Gynecology

Curriculum Background

Women’s health is a significant part of a Family Physician’s practice.  Family Physicians must understand women’s health maintenance, prevention, contraception, infertility, osteoporosis, menstrual disorders (pre- and postmenopausal), and pelvic disorders, and understand the role of appropriate consultation.   This will be accomplished on the Gynecology rotation, in Family Medicine continuity and colposcopy clinics, and other areas of medicine. 

Curriculum Goals:

The ACGME has outlined six core competencies for all residents in training. The primary goal of the women’s health experience is for residents to develop the following six competencies in the context of evaluating and treating women’s health issues to include annual exam, contraception, infertility, menstrual disorders and pelvic disorders. 

1. Patient care that is compassionate, appropriate, and effective for the treatment of health

problems and the promotion of health.

2. Medical Knowledge about established and evolving biomedical, clinical, and cognate sciences, as well as the application of this knowledge to patience care.

3. Practice-based learning and improvement that involves the investigation and evaluation of care for their patients, the appraisal and assimilation of scientific evidence, and improvements in patient care.

4. Interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and other health professionals.

5. Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to patients of diverse backgrounds.

6. Systems-based practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.

Key Rotation Specific Milestones

1.  Patient Care 3:  Health Promotion and Wellness

2.  Patient Care 5:  Management of Procedural Care

3.  Medical Knowledge 1: Demonstrates Medical Knowledge of Sufficient Breadth and Depth to Practice Family Medicine

4.  Problem Based Learning and Improvement 1:  Evidence-Based and Informed Practice

5.  Interpersonal and Communication Skills 1: Patient-and-Family –Centered Communication

Rotations/Experiences

PGY-1  

Gynecology—1 month of gynecology clinic

Surgery Inpatient – one month; exposure to evaluation and treatment of breast masses

PGY-2

Colposcopy clinic – one colposcopy clinic per week during Neurology and Cardiology rotations

PGY-3

Colposcopy clinic – one colposcopy clinic per week during  Palomar ER, Endocrinology, Urology and Elective rotations

Other Learning Activities –

Didactics—longitudinal curriculum of lectures over 18 months and topics lectured specifically by OB/GYN providers, surgical providers, and Family Medicine providers.

Simulator training

Colposcopy workshop annually by Family Medicine faculty

GYN test – PGY-1

FP clinic – Longitudinal gynecologic and women’s care

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ACGME Program Requirements for Women’s Health

www.acgme.org –Family Medicine RRC requirements

Administrative Information:

Last review: November 2021

Family Medicine Coordinator: Carrie Nichols, MD

GYN Coordinator: LCDR Erin Shiv

Length of rotation: 1 month – PGY-1

Number of months to be completed: PGY1- 1 month

Maximal time away allowed from rotation: 1 week

Number of half days in FM clinic: PGY1 – 2 per week

Preferred clinic times: TBD

A.M. Report attendance required: Yes

Friday afternoon conference attendance required: Yes

FM call required: Yes

Responsible for hospitalized FM panel patients: No

Responsible for OB panel patients: No

Selected Rotation Specific Objectives by ACGME Competency Category:

The following is a listing of selected knowledge, skills and attitudes (K.S.A.s) that residents are expected to gain competency in during their rotations on the Gynecology.  It is understood that not all the K.S.A.s will be attained on a single rotation, but they will be developed and attained throughout the 3 years of residency or rotating on  gynecology and family medicine; specific K.S.A.s that are not developed on the Gynecology rotation will be developed during the other rotational experiences.

The rotation specific objectives will be reviewed with each resident prior to rotating on Gynecology in order to clarify which objectives the resident is trying to attain. The resident will hold on to the curriculum, and use it as a reference point for areas to focus on during the rotation. At the end of the rotation, the rotation specific objectives will be reviewed with their advisor, and those attained will be checked. This review will be kept in the resident’s file in order to document the resident’s progress.

