Residency Program

Curriculum

Division of GYNECOLOGY

• FIRST YEAR - JUNIOR ASSISTANT RESIDENT (JAR) (1 rotation, 7 weeks plus night and weekend call)
• SECOND YEAR - ASSISTANT RESIDENT(AR) (2 rotations, 7 weeks each)
• THIRD YEAR - SENIOR ASSISTANT RESIDENT (SAR) (7 weeks)
• FOURTH YEAR - CHIEF RESIDENT (CR) (7 weeks)

This is generally considered a year of crucial importance for the acquisition of basic information and the mastery of basic skills. It is not a year during which the resident should anticipate being the primary surgeon on major abdominal or vaginal cases. Achievement in the following areas will be emphasized, and adequate progression expected:

1. Taking a comprehensive gynecologic history.
2. Performing gynecologic examinations, and developing an understanding of functional pelvic anatomy and derangements thereof.
3. Recognizing and appropriately dealing with associated medical and surgical disease in gyn patients.
4. Evaluating gyn patients preoperatively and managing them postoperatively.
5. Becoming thoroughly familiar with the instruments and suture materials used in gyn surgery.
6. Performing minor gyn surgical procedures such as a D&C and marsupialization of Bartholin's abscess.
7. Managing patients with spontaneous or missed abortion.
8. Managing first and second trimester elective abortions, including complications thereof. (Induction of elective abortion may be declined if for moral or ethical reasons a resident does not desire to participate. Care and management of inevitable, incomplete or complete abortion is the responsibility of all residents.)
9. Becoming a good assistant in both abdominal and vaginal surgery, with comprehension of the basic surgical anatomy involved and distortions thereof.
10. Becoming adept at opening and closing the abdomen, and in the process of this becoming familiar with the various incisions and closures employed.
11. Learning to perform laparoscopy.
12. Acquiring a basic knowledge of gyn infections, including sexually transmitted diseases, and of antibiotic usage in gynecology as well as the medical and surgical management thereof.
13. Acquiring basic concepts regarding the diagnosis and management of urinary incontinence in the female patient.
14. Learning to provide appropriate contraception and family planning advice.
15. Meeting first year technical skill goals in the endoscopy dry lab.

This rotation is regularly assigned to the general gynecology service in Fayetteville (Cape Fear Hospital) and Durham Regional Hospital. The AR may participate as the primary surgeon on selected cases at the discretion of the chief resident and attending staff. Progressive patient responsibility and surgical participation will be emphasized.

This year will be characterized by continued progression of responsibilities in all previously listed areas.

Specifically, the SAR will be expected to make a majority of decisions regarding management of ambulatory (clinic) patients and to run the wards, making or supervising a majority of decisions relevant to day today inpatient management. SAR's will meet surgical skills goals in the endoscopy dry lab and animal surgery sessions.

The SAR should expect to serve as primary surgeon on major cases, including abdominal and vaginal surgery, at the discretion of the chief resident and attending staff. Such assignments should provide enough major surgery to prepare the SAR for the additional surgical responsibilities of a chief resident. At the end of this year the SAR is expected to have developed adequate competence in routine gynecologic procedures to be capable of performing them independently.

The chief resident will be expected to run the gyn service, and to supervise the day-to-day care of all gyn patients, being responsible to the attending staff for the care of all patients. The chief resident will be responsible for providing gyn consultations with upper level residents of other services.

The chief resident will serve as the primary surgeon on his/her choice of available major gyn surgical cases, and will assign to other residents in a fair manner the remainder of the gyn surgical cases, and will assist them in the performance of these cases, as appropriate.

The chief resident will be expected to perform difficult major gyn surgical cases, such as those involving endometriosis, pelvic infection, and large leiomyomata. This implies familiarity with retroperitoneal structures and proficiency in retroperitoneal dissection. He/she will also be familiar with the proper evaluation of patients with genital prolapse and/or urinary incontinence. This implies proficiency in the performance of colpoplastic repairs and retropubic urethropexies and familiarity with vaginal and abdominal procedures for severe pelvic organ prolapse and for severe incontinence due to intrinsic failure of the urethral sphincter. He/She should also understand the role of non-surgical (behavioral and pharmacologic) therapy of incontinence. He or she will meet the final surgical skills goals in the endoscopy dry lab and animal surgery sessions.

It is recognized that rotations away from Duke constitute a significant part of the total gyn experience, and that communication must be maintained that will ensure that these rotations are an integral part of the overall training program, and are generally in compliance with the stated objectives for residency training in gynecology.