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

In PGY1 in the roulston room we will focus on electric and 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.  Make sure you have the form to complete a summary of the number of ultrasound assessments and contraception and suction dilatation and curettage procedures you have performed and for what indication.  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.

After that time, there will be an elective rotation in PGY4- 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/Ryan rotation. If you wish to perform D&E in the future, it would be important to return at that time to get your cases preceptored.

SIM sessions are 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.”

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