Education Table of Contents:

	Introduction
	Educational Objectives
	List of Recommended Textbooks
	Organization and Structure
	Master Rotation Schedule (on Hold for now)
	Rotation Descriptions and Educational Guidelines
	Continuity Clinics
	Teaching Conferences Schedule
	Resident Projects

ROTATION DESCRIPTIONS AND EDUCATIONAL GUIDELINES

The Residency Review Committee requires that residents be provided with learning guidelines for each rotation so that they may assess their own progress. These guidelines allow residents to focus their studies on subjects related to the rotation at hand. In this manner the department can help assure that the educational objectives for the residency program are being met. These guidelines are meant to be used in conjunction with the CREOG booklet, Educational Objectives: Core Curriculum for Residents in Obstetrics and Gynecology. This booklet will be given to each resident at the beginning of the residency.

The clinical responsibilities listed in these guidelines are not absolute, and due to staffing issues, residents will occasionally be asked to perform other duties.

PGY-1 ROTATIONS

I. Day Rotation, Roosevelt Obstetrics

Rotation Length, Logistics and Vacation: Rotation length is 8 to 9 weeks, with no vacation.

Attending Supervision:

MFM attending, faculty attending on call weekdays, weeknights and weekends, and private attendings for individual patients. Also, MFM back-up attending is on 24 hours/day.

Team:

PGY-4, PGY-3, PGY-2, PGY-1, and medical students.

Clinical Responsibilities:

Care of the postpartum patient (service and private patients), evaluating patients in the screening room, following labor patients, (including checking laboratory results for patients in L&D as well as postpartum), performing normal vaginal deliveries, performing primary cesarean sections, performing circumcisions.

Learning Goals:

1) obtain a thorough obstetrical history and perform a physical exam on the obstetrical patient;

2) evaluate the normal postpartum and postoperative patient, including problems such as fever, heavy vaginal bleeding and gastrointestinal dysfunction;

3) evaluate fetal heart rate tracings and perform basic ultrasound evaluation for fetal position, placental location, basic biometry and biophysical profile;

4) assess whether a patient is in labor or not;

5) manage normal labor, recognize abnormal labor, and become acquainted with fetal scalp electrode and IUPC placement and their indications;

6) perform normal vaginal deliveries, with or without episiotomy, as well as repair episiotomies and lacerations;

7) perform primary low transverse cesarean sections;

8) evaluate high-risk pregnancies such as preeclampsia, preterm labor, PPROM, abruptio placenta, and placenta previa. The PGY-1 resident is expected to acquire knowledge regarding these complications and their management, but is not expected to manage these patients. An upper level resident should always be contacted regarding any patient care that a PGY-1 renders. To 9) learn the principles of newborn evaluation, and resuscitation; 10) to counsel patients regarding breastfeeding, family planning and evaluate for breast complications from breastfeeding such as mastitis and nipple wounds.

Special Mandatory Conferences

Supervising Responsibilities:

Medical students; rotating residents from other services.

Study References:

Gabbe's Obstetrics: Normal and Problem Pregnancies or Williams Obstetrics, Cecil Textbook of Medicine or Harrison's Principles of Internal Medicine, PROLOG: Obstetrics, Precis: Obstetrics, CREOG Educational Objectives, and Compendium.

Credentialing:

Interns will be expected to perform two of each intern procedure with a faculty attending and be certified by such attending before they can perform such procedures under the supervision of a chief resident.

II. Night Float Rotation, Roosevelt Obstetrics

Rotation Length, Logistics and Vacation:

Night Float Rotation is incorporated into the schedules of PGY-1 residents in 4-to-5-week blocks, which are scattered throughout the year. Total rotation length is 8 to 9 weeks during the year, with no vacation. The Night Float Rotation weekday schedule starts with 24-hour call from Sunday morning until 6:00 am Monday. Monday through Thursday, night float is from 5:45 pm until 6:30 am. Weekend night coverage is provided by residents who are not currently on Night Float Rotation. The residency program has implemented the Night Float Rotation as a means of compliance with New York City Regulation 405, which restricts resident duty hours. Depending on the postgraduate year, residents do 2 to 3 months of night float annually. For more information on the night coverage schedule, see the Residency Manual on the Web, Departmental Policies on Residents, Policy on Coverage of Week Nights, Weekends, and Holidays.

Attending Supervision:

MFM attending, faculty attending on call weekdays, weeknights and weekends, and private attendings for individual patients. Also, MFM back-up attending is on 24 hours/day.

Team:

Clinical Responsibilities:

Care of the postpartum patient (service and private patients), evaluating patients in the screening room, following labor patients, (including checking laboratory results for patients in L&D as well as postpartum), performing normal vaginal deliveries, performing primary cesarean sections, performing circumcisions.

Learning Goals:

1) obtain a thorough obstetrical history and perform a physical exam on the obstetrical patient;

2) evaluate the normal postpartum and postoperative patient, including problems such as fever, heavy vaginal bleeding and gastrointestinal dysfunction;

3) evaluate fetal heart rate tracings and perform basic ultrasound evaluation for fetal position, placental location, basic biometry and biophysical profile;

4) assess whether a patient is in labor or not;

5) manage normal labor, recognize abnormal labor, and become acquainted with fetal scalp electrode and IUPC placement and their indications;

6) perform normal vaginal deliveries, with or without episiotomy, as well as repair episiotomies and lacerations;

7) perform primary low transverse cesarean sections;

8) evaluate high-risk pregnancies such as preeclampsia, preterm labor, PPROM, abruptio placenta, and placenta previa. The PGY-1 resident is expected to acquire knowledge regarding these complications and their management, but is not expected to manage these patients. An upper level resident should always be contacted regarding any patient care that a PGY-1 renders.

