OBGYN

EDUCATIONAL GOALS AND OBJECTIVES

The Emergency Medicine Resident will rotate on the Obstetrics service for a period of 4 weeks during the Emergency Medicine first year.

The rotation will be under the direction of the Program Directors of the Department of Obstetrics/Gynecology and the Department of Emergency Medicine. The residents will receive supervision by faculty and senior residents of the Department of Obstetrics.

During the rotation, the Emergency Medicine (EM) resident will have no clinical service obligations in the Emergency Department.  However, they are required to be released from their obstetric rotation obligations every Wednesday to attend the weekly Emergency Medicine educational conference.  In addition, the Emergency Medicine resident should not be scheduled to work overnight shifts on Tuesdays.  Occasionally, the resident may be pulled for sick calls or other EM residency related activities. 

While on the Obstetrics rotation, the Emergency Medicine resident will assume duties and responsibilities equivalent to those of other PGY 1 residents rotating through the Obstetrics Service.  The Emergency Medicine resident will function as an integral part of the Obstetric team and be fully integrated into the daily activities of the Obstetrics Service. 

The resident’s duty hours will comply with the requirements and limitations of the ACGME and the New York State law.

The Emergency Medicine resident on the Obstetrics rotation will have the same access to resources and facilities, including but not limited to library and medical records as do the residents in Obstetrics.

The educational objectives for the Emergency Medicine resident while on the Obstetrics rotation are as follows:

Patient Care

  • Demonstrate ability to perform uncomplicated vaginal deliveries.  As per the ACGME, the resident is required to perform a minimum of 10 vaginal deliveries during the rotation. 
  • Demonstrate the ability to assess and manage patients in labor until delivery and provide immediate post partum care. 
  • Demonstrate ability to determine the APGAR score in neonates and discuss the significance of different values, as well as the need for resuscitation.
  • Demonstrate the ability to properly triage obstetric patients with pregnancy related complaints and complications.
  • Demonstrate ability to evaluate and initiate management for patients with pregnancy related complaints and complications such as ectopic pregnancy, abortions, hyperemesis gravidarum, molar pregnancy, pyelonephritis, shock, eclampsia and pre-eclampsia.
  • Demonstrate ability to diagnose and initiate management for post-partum complications such as retained products, endometritis, mastitis, eclampsia, pre-eclampsia, and cardiomyopathy.

Medical Knowledge

  • Discuss the complications of pregnancy in the first, second and third trimester such as ectopic pregnancies, molar pregnancies, abortions, abruptio placenta, placenta previa, eclampsia/pre-eclampsia, and HELLP syndrome.
  • Discuss the normal stages of labor and the time course for each.
  • Discuss the diagnosis and treatment of complicated labor including premature rupture of membranes, premature labor, failure to progress, fetal distress, and ruptured uterus.
  • Describe the management of complicated deliveries, including prolapsed cord, uncommon presentations, dystocia, uterine inversion, multiple births and stillbirth.
  • Discuss Rh factor incompatibility and treatment.
  • Discuss the post partum complication including but not limited to endometritis, mastitis, retained product of conceptions, pre-eclampsia, eclampsia,
  • Discuss the pregnancy related changes in physiology, hematology and anatomy.
  • Discuss the evaluation and management of non-pregnancy related complaints in obstetric patients, including but not limited to the safety of medications, diagnostic imaging, procedures, and traumatic injury care.
  • Discuss the indications for perimortem caesarian section and describe the technique.

Practice Based Learning and Improvement

  • Demonstrate ability to obtain and appraise medical literature relevant to the practice of obstetrics and gynecology.
  • Demonstrate the ability to assess clinical questions or areas requiring knowledge improvement and address these issues with current medical literature. 

Interpersonal and Communication Skills

  • Create and sustain a therapeutic and ethically sound relationship with patients
  • Use effective listening skills and elicit, as well as provide information using effective nonverbal, explanatory, questioning, and writing skills
  • Work effectively with others as a member or leader of a health care team or during interactions with other professional groups

Professionalism

  • Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development
  • Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices
  • Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities
  • Demonstrate respect and adherence to timeliness, attendance, professional duties and responsibilities, as well as completion of charts, evaluations, reports, and required surveys in a timely manner.

