CREOG

Council on Resident Education in Obstetrics and Gynecology

EDUCATIONAL
OBJECTIVES
Core Curriculum in Obstetrics and Gynecology
12th Edition
CREOG Educational Objectives: Core Curriculum in Obstetrics and Gynecology, 12th Edition, was devel-
oped by members of the Education Committee approved by the Council on Resident Education in Obstet-
rics and Gynecology (CREOG). It should not be viewed as a body of rigid rules and serves as a guidance
to residency curriculum development. The information is general and intended to be adapted to many
different situations, taking into account the needs and resources particular to the locality, the institution, or
the type of practice. Variations and innovations that improve the quality of patient care are encouraged.

The Council is composed of representatives of the following organizations:

The American Academy of Family Physicians (AAFP)
The American Board of Obstetrics and Gynecology, Inc. (ABOG)
The American College of Obstetricians and Gynecologists (ACOG)
The ACOG Junior Fellows
Accreditation Council for Graduate Medical Education (ACGME)
The American College of Osteopathic Obstetricians and Gynecologists (ACOOG)
The American Gynecological and Obstetrical Society (AGOS)
The Association of Professors of Gynecology and Obstetrics (APGO)
The Association of Program Managers in Ob-Gyn (APMOG)
The Association of Professors of Obstetrics and Gynecology (APOG)
The American Society for Reproductive Medicine (ASRM)
The Council of University Chairs of Obstetrics and Gynecology (CUCOG)
Regional Residency Program Director Representatives
Federacion Mexicana de Associaciones de Ginecologia y Obstetricia

2019-2020 CREOG Education Committee Members:

Leah Ann Kaufman, MD, Chair
Amy Rose Stagg, MD, Vice Chair
Tamika C. Auguste, MD
Kelly A. Best, MD
Adrianne Vidalia Dade, MD
Marygrace Elson, MD
Lisa M. Foglia, MD
Dzhamala Gilmandyar, MD
Kenneth H. Kim, MD
Abigail Ford Winkel, MD
Mostafa A. Borahay, MD
Martin L. Hechanova, MD
Mark B. Woodland, MD, MS CREOG Chair
Karen E. George, MD, MPH CREOG Vice Chair
Maria Manriquez, MD, CREOG Program Chair

2020-2021 CREOG Education Committee Members:

Leah Ann Kaufman, MD, Chair
Amy Rose Stagg, MD, Vice Chair
Tamika C. Auguste, MD
Adrianne Vidalia Dade, MD
Lisa M. Foglia, MD
Dzhamala Gilmandyar, MD
Edward A. Jimenez, MD
Anthony Lee Shanks, II, MD
Veronique Tache, MD
Abigail Ford Winkel, MD
Martin Lorenzo Hechanova, MD
Shannon Scott Schellhammer, MD
Karen E. George, MD, MPH CREOG Chair
Erika Banks, MD, CREOG Vice Chair
Jennifer Mendillo Keller, MD, MPH CREOG Program Chair
ACOG Staff:
Marc Jackson, MD, MBA
Vice President for Education
Saran Myers-Martin, MPH
Sr. Director, Educational Development & Testing
Gale Mamatova
Former Director of CREOG
Darya Valantsevich, DES
CREOG Program Manager
Heather Friedman, MPH
CREOG Exam Editor

Copyright 2020 by the American College of Obstetricians and Gynecologists, 409 12th Street SW,
Washington, DC 20024-2188. All rights reserved. No part of this publication may be reproduced, stored
in a retrieval system, posted on the internet, or transmitted, in any form or by any means, electronic,
mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.
 CONTENTS
Introduction v

Preface vii

UNIT 1: GENERAL CONSIDERATIONS 1

PHYSICIAN COMPETENCIES 1
BASIC SCIENCE – OVERLAPPING CONTENT 5
PATIENT CARE 7

UNIT 2: OBSTETRICS 8
BASIC SCIENCE – MECHANISM OF DISEASE 8
ANTEPARTUM CARE 9
OBSTETRIC COMPLICATIONS 12
INTRAPARTUM CARE 13
NEWBORN CARE 14
POSTPARTUM CARE 14

UNIT 3: GYNECOLOGY 15
BENIGN DISORDERS OF THE UROGENITAL TRACT 15
NEOPLASIA AND MALIGNANCIES OF THE REPRODUCTIVE
TRACT AND BREAST 16

UNIT 4: OFFICE PRACTICE 18

PERIODIC HEALTH ASSESSMENT 18
FOCUSED AREAS IN GYNECOLOGIC CARE 19

UNIT 5: PERI-OPERATIVE OB-GYN CARE 23

OPTIMIZING PERIOPERATIVE OUTCOMES 23
PREOPERATIVE CONSIDERATIONS 23
INTRAOPERATIVE CARE 23
POSTOPERATIVE CARE 24
MANAGEMENT OF COMPLICATIONS 24
CRITICAL CARE 24

UNIT 6: PROCEDURES IN OBSTETRICS AND GYNECOLOGY 25

CORE PROCEDURES 25

iv
INTRODUCTION
CREOG Educational Objectives: Core Curriculum in Obstetrics and Gynecology, 12th
Edition was developed by members of the CREOG Education Committee and approved
by the Council on Resident Education in Obstetrics and Gynecology (CREOG). The
information serves as a guideline to curriculum development and is intended to be
adapted to many different situations, considering the needs and resources particular
to the locality, the institution, or the type of practice. Variations and innovations that
improve the quality of resident education and patient care are encouraged.
The 11th edition of the objectives outlined important concepts by defining the core,
intrinsic, specialty, and subspecialty objectives which outline all the career elements
and options of an obstetrician–gynecologist. A comprehensive residency program in

CREOG FLOWER
obstetrics and gynecology must encompass each of the core, intrinsic, and specialty
objectives, and they are therefore combined in the 12th edition to enhance the useful-
ness of this edition. CREOG FLOWER
CREOG FLOWER
Female Pelvic
Reproductive
Medicine and
Endocrinology
Reconstructive
Female Pelvic and Infertility
Surgery Reproductive
Medicine and
Endocrinology
Reconstructive
and Infertility
Surgery
Off
gy

ice
olo

Off

Pr
c
gy

*Areas of
ne

ac
ice
olo

Focused Practice
Gy

ti

Overlapping
ce

Gynecologic
Pr

(Addiction Medicine,
ec

*Areas of Minimally Invasive

Genetics,
Oncology Content
ac
n

Surgery, Obesity, and

Focused Practice
Gy

ti

Pediatric and Adolescent

Overlapping
ce

Gynecologic (Addiction Medicine,Gynecology)