9) learn the principles of newborn evaluation, and resuscitation;

10) to counsel patients regarding breastfeeding, family planning and evaluate for breast complications from breastfeeding such as mastitis and nipple wounds.

Special Mandatory Conferences:

All L&D sign in and sign out rounds, MFM morning rounds, Gabbe weekly chapter review, weekly M&M’s, weekly grand rounds and monthly journal club.

Supervising Responsibilities:

Medical students; rotating residents from other services.

Study References:

Gabbe's Obstetrics: Normal and Problem Pregnancies or Williams Obstetrics, Cecil Textbook of Medicine or Harrison's Principles of Internal Medicine, PROLOG: Obstetrics, Precis: Obstetrics, CREOG Educational Objectives, and Compendium.

Credentialing:

Interns will be expected to perform two of each intern procedure with a faculty attending and be certified by such attending before they can perform such procedures under the supervision of a chief resident.

III. Roosevelt Gynecology

Rotation Length, Logistics, and Vacation:

Rotation length is 8-9 weeks. Vacation is 1 week.

Attending Supervision:

Gynecology attending of the month; private attendings for individual patients.

Team:

PGY-4, PGY-3, PGY-2, PGY-1, and medical students.

Clinical Responsibilities:

Morning and afternoon rounds; evaluating pre- and postoperative patients and complications; minor GYN cases; assisting in major GYN cases as assigned by the chief resident; admitting GYN patients including history, physical and laboratory data; assisting in GYN booking clinic, urogynecology clinic, and continuity clinic.

Learning Goals:

1) obtain a thorough GYN history and perform a thorough exam;

2) evaluate patients for minor GYN procedures;

3) manage the postoperative patient and evaluate for such complications as postoperative bleeding, wound complications, elevated temperature, DVT, and shortness of breath (the management of such complicated patients is to be performed under the guidance of the chief resident);

4) perform procedures such as D&C, diagnostic laparoscopy and hysteroscopy cases, and laparoscopic tubal sterilizations;

5) open and close the abdomen;

6) learn the anatomy of the pelvis;

7) learn the principles of pelvic floor support as well as the types of incontinence;

8) begin to evaluate patients with incontinence and the principles of different management modalities;

9) become acquainted with laparoscopy and hysteroscopy equipment.

Special Conferences:

GYN rounds with team and the GYN attending of the month; weekly chapter review; Thursday gynecology rounds; regular departmental conferences.

Supervising Responsibilities:

Study References:

Droegemüller's Comprehensive Gynecology or Novak's Gynecology, Te Linde's Operative Gynecology, PROLOG: Gynecology and Surgery, PROLOG: Patient Management in the Office, Precis: Gynecology, Precis: Primary and Preventive Care, CREOG Educational Objectives, Compendium.

IV. St. Luke’s Gynecology

Rotation Length, Logistics, and Vacation:

Rotation length is 8 to 9 weeks. One week vacation will be given during this rotation and/or during the St. Luke's Obstetrics Rotation.

Attending Supervision:

Faculty Attending

Team:

PGY-4, PGY-3, PGY-2, and PGY-1.

Clinical Responsibilities:

The GYN-PGY-1 will be primarily assigned to minor gyn cases, covering booking clinic, following gynecology inpatients, and checking laboratory results under the guidance of the PGY-4.

Learning Goals:

Same as for the Roosevelt Gynecology Rotation. In addition, the Gyn-PGY 1 resident will begin to learn how to evaluate patients for elective abortion and learn to perform such procedures. Any resident with religious or moral opposition to elective termination will be excused from being involved with these patients, but should learn the principles and possible complications of such procedures.

Special Conferences:

Morning and afternoon rounds, attending rounds, Thursday Gynecology Rounds, and departmental conferences.

Study References:

Droegemüller's Comprehensive Gynecology or Novak's Gynecology, Te Linde's Operative Gynecology, PROLOG: Gynecology and Surgery, PROLOG: Patient Management in the Office, Precis: Gynecology, Precis: Primary and Preventive Care, CREOG Educational Objectives, Compendium. SEE ALSO St. Luke’s Obstetrics Rotation, PGY-1.

V. Medical or Surgical ICU

Rotation Length, Logistics, and Vacation:

Rotation length is 4 weeks. No vacation. Resident may be assigned to either Medical ICU or Surgical ICU.

Attending Supervision:

ICU attending, pulmonary fellow and medicine senior resident.

Team:

3 interns, 3 medicine residents, pulmonary fellow, and ICU attending.

Clinical Responsibilities:

Admit and manage patients assigned to your care under the supervision of the chief resident and ICU attending. Write daily progress notes and follow laboratory studies on your patients. Cross-cover other ICU patients when on call. Perform procedures such as central line and arterial line placement, thoracocentesis, and advanced cardiopulmonary resuscitation.

Learning Goals:

To 1) learn the principles of hemodynamic monitoring, mechanical ventilation, volume replacement, and antibiotic therapy for the critically ill patient; 2) read and learn about toxic shock syndrome, septic shock, hemorrhagic shock, and cardiogenic shock; 3) learn the principles and management of ARDS, advanced cardiopulmonary life support, and allergic drug reaction.

Special Conferences:

Morning and afternoon rounds, pulmonary critical care case conference and daily noon medical conference.

Study References:

Marino's The ICU Book.

VI. Emergency Room

Rotation Length, Logistics, and Vacation:

Rotation length is 4 weeks. Vacation is 1 or 2 weeks.

