Obstetrics (Maternity Care)
Residents at Highland Family Medicine receive comprehensive training at the Family Maternity Center at Highland Hospital, the busiest hospital maternity service in Rochester with approximately 3000 deliveries per year. Besides the Family Medicine faculty, residents have the opportunity to work with community family physicians, family medicine maternal-child health fellows, midwives, lactation consultants, pediatric nurse practitioners, and community obstetricians. Basic ultrasound training is provided in the first block that residents spend at the Family Maternity Center.
All residents spend two months at the Family Maternity Center and typically perform 40-60 deliveries. Residents also gain proficiency with obstetric procedures including amniotomy and placement of cervical balloon catheters, fetal scalp electrodes, and intrauterine pressure catheters. Residents also place post-placental IUDs and postpartum Nexplanons. They work with a team comprised of Family Medicine Maternal Child Health fellows, senior OB residents, emergency medicine interns, certified nurse midwives, and medical students. Residents are entrusted with a considerable amount of responsibility and gain significant hands-on experience as the first-call resident on the service.
Residents who choose the Maternity Care Track spend an additional three months working at the Family Maternity Center where they assume increasing amounts of responsibility including care of more complex medical complications of pregnancy and labor, supervision of family medicine and emergency medicine interns, and teaching of medical students. They also undertake electives in lactation medicine, neonatal care, and obstetric ultrasound.
All residents rotate through a weekly half-day prenatal clinic at Highland Family Medicine during certain outpatient rotations. Precepted by family medicine attendings who perform maternity care, it offers a concentrated learning experience in providing prenatal care. Residents also see their own continuity prenatal patients in their regular clinic sessions, and use a team-based approach to providing hospital coverage to deliver these patients when they present in labor. Highland Family Medicine is a Centering Pregnancy site that provides group prenatal visits, and has active Interconception Care and 4th Trimester Care programs.
Outpatient Gynecology and Gynecology Procedures
Gynecology is a major part of every resident’s office practice, with many opportunities to learn well woman care, contraception management, diagnosis and treatment of STIs, and management of common gynecologic problems. Procedural training includes IUD insertion, Nexplanon insertion, endometrial biopsy, and colposcopy in the Colposcopy/GYN Procedure clinic held two half-days each week at Highland Family Medicine and supervised by family medicine attendings with specialized training. Both Brown Square and Highland Family Medicine residents rotate through this clinic. Additional experiences are in other GYN specialty areas including Urogynecology and Reproductive Genetics.
During the gynecology rotation, residents spend one half-day at Planned Parenthood to observe options counseling and pregnancy termination services. It is a strictly observational experience and does not involve residents in directly providing medical or surgical abortion. The intent is to give residents a more comprehensive understanding of the abortion procedure including medical eligibility and pre-procedure workup and the opportunity to observe abortion procedures. Residents who feel that this shadowing experience is not consistent with their personal beliefs may opt out and are scheduled for office and teaching instead.
Residents also have the opportunity to observe or participate in providing medication abortion care at Highland Family Medicine under the supervision of family medicine doctors in a primary care setting. This training experience allows resident involvement in direct patient care and provides them with both practical and counseling skills. Residents may opt out of this experience as well.
Surgical abortion training is available to those residents strongly interested in gaining procedural competency with an intent to provide this service in their future practices. The program’s RHEDI grant helped train 2 family medicine faculty members who will work part-time at Planned Parenthood and provide this experience for family medicine learners. The purpose of this elective experience is to obtain training in first trimester medical and surgical abortions, as well as first trimester ultrasound. Participants use elective time to work with family medicine faculty at local and regional Planned Parenthood affiliates. Travel is required. Time off from both clinic and certain rotations is permitted to accommodate the scheduling of these experiences.