Residents practicing laparoscopic skills.
The four years of OB/GYN training provide an opportunity for individuals at each level of training to progressively develop their clinical skills and judgment and to assume increasingly greater responsibility for patient management. This progressive responsibility and independence is fostered by faculty and staff; OB/GYN residents always have direct supervision immediately available by a supervising physician who is physically present on site and whose responsibilities specifically include resident supervision.
Inpatient obstetrics experience occurs at both the URMC and HH clinical sites - 6 weeks per year at each site. The HH rotation is a combined OB and GYN experience while the URMC rotation focuses specifically on OB.
First year residents spend most of their time on obstetrics learning management of normal labor & delivery under the supervision of an attending, midwives, senior residents, and nurse practitioners. PGY-1s are assigned to low-risk labor and delivery and learn to actively manage spontaneous labor, perform labor induction, assess fetal well-being during labor, manage labor pain, and respond to obstetric emergencies as part of the obstetrics team. They will perform basic obstetric procedures including placement of intrauterine monitors, amniotomy, cervical assessment and ripening, vaginal deliveries, and circumcision. As they gain in skill, PGY-1s will assist at and perform more advanced procedures including operative deliveries and cesarean sections.
OB, Family Medicine, and the Emergency Department working to deliver babies together.
Second year residents will learn management of high-risk antepartum patients, evaluation and triage of patients presenting in labor or with acute medical problems in pregnancy, and will begin supervising junior residents in the management of normal pregnancy and labor. They will be the primary surgeon for scheduled & urgent cesarean sections and for operative deliveries on low-risk patients. They will be introduced to the care of patients in labor with high-risk pregnancies and postpartum care of the same. At HH, the PGY-2 will act as the supervising resident on labor & delivery in preparation for their 3rd year responsibilities.
Third year residents focus on the evaluation and management of labor in high-risk obstetric patients (preterm delivery, preeclampsia, medical co-morbidities, multiple gestation, diabetes), introduction to advanced obstetric procedures (complicated & emergent cesarean sections, repair of severe obstetric lacerations), and supervision of junior residents on the obstetric service.
The major focus of the 4th postgraduate year is on supervision and competent management of the obstetric service and resident team (supervision of service patients, assignment of cases, team education, liaison with attendings and staff, solving logistical issues), achievement of competence in intermediate and advanced obstetric procedures, and broadening depth of understanding of medical and surgical illness in pregnant women including medical and surgical treatment options.
Minnesota Representing at URMC
Inpatient gynecology experience occurs at both the URMC and HH clinical sites - 6 weeks per year at each site. The HH rotation is a combined OB and GYN experience while the URMC rotation focuses specifically on GYN. The teams at each site are responsible for management of patients with gynecologic problems admitted for medical management, evaluation of women with gynecologic complaints presenting to the emergency department, and providing inpatient and intra-operative consultations for other hospital service teams. Residents on the GYN services are primarily involved in care of surgical patients and perform a wide variety of vaginal, laparoscopic, and open abdominal procedures. Both clinical sites have 2 DaVinci robots and teaching consoles that are heavily used by both the oncology and general GYN services. At URMC, residents on the GYN service also operate with subspecialists in minimally invasive surgery, vulvar disorders, family planning, and urogynecology. PGY-1s typically start their surgical experience with basic procedures including diagnostic hysteroscopy & laparoscopy, dilation & curettage, tubal ligations, etc. and assisting at more complicated cases. Residents at all levels participate in robotic cases, first as bedside assistant and progressing to console surgeon as milestones are met. Weekly, residents are assigned to participate in cases at the university ambulatory surgery center.
Weekday night shifts at both URMC and HH are covered by night float teams, allowing the service teams to maintain team and patient care continuity during the week without interruption for call shifts and mandatory post-call days off. Team and patient care continuity for both the day and night shifts promotes resident education and satisfaction as well as patient safety.
"We take a very careful approach to preparing residents for the career they want—private practice, academic—and offer a lot of support and research opportunities for those interested in fellowships."
Amy Harrington, M.D.
URMC OB/GYN Academic Generalist
Residents spend 6 week each year on the AMB team where they are exposed to a variety of general and subspecialty outpatient care experiences. The Ambulatory rotation mainly occurs at UR Medicine Gender Wellness, Obstetrics & Gynecology.
- Colposcopy Clinic (R2, R4): Colpo Clinic-principles of colposcopy, pathology correlation, colposcopic examination, evaluation and management of cervical dysplasia and dermatoses (also occurs every other week at HH COB).
- Vulvar Clinic (R1, R3): Evaluation and management of cervical, vaginal, and vulvar dysplasia and dermatoses.