The primary objective for all residents rotating in the Emergency Department at St. Luke’s-Roosevelt is to learn Emergency Medicine - its content, its approach and its style. Rotating residents will have first contact responsibility for a wide variety of unselected patients; in fact, it is hoped that each resident will expand her/his knowledge base by seeing patients that might not fit into the traditional expectations of their primary field (e.g., IM residents will do suturing and apply splints, Ob/Gyn residents will see older males with abdominal pain, and surgical residents will see patients with chest pain). All patients will be pre-triaged by the ED RN as is standard care for all ED patients, but there will be no further selection of patients by the physicians in the ED, other than the occasional suggestion by the senior EM resident or EM attending to expand the scope of the rotating resident’s educational commitment in the ED.

During the ED block rotation, rotating residents will attend all of the EM conferences (Wednesdays from 7:30 a.m. until 12 noon and every fourth Friday from 7:30 a.m. until 10:00 a.m.) along with the EM residents and faculty. Residents assigned to an academic rotation in the ED will not have in-patient or other responsibilities to their departments during the time of the ED rotation. Our department will do everything possible to accommodate inservice examinations and major academic requirements in the resident’s home departments.

The faculty will complete an evaluation of each such rotating resident and return it to the home department. Problems with rotating residents will be brought to the attention of the EM Residency Director and by him/her to the residency director of the rotating department promptly.

Attending Supervision:

Emergency room attending.

Team:

Emergency room staff.

Clinical Responsibilities:

Evaluate emergency room patients, regardless of age, sex, or complaint, under the supervision of the ED attending.

Learning Goals:

1) evaluate and manage patients with common nongynecological problems such as upper respiratory tract infection, rash, hypertension, chest pain, GI disturbance, and diabetes;

2) perform and master advanced life support;

3) learn and master rape case evaluation;

4) learn to evaluate and manage common gynecological emergencies such as vaginitis, Bartholin’s abscess, and first trimester bleeding.

Special Conferences:

Wednesday morning ED departmental conferences.

Study References:

Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, Rosen’s Emergency Medicine: Concepts and Clinical Practice, Cecil Textbook of Medicine or Harrison's Principles of Internal Medicine, and Schwarz's Principles and Practice of Emergency Medicine (these books are available in the ED or in the Hospital Center's two medical libraries).

PGY-2 ROTATIONS

I. Roosevelt Obstetrics

Rotation Length, Logistics, and Vacation:

Rotation length is 8 to 9 weeks.

Attending Supervision:

Perinatologist covering, in-house attending, and private attendings.

Team:

PGY-4, PGY-3, PGY-2, PGY-1, and medical students.

Clinical Responsibilities:

Care for all antepartum inpatients, attend High Risk Clinic and Diabetes in Pregnancy Program, perform repeat cesarean sections, evaluate and manage laboring patients and screening room patients. Assist the entire team as necessary.

Learning Goals:

1. perfect techniques such as vaginal delivery; episiotomy repair, including fourth-degree lacerations; and cesarean section;
2. learn the principles of evaluation and management of complicated patients such as preterm labor, third-trimester bleeding, maternal diabetes, hypertension, asthma, pyelonephritis, isoimmunization, multiple gestation, and intrauterine growth retardation;
3. continue to learn labor management including induction and augmentation of labor, and vaginal birth after previous cesarean;
4. begin to learn the principles of operative vaginal deliveries such as vacuum extraction and forceps;
5. learn to perform thorough ultrasound evaluations under guidance of the perinatologist;
6. learn to perform amniocentesis;
7. perform cervical cerclages.

Special Conferences:

Perinatal rounds, MFM rounds, sign in and sign out rounds, neonatology conference, and all departmental conferences.

Study References:

II. Night Float

Rotation Length, Logistics and Vacation:

The Roosevelt Night Float Rotation for PGY-2's is a total of 8 to 9 weeks, which may be broken up into blocks during the year. The Night Float Rotation weekday schedule starts with 24-hour call from Sunday morning until 6:00 am Monday. Monday through Thursday, Night Float is from 5:45 pm until 6:30 am. On Fridays,the Night Float PGY-2, PGY-3 and PGY-4 work on Labor and Delivery until 2 pm, so that the Day OB Team can attend High Risk Clinic. Weekend coverage at Roosevelt is provided by residents who are not on Night Float Rotation  During day rotations, PGY-2 residents may also provide weekend coverage at St. Luke's. The residency program has implemented the Night Float Rotation as a means of compliance with New York City Regulation 405, which restricts resident duty hours. Depending on the postgraduate year, residents do 2 to 3 months of night float annually. For more information on the night coverage schedule, see the Residency Manual on the Web, Departmental Policies on Residents, Policy on Coverage of Week Nights, Weekends, and Holidays.

Attending Supervision:

MFM attending and full time faculty attending supervise L&D 24 hours per day on both weekdays and weekends. Also, private attendings for individual patients.

Team:

PGY-1, PGY-2, PGY-3, PGY-4, sometimes joined by an additional resident on Short Call from 5:45 pm until 11:00 pm.

Clinical Responsibilities:

Learning Goals:

Mandatory Conferences:

Sign in/sign out rounds, perinatology rounds, daily MFM rounds, weekly chapter reviews, and departmental conferences.

Study References:

Gabbe's Obstetrics: Normal and Problem Pregnancies or Williams Obstetrics, Creasy's Maternal-Fetal Medicine, Cecil Textbook of Medicine or Harrison's Principles of Internal Medicine, PROLOG: Obstetrics, Precis: Obstetrics, CREOG Educational Objectives, Compendium.

III. Roosevelt Antepartum

Rotation Length, Logistics, and Vacation:

Rotation length is 8 to 9 weeks; no vacation.

Attending Supervision:

MFM attendings, MFM fellow.

Team:

PGY-4, PGY-3, two PGY-2, PGY-1, and medical students. One PGY-2 is the full-time Antepartum Resident, while all other residents are on Obstetrics Rotation, into which Antepartum duties have been incorporated.

