OB-GYN Residency
Curriculum
Walter Reed National Military Medical Center
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The curriculum is designed to provide a fully-rounded educational experience in obstetrics and gynecology, as well as education in primary care topics, in order to provide graduating residents with all the tools necessary to be women’s health care providers. In general, the curriculum involves categorical and non-categorical rotations during the PGY-1 year; all rotations in the subsequent years are categorical obstetrics and gynecology rotations.
The curriculum is designed to directly address the educational objectives published by the Council on Resident Education in Obstetrics and Gynecology (CREOG), which are contained in a publication entitled “Educational Objectives, A Core Curriculum in Obstetrics and Gynecology – Ninth Edition” (most recently published in 2009 and updated periodically). Specific objectives are incorporated in each of the rotations, and the objectives are communicated to the residents at the beginning of each academic year as well as at the beginning of each rotation. The objectives for each rotation include educational (knowledge) and performance objectives, and are specified per resident year level as applicable to each rotation.
Although the general schedule of rotations has not changed over the last several years (except for enhancement for the PGY-1 year group), the objectives, and educational experiences, are continuously being updated. As faculty and residents attend scientific meetings and seminars, including those with an educational focus, new ideas and potential enhancements are shared with the entire resident and faculty group and are incorporated into the program whenever possible. In addition, one of the prior residents was a Council member of CREOG, and the former Program Director was a member of the CREOG Education Committee; these affiliations provide an invaluable resource by having a direct connection with CREOG and therefore enabling those in the program to stay constantly updated on curricular development. In addition, the curriculum is reviewed on a regular basis by the Program Director and Associate Program Directors, by the Division/Service Chiefs, and by the faculty at regularly scheduled Program/Faculty Meetings.
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Rotations: The general rotation schedule is shown in Tables I and II. For the PGY-2 through 4 years, all rotations are 8 weeks in length. For the PGY-1 year, all rotations are 4 weeks in length. We also have a Night Float rotation for residents in the PGY-2 and PGY-4 years, which covers WRNMMC call from Sunday through Thursday nights. As previously described, there are several non-categorical rotations during the PGY-1 year; these rotations address the educational objectives and requirements prescribed by the ACGME. In addition, there are numerous educational activities provided by WRAMC and WRNMMC that are attended by all PGY-1 residents and interns from all programs, some of which are military-specific or military-unique. As demonstrated in the Tables
I and II for resident rotation, the residents function as a
“team” on nearly all services. Functioning as a team,
and working closely with others, is an integral and vitally important
component of residency training. The team concept enhances education,
as well as teaching and supervision responsibilities associated
with Senior and Chief Resident positions. A team concept also contributes
to competency in professionalism and interpersonal and communication
skills, which are necessary competencies to be achieved according
to ACGME requirements. The faculty strongly believes in the team
concept, and the arrangement is fully supported. Competencies: Since 2003, all ACGME-accredited residency programs are required to demonstrate education in, and assessment, of, competency in the following 6 categories:
The curriculum is designed to provide education in all of these areas, involving all aspects of women’s health care. Assessment methods for each of the competencies are included in the individual resident’s overall ratings for each rotation as well as assessments of many individual components. For more information regarding the ACGME competencies, please refer to the ACGME web site. Academics: Academics are strongly emphasized in the program; we consider a strong academic background as essential on becoming a competent physician and to provide excellence in women’s health care. Teaching “rounds” are incorporated into each rotation, as well as numerous academic conferences. The main academic conferences occur on Thursday mornings each week. Each Thursday morning starts with a meeting between the Program Director and the residents, followed by 2 – 3 hours of a wide variety of educational venues, including skills sessions, simulation laboratories, anatomic dissection laboratories, didactics, and interactive sessions. Other conferences scheduled during these Thursday morning sessions include Journal Club/Evidence-Based Medicine Conference, Morbidity and Mortality (M&M) Conference, review sessions, and presentation practice sessions for major upcoming meetings and seminars in which the residents are involved. Military-unique conferences are also held during this time period. The “Thursday Academics” sessions are considered mandatory for residents; clinical activities are not scheduled during this time in order to maximize resident attendance and participation. In order to accommodate those residents (and faculty) unable to attend the Thursday academic sessions due to off-site rotations, leave, or TAD/TDY, a password-protected "Resident Academics" website can be accessed through the Uniformed Services University of the Health Sciences web page. All electronic presentations provided during Thursday academic sessions will be saved to this site which can be accessed from any location. This system allows all residents to access didactic academic sessions at any time from any location. In addition to the Thursday academic mornings, various conferences are held during the rotations on specific services. Some of these academic sessions include Perinatal Conference, Complicated Obstetrics Conference, and Maternal-Fetal Medicine Rounds while on the Obstetrics service, Tumor Planning Conference while on Gynecologic Oncology, Urogynecology Teaching Conference during the Urogynecology rotation, and Reproductive Endocrinology Pre-Op and Teaching Conference on the Reproductive Endocrinology and Infertility rotation. Other conferences are held, as applicable to the divisions and rotations, including Pre-Op Conferences and Colposcopy Conference, and GYN Ward Teaching Rounds. In addition, the PGY-1 residents attend hospital-specific conferences as previously described. Morning Report is also held at each facility every morning, during which all significant clinical events from the prior day and night are presented and discussed, with educational topics addressed relative to the issues relative to the presented cases. Educational Experiences: The educational objectives, as described, cover the full spectrum of women’s health. Primary and preventive care topics are addressed in both off-service rotations during the PGY-1 year as well as during categorical rotations throughout the residency. Continuity Clinic is incorporated into the program during all four years, which fosters continuity of follow-up as well as primary and preventive care issues.
There are 3 OB/GYN fellowship programs affiliated with the program, two of which also fall under the direction of the NCC. These fellowship programs include: Reproductive Endocrinology and Infertility, Urogynecology, and Gynecologic Oncology. Both the fellowship and residency programs are highly coordinated in order to achieve the educational objectives for both residents and fellows, and to maximize the educational experience. By closely coordinating the fellowship and residency programs, and by having the same faculty involved involved in the education of both the residents and the fellows, the potential for “fellows stealing resident cases” is eliminated. In fact, the fellows are also included on the resident “teams”; co-management of patients by the residents and fellows, under the direction of the faculty, further enhance the residents’ education.
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The
obstetric experience includes high-risk (complicated) obstetrics,
operative vaginal delivery (both forcep delivery and vacuum delivery),
genetic counseling, extensive involvement with advanced sonography,
and procedures including amniocenteses, chorionic villus sampling,
and percutaneous umbilical cord blood sampling (PUBS). The gynecologic
experience includes, as previously described, extensive involvement
with operative laparoscopy, complex gynecologic surgery including
gynecologic oncology surgery, and a very extensive experience in
pelvic reconstructive surgery and anti-incontinence procedures.
Rotations in gynecology and on the Reproductive Endocrinology and
Infertility services involve extensive experience in gynecologic
ultrasound, including saline sonography. The experience in Reproductive
Endocrinology and Infertility (REI) includes assisted reproduction
technology; the REI service has a fully functional, very busy, infertility
service, including in-vitro fertilization (IVF). Hysterosalpingograms
are also performed while rotating on this service. One of the faculty
is dually Board-certified in Obstetrics/Gynecology and Anatomic
Pathology, providing a unique addition to the curriculum in gynecologic
pathology.
Walter Reed National Military Medical Center
8901 Rockville Pike
Bethesda, MD 20889-5600
(301) 295-4611; toll-free 1-800-526-7101
www.bethesda.med.navy.mil