- Special Care Clinic (R2-R4): outpatient prenatal and postpartum care for women with high risk pregnancies including fetal anomalies, abnormal placentation, preterm labor, diabetes, and maternal disease.
- Pelvic Pain Clinic (R2): evaluation and management of women with chronic pelvic pain and pain syndromes with a gynecologic component including myofascial pain, irritable bowel syndrome and interstitial cystitis.
- Complicated Contraception Clinic (R3): evaluation, counseling, and management of women seeking contraception who have medical issues complicating counseling or with complications related to contraception and experience with difficult IUD and Nexplanon removals and insertions in the clinic setting.
- Family Planning Clinic & Procedures (R1): participate in patient consultations, counseling, and procedures including placement of long-acting contraceptives such as IUDs, Nexplanon and MVAs for uterine evaucation. One afternoon per week occurs at Planned Parenthood to provide a broader community experience.
- Pediatric Adolescent Gynecology (R1): participate in patient consultations and counseling, provide age appropriate gyn exams, evaluate and treat/refer for common peds and adolescent gynecological problems (congenital anomalies, amenorrhea, ambiguous genitalia, etc.).
- Urogyn Clinic (R1): introduction to urinary and pelvic floor disorders, evaluation, and management.
- Breastfeeding Medicine Clinic (R1, R4): observe and participate as appropriate in breastfeeding education and assessment at the UR Medicine Breastfeeding Center.
PGY-1s start their formal training in obstetric and gynecologic ultrasound at Red Creek, Lattimore, and the L&D floor. R1s spend 3 weeks working along-side our Ob/Gyn trained sonographers to learn basic TV and Obstetric US skills that residents will continue to use throughout residency. In addition to "knobology" and learning how to use the machines, there is a formal curriculum that includes didactic modules, hands-on practice, and skills evaluation.
Our residents rotate on GYN Oncology for 6 weeks in each of their 1st, 2nd, 3rd, and 4th years of training. First year residents focus on the medical management of patients admitted with complications or for adjuvant therapies and the postoperative care of surgical patients under the supervision of the service attendings, senior residents, and service nurse practitioner. PGY-1s also act as assistants in the operating rooms. PGY-2s , 3s and 4s spend most of their time in the operating room learning anatomy, developing surgical skills, and understanding the approaches to GYN cancers that may affect their future patients. Weekly, residents lead a formal Tumor Board conference discussing surgical pathology and treatment plans.
Residents rotate on the REI service during their 2nd year of training and in other years REI education is continued through on-line educational modules and didactic teaching sessions. During the REI rotation, residents participate in the outpatient care of women with primary & secondary infertility as well as women with disorders such as PCOS, mullerian anomalies, and genetic disorders. Residents participate in ultrasound evaluation and observe advanced procedures such as egg retrieval. Residents are encouraged to spend time in the REI lab to gain appreciation for the processes of egg hatching, fertilization, ICSI, and PGD. Residents participate in REI surgeries including hysteroscopy, laparoscopy, myomectomy, and tubal reversals while they are on inpatient gynecology at URMC.
Residents rotate on outpatient Urogynecology during their 3rd year of training where they learn to evaluate and manage pelvic floor disorders such as urinary and fecal incontinence, pelvic organ prolapsed, bladder pain, and recurrent bladder infections. During the rotation, residents complete 3 modules on urogynecologic topics and have one-on-one review sessions with the attendings with problem-based learning exercises and review of interesting cases. Residents on the rotation or who are interested attend the weekly Urogynecology didactic sessions which rotate between lecture, research meeting, journal club, and M&M.
Throughout the 4 years of training, residents gain continuity with patients across multiple clinic settings. They are each assigned to one of our two continuity clinic locations for the entirety of their residency training. Community OB/GYN through Highland Hospital allows residents to practice in a clinic allied with a busy midwifery practice in a community setting. Gender Wellness Ob/Gyn through URMC is a university-based clinic that is being developed as a medical home for the people of Rochester. Each clinical site has an interdisciplinary team of staff and providers. Didactic learning sessions are also scheduled during clinic days to review Ambulatory topics.
Residents have two electives during their training- 4 weeks in 3rd year and 4 weeks in 4th year. Residents use this time to plan an educationally-oriented elective experience designed to augment the curriculum during the core rotations. Residents are encouraged to consider their personal educational goals and interests. There are nearly 20 established elective options or residents can choose to “create your own” elective under the guidance of an elective supervisor. Recent resident elective experiences have included advanced ultrasound training, surgical rotations at affiliated hospitals, subspecialty away rotations, palliative care, vulvar dermatology and reproductive genetics.