Clinical Responsibilities:

Care for all antepartum inpatients (admissions, discharges, consults, labwork, studies), attend sign in and out rounds on L&D, daily rounds on inpatient antepartum with MFM attending and/or fellow, board rounds at 8:15 am with L&D team and MFM, maintain lists of high risk clinic patients who attend St. Luke’s and Roosevelt clinics, present at joint perinatal/neonatal conference, responsible for presenting two topics to the whole OB team. When PGY-2 on L&D is on vacation, will be responsible for repeat c-sections, cerclages, assisting in triage and on L&D as needed by the team.

Learning Goals:

1. Improve on techniques such as vaginal, breech, operative deliveries; shoulder dystocia; etc. with use of the simulator.
2. Begin to perform more complicated cesarean sections including; repeat cesarean sections, twins (or other multiples), placenta previa, stat cesarean sections.
3. Learn the principles of evaluation and management of complicated patients such as preterm labor, preterm premature rupture of membranes, third trimester bleeding, maternal diabetes, hypertension, preeclampsia, asthma, pyelonephritis, isoimmunization, multiple gestations, and intrauterine growth retardation.
4. Continue to learn labor management including induction and augmentation of labor and vaginal birth after previous cesarean.
5. Begin to learn the principles of operative vaginal deliveries such as vacuum extraction and forceps.
6. Learn to perform thorough ultrasound evaluations under the guidance of the perinatologist including basic sonographic evaluation of first/second/third trimester pregnancy, BPP, Doppler color flow measurements, identify major congenital anomalies.
7. Learn to perform amniocentesis, CVS.
8. Learn the indications for and practice of cervical cerclages.

Mandatory Conferences:

All sign in and sign out rounds, MFM rounds, neonatology conference every first and third Monday of the month, Gabbe weekly chapter review, weekly M&M’s, weekly grand rounds and monthly journal clubs.

Study References:

Gabbe’s Obstetrics: Normal and Problem Pregnancies or Williams Obstetrics, Creasy’s Maternal-Fetal Medicine Cecil Textbook of Medicine or Harrison’s Principles of Internal Medicine, PROLOG: Obstetrics, Precis: Obstetrics, CREOG Educational Objectives, Compendium, and perform directed literature searches through Medline.

IV. Roosevelt Gynecology

Rotation Length, Logistics, and Vacation:

Rotation length is 8 to 9 weeks, with no vacation.

Attending Supervision:

Gynecology attending of the month, in-house attending, and private attendings for individual cases.

Team:

PGY-4, PGY-3, PGY-2, PGY-1, and medical students.

Clinical Responsibilities:

Evaluate ED patients, help the intern with evaluation and management of admitted GYN patients, assist in major and minor cases as assigned by the chief resident, attend booking and urogynecology clinics.

Learning Goals:

1) learn the evaluation and management of first trimester bleeding and the principles of Rhogam administration;

2) perform vaginal probe ultrasound to evaluate for location of a pregnancy and pelvic masses;

3) evaluate patients with acute and chronic pelvic pain;

4) evaluate patients with vaginal and vulvar discomfort;

5) evaluate and manage abnormal vaginal bleeding in nonpregnant women;

6) evaluate and manage patients with pelvic inflammatory disease and pelvic masses, and those with pelvic floor dysfunction and urinary incontinence;

7) begin to perform major cases such as cystectomies, oophorectomies, laparoscopic salpingectomies and salpingostomies, and abdominal hysterectomies/myomectomies.

Special Conferences:

Morning and afternoon team rounds, attending rounds, weekly chapter reviews, Thursday gynecology rounds, and departmental conferences.

Study References:

Droegemüller's Comprehensive Gynecology or Novak's Gynecology, Te Linde's Operative Gynecology, PROLOG: Gynecology and Surgery, PROLOG: Patient Management in the Office, Precis: Gynecology, Precis: Primary and Preventive Care, CREOG Educational Objectives, Compendium, and begin to perform directed literature searches in Medline.

V. St. Luke’s Gynecology

Rotation Length, Logistics, and Vacation:

Rotation length is 8 to 9 weeks. Vacation is 2 weeks.

Attending Supervision:

In-house attending.

Team:

PGY-4, PGY-3, PGY-2, and PGY-1.

Clinical Responsibilities:

PGY-2 covers the ED-consult pager, including obstetric cases in the ED; attends booking clinic and urogynecology clinic; and covers GYN patients on the floor.

Learning Goals:

1) learn the evaluation and management of first trimester bleeding and the principles of Rhogam administration;

2) perform vaginal probe ultrasound to evaluate for location of a pregnancy and pelvic masses;

3) evaluate patients with acute and chronic pelvic pain;

4) evaluate patients with vaginal and vulvar discomfort;

5) evaluate and manage abnormal vaginal bleeding in nonpregnant women;

6) evaluate and manage patients with pelvic inflammatory disease and pelvic masses, and those with pelvic floor dysfunction and urinary incontinence;

7) begin to perform major cases such as cystectomies, oophorectomies, laparoscopic salpingectomies and salpingostomies, and abdominal hysterectomies/myomectomies.

In addition, learn the evaluation and management of patients requesting elective abortion, including the principles of second trimester abortion. Residents with religious or moral opposition to abortion are excused from these responsibilities, but should know the principles and possible complications of elective termination of pregnancy.

Special Conferences:

Attending rounds and departmental conferences, Thursday gynecology rounds and weekly chapter review.

Study References:

Droegemüller's Comprehensive Gynecology or Novak's Gynecology, Te Linde's Operative Gynecology, PROLOG: Gynecology and Surgery, PROLOG: Patient Management in the Office, Precis: Gynecology, Precis: Primary and Preventive Care, CREOG Educational Objectives, Compendium, and begin to perform directed literature searches on Medline.

VI. Gynecologic Oncology

Rotation length, logistics, and vacation:

Rotation length is 8 to 9 weeks, with no vacation.