Genetics, Minimally Invasive
Oncology Content Surgery, Obesity, and
Pediatric and Adolescent
Gynecology)

Obstetrics

Obstetrics
Complex Family Maternal-Fetal
Planning Medicine
Complex Family Maternal-Fetal
Planning Medicine

Key:

= Obstetrician-Gynecologist Core Knowledge – Common to Specialists & Sub-specialists

Key:
= Sub-specialty Knowledge Utilized by Specialists
= Obstetrician-Gynecologist Core Knowledge – Common to Specialists & Sub-specialists
= Obstetrician-Gynecologist Sub-specialties & Areas of Focused Practice
= Sub-specialty
*Areas ofKnowledge Utilized
Focused Practice bynon-ABOG
also include Specialists
certified Sub-specialty Areas

= Obstetrician-Gynecologist Sub-specialties & Areas of Focused Practice v

*Areas of Focused Practice also include non-ABOG certified Sub-specialty Areas
PREFACE
The Council on Resident Education in Obstetrics and Gynecology (CREOG) published
the first edition of Educational Objectives for Residency Programs in Obstetrics and
Gynecology in 1976 to establish a general framework for a comprehensive residency
education curriculum and make it easier for programs to establish realistic, practical
learning objectives. The 11th Edition of Educational Objectives: Core Curriculum in
Obstetrics and Gynecology recognized the dynamic nature of the specialty and was
revised extensively by the CREOG Council and the CREOG Education Committee to
more accurately reflect the practice of the specialist (formerly known as the generalist)
in obstetrics and gynecology.
The 11th edition represented a major revision to previous editions. The goal was to
establish a model for obstetrics and gynecology educators and department leaders
to follow to define the core curriculum for the specialist and intrinsic objectives for
the subspecialist. The following informational sources were used in the creation of the
11th edition:
• Surveys of practicing physicians (including specialists and subspecialists)
• Blueprints for the American Board of Obstetrics and Gynecology’s (ABOG) qualify-
ing and certifying examinations
• Workforce trends
• Competencies and milestones of resident education as sanctioned by the
Accreditation Council for Graduate Medical Education (ACGME) Review
Committee (RC) in obstetrics and gynecology
The core curriculum objectives and obstetric and gynecologic procedures in the 11th
edition were grouped into two categories:
1. Intrinsic Objectives: Topics that all obstetrician–gynecologists (specialists and
subspecialists) learn and maintain throughout their careers, grouped into four units:
General Considerations, Obstetrics, Gynecology, and Office Practice
2. Specialty Objectives: Topics for specialists in comprehensive obstetrics and gyne-
cology, grouped into seven subunits: Overlapping Content, Maternal–Fetal Medicine,
Oncology, Contraception, Pediatric and Adolescent Gynecology, Reproductive Endo-
crinology and Infertility, and Female Pelvic Medicine and Reconstructive Surgery
The teams charged with the development of the 12th edition relied heavily on feedback
from educators about the utility of the 11th edition. Many educators reported that the
separation of learning topics into intrinsic and specialty objectives could be helpful for
tracking and working with specialists and subspecialists throughout graduate medical
education and continuing medical education. However, the division was found to be less

vi
 Educational Objectives vii

useful for the purposes of building curricula in residency education because all topics in
both the intrinsic and specialty objectives must be learned by all graduates of an obstet-
rics and gynecology residency program. For this reason, the 12th edition presents these
core learning objectives by content area. The seven subtopics that were designated as
Specialty Objectives have been subsumed back under the four general units of General
Considerations, Obstetrics, Gynecology, and Office Practice. A fifth unit, Perioperative
Ob-gyn Care, has been added, and encompasses all learning objectives related to the
provision of perioperative and critical care in obstetrics and gynecology.
The 12th edition of the educational objectives are not necessarily progressive (linear)
and may be covered in any year of training. As with previous editions, the 12th edition
was cross-referenced with the newest revisions of both the ABOG examination blue-
prints and the ACGME ob-gyn and common program requirements, and can thus be
used to develop a curriculum consistent with graduating ob-gyns who have met all
needed milestones for practice. The CREOG Education Committee also has annotated
the 12th edition with ACOG educational resources to assist in teaching the outlined topic
areas. ACOG resources were listed for ease of access to most learners and educators.
New to this edition is an additional annotation system related to ACGME require-
ments to assist with the end result of satisfying the requirements as defined by ACGME.
Additionally, new educational elements have been italicized for ease of identification.
Finally, Unit 6 has been presented as a single list of core procedures, designated
according to the procedures a specialist is expected to perform or understand how to
perform consistent with the knowledge and skills to be a proficient clinician, women’s
health care physician, and advocate throughout their careers.
UNIT 1: GENERAL CONSIDERATIONS

I. Physician Competencies
A. Interpersonal and communication skills
1. Obtain and provide information using effective listening, nonverbal, explanatory,
questioning, and writing skills.
2. Describe the process of informed health care decision making, including
required components of an informed consent discussion.
3. Develop skills to effectively communicate with patients via telehealth
platforms.
4. Work with health care professionals in multidisciplinary teams.
a) Provide effective and professional consultation to other physicians and
health care professionals.
b) Communicate effectively with others as a member or leader of a health
care team.
c) Facilitate the learning process for students and other health care
professionals.
d) Develop awareness of the roles of other health care professionals and
their effect on patient care, the health care organization, and society.
e) Recognize the value of input from all members of the health care team
and methods to facilitate communication among team members.
5. Communicate effectively with patients and family members about the
following scenarios:
a) Unexpected outcomes including fetal demise and stillbirth
b) Crisis situations including substance abuse and intimate partner violence
c) Disclosure of adverse outcomes and medical errors
d) Disclosure of life-threatening illness
B. Professionalism
1. Demonstrate compassionate and respectful behavior when interacting
with patients, families, and professional colleagues, taking the following
characteristics into consideration:
a) Culture
b) Race/ethnicity

