Clinical Goals
Continuity ClinicEach resident at the R1 through R4 levels attends his or her primary care continuity session one-half day each week. This experience gives the resident an opportunity to provide outpatient care to the same group of patients over an extended period of time. Residents are encouraged to perform deliveries and gynecologic surgeries on their own patients to maintain the continuity relationship between patient and provider. One full-time physician is assigned as preceptor for each session with the exclusive role of providing supervisory guidance, support, and teaching for residents and students. Residents thus have the advantage of long-term management of a large number of patients with a wide range of problems. Special Care ClinicThe Special Care Clinic provides a unique opportunity to care for antepartum patients with a variety of diverse backgrounds with the full gamut of physical and mental health problems. An integrated health care team provides these women with specialized obstetric care. This interdisciplinary approach enlists the expertise of physicians, nurse practitioners, RNs, social workers, nutritionists, counselors, and patient advocates. Interns, residents, and medical students are integral to the clinical care and teaching provided by this program. The clinic is run and staffed by three residents (R4, R3, and R2) with the help of this support team, as well as a full-time perinatologist as a preceptor for each session. UrogynecologyThe Urogynecology Resident Clinic is staffed by the R3 on rotation with the oversight of the urogynecology faculty. The clinic accepts referrals, often from the resident continuity clinics, of women with urinary and fecal incontinence, pelvic organ prolapse, interstitial cystitis, fistulas, and diverticulae. Formal urodynamics and office cystoscopy are performed in the clinic when indicated. When necessary, patients are scheduled for surgical management of their urogynecologic problems and the resident manages the pre- and post-operative care. Colposcopy/Vulvovaginal Disease ClinicOur Colposcopy/Vulvovaginal Disease Clinic provides a valuable service for Women's Health Practice (WHP) patients with pre-malignant and malignant conditions of the lower genital tract. In this clinic we evaluate and manage a variety of other vulvovaginal conditions such as lichen sclerosus, lichen Planus, and vulvodynia. Prior to the start of the weekly Colposcopy Clinic on AC-5, the residents and full-time faculty participate in a Clinicopathologic Correlation for lower genital tract neoplasia/disease in conjunction with the Department of Pathology and with the assistance of Professor Tom Bonfiglio, Director of Cytopathology. Our colposcopy training emphasizes an understanding of the histopathologic changes that form the basis for visible changes seen at the time of colposcopy. Our referral sources include selected groups of women at high risk for genital tract neoplasia as well as complicating medical problems. The volume of colposcopy on AC-5 from July 2002 to June 2003 was 162 patients from the WHP and 70 from the faculty practices. The outpatient R4 and the ambulatory R2 staff the clinic, with oversight by Dr. Foster, an expert in vulvovaginal disorders. Highland Hospital Colposcopy ClinicThe Colposcopy Clinic at Highland Hospital is staffed by the ambulatory R3 with oversight by the staff attendings. This clinic allows the resident further colposcopy experience pre-malignant conditions of the cervix. Office conizations are performed when appropriate, including LEEP and cryotherapy. Pediatric and Adolescent Gynecology ClinicGynecologic concerns or disorders can start at birth and continue through childhood and adolescence. Although some of the medical problems may be similar to those of adult women, examination, diagnosis, and management may be different. More time and effort is needed to explain even the most obvious nature of our examinations. In addition, gynecologic care, education, and counseling to our young patients and their families are an important aspect of pediatric and adolescent gynecology. The education objectives of this clinic include providing age-appropriate gynecologic examinations, understanding the different instruments and equipment that allow us to examine young children and teens, and addressing the special needs for the adolescent examination especially if this is her first examination. Conditions encountered include labial adhesions, abdominal and pelvic pain, vaginal discharge, chronic genital rashes or itching, pelvic masses, unusual appearance of genitals, menstrual disorders, and pubertal disorders. The clinic is run and staffed by the ambulatory R3 with oversight by Dr. Reddy of the GYN Specialties Division.
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