PC)
M. Pre-invasive vulvar and vaginal lesions
1. Describe the epidemiology of vulvar intraepithelial neoplasia (VIN) and vaginal
intraepithelial neoplasia (VAIN). (MK)
2. Describe the clinical manifestations of VIN and VAIN. (MK)
3. Describe the differential diagnosis of pigmented and nonpigmented vulvar and vaginal
lesions. (MK)
4. Perform and interpret the results of diagnostic procedures for VIN and VAIN. (PC)
5. Perform surgical and/or medical treatment for patients with VIN and VAIN. (PC)
6. Establish a post-treatment follow-up plan for patients with VIN and VAIN. (SBP)
140
7. Describe the structural and histologic changes in the vagina characteristic of in utero
exposure to diethylstilbestrol. (MK)
N. Invasive vulvar carcinoma
1. Describe the epidemiology of invasive vulvar lesions, such as the following: (MK)
a. Melanoma
b. Squamous cell carcinoma
c. Basal cell carcinoma
d. Paget disease
e. Sarcoma
f. Verrucous carcinoma
g. Bartholin’s gland carcinoma
2. Describe the clinical manifestations of invasive vulvar malignancies. (MK)
3. Describe the differential diagnosis of vulvar cancer.
(MK)
4. Perform appropriate biopsies to diagnose vulvar carcinoma.(PC)
5. Describe the staging of invasive vulvar cancers using the system adopted by the
International Federation of Gynecology and Obstetrics (FIGO). (MK)
6. Counsel a patient about the evaluation and treatment (indications and complications) of
vulvar cancer. (PC, ICS)
7. Describe the prognosis for invasive vulvar malignancies. (MK)
8. Describe the effect of treatment of vulvar cancer on sexual function and manage/refer
the patient appropriately. (MK, PC, SBP)
9. Provide psychosocial support and long-term follow-up for patients with vulvar cancer.
(PC, ICS, SBP)
O. Invasive carcinoma of the vagina
1. Describe the epidemiology of invasive vaginal cancer such as the following:
a. Squamous cell carcinoma (MK)
b. Clear cell adenocarcinoma (MK)
2. Describe the clinical manifestations of invasive vaginal cancer. (MK)
3. Describe the differential diagnosis of invasive vaginal cancer. (MK)
4. Perform appropriate biopsies to diagnose vaginal cancer. (PC)
5. Describe the staging of invasive vaginal cancer using the system adopted by FIGO.
(MK)
6. Counsel the patient regarding the evaluation and treatment (indications and
complications) of vaginal cancer. (PC, ICS)
7. Describe the prognosis for invasive vaginal cancer. (MK)
8. Describe the effect of treatment of vaginal cancer on sexual function and manage/refer
patients appropriately. (MK, PC, SBP)
9. Provide psychosocial support and long-term follow-up for patients with vaginal cancer.
(PC, ICS, SBP)
P. Pre-invasive cervical disease
1. Describe the epidemiology of cervical dysplasia. (MK)
2. Obtain a pertinent history in a woman with an abnormal Pap test. (PC)
3. Interpret Pap test reports using the Bethesda classification system and determine
appropriate follow-up. (PC)
4. Perform and interpret the results of diagnostic procedures for cervical dysplasia. (PC)
141
5. Develop an age-appropriate treatment plan for cervical dysplasia with modalities, such
as the following: (PC)
a. Cryosurgery
b. Laser ablation
c. Loop electrical excision procedure
d. Cold knife conization
e. Observation/close follow-up
6. Manage the complications resulting from treatment of cervical dysplasia. (PC)
7. Establish an appropriate follow-up plan for a woman who has been treated for cervical
dysplasia. (PC)
8. Describe the structural changes in the cervix that are characteristic of in utero
diethylstilbestrol exposure.
9. Counsel patients regarding the use of vaccinations for the prevention of HPV related
diseases. (MK)
Q. Invasive cervical cancer
1. Describe the epidemiology of cervical cancer. (MK)
2. Describe the typical clinical manifestations of cervical cancer. (MK)
3. Describe the differential diagnosis of cervical cancer. (MK)
4. Perform appropriate biopsies to diagnose invasive cervical cancer. (PC)
5. Describe the staging of cervical cancer using the system adopted by FIGO. (MK)
6. Counsel the patient about the evaluation and treatment (indications and complications)
of cervical cancer. (PC, ICS)
7. Describe the prognosis for cervical cancer. (MK)
8. Describe the effect of treatment of cervical cancer on sexual function and manage/refer
patient appropriately. (MK, PC, SBP)
9. Provide psychosocial support and long-term follow-up for patients with cervical
cancer. (PC, ICS, SBP)
R. Endometrial hyperplasia
1. Obtain a targeted history in patients who have abnormal uterine bleeding, including an
assessment of risk factors, such as the following: (PC, ICS)
a. Obesity
b. Anovulation
c. Polycystic ovary syndrome
d. Glucose intolerance
e. Estrogen or antiestrogen (tamoxifen) exposure
f. Family history
2. Perform a focused physical examination in women who have abnormal bleeding and
risk factors for endometrial hyperplasia. (PC)
3. Describe factors that influence the treatment of hyperplasia, such as the following:
(MK)
a. Classification and histology
b. Age of patient
c. Reproduction goals
d. Risk of malignancy
4. Treat endometrial hyperplasia medically and surgically. (PC)
5. Describe and manage the potential complications of these interventions. (PC)
6. Describe appropriate posttreatment follow-up. (PC)
142
S. Carcinoma of the endometrium
1. Describe the epidemiology of endometrial cancer such as the following: (MK)
a. Uterine adenocarcinoma
b. Uterine sarcoma
2. Describe the clinical manifestations of endometrial cancer. (MK)
3. Describe the differential diagnosis of invasive endometrial cancer. (MK)
4. Perform biopsies to diagnose endometrial cancer. (PC)
5. Describe the staging of invasive endometrial cancer using the system adopted by
FIGO. (MK)
6. Counsel the patient about the evaluation and treatment (indications and complications)
of endometrial cancer. (PC, ICS)
7. Describe the prognosis for invasive endometrial cancer. (MK)
8. Provide psychosocial support and long-term follow-up for women with endometrial
cancer. (PC, ICS, SBP)
T. Carcinoma of the ovary
1. Describe the epidemiology of ovarian cancer. (MK)
2. Describe the inherited syndromes that increase a woman’s likelihood of developing
ovarian cancer. (MK)
3. Describe the screening protocols that may identify patients who have an inherited form
of ovarian cancer. (MK)
4. Describe the clinical manifestations of ovarian cancer. (MK)
5. Describe the staging of ovarian cancer using the system adopted by FIGO. (MK)
6. Describe the histology, staging and prognosis for the following: (MK)
a. Epithelial tumors
b. Germ cell tumors
c. Stromal tumors
d. Sarcomas
e. Metastatic tumors
f. Tumors of low malignant potential
7. Interpret for the patient the following tests to diagnose ovarian cancer: (PC, ICS)
a. Ultrasonography
b. Serum tumor markers
c. Cytology from thoracentesis or paracentesis
d. CT scan
8. Counsel the patient about the evaluation and treatment (indications and complications)
of ovarian cancer. (PC, ICS)
9. Provide psychosocial support and long-term follow-up for women with ovarian cancer.
(PC, ICS, SBP)
U. Carcinoma of the fallopian tube
1. Describe the epidemiology of fallopian tube cancer. (MK)
2. Describe the typical clinical manifestations of fallopian tube cancer. (MK)
3. Describe the staging of fallopian tube cancer using the system adopted by FIGO. (MK)
4. Counsel the patient about the evaluation and treatment (indications and complications)
of fallopian tube cancer. (PC, ICS)
5. Describe the prognosis of fallopian tube cancer. (MK)
143
6. Provide psychosocial support and long-term follow-up for women with fallopian tube
cancer. (PC, ICS, SBP)
V. Hydatidiform mole
1. Describe the epidemiology and genetics of hydatidiform mole. (MK)
2. Describe the clinical manifestations of gestational trophoblastic disease (GTD). (MK)
3. Diagnose GTD and its manifestations using tests, such as the following: (PC)
a. Ultrasonography
b. Quantitative b-hCG titer
c. Chest x-ray
d. Thyroid function tests
4. Distinguish between a complete and partial hydatidiform mole using histologic and
cytogenetic findings. (MK)
5. Provide surgical treatment for a patient with GTD. (PC)
6. Provide the appropriate follow-up for a patient who has had suction evacuation of a
molar pregnancy. (PC)
7. Counsel the patient regarding recurrence risk for GTD. (PC, ICS)
W. Malignant gestational trophoblastic disease
1. Describe the risk factors for malignant GTD. (MK)
2. Describe the histologic appearance of invasive mole versus choriocarcinoma versus
placental site trophoblastic tumor. (MK)
3. Describe the diagnosis of malignant GTD using a combination of physical
examination, b-hCG, chest x-ray, CT scan and ultrasonography. (MK)
4. Describe the features associated with low-risk versus high-risk GTD. (MK)
5. Counsel patients regarding risk of recurrence and prognosis for future pregnancies.
(PC, ICS)
6. Provide psychosocial support and long-term follow-up of patients with GTD. (PC, ICS,
SBP)
X. Radiation therapy
1. Describe the general principles of radiation therapy. (MK)
2. Describe the indications for radiation therapy in the treatment of gynecologic
neoplasms and the factors that influence decisions regarding intervention, such as the
following: (MK)
a. Classification and FIGO staging of disease and histology
b. Age of patient
c. Underlying medical conditions
d. Implications for future fertility
e. Concomitant therapy with radiosensitizers or chemotherapy
f. Previous abdominal procedures
g. Need for palliative management
3. Describe the potential complications of radiation therapy.(MK)
Y. Chemotherapy
1. Describe the general mechanisms of action of chemotherapy. (MK)
2. Describe the general indications for chemotherapy in the treatment of gynecologic
neoplasms. (MK)
144
3. Describe the most appropriate indication for chemotherapeutic agents, such as the
following: (MK)
a. Alkylating agents
b. Antimetabolites
c. Vinca alkaloids
d. Antibiotics
e. Hormonal agents
f. Heavy metals
g. Immunotherapy
4. Describe the potential complications of chemotherapy. (MK)
5. Describe the long-term effects of chemotherapy on fertility. (MK)
Z. Terminal care
1. Describe the basic principles of palliative care. (MK)
2. Describe medical, radiation and operative modalities for palliation of symptoms in
terminally ill patients. (MK)
3. Describe the appropriate indications for a “do not resuscitate” order. (MK)
4. Describe the medical, ethical, and legal implications of a “do not resuscitate” order.
(MK)
5. Describe the concept of therapeutic index when considering medical or operative
intervention to improve patients’ quality of life. (MK)
6. Describe the basic principles of pain management and provide appropriate pain control
for terminal patient. (MK)
145
GYNECOLOGIC ONCOLOGY 3
WEEKLY SCHEDULE*
Weeks 1 and 2
Monday
Tuesday
Wednesday
Thursday
Friday
OR/Office
OR
Office
OR
Lecture
OR/Office
OR
Office
OR
Office
*Weeks 3 and 4 Night Float. Please see Night Float PGY-3 for specifics. Gyn oncology
and night float weeks may be reversed as needed.
GYNECOLOGIC ONCOLOGY PGY-3
READING SCHEDULE
Clinical Gynecologic Oncology 8th edition
Disaia and Creasman
Chapters 1 – 21
Gabbe
Chapter 36
Please refer to Appendix I – Gyn Oncology specific instructions
146
Gynecologic oncology PGY-4
Goals and Objectives:
This PGY-4 rotation is 4 weeks in length in combination with a night float or ambulatory
rotation for 4 blocks out of the year. The PGY-4 chief resident is responsible, under the
guidance of the attending gyn oncologist, for the running of the gyn oncology service over
this four month rotation. They are responsible for all inpatient and outpatient gynecologic
oncology patients under the gyn onc service, including consults and chemo patients. They
delegate and supervise their junior resident (PGY-3 assigned to the service), as well as
coordinate care with the service attending.
The specific goals and objectives are the same as in the Gynecologic oncology PGY-3
rotation.
147
GYNECOLOGIC ONCOLOGY PGY-4
WEEKLY SCHEDULE*
Weeks 3 and 4
Monday
Tuesday
Wednesday
Thursday
Friday
OR/Office
OR
Office
OR
Lecture
OR/Office
OR
Office
OR
Office
*Weeks 1 and 2 Night float. Please see Night float PGY-4 for specifics. Gyn oncology
and night float weeks may be reversed as needed.
GYNECOLOGY ONCOLOGY PGY-4
READING SCHEDULE
Clinical Gynecologic Oncology 8th edition
Disaia and Creasman
Chapters 1 – 23
Please refer to Appendix I – Gyn Oncology specific instructions
148
GYNECOLOGIC ONCOLOGY PROCEDURE COMPETENCIES
Procedure
Level of Training
Understanding
Colectomy (partial or total)
R3
X
Colostomy
R3
X
Fistula repair
Enterocutaneous
R4
X
Ureterovaginal
R4
X
Hysterectomy
Extrafascial (with or without bilateral
salpingo-oophorectomy)
R3
Radical (with or without bilateralsalpingo-oophorectomy)
X
Lumpectomy of breast
R4
X
Lymph node biopsy/dissection
Axillary
R4
X
Inguinal
R3
X
Paraaortic
R3
X
Pelvic
R3
X
Sentinel
R3
X
Mastectomy
Simple
R3
X
Radical
R4
X
Paracentesis
R3
X
Pelvic exenteration with or without
reconstruction
R3
X
Port placement, intraperitoneal
R3
X
Radiation therapy
Brachytherapy
R3
X
External beam
R3
X
Interstitial
R3
X
Resection of large and small bowel
R3
X
Staging laparotomy
R3
Biopsy of pelvic lymph nodes
R3
Biopsy of peritoneal implants
and cytologic washing of the
peritoneal cavity
R3
X
Exploration of abdomen
R3
Infracolic omentectomy
R3
X
Suction evacuation of molar pregnancy
R3
Transverse rectus abdominis
myocutaneous flap
R4
X
Vaginal reconstruction
Gracilis flap
R4
X
Martius flap
R4
X
Skin graft
R4
X
Venous access device placement
R3
X
Vulvectomy, radical
R3
X
149
Understanding
and Perform
X
R4
X
X
X
Family Planning Rotation
Rotation dates:
Dr Natasha Spencer 12/2/13-12/13/13
Rotation location:
Planned Parenthood Orlando
The residency program will provide housing assistance, as well as reimbursement for travel
expenses and a per diem allowance for food.
Goals and Objectives
This PGY 3 rotation is 2- 4 weeks in length, and occurs at the PGY 3 year. The goal of this
rotation is to give the residents experience in abortion care, as well as additional experience
in family planning. This rotation is optional. If a resident opts out of the Family Planning
rotation, they will be asked to sign the “opt out” rotation form in Appendix XVII – Family
planning rotation opt out form
A. Contraception
The obstetrician–gynecologist is in a unique position to serve as a resource person for the
community or the individual regarding sexual health, family planning and/or contraception.
On the community level, the obstetrician–gynecologist should be able to speak to any
audience on the subject of birth control. He or she should be able to discuss the cultural,
societal, ethical, and religious implications of contraceptives as well as describe their
effectiveness, medical benefits, and adverse effects. (P, PC, MK, ICS, PBLI)
1. Define the following terms: method effectiveness and user effectiveness. (MK)
2. Describe national and local policies that affect control of reproduction. (MK, SBP)
3. Describe how religious, ethical, and cultural differences affect health care
providers and users of contraception. (PBLI)
4. Describe the effect of contraception on population growth in the United States and
other nations. (MK, SBP)
5. Describe the factors that influence the individual patient’s choice of contraception.
(MK, PBLI)
6. Obtain a pertinent history from a patient requesting information
about
contraception. (PC, ICS, P)
7. Perform a focused physical examination to detect findings that might influence the
choice of contraception. (P, PC)
8. Interpret the results of selected laboratory tests that might influence a patient’s
choice of contraception. (MK)
9. Describe the advantages, disadvantages, failure rates, mechanisms of action and
complications associated with the following methods of contraception: (MK)
a. Sterilization
b. Oral steroid contraception
c. Transdermal steroid contraception
d. Vaginal steroid contraception
e. Injectable steroid contraception
f. Implantable steroid contraception
g. Intrauterine devices
150
h. Barrier methods
i. Natural family planning
j. Abstinence
10. Describe the pharmacology of hormonal contraception. (MK)
11. Describe appropriate methods for postcoital contraception. (MK)
12. Describe the appropriate follow-up for a woman using any of the aforementioned
methods of contraception. (MK)
B. Induced abortion
Residents should be able to counsel pregnant patients on alternatives available to them,
including induced abortion and adoption. Residents who decide not to provide this service
because of a moral objection still should be able to counsel patients, make appropriate
referrals, and manage postabortal complications. (PC, ICS, PBLI, P)
1. Obtain a pertinent history from a patient requesting an induced abortion. (ICS, P)
2. Perform a targeted physical examination to confirm the presence of an intrauterine
pregnancy, accurately determine gestational age, and identify other abnormal
physical findings that may influence the choice of abortion method. (PC, P)
3. Order and interpret selected laboratory tests in patients requesting induced
abortion. (PC)
4. Describe the principal techniques for pregnancy termination, such as the following:
(PC, MK, P)
a. Suction curettage
b. Dilation and evacuation
c. Medical abortion
d. Induction termination
5. Describe and treat the principal complications of induced abortion. (PC, MK, P)
6. Perform postprocedure care and counseling
7. Describe the possible psychologic aftermath of induced abortion. (PC, MK, P)
151
FAMILY PLANNING ROTATION
WEEKLY SCHEDULE
Weeks 1 and 2
Monday
Tuesday
Wednesday
Thursday
Friday
PPO
PPO
PPO
PPO
PPO
PPO
PPO
PPO
PPO
PPO
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Elective Rotation PGY-3
Elective Schedule 2013-2104
Dr. Cecily Collins
Op out FP
8/26-9/6 Research
9/9-9/20 Private Practice OB/GYN Ervin
Dr. Jessica Jackson
Opt out FP
10/21-11/17 Away elective TBD
Dr. Gail Joseph
Opt out FP
9/23-9 27 Rutledge Fellowship
9/30-10/11 Research
10/14-10/18 Private Practice OBGYN TBD
Dr. Natasha Spencer
11/18-11/29 Research
12/2/13-12/13/13 Family Planning
Elective Goals and Objectives
This rotation is 2 weeks in length, and occurs during the PGY-3 year. The residents that opt
out of the Family Planning rotation may select another 2 week elective block in its place.
The goal of this rotation is to give the residents additional experience in an area of their
choice. With the permission of the PD, a resident may choose to spend these two weeks in an
outside facility. While on the rotation, if local, the residents will have Tuesday mornings as
their required continuity clinic day as well as be expected to attend didactics on Friday
mornings.
The following is a list of possible rotations, with the goals and objectives:
Research
Goals and Objectives
While rotating on the research block, the resident is expected to work with their mentor to
finalize and produce a manuscript according to the green journal specifications, as well as
submit for publication. The resident will be expected to attend am report on this rotation, as
well as complete the work on campus between the hours of 7am-5pm. Attendance at
required didactics and continuity clinics is also required.
A. Apply knowledge of study designs and statistical methods to the appraisal of
clinical studies and other information on diagnostic and therapeutic effectiveness.
(PBLI, MK, PC)
B. Use information technology to manage information, access online medical
information, and support their education. (PBLI, P, MK)
153
C. Produce a manuscript for journal submission. (PBLI, P, MK)
Private Practice OB/GYN
Goals and Objectives
While on the private practice rotation, the resident is expected to work with a selected private
OB/GYN attending. The resident experience is to expose them to the private practice side,
and integrate them into the business of medicine. A portion of this rotation should focus on
outpatient quality review, and how this impacts the practicioner. Focus on elements such as
patient flow, office management, and office staffing should be considered a priority.
A. Work with health care professionals, including those from other disciplines, to provide
patient-focused care. (PC, SBP, P, ICS)
B. Describe how types of medical practice and delivery systems differ from one another,
including methods of controlling health care costs and allocating resources. (SBP, ICS, PC)
1. List common systems of health care delivery, including various practice models.
(SBP, PC)
2. Describe common methods of health care financing. (SBP, PC)
3. Describe common business issues essential to running a medical practice. (SBP, P,
ICS)
4. Apply current procedural and diagnostic codes to reimbursement requests. (SBP,
PC, ICS)
C. Partner with health care managers and health care providers in the outpatient setting to
assess, coordinate, and improve health care and know how these activities can affect system
performance. (P, ICS, PC, PBLI)
1. Describe the process of quality assessment and improvement, including the role of
clinical indicators, criteria sets, and utilization review. (SBP, ICS, P, PC)
2. Participate in organized peer-review activities and use outcomes of such reviews to
improve personal and system-wide practice patterns. (SBP, P, ICS, PBLI, PC)
3. Demonstrate an ability to cooperate with other medical personnel to correct system
problems and improve patient care. (SBP, P, ICS, PC, PBLI)
D. See goals and objectives for the Obstetrics PGY-3 and Gynecology PGY-3 rotations.
ELECTIVE PGY-3 ROTATION
WEEKLY SCHEDULE
Monday
Rotation
Rotation
Tuesday
Cont. Clinic
Rotation
WEEKS 1-3
Wednesday
Rotation
Rotation
154
Thursday
Rotation
Rotation
Friday
Didactics
Clinic
D.O. specific rotational requirements for licensure in
Florida
Osteopathic residents selected to matriculation the Florida State University College of
Medicine Ob/Gyn residency program have two options for medical licensure.
A. Complete traditional ACGME Allopathic track, and obtain a license in another state (i.e.
Alabama). This means that this resident may have difficulty obtaining a Florida license in the
future. This decision will be based on the AOA board of medicine in the state of Florida.
B. Modify the curriculum, to meet the AOA requirements, and obtain a Florida License under
the Resolution 42 Summary (available at DO-Online.org) If selected, the following
curriculum adjustments will be made
A. In PGY-1, one additional block of Ambulatory is exchanged for one block of Gen
Surg; or in PGY 2 one GYN block is exxhanges for Gen Surgery
B. In PGY-2, one block of SICU will be done, instead of 2 weeks NICU/2 weeks SICU.
D. The DO resident will need to complete the 8 hour AOA meeting.
E. The DO resident will need to give a grand rounds lecture, related to osteopathic
principals in the PGY-2 year.
