Reproductive Endocrinology Curriculum
- Lee Hickok, MD (Swedish Medical Center)
The Reproductive Endocrinology and Infertility (REI) clinical training spans two institutional sites: Swedish Medical Center and University of Washington.
- The Swedish REI rotation as a PGY-2 focuses primarily on the evaluation and management of infertile couples and includes extensive training in transvaginal ultrasound, saline-infusion sonohysterogram, hysterosalpingogram, and intrauterine insemination.
- The UW REI rotation as a PGY-1, PGY 2, and PGY-4 focuses on reproductive endocrine disorders, polycystic ovarian syndrome, hirsutism, menopause and hormone replacement therapy, genito-urinary anomalies, amenorrhea, endometriosis, and complex contraceptive management issue as well as general infertility and recurrent pregnancy loss. The resident also receives extensive training in transvaginal ultrasound and hysterosalpingogram.
During the UW REI rotation as a PGY-1 and PGY-4, the residents are expected to actively prepare and participate in the case-base learning modules. This case-based learning requires the PGY-1 to prepare four cases during their first year- studying the case/topic, preparing answers to evaluation and management of a specific patient scenario. The PGY-1 learning is facilitated by the PYG-4 Gynecology as well as the REI attending. The R1 cases include:
- Secondary amenorrhea
- Polycystic Ovarian Syndrome
- Recurrent Pregnancy Loss
- Abnormal Uterine Bleeding
- Chronic Pelvic Pain
- Early Pregnancy
The PGY-4 practice their teaching skills in a formal setting directly supervised by an attending in REI when they are teaching the above basic reproductive endocrine topics to the PGY-1. This format also allows them to review these basic concepts. In addition, they prepare more advanced cases to discuss with the REI attending, including:
- Primary amenorrhea
- Disorders of Sexual Development
- REI Imaging
- Menopausal Symptoms
- Complicated Infertility
- Precocious Puberty
The PGY-2 and PGY-4 complete an 'End of Rotation REI exam' which assesses their acquisition of knowledge on abnormalities of the menstrual cycle, endometriosis, infertility and recurrent pregnancy loss. While this is an assessment tool, it is also a learning opportunity as the answers are reviewed electronically immediately following completion of the exam.
The PGY-1 complete two computerized simulations regarding evaluation and management of ectopic pregnancy. These are available during the entire first year on the computer in the residents' office and require less than 30 minutes of time to complete. The resident results from these simulations are reviewed with one of the REI faculty.
Family Planning Curriculum
To develop the OBGYN resident's knowledge and skills to effectively counsel and provide the most appropriate contraceptive and pregnancy termination options.
- Sarah Prager, MD (University of Washington)
- Dilys Walker, MD (Harborview Medical Center)
The family planning clinic, based at UW Roosevelt Women's Health Clinic, provides the PGY-1 and PGY-3 with education on the most up-to-date contraceptive methods, pregnancy termination counseling and methods including medical/D&C/D&Es, management of abortion complications, miscarriage management and counseling and contraceptive counseling particularly for those with challenging contraceptive needs. This clinic experience provides a solid medical and surgical abortion experience early in residency training so that the resident will be able to continue to provide these services as part of routine gynecologic services and care. Residents gain additional experience in pregnancy options counseling, cervical preparation, and termination procedures on the antepartum obstetric service as a PGY-2 and PGY-3.
Residents exercising their right to not perform elective abortions will still participate in the clinic and didactic experience without physically performing elective abortions. All FDA approved contraceptive methods will be taught and made available to clients and even off label use of some methods such as continuous OCP regimens for menstrual suppression. There will be a weekly review of Modules which contain assigned materials from current abortion and contraception texts, articles, and on-line resources. At the beginning of each academic year, a hands-on simulation workshop is held to train residents on the various family planning procedures.
The PGY-1 and PGY-3 are expected to learn to demonstrate competency in the following skills:
- Unbiased counseling: contraceptive and pregnancy options.
- Determination as to the most appropriate route of termination: medical abortion, office D&C, surgical D&C and management of complications of each.