1
2 Educational Objectives

c) Age
d) Gender identity and sexual orientation
e) Socioeconomic status
f) Beliefs and political affiliation
g) Disabilities
h) Other vulnerable/underserved populations or circumstances associated
with barriers to care (eg, incarceration, homelessness, recent immigration,
mental/behavioral health disorders, substance use disorder)
2. Develop awareness of implicit biases that may affect patient care.
3. Demonstrate respect, compassion, integrity, and responsiveness to the needs
of patients and society that supersedes self-interest.
4. Describe and apply the basic principles of medical ethics, including autonomy,
beneficence, justice, and nonmaleficence, taking into account the following
considerations:
a) Balancing accountability to patients, society, and the profession
b) Uncompromised honesty
c) Making decisions about the provision or withholding of clinical care
d) Fair allocation of limited medical resources
e) The role of a patient’s age and mental capacity in ethical decision making
f) Ethical implications of commonly used obstetric and gynecologic
technologies
g) Managing conflicting ethical obligations in complex patient care situations
5. Maintain a good work ethic (eg, positive attitude and high level of initiative).
a) Develop and maintain habits of punctuality and efficiency.
b) Demonstrate receptiveness to instruction and feedback.
c) Develop skills for providing constructive feedback.
6. Describe and manage common stressors in the health care environment that
affect physician well-being and patient care, including the following:
a) Factors contributing to physician burnout (eg, prolonged work hours,
electronic medical records, work compression, abuse by patients)
b) The relationship between physician burnout and poor-quality patient care
c) Warning signs of excessive fatigue, stress, burnout, or substance abuse
d) Appropriate and timely interventions to prevent harm to self or others
e) Effective preventive stress-reduction activities
 General Considerations 3

C. Practice-based learning and improvement

1. Understand that patient safety is always the first concern of the physician.
2. Participate in departmental and institutional quality improvement activities
and patient safety initiatives.
a) Describe the process of quality assessment and improvement.
b) Demonstrate an ability to collaborate with other medical personnel to
correct system problems and improve patient care.
3. Demonstrate understanding of institutional disclosure processes and
participate in disclosure and discussion of adverse events with patients.
4. Use scientific evidence and methods to investigate, evaluate, and improve
patient care practices.
a) Identify areas for personal and practice improvement; implement strategies
to enhance knowledge, skills, attitudes, and processes of care as well as
make a commitment to lifelong learning.
b) Analyze and evaluate personal practice experience and implement strategies
to continually improve the quality of patient care provided using a system-
atic methodology.
c) Locate, appraise, and assimilate evidence from scientific studies related to
patients’ health problems.
d) Obtain and use information about the unique needs and characteristics of
local and regional patient populations.
e) Apply knowledge of study designs and statistical methods to the appraisal
of clinical studies and other information on diagnostic and therapeutic
effectiveness.
f) Use information technology to manage information, access online medical
information, and support personal education.
g) Facilitate the learning process for students and other health care
professionals.
D. System-based practice
1. Use information technology to support patient care.
a) Maintain comprehensive and accurate medical records.
b) Understand and use telehealth modalities to enhance regular patient care
and assist in increasing access for patients.
c) Describe current standards for the protection of health-related patient
information.
d) Use online resources.
4 Educational Objectives

2. Understand the need for a commitment to excellence and ongoing profes-

sional development, including the following:
a) Maintain medical licensure, board certification, credentialing, hospital staff
privileges, and liability insurance
3. Analyze personal practice patterns and outcomes, identify areas for improve-
ment, and implement strategies to enhance knowledge, skills, attitudes, and
processes of care. Describe the process of shared health care decision
making, including the following:
a) Understand and counsel patients and families about the role of advance
directives, living wills, and durable powers of attorney for health care
b) Describe the appropriate indications and the medical, ethical, and legal
implications for “do not resuscitate” orders
c) Describe and counsel families about surrogate decision making for
incapacitated patients, including who can and should act as a health
care proxy
d) Elicit information about patients’ personal values and preferences for
end-of-life treatment
e) Describe the legal, ethical, and emotional issues surrounding withholding
and withdrawing medical therapies
4. Practice cost-effective health care and resource allocation while optimizing
quality of care.
a) Describe different types of medical practice and delivery systems,
emphasizing high-value care.
b) Describe common methods of health care financing.
c) Understand the documentation necessary for quality patient care, billing,
and coding.
5. Advocate for the patient, women’s health, and the field of obstetrics and
gynecology.
a) Describe how educational, socioeconomic, and political factors affect
social determinants of health.
b) Explain the factors that can lead to health care disparities, including race/
ethnicity, age, gender identity, sexual orientation, disability, geographic
location, socioeconomic circumstances, health literacy, language barriers,
and mental/behavioral health disorders.
c) Suggest potential ways to mitigate or solve barriers to care and inequities in
health care.
 General Considerations 5

d) Describe structural racism and explicit biases that can affect health care
outcomes.
e) Describe the role of the women’s health care professional in advocating for
patient populations and individual patients, particularly underserved and
vulnerable women.
6. Understand risk management and professional liability.
a) List the major types of liability insurance.
b) Describe the most common reasons for professional liability claims.
c) Understand risk-reduction strategies.
E. Medical knowledge
1. Locate, appraise and assimilate evidence from scientific studies and
appropriately apply to patient care.
2. Describe the difference between screening and diagnostic tests.

II. Basic Science—Overlapping Content

A. Describe the physiology of the normal menstrual cycle, including the
following:
1. Changes at puberty
2. Changes during perimenopause
3. Timing of fertilization
B. Describe patterns of inheritance.
1. Mendelian modes (eg, autosomal dominant, autosomal recessive, X-linked)
2. Non-Mendelian modes (eg, mitochondrial, imprinting, polygenic)
C. Describe the anatomy of the abdomen and pelvis.
1. Anterior and posterior abdominal wall
2. Pelvic floor
3. Retroperitoneal space
4. Para-aortic space
5. External genitalia
6. Pelvic organs
7. Vascular supply and innervation
6 Educational Objectives