155
Research goals and objectives
Director of Research – Dr. Barry Ripps
The purposes of a resident research effort within our residency training program are
multifaceted. Overall, these efforts will advance residents’ knowledge of the basic principles
of research, including how research is conducted, evaluated, explained to patients, and
applied to patient care.
Consistent with recommendations, implementation of the program should foster an
atmosphere of inquiry and scholarship within the residency program, develop skills to assess
quality of published clinical research, promote confidence in the reading of medical
literature, and cultivate a career-long curiosity and passion for continued exploration and
learning.
Toward this mission, faculty strives for the following goals and objectives:
1. Faculty members establish and maintain an environment conductive to inquiry and
scholarship with an active research component.
2. Regular clinical group discussion, rounds, journal club, and conferences.
3. Faculty members demonstrate a commitment to scholarship by one or more of the
following:
a. Publication of original research or review articles in peer-reviewed
journals, or chapters in textbooks.
b. Publication or presentation of original research, case reports, clinical series.
c. Participation in national committees or educational organizations.
d. Encouraging, organizing and supporting resident efforts in scholarly activities.
Resident will strive to achieve the following skills and tasks during the four year training
program
1. Recognize the role of clinical research in the advancement of medicine.
2. Develop systematic and sustainable approach to reading the medical literature to
keep current throughout their career with an evolving standard of practice.
3. Develop an appreciation for hierarchy of clinical study design and challenges to
achieving clinically meaningful evidence; statistical power, biases, confounding
variables, etc.
4. Advance a working knowledge of levels of evidence as guides to determine
Research utility and incorporation into clinical practice.
5. Understand function of institutional review boards.
6. Develop/conduct a research project of publication quality:
a. develop and propose test hypothesis
b. design study to test hypothesis
c. seek IRB review and approval as indicated
d. conduct the study/enrollment
e. perform data analysis
f. prepare abstract/manuscript/presentation
h. serve as a discussant for other projects
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Time Allocation and Faculty/Facility Support
Successful completion of item six (6) above will be best served by regular and
progressive interaction with a sponsoring faculty mentor and/or coordination by a
Director of Research. A general timeline for implementation and completion of the
project is provided:
PGY-1
Group discussions on topic of interest throughout the year
Identification and selection of a topic by late as indicated
Initiate project by late year
PGY-2
Draft of proposal for faculty review early in year
Develop and finalize study protocol
Seek review/approval by appropriate committees as indicated
Initiate project by late in the year
PGY-3
Data collection/entry
Data and statistical analysis
Interpretation of findings
Preparation of abstract/manuscript
Local presentation and recognition at department-wide conference
Submission of abstract for presentation at state, regional, national meetings
PGY-4
Submission of manuscript for peer-reviewed publication
Serve as discussant of PGY-3 project presentations
Research Policies
The Florida State University College of Medicine Office for Research (OFR) is responsible
for all matters pertaining to research proposals developed by College of Medicine faculty
members until such time as the contract, grant, or sub-contract is awarded (pre-award
procedures). Post-award procedures are handled by the Financial Affairs Office. It is the
responsibility of the OFR to assure compliance with college,
University and grant agency requirements. The OFR must review the proposal and the
Associate Dean for Research must sign approval for the College of Medicine prior to
submission of the proposal to the University Office of Sponsored Research.
1.
Any contract or grant proposal by a member of the COM faculty/staff must be
submitted through the COM OFR if that faculty/staff member uses his or her FSU title, or
the college or university name on the proposal.
2.
Proposals may be submitted only if a full-time FSU faculty member is listed as Co-PI
(university policy). Exceptions may be granted by the FSU Vice President for Research.
3.
Each PI should work with his/her Department Chair to determine a reasonable
percent effort for the proposal and include the corresponding salary required for that
percent effort, if the sponsoring agency allows PI salary.
4.
The COM does not permit cost-sharing in excess of that required by the sponsoring
agency. Exceptions to this policy must be approved by the Associate Dean for Research,
Dean of the COM, and the FSU Vice President for Research.
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5.
If Recombinant DNA, Human or Animal Subjects, Radioactive/Hazardous Materials,
or Workshops/Conferences are involved, the project must be approved by the appropriate
FSU Compliance Officer (FSU Biohazard Committee, FSU Human Subjects Committee,
Animal Use and Care Committee, Environment Health and Safety Director, Center for
Professional Development Director) prior to funding.
6.
All graduate resident Matriculation and Fee costs must be included in the proposal
budget or paid from an alternate source.
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RESIDENT DUTY HOURS
Duty hours are defined as all clinical and academic activities related to the residency
program; i.e., patient care (both inpatient and outpatient), administrative duties relative to
patient care, the provision for transfer of patient care, time spent in-house during call
activities, and scheduled activities such as conferences. Duty hours do not include reading
and preparation time spent away from the duty site.
Duty hours must be limited to 80 hours per week, averaged over a four-week period,
inclusive of all in-house call activities. Residents must be provided with 1 day in 7 free from
all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call.
One day is defined a 1 continuous 24-hour period free from all clinical, educational, and
administrative duties. PGY-1’s can only work a maximum shift of 16 hours. PGY-2-4 must
have 14 hours free after 24 hours of work.
Residents can stay on site for up to 4 fours in transitions of care, as long as no new patients
are cared for. In our program, it expected that the transition of care will last 30 minutes, with
rare exception.
Adequate time for rest and personal activities must be provided. This should consist of a 10hour time period provided between all daily duty periods and after in-house call.
Issues for residents to consider:
1. The shift ends when checkout begins. All new patients that occur during transitions of
care will be managed by incoming team.
2. When logging your hours, your shifts end at the start of AM report. Please record the
transition of care time as post-wards follow-up (in New Innovations).
3. The expectation is that the call team will see the majority of patients prior to transition of
care. Gyn Onc is the only exception.
4. Residents assigned to work the day weekend shifts will average their 24 hour period off at
the start of their 2 week block, and at the end of the 2 week block.
5. Bookended weekends are not guaranteed off around scheduled vacations.
6. As per #5, vacations should be logged as Monday thru Friday only.
Documentation of resident work hours
Residents are expected to document their work hours directly into New Innovations via the
Internet at www.newinnovations.com . Duty hours will be entered into the computer daily,
and will be verified by the Program Director weekly. The Program Director will monitor all
duty hours for verification and violations. Failure to comply will result in warning (1st
offense), suspension (2nd offense) and probation (3rd offense).
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Example call schedule
Sunday
Call Senior Shift
Call Junior Shift
Float Senior Shift
Float Junior Shift
7:00 am-7:00 pm Transition of Care 7:00-7:30pm
7:00 am-7:00 pm Transition of Care 7:00-7:30pm
7:00 pm-7:00 am Transition of Care 7:00-7:30am
7:00 pm-7:00 am Transition of Care 7:00-7:30am
Monday
Float Senior Shift
Float Junior Shift
7:00 pm-7:00 am Transition of Care 7:00-7:30am
7:00 pm-7:00 am Transition of Care 7:00-7:30am
Tuesday
Float Senior Shift
Float Junior Shift
7:00 pm-7:00 am Transition of Care 7:00-7:30am
7:00 pm-7:00 am Transition of Care 7:00-7:30am
Wednesday
Float Senior Shift
Float Junior Shift
7:00 pm-7:00 am Transition of Care 7:00-7:30am
7:00 pm-7:00 am Transition of Care 7:00-7:30am
Thursday
Float Senior Shift
Float PGY-2 Shift
Float PGY-1 shift
7:00 pm-7:00 am Transition of Care 7:00-7:30am
7:00 pm-7:00 am Transition of Care 7:00-7:30am
7:00 pm-7:00 am Transition of Care 7:00-7:30 am
Friday
Didactics
*Call Senior Shift
*Call PGY-2 Shift
7:30am-11:00 am (float team stays for lectures)
7:00 pm-7:00 am Transition of Care 7-7:30 am
7:00 pm-7:00 am Transition of Care 7-7:30 am
Saturday
Call Senior Shift
Call Junior Shift
Call Junior Shift
7:00 am-7:00 am Transition of Care 7:00-7:30pm
7:00 am-7:00 pm Transition of Care 7:00-7:30pm
7:00 pm-7:00 am Transition of Care 7:00-7:30am
On-call activities
The objective of on-call activities is to provide residents with continuity of patient care
experiences throughout a 24-hour period. In-house call is defined as those extra duty hours
beyond the normal work day, when residents are required to be immediately available in the
assigned institution.
In-house call must occur no more frequently than every third night, averaged over a 4-week
period. Continuous on-site duty, including in-house call, must not exceed 24 consecutive
hours. Residents may remain on duty for up to 4 additional hours to participate in didactic
activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of
medical and surgical care. No new patients may be accepted after 24 hours of continuous
duty.
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At-home call (or pager call) is defined as a call taken from outside the assigned institution.
The frequency of at-home call is not subject to the every third-night limitation. Residents
taking at-home call must be provided with 1 day in 7 completely free from all educational
and clinical responsibilities, averaged over a 4-week period. When residents are called into
the hospital from home, the hours residents spend in-house are counted toward the 80-hour
limit.
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EVALUATIONS
Open verses anonymous evaluations
In our program, some evaluations are open and some are anonymous.
Open mean that the subject and the evaluator are both known to each other.
Anonymous evaluations mean that the evaluator is 100% confidential to either the subject or
anyone else. Below is an explanation of the evaluation types, as well as frequency.
Resident evaluations of faculty – twice per year, confidential
Resident evaluations of program – once per year (May), confidential
Praise/concern cards (residents of faculty) – as needed, confidential
360 evaluations (APB evaluations for this) twice per year, confidential
Resident evaluations of rotations – each rotation, open
Procedure logger – twice per year, open
Procedure log audit – 4 times per year, open
Focused surgical assessments (surgical score cards) – 5/procedure/year, open
Faculty evaluations
Residents are required to complete an anonymous evaluation of each faculty member every 6
months, and an overall written assessment of the residency education program at the end of
the academic year. These assessments will be reviewed by the Program Director and used for
decisions for possible promotion(s) for individual faculty members.
Resident methods of evaluations
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All residents will have twice yearly, comprehensive revew of all evaluation methods. The program director will perform the review, with
the faculty mentor present.
Method of evaluation / Competency matrix
Competency
Global
Assess.
Professionalism
Medical
Know-ledge
Patient Care
Communication
PracticeBased
Learning
SystemsBased
Practice
CREOG Read. Oral
Exam.
Quiz. Exam.
June
Surg. Journal. Formal Research 360 Preop
Clinical Praise/ Medical OSCE System
Score Club
Present. Project Eval Confer- Topic
Concern Record
Based
Review Cards
Chart
Practice/
Card
.
ence
Log
Review
M&M Conf.
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Hosp
Comm
Part
1. Assessment of Professional Behavior on Residents
Objective: 360 evaluations, to provide multi-source feedback to resident physicians.
Goal: This time sensitive evaluation tool was developed by the NBME. The requirement for
this evaluation is from ACGME. It is completed by faculty, peers, nurses, and self. (1,500
sent out annually. Average return - 25 per resident) the goal is to rate resident behavior over a
3-week evaluation period.
The evaluations are 100% anonymous feedback. This tool is to facilitate the shaping and
enhancement of resident professional behaviors. The summary reports are viewed by the
resident at the midpoint and end-of-year reviews, and one professionalism-based goal and
objective is developed based upon this feedback.
See Appendix XV – Evaluations, Assessment of professional behavior of resident
2. Patient Evaluations
Objective: To provide feedback on the resident professional behaviors as viewed from the
patient perspective.
Goal: This tool is part of the 360 process, is an ACGME requirement, and a minimum of 10
evaluations’ completed in the in fall, 10 in the spring.
See Appendix XV – Evaluations, Patient evaluation of resident
3. Global Evaluation
Objective: This evaluation is a scheduled, competency based monthly summary of resident’s
progress. These are matched at the start of the academic year to service attending that you
are assigned to work with.
Goal: The goal is to provide timely feedback to resident learners. The expectation is that
you will review and sign the evaluation. PD will monitor these evaluations and meet with the
resident if needed. Competency based evaluation summary reports of these global
evaluations are reviewed at midpoint and end of year reviews.
See Appendix XV – Evaluations, Global evaluation
4. Praise/Concern Cards
Objective: To provide the faulty members a method to give instantaneous, competency
based feedback.
Goal: Praise cards are to recognize positive and give positive competency based feedback.
Concern cards are a method to document breeches in competency based standards in real
time. There is a place for the resident to document a response to the concern, as well as a
place for the PD to make action plans and follow up.
See Appendix XV – Evaluations, Praise card and Concern card
5. Focused Surgical Skills assessments (Surgical Score Cards)
Objective: To improve the evaluation method, as well as to assure competency on year
specific obstetrical and gynecological procedural skills.
Goal: Each resident will have 5 focused exams on these individual surgical skills (via
surgical score card), with immediate feedback provided after the evaluation. These
evaluations will be on demand for the faculty in New Innovations. If the resident does not
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have a minimum number of focused exams on an individual skill assigned to an academic
year level, they will be required to perform that skill in the next academic year.
PGY-1
SVD
CD (Primary)
Suction DC
Hysteroscopy
Colposcopy
PGY-2
CD (Repeat)
Cystoscopy
Laparoscopy
Urodynamic
PGY-3
TVH
TAH
Anterior Repair
Tension Free Tape
(any method)
PGY-4
Robotic hysterectomy
TLH
Vaginal Vault
Suspension
Posterior Repair
See Appendix XV – Evaluations, Surgical score card
5. OSCE Exams:
Objective: To observe the resident in a structured clinical setting, at a minimum of one item
per year. Competency Based evaluation will be utilized.
Goal: To observe and critique the resident’s clinical skills, via a competency based format.
Each year, three clinical scenarios will be developed – one OB, one GYN and one “other”
case, usually primary care. This evaluation is formative, and allows the faculty member and
resident unique insight regarding performance of clinical skills. Additional items such as
ethical principles, cultural competencies or other topics relating to women’s health may be
utilized. This evaluation will occur in the spring of the academic year, and will be reviewed
at the end of the year evaluation.
6. Oral Exams – Knowledge Assessment
Objective: To assess the residents basic fund of knowledge, as well as to promote familiarity
with the format of the oral exam.
Goal: To assess the resident’s performance and basic fund of knowledge in an oral setting.
Scenarios in office practice, obstetrics and gynecology have been developed. The resident is
scored by a team of 2 faculty members on 3 randomly resident selected scenarios. This exam
is for the rising PGY-2’s, PGY-3’s and PGY-4’s and will occur at the end of June. Scenarios
were developed by the faculty from ABOG bulletin topics as well as ACOG publication.
7. Oral Exam – Case List Collection/ Outcomes Project
Objective: To have the resident physician collect an organized list of clinical cases in which
they participated. Residents will be tasked with selecting appropriate cases from categories
whom they followed longitudinally, tracking outcomes.
Goal: The goal is to increase resident awareness regarding the importance of longitudinal
patient experience and their clinical outcomes and prepare for the ABOG oral exam.
Specifics regarding this requirement will be introduced to the residents in August. The
caselist collection period ends in April. The resultant caselist will be used to guide questions
during the oral exam.
8. Primary Care Audit
Objective: To audit primary care charts for key elements.
Goal: To promote awareness for key primary care elements, in order to comply with
OB/GYN RRC elements.
Competency Matrix
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Medical Knowledge
Global evaluation (Monthly)
Journal Club (Monthly)
Standardized Patients (Annually)
Patient Care
Surgical Score Cards
Standardized Patients
Global Evaluations
Practice Based Learning and Improvement
PBLI case presentations
M and M/Quality risk Improvement Conference (4 times year)
Systems Based Practice
All residents (except interns) will participate in hospital quality improvement/pt safety
committees
FSU seminars Business of Medicine
Team Building activities-Bill Dee weekly; entire group twice per year
M and M/Quality risk Improvement Conference (4 times year)
Professionalism
Global evaluations, monthly
360 (Patient – May/December, Staff-May/December, Self/Peer-May)
Standardized Patients (yearly, July)
Praise/Concern Cards (prn by staff and residents)
Medical Records (List emailed weekly)
Interpersonal Relationships/Communication Skills
Standardized Patients
Grand Rounds
Grand Round Evaluation
M&M Evaluation
Program Evaluation
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ADMINISTRATIVE GUIDELINES
Documentation of clinical and surgical experience
Throughout the four years of training, residents are expected to keep an accurate record of
their clinical experience. Vaginal deliveries, cesareans, surgical procedures, and primary care
encounters must be documented. Residents are to enter their surgical statistics directly into
the ACGME database via the Internet at http://www.acgme.org/residentdatacollection/.
Statistics will be entered into the computer daily, and will be verified the Program Director
weekly for verification. Failure to comply will result in warning (1st offense), suspension (2nd
offense) and probation (3rd offense).
Additionally, as approved by the GMEC, residents who scrub in on cases that are not in the
division they are assigned to, but who desire to gain the learning experience from assisting in
such cases, must follow all required hospital procedure and document such.
Background checks and drug screen
In connection with my application for residency with FSU, I understand and agree that
background and drug screen inquires are requested by Sacred Heart Health System that will
seek information as to my character, work habits, including oral assessments of my job
performance, experiences and abilities, along with reasons for termination of past
employment. Furthermore, I understand and agree that Sacred Heart Health System may
request information from various federal, state, and other agencies, including public and
private sources which maintain records concerning my past activities relating to my driving
record, credit history, criminal record, civil matters, previous employment, educational
background, and other past experiences. In addition, application to the Florida Board of
Medicine as in intern/resident/fellow, as well as for unrestricted licensure, requires selfdisclosure of criminal convictions and of prior substance abuse and/or treatment.
HIPAA privacy and security
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is an important
federal law that affects how you and the Florida State University College of Medicine must
handle confidential patient health information. The fundamental premise under the Privacy
Rules is to protect ‘Patient Health Information.’
‘Patient Health Information’ is broadly defined in the Privacy Rules to include any oral,
written or electronic individually identifiable information relating to (a) the past, present, or
future physical or mental health of an individual; (b) the provision of health care to the
individual; and/or (c) the payment for health care. This means that virtually all patient related
information is subject to the protections of the Privacy Rules. Consequently, it is vital that
you fully comprehend your obligations to protect this information in accordance with HIPAA
Policies and Procedures. The Sacred Heart Health System requires training in this area.
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Policies and guidelines for pharmaceutical / vendor
interactions
Purpose of Policy
The purpose of this policy is to establish guidelines to ensure that patient care and medical
education are not influenced by considerations other than what is in the best interests of
patients and/or trainees.
Statement of Policy
It is the policy of the FSU COM that pharmaceutical/industry access to residents is prohibited
on FSU COM property, including regional medical school campuses However, discussion
with representatives for the purpose of obtaining unrestricted educational grants is allowed.
This policy applies to all FSU COM residents when performing their duties on FSU COM
property.
Scope of Policy
I. Accepting Offers
Gifts
Residents may not solicit or accept any gifts from pharmaceutical company/industry
representatives. Additionally, the use of any vendor’s material with the vendor’s name or
logo is strongly discouraged in public or patient care areas.
Food
The direct provision of any meals, desserts, etc. by pharmaceutical/industry representatives
on FSU COM property is prohibited. This includes the provision of meals during any
organized, scheduled educational activity (e.g., grand rounds, journal club, faculty
development, etc.) or reception. Industry representatives who wish to provide support to the
FSU COM may, however, do so in the form of an unrestricted educational grant to the FSU
COM. Such grants are expended for food solely at the discretion of COM
departments/divisions/regional campuses/residency programs.
Entertainment
Faculty members, residents, or employees of the FSU COM participating in social events,
including meals, funded directly by pharmaceutical company/industry may not use their
official status as FSU employees or residents. Moreover, faculty and employees of the FSU
COM may not accept the use of supplier/vendor property, airplane transportation, travel
packages, or similar favors from industry as FSU employees.
Compensation
Residents may not accept gifts or compensation for listening to a sales talk by an industry
representative, including the defraying of costs for simply attending a CME or other activity
or conference.
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Honoraria provided directly by pharmaceutical/other industry are not allowed if resident
status with the FSU COM is acknowledged.
II. Site Access
Pharmaceutical/Industry Representatives are not allowed access to residents on FSU COM
property, including its regional campuses, except for the purpose of discussing/providing
unrestricted educational grants.
III. Educational Funds
Industry representatives may provide support for resident educational purposes in the form of
unrestricted educational grants. Initial contact with industry representatives for the purpose of
discussing or obtaining unrestricted educational grants is permitted.
No educational grant, financial award, donation, or expense reimbursement may be given
directly to a resident by an industry representative. Any educational grant must be provided
to the College of Medicine.
Note: These provisions do not apply to meetings of professional societies that may receive
partial industry support, i.e., meetings governed by ACCME Standards.
IV. Disclosure of Relationships with Industry
All College, Program and Sponsoring Institution-sponsored medical education events must
include full and appropriate disclosure of sponsorship and financial interests above and
beyond those already governed by the Standards for Commercial Support promulgated by the
Accreditation Council for Continuing Medical Education. Department Chairs, Program
Directors and Faculty should disclose any financial relationships with Industry, including but
not limited to ownership of practice and hospital sites at the time of appointment to these
positions, annually through the FSU COM Personnel Office, and as actual, potential, or the
appearance of Conflicts of Interest arise.
Faculty with supervisory responsibilities for residents should ensure that the faculty’s conflict
or potential conflict of interest does not affect or appear to affect his or her supervision of the
resident.
Individuals having a direct role making institutional decisions on equipment or drug
procurement must disclose to the FSU COM Administration / Personnel Office, prior to
making any such decision, any financial interest they or their immediate family have in
companies that might substantially benefit from the decision. Such financial interests could
include equity ownership, compensated positions on advisory boards, a paid consultancy, or
other forms of compensated relationship. They must also disclose any research or educational
interest they or their department have that might substantially benefit from the decision. The
administration will decide whether the individual must remove him/herself from the
purchasing decision.
Note: This provision excludes indirect ownership, such as stock held through mutual funds.
V. Training/Communication Regarding Potential Conflicts of Interest
All residents shall be provided with information regarding potential conflicts of interest in
interactions with industry to include:
169
•
•
•
A copy of these guidelines on vendor interactions.
Copies of the ethics statements of pertinent medical specialty societies and how to
apply those guidelines to practice.
Seminars sessions describing:
o
How activities can influence judgment in prescribing decisions and research
activities.
o
How to manage encounters with Industry representatives.
o
How to handle patient requests for medication, particularly regarding directto-consumer advertising of drugs.
o
The purpose, development, and application of drug formularies and clinical
guidelines and discussing such issues as branding, generic drugs, off-label use,
and use of free samples.
