Residency Program

Curriculum

Division of MATERNAL FETAL MEDICINE

FIRST YEAR - JUNIOR ASSISTANT RESIDENT (JAR) (2 rotations, 7 weeks each, plus weekend call, plus 1 rotation, 7 weeks each as "night float", off days).
SECOND YEAR - ASSISTANT RESIDENT (AR) (2 rotations, 7 weeks each)
THIRD YEAR - SENIOR ASSISTANT RESIDENT (SAR) (1 rotations, 7 weeks)
FOURTH YEAR - CHIEF RESIDENT (CR) (2 rotations, each 7 weeks)

The first year of a training program in obstetrics is considered a year which is critical for the acquisition of basic information of normal obstetrics, for learning the precepts of the general practice of medicine, and for an introduction to complicated obstetrics; however, it is not a year in which the resident should anticipate being the primary surgeon in a cesarean section or other major operative obstetrical procedures.

Achievement in the following areas will be emphasized, and adequate progression is expected:

1. taking a comprehensive obstetrical history;
2. performing an obstetrical examination with understanding of the functional pelvic anatomy of normal pregnancy;
3. comprehending the physiologic changes that occur during normal pregnancy and being able to deal with the common clinical problems associated with these changes;
4. acquiring comprehension of all major anatomic and functional changes of pregnancy, including the urinary tract, respiratory tract, gastrointestinal tract and cardiovascular system as well as the potential emotional changes of pregnancy;
5. becoming familiar with the use of drugs in pregnancy and being able to apply accepted principles of pharmacology relevant to the use of drugs in pregnancy;
6. learning developmental placentation, and normal placental physiology;
7. understanding normal carbohydrate metabolism and aberrations of carbohydrate metabolism during pregnancy;
8. developing the ability to wisely counsel a patient regarding the advisability of pregnancy;
9. demonstrating the ability to successfully conduct the management of labor and delivery, including fetal monitoring, assessment of labor and an introduction to the use of forceps;
10. developing expertise in the management of the immediate postpartum period and the remainder of the puerperium;
11. learning to properly perform circumcision and postpartum tubal ligation;
12. acquiring adequate skills in obstetrical anesthesia and ultrasound.

During this year it is anticipated that the resident will continue to progress in all previously noted areas. In addition, the resident should begin to develop skills and proper concepts in the realm of abnormal obstetrics. The assistant resident can expect to be the primary surgeon on many cesarean sections and to otherwise assist the chief resident as he/she directs. The assistant resident should develop skills in the following areas:

1. management of abortion and ectopic pregnancy;
2. management of second trimester pregnancy loss, including procedures for diagnosis, complications associated with fetal death at this stage of pregnancy and methods of termination of pregnancy;
3. the evaluation and management of late pregnancy bleeding;
4. the recognition and management of medical and surgical conditions which complicate pregnancy;
5. diagnosis and management of premature rupture of membranes;
6. comprehension and management of premature labor;
7. induction of labor, including proper indications for induction and management of induced labor;
8. management of postpartum hemorrhage and obstetrical shock;
9. facility in the use of forceps, including forceps rotation, and forceps delivery of the aftercoming head;
10. skill in interpretation/performance of fetal diagnostic evaluation, amniocentesis, and genetic counseling;
11. being a teacher and becoming established in a tradition of continued learning.

This year is characterized by a progression of responsibilities in all the previously listed areas. During this rotation, a "night float", the senior assistant resident is expected to make the majority of decisions and provide/supervise the specific management of patients in the labor and delivery area. This individual will work week nights (days off) and at other times to share in weekend call, both with a JAR obstetrical assistant. The SAR should significantly increase knowledge and skills in all areas of normal and abnormal obstetrics and rapidly increase in individual practice capability. The SAR will at all times be accountable to the chief resident regarding management.

One chief resident is expected to be operational chief of the obstetrical service and supervisor of other residents who provide for the day to day care of all obstetrical patients, private and staff, and to be at all times responsible to the attending staff in the fulfillment of these duties. The chief resident will be responsible for providing obstetrical consultation to upper level residents of other services.

This chief resident will serve as the primary surgeon on his/her choice of available surgical cases, and will assign to other residents the remainder of the major and minor OB surgical procedures. In addition, the chief resident is responsible for assuring that his/her junior residents are at all times provided with adequate supervision and assistance. The chief resident in obstetrics will assign all private obstetrical patients to the assistant resident for management unless he/she deems them to be of sufficient complexity that he/she will assume primary responsibility for their care. The second rotation (7 weeks) is as outpatient Chief Resident. This resident supervises all OB clinics and directs the Fetal Diagnostic Center (fetal assessment). The two OB chiefs will round together, daily, to aid in continuity.