Ryan Residency Training Program Didactic Curriculum 2025-2027 – Helen Pymar

In 2025/2026, there will be some changes to the curriculum.

PGY1 ultrasound rotation will no longer have time in fetal assessment unit.  We will therefore have more time in PGY1 to focus on manual uterine aspiration (2 completed EPA assessments in the Roulston room). You will be need to provide this skill for management of early pregnancy loss and retained products in the emergency department.  We will be re-making this the Ultrasound/MUA skills Ryan rotation and expect you to complete the assigned curriculum in PGY1  and complete a summary of the number of ultrasound assessments and contraception and suction dilatation and curettage procedures you have performed.  The main expectations of this rotation are to determine oligohydramnios, estimate gestational age and presence of multiple gestation in the first and second trimester, determine viability and measure heart rate using M- mode, determine fetal presentation in the third trimester, define and diagnose definite intrauterine pregnancy, and when a diagnostic imaging ultrasound is recommended to assess for ectopic pregnancy and basics of gynecology (free fluid, adenomyosis, fibroids, and ovarian masses that are likely to be benign or requiring ultrasound follow up).

This didactic curriculum has many modules but for the purposes of the rotation, you will be expected to complete Pre and Post Quiz for modules 3 (focus on first trimester abortion for reading), 4 (focus on  first trimester abortion), and 5 (early pregnancy loss).  Module 6- contraception is something you can do on your own in the future and the other modules are optional

Please download the CDC contraception 2024 app and be prepared to use it and please go to the following websites so you know where to find them:

www.reproductiveaccess.org  This site has information and handouts in multiple languages related to contraception, miscarriage and abortion.  There is a great resource under miscarriage on what is needed to complete an ultrasound for pregnancy assessment.

www.itsaplan.ca  This SOGC website asks patients questions about the birth control method they want and makes suggestions

www.sexandu.ca/itsmychoice  This SOGC website helps patients to decide about medication abortion vs procedural abortion for unwanted pregnancy

www.gov.mb.ca/health/pharmacare/mepp.html  This tells you what contraception is covered by people who have a valid Manitoba health card.

Please complete the following ISUOG modules related to ultrasound:

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.

The PGY2 Ryan rotation will happen for the PGY2 residents in 2025/26 with the exception of one resident who may do the rotation as a PGY3 because it was not possible to arrange during the PGY2 rotation.  For this rotation, please focus on completing your summary of diagnostic assessments and procedures, and complete the modules including Pre and Post Quiz for modules 3, 4, 5 and 6.

After that time, there will be an elective rotation in PGY2 to 5 available for those who want to expand their skills in Contraception and Abortion Provision which would happen at a time when there is not a resident doing the ultrasound rotation/Ryan rotation. If you wish to perform D&E in the future, I would recommend you do this rotation in your last 2 years.

Both rotations will have SIM sessions- it is very helpful for you to learn crown rump length and BPD for determining gestational age and you are welcome to explore if you have time to do more with what interests you.  Check out the new case studies if you have time. 

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.  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)

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, oddly entitled “Imaging of the uterus in the sagittal plane.”

1. Transabdominal Emergency Medicine US 

Look for trauma fluid in pouch of douglas FAST TA 1.5

TAS core obstetrics fetal lie TAS –CS105

For endovaginal options if you have time, check out
Core gyne uterus normal

1.1 TV uterus normal

1.3 TV uterus IUD

1.6 diffuse adenomyosis and fibroid

2.1 TV ovarian cystadenoma

2.2 TV ovary hemorrhagic cyst

2.4 TV uterus fibroid

2.5 TV uterus fibroid with saline infusion

TV case learning obstetrics early pregnancy

1.1 early pregnancy 8 weeks

1.3 empty gestational sac

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 RYAN (PGY2) 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.

Module 2- consider if the american and global content applies to you.  For Canadian numbers check out cihi.

I would ask that you focus on and complete modules 3 to 6 first and complete the pre and post quizzes at a minimum and then spend time on module 1,2 if you have time.

Due date will be at the end of the rotation, but I will leave it open so you can access whenever you want for at least a year.  Contact me if you want updated ones in the future.

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 3 to 6- These are required to complete your rotation and should be completed by the exit interview on your last Wednesday along with the summary of the cases you have completed – eg number of medication abortion, ultrasound, etc.