VI. Procedure, Monitoring and Responsibility
We want to ensure patients and residents know we are focusing on their welfare, not on any
commercial interest and eliminate the appearance of industry’s inappropriate influence over
the medical community. Therefore, all FSU COM residents will be given a copy of this
Policy and Guidelines document.
The Graduate Medical Education Committee (GMEC) must ensure that the Sponsoring
Institution monitors vendor interactions with residents and GME programs.
FSU COM administration, department heads, division heads, campus deans, program
directors, etc. are responsible for compliance with this policy and for ensuring the personnel
under their supervision understand and comply with this policy.
If FSU COM residents have any questions concerning the interpretation of this policy and
guidelines, or its applicability to a particular circumstance, they should first consult with their
supervisor. If their supervisor is unable to answer the question or provide appropriate
guidance, or if, because of the circumstances, it would be inappropriate to discuss the matter
with the supervisor, then the resident should contact the FSU COM Sr. Associate Dean’s
office. If any FSU COM personnel and/or staff member is aware of any violation or
threatened or potential violation of this policy, or suspects that a violation of this policy has
occurred, they must also refer to the FSU COM Sr. Associate Dean’s office.
VII. Exceptions
1. This policy does not apply to part-time faculty (clerkship directors and clerkship faculty)
engaged in their roles at venues other than FSU COM property; i.e., private offices, hospitals
or other sites.
2. This policy does not include faculty research and related activities, which are included in
the Florida State University Faculty Policies and Procedures for Dealing with Misconduct in
Research and Creative Activity (http://dof.fsu.edu/facultyhandbook/Ch6/Ch6.20.html).
Individuals should contact the FSU COM Office of Research
(http://med.fsu.edu/research/office/default.asp) with regard to publishing articles under their
name and FSU COM title, in disclosing their related financial interests etc.
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Conflicts of Interest: Any situation in which an individual is in a position to exploit his/her
professional or official capacity in some way for personal benefit.
Faculty: Physicians/Professors who possess the requisite expertise, documented educational
and administrative abilities, and experience to teach residents.
Meetings: Any gathering on FSU COM property involving FSU COM residents. Such
gatherings would include but not be limited to resident meetings, grand rounds, or regional
campus meetings.
Personnel: Faculty, staff, residents of FSU COM.
Representative: Includes any individual who is employed by or who represents any entity
defined under ‘Vendor/Industry’.
Sponsorship: Vendor/Supplier funding
Unrestricted Educational Grants: It is recommended that industry representatives provide
financial support for FSU COM events directly to the COM in the form of an unrestricted
educational grant to then be spent by the COM departments/divisions/regional
campuses/residency programs for educational activities at their discretion. Appropriate
recognition of the industry representative’s contribution should be given by the
department/division/regional campus/residency program. Educational grants must not be
made, conditioned, or related in any way to pre-existing or future business relationships with
Industry. Vendors should separate their grant making functions from their sales and
marketing functions. Accordingly, if vendor or patient-service representatives or other
corporate representatives wish to discuss a corporate contribution of cash, equipment,
supplies, or services, the employee should immediately notify the Dean or the Sr. Associate
Dean for Academic Affairs/DIO. This individual, or a designee, should then become the
principal point of contact with the vendor.
Vendor/Industry: Includes those businesses, corporations, or entities that supply or wish to
supply equipment, goods, services, or other medical related products to physicians,
administrators, residents, staff or hospitals.
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General disaster plan
Definition of Disaster: A disaster is defined herein as an event or set of events causing
significant alteration to the residency experience at one or more residency programs.
Declaration of Disaster: When warranted, the Accredited Council for Graduate Medical
Education (ACGME) Executive Director, with consultation of the ACGME Executive
Committee and the Chair of the Institutional Review Committee, will make a declaration of a
disaster. A notice of such will be posted (and periodically updated) on the ACGME website
with information relating to ACGME response to the disaster.
Resident Information: All programs will maintain a roster of all residents that includes at a
minimum, the following information: name, address, pager number, all available phone
numbers (home, cell, etc.), all available e-mail addresses, and emergency contact
individual(s) and their contact information. This information will be updated at least
annually before July 31, and as appropriate to maintain accuracy. The programs will
maintain this roster with internal backup, as well as external backup at the Florida State
University (FSU) College of Medicine.
As possible, residents may continue their roles and participate in disaster recovery efforts.
Resident reporting will continue during disaster recovery. Residents will continue to receive
their salary and benefits during the disaster event recovery period, and/or accumulate salary
and benefits until such time as utility restoration allows for fund transfer.
Medical-Legal Aspects: There are multiple mechanisms that may afford liability protection
to FSU residents who are or will be working in the affected areas of disaster response in the
State of Florida from incurring personal liabilities. In the capacity of assignment by Florida
National Guard and/or Department of Homeland Security, residents may become temporary
employees of Health and Human Services (HHS) and therefore are subject to and protected
by the Federal Tort Claims Act. It is preferred, whenever possible, that notwithstanding
other capacities in which residents may serve, they also perform within their FSU function
when they participate in disaster recovery efforts. While acting within their FSU function,
residents will maintain their personal immunity to civil actions via the state’s sovereign
immunity and the University’s Self-Insurance Program.
Communication with ACGME: The Designated Institutional Official will call or email the
Institutional Review Committee Executive Director with information and/or requests for
information.
Similarly, the Program Directors will contact the appropriate Review Committee Executive
Director with information and/or requests for information.
Residents should call or email the appropriate Residency Director (or Residency Review
Committee if unable to reach director) with information and/or requests for information. In
the ACGME Web Accreditation Data System, ACGME will provide instructions for
changing resident e-mail information as needed.
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Resident Transfers / Program Reconfiguration: If, because of a disaster, at least an
adequate educational experience cannot be provided for each resident the sponsoring
institution will:
(a)
Arrange temporary transfers to other programs/institutions until such time as the
residency program can provide an adequate educational experience for each of its
residents;
(b)
Cooperate in and facilitate permanent transfers to other programs/institutions. If
more than one program/institution is available for temporary or permanent transfer
of a particular resident, the transferee preferences of each resident will be
considered. Programs/institutions will make the keep/transfer decision expeditiously
so as to maximize the likelihood that each resident will timely complete the resident
year; and
(c)
Inform each transferred resident of the minimum duration of his/her temporary
transfer, and continue to keep each resident informed of the minimum duration. If
and when a program decides that a temporary transfer will continue to and/or
through the end of a residency year, it must so inform each such transferred resident.
Within ten days after the declaration of a disaster, the Designated Institutional Official (DIO)
will contact ACGME to discuss due dates that ACGME will establish for the programs, (a) to
submit program reconfigurations to ACGME; and, (b) to inform each program’s residents of
resident transfer decisions. The due dates for submission shall be no later than 30 days after
the disaster unless other due dates are approved by ACGME.
A form will be available on the ACGME website for institutions offering to accept temporary
or permanent transfers from disaster affected institutions that must be completed. Upon
request, ACGME will provide information from the form to the affected programs and
residents.
ACGME will expedite the process for reviewing (and approving or not approving)
submissions by programs relating to program changes to address disaster effects, including
the addition or deletion of a participating institution, change in the format of the educational
program, and/or change in the approved resident compliment.
Hurricane Preparedness: Please reference the Sacred Heart Hospital Emergency
Policy at Compliance 360 online
If Sacred Heart Hospital confirms or declares a disaster, then the FSU residency will
implement the hurricane preparedness plan. Seven (7) residents must stay at the hospital
(your family may stay with you at the hospital, if needed) and six (6) residents may evacuate.
Those residents staying at the hospital may volunteer to stay or may be assigned by the
Program Director to stay. Decisions of clinical operations will be made by the Program
Director, who will consult with the Sacred Heart Medical Group Director and the Office
Manager. Prior to evacuating the Pensacola area, all residents MUST contact the Program
Director. Residents not on duty may only evacuate after explicit permission is obtained from
the Program Director.
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Harassment policy
POLICY STATEMENT:
Sexual harassment is a form of discrimination based on a person's gender. Sexual harassment
is contrary to the University's values and moral standards, which recognize the dignity and
worth of each person, as well as a violation of federal and state laws and University rules and
policies. Sexual harassment cannot and will not be tolerated by the Florida State University,
whether by faculty, residents or staff; or by others while on property owned by or under the
control of the University.
OFFICE OF AUDIT SERVICES:
The Office of Audit Services (OAS) is charged with receiving and investigating sexual
harassment complaints as set forth in this policy and shall maintain the records pertaining
thereto. Within the OAS, the Coordinator of Sexual Harassment Resolutions has primary
responsibility for leading these investigations.
DEFINITION:
Sexual harassment is defined as unwelcome sexual advances, requests for sexual favors, and
other verbal or physical conduct of a sexual nature directed at an employee or resident by
another when:
a.
submission to such conduct is made either explicitly or implicitly a term or
condition of employment, academic status, receipt of University services,
participation in University activities and programs, or affects the measure of a
resident’s academic performance; or,
b.
submission to or rejection of such conduct is used as the basis for a decision
affecting employment, academic status, receipt of services, participation in
University activities and programs, or the measure of a resident’s academic
performance; or,
c.
such conduct has the purpose or effect of unreasonably interfering with
employment opportunities, work or academic performance or creating an
intimidating, hostile, or offensive work or educational environment.
EXAMPLES OF SEXUAL HARASSMENT:
Incidents of sexual harassment may involve persons of different or the same gender. They
may involve persons having equal or unequal power, authority or influence. Though romantic
and sexual relationships between persons of unequal power do not necessarily constitute
sexual harassment, there is an inherent conflict of interest between making sexual overtures
and exercising supervisory, educational, or other institutional authority. Decisions affecting
an employee's job responsibilities, promotion, pay, benefits, or other terms or conditions of
employment, or a resident's grades, academic progress, evaluation, resident status,
recommendations, references, referrals, and opportunities for further study, employment or
career advancement, must be made solely on the basis of merit.
Examples of sexual harassment include, but are not limited to, the following, when they
occur within the circumstances described above:
a.
use of gender-based verbal or written language, including electronic
communication, offensive or degrading to a person of that gender, whether or not
the content is sexual;
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b.
c.
d.
e.
f.
inappropriate display of gender-based pictorial images offensive or degrading
to a person of that gender, including but not limited to sexual posters,
photographs, cartoons, drawings, or other displays of sexually suggestive objects
or pictures;
use of inappropriate gestures or body language of a sexual nature, including
leering or staring at another;
unwelcome requests or demands for sexual favors or unwelcome sexual
advances;
inappropriate nonconsensual touching of another's body, including but not
limited to kissing, pinching, groping, fondling, or blocking normal movement; or
sexual battery. (Note: some acts of sexual harassment may also constitute
violations of criminal law, e.g., sexual battery, indecent exposure, sexual abuse,
etc. In such instances, please refer to the University's Sexual Battery Policy.)
DISCIPLINARY AND OTHER ACTIONS:
Sexual harassment is prohibited by the Florida State University. The University will take
appropriate action against any person found to be in violation of this policy. (Note: a person
who has sexually harassed another or retaliated against another may also be subject to civil or
criminal liability under state or federal law.)
a.
Disciplinary Actions. Any employee who has sexually harassed another
employee or a resident, retaliated against such person for bringing a complaint of
sexual harassment, or otherwise violated this policy shall be guilty of misconduct
and subject to disciplinary action up to and including dismissal, in accordance
with applicable law, rules, policies, and/or collective bargaining agreements. In
addition, any resident who has sexually harassed another resident or an employee,
retaliated against such person for bringing a complaint of sexual harassment, or
otherwise violated this policy may be subject to disciplinary action up to and
including expulsion, pursuant to the Student Code of Conduct. The term
"employee" includes all persons employed by the University including faculty,
residents and graduate teaching assistants.
b.
Other Actions. The University will take such corrective action against any
non-residents or non-employees found to have violated this policy, as may be
appropriate under the circumstances.
RETALIATION:
Retaliation against one who in good faith brings a complaint of sexual harassment or who in
good faith participates in the investigation of a sexual harassment complaint is prohibited and
shall be a violation of this policy and shall constitute misconduct subject to disciplinary or
other action as described above.
FILING OF FALSE SEXUAL HARASSMENT COMPLAINT:
Knowingly filing a false sexual harassment complaint is prohibited and shall be a violation
of this policy and shall constitute misconduct subject to disciplinary action as described
above. A complaint that is investigated and deemed unsubstantiated is not necessarily a false
complaint.
REPORTING REQUIRED:
Any resident or employee who has witnessed what is perceived to be a violation of this
policy should promptly report that conduct to the OAS, who then will proceed as appropriate.
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Any supervisor who has witnessed or becomes aware of the alleged occurrence of sexual
harassment by, or who receives a complaint of sexual harassment involving a person within
that supervisor's purview is required to take prompt corrective action as appropriate, and to
report the matter, if possible, within two work days to the OAS. Failure of the supervisor to
take appropriate corrective action or to report the incident shall be a violation of this policy
and shall constitute misconduct subject to disciplinary action as described above.
COMPLAINT PROCEDURE:
a.
Filing of Complaint. Any resident or employee who believes that he or she is
a victim of sexual harassment in violation of this policy is encouraged to
promptly notify the alleged perpetrator (the "respondent") verbally or in writing
that his or her conduct is unwelcome. Such action may cause the unwelcome
conduct to cease as well as help to maintain an environment free from sexual
harassment. Assistance and support is available from the Office of the Dean of
the Faculties (for faculty), the Office of the Dean of Students (for students), or the
Department of Human Resources (for non-faculty employees). Regardless of
having given notice to the respondent, the resident or employee (the
"complainant") may initiate a complaint under this policy by promptly bringing
the matter to the attention, preferably in writing by completing the complaint
form, of any of the following:
1.
The Office of Audit Services;
2.
The Department of Human Resources;
3.
The DIO; or,
4.
An employee's immediate or next immediate supervisor.
All complaints should be filed in a timely manner. Complaints filed for acts
that occurred more than one year from the filing date of the complaint will
generally not be investigated unless appropriate in the judgment of the OAS.
b. Preparing a Complaint. The complainant should provide the following
information to facilitate a prompt and thorough investigation:
1. The names, addresses, telephone numbers, administrative unit, and
position or status of the complainant and the respondent, if known;
2. Specific acts alleged, including dates, times, and locations;
3. Names, addresses, and phone numbers of potential witnesses;
4. The effect the alleged acts have had on the complainant;
5. Actions the complainant may have taken to attempt to stop the
harassment;
6. Complainant's suggestion of proposed action to address or resolve the
harassment; and
7. Other
information
the
complainant
believes
is
relevant.
c. Transmitting a Complaint to the OAS. The complaint shall immediately be
forwarded to the OAS. If the complaint is verbal, the person receiving the
complaint shall make a written summary thereof on the complaint form and
request the complainant to sign it.
d. Reviewing a Complaint. The OAS will make an initial determination whether the
alleged perpetrator is a resident or employee. If the alleged perpetrator is
identified, as one who is not a resident or employee, then the OAS will refer the
matter to the Office of the General Counsel for appropriate action. If the OAS
determines that the alleged perpetrator is a resident or employee, the OAS will
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review the complaint to determine whether the acts complained of, as stated by
the complainant, constitute a violation of this policy, and if not, the complainant
will be so informed. If the OAS determines the alleged acts may constitute a
violation of this policy, the investigation will proceed as set forth below, unless
the matter is satisfactorily resolved as in the following paragraph (e).
e. Notifying the Respondent and Supervisor; Informally Resolving a Complaint;
Withdrawing a Complaint. The OAS will notify the respondent and his or her
appropriate supervisor of the allegations contained in the complaint. In an effort
to informally resolve the complaint, the OAS will elicit from the complainant,
proposed actions the complainant believes are necessary to address or resolve the
alleged harassment. The OAS will discuss these proposed actions with the
respondent and with appropriate levels of management. The respective parties
will also have the opportunity to propose other means of resolution. Thus, if the
matter can be resolved informally, or if the complainant chooses to withdraw the
complaint, the complainant will sign a statement outlining the informal resolution
and releasing the University from taking any further action. If the matter is not
resolved at this stage, the complaint will be investigated as set forth in below.
INVESTIGATION:
The following procedures will govern all investigations of complaints alleging violations of
this policy:
a.
The OAS will thoroughly investigate complaints alleging violations of this
policy with the assistance, as needed, of the following: the Office of the Dean of
the Faculties, the Department of Human Resources, and/or the respondent's
supervisor(s), except in cases where the respondent is a resident. If the respondent
is a resident, the OAS will forward a copy of the complaint and any associated
materials to the Office of the Dean of Students, which will, if appropriate,
adjudicate the matter under the Code of Student Conduct. The Dean of Students
shall notify the OAS of the outcome.
b.
The investigation should include interviewing the complainant and witnesses
suggested by the complainant who may have knowledge of the alleged offending
behavior. Employees and residents shall fully cooperate in the investigation.
c.
The respondent will be given an opportunity to respond to the complaint
verbally and in writing and may suggest additional witnesses.
d.
The investigation should also include interviewing such other witnesses as are
deemed appropriate under the circumstances.
e.
The investigation should include a review of any files and records of previous
sexual harassment complaints against the respondent and any other documents
deemed relevant.
f.
All witnesses who provide relevant information should submit a written,
signed statement attesting to their knowledge of the subject circumstances.
g.
Confidentiality of the investigation will be maintained to the extent allowed
by law.
REPORT OF OAS:
The OAS will prepare a report setting forth its findings and a determination concerning
violation of this policy. The report should be completed within 120 days following the filing
of the complaint, where feasible, and will be submitted to the appropriate vice president of
the respondent's unit or department.
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SUBSEQUENT ACTION:
The vice president will make a determination, upon review of the OAS's report, consultation
with the Dean of the Faculties or the Director of Human Resources, and consideration of any
other relevant information, including aggravating or mitigating circumstances, whether
disciplinary action is warranted under the circumstances. If the vice president determines that
disciplinary action should be initiated, then, consistent with due process requirements, the
respondent will be notified in accordance with applicable Florida Board of Education and
University rules and policies and collective bargaining agreements, and appropriate
disciplinary procedures as provided for therein will be followed. Regardless of whether
formal disciplinary action is initiated, the University may take such informal corrective
action as may be appropriate under the circumstances. The vice president will notify the OAS
of the outcome. The OAS will notify the complainant of the results of the investigation and
subsequent disciplinary or other corrective action taken, if any, to the extent allowed by law.
The OAS will notify the respondent of the results of the investigation when no policy
violation is found and no further action planned.
DISTRIBUTION OF POLICY:
Copies of this policy are available to all current and future employees and residents at the
Florida State University in hard copy (policy brochures, resident handbooks, The Bulletin,
etc.), electronic format (www.auditservices.fsu.edu/sh/policy), and will be made available in
alternative format upon request. Any person involved in the process under this policy needing
accommodations for a disability should notify the OAS.
APPLICABILITY:
This policy supersedes any and all prior University policies regarding complaints of alleged
acts of sexual harassment.
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Residency closure / reduction
All program directors must report to the DIO any plans for change in residency size.
Reductions should be designed to maintain a high standard of educational experience that
continues to comply with ACGME standards. Significant changes in program size must be
discussed at the GMEC regarding the educational impact on that program, as well as other
associated programs.
In the event that the FSU COM decides to reduce the number of residency positions in and/or
close any GME program, the residents will be notified as soon as possible. Should a
Residency Program downsize for any reason, it will make a good faith effort to accomplish
the reduction by accepting fewer residents into the entry level of the program. Any such
reduction must include provision for a continued training program for existing
residents/fellows. If necessary, the institution and the individual residency program will assist
residents in finding another residency position in the same specialty at the appropriate PGY
level; however, every effort will be made to allow residents in the program to complete their
training through the FSU COM Residency Program with funding for their support remaining
intact.
Accomodation of residents with disabilities
The Florida State University (FSU) embraces the value of increasing knowledge and
awareness through diversity, which includes administration of the Americans with
Disabilities Act (ADA) program. This program ensures that faculty, staff, residents and
visitors with disabilities are included in the mainstream of University life.
As a public entity, FSU is required by Title II of the ADA to make all of its activities,
programs and services equally available to persons with disabilities. FSU has resources
available for those who have disabilities, which help ensure a quality, educational and work
environment.
If a resident wishes to request accommodation, he/she will submit the Employee Request for
Accommodations Under the American with Disabilities Act (ADA), form ADA-99, to his/her
residency program director, with copy to the DIO. The form is available from the FSU Office
of Diversity & Compliance. The program director and DIO will review the request. If it is
determined that additional medical information is needed, the resident will be provided with
any forms/questionnaires necessary for his/her health care provider to complete. The
Residency Coordinator will assist in the evaluation of the information to determine eligibility
within the guidelines of ADA.
The program director and DIO will then coordinate with the necessary institutional staff and
the resident to determine whether the requested accommodation would be effective,
reasonable, and enable the resident to perform the essential functions of the position and
achieve the essential educational goals and program objectives, or make a good faith effort to
negotiate another accommodation. The Residency Coordinator will follow-up on employee's
status/progress on annual basis, or earlier as need arises.
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A request for accommodation may be made at any time during residency training. In order
for the resident to receive maximum benefit from his/her residency training time, requests for
accommodation should be made as early in the training process as possible.
All medical-related information will be kept confidential and maintained separately from
other resident records. However, supervisors and managers may be advised of information
necessary to make the determinations they are required to make in connection with a request
for an accommodation. First aid and safety personnel may be informed, when appropriate, if
the disability might require emergency treatment or if any specific procedures are needed in
the case of fire or other evacuations. Government officials investigating compliance with the
ADA may also be provided relevant information as requested. Form ADA-99 and attached
documentation submitted to the Residency Coordinator will be maintained in a confidential
manner in accordance with applicable federal and state mandated retention schedules.
Physician impairment and substance abuse
See also Appendix X – Physician impairment policy and support
The FSU COM conforms to the Florida Medical Practice Act (F.S. 458). The rule calls for
all licensed practitioners to report to the appropriate authority any reasonable suspicion that a
practitioner is impaired to practice. The legislation provides for therapeutic intervention
through the Professionals Recovery Network (PRN). This organization works closely with
the State Board of Medicine and is recognized as the primary method of dealing with
physician impairment in the state.
1. Faculty, staff, peers, family or other individuals who suspect that a resident is suffering
from a psychological or substance abuse problem are obliged to report such problems.
Individuals suspecting such impairment can discuss their concerns with the Program Director
and/or the DIO, or may report it directly to the Physician’s Recovery Network (PRN). It is
the intent of the sponsoring institution that all appropriate rules that govern the practice of
medicine be strictly enforced.
a.