Specific Objectives for Women’s Health

Patient Care:

Gather essential and accurate information about their patients:

PGY-1

___Complete accurate history, physical and counseling for well women visit.

___Understand, analyze and interpret vaginal wet prep (normal saline) and KOH prep

Perform competently all medical and invasive procedures considered essential for the area of practice: Proficiency will be determined by several factors including understanding of indications, total attempted, total completed, skill level, confidence and outcome of procedure

PGY-1

___Perform annual women wellness exam to include:

___Pap smear

___Breast exam

___Pelvic exam

___Be able to collect sample for vaginal wet prep (normal saline) and KOH prep.

___Be able to collect sample for GC/chlamydia.

___Perform removal of retained foreign body

PGY-2 & PGY-3

___Perform colposcopy to include:

___Basic colposcopic exam

___Cervical biopsy

___Endocervical curettage (ECC)

___Intrauterine device (IUD)

___Insertion

___Removal

___Endometrial biopsy (EMB)

Medical Knowledge

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care.

The resident should gain understanding of pathophysiology, presentation, initial evaluation, inpatient management and appropriate follow-up of patients who have the following included (but not limited to) conditions:

PGY-1

___Recognition and treatment of vaginal infections, STD’s, and HPV.

___Understand and be able to discuss family planning to include counseling patients about contraception, with indications, contraindications and side effects

PGY-2

___Identify, work up and treat/refer menstrual disorders.

___Identify, work up and consultation for ovarian pathology

___Recognition of screening criteria, analysis of results, counseling, diagnosing and treatment of osteoporosis

___Identify, work up, diagnose and treat/refer pelvic disorders such as pelvic inflammatory disease, pelvic mass, fibroids

___Know criteria for and able to counsel about the Gardasil vaccine

PGY-3

___Recognition, work up, and treatment/referral for the following:

___Infertility

___Sexual dysfunction

___Polycystic Ovarian Syndrome

___Pelvic floor dysfunction

___Endometriosis

___Pelvic pain

___Hirsutism

___Bartholin’s cyst

___Cervical and/or vaginal dysplasia

___Breast disorders

___Premenstrual Dysphoric Disorder and Premenstrual Syndrome

___Understand and being able to counsel patients about hormone replacement therapy and menopause

Practice-Based Learning and Improvement

Use information technology and on-line medical information to support education:

PGY-1

___Understand and evaluate pap smear results using cytology guidelines by American Society for Colposcopic and Cervical Pathology (ASCCP)

PGY-2 & PGY-3

___ Understand and evaluate pap smear results using histology guidelines by ASCCP

___ Utilize hospital’s evidence-based medicine resources (Up To Date; MD Consult; Ovid; Medical Letter; Prescribers Letter; Other resources on Clinical Portal) to obtain current information on patient management.

Identify strengths, deficiencies, and limits in one’s knowledge and expertise; and set learning and improvement goals:

PGY-1, 2, 3

___ Set specific learning goals at the beginning of the rotation based on knowledge and skill gaps

Analyze practice experience and perform practice-based improvements:

PGY-1, 2, 3

___ Develop time management skills to increase efficiency in patient care.

Facilitate the learning of students and other health care professionals

PGY-1, 2, 3

___ Residents will participate in teaching team members on relevant topics of patient care.

Interpersonal and Communication Skills

Work effectively with others as a member or leader of a health care team or other professional group

PGY-1, 2, 3

___ Communicate effectively with physicians, other health professionals, and health related agencies

___ Interactions with other physicians and health care professionals will be collaborative with the patients’ interests held foremost.                     

Provide information using effective nonverbal, explanatory, questioning and writing skills

PGY-1, 2, 3

___ Demonstrate skills for complete, concise and relevant patient presentations to staff attendings and consultants.

___ Complete daily progress notes on all assigned patients.  

Professionalism

Residents must demonstrate a commitment to carrying out professional responsibilities and adherence to ethical principles.

PGY-1, 2, 3

___ Residents will be on-time to all work-related events, will complete all administrative work within hospital/departmental policies and will present themselves with an appropriate/professional appearance/demeanor at all times.

