Residents benefit from a comprehensive outpatient experience that spans the four years of the program. Residents attend continuity clinic at the Womens’ Health Practice (WHP) at Strong Memorial Hospital or at Community Obstetrics & Gynecology (COB) at Highland Hospital. In addition, each year of residency includes an ambulatory rotation at Strong Memorial Hospital. Areas emphasized on the ambulatory rotation include:
There are also opportunities for work in:
Each resident at the R1 through R4 levels attends his or her primary care continuity clinic one day per week. This experience provides each resident with the opportunity to provide outpatient care to the same group of women over the course of the four years of residency. Outpatient care includes a mix of obstetric and gynecologic care as well as opportunity for primary care practice such as management of diabetes, hypertension, hyperlipidemia, thyroid disease, etc. Residents are encouraged to perform deliveries and gynecologic surgeries on their own patients to maintain the continuity relationship between patient and provider. Clinic sessions are supervised by the generalist faculty in a rotating schedule- each faculty preceptor is assigned exclusively to provide supervisory guidance, support and teaching. Each clinic session is preceded by group review and discussion of assigned readings pertinent to the provision of outpatient primary care and a wide variety of topics are covered including menopause, osteoporosis, cardiovascular disease, thyroid disease, infectious disease, quality of care, etc.
Special Care Clinic
The Special Care Clinic (SCC) provides a unique opportunity for residents to care for high-risk antepartum patients in consultation with a Maternal-Fetal-Medicine specialist. The clinic cares for a diverse group of women with high-risk pregnancies referred from the resident continuity clinics or from outside institutions. An integrated health care team provides these women with specialized obstetric care. This interdisciplinary approach enlists the expertise of MFM faculty, nurse practitioners, RNs, social workers, nutritionists, counselors, and patient advocates. The clinic is held twice per week and is run and staffed by residents on the ambulatory rotation with the help of this support team and under the supervision of MFM faculty.
Colposcopy/Vaginal Disease Clinic
Colposcopy clinics are held at both resident continuity clinic sites, providing care for women with pre-malignant and malignant conditions of the lower genital tract, as well as those with vulvar conditions such as lichen sclerosus, lichen planus, and vulvodynia. Colposcopy training emphasizes an understanding of the histopathologic changes that form the basis for visible changes seen at the time of colposcopy. Additional time is devoted to clinicopathologic correlation in conjunction with the department of Pathology. The Highland Hospital colposcopy clinic experience also includes performance of outpatient cervical conization procedures. Women are referred to these clinics from the resident continuity clinics, as well as from community Ob-GYN practices and other institutions. The clinics are staffed by residents on the ambulatory rotation and supervised by generalist faculty, including Dr. David Foster, a nationally recognized expert in vulvovaginal disorders.
Menopause, Vulvar, and Pediatric (MVP) Clinic
Residents on the ambulatory rotation spend time at the generalist OB-GYN private practice clinic where faculty have developed specialty clinic activities in menopause, vulvar disease, and pediatric and adolescent gynecology. Patients are evaluated under the supervision of the faculty with special expertise in these areas. Issues addressed in the menopause clinic include management of climacteric systems, postmenopausal bleeding, and sexual dysfunction. In the pediatric gynecology clinic, residents evaluate patients with labial adhesions, abdominal & pelvic pain, vaginal discharge, chronic genital rashes or itching, pelvic masses, unusual appearance of genitals, congenital anomalies of the genital tract, menstrual disorders, and pubertal disorders. Vulvar clinic includes evaluation and management of vulvodynia, chronic vaginitis, vulvovaginal atrophy, vulvar dermatoses, and vulvar manifestations of systemic diseases such as Crohn’s disease.
Female Pelvic Pain Clinic
The Pelvic Pain Clinic is held weekly at the Women’s Health Practice at Strong Memorial Hospital and is supervised by generalist faculty with special expertise in the evaluation, conservative, and surgical management of chronic pain conditions including female pelvic pain, abdominal wall and musculoskeletal trigger point pain, interstitial cystitis, adhesive disease, endometriosis, dysmenorrhea, irritable bowel syndrome, fibromyalgia, pelvic venous congestion syndrome, as well as in chronic pain management techniques. Residents on the ambulatory rotation run and staff the clinic.
Family Planning and Contraception
Residents on the ambulatory rotation attend the Family Planning and Contraception clinic which is held three sessions per week, with one session occurring at an off-site outpatient facility. Residents have the opportunity to participate in the care of women seeking contraception counseling and family planning services as well as to assist in minor surgical procedures performed at the off-site facility. Residents become familiar with discussion of contraceptive options, provision of appropriate contraception for women with complicating medical illness, family planning counseling, and performance of office-based procedures including intrauterine and implantable contraceptive devices.
Residents on the ambulatory rotation spend time in the Ultrasound facility learning the basics of ultrasound physics, principles of ultrasound performance, and interpretation of ultrasound images. The clinic is supervised by MFM faculty and residents also work closely with the staff ultrasonagraphy team to gain basic skills in obstetric and gynecologic ultrasound techniques. In addition to hands-on experience, the rotation includes a web-based learning curriculum. After completion of this part of the rotation, residents are able to independently perform limited obstetric ultrasound and transvaginal ultrasound for gynecologic evaluation in the course of their clinical duties.
Reproductive Endocrinology and Infertility
Residents on the ambulatory rotation rotate to the REI service weekly where they participate in the evaluation and treatment of women with primary and secondary infertility, endocrine disorders, and congenital anomalies of the genital tract. There is also opportunity to practice transvaginal ultrasound skills during evaluation of new patient, patients undergoing ovarian stimulation, and diagnosing early pregnancy. Residents also assist with performance of hysterosalpingograms in an outpatient setting.
Continuity clinics are held for one full day throughout the year. Residents are assigned clinics either at SMH or HH. A clinic with predominately Hispanic patients is available at SMH. Additionally, a community-based clinic staffed by one of the private practices is also an option.