All referrals to the PRN are confidential and are evaluated by the
professionals of the PRN. Decisions about intervention, treatment and after care
are determined by the PRN.
b.
As long as the practitioner satisfactorily participates in the PRN program no
regulatory action would normally be anticipated by the Board of Medicine.
c. Resumption of clinical activity and residency program will be contingent upon
the continued successful participation in the PRN and continuation of the resident
in the program will be determined in consultation between the program director
and the professionals at the PRN.
d. Information on the PRN and its program can be obtained by calling 1-800-8888776 or by writing to the PRN at P. O. Box 1020, Fernandina Beach, FL 320351020.
2. Each program will provide an educational program to their residents regarding substance
abuse.
3. Compliance with the above will be monitored in the internal review process.
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Physicians with a past or current history of drug or alcohol addiction must contact the PRN as
soon as possible on or before arriving at your training program. This is a confidential and
professional organization that will help you in this regard, while maintaining your ability to
practice medicine in our State.
The purpose of the PRN Program is to ensure the public health and safety by assisting the ill
practitioners who may suffer from one or more of the following:
•
Chemical dependency
•
Psychiatric illness
•
Psychosexual illness, including boundary violations
•
Neurological/cognitive impairment
•
Physical illness
•
HIV infections/AIDS
•
Behavioral disorders
By supporting ill practitioners in regaining their health, PRN attempts to maintain the
integrity of the healthcare team in its role in serving the public. You are treated with respect,
confidentiality, and without discrimination. Recommendations by the PRN for any type of
follow-up, counseling, testing, assessment, etc. is the privacy of you and the PRN in their
Advocacy/Monitoring Contract.
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Resident promotion, probation, and termination
1.
2.
3.
4.
4.
5.
6.
7.
8.
MARCH 1st is the date by which residents will be notified of promotion or probation
for the following academic year.
Resident performance will be assessed quarterly at the Clinical Competency
Committee Meeting, including decisions for promotion and probation. Reports from this
committee are presented at monthly faculty meetings. The Program Director solits inout
form this committee, as well as the factulty regarding decisions for expectations,
probation and termination. However, the ultimate decision for these actions rests with
the authority of the Program Director.
Probation may be instituted at any time, at the discretion of the program director.
Promotion is dependent upon fulfillment of the following criteria to the satisfaction of the
faculty:
a.
Acquiring the specific cognitive, clinical, and operative skills for each level
of training, as stated by the various divisions and the CREOG guidelines.
b.
Appropriate moral, ethical, and professional conduct.
c.
Attendance and participation in teaching functions.
d.
Acceptable performance on the CREOG In-Service Training Examination.
“Acceptable” absolute (raw) scores and standardized scores will be determined
on an individual basis, taking into account level of training, prior scores on
standardized tests, and other aspects of clinical performance.
Failure to satisfactorily meet any of the above standards will result in the resident
being placed in expectations, or if the act is deemed significant enough probation.
Residents in expectations or probation will be given ample opportunity to correct
their deficiencies, and will be given a written expectation plan or a probation plan.
When such deficiencies are determined to be corrected by the program director, the
resident then will be removed from probation. Failure to correct these deficiencies within
the allotted time may be grounds for termination.
Any major departure from the faculty’s standards of resident performance may be
judged grounds for TERMINATION without a preliminary PROBATIONAL PERIOD.
Due process will be provided for any party potentially involved in dismissal actions
and for any resident who has a grievance against the program. (See Grievances)
Resident and Program Responsibilities:
The position of resident involves a combination of supervised, progressively more complex
and independent patient evaluation and management functions, and formal educational
activities.
Among a resident’s responsibilities in a training program of the University are the following:
1.
to meet the qualifications for resident eligibility outlined in the Essentials of
Accredited Residencies in Graduate Medical Education in the American Medical
Association (AMA) Graduate Medical Education Directory
2.
to develop a personal program of self-study and professional growth with guidance
from the teaching staff
3.
to provide safe, effective, and compassionate patient care, commensurate with the
resident’s level of advancement, responsibility, and competence, under the general
supervision of appropriately privileged attending teaching staff
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4.
5.
6.
7.
8.
9.
10.
to participate fully in the educational and scholarly activities of their program and, as
required, assume responsibility for teaching and supervising other residents
to participate in institutional orientation and educational programs and other activities
involving the clinical staff
to submit to the program director confidential written evaluations of the faculty and
the educational experiences
to participate on institutional committees and councils to which the resident is
appointed or invited, especially those that relate to their education and/or patient care
to adhere to established practices, procedures, and policies of the University and of
affiliated institutions as applicable, including among others, duty hours regulations and
state licensure requirements for physicians in training
to develop an understanding of ethical, socioeconomic, medical/legal issues,
communication skills and cost containment issues that affect graduate medical education
and medical practice
to develop an understanding of research design, statistics, and critical review of the
literature necessary for acquiring skills for lifelong learning.
Duration of Appointment and Conditions for Reappointment:
Your initial appointment will begin on July 01, 2013; however, the beginning date of the
contract is contingent upon you receiving a Resident Training License. Appointments are
continuously reviewed and retention in the training program depends on your satisfactory
performance/training progress, including your adherence to acceptable professional behavior.
A resident’s reappointment and progression to more advanced levels will be based on the
results of periodic reviews of the resident’s educational and professional achievement,
competence and progress as determined by the program director and teaching faculty. The
program maintains a confidential record of the evaluations.
The primary site of your graduate medical education training will be the Sacred Heart Health
System, Pensacola, and affiliates, but the location of the training for any resident may also
occur at various additional sites. All assignments and call schedules are made at the
discretion of the appropriate program director of the University. In addition should the
residency programs be closed or downsized, the University will inform the resident as early
as possible of such events. Every effort will be made to complete the resident’s course of
training or to find another site for the resident to complete training.
Discipline Policies and Procedures:
The position of the resident presents the dual aspect of learner in graduate training while
participating in the delivery of patient care. The Florida State University College of
Medicine is committed to the maintenance of a supportive educational environment in which
residents are given the opportunity to learn and grow. Inappropriate behavior in any form in
this professional setting is not permissible. A resident’s continuation in the training program
is dependent upon satisfactory performance as a learner, including the maintenance of
satisfactory professional standards in the care of patients and interactions with others on the
health care team. The resident’s academic evaluation will include assessment of behavioral
components, including conduct that reflects poorly on professional standards, ethics, and
collegiality. Disqualification of a resident as a learner or as a member of the health care team
from patient care duties disqualifies the resident from further continuation in the program.
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Grievances:
A grievance is defined as dissatisfaction when a resident believes that any decision, act or
condition affecting his/her program of study is arbitrary, illegal, unjust or creates unnecessary
hardship. Such grievance may concern, but is not limited to, the following: academic
progress, mistreatment by any University employee or resident, wrongful assessment of fees,
records and registration errors, discipline (other than non-renewal or dismissal) and
discrimination because of race, creed, color, gender, religion, national origin, age, disability,
veteran’s or marital status, or any other protected group status, subject to the exception that
complaints of sexual harassment will be handled in accordance with the specific published
policies of Florida State University and the College of Medicine.
A resident (employee) who has a complaint or grievance may discuss this with the Program
Director. If, after discussion, the grievances cannot be resolved, the resident may contact the
Chairman of the Graduate Medical Education Committee (CGMEC).
The CGMEC will meet with the resident and will review the grievance. The decision of the
CGMEC will be communicated in writing to the resident.
Alternatively, the employee may utilize the University’s Mediation Program that is
administered by the Employee Assistance Program (EAP) prior to the filing of a formal
complaint or grievance. Additional information on the EAP may be obtained through the
Florida Sate University.
The Office of the University’s Coordinator of Sexual Harassment Resolutions (the
“Coordinator”), within the Office of Audit Services, is designated to receive and investigate
sexual harassment complaints as set forth in the University’s policy and to maintain the
records pertaining thereto. Additional information may be obtained through the Florida State
University.
Suspension:
The Chief of Staff of a participating and/or affiliated hospital where the resident is assigned,
the Dean, the Chief Executive Officer (CEO) of the Hospital, or Program Director may at any
time suspend a resident from patient care responsibilities. The resident will be informed of
the reasons for the suspension and will be given an opportunity to provide information in
response.
The resident suspended from patient care may be assigned to other duties as determined and
approved by the Program Director. The resident will either be reinstated (with or without the
imposition of academic probation or other conditions) or dismissal proceedings will
commence by the University against the resident within thirty (30) days of the date of
suspension.
Any suspension and reassignment of the resident to other duties may continue until final
conclusion of the decision-making or appeal process. The resident may appeal to the Chair,
Graduate Medical Education Committee (CGMEC), for resolution.
Non-renewal:
In the event that the Program Director decides not to renew a resident’s appointment, the
resident will be provided written notice no later than four months prior to the end of the
resident’s contract. However, if the primary reason(s) for the non-renewal occurs within four
months prior to the end of the agreement, residents will be provided with as much written
184
notice of the intent not to renew as the circumstances will reasonably allow, prior to the end
of the agreement. The notice of intent will include a statement specifying the reason(s) for
non-renewal.
If requested in writing by the resident, the Program Director will meet with the resident; this
meeting should occur within 10 working days of the written request. The resident may
present relevant information regarding the proposed non-renewal decision. The resident may
be accompanied by an advisor during any meeting held pursuant to these procedures, but the
advisor may not speak on behalf of the resident. If the Program Director determines that
non-renewal is appropriate, he/she will use his/her best efforts to present the decision in
writing to the resident within 10 working days of the meeting; the resident will be informed
of the right to appeal to the CGMEC.
Dismissal:
In the event the Program Director of a training program concludes a resident should be
dismissed prior to completion of the program, the Program Director will inform the CGMEC
in writing of this decision and the reason(s) for the decision. The resident will be provided
previous evaluations, complaints, counseling, letters and other documents that relate to the
decision to dismiss the resident.
If requested in writing by the resident, the Program Director will meet with the resident; this
meeting should occur within 10 working days of the written request. The resident may
present relevant information regarding the proposed dismissal. The resident may be
accompanied by an advisor during any meeting held pursuant to these procedures, but the
advisor may not speak on behalf of the resident. If the Program Director determines that
dismissal is appropriate, he or she will use his/her best efforts to present the decision in
writing to the resident within 10 working days of the meeting.
Appeal:
If the resident appeals a decision for suspension, non-renewal or dismissal, this appeal must
be made in writing to the CGMEC within 10 working days from the resident’s receipt of the
decision of the person suspending the resident or the Program Director. Failure to file such
an appeal within 10 working days will render the decision of the person suspending the
resident or the Program Director the final agency action of the University.
The CGMEC will appoint an ad hoc committee to conduct a review of the action, and review
the documents or any other information relevant to the decision. The resident will be notified
of the date of the meeting with the CGMEC and the committee; it should occur within 15
working days of the CGMEC’s receipt of the appeal. The CGMEC, along with the
committee, may conduct an investigation and uphold, modify or reverse the recommendation
for suspension, non-renewal or dismissal. The CGMEC will notify the resident in writing of
the decision. If the decision is to uphold a suspension, the decision of the CGMEC is the
final agency action of the University. If the decision is to
uphold the non-renewal or dismissal, the resident may file within 10 working days a written
appeal to the Dean of the College of Medicine. Failure to file such an appeal within 10
working days will render the decision of the CGMEC the final agency action of the
University.
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The Dean will inform the CGMEC of the appeal. The CGMEC will provide the Dean a copy
of the decision and accompanying documents and any other material submitted by the
resident or considered in the appeal process. The Dean will use his/her best efforts to render
a decision within 15 working days, but failure to do so is not grounds for reversal of the
decision under appeal. The Dean will notify in writing the CGMEC and the Program
Director and resident of the decision. The resident will then be informed of the steps
necessary for the resident to further challenge the action of the University. The President of
the University will be the final agency action of the University.
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Policies on supervision
POLICY: RESIDENT SUPERVISION
PURPOSE
To establish supervision standards and responsibilities for all graduate medical educations
programs, ensuring quality of care and patient and resident safety
DEFINITION
Supervision will consist of three levels: Direct, Indirect, and Oversight
Direct supervision requires that the faculty member must be physically present in the
hospital or clinic with the resident and the patient.
Indirect supervision with direct supervision immediately available requires the
supervising faculty member to be physically within the hospital or other site of patient
care and is immediately available to provide direct supervision and direction
Indirect supervision with direct supervision available means that the supervising
faculty member is not physically present within the hospital or other site of patient care,
but is immediately available by mean of telephonic and/or electronic modalities, and is
available to provide direct supervision
Oversight means that the supervising physician is available to provide review of
procedures and/or encounters with feedback provided after care is delivered.
POLICY
This policy establishes minimum requirements for resident supervision. Individual residency
training programs should establish additional requirements for their faculty, medical staff,
and residents or fellows. It is the responsibility of program directors to outline policies for
residency supervision at each postgraduate year for their residency programs. These should
be reviewed annually and made available in either written or electronic format to all residents
and medical staff serving as faculty and supervising residents in each program.
The program director is ultimately responsible for supervision of the resident. Responsibility
for specific supervision will be assigned to a faculty member supervising the resident on
various rotations. The privilege of progressive authority and responsibility, conditional
independence, and a supervisory role in patient care delegated to each resident must be
conferred by the program director and program faculty.
All patients receiving care at the affiliated hospitals are assigned to a member of the
hospital’s medical staff, designated as that patient’s attending physician. The medical staff
have ultimate responsibility for the quality of medical services provided to patients.
Residents are not members of the hospital’s organized medical staff, but are recognized as
187
health care providers who will be involved in patient care under the supervision of an
appointed faculty member or an appropriate medical staff member, as defined in the
hospital’s medical staff bylaws. It is the responsibility of the medical staff to ensure that
each resident is supervised in patient care responsibilities. Requirements for on-site
supervision will be established by the program director for each program in accordance with
established ACGME requirements and will be monitored through residency program review,
with institutional oversight through the GMEC. Careful supervision and observation are
required to determine the ability of a resident/fellow to manage patients and to perform
procedures or interpret diagnostic studies.
The attending physician responsible for the care of patients with whom residents are involved
will provide the appropriate level of supervision based on the nature of the patient’s
condition, the likelihood of major changes in the management plan, the complexity of care,
and the experience and judgment demonstrated by the residents being supervised. The
supervising faculty member or medical staff member, within the limits of his clinical
privileges, may extend specific patient care responsibilities to the resident, commensurate
with the resident’s demonstrated competence. It is the decision of the faculty, with advice
from the program director, as to which activities the resident will be allowed to perform
within the context of the assigned levels of responsibility. The overriding consideration must
be the safe and effective care of the patient.
Although they are not licensed independent practitioners, residents must be given graded and
progressive levels of responsibility while assuring quality care of patients, such that the
residents ultimately learn to act in a supervisory and teaching capacity with less experienced
residents and students. The level of supervision required by residents at various levels of
training must be consistent with the requirements for progressively increasing resident
responsibility during a residency program and the program requirements of the individual
Review Committees.
The program faculty and program director will evaluate the residents on an ongoing basis in
the provision of patient care to determine whether residents are developing progressively
increased ability to critically evaluate patients and make independent decisions. This will be
evaluated in the formative and summative evaluation process and communicated in the
monthly faculty evaluation meetings, held with the program director, or his/her associates,
program faculty, and chief residents. Senior residents will not be permitted to perform
supervisory rotations or take supervisory night call until they have demonstrated adequate
competency in patient care. In some cases, interns or second year residents will be required to
complete additional clinical rotations with close clinical supervision before they are
permitted to perform supervisory rotations. In developing the master schedule for the year,
the individual abilities and competency of each resident will be carefully evaluated.
Increasing ability to demonstrate autonomy in clinical decision making and critical thinking
skills will be a requirement to progress to the final year of training. The program director,
supervising faculty members and chief residents will monitor each resident's performance
and make a determination at the end of each academic year as to whether the resident has
demonstrated the competencies required to progress to the next level of training, or at the end
of training, has demonstrated the competency to practice independently without supervision.
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PROCEDURES.
All resident patient care activities are supervised by credentialed providers of the medical
staff who are ultimately responsible for the care. The medical staff must be credentialed in
that institution for the specialty care and diagnostic and therapeutic procedures for which
they are supervising residents.
Each program director will define the policies in the program with regard to completion of
procedures. Each program will compile a list of resident clinical activities permitted by level
of training, with the required level of supervision for each activity, and any requirements for
performing an activity without direct supervision.
The program director will review
annually the resident clinical privilege delineation. At least annually, or more frequently as
indicated, the program director will determine if residents can progress to the next level of
training. This assessment will be documented in the annual evaluation of the residents.
Attending physicians and/or hospitalists must be available to supervise procedures directly 24
hours a day, unless the resident has been credentialed to perform a procedure independently,
or a senior resident who has been credentialed to supervise a procedure, is available to
provide supervision. The attending physician for the patient will ultimately decide whether a
resident may perform a procedure without direct supervision. Should the urgent need arise,
hospital based medical staff may provide direct supervision for the resident staff. In an
emergency, defined as a situation in which immediate care is necessary to preserve life or
prevent serious impairment of health, residents are permitted to perform everything possible
to save a patient from serious harm. The appropriate faculty member of medical staff member
will be notified as soon as possible.
The program director will determine, in conjunction with the affiliated hospitals, a
mechanism for notifying medical staff and ancillary personnel of the clinical privileges
afforded to each resident.
INPATIENT SUPERVISION
All supervision for inpatient care must be directed by a credentialed medical staff provider.
Medical staff supervision of care for hospitalized patients must be documented in the
inpatient record. Documentation of the degree of supervision will be by progress note or
signature from the attending physician and also reflected within the resident’s progress notes.
The resident must document in their admission and daily progress notes that the care plan
was discussed with the attending physician, including documenting the attending’s name.
The attending physician should also document in their admission and progress notes that the
case was discussed with the resident and document the resident’s name. Residents are
expected to write admission and daily orders and to write admission and daily progress notes,
according to the protocol of the service. Residents must also follow institutional policies
regarding verbal order and physician computer order entry.
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When initially admitting a new inpatient, the resident should speak with the attending
assigned to that patient to discuss the findings and formulate a plan for that patient. Each
patient encounter will be discussed in detail with the attending on rounds and monitored by
either a senior supervisory resident and/or attending during all facets of the rounding
experience. These discussions should occur with a frequency appropriate to the clinical
acuity of the patient and must take place no less frequently than once daily. This will
improve the ability of residents to develop increased autonomy and maximize the ability of
the faculty to monitor the resident’s progression. Inpatient supervision will be direct at least
once a day, and may be indirect with supervision either immediately available or available
electronically for the remainder of the day. On all rotations, interns will be directly
supervised by an attending physician or a supervisory resident.
OUTPATIENT.
On outpatient assignments, each patient encounter will be discussed with the supervisory
faculty, who must be immediately available for direct supervision. Interns will have direct
supervision. Senior residents who have been deemed capable of more autonomy may be
indirectly supervised with direct supervision available or with oversight as they near the
completion of their training and demonstrate the capacity to practice independently.
Florida State University College of Medicine
Graduate Medical Education
Policies and Procedures
Rev. March 2012
Each faculty is assigned to a clinical area and is responsible for the direct supervision of such
resident or teams of residents. There is in house 24 hour faculty coverage present. The lower
level residents report directly to the upper level residents and the upper level residents report
to the attending faculty currently in charge of that clinical area.
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Resident levels of care and supervisory lines of
responsibility
Department Name: Obstetrics & Gynecology
Resident Level: 1
Clinical Diagnosis
Management
Perform and document history &
physical exam including pelvic exam;
Perform differential diagnosis; Develop
and document preoperative and
postoperative care treatment plan;
Perform and document preoperative
exam; Perform and document
postoperative care; Develop and
document fluid and electrolyte therapy;
Order appropriate consults; Obtain and
document informed consent; Dictate
operative note; Dictate discharge
summary; Order & interpret diagnostic
laboratory tests; Order & interpret
imaging studies; Perform rectal exam
and hemocult tests; Perform Pap
smear; Perform and document wet prep
and ferning; Order and interpret EKG;
Perform cervical cultures; Perform
wound cultures; Perform and interpret
urinalysis; Perform pelvic and vaginal
ultrasound in both obstetrical and nonobstetrical patients*; Perform saline
ultrasound*; Perform Q-tip test;
Perform and interpret antepartum fetal
heart rate testing*; Perform and
interpret hysterosalpingogram*
Clinical Diagnosis Management
Order fluid and electrolyte therapy; Order
transfusions of blood and blood products; Order
pain management therapy; Order medications;
Management of common medical emergencies;
Medical management of ectopic pregnancy*;
Contraceptive management ; Management of
Obstetrical patients* with cardiac disease,
chronic hypertensive disease, connective tissue
disease, diabetes mellitus, fetal growth
retardation, gestational trophoblastic disease,
thyroid disease, renal disease, isoimmunization,
pregnancy induced hypertension, pre-eclampsia,
eclampsia, preterm labor, preterm rupture of
membranes, premature rupture of membranes,
complications of abortion
Management of gynecologic patients* with
abnormal uterine bleeding, abnormal Pap
smears, postmenopausal bleeding, urinary tract
infection, menopausal symptoms, pelvic
infection, acute salpingitis, endometritis,
endometriosis, gynecologic cancer
Post-operative care*
Management of labor and delivery including
fetal heart rate interpretation*
Pessary
insertion
Diaphragm fitting IUD
insertion
Norplant removal
Induction and augmentation of labor*
Clinical Invasive
(Operative Management)
Perform endometrial biopsy,
colposcopy and cervical, vaginal and
vulvar biopsies trucut biopsies of soft
tissue masses*, paracentesis*,
endotracheal intubation,
cardiopulmonary resuscitation; start
intravenous lines, venipuncture,&
blood cultures Perform, order, and
interpret arterial blood gases, bladder
cauterization, urodynamic testing
including cystometrogram, urethral
pressure profile, leak point
pressures*, central line insertion*,
arterial line insertion*,
cystoscopy/urethroscopy*,
proctoscopy, anoscopy*, diagnostic
laparoscopy*, laparoscopic tubal
sterilization*, postpartum
sterilization*, spontaneous vaginal
delivery , Perform manual removal of
placenta*, outlet/low forceps
delivery*, management of labor and
delivery including fetal heart rate
interpretation*, vacuum assisted
delivery*, dilatation & curettage*,
suction curettage*, diagnostic
hysteroscopy*, incision and drainage
of abscess including Bartholin's duct
abscess, marsupilization of
Bartholin's cyst*, cold knife
conization of cervix*, LEEP excision
of cervix/LEEP cone*, laser
vaporization of cervix/laser cone*,
cervical cryotherapy, excisional
biopsy of cervix, vaginal, vulva,
simple episiotomy repair, repair of
3rd & 4th degree lacerations*, Repair
of simple vaginal, cervical, labial
lacerations, repair of complex
vaginal, cervical, and labial
lacerations* , Perform wound care,
primary wound closure, wound
debridement and irrigation, excision
skin lesions, Repair simple
lacerations, as first assistant in
obstetrical and gynecologic surgery, ,
culdocentesis, abdominal incisions*,
trigger point injections*
*Requires Supervision by a Teaching (Faculty) Physician or Upper Level
Resident determined by the individual Resident level of performance.
