The PGY-3 on the gynecology service should learn to perform total laparoscopic hysterectomies, perform more extensive adhesiolysis by either laparotomy or laparoscopy, perform excision of large adnexal masses by either laparotomy or laparoscopy, perform diagnostic and operative hysteroscopy, and perform cystoscopy and placement of ureteral stents.
The PGY-4, in addition to gaining confidence in all of the above arenas, should learn to perform difficult vaginal hysterectomies, perform difficult myomectomies, perform pelvic support procedures--including sacrocolpopexy, paravaginal repair, sacrospinous ligament suspension and anterior posterior repair, and perform advanced laparoscopic procedures, including lysis of more extensive adhesions, treatment of endometriosis (including endometriomas) and difficult laparoscopic hysterectomies.
The midlevel REI rotation (eight weeks) is split between the second and third years. Midlevels (PGY-2 and 3’s) are introduced to reproductive endocrinology, infertility evaluation and treatment, and hysteroscopy and laparoscopy. Midlevel residents learn vaginal ultrasonography (follicular and early pregnancy ultrasounds) and hysterosalpingography by conducting these tests under the guidance of faculty. Clinical reproductive endocrinology and infertility is learned by shadowing faculty, caring for patients in the resident REI clinic under the guidance of the faculty, reading assignments, and a didactic course (lectures twice weekly). Midlevel residents cover the outpatient surgical cases including hysteroscopy (diagnostic and operative) and laparoscopy (diagnostic and operative) occurring weekly. Midlevels also observe assisted reproductive technologies (in vitro fertilization). Midlevels do a brief presentation on a topic of their choice at the conclusion of their rotation.
Fourth-year residents have an eight-week rotation that allows further exposure to reproductive endocrinology and infertility. As chief of the service they are responsible for assuring care of the complex REI patients. The chiefs continue their training by conducting morning follicle scans, shadowing faculty, participating in the resident REI clinic, and completing assigned readings and the didactic course. Chief residents cover the inpatient surgical cases (e.g. abdominal myomectomy) and complex laparoscopy and hysteroscopy. PGY-4 residents present an article at the REI journal clubs during their rotation.
Learning objectives for the midlevel and fourth year residents are studied, discussed and completed by the end of each rotation.