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DEFINITION:A
specialist in Obstetrics and Gynecology is a physician with special
education and expertise in the field of womens' health and reproduction.
He/she has the appropriate medical, surgical and obstetrical knowledge
and skills for the prevention, diagnosis and management of a broad range
of conditions affecting women's reproductive and gynecological health.
As well as providing clinical care and education in normal and
complicated obstetrics and gynecology, he/she may contribute
significantly to research.
EDUCATIONAL
OBJECTIVES:Two
levels of knowledge and proficiency are referred to in this document.
A working level
indicates a level of knowledge sufficient for the clinical management of
a condition, and/or an understanding of an approach or technique
sufficient to counsel and recommend it, without having personally
achieved mastery of that approach or technique. An extensive level
refers to an in-depth understanding of an area, from basic science to
clinical application, and possession of skills to manage independently a
problem in the area. The following
objectives must be achieved by the completion of residency training.
GENERAL
OBJECTIVES:
Consultancy Competence:
At the completion
of training, the resident must have the necessary knowledge, skills and
attitudes for independent management of a wide range of obstetrical and
gynecological conditions. He/she must have the ability to develop the
trusting and effective partnership with female patients necessary to
achieve successful outcomes in normal and complicated pregnancies, as
well as in gynaecologic health and illness throughout a woman's life.
Communication: The resident must
achieve a high level of competence in communicating with patients and
relatives, reflecting an understanding of their psychosocial and
cultural context. He/she must also develop effective oral and written
communication skills with other members of the health care team. Health Economics: The resident must
have a working knowledge of the economic aspects of health care. He/she
will understand that interventions should be limited to situations where
benefit can be reasonably expected, based on best available evidence.
The resident must have the ability to assess the efficacy, costs, risks,
benefits and reliability of diagnostic, investigative and therapeutic
interventions. Teaching: The resident will
recognize his/her responsibility to teach and will demonstrate
competence in the teaching of others. Violence Against Women: The resident will
learn to identify the characteristics of women at risk and demonstrate
an ability to initiate appropriate care and referral. Behaviours/Values: The resident will
demonstrate ethical, empathetic and professional behaviour, showing an
awareness of personal limitations and seeking consultation
appropriately. He/she must demonstrate leadership when appropriate, as
well as the ability to work collaboratively with other members of the
health care team. Fear, Anxiety and Pain: The resident must
have an understanding of the impact of fear and anxiety on pain, patient
satisfaction and treatment outcome. He/she must have a
working knowledge of pharmacologic and non-pharmacologic methods of
acute and chronic pain relief and their associated risks and benefits.
Critical Appraisal: The resident must
have an understanding of the basic biostatistical and clinical
epidemiological principles necessary for critical evaluation of the
medical literature, especially the aspects of causation, prevention,
diagnosis, prognosis and therapy. Research: The resident must
understand the strengths and limitations of various research designs,
and will, during residency training, design and present the results of
at least one study which addresses an issue of relevance to the
speciality. Medical Imaging: The resident must
have the working knowledge necessary for appropriate and effective
utilization of medical imaging in Obstetrics and Gynecology. He/she must have
extensive knowledge of the appropriate use and interpretation of
ultrasound in obstetrics and gynecology. Quality Improvement: The resident must
understand the value and application of various approaches to Quality
Improvement, and have participated in a medical audit process or served
on a Quality Assurance Committee. Equity: Residents must
demonstrate the knowledge, skills and attitudes relating to gender,
culture and ethnicity pertinent to Obstetrics and Gynecology. In
addition, all residents must demonstrate an ability to incorporate
gender, cultural and ethnic perspectives in research methodology, data
presentation and analysis. Ethics: The resident must
have knowledge of the fundamental principles of ethics and their
application to issues in obstetrics and gynecology, particularly as they
relate to informed consent, substitute decision making, conflict
resolution, confidentiality, the doctor-patient relationship, sexual
propriety, refusal of treatment, resource allocation and research. SPECIFIC
OBSTETRICS OBJECTIVES:
Antepartum Care: The resident must
have an extensive knowledge of maternal physiological changes in
pregnancy, fetal development and physiology, antepartum assessment of
mother and fetus, and the effects of underlying medical, surgical,
social and environmental conditions on pregnancy. The resident must
have a working knowledge of genetic screening, testing and counselling.