191
RESIDENT LEVELS OF CARE AND SUPERVISORY LINES OF RESPONSIBILITY
Department Name: Obstetrics & Gynecology
Resident Level: 2
Clinical Diagnosis
Management
Perform pelvic and vaginal ultrasound in
both obstetrical and non-obstetrical
patients*
Clinical Diagnosis Management
Medical management of ectopic
pregnancy
Post-operative care
Perform saline ultrasound*
Perform and interpret antepartum fetal
heart rate testing*
All other items listed for PG 1 without*
Management of Obstetrical patients with:
Cardiac disease*, Chronic hypertensive
disease*, Connective tissue disease*,
Diabetes mellitus*, Fetal growth
retardation*, Gestational trophoblastic
disease*, Thyroid disease*, Renal
disease*, Isoimmunization*, Pregnancy
induced hypertension*, Preeclampsia*,
Eclampsia*, Preterm labor*, Preterm
rupture of membranes*, Premature rupture
of membranes*, Complications of
abortion*
Management of gynecologic patients with
abnormal uterine bleeding, abnormal Pap
smears, postmenopausal bleeding, urinary
tract infection, menopausal symptoms, pelvic
infection, acute salpingitis, endometritis,
endometriosis, gynecologic cancer
Management of labor and delivery
including fetal heart rate interpretation
Induction and augmentation of labor
Ventilator management*
All other items listed for PG 1 without *
Clinical Invasive
(Operative Management)
Perform trucut biopsy of soft tissue
masses; Paracentesis*; Urodynamic
testing; Cystometrogram; Urethral pressure
profile; Leak point pressures; Central line
insertion; Arterial line insertion;
Cystoscopy/urethroscopy*; Proctoscopy*
; Anoscopy*; Diagnostic laparoscopy*;
Laparoscopic tubal sterilization; Postpartum sterilization; Spontaneous vaginal
delivery, vacuum assisted delivery*;
Outlet/low forceps delivery*; dilatation &
curettage; Suction curettage; Diagnostic
hysteroscopy*; Marsupilization of
Bartholin's cyst* ; Cold knife conization
of cervix; LEEP excision of cervix/LEEP
cone; Laser vaporization of cervix/laser
cone; Laser vaporization of vulvar
lesions*; Repair of complex vaginal,
cervical, and labial lacerations*; Perform
cesarean section*; Cervical cerclage*;
Manual removal of placenta ; Abdominal
hysterectomy*; Vaginal hysterectomy*;
Retropubic urethropexy*;
Colporraphy/perineorraphy*; Laparoscopic
assisted vaginal hysterectomy*;
Salpingectomy/salpingostomy - open &
laparoscopic*; Oophorectomy, ovarian
cystectomy - open & laparoscopic*;
Incidental appendectomy-open*; Amnio
reduction*; Genetic amniocentesis*;
Amniocentesis for lung maturity*;
External cephalic version*; Incision of
vaginal septum*; Abdominal incisions*;
Trigger point injections; Cystotomy and
repair*; Insertion of suprapubic catheter
under cystoscopic guidance*; alleged
sexual assault examinations
All other items listed for PG 1 without *
*Requires Supervision by a Teaching (Faculty) Physician or Upper Level Resident
determined by the individual Resident level of performance.
192
RESIDENT LEVELS OF CARE AND SUPERVISORY LINES OF RESPONSIBILITY
Department Name: Obstetrics & Gynecology
Resident Level: 3
Clinical Diagnosis
Management
Perform pelvic and vaginal ultrasound in
both obstetrical and non-obstetrical
patients
Clinical Diagnosis Management
Ventilator management
All other items listed for PG 2 without *
Perform saline ultrasound
Perform and interpret antepartum fetal
heart rate testing
All other items listed for PG 2 without*
Clinical Invasive
(Operative Management)
Perform laser vaporization of vulvar
lesions; Repair of complex vaginal
cervical, and labial lacerations; cervical
cerclage; cesarean section*; abdominal
hysterectomy*; vaginal hysterectomy*;
retropubic urethropexy*;
colporraphy/perineorrphy*; Laparoscopic
assisted vaginal hysterectomy*;
salpingectomy/salpingostomy –open &
laparoscopic*; Oophorectomy; Ovarian
cystectomy –open & laparoscopic*;
incidental appendectomy – open; Amnio
reduction*; Genetic amniocentesis*;
Amniocentesis for lung maturity; External
cephalic version*; Mid-forceps delivery*;
Vaginal breech delivery with or without
forceps*; Cesarean hysterectomy*;
Vaginal suspension – vaginal and
abdominal approach*; Culdoplasty –
abdominal and vaginal approach*;
colpotomy*; Myomectomy – open and
laparoscopic*; Enterocele resection –
vaginal and abdominal; Laparoscopic
surgery for excision/destruction of
endometriosis including harmonic
scalpel/electrocautery*; Repair of simple
bladder/bowel injuries*; Uretrolysis*,
pelvic, Para-aortic and inguinal lymph
node biopsies*; Hypogastric colpocleisis*;
Repair of wound
disruption/dehiscence/evisceration*;
Secondary wound closure*; Rectovaginal
fistula repair*; Vesicovaginal fistula
repair*; Simple vulvectomy*;
Hysteroscopic surgery including
endometrial ablation, metroplasty,
resection of polyps, myomas*; abdominal
incisions, cystotomy and repair; Insertion
of suprapubic catheter under cystoscopic
guidance
All other items listed for PG 1 without *
*Requires Supervision by a Teaching (Faculty) Physician or Upper Level Resident
determined by the individual Resident level of performance.
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RESIDENT LEVELS OF CARE AND SUPERVISORY LINES OF RESPONSIBILITY
Department Name: Obstetrics & Gynecology
Resident Level: 4
Clinical Diagnosis
Management
All items listed for PG 3 without*
Clinical Diagnosis Management
All items listed for PG 3 without *
Clinical Invasive
(Operative Management)
Perform cesarean section*; abdominal
hysterectomy*; vaginal hysterectomy*;
retropubic urethropexy*;
colporraphy/perineorrphy*; laparoscopic
assisted vaginal hysterectomy*;
salpingectomy/salpingostomy – open &
laparoscopic*; oophorectomy; ovarian
cystectomy –open & laparoscopic*;
incidental appendectomy –open; amnio
reduction; genetic amniocentesis&;
amniocentesis for lung maturity; external
cephalic version *; mid-forceps delivery*;
vaginal breech delivery with or without
forceps*; cesarean hysterectomy*; vaginal
suspension –vaginal and abdominal
approach*; culdoplasty –abdominal and
vaginal approach; colpotomy;
myomectomy –open and
laplaparoscopic*; enterocele resectionvaginal and abdominal*; laparoscopic
surgery for excision/destruction of
endometriosis including harmonic
scalpel/electrocautery*; repair of simple
bladder/bowel injuries*; uretrolysis* pelvic, Para-aortic, and inguinal lymph
node biopsies*; hypogastric artery
ligation*; total and partial colpocleisis*;
repair of wound
disruption/dehiscence/evisceration*;
laparoscopic appendectomy*; secondary
wound closure; rectovaginal fistula
repair*; vesicovaginal fistula repair*;
simple vulvectomy*; hysteroscopic
surgery including endometrial ablation;
metroplasty, resection of polyps,
myomas*; incision of vaginal septum
All other items listed for PG 3 without*
*Requires Supervision by a Teaching (Faculty) Physician or Upper Level Resident
determined by the individual Resident level of performance.
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Faculty notification policy
FSU COM OB/GYN Residency Program
Effective: February 3, 2012
ATTN: Residents
Effective immediately, you are now required to notify faculty members anytime the
following events occur:
1. Transfer patient to the ICU and any change in level of care.
2. ACT team notified
3. Call for any delivery (CD or vaginal)
4. Internal transfers
5. Any consults, which are called physician to physician.
Learning / work environment
POLICY: LEARNING / WORK ENVIRONMENT
PURPOSE
To establish learning and work environment standards for residents (includes fellows).
DEFINITION
Each program director must establish and implement formal written policies and procedures
governing duty hours and work environment for residents, which comply with this
institutional GME policy and the Common and Specialty-Specific Program Requirements.
Programs must be committed to and responsible for promoting patient safety and resident
well-being in a supportive educational environment. The learning objectives of the program
must be accomplished through an appropriate blend of supervised patient care
responsibilities, clinical teaching, and didactic educational events; and must not be
compromised by excessive reliance on residents to fulfill non-physician service obligations.
POLICY
The ACGME has delineated the concept of duty hours into multiple overarching categories,
with corresponding specifications, listed below.
Professionalism, Personal Responsibility, and Patient Safety
The program director and institution must ensure a culture of professionalism that supports
patient safety and personal responsibility. All residents and faculty members must
demonstrate responsiveness to patient needs that supersedes self-interest. Physicians must
recognize that under certain circumstances, the best interests of the patient may be served by
transitioning that patient’s care to another qualified and rested provider. Residents and
faculty members must demonstrate an understanding and acceptance of their personal role in
the following:
1.
Assurance of the safety and welfare of patients;
2.
Provision of patient- and family-centered care;
3.
Assurance of their fitness for duty;
4. Management of their time before, during, and after clinical assignments;
195
5. Recognition of impairment, including illness and fatigue, in themselves and their
peers;
6.
Attention to lifelong learning;
7.
Monitoring of their patient care performance improvement indicators; and
8.
Honest and accurate reporting of duty hours, patient outcomes, and clinical
experience data.
Transitions of Care
1. Programs must design clinical assignments to minimize the number of transitions
in patient care;
2. Sponsoring institutions and programs must ensure and monitor effective, structured hand-over
processes to facilitate both continuity of care and patient safety; and
3. Programs must ensure that residents are competent in communicating with team
members in the hand-over process.
Clinical Responsibilities
The clinical responsibilities for each resident must be based on PGY level, patient safety,
resident education, severity and complexity of patient illness/condition and available support
services (further specified by RRCs).
Teamwork
Residents must care for patients in an environment that maximizes effective communication.
This must include the opportunity to work with fellow residents and faculty as a member of
effective inter-professional teams that are appropriate to the delivery of care in the specialty
(further specified by RRCs).
Duty Hours
Programs will comply with resident duty hours and definitions as set forth in the applicable
Program Requirements.
Work Environment
•
•
•
•
•
Food Services: Residents on duty must have access to adequate and appropriate food services.
Food is provided to residents who take in-house call.
Call Rooms: Call rooms are provided for residents who take in-house call and are segregated by
gender.
Support Services: Adequate ancillary support for patient care shall be provided for residents at all
times.
Medical Records: Medical records system that document the course of each patient’s illness and
care must be available at all times and must be adequate to support quality patient care, the
education of residents, quality assurance and provide a resource for scholarly activity. Electronic
medical records are preferred.
Security/safety: Appropriate security and personal safety measures must be provided to residents
at all locations while on duty and while in transit between parking areas and duty assignments.
Oversight
1.
Each program must have written policies and procedures consistent with the
Institutional and Program Requirements for resident duty hours and the working
environment. These policies and procedures must be distributed to the residents and the
faculty.
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2.
Back-up support systems must be provided when patient care responsibilities are
unusually difficult or prolonged, or if unexpected circumstances create resident fatigue
sufficient to jeopardize patient care.
3.
Each program director should review each resident’s rotational schedule to assure
compliance with this institutional policy and the Common Program Requirements, and
should document and monitor unusual patient care circumstances that require an
extension of a duty period as specified above and in the Common Program Requirements.
4.
Each program director should regularly monitor resident duty hours for compliance
with this institutional policy and the Common Program Requirements. Monitoring of
duty hours is required with frequency sufficient to ensure an appropriate balance between
education and service.
5.
The GMEC shall monitor compliance with this policy through the:
a.
Internal review of each program;
b.
Annual GME Survey of Residents; and
c.
Periodic monitoring of individual programs.
Florida State University College of Medicine
Graduate Medical Education
Policies and Procedures
197
Rev. March 2012
Professionalism policy
The following list of professional responsibilities constitutes the professional
expectations of a resident physician. Violation of any of the following will be handled as
per the discipline policy of the residency. Adherence to this policy is as important as the
other ACGME core competencies.
We expect residents to:
Check your FSU email every day. Information may be communicated with you via email
only. You are responsible for any information communicated by this method.
Treat everyone with respect (e.g., colleagues, faculty, students, patients, families, guests).
Demonstrate integrity and honesty.
Ensure patient safety.
Perform Assigned tasks safely and competently to maximize patient health and safety, in
accordance to performance expectations.
Demonstrate commitment to excellence and to continuous learning, improvement, and
professional development.
Understand and comply with all university, hospital or affiliated premises, policies, and
procedures ie clinical safety, administrative and safety policies.
Comply with all federal, state and accreditation standards regulating the provision of
professional services.
Maintain duty hours in compliance with institutional, ACGME and RRC policies.
Protect confidentiality of sensitive information.
Attend work as assigned; arrive on time, fully prepared to work; remain throughout the work
period and until work is completed (patients seen, notes written or dictated, messages
completed).
Request leave and sick days as per departmental policy.
Arrange for coverage for patient follow up when absent.
Answer pages in a timely fashion.
Communicate effectively, and demonstrate care and respectful behaviors when interacting
with patients, families, staff and colleagues’; work collaboratively with all other co-workers,
including those form other disciplines.
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Demonstrate respect and courtesy towards fellow staff members, faculty, students, patients,
and visitors.
Demonstrate sensitivity and responsiveness to patients and co-workers with regard to age,
culture, gender and or disabilities.
Be productive and use all available time to accomplish expected work tasks; accomplish
personal business outside of work times and or scheduled time off
Use all available resources to resolve work related problems.
Facilitate learning of students and other health care professionals.
Dress or work according to the departments’ workplace attire guidelines, including any
required identification badge.
Give, ask, and accept balanced feedback on a regular basis.
Complete medical records/dictations in a timely fashion.
Respect and safeguard the property of theirs and the institution .Use hospital property only
for legitimate work purposes.
Use the university email system for work related items
Report any accident on hospital premises, involving on the job injury and or property
damage.
Obey all laws-civil, state and federal regulations.
PROPER APPEARANCE FOR RESIDENTS:
Men should wear a dress shirt with tie and a white coat with name badge. Comparable attire
is expected for women. SHH and FSU name badges are mandatory at all times when
engaged in patient care. Blue jeans and coveralls are unacceptable. The same is true of long
hair styles for men and untrimmed beards and mustaches. The following footwear is
unacceptable: tennis shoes, thongs, and heavy boots. Except in unusual circumstances, scrub
suits should be worn only in the Labor and Delivery and Operating Room areas. Residency
will provide program scrub suits. These may be worn with white lab coat in outpatient
clinical areas.
Two monogrammed laboratory coats and two sets of monogrammed scrubs will be provided
to each incoming resident. One additional coat and set of scrubs will be provided at the start
of each subsequent year of training. Anyone wishing to purchase a more expensive coat may
do so and be reimbursed the standard rate.
Program meetings
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All residents are expected to attend scheduled conferences/meetings unless specifically
excused. Attendance records are maintained.
Legal documents
If you receive legal documents, i.e., subpoenas, there are steps that must be followed. This is
the resident physician’s responsibility.
1.
Notify the program director.
2.
Notify your attending physician in the case.
3.
Notify Risk Management of Sacred Heart, Ext. 7864; fax – 6857 and
FSU Self
Insurance Office; Chuck Portero (904) 244-9070 cell (904) 244-0411 Email:
[email protected]
4.
Notify the Designated Institutional Official (DIO) at the FSU COM
Outside professional activities
All programs have established rules regarding active voluntary, outside and extracurricular
activities that meet their RRC requirements and University’s policy. There are two
categories of such activity: Programmatic moonlight and Non-Programmatic moonlighting.
See Appendix II – Moonlighting policy, Appendix III – Programmatic moonlighting approval
form, and Appendix IV – Non-programmatic moonlighting
Certificate of completion
A certificate of graduate medical education training will be issued to a resident on the
recommendation of the University’s appropriate Program Director only after satisfactory
completion of service and educational requirements and fulfillment of all other obligations
and debts, including completion of medical records and return by the resident of State of
Florida property, as well as property of any affiliated institution.
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Roadmap for Florida licensure
Every resident is expected to be licensed in the state of Florida by June 30 of PGY-2. Failure
to obtain licensure prior to this date will result in the resident being unable to progress to
PGY-3 status. Since a specified amount of time must be completed for RRC recognition of
satisfactory completion of residency, any time between June 30 of PGY-2 and licensure of
the resident will need to be made up after the resident’s prospective graduation date.
The fees associated with scheduling and taking USMLE Step 3 as well as the licensing
process will be paid in full by the program as long as the milestones below are met by the
deadlines stated. Should the resident delay either their USMLE Step 3 or application process
for licensure, that resident will be responsible for any and all associated fees.
The process for licensure is long and drawn out. Inevitably, the Florida Department of Health
will find something wrong with your application or a necessary document that you failed to
submit or was lost in transit. Count on the process taking longer than anticipated and do not
wait until the last minute to complete the milestones. Below are the absolute latest dates after
which the program will no longer provide financial assistance for completion.
June 30 of PGY-1
USMLE Step 3 should have been scheduled and completed. Results need not be available,
however results are necessary prior to sending in your application to the Florida DOH.
USMLE Step 3 cost – $730
The residency program will not reimburse or otherwise financially support a resident for
whom it is necessary to retake the USMLE Step 3 exam. The residency program will not
reimburse for any test taken after June 30 of the intern year, unless prior approval has
been obtained from the program director.
September 31 of PGY-2
USMLE results received and application for licensure submitted to the Florida DOH.
Florida License Application cost – approx. $750
December 30 of PGY-2
License number received from the DOH and application for DEA certification submitted.
DEA certification application cost – approx. $500
June 30 of PGY-2
If full licensure and DEA certification has not been received by this time, the resident will
not be graduated to PGY-3 status with implications for residency completion as stated above.
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FINANCIAL SUPPORT AND BENEFITS:
Stipend
Each resident is given a stipend to pursue the resident’s graduate medical education in an
amount appropriate to the resident’s level in the program. Stipend levels are reviewed
annually by the Graduate Medical Education Committee of the College of Medicine and
recommendations for changes are subject to approval by the Dean of the College of
Medicine. Stipend levels begin on the first (worked) day of the new contract year and are
paid bi-weekly.
Living quarters, meals, laundry, and other such expenses are the resident’s responsibilities. In
some cases, meal tickets may be issued to the resident when the resident is assigned in-house
call on nights and weekends; similarly, living quarters may be provided during some
rotations outside of the primary location of the program.
2013-2014
Level
PGY-1
PGY-2
PGY-3
PGY-4
Annual
Salary
$49,700
$51,400
$53,500
$55,800
Bi-weekly
Rate
$1,904.21
$1,969.35
$2,049.81
$2,137.93
FICA Alternative Plan – BENCOR
The FICA Alternative Plan is a defined contribution private retirement plan authorized under
Section 401 (a) of the Internal Revenue Code. Instead of paying 6.2% social security taxes
post-tax, eligible Residents/Fellows contribute 7.5% of pre-tax wages into an investment
account in the individual’s name. Medicare contributions at 1.45% will continue to be
withheld and matched by the university. The plan is mandatory for all eligible Residents and
Fellows. There are a variety of investment options for this retirement plan that include a
Guaranteed Pooled Fund (an interest bearing account) and variable investment options. As a
participant in the plan, you may direct the investment of your fund at any time by submitting
a completed *Retirement Plan Form to BENCOR Administrative Services. If you do not
submit this form to direct the investment of your funds, all of your contributions are
automatically deposited into the Guaranteed Pooled Fund, an interest bearing account.
A statement of your account activity, including contributions and earnings will be mailed
after the end of each calendar year to your home mailing address.
BENCOR, Inc. is the plan administrator for the Florida State University. Additional
information about the plan may be found at the Florida State University’s Human Resource
Service web site, www.hrfsu.edu
Under Faculty/Staff Benefits/Florida Retirement System/FICA Alternative Plan.
*First year residents receive this form during orientation.
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Health, Life and Disability insurance, Worker’s
Compensation insurance
Health and life insurance are provided to the resident. As you begin your residency, you will
receive a booklet which summarizes the benefits and limitations provided under this small
group policy. Please refer to your booklet for all information and any questions you may
have regarding your insurance coverage, or contact the FSU COM Coordinator.
Cobra (Title X of the Consolidated Omnibus Budget Reconciliation Act of 1985) In the event
of termination, you have the option to continue your health insurance policy at the current
premium plus 2% for maximum of 18 months under COBRA. Eighteen-month continuation
is also available in the event of reduction in hours or layoff. Thirty-six-month continuation is
available to dependents in the event of divorce, death, Medicare entitlement or a dependent
losing that status because of age. It is your responsibility to notify the Florida State university
college of Medicine Graduate Medical Education personnel within 30 days of any of the
above event; failure to provide notification could result in forfeiture of COBRA.
Disability insurance (DI) is offered to residents, and is provided for all who meet the
provider’s qualifications. DI coverage includes compensation for an occupational injury that
results in HIV infection. The approximate monthly compensation is up to $2,000.
Note: Prior to completion of this program, you will have the opportunity to convert this
group policy to an individual policy that provides compensation of up to $2,000 per month
(approximately $5,000 per month for catastrophic illness or injury).
If a resident suffers a work-related injury, the resident is covered under the workers’
compensation program of the University provided the resident complies with the
requirements of the workers’ compensation program.
Confidential counseling and psychological support services, provided by contracted
personnel, are available on an on-going basis.
Professional liability coverage
As a participant in a graduate medical education program of the University, a resident is an
employee of Florida State University, a public university of the State of Florida. The resident
is personally immune from civil liabilities which may arise from acts or omissions committed
by the resident in the course of employment. Section 768.28, Fla. Statutes, outlines the
protection against claims and/or judgments extended to employees of the University under
Sovereign Immunity. The Florida State University Board of Trustees is vicariously
responsible for any civil claims or actions arising from the acts of its employees and agents.