- Proficient in performing intrauterine device insertion, Implanon insertion, Essure placement, tubal sterilization.
Residents who "Opt-out" are expected to counsel, evaluate, and manage the patient in an unbiased fashion. They may opt-out only on the termination procedure portion. Specific clinical responsibilities are clearly delineated in MedHub.
Family Planning Educational Resources: (Articles available on MedHub; paper copies will be made available upon request)
- Reason U.S. Women Have Abortions: Quantitative and Qualitative Perspectives
- Finer et al, Perspectives on Sexual and Reproductive Health. 2005 Sept;37(3):110-18
- An Overview of Abortion in the United States. Guttmacher Institute, October 2009
- Facts on Induced Abortion in the United States. Guttmacher Institute, July 2008
- Chapter 10: First-trimester aspiration abortion. Meckstroth K and Paul M. In: Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD. Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care. Oxford, UK: Blackwell Publishing Ltd; 2009:135-156.
- Early Surgical Abortion: An alternative to and backup for medical abortion. MacIsaac et al, American Journal of Obstetrics and Gynecology. 2000 Aug;183(2):S76-83.
- Chapter 11: Dilation and evacuation. Hammond C and Chasen S. In: Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD. Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care. Oxford, UK: Blackwell Publishing Ltd; 2009:157-177.
- Chapter 9: Medical abortion in early pregnancy. Creinin MD and Danielsson KG. In: Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD. Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care. Oxford, UK: Blackwell Publishing Ltd; 2009:111-134.
- Chapter 12: Medical methods to induce abortion in the second trimester. Kapp N and von Hertzen H. In: Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD. Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care. Oxford, UK: Blackwell Publishing Ltd; 2009:178-192.
- NAF Protocol For Mifepristone/Misoprostol In Early Abortion. National Abortion Federation, January 2008.
- Medical management of early pregnancy failure: efficacy. Chen B and Creinin MD, Seminars in Reproductive Medicine. 2008 Sep;26(5):411-22.
- Expectant care versus surgical treatment for miscarriage. Nanada K. et al, Cochrane Database of Systematic Reviews. 2006 Apr 19;(2).
- Contraceptive Efficacy. Hatcher RA, Trussell J et al. Contraceptive Technology: Nineteenth Revised Edition. New York NY: Ardent Media, 2007.
- Pearl Index. Speroff et al, A Clinical Guide for Contraception. 2005:4.
- Hormonal Contraception. Blumenthal et al, Obstetrics and Gynecology. 2008 Sept;112(3):670-84.
- Summary Chart of the U.S Medical Eligibility Criteria for Contraceptive Use. Centers for Disease Control, March 2011.
Combined Hormonal Contraception
- Oral Contraception. Speroff et al, Clinical Guide for Contraception. 2005:677-80.
- Vaginal and Transdermal Combined Contraception. Speroff et al, Clinical Guide for Contraception. 2005:153-162.
- WHO Statement on hormonal contraception and bone health. World Health Organization, July 2005.
Non-hormonal & IUC
- Intrauterine and Barrier Contraception. A practical review of recent developments. Masters et al, Current Obstetrics and Gynecology. Feb 2005;15(1):31-37.
- Intrauterine Device. ACOG Practice Bulletin 59. 2005 Jan;105(1):223-232.
- Use of Copper Intrauterine Devices and the Risk of Tubal Infertility Among Nulligravid Women. Hubacher et al, New England Journal of Medicine. 2001 Aug;345(8):561-7.
- Benefits and Risks of Sterilization. Pollack. ACOG Practice Bulletin 46. 2003 Sept;102(3):647-58.
- Ambulatory Gynaecological Surgery: Transcervical sterilization. Abbot et al, Best Practice & Research Clinical Obstetrics & Gynecology. Oct 2005;19(5): 743-756.
Contraception in the Postpartum Period
- IMAP Statement on postpartum contraception and breast-feeding. IPPF Medical Bulletin. 2008 Sept;42(3):1-5.
- Emergency Contraception. ACOG Practice Bulletin 69. 2005 Dec;106(6):1443-52.