The resident must
have the extensive knowledge and skills necessary to evaluate the health
of mother and fetus, including appropriate history taking and physical
examination, provision of comprehensive ongoing antepartum surveillance,
ability to identify deviations from normality, and the effective use of
laboratory testing, imaging and non-stress testing. He/she will be able
to implement appropriate management strategies where deviation from
normal is identified. Medical and
Surgical Complications: The resident must
have a broad working knowledge of medical, surgical and psychosocial
complications of pregnancy and their appropriate management, including
timely consultation or transfer of care. Obstetric
Complications: The resident must
have extensive knowledge of the pathophysiology, prevention,
investigation, diagnosis and management of common obstetric
complications at all stages of pregnancy including second trimester
pregnancy loss, preterm labour, premature rupture of membranes,
antepartum haemorrhage, pregnancy induced hypertension, multiple
gestation, fetal growth restriction, isoimmunisation, dystocia,
post-term pregnancy, and fetal death. Intrapartum
Care: The resident must
have the extensive knowledge and skills necessary to conduct normal and
complicated labour and delivery. He/she will be able
to assess maternal and fetal health and progress in labour utilizing
history and physical examination, intermittent auscultation, electronic
fetal monitoring, basic ultrasound imaging and fetal scalp blood
sampling. The resident must
have extensive knowledge of techniques of induction and augmentation of
labour, including indications, methodology, pharmacology, management and
complications. Delivery:
The resident must
have extensive knowledge and skills with respect to the mechanisms and
techniques of spontaneous and assisted vaginal delivery. He/she will
have the ability to identify situations requiring assisted delivery, and
be able to appropriately perform forceps delivery, vacuum extraction,
cesarean section, breech delivery, management of shoulder dystocia,
repair of obstetric lacerations and vaginal birth after cesarean
delivery. Postpartum:
The resident must
have extensive knowledge of the puerperium and the skills necessary to
provide postpartum care, including the recognition and management of
early and delayed postpartum haemorrhage and sepsis, promotion of breast
feeding, family planning, recognition of risk factors for depression and
support in psychosocial adjustment. Medical Imaging:
The resident must
be able to perform a limited diagnostic obstetric ultrasound scan for
the purpose of ascertaining placental localisation, fetal number, fetal
presentation, and the level of fetal well-being, including viability.
Neonatal
Resuscitation: The resident will
have the working knowledge and skills necessary to recognize
abnormalities of the neonate. He/she must be able to carry out an
appropriate physical examination of the newborn and know when to seek
the assistance of a pediatrician. He/she must be able to institute
initial resuscitation and stabilization of the new-born. SPECIFIC
GYNAECOLOGY OBJECTIVES:
Physiological Changes:
The resident must
have an extensive knowledge of the changes in normal reproductive
physiology from birth to senescence. Pediatric and
Adolescent Gynecology: The resident must
have a working knowledge of the pathophysiology, investigation,
diagnosis, management and possible psychosocial ramifications of
gynecologic problems in children and adolescents. These problems include
developmental anomalies, precocious and delayed puberty, abnormal
vaginal discharge and bleeding, sexual abuse, family planning, teenage
pregnancy, and the medico-legal aspects of consent and confidentiality
specific to this age group. Reproductive and
Endocrine Disorders: The resident must
have extensive knowledge of normal physiology and pathophysiology,
investigation, diagnosis, and treatment in the areas of menstrual
irregularity, amenorrhoea, dysfunctional uterine bleeding, hormonal
underactivity and overactivity, galactorrhoea, hirsuitism, polycystic
ovarian disease and premenstrual syndrome. Menopause:
The resident must
have extensive knowledge of the changes associated with menopause and
aging, and be able to provide appropriate periodic assessment and
management including hormonal and non-hormonal modalities. Human Sexuality:
The resident must
have the ability to identify problems related to sexual dysfunction
including dyspareunia, vaginismus, inhibited sexual desire and
anorgasmia, and be able to initiate management and/or referral. Family Planning:
The resident must
have an extensive knowledge of methods of contraception including
mechanisms of action, indications, contraindications, and possible
complications. He/she must be able to inform women of options available
to them and provide any required service (such as counselling in
contraception, diaphragm fitting, prescription of oral contraceptives,
insertion of intrauterine device, and sterilisation or pregnancy
termination,) or refer appropriately to meet the patient's needs. Infertility:
The resident must
have an extensive knowledge of factors contributing to infertility,
enabling him/her to diagnose, evaluate and manage the major causes.