Pursuant to University Regulation, the University has created a program of self-insurance
covering claims and actions against the University which may arise from the actions or
omissions of University healthcare faculty members, residents, other professional employees
or residents of the University. A resident must identify himself or herself at all times as a
Florida State University employee while participating in the graduate medical education
program in order to assure this coverage; a University name tag will be provided.
Medical requirements
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Screening of the resident for infectious diseases, prophylaxis/treatment for exposure to
communicable disease (including influenza), and immunizations will be provided by the
University or through arrangements with Sacred Heart Hospital. The resident will have
documentation of immunity to measles, mumps, and rubella (MMR), hepatitis B, polio,
diphtheria, tetanus, and pertussis (DTPseries and Tdap as indicated); and varicella (chicken
pox). The resident will be required to have annual tuberculosis screening an annual
vaccination for influenza. The resident will comply with the infection control policies and
procedures of the institutions where the resident is assigned.
Florida State University conforms to the Florida Medical Practice Act (F.S. 458). The rule
calls for all licensed practitioners to report to the appropriate authority any reasonable
suspicion that a practitioner is impaired to practice. The legislation provides for therapeutic
intervention through the Professionals Recovery Network (PRN). This organization works
closely with the State Board of Medicine and is recognized as the primary method of dealing
with physician impairment in the state. Faculty, staff, peers, family or other individuals who
suspect that a member of the housestaff is suffering from a psychological or substance abuse
problem are obliged to report such problems. Reporting can be directly to the PRN or to the
Program Director. All referrals are confidential and there is early involvement of the PRN.
If the PRN feels intervention is necessary, they handle the situation and provide for treatment
and follow-up. Residents can only return to clinical duties with the approval of the PRN.
The PRN maintains contact with program directors about residents in the program of
recovery.
Institutional leave policy
The leave policy incorporates sick leave, vacation, uncompensated leave, temporary military
duty, absences pertaining to education and training, and maternity/paternity leave. Subject to
the approval of the program director and consistent with the guidelines of the appropriate
specialty board, all residents receive fifteen (15) days of annual leave. Unused annual leave
cannot be carried over from one year to the next and is non-transferable and nonreimbursable.
A resident will accrue ten (10) days of sick leave for each full year of employment. The
resident will be entitled to utilize sick leave for death, or in special cases, severe illness in the
immediate family (spouse, parents, brothers, sisters, children, grandparents, and
grandchildren of both resident and spouse). The number of days of sick leave allowed per
illness will be determined by the program director or assistant program director. A
physician’s note is required within 24 hours of return to the Program Director, Assistant
program Director or Coordinator. Unused sick leave cannot be carried over from one year to
the next and is non-transferable and non-reimbursable.
The total time allowed away from a graduate medical education program in any given year or
for the duration of the graduate medical education program will be determined by the
requirements of the specialty board involved. If leave time is taken beyond what is allowed
by the University or the applicable specialty board, the resident is required to extend his or
her period of activity in the graduate medical training program accordingly in order to fulfill
the appropriate specialty board requirements for the particular discipline. The resident may
be paid for makeup or extended time if funds are available at that time. All sick leave and
annual leave form must be completed and turned into the coordinator of the program.
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Vacation
1. ALL VACATIONS MUST BE APPROVED AT THE START OF THE ACADEMIC
YEAR -JULY 1.THEY MUST BE APPROVED BY THE ADMINISTRATIVE
CHIEF RESIDENT, DIVISION DIRECTOR, AND PROGRAM DIRECTOR.
2.
Only one resident from each service may be on vacation at a time.
3.
As a general rule, only one week of leave is permitted during a given rotation. In
addition, vacations usually should not be taken during the same rotation when a
scientific meeting is scheduled. Exceptions to this policy must be approved by the
program director and division director.
4.
The Night Float residents may not take vacation. The R4 and R2 may attend a
meeting during this rotation if coverage can be arranged with other residents.
5. Vacations should be taken in 5 day blocks, unless permission has been granted by the
program director.
6. If vacation is scheduled during a week that has a State holiday, the holiday will count as
a leave day, and will not result in a compensated additional day.
7. Vacation days may not be carried over from one academic year to the next.
8. VACATIONS MAY NOT CONFLICT WITH THE ANNUAL CREOG
EXAMINATION OR RESIDENT RESEARCH DAY PROGRAM.
9. Each resident is authorized ten days of paid sick leave annually. This type of leave may
be used for illness or unanticipated family emergencies but may not be carried over from
one academic year to the next. A leave form must be submitted immediately to Julie Floyd
after such an excused absence. You must submit a MD note to Julie Floyd within 24 hours
of return to work for a sick day. If you show up at work sick, and are sent home by the
attending physician then you do not need a note.
Medical educational allowances
1. Third or Fourth year residents will have 5 days of administrative leave to attend a
postgraduate course. The travel allowance for the postgraduate course is $2400.
Additional leave days must be taken as vacation time. Travel money can be used only to
defray expenses of the postgraduate course.
2. Extramural postgraduate courses must be approved by the program director. Approval
will be based upon the scientific content of the course curriculum. Residents must
complete a preauthorization travel form prior to their meeting, and travel must conform to
Florida State University guidelines.
3. Only one funded meeting is permitted in each academic year.
4. Resident’s research selected for presentation at a National meeting will be funded at the
discretion of the program director.
5. Residents may use $600 in years 1 & 2 for book allowance if they choose this option.
Leave for interviewing
It is expected that toward the end of the fourth year, residents will need to interview for a
Fellowship Program or job placement. Interviews for Fellowships generally occur during the
week and residents may be allowed 1-2 days at a time without being penalized for vacation.
Job interviews can usually be arranged on weekends. The total number of days allowed for
interviewing is at the discretion of the Program Director.
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Holidays
Florida State University holidays will be observed (New Years, Martin Luther King,
Memorial Day, Independence Day, Labor Day, Veteran’s Day, Thanksgiving and day after,
and Christmas). If the holiday falls on the weekend, the nearest Friday or Monday will be
designated. In the event a resident is unable to receive the time off while accounting for
patient care, a different day off will be afforded to the resident.
*Good Friday is a holiday to compensate for working on Veteran’s Day.
Vacation and call changes
1. The google calendar is considered correct.
2. If you wish to switch call or vacations, then you must submit a completed vacation call
switch form, with all of the required signatures.
Please see Appendix IX, Schedule change request
Sick leave / FMLA
Florida State University administers the Family and Medical Leave procedures for eligible
employees in accordance with the Family and Medical Leave Act of 1993, the Federal
regulations and the State University System rules. All employees are eligible for Family and
Medical Leave including Other Personnel Services (OPS) employees so long as they have
worked at least twelve (12) months (these need not have been consecutive) and worked at
least 1250 hours in the twelve (12) months prior to the leave. OPS employees will be granted
unpaid Family and Medical Leave up to a total of twelve (12) work weeks/480 hours during
the twelve (12) month calendar year period.
Proper medical certification may be required to grant Family and Medical Leave for one or
more of the following reasons:
• For the birth and care of a newborn child (FMLA) of the employee or for placement
with the employee of a child for adoption or foster care;
• To care for an immediate family member (FMLA) with a serious health condition; or
• To take medical leave when the employee is unable to work because of a serious
health condition.
Please see Appendix XVI – Sick leave policy
Pregnancy / adoption / paternity policy
1. FMLA states that any person may take up to 12 weeks off after pregnancy.
2. ACGME requires that a resident may not miss more than eight weeks of year level one –
three, or six weeks of year four. Additionally, ACGME guidelines state that residents
may not miss more than 20 weeks over four years.
3. Prior to twenty weeks EGA (or as soon as possible in the case of adoption) the resident
must meet with Program Director
( J. DeCesare) to go over this policy.
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4. Prior to twenty weeks EGA (or as soon as possible in the case of adoption), the resident
must draft a letter describing how much maternity leave they wish to take, and specify if
they are taking vacation days, sick days, etc.
5. Each resident receives 10 sick days per year. Unused sick leave cannot be carried over
from one year to the next and is non-transferable and non-reimbursable.
6. Each resident receives 15 vacations days per year, which do not carry over year to year.
7. It is recommended that a resident take a week of vacation alternating with a week of sick
time until they have exhausted their supply of vacation and/or sick days. The resident
may then take unpaid leave if they wish to take more time off. They will be limited to
three months maternity leave in accordance to the FMLA.
8. Each resident is required to do same number of night float rotations as their classmates.
The schedule will be adjusted accordingly.
9. If a resident, due to pregnancy complication or other reasons, misses more time than the
ACGME mandates for training, it will be at the discretion of the full time faculty to
determine appropriate make-up rotations. For example, if a resident misses eight weeks
of gyn they make-up the time doing a general surgery rotation or a gyn oncology rotation.
10. If a resident is placed on modified duty, such that they are no longer able fulfill the
requirements of their rotation but they are allowed to work, then it may be at the
discretion of the faculty to determine if the work that the resident is doing fulfills the
requirements of the rotation. If the requirements of the rotation are not met, then the
faculty will determine appropriate make-up rotations.
11. The duration of maternity leave before and/or after delivery will be determined by the
resident and her physician. All available sick and vacation leave must be used to cover
maternity leave. The Program Director must approve requests for leave in excess of six
weeks.
12. Accrued annual leave may be used prior to the employee being placed on leave without
pay. Any illness caused by or contributed to by pregnancy, miscarriage, abortion, or
child birth, shall be treated as a temporary disability, and the employee shall be allowed
to use accrued sick leave when certified by the patient’s physician.
13. While on unpaid leave, the resident’s insurance benefits will be maintained by the
department for up to two months. After two months, the resident will be responsible for
payment of insurance premiums.
14. Changes in the rotation schedule may be made for a resident who is pregnant if these
changes are approved by the Program Director.
15. In special circumstances, leave may be granted for a resident engaged in an adoption
proceeding with advance approval of the Program Director.
16. In special circumstances, paternity leave may be granted with the advance approval of the
Program Director.
*for the purpose of this document, the term pregnancy will be referred to however it is
implied that it refers to adoption and paternity leave time as well.
Libraries
The Medical Library at SHH is available for use by the residents. The library is located on
the first floor of the Main Hospital and has recently undergone renovation. After-hours
access can be obtained by using the “88” key. Computers for literature searches are available
in the library, and a librarian is available to assist you.
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In addition, the FSU COM has an extensive on-line library (http://www.med.fsu.edu/library/)
which is available for residents to use which also includes a number of Obstetric and
Gynecology journals and books. You will be provided with a username and password.
Training sessions will be held periodically throughout the year. (See Appendix XI –
OB/GYN journals online at the FSUCOM library and Appendix XII – OB/GYN books online
at the FSUCOM library)
Communications
The major means of communications within the program will be via e-mail. Residents are
required to have an active e-mail address and should check their mailboxes regularly. They
must use the College of Medicine e-mail account provided them. Computers are located in
the Resident’s Report Room, Resident’s Lounge, and clinic. Resident and faculty physician
e-mail addresses will be distributed to members of the program.
Resident and fellow loan deferment requests
The Association of American Medical Colleges (AAMC) and the Council of Deans have
established the policy that no loan deferment on National Direct Student Loans and
Guaranteed Student Loans for any resident or fellow past PGY-2 will be certified. Loan
deferment requests for other types of loans will be processed on an individual basis.
Meal vouchers
Each resident will be issued meal vouchers to cover the cost of meals during days and nights
of call.
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PATIENTS CHARTS / MEDICAL RECORDS:
The medical record is an essential ingredient for good medical care. The record serves
many purposes and proper documentation, chart completion and respect for the medical
record are expected of all housestaff. The medical record is, and always will be, an
important part of your medical career, so the time to develop good habits is now!
Documentation
• Indicate patient’s full name and medical record number in the upper right corner of
all forms.
• Write your note immediately after treating the patient. The longer you wait, the less
you will retain about the patient.
• Be specific.
• Sign, date and time all entries.
• Do not use abbreviations unless they are listed in the approved abbreviation list
published by Health Information and Record Management.
• Abbreviations are not acceptable for diagnoses and are not to be used on informed
consent forms.
• Choose your words carefully. The medical record is not the place to vehemently
disagree with a policy or a colleague.
• Make alterations carefully, avoid obliterations or creating the appearance of
tampering. Cross off errors with a single line, ensuring the entry is still legible. Date and
initial the correction.
• Write in black ink.
• Write neatly so that another healthcare provider can read your entry in the record.
Chart completion
By law, the medical record must be complete within twenty-three days of a patient’s
discharge. In order to accomplish this, all physicians need to complete their medical
records while the patient is in house or visit the Physicians’ Workroom minimally once
per week. Residents should sign both the department’s sign-in sheet and the Medical
Records Department register to document compliance.
Although it varies by service, most residents are responsible for signing their own
progress notes, verbal orders, and dictating operative reports and discharge summaries.
Chart completion will be monitored on a weekly basis, with the medical records
supervisor emailing the Program Director a listing of residents not in compliance. The
first time a resident is not in compliance, they will receive a warning. The second time,
they will receive a suspension. The third time they will receive probation.
Your attention to the completion of medical records is reported biweekly to the
Department Chairman, the Chief of Staff, and the Department Representative to Health
Information and Record Management. FAILURE TO COMPLETE MEDICAL
RECORDS IN A TIMELY MANNER MAY JEOPARDIZE YOUR CLINICAL
PRIVILEGES.
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Coding
Definition for Reporting Diagnoses and Procedures:
Principal Diagnosis:
The condition established, after study, to be chiefly
responsible for the admission of the patient to the
hospital.
Secondary Diagnosis:
All conditions that coexist at the time of admission,
that develop subsequently, or that affect the
treatment received and/or length of stay. Diagnoses
that relate to an earlier episode which have no
bearing on the current hospital stay should be
excluded.
Principal Procedure:
Secondary Procedure:
The procedure that was performed for definitive
treatment rather than one performed for diagnostic
or exploratory purposes or for management of a
complication. If there appear to be two major
procedures, the one most related to the principal
diagnosis should be selected as the principal
procedure.
These procedures are listed in order of significance
using the following criteria:
1. Surgical in nature
2. Carries a procedural risk
3. Carries an anesthetic risk
4. Requires specialized training
Coding Guidelines for Reporting Other (Additional) Diagnoses:
General Rule:
For reporting purposes, the definition of “other
diagnoses” is interpreted as additional conditions
that affect patient care by requiring:
1. Clinical evaluation
2. Therapeutic treatment
3. Diagnostic procedures, or
4. Extended length of hospital stay, or
5. Increased nursing care and/or monitoring.
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Charting for perinatal death
A perinatal death, in addition to the usual patient care and medical record documentation, has
some special requirements.
Include information helpful in determining the cause of death, e.g.,
History:
prenatal complications, date and findings at last prenatal visit, date of last
perception of movement, history of trauma, infection, bleeding or ROM,
events leading up to the diagnosis and how the diagnosis was made.
Indicate the parents’ choice regarding time of delivery (i.e., immediate
induction vs. expectant management.)
Delivery Note: Include parental reaction, who was present, and who saw and held the baby.
All mothers of fetuses of 13 weeks or greater at time of death who deliver a recognizable
fetus can choose autopsy or not and cremation or not. (Remember, if there is no cremation,
parents must make arrangements for a private funeral.) Appropriate consents are needed.
Photos will be taken automatically of all babies (no consent needed). If consent for autopsy
is denied, the placenta will automatically be examined. Nonrecognizable products of
conception should go to Surgical Pathology as specimens.
Discharge summaries
Discharge summaries must be completed before the patient is discharged from the
hospital.
All medical records must have a handwritten or dictated discharge summary (under 48 hours,
dictated summary is not required). A final progress note may be substituted for a discharge
summary in the case of patients with problems of a minor nature who require less than a 48hour period of hospitalization and in the case of uncomplicated obstetric deliveries. A
dictated discharge summary is required on the OB service for the following conditions:
1. All antepartum admissions (undelivered) except false labor
2. All indicated abortions (termination of pregnancy)
3. All deliveries by:
a. Classical cesarean
b. Low vertical or low transverse cesarean with complications such as infection,
ileus, hemorrhage
c. Cesarean hysterectomy
4. All patients with the following antepartum or postpartum complications:
a. Severe preeclampsia and eclampsia or severe chronic hypertension
b. Diabetes mellitus – insulin dependent
c. Cardiac patients
d. Isoimmunized pregnancy
e. Postpartum hemorrhage requiring blood transfusion
5. All fetal deaths in utero
6. Any other problem or condition which the attending physician or chief resident
decides needs to have a dictated summary.
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The discharge summary concisely summarizes the reason for hospitalization, significant
findings, procedures performed, treatment rendered, condition of the patient upon discharge,
and any specific instructions given to the patient and family. For the majority of patients, the
discharge summary should be no more than 1-2 pages in length. Be sure to include the full
name and address of the referring physician so a copy of the discharge summary can be sent
to that individual.
Discharge summary format
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Dictator’s name and service
Attending physician’s name and position
Referring physician’s name and address
Patient’s name and medical record number
Date of admission
Date of discharge
Chief complaint
History of present illness
Past medical history
Family history
Social history
Pertinent review of systems
Focused physical examination
Initial laboratory assessment
Hospital course – include subsequent laboratory studies and diagnostic and
therapeutic procedures
Final diagnoses
Summary of procedures
Condition on discharge
Disposition and instructions to patient and family members
Operative reports
Operative reports should be dictated as close to the procedure’s performance as is possible
and at NO time should the dictation occur more than 24 hours after the procedure is
completed. This is a hospital requirement as well as professionally and medico-legally
responsible.
Operative report format
•
•
•
•
•
•
Dictator’s name and service
Patient’s name and medial record number
Date of surgery
Pre and postoperative diagnoses. These should be as precise as possible so that
the reader can immediately determine the indication for surgery.
Operation performed
Surgeon and assistants. Always designate the attending physician as the primary
surgeon.
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•
•
•
•
•
•
•
•
•
•
•
•
Anesthesiologist and assistants. Always designate the attending physician as the
primary anesthesiologist.
Type of anesthesia
Technical procedure. You do no need to describe every specific instrument you
used and every minuscule detail of the procedure. Focus on the main points! For
example, rather than describing every detail of a routine abdominal incision, you
can simply indicate that “ … the peritoneal cavity was entered without
complication through a vertical (or Pfannenstiel) incision.” However, items such
as selection of suture material and type of fascial closure are clinically important
and should be noted. Pertinent intraoperative findings (e.g., uterine leiomyoma;
adnexal mass; neonate’s weight, Apgar scores, and cord blood gases) and
complications (e.g., hemorrhage, bowel or bladder injury) should be described.
Specimens removed
Blood loss
Fluid replacement
Urine output
Administration of prophylactic antibiotics
Administration of epidural narcotics
Extubation, if general anesthesia was used – complicated vs. uncomplicated
Disposition of patient (and infant, when appropriate), e.g., recovery room, SICU,
NICU
If the patient had a cesarean, be certain to indicate whether she is an acceptable
candidate for VBAC.
See Appendix XIV – Sacred Heart Health System dictation tips and tricks
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Appendix I – Gynecologic oncology specific instructions
Rotational duties and expectations on the gyn oncology service
Date: May 5, 2008
To:
All Residents
From: Steven DeCesare, M.D.
PRE-OPERATIVE DUTIES
1. Pre-operative duties of the residents should include having a thorough knowledge of
the patient’s history and physical examination. This includes not only the history and
present illness but also the past surgical history, obstetric and gynecologic history,
medical history, family history, and social history. Additionally, the resident
physician will be expected to know every medication that a given patient is taking.
Not only will they be required to know the name of the medication, but what type of
drug each medication is and what the relevant side effects related to surgery and postop care are.
2. The resident physician will be questioned on various aspects of each patient’s history
prior to a surgical case. If the resident physician is deemed not to have sufficient
knowledge of the patient’s case, they will be dismissed from operating on that given
patient. If a resident is dismissed from performing a surgical procedure, due to lack
of pre-operative knowledge on a given patient, they will still be expected to follow
that patient just as if they operated on said patient.
3. Additional pre-operative responsibilities will include making sure that the patient has
taken all of the medications that they are supposed to take prior to their surgery. This
includes taking a history of whether a bowel prep was done and how effective the
bowel prep was. Additionally, this includes making sure patients that are supposed to
receive SBE prophylaxis have received their antibiotic prophylaxis. This does not
mean that the resident checks to see if the order was written. This means that the
resident has physically ensured that the antibiotics are infusing or have infused into
the patient pre-operatively.
4. Additionally the resident physician is responsible for making sure that Plavix (or
other medications) are discontinued one week prior to surgery. Once again, this does
not mean that the resident should assume that it has been done, but rather makes sure
that this has been done with documentation in the office chart noting the date at
which Plavix was discontinued. Finding out that Plavix was not discontinued on the
day of surgery will be considered a major error. The same will hold true for
Coumadin patients. Additionally, those Coumadin patients who are stopped from
their Coumadin prior to surgery may require therapeutic Lovenox. As such, the
resident physician will need to make sure that this is arranged appropriately.
Coumadin should be stopped five days prior to a surgical procedure and the patient
should be placed on a milligram per kilogram of Lovenox bid for those patients
requiring continued anticoagulation. The last dose of Lovinox should be at 6:00 pm
the night prior to surgery. The residents will be held responsible to make sure these
orders are carried out appropriately. The same guidelines will hold true for any
patient on Lovinox in the hospital prior to surgery. Needless to say, if the surgery is
later in the day, the last dose of Lovinox can be moved up to a slightly later time in
214
the evening prior to surgery. Never rely on anyone except yourself to make sure that
anticoagulation has been discontinued appropriately. Lack of discontinuing
anticoagulation prior to a surgical procedure will result in a lethal outcome.
5. A fourth year resident on oncology will be responsible to make sure that all preoperative and post-operative care is being done appropriately by the third year
resident. The only area that the fourth year resident will not be held responsible is for
that done immediately in the pre-op area.
POST-OPERATIVE CARE
1. The night call resident is responsible for writing a progress note on all oncology
patients. The post-op day zero patients and ICU patients will be seen first. Unless
Labor and Delivery is markedly busy all patients however will be seen. The only
acceptable excuse for not writing a note on all oncology patients every night will be
that the resident did not sleep what so ever during their night shift. If you have been
up all night, then I will be more than happy to provide an oncology resident to take
over whatever service you were working on at 8:00 am.
2. Any nurse call which requires that an order be written, requires an additional
physician’s note. This will hold true for all nursing calls except for medications that
can be obtained over the counter. Failure to perform duties as the night call resident
will be considered a major error.
3. A morning and a nighttime note will be written on all oncology patients on Saturdays
and Sundays. Weekend notes should all be completed prior to beginning one’s
obstetrical duties for that day (by 8:00am).