Attending Supervision:

Gynecologic oncology attendings.

Team:

PGY-4, PGY-2 and medical student.

Clinical Responsibilities:

Management of all gynecologic oncology inpatients, attend oncology/colposcopy clinics, assist in all majors and perform minor procedures. Assist with colposcopy on Tuesday afternoon at St. Luke’s and on Thursday afternoon at Roosevelt, and attend the LEEP clinic on Friday afternoon. In addition, the PGY-2 oncology resident should attend breast clinic at St. Luke’s on Wednesday mornings.

Learning Goals:

1) learn the epidemiology, diagnosis, staging and treatment of breast, cervical, uterine, ovarian, fallopian, vulvar and vaginal cancers;

2) begin to appreciate the pathology of these tumors;

3) evaluate and manage endometrial hyperplasia and preinvasive diseases of the cervix, vulva and vagina;

4) learn the different types of gestational trophoblastic diseases, their genetics, history, diagnosis and management;

5) learn the theoretic principles of radiation therapy and chemotherapy, along with their indications, side effects and possible complications;

6) perform cone biopsies/LEEP’s.

Special Conferences:

Oncology clinic rounds, oncology pathology conference, tumor board, departmental conferences, weekly chapter review.

Study References:

DiSaia's Clinical Gynecologic Oncology or Berek's Gynecologic Oncology, Te Linde's Operative Gynecology, Droegemüller's Comprehensive Gynecology, PROLOG: Gyn Oncology and Surgery, Precis: Oncology.

PGY-3 ROTATIONS

I. Day Rotation, Roosevelt Obstetrics

Rotation Length, Logistics and Vacation:

Rotation length is 8 to 9 weeks, with no vacation.

Attending Supervision:

In-house attending, perinatologist, and private attendings for individual patients.

Team:

PGY-4, PGY-3, PGY-2, PGY-1 in L&D, and medical students.

Clinical Responsibilities:

To manage the board in L&D, be aware of all patients in labor, all complicated antepartum or postpartum patients being observed in L&D, and all screening room patients.

Learning Goals:

1) perfect the management of normal labor as well as complicated labor;

2) perfect the evaluation of fetal heart rate patterns and their management;

3) perform forceps and vacuum deliveries, vaginal breech deliveries and complicated cesarean sections;

4) perfect the evaluation and management of complications such as third trimester bleeding, preeclampsia/ eclampsia, preterm labor, chorioamnionitis, diabetes in labor, and other maternal complications during the puerperium.

Mandatory Conferences:

Sign in/out rounds, perinatology rounds, daily MFM rounds, weekly chapter reviews, and departmental conferences.

Study References:

Gabbe’s Obstetrics: Normal and Problem Pregnancies or Williams Obstetrics, Creasy's Maternal-Fetal Medicine, Cecil Textbook of Medicine or Harrison's Principles of Internal Medicine, PROLOG: Obstetrics, Precis: Obstetrics, CREOG Educational Objectives, Compendium, and perform directed literature searches through Medline.

II. Night Float Rotation, Roosevelt Obstetrics

Rotation Length, Logistics and Vacation:

Total rotation length is 8 to 9 weeks, with 4 weeks' vacation, given in 2 2-week blocks. Night Float Rotation is incorporated into the schedules of PGY-3 residents in 2-to-5-week blocks, scattered throughout the year. The Night Float Rotation weekday schedule starts with 24-hour call from Sunday morning until 6:00 am Monday. Monday through Thursday, night float is from 5:45 pm until 6:30 am. On Fridays, the Night Float PGY-2, PGY-3 and PGY-4 work on Labor and Delivery until 2 pm, so that the Day OB Team can attend High Risk Clinic. Weekend night coverage is provided by residents who are not currently on Night Float Rotation. The residency program has implemented a Night Float Rotation as a means of compliance with New York City Regulation 405, which restricts resident duty hours. Depending on the postgraduate year, residents do 2 to 3 months of night float annually. For more information on the night coverage schedule, see the Residency Manual on the Web, Departmental Policies on Residents, Policy on Coverage of Week Nights, Weekends, and Holidays.

Attending Supervision:

In-house attending, perinatologist, and private attendings for individual patients.

Team:

PGY-1, PGY-2, PGY-3, PGY-4, sometimes joined by an additional resident on Short Call from 5:45 pm until 11:00 pm.

Clinical Responsibilities:

To manage the board in L&D, be aware of all patients in labor, all complicated antepartum or postpartum patients being observed in L&D, and all screening room patients.

Learning Goals:

1) perfect the management of normal labor as well as complicated labor;

2) perfect the evaluation of fetal heart rate patterns and their management;

3) perform forceps and vacuum deliveries, vaginal breech deliveries and complicated cesarean sections;

4) perfect the evaluation and management of complications such as third trimester bleeding, preeclampsia/ eclampsia, preterm labor, chorioamnionitis, diabetes in labor, and other maternal complications during the puerperium.

Mandatory Conferences:

Sign in/out rounds, perinatology rounds, daily MFM rounds, weekly chapter reviews, and departmental conferences.

Study References:

Gabbe’s Obstetrics: Normal and Problem Pregnancies or Williams Obstetrics, Creasy's Maternal-Fetal Medicine, Cecil Textbook of Medicine or Harrison's Principles of Internal Medicine, PROLOG: Obstetrics, Precis: Obstetrics, CREOG Educational Objectives, Compendium, Droegemüller's Comprehensive Gynecology or Novak's Gynecology, Te Linde's Operative Gynecology, Ostergard's Urogynecology and Pelvic Floor Dysfunction, Walters’ Urogynecology and Reconstructive Pelvic Surgery, PROLOG: Gynecology and Surgery, PROLOG: Patient Management in the Office, Precis: Gynecology, Precis: Primary and Preventive Care, and perform directed literature searches through Medline.