Systems-Based Practice

  • Understand how obstetrical and gynecological care affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their practice of Emergency Medicine
  • Know how obstetrical and gynecological care differs from Emergency Medicine, including methods of controlling health care costs and allocating resources
  • Practice cost-effective health care and resource allocation that does not compromise quality of care
  • Advocate for quality patient care and assist patients in dealing with obstetrical and gynecological care
  • Know how to partner with health care managers and health care providers to assess, coordinate, and improve obstetrical and gynecological care and know how these activities can affect system performance

The Emergency Medicine resident will accomplish these objectives in the following manner:

  • Report to the Obstetrics Rotation Director, Dr. Kerr, on the first day of the rotation and the L&D Attending on the days of duties, which include Mondays, Tuesdays, Thursdays and Fridays.  If the Attending or Dr. Kerr is not present in L&D, then the resident will report to the senior resident in L&D until the faculty become available.
  • Report for morning teaching rounds at 7:00 a.m., in the L&D conference room, on Mondays, Tuesdays, Thursdays, and Fridays.  After morning report, the resident will function as an integral part of the Obstetric team in evaluating and managing obstetric patients, in the same manner as a new PGY 1 Ob/Gyn resident.  The EM resident’s educational duties and training experience should include evaluating and managing obstetric patients, especially the ones in labor, from presentation until delivery and post-partum care.  The resident should also assess patients at triage, when there is no vaginal delivery.  The EM resident may leave for the day at sign out rounds around 5:00 p.m. 
  • The EM resident’s obstetrics educational duty and training will include taking call once a week on Friday from sign out rounds at 5:00 p.m. until morning teaching rounds at 7:00 a.m. 
  • Attend conferences given by the Department of Obstetrics while on the rotation.
  • Evaluate and manage patients under the supervision of Obstetrics faculty and senior residents.  Progressive patient care responsibilities are at the discretion of the Obstetrics faculty based on the resident’s clinical experiences, didactic knowledge, psychomotor skills, procedural abilities and credentialing.
  • Discuss patient evaluation, management and results of all ancillary testing with supervisory faculty or senior obstetrics resident.
  • Perform deliveries and procedures under faculty or senior resident supervision commensurate with their PGY 1 year level of training and skills.

At the completion of the rotation in Obstetrics, faculty will assess the educational accomplishments of the Emergency Medicine Resident, and the Ob/Gyn Program Director, or her designee, will complete an online evaluation at the E*Value website.

Any major problems or concerns regarding the Emergency Medicine resident’s performance on the Obstetrics service should be immediately forwarded to the Emergency Medicine Residency Program Director in order to affect corrective measures.

The Emergency Medicine resident will complete an evaluation of the Obstetrics rotation regarding clinical experience, faculty supervision, and didactic program.

The Emergency Medicine Residency Program Director and the Program Director of the Department of Obstetrics and Gynecology will have contact, at least annually, to discuss the rotation evaluation and opportunities for improvement.

 

ROTATION INFORMATION

Where: 4th floor Labor and Delivery

When: Rounds are generally at 7am, Monday to Friday (you are excused Wednesday due to EM conference)

Schedule requests:  Simone Glover (Coordinator)

  • Email: sglover@tbh.org
  • Ext: 8322

Supervisor:  Michael Cabbad, MD, Chairman and Angela Kerr, MD Program Director

Attire: Scrubs +/- white coat

Expectations: You should arrive for rounds. Scope out the patients who are likely to deliver soon. The ob/gyn residents can teach you how to do this by looking at their board and the tocographic monitoring. Tuesday is their conference day so midwives will be doing the deliveries until noon. You may find this to be a useful time to come in if you have some experience already. Some residents will advocate coming in at night. Do as you prefer. Your main objective is to get the 10 deliveries that you need to log for the ACGME and feel comfortable with uncomplicated deliveries. Also, use this time to learn about third trimester complications. Bring reading material for the downtime between deliveries.