D. Describe the basic anatomy of the breast.

E. Describe the embryology of the pelvis and pelvic organs.
1. Describe normal development.
2. Describe abnormal development, including the following:
a) Ambiguous genitalia
b) Müllerian agenesis
c) Vaginal/uterine septum
F. Describe gametogenesis.
G. Describe the general principles of drug delivery, distribution,
metabolism, and excretion.
H. Describe the mechanism of action of the following classes of
medications:
1. Contraceptives
2. Prostaglandin inhibitors
3. Antiestrogens and antiprogestins
4. Analgesics, including opioids
I. Describe the physiology of wound healing.
J. Describe the microbiologic principles germane to the diagnosis and
treatment of gynecologic infectious diseases.
1. Describe the normal bacteriologic flora of the lower genital tract.
2. Describe the epidemiologic principles involved in the spread of infectious
diseases in the following populations:
a) Patients
b) Sexual partners
c) Health care professionals
3. Describe the immunologic response to infection.
4. List common gynecologic pathogens and appropriate therapies (bacterial,
viral, parasitic, and fungal).
 General Considerations 7

III. Patient care

A. Perform a complete history and examination specific to a patient’s
symptoms and appropriate for that patient’s age and condition.
B. Counsel patients regarding the age-appropriate use of vaccinations.
C. Understand universal screening for substance use disorder.
1. Know appropriate screening tools.
2. Initiate therapy with consultation as necessary (ie, Screening, Brief Intervention,
and Referral to Treatment [SBIRT]).
D. Provide trauma-informed care (ie, recognize, initiate management
and appropriate counseling or referral for the following):
1. Abuse (eg, sexual, physical, elder, and psychologic)
2. Violence (eg, intimate partner, workplace, and environmental)
3. Substance use
4. Psychosocial concerns
5. Human trafficking
6. Gender dysphoria
7. Post-traumatic stress disorder (PTSD)
UNIT 2: OBSTETRICS

I. Basic Science—Mechanism of Disease

A. Describe and evaluate the major physiologic changes and symptoms
in a pregnant patient. Interpret common diagnostic tests in each
organ system in the context of normal physiologic changes of
pregnancy.
1. Nutritional needs/vitamin supplements (eg, folic acid, iron supplements)
2. Immune system/immunizations
3. Cardiovascular system
4. Pulmonary system
5. Hematologic system
6. Renal system
B. Describe the musculoskeletal, neurologic, and vascular changes to
the pelvis, vulva, and breast.
1. Antepartum
2. Intrapartum
3. Postpartum
C. Describe embryologic and fetal development from fertilization until
term.
1. Morphology and anatomy
2. Immunology
3. Fetal organogenesis
4. Placentation and zygosity of multiple gestations
D. Describe pharmacokinetics in pregnancy.
1. Drug metabolism in pregnancy
2. Placental drug and nutrient transfer
E. Describe principles of teratology.
F. Describe fetal risk associated with exposure to the following:
1. Antimicrobial agents (eg antibiotics, antivirals, antifungals)
2. Exogenous hormones

8
 Obstetrics 9

3. Anesthetic agents
4. Radiation (eg, X-ray) and radioactive imaging
5. Recreational drugs and tobacco
6. Nonprescription medications and supplements
7. Environmental toxins

II. Antepartum Care

A. Perform a history and physical examination during pregnancy.
1. Identify risk factors for pregnancy complications (eg, previous cesarean,
obesity, diabetes, socioeconomic barriers to care).
2. Establish gestational age.
B. Perform Ultrasonography
1. Assess fetal number, lie, presentation, viability, and placental location.
2. Assess fetal biometry.
3. Assess cervical length.
4. Perform and interpret a biophysical profile (BPP).
5. Describe indications for assessment with Doppler ultrasonography
(eg, umbilical artery [UA] and middle cerebral artery [MCA]).
C. Counsel patients about genetics
1. Solicit a family pedigree.
2. Describe and perform prepregnancy counseling and testing.
3. Describe and perform antepartum genetic testing and counseling.
4. Perform prenatal genetic screening.
5. Refer for diagnostic testing.
D. Counsel the pregnant patient on the following:
1. Lifestyle modifications
a) Recommended weight gain based on prepregnancy body mass index
b) Nutrition
c) Exercise
d) Sexual health
e) Substance use
10 Educational Objectives

2. Effects of pregnancy on medical conditions

a) Hematologic disorders (eg, anemia, thrombocytopenia, thrombophilias,
coagulopathies)
b) Congenital heart disease
c) Cardiopulmonary disease (including asthma)
d) Gastrointestinal disease
e) Neurologic disease
f) Endocrine disorders (eg, preexisting diabetes mellitus, thyroid disorders)
g) Gestational diabetes mellitus
h) Collagen vascular disease
I) Renal disease
j) Infectious disease
k) Autoimmune disorders
l) Psychiatric disease
m) Dermatologic disease
n) Substance use disorder
o) Malignancy
3. Warning signs of adverse pregnancy events
E. Recognize and support diverse socioeconomic, family, and environ-
mental factors affecting access to care and pregnancy outcomes.
1. Screen for intimate partner violence (IPV).
2. Screen for social supports, socioeconomic needs, and need for social work
intervention.
F. Understand, perform, order, and interpret the gestational age-
appropriate screening, diagnostic testing, and treatment of routine
prenatal care, including the following approaches:
1. Serum tests
2. Imaging
3. Fetal surveillance
G. Counsel patients on breastfeeding.
1. Describe the effects of medical and surgical conditions on breastfeeding.
2. Understand drug transfer or effect of medication on breastfeeding.
3. Describe the approach to successful lactation and troubleshooting difficulty.
 Obstetrics 11

H. Provide risk-appropriate maternity care.

1. Understand maternal levels of care and indications for referral.
2. Counsel about non-hospital-based birth.
I. For the following conditions: describe the effects of the condition
on maternal and fetal outcome; develop a plan for monitoring
and managing the patient during pregnancy, delivery, and the
puerperium; describe the prognosis and interventions for this
pregnancy to minimize recurrence; and understand indications
for referral and consultation:
1. Hematologic disorders (eg, anemia, thrombocytopenia, thrombophilias,
coagulopathies)
2. Congenital heart disease
3. Cardiopulmonary disease (including asthma)
4. Gastrointestinal disease
5. Neurologic disease
6. Endocrine disorders (eg, preexisting diabetes mellitus, thyroid disorders)
7. Gestational diabetes mellitus
8. Collagen vascular disease
9. Renal disease
10. Infectious disease (eg, HIV, varicella, TORCH [Toxoplasmosis, Other (syphilis,
varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and
Herpes] infections, parvovirus, group A strep)
11. Autoimmune disorders
12. Psychiatric disease
13. Dermatologic disease
14. Substance use disorder
15. Malignancy
12 Educational Objectives

