PROFESSIONAL GROWTH and DEVELOPMENT
PRACTICE MANAGEMENT
In the latest edition of Educational Objectives several everyday aspects of one's professional and practice life are itemized and briefly discussed that are difficult to incorporate into a formal clinical curriculum. These topics, listed below, are nonetheless very important and every effort will be made to "cover "them in lecture/didactic sessions and through informal teaching, utilizing
resources both in and out of the department. All residents are expected to read the indicated portions of the Educational Objectives pertinent to these topics:
Professional Growth and Development
Ethics
Communication Skills
Information Management
Continuing Medical Education
Stress Management
Practice Management
Familiarity With the Health Care Delivery System
Terminology/Classification of Disease
In addition, a series of six Core Curriculum sessions, three a year during the two year sequence, will be given by Daniel G.
McMurtrie, M.D., Chair of OB/GYN at St. Joseph Mercy Hospital.
Resident Roles and Responsibilities In General Obstetric and Gynecology Rotations
FIRST YEAR (HO 1)
1) to function as a specialist-in-training under the supervision of attending physicians and senior residents
2) to rotate with HO II and other residents in evaluating and admitting obstetric patients
3.responsibility for weekly obstetric continuity clinic, including follow-up
4) specific clinical objectives:
Obstetrics:
spontaneous vaginal deliveries and episiotomies
cesarean sections, primary
scalp lead, IUPC placement
scalp pH
AROM, cervical gel placement
ultrasound for fetal position, fluid check, EFW, assess for major fetal anomalies
evaluation of triage patients, including bleeding and SROM
Gynecology:
minor gynecology surgical cases
Bartholin cysts/abscesses-Word catheter placement
Dilation and curettage
major gynecology surgical cases
exploratory laparotomy/hysterectomy, second assist
vaginal surgery, second assist
floor call (as assigned by gynecology chief)
ER evaluation and consultation under the guidance of senior residents.
SECOND YEAR (HO II)
1) to function as a specialist-in-training under the supervision of attending physicians and senior residents
2) responsible to HO IV 0B Chief, in-house senior resident or, attending physician in all clinic and operating activities
3.responsible for weekly Obstetric and Gynecology continuity clinics and coordination of care of these patients, including follow-up of laboratory reports on patients seen
4) to rotate with other residents in evaluating and admitting obstetric patients
5) specific clinical objectives:
Obstetrics:
repeat cesarean sections, stat cesarean sections/twin cesarean sections
outlet forceps and vacuums
biophysical profiles in conjunction with senior resident
preterm labor evaluation
perinatal consults while on service
evaluation of complicated pregnancies in labor and delivery/perinatal service
anticipated difficult spontaneous vaginal deliveries (fetal macrosomia, prior shoulder
dystocia, etc.)
Gynecology:
laparoscopy, diagnostic and tubal ligations
exploratory laparotomy
colposcopy
insertion
endometrial sampling
abdominal hysterectomy
floor call (as assigned by gynecology chief)
service specific objectives
THIRD YEAR (HO III)
1) under the supervision of the attending physicians, to coordinate and participate in care of all labor patients in the labor and delivery area as the night float senior resident in-house.
2) to develop leadership and teaching skills by organizing, supervising and teaching house officers and students in the labor and delivery area
4) to supervise care by HO I, HO II, rotating residents and medical students in the Birth Center
5) responsible for weekly Gynecology Continuity clinic and coordination of care of these patients, including follow-up of laboratory reports of patients seen in this clinic
6) specific clinical responsibilities/objectives:
Obstetrics:
forceps deliveries
vaginal delivery of twins
breech deliveries
stat cesarean sections
complicated pregnancy
NST, OCT interpretation
biophysical profiles
emergency cerclages
Gynecology:
exploratory laparotomy
abdominal hysterectomy and non-radical pelvic surgery
colposcopy
f1oor call responsibilities as assigned by gynecology chief (HO IV)
FOURTH YEAR (HO IV)
1) to function as a specialist in obstetrics and gynecology under the supervision of the attending physician
2) to supervise junior residents and students in staff deliveries and surgeries
3) to direct administrative and clinical activities of residents assigned to their service
4) to participate in Gynecology continuity clinics and coordinate care of their patients, including laboratory reports and phone calls to patients; to consult on high-risk obstetrics or gynecology patients being seen by junior residents in their clinic; to accept these patients into their clinic if necessary.