He/she will be able
to utilize and interpret the tests and procedures commonly used in
diagnosis, such as hormonal evaluation, semen analysis, basal body
temperature charting, ovulation prediction, endometrial biopsy,
hysterosalpingography and endoscopy. The resident will
be aware of the effectiveness, and complications of current standard
treatments as well as appropriate indications for subspecialty referral.
The resident must
have the necessary knowledge for diagnosis and management of ovulatory
disorders. He/she must have an extensive knowledge for situations
requiring simpler regimens such as clomiphene citrate and progestogens
and a working knowledge for more complex regimens utilising GnRH
analogues and gonadotropins. The resident must
have a working knowledge of the surgical techniques used in treating
tubal and pelvic causes of infertility, including pelvic adhesions,
endometriosis, tubal obstruction and uterine malformations. The resident must
have a working knowledge of the assisted reproductive technologies
currently available, including appropriate indications for referral.
Pregnancy Loss:
The resident must
have extensive knowledge of pathophysiology, investigation, diagnosis,
and treatment in spontaneous abortion, ectopic pregnancy and recurrent
pregnancy loss. Gynecologic
Infections: The resident must
have extensive knowledge of pathophysiology, investigation, diagnosis,
and treatment in vaginal and vulvar infections, sexually transmitted
diseases, gynecologic aspects of HIV and pelvic inflammatory disease.
Breast
Conditions: The resident must
have a working knowledge of the pathophysiology, diagnosis, and
management of benign breast disease, screening and referral for breast
cancer, and the effect of breast cancer and its therapies on the
reproductive system. Other
Non-Malignant Gynecologic Conditions: The resident must
have extensive knowledge of the underlying physiology, pathophysiology,
investigation, diagnosis, medical and surgical treatment in the areas of
pelvic support defects, pelvic masses, acute and chronic pelvic pain,
endometriosis, abnormal uterine bleeding, and vulvar pain and dermatoses.
Imaging:
The resident must
have a working knowledge of the use of imaging techniques including
ultrasound, and will have the skills to assess normal pelvic structures
and identify abnormalities. General
Gynecologic Surgery: The resident must
have extensive knowledge of the indications for and be highly skilled in
the performance of common gynecological procedures including vulvar,
vaginal and cervical surgery for benign conditions, hysterectomy
(abdominal and vaginal), myomectomy, adnexal surgery, pelvic node
sampling, abdominal exploration, retroperitoneal exploration,
omentectomy, identification and repair of operative complications,
paracentesis, cystourethropexy, anterior and posterior colporrhaphy and
evacuation of the pregnant uterus. The resident must
be able to discuss with the patient the risks, benefits, and
complications of any surgical treatment, as well as non-surgical
treatment alternatives. Laparoscopic and
Hysteroscopic Surgery: Endoscopic Surgery Hysteroscopic Surgery The resident must
have an extensive knowledge of the indications for and be highly skilled
in hysteroscopy for purposes of diagnosis, treatment of intrauterine
synechiae, simple polyp removal, removal of IUCD, and endometrial
ablation. The resident will
require a working knowledge of more advanced laparoscopic and
hysteroscopic techniques. He/she should know the indications for and
limitations of laparoscopically assisted vaginal hysterectomy in
comparison with vaginal and abdominal hysterectomy. Preoperative and
Postoperative Patient Care: The resident must
have the extensive knowledge and skills necessary to provide appropriate
preoperative and postoperative care, including recognition and
assessment of perioperative risk factors, provision of nutritional
support, promotion of wound healing, and management of medical and
surgical complications. Preinvasive and
Malignant Gynecological Disease: Risk Factors The resident must
have extensive knowledge of known risk factors for gynecologic
malignancy and of pre-malignant gynecologic conditions. Screening Colposcopy The resident will
have a working knowledge of colposcopic technique and interpretation,