III. Obstetric Complications

A. For the following obstetric complications, describe the differential
diagnosis; perform a pertinent history and physical examination;
evaluate (using laboratory testing and diagnostic imaging); manage
appropriately; determine and describe the prognosis and implement
interventions to minimize recurrence; and determine the indications
for referral to a subspecialist:
1. First-trimester, second-trimester, and third-trimester vaginal bleeding
2. Prior cesarean delivery and implications on current delivery mode
3. Abnormal placentation
4. Urinary tract infections
5. Preterm labor
6. Hypertensive disorders
7. Prelabor rupture of membranes
8. Hyperemesis gravidarum
9. Multiple gestation
10. Intrauterine growth restriction and macrosomia
11. Intrauterine fetal demise in the first, second, and third trimester
12. Post-term pregnancy
13. Isoimmunization
14. Emergency care during pregnancy (including surgical/trauma)
a) Venous thromboembolism
b) Seizure
c) Trauma
d) Cerebrovascular accident
e) Surgery (non-ob-gyn and adnexal masses)
f) Cardiac arrest
g) Uterine rupture
 Obstetrics 13

IV. Intrapartum Care

A. Evaluate the woman presenting in labor.
B. Define and describe the normal course of labor, including diagnosis
and management.
C. Define and describe abnormal labor, including diagnosis and
management.
D. Perform and interpret intrapartum fetal monitoring:
1. Intermittent auscultation
2. Electronic fetal heart rate monitoring
a) Define and recognize normal and abnormal heart rate and variability.
b) Define and recognize types of heart rate patterns.
c) Describe appropriate interventions for abnormal fetal heart rate patterns.
E. List indications for and complications of the following:
1. Normal vaginal delivery
2. Episiotomy
3. Forceps-assisted delivery
4. Vacuum-assisted delivery
5. Cesarean delivery
F. Manage the patient requiring labor induction, including the
following:
1. Indications, methods and procedures, risks and complications
G. Understand and counsel about options for obstetric analgesia and
anesthesia including unmedicated birth.
H. List risk factors of, diagnose, and perform initial management of the
following obstetric complications:
1. Shoulder dystocia
2. Obstetric lacerations
3. Obstetrical hemorrhage
4. Uterine inversion
5. Uterine rupture
6. Perineal hematoma
7. Intraamniotic infection
14 Educational Objectives

8. Retained placenta
9. Umbilical cord prolapses
10. Malpresentations (breech, face, shoulder, brow)
11. Amniotic fluid embolism
12. Eclampsia

V. Newborn Care
A. Perform an immediate assessment of the newborn.
B. Resuscitate a depressed neonate.
C. Counsel about and obtain cord blood for banking.
D. Assess indications for and interpret umbilical cord blood gas
evaluations.
E. Counsel about and perform circumcision pending local practice
patterns.

VI. Postpartum Care

A. Describe the normal course of the puerperium and perform routine
postpartum care, including the following:
1. Counsel about breast care, including breastfeeding.
2. Counsel about the normal healing process of obstetric lacerations and
episiotomy.
3. Counsel about diet and exercise during and after lactation.
4. Counsel about and provide contraception, including sterilization.
5. Counsel about and provide vaccinations.
6. Counsel about implications of perinatal complications for life-long health.
7. Screen for urinary and fecal incontinence.
B. Diagnose and perform initial management of postpartum
complications, including the following:
1. Delayed postpartum hemorrhage
2 Infections
3. Urinary tract injury
4. Mastitis/breast abscess
5. Postpartum depression, anxiety, and suicidal ideation
6. Laceration/episiotomy breakdown
UNIT 3: GYNECOLOGY

I. Benign Disorders of the Urogenital Tract

A. For the following presenting conditions, perform pertinent history and
evaluation, including diagnostic procedures, consult subspecialists
when appropriate, counsel, and manage medically and surgically:
1. Pelvic masses, including the following etiologies:
a) Uterine leiomyomas
b) Cystic and solid adnexal/ovarian masses
c) Tubo-ovarian abscess
d) Adnexal torsion
e) Ectopic pregnancy
2. Pelvic pain (acute or chronic), including the following etiologies:
a) Endometriosis
b) Adenomyosis
c) Dysmenorrhea
d) Nongynecologic conditions (eg, musculoskeletal, gastrointestinal,
neurologic, genitourinary, psychiatric)
3. Abnormal bleeding, including the following sources:
a) Uterine (polyp, adenomyosis, leiomyoma, and malignancy/hyperplasia–
coagulopathy, ovulatory, endometrial, iatrogenic, not classified
[PALM–COEIN])
b) Nonuterine gynecologic (cervical, vulvovaginal)
c) Nongynecologic (gastrointestinal, genitourinary, bleeding disorders)
4. Benign urogenital infections, including the following types:
a) Sexually transmitted infections (include partner therapy in treatment)
(1) Chlamydia
(2) Gonorrhea
(3) HPV with management of condylomata
(4) HSV
(5) Syphilis

15
16 Educational Objectives

(6) Trichomoniasis
(7) Rare STIs including lymphogranuloma venereum (LGV), chancroid,
molluscum
b) Pelvic inflammatory disease
c) Vulvovaginal infections
d) Urinary tract infections
e) Pelvic support defects
(1) Pelvic organ prolapse
(2) Urinary incontinence
(3) Fecal incontinence
B. Reproductive endocrinology and infertility
1. Describe normal steroid hormone biosynthesis and clinical applications.
2. For the following medical conditions, describe the appropriate screening,
diagnosis, pertinent history, focused physical examination, diagnostic testing,
and treatment, including indications for referral:
a) Amenorrhea
b) Galactorrhea/hyperprolactinemia
c) Androgen excess
d) Recurrent pregnancy loss and infertility
e) Premenstrual syndrome/premenstrual dysphoric disorder
f) Ovarian disorders, including polycystic ovary syndrome and primary
ovarian insufficiency
g) Müllerian anomalies