REMEDIATION FOR POOR PERFORMANCE
You will be notified of the specific event when you have committed a major error in writing.
You may refer to this memo to review the penalties for committing a major error. Not
knowing a patient sufficiently preoperatively and being dismissed from a given case, due to
not knowing a history and physical adequately, will not necessarily constitute a major error;
however, certainly has the potential to consist of being reported as a major error. These
errors are cumulative and you do not start with a new slate on a new month long rotation on
the oncology service. The errors will be recoded and kept on a record. Dr.DeCesare will
receive a communication each time you have committed a major infraction.
215
Appendix II – Moonlighting policy
POLICY: MOONLIGHTING
PURPOSE
The Florida State University College of Medicine (FSU COM), Residency Training Program
establishes this policy regarding resident moonlighting to ensure program compliance with the
Accreditation Council for Graduate Medical Education (ACGME). The ACGME requires that the
Sponsoring Institution have policies regarding professional activities outside the educational program.
(Institutional Requirement II.D.4).(1)
POLICY
Individual residency programs are accredited by their Residency Review Committee (RRC) and must
adhere to RRC requirements regarding moonlighting. Although RRC’s vary, the general scope is that
any professional activities which are outside the established educational program must not interfere
with the resident’s established educational process or the quality care of patients. Residents shall not
be required to engage in professional activities outside the educational program.
COMMON DEFINITION.
Moonlighting is defined as compensated clinical work performed by a resident during the time that
he/she is a member of a residency program. This policy addresses two categories of moonlighting:
Programmatic: The clinical work occurs within the specific residency program and its
participating institution(s), and is simply an extension of the same type and location of clinical work
performed as a requirement of the Graduate Medical Education (GME) program. Programmatic
moonlighting includes internal work only.
Non-Programmatic: The clinical work is not an extension of the residency program and its
participating institution(s), and in no circumstance is the resident to hold him/herself as an employee
of the University while engaged in such activities. Non-programmatic moonlighting may include
internal or external work.
PRIMARY RESPONSIBILITIES.
Institution and Program
It is the responsibility of the program director to decide whether or not moonlighting will be allowed.
The program director must comply with the institution’s policies and procedures. The conditions
under which a resident may be allowed to participate in programmatic and/or non-programmatic
moonlighting must meet ACGME requirements.
If a program director allows a resident to moonlight, a Programmatic Moonlighting Approval Form is
required if the moonlighting is programmatic, and a Non-Programmatic Moonlighting Approval Form
is required if the moonlighting is non-programmatic. The appropriate approval form is then made a
part of the resident’s file as required by the ACGME.
Because residency education is a full-time endeavor, the Program Director must approve and monitor
all moonlighting to ensure that moonlighting does not interfere with the ability of the resident to
achieve the goals and objectives of the educational program.
THE RESIDENTS.
The resident must be a current resident in the program, and must be in good standing.
PGY-1 residents are not permitted to moonlight.
216
Residents on J-1 visas may not moonlight, as mandated by the Educational Committee for Foreign
Medical Graduates (ECFMG).
A resident wishing to moonlight must obtain prior written approval from his/her program director.
(Ref. Institution and Program section above, para. 2)
Because residency education is a full time endeavor, residents must ensure that moonlighting does not
interfere with their ability to achieve the goals and objectives of their educational program. Residents
are responsible for ensuring that moonlighting and other outside activities do not result in fatigue that
might affect patient care or learning.
A resident’s failure to comply with the Moonlighting Policy is a breach of contract and grounds for
termination.
PROGRAMMATIC MOONLIGHTING.
The Program Director must ensure, direct, and document supervision and faculty support appropriate
for the level of training of residents at all times. While performing these services, residents are not to
act as independent practitioners. Faculty schedules must be structured to provide residents with
continuous supervision and consultation.
Residents must be provided with efficient, reliable systems for communicating with supervising
faculty. Faculty are also responsible to recognize the signs of fatigue and adopt and apply practices to
prevent and counteract the potential negative effects.
NONPROGRAMMATIC MOONLIGHTING.
Residents must be licensed for unsupervised medical practice in the state where such activity occurs,
including DEA licensure as applicable and any other requirements for clinical privileging at the
employment site. There must be an exchange of permission letters between the Program Director and
appropriate staff at the institution where the moonlighting will occur if the moonlighting is done
externally.
Residents are not covered under the University’s professional liability insurance program as the
activity is outside the scope of University employment. The resident is responsible for his/her own
professional liability coverage (either independently or through the entity for which the resident is
moonlighting) and must provide documentation of such.
Non-programmatic moonlighting hours must be documented (including days, hours, location, and
brief description of type of service[s] provided).
WORK HOURS.
All moonlighting hours must be documented, and they must comply with the written policies
regarding Duty Hours as per the training program, and the ACGME. The Program Director may not
approve residents for any internal moonlighting that requires residents to exceed the 80-hour per week
(on average per 4-week, or as defined by specialty specific Review Committee) rule or other
provisions of the duty-hour requirements.
(Not applicable to non-programmatic external
moonlighting).
MAINTAINING APPROVAL.
The Program Director will monitor resident performance in the Program to ensure that moonlighting
activities are not adversely affecting patient care, learning or resident fatigue. The GME Committee
will periodically review reports by the Program Director(s) regarding moonlighting activity.
217
If at any time the Program Director determines that a resident’s moonlighting schedule is adversely
impacting the resident’s performance in the training program, the Program Director may withdraw the
permission to moonlight.
Florida State University College of Medicine
Graduate Medical Education
Policies and Procedures
Rev. March 2012
218
Appendix III – Programmatic moonlighting approval
form
1115 West Call Street
Phone: 850.645.6867
Tallahassee, FL 32306-4300
Fax:
850.644.8924
PROGRAMMATIC MOONLIGHTING APPROVAL
FORM
PARTS 1 & 2 TO BE COMPLETED BY THE RESIDENT:
Part 1: GENERAL INFORMATION:
Name __________________________________ Date
Program
_______________________
_________________________
Program Location ___________________ PGY ____
Part 2: I UNDERSTAND THE FOLLOWING:
All Moonlighting is voluntary, programmatic, and requires the approval of the Program Director;
Any resident who moonlights without permission will be subject to disciplinary action;
Moonlighting may not be done during duty hours and is not to interfere with my training, including
my learning and/or patient care;
My total work hours including residency and all moonlighting activities will not exceed 80 hours per
week, averaged over 4 weeks;
If my moonlighting activities contribute to undue fatigue, I will cease all moonlighting activities;
I am not to function as an independent practitioner during this activity. I will not function above my
level of training or without my usual faculty supervision; and
There will be periodic reviews of my residency training, and if it is less than expected, permission to
moonlight will be withdrawn;
I acknowledge that I have carefully read and fully understand the policies regarding
programmatic moonlighting as stated in this Approval Form as well as the Moonlighting Policy.
Resident Signature ___________________
Date ____________________
PART 3 TO BE COMPLETED BY THE PROGRAM DIRECTOR:
Part 3: DIRECTOR’S ATTESTATIONS:
219
The resident is not on academic probation;
The total hours in the resident’s educational program and the moonlighting activities will
not exceed the limits set forth by ACGME; and
This opportunity does not replace any part of the clinical experiences integral to the
resident’s training program, and the resident will be under faculty supervision while
engaging in moonlighting activities.
This approval form is valid for the current GME year only.
Rev. 3/1/07
Program Director Signature __________________________ Date ______________________
220
Appendix IV – Non-programmatic moonlighting approval form
1115 West Call Street
Phone: 850.645.6867
Tallahassee, FL 32306-4300
Fax:
850.644.8924
NON-PROGRAMMATIC MOONLIGHTING
APPROVAL FORM
PARTS 1 & 2 TO BE COMPLETED BY THE RESIDENT:
Part 1: GENERAL INFORMATION:
Name ________________________
Program
Date
_______________________________
__________________ Program Location _____________________ PGY ___
Part 2: I UNDERSTAND THE FOLLOWING:
All Moonlighting is voluntary, non-programmatic, and requires the approval of the Program Director,
and any resident who moonlights without permission will be subject to disciplinary action;
Moonlighting may not be done during duty hours and is not to interfere with my training, including
my learning and/or patient care. My total work hours including residency and all moonlighting
activities will not exceed 80 hours per week, averaged over 4 weeks (not applicable to external nonprogrammatic moonlighting);
I am licensed for unsupervised medical practice in the state where such activity occurs, including
any other medical fees and/or requirements for clinical privileging at the employment site.
I understand I am not covered under the University’s professional liability insurance program and
am responsible for my own professional liability coverage (either independently or through the
entity for which I am moonlighting) and am attaching documentation of such;
If my moonlighting activities contribute to undue fatigue, I will cease all moonlighting activities; and
There will be periodic reviews of my residency training, and if it is less than expected, permission to
moonlight will be withdrawn;
I acknowledge that I have carefully read and fully understand the policies regarding non-programmatic
moonlighting as stated in this Approval Form as well as the Moonlighting Policy. Furthermore, I clearly
understand and agree that this non-programmatic activity is in no way related to my employment with the
University and that the Florida State University has no obligation, responsibility, or liability whatsoever for
any injury or harm which I may incur or which may befall me during my performance of or a result of this
non-programmatic activity. Accordingly, I hereby release, forever discharge, and waive any and all claims I
may have now or in the future arising out of or connected with my non-programmatic activities against the
Florida State University, the State of Florida, the Department of Education for the State of Florida, or the
Board of Governors for the State of Florida, and any and all officers, agents, employees, underwriters, and
insurers, all individually and in their respective official capacities.
Resident Signature _______________________ Date_____________________
PART 3 TO BE COMPLETED BY THE PROGRAM DIRECTOR:
Part 3: DIRECTOR’S ATTESTATIONS:
221
The resident is not on academic probation, and the total hours in the resident’s
educational program and the moonlighting activities will not exceed the limits set forth by
ACGME; and
This opportunity does not replace any part of the clinical experiences integral to the
resident’s training program.
This approval form is valid for the current GME year only.
Rev. 3/1/07
Program Director Signature _________________________
222
Date __________________
Appendix V – Use of prescriptions
Junior residents should have a training license number by the time they start in the
program. This license allows for the resident to prescribe all non-scheduled
medications. Scheduled medications, such as narcotics and benzodiazepines, cannot
be prescribed by a resident without a full medical license and DEA number and will
not be filled by local pharmacies if written. The only exception is the Sacred Heart
inpatient pharmacy where the prescription can be filled under the program’s hospitalwide license and DEA number.
The responsibility of providing a prescription for a scheduled drug, such as pain
medication for a post-operative patient being discharged, lies with the resident
performing the discharge. However, the prescription must be filled out completely by
a resident with a full medical license and DEA number. Compliance with Florida
statutes (specifically, FS Chapter 893.03 paragraph (7a)-7) must be upheld.
Residents without full licenses or DEA numbers should provide the resident from
whom they are requesting a prescription with the full name of the patient, any known
allergies, drug name, dose, frequency and quantity to be dispensed.
Residents, whether junior or senior, are expected to obtain their Florida licenses as
soon as possible (see CONTINUING MEDICAL EDUCATION - Florida Medical
License). In situations where neither the junior nor senior on call has their license, the
senior resident will be expected to obtain a completed prescription from the
supervising faculty or attending.
The first violation is a misdemeanor. Any resident violating this rule will be placed
on probation. A second offense is a third-degree felony and will result in a report
being filed with the Florida Medical Board and local or federal law enforcement
agencies as indicated.
223
Appendix VI – OB/GYN journals online at the FSUCOM library
http://www.med.fsu.edu/library/ejournals
Title
Acta Obstetricia et Gynecologica Scandinavica
Acta Obstetricia et Gynecologica Scandinavica
American Journal of Obstetrics and Gynecology
American Journal of Obstetrics and Gynecology
American Journal of Obstetrics and Gynecology
American Journal of Perinatology
Australian & New Zealand Journal of Obstetrics & Gynaecology.
Birth
BJOG: An International Journal of Obstetrics and Gynaecology
BJOG: An International J of Obstetrics and Gynaecology
(Elsevier)
Breastfeeding Medicine
British Journal of Obstetrics and Gynecology
Climacteric
Clinical Obstetrics and Gynecology
Current Opinion in Obstetrics and Gynecology
European J of Obstetrics, Gynecology, and Reproductive
Biology
Evidence-based Obstetrics & Gynecology
Gynecologic Oncology
Gynecological Endocrinology
Health Care for Women International
Hypertension in Pregnancy
Infectious Diseases in Obstetrics and Gynecology
International Journal of Gynaecology and Obstetrics
International Journal of Gynecological Pathology
Journal of Mammary Gland Biology and Neoplasia
Journal of Maternal-Fetal & Neonatal Medicine
Journal of Maternal-Fetal Medicine
Journal of Midwifery & Women's health
Journal of Obstetrics and Gynaecology
Journal of Pediatric and Adolescent Gynecology
Journal of Pediatric and Adolescent Gynecology
Journal of Women's Imaging
Maternal and child health journal
MCN. The American journal of maternal child nursing
Menopause
Obstetric Anesthesia Digest
Obstetrical and Gynecological Survey
Obstetrics and Gynecology
Obstetrics and Gynecology
Obstetrics and Gynecology
Obstetrics and Gynecology Clinics of North America
Placenta
Postgraduate Obstetrics & Gynecology
Prenatal Diagnosis
Ultrasound in Obstetrics and Gynecology
Ultrasound Quarterly
Women and Health
Women's Health Issues
224
Date
Provider
2001-2005
Blackwell Synergy
1998-present
InformaWorld
1995-present
MDConsult Journals
1993-April 2002
Ovid
1995-present
Science Direct
1999-present
Thieme
2002-present
Blackwell Synergy
1998-present
Blackwell Synergy
1997-present
Blackwell Synergy
2002-2003
Science Direct
2006-present
Mary Ann Liebert
2001
Science Direct
2000-present
InformaWorld
1996-present
Ovid Lippincott
1998-present
Ovid Lippincott
1995-present
Science Direct
1999-present
MDConsult Journals
1995-present
Science Direct
1999-present
InformaWorld
1998-present
InformaWorld
2000-present
InformaWorld
1996-2000
Wiley Interscience
1995-present
Science Direct
2000-present
Ovid Lippincott
1997-January 2006
Springer Link
2001-present
InformaWorld
1997-2000
Wiley Interscience
2000-present
Science Direct
1997-present
InformaWorld
2002-present
MDConsult Journals
1999-present
Science Direct
2001-September 2005
Ovid Lippincott
1997-present
Springer-Verlag
1996-present
Ovid Lippincott
November 2000present
2001-present
Ovid Lippincott
Ovid Lippincott
1995-present
Ovid Lippincott
1995-present
HighWire
1995-present
Ovid Lippincott
1995-2003
Science Direct
1996-present
1995-present
MDConsult Clinics
Journals
Science Direct
2005-present
Ovid Lippincott
1996-present
Wiley Interscience
1991-present
Wiley Interscience
2001-present
Ovid Lippincott
1999-2005
Haworth Press
1995-present
Science Direct
Appendix VII – OB/GYN books online at the FSUCOM library
http://www.med.fsu.edu/library/Ebooks
Author
Pernoll, Martin
Novak, Emil
Solomon, Diane
Bland, Kirby I.
Cohen, Wayne
R.
Parker, James
N.
Speroff, Leon
DiSaia, Philip J.
Stenchever,
Morton A.
DeCherney,
Alan H.
Danforth, David
N.
Mazur, Michael
T.
Harris, Jay R.
Fanaroff, Avroy
A.
Bianchi, Diana
W.
James, David K.
Bankowski,
Brandon J.
Craigo, Sabrina
D.
Gabbe, Steven
G.
Wylen, Michelle
Gershenson,
David M.
Sanfilippo,
Joseph S.
Sanders, Roger
C.
Schmidt,
Guenter
Cunningham, F.
Gary
Title
Benson and Pernoll's Handbook of Obstetrics
and Gynecology
Berek & Novak's Gynecology, 14th ed.
Bethesda System for Reporting Cervical
Cytology, 2nd ed.
Breast: comprehensive management of benign
and malignant disorders, 3rd ed.
Cherry and Merkatz’s Complications of
Pregnancy, 5th ed.
Child Development: A Medical Dictionary,
Bibliography, and Annotated Research Guide to
Internet References
Clinical Gynecologic Endocrinology and
Infertility, 7th ed.
Clinical Gynecologic Oncology, 6th ed.
Comprehensive Gynecology, 4th ed.
Current Diagnosis & Treatment Obstetrics &
Gynecology, 10th ed.
Danforth's Obstetrics and Gynecology, 9th ed.
Diagnosis of Endometrial Biopsies and
Curettings, 2nd ed.
Diseases of the Breast, 3rd ed.
Fanaroff and Martin's Neonatal-Perinatal
Medicine: Diseases of the Fetus and Infant, 8th
ed.
Fetology: Diagnosis and Management of the
Fetal Patient
High Risk Pregnancy: Management Options,
3rd ed.
Johns Hopkins Manual of Gynecology and
Obstetrics, 3rd ed.
Year
Provider
2001
NetLibrary (single user)
2007
Ovid
2004
R2Library (single user)
2004
MDConsult Books
2000
Ovid
2003
NetLibrary (single user)
2005
2002
Ovid
MDConsult Books
2001
MDConsult Books
2007
AccessMedicine
2003
Ovid
2005
2004
R2Library (single user)
Ovid
2006
MDConsult Books
2000
Ovid (single user)
2006
MDConsult Books
2007
Ovid
2005
R2Library (single user)
Medical Complications in Pregnancy
Obstetrics - Normal and Problem Pregnancies,
4th ed.
Obstetrics and Gynecology: PreTest (USMLE
Step 2) Self-Assessment and Review, 10th ed.
2002
MDConsult Books
2004
NetLibrary (single user)
Operative Gynecology, 2nd ed.
2001
MDConsult Books
Pediatric and Adolescent Gynecology, 2nd ed.
Structural Fetal Abnormalities: the total picture,
2nd ed.
2001
MDConsult Books
2002
MDConsult Books
Ultrasound
2007
Thieme
Williams Obstetrics, 22nd ed.
2005
AccessMedicine
225
Appendix VIII – Internet social networking and blogging
policy
ORGANIZATIONWIDE POLICY - ONLINE DOCUMENT (9/9/09)
Policy Number HR 77
Title INTERNET SOCIAL NETWORKING AND BLOGGING
POLICY:
Sacred Heart Health System recognizes that technology of Internet Social Networking and/or
the act of “blogging” have become an increasingly popular activity. Sacred Heart takes no
position on an associate’s decision to start or maintain a personal website and/or blog, or to
publish comments on online bulletin boards or online forums. In general, what associates do
on their own time is their own business. However, activities in or outside of the workplace
that affect an associate’s job performance, the performance of others, or the Health System’s
business interests are a proper focus for Health System policy. The Health System has
established Values and Performance Standards that associates must adhere to when identified
as Sacred Heart Health System staff.
PROCEDURE:
1. If it is deemed that an associate’s personal blog, or online bulletin board/online forum
comments have a negative impact on Sacred Heart, the nature and content of any website
and/or blog posting will be a factor in determining what (or whether) discipline action will be
imposed. Violation of any of the following may be grounds for discipline, up to and
including termination, as outlined in the Progressive Discipline Policy HR44:
A. Associates are not permitted to write online postings while on duty. Such action
may be viewed as an abuse of Health System time and inappropriate use of Health
System computers. Associates may also refer to the Electronic Communication
(IM 2) policy.
B. Associates must be respectful in all communications and online postings related to
or referencing the Health System and/or its associates.
C. Associates must not use blogs or other online posting sites to defame the Health
System and/or its associates.
D. Associates must not use blogs or other online posting sites to harass, bully, or
intimidate other associates. Behaviors that constitute harassment and bullying
include, but are not limited to, comments that are derogatory with respect to race,
religion, gender, sexual orientation, color, or disability; sexually suggestive,
humiliating, or demeaning comments; and threats to stalk, haze, or physically injure
another associate.
E. Associates must not post pictures of associates without obtaining permission from
the associate.
No pictures, photographs or any identifying information pertaining to Health System
patients, patients’ families, or visitors may be posted without written consent of the
family or patient, and approval from the Marketing/Public Relations Department.
226
F. Associates are not authorized to speak on behalf of the Health System and,
therefore must not do so without written permission from the Health System’s Public
Relations Director. Any postings which in any way pertain to the Health System
should clearly state that they represent personal views and opinions of the associate
and do not represent Health System positions or opinions.
G. Associates are prohibited from posting or referring to confidential information
concerning patients or Health System business on any internet site. Associates may
not identify patients or discuss any confidential information about patients.
Associates may not comment on confidential financial information of the Health
System, including but not limited to business performance, strategic plans, budgets,
and the like.
2. Laws against defamation, libel, slander and privacy apply to blogging. Associates could be
subject to legal action for spreading disparaging and untrue information related to the Health
System or for defaming another person.
A. Defamation is generally defined as a false accusation or malicious
misrepresentation that causes someone to be shamed, ridiculed, held in contempt,
lowered in the estimation of the community, or to lose employment status or earnings
or otherwise suffer a damaged reputation. Libel and slander are defamation.
B. Associates who publish information regarding a person’s medical, financial or
personal life could be subject to a claim for violation of privacy and/or violation of
HIPAA privacy regulations.
C. Blogging under an alias provides no protection against legal action, because
administrators of blogging websites may be forced by court order to reveal the
blogger’s identity.
Originated:
Reviewed Date Karen Emmanuel, General Counsel 12/2007 Karen Emmanuel, General
Counsel 03/2008
Please also see ACOG’s social media guide
(http://www.acog.org/~/media/ACOG%20Today/acogToday201211.pdf)
on how to properly comport yourself while using social media.
227
Appendix IX – Schedule change request
Florida State University Obstetrics and Gynecology Residency Program
Schedule change Request Form Academic year 2013-2014
Resident Name_________________________________________________________________
Date____________
The Google calendar vacation schedule is your vacation/call unless this form is completed. Please note
that all requests must be turned in 2 weeks ahead of time. An explanation of the reason why this
deadline cannot be met must accompany this form.
1. Scheduled Call Vacation________________________________________________________
Requested Call/Vacation__________________________________________________________
2. Reason for change
_____Interview
_____Planned Medical leave
_____Personal
_____Conference
_____Other (please describe)
3. Call shifts impacted with planned residents that will work your shifts. Please list dates, as well as
who has agreed to cover. Please have all residents who are covering your shifts sign the changes, as
well as the admin chief resident.