5) as GYN Chief Resident (HO IV)
(a) to prepare the daily surgery schedule and keep a balance between cases assigned to each resident
(b) to manage with junior residents inpatient care of non-surgical patients
(c) to help plan surgery on staff patients requiring major surgery.
(d) to attempt to scrub on all major abdominal or vaginal cases in tandem with a junior resident.
6) as OB Chief Resident (HO IV)
(a) to be aware of complicated staff cases and manage these patients, including consultation with
Maternal-Fetal Medicine and transfer of care according to departmental guidelines
(b) to attend and participate in staff perinatal consults and multidisciplinary conferences
(c) to participate in morning and evening report in the Birth Center
(d) to prepare cases/tracings for Staff Rounds
(e) to follow postpartum staff patients delivered by a junior resident/medical student or rotating resident, writing orders, co-signing notes and handling discharging of patients from the hospital
(f) to attend staff obstetrical deliveries during the day when not involved with clinic or administrative activities
(g) to attend all staff deliveries while on call at night
(h) to manage emergency maternal transports to the staff service including timely communication to the referring physician, coordinating ongoing care with them, and notifying them of delivery
7) specific clinical objectives/responsibilities
Obstetrics
vaginal breech deliveries (staff and private cases)
forceps deliveries
cesarean hysterectomies and hypogastric artery ligations when (these become necessary, the Chief OB Resident shall be contacted)
genetic and second trimester amniocenteses
vaginal delivery of multifetal gestations
cesarean deliveries of high order multifetal gestations or situations where there is high likelihood of hysterectomy (previa, percreta, large fibroids, etc.)
Gynecology:
major vaginal and abdominal operative procedures
SENIOR RESIDENT EXPECTATIONS
1) Notify staff attendings of all admissions to the Birth Center, to the antepartum unit, to inpatient gynecology, and for short stays
2) Notify and discuss with the staff attending all obstetric triage patients who are likely to be sent home.
3) Notify and discuss with staff attendings all patients seen in the Emergency Room prior to discharge to home or admission to hospital
4) Notify staff attendings of all OB/GYN off-service consultations; senior residents are expected to do all consultations unless they are deemed urgent and the senior resident is unavailable due to operating room or continuity clinic commitments, at which time an appropriate junior resident may do the consultation.
5) For all Birth Center admissions, the senior resident is expected to:
a. write an admit note with an outlined care plan
b. write or supervise progress notes during labor, discussions of interventions, eg., ISL, lUPC, and discussion of risks of pitocin, etc.
c. with evolving labor abnormalities write notes regarding assessment and care plan, paying particular attention to the "three Ps"
d. write notes describing all abnormal fetal heart tracings with impressions and care plans detailed
e. be available at all times to the junior residents on the obstetrics service to assist in re-examining patients, reviewing monitor strips, etc.
f. follow all staff OB cases delivered by rotators/junior residents/medical students, writing daily notes, assessing as to suitability for discharge and writing discharge order; no "management by proxy".
g. be certain to verify that all T.L. forms are signed and in the patient charts before their scheduled surgeries.
h. notify the staff M.D. when PPTL are to be performed
6) Pertinent to the gynecology service, the senior resident is expected to:
a. contact the staff attending the night before any scheduled staff case to discuss plans
b. write an admission note on all GYN service admissions before 10:00 AM
c. write personal progress notes on all staff patients on the GYN service
d. discuss with staff the appropriate assignment of 1st and 2nd year residents to cases, especially laser cases, laparoscopic surgeries
e. jointly follow and manage staff emergency room admissions