III. Roosevelt Gynecology

Rotation Length, Logistics and Vacation:

Rotation length is 8 to 9 weeks, with no vacation.

Attending Supervision:

Attending of the month, booking clinic attending and urogynecologist in urogynecology clinic.

Team:

Roosevelt Gynecology PGY-1, PGY-2, PGY-3, PGY-4 and medical student.

Clinical Responsibilities:

Performing and assisting on all major abdominal private cases, and following these patients during their postoperative course. Assisting on other cases as assigned by the chief resident. Attending booking and urogynecology clinics. Evaluating in-house consults.

Learning Goals:

1) perfect knowledge and management of emergency GYN problems such as first trimester bleeding, Bartholin’s cyst abscess, acute abdominal pain, PID, abnormal uterine bleeding, toxic shock syndrome, and septic abortion;

2) become comfortable with major procedures such as operative laparoscopy and hysteroscopy, abdominal hysterectomy, cystectomy, and oophorectomy;

3) evaluate and manage patients with pelvic floor dysfunction and urinary incontinence; 4) begin to perform vaginal and urogynecologic surgery.

Mandatory Conferences:

Morning and afternoon team rounds, attending rounds, weekly chapter review, Thursday gynecology rounds and departmental conferences.

Study References:

Droegemüller's Comprehensive Gynecology or Novak's Gynecology, Te Linde's Operative Gynecology, Ostergard's Urogynecology and Pelvic Floor Dysfunction, Walters’ Urogynecology and Reconstructive Pelvic Surgery, PROLOG: Gynecology and Surgery, PROLOG: Patient Management in the Office, Precis: Gynecology, Precis: Primary and Preventive Care, CREOG Educational Objectives, Compendium, and perform literature searches on Medline.

IV. St. Luke’s Gynecology

Rotation Length, Logistics and Vacation:

Rotation length is 8 to 9 weeks, with no vacation.

Attending Supervision:

In-house attending.

Team:

PGY-4, PGY-3, PGY-2, PGY-1.

Clinical Responsibilities:

Manage the Gynecology Service, do gynecologic surgery, ER consults, and clinic duties.

Learning Goals:

1) perfect knowledge and management of emergency GYN problems such as first trimester bleeding, Bartholin’s cyst abscess, acute abdominal pain, PID, abnormal uterine bleeding, toxic shock syndrome, and septic abortion;

2) become comfortable with major procedures such as operative laparoscopy and hysteroscopy, abdominal hysterectomy, cystectomy, and oophorectomy; 3) evaluate and manage patients with pelvic floor dysfunction and urinary incontinence; 4) begin to perform vaginal and urogynecologic surgery.

Mandatory Conferences:

Attending rounds, Thursday gynecology rounds, weekly chapter review.

Study References:

CREOG Educational Objectives, Compendium, Droegemüller's Comprehensive Gynecology or Novak's Gynecology, Te Linde's Operative Gynecology, Ostergard's Urogynecology and Pelvic Floor Dysfunction, Walters’ Urogynecology and Reconstructive Pelvic Surgery, PROLOG: Gynecology and Surgery, PROLOG: Patient Management in the Office, Precis: Gynecology, Precis: Primary and Preventive Care, Cecil Textbook of Medicine or Harrison's Principles of Internal Medicine, and perform directed literature searches on Medline.

V. St. Luke's Night Float

Rotation Length, Logistics, and Vacation:

Each month, either a PGY-3 or a PGY-4 is assigned to Night Float Rotation at St. Luke’s. For the PGY-3, this rotation will be a 5-week block. This night-float resident is relieved of duties during the weekdays for that month. The Night Float Rotation weekday schedule starts with 24-hour call from Sunday morning until 6:00 am Monday. Monday through Thursday, Night Float is from 6:00 pm until 6:00 am. Weekend night coverage is provided by residents who are not currently on Night Float.

Attending Supervision:

In-house attending.

Team:

Either a PGY-3 or PGY-4 resident.

Clinical Responsibilities:

The nightfloat resident is initially responsible for all inpatient GYN patients, including those with medical problems such as elevated temperatures, and for all OB and GYN patients presenting in the ED. All cases must be presented to the attending, who will be actively involved in the management of each patient.

Learning Goals:

To 1) evaluate and manage patients with first trimester bleeding, including vaginal probe ultrasound; 2) begin to learn the basic science of RH isoimmunization and the principles of Rhogam administration; 3) evaluate and manage vaginitis and Bartholin’s abscesses; 4) evaluate patients with pelvic pain, and treat such problems as PID; 5) learn the principles of evaluation and management of shock syndrome.

Special Conferences:

All night float residents are expected to attend the usual required lectures such as morbidity and mortality, case presentations, grand rounds, CREOG review and attending lectures.

Study References:

CREOG Educational Objectives, Compendium, Droegemüller's Comprehensive Gynecology or Novak's Gynecology, TeLinde's Operative Gynecology, Ostergard's Urogynecology and Pelvic Floor Dysfunction, Walters’ Urogynecology and Reconstructive Pelvic Surgery, Gynecology PROLOG, PROLOG: Patient Management in the Office, Precis: Gynecology, Precis: Primary and Preventive Care, Cecil Textbook of Medicine or Harrison's Principles of Internal Medicine, and perform directed literature searches on Medline.

VI. Reproductive Endocrinology

Rotation Length, Logistics and Vacation:

Rotation length is 8 to 9 weeks, with no vacation.

Attending Supervision:

Reproductive endocrine faculty, and private reproductive endocrinology specialists for specific patients.

Team:

None.

Clinical Responsibilities are as per the following table:

In addition, the RE resident will assist the faculty attendings with egg retrievals and transfers, as well as HSG’s.

