UCSF Residency Program in Obstetrics, Gynecology and Reproductive Sciences Educational Objectives R1 Primary & Preventive Ambulatory Health Care Training in primary and preventive ambulatory health care comprises several rotations and continuity clinic experiences across the 4-year residency, including 3 months during the PGY-1 year. Residents spend one month studying inpatient medicine, as well as 120 half-day sessions of continuity clinic. The UC Ambulatory Care rotation comprises 5-6 weeks of outpatient clinical experiences and spans across a wide area of primary care and preventative medicine as well as speciality clinics. The DPH Ambulatory Rotation consists of 5-6 weeks focusing on marginalized women in low resource settings. Ambulatory care is also a principal focus during the PGY-1 SFGH OB-Clinic rotation, SFGH Gynecology-Clinic rotation, as well. Working through these rotations will help you become comfortable interviewing patients, providing patient-centered care and understanding basic ambulatory medicine and gynecology. In addition, understanding the nuances of the care of women in an underserved setting is a primary goal. During the UC Ambulatory Care rotation, you will rotate through the UC high risk Ob resident clinic and prenatal diabetes clinic (DAPP) and endocrine clinic. Rotating through the High Risk Ob clinic at UCSF provides exposure to pregnant women with complex medical problems. You will participate in a ½ day of breast clinic with Dr. Goldman, which is a component of your R1 longitudinal experience in breast care and health (in combination with benign breast clinic at SFGH during the DPH ambulatory rotation.) Finally, you will spend time participating in our new genetics curriculum which will be a combination of prenatal genetics with Dr. Mary Norton. In the DPH ambulatory rotation, you will spend ½ day in the city jail focusing on issues particular to incarcerated women and also work in the City Clinic, a public health clinic that focuses primarily on STIs in both men and women. New Generations is a city teen clinic established by our department. Residency training reflects a progression of knowledge and skill acquisition through clinical work. The OB/GYN ACGME Milestones map this process across 28 milestone competencies divided into subcompetencies that should be achieved over the 4 years of residency. The UCSF OB/GYN residency program has assigned benchmarks of where residents are expected to be in each milestone at 6 months intervals. Thus, understanding the progression of skill across a milestone gives a resident an awareness of where his or her performance should be at different time intervals in residency. Below are the milestones that pertain to the R1 Ambulatory care rotations. Milestones on communication, systems-based practice, professionalism and problem based learning and improvement are included in each rotation to emphasize their importance in the development of a competent physician. The residency program recognizes that a resident’s particular schedule will influence when subcompetencies are achieved, and the benchmarks reflect the expected level of skill at 6 months and the end of the year. In addition to the milestones, the CREOG GYN Objectives are listed below for your reference of what CREOG identifies as key learning topics. Educational objectives are organized according to ACGME/RRC competencies. Additionally, you have two required modules to complete during your DPH Ambulatory Rotation one during your UC Ambulatory Rotation. We have identified several key ACOG practice bulletins that pertain to intern level objectives for ambulatory care. Try to complete these readings at least once over your first year. Required Online Modules DPH Ambulatory Rotation Caring for women in low resource settings, empowering women and fostering leaders. This curriculum includes a set of modules designed specifically to highlight disparities and health inequities encountered by marginalized women. Clinical Care in Low Resource Settings ARHP module on Adolescent Health (link to this module will be sent to you) UC Ambulatory Rotation ARHP module on 1st trimester bleeding (link to this module will be sent to you) Recommended Introductory Reading ACOG Practice Bulletins 148 Thyroid Disease in Pregnancy (April 2015) 141 Management of Menopausal Symptoms (January 2014) 140 Management of Abnormal Cervical Cancer Screening Test Results and Cervical Cancer Precursors (December 2013) 137 Gestational Diabetes Mellitus (August 2013) 131 Screening for Cervical Cancer (November 2012) 129 Osteoporosis (September 2012) (Replaces Practice Bulletin Number 50, January 2004, Reaffirmed 2014) 122 Breast Cancer Screening (August 