Original call/date
Resident who will
Signature of covering
Signature of admin
cover
resident
Chief Resident
4. Continuity Clinics or general clinics impacted, with planned residents that will cover for you.
Please list dates, as well as who has agreed to cover. Please have residents who are covering your
clinics sign, as well as Dr Seidel, Director of Ambulatory Medicine.
Clinic Date
Resident who will
Signature of covering
Signature of Dr Seidel,
cover
resident
Director of Ambulatory
Medicine
5. Turned into Julie Floyd completed on this date_______________________________________
6. Approved______Declined_____ ___________________________Julie DeCesare, PD
7. Changes entered into google calendar on this date______________________________
228
Appendix X – Impaired physician policy and support
POLICY: SUPPORT FOR RESIDENT PHYSICIANS WITH IMPAIRMENT
DEFINITION
For the purpose of this policy and procedure, impairment is defined as a condition which is,
or may be, adversely affecting patient care, including, but not limited to: alcoholism/alcohol
abuse, other drug addiction, sexual misconduct and/or harassment, physical or medical
conditions, psychiatric disorders, emotional disorders or behavioral disorders.
PURPOSE
The purpose of this policy is:
1. To establish a process to identify and manage matters of individual resident physician
impairment, separate from the medical staff disciplinary function.
2. To establish a mechanism of reporting for any individual with a reasonable suspicion that a
resident physician is impaired.
3. To provide a process that offers support and compassion to the affected resident physician.
POLICY
1. This policy places the highest priority on protection of the patient, while promoting prompt
referral for evaluation, treatment and support for resident physicians.
2. The sponsoring institution and each program are responsible for monitoring residents for
signs of psychological, medical or substance abuse problems that may be causing
impairment, and for initiating appropriate interventions. The FSU COM has contracted (via
the Employee Assistance Program of Florida State University) with LifeWorks, an
organization that provides 24/7 access to free confidential help with personal and workrelated problems, and which can assist residents with almost any issue, including: Life;
Family; Money; Work; and Health. Residents may phone toll-free to speak with a LifeWorks
consultant, or they may visit the website www.lifeworks.com to find the help and resources
needed. (See Attachment 1 for further details).
3. The FSU COM conforms to the Florida Medical Practice Act (F.S. 458), which provides
for the Impaired Practitioners Program, which is administered through the Professionals
Resource Network (PRN). PRN works closely with the State Board of Medicine and is
recognized as the primary mechanism for providing assistance to impaired physicians in the
state. Information on the PRN and its program can be obtained by calling 1-800-888-8776 or
by writing to the PRN at P. O. Box 1020, Fernandina Beach, FL 32035-1020.
4. It is the intent of the FSU COM that all appropriate rules that govern the practice of
medicine and all FSU COM related polices be strictly enforced.
a. Each program will provide an educational program to its residents regarding
substance abuse and other impairment and available assistance.
229
b. A resident physician whose behavior is consistent with substance abuse or other
impairment may be required by his/her Program Director to submit to a drug screen.
Drug screens will be performed by Sacred Heart Hospital Human Resource Office
Personnel.
Behavior indicating substance abuse may include:
1. Observed impairment of job performance.
2. Abnormal conduct or erratic behavior.
3. A serious workplace accident or number of minor workplace accidents.
4. Evidence of drug tampering in the employee’s workplace.
5. Arrest or conviction on an alcohol- or drug-related offense.
c. All referrals to the PRN are confidential and are evaluated by the professionals of
the PRN. Decisions about intervention, treatment and after care are determined by the
PRN.
d. As long as the resident physician satisfactorily participates in the PRN program, no
regulatory action would normally be anticipated by the Board of Medicine.
e. Resumption of clinical activity and residency program training will be contingent
upon the continued successful participation in the PRN and continuation of the
resident in the program will be determined in consultation between the program
director, DIO and the professionals at the PRN.
PROCEDURE
1. Resident physicians with a past or current history of drug or alcohol addiction, or mental or
physical health condition that may impact patient care should report such condition to PRN.
2. Faculty, staff, peers, family members or other individuals who suspect that a member of
the housestaff is suffering from a psychological, medical or substance abuse problem
impacting patient care are obligated to report such problems. Individuals suspecting such
impairment can discuss their concerns with the Program Director, Chief of Medical Staff at
SHH and/or the DIO, or may report it directly to the Professionals Resource Network (PRN).
3. Residents meeting any of the above criteria in 4b, or other reasonable criteria utilized by
the Program Director, may be required by the Program Director to submit to a drug test.
Refusal or failure to submit to a timely drug test is sufficient cause for termination of
employment.
4. The resident will be relieved of his/her duties and will be given a specific time (generally
less than two hours) that he/she is to report to the testing facility. Failure to report at the
specified time, without pre-approval of the Program Director, is sufficient cause for
230
immediate termination. In the event that the resident is obviously impaired, consulting staff
members will make arrangements to provide transportation to the testing facility.
5. The Designated Institutional Official should be promptly notified. Suspicious behavior
should be documented on the form appended to this policy (Attachment 2). This form is to be
retained in the resident’s confidential personnel file.
6. The submitted sample (blood, hair and/or urine, as appropriate) will be screened. If an
initial screen returns a positive result, a confirmatory test on the same sample will be
conducted. If the confirmatory test is also positive, the result will be turned over to the
Program Director. All sample collections for drug tests conducted for cause will be
performed under observation.
7. Test results will be granted confidentiality in accordance with all federal and state laws and
residency policy. Tests will be performed at the Sacred Heart Hospital Human Resource
Office and will be paid for by SHH. Notification of any other agency or licensing board will
be accomplished by the Residency Director in accordance with this policy.
8. Applicants may be asked to provide information as necessary to interpret drug screen
results. Such information will be considered confidential.
9. Attempts to alter or substitute a specimen will be cause for immediate termination, even if
the attempt is discovered at a later date.
10. The Program Director will schedule an appointment with the resident to discuss with
him/her the results and will inform the DIO and other hospital administration as appropriate.
11. Along with the DIO and hospital administration as appropriate, the Program Director will
determine the appropriate action necessary which will include prompt referral to with the
Employee Assistance Program (EAP) / Lifeworks and PRN, and depending upon the
circumstances may include immediate termination, while adhering to the ADA.
12. The Program Director will determine the resident’s ability to continue in the program
and/or remain in patient care activities after consultation with the professionals at EAP and
the PRN. Any resident terminated for cause will be ineligible for rehire for a minimum of six
months, may be more if situation indicates longer term.
Florida State University College of Medicine
Graduate Medical Education
Policies and Procedure
Rev. 6/18/2010
231
ATTACHMENT A
232
ATTACHMENT A cont.
233
ATTACHMENT B
Program Director Documentation Form
Organization:
Time of Call:___________________
Program:
Supervisor:
Telephone:
Title:
Beeper/Other:
Other Faculty:
Telephone#:
Title:
Beeper/Other:
Employee:
Job Title:
Length of Service:
Behavior Observed
Date
Yes
Consent to release of drug test results
234
No
I, the undersigned resident physician at the Florida State University College of
Medicine/Sacred Heart Hospital Residency Program(s) hereby acknowledge and agree as
follows:
As a resident employee, I am bound by the Graduate Medical Education “Support for
Resident Physicians with Impairment” Policy;
This policy may require me to submit to periodic drug testing;
I hereby consent to and expressly authorize the release by Hospital of any of my drug test
results to the FSU COM; and,
I hereby forever release Hospital from any and all liability, claims or causes of action which
might otherwise accrue against Hospital and which arise from or are related in any way to
Hospital’s release of my drug test results to the FSU COM.
IN WITNESS WHEREOF, I have executed this Consent to Release of Drug Test Results
effective as of the date set forth below.
__________________________________
Signature
__________________________________
Print Physician Name
_________________________________________
Date
235
Appendix XI – CREOG core curriculum in OB/GYN 10th
ed.
Educational Objectives
Core Curriculum
In Obstetrics and Gynecology
Tenth Edition
**PLEASE SEE JUMP DRIVE FOR FULL VERSION
OF CORE CURRICULUM**
COUNCIL ON RESIDENT EDUCATION IN OBSTETRICS AND
GYNECOLOGY
Appendix XII – Procedure logger
236
Procedure
Group
Procedure
Credential
Target
CPT®
Code
Logged
Items
Continuity
Complete physical exam
5
99395
0
Fecal occult blood testing
5
82270
0
Fitting of diaphragm or cervical cap
3
97140
0
Funduscopic examination (basic)
5
Insertion and removal of implantable steroid contraception
5
11975
0
Insertion and removal of intrauterine device
5
58300
0
Peak expiratory flow (FEV) determination
5
99070
0
Pulse oximetry
5
94760
0
Skin biopsy
5
11100
0
Abdominal sacrocolpopexy
0
57280
2
Ablation and excision of endometriosis implants
5
58622
0
Ablative procedure (cervix, endometrium, vagina, vulva)
5
58353
61
Anti-incontinence (urinary) procedure Sling (TOT or TVT)
5
57288
123
GYN
0
Appendectomy
5
44955
27
Biopsy - Cervix
5
57454
265
Biopsy - Endocervix
5
57505
0
Biopsy - Endometrium
5
58110
37
Biopsy - Vagina
5
57100
17
Biopsy - Vulva
5
56606
29
Cervical Conization
5
57520
101
Colpocleisis
0
57120
0
Colporrhaphy, anterior
5
57240
102
Colposcopy, with directed biopsy of cervix, Vagina or vulva
5
57455
27
Colposuspension - SSLF
5
57282
29
Colposuspension - USL
5
57283
41
Colprrhophy, posterior
5
57250
84
Culdoplasty - Abdominal
5
57270
6
Culdoplasty - Vaginal
5
57268
22
Cystometrography - Complex
5
51726
1
Cystometrography - Simple
0
51725
1
Cystometrography Simple Q tip test
5
51772
0
Cystotomy repair
3
51860
1
Cystourethroscopy
5
52000
578
Cystourethroscopy for IC
5
52260
22
Dilation and curettage
5
58120
321
Enterocele repair
5
57556
0
Enterotomy repair
3
44602
1
Excision of Bartholin's gland
3
56740
12
Excision of cyst (ovarian, tubal, vaginal, vulvar)
5
57135
11
Fistula Repair - Rectovaginal
0
57300
1
Fistula Repair - Ureterovaginal
0
57311
0
Fistula Repair - urethrovaginal
5
57310
0
Fistula Repair - Vesicovaginal
0
51900
0
Graft/mesh placement for pelvic support
5
57267
25
237
GYN ONC
OB
Hernia repair (incisional)
3
49560
4
Hymenotomy
2
56442
1
Hysterectomy - Abdominal, total or supacervical
5
58150
0
Hysterectomy - Laparoscopic, supracervical
5
58541
27
Hysterectomy - Total Hysterectomy
5
58570
19
Hysterectomy - Vaginal
5
58260
131
Hysterectomy - Vaginal, laparoscopically assisted
5
58550
62
Hysterosalpingography (HSG)
3
58340
0
Hysteroscopy - Diagnostic
5
58555
0
Hysteroscopy - Operative
5
58558
0
Hysteroscopy - Polypectomy
5
58560
0
Intrapartum Laparotomy skin incision Transverse
5
Laparoscopy - Diagnostic
5
Laparotomy skin incision - Transverse
5
Laparotomy skin incision - Vertical
5
Lysis of adhesions - Abdominal
5
44045
0
Lysis of adhesions - Laparoscopic
5
58660
0
Marsupialization of Bartholin's gland cyst
5
56440
13
Mechanical or osmotic preprocedural cervical preparation
5
Myomectomy
5
58140
15
Omentectomy, infracolic
5
49255
11
Oophorectomy
5
58720
83
Ovarian Biopsy
5
49321
14
Ovarian or paraovarian cystectomy
5
49322
0
Ovarian transposition
0
58825
3
Paravaginal defect repair
0
57284
10
Perrineorrhaphy / perineoplasty
5
56810
29
Postpartum Hematoma evacuation (vulvar, vaginal)
2
10140
0
Postpartum Wound Care Debridement
5
11005
0
Postpartum Wound Care Repair of dehiscence
3
12020
0
Postpartum Wound Care Secondary closure
3
13160
0
Salpingectomy
5
59120
19
Salpingostomy
5
58770
0
Salpingotomy
5
59121
1
Skin biopsy
5
11100
0
Sterilization Hysteroscopic
5
58565
58
Sterilization Laparoscopic
5
58671
104
Ultrasonography Abdominal
5
76803
0
Ultrasonography Endovaginal
5
76830
599
Vulvectomy simple
5
56640
0
Wide local excision (vulva)
5
0
Exploration of Abdomen (Exploratory Laparotomy)
5
0
Suction evacuation of molar pregnancy
5
0
Antepartum Abdominal ultrasonography targeted
0
58661
216
0
0
0
5
76812
8
Antepartum Amniocentesis 3rd trimester asst. of fetal lung maturity 5
59000
79
Antepartum Cervical cerclage Transabdominal
0
59325
0
Antepartum Cervical cerclage Transvaginal
5
59320
114
238
Antepartum Chorionic villus sampling any method
0
59015
2
Antepartum Cordocentesis
0
59012
4
Antepartum Fetal assessment antepartum Biophysical profile
5
76819
0
Antepartum Fetal assessment antepartum Contraction stress test
5
76818
0
Antepartum Fetal assessment antepartum Nonstress test
5
59025
0
Antepartum Fetal assessment antepartum Vibroacoustic stimulation
5
76820
0
Antepartum Three dimensional Ultrasound
0
76376
0
Antepartum Ultrasound examination Abdominal <14 weeks
5
76802
2
Antepartum Ultrasound examination Endovaginal <14 weeks
5
76817
240
Antepartum Version of breech external
3
59412
13
Intrapartum Amnioinfusion
5
59070
3
Intrapartum Amniotomy
5
Intrapartum Anesthetic/Analgesic Procedures Epidural Anesthesia
0
Intrapartum Anesthetic/analgesic procedures Administration of
narcotics
5
0
Intrapartum Anesthetic/analgesic Procedures Administration of
parenteral Analgesics/sedatives
5
0
Intrapartum Cesarean delivery Classical
5
59514
1
Intrapartum Cesarean delivery - Low transverse
5
59510
0
Intrapartum Cesarean delivery - Low vertical
3
59515
0
Intrapartum Cesarean hysterectomy
2
59525
21
Intrapartum Curettage for Adherent Placenta
3
59160
0
Intrapartum Dilation and evacuation for second-trimester fetal
death
2
59100
0
Intrapartum Episiotomy and repair
5
59300
221
Intrapartum Fetal assessment, intrapartum Fetal scalp stimulation
5
0
Intrapartum Fetal assessment, intrapartum Vibroacoustic stimulation
5
test
0
Intrapartum Fetal Assessment, Intrapartum, Fetal heart rate
monitoring
5
0
Intrapartum Forceps Delivery (i.e., Low, Outlet)
3
Intrapartum Induction of labor with postaglandins or oxytocin
5
0
Intrapartum Laparotomy skin incision Transverse
5
0
Intrapartum Manual removal of placenta
5
Intrapartum Suction evacuation for the first-trimester fetal death
5
59840
0
Intrapartum Uterine artery ligation
3
37617
0
Intrapartum Vacuum extraction - Low & Outlet
2
59409
0
Intrapartum Vaginal delivery, Spontaneous
5
Postpartum Circumcision neonatal (with anesthesia)
5
54150
0
Postpartum Hematoma evacuation (vulvar, vaginal)
2
10140
0
Postpartum Repair of genital tract laceration - Cervical
0
01967
59410
0
0
0
0
3
13131
0
Postpartum Repair of genital tract laceration Perineal (second, third,
5
and fourth degree lacerations)
12041
0
Postpartum Repair of genital tract laceration Vaginal
5
12047
0
Postpartum Sterilization
5
58615
0
Postpartum Wound Care Debridement
5
11005
0
Postpartum Wound Care Incision and drainage of abscess or
hematoma
5
Postpartum Wound Care Repair of dehiscence
3
239
0
12020
0
REI
Postpartum Wound Care Secondary closure
3
13160
0
Hysterosalpingography (HSG)
3
58340
0
Hysteroscopy - Diagnostic
5
58555
0
Hysteroscopy - Operative
5
58558
0
Hysteroscopy - Polyp Resection
5
Hysteroscopy - Submucosal Fibroid Resection
3
58561
0
Hysterosongraphy (SIS)
5
76831
0
Laparoscopy - Diagnostic
5
58661
216
Laparoscopy - Operative Chromopertubation
5
58350
0
Laparoscopy - Operative Fimbrioplasty
0
58672
0
240
0
Procedures Without Codes
PROCEDURE
Procedure 1
Procedure 2
Procedure 3
Procedure 4
Procedure 5
OB Intrapartum:
Amniotomy
Admin of parenteral analgesics: Narcotics
Admin of parenteral analgesics: Sedatives
Fetal Scalp Stimulation
Fetal Heart Rate Monitoring
Vibroacoustic Stimulation Test
Induct. of labor with prostaglandins/oxytocin
Manual removal of the placenta
OB Postpartum:
Wound Care: I&D of Abscess/Hematoma
GYN:
Laparotomy skin incision: Vertical
Laparotomy skin incision: Transverse
Wide local excision (vulva
Mechanical/osmotic preproced cervical prep
GYN ONC:
Exploration of abdomen
Suction evac. of molar pregnancy
Laparotomy Skin Incision, Transverse
REI:
Hysteroscopy – Polyp Resection
CONTINUITY:
Funduscopic examination (basic)
*Use this form anytime the above-name procedures are completed.
They do not have CPT codes and will not transfer from ACGME to New Innovations.
Please complete and return this form to the coordinator.
241
Appendix XIV – Sacred Heart Health System dictation
tips and tricks
•
•
•
•
•
•
•
•
•
Do not share your Dictation ID with anyone. We are using Voice Recognition Software that
learns your voice. If you allow someone else to use your id, it will create problems in the
system.
Do not dictate from a cell phone. Not only is this a possible HIPAA violation, but the sound
quality from a cell phone can be very poor.
Dictate the account number and the patient’s name. Please spell out any difficult names. If
you do not have an account number, please give the patient’s medical record number and date
of birth.
Always state the name of your attending physician. The transcriptionists do not have access to
the call lists so they can not validate this information. This can result in your document sitting
in a proofing queue until someone from Transcription office can verify the correct
information.
When dictating Operative/Procedure reports, always give the date of operation or procedure.
The transcriptionists do not have access to this information and will put your document in a
proofing queue until the date can be verified by the Transcription office. If you are dictating
an operative report but are not the surgeon, please state so. The transcriptionists will assume
that the dictator is the surgeon unless otherwise specified.
Please use the pause button instead of the hold button if you need to stop dictating for a
moment. When the hold button is pressed instead of pause, hold music is recorded and the
transcriptionist must listen to this until you begin dictating again. Sometimes pressing hold
and then resuming dictation can, because of the hold music, cause portions of your dictation
to be lost. Each Dictaphone in the hospital is programmed so that the button on the bottom
right corner of the phone is the pause button. If you are dictating from a regular phone, you
may press 9 to pause and 4 to resume dictating. The pause button will hold your document for
20 minutes.
Please do not carry on conversations while dictating. The voice recognition software will
record this and it can end up in the draft of your report. If you need to speak to someone while
dictating, please press the pause button.
Please do not eat, drink or chew gum while dictating. This can impact the recognition you
receive from the system.
Please dictate the full name of any physician to whom you would like us to send a copy of
your dictation. Due to HIPAA, our office will not mail your dictation unless complete
information is available to us.
If you have any questions please call the Transcription Office at 416-7613. Someone is available to
assist you Monday through Friday from 6:00am – 5:30 pm.
242
Appendix XV – Evaluations
Assessment of professional behavior of resident
r
243
244
245
246
247
Patient Evaluation of Resident
Florida State University College of Medicine
Department of Obstetrics & Gynecology
Women’s Care Center - Patient Satisfaction Questionnaire of a
Resident Physician
Please circle the resident physician who provided care for you today:
Dr. Poe
Dr. Petro
Dr. StanleyDr. Collins Dr. Jackson Dr. Joseph Dr. Spencer Dr. Bruce Dr. Osterrieder
Dr. Tidwell Dr. Antonetti Dr. Dunham Dr. McAlpin Dr. Williams
Please circle the amount of time you spent in the clinic:
30 min or less
Date_____________________
31 min to 1 hour
2 hours or more
61 min to 2 hours
Excellent
Very
Good
Good
Fair
Poor
5
4
3
2
1
Please grade your Resident Physician (Below):
Professionalism - Doctor greets you in a friendly manner;
treating you like you're on the same level; never "talking
down" to you .
Medical Knowledge - Doctor uses words you can
understand when explaining your problems and treatment;
explaining any technical medical terms in plain language to
you & your family.
System Based Learning – Doctor explained your illness or
injury to you thoroughly; informing you during the physical
exam about what he/she is going to do and why; telling you
what he/she finds & explains lab results, x-rays, etc.
Communication - Doctor shows interest in your concerns;
explaining what you need to know about your problems,
how and why they occurred, and what to expect next.
Practice Based Learning & Improvement - Demonstrates
learning from critique of patient care practice.
Doctor
appreciates role of all members in clinic such as nurses &
other physicians.
Patient Care - Discussing options with you and asking
your opinion; offering choices & letting you help decide
what to do; asking what you think before telling you what to
do; being truthful, upfront and frank; not keeping things
from you that you should know.
248
N/A
Global evaluation
249
250
Praise card
251
Concern card
252
Surgical score card
253
Appendix XVI – Sick leave policy
Policy for Sick Leave Use in the Florida State University College of Medicine Ob/Gyn
Residency Program
1. Make arrangements with a colleague to cover your clinical responsibilities. It is your
responsibility to do this. Cancelling your clinic patients or scheduled procedures is not an
option.
2. Text message administrative Chief Resident (PD in the chief’s absence) that you will be
out along with who will be covering your clinical responsibilities.
3. Presentation of a physician sick note is required to be turned in within 24 of return-to-work
for absences occurring greater than 2 consecutive working days.
3. Failure to comply with one of these steps will result in a loss of a vacation day, and/or
remediation.
I have been given a copy of this policy, and have read and understand it.
Signature:
_________________________
Print Name: _________________________ Date: _____________
Updated 6/21/2013
254
Appendix XVII – Family planning rotation opt out form
Resident Name:
Date:
I understand that by signing this form, I am opting out of my family planning rotation here at
Florida State University OBGYN residency program. I understand that I am not provided
these experiences at my primary teaching site, and I am still responsible for the educational
material.
Resident Signature
Julie DeCesare, MD Program Director
255