The mainstay of the academic training is our core didactic program, which is based on the CREOG learning objectives and is designed with attention to adult learning principles. This includes weekly Grand Rounds at both parent institutions, faculty led didactics, Obstetrics and Gynecology simulation activities, journal club, Morbidity and Mortality and Multi-disciplinary Cancer Conferences. Residents have protected didactic learning time on Wednesdays from 7:30 AM to 1:00 PM at BWH, and on Thursdays from 7:30 AM to 9:30 AM at MGH. Annual didactics include participation in the Obstetric Simulator, epidemiology and statistics course, IUD training, Intern Boot Camp and hysteroscopy/ laparoscopy workshops. The core didactic lecture series and overall program curriculum is based on the Educational Objectives outlined by CREOG and core topics rotate every one-two years to facilitate resident exposure during their residency tenure. In addition to general obstetrics/gynecology, surgical simulation, primary care and subspecialty topics, our core didactics also cover the ACGME's competency based curriculum including professionalism, communication skills, billing/coding, medical documentation, ethics, patient safety, medical student teaching, risk management and professional liability.
Correlation of several key workshops and lectures during this protected didactic time at both parent institutions is also made, in order to maximally expose residents to critical topics (e.g. Effects of Sleep Deprivation in the workplace, Communication with Difficult Patients, Laparoscopy and Hysteroscopy workshops). Lecturers will often travel to both institutions within a given rotation to present these core topics. Residents rotating at Newton-Wellesley Hospital, Children's Hospital Boston, and South Shore Hospital return to BWH to participate in the Wednesday protected didactic time. We maintain a library at BWH of videotaped Grand Round lectures that residents have access to at all times.
"Board rounds" on Labor and Delivery occur at both institutions twice daily. These are attended by OBGYN generalist faculty, perinatologists, midwives, residents and medical students. In addition to formal board rounds, interdisciplinary rounds occur twice daily on the L&D units at both BWH and MGH, which include nurses, anesthesiologists and pediatricians. During interdisciplinary rounds, every patient on labor and delivery is discussed among all teams to provide consensus about patient care. Didactic instruction is provided in these rounds as well as in weekly resident lectures, Chief's Rounds (Wednesdays at noon) and Grand Rounds. The PGY 4 is responsible for the weekly Chief's Rounds, which is a presentation to the Department of Ob/Gyn of the weekly statistics from the labor floor, with an evidence-based review of management of complicated and interesting cases. Simulation activities during didactic time include repair of 3rd and 4th degree lacerations, knot tying and suturing, operative vaginal deliveries (forceps and vacuums), vaginal breech deliveries, pudendal blocks, circumcision and surgical management of postpartum hemorrhage. Residents participate in shoulder dystocia skills workshops occurring during didactics and on labor and delivery utilizing a mannequin, and receive immediate feedback on performance.
High Risk Obstetrics
Rounds occur daily on the antenatal service where patients are reviewed with the attending perinatologists and formal care plans are made. Residents attend a weekly Maternal-Fetal Medicine teaching conference (BWH Thursday Noon) and Special OB Rounds of all charts and lab results of "active" patients occurs weekly (BWH Tuesday Noon). The PGY3 resident on the high-risk (Fuller) service is responsible for presenting Morbidity and Mortality conference from their block. A series of weekly didactic lectures provided by Maternal-Fetal Medicine attendings follow the CREOG Objectives for Obstetrics. Each month at MGH, there is an Obstetrics Case Conference presented by the PGY1 on OB, which highlights the management of medically complicated patients with critical literature review and discussion.
Formal obstetrical ultrasound training begins in the first year, where PGY1 residents have the opportunity to participate in OB ultrasound at MGH under the supervision of attending OB faculty one half-day per week. Residents learn the components of basic structural surveys, fetal biometry, biophysical profiles and placental abnormalities in a one-on-one hands-on setting.
Interactive hands-on obstetrical ultrasound training also occurs weekly during BWH protected didactics time. Under the supervision of a perinatologist who works in the AIUM-certified BWH antepartum facility, 3 residents from the OB and Fuller (MFM) rotations learn biophysical profiles, fetal biometry, placental abnormalities and basic structural surveys, as well as the basic physics of ultrasound equipment including probe choice, depth of presentation, gain, M-mode and resolution. This provides for ongoing, small-group formal instruction in obstetrical ultrasound throughout training; in addition, residents regularly perform ultrasound during L&D rotations under the supervision of senior residents and attending faculty.
The residents rotating on the Fuller (MFM) service perform appropriate amniocenteses and ultrasounds on the patients on their service. At BWH and MGH, Board certified Maternal-Fetal Medicine specialists perform all obstetrical ultrasounds in an AIUM certified antenatal diagnostic unit. In the PGY 2 and 3 year, residents rotate in the BWH unit, fine-tuning their skills and participating in the patient counseling. The PGY 2 resident on the Community Gynecology rotation spends time in MFM office hours and on the consult service, providing further exposure to ultrasound and genetics counseling. Residents perform vaginal probe ultrasound formally during the Family Planning (PGY 2), MGH GYN Junior (PGY 2), MGH Clinic Senior (PGY 3), NWH (PGY 3), Special Chief (PGY 4) and Jeopardy (PGY 4) rotations, under the supervision of board certified Reproductive Endocrinologists, as well as during GYN and OB ambulatory clinics under the supervision of the clinic-assigned faculty with a dedicated resident transvaginal US machine.