Learning Goals:

1) become proficient in the management of pediatric and adolescent gynecology, dysmenorrhea, dysfunctional uterine bleeding, amenorrhea, premenstrual syndrome, infertility, recurrent pregnancy loss, endometriosis and the climacteric period;

2) perform such procedures as hysterograms, hysterosonograms, transvaginal ultrasound, laparoscopic and hysteroscopic procedures;

3) learn the principles of ovulation induction and assisted reproductive techniques including egg retrieval and transfer as well as intrauterine inseminations.

Mandatory Conferences:

Endocrine rounds, prepare cases for case presentation rounds, weekly Speroff chapter reviews, all departmental rounds. In addition, the RE resident is responsible for preparation of the monthly statistics and M&M.

Study References:

Speroff's Clinical Gynecologic Endocrinology and Infertility, PROLOG: Reproductive Endocrinology, Precis: Reproductive Endocrinology.

PGY-4 ROTATIONS

I. Oncology

Rotation Length, Logistics and Vacation:

Rotation length is 8 to 9 weeks, with no vacation.

Attending Supervision:

Gynecologic oncologists.

Team:

PGY-2, PGY-4 and medical student.

Clinical Responsibilities:

Preoperative, operative and postoperative management of oncology patients. Attending oncology clinic, colposcopy clinics Tuesday afternoon at St. Luke’s and Thursday afternoon at Roosevelt; and LEEP clinic, including performing all colposcopies, biopsies and LEEP procedures. Supervise the PGY-2.

Learning Goals:

1) perform (not independently) radical surgery;

2) become proficient in colposcopy evaluation and management of intraepithelial neoplasia of cervix, vagina and vulva;

3) to perform cryotherapy, LEEP and laser;

4) learn the principles of chemotherapy and brachytherapy;

5) perfect the learning goals of the PGY-2 oncology rotator.

Mandatory Conferences:

Oncology-pathology and clinic conferences, oncology attending rounds, tumor board and departmental conferences. In addition, the PGY-4 oncology resident must prepare the monthly statistics and M&M.

Supervising Responsibilities:

PGY-2 oncology resident, medical student and other rotators.

Study References:

DiSaia's Clinical Gynecologic Oncology or Berek's Gynecologic Oncology, Te Linde's Operative Gynecology, Droegemüller's Comprehensive Gynecology, PROLOG: Gyn Oncology and Surgery, Precis: Oncology.

II. Day Rotation, Roosevelt Obstetrics

Rotation Length, Logistics and Vacation:

Rotation length is 8 to 9 weeks, with no vacation.

Attending Supervision:

Obstetrics attending of the day, perinatologist and private attending for individual patients.

Team:

PGY-4, PGY-3, PGY-2, PGY-1 and medical student.

Clinical Responsibilities:

Overseeing, supervising and/or performing all activities in L&D. The role of the PGY-4 on L&D is one of tremendous responsibility, and requires the ability to prioritize and assign appropriate resident coverage to L&D activities. The PGY-4 should also be involved in the care of all in-patient antepartum and postpartum patients.

Learning Goals:

1) take care of complicated deliveries, including vaginal breech, forceps and vacuum; also, neonatal resuscitation and cesarean hysterectomies;

2) perfect the knowledge base in complicated obstetrics as stated in the learning goals for previous years.

Mandatory Conferences:

All L&D sign in/out rounds, perinatal conference, daily MFM rounds, responsible for presentations of weekly statistics and M&M’s.

Supervising Responsibilities:

Study References:

Gabbe’s Obstetrics: Normal and Problem Pregnancies or Williams Obstetrics, Creasy's Maternal-Fetal Medicine, Cecil Textbook of Medicine or Harrison's Principles of Internal Medicine, PROLOG: Obstetrics, Precis: Obstetrics, CREOG Educational Objectives, Compendium, and perform directed literature searches through Medline.

III. Night Float Rotation, Roosevelt Obstetrics

Rotation Length, Logistics and Vacation:

Rotation length is 8 to 9 weeks, with 4 weeks' vacation, given in 2 2-week blocks. Night Float Rotation is incorporated into the schedules of PGY-4 residents in 2-to-5-week blocks, scattered throughout the year. The Night Float Rotation weekday schedule is Sunday for 12 or 24 hours, and Monday through Thursday from 5:45 pm until 6:30 am. On some Fridays, coverage may be needed on L&D  until 2 pm. The residency program has implemented the Night Float Rotation as a means of compliance with New York City Regulation 405, which restricts resident duty hours. Depending on the postgraduate year, residents do 2 to 3 months of night float annually. For more information on the night coverage schedule, see the Residency Manual on the Web, Departmental Policies on Residents, Policy on Coverage of Week Nights, Weekends, and Holidays.

Attending Supervision:

Obstetrics attending of the day, perinatologist and private attending for individual patients.

Team:

PGY-1, PGY-2, PGY-3, PGY-4, sometimes joined by an additional resident on Short Call from 5:45 pm until 11:00 pm.

Clinical Responsibilities:

Overseeing, supervising and/or performing all activities in L&D. The role of the PGY-4 on L&D is one of tremendous responsibility, and requires the ability to prioritize and assign appropriate resident coverage to L&D activities. The PGY-4 should also be involved in the care of all in-patient antepartum, postpartum, gynecology and gynecologic-oncology patients.

Learning Goals:

1) take care of complicated deliveries, including vaginal breech, forceps and vacuum; also, neonatal resuscitation and cesarean hysterectomies;

2) perfect the knowledge base in complicated obstetrics as stated in the learning goals for previous years;

3) consult and manage the patients on the gynecology floor, and the gynecologic-oncology patients.