the indications for and limitations of the procedure, and indications
for referral for colposcopic assessment. Vulvar Neoplasia The resident will
have the working knowledge and skills for diagnosis and staging, and for
appropriate referral for treatment. Vaginal Neoplasia The resident will
have the working knowledge and skills for diagnosis and staging, and for
appropriate referral for treatment. Cervical Neoplasia The resident will
have the working knowledge and skills for the management of benign and
preinvasive lesions of the cervix using techniques such as LEEP, laser,
cryotherapy and cone biopsy. He/she will have a
working knowledge of diagnosis, staging and appropriate surgical
management (simple or radical hysterectomy) for cervical carcinoma.
He/she will be able to refer appropriately for radical surgery,
radiotherapy and/or adjuvant therapy. Endometrial and Uterine Cancer The resident must
have the extensive knowledge and skills necessary for diagnosis, staging
and appropriate use of simple hysterectomy and bilateral
salpingo-oophorectomy and node sampling in management of endometrial and
uterine cancer. He/she will refer appropriately for more extensive
surgery, radiation, and systemic therapy. Ovarian and Tubal Cancer The resident must
have the working knowledge and skills for diagnosis, and for appropriate
referral for surgical staging, radiation chemotherapy, and other
treatment modalities. He/she must be able to appropriately use the
techniques of hysterectomy, salpingoopherectomy, omentectomy and
debulking in this context. Gestational Trophoblastic Disease The resident will
have the working knowledge and skills necessary for diagnosis, primary
intervention and follow-up. He/she will be able to carry out appropriate
metastatic work-up and distinguish low and high risk disease with
appropriate referral for further assessment and treatment. Adjuvant Cancer Therapies The resident will
have a working knowledge of the principles and complications of adjuvant
therapy, including an understanding of the indications for consultation
with appropriate specialists. Palliative Care The resident will
have a working knowledge of palliation in incurable gynecologic disease,
including the social, ethical and legal implications of the various
options. Medical And
Surgical Diseases: The resident will
have a working knowledge of the important medical and surgical disorders
which may have an effect on or be affected by the female reproductive
system. CONTENT
AND ORGANIZATION OF THE RESIDENCY PROGRAM:
There must be an organized
program of rotations and other educational experiences, both mandatory
and elective, designed to provide each resident with the opportunity to
fulfill the educational requirements and achieve competence in the
specialty.
RESOURCES:There
must be sufficient resources including teaching faculty, the number and
variety of patients, physical and technical resources, as well as the
supporting facilities and services necessary to provide the opportunity
for all residents in the program to achieve the educational objectives
and receive full training as defined by the specialty training
requirements in obstetrics and gynecology.
Learning
environments must include experiences that facilitate the acquisition of
knowledge, skills, and attitudes relating to aspects of age, gender,
culture, and ethnicity appropriate to obstetrics and gynecology. In those cases
where a university has sufficient resources to provide most of the
training in obstetrics and gynecology but lacks one or more essential
elements, the program may still be accredited provided that formal
arrangements have been made to send residents to another accredited
residency program for periods of appropriate prescribed training.
There
must be a sufficient number and variety of patients available to the
program to provide each resident registered in the program with the
opportunity to meet the following specific objectives:
Obstetrics
and gynecology teaching services participating in the program must have
adequate numbers of patients available for teaching and an identified
faculty member to whom residents are directly responsible. There must be
qualified obstetrician/gynecologists attached to each clinical teaching
service. The teaching service must have clearly identified educational
objectives.