Ultrasound principles are incorporated in case conferences, as well as during protected didactic time. Each year we have a "summer ultrasound series" during Wednesday didactics, with MFM and radiology faculty to enhance resident exposure to these topics and training early in the academic year, and to supplement the hands-on training that is ongoing.
Didactic experiences include CREOG based lectures during protected didactic time; teaching rounds every morning, GYN case conference teaching rounds ("11500 conference" at BWH) and resident GYN case presentations (at MGH). These case-based conferences involve an evidence-based discussion of management of gynecologic issues that have arisen during the team's rotation. Residents are involved in the decision-making process for surgery and preoperative workup of all gyn continuity patients requiring surgery. These cases are brought to the ward
To enhance surgical training in endoscopy, the Reproductive Endocrinology division developed basic hysteroscopy and laparoscopy workshops, which were implemented in 2006 at both institutions and occur each summer. Residents are expected to participate in these courses at least once during their training. A comprehensive surgical simulation curriculum was introduced in 2007 that provides simulation based activities for each year of training. Surgical simulation exercises occur during protected didactic time at BWH’s STRATUS Patient Simulation Center http://www.brighamandwomens.org/stratus/ and includes laparoscopy skills lab, suturing, knot tying, and hysteroscopy. The STRATUS Center features two full-scale computer controlled patient simulation systems, a 17-station interactive computer simulation lab, and an advanced skills laboratory. Our surgical simulation curriculum is based on the Fundamentals of Laparoscopic Surgery (FLS) Program and requires the residents to be credentialed in the basic laparoscopic skills prior to graduation. Residents have access to the “Laparoscopy Arcade” 24 hours a day which has state-of-the-art laparoscopic simulators to practice basic skills, procedures and ob/gyn surgeries.
Rounds occur twice daily with fellows and/or faculty, and residents attend all educational conferences throughout the oncology rotation including weekly Tumor Board at MGH and Multidisciplinary Cancer Conference and Pathology Conference at BWH. At MGH, combined rounds occur each Tuesday morning with the GYN Oncology and benign Gynecology teams, with didactic learning occurring during that time. Additional GYN Oncology lectures occur on a weekly basis during protected Wednesday didactic time at BWH that follow the oncology topics based on the Educational Objectives outlined by CREOG.
Reproductive Endocrinology and Infertility
REI topics including pediatric and adolescent gynecology as outlined by CREOG are also discussed approximately once/month during protected Wednesday didactic time. During the REI rotation, residents attend IVF cycle review conference every week, a multi-disciplinary meeting attended by CRM/REI faculty, embryologists and nurses during which IVF cycles are reviewed and management plans are discussed. Residents also attend the Tuesday afternoon REI conference/journal club. The PGY 2 is responsible for giving one journal club at this conference during the rotation. Once per month, there is a CRM/REI ethics meeting to discuss challenging cases and ethical dilemmas in the treatment of the infertile patient. This conference is attended by CRM/REI faculty, the director of IRB, CRM nurses, embryologist, and social workers.
Residents are exposed to both gynecologic and obstetrical pathology during case conferences and grand rounds at both parent institutions occurring during protected didactics time. Additionally, the Multidisciplinary Cancer Conference occurs weekly during Wednesday protected time to provide for interactive, case-based pathology reviews. Residents participate in Tumor Board conferences at each institution during the oncology rotations.
Genetics topics are regularly included in Grand Rounds, case conferences in obstetrics, Gynecology and GYN Oncology, and during protected didactic time. The perinatologists teach genetic principles as they relate to birth defects and heritable disorders. Residents attend genetic counseling sessions with genetic counselors during the BWH PGY 2 OB rotation as well.
In accordance with the increasing importance of genomics, a didactic curriculum based on the supplemental objectives outlined by CREOG was created with the Director of Prenatal Genetics. This one-year course commenced January 2007, occurring every 6-8 weeks during Wednesday protected didactics time at BWH, and covering basic science and clinically relevant genetics principles as they relate to both obstetrics and gynecology.
Urinary Incontinence and Pelvic Floor Dysfunction
Lectures in core urogynecology topics occur approximately every six weeks during protected didactic time that emphasize the various diagnostic and therapeutic modalities for patients with urogynecologic disorders.
Basic Medical Epidemiology and Statistics
Residents receive teaching in basic epidemiology and statistics through lectures, journal club, and resident research projects. This is taught by biostatisticians in the department during protected Wednesday didactic time. This course provides for a small-group, interactive forum through which residents learn the basic principals of research methods and design, power analysis, and basic epidemiology. It is often immediately followed by journal club, whereby residents critique an article with an invited faculty member to facilitate the discussion, with the primary goal of learning the critical assessment of a study.
Family Planning and Abortions
Each year during protected didactic time, an IUD workshop reviews the principles and mechanism of action of the IUD, followed by insertion and removal workshop on plastic models of both Paragard and Mirena IUD's. Training sessions on Nexplanon use/insertion have also been arranged during the didactic times at both BWH and MGH. Lectures on abortion techniques and complications, as well as contraception, occur on a rotational basis throughout the Wednesday protected didactics time.