Mandatory Conferences:

All L&D sign in/out rounds, perinatal conference, daily MFM rounds, responsible for presentations of weekly statistics and M&M’s.

Supervising Responsibilities:

The entire team.

Study References:

Gabbe’s Obstetrics: Normal and Problem Pregnancies or Williams Obstetrics, Creasy's Maternal-Fetal Medicine, Cecil Textbook of Medicine or Harrison's Principles of Internal Medicine, PROLOG: Obstetrics, Precis: Obstetrics, CREOG Educational Objectives, Compendium, Droegemüller's Comprehensive Gynecology or Novak's Gynecology, Te Linde's Operative Gynecology, Nichols' Vaginal Surgery, Ostergard's Urogynecology and Pelvic Floor Dysfunction, Walters’ Urogynecology and Reconstructive Pelvic Surgery, PROLOG: Gynecology and Surgery, PROLOG: Patient Management in the Office, Precis: Gynecology, Precis: Primary and Preventive Care, and perform directed literature searches through Medline.

IV. Roosevelt Gynecology

Rotation Length, Logistics and Vacation:

Rotation length is 8 to 9 weeks, with no vacation.

Attending Supervision:

Attending of the month, urogynecologist, and private physicians for individual patients.

Team:

Roosevelt Gynecology PGY-4, PGY-3, PGY-2, PGY-1 and medical students.

Clinical Responsibilities:

Admitting, rounding, and operating on all benign gynecology patients, both private and service; evaluation and management of emergency room patients, in-house consultations and outpatients in the booking and urogynecology clinics. Perform under attending supervision the most difficult cases. Teach junior residents and supervise them intraoperatively.

Learning Goals:

1) To become proficient in all aspects of benign gynecology including the evaluation and management of patients requiring vaginal surgery, procedures for urinary incontinence, and operative laparoscopy.

Mandatory Conferences:

Morning and afternoon rounds, attending rounds, Thursday gynecology rounds, and prepare statistics and M&M.

Study References:

Droegemüller's Comprehensive Gynecology or Novak's Gynecology, Te Linde's Operative Gynecology, Nichols' Vaginal Surgery, Ostergard's Urogynecology and Pelvic Floor Dysfunction, Walters’ Urogynecology and Reconstructive Pelvic Surgery, PROLOG: Gynecology and Surgery, PROLOG: Patient Management in the Office, Precis: Gynecology, Precis: Primary and Preventive Care, CREOG Educational Objectives, Compendium, and perform literature searches on Medline.

V. St. Luke’s Gynecology

Rotation Length, Logistics and Vacation:

Rotation length is 8 to 9 weeks, with no vacation.

Attending Supervision:

In-house attending.

Team:

PGY-4, PGY-3, PGY-2, PGY-1.

Clinical Responsibilities:

Primary responsibility for the GYN Service, and responsible for presentation of the St. Luke's statistics. Oversee ER consults and develop operative skills with emphasis on teaching.

Learning Goals:

To perfect knowledge of all aspects of gynecology, including pelvic-floor and gynecologic surgery.

Mandatory Meetings:

All team rounds, gynecology attending rounds, departmental conferences.

Study References:

CREOG Educational Objectives, Compendium, Droegemüller's Comprehensive Gynecology or Novak's Gynecology, Te Linde's Operative Gynecology, Nichols' Vaginal Surgery, Ostergard's Urogynecology and Pelvic Floor Dysfunction, Walters’ Urogynecology and Reconstructive Pelvic Surgery, PROLOG: Gynecology and Surgery, PROLOG: Patient Management in the Office, Precis: Gynecology, Precis: Primary and Preventive Care, Cecil Textbook of Medicine or Harrison's Principles of Internal Medicine, and perform directed literature searches on Medline.

VI. St. Luke's Night Float

Rotation Length, Logistics, and Vacation:

Each month, either a PGY-3 or a PGY-4 is assigned to Night Float Rotation at St. Luke’s. This night-float resident is relieved of duties during the weekdays for that month. The Night Float Rotation weekday schedule starts with 24-hour call from Sunday morning until 6:00 am Monday. Monday through Thursday, Night Float is from 6:00 pm until 6:00 am. Weekend night coverage is provided by residents who are not currently on Night Float.

Attending Supervision:

In-hous attending.

Team:

Either PGY-3 or PGY-4 resident.

Clinical Responsibilities:

The nightfloat resident is initially responsible for all inpatient GYN patients, including those with medical problems such as elevated temperatures, and for all OB and GYN patients presenting in the ED. All cases must be presented to the attending, who will be actively involved in the management of each patient.

Learning Goals:

1) evaluate and manage patients with first trimester bleeding, including vaginal probe ultrasound;

2) begin to learn the basic science of RH isoimmunization and the principles of Rhogam administration;

3) evaluate and manage vaginitis and Bartholin’s abscesses;

4) evaluate patients with pelvic pain, and treat such problems as PID;

5) learn the principles of evaluation and management of shock syndrome;

6) Begin to master the evaluation and management of postoperative complications such as fever, hemorrhage, and thromboembolism.

Special Conferences:

All night float residents are expected to attend the usual required lectures such as morbidity and mortality, case presentations, grand rounds, CREOG review and attending lectures.

Study References:

CREOG Educational Objectives, Compendium, Droegemüller's Comprehensive Gynecology or Novak's Gynecology, TeLinde's Operative Gynecology, Nichols' Vaginal Surgery, Ostergard's Urogynecology and Pelvic Floor Dysfunction, Walters’ Urogynecology and Reconstructive Pelvic Surgery, PROLOG: Gynecology and Surgery, PROLOG: Patient Management in the Office, Precis: Gynecology, Precis: Primary and Preventive Care, Cecil Textbook of Medicine or Harrison's Principles of Internal Medicine, and perform directed literature searches on Medline.

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