The PGY-4 Resident on the Benign GYN service will perform hysterectomies across all across routes of access from vaginal to laparoscopic to robotic to open abdominal. The PGY-4 Resident will 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.
The PGY-4, in addition to gaining confidence in all of the above areas, will gain experience in performing difficult vaginal hysterectomies, difficult myomectomies, pelvic support procedures, and advanced laparoscopic procedures, including lysis of more extensive adhesions and surgical treatment of endometriosis (including endometriomas).
The complex family planning rotation during the PGY2 year exposes residents to the full breadth of reproductive health care. Residents learn not only specific clinical, procedural and surgical skills, but also the importance of a patient-centered approach to care. We recognize that learners come to this care with a wide variety of backgrounds and beliefs and support engaged learning to fit their needs.
- Full scope contraceptive counseling and management (patient-centered care, postpartum and post-abortion contraception, contraceptive use in medically complex patients)
- Medication abortion
- Patient centered miscarriage management
- Disparities in reproductive health
- Ultrasound skills (pregnancy dating, diagnosis of early pregnancy loss, intraoperative guidance)
- Complex LARC management (implant removal with ultrasound, challenging IUD removals)
- First & second trimester surgical abortion
- Office-based procedures and sedation
- Surgical sterilization
The PGY-3 Resident will accomplish all that is outlined for the PGY-1 Resident and will also be well experienced in the techniques of evaluation of abnormal pap smears to include colposcopy, biopsies, cryosurgery, laser therapy, and LEEP procedures. The PGY-3 Resident will achieve competency with hysterectomies across routes from open abdominal to minimally invasive (laparoscopic and robotioc). The PGY-3 Resident will be very familiar with the retroperitoneal space. The PGY-3 Resident will be able to serve as a first assistant for radical procedures such as radical hysterectomy and groin node dissections.
The PGY-4 Resident will accomplish all that is expected of the PGY-1 and PGY3 Residents, will be very familiar with pelvic node dissections, will be able to perform paracentesis and thoracentesis, will be familiar with bowel techniques such as resection and bypass, will be able to accomplish repair of bladder injuries and enterotomies.
The PGY-1 and PGY-2 residents on the Obstetrics Rotation at UNC Hospitals and the PGY-1, PGY-2, and PGY-3 Residents at WakeMed are expected to achieve competency in performing an initial history and physical on patients who present with suspected labor. The PGY-1 and PGY-2 residents will be able to detect evidence of preeclampsia, abruptio placentae, and malpresentation of the fetus. She/he should be skilled in formulating a plan and writing appropriate orders for patients with diabetes, hyperemesis gravidium, and hypertensive disorders of pregnancy. The PGY-1 and PGY-2 Residents will become adept in the antepartum and intrapartum management of the normal course of labor and delivery including the interpretation of electronic fetal heart rate monitoring. In regard to operative procedures, the PGY-1 and PGY-2 Residents will be able to perform third trimester amniocentesis, repair of episiotomies and perineal lacerations, abdominal tubal ligations, circumcisions, and the performance of primary and repeat cesarean sections.
During a separate one-month rotation on obstetrical ultrasound, the PGY-1 is expected to be able to obtain the standard obstetric fetal growth parameters. In addition, she/he should be able to determine placental location, amniotic fluid volume, and fetal lie. Finally, the PGY-1 should become skilled in the basic anatomical survey of the fetus.
The PGY-3 Resident on the OB service will accomplish all objectives expected of the PGY-1 and PGY-2 Residents in addition to being able to supervise the clinical activities of the PGY-1 and PGY-2 Residents. The PGY-3 Resident will be accomplished in the diagnosis of complications of pregnancy such as severe preeclampsia, eclampsia, both pregestational and gestational diabetes, and hematologic problems in pregnancy. She/he will be able to diagnose abruption, amniotic fluid embolism, and fetal distress. In regard to operative procedures, the PGY-3 Resident will be proficient in the performance of repeat cesarean sections, vaginal breech deliveries, and outlet-, low- and mid- forceps deliveries, vacuum extraction deliveries as well as cervical cerclage procedures. The PGY-3 Resident will become experienced with the intensive care of the seriously ill obstetric patient secondary to complications of preeclampsia, diabetes and chronic renal failure.
The PGY-4 Chief Resident is the leader and the team captain for all activities during the Obstetrics rotations. This PGY-4 Resident is responsible for the supervision of all patients being actively managed in the labor and delivery area as well as all inpatients on both the antepartum and postpartum wards. The PGY-4 Resident makes assignments for teaching rounds, schedules all surgeries, performs cesarean deliveries and other complicated obstetrics procedures under the supervision of the attending physician. She/he will be familiar with all complications of pregnancy and be able to formulate effective treatment plans. The PGY-4 Resident will be able to direct the PGY-3, PGY-2 and the PGY-1 Residents in developing a team concept of management for these complications. The PGY-4 Resident will co-manage the PGY-3 Resident in the intensive care of the seriously ill obstetric patient secondary to complications of preeclampsia, diabetes and chronic renal failure. She/he will understand and instruct the PGY-1, PGY-2, and PGY-3 Residents in standard protocols for the management of such obstetrical emergencies as shoulder dystocia, amniotic fluid embolism and postpartum hemorrhage. The PGY-4 Resident will also be proficient in the ultrasonographic recognition of fetal anomalies including, among others, ventral wall defects and neural tube defects.
The PGY-4 Resident on service will further develop skills with vaginal ultrasonography (follicular and early pregnancy ultrasounds) and hysterosalpingography by conducting these tests under the guidance of faculty. The rotation for the PGY-4 rotation allows further exposure to the full depth and breadth of clinical reproductive endocrinology and infertility practice. As Chief of the service, the PGY-4 Resident will be responsible for assuring care of the complex REI patients. The PGY-4 Resident will continue their training by conducting morning follicle scans, shadowing faculty, actively caring for patients in the outpatient setting, and completing assigned readings and the didactics. The PGY-4 Resident will perform the inpatient surgical cases including complex laparoscopic and hysteroscopic procedures.
The use of and indications for 2d, 3D and 4D grey scale and color doppler as well as transvaginal and transabdominal ultrasound and the limitations of ultrasound.
The use and indications for ultrasound to diagnose the location and viability of early pregnancies
Understanding the determination of gestational age through measurement of fetal morphometrics
Understanding of the limitations of ultrasound in the assignment of gestational age
Evaluate for abnormal fetal growth using morphometrics and umbilical artery doppler measurements.
Evaluate fetal well-being through the use of biophysical profile and umbilical artery dopplers.
Recognize normal fetal anatomy and major malformations on ultrasound:
Intracranial: Acrania, anenecephaly, hydrocephalus, Dandy walker malformation
Cardiac: abnormal situs, arrhythmias
Gastrointestinal – omphalocele, gastroschisis, duodenal atresia
Genitourinary – renal pelvic dilation, hydronephrosis, renal agenesis, multicystic kidney, polycystic kidney
The use of ultrasound in risk adjustment for fetal aneuploidy in the first and second/third trimester
The PGY1 Resident also obtains knowledge and skills in Transvaginal Ultrasound during their 7-week Reproductive & Endocrinology Rotation.
All Residents hone their knowledge and skills in ultrasound participating in longitudinal experiences throughout the 4-year curriculum