II. Neoplasia and Malignancies of the Reproductive Tract

and Breast
A. Risk identification and reduction
1. Assess patients’ risk for cancer of the breast, ovary, endometrium, and other
sites.
a) Review family and personal history to identify patterns suggestive of
hereditary cancer syndromes.
b) List genetic markers most frequently associated with hereditary cancer
risk (eg, BRCA1/2, MSH6, MSH2, MLH1, PMS2).
 Gynecology 17

c) Understand implications of positive and negative genetic test results for

surveillance planning and risk-reducing strategies.
d) Provide appropriate referral to a genetic counselor.
1. For Genetic testing, understand and counsel with respect to available testing
options, indications, interpretation, and limitations.
2. For patients at increased cancer risk, counsel about risk-reducing strategies
and manage or refer as appropriate, including the following approaches:
a) Lifestyle modifications
b) Medical interventions
c) Surgical interventions
B. For the following types/sites of neoplasia and malignancies, identify
risk factors, obtain an appropriate family history and identify risk
factors, recommend preventive strategies, perform screening and
diagnostic procedures, and perform initial management and referral:
1. Cervix
2. Uterus
3. Ovary, fallopian tube, and peritoneal
4. Vulva and vagina
5. Breast
6. Gestational trophoblastic neoplasia
C. Provide comprehensive care of women with malignancies.
1. Understand, evaluate, and manage the medical, psychological, and sexual
effects of treatments for gynecologic cancers and breast cancer.
2. Counsel patients about the reproductive implications of nongynecologic
cancer care and manage or refer as indicated for the following health
concerns:
a) Sexual and psychosocial function
b) Fertility preservation strategies
c) Contraceptive needs and options
d) Gynecologic side effects of cancer treatments (eg, hormonal treatments,
immunosuppressive therapy, radiation therapy)
UNIT 4: OFFICE PRACTICE

I. Periodic Health Assessment

A. Perform routine preventive and health maintenance care.
1. Perform a complete age-appropriate history and physical examination.
2. Counsel patients regarding the age-appropriate use of vaccinations.
3. Counsel patients about appropriate screening for cancer and other conditions
based on age, history, and personal risk factors.
4. Provide lifestyle and life-phase counseling, such as reproductive health or
menopause counseling.
5. Initiate management or provide appropriate referral.
6. Provide HIV counseling, testing, and prophylaxis with PrEP
B. Understand the effect of personal genetics on periodic assessment of
a patient and initiate appropriate referral for further evaluation.
C. Understand universal screening protocols for substance use disorder.
1. Know appropriate screening tools.
2. Initiate therapy with consultation as necessary.
D. Develop the patient–physician relationship and gain the patient’s
confidence and collaboration, appreciating that many factors can
affect overall health and shared decision-making process, including
the following:
1. Age
2. Race/ethnicity
3. Cultural and religious background
4. Sexual preference/orientation
5. Gender identity
6. Socioeconomic status
7. Lifestyle
8. Primary language
9. Mental status
10. Health care literacy
11. Level of comfort and personal modesty
18
 Office Practice 19

12. Values and beliefs

13. Violence and abuse

II. Focused Areas in Gynecologic Care

A. Contraception
1. Describe and counsel patients on the use of contraception, including the
following:
a) Options and effectiveness of various methods, including hormonal,
nonhormonal, long-acting reversible contraception, and sterilization
b) Benefits and risks of usage or abstinence
c) Mechanisms of action
d) Relative and absolute contraindications for individual patients
e) National, local, and institutional policies
f ) Effect of contraceptive use on population health
B. Pediatric/Adolescent Gynecology
1. Address the unique needs of pediatric and adolescent gynecology patients
(including indications for referral) for conditions and topics including the
following:
a) Healthy lifestyle choices (including nutrition, substance use, and physical
activity)
b) Healthy and safe relationships (including psychological and physical abuse,
intimate partner violence, bullying, and social media use)
c) Mental health, depression, anxiety, and suicide
d) Sexual abuse and assault
e) Normal and abnormal pubertal development
f) Primary amenorrhea
g) Breast masses
h) Dysmenorrhea
i ) Vulvovaginitis
j) Ovarian diseases and masses
k) Sexuality
l) Contraceptive needs
20 Educational Objectives

m) Screening for sexually transmitted infections

n) Pregnancy
C. Spontaneous and Induced Abortion
1. Understand the etiology, natural course, and options for initial management
of spontaneous abortion, including the following approaches:
a) Expectant management
b) Medical management
c) Surgical management
2. Provide unbiased, individualized counseling about available options for
induced abortion.
3. Understand the public health aspect of unintended pregnancy and abortion
services for women’s health.
4. Provide appropriate referral for patients seeking abortion services.
5. Address premedical/preprocedural and postmedical/postprocedural con-
cerns for patients undergoing pregnancy termination.
6. Describe potential outcomes for subsequent pregnancies after spontaneous
or induced abortion.
7. Understand national, local, and institutional laws and policies related to
provision of abortion services.
D. Sexual Health
1. Use a positive and respectfully inclusive approach to patients regarding
gender identity and sexual preference.
2. Support positive attitudes toward sexuality, healthy sexual relationships,
and pleasurable and safe sexual experiences that are free of coercion,
discrimination, and violence in the following ways:
a) Understand and counsel patients about normal sexual function and
physiology
b) Obtain a comprehensive sexual health history using open-ended and
inclusive questions
c) Understand the effect of medication, substance use, behavior, and social
media on sexual function
d) Understand common sexual dysfunction
 Office Practice 21

E. Trauma and Abuse

1. Provide trauma-informed care by obtaining a pertinent history and physical
examination and initiating management, appropriate counseling, or referral
for the following:
a) Abuse (eg, sexual, physical, elder, and psychologic)
b) Sexual assault/rape
c) Violence (eg, intimate partner, workplace, and environmental)
d) Substance use
e) Psychosocial concerns
f) Human trafficking
g) Gender dysphoria
h) Posttraumatic stress disorder
2. Understand and follow regional forensic evaluation policies (ie, rape kits).
F. Breast Conditions and Disorders
1. Understand, evaluate, and manage benign disorders of the breast
(eg, nipple discharge, pain, asymmetry).
2. Evaluate and initially manage patients with a breast mass.
a) Describe the characteristics and evaluation findings suggestive of benign
versus malignant breast masses.
b) Perform an evaluation (including physical examination, testing, imaging,
and indications for biopsy and referral).
c) List individual risk factors for breast disease/cancer (not including genetic/
hereditary risks).
3. Evaluate and manage patients who have undergone or are planning a breast
surgery (eg, reduction, augmentation, mastectomy).
4. Describe the effect of hormonal therapy on breast health.
G. Management of Nongynecological Conditions and Disorders
1. Define each of the following, perform a pertinent history and physical
examination, develop a differential diagnosis, perform appropriate diagnostic
testing, and describe the initial management and indications for referral:
a) Hypertension and cardiovascular disease including hyperlipidemia
b) Pulmonary function and disease (eg, asthma, upper respiratory infection
[URI], bronchitis)
22 Educational Objectives