Opportunities
must be provided for residents to participate in community-based
learning experiences.
There
must be available to the program:
ACADEMIC
AND SCHOLARLY ASPECTS OF THE PROGRAM:
The
academic and scholarly aspects of the program must be commensurate with
the concept of a university postgraduate education. The quality of
scholarship in the program will in part, be demonstrated by a spirit of
enquiry during clinical discussions, rounds, and conferences.
Scholarship implies an in-depth understanding of basic mechanisms of
normal and abnormal states and the application of current knowledge to
practice.
There
must be a program of organized scholarly activities such as journal
clubs, rounds, seminars and research conferences. Service demands must
not seriously interfere with the ability of the residents to follow the
academic program.
The
educational program must provide opportunities for residents to learn
and demonstrate:
Knowledge
of anatomy of the abdomen, pelvis and breast; physiology including the
principles of the major organ systems relative to reproduction, the
principles of immunology, and a particularly thorough understanding of
the physiology and biochemistry of reproduction; principles of
embryology, conception, fertilization and placentation; the principles
of endocrinology with particular reference to reproduction; the basis of
human sexual dysfunction; the principles of human genetics; pathology
and microbiology of obstetrical and gynecological disorders;
pharmacology including the principles of metabolism, action and toxicity
of drugs commonly used in obstetrics and gynecology.
The
capability of independent patient care in all facets of obstetrics and
gynecology and the ability to choose investigation and management
appropriate to the clinical situation.
Competence
in all surgical and technical procedures commonly performed in
obstetrics and gynecology as well as competence in pre-operative and
postoperative care.
The
ability to select the management and procedure appropriate to the
clinical situation and recognize one's own personal, professional and
technical limitations.
A
compassionate interest and overall understanding of the patient as a
person; the ability to function as a member of the health care team; an
understanding of the obligation of continuing self-education and the
teaching of others; sensitivity to psychosocial and gender issues.
The
program must ensure that residents gain an understanding of the basic
principles and practice of biomedical ethics as it relates to obstetrics
and gynecology.
The
program must ensure that residents learn effective communication skills
for interacting with patients and their families, colleagues, co-workers
from other disciplines and students. Clearly defined educational
objectives for teaching these skills and mechanisms of formal assessment
should be in place.
Residents
must be given opportunities to develop effective skills in collaborating
with all members of the patient care team.
Development
of effective teaching skills by teaching junior colleagues and students,
as well as through conference presentations, clinical and scientific
reports, and patient education.
Residents
must be given opportunities to develop skills in management as applied
to obstetrics and gynecology such as efficient practice and records
management and the ethical use of health care resources. Residents
should also be prepared for their role as a health care advocate.
The
program must provide residents with opportunities to gain an
understanding of the principles relating to medico-legal issues, the
improvement of quality of care and resource utilization and their
applications.
There
must be a faculty member with the responsibility to facilitate the
involvement of residents in research and other scholarly work. The
program must provide opportunities for residents to develop an
appreciation of the role of research through the critical analysis of
current scientific developments related to obstetrics and gynecology,
and an understanding of research methodology, study design, data
collection and analyses. Such teaching must include issues related to
age, gender, culture, and ethnicity in research protocols and data
presentation and discussion. In addition, the program must provide
opportunities for residents to participate in research in order to
develop research skills appropriate to their career plans.
A
satisfactory level of research and scholarly activity must be maintained
among the faculty identified with the program.
All
programs must promote development of skills in self-assessment and
self-directed life-long learning. To promote this end, the program
should provide opportunities for residents to attend conferences outside
their own university. SPECIALTY REQUIREMENTS: Approved residency including:
PROGRAMS (WITH TRAINING REQUIREMENTS): Diplomas(Dip):
Six
months of approved residency training.
Doctor
of Medicine(M.D):
Eighteen
months of approved residency training. Doctor
of Philosophy(Ph.D):
Forty
eight months(four years)of approved residency training. |