Ryan Residency Training Program Didactic Curriculum 2023-2024 – Helen Pymar

Welcome to the didactic curriculum for Ultrasound and REC rotations that you will take in PGY1 and PGY2, respectively.  In your ultrasound rotation, your focus will be on ultrasound in obstetrics and gynecology but you will start to see patients who wish to discuss contraception.  In your REC rotation, you will consolidate early pregnancy complication diagnosis and management, medication and surgical/procedural abortion management for pregnancy loss and unwanted pregnancy, giving bad news, discussion of contraception options without coercion in patients with medical complications, and LARC provision.

I have 5 exciting new videos relating to early pregnancy loss, medication abortion, MUA and some extra links:

https://umanitoba.yuja.com/V/Video?v=1150799&node=6387577&a=69540217

https://umanitoba.yuja.com/V/Video?v=1150802&node=6387581&a=64523900

https://umanitoba.yuja.com/V/Video?v=1186995&node=6516887&a=34086244

https://umanitoba.yuja.com/V/Video?v=1150803&node=6387585&a=9337793

Society of Family Planning Clinical Recommendation_ Management of undesired pregnancy of unknown location and abortion at less than 42 days of gestation

Stream  medication abortion video

If you are doing the Ultrasound rotation, please focus on modules 4 and 5 which review early pregnancy loss and medication abortion  Please review the sogc guidelines (PDF when you google) for contraception and induced abortion during the pandemic (focus specifically on medical abortion during the pandemic), and SOGC guideline on PUL and ectopic pregnancy.  Please complete the following ISUOG modules:

Lecture 1

http://www.isuog.org/resource/lecture-1-the-physical-principles-of-ultrasound-imaging-including-safety.html

Lecture 2

http://www.isuog.org/resource/lecture-2-transducers-image-production-knobology-scanning-planes.html

Lecture 6 the six step approach

http://www.isuog.org/resource/lecture-9-the-6-steps-approach.html

Lecture Number 25= gynecology ultrasound the basics

http://www.isuog.org/resource/lecture-25.html

Lecture 26 examining the cervix and myometrium

http://www.isuog.org/resource/lecture-26.html

Lecture 27 examining the uterus myometrium

http://www.isuog.org/resource/lecture-27.html

Lecture 29 adnexal pathology

http://www.isuog.org/resource/lecture-29.html

The following website has some similar options created by the american society of ultrasound you are welcome to review.

https://apps.aium.org/uls/lectures.htm.

elsewhere and the Abdominal ultrasound SIM modules listed:

Ultrasound Simulation Curriculum:  Recommended Modules    

Watch the Orientation Video located in “Menu” use the dropdown menu to find “Video Guide.”

In each module click “Learn” icon on the Menu screen and watch the “Guided Practice Video” under “Additional Learning Resources.”  After watching the video go back to the menu and click on “Practice” to complete the module.  I recommend moving on to the next item without taking the Test.  Take a screen shot of the completed module summary of results (including happy and sad faces).  Email to Dr Pymar and send out a C6 request with details to receive your Entrada CBD report for any SIM you want approved- max 2 sims for C6 allowable Don’t obsess about getting all happy faces.  Consider >50% happy faces in a model a “pass.”  We are looking for basic competency not perfection.

1. In “Skills Learning” make sure the “All” tab is open in order to see all available modules as you move from one to the next.
2. Transabdominal Obstetrical Ultrasound (Recommended to be completed before the end of US rotation)- should be proficient by end of Ryan rotation.

