Ryan Residency Training Curriculum (PGY 3 Updated)

University of Maryland

FAMILY PLANNING – R-3

Welcome to your Family Planning rotation! Please read below on our learning objectives and some important readings for this rotation.

Extra Reading regarding later abortion that may help you process some of our later abortion care:

1. Thinking about and Processing Later Abortion: Second Trimester Abortion Provision: Breaking the Silence and Changing the Discourse

Educational Purpose:

Provide exposure to all aspects of family planning including contraception and elective pregnancy termination

 Rotation Director:

Dr. Jessica Lee, jklee@som.umaryland.edu

Ryan Family Planning Residency Program Director

University of Maryland School of Medicine

Length of Rotation:  3 weeks

Supervision: 

Residents work directly with faculty including attending physicians and nurse practitioner in the family planning clinic. Residents are directly supervised by faculty in performance of pregnancy terminations and miscarriage management.

Educational Objectives:

Patient Care & Medical Knowledge – Abortion/Miscarriage management

1. Counsel patients with complex medical history regarding all options for an unplanned pregnancy
2. Become proficient at evaluation of gestational age by bimanual examination.
3. Gain transabdominal and transvaginal ultrasound skills to determine 1^st and 2^nd trimester gestational age, placental location, completed medical abortion, and location of abnormal pregnancies (including ectopic pregnancy).
4. Gain familiarity with use of conscious sedation in an outpatient setting.
5. Develop competency in first trimester and early second trimester uterine evacuation.
   1. *Residents with religious or ethical objections to performing pregnancy terminations will not be required to perform the procedure but will be expected to become familiar with the process and be able to manage potential complications.
6. Performs surgical uterine evacuation on patients with complex comorbidities and manages complications.
7. Gain competency for evidence-based labor induction management.
8. Independently identify and manage complex peri-procedural risks and complications for medical and surgical abortion in the 2^nd
9. Manages any family planning consultations (including coordination of care) requiring intervention, including procedural options.

Patient Care & Medical Knowledge – Contraception

1. Develop understanding of appropriate contraceptive options for women with coexisting medical conditions.
2. Implements comprehensive management plans for patients with complex medical conditions complicating their use of contraceptive methods

Interpersonal and Communication skills

1. Establishes a therapeutic relationship in challenging encounters (e.g. shared decision-making).
2. When prompted reflects on personal biases while attempting to minimize communication barriers.
3. Counsel patient through decision-making process, including responding to questions, for complex clinical problems.
4. Integrates contributions from interprofessional team members into the team plan.
5. Communicates clearly, concisely, on time, and in an organized written form.

Professionalism

1. Demonstrates profesional behavior in complex or stressful situations.
2. Recognizes the need to seek help in managing and resolving complex ethical situations.
3. Performs tasks and responsibilities in a timely manner in complex and stressful situations.

Practice-based learning improvement

1. Maintain a willingness to learn from errors.
2. Appraise and assimilate evidence from scientific studies related to their patients’ health problems.
3. Master technology to manage information for patient care and self-improvement.
4. Be evaluated by medical students and faculty.

System-based practice

1. Anticipate problems patients/care givers may face in negotiating the health care system and advocate on the patient’s behalf.
2. Participates in analysis of patient safety events.
3. Participates in disclosure of patient safety events to patients and their families.
4. Coordinates care of patients in complex clinical situations- effectively uses the roles of all team members.
5. Performs safe and effective transitions of care/hand-offs in complex clinical situations.

Resident Responsibilities:

1. Read assigned literature and participate in weekly didactic sessions.
2. Keep log of procedures. (including procedure, ultrasound, osmotic dilator and IUD/Implant logs). Make sure you log as appropriate to ACGME website.
3. Complete all assigned tasks, including oral examination (during 3^rd week), prior to completion of the 3-week rotation.
   1. Resident must complete all necessary evaluations, including medical student evaluations.

The team consists of a third year resident, attending, and nurse practitioner.  Continuity clinic should be attended as assigned.

Daily Schedule:

Monday

AM:    Penn Street Continuity Clinic *day of the week subject to change for continuity clinic*

PM:        Work-ups UMRH

Tuesday

AM:       Procedures UMRH

PM:        Procedures UMRH, didactics with Dr. Lee

Wednesday

AM:    Work-ups UMRH

PM:        Work-ups UMRH

Thursday

AM:        7:30 GYN conference , then procedures UMRH (you are not expected at UMRH until 8:15am given you are attending GYN conference)

PM:        Procedures UMRH

Friday

AM:        Protected didactic time

PM:        VA GYN clinic as needed/ research time

Evaluation:

1. Based on direct observation of clinical care
2. CREOG examination
3. Global evaluation – Assessing six competencies: Patient Care; Medical Knowledge; Practice-based Learning and Improvement; Interpersonal and Communication Skills; Professionalism; Systems-based Practice. Completed by attending physicians based on personal contact.
4. Oral examination with Dr. Lee in 3^rd week of rotation.
5. At the completion of your rotation, you will be asked to complete an anonymous survey for the Ryan program. You must complete it for full credit for your rotation. Link provided at end of last Module.