1. Transition to Discipline
Excellence in the practice of obstetrics and gynecology requires a broad foundation in the principles of both medicine and surgery. Focused history taking, problem identification and information gathering are essential competencies. The first months of the residency are designed to promote excellence in these basic skills through collaboration with Internal Medicine, Acute Surgical Service, Emergency Medicine, Surgical Intensive Care and Ultrasound. On service rotations provide an introduction to in-patient and outpatient services in our discipline.
2. Foundations of Discipline
In this busy and exciting phase, the resident learning curve is steep. Competency is developed in the diagnosis and management of conditions commonly encountered in the practice of obstetrics and gynecology. The majority of rotations are spent in the fast-paced, tertiary hospital environment where the resident is immersed in a wide variety of clinical learning opportunities. The resident masters the essential surgical skills and perioperative care in cesarean section, operative vaginal delivery, laparotomy, laparoscopy and hysteroscopy. The resident develops the confidence to assess and manage common obstetrical emergencies such as obstructed labour, shoulder dystocia, cord prolapse, obstetrical hemorrhage, and malpresentation.
We have two tertiary care hospitals in Winnipeg, each providing rich clinical experience with over 11,000 deliveries per year. At least one attending physician is present on-site at all times to ensure that the resident us able to hone his/her skills with the guidance of an experienced clinician.
Many of the women we care for live in Northern communities. In order to better understand the issues of remote and under-resourced populations, our residents accompany one or more of our attending physicians on at least one rural/Northern trip to see consultations these communities. This experience occurs during a flexible month in which the resident is also expected to initiate his/her resident research project.
3. Core of Discipline
The resident expands and builds on the skills previously mastered. The 3-month Maternal Fetal Medicine rotation provides the resident with opportunities to manage high-risk antenatal patients and to master complex obstetrical skills. Obstetrical and gynecological ultrasound scanning skills become a useful adjunct to the resident’s toolkit. The blended rotation in Pediatric/Adolescent Gynecology and Menopause promotes clinical skill development in the ambulatory care setting. The one-month Family Planning rotation allows the resident to acquire skills in pregnancy termination and transvaginal ultrasound scanning. Research time is built into the curriculum with the expectation that the resident will substantially complete his/her research projects.
The curriculum is designed to promote mastery of complex surgical skills. including laparoscopic surgery, vaginal surgery and surgery for malignancy. Reproductive Endocrinology and Minimal Invasive Surgery are developed in the REI rotation by involving the resident in patient care at Heartland Fertility Center in addition to several community hospitals. During the 3-month rotation in Gynecological Oncology, the residents is exposed to a wide variety of challenging clinical problems in this subspecialty area. Two months of Urogynecology provides the resident with experience in vaginal surgery and treatment of incontinence and prolapse. Elective time helps the resident round-out career planning and skill development. The fourth year resident assumes the role of Senior Administrative Resident in order to develop managerial and leadership skills by taking responsibility for the day-to-day functioning of the in-patient units.
4. Transition to Practice
The last phase of residency consolidates skills, knowledge and behaviours that support practice as a fully competent consultant in obstetrics and gynecology. The senior resident builds independence by managing patients from initial consultation through therapeutic intervention and follow up. Rotations at community surgical sites, family planning clinics, mature women’s clinic, and private practice clinics assist the resident in integrating essential skill sets. A cornerstone of this learning experience is the longitudinal rotation known as Chief Resident Clinic. Each resident chooses an attending physician under whose mentorship the resident will function as a junior consultant. The resident is expected to develop a “practice within a practice” at his/her mentor’s clinic. New patients are seen in consultation. Medical and surgical treatment options are negotiated. The resident is responsible for communicating with the referring physician and for the longitudinal care of his/her patients including surgery and postoperative care over the course of the following year. The residents are expected to take on leadership roles on the in-patient services at the two teaching hospitals where they function as clinical experts, role models and teachers for the junior housestaff.
A popular addition to the curriculum is the Community Junior Consultant Rotation. This one-month experience places the resident in community hospitals. The resident is expected to participate in gynecological surgery, attend clinic, see consultations in the Emergency Department and contribute to the teaching of the other health professionals on-site. The two rotations before the Royal College examinations are reserved for examination preparation. These weeks are devoted to practice examinations, consultation clinics, teaching rounds, seminars and independent study.
An important piece in successful transition to practice is the development of professionalism and the commitment to competency. An environment of collegiality fosters life-long learning, resiliency, mentorship and a willingness to teach others. Residents are encouraged to apply for annual funding support to travel to clinical meetings in order to learn, present and network with others.