Systems-Based Practice

Demonstrate an awareness of and responsiveness to the larger context and system of health care.

PGY-1

___Understand requirements for STD reporting

___ Residents will gain an understanding of the larger context of inpatient care within the existing military and civilian healthcare organizations within the region.  This will be accomplished via discussions with faculty, direct consultation with medical services at other centers and facilitation of transfers of care when appropriate to other centers.

­­­___ Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate by utilizing applying EBM principles and utilizing EBM databases

Specific Expectations of Residents:

PGY-1

• Complete waived testing for NS/KOH vaginal prep

• Pass and complete GYN test at end of rotation with 80% or better.

• Be present for all GYN lectures given by OB/GYN providers.

PGY-2 & PGY-3

• Complete minimum number of colposcopies (25), cervical biopsies (10) and ECC’s (10)

• Complete minimum number of EMB’s (3)

• Complete minimum number of IUD insertions (5) and removals (5)

• Complete colposcopy workshop during training

1.  Record all procedures in New Innovations in a timely manner and assign a supervising physician

2.  Complete rotational evaluation on New Innovations within 2 weeks of completion of rotation.

3.  Complete curriculum review within 2 weeks of completing the rotation with resident advisor; denote on the curriculum areas where competency was attained

4.  Required attendance at:

a.   Morning report

b.  Academic conferences

5.  Routine call responsibilities

6.  Coverage on OB panel patients and deliveries

7.  Family Medicine Clinic as scheduled.

Evaluation: 

Resident Evaluation:

Daily evaluation

The Gynecology attending should provide daily and weekly oral feedback to the residents on progress and performance. Attendings will also provide feedback on the quality of written communication by critically reviewing resident chart entries.

Mid-rotation feedback

With Gynecology attending at completion of week 2. Resident must ensure time is scheduled with staff.  Written feedback required if resident is failing at mid-rotation evaluation or at any other time with a copy provided to the Program Director.

Final Evaluation

All attendings should be sent an evaluation by the resident via New Innovations. Evaluations should be completed within two weeks after rotation.

Methods of Evaluation:

Test during PGY-1 GYN rotation

Colposcopy workshop

Direct supervision

Lecture attendance

Waived testing for vaginal wet preps (NS and KOH)

Portfolio:

The following items will be entered in the residents training record by the GME coordinator:

• Procedures documented in New Innovations

• Resident New Innovation evaluation

• Rotation-specific objectives completed

Staff Evaluation: (the staff is evaluated by the resident)

Residents evaluate staff using the annual New Innovations staff evaluation

Rotation Evaluation: (the rotation is evaluated)

Resident assesses quality of the rotation by completing the New Innovations standard rotation evaluation form. Evaluations should be completed within two weeks after rotation.

Recommend reading list:

It is expected that residents will read, at a minimum, Up To Date or web-based articles on the conditions of the patients they are following. They will check off in the knowledge portion of the goals and objectives those conditions they have seen. They should check off each of the specific conditions they have gained knowledge in, and they should have checked off all the knowledge specific objectives by the time they have completed their final gynecology rotation as a PGY-1 and by completion of their 3rd year for PGY-3.

References:

1. Program Requirements for Graduate Medical Education in Family Medicine; effective July, 2007.

2. AAFP’s Residency Solutions: Recommended Curriculum Guidelines for Family Medicine Residents: http://www.aafp.org/online/en/home/aboutus/specialty/rpsolutions/eduguide.html.

3.  ACOG Compendium – Practice Bulletins

4.  Hacker,NF, Gambone, JC, Hobel, CJ.,  Hacker & Moore’s Essentials of Obstetrics and Gynecology, (5th edition).  Saunders, 2010.

5.  Gordon, JD, Rydfors, JT, Druzin, ML, Tadir, Y.  Obstetric Gynecology and Infertility Handbook for Clinicians 6th edition.  Scrub Hill Press, 2007