c) Endocrine disorders
(1) Galactorrhea/hyperprolactinemia
(2) Thyroid disease
(3) Androgen excess
(4) Diabetes mellitus
d) Gastrointestinal disease
e) Genitourinary disease
f) Musculoskeletal disease (eg, low back pain, sprains, osteoarthritis)
g) Osteopenia/osteoporosis
h) Weight disorders (eg, obesity, underweight, anorexia, bariatric medicine)
i) Headaches
j ) Low back pain
k) Mental health disorders (eg, depression, anxiety, other mood disorders,
premenstrual syndrome)
H. Perimenopause and Menopause
1. Understand the definition, physiology, and description.
2. Counsel and advise patients about perimenopause and natural and induced
menopause.
3. Evaluate the extent of metabolic changes.
a) Perform laboratory testing (eg, serum lipid and glucose levels).
b) Perform imaging (eg, bone densitometry).
4. Manage patients with perimenopause and menopause.
a) Counsel and advise patients about nutritional and behavioral interventions.
b) Counsel and advise patients about medical and pharmacologic
interventions, including hormone therapy.
c) Counsel patients about benefits and risks of medical interventions.
I. Geriatric Care
1. Counsel and provide health care for the geriatric patient.
2. Describe management and subsequent counseling for medical, surgical,
palliative, and end-of-life care.
3. Diagnose and manage pelvic floor support and incontinence disorders.
4. Diagnose and manage cognitive and physical limitations.
5. Diagnose and manage elder abuse.
UNIT 5: PERIOPERATIVE OB-GYN CARE

I. Optimizing Perioperative Outcomes

A. For the following perioperative considerations, describe your options
and management in the days prior to, immediately before, and after
surgery:
1. Antibiotic prophylaxis
2. Thromboprophylaxis
3. Pain control
4. Bowel function
5. Consideration/Plans for ERAS protocol

II. Preoperative Considerations

A. For patients requiring procedural intervention in each of the following
areas, list the integral components and key considerations:
1. Routine preoperative evaluation
2. Preoperative assessment with consideration of special populations and comor-
bidities, including the following:
a) Children/adolescents
b) Geriatric women
c) Diabetes mellitus
d) Obesity
e) Other medical conditions
3. Obtaining surgical informed consent

III. Intraoperative Care

A. Describe key considerations and elements of the following aspects of
intraoperative care:
1. Team communication and patient safety measures
2. Suture selection and use
3. Instrumentation selection and use
4. Patient positioning
5. Incision planning
23
24 Educational Objectives

6. Surgical field exposure and use of assistants

7. Safe use of technology (eg, power sources, fluid management, blood
product usage)

IV. Postoperative Care

A. Describe your considerations for and approach to the optimization
of the following components of postoperative care:
1. Assessment of postoperative milestones
2. Management of lines, tubes, and drains
3. Wound care
4. Discharge planning and coordination

V. Management of Complications
A. Understand risk factors, etiologies, signs and symptoms, evaluation,
initial management, and indications for referral for the following
complications:
1. Fever
2. Ileus/obstruction
3. Wound complications (eg, infection, dehiscence)
4. Fluid or electrolyte imbalance, including abnormal urinary output
5. Injury to pelvic structures (eg, urinary tract, gastrointestinal tract, blood
vessels, nerves)
6. Cardiovascular and pulmonary events (eg, deep vein thrombosis/pulmonary
embolism, myocardial infarction, stroke, aspiration pneumonia)
7. Acute and chronic blood loss

VI. Critical Care

A. Describe the evaluation, diagnosis and management of the following
conditions:
1. Anaphylaxis and severe allergic reactions
2. Systemic inflammatory response syndrome/acute respiratory distress syn-
drome
3. Shock (hypovolemic, cardiogenic, septic, neurogenic)
4. Necrotizing fasciitis
UNIT 6: PROCEDURES IN OBSTETRICS AND
GYNECOLOGY

CORE PROCEDURES UNDERSTAND PERFORM

Abdominal sacrocolpopexy X
Ablation and excision of endometriosis implants X X
Ablative procedures of the cervix X X
Ablative procedures of the endometrium X X
Amniocentesis X X
• Second trimester—genetic diagnosis X
• Third trimester—assessment of fetal lung maturity X
Amnioinfusion X X
Amniotomy X X
Anesthetic/analgesic procedures X
• Epidural anesthesia X
• General anesthesia X
• Spinal anesthesia X
Anesthetic/analgesic procedures X X
• Administration of narcotic antagonists X X
• Administration of parenteral analgesics/sedatives X X
• Pudendal block X
• Use of other topical and local anesthetic X X
blocks
Anoscopy X
Appendectomy X
Arterial blood gas assessment X X
Auditory acuity testing X
Bartholin Abscess Management X X
• Word catheter X X
B-Lynch suture placement X X

25
26 Educational Objectives

CORE PROCEDURES UNDERSTAND PERFORM

Biopsy X X
• Cervix X X
• Endocervix X X
• Endometrium X X
• Peritoneum X X
• Skin X X
• Vagina X X
• Vulva X X
Bone densitometry studies X
Breast biopsy X
Breast cyst aspiration X
Cervical cerclage
• Transvaginal X X
Cervical cerclage
• Transabdominal X
Cervical conization (including loop electrosurgical X X
excision procedure)
Cesarean delivery X X
• Classical X X
• Low transverse X X
• Low vertical X X
Cesarean hysterectomy X X
Chorionic villus sampling X
Circumcision, neonatal (with anesthesia) X X
Colectomy (partial or total) X
Colostomy X
Colpocleisis X X
Colporrhaphy X X
• Anterior (including urethropexy) X X
• Posterior X X
Colposcopy, with directed biopsy of cervix, X X
vagina, or vulva
Colposuspension X X
Complete physical examination X X
Cordocentesis X
 Procedures in Obstetrics and Gynecology 27

