A project of the Bixby Center for Global Reproductive Health

Ryan Residency Training Program Didactic Curriculum (PGY 2 Updated)

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Welcome to your Family Planning Rotation at UMMC!

Please see our course objectives, expectations and schedule layout as below.

A reminder that your continuity clinic is on Monday mornings and on Fridays UMRH is closed.

During this rotation you will have self-directed learning via this website’s videos (less than 90 mins for each module), readings (optional but please engage with them), and quizzes (required) as well formal didactics with Dr. Lee/FP attending on Wednesdays generally. You can always do these modules earlier than they are due.

You will be evaluated by UMRH attendings as well as CRNP Gracie Nichols.

We hope you get a lot out of your rotation with us and never hesitate to contact Ryan Program Director Dr. Lee (jklee@som.umaryland.edu) with any questions or concerns.

 

FAMILY PLANNING – R-2

Educational Purpose:

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

Rotation Director:

Dr. Jessica Lee

Ryan Family Planning Residency Program Director

University of Maryland School of Medicine

 

Length of Rotation:  3 weeks

 

Supervision: 

Residents work directly with 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. Perform a thorough Ob/Gyn history, including menstrual, obstetric, gynecologic, contraceptive and sexual history. Elicit any medical history that may complicate pregnancy or abortion.
  2. Counsel patients regarding all options for an unplanned pregnancy and early pregnancy loss.
  3. Understand indications for 1st and 2nd trimester termination of pregnancy.
  4. Gain familiarity with medical abortion, including contraindications, medications used, and postoperative management.
  5. Develop competency in first trimester uterine evacuation and gain familiarity with 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. Gain familiarity with post-abortion contraceptive options, including intrauterine contraception and subdermal implants.
  7. Understand and develop competency in management of possible complications of medical and surgical abortion in the 1st
  8. Independently identify and manage common peri-procedural risks and complications for uterine evacuation.

Patient Care & Medical Knowledge – Contraception

  1. Describe the mechanisms of action of hormonal and non-hormonal contraception.
  2. Understand the difference between efficacy and effectiveness.
  3. Understand and describe the advantages, disadvantages, contraindications, failure rates, complications and appropriate follow-up associated with the following methods of contraception in low-risk patients:
    1. Surgical sterilization (trans-abdominal and transcervical)
    2. Combined-oral contraception
    3. Progestin-only oral contraception
    4. Transdermal contraception
    5. Vaginal contraception
    6. Injectable contraception
    7. Intrauterine contraceptives
    8. Subdermal implants
    9. Barrier methods
    10. Natural family planning

Interpersonal and Communication skills

  1. Demonstrate the ability to create and maintain a therapeutic relationship with patients and families.
  2. Counsel patients through the decision-making process, including responding to questions, for simple clinical problems.
  3. Communicate effectively and respectfully with other members of the health care team.
  4. Identify barriers to effective communication (e.g. health literacy, cultural differences).
  5. Concisely reports diagnostic and therapeutic reasoning in the patient record in an efficient manner.

Professionalism

  1. Demonstrate respect, compassion, integrity, honesty.
  2. Teach/role model responsible behavior.
  3. Exhibit total commitment to self-assessment.
  4. Acknowledge errors.
  5. Act as an educator to medical students.

 

Practice-based learning improvement

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

System-based practice

  1. Demonstrate commitment to the practice of cost-effective medical care.
  2. Recognize problems patients/care givers may face in negotiating the health care system and advocate on the patient’s behalf.
  3. Identify and work with other health care professionals and organizations that may assist in a patient’s care.
  4. Function as the coordinator of a health-care team to manage patient issues.

 

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 3rd 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 second 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)

PM:       Work-ups UMRH

Tuesday

AM:       Procedures UMRH

PM:        Procedures UMRH

Wednesday

AM:       Work-ups UMRH; formal didactics with Dr. Lee

PM:       Work-ups UMRH

Thursday

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

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 3rd 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 is here.

Demonstrated Competency

R2-specific goals summary:

    1. Ultrasound for assessment of gestational age
    2. Comprehensive family planning options counseling
    3. Contraceptive counseling
    4. 1st Trimester uterine evacuation
    5. Medical abortion counseling
    6. IUD insertion
    7. Subdermal contraceptive implant insertion

**I recommend you watch this video before the start of the rotation, it will help you understand our D&C procedures:

https://vimeo.com/album/3395660/video/127882643
Passcode: outpatientEPL2015 

**Please read before starting the rotation or in the first few days of the rotation to help set you up for success on the rotation**

  1. Medical evaluation and management Ch 7
  2. First trimester aspiration abortion Ch 10
  3. Dilation and evacuation Ch 11
  4. An Overview of Maryland Abortion Law – Maryland Abortion and Reproductive Clinical Health Training Program

Course Content

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