2011, Reaffirmed 2014) 121 Long-Acting Reversible Contraception: Implants and Intrauterine Devices (July 2011, Reaffirmed 2013) 119 Female Sexual Dysfunction (April 2011, Reaffirmed 2015) 117 Gynecologic Care for Women With Human Immunodeficiency Virus (December 2010, Reaffirmed 2015) 112 Emergency Contraception (May 2010, Reaffirmed 2014) 126 Management of Gynecologic Issues in Women With Breast Cancer (March 2012, Reaffirmed 2014) 57 Gynecologic Herpes Simplex Virus Infections (November 2004, Reaffirmed 2014) 72 Vaginitis (May 2006, Reaffirmed 2015) 90 Asthma in Pregnancy (February 2008, Reaffirmed 2014) 95 Anemia in Pregnancy (July 2008, Reaffirmed 2013) ACGME Milestones (on Google drive and flash drive) There are no specific milestones assigned to ambulatory rotations. CREOG Educational Objectives, A Core Curriculum in Obstetrics and Gynecology, Tenth Edition Unit 4 (on your flash drive) Patient Care Demonstrate caring and respectful behaviors when interacting with patients and their families. Gather essential information about patients by performing a complete and accurate medical history and physical examination. Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment. Develop, negotiate, and implement effective patient management plans. Counsel and educate patients and their families. Use information technology to support patient care decisions and patient education. Perform competently all medical and invasive procedures considered essential for generalist practice in the discipline of obstetrics and gynecology. Understand the differences between screening and diagnostic tests essential for generalist practice in obstetrics and gynecology. Provide health care services aimed at preventing health problems or maintaining health. Work with health care professionals, including those from other disciplines, to provide patient-focused care. Perform competently a medical history including a history of genetic diseases and physical examination and provide appropriate periodic screening, evaluation and preventive services at an ambulatory or inpatient visit. Demonstrate a positive attitude toward the provision of services to women of all ages and an understanding of the impact of socioeconomic status, lifestyle, and social support on patient well-being. Counsel patients regarding: (CPSP, DAPP, breast clinic) General health risk behavior Healthy diet and exercise Substance abuse Weight management Contraception Prevention of sexually transmitted infections Prevention of accidents in home and workplace Maintenance of dental health Psychosocial issues Cancer screening, specifically breast, cervical, and colon Understand and perform the following procedures (SACC clinic/Medicine rotation) Arterial blood gas measurement Complete physical examination Electrocardiogram External auditory canal and tympanic membrane examination Fecal occult blood testing Basic fundoscopy of the eye Insertion/removal of intrauterine device Insertion and removal of implantable steroid contraception FEV-1 determination Fitting of diaphragm and cervical cap Pulse oximetry Skin biopsy Visual field testing using standard eye chart PRECONCEPTIONAL CARE (CPSP) Perform a thorough history assessing historical and ongoing risks that may affect a future pregnancy. Counsel a patient regarding appropriate lifestyle modifications conducive to favorable pregnancy outcome. Counsel a patient regarding appropriate preconception evaluation. PRENATAL CARE (CPSP/DAPP) Perform a comprehensive history and physical examination. Order and interpret routine laboratory tests and those based on risk factors during pregnancy. Counsel patients regarding lifestyle modifications that improve pregnancy outcome, including activity, employment, nutrition, travel, and substance use. Counsel patients regarding warning signs of adverse pregnancy events. Schedule and perform appropriate antepartum follow-up visits for routine and high-risk obstetric care. Counsel patients about appropriate immunizations during pregnancy Counsel patients about the benefits of breastfeeding. DIABETES MELLITUS (CPSP/DAPP) Interpret screening tests for gestational diabetes. Manage gestational and pregestational diabetes in the antepartum, intrapartum and postpartum period. DISEASES OF THE URINARY SYSTEM (CPSP/DAPP) Evaluate signs and symptoms of urinary tract pathology in pregnant patients. Interpret the results of common diagnostic tests for renal disease in pregnancy. INFECTIOUS DISEASES (CPSP/DAPP) Perform a focused history and physical examination in pregnant patients who have a known or suspected infectious disease. Choose and perform laboratory tests to confirm the diagnosis of infection. PSYCHIATRIC DISORDERS