CORE PROCEDURES UNDERSTAND PERFORM

Cornual Wedge Resection X X
Culdoplasty X X
Curettage for adherent placenta X X
Cystometrography
• Simple X X
Cystotomy repair X X
Cystourethroscopy X X
Dilation and curettage X X
Dilation and evacuation for second-trimester X X
fetal death
Electrocardiography X
Enterocele repair X X
Enterotomy repair X X
Episiotomy and repair X X
Excision of Bartholin gland X X
Excision of cyst (ovarian, tubal, vaginal, or vulvar) X X
Fecal occult blood testing X
Fetal assessment, antepartum X X
• Biophysical profile X X
• Contraction stress test X X
• Nonstress test X X
• Vibroacoustic stimulation X X
Fetal assessment, intrapartum X X
• Fetal heart rate monitoring (internal/external) X X
• Fetal scalp stimulation test X
• Vibroacoustic stimulation test X
Fistula repair X
• Enterocutaneous X
• Rectovaginal X
• Ureterovaginal X
• Urethrovaginal X
• Vesicovaginal X
Fitting of diaphragm or cervical cap X X
Forceps delivery (and/or vacuum) X X
• Low X X
• Outlet X X
• Breech X
28 Educational Objectives

CORE PROCEDURES UNDERSTAND PERFORM

Funduscopic examination (basic) X X
Hematoma evacuation, intra-abdominal X X
• Vaginal X X
• Vulvar X X
Hernia repair (incisional) X X
Hymenotomy X X
Hypogastric artery ligation X
Hysterectomy X X
• Extrafascial (with or without bilateral X X
salpingo-oophorectomy)
• Radical (with or without bilateral X
salpingo-oophorectomy
Hysterectomy X X
• Abdominal, total or supracervical X X
• Minimally invasive: Laparoscopic, total or X X
supracervical
• Vaginal X X
• Vaginal, laparoscopically assisted X X
• Robotic X
Hysterosalpingography X X
Hysteroscopic resection of uterine septum X
Hysteroscopy (diagnostic/operative) X X
• Polyp resection X X
• Submucosal fibroid resection X X
Incision and drainage of an abscess or hematoma X X
Incision of vaginal septum X X
Induction of labor X X
Insertion and removal of implantable steroid X X
contraception
Insertion and removal of intrauterine device X X
Intrauterine transfusion X
Laparoscopy (diagnostic/operative) X X
• Chromopertubation X X
• Lysis of adhesions X X
• Treatment of endometriosis X X
 Procedures in Obstetrics and Gynecology 29

CORE PROCEDURES UNDERSTAND PERFORM

Laparoscopy, operative X X
• Lysis of adhesions X X
• Myomectomy X X
• Ovarian cystectomy X X
• Salpingectomy X X
• Salpingo-oophorectomy X X
• Salpingostomy X X
• Sterilization X X
Laparotomy incisions, abdominal X X
• Transverse (including extension such as X X
Maylard or Cherney)
• Vertical X X
Lumpectomy of breast X
Lymph node biopsy/dissection X
• Inguinal X
• Para-aortic X
• Pelvic X
• Sentinel X
Lysis of adhesions X X
• Abdominal X X
Manual removal of the placenta X X
Marsupialization of Bartholin cyst X X
Mastectomy X
Myomectomy X X
• Laparotomy X X
• Laparoscopic X X
Neonatal resuscitation, immediate X X
Omentectomy, infracolic X
Oophorectomy X X
Ovarian biopsy X X
Ovarian or paraovarian cystectomy X X
Paracentesis X
Paravaginal repair X
Peak expiratory flow determination X
Pelvic exenteration with or without reconstruction X
30 Educational Objectives

CORE PROCEDURES UNDERSTAND PERFORM

Perineoplasty X X
Perineorrhaphy X X
Pessary fitting X X
Port placement, intraperitoneal X
Presacral neurectomy X
Radiation therapy X
• Brachytherapy X
• External beam X
• Interstitial X
Repair of dehiscence X X
Repair of genital tract lacerations X X
• Cervical X X
• Perineal (second-, third-, and fourth-degree X X
lacerations)
• Vaginal X X
Resection of large and small bowel X
Salpingotomy X X
Scraping of skin lesions for microscopy X
Shoulder dystocia maneuvers X X
Skin biopsy X X
Sonohysterography X X
Staging laparotomy X
• Biopsy of pelvic lymph nodes X
• Infracolic omentectomy X
Staging laparotomy X X
• Biopsy of peritoneal implants and cytologic X
washings of the peritoneal cavity
• Exploration of abdomen X
Sterilization X X
• Abdominal X X
• Laparoscopic X X
Suction evacuation of molar pregnancy X X
Trachelectomy X
Trigger-point injection X
 Procedures in Obstetrics and Gynecology 31

CORE PROCEDURES UNDERSTAND PERFORM

Tubal anastomosis X
Ultrasonographic examination X X
• Cervical length X X
Ultrasonographic examination X
• Color Doppler ultrasonography X
• Doppler velocimetry X
Ultrasonography X X
• Saline infusion ultrasonography X X
Ultrasonography X X
• Abdominal X X
• Endovaginal X X
Ureteral reimplantation X
Ureteroureterostomy X
Urethral bulking procedures X
Urethral diverticulum repair X
Urethral pressure profilometry X
Uterine artery embolization X
Uterine artery ligation X X
Uterine evacuation X X
• Dilation and evacuation X X
Uterine evacuation (incomplete abortion, X X
fetal death)
• Mechanical or osmotic preprocedural cervical X X
preparation
• Suction curettage X X
Uterine tamponade X X
Vacuum extraction (and/or forceps) X X
• Low X X
• Outlet X X
Vaginal delivery X X
• Breech X
• Twins X X
Vaginal delivery, spontaneous X X
Vaginal reconstruction X X
32 Educational Objectives

CORE PROCEDURES UNDERSTAND PERFORM

Vaginal sling for urinary incontinence X
Venous access device placement X X
Version of breech, external X
Visual acuity testing (ie, standard eye chart) X
Wide local excision (vulva) X X
Wound care X X
• Repair of dehiscence X X
• Secondary closure X X
• Debridement X X
• Incision and drainage of abscess or hematoma X X