Core Obstetrics Measuring Fetal Growth (TAS-O-CS-103)

1. Confirming viability of a term fetus
2. Fetal Head (BPD, OFD and HC)
3. Transthalamic view
4. Fetal abdomen
5. Femur Length
6. Amniotic fluid
7. Placental localization

Core Obstetrics 20 weeks (TAS-O-CS-102)

1. Confirming Viability
2. Assessment of the Fetal Head
3. Assessment of the Fetal Abdomen
4. Examination of other structures (ie. femur length and placental localization)

Core Obstetrics 12 weeks (TAS-O-CS-101 2.1 + 2.2)

2.1  Assessment of the Fetus

2.2  Crown Rump Length

1. Transvaginal Obstetrical and Gynecological Ultrasound  Can start if time during ultrasound rotation- otherwise work on during Ryan rotation) 

Obstetrics: Core Skills Learning

TV Core Obstetrics without NT (TVS-O-CS-202)

1.1  Identification of the Uterus in the Sagittal and Coronal Planes

-orientation to the probe and how to obtain images of the pregnancy

1.2  Identification of the adnexae

-orientation of how to get views of the adnexae including a corpus luteum cyst

2.1  Assessment of Fetal Viability and Position

-number of fetuses, location of gestation and fetal heart, use of M Mode.

3.1  Measurement of the Crown Rump Length

-orientation on optimal view of the fetus and correct measurement techniques

-identification of basic fetal structures

Obstetrics: Advanced Skills Learning

Early Pregnancy (TVS-O-AS-105 1.1 and 1.2)

This module is very good for orienting the resident to the scan of a 6-7 week embryo.  Includes identification of the gestational sac, fetal pole and yolk sack.  Technique for measuring the diameters of the gestational sac is described in Module 1.2, oddlyentitled “Imaging of the uterus in the sagittal plane.”

1. Transabdominal Emergency Medicine US (to be completed by the end of the REC rotation) 

Core Skills Learning

TA Core Emergency Medicine FAST Examination (TAS-EM-CS-002 4.1)

4.1  FAST examination of the pelvic cavity (fluid present)

This is an EPA required by the RCPSC.  See above for how to get this C6 using SIM

THIS IS THE ONLY REQUIREMENT FOR THE ROTATIONS WITH SIM- THE REST IS FOR YOUR BENEFIT TO LEARN

Medical Expert

1. Demonstrates a working knowledge of the following:
2. Normal pelvic anatomy by ultrasound
3. Diagnostic criteria of spontaneous abortion and fetal demise
4. Diagnostic criteria of ectopic pregnancy and pregnancy of unknown location
5. Basic fetal anatomy and biometry.
6. Assess the following with endovaginal or transabdominal ultrasound (this may be a skill that is performed by the resident or the technical knowledge on how to perform the exam); complete as many U/S EPAs as possible on this rotation:

1. Endometrial thickness
2. Adnexal mass
3. Cervix, Endometrium, Myometrium and be aware of potential pathology
4. IUD location
5. Free fluid in the pelvis
6. Retained products of conception
7. Pregnancy location
8. Gestational age in trimester one
9. Fetal presentation
10. Placentation
11. Fetal heart rate
12. Fetal number
13. Amniotic fluid

FOR THE REC ROTATION< I will offer you all that the program offers.

Module 1- There are 3 sections in module 1 and they are super interesting and very relevant to your long term care of patients.

I would ask that you complete modules 2 to 6 first and complete the pre and post quizzes at a minimum and then spend time on module 1.

Module 2- consider if the American and global content applies to you.  For Canadian numbers, google cihi data to get the most recent numbers.  Note that Canadian numbers are likely underestimated since many patients who receive medication abortion are not counted.

Due date will be at the end of the rotation, but I will leave it open so you can access whenever you want.

Please note, this program was designed in the USA.  If there is conflicting information between this and SOGC, use SOGC guidelines for your exams. If SOGC has a guideline, you do not need to read the American guidelines unless you want to. The Canadian guidelines are used for your examinations.

THIS IS A LOT OF INFORMATION< PLEASE PAY ATTENTION TO WHAT IS REQUIRED AND ASK ME BEFORE YOU DO THE WORK IF IT SEEMS LIKE TOO MUCH>

In summary, for the REC rotation, please complete pre and post quizzes for modules 2 to 6- These are required to complete your rotation and should be completed by the exit interview on your last Wednesday.