This is centered at the University and is a 4-year experience, although a large volume of this experience takes place in the early years. Residents are not only assigned to Labor and Delivery for labor management and delivery but also to the ambulatory clinic for prenatal care. We also have a 3-month obstetrical rotation for our first-year residents at a community hospital, Tucson Medical Center. The residents are directly supervised by a group of five perinatal specialists.
The Obstetrical service, including general and high risk patients, is managed by the Maternal-Fetal medicine group. Work and teaching rounds are conducted daily (including weekends and holidays) with the obstetrical team of a Chief resident, 1 or 2 second-year residents and 1 to 3 first-year residents. Family Practice and Emergency Medicine Residents may also rotate through this service. Residents learn the conduct of normal prenatal care, normal labor and postpartum management. Operative obstetrics is also taught, as well as management of complicated obstetrics. Prenatal diagnostic techniques, diabetes in pregnancy, fetal circulation and preterm labor are special areas of emphasis.
The Department of Obstetrics and Gynecology, Section of Maternal-Fetal Medicine has one full- time and one part-time, board certified genetic counselors. Prenatal genetic counseling is offered for maternal age, abnormal test results, teratogenic exposures, specific maternal conditions and family history of genetic disorders. Genetic counseling is also available for preconceptional concerns, adult onset disorders and family history of cancer. Procedures such as amniocentesis, CVS, PUBS, chromosome analysis and ultrasonography are available in-house. Maternal serum screening and DNA diagnostic tests are coordinated through the service but sent out for analysis. Residents receive didactic training in clinical genetics and are encouraged to participate in counseling sessions.
University Gynecology Service
The GYN Service is an active practice of both inpatient and ambulatory surgery. Inpatient procedures include the full range of major and minor surgery. A Monday GYN clinic operates weekly for those residents on the GYN service. Tuesday, an all day dysplasia clinic occurs, Leep are performed. A colposcopy correlation is held each Monday morning in conjunction with the pathology department. At that time colposcopic cases are discussed, cytology and histopathology is reviewed, and management plans are finalized. Candidates for benign gynecologic surgery are also presented at the weekly gynecology case care conference to discuss specific cases and proposed surgical intervention. A strong emphasis is placed on benign surgery with seven attendings who have special expertise in this area. Faculty are present and participate in every gynecologic surgical procedure. Didactic presentations on gynecologic subjects are made at three different weekly conferences.
Resident Continuity Clinics
Weekly continuity clinics with ongoing obstetric and gynecologic care begin in the first-year and are continued throughout the 4-years. For each resident, this provides an ongoing care experience that prepares the resident for an obstetric and gynecology practice. Residents doing rotations around the community return to their continuity clinic 1 half-day each week.
Ambulatory Women's Health Care
During the first-year residents attend the Ambulatory Women‚ Health Care Rotation. This rotation consists of a 1/2 day sessions at the Theresa Lee STD Clinic, 1 and a half day session doing ultrasounds in our OB Clinic as well as a full day of genetic counseling evaluations once a week. Residents also attend a weekly half-day OB/GYN continuity clinic at St. Elizabeth's Clinic also spending one full day with the internal medicine department doing primary care.
For 3 months in the third-year, a resident is assigned to the Gynecologic Endocrinology service. The resident is involved in the outpatient evaluation of patients with endocrinopathy or infertility, multiple exploratory laparoscopy procedures, laparotomy with microsurgical repair, and involved with assisted reproductive methods. The residents are also involved in a menopause clinic where they formulate treatment plans for women with estrogen deprivation. They are also involved in a preventive medicine plan.
Infertility and Endocrinopathies
The resident is expected to diagnose and manage disorders of the pituitary, central nervous system, ovaries, thyroid, immune system, and adrenal glands as they contribute to infertility. Full service assisted reproductive techniques are observed during the third year rotation, including IVF and ISCI.
The University Gynecologic Oncology Service has a fourth-year, a second-year and a first-year resident assigned. The resident is expected to understand the FIGO staging systems and learn the appropriate biopsies and surgical procedures. They are taught abdominal and pelvic anatomy to include the ureters, major vessels and relationship to the bladder, bowel, and pelvic organs. The residents learn the epidemiology, signs and symptoms and proper diagnostic evaluation for gynecologic malignancy. They learn the principles of surgery including the preoperative evaluation and intensive postoperative care. The resident assists or performs the surgery with the oncologists and manages the patients post-op with the attending. The surgical experience emphasizes laparoscopic surgery in the evaluation and management of both benign and malignant diseases. They learn the principles of chemotherapy and radiation therapy and participate in the evaluation of patients for both, and the treatment of the side effects. The residents participate in the treatment of planning and the placement of intracavitary brachytherapy.
The second-year resident is assigned to Pathology. While on GYN/ONC, he or she is responsible for the pathology conference 2 times a month. There is a weekly pathology conference where colposcopy, LEEP, and oncology cases are reviewed.
State of the art diagnostic ultrasound equipment is fully within and under the control of the Department of Obstetrics and Gynecology. Formal learning begins the first week of residency. Ultrasound lectures are presented throughout the year during core lecture series. Hands-on training is part of the Ambulatory Women's Health Care rotation.
Inpatient Teaching Service
There is a designated night float system, staffed 1 month at a time by second-year residents. The designated night float for a given month works from 1800 to 0600 during the work week and is off for weekends. There are 3 residents on call in the hospital at all times, at night or weekends/holidays. These 3 residents include a first-year resident, a back-up resident at the second year level and a senior resident at either the third or fourth-year level. There is a full-time faculty on call in the hospital 24-hours every day. There is a maternal-fetal sub-specialist and a gynecologist on backup call each night.